RN, Utilization Management | Utilization Management| Variable | PRN

UF Health; Leesburg (FL); On-site; USD 55,000 - 96,000; Part time

Job summary

UF Health in Leesburg, FL is seeking a qualified RN to support utilization management by evaluating patient records for medical necessity and coordinating with care teams to meet payer requirements. The role is onsite with a .10 FTE PRN schedule, offering exposure to discharge planning and quality improvement.

You will analyze utilization data, document decisions, and ensure regulatory compliance to optimize patient care and resource use.

Qualifications

• RN with Florida license
• 3+ years in utilization review/management or case management
• Knowledge of payer requirements and regulatory standards

Responsibilities

• Evaluate patient records to determine medical necessity
• Coordinate with care teams to ensure guidelines and payer requirements
• Support treatment planning and discharge planning
• Communicate authorization decisions and determinations
• Analyze utilization data to identify trends and improve coordination
• Ensure documentation and regulatory compliance

Skills

Utilization review

Care coordination

Communication

Regulatory compliance

Education

Florida nursing license

Job description

Overview

Make an impact by supporting the right care at the right time through utilization management excellence.

Work Style: Onsite
Location: Leesburg, FL
FTE: PRN (.10 FTE)
Schedule: Variable

Plays a critical role in evaluating patient medical records to ensure the necessity and appropriateness of healthcare services. Involves coordinating with healthcare providers to maintain compliance with utilization management guidelines and optimizing treatment plans for effective patient care and resource utilization. Requires clear communication of authorization decisions and ongoing monitoring to support timely discharge planning. Analyzes utilization data to identify trends and collaborates with interdisciplinary teams to enhance care coordination while ensuring accurate documentation and regulatory compliance.

Responsibilities

Key Responsibilities

• Evaluates patient medical records to determine the medical necessity and appropriateness of healthcare services.
• Coordinates with healthcare providers and care teams to ensure compliance with utilization management guidelines and payer requirements.
• Supports effective treatment planning, patient care coordination, and appropriate resource utilization.
• Communicates authorization decisions and utilization determinations while supporting timely discharge planning efforts.
• Analyzes utilization management data and trends to identify opportunities for improved care coordination and operational efficiency.
• Collaborates with interdisciplinary teams to ensure accurate documentation, regulatory compliance, and quality patient outcomes.

Qualifications

Education & Licensure

• Registered Nurse (RN) with a current Florida nursing license required.

Experience & Skills

• Minimum of three (3) years of experience in utilization review, utilization management, or case management required.
• Knowledge of healthcare utilization guidelines, payer requirements, and regulatory compliance standards.
• Experience evaluating medical necessity, treatment plans, and appropriate levels of care.
• Strong communication and collaboration skills related to authorization determinations and care coordination.
• Demonstrated ability to analyze utilization data, identify trends, and support patient care and discharge planning initiatives.