RN Utilization Review Leader — Enterprise Operations

UF Health; Gainesville (FL); On-site; USD 90,000 - 120,000; Full time

Job summary

UF Health in Gainesville is seeking a Manager of Utilization Review to provide operational leadership for utilization review activities across the health system. The role ensures clinical appropriateness of status determinations and regulatory compliance, while driving denial prevention and efficient resource use.

The position leads a team of UR Specialists and nurses, collaborating with physician advisors, case management, care coordination, revenue cycle, and payer relations to standardize

Qualifications

• RN with active license required.
• Experience leading utilization management operations.
• Experience with Medicare/Medicaid/payers.

Responsibilities

• Provide operational leadership for utilization review activities across the health system.
• Ensure clinical appropriateness of patient status determinations and regulatory compliance.
• Drive denial prevention strategies and efficient utilization of resources.
• Lead multi-site enterprise coding operations and staff oversight.
• Collaborate with physician advisors, case management, care coordination, revenue cycle, and payer relations.

Skills

Leadership

Regulatory compliance

Denials management

Utilization review

Data analysis

Education

Bachelor’s degree in nursing

Master’s degree in Nursing/Healthcare Administration/Business Administration

Tools

Epic

Job description

UF Health in Gainesville is seeking a Manager of Utilization Review to provide operational leadership for utilization review activities across the health system. The role ensures clinical appropriateness of status determinations and regulatory compliance, while driving denial prevention and efficient resource use.

The position leads a team of UR Specialists and nurses, collaborating with physician advisors, case management, care coordination, revenue cycle, and payer relations to standardize