Utilization Management Nurse — Care Coordination Pro

Solis-Health-Plans; Florida; On-site; USD 60,000 - 70,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401K with company match

Job summary

Solis Health Plans is seeking a Utilization Management Nurse (LPN or RN) for an on-site role in Doral, FL. You will conduct utilization reviews, coordinate care with medical teams, and ensure medical necessity aligned with benefit criteria and CMS timelines.

Requirements include Florida RN licensure and 3–5 years of RN experience, with preference for UM payer or case management background. A bilingual English/Spanish proficiency is required, and a comprehensive benefits package is offered.

Qualifications

• Bilingual English/Spanish required.
• Active Florida RN license.
• 3–5 years RN clinical experience.
• 2 years Utilization Management nursing in managed care preferred.
• 1 year case management experience in payer or facility setting highly preferred.
• Discharge planning experience highly preferred.

Responsibilities

• Conduct concurrent and retrospective utilization review for inpatient, observation or SNF services.
• Review proposed services against criteria to determine medical necessity and eligibility.
• Coordinate with Medical Directors and provider relations to identify barriers to timely decisions.
• Identify resources to manage high-cost/high-risk care.
• Act as liaison between facilities, members and Solis Health Plans; authorize services and coordinate care.

Skills

Bilingual English/Spanish

RN licensure in Florida

3–5 years RN clinical experience

UM nursing experience

Case management experience

Discharge planning experience

Education

Graduate from accredited nursing program; BSN or higher

Job description

Solis Health Plans is seeking a Utilization Management Nurse (LPN or RN) for an on-site role in Doral, FL. You will conduct utilization reviews, coordinate care with medical teams, and ensure medical necessity aligned with benefit criteria and CMS timelines.

Requirements include Florida RN licensure and 3–5 years of RN experience, with preference for UM payer or case management background. A bilingual English/Spanish proficiency is required, and a comprehensive benefits package is offered.