Utilization Management RN

College of Charleston; Orlando (FL); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare provider in Orlando is seeking a Utilization Management RN. This role involves using clinical expertise to analyze patient records and collaborate with care teams to ensure appropriate levels of care. Applicants should have significant nursing experience and a valid Florida RN license, with strong analytical and communication skills being crucial. Join us to make a difference in patient care while enjoying comprehensive benefits from day one.

Benefits

Benefits from Day One

Paid Days Off from Day One

Debt-free Education

Qualifications

• Minimum three years acute care nursing experience required.
• Two years of Utilization Management experience preferred.
• Experience with electronic health records desired.

Responsibilities

• Analyze patient records for admission legitimacy and care level.
• Collaborate with physicians and care teams on patient management.
• Document findings in compliance with regulatory standards.

Skills

Strong analytical skills

Excellent interpersonal communication

Negotiation skills

Data management skills

Education

Current and valid Florida RN license

ADN or BSN

Bachelor of Science in Nursing (preferred)

Job description

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Utilization Management RN

AdventHealth

Facebook LinkedIn Share Application By using this feature you agree to our Terms and Conditions and Privacy Policy . Details Posted: June 23, 2025 Location: Orlando, Florida Show Map

All the benefits and perks you need for you and your family:

· Benefits from Day One

· Paid Days Off from Day One

· Debt-free Education* (Certifications and Degrees without out-of-pocket tuition expense)

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Schedule: Full Time Remote, Applicant must live within a 50-mile radius or be a current employee within an AdventHealth region.

Shift : Monday – Friday, 8am - 4:30pm, every 4 th weekend, may vary based on business needs.

The community you’ll be caring for:

• The Maitland Office Plaza houses our highly skilled teams that support our hospital system including Marketing, Patient Financial Services, Revenue Management, the Credit Union and Human Resources.
• The Trickle Building, a two-story office structure, creates an atmosphere of health and healing, with a healthy-style café and quaint chapel.
• The main lobby is filled with lush greenery and a light trickle of water, creating a holistic environment.

The role you’ll contribute:

The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by analyzing patient records to determine legitimacy of hospital admission, treatment, and appropriate level of care. The UM RN leverages the algorithmic logic of the XSOLIS Cortex platform, utilizing key clinical data points to assist in status and level of care recommendations. The UM RN is responsible to document findings based on department and regulatory standards. When screening criteria does not align with the physician order or a status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor or designated leader for additional review as determined by department standards. Additionally, the UM RN is responsible for denial avoidance strategies including concurrent payer communications to resolve status disputes.

The value you’ll bring to the team:

• Monitors admissions and performs initial patient reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis.
• Performs pre-admission status recommendation in Emergency Department or elective procedure settings as assigned, to communicate with providers status guidance based on available information.
• Maintaining thorough knowledge of payer guidelines, familiarity with payer processes for initiating authorizations, and following through accordingly to prevent loss of reimbursement, including the management of concurrent and pre-bill denials.
• Ensuring all benefits, authorization requirements, and collection notes are obtained and clearly documented on accounts in the pursuit of timely reimbursement within established timeframes to avoid denials.
• Works collaboratively and maintains active communication with physicians, nursing and other members of the multidisciplinary care team to effect timely, appropriate management of claims.
• Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.
• Collaborates with the physician and all members of the multidisciplinary team to facilitate care for designated case load; monitors the patient's progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused, high quality, efficient, and cost effective; facilitates the following on a timely basis:
• Communication to third party payors and other relevant information to the care team;
• Ability to work independently and exercise sound judgment in interactions with physicians, payors, patients and their families;
• Completion of all required documentation in the Cortex platform and in the system's electronic health record.

Qualifications

The expertise and experiences you'll need to succeed:

EDUCATION AND EXPERIENCE REQUIRED:

• Current and valid license to practice in Florida as a Registered Nurse (ADN or BSN) required.
• Minimum three years acute care clinical nursing experience required.
• Minimum two years Utilization Management experience, or equivalent professional experience.
• Excellent interpersonal communication and negotiation skill.
• Strong analytical, data management, and computer skills.
• Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.

PREFERRED:

• Bachelor of Science in Nursing – or other related BS or BA in addition to Nursing
• Clinical experience in acute care facility – greater than five years
• Minimum four years Utilization Management within acute care setting
• Experience working in electronic health records of at least two years

REGISTRATION REQUIRED:

• Registered Nurse

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

Category: Case Management

Organization: AdventHealth Orlando

Schedule: Full-time

Shift: 1 - Day

Req ID: 25023817

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.

Internal Number: 25023817 About AdventHealth At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. More than 100,000 skilled and compassionate caregivers in physician practices, hospitals, outpatient clinics, skilled nursing facilities, home health agencies and hospice centers provide individualized, wholistic care.Our Christian mission, shared vision, common values and focus on whole-person health is our commitment to making communities healthier with a unified system: 51 hospital campuses and hundreds of care sites in diverse markets throughout nine states. More Jobs from This Employer BACK TO TOP