Utilization Management RN: Patient Access & Authorization

adventhealth; Orlando (FL); On-site; USD 68,132 - 119,520; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

PTO (Paid Time Off)

403(b) Retirement Plan

Parental Leave (4 weeks)

Career Development

Well-being Resources

Mental Health Support

Pet Benefits

Job summary

AdventHealth in Altamonte Springs, FL is seeking a registered nurse to join our utilization management team. You will monitor admissions, review medical necessity, and collaborate with a multidisciplinary care team to ensure timely authorizations.

You will use EMR systems to review documentation, handle concurrent and pre-bill denials, and communicate with insurance carriers. A strong focus on interdisciplinary care and patient status alignment is required.

Qualifications

• Associates degree in nursing is required.
• Bachelors degree in nursing preferred.
• 3+ years clinical nursing experience required.
• Experience with utilization management or case management preferred.

Responsibilities

• Monitor admissions and perform initial and continued stay medical necessity reviews.
• Maintain knowledge of payer guidelines and regulatory requirements; manage denials to prevent loss of reimbursement.
• Collaborate with multidisciplinary care team regarding patient status and concurrent denials.
• Build relationships to promote interdisciplinary collaboration.
• Ensure communication of requested clinical information; monitor discharge reports; follow up with insurance for complete authorization.
• Other duties as assigned.

Skills

Clinical Nursing

Case Management

Medical Necessity

EMR

Communication

Education

Associate's Degree in Nursing

Bachelor's Degree in Nursing

Tools

Electronic Health Records

Job description

AdventHealth in Altamonte Springs, FL is seeking a registered nurse to join our utilization management team. You will monitor admissions, review medical necessity, and collaborate with a multidisciplinary care team to ensure timely authorizations.

You will use EMR systems to review documentation, handle concurrent and pre-bill denials, and communicate with insurance carriers. A strong focus on interdisciplinary care and patient status alignment is required.