Utilization Management RN Remote

AdventHealth; Orlando (FL); Remote; USD 69,000 - 121,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

Paid Time Off

403-B Retirement Plan

Parental Leave

Career Development

Well-being Resources

Mental Health Resources

Pet Benefits

Job summary

AdventHealth in Orlando, FL seeks a Registered Nurse for Utilization Management/Case Management. This full-time day-shift role monitors admissions, reviews medical necessity, and coordinates with the multidisciplinary team to secure authorizations. A Florida RN license is required with 3+ years in acute care; payer guidelines experience is preferred.

The position offers comprehensive benefits, professional growth, and a chance to contribute to patient care across the continuum.

Qualifications

• Associate's degree in nursing is required.
• Florida RN license is required with ongoing eligibility.
• 3+ years of clinical nursing in an acute care setting preferred.
• Experience with Utilization/Case Management and payer guidelines is preferred.

Responsibilities

• Monitor admissions and perform initial and continued stay medical necessity reviews.
• Maintain knowledge of payer guidelines and manage denials to protect reimbursement.
• Collaborate with the care team regarding patient status and denials.
• Build relationships to promote interdisciplinary collaboration.
• Ensure communication of requested clinical information and obtain authorizations.

Skills

Clinical nursing

Utilization management

Case management

EMR/EHR systems

Education

Associate's Degree in Nursing

Bachelor's in Nursing (Preferred)

Tools

EMR/EHR systems

Job description

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.

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

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance

• Paid Time Off from Day One

• 403-B Retirement Plan

• 4 Weeks 100% Paid Parental Leave

• Career Development

• Whole Person Well-being Resources

• Mental Health Resources and Support

• Pet Benefits

Schedule:

Full time

Shift:

Day (United States of America)

Address:

601 E Rollins St

City:

Orlando

State:

Florida

Postal Code:

32803

Job Description:

• Monitor admissions and perform initial and continued stay medical necessity reviews.
• Maintain thorough knowledge of payer guidelines and regulatory requirements and manages concurrent and pre-bill denials to prevent loss of reimbursement.
• Collaborate and communicate with the multidisciplinary care team regarding patient status and concurrent denials.
• Build relationships to promote interdisciplinary collaboration.
• Ensure requested clinical information is communicated, monitors daily discharge reports, and follows up with insurance carriers to obtain complete authorization.

Knowledge, Skills, and Abilities:

• Must be able to demonstrate knowledge and skills necessary to provide appropriate status recommendations.
• Demonstrates knowledge of the principles of growth, development, and disease states as it relates to the different life cycles.
• Ability to understand differences between notification, reference, and authorization numbers.
• Maintains up-to-date concurrent authorizations for in-house patients, utilizing daily commercial authorization reports.
• Accesses and reviews payer portals for authorization numbers in collaboration with department assistants; ensures proper update of authorization fields within EMR accordingly, delegating appropriate tasks to support staff.

Education:

• Associate's of Nursing [Required]
• Bachelor's of Nursing [Preferred]

Work Schedule:

Weekend UM nurse; 4 -10hr days, 630am - 5pm or 7am - 530pm, templated schedule includes 5 out of 6 weekends per 6 week schedule rotation

Work Experience:

• 3+ years clinical nursing [Required]
• 5+ years clinical nursing in an acute care setting [Preferred]
• Experience working in electronic health records [Preferred]
• Utilization Management or Case Management [Preferred]

Licenses and Certifications:

• Registered Nurse (RN) [Required] AND
• Accredited Case Manager (ACM) [Preferred] OR
• Certified Case Manager (CCM) [Preferred]

Physical Requirements:

(Please click the link below to view work requirements) Physical Requirements - https://tinyurl.com/msy4mja2

Pay Range:

$68,806.40 - $120,723.20

Background Screening Requirement (Florida Law)

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law.

Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse: https://info.flclearinghouse.com/

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.