Utilization Management RN Remote

AdventHealth; United States; Remote; USD 6,800 - 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 Support

Pet Benefits

Job summary

AdventHealth Orlando is seeking a Registered Nurse to join our Utilization Management team. This full-time role focuses on admissions reviews, payer guidelines, and collaboration with the care team to secure timely authorizations.

You will manage concurrent and pre-bill denials, communicate with Insurance carriers, and ensure accurate documentation in the EMR. A strong background in acute care and case management is preferred; Florida background screening may apply.

Qualifications

• Knowledge of admissions reviews and medical necessity criteria.
• Familiarity with payer guidelines and authorization workflows.
• Experience with concurrent/denial management and EMR documentation.
• Ability to collaborate with multidisciplinary teams for patient status.
• Understanding of life cycle growth and disease states relevant to care.

Responsibilities

• Monitor admissions and perform initial and continued stay reviews.
• Manage payer guidelines and denials to protect reimbursement.
• Collaborate with care teams regarding patient status and denials.
• Build relationships to promote interdisciplinary collaboration.
• Ensure authorization information is communicated and documented in EMR.

Skills

Clinical Nursing

Acute Care Experience

EHR Knowledge

Utilization/Case Management

Regulatory Knowledge

Education

Associate's of Nursing [Required]

Bachelor's of Nursing [Preferred]

RN License (Required)

ACM [Preferred]

CCM [Preferred]

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.