Florida Licensed RN Care Manager

Job Summary

To ensure efficient care management processes, the full-time Florida Licensed RN Care Manager will oversee medical necessity determinations, coordinate insurance reviews, and facilitate authorization processes while working onsite in St. Petersburg, Florida.

Key responsibilities

• Guide care managers in medical record reviews and patient bed status placement
• Coordinate with various departments to enhance claims processing and denial management
• Conduct retrospective reviews for medical necessity and assist in denial prevention efforts

Required qualifications

• Graduate of an approved school of nursing
• Current license as a Registered Nurse (RN) in Florida
• Certification as an InterQual trainer within six months of hire
• Five years of acute clinical experience, including two years in care management or utilization management