Florida Licensed Utilization Management RN

Job Summary

To support patient care, the full-time Florida Licensed Utilization Management RN will monitor admissions, perform medical necessity reviews, and collaborate with the care team in a fully remote capacity.

Key responsibilities

• Monitor admissions and conduct initial and continued stay medical necessity reviews
• Manage concurrent and pre-bill denials to ensure reimbursement and compliance with payer guidelines
• Collaborate with the multidisciplinary care team regarding patient status and authorization processes

Required qualifications

• Associate's degree in Nursing (Required)
• 3+ years of clinical nursing experience (Required)
• Registered Nurse (RN) license (Required)
• Experience in Utilization Management or Case Management (Preferred)
• Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification (Preferred)