Florida Licensed Utilization Management RN

Job Summary

To support patient care initiatives, the full-time Florida Licensed Utilization Management RN will monitor admissions, perform medical necessity reviews, and manage concurrent denials while working remotely four days a week.

Key responsibilities

• Monitor admissions and conduct initial and ongoing medical necessity reviews to ensure compliance with payer guidelines
• Collaborate with the multidisciplinary care team to communicate patient status and manage authorization processes
• Maintain thorough knowledge of regulatory requirements and assist in preventing reimbursement losses through effective management of concurrent and pre-bill denials

Required qualifications

• Associate's degree in Nursing (Required); Bachelor's degree in Nursing (Preferred)
• Registered Nurse (RN) license (Required)
• 3+ years of clinical nursing experience (Required); 5+ years in an acute care setting (Preferred)
• Experience with electronic health records (Preferred)
• Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification (Preferred)