Florida Licensed Utilization Management RN

Job Summary

Managing patient admissions and medical necessity reviews, the full-time Florida Licensed Utilization Management RN will work remotely to ensure compliance with payer guidelines, collaborate with the care team, and prevent reimbursement losses through effective authorization management.

Key responsibilities

• Monitor admissions and conduct initial and continued stay medical necessity reviews
• Collaborate with the multidisciplinary care team to manage concurrent denials and ensure proper clinical information communication
• Maintain knowledge of payer guidelines and regulatory requirements to prevent loss of reimbursement

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)
• Experience in Utilization Management or Case Management (Preferred)
• Basic Life Support (BLS) certification (Preferred)