Florida Licensed Utilization Management RN

Job Summary

Working remotely, the Florida Licensed Utilization Management RN will perform utilization management and review for in-home long-term care services, ensuring medical necessity and collaborating with the Medical Director while maintaining accurate documentation.

Key responsibilities

• Perform utilization management and concurrent review to determine medical necessity for services
• Identify solutions for non-standard requests and provide coaching and feedback to less experienced team members
• Prepare and present cases for Medical Director review, ensuring timely and accurate documentation of decisions

Required qualifications

• Unrestricted RN license in the state of Florida
• Experience in Managed Care and/or Clinical settings, preferably within Medicaid and Utilization Management
• Proficiency in Microsoft Office (Word, Excel, PowerPoint) and navigating a Windows environment