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 collaborate with the multidisciplinary care team in a fully remote setting.

Key responsibilities

• Monitor admissions and perform initial and continued stay medical necessity reviews
• Manage concurrent and pre-bill denials to prevent loss of reimbursement while maintaining knowledge of payer guidelines
• Communicate with the care team regarding patient status and ensure requested clinical information is relayed to insurance carriers

Required qualifications

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