Florida Licensed Utilization Review Nurse
Job Summary
To support optimal patient care, the part-time Florida Licensed Utilization Review Nurse will conduct admission and continued stay reviews remotely, ensuring compliance with medical necessity criteria and collaborating with healthcare teams during day shift hours.
Key responsibilities
- Perform hospital admission reviews to determine medical necessity and appropriate patient status
- Conduct continued stay reviews using approved clinical criteria and guidelines
- Communicate review findings and collaborate with interdisciplinary teams to optimize reimbursement and patient care
Required qualifications
- Current, unrestricted Registered Nurse (RN) license
- Minimum five (5) years of acute care nursing experience in a hospital setting
- Minimum two (2) years of recent hospital-based or health plan utilization review experience
- Graduate of an accredited school of nursing; Bachelor of Science in Nursing (BSN) preferred
- Certification in case management (CCM, ACM, CMCN, or CMGT-BC) preferred
Complete Job Description
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