Florida RN Utilization Reviewer
Job Summary
Working remotely in a full-time capacity, the Florida RN Utilization Reviewer will conduct admission, concurrent, and retrospective reviews of medical records to ensure compliance with clinical performance standards and reimbursement guidelines while managing a caseload of 25-30 reviews per day.
Key responsibilities
- Perform medical record reviews and provide clinical information to payers
- Utilize analytical skills to gather data and identify issues affecting patient care and reimbursement
- Document findings accurately in UM notes and attend scheduled staff meetings
Required qualifications
- Graduate of an accredited school of nursing
- Current state licensure as a Registered Nurse (RN)
- Basic Life Support (BLS) certification through the American Heart Association (AHA) or American Red Cross
- Three years of equivalent full-time clinical experience as a Registered Nurse
- Knowledge of medical terminology, anatomy and physiology, and basic disease processes
Complete Job Description
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