RN, Utilization Management | Utilization Management | PRN

Overview

• Join an onsite clinical team focused on ensuring the right care at the right time for every patient. 💻 Work Style: Onsite 📍 Location: Gainesville, FL 🕒 FTE: PRN (Approximately 4 hours per week) Evaluates patient medical records to determine the necessity and appropriateness of healthcare services in alignment with utilization management guidelines.
• Collaborates with healthcare providers to support compliance, optimize treatment plans, and promote effective resource utilization.
• Communicates authorization decisions clearly and monitors patient progress to support timely discharge planning.
• Analyzes utilization data to identify trends and opportunities for improvement, partnering with interdisciplinary teams to enhance care coordination.
• Ensures accurate documentation and adherence to regulatory and compliance standards.

Responsibilities

• Key Responsibilities Reviews patient medical records to evaluate the necessity and appropriateness of healthcare services.
• Collaborates with healthcare providers to ensure compliance with utilization management guidelines.
• Supports optimization of treatment plans to promote effective patient care and appropriate resource utilization.
• Communicates authorization decisions clearly and in a timely manner to providers and stakeholders.
• Monitors patient progress to support efficient discharge planning and continuity of care.
• Analyzes utilization data to identify trends and opportunities for improvement.
• Collaborates with interdisciplinary teams to enhance care coordination.
• Ensures accurate documentation and adherence to regulatory and compliance standards.

Qualifications

Education & Experience

Registered Nurse (RN) with a current Florida license required. Three (3) years of critical care nursing experience, or Five (5) years of medical-surgical nursing experience, or Three (3) years of utilization review, case management, or third-party payer experience.

Qualifications

Active Registered Nurse (RN) license with 3+ years of experience in utilization review or case management. Strong knowledge of healthcare utilization management guidelines and regulatory compliance. Experience evaluating medical necessity and optimizing treatment plans. Excellent communication skills with the ability to clearly convey authorization decisions. Ability to analyze utilization data and support effective care coordination. Strong organizational skills with the ability to manage multiple priorities simultaneously. Ability to work independently and collaboratively with multidisciplinary teams. Strong attention to detail and innovative problem-solving skills. Flexibility to adjust work hours and days based on departmental needs. Motor Vehicle Operator Designation: Employees in this position will not operate vehicles for an assigned business purpose.