RN Utilization Management Specialist

6 days ago


Saint Augustine Beach, Florida, United States University of Florida Health Full time
Job Summary

We are seeking a skilled RN Utilization Management Specialist to join our team at the University of Florida Health. As a key member of our healthcare team, you will play a critical role in ensuring that patients receive the most appropriate level of care, while also promoting efficient use of hospital resources.

Key Responsibilities
  • Conduct thorough clinical reviews of assigned patients to determine medical necessity and ensure that care is provided at the appropriate level.
  • Collaborate with direct care givers, including nurses, physicians, and ancillary departments, to coordinate patient care and promote timely utilization of resources.
  • Apply regulatory requirements and policy concerning observation, including time limitations, physician orders, and diagnostic testing.
  • Provide documentation review and certification to third-party payers, negotiating for additional days if necessary.
  • Identify opportunities for improvement in hospital processes and suspected problems of under or over utilization, bringing attention to the Utilization Management Manager.
Requirements
  • Associates degree in nursing
  • 3 years of acute care nursing experience
  • Experience in acute care utilization management preferred
  • Accredited Case Manager (ACM) certification
What We Offer

We offer a competitive salary and benefits package, as well as opportunities for professional growth and development. If you are a motivated and detail-oriented RN with a passion for utilization management, we encourage you to apply for this exciting opportunity.


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