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RN Utilization Management Specialist

2 months ago


Saint Augustine Florida, United States UF Health Full time
Job Summary

We are seeking a skilled RN Utilization Management Specialist to join our team at UF 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 resources.

Key Responsibilities
  • Conduct thorough clinical reviews of patient cases to determine medical necessity and ensure compliance with regulatory requirements.
  • Collaborate with healthcare teams to coordinate patient care, including direct care givers, nurses, physicians, and ancillary departments.
  • Provide documentation review and certification to third-party payers, negotiating for additional days if necessary.
  • Identify opportunities for improvement in hospital system processes and suspected problems of under or over utilization.
Requirements
  • Associates degree in nursing.
  • 3 years of acute care nursing experience.
  • Preferred experience in acute care utilization management and accredited case management.
About UF Health

UF Health is a leading healthcare provider dedicated to delivering high-quality patient care, education, and research. Our team is committed to making a positive impact in the lives of our patients and the community we serve.