RN, Utilization Management Lead | Utilization Management| Day Full Time

Responsibilities

• Perform all duties according to the utilization review (UR) plan, Federal and State guidelines, as well as TJC standards.
• Operate as a backup for the Director during their absence.

Qualifications

• Minimum Education and Experience: Registered nurse (RN) with current Florida license, at least two (2) years of experience in utilization review in a hospital setting, for a third party payer or other review agency or organization.
• Knowledge: Strong understanding of diagnostic related groups (DRGs), Federal and State guidelines, commercial and other payer groups and coding.
• Skills: Excellent written and verbal communication skills, proficiency in typing and using a computer.