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

Responsibilities

• Evaluates patient medical records to ensure necessity and appropriateness of healthcare services.
• Captivates with healthcare providers to maintain compliance with utilization management guidelines.
• Optimizes treatment plans for effective patient care and resource utilization.
• Communicates authorization decisions clearly and supports timely discharge planning.
• Analyzes utilization data to identify trends and improve care coordination.
• Collaborates with interdisciplinary teams to ensure accurate documentation and regulatory compliance.

Qualifications

• Registered Nurse (RN) with a current Florida license required.
• 3+ years experience in utilization review or case management.
• Knowledge of healthcare utilization guidelines and compliance.
• Experience evaluating medical necessity and treatment plans.
• Strong communication skills for authorization decisions.
• Ability to analyze utilization data and support care coordination.