Case Manager, RN- Utilization Review

Key Responsibilities

The Utilization Management Nurse performs admission, concurrent, and retrospective reviews to ensure patients are assigned to the appropriate level of care based on medical necessity. They collaborate with physicians, payers, and interdisciplinary teams to resolve denials, support efficient patient flow, and ensure documentation meets regulatory standards.

Requirements

Candidates must be a Registered Nurse licensed in the state of Florida with at least three years of practicing experience. Proficiency in utilization review processes, medical necessity criteria, and electronic medical record systems is required.

Qualifications

Education

Professional certificate or licensure

Experience

2+ years of experience

Key Skills