Registered Nurse Utilization Review, Case Management, FT, 8:30A-5P

Registered Nurse Utilization Review, Case Management, FT, 8:30A-5P

The purpose of this position is to conduct initial, concurrent, retrospective chart review for clinical financial resource utilization. Coordinates with healthcare team for optimal/efficient patient outcomes, while decreasing length of stay (LOS) and avoid delays and denied days. They are accountable for a designated patient caseload and provides intervention, coordination to decrease avoidable delays, denial of reimbursement. Specific functions within this role include:

• Screens pre-admission, admission process using established criteria for all points of entry.
• Facilitates communication between payers, review agencies, healthcare team.
• Identify delays in treatment or inappropriate utilization and serves as a resource.
• Coordinates communication with physicians.
• Identify opportunities for expedited appeals and collaborates to resolve payer issues.
• Ensures/Maintains effective communication with Revenue Cycle Departments.

Estimated salary range for this position is $73860.80 - $98234.86 / year depending on experience.

Qualifications:

• Degrees: Associates.
• Licenses & Certifications: MCG Care Guidelines Specialist. Registered Nurse.
• Additional Qualifications: RNs hired prior to 2-2012 (10/1/2017 at Bethesda or 7/1/2019 at BRRH) with an Associates Degree in Nursing are not required to have a BSN to continue their non-leadership role as an RN. however, they are required to complete the BSN within 3 years of job entry date. MCG Specialist Certification ISC/HRC required within 12 months of job entry date. 3 years of Nursing experience preferred.
• Excellent written, interpersonal communication and negotiation skills.
• Strong critical thinking skills and the ability to perform clinical/chart review abstract information efficiently.
• Strong analytical, data management and computer skills.
• Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
• Current working knowledge of payer and managed care reimbursement preferred.
• Ability to work independently and exercise sound judgment in interactions with the health care team and patients/families.
• Knowledgeable in local, state, and federal legislation and regulations.
• Ability to tolerate high volume production standards.
• Minimum Required Experience: 3 Years

Job: Case Management/Home Health

Primary Location: Miami

Organization: Baptist Hospital of Miami

Schedule: Full-time

Job Posting: Jun 24, 2026, 4:00:00 AM

Unposting Date: Ongoing

EOE, including disability/vets