Utilization Management Nurse

Managing patient admissions and medical necessity reviews, the full-time Florida Licensed Utilization Management RN will work remotely to ensure compliance with payer guidelines, collaborate with the care team, and prevent reimbursement losses through effective authorization management. Key responsibilities Monitor admissions and conduct initial and continued stay medical necessity reviews Collaborate with the multidisciplinary care team to manage concurrent denials and ensure proper clinical information communication Maintain knowledge of payer guidelines and regulatory requirements to prevent loss of reimbursement Required qualifications Associate's degree in Nursing (Required); Bachelor's degree in Nursing (Preferred) Registered Nurse (RN) license (Required) 3+ years of clinical nursing experience (Required) Experience in Utilization Management or Case Management (Preferred) Basic Life Support (BLS) certification (Preferred)