RN Case Manager, Utilization Review, PRN - JR248-4

Job Description

Job Description

PRN RN CASE MANAGER – UTILIZATION REVIEW

Northwest Florida Community Hospital (NFCH)
Department: Med-Surg / Utilization Review
Position Type: PRN (As Needed)
Location: Chipley, Florida

Position Summary

Northwest Florida Community Hospital (NFCH) is seeking a qualified and motivated PRN Registered Nurse (RN) Case Manager to support our Med-Surg department. This position is responsible for reviewing patient admissions and continued stays, coordinating patient care, and ensuring appropriate utilization of hospital resources while supporting quality outcomes and compliance with applicable healthcare regulations.

Essential Duties and Responsibilities

• Conduct utilization reviews to assess medical necessity, level of care, and appropriateness of hospital admissions and continued stays.

• Review medical records and clinical documentation to ensure compliance with payer requirements and established guidelines.

• Collaborate with physicians, nursing staff, case management, and other healthcare professionals to support effective patient care.

• Identify potential discharge planning needs and assist with coordination of appropriate post-acute services.

• Communicate with insurance companies and third-party payers regarding authorization, medical necessity, and continued stay reviews.

• Identify opportunities to improve resource utilization, patient outcomes, and length of stay.

• Maintain accurate and timely documentation of utilization review activities.

• Support compliance with hospital policies, regulatory standards, and applicable reimbursement guidelines.

Qualifications

• Current, active Registered Nurse (RN) license in the State of Florida or a multistate license valid for practice in Florida.

• Previous acute care nursing experience required.

• Experience in utilization review, case management, discharge planning, or medical necessity review preferred.

• Knowledge of clinical documentation, insurance authorization processes, and payer requirements preferred.

• Strong critical-thinking, communication, organizational, and documentation skills.

• Ability to work collaboratively with physicians, nursing staff, and interdisciplinary teams.

Why Join NFCH?

At Northwest Florida Community Hospital, we are committed to providing quality healthcare to our community. Join a team where your clinical expertise can make a meaningful difference in patient care, care coordination, and responsible utilization of hospital resources.

Northwest Florida Community Hospital is committed to the principle of equal employment opportunity for all employees and to providing employees with a work environment free of discrimination and harassment. All employment decisions at Northwest Florida Community Hospital are based on business needs, job requirements and individual qualifications, without regard to race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. Northwest Florida Community Hospital will not tolerate discrimination or harassment based on any of these characteristics. We encourage applicants of all ages.

In addition, as part of our commitment to quality and excellence, Northwest Florida Community Hospital will continue to maintain a safe, healthy environment for you by requiring all applicants, who are tentatively selected for a position, to submit to a criminal history check and screening for illegal drug use prior to appointment for a job.

Final confirmation of any job offer will be contingent upon the successful completion of all pre-employment requirements, including a pre-employment drug screening and background screening. Failure to submit to either screening, falsification of any screening information, or a positive finding on a drug test will result in removal from consideration for employment for a period of one year.