RN Utilization Management Care Reviewer Position Available In Miami-Dade, Florida

Location:

REMOTE Salary:

$45.00 USD Hourly – $50.00

USD Hourly Description:

Job Title:

Utilization Management Nurse Location:

Remote Job Type:

Full Time Contract, 6+ months About the Job As a Utilization Management Nurse, you will play a critical role in determining the medical appropriateness of requested services. By reviewing clinical information and applying evidence-based guidelines, you will ensure quality patient care while optimizing outcomes. You will collaborate with providers, members, and service teams to obtain necessary information and communicate determinations efficiently. Additionally, you will oversee pre-service, admission, and concurrent review decisions while managing length of stay, discharge planning, and resource utilization. Key Responsibilities Assess inpatient services to ensure cost-effectiveness and compliance with state and federal regulations. Analyze clinical service requests using evidence-based guidelines. Identify appropriate benefits, eligibility criteria, and expected length of stay for treatments. Conduct inpatient reviews to determine financial responsibility and process authorization requests within set timelines. Refer cases to Medical Directors and facilitate appropriate referrals to other clinical programs. Collaborate with multidisciplinary teams to promote Banner Health’s integrated model. Adhere to all Utilization Management policies, procedures, and professional standards.

Minimum Qualifications Education:

Bachelor’s degree in nursing or equivalent experience.

Licensure:

Active, unrestricted State Registered Nursing (RN) license.

Certification:

MCG certification (or ability to obtain within six months of hire).

Experience:

Five years of clinical nursing experience or equivalent knowledge.

Technical Skills:

Proficiency in Microsoft Suite, electronic medical record (EMR) systems, and multiple platforms for medical record review. Apply today for immediate consideration! By providing your phone number, you consent to: (1) receive automated text messages and calls from the Judge Group, Inc. and its affiliates (collectively “Judge”) to such phone number regarding job opportunities, your job application, and for other related purposes. Message & data rates apply and message frequency may vary. Consistent with Judge’s Privacy Policy, information obtained from your consent will not be shared with third parties for marketing/promotional purposes. Reply STOP to opt out of receiving telephone calls and text messages from Judge and HELP for help.

Contact:

bkirking@judge.com This job and many more are available through The Judge Group. Find us on the web at www.judge.com