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UF Health

RN, Utilization Management

Career Insights for Registered Nurse (General)

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What they do

A Registered Nurse provides medical care and treatment, educates patients about their conditions, and provides emotional support to patients and families. Works in hospitals, schools, clinics or community health centers. Works under the supervision of a physician or other specialist, and serves as the primary point of care for patients in a hospital setting. May specialize in emergency room work, or treatment for a particular condition, or specialize in working with infants, the elderly or other patient groups. May work as an advanced practice specialists and prescribe medications in addition to offering specialty care.

$70,422 / year median in Florida

+8% projected growth

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Job Description

Overview Plays a critical role in evaluating patient medical records to ensure the necessity and appropriateness of healthcare services. Involves coordinating with healthcare providers to maintain compliance with utilization management guidelines and optimizing treatment plans for effective patient care and resource utilization. Requires clear communication of authorization decisions and ongoing monitoring to support timely discharge planning. Analyzes utilization data to identify trends and collaborates with interdisciplinary teams to enhance care coordination while ensuring accurate documentation and regulatory compliance. Responsibilities Evaluates patient medical records to ensure necessity and appropriateness of healthcare services.
  • Coordinates with healthcare providers to maintain compliance with utilization management guidelines.
  • Optimizes treatment plans for effective patient care and resource utilization.
  • Communicates authorization decisions clearly and supports timely discharge planning.
  • Analyzes utilization data to identify trends and improve care coordination.
  • Collaborates with interdisciplinary teams to ensure accurate documentation and regulatory compliance. Qualifications Required Education . Graduate from an accredited Nursing school Required experienc e: Registered Nurse (RN) license with 3+ years experience in utilization review or case management Necessary Skills
  • Knowledge of healthcare utilization guidelines and compliance
  • Experience evaluating medical necessity and treatment plans
  • Strong communication skills for authorization decisions
  • Ability to analyze utilization data and support care coordination
License Requirement:
Registered Nurse (RN) with a current Florida nursing license required.
Qualifications:
Required Education . Graduate from an accredited Nursing school Required experienc e: Registered Nurse (RN) license with 3+ years experience in utilization review or case management Necessary Skills Knowledge of healthcare utilization guidelines and compliance Experience evaluating medical necessity and treatment plans Strong communication skills for authorization decisions Ability to analyze utilization data and support care coordination
License Requirement:
Registered Nurse (RN) with a current Florida nursing license required.