Location:Cape Coral Hospital -636 Del Prado BlvdCape Coral FL 33990
Department: Utilization Management - Corporate
Work Type: Full Time
Shift: Shift 2/8:00:00 AM to 8:00:00 PM
Minimum to Midpoint Pay Rate:$30.27 - $40.86 / hour
Are you detail-oriented and passionate about ensuring high-quality, cost-effective care? Were seeking a Utilization Management Nurse who will play a key role in optimizing patient outcomes, maintaining compliance, and supporting appropriate resource use across the continuum of care.
The Utilization Management Nurse is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. This role ensures compliance with regulatory standards and payer requirements while promoting accurate, concurrent clinical documentation that reflects the patients care and supports reimbursement.
Review clinical documentation to determine medical necessity and appropriate level of care using established criteria
Ensure timely, accurate utilization reviews and documentation to support reimbursement and regulatory compliance
Collaborate with physicians, nursing staff, and case managers to clarify clinical information and support appropriate care planning
Monitor patient progress and facilitate transitions across levels of care as needed
Support concurrent documentation efforts to ensure the medical record reflects the full scope of care and services delivered
Meet or exceed established productivity and quality benchmarks for utilization review and documentation accuracy
Be part of a collaborative, high-performing utilization management team
Play a vital role in improving care quality and resource stewardship
Access ongoing education and leadership opportunities
Competitive salary and comprehensive benefits
Help us make sure every patient gets the right care at the right timefor the right reasons. Join our Utilization Management team and make a meaningful impact every day.
RequirementsEducation: Graduate of an accredited school of professional nursing required. BSN or BS in a related healthcare field, or able to obtain within the first year of hire.
Experience: Minimum of 3 years acute care hospital clinical experience or equivalent utilization management experience within 2 years with a focus on acute care.
Certification: Case Management certification, ACM, CCM, CMCN or NACCM required after 3 yrs. employment (time exception provided for unsuccessful attempts).
License: Currently licensed as an RN in the State of Florida.
Other: Communication and interpersonal skills, basic computer, analytical, grammar and spelling skills. Ability to effectively multi-task responsibilities.
US:FL:Cape Coral
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