RN Utilization Review Full-time
UF Health

RN, Utilization Management | Utilization Management

UF Health St. Augustine, FL, US
Overview

Make an impact by supporting the right care at the right time through utilization management excellence. 

 

💻 Work Style: Onsite
📍 Location: St. Agustine, FL 
🕒 FTE: Full-Time (1.0 FTE)
⏰ Schedule: Monday – Friday, 3:00 PM – 11:00 PM

 

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

Key Responsibilities

  • Evaluates patient medical records to determine the medical necessity and appropriateness of healthcare services.
  • Coordinates with healthcare providers and care teams to ensure compliance with utilization management guidelines and payer requirements.
  • Supports effective treatment planning, patient care coordination, and appropriate resource utilization.
  • Communicates authorization decisions and utilization determinations while supporting timely discharge planning efforts.
  • Analyzes utilization management data and trends to identify opportunities for improved care coordination and operational efficiency.
  • Collaborates with interdisciplinary teams to ensure accurate documentation, regulatory compliance, and quality patient outcomes.

Qualifications

Education & Licensure

  • Registered Nurse (RN) with a current Florida nursing license required.

Experience & Skills

  • Minimum of three (3) years of experience in utilization review, utilization management, or case management required.
  • Knowledge of healthcare utilization guidelines, payer requirements, and regulatory compliance standards.
  • Experience evaluating medical necessity, treatment plans, and appropriate levels of care.
  • Strong communication and collaboration skills related to authorization determinations and care coordination.
  • Demonstrated ability to analyze utilization data, identify trends, and support patient care and discharge planning initiatives.

Share this job

Share to FB Share to LinkedIn Share to Twitter

Related Jobs

RN Full-time
ScionHealth

Registered Nurse - Full Time Nights

ScionHealth Green Cove Springs, FL
Description At ScionHealth , we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates. Job Summary Provides planning and delivery of direct and indirect patient care through the nursing process of Assessment, Planning, Intervention, and Evaluation. Develops nursing care plans in coordination with patient, family and interdisciplinary staff as necessary. Communicates changes in patient’s clinical condition with Physicians, Nursing Supervisor/Manager, and co-workers as appropriate. Participates in discharge planning process. Essential Functions Maintains the standard of nursing care and implements policies and procedures of the hospital and nursing department. Directs, supervises, provides and evaluates nursing care provided to patients. Assigns or delegates tasks based on the needs and condition of the patient, potential for harm, complexity of the task, and within scope of practice of the staff to whom the task is delegated. Assigns nursing care team members in accordance with patient needs, team member’s capabilities and qualifications. Documents patient admission assessment and reassessments, patient care plans and other pertinent information, completely in the patient’s medical record according to nursing standards and policies. Performs assessment on all patients on admission and reassessments as per policy. Makes referrals to other disciplines based on assessment. Develops nursing care plan of assigned patient on admission, updates plan of care as needed and ensures plan of care is coordinated with patient, family, and other members of the team. Assesses and reassesses pain. Utilizes appropriate pain management techniques. Educates the patient and family regarding pain management. Revises the plan of care as indicated by the patient’s response to treatment and evaluates overall plan daily for effectiveness. Performs patient care responsibilities considering needs specific to the standard of care for patient’s age. Receives physician’s orders, ensures transcription is accurate and documents completion. Administers medication utilizing the five rights of medication administration reducing the potential for medication errors. Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning; family is included in teaching as appropriate. Assists physicians with examinations, treatments and special procedures and performs services requiring technical and manual skills within scope of practice. Performs treatments and provides services to level of licensure. Treats patients and their families with respect and dignity. Identifies and addresses psychosocial, cultural, ethnic, and religious/spiritual needs of patients and their families. Functions as liaison between administration, patients, physicians, and other healthcare providers. Interacts professionally with patient/family and involves patient/family in the formation of the plan of care. Interprets data about the patient’s status to identify each patient’s age specific needs and provide care needed by the patient group. Performs all aspects of patient care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors. Initiates or assists with emergency measures for sudden adverse developments in patients’ condition. Answers telephone, paging system, patients’ call lights, anticipates patients’ needs, and makes rounds of assigned patients and responds as appropriate. Consults other departments as appropriate to provide for an interdisciplinary approach to the patient’s needs. Provides end of shift report to oncoming nurse, narcotics are counted, documentation is complete, and physician orders signed off. Communicates appropriately and clearly to management, co-workers, and physicians. Identifies and addresses psychosocial needs of patients and family; communicates with Social Service/Discharge Planner regarding both in hospital and post discharge needs. Participates in orientation, instruction/training of new personnel. Manages and operates equipment safely and correctly. Knowledge/Skills/Abilities/Expectations Knowledge of medications and their correct administration based on age of the patient and their clinical condition. Basic computer knowledge. Able to organize tasks, develop action plans, set priorities and function under stressful situations. Ability to maintain a good working relationship both within the department and with other departments. Approximate percent of time required to travel: 0% Must read, write and speak fluent English. Must have good and regular attendance. Performs other related duties as assigned. Qualifications Education Postsecondary certificate, diploma, or program graduation from an accredited school of nursing. (Required) Associate’s Degree or Bachelor’s Degree in Nursing. (Preferred) Licenses/Certifications Registered Nurse (RN) – State Licensure and/or Compact State Licensure in the state of practice. (Required upon hire) Basic Life Support (BCLS). (Required upon hire) Advanced Cardiac Life Support (ACLS). (Preferred upon hire) Experience Six (6) months of Medical/Surgical nursing experience in an acute care setting. (Preferred) Experience demonstrating critical thinking, decision-making, and effective prioritizat ion in a fast-paced clinical environment. (Preferred)
RN Full-time
ScionHealth

Registered Nurse - Full Time Days

ScionHealth Green Cove Springs, FL
Description At ScionHealth , we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates. Job Summary Provides planning and delivery of direct and indirect patient care through the nursing process of Assessment, Planning, Intervention, and Evaluation. Develops nursing care plans in coordination with patient, family and interdisciplinary staff as necessary. Communicates changes in patient’s clinical condition with Physicians, Nursing Supervisor/Manager, and co-workers as appropriate. Participates in discharge planning process. Essential Functions Maintains the standard of nursing care and implements policies and procedures of the hospital and nursing department. Directs, supervises, provides and evaluates nursing care provided to patients. Assigns or delegates tasks based on the needs and condition of the patient, potential for harm, complexity of the task, and within scope of practice of the staff to whom the task is delegated. Assigns nursing care team members in accordance with patient needs, team member’s capabilities and qualifications. Documents patient admission assessment and reassessments, patient care plans and other pertinent information, completely in the patient’s medical record according to nursing standards and policies. Performs assessment on all patients on admission and reassessments as per policy. Makes referrals to other disciplines based on assessment. Develops nursing care plan of assigned patient on admission, updates plan of care as needed and ensures plan of care is coordinated with patient, family, and other members of the team. Assesses and reassesses pain. Utilizes appropriate pain management techniques. Educates the patient and family regarding pain management. Revises the plan of care as indicated by the patient’s response to treatment and evaluates overall plan daily for effectiveness. Performs patient care responsibilities considering needs specific to the standard of care for patient’s age. Receives physician’s orders, ensures transcription is accurate and documents completion. Administers medication utilizing the five rights of medication administration reducing the potential for medication errors. Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning; family is included in teaching as appropriate. Assists physicians with examinations, treatments and special procedures and performs services requiring technical and manual skills within scope of practice. Performs treatments and provides services to level of licensure. Treats patients and their families with respect and dignity. Identifies and addresses psychosocial, cultural, ethnic, and religious/spiritual needs of patients and their families. Functions as liaison between administration, patients, physicians, and other healthcare providers. Interacts professionally with patient/family and involves patient/family in the formation of the plan of care. Interprets data about the patient’s status to identify each patient’s age specific needs and provide care needed by the patient group. Performs all aspects of patient care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors. Initiates or assists with emergency measures for sudden adverse developments in patients’ condition. Answers telephone, paging system, patients’ call lights, anticipates patients’ needs, and makes rounds of assigned patients and responds as appropriate. Consults other departments as appropriate to provide for an interdisciplinary approach to the patient’s needs. Provides end of shift report to oncoming nurse, narcotics are counted, documentation is complete, and physician orders signed off. Communicates appropriately and clearly to management, co-workers, and physicians. Identifies and addresses psychosocial needs of patients and family; communicates with Social Service/Discharge Planner regarding both in hospital and post discharge needs. Participates in orientation, instruction/training of new personnel. Manages and operates equipment safely and correctly. Knowledge/Skills/Abilities/Expectations Knowledge of medications and their correct administration based on age of the patient and their clinical condition. Basic computer knowledge. Able to organize tasks, develop action plans, set priorities and function under stressful situations. Ability to maintain a good working relationship both within the department and with other departments. Approximate percent of time required to travel: 0% Must read, write and speak fluent English. Must have good and regular attendance. Performs other related duties as assigned. Qualifications Education Postsecondary certificate, diploma, or program graduation from an accredited school of nursing. (Required) Associate’s Degree or Bachelor’s Degree in Nursing. (Preferred) Licenses/Certifications Registered Nurse (RN) – State Licensure and/or Compact State Licensure in the state of practice. (Required upon hire) Basic Life Support (BCLS). (Required upon hire) Advanced Cardiac Life Support (ACLS). (Preferred upon hire) Experience Six (6) months of Medical/Surgical nursing experience in an acute care setting. (Preferred) Experience demonstrating critical thinking, decision-making, and effective prioritization in a fast-paced clinical environment. (Preferred)
RN Full-time
ScionHealth

Registered Nurse Acute Rehab - Full Time Days

ScionHealth Green Cove Springs, FL
Description At ScionHealth , we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates. Job Summary Provides planning and delivery of direct and indirect patient care through the nursing process of Assessment, Planning, Intervention, and Evaluation. Develops nursing care plan in coordination with patient, family and interdisciplinary staff as necessary. Communicates changes in patient’s clinical condition with Physicians, Nursing Supervisor/Manager, and co-workers as appropriate. Participates in discharge planning process. Essential Functions Maintains the standard of nursing care and implements policies and procedures of the hospital and nursing department. Directs, supervises and evaluates nursing care provided to patients. Assigns nursing care team members in accordance to patient needs, team members capabilities and qualifications. Documents patient admission assessment and reassessments, patient care plans and other pertinent information, completely in the patient’s medical record according to nursing standards and policies. Performs assessment on all patients on admission and reassessments as per policy. Develops nursing care plan of assigned patient on admission, updates plan of care as needed and ensures plan of care is coordinated with patient, family, and other members of the team. Assesses and reassess pain. Utilizes appropriate pain management techniques. Educates the patient and family regarding pain management. Revises the plan of care as indicated by the patient’s response to treatment, and evaluates overall plan daily for effectiveness. Performs patient care responsibilities considering needs specific to the standard of care for patient’s age. Performs treatments and provide services to level of license Receives physician’s orders, ensures transcription is accurate and documents completion. Assists physicians with examinations, treatments and special procedures and performs services requiring technical and manual skills within scope of practice. Administers medication utilizing the five rights of medication administration reducing the potential for medication errors. Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning; family is included in teaching as appropriate. Interacts professionally with patient/family and involves patient/family in the formation of the plan of care. Treats patients and their families with respect and dignity. Identifies and addresses psychosocial, cultural, ethnic and religious/spiritual needs of patients and their families. Knowledge/Skills/Abilities/Expectations Excellent oral and written communication and interpersonal skills. Knowledge of medications and their correct administration based on age of the patient and their clinical condition. Basic computer knowledge. Able to organized tasks, develop action plans, set priorities and function under stressful situations. Ability to maintain a good working relationship both within the department and with other departments. Must have good and regular attendance. Must read, write and speak fluent English. Approximate percent of time required to travel: 0% Performs other related duties as assigned. Qualifications Education Graduation from an accredited Bachelor of Science in Nursing, Associate Degree in Nursing or Nursing Diploma program. Licenses/Certifications Current state licensure as Registered Nurse. BCLS certification. ACLS preferred. Experience Minimum six months’ Medical/Surgical experience in an acute care setting preferred.
RN Full-time
ScionHealth

Registered Nurse Acute Rehab - Full Time Nights

ScionHealth Green Cove Springs, FL
Description At ScionHealth , we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates. Job Summary Provides planning and delivery of direct and indirect patient care through the nursing process of Assessment, Planning, Intervention, and Evaluation. Develops nursing care plan in coordination with patient, family and interdisciplinary staff as necessary. Communicates changes in patient’s clinical condition with Physicians, Nursing Supervisor/Manager, and co-workers as appropriate. Participates in discharge planning process. Essential Functions Maintains the standard of nursing care and implements policies and procedures of the hospital and nursing department. Directs, supervises and evaluates nursing care provided to patients. Assigns nursing care team members in accordance to patient needs, team members capabilities and qualifications. Documents patient admission assessment and reassessments, patient care plans and other pertinent information, completely in the patient’s medical record according to nursing standards and policies. Performs assessment on all patients on admission and reassessments as per policy. Develops nursing care plan of assigned patient on admission, updates plan of care as needed and ensures plan of care is coordinated with patient, family, and other members of the team. Assesses and reassess pain. Utilizes appropriate pain management techniques. Educates the patient and family regarding pain management. Revises the plan of care as indicated by the patient’s response to treatment, and evaluates overall plan daily for effectiveness. Performs patient care responsibilities considering needs specific to the standard of care for patient’s age. Performs treatments and provide services to level of license Receives physician’s orders, ensures transcription is accurate and documents completion. Assists physicians with examinations, treatments and special procedures and performs services requiring technical and manual skills within scope of practice. Administers medication utilizing the five rights of medication administration reducing the potential for medication errors. Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning; family is included in teaching as appropriate. Interacts professionally with patient/family and involves patient/family in the formation of the plan of care. Treats patients and their families with respect and dignity. Identifies and addresses psychosocial, cultural, ethnic and religious/spiritual needs of patients and their families. Knowledge/Skills/Abilities/Expectations Excellent oral and written communication and interpersonal skills. Knowledge of medications and their correct administration based on age of the patient and their clinical condition. Basic computer knowledge. Able to organized tasks, develop action plans, set priorities and function under stressful situations. Ability to maintain a good working relationship both within the department and with other departments. Must have good and regular attendance. Must read, write and speak fluent English. Approximate percent of time required to travel: 0% Performs other related duties as assigned. Qualifications Education Graduation from an accredited Bachelor of Science in Nursing, Associate Degree in Nursing or Nursing Diploma program. Licenses/Certifications Current state licensure as Registered Nurse. BCLS certification. ACLS preferred. Experience Minimum six months’ Medical/Surgical experience in an acute care setting preferred.
RN Per Diem
ScionHealth

Registered Nurse - PRN Days

ScionHealth Green Cove Springs, FL
Description At ScionHealth , we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates. Job Summary Provides planning and delivery of direct and indirect patient care through the nursing process of Assessment, Planning, Intervention, and Evaluation. Develops nursing care plans in coordination with patient, family and interdisciplinary staff as necessary. Communicates changes in patient’s clinical condition with Physicians, Nursing Supervisor/Manager, and co-workers as appropriate. Participates in discharge planning process. Essential Functions Maintains the standard of nursing care and implements policies and procedures of the hospital and nursing department. Directs, supervises, provides and evaluates nursing care provided to patients. Assigns or delegates tasks based on the needs and condition of the patient, potential for harm, complexity of the task, and within scope of practice of the staff to whom the task is delegated. Assigns nursing care team members in accordance with patient needs, team member’s capabilities and qualifications. Documents patient admission assessment and reassessments, patient care plans and other pertinent information, completely in the patient’s medical record according to nursing standards and policies. Performs assessment on all patients on admission and reassessments as per policy. Makes referrals to other disciplines based on assessment. Develops nursing care plan of assigned patient on admission, updates plan of care as needed and ensures plan of care is coordinated with patient, family, and other members of the team. Assesses and reassesses pain. Utilizes appropriate pain management techniques. Educates the patient and family regarding pain management. Revises the plan of care as indicated by the patient’s response to treatment and evaluates overall plan daily for effectiveness. Performs patient care responsibilities considering needs specific to the standard of care for patient’s age. Receives physician’s orders, ensures transcription is accurate and documents completion. Administers medication utilizing the five rights of medication administration reducing the potential for medication errors. Formulates a teaching plan based upon identified learning needs and evaluates effectiveness of learning; family is included in teaching as appropriate. Assists physicians with examinations, treatments and special procedures and performs services requiring technical and manual skills within scope of practice. Performs treatments and provides services to level of licensure. Treats patients and their families with respect and dignity. Identifies and addresses psychosocial, cultural, ethnic, and religious/spiritual needs of patients and their families. Functions as liaison between administration, patients, physicians, and other healthcare providers. Interacts professionally with patient/family and involves patient/family in the formation of the plan of care. Interprets data about the patient’s status to identify each patient’s age specific needs and provide care needed by the patient group. Performs all aspects of patient care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors. Initiates or assists with emergency measures for sudden adverse developments in patients’ condition. Answers telephone, paging system, patients’ call lights, anticipates patients’ needs, and makes rounds of assigned patients and responds as appropriate. Consults other departments as appropriate to provide for an interdisciplinary approach to the patient’s needs. Provides end of shift report to oncoming nurse, narcotics are counted, documentation is complete, and physician orders signed off. Communicates appropriately and clearly to management, co-workers, and physicians. Identifies and addresses psychosocial needs of patients and family; communicates with Social Service/Discharge Planner regarding both in hospital and post discharge needs. Participates in orientation, instruction/training of new personnel. Manages and operates equipment safely and correctly. Knowledge/Skills/Abilities/Expectations Knowledge of medications and their correct administration based on age of the patient and their clinical condition. Basic computer knowledge. Able to organize tasks, develop action plans, set priorities and function under stressful situations. Ability to maintain a good working relationship both within the department and with other departments. Approximate percent of time required to travel: 0% Must read, write and speak fluent English. Must have good and regular attendance. Performs other related duties as assigned. Qualifications Education Postsecondary certificate, diploma, or program graduation from an accredited school of nursing. (Required) Associate’s Degree or Bachelor’s Degree in Nursing. (Preferred) Licenses/Certifications Registered Nurse (RN) – State Licensure and/or Compact State Licensure in the state of practice. (Required upon hire) Basic Life Support (BCLS). (Required upon hire) Advanced Cardiac Life Support (ACLS). (Preferred upon hire) Experience Six (6) months of Medical/Surgical nursing experience in an acute care setting. (Preferred) Experience demonstrating critical thinking, decision-making, and effective prioritizat ion in a fast-paced clinical environment. (Preferred)