RN Utilization Review Outpatient Full-time
Baptist Health South Florida

Registered Nurse Utilization Review, Case Management, Part Time, 7A-7:30P

Baptist Health South Florida Miami, FL 33143, US
$73,860.80 - $98,234.86 / year

Baptist Health is the region's largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence. For 26 years, we've been named one of Fortune's 100 Best Companies to Work For, and in the 2025-2026 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 63 high-performing honors.

What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families that extend beyond delivering care. Many of us have walked in our patients' shoes ourselves and that shared experience fuels out commitment to compassion and quality. Our culture is rooted in purpose, and every team member plays a part in making a positive impact – because when it comes to caring for people, we're all in.

At Baptist Health, we’re committed to supporting our employees at every stage of their journey, both personally and professionally. Our approach is rooted in a “grow our own” philosophy, designed to help our team members build meaningful, long-term careers with us, supported by benefits that make a real difference, including:

  • Career growth and development opportunities, with clear pathways and ongoing support
  • Comprehensive health and wellness resources that go beyond traditional benefits
  • A wellness program that can help employees eliminate their medical plan deductible, reducing out-of-pocket healthcare costs
  • Tuition reimbursement to support continued learning and advancement
  • And so much more
  •  

Together, these benefits and others reflect our commitment to caring for our people, so they can build fulfilling careers with us while making a meaningful impact every day.

Description:

The purpose of this position is to conduct initial, concurrent, retrospective chart review for clinical financial resource utilization. Coordinates with healthcare team for optimal/efficient patient outcomes, while decreasing length of stay (LOS) and avoid delays and denied days. They are accountable for a designated patient caseload and provides intervention, coordination to decrease avoidable delays, denial of reimbursement. Specific functions within this role include: Screens pre-admission, admission process using established criteria for all points of entry. Facilitates communication between payers, review agencies, healthcare team. Identify delays in treatment or inappropriate utilization and serves as a resource. Coordinates communication with physicians. Identify opportunities for expedited appeals and collaborates to resolve payer issues. Ensures/Maintains effective communication with Revenue Cycle Departments. Estimated salary range for this position is $73860.80 - $98234.86 / year depending on experience.

Qualifications:

Degrees:

  • Associates.

Licenses & Certifications:

  • MCG Care Guidelines Specialist.
  • Registered Nurse.

Additional Qualifications:

  • RNs hired prior to 2-2012 (10/1/2017 at Bethesda or 7/1/2019 at BRRH) with an Associates Degree in Nursing are not required to have a BSN to continue their non-leadership role as an RN.
  • however, they are required to complete the BSN within 3 years of job entry date.
  • MCG Specialist Certification ISC/HRC required within 12 months of job entry date.
  • 3 years of Nursing experience preferred.
  • Excellent written, interpersonal communication and negotiation skills.
  • Strong critical thinking skills and the ability to perform clinical/chart review abstract information efficiently.
  • Strong analytical, data management and computer skills.
  • Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
  • Current working knowledge of payer and managed care reimbursement preferred.
  • Ability to work independently and exercise sound judgment in interactions with the health care team and patients/families.
  • Knowledgeable in local, state, and federal legislation and regulations.
  • Ability to tolerate high volume production standards.

Minimum Required Experience: 3 Years

EOE, including disability/vets

Share this job

Share to FB Share to LinkedIn Share to Twitter

Related Jobs

RN Outpatient Full-time
Cleveland Clinic

RN Ambulatory Team Lead - Colorectal Surgery/General Surgery

Cleveland Clinic Weston, FL
At Cleveland Clinic Health System, we believe in a better future for healthcare. And each of us is responsible for honoring our commitment to excellence, pushing the boundaries and transforming the patient experience, every day. We all have the power to help, heal and change lives — beginning with our own. That’s the power of the Cleveland Clinic Health System team, and The Power of Every One. Job Title RN Ambulatory Team Lead - Colorectal Surgery/General Surgery Location Weston Facility Florida Weston Hospital Department DDSI/Colorectal Surgery-Digestive Disease Institute Job Code 000306 Shift Days Schedule 8:00am-5:00pm Job Summary Job Details Join Cleveland Clinic Weston Hospital’s team of caregivers that remain on the leading edge of technology and education, all while consistently providing patient-centered healthcare. As part of Cleveland Clinic’s Florida region, Weston Hospital is recognized as one of the top hospitals in the Miami-Fort Lauderdale and Florida regions. Here, you will receive endless support and appreciation while building a rewarding career with one of the most respected healthcare organizations in the world. As a Registered Nurse (RN) Ambulatory Team Lead, you will work as part of an interdisciplinary care team to provide professional nursing care to patients in an ambulatory setting, sharing oversight of both the Colorectal Surgery and General Surgery departments. In this role, you will assist with clinical oversight of caregivers and patients, coordinate and resolve daily operational issues within the clinical area, and ensure the delivery of safe, high-quality care. A caregiver in this role works days from 8:00 a.m. – 5:00 p.m. A caregiver who excels in this role will: Perform duties of the RN ambulatory Coordinate and resolve daily operational issues in specified clinical area. Ensure compliance with regulatory standards and patient safety initiatives. Facilitate orientation, teaching, coaching and mentoring of assigned employees. Assist in the preparation of the department specific education for patients and colleagues. Participate in quality initiatives, process improvement and research activities to improve patient outcomes, patient experience and patient safety. Ensure compliance with regulatory standards and patient safety initiatives. Collaborate with care coordinators to ensure smooth and effective transition of care. Minimum qualifications for the ideal future caregiver include: Graduate of an accredited school of nursing Current state licensure as a Registered Nurse (RN) Basic Life Support (BLS) certification through the American Heart Association (AHA) or American Red Cross Two years of recent experience as an RN Preferred qualifications for the ideal future caregiver include: Bachelor of science in nursing (BSN) Previous charge nurse or supervisory experience Prior experience in general surgery Physical Requirements: Essential Duties: This position requires knowledge of all aspects of patient care including assessing; planning, coordinating, monitoring, and evaluating the patient's progress through the entire continuum of car in conjunction with the R.N. or physician. Physical Duties: This position requires frequent walking, sitting, and standing. Frequent talking and listening when giving instructions and explanations. Frequent use of the phone; fax machines, and occasional use of the computer. Work is heavy, with constant lifting and moving patients, carrying equipment, supplies, and material up to 50 pounds without help and over 50 pounds with the help of mechanical devices or other personnel. You will be stooping, pushing, and pulling when moving a patient into position for treatment; also you will be reaching, handling, feeling, and manipulation of equipment into position. Working Conditions: The majority of the time employee spends indoors in air-conditioned areas. The potential for exposure to blood and blood-borne pathogens is significant. Clinical exposure to patients requires the use of personal protective equipment. Personal Protective Equipment: This position is high exposure to infectious wastes such as blood and bodily fluids that mandate the wearing of gloves, masks, gowns, and goggles as appropriate. Follows Standard Precautions using personal protective equipment as required for procedures. The policy of Cleveland Clinic Health System and its system hospitals (Cleveland Clinic Health System) is to provide equal opportunity to all of our caregivers and applicants for employment in our drug free environment. All offers of employment are followed by testing for controlled substances. Cleveland Clinic Health System administers an influenza prevention program. You will be required to comply with this program, which will include obtaining an influenza vaccination on an annual basis or obtaining an approved exemption. Decisions concerning employment, transfers and promotions are made upon the basis of the best qualified candidate without regard to color, race, religion, national origin, age, sex, sexual orientation, marital status, ancestry, status as a disabled or Vietnam era veteran or any other characteristic protected by law. Information provided on this application may be shared with any Cleveland Clinic Health System facility. If applying for a Florida position, please see the following website for more information on the background screening requirements required by the Agency of Health Care Administration: https://info.flclearinghouse.com/ Please review the Equal Employment Opportunity poster . Cleveland Clinic is pleased to be an equal employment opportunity employer.
RN Pediatric NICU Full-time
Nicklaus Children's Health System

RN- NICU, Ft Lauderdale (Per Diem, Nights)

Nicklaus Children's Health System Fort Lauderdale, FL
Description Job Summary Under general supervision, renders professional nursing care in accordance with physicians' treatment plans in order to provide for the comfort and well-being of patients. Assesses patients' condition, administers prescribed drugs, provides treatments, observes patients' progress, records pertinent observations and reports reaction to drugs and treatments. Assists physicians with examinations and prepares instruments and equipment for physicians' use. Coordinates care planning, collaborates with the clinical and medical staff, and educates patients and their family members on the procedure in a compassionate patient and family centered care environment. Supports and upholds quality standards of a Magnet designated hospital and Patient Bill of Rights. Job Specific Duties Completes all nursing multi-system assessment that includes head to toe, vitals, dressing changes, suction, feeding, bathing, and repositioning. Reviews patient admission history, prepares and accurately completes the discharge planning process as per department and hospital policies & procedures. Communicates the patient's progress including critical findings, changes in the patients' condition with the physician and/or disciplines involved in the care of the child. Plans, implements, and documents the plan of care in collaboration with the other disciplines and services to assure safe and efficient care. Provides nursing care that includes IV site monitoring and troubleshooting, specimen collection, and assists medical team with special procedures. Follows physician’s orders and administers & reconstitutes medications directed. Adheres to the six rights of medication administration. Collaborates and rounds with a multi-disciplinary team in daily care planning rounds, as appropriate, and fosters a Family Centered Care environment. Accesses electronic health record independently according to hospital policy. Completes accurate and timely documentation in the patient’s electronic health record. Communicates with patients and families to review plan of care and solicits input and communicates any patient and family concerns to physician. Educates patients and their family about disease processes, post treatment home care such as disease, medication, treatments, pain, discharge, and safety. Promotes an 'error free' working environment by consistently providing high-quality, safe care as per hospital policies, conducts prevention rounding, & follows up on identified concerns promptly. Assesses all body systems, ensures safe, effective & efficient care delivery with emphasis on the absence of medication errors, avoidance of falls, ouch-free procedural pain & reduction of pain. Provides patient information and effectively completes the hand off process at shift change and patient reassignments. Qualifications Minimum Job Requirements Completion of a nursing program from an accredited school of Nursing RN Licensure within the State of Florida or Multi-State Enhanced Nursing License Compact (eNLC) – maintain active and in good standing throughout employment American Heart Association BLS - maintain active and in good standing throughout employment American Heart Association PALS required within 1 year of hire - maintain active and in good standing throughout employment Neonatal Resuscitation Program (NRP) as specified by the department within 1 year of hire American Heart Association ACLS as specified by the department within 1 year of hire Knowledge, Skills, and Abilities CPI (Crisis Intervention Training) is preferred. National certified preferably within 2 years of hire. Functions as IV champions within 6 months of hire. Ability to work in an acute care setting, demonstrates strong problem solving, critical thinking, and conflict resolution skills. Ability to manage multiple priorities and strong time management skills. Effective verbal and written communication skills. Computer literate. Participates and supports nursing research projects and/or authors/co-authors an evidence-based article within 2 years of hire. Works effectively in a collaborative environment. Flexible and has a passion for learning. Ability to apply principles of evidenced-based practice, analytical thinking, and service excellence in practice. Able to analyze and interpret data and utilize the information to make judgments regarding patient care. Float to various nursing units while maintaining the delivery of clinical excellence and high quality service. Coverage for on-call assignments per department and hospital policy. Job: Nursing - Clinical Department: FTL NICU ACUTE-2200-620011 Job Status: Professional
RN Pediatric NICU Full-time
Nicklaus Children's Health System

RN- NICU, Ft Lauderdale (Full Time, Nights)

Nicklaus Children's Health System Fort Lauderdale, FL
Description Job Summary Under general supervision, renders professional nursing care in accordance with physicians' treatment plans in order to provide for the comfort and well-being of patients. Assesses patients' condition, administers prescribed drugs, provides treatments, observes patients' progress, records pertinent observations and reports reaction to drugs and treatments. Assists physicians with examinations and prepares instruments and equipment for physicians' use. Coordinates care planning, collaborates with the clinical and medical staff, and educates patients and their family members on the procedure in a compassionate patient and family centered care environment. Supports and upholds quality standards of a Magnet designated hospital and Patient Bill of Rights. Job Specific Duties Completes all nursing multi-system assessment that includes head to toe, vitals, dressing changes, suction, feeding, bathing, and repositioning. Reviews patient admission history, prepares and accurately completes the discharge planning process as per department and hospital policies & procedures. Communicates the patient's progress including critical findings, changes in the patients' condition with the physician and/or disciplines involved in the care of the child. Plans, implements, and documents the plan of care in collaboration with the other disciplines and services to assure safe and efficient care. Provides nursing care that includes IV site monitoring and troubleshooting, specimen collection, and assists medical team with special procedures. Follows physician’s orders and administers & reconstitutes medications directed. Adheres to the six rights of medication administration. Collaborates and rounds with a multi-disciplinary team in daily care planning rounds, as appropriate, and fosters a Family Centered Care environment. Accesses electronic health record independently according to hospital policy. Completes accurate and timely documentation in the patient’s electronic health record. Communicates with patients and families to review plan of care and solicits input and communicates any patient and family concerns to physician. Educates patients and their family about disease processes, post treatment home care such as disease, medication, treatments, pain, discharge, and safety. Promotes an 'error free' working environment by consistently providing high-quality, safe care as per hospital policies, conducts prevention rounding, & follows up on identified concerns promptly. Assesses all body systems, ensures safe, effective & efficient care delivery with emphasis on the absence of medication errors, avoidance of falls, ouch-free procedural pain & reduction of pain. Provides patient information and effectively completes the hand off process at shift change and patient reassignments. Qualifications Minimum Job Requirements Completion of a nursing program from an accredited school of Nursing RN Licensure within the State of Florida or Multi-State Enhanced Nursing License Compact (eNLC) – maintain active and in good standing throughout employment American Heart Association BLS - maintain active and in good standing throughout employment American Heart Association PALS required within 1 year of hire - maintain active and in good standing throughout employment Neonatal Resuscitation Program (NRP) as specified by the department within 1 year of hire American Heart Association ACLS as specified by the department within 1 year of hire Knowledge, Skills, and Abilities CPI (Crisis Intervention Training) is preferred. National certified preferably within 2 years of hire. Functions as IV champions within 6 months of hire. Ability to work in an acute care setting, demonstrates strong problem solving, critical thinking, and conflict resolution skills. Ability to manage multiple priorities and strong time management skills. Effective verbal and written communication skills. Computer literate. Participates and supports nursing research projects and/or authors/co-authors an evidence-based article within 2 years of hire. Works effectively in a collaborative environment. Flexible and has a passion for learning. Ability to apply principles of evidenced-based practice, analytical thinking, and service excellence in practice. Able to analyze and interpret data and utilize the information to make judgments regarding patient care. Float to various nursing units while maintaining the delivery of clinical excellence and high quality service. Coverage for on-call assignments per department and hospital policy. Job: Nursing - Clinical Department: FTL NICU PROGRESSIVE-2200-620012 Job Status: Professional
RN ICU Full-time
Broward Health

Registered Nurse, Critical Care ICU BHIP Nights POOL

Broward Health Fort Lauderdale, FL
Broward Health Imperial Point Shift: Shift 3 Nights 7p-7:30am FTE: 0.01 Summary Provides care in accordance with physicians' treatment plans in order to provide for the comfort and well-being of patients. Assesses patients' condition, develops a nursing plan of care, administers prescribed drugs, provides treatments, observes patients' progress, records pertinent observations, and reports reactions to drugs and treatments. Assists physicians with procedures/examinations and prepares instruments and equipment for physicians' use. Education Essential: Associate ASN or BSN Essential Education specialization: in a Nursing Program from an Accredited School of Nursing Experience Essential: Two Years of Hospital RN experience (Critical Care) Credentials Essential: Registered Nurse Basic Life Support and ACLS card Visit us online at www.BrowardHealth.org or contact Talent Acquisition Broward Health is proud to be an equal opportunity employer. Broward Health prohibits any policy or procedure which results in discrimination on the basis of race, color, national origin, gender, gender identity or gender expression, pregnancy, sexual orientation, religion, age, disability, military status, genetic information or any other characteristic protected under applicable federal or state law.
RN Full-time
Broward Health

Non-RN Infection Preventionist - Epidemiology - FT - Days - BHMC

Broward Health Fort Lauderdale, FL
Broward Health Medical Center Shift: Shift 1 FTE: 1.000000 Req #29844 Summary Infection Preventionist directs interventions that protect patients from healthcare-associated infections (HAIs) in clinical and other settings. Infection Preventionist works with clinicians and administrators to improve patient and systems-level outcomes and reduce HAIs and related adverse events Education Bachelor's degree in a related field obtained through a formal 4-year program Experience One year of related experience Credentials CIC certified preferred, must be eligible of CIC certification and obtain within 2 years Visit us online at www.BrowardHealth.org or contact Talent Acquisition Bonus Exclusions may apply in accordance with policy HR-004-026 Broward Health is proud to be an equal opportunity employer. Broward Health prohibits any policy or procedure which results in discrimination on the basis of race, color, national origin, gender, gender identity or gender expression, pregnancy, sexual orientation, religion, age, disability, military status, genetic information or any other characteristic protected under applicable federal or state law. At Broward Health, the dedication and contributions of veterans are valued. Supporting the military community and giving back to those who served is a priority. Broward Health is proud to offer veteran's preference in the hiring process to eligible veterans and other individuals as defined by applicable law.