Utilization Review Nurse – Full-Time, 3 Twelve-Hour Shifts, Weekends

This is a fully remote position, open to applicants in Florida.

📋 Description

• Perform hospital admission reviews to assess medical necessity and determine the appropriate patient status (inpatient, observation, outpatient).

• Execute continued stay reviews utilizing sanctioned clinical criteria and guidelines.

• Review clinical documentation for accuracy, completeness, and adherence to payer and regulatory standards.

• Implement evidence-based criteria such as InterQual® and/or MCG®.

• Relay review findings and recommendations to physicians, case management personnel, and leadership.

• Collaborate with Physician Advisors on complex cases or those not supported by criteria.

• Assist in denial prevention initiatives and ensure proper documentation.

• Engage collaboratively with physicians, case managers, revenue cycle teams, and interdisciplinary care groups.

• Undertake additional duties as assigned.

⛳️ Requirements

• Extensive experience in acute care nursing with proven expertise in utilization review within a hospital environment.

• Skilled in various Electronic Health Records and case management systems.

• Excellent communication abilities; conveys information clearly and concisely, both verbally and in writing.

• Capacity to excel in a fast-paced setting and adjust to frequently changing business demands.

• Ability to work autonomously with minimal supervision.

• Graduate of an accredited nursing program.

• Current, unrestricted Registered Nurse (RN) license.

• A minimum of five (5) years of acute care nursing experience in a hospital setting.

• At least two (2) years of recent experience in hospital-based utilization review.

• Experience with acute admission reviews and continued stay assessments.

• Bachelor’s of Science in Nursing (BSN) is preferred.

• Certifications such as Certified Case Manager (CCM), Accredited Case Manager (ACM), Certified Managed Care Nurse (CMCN), or Case Management Board Certification (CMGT-BC) are preferred.

• Expected to work every other weekend as necessary.

• Ability to perform tasks involving physical activity, including lifting up to 25 pounds.

• Subject to exposure to environmental hazards associated with healthcare and office environments.

🏝️ Benefits

• Full-time employees may be assigned to 8-, 10-, or 12-hour shifts based on operational requirements and mutual scheduling arrangements.

• Work schedules are made available one month in advance.

• Requests for vacation, time off, or schedule accommodations may be submitted.

• Three of the six company-recognized holidays are allocated annually.