Utilization Review Nurse – Full-Time, Day Shift

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

📋 Description

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

• Carry out ongoing stay assessments using approved clinical criteria and guidelines.

• Review clinical documentation for accuracy, completeness, and compliance with payer and regulatory standards.

• Utilize 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 meeting criteria.

• Support denial prevention initiatives and ensure proper documentation.

• Execute additional responsibilities as assigned.

• Work assigned shifts of 8, 10, or 12 hours based on operational requirements and mutual scheduling agreements.

• Commit to working every other weekend as necessary.

• Participate in three of six company-recognized holidays each year as assigned.

⛳️ Requirements

• Extensive experience in acute care nursing.

• Proven expertise in utilization review within a hospital environment.

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

• Excellent written and verbal communication abilities.

• Capability to excel in a fast-paced setting and adapt to evolving business needs.

• Ability to work autonomously with minimal oversight.

• Graduate from an accredited nursing school.

• Current, unrestricted Registered Nurse (RN) license.

• At least five (5) years of acute care nursing experience in a hospital.

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

• Experience with acute admission and continued stay reviews.

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

• Preferred certifications include Certified Case Manager (CCM), Accredited Case Manager (ACM), Certified Managed Care Nurse (CMCN), or Case Management Board Certification (CMGT-BC).

🏝️ Benefits

• Full-time employment.

• Options for 8-, 10-, or 12-hour shifts.

• Work schedules are published one month in advance.

• Assigned three of six company-recognized holidays annually.

• Opportunities to submit requests for vacation, time off, and schedule accommodations in advance.