Utilization Review Nurse – Full-Time, Evening Shift

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

📋 Description

• Perform reviews of hospital admissions to assess medical necessity and the appropriate status of patients.

• Carry out continued stay evaluations following established clinical criteria and guidelines.

• Assess clinical documentation for precision, thoroughness, and adherence to payer and regulatory standards.

• Utilize evidence-based criteria, including InterQual® and/or MCG®.

• Relay review outcomes and suggestions to physicians, case management teams, and leadership.

• Collaborate with Physician Advisors on intricate cases or those not aligned with established criteria.

• Support denial prevention initiatives and ensure accurate documentation.

• Execute additional duties as assigned.

• Partner effectively with physicians, case managers, revenue cycle personnel, and interdisciplinary care teams to ensure accurate patient status determinations and enhance reimbursement while promoting quality patient care.

⛳️ Requirements

• Significant experience in acute care nursing with proven expertise in utilization review within a hospital context.

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

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

• Capacity to excel in a dynamic environment and adjust to rapidly changing business demands.

• Graduate from an accredited nursing school.

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

• Valid, 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.

• Familiarity with acute admission reviews and continued stay evaluations.

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

• Willingness to work 8-, 10-, or 12-hour shifts.

• Expected to work every other weekend as necessary.

• Required to work three of six company-recognized holidays each year based on departmental and organizational needs.

• Capability to perform physical tasks, including lifting up to 25 pounds.

• Ability to withstand healthcare and office environmental hazards.

🏝️ Benefits

• Full-time employment.

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

• Work schedules made available one month in advance.

• Three of the six recognized company holidays assigned each year.

• Vacation, time off, and scheduling adjustment requests are accommodated with prior notice.