Utilization Review Nurse, PRN – Evening Shift

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

📋 Description

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

• Carry out continued stay assessments utilizing established clinical criteria and guidelines.

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

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

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

• Work in collaboration with Physician Advisors on complex cases or those lacking support from criteria.

• Contribute to denial prevention efforts and ensure accurate documentation.

• Undertake additional responsibilities as assigned.

⛳️ Requirements

• Significant experience in acute care nursing and proven expertise in utilization review within a hospital environment.

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

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

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

• Ability to work autonomously with minimal oversight.

• Graduate from an accredited nursing program.

• Possess a current, unrestricted Registered Nurse (RN) license.

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

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

• Familiarity with acute admission reviews and continued stay evaluations.

• This is a PRN position requiring a minimum of forty (40) hours per month when hours are available.

• At least sixteen (16) of the required monthly hours must be worked during weekend shifts.

• Must work two of the six organization-recognized holidays each calendar year.

• Should maintain flexibility and communicate availability in accordance with department scheduling practices.

• Expected to report to work as scheduled and adhere to attendance and call-off policies.

🏝️ Benefits

• PRN scheduling with options for four or eight-hour shifts.

• Additional hours may be arranged based on departmental requirements and employee availability.