RN, Utilization Management Lead | Utilization Management| Day Full Time

Job description

Overview
Make an impact by supporting the right care at the right time through utilization management excellence.
RN Utilization Lead under the general supervision of the Director, is responsible for department coordination of utilization, other review activities to ensure payment for services is authorized and an active and effective utilization management program is maintained.
💻 Work Style: Onsite
📍 Location: Gainesville, FL
🕒 FTE: Full-time (1.00 FTE)
⏰ Schedule: Thursday-Sunday - 5:30 AM - 4:00 PM
Responsibilities
Responsible to perform all duties accordance with the utilization review (UR) plan, Federal and State guidelines, as well as TJC standards. Is also responsible for operational logistics in the absence of the Director.
Qualifications
Minimum Education and Experience Requirements:
Re gistered nurse (RN) with current Florida license with a minimum of two (2) years experience performing utilization review in a hospital setting, for a third party payer or other review agency or organization. Knowledge of diagnostic related groups (DRGs), Federal and State guidelines, commercial and other payer groups and coding preferred. Must possess strong written and verbal communication skills. Ability to type and use a computer proficiently required.
Licensure/Certification/Registration: Registered Nurse.
Responsible to perform all duties accordance with the utilization review (UR) plan, Federal and State guidelines, as well as TJC standards. Is also responsible for operational logistics in the absence of the Director.
Minimum Education and Experience Requirements:
Re gistered nurse (RN) with current Florida license with a minimum of two (2) years experience performing utilization review in a hospital setting, for a third party payer or other review agency or organization. Knowledge of diagnostic related groups (DRGs), Federal and State guidelines, commercial and other payer groups and coding preferred. Must possess strong written and verbal communication skills. Ability to type and use a computer proficiently required.
Licensure/Certification/Registration: Registered Nurse.