Top 8 Utilization management nurse Jobs in Citrus County Fl

Hospital Case Manager
Premier Medical Assoicates —Ocala, FL
- $23.10 - $27.81 an hour
- Full-time
- Acute care
- Master of Social Work
- Nursing
- Health insurance
- Dental insurance
Quick Apply
Director Case Management
HCA Florida Oak Hill Hospital —Brooksville, FL
- Full-time
- Senior level
- Leadership
- Communication skills
- Employee stock purchase plan
- Disability insurance
Quick Apply
7d
Home Health Clinical Manager
Centerwell —Beverly Hills, FL
- $77,200 - $106,200 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Paid holidays
6d
Nurse Practitioner
Neal Lumapas MD PA —Dunnellon, FL
- $80,000 - $120,000 a year
- Full-time
- Vital signs
- Primary Care
- HIPAA
- Paid time off
- Flexible schedule
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The RN Case Manager ensures compliance with state and federal regulations and CMS Conditions of Participation. Tuition assistance and education support.
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Hospital Case Manager

Premier Medical Assoicates
Ocala, FL

Quick Apply

Job Details

Full-time
$23.10 - $27.81 an hour

Benefits

Health insurance
Dental insurance
401(k)
Paid time off
Vision insurance
401(k) matching
Life insurance

Qualifications

Collaborate with healthcare professionals
Resource identification in social services
Teamwork
Patient resource coordination
Medicare
Electronic health records (EHR) management
RN License
Patient advocacy
Care documentation
Community resource coordination in health services social work
Palliative care expertise
Medicaid health insurance
Transitional care planning in clinical case management
Overseeing care coordination
Pre-authorization review for utilization management
Medicare regulations
Utilization management
Clinical assessment documentation
Conflict management
Resource utilization in healthcare
Multidisciplinary team collaboration for treatment planning
Concurrent review in utilization management
Computer skills
Medicaid
Managing patient records
Hospital experience
Time management

Full Job Description

Job Title: Hospital case manager
Location: Premier Medical Associates –Ocala
Department: Clinical Operations
Reports To: Clinical Operations Manager

Job Summary

The Hospital Case Manager is responsible for coordinating patient care throughout the hospital stay and ensuring a safe, timely, and cost-effective transition of care. This role works closely with physicians, nurses, social workers, insurance companies, patients, and families to develop individualized care plans, facilitate discharge planning, obtain insurance authorizations, and reduce avoidable readmissions while maintaining regulatory compliance.

Key ResponsibilitiesPatient Care Coordination

Assess patients' medical, psychosocial, and discharge needs.
Develop individualized case management plans.
Coordinate multidisciplinary care with physicians, nursing staff, therapists, and ancillary departments.
Monitor patient progress and adjust care plans as needed.

Discharge Planning

Begin discharge planning upon admission.
Coordinate home health services, skilled nursing facilities, rehabilitation, hospice, or other post-acute services.
Ensure patients and families understand discharge instructions.
Arrange transportation and follow-up appointments.

Utilization Management

Review medical necessity for admissions and continued hospital stay.
Monitor length of stay.
Ensure compliance with payer guidelines.
Collaborate with insurance companies regarding authorizations and continued stay reviews.

Insurance & Authorization

Obtain prior authorizations when required.
Communicate with Medicare, Medicaid, commercial insurance plans, and managed care organizations.
Resolve insurance-related barriers affecting patient care.

Patient & Family Education

Educate patients regarding treatment plans and available community resources.
Provide disease management education.
Discuss financial assistance resources when appropriate.

Documentation

Maintain accurate and timely documentation in the Electronic Medical Record (EMR).
Complete utilization review documentation.
Document discharge planning activities and care coordination notes.
Ensure compliance with CMS, Joint Commission, and hospital policies.

Collaboration

Participate in interdisciplinary rounds.
Work closely with physicians, nursing, pharmacy, rehabilitation, social services, and financial counselors.
Coordinate communication between hospital departments and external providers.

Quality Improvement

Monitor readmission risks.
Assist with quality improvement initiatives.
Participate in case reviews and performance improvement projects.
Support hospital accreditation standards.

Required QualificationsEducation

Bachelor's degree in Nursing (BSN), Social Work (BSW/MSW), or related healthcare field.
RN license or Licensed Clinical Social Worker (LCSW) preferred.

Experience

2–5 years of hospital clinical experience.
Previous case management or utilization review experience preferred.
Experience with Medicare Advantage and managed care preferred.

Required Skills

Strong clinical assessment skills
Critical thinking and problem-solving
Knowledge of CMS regulations
Discharge planning expertise
Care coordination
Utilization review
Insurance authorization management
Excellent communication skills
Time management
Conflict resolution
Patient advocacy
EMR documentation
Multidisciplinary teamwork
Knowledge of community resources

Preferred Certifications

Certified Case Manager (CCM)
Accredited Case Manager (ACM)
Certified Professional in Healthcare Quality (CPHQ) (preferred)

Key Performance Indicators (KPIs)

Average Length of Stay (LOS)
Readmission Rate (30-day)
Discharge Before Noon Percentage
Timely Completion of Discharge Plans
Insurance Authorization Turnaround Time
Patient Satisfaction Scores
Avoidable Days Reduction
Denial Rate
Documentation Compliance
Care Plan Completion Rate

Physical Requirements

Ability to sit, stand, and walk for extended periods.
Ability to communicate effectively with patients and healthcare professionals.
Ability to use computers and electronic medical records.
Occasionally lift up to 25 pounds.

Work Environment

Acute Care Hospital
Inpatient Units
Emergency Department
Intensive Care Units
Medical-Surgical Units
Case Management Office

Core Competencies

Patient Advocacy
Compassion
Clinical Judgment
Communication
Collaboration
Accountability
Ethical Decision-Making
Leadership
Organization
Adaptability
Cultural Competence
Confidentiality (HIPAA Compliance)

Pay: $23.10 - $27.81 per hour

Benefits:

401(k)
401(k) matching
Dental insurance
Health insurance
Life insurance
Paid time off
Vision insurance

Work Location: In person

Quick Apply

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utilization management nurse jobs in citrus county fl

Hospital Case Manager

Director Case Management

Home Health Clinical Manager

Nurse Practitioner

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