Top 6 Clinical documentation & utilization review nurses Jobs in Gainesville, Fl

RN, Utilization Management | Utilization Management| Night | Part Time
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- Part-time
- Nursing
- RN License
- Mid-level
RN, Utilization Management Lead | Utilization Management| Day Full Time
UF Health —Gainesville, FL
- Full-time
- RN License
- Computer literacy
- Mid-level

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RN, Utilization Management | Utilization Management| Night | Part Time

UF Health -
Gainesville, FL

Apply Now

Job Details

Part-time

Qualifications

RN License
Regulatory compliance
Discharge planning
Legal compliance
Healthcare performance metrics analysis

Full Job Description

Overview:

Make an impact by supporting the right care at the right time through utilization management excellence.

Work Style: Onsite
Location: Gainesville, FL
FTE: Part-Time (.6 FTE)

Schedule: Wednesday – Thursday - 7:00 PM – 7:00 AM

Plays a critical role in evaluating patient medical records to ensure the necessity and appropriateness of healthcare services. Involves coordinating with healthcare providers to maintain compliance with utilization management guidelines and optimizing treatment plans for effective patient care and resource utilization. Requires clear communication of authorization decisions and ongoing monitoring to support timely discharge planning. Analyzes utilization data to identify trends and collaborates with interdisciplinary teams to enhance care coordination while ensuring accurate documentation and regulatory compliance.

Responsibilities:

Key Responsibilities

Evaluates patient medical records to determine the medical necessity and appropriateness of healthcare services.
Coordinates with healthcare providers and care teams to ensure compliance with utilization management guidelines and payer requirements.
Supports effective treatment planning, patient care coordination, and appropriate resource utilization.
Communicates authorization decisions and utilization determinations while supporting timely discharge planning efforts.
Analyzes utilization management data and trends to identify opportunities for improved care coordination and operational efficiency.
Collaborates with interdisciplinary teams to ensure accurate documentation, regulatory compliance, and quality patient outcomes.

Qualifications:

Education & Licensure

Registered Nurse (RN) with a current Florida nursing license required.

Experience & Skills

Minimum of three (3) years of experience in utilization review, utilization management, or case management required.
Knowledge of healthcare utilization guidelines, payer requirements, and regulatory compliance standards.
Experience evaluating medical necessity, treatment plans, and appropriate levels of care.
Strong communication and collaboration skills related to authorization determinations and care coordination.
Demonstrated ability to analyze utilization data, identify trends, and support patient care and discharge planning initiatives.

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clinical documentation & utilization review nurses jobs in gainesville, fl

RN, Utilization Management | Utilization Management| Night | Part Time

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

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I want to receive the latest job alert for clinical documentation & utilization review nurses in gainesville, fl

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