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Full Time Utilization Management Jobs in Florida

Baptistfirst

Summary : The RN - Case Management will be utilized as either Utilization Management or as ... Regular-Full time Shift : First Shift (United States of America)

Tenet Health

Physician Advisor

Palm Beach Gardens, FL · On-site

This on-site, full-time position involves influencing utilization management, documentation integrity, and physician education to enhance patient care and hospital performance. The role offers an ...

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Full Time Utilization Management information

What is utilization management?

Utilization Management (UM) in a full-time role involves evaluating the necessity, appropriateness, and efficiency of the use of healthcare services, procedures, and facilities. Professionals in this field, often nurses or healthcare administrators, review patient cases, coordinate with healthcare providers, and ensure that care meets established guidelines while controlling costs. Their goal is to optimize patient outcomes by ensuring the right level of care is provided at the right time, while also helping organizations comply with regulations and insurance requirements.

How does a full time utilization management role typically interact with clinical and administrative teams?

In a Full Time Utilization Management position, you will regularly collaborate with both clinical staff, such as physicians and nurses, and administrative teams, like case managers and billing specialists. Your main responsibility is to review patient care requests, ensure services are medically necessary, and coordinate approvals or denials based on established guidelines. Effective communication and teamwork are essential, as you’ll often facilitate discussions between departments to optimize patient outcomes and resource use. This collaborative environment helps you build a broad understanding of healthcare processes and strengthens your problem-solving skills.

What are the key skills and qualifications needed to thrive as a full time utilization management professional?

To thrive in Full Time Utilization Management, you need a background in healthcare (often as an RN or other clinical license), strong knowledge of medical necessity criteria, and familiarity with insurance guidelines. Expertise in case management software, electronic health records (EHRs), and certifications such as Certified Case Manager (CCM) or Accredited Case Manager (ACM) are typically required. Attention to detail, critical thinking, effective communication, and negotiation skills help you advocate for appropriate patient care while managing costs. These skills ensure efficient resource allocation, compliance with regulations, and optimal patient outcomes within healthcare organizations.

What is the difference between Full Time Utilization Management vs Utilization Review Nurse?

AspectFull Time Utilization ManagementUtilization Review Nurse
CredentialsRN license, certifications in case management or utilization reviewRN license, certifications in utilization review or case management
Work EnvironmentTypically full-time, office-based, healthcare organizationsOften part-time or per review, hospital or insurance settings
Employer & IndustryHealth insurance companies, healthcare providersHospitals, insurance companies, third-party review organizations

Full Time Utilization Management professionals oversee the entire utilization review process, often in a full-time capacity, focusing on managing patient care and resource utilization. Utilization Review Nurses perform specific review tasks, usually on a case-by-case basis, and may work part-time or per review. Both roles require RN licensure and related certifications, but Full Time Utilization Management roles involve broader responsibilities and continuous oversight.

What are the most commonly searched types of Utilization Management jobs in Florida?

The most popular types of Utilization Management jobs in Florida are:

What cities in Florida are hiring for Full Time Utilization Management jobs?

Cities in Florida with the most Full Time Utilization Management job openings:

Full Time Utilization Management jobs near you

Discharge Planner - RN Case Management

Baptistfirst

On-site

Full-time

Re-posted 15 days ago

Key responsibilities

  • Coordinate care of an assigned caseload of patients through collaboration with physicians, nursing staff, and other health professionals to facilitate efficient utilization of clinical resources and optimal clinical and continuing care.

  • Complete admission, continued stay, and discharge reviews in accordance with federal regulations, insurance guidelines, and Baptist Health's Utilization Management Plan.

  • Assess patient care progression from acute care episode through post-discharge for quality, efficiency, and effectiveness.

Job description

Baptist Health is the largest healthcare system serving central Alabama, providing comprehensive hospital-based and outpatient services to nearly 60 percent of the residents in Montgomery, Autauga and Elmore counties.

To learn more about Baptist Health, visit us at https://www.baptistfirst.org.

Highlights:

Summary: The RN – Case Management will be utilized as either Utilization Management or as Discharge Planning. The Case Manager tasked with discharge planning shall coordinate care of an assigned caseload of patients through collaboration with physicians, nursing staff, and other health professionals to facilitate efficient utilization of clinical resources, optimal clinical and continuing care, as well as financial outcomes. This individual shall be responsible for providing a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive human service needs through communication and available resources.The Case Manager tasked with utilization management shall work in collaboration with the patient/family, and interdisciplinary team (including physicians, other care providers, and payers), and assesses the patient care progression from acute care episode through post discharge for quality, efficiency, and effectiveness. This individual shall work collaboratively with other Clinical Care staff to ensure patient needs are met and care delivery is coordinated across the continuum. The RN will complete admission, continued stay, and discharge reviews in accordance with federal regulations, Insurance guidelines and Baptist Health's Utilization Management Plan. In addition, the RN is responsible for revenue protection by reconciling physician orders, bed billing type, and medical necessity. This position may have additional duties assigned that are within scope of the role.Education / Experience: Degree in Nursing, Bachelor's degree preferred. At least 2 years hospital patient care experienced required. Previous experience in home care, reimbursement, or hospital insurance preferred. Previous inpatient hospital case management experience including utilization review (third party payor reimbursement, DRGs), and home care.License / Certification: Active RN license required, Case Manager certification preferredKnowledge, Skills, and Abilities:
• Must possess basic computer skills.
• Strong oral, written and interpersonal skills.
• Ability to work independently with minimal supervision.
• Must be able to function in high-stress environment subject to frequent interruptions and changing priorities.
• Knowledgeable in use of appropriate infection control or isolation techniques when necessary.Work Conditions/Physical Requirements:Position requires sitting and mobility with occasional stooping, bending, kneeling, and crouching.
There is frequent reaching, use of hands and repetitive action.
Requires occasional lifting or carrying up to 20 pounds.
There is a continuous need for speaking with clear diction and hearing sensitivity in conversation either by phone or in person.
Continuous visual acuity at close and distant range.
Inside protected from weather conditions but not necessarily from temperature changes. Minimal noise levels but frequent interruptions.
Much exposure to computer work.
Occasional exposure to risk of electrical shock.
Some exposure to infectious disease while performing job-related tasks.
Some exposure to hazardous chemicals. Occasional exposure to radiation.
Ability to travel to seminars when required.
Weekend and holiday work required.
On-Call work required for after hours, weekends, and holidays.

Primary Location:

Baptist Medical Center South

Job:

Discharge Planner - RN Case ManagementRN Case Management

Job Type:

Regular-Full time

Shift:

First Shift (United States of America)

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