Remote Rn Utilization Review Nurse Jobs in Ocala, FL

About Company:

We’re officially a Great Place To Work®! We’ve always believed that supporting our team is just as important as supporting our patients. Now, we’re proud to share that we’ve earned Great Place To Work® Certification - based entirely on feedback from our own employees.

Read more here: https://ow.ly/YQ1C50WuRH1

This certification reflects the culture we’ve worked hard to build - one rooted in trust, inclusion, and purpose-driven leadership.

At Bradford Health Services, we are committed to providing exceptional care to our patients while fostering a supportive and rewarding workplace for our employees. We believe that taking care of our team allows them to take better care of others, which is why we offer a comprehensive benefits package designed to support their well-being.

Our benefits include:

• Medical Coverage – Three new BCBSAL medical plans with better rates, improved co-pays, and enhanced prescription benefits.

• Expanded Coverage – Options for domestic partners and a wider network of in-network providers.

• Mental Health Support – Improved access to services and a new Employee Assistance Program (EAP) featuring digital wellness tools like Cognitive Behavioral Therapy (CBT) modules and wellness coaching.

• Voluntary Coverages – Pet insurance, home and auto insurance, family legal services, and more.

• Student Loan Repayment – Available for nurses and therapists.

• Retirement Benefits – 401(k) plan through Voya to help employees plan for the future.

• Generous PTO – A robust paid time off policy to support work-life balance.

• Voluntary Benefits for Part-Time Employees – Dental, vision, life, accident insurance, and telehealth options for those working 20 hours or more per week.

At Bradford Health Services, we don’t just invest in our patients—we invest in our people.

Position Title: Admin/PFSM- Outpatient

Department: Administration/Fiscal Services
Reports To: Facility CEO, Executive Director, or Regional Director
Supervises: All Outreach/Outpatient Departments
FLSA Status: Non-Exempt

Position Summary

The Administrator/PFSM individual is responsible for the overall leadership, administration, fiscal management, clinical operations support, compliance oversight, marketing, and business development of the outpatient and outreach facility. This position ensures the delivery of high-quality patient care, operational efficiency, regulatory compliance, and financial performance while maintaining effective relationships with referral sources, patients, staff, and community stakeholders. They support clinical, crisis, and marketing personnel and serves as a key liaison between facility operations and corporate leadership.

Essential Duties and Responsibilities

Leadership and Operations Management

• Plan, organize, direct, and oversee all facility operations in accordance with corporate policies, procedures, and strategic objectives.
• Supervise and direct all facility affairs, ensuring compliance with established organizational policies and practices.
• Implement and enforce corporate directives and operational initiatives.
• Recruit, hire, supervise, evaluate, develop, and, when necessary, terminate employees in accordance with company policies.
• Maintain personnel practices that support a positive, productive, and compliant work environment.
• Develop and manage annual operating, marketing, and financial budgets.
• Ensure facility operations and financial performance align with approved budgets and organizational goals.
• Maintain all physical properties and equipment in safe, functional, and operational condition.
• Participate in department head meetings, utilization review meetings, and other committees as assigned.

Financial Management

• Manage day-to-day business office operations, including billing, collections, admissions processing, cash posting, and data entry.
• Oversee all financial procedures, including accounts receivable, collections activities, accounts payable processing, and cash management.
• Serve as a financial resource to leadership regarding receivables, payables, and revenue performance.
• Prepare and submit monthly reports related to revenue, collections, admissions, and financial performance.
• Maintain petty cash and administrative checking accounts, including reconciliation and documentation.
• Review and process approved accounts payable transactions in accordance with company policies.
• Prepare daily receipts journals, cash reports, weekly reconciliations, and bank deposits.
• Balance and post daily receipts and patient charges accurately and timely.
• Review Explanation of Benefits (EOBs) and post contractual adjustments as required.
• Monitor accounts receivable, collection activities, and bad debt recommendations.
• Review and resolve financial class review accounts in accordance with company procedures.
• Serve as liaison between the facility and corporate accounting to ensure accurate financial reporting and cash management.

Clinical Operations and Patient Care Support

• Collaborate with clinical staff, crisis coordinators, physicians, case managers, and other professionals to ensure patients receive high-quality, coordinated care.
• Support the effective delivery of treatment services and operational processes that enhance patient outcomes.
• Mediate patient and family concerns regarding treatment services and care delivery.
• Participate in utilization review activities and advocate for patient needs in both clinical and financial discussions.
• Stay informed of emerging trends, evidence-based practices, and innovations in addiction treatment and behavioral healthcare.

Marketing and Community Relations

• Develop and maintain strong relationships with referral sources, healthcare providers, community organizations, schools, employers, and judicial systems.
• Coordinate with clinical and crisis staff to maintain effective communication with referral sources and stakeholders.
• Conduct individual marketing, business development, and public relations activities to promote facility services and growth.
• Support community outreach efforts and represent the organization professionally in the community.

Compliance and Quality Improvement

• Ensure compliance with all applicable federal, state, and local regulations, including HIPAA, 42 CFR Part 2, and accreditation standards.
• Maintain unrestricted access to protected health information only as necessary to perform assigned responsibilities.
• Conduct audits of patient records, treatment documentation, and operational processes to ensure compliance and quality standards.
• Develop, implement, and monitor policies and procedures designed to improve operational effectiveness, clinical quality, and patient outcomes.
• Ensure compliance with all organizational policies, procedures, and regulatory requirements.

Administrative Responsibilities

• Maintain patient records, including storage, retrieval, retention, and closeout procedures.
• Perform general administrative and clerical duties as required.
• Maintain accurate and timely documentation, reports, and records.
• Perform additional duties as assigned by executive leadership.

Qualifications and Requirements

Education and Experience

• Bachelor’sDegree in Behavioral Sciences preferred.
• Minimum of three (3)years’ experiencepreferred.
• Minimum of two (2) years of supervisory experiencepreferred.
• Experience in chemical dependency, behavioral health, or addiction treatment settings preferred.
• Three (3) years of experience managing clinical programsis preferred.
• Demonstrated knowledge of healthcare operations, organizational structures, business management, and community systems preferred.

Certifications and Licensure

• CPR certification required within 30 days of hire.
• Valid driver's license with a safe driving record required.

Knowledge, Skills, and Abilities

• Strong leadership, supervisory, and team development skills.
• Excellent verbal, written, interpersonal, and presentation skills.
• Strongfiscal management, budgeting, and accounts receivable experience.
• Knowledge of healthcare regulations, compliance requirements, and accreditation standards.
• Ability to manage multiple priorities while maintaining attention to detail and accuracy.
• Proficiency with computers, office software, and standard office equipment.
• Strong organizational, problem-solving, and decision-making abilities.
• Ability to work independently with minimal supervision.

Core Competencies

• Clinical and operational leadership.
• Strategic planning and execution.
• Fiscal managementand accountability.
• Regulatory compliance and risk management.
• Quality improvement and performance management.
• Effective communication and relationship building.
• Conflict resolution and customer service excellence.
• Team collaboration and staff development.

Physical and Work Environment Requirements

• Ability to sit, stand, walk, bend, and move throughout the facility for extended periods.
• Ability to occasionally lift and carry up to 20 pounds.
• Ability to work in a fast-paced healthcare environment that may involve emotionally challenging situations.
• Ability to remain alert and perform duties safely at all times.
• Regular and reliable attendance required.

DESCRIPTION OF PHYSICAL DEMANDS

Job Title: Clinical Manager

Department: Clinical

CHECK APPROPRIATE BOX FOR EACH OF THE FOLLOWING ITEMS TO BEST DESCRIBE THE EXTENT OF THE SPECIFIC ACTIVITY PERFORMED BY THE STAFF MEMBERS IN THIS POSITION.

PHYSICAL DEMANDS:

Seldom

Occasionally

Constantly

None

Indicate frequency of activity during performance of position duties

Performed up to 1/3 of the time

Performed between 1/3 and 1/2 of the time

Performed over 2/3 of the time

N/A

Reading

X

Writing

X

Speaking

X

Visual acuity

X

Hearing

X

Squatting/Kneeling/Stooping

X

Dominant hand manipulation

X

Non-dominant hand manipulation

X

Working in close quarters

X

Working in outdoor weather conditions

X

Operating motor vehicles/mechanical parts

X

Sitting

X

Standing

X

Walking

X

Pushing or pulling

X

This job requires that weight be lifted or force be exerted. Show how much and how often by checking the appropriate boxes below.

Up to 10 pounds

X

Up to 25 pounds

X

Up to 50 pounds

X

More than 50 pounds

X

Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care.

Equal Opportunity Employer Statement

Bradford Health Services is an Equal Opportunity Employer and is committed to fostering a diverse and inclusive workplace. We do not discriminate based on race, color, religion, gender, sexual orientation, national origin, disability, veteran status, or any other protected characteristic under applicable laws.