Utilization Management RN

AdventHealth Central Florida - Orlando, FL

Job Title: Utilization Management RN

Position: Utilization Management (UM) RN

Job Type: Full Time

Pay:

Shift: Monday – Friday, 8am - 4:30pm, every 4th weekend, may vary based on business needs

Work Type: Remote

Location

Address:

City: Orlando

State: FL

ZIP Code:

Job Responsibilities

Analyze patient records to determine legitimacy of hospital admission, treatment, and appropriate level of care.
Leverage algorithmic logic of the XSOLIS Cortex platform utilizing key clinical data points for status and level of care recommendations.
Document findings based on department and regulatory standards.
Escalate to the Physician Advisor or designated leader when screening criteria does not align with the physician order or a status conflict is indicated.
Implement denial avoidance strategies including concurrent payer communications to resolve status disputes.
Monitor admissions and perform initial patient reviews within 24 hours of admission.
Perform pre-admission status recommendations in Emergency Department or elective procedure settings as assigned.
Maintain knowledge of payer guidelines and processes for initiating authorizations.
Ensure all benefits, authorization requirements, and collection notes are obtained and documented on accounts.
Work collaboratively with physicians, nursing, and other members of the multidisciplinary care team.
Utilize advanced conflict resolution skills to ensure timely resolution of issues.
Collaborate with the physician and multidisciplinary team to facilitate care for designated case load.
Monitor patient progress, intervening to ensure that the plan of care and services are patient-focused and high quality.
Complete all required documentation in the Cortex platform and EHR system.

Required Skills

Core Skills

Current and valid license to practice in Florida as a Registered Nurse
Minimum three years acute care clinical nursing experience
Minimum two years Utilization Management experience or equivalent professional experience
Excellent interpersonal communication and negotiation skills
Strong analytical, data management, and computer skills
Strong organizational and time management skills

Preferred Skills

Bachelor of Science in Nursing or related BS/BA
Clinical experience in acute care facility greater than five years
Minimum four years Utilization Management within acute care setting
Experience working in electronic health records for at least two years

Requirements

Experience: Minimum three years acute care clinical nursing experience; Minimum two years Utilization Management experience

Education: ADN or BSN required

License & Certification:

Registered Nurse in Florida

Schedule:

Full Time Remote, Applicant must live within a 50-mile radius or be a current employee within an AdventHealth region

COVID-19 Requirements: Not Specified

Benefits

Benefits from Day One
Paid Days Off from Day One
Debt-free Education (Certifications and Degrees without out-of-pocket tuition expense)

Supplemental Pay

Not specified

Special Notes

Joining AdventHealth is about being part of a community that believes in the wholeness of each person, serving to uplift others in body, mind, and spirit.

Facility Details

Name: AdventHealth Central Florida

Description: The Maitland Office Plaza houses highly skilled teams supporting the hospital system including Marketing, Patient Financial Services, Revenue Management, the Credit Union, and Human Resources.

Specialties: