Florida Licensed UM Case Manager RN

Job Summary

A company is looking for a PRN UM Case Manager RN.

Key Responsibilities:

• Review clinical documentation to determine medical necessity and appropriate level of care using established criteria
• Ensure timely, accurate utilization reviews and documentation to support reimbursement and regulatory compliance
• Collaborate with physicians, nursing staff, and case managers to clarify clinical information and support appropriate care planning

Required Qualifications:

• Graduate of an accredited school of professional nursing required
• BSN or BS in a related healthcare field, or able to obtain within the first year of hire
• Minimum of 3 years acute care hospital clinical experience or equivalent utilization management experience within 2 years
• Case Management certification required after 3 years of employment
• Currently licensed as an RN in the State of Florida