Working remotely in a full-time capacity, the Florida RN Utilization Reviewer will conduct admission, concurrent, and retrospective reviews of medical records to ensure compliance with clinical performance standards and reimbursement guidelines while managing a caseload of 25-30 reviews per day.
Key responsibilities Perform medical record reviews and provide clinical information to payers Utilize analytical skills to gather data and identify issues affecting patient care and reimbursement Document findings accurately in UM notes and attend scheduled staff meetings Required qualifications Graduate of an accredited school of nursing Current state licensure as a Registered Nurse (RN) Basic Life Support (BLS) certification through the American Heart Association (AHA) or American Red Cross Three years of equivalent full time clinical experience as a Registered Nurse Knowledge of medical terminology, anatomy and physiology, and basic disease processes