Utilization Management RN Remote

About the role

We are seeking a Remote Utilization Management Registered Nurse to join AdventHealth’s interdisciplinary team. In this full‑time position you will evaluate admissions and ongoing stays to ensure medical necessity, while supporting our commitment to whole‑person care.

Key responsibilities

• Monitor patient admissions and conduct initial and continued medical necessity reviews.
• Maintain up‑to‑date knowledge of payer guidelines and regulatory requirements.
• Manage concurrent and pre‑bill denials to protect reimbursement.
• Collaborate with multidisciplinary care teams, communicating patient status and denial information.
• Obtain and verify clinical information, monitor daily discharge reports, and follow up with insurance carriers for authorizations.
• Maintain concurrent authorizations for in‑house patients using commercial authorization reports.
• Access payer portals, update authorization fields in the EMR, and delegate tasks to support staff as needed.

Required profile

• Active Registered Nurse (RN) license.
• Associate’s degree in Nursing (required); Bachelor’s degree preferred.
• Minimum 3 years of clinical nursing experience; 5 years in acute care preferred.
• Experience with electronic health records and familiarity with utilization or case management preferred.
• Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification is a plus.

Required skills

• Knowledge of payer guidelines, regulatory requirements and medical necessity criteria.
• Proficiency with Electronic Health Records (EHR) and payer portal navigation.
• Ability to interpret notification, reference and authorization numbers.
• Strong collaboration and communication skills with multidisciplinary teams.

What we offer

• Comprehensive benefits from day one (medical, dental, vision, life and disability insurance).
• Paid time off, 4 weeks of 100 % paid parental leave, and a 403(b) retirement plan.
• Career development resources, whole‑person well‑being programs, mental‑health support and pet benefits.
• Full‑time day shift schedule with remote work flexibility.