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Join us as a **Registered Nurse (RN) - Utilization Review position** at Physicians Regional Collier

Unit: Utilization Review

Shift: Mon-Fri (this is an onsite position)

3-5 years of experience in critical care preferred

Student Loan Contribution: Up to $20k

Other incentives include: Medical, Vision, Dental, 401k match & more available for Full and Part-Time roles

Job Summary

The Utilization Review Nurse - RN reviews hospital admissions, extended stays, and supporting documentation to ensure medical necessity, appropriate level of care, and accurate clinical documentation. Under the direction of the Utilization Review leadership, this role supports concurrent review processes, facilitates authorizations, and partners with providers and staff to drive compliance with utilization policies. The UR Nurse also contributes to the development of departmental procedures, education, and performance improvement initiatives aligned with utilization review metrics.

Essential Functions

+ Conducts admission and continued stay reviews to determine medical necessity and level of care using approved screening criteria and third-party tools.

+ Collaborates with providers, care teams, and case management to ensure appropriate documentation, clinical justification, and status assignment (e.g., inpatient vs. observation).

+ Facilitates authorization processes with payers for hospital admissions and ongoing services.

+ Monitors and documents utilization review activities, trends, and outcomes to support regulatory and quality reporting requirements.

+ Supports utilization review team performance by contributing to education, standard work, and policy/procedure development.

+ Partners with internal departments to promote process improvement and compliance with UR standards and KPIs.

+ Serves as a resource for best practices in documentation and utilization review for care teams.

+ Participates in daily communication activities including timely review of correspondence and updates.

+ Performs other duties as assigned.

+ Maintains regular and reliable attendance.

+ Complies with all policies and standards.

Qualifications

+ 2-4 years of clinical nursing experience required

+ 1-2 years of experience in HEDIS, MIPS, PQRS, ACO, STARS programs preferred

Knowledge, Skills and Abilities

+ Ability to evaluate clinical documentation and make timely, independent decisions regarding medical necessity and care status.

+ Proficient in utilization review processes, admission criteria, and payer authorization requirements.

+ Strong interpersonal skills to collaborate with multidisciplinary teams and external partners.

+ Effective written and verbal communication skills.

+ Proficient in Microsoft Office (Word, Excel, PowerPoint) and Google Workspace tools.

+ High attention to detail, organizational skills, and ability to manage competing priorities in a fast-paced environment.

+ Committed to patient-centered service and continuous improvement.

Licenses and Certifications

+ RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Equal Employment Opportunity

This organization does not discriminate in any way to deprive any person of employment opportunities or otherwise adversely affect the status of any employee because of race, color, religion, sex, sexual orientation, genetic information, gender identity, national origin, age, disability, citizenship, veteran status, or military or uniformed services, in accordance with all applicable governmental laws and regulations. In addition, the facility complies with all applicable federal, state and local laws governing nondiscrimination in employment. This applies to all terms and conditions of employment including, but not limited to: hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training. If you are an applicant with a mental or physical disability who needs a reasonable accommodation for any part of the application or hiring process, contact the director of Human Resources at the facility to which you are seeking employment; Simply go to http://www.chs.net/serving-communities/locations/ to obtain the main telephone number of the facility and ask for Human Resources.