PRN UM Case Manager RN
 Lee Health | |
$40.86 / hr
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 United States, Florida, Fort Myers | |
| 2776 Cleveland Avenue (Show on map) | |
 Aug 25, 2025 | |
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Location:Lee Health -2776 Cleveland AveFort Myers FL 33901 Department: Utilization Management - Corporate Work Type: PRN Shift: Shift 1/8:00:00 AM to 4:00:00 PM Minimum to Midpoint Pay Rate:$40.86 - $40.86 / hour This position will be remote (with occasional onsite requirements) after your first 90 days of employment. SummaryAre you detail-oriented and passionate about ensuring high-quality, cost-effective care? Were seeking aUtilization Management Nursewho will play a key role in optimizing patient outcomes, maintaining compliance, and supporting appropriate resource use across the continuum of care. The Utilization Management Nurse is responsible for evaluating the medical necessity, appropriateness, and efficiency of healthcare services provided to patients. This role ensures compliance with regulatory standards and payer requirements while promoting accurate, concurrent clinical documentation that reflects the patients care and supports reimbursement. Key Responsibilities: Review clinical documentation to determine medical necessity and appropriate level of care using established criteriaEnsure timely, accurate utilization reviews and documentation to support reimbursement and regulatory complianceCollaborate with physicians, nursing staff, and case managers to clarify clinical information and support appropriate care planningMonitor patient progress and facilitate transitions across levels of care as neededSupport concurrent documentation efforts to ensure the medical record reflects the full scope of care and services deliveredMeet or exceed established productivity and quality benchmarks for utilization review and documentation accuracy Why Join Us: Be part of a collaborative, high-performing utilization management teamPlay a vital role in improving care quality and resource stewardshipAccess ongoing education and leadership opportunitiesCompetitive salary and comprehensive benefitsHelp us make sure every patient gets the right care at the right timefor the right reasons. Join our Utilization Management team and make a meaningful impact every day. RequirementsEducation: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. Experience:Minimum of 3 years acute care hospital clinical experience or equivalent utilization management experience within 2 years with a focus on acute care. Certification:Case Management certification, ACM, CCM, CMCN or NACCM required after 3 yrs. employment (time exception provided for unsuccessful attempts). License:Currently licensed as an RN in the State of Florida. Other:Communication and interpersonal skills, basic computer, analytical, grammar and spelling skills. Ability to effectively multi-task responsibilities. US:FL:Fort Myers | |