**All the benefits and perks you need for you and your family:** Paid Days Off from Day One Student Loan Repayment Program Career Development Whole Person Wellbeing Resources Mental Health Resources and Support **Our promise to you:** Joining AdventHealth is about being part of something bigger. Its about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that **together** we are even better. **Schedule:** Full Time **Shift** :Days - Friday, Saturday, Sunday, Monday from 6:30 am to 5:00 pm **Location:** Virtual **The community you'll be caring for:** AdventHealth Division AdventHealth Tampa, a faith-based not-for-profit 626-bed tertiary-level acute care hospital located in the uptown district of Tampa, Florida, specializes in advanced cardiovascular medicine, neuroscience and neurology, digestive health, orthopedics, womens services, pediatrics, oncology, endocrinology, bariatrics, wound healing, sleep medicine and general surgery including minimally invasive and robot-assisted procedures. GME programs on the hospital campus currently include general surgery, obstetrics and gynecology, internal medicine and transitional year. AdventHealth Tampa is home to the renowned AdventHealth Pepin Heart Institute, a recognized leader in cardiovascular disease prevention, diagnosis, treatment and leading-edge research caring for Tampa Bays hearts for over 35 years. The Kiran C. Patel Research Institute, also located at AdventHealth Tampa, leads the way in clinical and academic research in the areas of neuroscience, cardiovascular medicine, advanced surgery and more contributing valuable knowledge that leads to tomorrows cures for conditions such as heart failure, cancer and other diseases. **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by analyzing patient records to determine legitimacy of hospital admission, treatment, and appropriate level of care. The UM RN leverages the algorithmic logic of the XSOLIS Cortex platform, utilizing key clinical data points to assist in status and level of care recommendations. The UM RN is responsible to document findings based on department and regulatory standards. When screening criteria does not align with the physician order or a status conflict is indicated, the UM nurse is responsible for escalation to the Physician Advisor or designated leader for additional review as determined by department standards. Additionally, the UM RN is responsible for denial avoidance strategies including concurrent payer communications to resolve status disputes. **The value you'll bring to the team:** Monitors admissions and performs initial patient reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. Performs pre-admission status recommendation in Emergency Department or elective procedure settings as assigned, to communicate with providers status guidance based on available information. Maintaining thorough knowledge of payer guidelines, familiarity with payer processes for initiating authorizations, and following through accordingly to prevent loss of reimbursement, including the management of concurrent and pre-bill denials. Ensuring all benefits, authorization requirements, and collection notes are obtained and clearly documented on accounts in the pursuit of timely reimbursement within established timeframes to avoid denials. Qualifications **The expertise and experiences you'll need to succeed:** Associates degree in Nursing Required 3 years of relevant work experience required. Registered Nurse (RN) License Required. 1 years of critical care nursing experience preferred. 1 years of utilization management experience preferred. This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location. **Category:** Case Management **Organization:** AdventHealth Tampa **Schedule:** Full-time **Shift:** 1 - Day **Req ID:** 25030609 We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.