Registered Nurse – Utilization Review, Case Management

Baptist Health

Registered Nurse conducting chart reviews for clinical resource utilization at Baptist Health. Coordinating with healthcare teams for optimal patient outcomes while managing caseload and communications.

Posted 7/28/2026part-timeRemote • Florida • 🇺🇸 United StatesMid-LevelSenior💰 $73,860 - $98,234 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in clinical financial resource utilization, effective communication with healthcare teams, and the ability to manage patient caseloads while ensuring optimal outcomes. Proficient in chart review, appeals processes, and understanding payer reimbursement systems.

Highest-signal resume keywords

Registered NurseMCG Care Guidelines SpecialistClinical/Chart ReviewPayer Reimbursement KnowledgeAnalytical Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Chart ReviewData ManagementClinical AssessmentPatient CoordinationCritical Thinking

Soft Skills

Interpersonal CommunicationNegotiation SkillsOrganizational SkillsTime ManagementSound Judgment

Certifications & Qualifications

MCG Specialist Certification ISC/HRC

Industry Keywords

Healthcare Team CoordinationRevenue Cycle ManagementManaged CareLegislation and RegulationsLength of Stay (LOS)

About the role

Key responsibilities & impact

Conduct initial, concurrent, retrospective chart review for clinical financial resource utilization.
Coordinates with healthcare team for optimal/efficient patient outcomes, while decreasing length of stay (LOS) and avoid delays and denied days.
Accountability for a designated patient caseload and provides intervention, coordination to decrease avoidable delays, denial of reimbursement.
Screens pre-admission, admission process using established criteria for all points of entry.
Facilitates communication between payers, review agencies, healthcare team.
Identifies delays in treatment or inappropriate utilization and serves as a resource.
Coordinates communication with physicians.
Identifies opportunities for expedited appeals and collaborates to resolve payer issues.
Ensures/Maintains effective communication with Revenue Cycle Departments.

Requirements

What you’ll need

Associates.
MCG Care Guidelines Specialist.
Registered Nurse.
RNs hired prior to 2-2012 (10/1/2017 at Bethesda or 7/1/2019 at BRRH) with an Associates Degree in Nursing are not required to have a BSN to continue their non-leadership role as an RN.
however, they are required to complete the BSN within 3 years of job entry date.
MCG Specialist Certification ISC/HRC required within 12 months of job entry date.
3 years of Nursing experience preferred.
Excellent written, interpersonal communication and negotiation skills.
Strong critical thinking skills and the ability to perform clinical/chart review abstract information efficiently.
Strong analytical, data management and computer skills.
Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
Current working knowledge of payer and managed care reimbursement preferred.
Ability to work independently and exercise sound judgment in interactions with the health care team and patients/families.
Knowledgeable in local, state, and federal legislation and regulations.
Ability to tolerate high volume production standards.

Benefits

Comp & perks

Career growth and development opportunities, with clear pathways and ongoing support
Comprehensive health and wellness resources that go beyond traditional benefits
A wellness program that can help employees eliminate their medical plan deductible, reducing out-of-pocket healthcare costs
Tuition reimbursement to support continued learning and advancement
And so much more