Utilization Management RN

GuideWell Source

Registered Nurse specializing in Utilization Management at Florida Blue. Liaising with departments, ensuring compliance with healthcare regulations and policies.

Posted 4/29/2026full-timeRemote • Florida • 🇺🇸 United StatesMid-LevelSenior💰 $77,600 - $126,100 per yearWebsite

About the role

Key responsibilities & impact

Serve as a liaison between internal clients and functional departments;
Identify risks, evaluate controls and prepare findings and recommendations.
Ensure through audits that the organization’s programs are consistently administered in compliance with organizational policies and procedures.
Monitor and evaluate the effectiveness of solutions, policies, practices and processes.
Develop, implement, administer and revise policies, procedures and programs that meet business needs.
Research, analyze, maintain, modify, validate and prepare data, information and content used in making business decisions.
Produce, edit and distribute a variety of business documents such as reports, proposals, policies, procedures, etc.
Create, present and/or facilitate meetings, webinars, training programs, etc.
Participate on or lead large, complex departmental and/or divisional projects.
Develop and build internal and external partnerships to improve communication, coordination, collaboration and effective working relationships within own department.

Requirements

What you’ll need

5+ years related work experience.
Related Bachelor’s degree or additional related equivalent work experience.
FL active and unrestricted RN license or compact RN license.

Benefits

Comp & perks

Medical, dental, vision, life and global travel health insurance;
Income protection benefits: life insurance, short- and long-term disability programs;
Leave programs to support personal circumstances;
Retirement Savings Plan including employer match;
Paid time off, volunteer time off, 10 holidays and 2 well-being days;
Additional voluntary benefits available;
A comprehensive wellness program

ATS Keywords

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Applicant Tracking System Keywords

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Soft Skills

liaisonrisk evaluationaudit compliancepolicy developmentdata analysisdocument productionpresentation skillsproject leadershippartnership buildingcommunication

Certifications

RN licensecompact RN license