Utilization Management RN

GuideWell Source

Utilization Management Compliance Specialist role requires an RN with 5+ years experience. Join Florida Blue to support compliance with CMS and NQCA guidelines.

Posted 6/1/2026full-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.
Help clients achieve their objectives by serving as a resource.
Identify risks, evaluate controls and prepare findings and recommendations.
Implement compliance programs to prevent illegal, unethical or improper business practices.
Ensure through audits that the organization’s programs are consistently administered in compliance.
Monitor and evaluate the effectiveness of solutions, policies, practices and processes.
Recommend improvements to achieve and deliver high quality, value-added services.
Develop, implement, administer and revise policies, procedures and programs.
Research, analyze, maintain, modify, validate and prepare data, information and content.
Produce, edit and distribute a variety of business documents.
Create, present and/or facilitate meetings, webinars, trainings, etc.
Represent assigned function at external hearings, mediations, audits, meetings, etc.
Participate on or lead large, complex departmental and/or divisional projects.
Develop and build internal and external partnerships.

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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Hard Skills & Tools

compliance programsauditsrisk evaluationdata analysispolicy developmentdocument productionmeeting facilitationproject management

Soft Skills

liaisonclient resourcerecommendationmonitoringevaluationcommunicationpartnership building

Certifications

RN licensecompact RN license