Schedule: Full-Time, Onsite Monday-Friday in Miami, FL.
Description:

The Utilization Management Nurse (RN or LPN) is responsible for coordinating, monitoring, evaluating, and managing utilization review activities and authorization requests for members with complex medical and psychosocial needs. Working collaboratively with Medical Directors, Care Coordination teams, providers, and facilities, this role ensures high-quality, cost-effective healthcare outcomes while maintaining compliance with regulatory standards and medical necessity guidelines.



This position performs concurrent and retrospective reviews for inpatient, observation, and skilled nursing facility services, while supporting safe discharge planning and continuity of care.

What You Will Do:

• Conduct concurrent and retrospective utilization reviews for inpatient, observation, and SNF services.


• Review clinica...