Supervisor Utilization Review RN, Case Management, FT, 08A-4:30P
Baptist Health
Baptist Health is the region’s largest not-for-profit healthcare organization, with 12 hospitals, over 28,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties. With internationally renowned centers of excellence in cancer, cardiovascular care, orthopedics and sports medicine, and neurosciences, Baptist Health is supported by philanthropy and driven by its faith-based mission of medical excellence. For 25 years, we’ve been named one of Fortune’s 100 Best Companies to Work For, and in the 2024-2025 U.S. News & World Report Best Hospital Rankings, Baptist Health was the most awarded healthcare system in South Florida, earning 45 high-performing honors.
What truly sets us apart is our people. At Baptist Health, we create personal connections with our colleagues that go beyond the workplace, and we form meaningful relationships with patients and their families that extend beyond delivering care. Many of us have walked in our patients’ shoes ourselves and that shared experience fuels out commitment to compassion and quality. Our culture is rooted in purpose, and every team member plays a part in making a positive impact – because when it comes to caring for people, we’re all in.
Description
To supervise the Care Management staff in the provision and maintenance of discharge planning and utilization management services with specific focus on the clinical aspects of services provided. Responsible for managing the care for specific group of patients, facilitates the safe movement of patients throughout the continuum of care, ensures optimal utilization of resources , service delivery and compliance with external review agency requirements. Collaborates with patients/families and the team in care coordination and the discharge planning process. Provides biopsychosocial assessments, counseling and education to patients/families to assist them in coping with the patients hospitalization, illness, and/or life situation. Works with patients spanning all age groups and diverse entities. Provides direct supervision to the Care Management staff. Assists with program development and varied administrative tasks. Estimated salary range for this position is $95721.60 - $127309.73 / year depending on experience. Qualifications
Degrees:
- Bachelors.
Licenses & Certifications:
- Registered Nurse.
- ACMA ACM Certification.
- CCMC Case Manager.
- ACMA Case Management Administrator Certification.
- NAHQ Certified Professional in Healthcare Quality.
- MCG Care Guidelines Specialist.
- ANCC Nursing Case Management.
- ANCC Nurse Executive, Advanced Certification.
- ANCC Nurse Executive - Board Certified.
- NACCM Care Manager Certified.
Additional Qualifications:
- BSN-Bachelor of Science in Nursing required.
- One of the listed certifications required at job entry.
- If another type of certification other than MCG is presented upon hire, the MCG Care Guidelines Specialist Certifications -ISR/GR must be obtained within one year of job entry date.
- Experience in denial and appeals process.
- Knowledge of reimbursement principles, Medicare/Medicaid regulations, InterQual and/or MCG.
- Advanced written, verbal and interpersonal skills.
- Must be able to deal effectively with coworkers and medical staff.
- Excellent organizational skills including effective time management, collaboration, priority setting and process improvement.
- Demonstrates leadership ability, professionalism and integrity.
Minimum Required Experience:
- Registered Nurse
- 5 years of Acute Utilization Management experience required
- Knowledge of reimbursement principles, Medicare/Medicaid regulations, InterQual and/or MCG.
Job
Case Management/Home HealthPrimary Location
Boca RatonOrganization
Boca Raton Regional HospitalSchedule
Full-timeJob Posting
Aug 29, 2025, 12:00:00 AMUnposting Date
OngoingEOE, including disability/vets