Senior Registered Nurse – Utilization Management

Location & Practice Overview

• Base location: Miami, FL
• Department: Utilization Management / Prior Authorization
• Practice type: Managed care staffing placement
• Care setting: Administrative review of inpatient and outpatient services
• Patient population: Health plan members requiring authorization for hospital stays, elective procedures, home care, and specialty referrals

Utilization Review & Authorization Duties

• Complete medical necessity reviews for inpatient admissions, rehabilitation, skilled nursing, home infusion, elective surgeries, and non-participating specialty referrals using established health plan policies
• Apply Milliman, InterQual, and internal guidelines to authorize or refer cases to the Medical Director when criteria are not met
• Document receipt date, nature of request, eligibility verification, determination, and all supporting events in real time within MeDecision
• Coordinate with referral sources to obtain missing clinical information needed to finish the authorization process
• Issue verbal or fax denial notifications and generate denial letters according to policy timelines
• Facilitate discharge planning requests and channel cases appropriately while following prior authorization or concurrent review process standards

Licensure, Experience & Core Qualifications

Pay Range for This Miami Role

• Base Salary: $85,000–$105,000 annually

Daily Clinical Decision Tools & Systems

Review work relies on Milliman, InterQual, and internal process standards along with Standard Operating Procedures. Cases are documented in MeDecision as events occur, including detail lines and ASF completion. Real-time communication with providers occurs by telephone and live encounters rather than heavy dependence on voice mail. Access to medical guidelines supports decisions before any Medical Director referral.

Living and Working in Miami, FL

Miami’s healthcare market includes a strong managed-care presence and ongoing demand for experienced utilization nurses who can handle prior authorization and concurrent review volume. Many professionals choose residential areas with reasonable commute access to administrative offices, balancing traffic patterns common to South Florida. Housing ranges from urban apartments to suburban options farther inland, with public transit and major roadways supporting daily travel. Cost of living sits above the national average, driven largely by housing, so candidates often weigh salary against local expenses when evaluating relocation or local moves.

Professional Growth in Utilization Management

Nurses in this senior review role commonly progress into lead utilization nurse positions, concurrent review team coordination, or specialized prior-authorization leadership within managed-care organizations. Experience applying InterQual and Milliman guidelines, combined with consistent Medical Director collaboration, supports movement into quality or clinical operations roles over time.

About Integrated Resources, Inc

Integrated Resources, Inc is a specialty staffing firm founded in 1996 that places professionals in Information Technology, Clinical Research, Rehabilitation Therapy, and Nursing. The company focuses on matching experienced clinicians with contract and permanent opportunities, including utilization management and prior authorization assignments for health-plan clients.

Clinical candidates typically work within the client’s established policies, documentation systems, and Medical Director review pathways while receiving support from the staffing firm’s recruitment and placement process. The operational environment emphasizes accurate, real-time documentation and consistent application of medical necessity guidelines.

• Healthcare specialties: Nursing, Clinical Research, Rehabilitation Therapy, Information Technology

Typical Hiring Sequence

FAQ

Senior Registered Nurse – Utilization Management – Miami, FL

This senior registered nurse position centers on utilization management and prior authorization for a managed-care client in Miami. The nurse reviews inpatient hospital stays, elective procedures, skilled nursing admissions, home care, and specialty referrals, applying established medical necessity criteria and health-plan policies. Real-time documentation, provider communication, and timely referral of borderline cases to a Medical Director form the core of the daily workflow. Candidates bring a current Florida RN license, at least three years of clinical experience preferably in critical care, and familiarity with InterQual standards. The role sits within a staffing placement that supports accurate authorization decisions and coordinated discharge planning for health-plan members across inpatient and outpatient settings.

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Complete application for Senior Registered Nurse – Utilization Management at Integrated Resources, Inc.