Location & Practice Overview

This senior nursing role supports a health plan utilization management department based in Miami, Florida. Work occurs within a managed-care environment focused on medical necessity determinations across multiple care settings.

Base Location Miami, FL
Department Utilization Management
Practice Type Health Plan Utilization Review
Care Continuum Inpatient, outpatient, and post-acute services
Placement Structure Contract assignment through staffing partner for client health plan

Responsibilities

  • Conduct medical necessity reviews for inpatient and outpatient elective procedures using KFHP policies, Milliman criteria, and InterQual guidelines.
  • Authorize inpatient hospital stays, rehabilitation services, skilled nursing admissions, home care, and infusion therapy when criteria are met.
  • Coordinate real-time discharge planning requests and collaborate with providers to support appropriate transitions of care.
  • Verify member eligibility, document all authorization activity in the utilization management system, and refer non-meeting cases to the Medical Director for denial preparation.
  • Obtain additional clinical information directly from referring providers when needed to complete accurate determinations.

Documentation occurs in real time within the designated utilization management platform as reviews and decisions are completed.

Qualifications & Requirements

Candidates must hold active Florida licensure and bring substantial bedside experience, ideally from high-acuity settings, along with familiarity with standardized medical necessity tools.

Education
Graduate of an accredited Diploma, ADN, or BSN nursing program
License
Current unrestricted Florida RN license
Clinical Experience
Minimum 3 years nursing experience, preferably in critical care (ER or ICU)
Utilization Background
Prior Utilization Review, Prior Authorization, or Case Management experience strongly preferred
Guidelines & Systems
Familiarity with InterQual criteria plus proficiency in MS Office and electronic documentation platforms

Compensation & Benefits

Pay is structured as an hourly rate for the contract assignment. Performance incentives are available; additional benefit details are not listed in the posting.

  • Hourly compensation range of $45–$55
  • Performance incentives available
  • Contract placement through Integrated Resources, Inc

Schedule & Work Environment

Hours Full-time daytime / standard business hours
Work Model Onsite
Collaboration Style Real-time provider communication and interdisciplinary coordination with Medical Directors
Documentation Expectation Real-time entry into the utilization management platform

Patient Population & Clinical Setting

Reviews support managed-care members whose care needs span acute inpatient, elective outpatient procedures, rehabilitation, skilled nursing, and home-based services.

Member Type Managed care members
Acuity Range Various acuity levels
Service Categories Inpatient admissions, elective surgeries, rehabilitation, skilled nursing, home infusion
Clinical Focus Level-of-care determinations and timely transition coordination

About Integrated Resources, Inc

Integrated Resources, Inc (IRI) is a national staffing firm founded in 1996 and headquartered in Edison, New Jersey. The organization specializes in placing experienced healthcare professionals into contract, contract-to-hire, and permanent roles, with particular emphasis on nursing, clinical research, rehabilitation therapy, and information technology. IRI holds Joint Commission certification for healthcare staffing services and partners with health plans, hospitals, and health systems across major U.S. markets.

Founded 1996
Organization Type Healthcare and IT staffing firm
Headquarters Edison, NJ
Service Focus Nursing, Clinical Research, Rehabilitation Therapy, Information Technology
Accreditation Joint Commission certified for healthcare staffing services

Frequently Asked Questions

Which utilization management platform is used for documentation?
Reviews and determinations are entered in real time into the MeDecision platform.
How often will I interact directly with referring physicians or providers?
The role requires real-time communication with referring providers to gather additional clinical information and facilitate authorizations as needed.
Is prior experience with both Milliman and InterQual required?
Familiarity with InterQual is preferred; medical necessity reviews are performed using KFHP policies together with both Milliman and InterQual guidelines.
What happens when a case does not meet medical necessity criteria?
Cases that do not meet criteria are referred to the Medical Director, and the nurse prepares the corresponding denial notifications.
Is this assignment with Integrated Resources, Inc itself or with a client health plan?
The position is a contract placement by Integrated Resources, Inc into a client health plan’s utilization management department.

Senior Registered Nurse – Utilization Management in Miami, FL

Experienced registered nurses with critical-care backgrounds can apply clinical judgment to medical necessity decisions in this Miami-based utilization management contract. The role centers on concurrent and prospective reviews for managed-care members across inpatient, outpatient elective, rehabilitation, skilled nursing, and home infusion services. Nurses apply standardized criteria sets and health-plan policies while coordinating discharge planning and communicating directly with providers. Placement occurs through a Joint Commission-certified national staffing firm that connects clinicians with health-plan opportunities. The position emphasizes accurate, real-time documentation and timely level-of-care determinations that support efficient transitions within a structured managed-care framework.

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