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Baptist Health · Posted Nov 10, 2026
Degrees: Bachelors. Licenses & Certifications: ACMA ACM Certification. CCMC Case Manager. AACN Acute/Critical Care Nursing (Adult, Pediatric & Neonatal). Registered Nurse. ABMCM Certified Managed Care Nurse. AAMCN Utilization Review Professionals. MCG. ANCC Nursing Case Management. ACMA Case Management Administrator Certification. Additional Qualifications: RNs hired prior to 2/2012 with an Associates Degree in Nursing are not required to have a BSN to continue their non-leadership role as an RN, however,they are required to complete the BSN within 3 years of hire. RN license & one of the listed certifications is required. 3 years of hospital clinical experience preferred & 2 years of hospital or payor Utilization management review experience required. Excellent written, interpersonal communication & negotiation skills. Strong critical thinking skills & the ability to perform clinical chart review abstract information efficiently. Strong analytical,data management & computer skills/Word /Excel. Strong organizational & time management skills,as evidenced by capacity to prioritize multiple tasks & role components. Current working knowledge of payor & managed care reimbursement preferred. Ability to work independently & exercise sound judgment in interactions with the health care team & patients/families. Knowledgeable in local, state, & federal legislation & regulations. Ability to tolerate high volume production st&ards. MCG Certification or eligible to pursue within 90 days of hire. Case management,utilization review/surgery pre-anesthesia experience preferred. Familiar with CPT, ICD-9 &-10 & DRG coding preferred. Strong ability to research evidence-based practices. Minimum Required Experience: 4 Years EOE, including disability/vets