Hybrid, Per-diem Utilization Review RN

Description

The Utilization Review (UR) Nurse has well-developed knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the department by developing and/or maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers.

Part time

Hybrid Position

Utilization Review (UR) Nurses play a vital role in healthcare by ensuring patients receive appropriate care while managing healthcare costs effectively. They assess patient care plans and medical records to verify the necessity and effectiveness of the treatments being proposed or provided.

• Review hospital admissions to ensure appropriate admission status in accordance with MCG/Inter Qual criteria and ensure the physician admits the patient under the guidelines of Managed Care Companies, facilitating authorizations.
• Monitor ongoing case assignment for Managed Care Companies authorization of hospital stay.
• Review urgent cases authorized for one day within 24 hours of admission and review concurrent cases and discharge plans according to review process time frames with external entities.
• Provide clinical data as part of the telephonic or electronic review process to external parties (as required) to ensure continued stay authorizations.
• Coordinate Physician Advisor referrals when concerns arise regarding meeting level of care criteria (utilizing Indicia/Inter Qual). Review PA referrals with the department manager as needed.
• Ensure observation services begin when care is initiated in accordance with the physician’s order for patients placed in observation, from the ED or as directed, and that extended recovery services begin after an ambulatory surgery patient arrives on the unit after the routine period ends.

• Graduate of an accredited school of professional nursing.

• Licensed RN in the State of Florida is required.
• Bachelor of Nursing is preferred (BSN).

• Comprehensive benefits that start on your first day of work.
• Retirement savings program with employer matching.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, or basis of disability or any other federal, state or local protected class.

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.