What are the responsibilities and job description for the Utilization Review Nurse | Utilization Review | PRN Days position at UF Health?
Since the doors opened more than 59 years ago, UF Health Leesburg Hospital has continued to build upon its reputation as a leading medical center and the most comprehensive provider of health care services in the region. The hospital offers advanced cardiovascular care, including one of the largest open-heart programs in Florida. The American College of Cardiology has recognized UF Health Leesburg Hospital for its demonstrated expertise and commitment in treating patients with chest pain by awarding a Chest Pain Center Accreditation with Primacy PCI and Resuscitation — its highest and best level of accreditation. The hospital also offers world-class orthopedics, minimally invasive robotic surgery, life-saving emergency care, stroke treatment, labor & delivery, and so much more.
Responsibilities
The Utilization Review Nurse is responsible for determining the appropriateness of hospital admission; utilization of resources and medical necessity for continued stay; facilitates timely discharge; assures medical documentation accurately reflects the patient's severity of illness; provides appropriate interventions and discharge planning services to the patients and families in collaboration with Case Management. Performs other duties as assigned.
Qualifications
Education:
- Professional Certification in CM preferred
- Associates Degree required
Licensure/Certification/Registration:
- Current Florida nursing license required
Special Skills/Qualifications/Additional Training/Experience Required:
- Must be able to read, write, speak and understand English
Experience: Minimum of 5 years clinical experience
- Current working knowledge of Utilization management, performance improvement and reimbursement issues, preferred
- Utilization review, Case Management, appeals, denials, managed care contracting experience preferred
- Requires excellent observation skills, analytical thinking and problem solving as well as excellent communication skills
- Effective communication skills required to facilitate contact with physicians, patients/clients, families and staff
- CM certification preferred
