Utilization Review Nurse, RN

The Utilization Review Nurse is responsible for determining the appropriateness of hospital admission, utilization of resources and medical necessity for continued stay, facilitating timely discharge, ensuring medical documentation accurately reflects the patient's severity of illness, and providing appropriate interventions and discharge planning services to the patients and families in collaboration with Case Management. Performs other duties as assigned.

Education:

• Professional certification in CM preferred.
• Associate's degree required.

Licensure/Certification/Registration:

• Current Florida nursing license required.

Special Skills/Qualifications/Additional Training/Experience Required:

• Must be able to read, write in, speak and understand English.
• Experience: Minimum of 5 years of clinical experience.
• Current working knowledge of utilization management, performance improvement and reimbursement issues preferred.
• Utilization review, case management, appeals, denials and managed care contracting experience preferred.
• Requires excellent observation, analytical thinking and problem-solving skills, as well as excellent communication skills.
• Effective communication skills required to facilitate contact with physicians, patients/clients, families and staff.
• CM certification preferred.