LPN – Utilization Review Specialist (PRN only) Position Available In Hillsborough, Florida

LPN – Utilization Review Specialist (PRN only) Toria’s Support Care Services Inc. 3702 East Osborne Avenue, Tampa, FL 33610 LPN – Utilization Review Specialist

JOB DESCRIPTION

Overview:

Toria’s Support Care Services has been a trusted provider of care for the elderly and developmentally disabled populations for over 25 years. Operating two assisted living facilities licensed by the Agency for Health Care Administration (AHCA) and a group home licensed by the Agency for Persons with Disabilities (APD), Toria’s offers compassionate, high-quality care across multiple locations. The LPN – Utilization Review Specialist will work across all locations as needed, with a primary focus on the main location specified in this posting. Reporting to the CEO/Administrator, this role collaborates with the management team, Direct Care staff, and consumers (residents) to ensure high-quality, cost-effective healthcare services. The position emphasizes maintaining the appropriate level of care through comprehensive reviews of medical records, medication management, physical activities, patient care (including stimulation and emotional well-being), and ancillary services.

Job Responsibilities:

Conduct pre-certifications, continued stay reviews, care coordination, and discharge planning to ensure compliance with applicable criteria, medical policies, and contracts. Initiate and complete chart reviews, follow-up evaluations, and escalate cases for secondary reviews to medical personnel when necessary. Collaborate with clinical reviewers and medical staff to ensure medically appropriate, high-quality, and cost-effective care throughout the medical management process. Work closely with providers to assess consumer needs, focusing on early identification and proactive planning for quality care. Ensure compliance with accrediting and regulatory standards by understanding, interpreting, and accurately applying requirements. Review clinical documentation, facilitating modifications to ensure accurate representation of services rendered. Communicate documentation issues requiring clarification to attending physicians, Direct Care staff, and other relevant personnel. Interface with the Direct Care team to provide insights on quality outcome metrics, such as the timeliness and appropriateness of services. Administer medications and injections to consumers as needed. Perform other duties as assigned.

Qualifications:

Minimum Requirements:

Active LPN license in the state of Florida. At least two years of clinical experience in acute care settings.

Preferred Qualifications:

Experience in Utilization Review (UR). Proficiency in computer systems and software applications. Strong oral, written, and interpersonal communication skills. Demonstrated problem-solving, facilitation, and analytical abilities. Familiarity with agency policies and procedures. “

Physical Requirements:

This position requires the ability to lift and carry, stand and walk for extended periods of time, bend, stoop, kneel, and reach. The ability to perform repetitive motions and work in various physical environments is also required.

Job Types:

Full-time, PRN Pay:

$22.00 – $30.00 per hour

Medical Specialty:

Home Health Primary Care Wound Care Physical Setting:

Nursing home People with a criminal record are encouraged to apply

Work Location:

In person