Utilization Review Nurse | Utilization Review | PRN Days Position Available In Lake, Florida

Overview 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

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