Intermediate Care Utilization Review Nurse

POSITION SUMMARY

Under the direction and oversight of the Nurse Supervisor Utilization Review, the Intermediate Care Utilization Review Nurse is responsible for coordination of services for members of Florida Healthcare Plans admitted to and/or discharged from a skilled nursing facility or home healthcare agency as well as sub-acute inpatient and outpatient services as delegated. The Intermediate Care Utilization Review Nurse coordinates all services needed for an organized, multidisciplinary, member focused team approach. This includes but is not limited to durable medical equipment requests, appropriate discharge from SNF or home health care and follow-up with providers to coordinate movement to the next level of care. The Intermediate Care Utilization Review Nurse follows and manages the course of treatment for patients while coordinating care with physicians, nurses, case managers, and other staff from outside as well as within the company to ensure quality care and safe outcomes. The Intermediate Care Utilization Review Nurse conducts initial and ongoing assessments and ensures continuity of care through discharge planning and utilization of resources. Care should be approached in a cost-effective manner as this position bears risk for financial impact to the organization.

QUALIFICATIONS

Education, skills and experience:

• Graduate of an accredited school of nursing
• Florida residency required upon employment. Must live within Volusia or Flagler County.
• Current active and unrestricted licensure in Florida as a Licensed Practical Nurse (LPN)
• Minimum of two (2) years post-licensure clinical experience as a practicing LPN. Acceptable areas include but not limited to: Home Health Care, Skilled Nursing Facility Care, or Hospice Care
• Previous experience with utilization management, utilization review, prior authorization, or case management strongly preferred.
• Knowledge of Medicare criteria, DRG's, InterQual, and/or MCG Care Guidelines required.
• Knowledge of levels of hospitalization, inpatient rehabilitation, skilled nursing facility, home health care, behavioral health, community resources, and FHCP networks preferred.
• Excellent communication skills, including both oral and written.
• Strong telephone and customer service skills required. Must be able to diffuse difficult situations.
• Strong organizational and time management skills. Must be capable of multitasking.
• Proficiency with computer skills including Microsoft Word, Outlook, and Office Suite
• Must be able to type at a fast speed with high accuracy.
• Reliable transportation, home internet, and smart device for secondary identification required