Utilization Review Nurse

Growing Healthcare company specializing in Managed Care. Promoting good worklife balance, competitive pay, employee incentives and full benefits.

Benefits: Medical, Dental, Vision, STD, LTD, Life

The Utilization Review nurse position is an RN or LPN that is responsible for providing clinical chart review. They will serve as a clinical resource, monitoring admissions and working closely with the healthcare team to reduce readmissions. The Utilization Review Nurse acts as a liaison in the coordination of care services, and monitors the health care delivery plan to maximize positive patient outcomes. This is NOT a remote position.

The role will require the Utilization Review nurse to work hand in hand with the health care team to include the physicians, mid level providers, nurses, and ancillary staff to create a successful outcome. The Utilization Review Nurse acts as a liaison in the coordination of care services to meet patients' needs,monitors the health care delivery plan to maximize positive patient outcomes,

RESPONSIBILITIES FOR UTILIZATION NURSE:

1. Review and coordinate clinical utilization on hospital admissions.
2. Serve as a clinical resources person for the healthcare team when determining appropriateness of admission.
3. Effectively communicate patient status information with the healthcare team
4. Communicate information to appropriate staff members to assist in discharge planning efforts.
5. Provide effective documentation to physicians and/or other clinical staff to assist with peer to peer reviews.
6. Inform UR manager of any ongoing trends/issues occurring with managed care companies.
7. Work collaboratively with the UM department for alternative treatment options for selecting and locating appropriate providers and assist with working through the referral process.
8. Provide education and act as a patient advocate to provide guidance, education, and support related to the patient and health care providers care plan goals.
9. Ability to problem solve regarding operational and clinical procedures that could affect a patient's outcomes.
10. Participate in prospective, concurrent, and retrospective case reviews involving high risk or "targeted" patients.
11. Ability to communicate with hospitals for clinical updates and discharge planning to ensure the best possible outcomes and decrease readmission.
12. Assist with the collection, analysis, and benchmarking of data.
13. Collaborate in the development of protocols and guidelines for patient care management.
14. Other tasks as assigned.

REQUIRED SKILLS FOR UTILIZATION NURSE:

1. Knowledge and skill in chronic disease management.
2. Ability to work in a team environment
3. Strong clinical assessment skills/triage skills
4. Flexible and Adaptable
5. Professional demeanor
6. Excellent written and verbal communication skills
7. Computer proficiency
8. Ability to learn and utilize EMR.
9. Exceptional customer service skills
10. Ability to work with the geriatric population and younger disabled adults
11. Must be able to build strong relationships with good listening skills
12. Strong understanding of Managed Care

EDUCATION FOR UTILIZATION NURSE:

Associates Degree in Nursing or Certificate in Practical Nursing

EXPERIENCE FOR UTILIZATION NURSE:

Two years minimum experience in Utilization Management

LICENSES & CERTIFICATION FOR UTILIZATION NURSE:

Maintain a Florida state RN or LPN license.

PI180969056