Utilization Review Nurse | Utilization Review | FT Days
: Job Details :

Overview UF Health Leesburg Hospital has been serving the health care needs of our community for 58 years. The hospital offers advanced cardiac care including one of the largest cardiothoracic surgery programs in the state. 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 Primary PCI and Resuscitation - its highest and best level of accreditation. UF Health Leesburg Hospital also offers advanced orthopedic surgery, stroke care, emergency services as well as labor and delivery care. The hospital is part of UF Health Central Florida, a not-for-profit health care system and the largest most comprehensive provider of health care services in the region. UF Health Central Florida provides inpatient acute hospital services at UF Health Leesburg Hospital and UF Health Spanish Plaines Hospital, inpatient rehabilitation services at UF Health Rehab Hospital - The Villages and diagnostic laboratory services at several locations. We take pride in providing progressive, innovative technology, along with building strong relationships with patients, families, physicians and residents of the communities we serve. Responsibilities Monday Through Friday 8am to 4:30PM (occasional weekends required) 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