Hybrid, Per-diem Utilization Review RN

Position Purpose

Utilization Review (UR) Nurses play a vital role in healthcare by making sure that patients receive appropriate care while managing healthcare costs effectively. They assess patient care plans and medical records to verify the necessity and effectiveness of the treatments being proposed or provided.

What You Will Do

• Reviews hospital admissions to ensure appropriate admission status in accordance with MCG/InterQual criteria and to assure that the physician admits patient under the guidelines of the Managed Care Companies thus facilitating the authorizations.
• Maintains on an on-going basis case assignment for Managed Care Companies authorization of hospital stay.
• Reviews urgent cases authorized for one day within 24 hours of admission.
• Reviews concurrent cases and discharge plans in timeframes determined in the review process with external entities.
• Provides clinical data as part of the telephonic or electronic review process to external parties (as required) to ensure continued stay authorizations.
• Collaborates with Physician Advisors to ensure patients meet level of care criteria (using Indicia/InterQual).
• Coordinates Physician Advisor referrals with their concerns regarding meeting level of care criteria.
• Ensures Observation services begin when care is initiated in accordance with the physician’s order for patients placed in observation, from the ED or as directed admit.
• This time will be identified by the time the order for Observation is written by the attending physician.
• Ensures Extended Recovery services begin after an ambulatory surgery patient arrives on the unit after the routine period ends.

Minimum Qualifications

• Graduate of an accredited school of professional nursing.
• Licensed RN in the State of Florida is required.
• Bachelor of Nursing is preferred (BSN).