RN - Utilization Review - Utilization Review
Company: Interim Healthcare
Location: Fort Lauderdale
Posted on: September 20, 2022
RN - Utilization ReviewView All Jobs
Utilization Review Nurse - Great Benefits
Interim HealthCare - Severn, MD
APPLY WITH INDEED
The Utilization Review (UR) Nurse assesses the medical necessity,
level of services, and appropriateness of care in individual cases
requiring prospective, concurrent or retrospective utilization
review. Evaluates the patient's needs and appropriate services.
Reviews patient medical records applying utilization criteria,
norms and clinical knowledge to assess the medical necessity, level
of services, and appropriateness of care in individual cases.
Prepares confidential documentation on the results of the case
review, records variations on screening sheets and interfaces with
necessary individuals for follow-up.
Must be able to coordinate with department physician advisors,
Nursing, Social Service, Infection Control, Medical Records, other
departments/personnel and community resources to ensure continuity
along the continuum of care.
Must be able to review patient record, identify variant patterns of
care, using comprehensive screening methods, including utilization
Performs quality assurance functions of coordination, monitoring
and reporting of quality assurance studies according to the UR
Responsible for knowing current QA and UR regulations and informing
others of regulation changes.
Collects and compiles information for special projects if
Reports identified or possible variations to appropriate
Completes other assignments as requested and assigned.
May have access to personal health information ("PHI") necessary to
fulfill the above duties and responsibilities. Access to use and
ability to disclose PHI is further defined by each
Minimum Education & Experience Requirements:
Registered Nurse experience with active license in the state(s) in
which he/she is employed and practices.
One (1) year UR nursing experience within the last five (5)
Case Management experience as defined by the contracting
Knowledge, Skills & Abilities Required:
Able to effectively communication with clinical, non-clinical
staff, providers, outside organizations, patent and
Able to demonstrate skill in quality assurance/utilization review
Able to effectively communicate with the clinical and non-clinical
Able to demonstrate basic understanding of computers and workplace
Able to demonstrate skills in consultation, collaboration and
Able to provide proof of a valid driver's license, if
Able to provide proof of valid auto liability insurance if
assignment(s) include driving own vehicle.
Meets applicable health requirements to provide patient care.
Working Conditions & Physical Effort:
Work is performed in clinics, schools, hospitals, nursing homes or
Requires ability to sit for long periods.
Requires normal, correctable vision and hearing.
Work environment may involve occasional exposure to communicable
diseases, blood borne pathogens and/or potentially infectious or
Physical activity is medium and may require occasional lifting,
carrying, pushing or pulling up to 50 lbs.
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Interim HealthCare Inc
Keywords: Interim Healthcare, Fort Lauderdale , RN - Utilization Review - Utilization Review, Healthcare , Fort Lauderdale, Florida
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