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Utilization Review Nurse Behavioral Health
1 month ago
POSITION SUMMARY:
Under the direction and oversight of the Utilization Management Nurse Supervisor, the Utilization Review Nurse Behavioral Health is responsible for utilization review and coordination of services for Florida Healthcare Plans members requiring Medical and Behavioral Health services. The Utilization Review Nurse coordinates all systems/services needed for an organized, multidisciplinary, member focused team approach. The Utilization Review Nurse follows and manages the course of treatment for patients while coordinating care with physicians, nurses, therapists, case managers, and other staff from outside as well as within the company to ensure quality care and safe outcomes. The Utilization Review Nurse conducts initial and ongoing assessments and ensures continuity of care through discharge planning and utilization of resources. The Utilization Review Nurse will assist with complex admissions, identify quality concerns, and support the FHCP Behavioral Health Team. 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 accredited school of nursing,
* Florida residency required upon employment.
* Current active and unrestricted licensure in Florida as a Registered Nurse.
* Associate degree in nursing required. Bachelor's degree in nursing preferred.
* Minimum of two (2) years post-licensure experience in a Behavioral Health setting; acceptable areas include inpatient medical/behavioral, detox, residential.
* Knowledge of behavioral health care.
* Previous experience with referrals, utilization review, case management, pre-certification, authorization and denial of services preferred.
* Knowledge of Medicare criteria, DRG's, InterQual, and/or MCG Care Guidelines 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
* Exceptional computer skills with knowledge of Microsoft Office and Electronic Medical Record systems.
* Willing to work an alternative schedule, occasional weekend/holiday rotation, and 24/7 on-call
