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Clinical Utilization Review Nurse
2 months ago
Overview
UF Health Leesburg Hospital has been a cornerstone of health care in our community for over five decades. The facility is renowned for its advanced cardiac services, featuring one of the most extensive cardiothoracic surgery programs in the state.
The American College of Cardiology has honored UF Health Leesburg Hospital with a prestigious Chest Pain Center Accreditation with Primary PCI and Resuscitation, recognizing our commitment to excellence in treating patients experiencing chest pain.
In addition to cardiac care, UF Health Leesburg Hospital provides cutting-edge orthopedic surgery, stroke treatment, emergency services, and comprehensive labor and delivery care.
As part of UF Health Central Florida, a not-for-profit health care system, we are the largest and most comprehensive provider of health services in the region.
UF Health Central Florida offers a wide range of services, including inpatient acute care at UF Health Leesburg Hospital and UF Health Spanish Plaines Hospital, rehabilitation services at UF Health Rehab Hospital The Villages, and diagnostic laboratory services across multiple locations.
We pride ourselves on delivering innovative technology and fostering strong relationships with patients, families, physicians, and the communities we serve.
Responsibilities
The Utilization Review Nurse plays a crucial role in assessing the appropriateness of hospital admissions, evaluating resource utilization, and determining the medical necessity for continued patient stays. This position facilitates timely discharges and ensures that medical documentation accurately reflects the patient's severity of illness. The nurse collaborates with Case Management to provide essential interventions and discharge planning services for patients and their families.
Qualifications
Education:
- Professional Certification in Case Management preferred
- Associate's Degree required
Licensure/Certification/Registration:
- Current Florida nursing license required
Special Skills/Qualifications/Additional Training:
- Must possess the ability to read, write, speak, and understand English
- Minimum of 5 years of clinical experience required
- Current knowledge of utilization management, performance improvement, and reimbursement issues preferred
- Experience in utilization review, case management, appeals, denials, and managed care contracting is preferred
- Strong observation skills, analytical thinking, and problem-solving abilities are essential
- Excellent communication skills are necessary for effective interaction with physicians, patients, families, and staff
- Certification in Case Management is preferred
