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Clinical Utilization Review Nurse
2 months ago
Overview
UF Health Leesburg Hospital has been a cornerstone of healthcare in our community for over 58 years. This facility is renowned for its advanced cardiac care, featuring one of the most extensive cardiothoracic surgery programs in the state.
The American College of Cardiology has honored UF Health Leesburg Hospital for its exceptional proficiency and dedication in managing patients with chest pain, granting it the prestigious Chest Pain Center Accreditation with Primary PCI and Resuscitation.
In addition to cardiac services, UF Health Leesburg Hospital provides advanced orthopedic surgery, stroke management, emergency care, and maternity services.
As part of UF Health Central Florida, a not-for-profit healthcare system, we are the largest and most comprehensive provider of healthcare services in the region.
UF Health Central Florida offers 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 are committed to delivering cutting-edge technology while fostering strong relationships with patients, families, physicians, and the communities we serve.
Responsibilities
The Utilization Review Nurse plays a critical role in assessing the appropriateness of hospital admissions, managing resource utilization, and ensuring medical necessity for continued patient stays. This position facilitates timely discharges and ensures that medical documentation accurately reflects the patient's condition. The nurse also provides essential interventions and discharge planning services in collaboration with Case Management.
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 be proficient in reading, writing, speaking, and understanding 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 observational 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
