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Clinical Nurse Specialist, Utilization Review
2 months ago
Job Overview
Baptist Medical Center Jacksonville is seeking a dedicated Clinical Nurse Specialist to join our Utilization Review team.
Role Responsibilities
The Utilization Review Nurse is tasked with evaluating patient records to ascertain the appropriate classification of care (inpatient, observation, outpatient) to facilitate accurate billing processes.
This role involves utilizing regulatory guidelines from CMS and Medicaid, alongside various tools to assess the medical necessity for both admission and ongoing patient care.
The RN will collaborate with physicians, insurance providers, and nursing personnel to gather and disseminate essential information.
Key Duties Include:
- Ongoing assessment of patient documentation to confirm the necessity for hospitalization.
- Effective use of resources and support for documentation enhancement.
- Ensuring compliance with the Utilization Review Plan in alignment with all QIO/PRO requirements and governmental regulations.
- Providing utilization data to commercial insurance entities as per contractual obligations.
- Assisting in discharge planning and case management functions.
Position Details
This Utilization Review Nurse position is based at Baptist Jacksonville. We are looking for candidates interested in a PRN role.
Work Schedule
Days
Educational Requirements
Minimum: Associate's Degree in Nursing
Preferred: Bachelor's Degree in Nursing
Experience Requirements
- 3-5 years of experience in Case Management.
Licensure and Certifications
- Current Registered Nurse License is required.
About Baptist Health
Baptist Health, established in 1955, is the most extensive healthcare system in North Florida and operates as a non-profit, mission-driven, locally governed provider.
With over 200 care locations across Northeast Florida, Baptist Health encompasses six award-winning hospitals and a wide range of services including primary care, home health, behavioral health, rehabilitation, and urgent care.
