Utilization Management Nurse

2 weeks ago


Hollywood, Florida, United States Integrated Home Full time

About Integrated Home Care Services:

Integrated Home Care Services (IHCS) is dedicated to providing a comprehensive delivery system within the comfort of patients' homes. Our offerings encompass Durable Medical Equipment (DME), Respiratory Care, Home Health, and Home Infusion services. We collaborate with a select network of Medicare and/or Medicaid Certified and Accredited providers to meet the needs of our patients around the clock. Our primary goal is to deliver the highest quality in-home care services, ensuring our patients' well-being is our top priority.

With over three decades of experience, IHCS stands as a trusted leader in the Home Health sector, Durable Medical Equipment, and Home Infusion Services. If you possess a passion for motivating and guiding teams, this role may align with your career aspirations.

Key Responsibilities:

As a Utilization Management Nurse, your role will be pivotal in ensuring that home health care services are delivered with optimal quality, cost-effectiveness, and compliance. You will conduct continuous reviews and audits of patient treatment files to prevent unnecessary procedures, ineffective treatments, or overly extensive home healthcare services.

  • Perform concurrent reviews of patients' clinical data for efficiency.
  • Review precertification requests for medical necessity on an ongoing basis.
  • Coordinate patient care requirements with a multidisciplinary healthcare team.
  • Maintain precise records of all patient-related interactions.
  • Exhibit strong organizational skills and effective interpersonal communication.
  • Provide updates to the Manager of Utilization Management for evaluation.
Qualifications:
  • Current state licensure as a Licensed Practical Nurse (LPN) or Registered Nurse (RN).
  • A minimum of two years of experience in Utilization Management.
  • Proficient in word processing and spreadsheet software.
  • Certification in Utilization Management or Case Management is preferred.
Our Commitment:

At IHCS, we are committed to excellence through collaboration, where our patients' needs are paramount. We celebrate diversity and are dedicated to fostering an inclusive environment for all employees.

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