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Clinical Utilization Review Nurse
2 months ago
Overview
UF Health Leesburg Hospital has been a cornerstone of health care for our community for 58 years, providing exceptional services including advanced cardiac care and one of the largest cardiothoracic surgery programs in the state.
Recognized by the American College of Cardiology, UF Health Leesburg Hospital has earned a prestigious Chest Pain Center Accreditation with Primary PCI and Resuscitation, reflecting our commitment to excellence in treating patients with chest pain.
In addition to cardiac services, the hospital excels in advanced orthopedic surgery, stroke care, emergency services, and labor and delivery.
As part of UF Health Central Florida, a not-for-profit health care system, we are the largest and most comprehensive provider of health care services in the region.
UF Health Central Florida delivers inpatient acute hospital services at both UF Health Leesburg Hospital and UF Health Spanish Plaines Hospital, along with rehabilitation services at UF Health Rehab Hospital The Villages and diagnostic laboratory services across multiple locations.
We pride ourselves on utilizing innovative technology while fostering strong relationships with patients, families, physicians, and the communities we serve.
Responsibilities
The Utilization Review Nurse plays a crucial role in evaluating the necessity 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 severity of illness. 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:
Experience Required:
- Proficient in reading, writing, speaking, and understanding English
- Minimum of 5 years of clinical experience required
- Familiarity with utilization management, performance improvement, and reimbursement issues preferred
- Experience in utilization review, case management, appeals, denials, and managed care contracting is advantageous
- 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
