Clinical Utilization Review Nurse

2 weeks ago


Leesburg, Virginia, United States UF Health-Central Florida Full time

Overview
UF Health Leesburg Hospital has been a cornerstone of healthcare in our community for over 58 years, providing exceptional services including advanced cardiac care and one of the state's leading cardiothoracic surgery programs.

Recognized by the American College of Cardiology, UF Health Leesburg Hospital has achieved a prestigious Chest Pain Center Accreditation with Primary PCI and Resuscitation, showcasing our commitment to excellence in treating patients with chest pain.

In addition to cardiac services, we offer advanced orthopedic surgery, comprehensive stroke care, emergency services, and labor and delivery care.


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.

Our facilities include inpatient acute hospital services at UF Health Leesburg Hospital and UF Health Spanish Plaines Hospital, inpatient rehabilitation services at UF Health Rehab Hospital The Villages, and diagnostic laboratory services at multiple locations.

We pride ourselves on utilizing progressive and 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 assessing the appropriateness of hospital admissions, evaluating resource utilization, and determining medical necessity for continued patient stays. This position facilitates timely discharges and ensures that medical documentation accurately reflects the patient's severity of illness. Additionally, the nurse provides essential interventions and discharge planning services to patients and their families in collaboration with Case Management.

Other duties may be assigned as necessary.

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
  • Current knowledge of utilization management, performance improvement, and reimbursement issues preferred
  • Experience in utilization review, case management, appeals, denials, and managed care contracting 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 preferred


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