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Clinical Utilization Review Nurse

2 months ago

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

Overview
UF Health Central Florida is dedicated to meeting the healthcare needs of our community with a commitment to excellence. Our facilities are recognized for providing advanced medical services, including specialized cardiac care and comprehensive orthopedic surgery.

Our hospital has received accolades for its expertise in managing critical conditions, demonstrating our commitment to quality patient care.

We pride ourselves on our innovative approaches and state-of-the-art technology, ensuring that we deliver the highest standard of healthcare to our patients and their families.


Responsibilities


The Clinical Utilization Review Nurse plays a vital role in assessing the necessity of hospital admissions and the ongoing appropriateness of care. This position involves ensuring timely patient discharges and verifying that medical documentation accurately reflects the patient's condition. The nurse will collaborate closely with Case Management to provide essential interventions and discharge planning services to patients and their families.

Additional duties may be assigned as necessary.

Qualifications

Education:

  • Professional Certification in Case Management is preferred
  • Associate's Degree is required

Licensure/Certification/Registration:
  • Current nursing license in Florida is mandatory

Experience Required:

  • Proficiency in reading, writing, and understanding English is essential
  • A minimum of 5 years of clinical experience is required
  • Familiarity with utilization management and reimbursement processes is preferred
  • Experience in utilization review, case management, and managed care contracting is advantageous
  • Strong observational skills, analytical thinking, and problem-solving abilities are necessary
  • Excellent communication skills are required for effective interaction with healthcare professionals, patients, and families
  • Certification in Case Management is preferred