Clinical Utilization Nurse

1 week ago


Pensacola, Florida, United States LUKE Full time
Job Description

Position Title: Clinical Utilization Nurse

Overview:
The Clinical Utilization Nurse plays a pivotal role in enhancing healthcare delivery through effective management of patient care services. This position is essential for ensuring that patients receive appropriate and timely medical attention while adhering to established healthcare protocols.

Site of Service:
The role is based within a healthcare facility, focusing on optimizing patient outcomes and resource utilization.

Qualifications:

  • Education: An Associate's Degree in Nursing from an accredited institution.
  • Experience: A minimum of one year of nursing experience post-graduation, with a focus on utilization management or case management.
  • Licensure: Must hold a current, unrestricted RN license in any U.S. state or territory.
  • Certification: Current certification in one of the following areas is required:
    • Certified Professional Utilization Review (CPUR)
    • Certified Professional Utilization Management (CPUM)
    • Health Care Quality and Management Certification
    • Certified Case Manager (CCM)
    • Advanced Certification in Continuity of Care (ACCC)
    • Nurse Case Manager (RN-NCM)
    • Care Manager Certified (CMC)
  • Additional Requirement: Basic Life Support (BLS) certification.

Responsibilities:
The Clinical Utilization Nurse will be responsible for:

  • Collaborating with healthcare teams to enhance patient care through effective utilization management strategies.
  • Conducting thorough reviews of patient care to ensure compliance with medical necessity and appropriateness standards.
  • Facilitating communication among clinical staff to promote high-quality care delivery.
  • Identifying patients at risk for overutilization of services and implementing strategies to mitigate such risks.
  • Participating in the development of monitoring processes to identify at-risk patients early in their care journey.
  • Providing expert nursing assessments and recommendations to improve patient outcomes.
  • Maintaining up-to-date knowledge of relevant healthcare regulations and standards.

Core Competencies:
The ideal candidate will demonstrate:

  • Strong analytical and problem-solving skills.
  • Excellent communication and interpersonal abilities.
  • Ability to work effectively in a fast-paced environment.
  • Commitment to continuous professional development and adherence to ethical standards.

Work Schedule:
This position typically requires availability during standard business hours, with a commitment to maintaining a high level of productivity and professional conduct.

Equal Opportunity:
LUKE is committed to diversity and inclusion in the workplace and encourages all qualified applicants to apply without regard to race, color, religion, sex, or national origin.



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