Utilization Review Nurse

2 weeks ago


Fort Lauderdale, Florida, United States Trinity Health Full time
Job Summary:

As a Utilization Review Nurse at Trinity Health, you will play a vital role in ensuring that patients receive appropriate care while managing healthcare costs effectively. You will assess patient care plans and medical records to verify the necessity and effectiveness of treatments being proposed or provided. Your expertise will help determine the appropriate admission status based on regulatory and reimbursement requirements of various commercial and government payers.

Key Responsibilities:
* Review hospital admissions to ensure appropriate admission status in accordance with Indicia/InterQual criteria and to assure that the physician admits patient under the guidelines of the Managed Care Companies thus facilitating the authorizations.
* Monitor on an on-going basis case assignment for Managed Care Companies authorization of hospital stay.
* Review urgent cases authorized for one day within 24 hours of admission. Review concurrent cases and discharge plans in timeframes determined in the review process with external entities.
* Provide clinical data as part of the telephonic or electronic review process to external parties (as required) to ensure continued stay authorizations.
* Coordinate Physician Advisor referrals with there are concerns regarding meeting level of care criteria (utilizing Indicia/InterQual). Review PA referrals with department manager as needed.

Requirements:
Graduate of an accredited school of professional nursing.
Licensed RN in the State of Florida is required.
Bachelor of Nursing is preferred. (BSN)

What We Offer:
Comprehensive benefit packages available, including medical, dental, vision, paid time off, 403B, and education assistance.
We serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.
We live and breathe our guiding behaviors: we support each other in serving, we communicate openly, honestly, respectfully, and directly, we are fully present, we are all accountable, we trust and assume goodness in intentions.

About Us:
Holy Cross Hospital in Fort Lauderdale, Florida is a full-service, non-profit Catholic hospital, sponsored by the sisters of Mercy and a member of Trinity Health. We are committed to providing compassionate and holistic person-centered care. We are the only Catholic hospital in Broward and Palm Beach counties and are not for profit. We are part of Trinity Health, one of the largest multi-institutional Catholic health care delivery systems in the nation. Together, we serve people and communities in 21 states from coast to coast, providing nearly 2.8 million visits annually. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

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