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Utilization Review Nurse

Fort Lauderdale, FL, United StatesRemoteFull-time

AI Summary

Utilization Review Nurse conducts pre-admission, concurrent, and retrospective case reviews to assess medical necessity and coordinate care. They complete documentation, collaborate with physicians and case managers, and perform outpatient or pharmacy utilization reviews.

About this role

Utilization Review Nurse

HealthCare Support Staffing, Inc. (HSS), is a proven industry-leading national healthcare recruiting and staffing firm. HSS has a proven history of placing talented healthcare professionals in clinical and non-clinical positions with some of the largest and most prestigious healthcare facilities including: Fortune 100 Health Plans, Mail Order Pharmacies, Medical Billing Centers, Hospitals, Laboratories, Surgery Centers, Private Practices, and many other healthcare facilities throughout the United States. HealthCare Support Staffing maintains strong relationships with top providers in healthcare and can assure healthcare professionals they will receive fast access to great career opportunities that best fit their expertise. Connect with one of our Professional Recruiting Consultants today to see how a conversation can turn into a long-lasting and rewarding career!

  • Conducts pre-admission, concurrent and retrospective acute care, sub-acute, hospice, qualification of transitional care and long-term care needs for medical necessity
  • Perform case reviews and complete all required documentation in appropriate database
  • Collaborate with primary or attending physician, case managers, patient and/or family to provide continuity and quality of care in the most cost-effective manner.
  • Timely completion of admission reviews (within 48-hours for weekday, 72-hours for weekend)
  • Provide outpatient or pharmacy services utilization review

Qualifications

  • Current Florida RN License
  • 3+ years in recent medical/surgical or critical care experience
  • 3+ years of Utilization Review / Case Management experience
  • Strong reasoning ability: define problems, collect data, establish facts, and draw conclusions

Additional Information

Hours for this Position:

  • M-F 8-5

Advantages of this Opportunity:

Competitive salary

  • $28.85/hr - $31.25/hr pending experience
  • Excellent Medical benefits Offered, Medical, Dental, Vision, 401k, and PTO
  • Growth potential
  • Fun and positive work environment

Skills

Case ManagementEMRHospiceMedical NecessityRNSub-acute CareTransitional CareUtilization Review

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