What are the responsibilities and job description for the Utilization Review Nurse--Utilization Review--PT Nights position at UF Health?
UF Health Spanish Plaines Hospital, formerly known as The Villages Regional Hospital and acquired by University of Florida Health in January 2020, has been serving residents of The Villages as well as patients in Lake, Sumter and Marion counties since 2002. At UF Health The Villages® Hospital, we are committed to providing the community with leading-edge patient care, clinical training and research programs. Our teams of physicians and clinical staff work together to offer specialty services, advanced technology and clinical studies – bringing world-class health care closer to you and your loved ones.
We are part of UF Health Central Florida, a not-for-profit health care system and the largest most comprehensive provider of health care services in the region. UF Health Central Florida provides inpatient acute hospital services at UF Health Spanish Plaines Hospital and UF Health Leesburg Hospital, inpatient rehabilitation services at UF Health Rehab Hospital – The Villages and diagnostic laboratory services at several locations. We take pride in providing progressive, innovative technology, along with building strong relationships with patients, families, physicians and residents of the communities we serve.
Responsibilities
The Utilization Review Nurse is responsible for determining the appropriateness of hospital admission; utilization of resources and medical necessity for continued stay; facilitates timely discharge; assures medical documentation accurately reflects the patient's severity of illness; provides appropriate interventions and discharge planning services to the patients and families in collaboration with Case Management. Performs other duties as assigned.
Qualifications
Education:- Professional Certification in CM preferred- Associates Degree requiredLicensure/Certification/Registration:- Current Florida nursing license requiredSpecial Skills/Qualifications/Additional Training/Experience Required:- Must be able to read, write, speak and understand English- Experience: Minimum of 5 years clinical experience- Current working knowledge of Utilization management, performance improvement and reimbursement issues, preferred- Utilization review, Case Management, appeals, denials, managed care contracting experience preferred- Requires excellent observation skills, analytical thinking and problem solving as well as excellent communication skills- Effective communication skills required to facilitate contact with physicians, patients/clients, families and staff- CM certification preferred
