What are the responsibilities and job description for the RN | Utilization Management | Evenings - Manager position at University of Florida Health?
RN Utilization Management Evening Shift
Job Overview
This role is responsible for facilitating care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources.
Main Responsibilities:
- Clinical review of assigned patients to determine if MCG criteria are met in the appropriate setting (inpatient or observation)
- Application of MCG SI/IS criteria to ensure necessity of admission/CSR (including all adults and pediatrics)
- Collaboration with direct care givers (care coordination, nurses, physicians, ancillary departments) to coordinate patient length of stay, timely utilization and appropriateness of resources
- Documentation review to certify admission and/or continued length of stay to third-party payers
- Tracking of avoidable days and identification of opportunities for improvement in hospital system processes
Qualifications:
- Associate's degree in nursing required
- 3 years acute care nursing experience required
- Accredited Case Manager (ACM) certification preferred
