Utilization Review Nurse, RN
Florida, United States of America
Full Time
3 weeks ago
Visa Sponsor
Key skills
Communication
About this role
Role Overview
- Ensure appropriate admission status and level of care for hospitalized patients
- Partner closely with physicians, physician advisors, case management, and payers
- Support timely authorizations, concurrent reviews, and discharge planning
- Conduct initial and concurrent chart reviews to confirm admission and continued stay meet level-of-care criteria
- Provide telephonic or electronic clinical reviews to external payers to support authorization decisions.
Requirements
- Experience in Utilization Review, Case Management, or Managed Care
- Working knowledge of MCG/InterQual (Indicia) criteria
- Familiarity with CMS, Medicare, Medicaid, and commercial payer regulations
- Proficiency with Epic or similar EMR systems
- Strong clinical judgment, communication, and documentation skills.
Benefits
- Our Commitment Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings.
- Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.