Clinical Reviewer Nurse
Integrated Home•Miramar, FL
About The Position
The Clinical Reviewer Nurse (also described as a Utilization Management Nurse) reviews and audits patient treatment files to help ensure home health care services are high quality, cost-efficient, and compliant. The role includes reviewing clinical information and precertification requests, coordinating patient care needs with a multidisciplinary healthcare team, maintaining accurate interaction records, and providing updates to the Manager of Utilization Management.
Requirements
- State licensure as an LPN or RN.
- At least 2 years of prior experience in Utilization Management.
- Strong knowledge of word processing and spreadsheet computer programs.
Nice To Haves
- Utilization Management or Case Management certification.
Responsibilities
- Conduct concurrent reviews of patient clinical information for efficiency.
- Review precertification requests for medical necessity on an ongoing basis.
- Coordinate patient care needs with a multidisciplinary healthcare team.
- Maintain accurate records of all patient-related interactions.
- Stay organized and interact effectively with others in different situations.
- Provide updates to the Manager of Utilization Management for review.
Benefits
- Medical insurance
- Vision insurance
- Dental insurance
- Short- and long-term insurance
- More than 6 days of paid holidays
- Paid time off (PTO)
- Employer-paid life insurance
- 401(k) with employer contribution
- Wellness program with reward incentives
- Employee recognition and reward programs
- Comprehensive paid training program
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
