Utilization Review RN, Case Management/UR, Full Time, Day Shift, Job ID # 1876071

Palmetto General Hospital • Hialeah, FL

10d • Onsite

About The Position

Performs Case Management activities to assure medical necessity of admissions and appropriateness of continued stay utilizing the Interqual Criteria guidelines. Monitors the utilization of resources of all patients reviewed. Working with clients, family and friend support networks and health care professionals to put care plans in place. Evaluating clients' progress daily and making adjustments as needed to improve outcomes. Maintains confidential communication with physicians and multi-disciplinary personnel to meet individual needs or the patients served. Functions as an independent contributor as well as a team member.

Requirements

• Communication is an essential skill requiring the ability to see, hear, and speak.
• Fluent in written and spoken English.
• Must be able to fulfill the essential functions of the position.
• Familiar with the operations of the healthcare industry and healthcare delivery systems.
• Able to use the medical record in order to obtain clinical information to perform Interqual reviews.
• Utilize Outlook, and the computer based systems to perform reviews/CM assessments/CM tasks.
• Current Florida RN Licensure
• BLS Certification.
• Must possess a solid clinical background to accomplish extensive Medical Record review.
• Computer skills
• Communication Skills: Ability to effectively communicate in writing and orally with all levels of the organization

Nice To Haves

• Three or more years of acute care hospital experience preferred.
• Work experience in Medical-Surgical, Telemetry, Critical Care, and/or Pediatrics, NICU preferred.

Responsibilities

• Assure medical necessity of admissions and appropriateness of continued stay utilizing the Interqual Criteria guidelines.
• Monitor the utilization of resources of all patients reviewed.
• Work with clients, family and friend support networks and health care professionals to put care plans in place.
• Evaluate clients' progress daily and make adjustments as needed to improve outcomes.
• Maintain confidential communication with physicians and multi-disciplinary personnel to meet individual needs or the patients served.
• Function as an independent contributor as well as a team member.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed