Utilization Review Nurse – HCA North Florida Division
POSITION SUMMARY :
Provide clinical information to patient Insurance Plans according to the terms of the contract, receive authorization / certification for the stay, work concurrent denials, determine the correct patient status and communicate to the facilities, follow the X Code process per HCA policy, maintain communication with the facility case managers, physicians and the Insurance Plans. This position will focus on initial and continued stay utilization review and denials to include assessment of medical records for appropriateness, level of care provided, including assessment of treatment modalities, medications, services and application of treatment protocols. A team approach with the facility Case Management team is critical.
SCHEDULE : This is a work from home position. However, candidates must live within the HCA North Florida Division and reside within reasonable driving distance of a facility in the Orlando or Gainesville areas . Schedule requirements are variable per UR department needs. Some weekend and / or holiday work will be required.
B.S. in Business Administration, Nursing or Healthcare Administration preferred or equivalent work experience
Registered Nurse (RN) license required
Certification in Case Management or UR preferred or is willing to pursue in the first year (or when eligible)
InterQual experience strongly preferred , minimum of one year.
Acute care hospital experience preferred.
Third Party Payer and Denial Management experience a plus.
Excellent personal computer skills (MS Outlook, MS Office, Midas, Meditech, OnBase DOS based and other related software) required
Special Qualifications : Able to work independently with little supervision. Ability to communicate clearly, professionally and concisely. Excellent critical thinking skills. Strong organizational skills and able to proactively prioritize needs and effectively manage resources. Ability to work within a Team. Excellent written and oral communication skills along with excellent interpersonal skills. Position requires candidates with determined and assertive communication skills.
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