Employment Type:

Part time

Shift:

Description:

The Utilization Review (UR) Nurse has well-developed knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the department by developing and/or
maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers.

***Hybrid Position***

Position Purpose: Utilization Review (UR) Nurses play a vital role in healthcare by making sure that patients receive appropriate care while managing healthcare costs effectively. They assess patient care plans and medical records to verify the necessity and effectiveness of the treatments being proposed or provided.

What you will do:

*Reviews hospital admissions to ensure appropriate admission status in accordance with MCG/InterQual criteria and to assure that the physician admits patient under the guidelines of the Managed Care Companies thus facilitating the authorizations.

*Monitors on an on-going basis case assignment for Managed Care Companies authorization of hospital stay. 

*Reviews urgent cases authorized for one day within 24 hours of admission. Reviews concurrent cases and discharge plans in timeframes determined in the review process with external entities. 

*Provides clinical data as part of the telephonic or electronic review process to external parties (as required) to ensure continued stay authorizations.

*Coordinates Physician Advisor referrals with there are concerns regarding meeting level of care criteria (utilizing Indicia/InterQual). Reviews PA referrals with department manager as needed.

*Ensure Observation services begin when care is initiated in accordance with the physician’s order for patients placed in observation, from the ED or as directed admit. This time will be identified by the time the order for Observation is written by the attending physician. Extended Recovery services begin after an ambulatory surgery patient arrives on the unit after the routine period ends. 

Minimum Qualifications:

* Graduate of an accredited school of professional nursing.

Licensure/Certification

* Licensed RN in the State of Florida is required.

* Bachelor of Nursing is preferred. (BSN)

Ministry/Facility Information:

• Holy Cross Hospital in Fort Lauderdale, Florida is a full-service, non-profit Catholic hospital, sponsored by the sisters of Mercy and a member of Trinity Health.
• We are committed to providing compassionate and holistic person-centered care.
• We are the only Catholic hospital in Broward and Palm Beach counties and are not for profit. We are part of Trinity Health, one of the largest multi-institutional Catholic health care delivery systems in the nation. Together, we serve people and communities in 21 states from coast to coast, providing nearly 2.8 million visits annually.
• Comprehensive benefits that start on your first day of work
• Retirement savings program with employer matching
   

Legal Info

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.

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. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an 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.