Utilization Review RN, Case Management/UR, Full Time, Day Shift, Job ID # 1876071
Palmetto General Hospital
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- Location
- Hialeah, FL
- Work style
- On-site
- Job type
- Full time
- Posted
- Oct 1
- 18 days ago
Career path
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About the company
Palmetto General Hospital
Hospital & health care · 1,001 to 5,000 employees
What you'll do
- Reviews admissions and continued stays for medical necessity and appropriateness using Interqual Criteria, and monitors resource use.
- Coordinates care plans, evaluates progress, adjusts plans as needed, and communicates with physicians and multidisciplinary personnel.
What you need
- Requires current Florida RN licensure and BLS certification, fluent written and spoken English, and a solid clinical background.
- Three or more years of acute care hospital experience and experience in specified clinical areas are preferred.
Key skills
Interqual CriteriaCurrent Florida RN LicensureBLS CertificationMedical Record reviewComputer skillsCommunication SkillsClinical backgroundOutlook
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Position Summary: 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. Position Qualification: 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. Possess three or more years of acute care hospital experience preferred. 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. Work experience in Medical-Surgical, Telemetry, Critical Care, and/or Pediatrics, NICU preferred. Required Licenses/Certifications: 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