Clinical Reviewer Nurse- LTSS

Integrated Home; Florida; On-site; USD 65,000 - 95,000; Full time

Benefits offered by this job

Medical, Vision, Dental, Short- and L‑

6+ Holidays Pay

PTO

Employer paid life insurance

401K with employer contribution

Wellness program with reward Incentive

Employee recognition and reward

Job summary

Integrated Home Care Services (IHCS) seeks a Utilization Management Nurse to ensure home health care services are delivered with quality and cost efficiency. You will review patient treatment files, verify medical necessity, and coordinate with a multidisciplinary team.

Requirements include state licensure as an LPN or RN, at least 2 years in Utilization Management, and proficiency with Word and Excel. Certification in UM or Case Management is preferred. IHCS offers comprehensive benefits.

Qualifications

• State licensure as a LPN or RN.
• Minimum 2 years of prior experience in Utilization Management.
• Strong knowledge of word processing and spreadsheet computer programs.
• Utilization Management or Case Management certification preferred.

Responsibilities

• Concurrent review of patient’s clinical information for efficiency.
• Ongoing review of precertification requests for medical necessity.
• Coordinates patient care needs with a multi-disciplinary healthcare team.
• Maintain accurate records of all patient related interactions.
• Ability to stay organized and interact well with others in any situation.
• Provide updates to Manager of Utilization Management for review.

Skills

Word processing

Spreadsheet

Tools

Microsoft Office

Job description

Integrated Home Care Services (IHCS) provides a comprehensive Integrated Delivery System in the home setting, offering Durable Medical Equipment (DME), Respiratory, Home Health, and Home Infusion services. Through our select network of Medicare and Medicaid Certified and Accredited providers, we are available 24/7 to meet the needs of our patients with compassion, expertise, and excellence.

For more than 30 years, we have been dedicated to improving lives by delivering the highest quality in-home care services. As a trusted market leader in value-based Home Health, Durable Medical Equipment, and Home Infusion Services, we proudly serve more than 2 million lives across the United States and the Commonwealth of Puerto Rico. Our integrated care model is trusted by leading Managed Care Organizations (MCOs), physicians, and healthcare partners because of our commitment to exceptional patient outcomes and coordinated care.

At IHCS, our patients are at the heart of everything we do. We believe in creating a culture built on compassion, integrity, collaboration, and innovation. Every team member plays a vital role in fulfilling our mission of enhancing the quality of life for those we serve through Exceptional Customer Service, Proven Outcomes, and Seamless Care.

If you are passionate about making a meaningful impact, thrive in a collaborative environment, and are committed to excellence, we invite you to join our growing team. Together, we can continue transforming home healthcare while making a difference in the lives of our patients and the communities we serve.

Offering a competitive compensation package, including but not limited to;

• Medical, Vision, Dental, Short- and Long-term insurance
• 6+ Days of Holidays Pay
• PTO
• Employer paid life insurance
• 401K with employer contribution
• Wellness program with reward incentives
• Employee recognition and reward programs

What will you be doing:

As a Utilization Management Nurse, you will ensure that home health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing patient treatment files, the utilization nurse will ensure that patients won’t receive unnecessary procedures, ineffective treatment, or unnecessarily extensive home healthcare.

• Concurrent review of patient’s clinical information for efficiency
• Ongoing review of precertification requests for medical necessity
• Coordinates patient care needs with a multi-disciplinary healthcare team
• Maintain accurate records of all patient related interactions
• Ability to stay organized and interact well with others in any situation
• Provide updates to Manager of Utilization Management for review

What will you need to succeed:

• State licensure as a LPN or RN
• Minimum 2 years of prior experience in Utilization Management
• Strong knowledge of word processing and spreadsheet computer programs
• Utilization Management or Case Management certification preferred

Join our team as we strive for excellence through teamwork, where our patients are #1!

IHCS is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.

#IND

Travel Required

No .

Qualifications

Behaviors

Preferred

Team Player : Works well as a member of a group

Enthusiastic : Shows intense and eager enjoyment and interest

Detail Oriented : Capable of carrying out a given task with all details necessary to get the task done well

Dedicated : Devoted to a task or purpose with loyalty or integrity

Motivations

Preferred

Ability to Make an Impact : Inspired to perform well by the ability to contribute to the success of a project or the organization

Growth Opportunities : Inspired to perform well by the chance to take on more responsibility

Experience

Required

Strong knowledge of word processing and spreadsheet computer programs

Utilization Management or Case Management certification preferred

2 years: experience in Utilization Management

State licensure as a LPN or RN

Licenses & Certifications

Preferred

LPN -LICENSE

Equal Opportunity Employer
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.