In-Home Utilization Review RN — Home Health

Integrated Home Care Services, Inc.; Florida; On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Medical insurance

Vision insurance

Dental insurance

Short- and Long-term disability

401K plan with employer contribution

Wellness program

Job summary

IHCS is seeking a Clinical Reviewer RN for the Hollywood, FL area to oversee utilization management within home health services. The role focuses on ensuring quality and cost-efficient care by reviewing patient treatment files and coordinating with a multidisciplinary team.

Requirements include state licensure as an RN or LPN, at least 2 years in utilization management, and proficiency with word processing and spreadsheet software. Certification in UM or Case Management is a plus.

Qualifications

• State licensure as a LPN or RN.
• Minimum 2 years of prior experience in Utilization Management.
• Strong knowledge of word processing and spreadsheet 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 and stay organized.
• Provide updates to Manager of Utilization Management for review.

Skills

Utilization Management

Case Management

Tools

Word processing software

Spreadsheet software

Job description

CLINICAL REVIEWER RN job at Integrated Home Care Services, Inc.. Hollywood, FL. Job Details Description Who we are: IHCS provides an Integrated Delivery System in the home setting, which includes, DME, Respiratory, Home Health and Home Infusion services. IHCS has a select network of Medicare and/or Medicaid Certified and Accredited providers to respond to the needs of our patients – 24/7. We operate with the sole intent of providing the highest quality in-home care services that improve and enhance the daily living for our patients, where our patients are #1 With over 30 years of experience, we are the trusted market leader in Home Health, Durable Medical Equipment, and Home Infusion Services. If you are passionate about inspiring, motivating, and leading teams this opportunity could be for you and we want to hear from you! Join our team as we strive for excellence through teamwork. We are committed to delivering high quality care to our patients through Exceptional Customer Service, Proven Outcomes, and Seamless Care. Full time team members competitive compensation package, include but not limited to;

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

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 Come With

• 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.