Utilization Review RN

Jobtailor; Fort Lauderdale (FL); On-site; USD 65,000 - 90,000; Full time

Job summary

Jobtailor is seeking a Registered Nurse for hospital admission review and case management in Fort Lauderdale, FL. The role focuses on ensuring appropriate admission status, monitoring authorization, and coordinating discharge planning with external entities.

The ideal candidate is a Florida-licensed RN, with a BSN preferred, and experienced in applying MCG/InterQual criteria to keep stays authorized and efficient.

Qualifications

• Graduate of an accredited school of professional nursing.
• Licensed RN in the State of Florida is required.
• BSN preferred.

Responsibilities

• Assess hospital admissions for appropriate status per MCG/InterQual criteria.
• Monitor ongoing case assignment for Managed Care Companies authorization of hospital stay.
• Review urgent cases authorized for one day within 24 hours of admission.
• Review concurrent cases and discharge plans in timeframes determined in the review process with external entities.
• Provide clinical data as part of the telephonic or electronic review process to external parties to ensure continued stay authorizations.
• Coordinate Physician Advisor referrals when there are concerns regarding meeting level of care criteria.
• Ensure observation services begin when care is initiated in accordance with the physician’s order for patients placed in observation.

Education

RN license Florida

BSN preferred

Graduate of accredited nursing program

Job description

Responsibilities

• Reviews hospital admissions to ensure appropriate admission status in accordance with MCG/InterQual criteria
• Monitors ongoing 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 to ensure continued stay authorizations
• Coordinates Physician Advisor referrals when there are concerns regarding meeting level of care criteria
• Ensures observation services begin when care is initiated in accordance with the physician’s order for patients placed in observation

Requirements

• Graduate of an accredited school of professional nursing
• Licensed RN in the State of Florida is required
• Bachelor of Nursing preferred (BSN)