Florida Licensed Utilization Review Nurse

Job Summary

To enhance patient outcomes, the full-time Florida Licensed Utilization Review Nurse will conduct initial, concurrent, and retrospective chart reviews while coordinating with healthcare teams to decrease length of stay and avoid reimbursement denials, working locally and remotely from 7 AM to 7:30 PM.

Key responsibilities:

• Conduct initial, concurrent, and retrospective reviews of clinical financial resource utilization
• Facilitate communication between payers, review agencies, and the healthcare team to optimize patient outcomes
• Identify and address delays in treatment and reimbursement issues, coordinating appeals and resolutions

Required qualifications:

• Associate's degree in Nursing; BSN required within 3 years for RNs hired prior to 2012
• MCG Care Guidelines Specialist certification required within 12 months of job entry
• Minimum of 3 years of nursing experience, with at least 1 year in Utilization Review
• Current knowledge of payer and managed care reimbursement preferred
• Strong analytical, data management, and organizational skills