Utilization Review Nurse, PRN/Weekend Shift

This is a fully remote position, open to applicants in Florida.

📋 Description

• Perform reviews of hospital admissions to assess medical necessity and determine the appropriate patient status.

• Conduct ongoing stay evaluations utilizing approved clinical guidelines and criteria.

• Analyze clinical documentation to ensure it is accurate, complete, and compliant with payer and regulatory standards.

• Utilize evidence-based criteria such as InterQual® and/or MCG® in evaluations.

• Relay review outcomes and recommendations to physicians, case management personnel, and leadership.

• Work collaboratively with Physician Advisors on complex cases or cases lacking sufficient criteria support.

• Aid in activities aimed at preventing denials and ensuring accurate documentation.

• Execute additional assigned responsibilities as needed.

• Collaborate effectively with physicians, case managers, revenue cycle teams, and interdisciplinary care teams to ensure appropriate patient status determinations and maximize reimbursement while promoting quality patient care.

⛳️ Requirements

• Proficient in various Electronic Health Records and case management systems.

• Excellent communication abilities; conveys information clearly and succinctly, both verbally and in writing.

• Capable of thriving in a dynamic environment and adjusting to changing business demands.

• Ability to operate independently with minimal oversight.

• Graduate from an accredited nursing school.

• Current, unrestricted Registered Nurse (RN) license required.

• Minimum of five (5) years of acute care nursing experience within a hospital environment.

• At least two (2) years of recent experience in hospital-based or health plan utilization review.

• Familiarity with acute admission assessments and ongoing stay reviews.

• PRN role necessitating at least forty (40) hours per month when available.

• At least sixteen (16) of the required monthly hours must be completed during weekend shifts.

• Must work two (2) out of six organization-recognized holidays each year.

• Availability must be submitted thirty (30) days in advance.

• Adherence to attendance and call-off policies is mandatory.

• Must be capable of performing tasks that involve physical activity, including lifting up to 25 pounds.

• Preferred certifications include Certified Case Manager (CCM), Accredited Case Manager (ACM), Certified Managed Care Nurse (CMCN), or Case Management Board Certification (CMGT-BC).

• A Bachelor of Science in Nursing (BSN) is preferred.

🏝️ Benefits

• PRN scheduling with the possibility of additional hours based on departmental needs and employee availability.

• Flexible shift options of four or eight hours, contingent on departmental requirements and manager approval.

• Option to work remotely.

• Paid work on recognized holidays is guaranteed through the required holiday shifts.