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Utilization Review RN
Trinity HealthUtilization Review Nurse ensuring appropriate admissions and healthcare cost management at Holy Cross Hospital in Florida. Collaborating with medical staff to verify treatment necessity and authorizations.
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in reviewing hospital admissions and ensuring compliance with MCG/InterQual criteria, while effectively coordinating with external entities for authorization processes. Proficient in providing clinical data and managing case assignments for Managed Care Companies.
Highest-signal resume keywords
Licensed RN in FloridaMCG/InterQual Criteria ReviewCase Assignment MonitoringClinical Data ProvisionPhysician Advisor Coordination
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
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Hard Skills
Hospital Admission ReviewConcurrent Case ReviewDischarge PlanningObservation Services CoordinationManaged Care Authorization
Certifications & Qualifications
Bachelor of Nursing (Preferred)
Industry Keywords
Managed CareClinical Review ProcessTelephonic ReviewExternal Entity Coordination
About the role
Key responsibilities & impact- Reviews hospital admissions to ensure appropriate admission status in accordance with MCG/InterQual criteria
- Monitors on an ongoing basis 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 with 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
Requirements
What you’ll need- Graduate of an accredited school of professional nursing
- Licensed RN in the State of Florida is required
- Bachelor of Nursing is preferred. (BSN)
Benefits
Comp & perks- Comprehensive benefits that start on your first day of work
- Retirement savings program with employer matching