Independent Auditor Hospital Utilization Management Registered Nurse, Broward
Wellpath | Pompano Beach, FL
Our UM Nurse will assist with analyses of medical necessity, level of care, care progression, and resource utilization.
- Graduation from an accredited School of Nursing
- Previous experience working with utilization management
- Computer data entry experience
- Current licensure as a Registered Nurse
ResponsibilitiesUtilizes nationally recognized evidence-based criteria to determine medical necessity of requested services, diagnostics, specialty care, or inpatient care.Refers provider requests when the requested services do not meet the recognized criteria.Coordinate with healthcare staff and providers to plan for discharge back to DOC institutions.Reviews information to determine the level of care or the medical necessity of any services requested by a provider.Reviews and audit inmate medical records to determine what services or procedures are medically necessary.Must be able to obtain and maintain security clearance.Must be able to apply principles of critical thinking to a variety of practical and emergent situations and accurately follow standardized procedures that may call for deviations.Must be able to apply sound judgment beyond a specific set of instructions and apply knowledge to different factual situations.Must be alert at all times; pay close attention to details.Must be able to work under stress on a regular or continuous basis.Post orders, if applicable, per site contract.Perform other duties as assigned.
CCS is an EOE/Minorities/Females/Vet/Disability Employer