Responsible for collaborating with all members of the healthcare delivery team. Serves as a resource to the hospital for Utilization Review issues. The focus is on care appropriateness and quality care. Serves as a resource to the hospital for utilization.
Requires current Florida Registered Nurse license, minimum 5 years clinical or hospital experience. Certification or experience in UR Case Mgmt, or Medical Review. Knowledge of reimbursement principles, discharge planning process, JCAHO standards, ubfectuib cibtrik principles, Interqual or Milliman criteria. Advanced written, verbal and interpersonal skills, including effective time management, priority setting and process improvement.