DescriptionSHIFT: Work From Home
SCHEDULE: PRN/Per Diem
Behavioral Health RN Utilization Reviewer PRN Per Diem, FTE 0.001
HCA East Florida DivisionFort Lauderdale, FL Facility Description:
With more than 18,000 of your neighbors, friends and colleagues, the East Florida Division of HCA is committed to building healthy communities in South Florida and the Treasure Coast. The core of our values emanates from our continued focus on improving the health and quality of life for residents in the communities we serve. To accomplish this we strive to identify top talent aligned with our values and dedicated to furthering our mission. With 14 hospitals to choose from, your possibilities for achievement, variety, and career growth are endless. We invite you to learn more about who we are and how you can join our dynamic team!
HCA East Florida Division is part of the nation's leading provider of healthcare services, Hospital Corporation of America. HCA has been named one of Ethisphere's World's Most Ethical Companies for eight consecutive years. Join our tradition of excellence!Position Description:
This position will focus on initial and continued stay utilization review as needed for authorization procurement and mitigation of concurrent denials. This involves assessment of the medical records for appropriateness, level of care provided, including assessment of treatment modalities, medications, services and application of treatment protocols. Remain current with HCA education standards and guidelines, such as annual InterQual education, ongoing Midas education and Midas worklist rules. Maintain nursing/SW licensure for assigned geographical market.
Specific job duties include (but are not limited to):
- Conduct medical record review, validate admission status order, conduct a medical necessity review and provide clinical information to payor
- Document all efforts to gain authorization and payor communications, confirming all days authorized or denied and document in Midas
- Utilize critical thinking skills to review and apply medical necessity criteria
- Proficient in application and use of InterQual
- Analyze documentation of clinical care from the electronic medical record
- Exhibit determined and assertive verbal and written communication skills when interacting with payors
- Demonstrate knowledge and effective use of multiple applications, systems and resources
- Example, but not limited to: Call Recording, WebEx Teams, Electronic Health Records, Payor portals, Right Fax, Share Point sites and On base
- Communicate with physicians regarding patient status, clinical documentation and concurrent denial mitigation strategies
- Practice adherence to HCA UR guidelines and practice standards
- Ability to work independently, show initiative and work with minimal supervision in a work from home environment
Education & Experience:
- Bachelor's degree in Nursing (Preferred)
- 1+ year(s) of experience in InterQual (Required)
- 1+ year(s) of experience in acute hospital experience (Required)
Or equivalent combination of education and/or experience
Licenses, Certifications, & Training:
- RN license (Required)
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For questions about your job application or this site please contact HCAhrAnswers at 1-844-422-5627 option 1.
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