Utilization Review Registered Nurse

Are you a passionate and dedicated Registered Nurse looking for a rewarding career opportunity? Look no further than Baptist Health South Florida! We are currently seeking a Utilization Review Registered Nurse to join our team and play a vital role in ensuring the delivery of high-quality healthcare services to our patients. As a Utilization Review RN, you will utilize your clinical expertise to review and assess the appropriateness and efficiency of medical services provided to our patients. The ideal candidate will possess strong critical thinking skills, excellent communication abilities, and a commitment to providing exceptional patient care. If you meet the qualifications listed below, we encourage you to apply for this exciting opportunity and become part of our dynamic healthcare team.\n\nConduct utilization reviews to determine the appropriateness and efficiency of medical services provided to patients.\nUtilize clinical expertise to assess patient needs and make recommendations for appropriate care plans.\nCommunicate with healthcare providers and insurance companies to ensure proper utilization and reimbursement for medical services.\nMaintain accurate and detailed records of patient assessments, referrals, and care plans.\nCollaborate with interdisciplinary teams to develop and implement strategies for improving patient care and outcomes.\nStay up-to-date on industry regulations and guidelines related to utilization review.\nEducate and train healthcare staff on proper utilization review processes and procedures.\nAdvocate for patients to receive the best care possible while also managing costs for the healthcare organization.\nIdentify areas for process improvement and make recommendations to enhance efficiency and quality of care.\nProvide support and guidance to patients and their families, addressing any questions or concerns related to utilization review.\nParticipate in quality improvement initiatives to maintain high standards of patient care.\nAdhere to all ethical and legal standards related to patient confidentiality and privacy.\nCollaborate with insurance companies and other third-party payers to ensure timely and accurate reimbursement.\nMaintain a positive and professional demeanor while interacting with patients, families, and colleagues.\nAttend trainings and conferences to stay current on best practices and new developments in the field of utilization review.\n\nBaptist Health South Florida is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.