Top 9 Utilization review nurse Jobs in Ocala Fl

Utilization Specialist
The Refuge, A Healing Place —Ocklawaha, FL
- From $20 an hour
- Full-time
- CPR Certification
- Nursing
- BLS Certification
MDS Resource
Everglades Healthcare —Ocala, FL
- $86,000 - $91,000 a year
- Weekends as needed
- Nursing
- Skilled nursing facility
- RN License
- Health insurance
- Dental insurance
Quick Apply
Home Health Clinical Manager
Centerwell —Ocala, FL
- $77,200 - $106,200 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Paid holidays
7d
Nurse Practitioner
Neal Lumapas MD PA —Dunnellon, FL
- $80,000 - $120,000 a year
- Full-time
- Vital signs
- Primary Care
- HIPAA
- Paid time off
- Flexible schedule
Quick Apply

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Utilization Specialist
The Refuge, A Healing Place —Ocklawaha, FL
Facilitate peer review calls between facility and external organizations. Gather and develop statistical and narrative information to report on utilization, non…
From $20 an hour
Case Manager / PRN ( RN / RT / SW / LPN )
Select Specialty Hospital - Gainesville —Gainesville, FL
Current licensure in a clinical discipline either as a Nurse (RN /LPN/ LVN)or a Respiratory Therapist OR current license / certified Social Work license per…
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Case Manager / PRN ( RN / RT / SW / LPN )
Select Specialty Hospital - Columbus Vic Village(Grant) —Columbus, OH
Current licensure in a clinical discipline either as a Nurse (RN /LPN/ LVN)or a Respiratory Therapist OR current license / certified Social Work license per…
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Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…

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Utilization Specialist

The Refuge, A Healing Place -
Ocklawaha, FL

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Job Details

Full-time
From $20 an hour

Qualifications

CPR Certification
BLS Certification
High school diploma or GED
Behavioral health

Full Job Description

Overview:

The Refuge provides premier residential treatment for adults aged 18 and older who are struggling with substance use disorders, behavioral health, trauma, eating disorder and other co-occurring disorders.

We are looking to for a Full Time Utilization Review Specialist to join our team. The UR specialist proactively monitors utilization of services for patients to optimize reimbursement for the facility. This is a Monday-Friday, day position working 40 hours per week.

PURPOSE STATEMENT:

Proactively monitor utilization of services for patients to optimize reimbursement for the facility.

Pay for this position starts at $20/hr and based on relevant work experience. Higher starting wages for candidates that meet the preferred education criteria will be discussed.

Preferred education: Associate's, Bachelor's or Master's Degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.

Required experience: Clinical experience is required, 2 or more years experience working in the behavioral health field. Previous experience in utilization management is strongly preferred.

Responsibilities:

ESSENTIAL FUNCTIONS:

Act as liaison between managed care organizations and the facility professional clinical staff.
Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coordinate the flow of communication concerning reimbursement requirements.
Monitor patient length of stay and extensions and inform clinical and medical staff on issues that may impact length of stay.
Gather and develop statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal information), discharges and quality of services, as required by the facility leadership or corporate office.
Conduct quality reviews for medical necessity and services provided.
Facilitate peer review calls between facility and external organizations.
Initiate and complete the formal appeal process for denied admissions or continued stay.
Assist the admissions department with pre-certifications of care.
Provide ongoing support and training for staff on documentation or charting requirements, continued stay criteria and medical necessity updates.

OTHER FUNCTIONS:

Perform other functions and tasks as assigned.

Qualifications:

EDUCATION/EXPERIENCE/SKILL REQUIREMENTS:

Required Education: High school diploma or equivalent.
Preferred Education: Associate's, Bachelor's, or Master’s degree in Social Work, Behavioral or Mental Health, Nursing, or a related health field.
Experience: Clinical experience is required, or two or more years' experience working with the facility's population. Previous experience in utilization management is preferred

LICENSES/DESIGNATIONS/CERTIFICATIONS:

CPR and de-escalation and restraint certification required (training available upon hire and offered by facility.
First aid may be required based on state or facility requirements.

ADDITIONAL REGULATORY REQUIREMENTS:

While this job description is intended to be an accurate reflection of the requirements of the job, management reserves the right to add or remove duties from particular jobs when circumstances
(e.g. emergencies, changes in workload, rush jobs or technological developments) dictate.

We are committed to providing equal employment opportunities to all applicants for employment regardless of an individual’s characteristics protected by applicable state, federal and local laws.

REFHP

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utilization review nurse jobs in ocala fl

Utilization Specialist

MDS Resource

Home Health Clinical Manager

Nurse Practitioner

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