Current active and unrestricted licensure in Florida as a Registered Nurse (RN)
Associate degree in nursing required. Bachelor Science Nursing or additional degree in health care management/health care administration preferred.
Minimum of three (3) years post-licensure experience as a practicing RN. Acceptable areas include but are not limited to: Emergency Room, Medical/Surgical, or ICU.
Prior experience in a leadership role in managed care or healthcare environment preferred.
Previous experience with utilization management, utilization review, prior authorization, or case management required.
Knowledge of Medicare criteria, DRG’s, InterQual, and/or MCG Care Guidelines required.
Knowledge of levels of hospitalization, inpatient rehabilitation, skilled nursing facility, home health care, behavioral health, community resources, and FHCP networks preferred.
Excellent communication skills, including both oral and written.
Strong telephone and customer service skills required. Must be able to diffuse difficult situations.
Strong organizational and time management skills. Must be capable of multitasking.
Proficiency with computer skills including Microsoft Word, Outlook, and Office Suite
Must be able to type a minimum at a fast pace with high accuracy.
Willing to work an alternate work schedule, occasional weekend/holiday rotation and 24/7 on-call.
Must have reliable transportation for travel requirements.
POSITION SUMMARY:Under the direction and oversight of the Manager of Utilization Review, the Nurse Supervisor Utilization Review is responsible for supervising the coordination of services for members of Florida Healthcare Plans admitted to and/or discharged from an inpatient acute or skilled nursing facility as well as outpatient services as delegated. This position will oversee day to day activities related to utilization review conducted by Inpatient Utilization Review Nurses for members at the acute hospital, recovery facility, behavioral health, and home health care levels. The Nurse Supervisor Utilization Review will collaborate with Management and Administration on policies, projects, and strategies that adhere to organizational goals for cost effective quality care of members. This position will also assist the Manager of Utilization Review in performance projects, departmental reporting, and departmental educational needs as necessary.POSIT
