[Hiring] Nurse Utilization Review Supervisor @University of Miami

Role Description

This position functions as the Supervisor for the Case Management Department under the direction of the Director of Case Management, with supervision by the Case Manager Manager. Responsibilities include:

• Analyzing and distributing daily assignments.
• Oversight of staff and ensuring compliance with case manager and/or utilization review initiatives.
• Providing input and completing annual evaluations.
• Assisting Care Coordination staff with family/physician issues.
• Functioning as a Case Manager and/or Utilization Review Nurse as needed.
• Managing observation patient processes and overseeing medical necessity reviews.
• Facilitating decision-making for evaluation programs and interdisciplinary treatment plans.

Qualifications

• Bachelor’s degree in relevant field required.
• Valid State of Florida RN license required.
• Minimum 2 years of relevant experience required.

Requirements

• Reviews hospital EMR census and forwards daily assignments to staff.
• Assures compliance of admission reviews utilizing InterQual® criteria.
• Conducts audits to ensure admission appropriateness and clinical necessity.
• Collaborates with attending physicians and other healthcare professionals on difficult cases.
• Participates in the development, implementation, and evaluation of the continuum of care.
• Notifies Manager and/or Director of Case Management of potential and/or actual denials.
• Assists with discharge planning and coordination with appropriate departments.
• Serves as an educational resource to Medical and Facility Staff.
• Complies with all policies & procedures pertaining to HIPAA.
• Works closely with the entire Case Management Department.

Benefits

• Competitive salaries.
• Comprehensive benefits package including medical, dental, and tuition remission.