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Utilization Review Nurse (RN) – Full-Time, Hybrid

Trinity Health
  • Ft. Lauderdale, Florida
    3 days ago

    Job Description

    Employment Type:

    Full time

    Shift:

    Day Shift

    Description:

    The Utilization Review Nurse is responsible for ensuring appropriate admission status and level of care for hospitalized patients in accordance with MCG/InterQual (Indicia) criteria, CMS regulations, and Managed Care payer requirements. This role partners closely with physicians, physician advisors, case management, and payers to support timely authorizations, concurrent reviews, and discharge planning while minimizing avoidable days and ensuring regulatory compliance.
    • Full-time position
    • Hybrid model (combination of on-site and remote work based on department needs)
    • Ability to adapt to multiple UR roles including Observation, Inpatient Review, and Department Coordination
    • Conduct initial and concurrent chart reviews to confirm admission and continued stay meet level-of-care criteria
    • Provide telephonic or electronic clinical reviews to external payers to support authorization decisions
    • Experience in Utilization Review, Case Management, or Managed Care
    • Working knowledge of MCG/InterQual (Indicia) criteria
    • Familiarity with CMS, Medicare, Medicaid, and commercial payer regulations
    • Proficiency with Epic or similar EMR systems
    • Strong clinical judgment, communication, and documentation skills

    Our Commitment

    Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

    Numbers & Facts

    LocationFt. Lauderdale, Florida
    IndustryHealthcare Services
    Company Size10,000 employees or more
    Websitehttps://jobs.trinity-health.org/search-results

    About Company

    Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. It is a family of 121,000 colleagues and nearly 36,500 physicians and clinicians caring for diverse communities across 27 states. Nationally recognized for care and experience, the Trinity Health system includes 101 hospitals, 126 continuing care locations, the second largest PACE program in the country, 136 urgent care locations and many other health and well-being services. In fiscal year 2023, the Livonia, Michigan-based health system invested $1.5 billion in its communities in the form of charity care and other community benefit programs.

    Skills

    • Case Managementunmatched
    • Centers for Medicare and Medicaid Services (CMS)unmatched
    • Clinical Validationunmatched
    • Content Management Systems (CMS)unmatched
    • Discharge Plansunmatched
    • Documentationunmatched
    • Electronic Medical Recordsunmatched
    • Epic Systemsunmatched
    • Health Informaticsunmatched
    • Maintain Complianceunmatched
    • Managed Careunmatched
    • Medicaidunmatched
    • Medicareunmatched
    • Nursingunmatched
    • Patient Careunmatched
    • Quality of Careunmatched
    • Registered Nurse (RN)unmatched
    • Regulationsunmatched
    • Requirements Managementunmatched
    • Time Managementunmatched
    • Utilization Managementunmatched
    • Work From Homeunmatched

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