University of Miami
NurseUtilizationReviewSupervisor
“Nurse Utilization Review Supervisor at University of Miami. Skills: Utilization review, Case management, Supervision. Analyze and distribute daily assignments. Oversee staff and assure compliance”
Industry & Context.
Attempt to resolve issues; Resolve issues; Identify problems and alternative solutions
What They're Looking For.
Must Have
Bachelor’s degree in relevant field required, Valid State of Florida RN license required, Minimum 2 years of relevant experience required
What You'll Do.
Analyze and distribute daily assignments
Oversee staff and assure compliance
Provide input and complete annual evaluations
Assist Care Coordination staff with issues
Function as a Case Manager/Utilization Review Nurse
Assist with physician
patient and family issues
Escalate to Managed Care plans
Round on assigned floors
Manage observation patient process
Oversee medical necessity review completions
Work with physician(s) regarding medical necessity
Facilitate decision making in evaluation program
Review hospital EMR census
Complete and forward daily assignment
Oversee Outpatient Observation cases
Assure compliance of admission reviews
Conduct continued stay case reviews
Conduct audits for admission appropriateness
Collaborate with attending physician
Collaborate with manager
Review and discuss case with Physician Advisor
Facilitate patient access
Ensure smooth transition between care settings
Provide information to patients and families
Disseminate case management activities
Document treatment plan
Establish monitoring protocols
Maintain working relationship with managed care plans
Notify Manager/Director of potential/actual denials
Oversee denials during weekends
Assist management with regulatory information
Coordinate discharge plans
Arrange interagency referrals
Arrange transportation needs
Coordinate discharge planning with patient and family
Escalate coordination delays with Managed Care Plan
Participate in complex case review meetings
Document Avoidable Days
Monitor compliance with Discharge Important Message
Monitor and assure compliance with case manager documentation
and provide information to healthcare team
Enhance professional growth and development
Serve as preceptor to new Case Managers
Provide in-service on utilization management
How You'll Work.
Team & Collaboration
Cross-functional coordination; Work with the entire Case Management Department; Collaborate with attending physician; Collaborate with manager, director and physician advisor; Collaborate with social services; Coordinate discharge plans with appropriate departments; Coordinate discharge planning with patient and family; Disseminate case management activities to appropriate members of the health care team; Educate, coordinate, and provide information to members of the multidisciplinary healthcare team
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