Clinical Reviewer Nurse

Locations Showing 1 location Broward 3700 Commerce Parkway Miramar, FL 33025, USA Remote Travel Required : No Clinical Care Coordination HH Full-Time Requisition #: CLINI002660 Description Who we are: Integrated Home Care Services (IHCS) provides a comprehensive Integrated Delivery System in the home setting, offering Durable Medical Equipment (DME), Respiratory, Home Health, and Home Infusion services. Through our select network of Medicare and Medicaid Certified and Accredited providers, we are available 24/7 to meet the needs of our patients with compassion, expertise, and excellence. For more than 30 years, we have been dedicated to improving lives by delivering the highest quality in-home care services. As a trusted market leader in value-based Home Health, Durable Medical Equipment, and Home Infusion Services, we proudly serve more than 2 million lives across the United States and the Commonwealth of Puerto Rico. Our integrated care model is trusted by leading Managed Care Organizations (MCOs), physicians, and healthcare partners because of our commitment to exceptional patient outcomes and coordinated care. At IHCS, our patients are at the heart of everything we do. We believe in creating a culture built on compassion, integrity, collaboration, and innovation. Every team member plays a vital role in fulfilling our mission of enhancing the quality of life for those we serve through Exceptional Customer Service, Proven Outcomes, and Seamless Care. If you are passionate about making a meaningful impact, thrive in a collaborative environment, and are committed to excellence, we invite you to join our growing team. Together, we can continue transforming home healthcare while making a difference in the lives of our patients and the communities we serve. Offering a competitive compensation package, including but not limited to; Medical, Vision, Dental, Short- and Long-term insurance 6+ Days of Holidays Pay PTO Employer paid life insurance 401K with employer contribution Wellness program with reward incentives Employee recognition and reward programs What will you be doing: As a Utilization Management Nurse, you will ensure that home health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing patient treatment files, the utilization nurse will ensure that patients won’t receive unnecessary procedures, ineffective treatment, or unnecessarily extensive home healthcare. Concurrent review of patient’s clinical information for efficiency Ongoing review of precertification requests for medical necessity Coordinates patient care needs with a multi-disciplinary healthcare team Maintain accurate records of all patient related interactions Ability to stay organized and interact well with others in any situation Provide updates to Manager of Utilization Management for review What will you need to succeed: State licensure as a LPN or RN Minimum 2 years of prior experience in Utilization Management Strong knowledge of word processing and spreadsheet computer programs Utilization Management or Case Management certification preferred Join our team as we strive for excellence through teamwork, where our patients are #1! IHCS is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. #IND Travel Required No . Skills Team Player : Works well as a member of a group Enthusiastic : Shows intense and eager enjoyment and interest Detail Oriented : Capable of carrying out a given task with all details necessary to get the task done well Dedicated : Devoted to a task or purpose with loyalty or integrity Behaviors Team Player : Works well as a member of a group Enthusiastic : Shows intense and eager enjoyment and interest Detail Oriented : Capable of carrying out a given task with all details necessary to get the task done well Dedicated : Devoted to a task or purpose with loyalty or integrity Preferred Team Player : Works well as a member of a group Enthusiastic : Shows intense and eager enjoyment and interest Detail Oriented : Capable of carrying out a given task with all details necessary to get the task done well Dedicated : Devoted to a task or purpose with loyalty or integrity Motivations Ability to Make an Impact : Inspired to perform well by the ability to contribute to the success of a project or the organization Growth Opportunities : Inspired to perform well by the chance to take on more responsibility Preferred Ability to Make an Impact : Inspired to perform well by the ability to contribute to the success of a project or the organization Growth Opportunities : Inspired to perform well by the chance to take on more responsibility Required Strong knowledge of word processing and spreadsheet computer programs Utilization Management or Case Management certification preferred 2 years: experience in Utilization Management State licensure as a LPN or RN Licenses & Certifications Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. #J-18808-Ljbffr Integrated HomeCare Services