RN Behavioral Health Utilization Reviewer PRN at HCA

HCA East FloridaDivision

With more than 18,000 ofyour neighbors, friends and colleagues, the East Florida Division of HCA iscommitted to building healthy communities in South Florida and the TreasureCoast. The core of our values emanates from our continued focus on improvingthe health and quality of life for residents in the communities we serve. Toaccomplish this we strive to identify top talent aligned with our values anddedicated to furthering our mission. With 14 hospitals to choose from, yourpossibilities for achievement, variety, and career growth are endless. Weinvite you to learn more about who we are and how you can join our dynamicteam!

HCA East Florida Division is part of the nation’s leading providerof healthcare services, Hospital Corporation of America. HCA has been named oneof Ethisphere’s World’s Most Ethical Companies for eight consecutive years.Join our tradition of excellence!

Thisposition will focus on initial and continued stay utilization review as neededfor authorization procurement and mitigation of concurrent denials. Thisinvolves assessment of the medical records for appropriateness, level of careprovided, including assessment of treatment modalities, medications, servicesand application of treatment protocols. Remain current with HCA educationstandards and guidelines, such as annual InterQual education, ongoing Midaseducation and Midas worklist rules. Maintain nursing/SW licensure for assignedgeographical market.

Specificjob duties include (but are not limited to):

• Conduct medical recordreview, validate admission status order, conduct a medical necessity review andprovide clinical information to payor
• Document all efforts togain authorization and payor communications, confirming all days authorized ordenied and document in Midas
• Utilize criticalthinking skills to review and apply medical necessity criteria
• Proficient inapplication and use of InterQual
• Analyze documentationof clinical care from the electronic medical record
• Exhibit determined andassertive verbal and written communication skills when interacting with payors
• Demonstrate knowledgeand effective use of multiple applications, systems and resources
• Example, but notlimited to: Call Recording, WebEx Teams, Electronic Health Records, Payorportals, Right Fax, Share Point sites and On base
• Communicate withphysicians regarding patient status, clinical documentation and concurrentdenial mitigation strategies
• Practice adherence toHCA UR guidelines and practice standards
• Ability to workindependently, show initiative and work with minimal supervision in a work fromhome environment