Utilization review nurse [h1.location_city]

PHYSICIAN ADVISOR - CENTRALIZED UTILIZATION REVIEW - FT DAYS - MHS

• Location : Hollywood, FL
• Specialty : Physician Advisor
• Job Number : FY26 01

Summary :

Ensures documentation, data capture and opportunities for utilization are compliant, accurate and consistent.

Responsibilities :

Makes decisions on referred individual patient cases regarding : Pre-admission, authorization, Medical necessity and services / setting, transfers, appropriateness of admission, and continued stay. Conducts peer to peer discussions with health plans when required.Works in collaboration with the Medical Director of Centralized UR / HIM, utilization committees and medical staff to maintain and improve utilization and documentation efforts.Performs regular, follow-up and focused chart audits / reviews (concurrent and retrospective) for the purpose of assessing the accuracy of clinical documentation and utilization. Ability to work weekends and holidays as needed.Serves as a resource to the medical staff for Utilization Review activities. Educates and communicates to the Medical staff the benefits / need for utilization review and documentation.

Competencies :

Education and Certification Requirements :

Medical Doctor (Required)Medical Doctor License (ME LICENSE) - State of Florida (FL), Osteopathic Physician License (OS LICENSE) - State of Florida (FL)

Additional Job Information :

Complexity of Work : Requires critical thinking skills, effective communication, decisive judgment and the ability to work with minimal supervision. The incumbent must be able to work in a stressful environment and take appropriate action when required.

Required Work Experience : Minimum of 1 year of work experience in a clinical setting

Other Information : Prior experience in Utilization Management with hospital system or health system preferredAdditional Education Info : Graduate of a medical school approved by the Council on Medical Education of the American Medical Association.

About Memorial Healthcare System

Since its inception in , Memorial Healthcare System has been a leader in providing high-quality healthcare services to South Florida residents. Moving health forward to meet the needs of the community, Memorial is one of the largest public healthcare systems in the nation and highly regarded for its exceptional patient- and family-centered care that creates the Memorial experience. Memorial's patient, physician and employee satisfaction rates are some of the most admired in the country, and the system is recognized as a national leader in quality healthcare.

is the flagship facility of the healthcare system and is one of the largest hospitals in Florida. Memorial Regional Hospital offers extensive and diverse health care services that include featuring renowned surgeons, treating more inpatients than any other in Broward County, and providing innovative technology and world-class physicians. Memorial Regional Hospital and are both located in Hollywood, Florida, and offer our community a variety of medical and surgical services. at Memorial provides a comprehensive array of pediatric services and is the leading children's hospital in Broward and Palm Beach counties. , and serve the communities of western Broward County and others in South Florida. Memorial Home Health Services, nursing home and a variety of ancillary healthcare facilities round out the system's wide-ranging health services.

About South Florida

South Florida combines Miami-Dade, Broward, and Palm Beach counties, as well as the Florida Keys in Monroe County, with beautiful beaches, museums, wildlife, and sunshine all year round. The area offers a dynamic lifestyle with an abundance of cultural and recreational amenities, including top-rated golf courses, historic art communities, zoos and wildlife refuges, and world-class restaurants. South Florida is home to some of the biggest championship-winning sports teams, the Florida Panthers, Miami Heat, Miami Dolphins, and Miami Marlins, with games hosted in several of South Floridas premier stadiums. Florida residents enjoy beautiful weather year-round and benefit from no state income tax attracting new residents from all over the country and around the world.