BayCare Winter Haven, FL

About the Job


The Advanced Practice RN - Utilization Management/Physician Advisor Services (APRN - UM/PAS) is an APRN serving the health system through assisting Physician Advisors on a hospital and system level with clinical reviews and data analysis in collaboration with the Care Management, Utilization Review/Denials, Clinical Documentation Integrity, Coding, and Managed Care departments. The APRN - UM/PAS will assist Physician Advisors to develop and implement methods to optimize use of hospital services for all patients while also ensuring the quality of care provided by efficient management of resources, ensuring patients are in the appropriate level of care, supporting documentation, coding improvements and compliance and monitoring the appropriate use of diagnostic and therapeutic modalities. Primary focus will be on assisting with denials prevention and management. The APRN - UM/PAS will also assist with the administration and functioning of the Physician Advisor program. Preferred certification includes Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP). Required qualifications includes Advanced Practice Registered Nurse obtaining graduate education at the masters, post-master?s or doctoral level and obtain national board certification. Preferred qualifications include Non-Physician Member of the American College of Physician Advisors (ACPA); Familiarity with MCG/InterQual placement status criteria.


Certifications and Licensures

RequiredAPRN (Advanced Practice Registered Nurse)Nursing
PreferredReference summary for details


Required3 yearsHealthcare

Specific Skills
RequiredCustomer service skills
RequiredWritten and verbal communication skills
RequiredInterpersonal skills
RequiredWork independently
RequiredWork with a team
RequiredCritical thinking skills
RequiredOrganizational skills
RequiredAdministrative and clerical skills
RequiredComputer skills appropriate to position
RequiredKnowledge of regulatory standards appropriate to position
RequiredManagement skills
RequiredMedical terminology use and understanding