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Job Summary |
The Utilization Review (UR) Nurse has acute knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual supports the UM program by developing and/or maintaining effective and efficient processes for determining the appropriate admission status based on the regulatory and reimbursement requirements of various commercial and government payers. This individual is responsible for performing a variety of concurrent and retrospective UM-related reviews and functions and for ensuring that appropriate data is tracked, evaluated, and reported. This individual identifies, develops, and provides orientation, training, and competency development for appropriate staff and colleagues on an ongoing basis. He/she actively participates in process improvement initiatives, working with a variety of departments and multi-disciplinary staff. This individual maintains current and accurate knowledge regarding commercial and government payers and CIHQ regulations/guidelines/criteria related to UM. The UR Nurse effectively and efficiently manages a diverse workload in a dynamic regulatory environment. The UR Nurse is a member of, and provides support to, the hospital’s UR Committee. He/she collaborates with multiple leaders at various levels throughout Shannon Health, for the purpose of supporting and improving the UM program.
Education |
Education Type | Program of Study | Required/Preferred |
High School Diploma | N/A | Required |
Associate’s degree | Nursing | Required |
Bachelor’s degree | Nursing | Preferred |
Experience |
Number of Years | Type of Experience | Required/Preferred |
5 Years | Clinical nursing | Required |
1 Year | Inpatient Utilization Review | Preferred |
Certification & Licensures |
Certification/Licensure Type | Required/Preferred |
Registered Nurse (RN), with Authorization to Practice in the State of Texas | Required |
ACM (Accredited Case Manager) through ACMA | Preferred |
CCM (Certified Case Manager) through CCMC | Preferred |
*Must obtain within ninety (90) days of hire
Other
$67k-82k (estimate)
01/27/2024
06/26/2024
The job skills required for Utilization Review Nurse include Initiative, Clinical Nursing, etc. Having related job skills and expertise will give you an advantage when applying to be an Utilization Review Nurse. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Utilization Review Nurse. Select any job title you are interested in and start to search job requirements.
The following is the career advancement route for Utilization Review Nurse positions, which can be used as a reference in future career path planning. As an Utilization Review Nurse, it can be promoted into senior positions as a Clinical Outcomes Manager that are expected to handle more key tasks, people in this role will get a higher salary paid than an ordinary Utilization Review Nurse. You can explore the career advancement for an Utilization Review Nurse below and select your interested title to get hiring information.