6 Utilization Review RN Jobs in Dallas, TX
Texas Institute for Surgery is Hiring an Utilization Review RN Near Dallas, TX
Job Location
Texas Institute for Surgery LL SURG - Dallas, TX
Salary Range
$38.00 - $43.00 Hourly
Job Category
Health Care
Description
Job Summary:
- The Utilization Management Nurse will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorizations. This role performs telephonic and/or concurrent review of inpatient hospitalizations and extended courses of outpatient. The nurse will use clinical judgement, utilization management, application of product benefits, understanding of regulatory requirements, and verification of medical necessity utilizing nationally recognized criteria. Acute Care Hospital Utilization Management Experience Required
- Facilitates progress through the continuum of care, from pre-admission through discharge
- Provide consultation to medical, nursing staff, health information management, revenue cycle, and payers on potential issues with reimbursement of hospitalization.
- Provides feedback to payers on patient's clinical status, and secures approvals for additional days of stay.
- Assists and facilitate the physician peer-to-peer review process with insurance medical directors.
- Prepares, drafts, and submit clinical on pre admission, denials, and additional days requests.
- Leads UR Committee. Must work within scope of practice.
- Assists Case Management with discharge planning and other tasks assigned.
- Assists in aggregating data for quality trending
- Adherence to Best Practices including CMS, Joint Commission and State laws governing medical necessity and adherence to the Case Management Standards
- All other tasks assigned by leadership.
Experience and Education:
- Acute Care Hospital Utilization Management Experience Required
- Five years Inpatient clinical nursing experience in an acute care hospital setting required.
- Minimum of two years Utilization Management acute care setting experience required.
- Minimum of one year drafting and submitting reconsiderations and appeals to Medicare experience.
- Preferably a minimum of two years of experience in an acute care setting.
- BLS Certified
- Licensed Vocational Nursing or Associate Degree in Nursing
Job Summary
Full Time
$74k-93k (estimate)
04/27/2024
05/11/2024
texasinstituteforsurgery.org
Dallas, TX
<25
Related Companies
The following is the career advancement route for Utilization Review RN positions, which can be used as a reference in future career path planning. As an Utilization Review RN, 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 RN. You can explore the career advancement for an Utilization Review RN below and select your interested title to get hiring information.
