We are seeking an experienced Utilization Management RN to join our esteemed surgical center in the one and only, Dallas, TX! This Nurse shoud ahve a minimum of 5 years INPATIENT clinical nursing experience in an acute care hospital setting, minimum of 2 years Utilization Management/Review in an acute care setting, Minimum of 2 yeras experience working with InterQual or Milliman in an acute care setting, and Bilingual preferred.

Experience:

Experience with Admin/Finance for patient stays

Medicare knowledge

Understands denial reports and trending

Experince with ways to prevent denials

Leads UR committee: Attends these meetings, times vary based on physicians schedule- Once per quarter

• Hours--> M-F 7am-3pm, 8am-4pm, or 9-5pm (Flexible on start/end times)

• Salary--> $80k-90k, based on experience

• Benefits--> Medical, Dental, HSA, Life Insurance/AD&D, Supplemental LI, ST/LT Disability, Accidental Injury & Critical Illness, 401k, PTO/Sick time, Tuition Reimbursement, Continuing Ed, Free Parking, Free Employee Health visits, Life Assistance program, Credit Union Membership, Fitness Program, and more!

We are seeking someone who has great customer service skills, experience taking inbound calls and making outbound calls, and someone who has experience with different types of cases. This team is a very close knit team and being a team player is a must!

The Utilization Management Nurse will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorizations. This role perfoms telephonic and/or concurrent review of inpatient hospitalizations and extended courses of outpatient. The nurse will use clinical judgement, utlization management, application of product benefits, understanding of regulatory requirements, and verification of medical necessity utilizing nationally recognized criteria.