Impactful Weekend Utilization Review Nurse (PRN)

University of Texas Southwestern Medical Center; Dallas (TX); On-site; USD 60,000 - 90,000; Part time

Job summary

UT Southwestern Medical Center is seeking an Utilization Review RN for PRN weekend shifts to conduct medical necessity reviews for acute care. The role relies on evidence-based guidelines to determine appropriate levels of care and to support physicians and care teams in admission decisions.

The position emphasizes collaboration across departments, adherence to regulatory requirements, and ongoing education to maintain high-quality, cost-effective care at our Dallas facility.

Qualifications

• Education: Graduate of accredited nursing program and holds an active unrestricted RN license in the State of Texas.
• Experience: 5 years total, including 2 years clinical and 3 years recent utilization review; prior experience with Epic CCM.

Responsibilities

• Collaborate with scheduling to obtain required clinical information for authorization.
• Conduct medical necessity reviews for Medicare/Medicaid and private insurers.
• Review new admissions concurrently at entry with available chart data.
• Communicate with admitting physicians when documentation does not support level of care.
• Apply hospital-approved tools to determine inpatient vs observation level of care.

Skills

Utilization review

Clinical experience

Education

RN education (Nursing degree)

Tools

Epic CCM

Job description

UT Southwestern Medical Center is seeking an Utilization Review RN for PRN weekend shifts to conduct medical necessity reviews for acute care. The role relies on evidence-based guidelines to determine appropriate levels of care and to support physicians and care teams in admission decisions.

The position emphasizes collaboration across departments, adherence to regulatory requirements, and ongoing education to maintain high-quality, cost-effective care at our Dallas facility.