Registered Nurse (RN) - Utilization Review

Oracle Corporation; El Paso (TX); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

401(k) with employer match

Generous paid time off

Career development opportunities

Health savings accounts

Job summary

Tenet Healthcare’s Hospitals of Providence in El Paso is seeking a Registered Nurse (RN) for Utilization Review. The role focuses on medical necessity screening, payer coordination, and ensuring appropriate care levels. Requires Texas RN license and 2 years acute care experience with 1 year in utilization review.

Graduate of an accredited nursing program is required; a BSN is preferred. The job offers professional growth and a comprehensive benefits package, reflecting Tenet’s commitment to

Qualifications

• Education: Graduate of an accredited school of nursing.
• Experience: 2 years of acute hospital or behavioral health patient care with at least 1 year utilization review in acute hospital or payer setting.

Responsibilities

• Provide accurate medical necessity screening and submission for Physician Advisor review.
• Secure and document authorization for services from payers.
• Manage concurrent disputes and collaborate with payers, physicians, and staff.
• Maintain timely, complete documentation in the Case Management system.
• Identify potentially avoidable days and report over/underutilization.

Education

Graduate of an accredited school of nursing

Bachelor's degree in nursing

Job description

Registered Nurse (RN) - Utilization Review

Job Description

Job Shift:Days

Job Type:Full Time

The individual in this position is responsible to facilitate effective resource coordination to help patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient’s resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity. This position manages medical necessity process for accurate and timely payment for services which may require negotiation with a payer on a case-by-case basis. This position integrates national standards for case management scope of services including: Utilization Management services supporting medical necessity and denial prevention; Coordination with payers to authorize appropriate level of care and length of stay for medically necessary services required for the patient; Compliance with state and federal regulatory requirements, TJC accreditation standards, and Tenet policy; and Education provided to payers, physicians, hospital/office staff, and ancillary departments related to covered services and administration of benefits.

Responsibilities

Responsible for providing accurate medical necessity screening and submission for Physician Advisor review. Securing and documenting authorization for services from payers. Managing concurrent disputes. Collaborating with payers, physicians, office staff, and ancillary departments. Timely, complete, and concise documentation in the Tenet Case Management documentation system. Maintenance of accurate patient demographic and insurance information. Identification and documentation of potentially avoidable days. Identification and reporting over and underutilization.

Qualifications

Education:

Required: Graduate of an accredited school of nursing

Preferred: Academic degree in nursing (bachelor's or master's)

Experience:

Required: 2 years of acute hospital or behavioral health patient care experience with at least 1 year utilization review in an acute hospital or commercial/managed care payer setting

Certifications:

Required: RN. Must be currently licensed, certified or registered to practice profession as required by law or regulation in state of practice or policy. Active RN license for state(s) covered.

About Us

Join our dedicated healthcare team where compassion meets innovation! As a Registered Nurse with us, you'll have the opportunity to make a meaningful impact in patients' lives while enjoying a supportive work environment that fosters professional growth and work-life balance. Ready to be a vital part of our mission? and bring your passion for nursing to a place where it truly matters!

At Tenet Healthcare, we understand that our greatest asset is our dedicated team of professionals. That’s why we offer more than a job – we provide a comprehensive benefit package that prioritizes your health, professional development, and work-life balance. The available plans and programs include:

• Medical, dental, vision, and life insurance
• 401(k) retirement savings plan with employer match
• Generous paid time off
• Career development and continuing education opportunities
• Health savings accounts, healthcare & dependent flexible spending accounts
• Employee Assistance program, Employee discount program
• Voluntary benefits include pet insurance, legal insurance, accident and critical illness insurance, long term care, elder & childcare, auto & home insurance

Note: Eligibility for benefits may vary by location and is determined by employment status

About the Team

The Hospitals of Providence have faithfully been serving our community since 1902. Generations of families have chosen our hospitals to be a steward of health in the El Paso community. Our five hospitals include a childrens hospital committed to providing the care patients need, when they need it. Today, the Hospitals of Providence are comprised of our region's most trusted hospitals, each dedicated to meeting our families specific healthcare needs. Join our team!

Job Info

• Job Identification 2603019659
• Job Category Support/Clinical
• Posting Date 08/07/2026, 06:56 PM
• Degree Level Bachelor's Degree (±16 years)
• Job Schedule Full time
• Job Shift Day
• Locations Thop Transmountain Campus (Remote)