RN Utilization Review Care Navigator

UT Health San Antonio; San Antonio (TX); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Disability insurance

Retirement plan

Paid time off

Job summary

UT Health San Antonio is seeking an Utilization Review Care Coordinator in the Care Management Department. You will ensure appropriate use of healthcare resources, review patient cases, monitor treatment plans, and collaborate with healthcare providers to optimize care delivery and resource utilization.

The role requires RN licensure, 3+ years of clinical nursing, and 2+ years in utilization review, with InterQual knowledge preferred.

Qualifications

• 3+ years of clinical nursing experience.
• 2+ years in utilization review.
• Experience with InterQual preferred.
• RN licensure (state or compact) required.

Responsibilities

• Conduct utilization reviews to ensure medical necessity and efficiency of services.
• Evaluate patient records and treatment plans for guideline adherence.
• Collaborate with physicians, nurses, and case managers to improve care.
• Facilitate authorization for admissions and procedures with payers.
• Monitor progress and discharge plans for timely transitions of care.
• Educate patients and families about UR processes and requirements.
• Maintain detailed documentation of reviews and actions.

Skills

Clinical nursing experience

Utilization review experience

InterQual knowledge

RN licensure

Education

Bachelor's in Nursing

Tools

InterQual

Job description

UT Health San Antonio is seeking an Utilization Review Care Coordinator in the Care Management Department. You will ensure appropriate use of healthcare resources, review patient cases, monitor treatment plans, and collaborate with healthcare providers to optimize care delivery and resource utilization.

The role requires RN licensure, 3+ years of clinical nursing, and 2+ years in utilization review, with InterQual knowledge preferred.