RN Utilization Review Coordinator - Hybrid Case Management

Surgery Partners Brand; Addison (TX); Hybrid; USD 65,000 - 95,000; Full time

Job summary

Surgery Partners Brand seeks an RN Utilization Review Coordinator for Methodist Hospital for Surgery in Addison, TX. This full-time, hybrid role supports prospective, concurrent, and post-discharge reviews to ensure medical necessity and payer compliance.

The successful candidate will collaborate with physicians and the Case Management team, manage denials, and contribute to discharge planning and quality improvement initiatives. A Texas RN license and five years in case management are preferred.

Qualifications

• Bachelor of Science in Nursing preferred.
• Active RN license in Texas; CPR certification required.
• Case Management Certification(s) preferred.
• At least five years of experience in Case Management, Discharge Planning, and Utilization Review.

Responsibilities

• Perform prospective, concurrent, and post-discharge utilization reviews to determine medical necessity.
• Collaborate with physicians and interdisciplinary team to promote efficient patient progression.
• Assist with discharge planning activities and quality improvement initiatives.
• Submit admission, continued stay, and discharge notifications to insurers.
• Maintain accurate documentation to regulatory standards.

Skills

RN

Case Management

Utilization Review

Discharge Planning

Education

Bachelor of Science in Nursing

Job description

Surgery Partners Brand seeks an RN Utilization Review Coordinator for Methodist Hospital for Surgery in Addison, TX. This full-time, hybrid role supports prospective, concurrent, and post-discharge reviews to ensure medical necessity and payer compliance.

The successful candidate will collaborate with physicians and the Case Management team, manage denials, and contribute to discharge planning and quality improvement initiatives. A Texas RN license and five years in case management are preferred.