RN Utilization Review & Denial Specialist (Hybrid)

Surgery Partners, Inc; Addison (TX); Hybrid; USD 70,000 - 90,000; Full time

Job summary

A healthcare organization in Texas is seeking an RN Utilization Review Coordinator to perform utilization reviews and ensure medical necessity compliance. The role involves collaborating with healthcare teams, managing denial appeals, and supporting discharge planning. Candidates should possess a Bachelor's in Nursing and an active Texas RN license along with at least five years of relevant experience. This full-time hybrid position emphasizes attention to detail and critical thinking skills.

Qualifications

• Must have 5+ years of experience with Case Management, Discharge Planning, and Utilization Review.
• Active RN license in Texas and current CPR certification required.
• Case Management Certification(s) preferred.

Responsibilities

• Conduct comprehensive medical record reviews for utilization management.
• Facilitate admission status determinations based on clinical documentation.
• Collaborate with physicians and case managers on discharge planning.

Skills

Attention to detail

Critical thinking

Communication

Multi-tasking

Education

Bachelor of Science in Nursing

Job description

A healthcare organization in Texas is seeking an RN Utilization Review Coordinator to perform utilization reviews and ensure medical necessity compliance. The role involves collaborating with healthcare teams, managing denial appeals, and supporting discharge planning. Candidates should possess a Bachelor's in Nursing and an active Texas RN license along with at least five years of relevant experience. This full-time hybrid position emphasizes attention to detail and critical thinking skills.