RN Utilization Review Specialist

HUMBLE VASCULAR SURGICAL CENTER INC; Addison (TX); On-site; USD 75,000 - 90,000; Full time

Job summary

HUMBLE VASCULAR SURGICAL CENTER INC in Addison, Texas, is seeking a dedicated RN Case Manager to oversee utilization reviews and discharge planning. The role involves ensuring compliance with medical necessity guidelines while collaborating with physicians and interdisciplinary teams.

The ideal candidate will possess a Bachelor of Science in Nursing, an active RN license in Texas, and five years of relevant experience. Strong communication and critical thinking skills are essential for effectively managing patient care and achieving optimal outcomes.

Qualifications

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

Responsibilities

• Conduct comprehensive medical record reviews using specific criteria.
• Perform prospective, concurrent, and post-discharge utilization reviews.
• Identify, track, and manage utilization review denials.
• Collaborate with Case Management team for discharge planning.

Skills

Critical thinking skills

Attention to detail

Communication skills

Multi-tasking

Education

Bachelor of Science in Nursing

Tools

Hospital-approved criteria software

Job description

HUMBLE VASCULAR SURGICAL CENTER INC in Addison, Texas, is seeking a dedicated RN Case Manager to oversee utilization reviews and discharge planning. The role involves ensuring compliance with medical necessity guidelines while collaborating with physicians and interdisciplinary teams.

The ideal candidate will possess a Bachelor of Science in Nursing, an active RN license in Texas, and five years of relevant experience. Strong communication and critical thinking skills are essential for effectively managing patient care and achieving optimal outcomes.