RN Utilization Review Specialist - Inpatient Certification

The University of Texas Southwestern Medical Center; Dallas (TX); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

PPO medical plan

Paid Time Off

TRS retirement

Parental Leave

Tuition Reimbursement

PSLF eligible

Job summary

UT Southwestern Medical Center seeks an experienced RN Utilization Review Specialist. You will conduct medical necessity reviews for acute care, determine level of care using evidence-based guidelines, and serve as a resource on admission qualifications, coverage determinations, and documentation requirements.

The role requires 5 years of experience with 2 years clinical and 3 years utilization review, plus an active RN license in Texas.

Qualifications

• Graduate of accredited nursing program
• Active unrestricted RN license in Texas
• 5 years experience including 2 years clinical and 3 years utilization review

Responsibilities

• Collaborates with Central Scheduling to provide accurate clinical information for authorization
• Conducts admission reviews for Medicare/Medicaid and private insurance using evidence-based guidelines
• Coordinates with admitting physicians to verify documentation supports level of care
• Uses hospital-approved medical necessity tools to determine inpatient vs observation level of care
• Escalates progression-of-care barriers to appropriate departments

Skills

RN license

Clinical experience

Utilization review

Education

RN program graduate

Tools

Epic CCM

Job description

UT Southwestern Medical Center seeks an experienced RN Utilization Review Specialist. You will conduct medical necessity reviews for acute care, determine level of care using evidence-based guidelines, and serve as a resource on admission qualifications, coverage determinations, and documentation requirements.

The role requires 5 years of experience with 2 years clinical and 3 years utilization review, plus an active RN license in Texas.