Utilization Rev Nurse Coord , El Paso Health

El Paso Health; El Paso (TX); On-site; USD 70,000 - 90,000; Full time

Job summary

El Paso Health is seeking a Registered Nurse for their inpatient Utilization Review Unit. The role involves ensuring compliance with regulatory standards while providing quality healthcare. Candidates must have a Bachelor’s degree in Nursing and three years of nursing experience, preferably in a clinical setting.

The ideal candidate should exhibit strong organizational skills, the ability to manage multiple tasks, and be bilingual in English and Spanish. This position is full-time and requires a current Texas RN license.

Qualifications

• Three years of experience as a Registered Nurse required, preferably in a clinical setting.
• Strong knowledge of utilization review in Medicaid HMO required.
• Understanding of pre-acute and post-acute venues of care and community resources.

Responsibilities

• Assist with all activities associated with inpatient Utilization Review Unit.
• Ensure thorough and efficient review of each admission and continued stay.
• Serve as primary backup for the inpatient Utilization Reviewer.

Skills

Excellent verbal and written communication skills

Strong analytical and data management skills

Ability to work with diverse backgrounds

Strong organizational and time management skills

Ability to work independently

Bilingual English/Spanish

Education

Bachelor degree in Nursing

Job description

• Facility University Medical Center of El Paso
• Department EPH Health Services
• Schedule - Shift - Hours Full Time - Days

Job Summary

Assists the organization with all activities associated with El Paso Health’s (EPH) inpatient Utilization Review Unit. Ensures the Utilization Reviewers conduct a thorough and efficient review of each admission and continued stay while providing high quality health care in a cost effective manner. Ensures the Utilization Management (UM) unit’s compliance with all regulatory agencies’ rules and regulations, which govern health plan operations. Serves as the primary back up for the inpatient Utilization Reviewer in case of illness, vacation or other needs.

Skills

• Excellent verbal and written communication and interpersonal skills required as demonstrated by past job experience.
• Strong analytical, data management and computer skills.
• Able to work with people of all social, economic, and cultural backgrounds.
• Flexible, open-minded and adaptable to change.
• Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
• Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients/families.
• Bilingual English/Spanish and culturally sensitive highly preferred.

Work Experience

Three years of experience as a Registered Nurse required, preferably in a clinical setting. Strong knowledge of utilization review in Medicaid HMO required, with working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement required. Understanding of pre-acute and post-acute venues of care and community resources.

License/Registration/Certification

Current, active, unrestricted license as to practice as a Registered Nurse in the state of Texas.

Education and Training

Bachelor degree in Nursing required.

Contact

1145 Westmoreland Drive
El Paso, TX 79925-5615