Utilization Rev Nurse Coord , El Paso Health

University Medical Center of El Paso (UMC); El Paso (TX); On-site; USD 60,000 - 80,000; Full time

Job summary

University Medical Center of El Paso (UMC) is looking for a Registered Nurse for its inpatient Utilization Review Unit. The role involves ensuring compliance with regulations, assisting Utilization Review activities, and serving as a backup for reviewers.

Candidates should have a Bachelor degree in Nursing and at least three years of relevant experience. Bilingual skills are preferred to work with diverse patient populations.

Qualifications

• Three years of experience as a Registered Nurse required, preferably in a clinical setting.
• Strong knowledge of utilization review in Medicaid HMO is required.
• Current, active, unrestricted license to practice as a Registered Nurse in Texas.

Responsibilities

• Assist with activities of the inpatient Utilization Review Unit.
• Ensure compliance with all regulatory agencies' rules and regulations.
• Serve as the primary backup for the Utilization Reviewer.

Skills

Excellent verbal and written communication skills

Analytical skills

Data management

Interpersonal skills

Time management

Bilingual English/Spanish

Education

Bachelor degree in Nursing

Job description

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.