Utilization Review Nurse - 4x10 Day Shifts

UT Southwestern Medical Center; Dallas (TX); On-site; USD 85,000 - 115,000; Full time

Job summary

UT Southwestern Medical Center in Dallas is seeking an experienced Utilization Review RN to conduct medical certification reviews for acute care services. You will apply nationally recognized guidelines to determine level of care and support physicians with admission decisions.

You will collaborate with the Central Scheduling Department, coordinate with care teams, stay current on regulatory changes, and help ensure high-quality, cost-effective care.

Qualifications

• RN license in Texas with nursing degree.
• 5 years total experience including 2 years clinical and 3 years utilization review.
• Epic CCM experience preferred.

Responsibilities

• Collaborates with Central Scheduling to obtain authorization.
• Conducts admission reviews for Medicare/Medicaid and private insurance.
• New admission reviews are done concurrently at entry when order placed.
• Communicates with admitting physicians when documentation does not support hospital level of care.
• Uses hospital-approved medical necessity tool to determine level of care for inpatient or observation/outpatient services.
• Keeps current on Federal, State and local regulatory changes affecting utilization management.
• Collaborates with admitting physician to provide accurate level of care at review.
• Escalates progression-of-care barriers to appropriate departments.
• Participates in daily huddles and departmental meetings.
• Educates care team on access to and use of levels of care.
• Promotes evidence-based protocols and/or order sets to influence high-quality, cost-effective care.
• Serves as a resource to physicians and billing for coverage and compliance issues.
• Completes reviews within department policies and quality standards.

Skills

Performance improvement

Basic computer skills

Medical necessity tool

Education

Nursing degree (RN)

Tools

Epic CCM

Job description

UT Southwestern Medical Center in Dallas is seeking an experienced Utilization Review RN to conduct medical certification reviews for acute care services. You will apply nationally recognized guidelines to determine level of care and support physicians with admission decisions.

You will collaborate with the Central Scheduling Department, coordinate with care teams, stay current on regulatory changes, and help ensure high-quality, cost-effective care.