Utilization Review Nurse - Acute Care & Care Coordination

UT Southwestern Medical Center; Dallas (TX); On-site; USD 80,000 - 110,000; Part time

Benefits offered by this job

PPO medical plan

Preventive care coverage

Paid Time Off

Retirement (TRS)

Parental Leave

Wellness programs

Tuition Reimbursement

Job summary

UT Southwestern Medical Center in Dallas is seeking a Utilization Review Nurse - RN (PRN). The role requires flexible availability Monday through Friday, 8am–5pm, to conduct utilization reviews for acute care services and ensure medical necessity per guidelines.

The ideal candidate holds an accredited nursing degree and active Texas RN license, with 5 years of nursing experience including 2 years in clinical settings and 3 years in utilization review.

Qualifications

• RN license in Texas and graduation from an accredited nursing program.
• At least 5 years in nursing with 2 years in clinical settings and 3+ years in utilization review.
• Experience with Epic CCM is preferred.

Responsibilities

• Conduct medical certification reviews for medical necessity for acute care.
• Review admissions for Medicare/Medicaid and private insurance using evidence-based guidelines.
• Communicate with admitting physicians when documentation does not support level of care.
• Escalate progression-of-care barriers to appropriate departments.
• Participate in daily huddles and department meetings.

Skills

Utilization review

Clinical experience

Education

RN license (Texas)

Tools

Epic CCM

Job description

UT Southwestern Medical Center in Dallas is seeking a Utilization Review Nurse - RN (PRN). The role requires flexible availability Monday through Friday, 8am–5pm, to conduct utilization reviews for acute care services and ensure medical necessity per guidelines.

The ideal candidate holds an accredited nursing degree and active Texas RN license, with 5 years of nursing experience including 2 years in clinical settings and 3 years in utilization review.