Utilization Review Nurse: Case Management & Denials Expert

El Paso Childrens Hospital Corporation; El Paso (TX); On-site; USD 70,000 - 95,000; Full time

Job summary

Paycom - ATS is seeking an Experienced Utilization Management Nurse in El Paso, TX to monitor hospital utilization and ensure appropriate admissions and stays. You will integrate clinical and billing knowledge while coordinating peer reviews with physician advisers to support policy and process improvements.

The role requires an RN with UM experience, familiarity with ICD-10/DRGs, and strong communication skills in a fast-paced hospital environment.

Qualifications

• Two years experience with Utilization Management.
• Experience with InterQual and/or Milliman Care Guidelines.
• Strong organizational and time management skills.
• Current RN License to practice in the State of Texas.
• Associate’s Degree in Nursing; BSN preferred.

Responsibilities

• Monitor adherence to the hospital’s utilization review plan for efficient use of services.
• Ensure appropriateness of hospital admissions and extended stays.
• Collaborate with physician advisers to support policy development and process improvement.

Skills

Communication skills

Analytical problem solving

HIPAA knowledge

ICD-10/DRGs

Medical necessity

Utilization management

Negotiation

Time management

Billing integration

Education

Associate’s Degree in Nursing

BSN preferred

Job description

Paycom - ATS is seeking an Experienced Utilization Management Nurse in El Paso, TX to monitor hospital utilization and ensure appropriate admissions and stays. You will integrate clinical and billing knowledge while coordinating peer reviews with physician advisers to support policy and process improvements.

The role requires an RN with UM experience, familiarity with ICD-10/DRGs, and strong communication skills in a fast-paced hospital environment.