Utilization Review Nurse - Optimize Patient Care (PRN)

The University of Texas Southwestern Medical Center; Dallas (TX); On-site; USD 85,000 - 115,000; Part time

Benefits offered by this job

PPO medical plan

Paid Time Off

Retirement programs (TRS)

Paid parental leave

Tuition reimbursement

Job summary

The University of Texas Southwestern Medical Center in Dallas is seeking a PRN Utilization Review Nurse to conduct medical necessity reviews for acute care. You will use evidence-based guidelines to recommend levels of care, serve as a resource to medical staff, and ensure documentation meets criteria for admission decisions.

Qualified candidates are graduates of accredited nursing programs with an active Texas RN license and at least 5 years of clinical experience including 2 years in

Qualifications

• RN license in Texas and nursing degree from an accredited program.
• Experience in clinical setting with utilization review and admission decisions.

Responsibilities

• Collaborate with Central Scheduling to obtain accurate clinical information for authorization.
• Conduct admission reviews for Medicare/Medicaid and private insurance.
• Review new admissions at entry with available clinical data.
• Communicate with admitting physicians when documentation does not support level of care.
• Apply hospital-approved tools to determine level of care for inpatient or observation services.
• Keep current on regulatory changes affecting delivery/reimbursement of acute care services.
• Collaborate with admitting physician to ensure timely level-of-care determinations.
• Escalate barriers to appropriate departments to improve patient flow.
• Participate in daily huddles and department meetings and education offerings.
• Educate care team on access to various levels of care and evidence-based protocols.

Skills

Utilization review

Clinical experience

Epic CCM

Communication

Education

RN license (Texas)

Tools

Epic CCM

Job description

The University of Texas Southwestern Medical Center in Dallas is seeking a PRN Utilization Review Nurse to conduct medical necessity reviews for acute care. You will use evidence-based guidelines to recommend levels of care, serve as a resource to medical staff, and ensure documentation meets criteria for admission decisions.

Qualified candidates are graduates of accredited nursing programs with an active Texas RN license and at least 5 years of clinical experience including 2 years in