Utilization Review RN: Medical Necessity & Care Level

The University of Texas Southwestern Medical Center; Dallas (TX); On-site; USD 90,000 - 120,000; Full time

Job summary

UT Southwestern Medical Center seeks a Registered Nurse for medical necessity Utilization Review in our Dallas facility. The role involves reviewing admissions, using evidence-based criteria, and advising on level of care with physicians and care teams.

The ideal candidate has an active Texas RN license, 5 years of experience including clinical and utilization review, and familiarity with Epic CCM. Join a reputable academic medical center with strong benefits.

Qualifications

• Graduate of accredited nursing program and holds an active unrestricted RN license in the State of Texas.
• 5 years experience to include 2 years of clinical experience and minimum of 3 years of recent utilization review experience; prior experience with Epic CCM.

Responsibilities

• Collaborates with scheduling and care teams to obtain accurate clinical information for authorization.
• Conducts admission reviews for Medicare, Medicaid, private insurance, and self-pay patients using evidence-based guidelines.
• Communicates with admitting physicians when documentation does not support hospital level of care.
• Determines level of care for inpatient or observation services based on documentation, H&P, and treatment plan.

Skills

Utilization review

Epic CCM

RN licensure

Education

RN nursing degree

Accredited nursing program

Job description

UT Southwestern Medical Center seeks a Registered Nurse for medical necessity Utilization Review in our Dallas facility. The role involves reviewing admissions, using evidence-based criteria, and advising on level of care with physicians and care teams.

The ideal candidate has an active Texas RN license, 5 years of experience including clinical and utilization review, and familiarity with Epic CCM. Join a reputable academic medical center with strong benefits.