Utilization Review RN | Optimize Care & Coverage

Baylor Scott & White Health; Irving (TX); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Health benefits

401(k) match

Tuition reimbursement

PTO from Day 1

Job summary

Baylor Scott & White Health in Texas is seeking an Utilization Review RN to review cases for medical necessity and optimize resource use.

You will perform prospective, concurrent, and retrospective reviews, coordinating with health plans, doctors, and the care team to ensure appropriate levels of care and documentation.

The role emphasizes communication, compliance with regulations, and contribution to care coordination and policy development.

Qualifications

• Associate degree in nursing.
• 3+ years of nursing experience.
• Current RN license.

Responsibilities

• Review cases using medical guidelines to evaluate services.
• Collaborate with Utilization Review coordinators when needed.
• Confirm admission status and communicate with insurance and doctors.
• Identify insurance issues and report to leadership promptly.
• Develop, evaluate, and implement protocols, policies, and procedures.

Skills

RN license

Discharge planning

Care coordination

Medical terminology

Education

Associate degree

Job description

Baylor Scott & White Health in Texas is seeking an Utilization Review RN to review cases for medical necessity and optimize resource use.

You will perform prospective, concurrent, and retrospective reviews, coordinating with health plans, doctors, and the care team to ensure appropriate levels of care and documentation.

The role emphasizes communication, compliance with regulations, and contribution to care coordination and policy development.