Utilization Review RN: Optimize Care & Resources

Baylor Scott & White Health; Dallas (TX); On-site; USD 75,000 - 100,000; Full time

Benefits offered by this job

Health benefits

401(k) with match up to 5%

Tuition Reimbursement

PTO from Day 1

Job summary

Baylor Scott & White Health is seeking an experienced Utilization Review RN to review cases for medical necessity across insured patients. You will apply clinical criteria, coordinate with care teams, and support efficient resource use.

You will communicate with health plan departments to ensure services meet standards, perform prospective, concurrent, and retrospective reviews, and help implement care plans and policies across care settings.

Qualifications

• Associate degree in nursing.
• Three years of nursing experience.
• Valid RN license/registration.

Responsibilities

• Review cases to evaluate medical necessity using established guidelines.
• Communicate with health plan departments to ensure services meet standards.
• Perform prospective, concurrent, and retrospective reviews.
• Coordinate with care teams to optimize resource use.
• Document and report findings for quality and compliance.

Job description

Baylor Scott & White Health is seeking an experienced Utilization Review RN to review cases for medical necessity across insured patients. You will apply clinical criteria, coordinate with care teams, and support efficient resource use.

You will communicate with health plan departments to ensure services meet standards, perform prospective, concurrent, and retrospective reviews, and help implement care plans and policies across care settings.