Utilization Review RN (PRN)

Dallas Behavioral; Texas; In loco; USD 65.000 - 95.000; Tempo pieno

Vantaggi offerti da questo lavoro

Medical, dental, vision coverage

Company paid disability

401(k)

Generous PTO

Descrizione del lavoro

Dallas Behavioral is seeking an on-site Utilization Review RN to coordinate authorization for admitted patients, reviewing care across the admission and stay processes. You will work with insurance and managed care to ensure access to benefits and adhere to utilization review standards.

The role requires a nursing clinical degree and Texas RN license, with at least two years of related clinical experience in psychiatric or acute care settings.

Competenze

• Two years clinical experience with medical terminology and acute psychiatric criteria.
• Clinical degree in nursing or related healthcare field.

Mansioni

• Conduct admission reviews.
• Conduct concurrent and extended stay reviews.
• Prepare and submit appeals to third party payors.
• Maintain records of Utilization Review Department.
• Uphold ethics and customer service standards.
• Perform related duties as requested.

Conoscenze

Attention to detail

Time management

Multitasking

Communication

Persuasiveness

Regulatory knowledge

Medical terminology

Formazione

Nursing degree

Descrizione del lavoro

The Utilization Review RN is responsible for working with insurance companies and managed care systems for the authorization, concurrent and retrospective review of inpatient admissions and services. This position will obtain authorization for each admitted patient. Review and monitor each step of the authorization process to proactively identify potential problems to help patients access the full range of their benefits through the utilization review process.

• Conducts admission reviews.
• Conducts concurrent and extended stay reviews.
• Prepares and submits appeals to third party payors.
• Maintains appropriate records of the Utilization Review Department.
• Performs related duties, as requested.
• Upholds the Organization's ethics and customer service standards.

*This position is on-site and NOT a remote position.*

• Education: Clinical degree such as nursing, social work, psychology, health information management or other related healthcare field is required or related experience.
• Required Licenses: Texas RN License required.
• Experience: Two years clinical experience in a facility with medical terminology and in criteria for acute psychiatric care or combination of education and experience preferred.
• Knowledge, Skills & Abilities:
• Flexibility; attention to detail; able to multi-task, prioritize with strong time management skills; responsiveness to deadlines, assertiveness, persistence, and persuasiveness; able to work with minimal direction or supervision.
• Knowledge of managed care environment; ability to apply and interpret admission and continued stay criteria; understanding of admission and discharge function; familiarity with medical terminology, diagnostic terms and treatment modalities.
• Knowledge of medical record keeping; strong interpersonal, organizational, evaluative, and time management skills; policy interpretation skills; familiarity with applicable standards and regulations.
• Ability to comprehend psychiatric evaluations, consults, lab results, etc.
• Screening: Must successfully pass background check, drug screen, physical and be able to provide positive employment references.
• Physical Demands: With or without reasonable accommodations, must be able to stoop, kneel, crouch, reach, stand for sustained period of time, walk, pull, lift, raise and move objects from position to position (up to 50 lbs), finger grasp; feel sizes, shapes, temperatures, and textures; express or exchange ideas orally and potentially loudly, accurately, or quickly; visually detect, determine, perceive, identify, recognize, judge, observe, inspect, assess; perceive the nature of sound with or without correction; perform repetitive motions of the wrist, hands, or fingers.

This job description is not intended to be all-inclusive. Employee may perform other related duties to meet the ongoing needs of the hospital.

• Full-time employees are eligible for medical, dental, vision, company paid disability, 401(k) and a generous amount of paid time off.