Utilization Review RN (PRN) — Clinical Impact & Collaboration

University of Texas Southwestern Medical Center; Dallas (TX); On-site; USD 80,000 - 120,000; Part time

Benefits offered by this job

PPO medical plan

Paid Time Off

Retirement Programs

Paid Parental Leave

Wellness programs

Tuition Reimbursement

Job summary

UT Southwestern Medical Center in Dallas is seeking a Utilization Review Nurse (RN) to perform medical necessity reviews for acute care services on a PRN basis. Flexible availability Monday through Friday, 8am–5pm is required.

You will collaborate with the Central Scheduling Department to obtain complete clinical information, conduct admission reviews for Medicare, Medicaid and private pay, and determine level of care using hospital-approved guidelines and Epic CCM.

Qualifications

• Graduate of accredited nursing program with active Texas RN license.
• 5 years nursing experience including 2 years clinical and 3 years in utilization review.
• Prior experience with Epic CCM.

Responsibilities

• Collaborates with the Central Scheduling Department (CSD) to provide accurate clinical information for authorization.
• Conducts admission reviews for Medicare, Medicaid, and private insurance.
• New admission reviews are done concurrently at entry when information is available in the medical record.
• Communicates with admitting physicians when documentation does not support hospital level of care.
• Uses hospital-approved medical necessity tools to determine level of care for inpatient or observation/outpatient services.
• Keeps current on federal, state and local regulatory changes affecting delivery or reimbursement of acute care services.
• Collaborates with admitting physicians to provide accurate level of care determination at time of review.
• Escalates progression-of-care/patient-flow barriers to appropriate departments.
• Participates in daily huddles, departmental meetings, and education offerings.
• Educates care team on appropriate access to and use of various levels of care.
• Promotes evidence-based protocols to influence high-quality and cost-effective care.
• Serves as a resource for coverage and compliance issues.

Education

Texas RN license

Tools

Epic CCM

Job description

UT Southwestern Medical Center in Dallas is seeking a Utilization Review Nurse (RN) to perform medical necessity reviews for acute care services on a PRN basis. Flexible availability Monday through Friday, 8am–5pm is required.

You will collaborate with the Central Scheduling Department to obtain complete clinical information, conduct admission reviews for Medicare, Medicaid and private pay, and determine level of care using hospital-approved guidelines and Epic CCM.