Registered Nurse Utilization Review
About The Position
Provide healthcare services related to admissions, case management, discharge planning, and utilization review. Review admissions and service requests for medical necessity, reimbursement compliance, and utilization management criteria. Support complex case management and assist staff with coding, documentation, precertification, reimbursement, and denial/appeal issues. Coordinate discharge planning needs with patients, providers, and interdisciplinary healthcare teams. Ensure compliance with federal regulations and third-party payer utilization management requirements while preparing reports and statistical analyses as needed.
Requirements
- Licensed Registered Nurse credentialed from the Texas Board of Nursing or current home state license for multi-state license recognition "Compact State" obtained prior to hire date or job transfer date required.
- Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.
Responsibilities
- Provide healthcare services related to admissions, case management, discharge planning, and utilization review.
- Review admissions and service requests for medical necessity, reimbursement compliance, and utilization management criteria.
- Support complex case management and assist staff with coding, documentation, precertification, reimbursement, and denial/appeal issues.
- Coordinate discharge planning needs with patients, providers, and interdisciplinary healthcare teams.
- Ensure compliance with federal regulations and third-party payer utilization management requirements while preparing reports and statistical analyses as needed.
Benefits
- Paid time off (PTO)
- Various health insurance options & wellness plans
- Retirement benefits including employer match plans
- Long-term & short-term disability
- Employee assistance programs (EAP)
- Parental leave & adoption assistance
- Tuition reimbursement
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree
