Hospital - Utilization Review Care Coordinator (RN)

UT Health San Antonio•San Antonio, TX

5d•Onsite

About The Position

The Utilization Review (UR) Care Coordinator in the Care Management Department will be responsible for ensuring the appropriate use of healthcare resources while maintaining high standards of patient care. The individual in this position will review patient cases, monitor treatment plans, and collaborate with healthcare providers to optimize care delivery and resource utilization.

Requirements

Comprehensive understanding of utilization review processes, guidelines, and regulations.
Knowledge of medical terminology, disease processes, and treatment protocols.
Familiarity with healthcare delivery systems and insurance requirements.
Understanding of regulatory requirements, including Medicare and Medicaid guidelines.
Strong analytical and critical thinking skills.
Proficient in reviewing and interpreting medical records and clinical documentation.
Ability to work collaboratively with a multidisciplinary healthcare team.
Capacity to handle multiple priorities and manage complex cases.
Ability to advocate for patients and ensure the appropriate use of healthcare resources.
Flexibility and adaptability to meet the diverse needs of patients and the healthcare system.
Bachelor's in Nursing
Registered Nurse (RN)

Responsibilities

Conduct utilization reviews to ensure medical necessity, appropriateness, and efficiency of healthcare services.
Evaluate patient records, treatment plans, and clinical documentation to verify that services meet established guidelines and standards.
Collaborate with physicians, nurses, case managers, and other healthcare providers to discuss patient care and identify opportunities for improvement.
Facilitate the authorization process for hospital admissions, treatments, and procedures with insurance companies and payers
Monitor patient progress and discharge plans to ensure timely and appropriate transitions of care.
Educate patients, families, and healthcare providers about utilization review processes and requirements.
Maintain accurate and detailed documentation of reviews, findings, and actions taken.
Participate in interdisciplinary team meetings to discuss patient care and utilization management.
Stay current with industry regulations, standards, and best practices in utilization review and care management.

Benefits

Medical insurance offered free for employees and administered by Blue Cross and Blue Shield of Texas.
Family members can be added to the plan through payroll deduction.
Discounted copays and coinsurance when using UT Health Physicians.
$50,000 of group term life insurance and $50,000 of basic accidental death and dismemberment insurance for free, with options to purchase additional employee and dependent coverage.
Three dental insurance plan options available through Delta Dental Insurance Company.
Fully insured Vision Care benefits offered by Superior Vision Services.
Disability Insurance which provides income if a non-work related illness or injury prevents you from working.
Flexible spending accounts (FSAs) to set aside money from earnings before taxes for qualifying dependent day care expenses or out-of-pocket health care expenses.
Eligible for either the Teacher Retirement System (TRS) or the Optional Retirement Plan (ORP).
Voluntary retirement programs are also available.
Generous leave program offers multiple paid leave options: Front-loaded Paid Time Off (128 to 208 hours), Extended Illness Bank (8 hours accrued per month), Paid Family Leave (up to 240 hours), 12 set paid holidays each year.
Range of discounts on services, tickets, and gym membership.