Utilization Review RN

Dallas Behavioral Healthcare Hospital•Desoto, TX

6h•Onsite

About The Position

The Utilization Review RN works with insurance companies and managed care systems to obtain authorization for inpatient admissions and services and to conduct concurrent and retrospective reviews. The role monitors each step of the authorization process to identify potential problems and help patients access the full range of their benefits through utilization review. This position is on-site and is not remote. The employee is expected to uphold the Organization's ethics and customer service standards. This job description is not intended to be all-inclusive; the employee may perform other related duties to meet the ongoing needs of the hospital.

Requirements

A clinical degree such as nursing, social work, psychology, health information management, or another related healthcare field, or related experience.
Texas RN License required.
Flexibility, attention to detail, ability to multitask and prioritize, strong time management, responsiveness to deadlines, assertiveness, persistence, and persuasiveness.
Ability to work with minimal direction or supervision.
Knowledge of the managed care environment and ability to apply and interpret admission and continued-stay criteria.
Understanding of admission and discharge functions.
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, and familiarity with applicable standards and regulations.
Ability to comprehend psychiatric evaluations, consults, lab results, and similar materials.
Must successfully pass a background check, drug screen, and physical, and provide positive employment references.
With or without reasonable accommodations, must be able to stoop, kneel, crouch, reach, stand for a sustained period, walk, pull, lift, raise, and move objects weighing up to 50 pounds; finger and grasp; feel sizes, shapes, temperatures, and textures; exchange ideas orally, potentially loudly, accurately, or quickly; visually detect, determine, perceive, identify, recognize, judge, observe, inspect, and assess; perceive the nature of sound with or without correction; and perform repetitive wrist, hand, or finger motions.

Nice To Haves

Two years of clinical experience in a facility involving medical terminology and criteria for acute psychiatric care, or a combination of education and experience, is preferred.

Responsibilities

Obtain authorization for each admitted patient.
Conduct admission reviews.
Conduct concurrent and extended stay reviews.
Prepare and submit appeals to third-party payors.
Maintain appropriate records of the Utilization Review Department.
Monitor the authorization process and proactively identify potential problems that could affect patients' access to benefits.
Perform related duties as requested.
Uphold the Organization's ethics and customer service standards.