[Hiring] Utilization Management RN - Clinical Review - Weekend PRN @Texas Health Resources
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Role Description
This role involves utilization management and clinical review for inpatient admissions, observation, and outpatient admissions.
ā¢ Responsible for determining initial admission status and level of care recommendations for inpatient admissions, observation, and outpatient admissions.
ā¢ Conduct initial admission review of inpatient, observation, and outpatient admissions according to established criteria.
ā¢ Provide clinical information to payors for completion of the pre-certification process.
ā¢ Ensure proper authorization requirements are met with each admission.
ā¢ Obtain or facilitate acquisition of urgent/emergent authorizations and continued stay authorizations.
ā¢ Maintain a working knowledge of care management, utilization review changes, and regulatory requirements.
ā¢ Provide consultation to medical and nursing staff, health information management, and payers on reimbursement issues.
ā¢ Partner with hospital care transitions managers to assure effective hand-off of information related to the plan of care.
ā¢ Work with bedside nurses and care team members to assure orders related to status are accurate and valid.
ā¢ Evaluate concurrent potential denials or payment issues and initiate communication with admitting physician.
ā¢ Initiate and facilitate physician communication relative to the UR process when indicated.
ā¢ Determine working DRG with each initial review via CareConnect1 or other Utilization Management tool.
ā¢ Cover multiple THR sites adjusting practice to meet the requirements of each location.
Qualifications
ā¢ Associate's degree in Nursing required
ā¢ Bachelor's degree in Nursing preferred
ā¢ 5 years inpatient clinical nursing experience in an acute hospital setting required
ā¢ 1 Year Utilization Management experience preferred
ā¢ Case management and/or the application of medical necessity criteria preferred
ā¢ Texas RN upon hire required
ā¢ Case management certification within 12 months of hire preferred
ā¢ MCG certification within 12 months of hire preferred
Requirements
ā¢ Must be available to train for 4-6 weeks during the week then transition to weekends
ā¢ PRN Weekends from 6:45a - 3:15p with some holiday requirements
Benefits
ā¢ Benefits include 401k, PTO, medical, dental, Paid Parental Leave, flex spending, tuition reimbursement, Student Loan Repayment Program, and several other benefits.
ā¢ A supportive, team environment with outstanding opportunities for growth.
Apply Now
Apply Now
Role Description
This role involves utilization management and clinical review for inpatient admissions, observation, and outpatient admissions.
ā¢ Responsible for determining initial admission status and level of care recommendations for inpatient admissions, observation, and outpatient admissions.
ā¢ Conduct initial admission review of inpatient, observation, and outpatient admissions according to established criteria.
ā¢ Provide clinical information to payors for completion of the pre-certification process.
ā¢ Ensure proper authorization requirements are met with each admission.
ā¢ Obtain or facilitate acquisition of urgent/emergent authorizations and continued stay authorizations.
ā¢ Maintain a working knowledge of care management, utilization review changes, and regulatory requirements.
ā¢ Provide consultation to medical and nursing staff, health information management, and payers on reimbursement issues.
ā¢ Partner with hospital care transitions managers to assure effective hand-off of information related to the plan of care.
ā¢ Work with bedside nurses and care team members to assure orders related to status are accurate and valid.
ā¢ Evaluate concurrent potential denials or payment issues and initiate communication with admitting physician.
ā¢ Initiate and facilitate physician communication relative to the UR process when indicated.
ā¢ Determine working DRG with each initial review via CareConnect1 or other Utilization Management tool.
ā¢ Cover multiple THR sites adjusting practice to meet the requirements of each location.
Qualifications
ā¢ Associate's degree in Nursing required
ā¢ Bachelor's degree in Nursing preferred
ā¢ 5 years inpatient clinical nursing experience in an acute hospital setting required
ā¢ 1 Year Utilization Management experience preferred
ā¢ Case management and/or the application of medical necessity criteria preferred
ā¢ Texas RN upon hire required
ā¢ Case management certification within 12 months of hire preferred
ā¢ MCG certification within 12 months of hire preferred
Requirements
ā¢ Must be available to train for 4-6 weeks during the week then transition to weekends
ā¢ PRN Weekends from 6:45a - 3:15p with some holiday requirements
Benefits
ā¢ Benefits include 401k, PTO, medical, dental, Paid Parental Leave, flex spending, tuition reimbursement, Student Loan Repayment Program, and several other benefits.
ā¢ A supportive, team environment with outstanding opportunities for growth.
Apply Now
Apply Now