Clinical Insurance Reviewer Jobs (NOW HIRING)

As a RN Clinical Reviewer Maternal, your voice to influence patient care is valued and empowered at every turn –whether through open, collaborative relationships with your direct manager or more formal opportunities through hospital councils and national nursing initiatives. You'll help shape decisions that elevate both patient outcomes and the future of nursing.

The Women’s Center of Texas Clinical Review Nurse fulfills an important role in patient care and safety by performing reviews of the maternal medical records to ensure the standard of care is provided. The RN Clinical Reviewer is responsible for the analysis of the medical accord and then documenting and reporting findings to the Maternal Program Manager using facility approved audit tools. As a full partner of the healthcare team, the SDHRN Clinical Reviewer collaborates with all other healthcare disciplines to achieve successful execution of the of the results of the quality metrics determined by the Maternal QAPI Committee oversight.  

• Reviews patient's medical record and documents’ compliance of the medical record documentation using QAPI approved audit tools 

• Performs audits on a regular basis in accordance with maternal program plan. Pertinent data is collected using appropriate assessment techniques 

• Prioritizes data collection by collaborating with the Maternal Program Manager or Neonatal Program Manager as appropriate 

• Is able to discern critical findings and timely communicates issues found to Maternal/Neonatal Program Manager and appropriate department manager so education or counseling can be provided quickly to prevent further issues 

• Is able to discern critical findings and timely communicates changes in the patient’s condition to the appropriate patient care providers 

•  Data collection is inclusive of the patient, significant others and health care providers when appropriate 

What qualifications you will need: 

Education: 

• Associates Degree in Nursing - required 

• Bachelor’s Degree in Nursing or related field – preferred 

Experience: 

• 1 year of RN experience – required 

License/Certification: 

• Currently licensed as a registered professional nurse in the state(s) of practice and/or has an active compact license, in accordance with law and regulation. Required 

• Basic Life Support (BLS)- Required 

• RNC-OB – preferred 

• RNC-NICU – preferred 

• C-EFM - preferred 

St. David's North Austin Medical Center, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

• Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
• Wellbeing support, including free counseling and referral services
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
• Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

"Nurses are essential to the delivery of healthcare and serve as its foundation. At HCA Healthcare, we are committed to equipping nurses with the tools and resources they need to deliver exceptional patient care, championing the profession, and supporting the advancement of nursing’s future."

Erica Rossitto, MBA/HCM, BSN, RN, NEA-BC

Senior Vice President and Chief Nurse Executive

HCA Healthcare

St. David’s North Austin Medical Center, part of St. David’s HealthCare, is a full-service medical center providing comprehensive medical care at two locations – St. David’s North Austin Medical Center and St. David’s Surgical Hospital.
St. David’s North Austin Medical Center is a 460+ bed, multi-specialty, acute care hospital. It provides advanced women’s health services, including maternity and newborn care with Level I, II, and III neonatal intensive care units (NICUs) at the nearby St. David’s Women’s Center of Texas. The hospital also offers minimally invasive gynecological surgery and comprehensive breast imaging through Solis Mammography, which is located on-site. Other services include a 24-hour emergency department, pediatric emergency care, and intensive care at St. David’s Children’s Hospital. The hospital also features the Texas Institute for Robotic Surgery, bariatric (weight loss) surgery, a Heart and Vascular Center, neurology and neurosurgery, a kidney transplant program, a Level IV Epilepsy Center, as well as inpatient and outpatient surgery and acute rehabilitation services for both inpatients and outpatients.

St. David’s Women’s Center of Texas, located at St. David's North Austin Medical Center, is recognized by the State of Texas as a Level IV Maternal Facility. This means it provides the highest level of care for pregnant and postpartum patients, especially those with serious or complex medical, surgical, or pregnancy-related conditions, including those at high risk for maternal morbidity or mortality. The center includes a 95+ bed Level III Neonatal Intensive Care Unit (NICU) with 30+ private rooms, 10+ rooms for very small babies, and 10+ beds for babies needing neurological care. It also has 35+ labor, delivery, and recovery rooms, including Central Texas’ first low-intervention birthing suites with tubs. There are 95+ postpartum beds, 20+ antepartum beds, and Cesarean section surgical suites. The facility offers 24/7 neonatology coverage, OB/GYN hospitalists, maternal-fetal medicine specialists, lactation consultants, and a midwifery program. It is part of the National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network and TexasAIM, and it also provides a high-risk pregnancy navigation and support program.

St. David's Surgical Hospital is part of St. David’s North Austin Medical Center and is the first Level 4 Epilepsy Center in Central Texas for both adults and children. It has its own 24-hour emergency department, a medical-surgical inpatient unit, and a pediatric intensive care unit (PICU) for patients ages 17 and under. The hospital is staffed with pediatric emergency physicians, pediatric hospitalists, intensivists, and other specialists who are specially trained to care for children. It also includes certified child-life specialists who help kids feel more comfortable during their hospital stay. St. David’s Children’s Hospital offers many pediatric services, such as pediatric surgery, pediatric radiology (including imaging and interventional procedures), and pediatric anesthesia for surgical support. It also has a wide range of pediatric specialists available for consultation and treatment, including general surgery, ENT (ear, nose, and throat), craniofacial and plastic surgery, neurology, neurosurgery, urology, and cardiology, among others.
HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

If this opportunity is your next step in your career path, we encourage you to apply for our RN Clinical Reviewer Maternal opening. We review all applications. Qualified candidates will be contacted by a member of our team. We are interviewing, apply today!

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.