The Utilization Review Nurse is responsible for determining the clinical appropriateness of care ... * RN license in state of employment or compact preferred Work Schedule: 5 Days - 8 Hours Work Type ...
The Utilization Review Nurse is responsible for determining the clinical appropriateness of care ... * RN license in state of employment or compact preferred Work Schedule: 5 Days - 8 Hours Work Type ...
The Utilization Review Nurse is responsible for determining the clinical appropriateness of care ... * RN license in state of employment or compact preferred Work Schedule: 5 Days - 8 Hours Work Type ...
The Utilization Review Nurse is responsible for determining the clinical appropriateness of care ... * RN license in state of employment or compact preferred Work Schedule: 5 Days - 8 Hours Work Type ...
As our Utilization Management Professional, you will be a critical guardian of healthcare ... review outcomes. * Collaborates with facility RN Care Coordinators to ensure progression of care.
As our Utilization Management Professional, you will be a critical guardian of healthcare ... review outcomes. * Collaborates with facility RN Care Coordinators to ensure progression of care.
Utilization Review RN
Houston, TX · On-site
Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical ... review outcomes. * Collaborates with facility RN Care Coordinators to ensure progression of care.
Utilization Review RN
Houston, TX · On-site
Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical ... review outcomes. * Collaborates with facility RN Care Coordinators to ensure progression of care.
Utilization Review RN
Houston, TX · On-site
$41.14 - $61.20/hr
Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical ... review outcomes. * Collaborates with facility RN Care Coordinators to ensure progression of care.
Utilization Review RN
Houston, TX · On-site
$41.14 - $61.20/hr
Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical ... review outcomes. * Collaborates with facility RN Care Coordinators to ensure progression of care.
Utilization Review RN
Houston, TX · On-site
$41.14 - $61.20/hr
Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical ... review outcomes. * Collaborates with facility RN Care Coordinators to ensure progression of care.
Utilization Review RN
Houston, TX · On-site
$41.14 - $61.20/hr
Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical ... review outcomes. * Collaborates with facility RN Care Coordinators to ensure progression of care.
PreCert Nurse - LVN Utilization Review Nurse (Administrative Nursing) Are you looking for a ... LVN/RN license, without restrictions, from an accredited vocational nursing program (LVN) or a ...
PreCert Nurse - LVN Utilization Review Nurse (Administrative Nursing) Are you looking for a ... LVN/RN license, without restrictions, from an accredited vocational nursing program (LVN) or a ...
Utilization Review RN
Houston, TX · On-site
$41.14 - $61.20/hr
Utilization Review RN Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of ...
Utilization Review RN
Houston, TX · On-site
$41.14 - $61.20/hr
Utilization Review RN Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of ...
PreCert Nurse - LVN Utilization Review Nurse (Administrative Nursing) Are you looking for a ... LVN/RN license, without restrictions, from an accredited vocational nursing program (LVN) or a ...
PreCert Nurse - LVN Utilization Review Nurse (Administrative Nursing) Are you looking for a ... LVN/RN license, without restrictions, from an accredited vocational nursing program (LVN) or a ...
Utilization Review RN
Houston, TX · On-site
$41.14 - $61.20/hr
Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical ... review outcomes. * Collaborates with facility RN Care Coordinators to ensure progression of care.
Utilization Review RN
Houston, TX · On-site
$41.14 - $61.20/hr
Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical ... review outcomes. * Collaborates with facility RN Care Coordinators to ensure progression of care.
Utilization Review RN
$41.14 - $61.20/hr
Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical ... review outcomes. * Collaborates with facility RN Care Coordinators to ensure progression of care.
Utilization Review RN
$41.14 - $61.20/hr
Job Summary and Responsibilities As our Utilization Management Professional, you will be a critical ... review outcomes. * Collaborates with facility RN Care Coordinators to ensure progression of care.
... year utilization review in an acute hospital or commercial/managed care payer setting ... Required: RN. Must be currently licensed, certified or registered to practice profession as ...
New
... year utilization review in an acute hospital or commercial/managed care payer setting ... Required: RN. Must be currently licensed, certified or registered to practice profession as ...
New
As a Registered Nurse with us, you'll have the opportunity to make a meaningful impact in patients ... year utilization review in an acute hospital or commercial/managed care payer setting ...
New
As a Registered Nurse with us, you'll have the opportunity to make a meaningful impact in patients ... year utilization review in an acute hospital or commercial/managed care payer setting ...
New
As a Registered Nurse with us, you'll have the opportunity to make a meaningful impact in patients ... year utilization review in an acute hospital or commercial/managed care payer setting ...
New
As a Registered Nurse with us, you'll have the opportunity to make a meaningful impact in patients ... year utilization review in an acute hospital or commercial/managed care payer setting ...
New
As a Registered Nurse with us, you'll have the opportunity to make a meaningful impact in patients ... year utilization review in an acute hospital or commercial/managed care payer setting ...
New
As a Registered Nurse with us, you'll have the opportunity to make a meaningful impact in patients ... year utilization review in an acute hospital or commercial/managed care payer setting ...
New
Bracane Company is seeking a dedicated and detail-oriented Utilization Review RN to join our team in Austin, TX. This is an exciting opportunity for a clinical professional to make a meaningful ...
Bracane Company is seeking a dedicated and detail-oriented Utilization Review RN to join our team in Austin, TX. This is an exciting opportunity for a clinical professional to make a meaningful ...
The Utilization Review RN is responsible for ensuring that all behavioral health patients receive the appropriate level of care, and that all services rendered meet medical necessity, payer ...
Quick apply
The Utilization Review RN is responsible for ensuring that all behavioral health patients receive the appropriate level of care, and that all services rendered meet medical necessity, payer ...
The Utilization Review RN is responsible for ensuring that all behavioral health patients receive the appropriate level of care, and that all services rendered meet medical necessity, payer ...
The Utilization Review RN is responsible for ensuring that all behavioral health patients receive the appropriate level of care, and that all services rendered meet medical necessity, payer ...
The Utilization Review RN is responsible for ensuring that all behavioral health patients receive the appropriate level of care, and that all services rendered meet medical necessity, payer ...
The Utilization Review RN is responsible for ensuring that all behavioral health patients receive the appropriate level of care, and that all services rendered meet medical necessity, payer ...
The Utilization Review RN is responsible for ensuring that all behavioral health patients receive the appropriate level of care, and that all services rendered meet medical necessity, payer ...
The Utilization Review RN is responsible for ensuring that all behavioral health patients receive the appropriate level of care, and that all services rendered meet medical necessity, payer ...
Trainee Rn Utilization Review Nurse information
What is the difference between Trainee Rn Utilization Review Nurse vs Registered Nurse in Utilization Review?
| Aspect | Trainee Rn Utilization Review Nurse | Registered Nurse in Utilization Review |
|---|---|---|
| Credentials | Licensed RN, in training or early in career | Licensed RN with experience in utilization review |
| Work Environment | Supervised training setting, often in healthcare or insurance companies | Independent review, case analysis, and decision-making in healthcare or insurance |
| Job Responsibilities | Assisting with reviews, learning policies, supporting senior staff | Conducting utilization reviews, making coverage decisions, ensuring compliance |
The main difference is that the Trainee Rn Utilization Review Nurse is in training and gaining experience, while the Registered Nurse in Utilization Review is a fully qualified professional responsible for independent review and decision-making. The trainee role focuses on learning, whereas the registered nurse role involves applying expertise to evaluate patient care and insurance coverage.
What are the most commonly searched types of Rn Utilization Review Nurse jobs in Texas? The most popular types of Rn Utilization Review Nurse jobs in Texas are:
What cities in Texas are hiring for Trainee Rn Utilization Review Nurse jobs? Cities in Texas with the most Trainee Rn Utilization Review Nurse job openings:
Utilization Review Nurse Health Plans - HP Utilization Management
Irving, TX • On-site
Full-time
Re-posted 6 days ago
CHRISTUS Health rating
6.7
Based on 530 frontline employees who took The Breakroom Quiz
531st of 887 rated healthcare providers
Job description
Summary:
The Utilization Review Nurse is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This nurse is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services "CMS" Inpatient List). They effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and guidelines related to UM. This nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services. The Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS.
Responsibilities:
Job Requirements:
Education/Skills
Experience
Licenses, Registrations, or Certifications
Work Schedule:
5 Days - 8 Hours
Work Type:
Full Time
The Utilization Review Nurse is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This nurse is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services "CMS" Inpatient List). They effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and guidelines related to UM. This nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services. The Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS.
Responsibilities:
- Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
- The prior authorization role completes an assessment of a proposed service to determine if the beneficiary has eligible coverage for the service and if it is medically necessary.
- Promote quality, cost-effective outcomes through prior authorization and concurrent review of requested services for medical necessity based upon evidence-based clinical guidelines.
- Identify and present cases of possible quality of care deviations, questionable admissions, and prolonged lengths of stay to the Medical Director for further determination.
- Appropriately refer beneficiaries who have complex or chronic conditions, a need for transition of care, disease management support, or other identifiable needs for coordination of the beneficiary's member's health care for behavioral health care management.
- Follow CHRISTUS Health Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent, or detect unauthorized disclosure of Protected Health Information (PHI).
- Protect the confidentiality of data and intellectual property; assures compliance with national health information guidelines.
- Analyze clinical information submitted by medical providers to evaluate the medical necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities.
- Perform provider outreach to address post-hospital discharge services, redirection to in-network providers for appropriate steerage, durable equipment usage, and utilization of other medical services and/or procedures and other necessary telephonic follow-up.
- Utilize the nursing process and critical thinking skills to provide oversight of services and evaluation of service options.
- Ability to work in a variety of settings with culturally diverse communities with the ability to be culturally sensitive and appropriate.
- Must have excellent communication skills (written and verbal), clinical judgment, initiative, critical thinking, and problem-solving abilities.
- Must be able to take after hour calls to meet business requirements as needed.
Job Requirements:
Education/Skills
- Graduate of an accredited school of vocational nursing or equivalent required
- Associate's (ADN) or Bachelor's (BSN) in Nursing preferred
Experience
- 3 - 5 years of nursing experience preferred
- Experience in Microsoft software (e.g., Outlook, Teams, Word, and Excel) required
- General computer knowledge and capability to use computers required
Licenses, Registrations, or Certifications
- LVN license in the state of employment or compact required
- RN license in state of employment or compact preferred
Work Schedule:
5 Days - 8 Hours
Work Type:
Full Time
What CHRISTUS Health employees say
Pay
Benefits
Hours and flexibility
Workplace
Get the full story on Breakroom
About CHRISTUS Health
Sourced by ZipRecruiter
CHRISTUS Health is a prominent name in the healthcare industry, with its headquarters situated in Irving, TX, USA. Established in 1999, the company has since been devoted to providing comprehensive care and extending the healing ministry of Jesus Christ. This not-for-profit health system primarily operates more than 600 healthcare services and programs, including long-term care facilities, health insurance products, community clinics, and outreach services, serving both urban and rural populations.
Industry
Outpatient health care
Company size
1,001 - 5,000 Employees
Headquarters location
Irving, TX, US
Year founded
1999