Registered Nurse Utilization Review \
Location
Irving, TX | United States
Job description
Job Title: Registered Nurse Utilization Review
Location: Irving, TX, 75038
Duration: 13 Weeks
Shift: Monday - Friday 8 am - 5 pm
Pay Rate: $30/hr. - $35/hr.
Notes: Temp to Perm - Local Candidates only. Current RN Compact license required
Summary: - The RN Utilization Review II is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services.
- This RN 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 Joint Commission regulations and guidelines related to UM.
- This RN 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 RN Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above is according to the mission of CHRISTUS.
Responsibilities: - Applies demonstrated clinical competency and judgment to perform comprehensive assessments of clinical information and treatment plans and apply medical necessity criteria to determine the appropriate level of care
- Resource/Utilization Management appropriateness: Assess assigned patient population for medical necessity, level of care, and appropriateness of setting and services.
- Utilizes MCG/InterQual Care Guidelines and/or health system-approved tools to track impact and variance
- Uses appropriate criteria
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