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**Registered Nurse (RN) - Utilization Review Nurse - PRN

Job Number: 64366
Categories: Nursing
Location: 5323 Harry Hines Blvd, Dallas, TX
Department: 844106 - Decision Support
Full/Part Time/PRN: Day Job
Regular/Temporary: Regular


Security


This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information

Salary


Salary Negotiable

Experience and Education


Graduate of accredited nursing program. BSN preferred.

Current TX RN license.

Current BLS, through American Heart Association.

RN, BSN or RN with 6 years of clinical experience and UR experience OR RN, CCM with 4 years experience in related field.

Prefer knowledge of InterQual and TMF care criteria.

Job Duties


  • Collaborates with other disciplines, physicians and payers to assess, develop, implement and monitor a comprehensive plan of care to ensure continuity of care and cost effectiveness.
  • Collaborates with physicians and staff regarding medical necessity for admission, continued stay or alternative treatment facilities/levels of care.
  • Consistently relates utilization assessment to payers that are needed to justify continued stay review and to obtain pre-certification.
    On a concurrent basis, assesses appropriateness of the level of care.
  • Evaluates effectiveness of care and facilitates coordination of care toward specific outcomes criteria.
    Identifies quality and risk issues, makes appropriate referrals.
  • Confers with supervisor and/or Medical Director as appropriate.
  • Communicates effectively with other health care providers, patients, families, other hospital personnel and visitors.
  • Demonstrates effective communication with adolescents, adults and older adults.
  • Knowledgeable of Department Performance Improvement Program and is aware of the expected participation.
  • Collaborates with Social Work and others to arrange discharge planning referrals per physician orders.
  • Identifies the need for professional growth and seeks appropriate development opportunities.
  • Evaluates care management outcomes data to identify trends and areas for improvement (i.e. avoidable day, denial information)
  • Performs initial and concurrent medical necessity reviews on all admissions.
  • Confirm patients are in the correct patient class based on InterQual medical necessity criteria sets.
  • Relates utilization assessment to payers to confirm authorization and days approved.
  • Evaluates care management outcomes data and assign avoidable days when appropriate.
  • Facilitate peer to peer reviews for insurance denials.
  • Issue Medicare Change in Admission Status notices when necessary.
  • Provide education as needed regarding medical necessity for hospital admission and appropriate levels of care.
  • Perform other duties as assigned.

Additional Job Preferences

Utilization Review experience in acute hospital environment.

Knowledge of InterQual.




UTSouthwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. In accordance with federal and state law, the University prohibits unlawful discrimination, including harassment, on the basis of: race; color; religion; national origin; sex; including sexual harassment; age; disability; genetic information; citizenship status; and protected veteran status. In addition, it is UTSouthwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.

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