- 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.
- 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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RN Utilization Review
2 weeks ago
Tekaccel Irving, United StatesSummary: · 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 re ...
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RN Utilization Review II
3 weeks ago
Impresiv Health Irving, United StatesTitle: RN Utilization Review II · Description: 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 ...
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Registered Nurse Utilization Review
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CornerStone Irving, TX, United StatesCornerStone Medical is looking for a Registered Nurse Utilization Review for a state of the art hospital system in Irving, TX. This is an onsite role. Current RN Compact License required 8 am - 5 pm Monday - Friday $37/ Hr Summary: The RN Utilization Registered Nurse, Registered, ...
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rn utilization review ii
2 weeks ago
Impresiv Health Irving, TX , USA, United StatesTitle: RN Utilization Review II · Description: 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 o ...
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Registered Nurse Utilization Review \ 1366
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Softpath System LLC Irving, TX, United StatesArea: HPUtilization Mgmt 7065 / 1346 · Class: RN Utilization Review · Shift: 1 · Start: 08:00:00 · End: 17:00:00 ...
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Utilization Review RN
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Texas Institute for Surgery Dallas, United StatesJob Details · Job Location · Texas Institute for Surgery LL SURG - Dallas, TX · Salary Range · $ $43.00 Hourly · Job Category · Health Care · Description · Job Summary: The Utilization Management Nurse will provide precertification of inpatient hospitalizations and all out ...
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Utilization Review RN
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HireOps Staffing LLC Dallas, United StatesThis position is fully remote, however, you must reside in the State of Texas · The position is a contract for about 6 months. · RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the tre ...
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Utilization Review Specialist
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Carrollton Springs Carrollton, United StatesOverview: · Carrollton Springs is a 72-bed behavioral hospital located Carrollton, TX. The hospital offers inpatient and outpatient mental health and addiction treatment to adults, adolescents and their families. At Carrollton Springs we are dedicated to Changing Peoples Lives ...
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Utilization Review Specialist
2 weeks ago
Mesa Springs Fort Worth, United StatesOverview: · Mesa Springs is a 72-bed behavioral hospital located in Fort Worth, TX. The hospital offers inpatient and outpatient mental health and addiction treatment to adults, adolescents and their families. At Mesa Springs we are dedicated to Changing Peoples Lives. · Mesa S ...
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Utilization Review Specialist
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Springstone Fort Worth, United StatesOverview · MesaSprings · is a 72-bed behavioral hospital located in Fort Worth, TX.The hospital offers inpatient and outpatient mental health and addiction treatment to adults, adolescentsand their families. At · MesaSprings · we are dedicated to Changing Peoples Lives. · Me ...
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Utilization Review Specialist
1 week ago
Springstone, Inc Ft. Worth, United StatesMesa Springs is a 72-bed behavioral hospital located in Fort Worth, TX. The hospital offers inpatient and outpatient mental health and addiction treatment to adults, adolescents and their families. At Mesa Springs we are dedicated to Changing People's Lives. · Mesa Springs is lo ...
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Utilization Review Specialist
2 weeks ago
Springstone Fort Worth, United StatesOverviewMesaSprings is a 72-bed behavioral hospital located in Fort Worth, TX.The hospital offers inpatient and outpatient mental health and addiction treatment to adults, adolescentsand their families. At MesaSprings we are dedicated to Changing Peoples Lives.Mesa Springs is loo ...
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Director of Utilization Review
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ADDICTION AND MENTAL HEALTH SERVICES, LLC Waxahachie, United StatesJob Description · Job DescriptionTwo years minimum experience in utilization review. Must possess good grammatical and communication skills. Must be skilled in Microsoft Office applications and have a working knowledge of office equipment. · 1. Must be able to see and read handwr ...
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Utilization Review Coordinator
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Carrus Hospital Mansfield, United StatesCarrus Care Mansfield mental health clinic serving the pediatric and adolescent population, is seeking a Utilization Review Coordinator (RN)ESSENTIAL FUNCTIONS:1. Responsible for coordinating andmonitoring day-to-day operations of the utilization management program for theoutpati ...
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Utilization Review Specialist
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Mesa Springs Fort Worth, United StatesOverview: · Mesa Springs is a 72-bed behavioral hospital located in Fort Worth, TX. The hospital offers inpatient and outpatient mental health and addiction treatment to adults, adolescents and their families. At Mesa Springs we are dedicated to Changing Peoples Lives. · Mesa S ...
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Utilization Review Coordinator
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Carrus Hospital Frisco, United StatesCarrus Care Frisco mental health clinic serving the pediatric and adolescent population, is seeking a Utilization Review Coordinator (RN)ESSENTIAL FUNCTIONS:1. Responsible for coordinating andmonitoring day-to-day operations of the utilization management program for theoutpatient ...
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OCOK Utilization Review Specialist
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Shelby American Inc Fort Worth, United StatesPosition Function · : · Responsible for ensuring that youth receive the most appropriate level of residential services for well-being and to achieve permanency. Responsible for ensuring that exceptional services and/or placement waivers are secured and reviewed, with all deadli ...
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OCOK Utilization Review Specialist
3 weeks ago
Shelby American Inc Fort Worth, United StatesPosition Function : Responsible for ensuring that youth receive the most appropriate level of residential services for well-being and to achieve permanency. Responsible for ensuring that exceptional services and/or placement waivers are secured and reviewed, with all deadlines me ...
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OCOK Utilization Review Specialist
2 weeks ago
ACH Child and Family Services Fort Worth, United StatesPosition Function : Responsible for ensuring that youth receive the most appropriate level of residential services for well-being and to achieve permanency. Responsible for ensuring that exceptional services and/or placement waivers are secured and reviewed, with all deadlines me ...
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Parkland Health & Hospital System Dallas, United StatesInterested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and ...
Registered Nurse Utilization Review \ 1366 - Irving, TX, United States - TalentBurst, Inc.
Description
Job Title: Registered Nurse Utilization ReviewLocation: 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:
