RN/Registered Nurse-Utilization Management, Clinical Reviews - Arlington, TX - Utilization Review

Company: Texas Health Arlington Memorial Hospital
Location: Arlington
Posted on: September 23, 2022

Job Description:

RN/Registered Nurse-Utilization Management, Clinical Reviews - Arlington, TXRN/Registered Nurse-Utilization Management, Clinical Reviews Fast-paced, high volume reviews and denials department is looking for top skilled UM Nurse.-- Is that you? -- Work location: 100% remote but must live in the Dallas-Fort Worth area. Work hours: PRN, with rotating days, based on the need. Must be available to work any day of the week. Hours worked will be 7a-3:30p, with option of working 3p-11p as needed. -- Department highlights:

• Flexible schedule
• Remote work environment
• Collaborative team approach -- Here's What You Need Education Associate's Degree Nursing Required Or Bachelor's Degree Nursing Preferred Experience 5 Years Inpatient clinical nursing experience in an acute hospital setting Required and 1 Year Utilization Management Required and Experience in case management, and/or the application of medical necessity criteria Preferred One year of utilization management experience is highly preferred -- What You Will Do
  • Responsible for determining initial admission status and level of care recommendations for inpatient admissions, observation and outpatient admissions for any hospital in the THR system (requires access to all facilities in Care Connect)
  • Conduct initial admission review of inpatient, observation and outpatient admissions (commercial insurance, Medicare Advantage and self-pay) according to established criteria set adopted by System. Conduct initial admission review of inpatient, observation and outpatient admissions with traditional Medicare for compliance with the New IPPS rule. Provide clinical information to payors as needed for completion of pre-certification process. Additional perks of being a Texas Health Employee
    • Delivery of high quality of patient care through education, research, and innovations in practice.
    • Strong Unit Based Council (UBC).
    • A supportive, team environment with outstanding opportunities for growth. Explore our for info like , , recent we've won and more. Do you still have questions or concerns? Feel free to email your questions to

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