Registered Nurse Utilization Review $37/hr
919 Hidden Ridge Irving, TX 75038 US
Job Description
CornerStone 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
8am - 5pm Monday - Friday
$37/Hr
Summary:
The RN Utilization Review 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-paces, 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.
Responsibilities:
•Applies demonstrated clinical competency and judgment in order to perform comprehensive assessments of clinical information and treatment plans and apply medical necessity criteria in order to determine 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 sets for admission reviews, continued stay reviews, outlier reviews and clinical appropriateness recommendations
•Coordinate and facilitate correct identification of patient status.
•Analyze quality and comprehensiveness of documentation and collaborates with physician and treatment team to obtain documentation needed to support level of care
Requirements:
• Associate of Nursing Degree required.
•BSN Degree from an accredited nursing program or proven success as Registered Nurse Utilization Review I role
•Familiarity with criteria sets including InterQual and MCG preferred •Excellent verbal and written communication
•Critical and analytical thinking skills
•Demonstrated clinical competency Licenses, Registrations, or Certifications •RN License in state of employment or compact required
•CPR certification preferred
•Certification in Case Management preferred
Quick apply online or text Tez @ 972.525.5539
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Meet Your Recruiter
Tez Williams
Clinical Recruitment Manager
Tez has been with CornerStone Medical since November 2017. He has spent ten years in the healthcare industry, the last two years as a healthcare recruiter. He developed skills for recruiting, training and managing pipelines of 10-50 clinicians at a time while working for Fortune 500 companies. He also gained experience working multiple verticals within the healthcare industry such as allied health, clinical and non-clinical.
As the Clinical Recruitment Manager, his main objective is to locate talented clinicians who are amazing at what they do and match them with their dream jobs. He serves his candidates to the best of his ability, always going the extra mile to locate the best career opportunities in the marketplace. He once even brought a can of gas to a travel nurse stuck on the side of the road on the FIRST day of her assignment!
Tez graduated from Northwestern State University in Louisiana with a Bachelor of Science.