Registered Nurse Utilization Review

Irving, TX

Category: RN Job Number: 3307 Pay Rate: 37.00

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

#CSM2
#ZR

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.

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About Irving, TX

Discover exciting job opportunities in the vibrant city of Irving, Texas! Known for its diverse community and thriving economy, Irving offers endless possibilities for career growth and development. With its close proximity to Dallas Fort Worth International Airport, major corporations, and charming neighborhoods like Las Colinas, Irving is the perfect place to advance your career. Explore job listings in this bustling city and be part of the dynamic energy that surrounds attractions like the Toyota Music Factory, the Irving Arts Center, and the Mustangs of Las Colinas sculpture. Embrace the blend of Texan hospitality and cosmopolitan flair that makes Irving a truly exceptional place to work and live. Take the next step in your career journey and find your perfect match in Irving, Texas!