Registered Nurse / RN Utilization Review

Join our team as a PRN, day shift, Utilization Review Registered Nurse in Tyler, TX.

Fulfilling your purpose begins here:

People First, Always. Here's how we take care of our people:

• Competitive salaries, support teams and growth opportunities.

Your team is bigger than your department:

• UT Health Tyler, the flagship hospital of the system, has 502 licensed beds specializing in advanced acute care medicine. Our hospital includes a 24-hour ER with Level 1 trauma center, a comprehensive stroke center, more than 500 physicians and a full complement of subspecialty groups.
• We believe healthcare is a team sport and every player has something to contribute. We show compassion, celebrate differences and treat one another with respect.

The Utilization Review (UR) Nurse is a registered nurse responsible for applying standardized, evidenced-based, medical necessity criteria to form utilization review determinations, communicate relevant information to third party payors, and secure authorization to facilitate the patient's treatment and discharge plan. The UR Nurse communicates with physicians to obtain necessary information as requested by the payor, or to inform the physician of a potential payor denial. The UR Nurse functions as an advocate and contact person for the patient with the insurance company and outside agencies to assure optimal clinical and resource outcomes.

The UR Nurse clarifies treatment plans as needed to support the patient needs, treatment and discharge plan and reimbursement for services rendered. Proactively mitigate denials by engaging the physician, physician advisor or other members of the patient's healthcare team in concurrent and/or retrospective payor discussions. Collaborates with members of the patient's healthcare team to promote appropriate patient care progression; and analyzes current systems to prevent avoidable delays and identify opportunities for improvement.

Job Requirements:

• Registered Nurse with an Associates, Bachelor's or Master's Degree required.
• Current RN license in the state of Texas required and Case Management certification desired.
• A minimum of three (3) years of clinical experience is required.

Preferred Job Requirements:

• Experience in utilization review, discharge planning, quality programs preferred.