Utilization Review Nurse

%3Cp style=%22text-align%5C:center;%22%3E%3Cstrong%3EUtilization Review RN%3C/strong%3E%3C/p%3E%3Cp style=%22text-align%5C:center;%22%3E%3Cstrong%3E%3Cu%3EWork Schedule%3C/u%3E%5C: Thursday - Sunday; (4) 10-Hour Day Shifts%3C/strong%3E%3C/p%3E%3Cp%3E%3Cstrong%3EWHY UT SOUTHWESTERN?%3C/strong%3E%3Cbr%3EWith over 75 years of excellence in Dallas-Fort Worth, Texas, UT Southwestern is committed to excellence, innovation, teamwork, and compassion. As a world-renowned medical and research center, we strive to provide the best possible care, resources, and

benefits

for our valued employees. Ranked as the No. 1 hospital in Dallas-Fort Worth according to %3Ci%3EU.S. News %26amp; World Report%3C/i%3E, we invest in you with opportunities for career growth and development to align with your future goals. Our highly competitive

benefits

package offers healthcare, PTO and paid holidays, on-site childcare, wage, merit increases and so much more. We invite you to be a part of the UT Southwestern team where you%27ll discover a culture of teamwork, professionalism, and a rewarding career!%26nbsp;%3Cbr%3E%3Cbr%3E%3Cstrong%3EJOB SUMMARY%3C/strong%3E%3Cbr%3EConduct medical certification review for medical necessity for acute care facility and services. Use nationally recognized, evidence-based guidelines approved by medical staff to recommend level of care to the physician and serve as a resource to the medical staff on issues related to admission

qualifications

, resource utilization, national and local coverage determinations and documentation requirements.%26nbsp;%3Cbr%3E%3Cbr%3E%26nbsp;%3C/p%3E%3Cp%3E%3Cstrong%3EBENEFITS%3C/strong%3E%3Cbr%3EUT Southwestern is proud to offer a competitive and comprehensive

benefits

package to eligible employees. Our

benefits

are designed to support your overall wellbeing, and include%5C:%3C/p%3E%3Cul%3E%3Cli%3EPPO medical plan, available day one at no cost for full-time employee-only coverage%3C/li%3E%3Cli%3E100% coverage for preventive healthcare-no copay%3C/li%3E%3Cli%3EPaid Time Off, available day one%3C/li%3E%3Cli%3ERetirement Programs through the Teacher Retirement System of Texas (TRS)%3C/li%3E%3Cli%3EPaid Parental Leave Benefit%3C/li%3E%3Cli%3EWellness programs%3C/li%3E%3Cli%3ETuition Reimbursement%3C/li%3E%3Cli%3EPublic Service Loan Forgiveness (PSLF) Qualified Employer%3C/li%3E%3Cli%3E%3Ca href=%22http%5C://jobs.utsouthwestern.edu/

benefits

/#top%22 target=%22_blank%22%3ELearn more about these and other UTSW employee

benefits

!%3C/a%3E%3C/li%3E%3C/ul%3E%3Cp%3E%3Cbr%3E%3Cbr%3E%3Cstrong%3EEXPERIENCE AND EDUCATION%3C/strong%3E%3Cbr%3E%3Cbr%3E%3Cstrong%3ERequired%3C/strong%3E%3C/p%3E%3Cul%3E%3Cli%3E%3Cstrong%3EEducation%3C/strong%3E%3Cbr%3EGraduate of accredited nursing program and holds an active unrestricted RN license in the State of Texas.%26nbsp;%3Cbr%3E%26nbsp;%3C/li%3E%3C/ul%3E%3Cul%3E%3Cli%3E%3Cstrong%3EExperience%3C/strong%3E%3Cbr%3E5 years experience to include 2 years of clinical experience and minimum of 3 years of recent utilization review experience.%26nbsp;%3Cbr%3EPrior experience with Epic CCM.%26nbsp;%3Cbr%3E%26nbsp;%3C/li%3E%3C/ul%3E%3Cul%3E%3Cli%3E%3Cstrong%3ELicenses and Certifications%3C/strong%3E%3Cbr%3E(RN) REGISTERED NURSE holds an active unrestricted RN license in the State of Texas.%26nbsp;%3Cbr%3E%26nbsp;%3C/li%3E%3C/ul%3E%3Cp%3E%3Cstrong%3EPreferred%3C/strong%3E%3C/p%3E%3Cul%3E%3Cli%3E%3Cstrong%3EExperience%3C/strong%3E%3Cbr%3EAcute care experience preferred.%26nbsp;%3Cbr%3E%26nbsp;%3C/li%3E%3C/ul%3E%3Cp%3E%3Cbr%3E%3Cstrong%3EJOB DUTIES%3C/strong%3E%3C/p%3E%3Cul%3E%3Cli%3ECollaborates with the Central Scheduling Department (CSD) team to provide accurate and complete clinical information in order to obtain authorization.%3C/li%3E%3Cli%3EConducts admission reviews for Medicare and Medicaid beneficiaries as well as private insurance members and self-pay patients utilizing evidence-based guidelines.%3C/li%3E%3Cli%3ENew admission reviews are done concurrently at the point of entry when the admission order is placed and necessary clinical information is available in the medical record.%3C/li%3E%3Cli%3ECommunicate with admitting physicians and physician advisors when documentation does not appear to support hospital level of care.%3C/li%3E%3Cli%3EUse hospital approved medical necessity tool to determine level of care for inpatient or observation/outpatient services based on physician documentation, H%26amp;P, treatment plan, potential risks, and basis for expectation of a two-midnight stay.%3C/li%3E%3Cli%3EKeeps current on all Federal, State and local regulatory changes that affect delivery or reimbursement of acute care services within the scope of Utilization Management. Uses knowledge of national and local coverage determinations to appropriately advise physicians.%3C/li%3E%3Cli%3EProactively collaborates with admitting physician to provide accurate level of care determination at the time of review.%3C/li%3E%3Cli%3EEscalates identified progression-of-care/patient flow barriers to appropriate departments.%3C/li%3E%3Cli%3EActively participates in daily huddles, departmental meetingsand education offerings.%3C/li%3E%3Cli%3EIdentifies and records episodes of preventable delays or avoidable days due to failure of progression-of-care processes.%3C/li%3E%3Cli%3EEducates members of the patient%27s care team on the appropriate access to and use of various levels of care.%3C/li%3E%3Cli%3EPromotes use of evidence-based protocols and/or order sets to influence high-quality and cost-effective care.%3C/li%3E%3Cli%3EServes as a resource person to physicians, care coordinators, physician offices and billing office for coverage and compliance issues.%3C/li%3E%3Cli%3ECompletes all reviews within department established policies and best practice standards. Meets department quality standards as established for the department, ie%5C: Inter-rater Reliability audits, completing all initial reviews within established time frames, completes concurrent and discharge reviews to meet department and industry standards.%3C/li%3E%3Cli%3EPerforms other duties as assigned.%3C/li%3E%3C/ul%3E%3Cp style=%22font-size%5C:9pt;margin-bottom%5C:0pt;margin-top%5C:0pt;%22%3E%3Cspan style=%22font-family%5C:Verdana;%22%3E%26nbsp;%3C/span%3E%3C/p%3E%3Cp style=%22font-size%5C:9pt;margin-bottom%5C:0pt;margin-top%5C:0pt;%22%3E%3Cspan style=%22font-family%5C:Verdana;%22%3E%3Cstrong%3EKnowledge, Skills and Abilities%3C/strong%3E%3C/span%3E%3C/p%3E%3Cul%3E%3Cli%3EActively participates in the department%27s performance improvement initiatives.%3C/li%3E%3Cli%3EBasic computer skills and knowledge.%3C/li%3E%3Cli%3EExpert knowledge of hospital approved, evidence based medical necessity tool and knowledge of local and national coverage determinations.%3C/li%3E%3Cli%3EIdentifies avoidable days (quality and risk issues), makes appropriate referrals. Confers with Manager and/or Medical Director as appropriate.%3C/li%3E%3Cli%3EIdentifies the need for professional growth and seeks out appropriate development opportunities.%3C/li%3E%3Cli%3EEvaluates outcomes data to identify trends and areas for improvement (i.e. avoidable days, denial information).%3C/li%3E%3Cli%3EGeneral good health and stress coping ability.%3C/li%3E%3Cli%3EAbility to speak and hear, to allow discussions with physicians, patients, and other members of the healthcare team.%3C/li%3E%3Cli%3EPossess near vision acuity for accurate reading of computer screens and recording on patient charts.%3C/li%3E%3C/ul%3E%3Cp style=%22font-size%5C:9pt;margin-bottom%5C:0pt;margin-top%5C:0pt;%22%3E%3Cspan style=%22font-family%5C:Verdana;%22%3E%26nbsp;%3C/span%3E%3C/p%3E%3Cp style=%22font-size%5C:9pt;margin-bottom%5C:0pt;margin-top%5C:0pt;%22%3E%3Cspan style=%22font-family%5C:Verdana;%22%3E%3Cstrong%3EPHYSICAL REQUIREMENTS/WORKING CONDITIONS%3C/strong%3E%3C/span%3E%3C/p%3E%3Cp style=%22font-size%5C:9pt;margin-bottom%5C:0pt;margin-top%5C:0pt;%22%3E%3Cspan style=%22font-family%5C:Verdana;%22%3E%26nbsp;%3C/span%3E%3C/p%3E%3Cp style=%22font-size%5C:9pt;margin-bottom%5C:0pt;margin-top%5C:0pt;%22%3E%3Cspan style=%22font-family%5C:Verdana;%22%3E%3Cstrong%3EPhysical Requirements%3C/strong%3E%3C/span%3E%3C/p%3E%3Cul%3E%3Cli%3ETalking%3C/li%3E%3C/ul%3E%3Cp style=%22font-size%5C:9pt;margin-bottom%5C:0pt;margin-top%5C:0pt;%22%3E%3Cspan style=%22font-family%5C:Verdana;%22%3E%26nbsp;%3C/span%3E%3C/p%3E%3Cp style=%22font-size%5C:9pt;margin-bottom%5C:0pt;margin-top%5C:0pt;%22%3E%3Cspan style=%22font-family%5C:Verdana;%22%3E%3Cstrong%3EWorking Conditions%3C/strong%3E%3C/span%3E%3C/p%3E%3Cul%3E%3Cli%3EOffice Setting%3C/li%3E%3C/ul%3E%3Cp style=%22font-size%5C:9pt;margin-bottom%5C:0pt;margin-top%5C:0pt;%22%3E%3Cspan style=%22font-family%5C:Verdana;%22%3E%26nbsp;%3C/span%3E%3C/p%3E%3Cp%3E%3Cstrong%3ESalary Information%3C/strong%3E%3Cbr%3ESalary is commensurate with education, skills, and relevant experience.%3Cbr%3E%3Cbr%3E%3Cstrong%3ESECURITY AND EEO STATEMENT%3C/strong%3E%3Cbr%3E%3Cbr%3E%3Cstrong%3ESecurity%3C/strong%3E%3Cbr%3EThis position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.%3Cbr%3E%3Cbr%3E%3Cstrong%3EEEO%3C/strong%3E%3Cbr%3EUT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination, including discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.%3Cbr%3E%26nbsp;%3C/p%3E