Job Details

Manager Registered Nurse UR/DENIALS

Job Number: 527723
Categories: Nursing
Location:
Dallas, TX

Department: University Hospitals
Full/Part Time/PRN: Full-Time
Regular/Temporary: Regular



Security


This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information


Salary


Salary Negotiable


Experience and Education


-BA/BS degree in Clinical desired. Registered Nurse required.-Minimum of five (5) years in a health care management position and six (6) years nursing experience with three (3) years UR experience is required. Must have extensive knowledge of the healthcare revenue cycle including insurance verification; knowledge of established medical necessity criteria; basic knowledge of ICD-9 / ICD-10 coding, CPT coding, MS-DRG's, APC's, contracts and applicable rules and regulations affecting reimbursement for healthcare services. Proven record of identifying process improvement opportunities. Requires strong negotiating, analytical and organizational skills as well as the ability to be flexible with changing needs and deadlines; the ability to interact and communicate both verbally and in writing with all levels of associates, management and patients. -Current Texas Registered Nurse license is required

Job Duties


1. Ensures that inpatient concurrent reviews and retrospective review requests are performed using nationally recognized and evidence based standards. Ensures quality of documentation and actively participates in managing inpatient utilization across the Continuum of Care to full efficiency.
2. Provides leadership guidance to the UR Nurses and Denials team. Tracks and monitors accuracy and timeliness of data entered by staff.
3. Provides leadership in Health Services programs, operations, projects, policies and procedures to ensure high quality results. Leads team in assuring resources are optimally used to facilitate patient care goals, appropriate cost and length of stay.
4. Utilizes data research to develop and implement programs to reduce length of stay. Interfaces with and coordinates efforts of admissions, PFS and HIM relevant to concurrent utilization review system. Evaluates, recommends and implements policies procedures related to utilization review system, including appropriate resource utilization and identification of avoidable days.
5. Analyze denials information to identify problems and trends and develop reports/feedback to be presented to Senior Management and Clinical Department leadership.
6. Leads monthly/periodic meetings with focused denial groups as well as Utilization Review Committee.


**Other Duties: Performs other duties as assigned.

UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. In accordance with federal and state law, the University prohibits unlawful discrimination, including harassment, on the basis of: race; color; religion; national origin; gender, including sexual harassment; age; disability; citizenship; and veteran status. In addition, it is UT Southwestern policy to prohibit discrimination on the basis of sexual orientation, gender identity, or gender expression.

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