Job Details

UTILIZATION REVIEW NURSE

Job Number: 529588
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


Graduate of accredited nursing program; BSN preferred. Current TX RN license; current CPR certification RN, BSN; or RN with 6 years of clinical experience and UR experience; or RN, CCM with 4 years experience in related field. Prefer knowledge of InterQual and TMF care criteria

Job Duties


Collaborates with other disciplines, physicians and payers to assess, develop, implement and monitor a comprehensive plan of care to ensure continuity of care and cost effectiveness.
Collaborates with physicians and staff regarding medical necessity for admission, continued stay or alternative treatment facilities/levels of care.
Consistently relates utilization assessment to payers that are needed to justify continued stay review and to obtain pre-certification.
On a concurrent basis, assesses appropriateness of the level of care.
Evaluates effectiveness of care and facilitates coordination of care toward specific outcomes criteria.
Maintains timely documentation; consistently meets department and UH documentation standards.
Identifies quality and risk issues, makes appropriate referrals. Confers with supervisor and/or Medical Director as appropriate.
Communicates effectively with other health care providers, patients, families, other hospital personnel and visitors. Demonstrates effective communication with adolescents, adults and older adults.
Knowledgeable of Department Performance Improvement Program and is aware of the expected participation.
Collaborates with Social Work and others to arrange discharge planning referrals per physician orders.
Identifies the need for professional growth and seeks appropriate development opportunities.
Evaluates care management outcomes data to identify trends and areas for improvement (i.e. avoidable day, denial information).


**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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