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Posted: 23-May-23
Location: San Antonio, Texas
Salary: Open
Categories:
Internal Number: 12426402
Summary:
The RN Utilization Review II 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. The RN Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS.
The Children's Hospital of San Antonio, established in 1959, was the first children's hospital in South-Central Texas. Located downtown, this 190-plus-bed hospital serves more than 70,000 children annually from San Antonio, South Texas and around the world. The hospital (in partnership with Baylor College of Medicine) is the only academic children's hospital in San Antonio. Our highly specialized services meet the unique medical needs of children, from Pediatric and Neonatal Intensive Care to Children's Emergency Services, the latest treatments for deformities of the spine including titanium rib implants and halo traction, a Heart Center, a specialized asthma program, a highly regarded Cancer and Blood Disorders Center, and growing maternal services to include consultation, delivery, and maternal fetal medicine.
Requirements:
- 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
- Three to Five years experience in case management or utilization review or proven success as Registered Nurse Utilization Review I role
- RN License in state of employment or compact required
- CPR certification preferred
- Certification in Case Management preferred
Work Type:
Per Diem As Needed
