Utilization Review Nurse

1 month ago


San Angelo, Texas, United States Shannon Health Full time
Job Summary

The Utilization Review (UR) Nurse plays a critical role in ensuring the efficient and effective management of patient care. This individual is responsible for developing and maintaining processes that ensure compliance with regulatory and reimbursement requirements. The UR Nurse performs concurrent and retrospective reviews, ensuring that data is accurate and up-to-date. This individual is also responsible for identifying and developing training programs for staff and colleagues. The UR Nurse actively participates in process improvement initiatives, collaborating with various departments and staff members. This individual maintains current knowledge of commercial and government payers, as well as CIHQ regulations and guidelines. The UR Nurse effectively manages a diverse workload in a dynamic regulatory environment.

Education

Education Type

Program of Study

Required/Preferred

High School Diploma

Required

Associate's degree

Nursing

Required

Bachelor's degree

Nursing

Preferred

Experience

Number of Years

Type of Experience

Required/Preferred

5 Years

Clinical nursing

Required

1 Year

Inpatient Utilization Review

Preferred

Certification & Licensures

Certification/Licensure Type

Required/Preferred

Registered Nurse (RN),

with Authorization to Practice in the State of Texas

Required

ACM (Accredited Case Manager) through ACMA

Preferred

CCM (Certified Case Manager) through CCMC

Preferred

*Must obtain within ninety (90) days of hire
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