Utilization Review Nurse
1 month ago
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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