Staff Nurse, RN Medical Oncology Specialist

2 weeks ago

Dallas, Texas, United States Children's Health (Dallas) Full time
Job Title: Staff Nurse, RN Medical Oncology

Children's Health (Dallas) is seeking a highly skilled Registered Nurse (RN) to join our team as a Utilization Review Specialist. This is a unique opportunity to make a meaningful impact on the lives of children and their families.

About the Role:

We are looking for a dedicated and detail-oriented RN to work in our Utilization Review department. As a Utilization Review Specialist, you will be responsible for determining and managing medical necessity of acute inpatient admissions utilizing clinical criteria. This includes communication with physicians and collaboration with the Physician Advisor during the review process.

Responsibilities:
  • Reviews inpatient medical necessity criteria utilizing Indicia or Interqual, CHST clinical pathways, and clinical knowledge to determine appropriateness of admission, level of care, and continued stay.
  • Analyzes patient records to determine legitimacy of admission, treatment, and length of stay in health-care facility to comply with government and insurance company reimbursement policies.
  • Collaborates with Patient Access Services as it relates to inpatient authorization, predetermination, pre/prior authorization, and status changes.
  • Communicates with Commercial or MMC (Medicaid Managed Care) payers to certify inpatient days as required.
Requirements:
  • At least 4 years clinical nursing experience. CCBD (Oncology), NICU, PICU, Heart Center (Cardiology, Pulmonary and/or Emergency Department) required.
  • Four-year Bachelor's degree or equivalent experience Bachelor's of Nursing preferred.
  • Two-year Associate's degree or equivalent experience Associate's Degree of Nursing required.
What We Offer:

We are committed to delivering culturally effective care, creating meaningful partnerships in the communities we serve, and equipping and developing our team members to make Children's Health a place where everyone can contribute. Our holistic benefits package includes employee portion of medical plan premiums covered after 3 years, adoption and surrogacy reimbursement, and more.

As an equal opportunity employer, Children's Health does not discriminate against employees or applicants because of race, color, religion, sex, gender identity and expression, sexual orientation, age, national origin, veteran or military status, disability, or genetic information or any other Federal or State legally-protected status or class.

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