Registered Nurse

1 day ago

Dallas, Texas, United States Children's Health (Dallas) Full time
Job Title & Specialty Area:

Utilization Management RN

Department:

Utilization Review

Location:

Dallas

Shift:

Day, M-F (This position does provide some flexibility in start/end time, and does require availability to be on campus for meetings)

Job Type:

Remote

About the Role:

The Utilization Management Nurse is responsible for determining and managing medical necessity of acute inpatient admissions utilizing clinical criteria. This includes communication with the Physician's admitting patients to a Children's Health System of Texas (CHST) facility and collaboration with the Physician Advisor during the review process.

Responsibilities:
  • Accountable for current knowledge of utilization management responsibilities, including: payer information; business rules; regulatory guidelines; and policies and procedures.
  • Performs initial, concurrent, discharge, and retrospective reviews on assigned caseload. 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: Analyzes insurance, governmental, and accrediting agency standards to determine criteria concerning admissions, treatment, and length of stay of patients.
  • Combines clinical, business and regulatory knowledge and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided.
  • Maintains productivity and optimum case load, delegating appropriately to maximize skills set, productivity and effectiveness.
  • 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. Utilizes various methods to obtain necessary information: telephone, fax, secure email, secure web portal. Removing completed cases from the Midas worklist.
  • Maintain accurate documentation of all communication and interventions in EMR.
  • Escalate payer problems to UM RN II or Denials Management Specialist
  • Proactively intervenes with medical necessity, or level of care denials by exercising all real-time options to overturn decision. Actions include, but not limited to,
    requesting expedited appeal, use of third party Physician Advisor, facilitation of peer to peer with CHST Physician.
  • Identifies issues and strategies to modify and/or enhance the utilization management program.
  • Advances clinical expertise through attendance at in-hours education opportunities, reading journals, and attendance at conferences.
  • Attends department/program meetings regularly.
  • Maintains a level of productivity and quality consistent with: complexity of the assignment; facility policies and guidelines; established principles, ethics and standards of practice of professional nursing;
    Other job duties as assigned
Requirements:
  • At least 4 years clinical nursing experience. For those employees hired after 4/1/2022 experience must be in the following areas: CCBD (Oncology), NICU, PICU, Heart Center (Cardiology, Pulmonary and/or Emergency Department) required
  • At least 1 year Utilization Review or Case Management experience preferred
  • Previous experience with Interqual or Milliman preferred
  • 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 required
  • Registered Nurse required
  • Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification preferred
Benefits:
  • Wellness and fitness programs
  • Medical benefits
  • Dental benefits
  • Vision benefits
  • Holiday Pay
  • Pet insurance
  • Employee assistance programs
  • License and certification reimbursement
  • Life insurance

  • ER/Trauma Registered Nurse

    2 weeks ago

    Dallas, Texas, United States Travel Nurse Source Full time

    ER/Trauma Registered Nurse Job OpportunityWe are seeking an experienced ER/Trauma Registered Nurse to join our team at North Austin Medical Center in Austin, TX. This 13-week contract offers a Rotating shift and a competitive pay package.About the PositionAs a ER/Trauma travel nurse, you will provide high-quality care to patients in a fast-paced environment....

  • ER/Trauma Registered Nurse

    2 weeks ago

    Dallas, Texas, United States Travel Nurse Source Full time

    ER/Trauma Registered Nurse Job OpportunityWe are seeking an experienced ER/Trauma Registered Nurse to join our team at North Austin Medical Center in Austin, TX. This 13-week contract offers a Rotating shift and a competitive pay package.About the PositionAs a ER/Trauma travel nurse, you will provide high-quality care to patients in a fast-paced environment....

  • Operating Room Registered Nurse

    3 weeks ago

    Dallas, Texas, United States Travel Nurse Across America Full time

    Travel Nurse Opportunity in Dallas, TXTravel Nurse Across America is seeking a qualified Operating Room Registered Nurse for a travel nurse assignment in Dallas, TX.This assignment is in a traveler-friendly facility and offers excellent pay, benefits, bonus opportunities, travel reimbursement, and more.Requirements:Minimum 1-2 years' experience requiredACLS...

  • Cardiac Cath Lab Travel Registered Nurse

    2 months ago

    Dallas, Texas, United States Wellspring Nurse Source Full time

    Wellspring Nurse Source is currently in search of a travel nurse RN specializing in the Cardiac Catheterization Laboratory.Position Overview & RequirementsSpecialty: Cardiac Catheterization LaboratoryDiscipline: Registered NurseStart Date: ImmediateDuration: 13 weeks40 hours per weekShift: 8 hours, daytimeEmployment Type: TravelThe compensation package is...

  • Travel Nurse RN

    2 weeks ago

    Dallas, Texas, United States Travel Nurse Source Full time

    Job Title: Registered Nurse - Radiology - Cardiac Cath LabTravel Nurse Source is working with TRS Healthcare to find a qualified Registered Nurse for a Radiology - Cardiac Cath Lab position in Dallas, Texas.About the PositionThe Registered Nurse will be responsible for providing high-quality patient care in a dynamic and fast-paced environment. The ideal...

  • Travel Nurse RN

    2 weeks ago

    Dallas, Texas, United States Travel Nurse Source Full time

    Job Title: Registered Nurse - Progressive Care UnitTravel Nurse Source is working with TRS Healthcare to find a qualified Registered Nurse for a Progressive Care Unit position in Austin, Texas.About the PositionThe Registered Nurse will assume responsibility and accountability for incorporating the vision, values, mission, and critical goals of the...

  • Travel Nurse Position

    2 weeks ago

    Dallas, Texas, United States Travel Nurse Source Full time

    Job Title: Registered Nurse - OB - PostpartumTravel Nurse Source is working with TRS Healthcare to find a qualified Postpartum RN in Austin, Texas.About the PositionWe are seeking a Registered Nurse who is licensed to work in TX, and has OB - Postpartum experience. The Registered Nurse assumes responsibility and accountability for incorporating the vision,...

  • Travel Nurse Position

    2 weeks ago

    Dallas, Texas, United States Travel Nurse Source Full time

    Travel Nurse Opportunity in Pecos, TexasTravel Nurse Source is partnering with TRS Healthcare to find a qualified Med/Surg RN for a travel nursing assignment in Pecos, Texas.About the PositionThe Registered Nurse will be responsible for providing high-quality patient care in a Medical Surgical setting. The ideal candidate will have recent experience as a...

  • Travel Nurse

    2 weeks ago

    Dallas, Texas, United States Travel Nurse Source Full time

    Job Title: Telemetry Registered NurseTravel Nurse Source is partnering with Amare Medical Network to find a skilled Telemetry Registered Nurse in Dallas, Texas.About the PositionThe Telemetry Registered Nurse will be responsible for providing high-quality patient care in a fast-paced environment. The ideal candidate will have excellent critical thinking...

  • Travel Nurse Position

    3 weeks ago

    Dallas, Texas, United States Travel Nurse Source Full time

    About the PositionTRS Healthcare is seeking a Registered Nurse with experience in Telemetry Unit to work in Austin, Texas. The ideal candidate will have a current Registered Nurse license to work in the state of TX and at least 1 year of recent experience specializing in Telemetry Unit.ResponsibilitiesAssume responsibility and accountability for...

  • Travel Nurse RN

    5 days ago

    Dallas, Texas, United States Travel Nurse Source Full time

    About the JobWe are seeking a highly skilled Registered Nurse to join our team at TRS Healthcare. As a Registered Nurse - Electrophysiology Lab, you will be responsible for providing exceptional patient care and working collaboratively with our team to deliver high-quality healthcare services.ResponsibilitiesProvide direct patient care and develop...

  • Travel Nurse RN Position

    3 weeks ago

    Dallas, Texas, United States Travel Nurse Source Full time

    Job Title: Registered Nurse - ER/Trauma RNTravel Nurse Source is working with TRS Healthcare to find a qualified ER/Trauma RN in Dallas, Texas.About the PositionWe are seeking a Registered Nurse who is licensed to work in TX, and has Emergency Room experience. The Registered Nurse assumes responsibility and accountability for incorporating the vision,...

  • Travel Nurse RN

    2 hours ago

    Dallas, Texas, United States Travel Nurse Source Full time

    About the Position:Travel Nurse Source is working with TRS Healthcare to find a qualified Radiology RN in a dynamic healthcare setting. As a Registered Nurse - Electrophysiology Lab, you will be responsible for providing high-quality patient care and working collaboratively with a multidisciplinary team.Minimum Requirements: RN Registered Nurse...

  • Travel Nurse

    2 weeks ago

    Dallas, Texas, United States Travel Nurse Source Full time

    Job Title: Travel Registered NurseTravel Nurse Source is working with Amare Medical Network to find a qualified Labor/Delivery RN in Austin, Texas.About the PositionLabor and Delivery Registered Nurses play a vital role in the healthcare system, providing care to expecting and new mothers. They work closely with doctors to ensure a safe delivery and provide...

  • Travel Nurse RN Position

    3 weeks ago

    Dallas, Texas, United States Travel Nurse Source Full time

    About the PositionTravel Nurse Source is working with TRS Healthcare to find a qualified Registered Nurse for a Progressive Care Unit (PCU) position in Austin, Texas. The ideal candidate will have recent experience as a Registered Nurse in a PCU setting and be licensed to work in the state of Texas.ResponsibilitiesProvide high-quality patient care in a PCU...

  • Travel Nurse RN

    3 weeks ago

    Dallas, Texas, United States Travel Nurse Source Full time

    About the JobTravel Nurse Source is partnering with Cynet Health to find a skilled Registered Nurse for a 13-week assignment in Dallas, Texas.Job DetailsJob Title: Registered Nurse - Operating Room (OR)Job Specialty: ORShift: 19:00 - 07:00, Thursday - SaturdayGuaranteed Hours: Experience: Minimum 1 yearLicense: Registered Nurse LicenseCertifications: Basic...

  • Travel Nurse Position

    3 weeks ago

    Dallas, Texas, United States Travel Nurse Source Full time

    About the PositionTravel Nurse Source is working with TRS Healthcare to find a qualified Postpartum RN in Austin, Texas, 78758. As a Registered Nurse - OB - Postpartum, you will be responsible for providing high-quality patient care in a dynamic and fast-paced environment.ResponsibilitiesProvide direct patient care to postpartum patients, including...

  • Travel Nurse RN Position

    3 weeks ago

    Dallas, Texas, United States Travel Nurse Source Full time

    About The PositionTravel Nurse Source is working with TRS Healthcare to find a qualified OR RN in Dallas, Texas. The Registered Nurse assumes responsibility and accountability for incorporating the vision, values, mission, and critical goals of the organization into their job performance.Minimum Requirements Include:Current Registered Nurse license to work...

  • Travel Nurse RN Position

    3 weeks ago

    Dallas, Texas, United States Travel Nurse Source Full time

    About The PositionTravel Nurse Source is working with TRS Healthcare to find a qualified ER/Trauma Registered Nurse in Alpine, Texas.Pay Information$1,708 per weekJob RequirementsRegistered Nurse License/Certification2 years of recent experience as a Registered Nurse1 year of recent experience specializing in Emergency RoomCurrent Registered Nurse license to...

  • Travel Nurse RN Position

    2 weeks ago

    Dallas, Texas, United States Travel Nurse Source Full time

    Oncology Registered Nurse Job OpportunityTravel Nurse Source is partnering with Amare Medical Network to find a skilled Oncology Registered Nurse (RN) for a travel nursing assignment in Dallas, Texas.About the PositionAn Oncology Registered Nurse is a specialist in the healthcare field who administers care and support for patients undergoing cancer...