Utilization Review Nurse

7 days ago


Houston, Texas, United States Steward Health Care Full time
Job Title: Utilization Review RN

At St. Joseph Medical Center, we are seeking a highly skilled and dedicated Utilization Review RN to join our team. As a Utilization Review RN, you will play a critical role in ensuring that our patients receive the highest quality care while minimizing unnecessary hospital stays.

Job Summary:

The Utilization Review RN is responsible for conducting thorough reviews of patient medical records to determine medical necessity for admission, observation, and continued stays. You will work closely with our Physician Advisor and other healthcare professionals to ensure that our patients receive the most appropriate care.

Key Responsibilities:
  • Conduct concurrent reviews of admissions to determine medical necessity for admission, observation, and continued stays.
  • Review patient medical records to collect data pertaining to diagnoses and major procedures performed.
  • Evaluate appropriateness of hospitalization and continued care.
  • Collaborate with Physician Advisor and other healthcare professionals to ensure that patients receive the most appropriate care.
  • Communicate with payors regarding clinical updates and the need for continued hospitalization.
Requirements:
  • Current RN licensure issued by the Board of Nurse Examiners issued by the State of Texas.
  • Three (3) years experience as a Clinical Nurse, proficient in clinical and technical skills in nursing specialty.
  • Leadership and teaching skills in order to gain a full understanding of case management practices and procedures.
About Us:

St. Joseph Medical Center is a 137-year-old hospital that has been providing health care services to Greater Houston residents for over 130 years. We are committed to delivering world-class care to our patients and are seeking a dedicated and skilled Utilization Review RN to join our team.



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