Registered Nurse Utilization Review - Dallas, TX - Utilization Review
Company: William P. Clements Jr. University Hospital
Location: Dallas
Posted on: January 27, 2023
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Job Description:
Registered Nurse Utilization Review - Dallas, TXRegistered Nurse
Utilization Review Full Time Days Remote
Friday to Tuesday Evenings 3:00PM to 11:30PM
Why UT Southwestern? With over 75 years of excellence in
Dallas-Fort Worth, Texas, UT Southwestern is committed to
excellence, innovation, teamwork, and compassion. As a
world-renowned medical and research center, we strive to provide
the best possible care, resources, and benefits for our valued
employees. Ranked as the #1 hospital in Dallas-Fort Worth for the
sixth consecutive year, we invite you to continue your healthcare
career with us at William P. Clements Jr. University Hospital.
You'll discover a culture of teamwork, professionalism, and
consistent opportunities for learning and advancement into
leadership roles.
Job Summary
Conduct medical certification review for medical necessity for
acute care facility and services. Use nationally recognized,
evidence-based guidelines approved by medical staff to recommend
level of care to the physician and serve as a resource to the
medical staff on issues related to admission qualifications,
resource utilization, national and local coverage determinations
and documentation requirements.
Conducts inpatient admission review for Medicare and Medicaid
beneficiaries as well as private insurance members and self-pay
patients based on evidence-based guidelines. Confers with admitting
physicians when documentation does not appear to support hospital
level of care and offers suggestions for clarity and completeness.
Uses InterQual Level of Care Criteria for appropriateness for
inpatient level of care or observation services based on physician
documentation, H&P, treatment plan, potential risks, and basis
for expectation of a two-midnight stay.
Experience and Education
Job Duties
Knowledge, Skills, & Abilities
Working Conditions
This job is remote only and individuals who reside in the job will
permanently work 100% from an alternate approved worksite. Any
qualifications to be considered as equivalents in lieu of stated
minimums require prior approval of the Vice President for Human
Resources Administration, or his/her designee.
Compliance with the COVID-19 vaccine mandate enforced by the
Centers for Medicare and Medicaid (CMS) is a requirement for this
position. Federal law requires individuals holding this position to
be fully vaccinated or have an approved exemption for certain
medical, disability, or religious reasons. Individuals who do not
meet CMS vaccination requirements are not eligible and should not
apply for this position but are encouraged to apply for other
non-healthcare positions at UT Southwestern for which they
qualify.
For COVID-19 vaccine information, applicants should visit
To learn more about the benefits UT Southwestern offers, visit
This position is security-sensitive and subject to Texas Education
Code --51.215, which authorizes UT Southwestern to obtain criminal
history record information.
UT Southwestern Medical Center is committed to an educational and
working environment that provides equal opportunity to all members
of the University community. As an equal opportunity employer, UT
Southwestern prohibits unlawful discrimination, including
discrimination on the basis of race, color, religion, national
origin, sex, sexual orientation, gender identity, gender
expression, age, disability, genetic information, citizenship
status, or veteran status. To learn more, please visit:
Keywords: William P. Clements Jr. University Hospital, Dallas , Registered Nurse Utilization Review - Dallas, TX - Utilization Review, Healthcare , Dallas, Texas
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