Texas Licensed Utilization Management RN

Job Summary

Responsible for determining and managing medical necessity for acute inpatient admissions, the full-time Texas Licensed Utilization Management RN will perform reviews on assigned cases and collaborate with healthcare providers, working remotely with monthly onsite requirements and occasional weekend and holiday shifts.

Key responsibilities

• Conduct initial, concurrent, discharge, and retrospective reviews to assess medical necessity and appropriateness of admissions and continued stays
• Analyze patient records and collaborate with physicians to ensure compliance with regulatory guidelines and reimbursement policies
• Maintain productivity and manage caseload effectively while communicating with payers for inpatient authorization and status changes

Required qualifications

• Four years of clinical nursing experience, with specific experience in CCBD (Oncology), NICU, PICU, or Heart Center for those hired after 4/1/2022
• One year of experience in Utilization Review or Case Management is preferred
• Four-year Bachelor's degree in Nursing or equivalent experience is preferred; a two-year Associate's degree in Nursing is required
• Current Registered Nurse license is required
• Preferred certifications include Accredited Case Manager (ACM) or Certified Case Manager (CCM)