RN - Utilization Review


: $72,070.00 - $98,340.00 /year *

Employment Type

: Full-Time


: Healthcare - Nursing

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We Are Hiring
RN-Utilization Review
PRN, Day - Chevy Chase Building, Suite 300 - Austin, TX
Flexible hours weekdays and/or weekends
We are seeking a UR nurse to join our terrific high functioning UR team that can provide a high level of service with attention to detail
North Central location (very easy access and parking)
Preferred Candidates:
Preferred candidates for this position will have a minimum of 5 years of clinical nursing experience as a registered nurse in a hospital or payor setting. Must demonstrate experience in utilization review management.
Desired Skills:
+ Strong clinical skills
+ Critical thinking skills
+ Decisive judgement
+ Ability to work with minimal supervision
+ Knowledge of payor practices
+ Organizational skills
+ Attention to detail
+ Technical skills
Other Position Details:
+ PRN positions needed weekdays and/or weekends
+ PRN orientation/training must be for 2 weeks (consecutive days) or more
Why Join Ascension?
Ascension Seton, based in Austin, Texas, is a faith-based non-profit healthcare system founded in 1902 by the Daughters of Charity. Called to be a sign of Gods unconditional love for all, Ascension Seton strives to expand access to high-quality, low-cost, person-centered care and services. Ascension Seton operates more than 100 clinical locations, including four teaching hospitals which serve as training sites for Dell Medical School at The University of Texas.
Ascension is a faith-based healthcare organization dedicated to transformation through innovation across the continuum of care. As one of the leading non-profit and Catholic health systems in the U.S., Ascension is committed to delivering compassionate, personalized care to all, especially to those most in need. In FY2018, Ascension provided nearly $2 billion in care of persons living in poverty and other community benefit programs.
What You Will Do
As an Ascension Seton, you will have the opportunity to provide health care services regarding admissions, case management, discharge planning and utilization review.
+ Reviews admissions and service requests within assigned unit for prospective, concurrent and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provides case management and/or consultation for complex cases.
+ Assists departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement and claim denials/appeals.
+ Assesses and coordinates discharge planning needs with healthcare team members.
+ May prepare statistical analysis and utilization review reports as necessary.
+ Oversees and coordinates compliance to federally mandated and third party payer utilization management rules and regulations.
+ Actively participates in the discussion and notification processes that result from the clinical utilization reviews with the requestors. Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum.
+ Consults with physicians, payors, and outside agencies regarding continued care and treatment or hospitalization. Coordinates identification and reporting of potential high dollar/utilization cases to reinsure and finance department for appropriate reserve allocation.
What You Will Need
+ Required Credential(s):
+ Licensed Registered Nurse credentialed from the Texas Board of Nursing .
+ Diploma
+ Diploma from an accredited school/college of nursing required
Work Experience:
+ None required.
Equal Employment Opportunity
Seton Healthcare Family is an equal employment opportunity / Affirmative Action employer and complies with all applicable federal, state and local equal employment regulations and laws. It is the policy of the Seton Healthcare Family to afford equal employment opportunities to all employees and prospective employees without regard to their race, color, ancestry, religion, sex, sexual orientation, national origin, age, physical or mental disability, citizenship status, veteran status, gender identity or expression, or any other characteristic or status that is protected by federal, state, or local laws. This policy applies to all personnel actions, such as hiring, promotion, transfer, demotion, termination, layoff and all other conditions and privileges of employment in accordance with applicable federal, state, and local laws.
Affirmative Action goes beyond the concept of equal employment opportunity. Affirmative Action policies and programs are required to overcome the present effects of past discrimination and to achieve equal employment opportunity for members of groups that are or have been formerly under-represented. Affirmative Action policies and programs are tools whereby additional efforts are made to recruit, employ and promote qualified members of formerly excluded groups, even if that exclusion cannot be traced to particular discriminatory actions. Through specific and result-oriented activities, Seton Healthcare Familys goals are to ensure that every person is given full consideration through equal employment opportunity policies and practices and to achieve a representative workforce through its affirmative action efforts.
It is further the policy of the Seton Healthcare Family to encourage vendors, contractors, affiliate institutions and others doing business with the Seton Healthcare Family to observe the principles of Equal Employment Opportunity and Affirmative Action.
Seton Healthcare Family is an EEO/AA employer: M/F/Disabled/Vet.
For further information regarding your EEO rights, click on the following link to the EEO is the Law poster:
EEO is the Law Poster Supplement
Please note that Ascension will make an offer of employment only to individuals who have applied for a position using our official application. Be on alert for possible fraudulent offers of employment. Ascension will not solicit money or banking information from applicants.
REQNUMBER: 374857-1A
Associated topics: ambulatory, asn, cardiothoracic, domiciliary, intensive, nurse, nurse clinical, registered nurse, surgical, tcu * The salary listed in the header is an estimate based on salary data for similar jobs in the same area. Salary or compensation data found in the job description is accurate.

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