Registered Nurse Utilization Review

Responsibilities: Manage admissions, case management, and utilization review to ensure quality patient care and efficient coordination. Collaborate with clinical teams to resolve issues regarding coding, reimbursement, and discharge planning.

Requirements: Requires a valid Registered Nurse license from Texas or a Compact State. A diploma from an accredited nursing school and experience in Utilization Review are required.

Key skills: Utilization Review, Case Management, Discharge Planning, Medical Necessity Review, Reimbursement Compliance, Clinical Coordination, Medical Documentation, Precertification, Claim Denials Management, Appeals Process, Federal Regulations Compliance, Performance Metrics Reporting

Keywords: Registered Nurse, Utilization Management, Medical Necessity, Case Management, Discharge Planning, Reimbursement, Claim Denials, Precertification, Texas Board of Nursing, Compact State License, Healthcare Compliance, Patient Care Coordination