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Utilization Review Nurse (UR RN) - M-F - No Weekends

Dallas, TexasCornerStone Medical

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Utilization Review Nurse (UR RN) - M-F - No Weekends - Contract 
Dallas, TX

CornerStone Medical is currently seeking an experienced Utilization Review Registered Nurse (RN). The UR Registered Nurse (RN) is responsible for conducting and evaluating clinical review for commercial payers to approve patient hospital days. This role involves contacting physicians to discuss status and obtain orders as appropriate for inpatient or observation. Also contacting payer as appropriate to provide additional clinical and overturn denial.This is a contract/ project role with the possibility of going permanent.

Responsibilities of the Utilization Review Nurse (UR RN):
  • Critical thinking skills needed, gather data from electronic medical record and experience using Interqual application to determine medical necessity. 
  • Ability to problem solve and work well in a fast paced environment.
  • Self motivated, able to prioritize multiple issues, excellent organizational skills. 
  • Communicate identified patients who do not meet criteria to Care Coordination for discharge planning.
  • Communicate problems or trends with insurance companies to Clinical Resource Manager/Director.
  • Perform chart analysis on quality surveillance and special studies as requested.

Qualifications of the Utilization Review Nurse (UR RN):
  • Bachelor’s degree or equivalent experience required
  • Current TX RN License required
  • Minimum of 5 years clinical experience
  • 3 – 5 years utilization review/case management experience required
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