Top 12 Utilization review nurse Jobs in Edinburg Tx

Clinical Documentation Specialist RN
Houston Methodist —Texas
- Full-time
- Nursing
- RN License
- Customer service
2d
Case Manager RN
Mission Regional Medical Center —Mission, TX
- Day shift
- Nursing
- Hospital
- Computer literacy
- 401(k)
RN Case Manager
Mission Regional Medical Center —Mission, TX
- 8 hour shift
- Nursing
- RN License
- Hospital
- Health insurance
LVN Case Manager- FT - Days - Res Mgmt
DHR Health —Edinburg, TX
- Full-time
- Nursing
- LVN
- Hospital
RN Transfer - PRN - Varies - Patient Intake Care
DHR Health —Edinburg, TX
- Call employer
- Spanish
- Nursing
- RN License
Quality Assurance Nurse
Stepping Stones Home Care Services Ltd —McAllen, TX
- $25 - $30 an hour
- Full-time
- LVN
- RN License
- Data analysis skills
- Health insurance
- Dental insurance
Quick Apply
4d
NPST Clinical Operations Manager
Nurse Practitioner Services of Texas —Weslaco, TX
- Weekends as needed
- Nursing
- RN License
- Computer literacy
Quick Apply
12d

Discover related jobs

Based on your search for utilization review nurse jobs.

Clinical Documentation Specialist RN
Houston Methodist —Texas
RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure – Must obtain permanent Texas license within 60 days (if…
2d
BILLING CLERK
The University of Texas Rio Grande Valley —Edinburg, TX
Responds to calls and ensures caller’s needs are met and accurate information is obtained. Skill in data entry with minimal errors.
4d

Show more related jobs

Explore jobs in cities nearby

Check out jobs in cities near your current location, Columbus

Utilization Review Specialist - Autism
Nationwide Children's Hospital —Columbus, OH
Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
11d
Clinical Review Nurse Supervisor (Medicaid Health Systems Administrator 1)
State of Ohio - Medicaid —Columbus, OH
Or, in order to operate a state vehicle, you must have a valid driver's license from state of residence. Exp. in the delivery of a health services program or…
$40.40 an hour
11d

Show more jobs in cities nearby

I want to receive the latest job alert for utilization review nurse in edinburg tx

By signing in to your account, you agree to SimplyHired's Terms of Service and consent to our Cookie and Privacy Policy.

Explore jobs in more locations

utilization review nurse jobs near edinburg tx

Case Manager jobs in Edinburg, TX

Registered Nurse Case Manager jobs in Mission, TX

Clinical Documentation Specialist jobs in Texas

Case Manager jobs in Memphis, TN

Case Manager jobs in Waukesha, WI

Customer Success Manager jobs in Portland, OR

Rn Case Manager Remote Jobs jobs in New York State

Case Manager jobs in Bronx, NY

Case Manager jobs in Winston Salem, NC

Safety Manager jobs in Kansas City, MO

Case Manager jobs in Dover, DE

Registered Nurse Case Manager jobs in Hollywood, FL

Lvn Case Manager jobs in Texas

Registered Dietitian jobs in Waco, TX

Travel Nurse jobs in Honolulu, HI

Registered Nurse Case Manager jobs in Emeryville, CA

Registered Nurse Case Manager jobs in Hampton, VA

Registered Nurse Case Manager jobs in Williamsport, PA

Case Manager jobs in Roanoke, VA

Social Work Case Manager jobs in Memphis, TN

Clinical Documentation Specialist RN

Houston Methodist -
Texas

Apply Now

Job Details

Full-time
2 days ago

Qualifications

Direct patient care
Customer communication
RN License
English
Acute care experience

Full Job Description

At Houston Methodist, the Clinical Documentation Specialist RN position is responsible for improving the overall quality and completeness of clinical documentation. This position analyzes medical records for DRG's, complications, and comorbidities; identifies trends; and notes observations and recommendations for documentation improvement. This Clinical Documentation Specialist RN position also facilitates modifications to clinical documentation through extensive interaction with physicians, nursing staff, other patient care givers, and medical records coding staff to ensure that appropriate reimbursement is received for the level of service rendered to all patients. Additional duties for this position include supporting the accuracy and completeness of the clinical information used for measuring and reporting physician and hospital outcomes and educating all members of the patient care team on an ongoing basis.

FLSA STATUS
Exempt

QUALIFICATIONS

EDUCATION

Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certifications, Licenses and Registrations section

EXPERIENCE

Five years of recent clinical experience caring for adults in an acute care hospital setting
Coding and utilization review experience preferred

LICENSES AND CERTIFICATIONS
Required

RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure – Must obtain permanent Texas license within 60 days (if establishing Texas residency)

Preferred

CCDS - Clinical Documentation Specialists (ACDIS) or
CDIP - Certified Documentation Integrity Practitioner (AHIMA) or
CCS - Certified Coding Specialist (AHIMA)

KNOWLEDGE AND ABILITIES

Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing skills, competency assessments, and performance evaluations
Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security
Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles
Demonstrates knowledge of DRG payor issues, appropriate DRG assignment alternatives, clinical documentation requirements, and referral policies and procedures
Demonstrates accountability and professional development
Excellent observation skills, analytical thinking, problem solving, plus good verbal and written communication
Regular significant contacts with other personnel throughout the institution (including but not limited to physicians and their staff, mid-level providers, mid-level staff, coders, Case Managers). Contacts may be in person, by telephone, or through correspondence

ESSENTIAL FUNCTIONS

PEOPLE ESSENTIAL FUNCTIONS

Improves the overall quality, completeness and accuracy of clinical documentation by performing open record reviews using clinical documentation guidelines.
Supports the accuracy and completeness of clinical information used for measuring and reporting physician and medical outcomes.

SERVICE ESSENTIAL FUNCTIONS

Seeks additional information regarding clinical condition from appropriate clinical personnel and follows up as necessary.
Tracks responses and trends completion of DRG/Documentation worksheets as pertinent to scope of department.
Conducts follow-up reviews of clinical documentation to ensure points of clarification have been recorded in the patient’s chart.

QUALITY/SAFETY ESSENTIAL FUNCTIONS

Demonstrates knowledge of DRG payor issues, optimization strategies, clinical documentation requirements and referral policies and procedures.
Requests clarification and/or correction from physicians for unclear diagnoses, complications, procedures, and clinical information.
Helps identify appropriate ICD10 codes for diagnoses or procedures related to projects or studies being conducted as needed.

FINANCE ESSENTIAL FUNCTIONS

Promotes clarification to clinical documentation to ensure that appropriate reimbursement is received for the level of service rendered to all patients.
Identifies diagnoses and procedures performed and comorbidities and complications.
Impacts discharges by updating the DRG worksheet to reflect any changes in status, procedures/treatments, conferring with physician to finalize diagnosis as necessary.

GROWTH/INNOVATION ESSENTIAL FUNCTIONS Educates all internal customers on clinical documentation opportunities, coding, and reimbursement issues, as well as performance improvement methodologies.

SUPPLEMENTAL REQUIREMENTS

WORK ATTIRE

- Uniform: No
- Scrubs: No
- Business professional: Yes
- Other (department approved): No

ON-CALL*

- Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below.
- On Call* No

TRAVEL**

**Travel specifications may vary by department**

- May require travel within the Houston Metropolitan area No
- May require travel outside Houston Metropolitan area No

QUALIFICATIONS

EDUCATION

Graduate of education program approved by the credentialing body for the required credential(s) indicated below in the Certifications, Licenses and Registrations section

EXPERIENCE

Five years of recent clinical experience caring for adults in an acute care hospital setting
Coding and utilization review experience preferred

LICENSES AND CERTIFICATIONS
Required

RN - Registered Nurse - Texas State Licensure - Texas Board of Nursing_PSV Compact Licensure – Must obtain permanent Texas license within 60 days (if establishing Texas residency)

Preferred

CCDS - Clinical Documentation Specialists (ACDIS) or
CDIP - Certified Documentation Integrity Practitioner (AHIMA) or

Company Profile:

Houston Methodist is one of the nation’s leading health systems and academic medical centers. The health system consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the Texas Medical Center, seven community hospitals and one long-term acute care hospital throughout the Greater Houston metropolitan area. Houston Methodist also includes a research institute; a comprehensive residency program; international patient services; freestanding comprehensive care clinics, emergency care and imaging centers; and outpatient facilities. Come lead with us!

Houston Methodist is an Equal Opportunity Employer.

Apply Now

Refine Your Search

utilization review nurse jobs in edinburg tx

Clinical Documentation Specialist RN

Case Manager RN

RN Case Manager

LVN Case Manager- FT - Days - Res Mgmt

RN Transfer - PRN - Varies - Patient Intake Care

Quality Assurance Nurse

NPST Clinical Operations Manager

Discover related jobs

Explore jobs in cities nearby

I want to receive the latest job alert for utilization review nurse in edinburg tx

Explore jobs in more locations

Job Seeker Tools

Employer Tools

Browse

Stay Connected