Top 20 Utilization review nurse Jobs in El Paso, Tx

Utilization Review Nurse
EL PASO CHILDRENS HOSPITAL CORPORATION —El Paso, TX
- Full-time
- Nursing
- RN License
- Customer service
Utilization Specialist - PRN
Rio Vista Behavioral Health —El Paso, TX
- PRN
- CPR Certification
- Nursing
- RN License
Utilization Rev Nurse Coord , El Paso Health
University Medical Center of El Paso —El Paso, TX
- Full-time
- Spanish
- Nursing
- RN License
Utilization Specialist - FT
Rio Vista Behavioral Health —El Paso, TX
- Full-time
- CPR Certification
- Nursing
- RN License
12d
Case Manager, PRN
University Medical Center of El Paso —El Paso, TX
- PRN
- Spanish
- Nursing
- RN License
Quality Improvement Coordinator (RN)
The Hospitals of Providence - East Campus —El Paso, TX
- Full-time
- Nursing
- RN License
- Hospital
- Health savings account
- Health insurance
Case Manager II Full Time
Kindred Hospital El Paso —El Paso, TX
- Full-time
- Master of Social Work
- Nursing
- RN License
Medical Case Manager I - Spanish Speaking Part-Time
CorVel Corporation —El Paso, TX
- $63,739 - $95,264 a year
- Part-time
- Remote
- Spanish
- Nursing
- RN License
- Health savings account
- Disability insurance
Quick Apply
Nurse Practitioner- General Surgery
Greater Texas Healthcare Enterprises —El Paso, TX
- Full-time
- Nursing
- Surgery
- RN License
Nurse Practitioner- Gastroenterology- El Paso, TX
Greater Texas Healthcare Enterprises —El Paso, TX
- Full-time
- Nursing
- RN License
- HIPAA
Advanced Practice Provider
NAUTILUS MEDICAL GROUP INC —El Paso, TX
- Nursing
- Doctoral degree
- Certified Nurse Practitioner
Quick Apply

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Utilization Review Nurse
EL PASO CHILDRENS HOSPITAL CORPORATION —El Paso, TX
An understanding of the severity of an array of illnesses, intensity of service, and care coordination needs are the key, as the nurse must integrate clinical…
Utilization Specialist - PRN
Rio Vista Behavioral Health —El Paso, TX
Preferred Licensure: LPN, RN, LMSW, LCSW, LPC, LPC-I within the state where the facility provides services; or current clinical professional license or…

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Utilization Review Specialist - Autism
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Bachelor’s Degree in Social Work, Psychology, or related field, required. Documents all case reviews and maintains accurate records of all clinical activities…
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Current unencumbered license for the state of Ohio to practice as a Licenses Practical Nurse (LPN) preferred Certificate for OASIS Specialist-Clinical…
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utilization review nurse jobs near el paso, tx

Utilization Review Nurse

EL PASO CHILDRENS HOSPITAL CORPORATION -
El Paso, TX

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Job Details

Full-time

Qualifications

Nursing
RN License
Quality assurance
Utilization management
Typing
Associate's degree
Associate Degree in Nursing
Nursing

Full Job Description

To monitor adherence to the hospital’s utilization review plan to ensure the effective and efficient use of hospital services. Responsible for ensuring the appropriateness of hospital admissions and extended hospital stays. An understanding of the severity of an array of illnesses, intensity of service, and care coordination needs are the key, as the nurse must integrate clinical knowledge with billing knowledge to review, evaluate and arrange peer to peers when clinical denials related to medical necessity of the patient while hospitalized. UM nurse will work closely in collaboration with physician advisers to support policy development, and process improvement.

Work Experience:

Two (2) years prior experience with Utilization Management.
Previous training and demonstrated competence in negotiations, quality assurance, case management outcomes, and keyboarding/computer use.
Experience with InterQual and/or Milliman Care Guidelines. Strong organizational and time management skills.
Ability to work on extremely complex problems where analysis of situation or data requires an evaluation of intangible variance factors.

License/Registration/Certification:

Current RN License to practice in the State of Texas.

Education and Training:

Associate’s Degree in Nursing, BSN preferred.

Skills:

Ability to utilize proficient verbal, written and interpersonal communication skills.
Ability to work on extremely complete problems where analysis of situations or data requires an evaluation of intangible variance factors.
Knowledge of managed care, reimbursement and utilization management.
Knowledge of current International Classification of Disease (ICD-10), Diagnostic Related Groups (DRGs), and medical necessity criteria.
Knowledge of claims denials and appeals processing
Ability to coordinate and manage multiple priorities, projects simultaneously, reprioritizing as necessary
Ability to self-motivate, multi-task and prioritize in a fast paced environment.
Ability to use analytical and problem solving skills.
Knowledge of HIPAA standards.
Knowledge of various insurance plan coverages for Home Health, DME, SNF, LTAC agencies.
Works well with people of all social, economic, and cultural backgrounds.
Strong customer service orientation.
Knowledgeable regarding community resources.
Knowledge of basic computer, word-processing, and spreadsheet skills, Microsoft.
Ability to operate standard office equipment.
Knowledge of English grammar, punctuation and spelling.

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utilization review nurse jobs in el paso, tx

Utilization Review Nurse

Utilization Specialist - PRN

Utilization Rev Nurse Coord , El Paso Health

Utilization Specialist - FT

Case Manager, PRN

Quality Improvement Coordinator (RN)

Case Manager II Full Time

Medical Case Manager I - Spanish Speaking Part-Time

Nurse Practitioner- General Surgery

Nurse Practitioner- Gastroenterology- El Paso, TX

Advanced Practice Provider

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