Utilization Review ( UR ) Nurse
Are you tired of: being on your feet all day? shift work? feeling over worked and under appreciated? UniMed has the answer for you! We have an immediate opening for a full-time UR Nurse in the Dallas or Austin area and an opportunity to truly make a difference.
The Key Roles/Essential Job Functions include:
*Performing utilization review activities according to UR policy and procedures.
*Contact providers as appropriate to obtain necessary information.
*Evaluate and authorize the medical necessity of inpatient and outpatient services as assigned, using approved criteria and established policies and guidelines.
*Refer cases to the Medical Director/Physician Advisor as appropriate.
*Evaluate each case for quality of care; documents quality issues and appropriately refers cases to the quality management coordinator.
*Review selected requests for quality and follow-up as necessary with the Medical Director.
*Participate in educating providers regarding UR services, policies and procedures.
*Maintain strong working relations with internal and external customers.
*Communicate positively and professionally.
*Actively participates in weekly staff meetings.
*Maintain confidentiality in all aspects of operations.
*Effectively articulates clinical and non-clinical information to personnel of all levels of understanding.
*Communicates information accurately and timely to internal and external staff both orally and in writing in operations, policies, procedures and regulatory standards.
Qualifications Include:
*Active and unrestricted Registered Nurse license
*A minimum of 2-3 years clinical experience preferably with a background in acute, sub-acute, inpatient, outpatient or long term care
*PC proficiency (knowledge of Microsoft Office Suite of programs)
*Knowledge of ICD-9 and CPT coding guidelines preferred
*Familiarity with ACOEM or ODG guidelines a plus
*Self-directed, excellent work ethic, and a strong sense of leadership
UniMed Direct is a URAC-accredited company with locations in the Dallas and Austin areas. Our full service platform includes prospective, concurrent and retrospective review, peer review and software solutions.
At UniMed, our AIM is:
A … Aspire to learn, grow, and please those we serve
I … Invest in people, customers, and employees
M … Master the quality of products and processes for each of our services
UniMed Direct offers a full range of comprehensive benefits, including medical and dental, life and a wide host of ancillary benefits, as well as a 401k plan. If you are interested in growing professionally within an innovative, highly respected organization, we invite you to explore this excellent growth opportunity!
