Utilization Review Registered Nurse (UR RN)- Full Time-Days
Company: Methodist Healthcare System
Location: San Antonio
Posted on: March 18, 2019
Description SHIFT: Days (rotating weekends) SCHEDULE: Full-time Methodist Hospital System Utilization Review Registered Nurse Full Time Days Methodist Healthcare is the largest provider of health care services in the South Texas region and enjoys the highest consumer preference share of services as measured by the National Research Corporation (NRC). Methodist has also won the San Antonio Express-News' People's Choice Award every year since its inception and the NRC Consumer Choice Award a dozen times - more than almost any other hospital organization in Texas. As San Antonio's second largest private employer, our facilities employ more than 10,000 individuals, including 2,700 physicians in all specialties. Our network of greater San Antonio hospitals includes: Methodist Hospital, Methodist Children's Hospital, Methodist Specialty and Transplant Hospital, Northeast Methodist Hospital, Metropolitan Methodist Hospital, Methodist Ambulatory Surgery Hospital, Methodist Stone Oak Hospital, Methodist Texsan Hospital, and Methodist Hospital South. We also have 2 freestanding emergency centers, Methodist Boerne Emergency Center and Metropolitan Methodist Emergency Center. At each of our facilities, Methodist Healthcare offers an outstanding selection of doctors, healthcare professionals, equipment and health services from wellness events to transplant services, pediatrics, dermatology, cardiology, oncology and a complete range of other medical services in the South Texas region. For more information, please visit our website at www.sahealth.com . The RN Utilization Review works with physicians and other members of the multidisciplinary team to develop a plan for each patient from admission to discharge. The tasks and responsibilities include: Performs continuous assessments and evaluations to ensure patient is progressing towards desired outcomes. Assesses and responds to patient/family needs by coordinating efforts of other team members. Identifies and resolves barriers that hinder effective patient care. Collaborates and consults with physicians on patient's progress and discharge planning needs. Performs utilization review ensuring admissions meet criteria for appropriateness of care and medical necessity. Manages the process to review and, as appropriate, appeal denials received from payors. Coordinates the discharge planning process ensuring involvement of all members of the healthcare team. Counsels with patients and family members in decision making and in meeting psycho social needs of the patient. Maintains knowledge of resources and facilities available to patients and family members. Collaborates with personnel at other facilities to coordinate smooth and effective patient transfers and transitions. Compiles, evaluates, and reports statistics to members of the team and utilizes the information to facilitate process improvement activities. Provides age and culturally appropriate care. Orients and mentors new staff members. Follows Standard Precautions using personal protective equipment as required. Qualifications Required Job Qualifications include: Current licensure as an RN Graduate of an accredited school of professional nursing. Bachelor's of Science in Nursing preferred. CCM preferred Minimum 5 years of clinical nursing experience. Knowledge of CMS guidelines and experience working with payor specific guidelines and contractual rules preferred. Customer service abilities including effective listening skills. Critical thinking skills, decisive judgment and the ability to work with minimal supervision meeting firm deadlines. Assertive and persuasive communication skills, action oriented.
Keywords: Methodist Healthcare System, San Antonio , Utilization Review Registered Nurse (UR RN)- Full Time-Days, Healthcare , San Antonio, Texas
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