Utilization Review Nurse - DMC in Farmers Branch, TX at Dallas Medical Center

Date Posted: 7/8/2018

Job Snapshot

Job Description

Summary:
JOB SUMMARY: The Utilization Review Nurse is responsible for maximizing the quality and cost efficiency for the EPO Plan. Utilization Review Nurse will set up processes, systems, and measures of performance with our Prime Hospitals, Prime Physicians and our employees related to effective authorization and care management programs in our employee health plan. This position will work closely with the Corporate Utilization Review Department, Prime Healthcare Case Managers, Social Workers, and Discharge Planners.JOB SUMMARY: The Utilization Review Nurse is responsible for maximizing the quality and cost efficiency for the EPO Plan. Utilization Review Nurse will set up processes, systems, and measures of performance with our Prime Hospitals, Prime Physicians and our employees related to effective authorization and care management programs in our employee health plan. This position will work closely with the Corporate Utilization Review Department, Prime Healthcare Case Managers, Social Workers, and Discharge Planners.

EDUCATION, EXPERIENCE, TRAINING

1. Post graduate of an accredited school of nursing and an active Registered Nurse license.
2. Five (5) years’ experience in acute hospital case management or equivalent.
3. Utilization Management experience required.
4. Proficient in word processing, spread sheets and database.
5. Excellent interpersonal relationship skills with exceptional professional work ethics.
6. Knowledge of Milliman Care Guidelines, InterQual Criteria, and CMS.
7. Experience and knowledge of self-funded plans, ERISA, and HIPPA guidelines.
   

Work Type: Full Time Employee    

Shift: 1

Legend: Shift 1=Day, 2=Evening, 3=Night, 4=Varied.

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation, or other protected characteristics. If you need special accommodation for the application process, please contact the Human Resources Department.

EEO is the law poster.