Summary:

The RN Utilization Review II is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This RN is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services “CMS” Inpatient List). They effectively and efficiently manage a diverse workload in a fast-paces, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and Joint Commission regulations and guidelines related to UM. This RN effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services. The RN Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS.

CHRISTUS Santa Rosa Hospital - Westover Hills (CSRH-WH) is a 150-bed hospital serving the fastest growing area of San Antonio. Specialized care includes orthopedic and surgical services, ICU, women’s services, a newborn nursery, comprehensive cardiovascular care from diagnostics to open heart surgery, vascular lab, sleep center, emergency services, the CHRISTUS Weight Loss Institute, wound care, rehabilitation, and more. The campus also boasts an Outpatient Imaging Center and three medical plazas, one of which houses our CHRISTUS Santa Rosa Family Medicine Residency Program and CHRISTUS Santa Rosa Family Health Center.

Requirements:

• BSN Degree from an accredited nursing program or proven success as Registered Nurse Utilization Review I role
• Familiarity with criteria sets including InterQual and MCG preferred
• Excellent verbal and written communication
• Critical and analytical thinking skills
• Demonstrated clinical competency
• Three to Five years experience in case management or utilization review or proven success as Registered Nurse Utilization Review I role
  
• RN License in state of employment or compact required
  
• CPR certification preferred
• Certification in Case Management preferred

Work Type:

Per Diem As Needed

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