Registered Nurse (RN) Utilization Review Nurse- PRN

About the Role

Join Houston Methodist as a Registered Nurse (RN) Utilization Review Nurse- PRN in United States.

Key Responsibilities

• Must obtain permanent Texas license within 60 days (if establishing Texas residency) SKILLS AND ABILITIES Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through ongoing skills, competency assessments, and performance evaluations Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles Progressive knowledge of InterQual Level of Care Criteria or Milliman Care Guidelines and knowledge of local and national coverage determinations Recent work experience in a hospital or insurance company providing utilization review services Knowledge of Medicare, Medicaid, and Managed Care requirements Progressive knowledge of community resources, health care financial and payer requirements/issues, and eligibility for state, local, and federal programs Progressive knowledge of utilization management, case management, performance improvement, and managed care reimbursement Ability to work independently and exercise sound judgment in interactions with physicians, payers, and health care team members Strong assessment, organizational, and problem-solving skills Maintains level of professional contributions as defined in Career Path program Understands and applies federal law regarding the use of Hospital Initiated Notice of Non-Coverage (HINN), Ambulatory Benefit Notice (ABN), Important Message from Medicare (IMM), Medicare Outpatient Observation Notice (MOON), and Condition Code 44 (CC44) ESSENTIAL FUNCTIONS PEOPLE ESSENTIAL FUNCTIONS Establishes and maintains effective professional working relationships with patients, families, interdisciplinary team members, payers, and external case managers; listens and responds to the ideas of others.

• manage time effectively and prioritize daily tasks, assisting coworkers as needed.

Requirements

• Registered Nurse

• Texas State Licensure

• solving skills Maintains level of professional contributions as defined in Career Path program Understands and applies federal law regarding the use of Hospital Initiated Notice of Non

• peer accountability. SERVICE ESSENTIAL FUNCTIONS Pro

Work Schedule

• Per Diem position.

• Call responsibilities required.

Apply to join Houston Methodist as a Registered Nurse (RN) Utilization Review Nurse- PRN.