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Utilization Review RN - Utilization Review

Company: CHI Saint Luke's Hospital at the Vintage
Location: Houston
Posted on: August 7, 2022

Job Description:

Utilization Review RNOverview

Baylor St. Luke's Medical Center is an 881-bed quaternary care academic medical center that is a joint venture between Baylor College of Medicine and CHI St. Luke's Health. Located in the Texas Medical Center, the hospital is the home of the Texas Heart-- Institute, a cardiovascular research and education institution founded in 1962 by Denton A. Cooley, MD. The hospital was the first facility in Texas and the Southwest designated a Magnet-- hospital for Nursing Excellence by the American Nurses Credentialing Center, receiving the award five consecutive times. Baylor St. Luke's also has three community emergency centers offering adult and pediatric care for the Greater Houston area.

CHI St. Luke's Health, now part of CommonSpirit Health formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health, has been serving our community since 1954. We proudly provide a vast array of services that help us keep our community safe and healthy. Our world needs compassion like never before. Our communities need caring, and our families need protection. With our combined resources, we are committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen, both inside our hospitals and out in the community. This role will allow you to give back to our community and broaden your healthcare skills.

We offer the following benefits to support you and your family:

* Health/Dental/Vision Insurance
* Free Premium Membership to Care.com with preloaded credits for children and dependent adults
* Care for Caregivers: Resilience Through Adversity is a series of sessions designed to help caregivers build their resilience and advance their mental well-being during these difficult times
* Flexible spending accounts
* Voluntary Protection: Group Accident, Critical Illness, and Identity Theft
* Employee Assistance Program (EAP) for you and your family
* Paid Time Off (PTO)
* Tuition Assistance for career growth and development
* Matching Retirement Programs
* Wellness Programs

Responsibilities

Provides the Center for Integrated Care with clinical expertise and knowledge of appropriate utilization management, managed care guidelines, Medicare and Medicaid rules, and level of care criteria by performing data collection and analysis, concurrent and retrospective reviews, documentation audits, physician advisor referrals, and staff education. Supports ongoing quality enhancement and third-party reimbursement for services rendered.

Qualifications

Required:

* Associate's Degree
* Registered Nurse (RN)
* Two (2) years of experience
* Knowledge of case management, working of Medicare, Medicaid and private insurance
* Ability to interact professionally with case management staff, physicians and payers

Preferred:

Bachelors Degree (BSN)

Keywords: CHI Saint Luke's Hospital at the Vintage, Houston , Utilization Review RN - Utilization Review, Healthcare , Houston, Texas

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