Utilization Review Nurse-(HCPC)

apartment UTHealth Houston location_onHouston, TX, US

What we do here changes the world. UTHealth Houston is Texas’ resource for healthcare education, innovation, scientific discovery, and excellence in patient care. That’s where you come in.

Once you join us you won't want to leave. It’s because we reward our team for the excellent service they provide. Our total rewards package includes the benefits you’d expect from a top healthcare organization (benefits, insurance, etc.), plus:

100% paid medical premiums for our full-time employees
Generous time off (holidays, preventative leave day, both vacation and sick time – all of which equates to around 37-38 days per year)
The longer you stay, the more vacation you’ll accrue!
Longevity Pay (Monthly payments after two years of service)
Build your future with our awesome retirement/pension plan!

We take care of our employees! As a world-renowned institution, our employees’ wellbeing is important to us. We offer work/life services such as...

Free financial and legal counseling
Free mental health counseling services
Gym membership discounts and access to wellness programs
Other employee discounts including entertainment, car rentals, cell phones, etc.
Resources for child and elder care
Plus many more!

Join a growing team! With the opening of Dunn Behavioral Sciences Center/HCPC at UTHealth Houston, we will soon have the largest academic psychiatric hospital in the country, serving the region with an 500+ bed facility. Our dedicated health care employees will have the opportunity to be exposed to a variety of mental health specialties and cutting-edge research. With exposure to a variety of specialties such as Acute, Subacute, and Intensive Outpatient, Continuum of Care, Mood Disorders, ECT, Early Onset Treatment , Adult General Psychiatry, Competency Restoration, Child and Adolescent, Juvenile Justice, Geriatric Psychiatry, Treatment Mall and Unit-Based Programming.

This dedicated team will work in an integrated campus to bring world class resources to the community. Apply today to be a part of this committed team serving the mental health needs of the area.

Position Summary:

Assists in the coordination of the appropriate utilization of services and resources of patient care and continuum at HCPC.

Location: Dunn Behavioral Sciences Center/HCPC at UTHealth Houston

Dept.: BSC Patient Revenue Cycle

Status: Full-Time

FLSA: Exempt

Position Key Accountabilities:

1. Assists in the coordination of all aspects of concurrent review process for individual cases.
2. Coordinates clinical documentation to third-party payers and state agencies to secure timely payment for patient charges.
3. Participates in the utilization review and/or quality assurance programs.
4. Conducts various types of case reviews for quality and appropriate medical management, cost containment, peer review and rehabilitation.
5. Implements utilization review policies and procedures.
6. Reviews to determine appropriateness and medical necessity of admissions, continued stay and use of ancillary services.
7. Monitors third-party administrator and agency files to oversee contractor handling.
8. Performs data entry, which includes application of criteria sets and Diagnosis Review Groups (DRG) for the utilization review process.
9. Maintains a permanent record of all utilization review records, identifies problems, and follows through with resolutions.
10. Prepares reports and analyzes statistical data.
11. Other duties as assigned.

Certification/Skills:

Registered Nurse (RN) State Licensure or Nurse Licensure Compact (NLC) by Texas Board of Nursing (BON) required

Minimum Education:

Bachelor’s degree in Nursing from an accredited school.

Minimum Experience:

Three years experience in nursing, preferably in Psychiatric nursing.

Physical Requirements:

Exerts up to 50 pounds of force occasionally and/or up to 20 pounds frequently and/or up to 10 pounds constantly to move objects.

Security Sensitive:

This position is a security-sensitive position pursuant to Texas Education Code §51.215 and Texas Government Code §411.094. To the extent that a position requires the holder to research, work on, or have access to critical infrastructure as defined in Texas Business and Commerce Code §117.001(2), the ability to maintain the security or integrity of the infrastructure is a minimum qualification to be hired for and to continue to be employed in that position. Personnel in such positions, and similarly situated state contractors, will be routinely reviewed to determine whether things such as criminal history or continuous connections to the government or political apparatus of a foreign adversary might prevent the applicant, employee, or contractor from being able to maintain the security or integrity of the infrastructure. A foreign adversary is a nation listed in 15 C.F.R. §791.4.

Residency Requirement:

Employees must permanently reside and work in the State of Texas.

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