Utilization Review RN – PRN

About the role

Are you an experienced RN with a strong background in hospital-based utilization review? As a PRN Utilization Review RN, you will play an important role in supporting quality patient care by conducting thorough clinical reviews to determine medical necessity, appropriate level of care, and resource utilization. Using established clinical criteria and your nursing expertise, you will perform prospective, concurrent, and retrospective utilization reviews while partnering with physicians, care management teams, health plans, and other healthcare professionals. Your clinical judgment and communication skills will help ensure patients receive the right care, at the right level, while supporting appropriate resource utilization and regulatory requirements.

Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our Core Values Are: We serve faithfully by doing what's right with a joyful heart.We never settle by constantly striving for better.We are in it together by supporting one another and those we serve.We make an impact by taking initiative and delivering exceptional experience.

We believe that all people should feel welcomed, valued and supported.

Responsibilities

• Conduct prospective, concurrent, and retrospective utilization reviews using established clinical criteria and evidence-based guidelines to determine medical necessity and appropriate level of care.
• Review patient clinical information, including diagnoses, treatment plans, services, and length of stay, to support appropriate utilization and care delivery.