About Us
At Baylor Scott & White Health, we promote well-being for people, families, and communities. It is the largest not-for-profit healthcare system in Texas. They empower 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.
Benefits
Our competitive benefits package empowers you to live well and provides:
- Eligibility on day 1 for all benefits
- Dollar-for-dollar 401(k) match, up to 5%
- Debt-free tuition assistance, offering access
to many no-cost and low-cost degrees, certificates and more
- Immediate access to time off benefits
At Baylor Scott & White Health, your well-being is our top priority. Visit BSWHealth.com/Benefits to learn about all of our programs that supports mind, body and spirit
Note: Benefits may vary based on position type and/or level
Job Summary
Are you seeking an impactful nursing role? As a Utilization Review RN, review cases to establish medical suitability of services for insured patients. Your expertise shines through meticulous clinical reviews using established criteria. You play a key role in supporting the healthcare team by optimizing resource use and implementing care plans. Communication with health plan departments is important to ensure services meet medical necessity standards. This includes prospective, concurrent, and retrospective reviews.
What You'll Do
- You will review all cases. Use medical guidelines to evaluate services.
- Understand patient needs. Resolve complex matters when necessary.
- Confirm admission status is correct. Collaborate with Utilization Review coordinators when needed.
- You will communicate with insurance. Talk to doctors about patients. Make sure needed paperwork is completed.
- You'll report insurance company issues to leadership. Identify and communicate quality assurance or risk management issues promptly when they arise.
- You will help improve our processes by evaluating, developing, and implementing protocols, policies, and procedures.
What Will Make You Successful In The Role
- Comprehensive understanding of diverse healthcare techniques, practices, and industry-related language.
- Proficiency in customer engagement, ensuring their concerns are heard and promptly addressed.
- Thorough understanding of discharge planning, care coordination, utilization assessment and care levels.
- Knowledge of local and national regulations is needed, like those from Department of Insurance and Department of Labor. Centers for Medicare and Medicaid Services, Health and Human Services Commission, and National Committee for Quality Assurance.
- Exceptional communication skills, including articulating thoughts clearly in speech and writing.
- Personable, with the ability to interact effectively with a diverse range of stakeholders.
- Problem-solving capability, equipped with critical thinking skills.
- Ability to juggle multiple tasks and work under time pressures.
Belonging Statement
We believe everyone should feel welcomed, valued, and supported. Our workforce should reflect our communities.
Qualifications
- Associate degree.
- Prior experience of at least 3 years in the nursing field.
- Must have a valid nursing registration.