Job Description

Location: Bellaire, Texas

Position Type: Full-Time, Permanent

Schedule/Shift:

• 8:00 AM - 5:00 PM, Monday through Friday (onsite for initial period due to collaboration needs)
• Hybrid schedule (2 days/week) after 90+ days
• Occasional light travel to site locations as needed

Salary: $80,000 - $110,000 per year

Job Overview:

We are seeking an experienced Utilization Management / Review Registered Nurse (RN) to take on a newly created, centralized leadership role in our organization. This role will focus on coordinating and expediting utilization review (UR) processes across multiple facilities. As an SME in the UR space, you will collaborate with hospital leaders, clinical staff, and revenue cycle teams to ensure proper patient status, optimize revenue cycles, and maintain compliance across multiple facilities in various states.

This is a great opportunity to step into a key leadership role with room to build out a team and impact the future of utilization management.

Key Responsibilities:

• Oversee and coordinate utilization review processes for inpatient and observation patients, ensuring proper patient status is assigned in accordance with clinical and compliance guidelines.
• Work closely with the Chief Nursing Officer (CNO), Revenue Cycle leaders, and medical staff to improve UR workflows across 24 hospitals in 10 states.
• Establish and build the Utilization Review committee, collaborating with nursing staff and leaders across multiple facilities.
• Provide guidance and training to the clinical team on documentation, coding standards, and compliance requirements, including working with insurance companies.
• Ensure alignment with revenue cycle teams to optimize documentation processes and minimize unnecessary coding issues.
• Work directly with physicians and clinical teams to ensure accurate and complete documentation for proper billing and compliance.
• Assist in the design and development of metrics to track performance and improvement within the UR program.
• Collaborate closely with the Director of Compliance and other leadership to refine UR workflows, identify gaps, and implement process improvements.

Qualifications:

Required:

• Current Registered Nurse (RN) license
• 3+ years of experience in Utilization Review (UR)
• Experience in the ER or inpatient settings, preferably within the UR space
• 2-3 years of clinical nursing experience or case management (preferably acute care)
• Previous experience with coding (preferably ICD-10, CPT) and coding documentation
• Strong ability to collaborate with clinical leadership and staff to ensure compliance and improve processes

Preferred:

• Coding certification from AAPC or AHIMA
• Familiarity with EPowerDoc EMR system

Skills & Competencies:

• Excellent communication skills, both verbal and written, with the ability to present to and influence key stakeholders
• Strong problem-solving and critical thinking abilities to manage complex UR challenges
• Detail-oriented with the ability to manage multiple priorities and tight timelines
• Ability to build relationships and collaborate across diverse teams
• Knowledge of insurance regulations, compliance standards, and billing processes

Benefits & Selling Points:

• Work in a rapidly growing organization with significant opportunities for career development
• Play a key role in shaping the future of utilization management within the organization
• Competitive salary and benefits package
• Publicly traded company with strong growth potential

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