Utilization Review Nurse - Dunn Behavioral Sciences Center/HCPC at UTHealth Houston

Houston, TX

Utilization Review Nurse - Dunn Behavioral Sciences Center/HCPC at UTHealth Houston

Location: Houston, Texas

Hot

Texas Medical Center-Houston, Texas

Category: Healthcare Support Services

UTHealth Houston Behavioral Sciences Campus

Requisition #: 230002MO

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 , 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:

Texas license as a Registered Nurse

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 job class may contain positions that are security sensitive and thereby subject to the provisions of Texas Education Code § 51.215

If you are looking for a great healthcare career in Houston, visithttp://go.uth.edu/careers!

University of Texas Health Science Center at Houston (UTHealth)

Established in 1972 by The University of Texas System Board of Regents, The University of Texas Health Science Center at Houston (UTHealth) is Houston’s Health University and Texas’ resource for health care education, innovation, scientific discovery and excellence in patient care. The most comprehensive academic health center in the UT System and the U.S. Gulf Coast region, UTHealth Houston is home to schools of biomedical informatics, biomedical sciences, dentistry, nursing and public health and the John P. and Kathrine G. McGovern Medical School. UTHealth Houston includes The University of Texas Harris County Psychiatric Center, as well as the growing clinical practices UT Physicians, UT Dentists and UT Health Services. The university’s primary teaching hospitals are Memorial Hermann-Texas Medical Center, Children’s Memorial Hermann Hospital and Harris Health Lyndon B. Johnson Hospital.

UTHealth Benefits

UTHealth Houston offers a comprehensive and competitive benefits package. For more information on our benefits programs please refer to the UTHealth Houston Office of Benefits Website.

https://www.uth.edu/benefits/

Equal Employment Opportunity Statement

UTHealth Houston is committed to providing equal opportunity in all employment-related activities without regard to race, color, religion, sex, sexual orientation, national origin, age, disability, genetic information, gender identity or expression, veteran status or any other basis prohibited by law or university policy. Reasonable accommodation, based on disability or religious observances, will be considered in accordance with applicable law and UTHealth Houston policy. The University maintains affirmative action programs with respect to women, minorities, individuals with disabilities, and eligible veterans in accordance with applicable law.

UTHealthHoustonhas adopted a policy consistent with CMS regulations to protect our patients and university community from exposure to COVID-19. This policy affects all employees, residents, fellows, students, contractors, new hires, visiting scholars program participants, adjunct faculty, and volunteers who work, train, or collaborate at the John S. Dunn Behavioral Science Center.

In addition, all UTHealthHouston​​​​​​​employees who are assigned to work at a location that is subject to the affiliated partner’s hospital, clinical offices, or agency are required to abide by UTHealth’sHoustonrules and regulations, as well as the affiliate’s rules and regulations, including COVID-19 vaccination and safety requirements.

Work location is based on the needs of the department and may be adjusted.