RN Case Manager – Utilization Review
Surgery Partners, Inc
full-time
Posted on:
Location Type: Hybrid
Location: Addison • Texas • United States
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About the role
- Responsible for performing prospective, concurrent, and post-discharge utilization reviews.
- Supports accurate admission status determinations and active denial management.
- Assists with discharge planning activities and contributes to performance improvement initiatives.
- Conducts comprehensive medical record reviews and ensures compliance with hospital policy and regulations.
- Facilitates appropriate admission status determinations based on clinical documentation and payer requirements.
Requirements
- Bachelor of Science in Nursing preferred.
- Active RN license in Texas; current CPR certification.
- Case Management Certification(s) preferred.
- At least five years of experience with Case Management, Discharge Planning, and Utilization Review.
Benefits
- Health insurance
- Paid time off
- Professional development opportunities
- 401(k) retirement plan
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
utilization reviewdischarge planningmedical record reviewcomplianceadmission status determinationdenial managementperformance improvement
Certifications
RN licenseCPR certificationCase Management Certification