Hospital - Utilization Review Care Coordinator (RN)

The Utilization Review (UR) Care Coordinator in the Care Management Department will be responsible for ensuring the appropriate use of healthcare resources while maintaining high standards of patient care.  The individual in this position will review patient cases, monitor treatment plans, and collaborate with healthcare providers to optimize care delivery and resource utilization.

The University of Texas at San Antonio (UT San Antonio) is a nationally recognized, top-tier public research university that unites the power of higher education, biomedical discovery and healthcare within one visionary institution. As the third-largest research university in Texas and a Carnegie R1-designated institution, UT San Antonio is a model of access and excellence - advancing knowledge, social mobility and public health across South Texas and beyond. UT San Antonio serves approximately 42,000 students in 320 academic programs spanning science, engineering, medicine, health, liberal arts, AI, cybersecurity, business, education and more. With 17,000 faculty and staff, UT San Antonio has been recognized by Forbes as one of America's Best Employers for Company Culture.

Benefits Overview

UT Health San Antonio offers an excellent benefits package for its employees. Employees who work at least 20 hours a week, with an appointment of at least 4.5 months, are eligible for benefits.

Medical - UT SELECT Medical insurance is offered free for employees and administered by Blue Cross and Blue Shield of Texas. Family members can be added to the plan through payroll deduction. Employees and their dependents can also receive discounted copays and coinsurance when using UT Health Physicians, a network of 800 premier physicians including more than 100 specialists. Employees receive $50,000 of group term life insurance and $50,000 of basic accidental death and dismemberment insurance for free, with options to purchase additional employee and dependent coverage for both at group rates.

Dental - Three dental insurance plan options are available for employees and their families through Delta Dental Insurance Company, two PPOs and one dental HMO plan. Both PPO plans allow employees to choose any licensed dentist.

Vision - Fully insured Vision Care benefits are offered by Superior Vision Services. Two vision plan options that offer either standard or enhanced vision benefits.

Disability - Employees can enroll in the Disability Insurance which provides income if a non-work related illness or injury prevents you from working.

FSAs - Employees can enroll in flexible spending accounts (FSAs) to set aside money from earnings before taxes for qualifying dependent day care expenses or out-of-pocket health care expenses.

Retirement - Employees are eligible for either the Teacher Retirement System (TRS) or the Optional Retirement Plan (ORP). TRS is a defined benefit retirement plan which UT Health matches employee contributions. ORP is for eligible faculty staff employees. Voluntary retirement programs are also available to invest before- or after-tax dollars with the choice of five quality retirement plan providers.

Time Off - A generous leave program offers multiple paid leave options:

• Front-loaded Paid Time Off: 128 to 208 hours (16 to 26 days) of Paid Time Off based on years of service, given at the start of each fiscal year. PTO may be prorated in year one based on date of hire.
• Extended Illness Bank: 8 hours (1 day) accrued per month which can be used for illness or injury after one day of Paid Time Off is taken.
• Paid Family Leave: Up to 240 hours (6 weeks) to care for a spouse, child, or parent after 6 months of consecutive employment.
• Holidays: 12 set paid holidays each year.

Discounts - Employees enjoy a range of discounts on services, tickets, and gym membership.

EEO Statement

UT Health San Antonio is an equal employment opportunity and affirmative action employer. It is our policy to promote and ensure equal employment opportunity for all individuals without regard to race, color, religion, sex, gender identity, national origin, age, sexual orientation, disability, or veteran status.

• Comprehensive understanding of utilization review processes, guidelines, and regulations.
• Knowledge of medical terminology, disease processes, and treatment protocols.
• Familiarity with healthcare delivery systems and insurance requirements.
• Understanding of regulatory requirements, including Medicare and Medicaid guidelines.
• Strong analytical and critical thinking skills.
• Proficient in reviewing and interpreting medical records and clinical documentation.
• Ability to work collaboratively with a multidisciplinary healthcare team.
• Capacity to handle multiple priorities and manage complex cases.
• Ability to advocate for patients and ensure the appropriate use of healthcare resources.
• Flexibility and adaptability to meet the diverse needs of patients and the healthcare system.

Education

• Bachelor''s in Nursing

Certification/Licensure:

• Registered Nurse (RN)
• Conduct utilization reviews to ensure medical necessity, appropriateness, and efficiency of healthcare services.
• Evaluate patient records, treatment plans, and clinical documentation to verify that services meet established guidelines and standards.
• Collaborate with physicians, nurses, case managers, and other healthcare providers to discuss patient care and identify opportunities for improvement.
• Facilitate the authorization process for hospital admissions, treatments, and procedures with insurance companies and payers
• Monitor patient progress and discharge plans to ensure timely and appropriate transitions of care.
• Educate patients, families, and healthcare providers about utilization review processes and requirements.
• Maintain accurate and detailed documentation of reviews, findings, and actions taken.
• Participate in interdisciplinary team meetings to discuss patient care and utilization management.
• Stay current with industry regulations, standards, and best practices in utilization review and care management.
• Conduct utilization reviews to ensure medical necessity, appropriateness, and efficiency of healthcare services.
• Evaluate patient records, treatment plans, and clinical documentation to verify that services meet established guidelines and standards.
• Collaborate with physicians, nurses, case managers, and other healthcare providers to discuss patient care and identify opportunities for improvement.
• Facilitate the authorization process for hospital admissions, treatments, and procedures with insurance companies and payers
• Monitor patient progress and discharge plans to ensure timely and appropriate transitions of care.
• Educate patients, families, and healthcare providers about utilization review processes and requirements.
• Maintain accurate and detailed documentation of reviews, findings, and actions taken.
• Participate in interdisciplinary team meetings to discuss patient care and utilization management.
• Stay current with industry regulations, standards, and best practices in utilization review and care management.