| Location | El Paso, TX |
Summary
Job Summary
Assists the organization with all activities associated with El Paso Health’s (EPH) inpatient Utilization Review Unit. Ensures the Utilization Reviewers conduct a thorough and efficient review of each admission and continued stay while providing high quality health care in a cost effective manner. Ensures the Utilization Management (UM) unit’s compliance with all regulatory agencies’ rules and regulations, which govern health plan operations. Serves as the primary back up for the inpatient Utilization Reviewer in case of illness, vacation or other needs.
Skills
1. Excellent verbal and written communication and interpersonal skills required as demonstrated by past job experience.
2. Strong analytical, data management and computer skills.
3. Able to work with people of all social, economic, and cultural backgrounds.
4. Flexible, open-minded and adaptable to change.
5. Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components.
6. Ability to work independently and exercise sound judgment in interactions with physicians, payors, and patients/families.
7. Bilingual English/Spanish and culturally sensitive highly preferred.
Work Experience
Three years of experience as a Registered Nurse required, preferably in a clinical setting. Strong knowledge of utilization review in Medicaid HMO required, with working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement required. Understanding of pre-acute and post-acute venues of care and community resources.
License/Registration/Certification
Current, active, unrestricted license as to practice as a Registered Nurse in the state of Texas.
Education and Training
Bachelor degree in Nursing required.