USPI Utilization Review/Appeals RN
Treating patients like family
USPI Utilization Review/Appeals RN
Dallas, TexasThe USPI Utilization Review/Appeals RN is responsible to facilitate effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient’s resources and right to self-determination across United Surgical Partners International (USPI) Hospitals. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity. This position manages medical necessity process for accurate and timely payment for services which may require negotiation with a payer on a case-by-case basis. This position integrates national standards for case management scope of services including:
- Utilization Management services supporting medical necessity and denial prevention
- Coordination with payers to authorize appropriate level of care and length of stay for medically necessary services required for the patient
- Compliance with state and federal regulatory requirements, TJC accreditation standards and USPI policy
- Education provided to payers, physicians, hospital/office staff and ancillary departments related to covered services and administration of benefits
- Recovering revenue associated with disputed/denied clinical claims or those eligible for clinical review
- Preparing and documenting appeal letters based on industry accepted criteria.
Related Content
-
Working hard in every community
At both the local and the national level, we support programs that facilitate education for the underserved, fight hunger, aid in disaster recovery, and provide assistance to all in need.
-
Finding strength in our differences
We know that we can better serve our communities because the many unique backgrounds, skillsets and experiences found throughout our teams.
-
Opportunities across the nation
As the largest ambulatory surgery platform in the country, we are part of USPI and can offer career opportunities that span our entire system.
Sign up for Job Alerts
Don't see what you're looking for? Sign up and we'll notify you when roles become available.
Sign Up