Job Details

Utilization Review Nurse LVN

Company name
HCA Holdings, Inc

Austin, TX, United States

Employment Type

Healthcare, Nursing

Posted on
Jan 09,2019

Valid Through
Apr 24,2019

Apply for this job


With more than 119 sites across Central Texas, St. David’s HealthCare includes seven of the area’s leading hospitals and is one of the largest health systems in Texas. The organization has been recognized with a Malcolm Baldrige National Quality Award — the nation’s highest presidential honor for performance excellence. St. David’s HealthCare is the third-largest private employer in the Austin area, with more than 10,200 employees.

St. David’s HealthCare is a unique partnership between a hospital management company and two local non-profits—St. David’s Foundation and Georgetown Health Foundation. The proceeds from the operations of the hospitals fund the foundations, which, in turn, invest those dollars back into the community. Since the inception of St. David’s HealthCare in 1996, more than $425 million has been given back to the community to improve the health and healthcare of Central Texans.


The Utilization Review Nurse (URN) functions as the primary liaison between all managed care payers and the Case Management department. The URN is responsible for communicating required clinical information for the purpose of obtaining certification and approval for payment for all applicable outpatient observation stays, inpatient admissions and continued stay days. The URN will communicate and document all payer contacts using the established Case Management process. The URN works collaboratively with all payers, as well as, Case Management staff, Physician Advisor(s), physicians, healthcare team members, Patient Access Department, Central Verification Office and other key departments regarding the payer certification process to ensure authorization is received for all services provided.


* Serves as the primary contact for all payors regarding utilization review and management issues.

* Performs concurrent payor reviews for medical appropriateness for patients placed in outpatient observation or in an inpatient setting according to payor guidelines, rules and regulations.

* Provides all required clinical information to the payor according to the payor's timeframe standards throughout the hospitalization to obtain certification approval for all services provided.

* Maintains a collaborative working relationship with the payor's utilization review nurses and case managers and maintains contact with the payor regarding initial assessment, progress, changes in condition, discharge planning, discharge date, etc. as needed.

* Refers all cases that are denied by the payor to the Concurrent Appeal URN or Physician Advisor.

* Establishes and maintains professional, collaborative working relationships with the Business Office Registration Department, Revenue Cycle Department and other key departments to facilitate processes to ensure timely and appropriate reimbursement for services provided.

* Maintains productivity and meets all UR performance standards according to department policies and procedures.

* Participates in process performance improvement activities related to utilization management.

* Attends education sessions each year for internal and external customers regarding utilization management.


* LVN with current state licensure

* Two years of experience in case management, utilization management or related field

* Certification in Case Management, Nursing, or Utilization Review preferred

* Acute care hospital experience, preferred

* Knowledge of InterQual or related evidenced based criteria sets

* Familiar with Joint Commission, State and Federal standards/requirements.

* Knowledgeable about third party payer source criteria of medical necessity.

* Organized and able to meet deadlines consistently.

* Computer experience required with skills including but not limited to Microsoft Windows, spreadsheets, and word processing.


Required:**Two years of experience in case management, utilization management or related field


Required:Current LVN license in the state of Texas or compact state

Job: *Case Management

Title: Utilization Review Nurse (LVN)

Location: Texas-Austin-Partnership Market Office

Requisition ID: PARTN-2018

Company info

HCA Holdings, Inc
Website :

Company Profile
At its founding in 1968, Nashville-based HCA was one of the nation's first hospital companies. Today, we are the nation's leading provider of healthcare services, a company comprised of locally managed facilities that includes about 165 hospitals and 115 freestanding surgery centers in 20 states and England and employing approximately 204,000 people. Approximately four to five percent of all inpatient care delivered in the country today is provided by HCA facilities. Milton Johnson serves as Chairman and Chief Executive Officer of HCA. HCA is committed to the care and improvement of human life and strives to deliver high quality, cost effective healthcare in the communities we serve. Building on the foundation provided by our Mission & Values, HCA puts patients first and works to constantly improve the care we give them by implementing measures that support our caregivers, help ensure patient safety and provide the highest possible quality. Investing in our communities is important to us. HCA typically invests about $1.5 billion annually to keep our facilities modern and up-to-date technologically and to expand and add services where needed. Focusing primarily on communities where the company is a leading healthcare provider, HCA selectively adds new facilities in order to better serve our communities. And because two HCA founders were physicians, we value highly the strong relationships we've created with local physicians. We endeavor to provide them with a wide array of services and modern facilities in order to help them deliver the best possible care.

Similar Jobs:
We Are Hiring ECHOCARDIOGRAPHER - Full Time Rotating Shifts - Dell Seton Medical Center at UT - Austin,TX - Applicable Shift Differentials: Night: $4/hr  Weekend: $2.25/hr  Evening: $2.50hr * For all hospital-setting positions,...
We Are Hiring RN Supervisor-Nursing - Pediatric Magnetic Resonance Imaging - Full-Time,Day - Dell Children's Medical Ctr - Austin,TX Why Join Ascension? At Seton, we’re using the power of purpose to change healthcare for the bette...
We Are Hiring SONOGRAPHER - PRN Days 7a-4p  - Seton Medical Center Austin - Austin,TX - Applicable Shift Differentials: Night: $4/hr  Weekend: $2.25/hr  Evening: $2.50hr * For all hospital-setting positions, rotating call wil...
I was very pleased with the EmploymentCrossing. I found a great position within a short amount of time … I definitely recommend this to anyone looking for a better opportunity.
Jose M - Santa Cruz, CA
  • All we do is research jobs.
  • Our team of researchers, programmers, and analysts find you jobs from over 1,000 career pages and other sources
  • Our members get more interviews and jobs than people who use "public job boards"
Shoot for the moon. Even if you miss it, you will land among the stars.
EmploymentCrossing - #1 Job Aggregation and Private Job-Opening Research Service — The Most Quality Jobs Anywhere
EmploymentCrossing is the first job consolidation service in the employment industry to seek to include every job that exists in the world.
Copyright © 2019 EmploymentCrossing - All rights reserved. 169 192