PRN Utilization Review RN - M-F

Must be available to work daytime hours (between 8am-6:30pm) Monday - Friday.

UT Southwestern is a world-renowned medical and research center committed to excellence, innovation, teamwork, and compassion. Ranked as the number 1 hospital in Dallas-Fort Worth according to U.S. News & World Report, UT Southwestern offers a competitive benefits package and opportunities for career growth and development.

Conduct medical certification review for medical necessity for acute care facility and services. Use nationally recognized, evidence-based guidelines approved by medical staff to recommend level of care to the physician and serve as a resource to the medical staff on issues related to admission qualifications, resource utilization, national and local coverage determinations and documentation requirements.

UT Southwestern is proud to offer a competitive and comprehensive benefits package to eligible employees. Our benefits are designed to support your overall wellbeing, and include:

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100% coverage for preventive healthcare-no copay
• Paid Time Off, available day one
• Retirement Programs through the Teacher Retirement System of Texas (TRS)
• Paid Parental Leave Benefit
• Wellness programs
• Tuition Reimbursement
• Public Service Loan Forgiveness (PSLF) Qualified Employer
• Learn more about these and other UTSW employee benefits!

• Education:
  
  Graduate of accredited nursing program and holds an active unrestricted RN license in the State of Texas
• Experience:
  
  5 years experience to include 2 years of clinical experience and minimum of 3 years of recent utilization review experience, and prior experience with Epic CCM
• Licenses and
  
  Certifications:
  
  RN with an active unrestricted license in the State of Texas

• Experience in utilization management or related field

• Acute care experience preferred
• Collaborates with the Central Scheduling Department (CSD) team to provide accurate and complete clinical information to obtain authorization
• Conducts admission reviews for Medicare and Medicaid beneficiaries as well as private insurance members and self-pay patients using evidence-based guidelines
• New admission reviews are performed concurrently at the point of entry when the admission order is placed and necessary clinical information is available in the medical record
• Communicate with admitting physicians and physician advisors when documentation does not appear to support hospital level of care
• Use hospital-approved medical necessity tool to determine level of care for inpatient or observation/outpatient services based on physician documentation, H&P, treatment plan, potential risks, and basis for expectation of a two-midnight stay
• Stay current on all federal, state, and local regulatory changes affecting delivery or reimbursement of acute care services; use knowledge of national and local coverage determinations to advise physicians
• Collaborate with admitting physician to provide accurate level of care determination at the time of review
• Escalate identified progression-of-care/patient flow barriers to appropriate departments
• Actively participate in daily huddles, departmental meetings, and education offerings
• Identify and record episodes of preventable delays or avoidable days due to failure of progression-of-care processes
• Educate members of the patient s care team on appropriate access to and use of various levels of care
• Promote use of evidence-based protocols and/or order sets to influence high-quality and cost-effective care
• Serve as a resource to physicians, care coordinators, physician offices and billing office for coverage and compliance issues
• Complete all reviews within department-established policies and meet quality standards
• Perform other duties as assigned

Security: This position is security-sensitive and subject to Texas Education Code 51.215, which authorizes UT Southwestern to obtain criminal history record information.

EEO: UT Southwestern Medical Center is committed to an educational and working environment that provides equal opportunity to all members of the University community. As an equal opportunity employer, UT Southwestern prohibits unlawful discrimination on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, gender expression, age, disability, genetic information, citizenship status, or veteran status.

Primary

Location:

Texas-Dallas-5323 Harry Hines Blvd

Work Locations: 5323 Harry Hines Blvd

Job: Nursing

Organization: 844107 - Utilization Management

Schedule: Per Diem - PRN

Shift: Day Job

Employee Status: Regular

Job Type: Standard

Job Posting: Jan 21, 2026, 12:49:13 AM