Use effective relationship management, coordination of services, resource management, education, patient advocacy, and related interventions to: a)promote improved quality of care and/or life, b) promote cost effective medical outcomes, c) assist in prevent hospitalization when possible and appropriate, d) promote decreased lengths of hospital stays when appropriate, e) assist in working with medical and nursing team preventing complications in participant health status that are under the care of Silver Star. f) check IDT decisions in assuring appropriate levels of care are received by participants. Completes MNLOC (Medical Necessity Level of Care) assessments when needed. Gathers all pertinent information and medical records from providers and facilities to ensure Silver Star Medical Director has sufficient information to decide to approve or deny services.

RNUR will monitor, examine, and report the appropriateness of healthcare expenditures, services, and therapies, at Silver Star and with contract facilities, and physician offices. The RN Utilization Review Coordinator relies on her/his experience, education, and awareness of proper review criteria to compile a correct account of the PACE participant’s clinical picture. The RNUR will check the care that is to be given to each patient at Silver Star. Complete Audits on IDT assessment completion prior to IDT.

In case of emergency or health crisis will assist and function as a nurse. Assist in taking call according to schedule.

Hours: This is an EXEMPT position; normal work hours between 8:00 am – 5:00pm, Monday through Friday, with flexibility to meet program needs.

Graduation from an accredited school of nursing and currently licensed in the State of Texas by the Board of Nurse Examiners as a Registered Nurse (master’s in nursing or Bachelor’s degree preferred), plus a minimum of four years of full-time experience as a practicing registered nurse. Management experience preferred. Auditing and Review experience preferred. Prefer experience in geriatrics and home health care, with emphasis on Interdisciplinary approach to treatment. Must have at least one year experience with a frail or elderly population, meet the standardized set of competencies for the specific position description before working independently, and be medically cleared for communicable diseases and have all immunizations up-to-date before engaging in direct participant contact. Administrative and supervisory experience is also preferred. Knowledge and skill in operating office equipment (phone, fax machine, copier, printer, etc.) and personal computer with Microsoft Office products is required.

Bilingual (English/Spanish) is desirable, though not required.

Must have a current Texas driver’s license and be insurable under the Center’s insurance

Posted 09-19-2022