Methodist Healthcare Ministries
San Antonio, TX, USA
Role Overview & Responsibilities Position Summary The Utilization Review Nurse is a vital member of the care coordination team, responsible for reviewing patient records, assessing the necessity and appropriateness of proposed treatments, collaborating with healthcare providers, and facilitating communication across multidisciplinary teams to ensure continuity of care. This role requires strong clinical knowledge, excellent communication and organizational skills, and the ability to manage multiple referrals in a fast-paced environment. Scope and Impact Supports care coordination across MHM clinics and contracted specialty providers. Influences patient access, quality of care, and timeliness of services through referral review, pre-authorization, and diagnostic coordination. May manage a high-volume caseload of concurrent referrals and authorizations. Decision-Making Authority Exercises independent clinical judgment to determine medical necessity and level of...
