Utilization Management Clinical Registered Nurse
Found in: Jooble US O C2 - 2 weeks ago
Job Summary We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This role performs telephonic and/or concurrent review of inpatient hospitalizations and extended courses of outpatient treatment. This process includes clinical judgement, utilization management, application of product benefits, understanding of regulatory requirements, and verification of medical necessity utilizing nationally recognized criteria. In addition, discharge planning and provider education are major components of this process. This position will be working remote Monday- Friday 9a-6p. The UM clinical RN will be responsible for inpatient compliance for The Health Plan. Think you've got what it takes? Responsibilities * Analyze submitted information including clinical assessments, treatment plan, regulatory guidelines, medical necessity, and accrediting standards for all requests * Creates a case summary evaluation for requests failing medical necessity criteria, and has collaborative discussion with the medical director or designee for review and disposition * Documents due process, attempts to gain adequate clinical information to analyze for decision, reviews all denial letters for appropriate regulatory verbiage, accuracy of the member plan type and adherence to applicable policy and procedure with regards to the denial letter process * Creates communication pieces to providers which meet accrediting and regulatory guidelines for clinical content and readability levels describing decision making rationale for service requests and notifies providers through written correspondence * Collaborates with all disciplines within the health plan to meet goals and objectives meeting with contracting and provider relations on routine basis * Creates recommendation of direction for care planning based on projected course of treatment and prognosis analysis * Creates a cost benefit analysis in situations where coverage outside of benefit s needs to be evaluated on due to unique member situation and delivers that to medical director/designee * Works closely with UM Analyst staff to expedite appeals and complaint process by coordination of concurrent activity with policy and procedure requirements Qualifications * Being fully vaccinated against COVID-19 is required for all employees unless approved for a medical or religious exemption * Diploma in or associate's degree in Nursing, or an associate's degree in a related field accepted by the Texas Board of Nursing for the purposes of obtaining and maintaining an RN license * Bachelor's degree in Nursing preferred * RN license from the Texas Board of Nursing or Nursing Licensure Compact required * 3 years of nursing experience * Experience with Utilization Management or Case Management preferred Company Profile Founded in 1996, Texas Children's Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area. To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org. Texas Children's is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.
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Utilization Management Clinical Registered Nurse
Found in: Jooble US O C2 - 2 weeks ago
Bellaire, TX, United States Texas Children's Hospital Full timeUtilization Management Clinical Registered Nurse (RN) Job Summary We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This role performs telephonic...
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Utilization Management Clinical Registered Nurse
2 weeks ago
Bellaire, United States Texas Children's Hospital Full timeUtilization Management Clinical Registered Nurse (RN)Job Summary We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This role performs telephonic...
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Utilization Management Clinical Registered Nurse
2 weeks ago
Bellaire, United States Texas Children's Hospital Full timeUtilization Management Clinical Registered Nurse (RN)Job Summary We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This role performs telephonic...
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Utilization Management Clinical Registered Nurse
Found in: Jooble US O C2 - 3 weeks ago
Bellaire, TX, United States Texas Children's Hospital Full timeUtilization Management Clinical Registered Nurse (RN) - The Health Plan Job Summary We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This role...
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Utilization Management Clinical Registered Nurse
2 weeks ago
Bellaire, United States Texas Children's Hospital Full timeUtilization Management Clinical Registered Nurse - The Health Plan - RemoteJob Summary We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This role...
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Utilization Management Clinical Registered Nurse
3 weeks ago
Bellaire, United States Texas Children's Hospital Full timeUtilization Management Clinical Registered Nurse - The Health Plan - RemoteJob Summary We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This role...
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Utilization Management Clinical Registered Nurse
2 weeks ago
Bellaire, United States Texas Children's Hospital Full timeUtilization Management Clinical Registered Nurse (RN) - The Health PlanJob Summary We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This role...
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Utilization Management Clinical Registered Nurse
2 weeks ago
Bellaire, TX, United States Texas Children's Hospital Full timeUtilization Management Clinical Registered Nurse (RN)Job Summary We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This role performs telephonic...
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Utilization Management Clinical Registered Nurse
2 weeks ago
Bellaire, TX, United States Texas Children's Hospital Full timeUtilization Management Clinical Registered Nurse - The Health Plan - RemoteJob Summary We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This role...
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Utilization Management Clinical Registered Nurse
2 weeks ago
Bellaire, TX, United States Texas Children's Hospital Full timeUtilization Management Clinical Registered Nurse (RN) - The Health PlanJob Summary We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This role...
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Bellaire, United States Texas Children's Hospital Full timeJob Summary We are searching for a Utilization Management Clinical LVN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and outpatient procedures and services requiring authorization. This process includes clinical judgment, utilization management application, verification...
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Utilization Mgmt Clinical LVN
2 days ago
Bellaire, United States Texas Children's Hospital Full timeJob Summary We are searching for a Utilization Management Clinical LVN - someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and outpatient procedures and services requiring authorization. This process includes clinical judgment, utilization management application, verification of...
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REGISTERED NURSE UTILIZATION REVIEW
Found in: Careerbuilder One Red US C2 - 7 days ago
Irving, TX, USA, United States CornerStone Full timeCornerStone Medical is looking for a Registered Nurse Utilization Review for a state of the art hospital system in Irving, TX. This is an onsite role. Current RN Compact License required 8 am - 5 pm Monday - Friday $37/ Hr Summary: The RN Utilization Registered Nurse, Registered, Nurse, RN, Clinical, Healthcare, Staffing
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Case Manager
Found in: Jooble US O C2 - 3 weeks ago
Bellaire, TX, United States Texas Children's Hospital Full timeCase Manager (Registered Nurse) - South/SE Houston/- The Health Plan Job Summary We are searching for a Case Manager (Registered Nurse) -- someone who works well in a fast-paced setting. In this position, you will assess, plan, implement, monitor, and evaluate the options and services required to meet an individual's health needs. This position...
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TELEMETRY REGISTERED NURSE
Found in: Careerbuilder One Red US C2 - 3 days ago
El Paso, TX 88568, USA, United States Clinical Management Consultants Full timeA renowned hospital in New Mexico is actively interviewing for a Telemetry Registered Nurse to join their team. About the Hospital: The Telemetry Registered Nurse will have the privilege of joining this full-service hospital that is Joint Commission Registered Nurse, Telemetry, Registered, Nurse Manager, Nurse, Healthcare, Staffing, Hospital
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Case Manager
Found in: Jooble US O C2 - 3 weeks ago
Bellaire, TX, United States Texas Children's Hospital Full timeCase Manager (Registered Nurse) - South/SE Houston/- The Health Plan In this position, you will assess, plan, implement, monitor, and evaluate the options and services required to meet an individual's health needs. This position provides comprehensive ongoing case management services by coordinating and managing care of high-risk members in order to meet...
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UTILIZATION MANAGEMENT CLINICAL LICENSED VOCATIONAL NURSE
Found in: Careerbuilder One Red US C2 - 5 days ago
Bellaire, TX 77401, USA, United States Texas Children's Hospital Full timeJob SummaryWe are searching for a Utilization Management Clinical LVN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and outpatient procedures and services requiring authorization. This process includes clinical judgment, utilization management application, verification of...
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CATH LAB REGISTERED NURSE
Found in: Careerbuilder One Red US C2 - 3 days ago
El Paso, TX 88568, USA, United States Clinical Management Consultants Full timeA renowned hospital in New Mexico is actively interviewing for a Cath Lab Registered Nurse to join their team. About the Hospital: The Cath Lab Registered Nurse will have the privilege of joining this full-service hospital that is Joint Commission Ac Registered Nurse, Cath Lab, Lab, Lab, Registered, Nurse Manager, Healthcare, Staffing
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Case Manager
2 weeks ago
Bellaire, United States Texas Children's Hospital Full timeCase Manager (Registered Nurse) - South/SE Houston/- The Health PlanJob Summary We are searching for a Case Manager (Registered Nurse) -- someone who works well in a fast-paced setting. In this position, you will assess, plan, implement, monitor, and evaluate the options and services required to meet an individual's health needs. This position provides...
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UTILIZATION MGMT CLINICAL LVN
Found in: Careerbuilder One Red US C2 - 5 days ago
Bellaire, TX 77401, USA, United States Texas Children's Hospital Full timeJob SummaryWe are searching for a Utilization Management Clinical LVN - someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and outpatient procedures and services requiring authorization. This process includes clinical judgment, utilization management application, verification of...
