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Case Manager

3 months ago

Tyler, United States Tyler Regional Hospital Full time
Overview

Join our team as a full-time, day shift, Case Manager Registered Nurse in Tyler, TX.

Fulfilling your purpose begins here:

People First, Always. Here's how we take care of our people:

  • Medical, vision, dental health insurance, health savings account / flexible spending, competitive pay, paid time off, 401k retirement plan with company match, employee assistance program and more

Your team is bigger than your department:

  • UT Health Tyler, the flagship hospital of the system, has 502 licensed beds specializing in advanced acute care medicine. Our hospital includes a 24-hour ER with Level 1 trauma center, a comprehensive stroke center, more than 500 physicians and a full complement of subspecialty groups.
  • We believe healthcare is a team sport and every player has something to contribute. We show compassion, celebrate differences and treat one another with respect.
Responsibilities

  • The Utilization Review (UR) Nurse is a registered nurse responsible for applying standardized, evidenced-based, medical necessity criteria to form utilization review determinations, communicate relevant information to third party payors, and secure authorization to facilitate the patient's treatment and discharge plan.

  • The UR Nurse communicates with physicians to obtain necessary information as requested by the payor, or to inform the physician of a potential payor denial.

  • The UR Nurse functions as an advocate and contact person for the patient with the insurance company and outside agencies to assure optimal clinical and resource outcomes.

  • The UR Nurse clarifies treatment plans as needed to support the patient needs, treatment and discharge plan and reimbursement for services rendered.

  • Proactively mitigate denials by engaging the physician, physician advisor or other members of the patient's healthcare team in concurrent and/or retrospective payor discussions.

  • Collaborates with members of the patient's healthcare team to promote appropriate patient care progression; and analyzes current systems to prevent avoidable delays and identify opportunities for improvement.


Qualifications

Job Requirements:

  • Current RN license in the state of Texas required and Case Management certification desired
  • Registered Nurse with an Associates, Bachelor's or Master's Degre required.
  • A minimum of three (3) years of clinical experience is required.

Preferred Job Requirements:

  • Experience in utilization review, discharge planning, quality programs preferred