Utilization Management Nurse II
3 weeks ago
We are seeking a skilled Utilization Management Nurse II to join our team at Christus Health. This role involves determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services.
About Us:
Christus Health is a leading healthcare provider in the region, with a full range of diagnostic and surgical specialty services in cardiac, cancer, and stroke care. Our state-of-the-art emergency department, ICU, Cardiac Cath Lab, and surgical suites provide top-notch care for our patients.
Responsibilities:
This position requires excellent communication and analytical skills, as well as the ability to work independently and exercise sound judgment in interactions with physicians, payors, patients, and their families. Key responsibilities include:
• Applying demonstrated clinical competency and judgment to perform comprehensive assessments of clinical information and treatment plans.
• Assessing assigned patient population for medical necessity, level of care, and appropriateness of setting and services, utilizing MCG/InterQual Care Guidelines and/or health system-approved tools.
• Collaborating with the interdisciplinary team, including the Physician Advisor, to ensure accurate and timely review determinations.
• Proactively reviewing patients at the point of entry to determine medical necessity of requested hospitalization and appropriate level of care or placement for the patient.
• Regularly reviewing patients in Observation status to determine if discharge or conversion to inpatient status is appropriate.
• Identifying and resolving issues regarding clinical appropriateness recommendations, coverage, and potential or actual payor denials.
Requirements:
To be successful in this role, you will need:
• A graduate degree in nursing from an accredited program OR 5+ years of experience as a Utilization Management Nurse I at Christus Health.
• At least 2 years of clinical experience with 1 year in acute care settings OR demonstrated success in the Utilization Management Nurse I role at Christus Health.
• RN License in state of employment or compact required; LPN/LVN license accepted for associates with 5+ years of experience and success in the Utilization Management Nurse I role at Christus Health.
• Certification in Case Management preferred; BLS preferred.
Salary and Benefits:
The estimated salary for this position is $85,000 per year, based on national averages for similar positions in the United States. In addition to competitive compensation, we offer a range of benefits, including health insurance, retirement savings, and paid time off.
Work Schedule and Location:
This role will be working from 7PM to 7AM, Monday to Friday. The location is in Corpus Christi, Texas.
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