Utilization Management Nurse Specialist

6 days ago


Tyler, Texas, United States Christus Health Full time
Job Description

We are seeking a skilled Utilization Management Nurse Specialist to join our team at Christus Health.

Responsibilities:
  • Ensure medical necessity and proper hospital resource utilization of services.
  • Perform pre-admission, concurrent, and retrospective UM related reviews and functions.
  • Maintain current knowledge of commercial and government payors and Joint Commission regulations and guidelines related to UM.
  • Effectively communicate with internal and external clinical professionals and relay clinical data to insurance providers and vendors.
  • Collaborate with the healthcare team to ensure seamless patient care progression throughout the continuum.
Requirements:
  • Bachelor's degree in Nursing or relevant experience.
  • Two or more years of clinical experience with at least one year in the acute care setting.
  • RN License in state of employment or compact required.
  • Certification in Case Management preferred.
  • Estimated Salary: $85,000 - $110,000 per annum.

We offer a comprehensive benefits package and opportunities for professional growth and development. If you are a motivated and detail-oriented individual who is passionate about delivering high-quality patient care, we encourage you to apply for this exciting opportunity.


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