Utilization Management Nurse II

3 days ago


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

The Utilization Management Nurse II is a key member of the healthcare team, responsible for ensuring the clinical appropriateness of care provided to patients and optimizing hospital resource utilization. This role requires a strong clinical background, excellent communication skills, and the ability to work effectively in a fast-paced environment.

Key Responsibilities
  • Conduct comprehensive assessments of clinical information and treatment plans to determine medical necessity and level of care.
  • Utilize approved screening criteria to track impact and variance, and make timely review determinations based on appropriate criteria and standards.
  • Collaborate with the interdisciplinary team, including physicians and payors, to ensure seamless care coordination and optimal resource utilization.
  • Proactively identify and resolve issues regarding clinical appropriateness recommendations, coverage, and potential or actual payor denials.
  • Communicate effectively with internal and external stakeholders, including patients, families, and healthcare providers.
Requirements
  • Graduate of an accredited School of Nursing or demonstrated success in the Utilization Management Nurse I role for at least five years at CHRISTUS Health.
  • Two or more years of clinical experience with at least one year in the acute care setting or demonstrated success as Utilization Management Nurse I role at CHRISTUS Health.
  • RN License in state of employment or compact required. LPN or LVN license accepted for associates with 5+ years of demonstrated success and experience in the Utilization Management Nurse I role at CHRISTUS Health.
Work Schedule

8AM - 5PM Monday-Friday

Work Type

Full Time



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