Clinical Utilization Management Nurse
1 week ago
Job Summary:
The Utilization Management Nurse II is a key member of the healthcare team at Christus Health, 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 appropriateness of care.
- Utilize approved screening criteria to evaluate patient care and ensure compliance with regulatory requirements.
- Collaborate with the interdisciplinary team to ensure seamless patient care progression and effective communication with payors.
- Develop and maintain knowledge of regulatory requirements, payor policies, and clinical guidelines to ensure accurate and timely reviews.
- Provide education and support to patients, families, and healthcare providers to promote optimal care and resource utilization.
- Participate in quality improvement initiatives to enhance patient outcomes and reduce healthcare costs.
- Stay up-to-date with industry trends, best practices, and emerging technologies to continuously improve utilization management processes.
Requirements:
- Graduate of an accredited School of Nursing or demonstrated success in the Utilization Management Nurse II 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.
- Certification in Case Management preferred. BLS preferred.
Work Schedule:
8AM - 5PM Monday-Friday
Work Type:
Full Time
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