Care Management RN

1 week ago


Tyler, Texas, United States Christus Health Full time
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 navigate complex regulatory requirements.

Key Responsibilities
  • Conduct thorough assessments of patient information and treatment plans to determine medical necessity and level of care.
  • Utilize approved screening criteria to track impact and variance, ensuring compliance with regulatory requirements.
  • Collaborate with physicians and treatment teams to obtain necessary documentation and support level of care.
  • Proactively refer cases to physician advisors for medical necessity reviews and denial avoidance.
  • Maintain consistent communication and exchange of information with payors to coordinate certification of hospital services.
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.
  • 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.
Work Environment

This role is a full-time position, Monday through Friday, 8am-5pm. The ideal candidate will possess excellent communication and negotiation skills, with the ability to interact with physicians, nursing staff, administrative staff, discharge planners, and payors.


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