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Care Management RN
1 month ago
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.
- 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.
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.
