RN Case Manager

6 days ago


Kingwood, West Virginia, United States United Surgical Partners Full time
Job Summary:

United Surgical Partners is seeking a skilled RN Case Manager to collaborate in the process of assessment, planning, facilitation, and advocacy for options and services to meet an individual's health needs through communication and available resources to promote quality, cost-effective care.

The case management process begins when the patient enters the healthcare system and continues through discharge planning, discharge, and post-discharge follow-up. The RN Case Manager performs utilization management and review functions, peer review relating to utilization review, and follows best practices including CMS, JC, and State laws governing medical necessity.

Duties:

Pro-actively reviews records and patient admission and treatment plans for medical necessity using evidence-based criteria such as InterQual or Milliman.
Pro-actively works with physicians to obtain the documentation needed to support medical necessity.
Pro-actively monitors admission status for appropriate status orders and communicates needs to the attending physician.
Receives Recovery Audit Contractor (RAC) requests documenting date and time of receipt.
Reviews the records requested by RAC for medical necessity and appropriate documentation to support medical necessity.
Utilizes physician advisors to assist in the review of RAC requested records.
Communicates needs and timely submits complete records to the RAC requesting agency by certified mail.
Tracks the RAC audit and appeal process for submission or extension requests or timely submission of appeals from request to final determination.
Reports all RAC activity to the UR committee and administration.
Takes responsibility for the OPPE/FPPE process and works closely with the Peer Review and Credentialing Committee.

Requirements:

Graduate of an accredited school of nursing; BSN preferred.
Current, active Texas RN licensure required.
Case Management certification preferred, but not required.
BLS required.
Minimum two (2) years acute care experience required.
Previous experience in case management required.

United Surgical Partners complies with federal, state, and/or local laws regarding mandatory vaccination of its workforce. If you are offered this position and must be vaccinated under any applicable law, you will be required to show proof of full vaccination or obtain an approval of a religious or medical exemption prior to your start date. If you receive an exemption from the vaccination requirement, you will be required to submit to regular testing in accordance with the law.

Employment practices will not be influenced or affected by an applicant's or employee's race, color, religion, sex (including pregnancy), national origin, age, disability, genetic information, sexual orientation, gender identity or expression, veteran status or any other legally protected status. United Surgical Partners will make reasonable accommodations for qualified individuals with disabilities unless doing so would result in an undue hardship. United Surgical Partners participates in the E-Verify program.
  • RN Case Manager

    2 weeks ago


    Kingwood, West Virginia, United States United Surgical Partners Full time

    Job Summary:We are seeking a highly skilled RN Case Manager to join our team at USPI Memorial Hermann Surgical Hospital Kingwood. As a key member of our healthcare team, you will be responsible for collaborating with patients, families, and healthcare providers to ensure high-quality, cost-effective care.Key Responsibilities:Conduct thorough assessments of...

  • Traveling Pharmacist

    1 month ago


    Kingwood, West Virginia, United States TotalMed Case Management Staffing Full time

    Job Title: PharmacistTotalMed Case Management Staffing is seeking a skilled Pharmacist to fill a travel position in Kingwood, Texas.Job Description:We are looking for a highly qualified Pharmacist to join our team for a 13-week assignment. The ideal candidate will have experience working in a hospital setting and be able to work 36 hours per week, with...

  • Traveling Pharmacist

    3 weeks ago


    Kingwood, West Virginia, United States TotalMed Case Management Staffing Full time

    Job Title: PharmacistTotalMed Case Management Staffing is seeking a skilled Pharmacist to fill a travel position in Kingwood, Texas.Job Details:Specialty: PharmacistDiscipline: Allied Health ProfessionalShift: 12 hours, nightsEmployment Type: TravelWe are looking for a dedicated and experienced Pharmacist to join our team for a 13-week assignment. The ideal...

  • Traveling Pharmacist

    4 weeks ago


    Kingwood, West Virginia, United States TotalMed Case Management Staffing Full time

    Job Title: PharmacistTotalMed Case Management Staffing is seeking a skilled Pharmacist to fill a travel position in Kingwood, Texas.Job Details:Specialty: PharmacistDiscipline: Allied Health ProfessionalShift: 12 hours, nightsEmployment Type: TravelWe are looking for a dedicated and experienced Pharmacist to join our team for a 13-week assignment. The ideal...

  • Traveling Pharmacist

    1 month ago


    Kingwood, West Virginia, United States TotalMed Case Management Staffing Full time

    Job Opportunity for a Hospital PharmacistTotalMed Case Management Staffing is seeking a skilled Hospital Pharmacist to fill a travel position in Texas.Job DetailsSpecialty: PharmacistDiscipline: Allied Health ProfessionalShift: 12 hours, nightsEmployment Type: TravelWe are looking for a qualified individual to work in a hospital setting, providing...

  • Traveling Pharmacist

    1 month ago


    Kingwood, West Virginia, United States TotalMed Case Management Staffing Full time

    Job Title: PharmacistTotalMed Case Management Staffing is seeking a skilled Pharmacist for a travel assignment in Kingwood, Texas.Job Details:Specialty: PharmacistDiscipline: Allied Health ProfessionalDuration: 13 weeksShift: 12 hours, nightsEmployment Type: TravelWe are looking for a highly qualified Pharmacist to join our team for a 13-week assignment in...

  • Traveling Pharmacist

    1 month ago


    Kingwood, West Virginia, United States TotalMed Case Management Staffing Full time

    Job Title: Travel PharmacistTotalMed Case Management Staffing is seeking a skilled and experienced pharmacist to join our team as a travel pharmacist. This is a fantastic opportunity to work in a dynamic and fast-paced environment, providing high-quality patient care and contributing to the success of our healthcare team.Job Summary:We are looking for a...

  • Hospice Nurse

    2 weeks ago


    Kingwood, West Virginia, United States Gentiva Full time

    About the RoleGentiva Hospice is seeking a dedicated and compassionate Hospice Registered Nurse (RN) to join our team as a RN Case Manager. As a RN Case Manager, you will be responsible for providing high-quality patient care and support to patients and their families in their homes.Key Responsibilities:Provide direct patient care services to hospice...


  • Kingwood, West Virginia, United States HCA Houston Healthcare Kingwood Full time

    Job SummaryWe are seeking a skilled Licensed Social Worker to join our team at HCA Houston Healthcare Kingwood. As a Licensed Social Worker, you will be responsible for providing non-clinical, biopsychosocial assessments and interventions for patients on the inpatient floors and in the outpatient emergency department. You will work collaboratively with RN...


  • Kingwood, West Virginia, United States Stonerise Healthcare Full time

    Compassionate Caregivers WantedWe are seeking a dedicated and compassionate RN Nursing Unit Manager to join our team at Kingwood Healthcare Center. As a Nursing Unit Manager, you will be responsible for overseeing the daily operations of our nursing units, ensuring that our residents receive the highest quality care.Key Responsibilities:Lead and manage a...

  • Home Health Nurse

    6 days ago


    Kingwood, West Virginia, United States WVUHS Home Care, LLC Full time

    Welcome to WVUHS Home Care, LLC, where we're dedicated to providing exceptional home health services. We're seeking a highly skilled and compassionate Registered Nurse to join our team as a Nurse Case Manager - Home Health.Job Summary:The Nurse Case Manager - Home Health will be responsible for providing direct and indirect nursing care to patients in their...


  • Kingwood, West Virginia, United States Stonerise Healthcare Full time

    Leadership Opportunity in NursingWe are seeking a dedicated and compassionate RN Nursing Unit Manager to join our team at Kingwood Healthcare Center. As a leader in patient-centered care, you will be responsible for overseeing the operational aspects of our nursing units, ensuring the highest standard of care for our residents and their families.Key...


  • Kingwood, West Virginia, United States Sunbelt Staffing Full time

    Job Title: Home Health Contract Registered NurseSeeking a skilled and compassionate Registered Nurse (RN) to fill a contract position with our dynamic and growing home health care agency in Kingwood. As a contract RN, you will deliver high-quality nursing care in the home setting, following established care plans.Key Responsibilities:Conduct initial patient...


  • Kingwood, West Virginia, United States Supplemental Health Care Full time

    Job Title: Operating Room RNSupplemental Health Care is seeking a skilled Operating Room Registered Nurse to join our team in Kingwood, Texas.Job Summary:We are looking for a dedicated and compassionate Operating Room RN to provide high-quality patient care in a fast-paced hospital setting. As an Operating Room RN, you will be responsible for preparing...


  • Kingwood, West Virginia, United States Supplemental Health Care Full time

    Job Title: Operating Room RNSupplemental Health Care is seeking a skilled Operating Room Registered Nurse to join our team in Kingwood, Texas.Job Summary:We are looking for a dedicated and compassionate Operating Room RN to provide high-quality patient care in a fast-paced hospital setting. As an Operating Room RN, you will be responsible for preparing...


  • Kingwood, West Virginia, United States HCA Houston Healthcare Kingwood Full time

    Job SummaryWe are seeking a skilled and experienced Registered Nurse Manager to lead our Emergency Room team at HCA Houston Healthcare Kingwood. As a key member of our nursing leadership team, you will be responsible for ensuring the delivery of high-quality patient care and promoting a positive work environment.Key ResponsibilitiesInitiate, guide, and...


  • Kingwood, West Virginia, United States US Renal Care Full time

    Dialysis Charge Nurse Job SummaryWe are seeking a skilled and experienced Dialysis Charge Nurse to join our team at US Renal Care. As a Dialysis Charge Nurse, you will be responsible for overseeing nursing services and providing daily supervision of staff on duty during operational hours.Key Responsibilities:Assist with clinical and operational processes to...


  • Kingwood, West Virginia, United States US Renal Care Full time

    Job Title: Dialysis Charge NurseThe RN Charge Nurse is a vital member of our dialysis team, responsible for overseeing nursing services during each shift. This role functions as a nursing supervisor, ensuring the delivery of high-quality patient care.Key Responsibilities:Assist with clinical and operational processes to improve patient health and minimize...


  • Kingwood, West Virginia, United States WVU Medicine Full time

    Job SummaryWe are seeking a highly skilled Registered Nurse to join our Home Health Care team at WVU Medicine. As a Home Health Nurse Case Manager, you will be responsible for providing direct and indirect nursing care to patients in their homes, collaborating with the patient, family, and healthcare team to develop, implement, and evaluate nursing care...


  • Kingwood, West Virginia, United States HCA Houston Healthcare Kingwood Full time

    Unlock Your Potential as a Clinical Nurse Coordinator RN Operating RoomAre you a dedicated and compassionate nurse looking to take your career to the next level? HCA Houston Healthcare Kingwood is seeking a skilled Clinical Nurse Coordinator RN Operating Room to join our team.About the RoleThe Clinical Nurse Coordinator (CNC) plays a vital role in ensuring...