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Clinical Utilization Manager
2 months ago
We are seeking a skilled Utilization Management Clinical RN to join our team at Texas Children's Hospital. As a key member of our healthcare team, you will play a critical role in ensuring that our patients receive the most appropriate and cost-effective care.
Responsibilities:- Analyze submitted information, including clinical assessments, treatment plans, regulatory guidelines, and medical necessity, to determine the appropriateness of services.
- Collaborate with medical directors and other healthcare professionals to review and make decisions on service requests.
- Document due process, attempts to gain adequate clinical information, and reviews of denial letters to ensure accuracy and adherence to policy and procedure.
- Communicate with providers through written correspondence, meeting accrediting and regulatory guidelines for clinical content and readability levels.
- Work closely with UM Analyst staff to expedite appeals and complaint processes by coordinating concurrent activity with policy and procedure requirements.
- Diploma in or associate's degree in nursing, or an associate's degree in a related field accepted by the Texas Board of Nursing for the purposes of obtaining and maintaining an RN license.
- Bachelor's degree in nursing preferred.
- RN license from the Texas Board of Nursing or Nursing Licensure Compact required.
- 3 years nursing experience required.
- Experience with Utilization Management or Case Management preferred.
Why Join Our Team?
At Texas Children's Hospital, we are committed to providing exceptional patient care and advancing the field of pediatric healthcare. As a Utilization Management Clinical RN, you will have the opportunity to work with a talented team of healthcare professionals and make a meaningful impact on the lives of our patients and families.
