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RN - Case Manager - Med Surg Tele - PRN
2 months ago
At Titus Regional Medical Center, we are seeking a skilled and compassionate Registered Nurse to join our team as a Case Manager in the Medical Surgical Tele department. As a Case Manager, you will play a vital role in ensuring the efficient and effective management of patient care, while promoting a positive patient experience.
Job Summary:The RN Case Manager will be responsible for monitoring and compiling information on the necessity of patient admissions and continued stays. This role requires strong clinical knowledge, effective communication skills, and the ability to prioritize activities according to urgency.
Key Responsibilities:- Review inpatient records for admission necessity and justification of continued stay.
- Conduct reviews and ensure proper status of patient.
- Collaborate with medical staff to achieve utilization objectives.
- Communicate effectively and professionally with the medical staff, other hospital departments, and outside organizations.
- Maintain required logs of utilization activity according to hospital procedures and requirements of third-party payers.
- Provide ongoing support in preparation of required documentation for management and other review committees.
- Assist in the preparation of and delivers denial letters in cases of non-covered admissions.
- Provide timely completion of required utilization review certification for billing, including private insurance certifications.
- Oversee audits and assemble record and necessary utilization review documentation for audits and surveys by third-party payers in conjunction with the denial management team.
- One year of clinical or case management experience preferred.
- Registered Nurse currently licensed to practice in the State of Texas required.
- BLS (Basic Life Support) within 30 days of hire date required.
This role requires the ability to work in a fast-paced environment, with frequent interruptions and deadlines. The RN Case Manager will be required to work effectively in a team environment, with minimal supervision.
Titus Regional Medical Center is an equal opportunity employer and welcomes applications from diverse candidates. We offer a competitive salary and benefits package, as well as opportunities for professional growth and development.
