Clinical Resource Manager

7 days ago


San Antonio, Texas, United States Christus Health Full time

Job Summary:

The RN Utilization Review Specialist is responsible for ensuring the clinical appropriateness of care provided to patients and optimizing hospital resource utilization. This role involves performing pre-admission, concurrent, and retrospective reviews to ensure compliance with regulatory requirements and industry standards. The ideal candidate will possess excellent analytical and communication skills, with the ability to effectively manage a diverse workload in a fast-paced environment.

Key Responsibilities:

  • Conduct thorough reviews of patient records to determine clinical appropriateness of care
  • Develop and implement strategies to optimize hospital resource utilization
  • Collaborate with internal stakeholders to ensure compliance with regulatory requirements and industry standards
  • Communicate effectively with internal and external stakeholders to obtain approved certification for services
  • Stay up-to-date with current knowledge of commercial and government payors, as well as Joint Commission regulations and guidelines

Requirements:

  • BSN Degree from an accredited nursing program or proven success in a related role
  • Familiarity with criteria sets, including InterQual and MCG
  • Excellent verbal and written communication skills
  • Critical and analytical thinking skills
  • Demonstrated clinical competency
  • Three to Five years experience in case management or utilization review
  • RN License in state of employment or compact required
  • CPR certification preferred
  • Certification in Case Management preferred

Work Environment:

This role is a per diem position, requiring flexibility to work as needed to meet business demands.



  • San Antonio, Texas, United States ICON Clinical Research Full time

    About ICON plc:ICON plc is a premier organization specializing in healthcare intelligence and clinical research. We are dedicated to advancing clinical research by providing outsourced services to pharmaceutical, biotechnology, medical device, and governmental organizations.With a patient-centric approach, we strive to expedite the development of medications...


  • San Marcos, Texas, United States Clinical Pathology Laboratories, Inc Full time

    Position Overview:As a pivotal resource for specimen and testing information, the Clinical Writing Operations Manager plays a crucial role in ensuring the efficiency and quality of laboratory services.Key Responsibilities:1. Serve as an essential internal and external resource for specimen and testing details.2. Optimize resource utilization to enhance...

  • Nurse Team Lead

    2 weeks ago


    San Antonio, Texas, United States Worldwide Clinical Trials Full time

    Job SummaryWe are seeking a highly skilled and experienced Nurse Team Lead to join our team at Worldwide Clinical Trials. As a key member of our clinical research team, you will be responsible for overseeing study activity, ensuring participant safety, and providing medical coverage in case of emergencies.Key ResponsibilitiesRepresent Worldwide in a...

  • Nurse Team Lead

    5 days ago


    San Antonio, Texas, United States Worldwide Clinical Trials Full time

    About the RoleWe are seeking a highly skilled and experienced Nurse Team Lead to join our team at Worldwide Clinical Trials. As a key member of our clinical research team, you will be responsible for overseeing study activity, ensuring participant safety, and providing medical coverage in case of emergencies.Key ResponsibilitiesRepresent Worldwide in a...

  • Program Manager

    3 days ago


    San Antonio, Texas, United States CHRISTUS Health Full time

    Job Summary:We are seeking a highly skilled and experienced Program Manager to lead the clinical operations of our hospital. As a key member of our leadership team, you will be responsible for directing the operation of clinical programs and promoting quality services for the community and patients.About CHRISTUS Health:CHRISTUS Health is a Catholic health...


  • San Antonio, Texas, United States EHR Encore Health Resource Full time

    We are pleased to welcome you if you are interested in joining our team. The initial step involves creating an account with a username and password, which is a quick process taking less than a minute. The overall application procedure should not exceed 5-7 minutes.Position Overview:Delivering assistance to a medical device organization by attending...


  • San Antonio, Texas, United States Christus Health Full time

    About the RoleThis position provides expertise and leadership to ensure effective resource management for patient care delivery. As a Clinical Nurse Leader - Care Management, you will play a critical role in enhancing the continuity of care and cost-effectiveness by integrating case management, resource management, clinical documentation management, and...


  • San Antonio, Texas, United States Methodist Hospital Northeast Full time

    Salary: $113, $169,832.00Full-time Days (No Weekends)This position is incentive eligible.Eligible for Sign on Bonus or Relocation.OverviewJoin a healthcare organization that prioritizes your growth as a Clinical Pharmacy Manager. At Methodist Hospital Northeast, we value our team members and have dedicated substantial resources to enhance their professional...


  • San Antonio, Texas, United States Synergyst Research GroupDiscovery Clinical Trials Full time

    Exciting Role in Clinical Research at Synergyst Research GroupPosition OverviewKey Responsibilities:Manage and facilitate clinical trial operationsGather, interpret, and oversee research dataEnsure adherence to regulatory standards while safeguarding patient privacyLead and mentor research personnelObserve participants during studies and document essential...


  • San Antonio, Texas, United States Department of Veterans Affairs Full time

    Clinical Nurse Manager - Utilization OversightOverviewThe Department of Veterans Affairs is in search of a Clinical Nurse Manager to lead Utilization Oversight initiatives.Role SummaryThe Clinical Nurse Manager (CNM) will be pivotal in directing and managing utilization oversight activities within the healthcare environment. This role demands a blend of...

  • Program Manager

    1 week ago


    San Antonio, Texas, United States Christus Health Full time

    Job Summary:As a Program Manager - Clinical Operations at Christus Health, you will play a critical role in directing the operation of clinical programs and promoting quality services for the community and patients. This position requires a strong leader who can oversee the development and implementation of clinical programs, ensuring they meet the highest...

  • Program Manager

    7 days ago


    San Antonio, Texas, United States CHRISTUS Health Full time

    Job Summary:As a Program Manager - Clinical Operations at CHRISTUS Health, you will play a critical role in directing the operation of clinical programs and promoting quality services for the community and patients. This position requires a strong leader who can oversee the development and implementation of clinical programs, ensuring they meet the highest...


  • San Antonio, Texas, United States Hotel Resource Full time

    Job Summary:Hotel Resource is seeking an experienced Hotel Operations Manager to join our team. As an Assistant General Manager, you will be responsible for providing exceptional leadership and service to our guests and team members.Key Responsibilities:Provide expert leadership across all departments of the hotel, ensuring exceptional service to each...

  • Program Manager

    3 days ago


    San Antonio, Texas, United States CHRISTUS Health Full time

    Job SummaryAs a Program Manager - Clinical Operations at CHRISTUS Health, you will play a critical role in directing the operation of clinical programs and promoting quality services for the community and patients.CHRISTUS Health is a leading healthcare provider with a strong commitment to delivering high-quality patient care. Our hospitals and facilities...

  • Program Manager

    7 days ago


    San Antonio, Texas, United States Christus Health Full time

    Job SummaryAs a Program Manager - Clinical Operations at Christus Health, you will play a critical role in directing the operation of clinical programs and promoting quality services for the community and patients.About UsChristus Health is a faith-based, non-profit health care system that has been serving the community for over 150 years. We are committed...


  • San Antonio, Texas, United States Methodist Hospital Northeast Full time

    Position OverviewThis role is eligible for incentives.IntroductionAre you ready to be part of an organization that prioritizes your growth as a Pharmacy Clinical Manager? At Methodist Hospital Northeast, we place our employees first.HCA Healthcare has dedicated up to $300 million in initiatives to support our exceptional team members over three years.We take...

  • RN Program Manager

    2 hours ago


    San Antonio, Texas, United States Christus Health Full time

    Job Summary:As a Clinical Program Manager at Christus Health, you will play a critical role in directing the operation of clinical programs and promoting quality services for the community and patients. This position requires a strong leader who can foster a culture of excellence and patient-centered care.About Christus Health:Christus Health is a...


  • San Antonio, Texas, United States Methodist Hospital Metropolitan Full time

    Position OverviewAbout UsAt Methodist Hospital Metropolitan, we value our nursing staff for their dedication and compassion towards patients. Our team is recognized for their commitment to quality care and patient satisfaction. We are currently looking for a skilled RNII to enhance our nursing family.About Methodist Hospital MetropolitanWith a capacity of...


  • San Antonio, Texas, United States Sigma Core LLC Full time

    Job OverviewSigma Core LLC is in search of a skilled Human Resources Operations Manager to oversee our HR functions. The successful candidate will possess a solid background in HR practices, comprehensive knowledge of labor regulations, and a proven track record in employee relations, onboarding processes, benefits management, payroll support, and daily...


  • San Antonio, Texas, United States Methodist Le Bonheur Healthcare Full time

    Position Overview:This role is eligible for incentives and offers potential sign-on bonuses or relocation assistance. Are you seeking a workplace that champions diversity and inclusion? Join our team at Methodist Le Bonheur Healthcare as a Clinical Pharmacy Manager and discover the true essence of being part of a dedicated healthcare organization.About...