Utilization Management Nurse II: Healthcare Professional

4 days ago


Tyler, Texas, United States Christus Health Full time

Job Overview

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The Utilization Management Nurse II is a key role within CHRISTUS Health, playing a vital part in ensuring the optimal use of hospital resources while providing high-quality patient care. As a seasoned professional with strong clinical expertise, you will be responsible for conducting thorough reviews of patient cases to determine medical necessity and appropriateness of care.

About the Role

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This position requires a skilled and detail-oriented individual who can effectively communicate with internal and external stakeholders, including physicians, payors, and patients. You will work collaboratively as part of an interdisciplinary team to ensure seamless patient progression throughout the healthcare continuum.

Responsibilities

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  • Clinical Review and Decision-Making: Conduct comprehensive reviews of patient cases to determine medical necessity and appropriateness of care, utilizing evidence-based guidelines and criteria sets.">
  • Collaboration and Communication: Work closely with healthcare professionals, payors, and patients to facilitate timely and informed decision-making regarding patient care.">
  • Resource Optimization: Identify opportunities to optimize resource utilization, ensuring efficient allocation of hospital resources while maintaining high-quality patient care.">
  • Documenting and Reporting: Maintain accurate and detailed records of patient reviews, outcomes, and recommendations, providing regular reports to stakeholders as needed.">
  • Professional Development: Stay up-to-date with the latest clinical guidelines, regulations, and best practices in utilization management, actively participating in ongoing education and training.">
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Requirements

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To be successful in this role, you will need:

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  • Clinical Expertise: Minimum two years of clinical experience, preferably in an acute care setting, with a strong foundation in nursing principles and practices.">
  • Education and Certifications: Graduate of an accredited School of Nursing or demonstrated success in a Utilization Management Nurse I role at CHRISTUS Health, supplemented by relevant certifications (e.g., Case Management certification).">
  • Licenses and Registrations: Active RN license in the state of employment or compact required; LPN/LVN license accepted for associates with 5+ years of demonstrated success and experience in the Utilization Management Nurse I role at CHRISTUS Health.">
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Salary Range:

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$83,456 - $110,532 per year

Work Schedule:

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Monday-Friday, 8:00 AM - 5:00 PM

Location:

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Texas, USA



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