Utilization Management Nurse III

2 days ago


San Antonio, Texas, United States Christus Health Full time
Job Summary

The Utilization Management Nurse III is a key member of the healthcare team, responsible for ensuring the clinical appropriateness of care provided to patients and optimizing hospital resource utilization. This role requires a strong clinical background, excellent communication skills, and the ability to work effectively in a fast-paced environment.

Responsibilities
  • Conduct comprehensive assessments of clinical information and treatment plans to determine medical necessity and appropriateness of care.
  • Utilize approved screening criteria to track impact and variance, and make recommendations for clinical appropriateness.
  • Collaborate with the interdisciplinary team to ensure seamless care coordination and communication.
  • Facilitate joint decision-making with the team regarding patient status and outcomes.
  • Stay up-to-date with regulatory requirements and industry developments to ensure compliance and best practices.
  • Develop and maintain strong relationships with payors, physicians, and other stakeholders to ensure effective communication and coordination.
  • Participate in multidisciplinary rounds and contribute to the development of care plans that meet the needs of patients and the organization.
Requirements
  • BSN required or demonstrated success as a Registered Nurse in the Utilization Management Nurse II role for at least five years at CHRISTUS Health.
  • 5 years of experience in the clinical setting with at least 3 years in the acute care setting required.
  • RN License in state of employment or compact required.
  • Certification in Case Management preferred.
Work Environment

This role is part of the CHRISTUS Health team, a faith-based, not-for-profit health system committed to delivering high-quality, compassionate care to the communities we serve.



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