Utilization Management Specialist

3 weeks ago


Corpus Christi, Texas, United States Driscoll Children's Hospital Full time
Job Summary

We are seeking a highly skilled Utilization Management Case Manager to join our team at Driscoll Children's Hospital. As a key member of our healthcare team, you will play a critical role in ensuring the efficient utilization of healthcare resources while providing quality care to our patients.

Key Responsibilities
  • Coordinate and manage the utilization of healthcare resources to ensure optimal patient outcomes.
  • Collaborate with healthcare providers, social workers, and other multidisciplinary team members to develop and implement effective care plans.
  • Conduct concurrent and retrospective reviews to ensure appropriateness of hospital treatment using plan-approved evidence-based criteria.
  • Participate in health plan performance improvement activities and committees as needed.
  • Communicate effectively with management regarding workload and turn-around-time discrepancies.
Requirements
  • Graduate of an accredited school of nursing with a minimum of three years of prior clinical experience.
  • One year of acute inpatient case management or managed care case/utilization management experience preferred.
  • Strong knowledge of Medicaid criteria/guidelines, managed care contracts/guidelines, and various reimbursement mechanisms.
  • Excellent communication and interpersonal skills with the ability to establish and maintain effective working relationships.
What We Offer

As a Utilization Management Case Manager at Driscoll Children's Hospital, you will have the opportunity to work in a dynamic and compassionate environment that values innovation and technology. We offer a competitive salary and benefits package, as well as opportunities for professional growth and development.



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