Care Management Registered Nurse
5 days ago
The RN Utilization Review II plays a pivotal role in ensuring the clinical appropriateness of care provided to patients and optimizing hospital resource utilization.
They must effectively utilize approved screening criteria, including InterQual, MCG, and CMS Inpatient List, to make informed decisions.
With a focus on maintaining current and accurate knowledge of commercial and government payors, as well as Joint Commission regulations and guidelines, this RN efficiently manages a diverse workload in a fast-paced, rapidly changing environment.
Key responsibilities include communicating with internal and external clinical professionals, organizing patient financial insurance care, and relaying clinical data to insurance providers and vendors to obtain approved certification for services.
The RN Utilization Review Nurse collaborates with the healthcare team to ensure seamless care delivery, aligning with the mission of CHRISTUS Health.
Required qualifications include a BSN degree from an accredited nursing program or proven success in a Registered Nurse Utilization Review I role.
A minimum of three to five years of experience in case management or utilization review, or proven success in a Registered Nurse Utilization Review I role, is also required.
Certification in Case Management is preferred.
This is a PRN, Per Diem As Needed position.
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