Clinical Resource Utilization Specialist

4 days ago


Tyler, Texas, United States Christus Health Full time
Job Summary:

We are seeking a highly skilled Clinical Resource Utilization Specialist to join our team at Christus Health. As a key member of our clinical staff, you will play a critical role in ensuring the appropriate utilization of hospital resources and promoting high-quality patient care.

About the Role:

The Clinical Resource Utilization Specialist will be responsible for conducting comprehensive reviews of patient cases to determine medical necessity and ensure compliance with regulatory requirements. This involves analyzing clinical information, treatment plans, and medical necessity criteria to make informed decisions about resource allocation.

You will work closely with our interdisciplinary team, including physicians, nurses, and other healthcare professionals, to coordinate patient care and promote effective communication. Your expertise in clinical resource utilization and ability to navigate complex healthcare systems will be essential in this role.

Key Responsibilities:
  • Conduct thorough reviews of patient cases to determine medical necessity and ensure compliance with regulatory requirements
  • Analyze clinical information, treatment plans, and medical necessity criteria to inform decision-making
  • Collaborate with interdisciplinary teams to coordinate patient care and promote effective communication
  • Develop and maintain knowledge of current clinical guidelines, regulations, and industry standards
  • Provide education and training to healthcare staff on clinical resource utilization best practices
Requirements:
  • RN License in state of employment or compact required
  • Two or more years of clinical experience with at least one year in the acute care setting
  • Demonstrated success as Utilization Management Nurse I role at CHRISTUS Health required
  • Certification in Case Management preferred
Work Schedule:

5 Days - 8 Hours

Salary:

$83,610 per year



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