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Utilization Management Nurse III
4 months ago
Job Description
Summary:
The Utilization Management Nurse III is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This Nurse is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services “CMS” Inpatient List). They effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and Joint Commission regulations and guidelines related to UM. This Nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services. The Utilization Management Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS.
CHRISTUS Santa Rosa Hospital - Westover Hills (CSRH-WH) is a 150-bed hospital serving the fastest growing area of San Antonio. Specialized care includes orthopedic and surgical services, ICU, women’s services, a newborn nursery, comprehensive cardiovascular care from diagnostics to open heart surgery, vascular lab, sleep center, emergency services, the CHRISTUS Weight Loss Institute, wound care, rehabilitation, and more. The campus also boasts an Outpatient Imaging Center and three medical plazas, one of which houses our CHRISTUS Santa Rosa Family Medicine Residency Program and CHRISTUS Santa Rosa Family Health Center.
Responsibilities:
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 on top of the required experience to include: Demonstrated leadership skills – formal or informal Demonstrated willingness to mentor team members including onboarding and orienting new associates Demonstrated problem-solving skills Demonstrated positive approach in difficult and challenging situations Demonstrated agent for change and change management 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. BLS preferred.
Work Schedule:
Varies
