Registered Nurse (RN) - Case Manager, Acute Care Case Management - $28+ per hour

Company: UT Health East Texas
Location: Tyler
Posted on: March 18, 2023

Job Description:

UT Health East Texas is seeking a Registered Nurse (RN) Case Manager, Acute Care Case Management for a nursing job in Tyler, Texas.Job Description & Requirements

• Specialty: Acute Care Case Management
• Discipline: RN
• Start Date: ASAP
• Duration: Ongoing
• Employment Type: Permanent
  OverviewJoin UT Health East Texas as a Full Time, Day Shift, Case Manager RN! **INCREASED SIGN ON BONUS!!**--Advancing Healthcare--Together ---The Future of Healthcare--is--in East TexasWhy UT Health - East Texas?Our People.----Our people truly are our greatest strength.-- They make a massive difference in the amazing care we provide every day.-- We work closely together to create a positive experience for our patients and each other.Our Purpose.--We will build on your experience and provide meaningful and purposeful career growth for your future. You will have the opportunity every day to make a difference in someone's life and change the course of healthcare.Our Place.--Tyler, Texas is a small town with a huge heart where you will have the privilege of caring for your neighbors. Everybody is somebody here.Representing the very best in healthcare, UT Health East Texas is comprised of 10 hospitals and more than 50 clinics across east Texas.-- With nearly 7,500 employees and over 1,000 licensed in-patient beds, UT Health East Texas provides healthcare services to thousands of patients annually through our hospitals, clinics, Level 1 trauma facility, air emergency fleet and EMS service in a metropolitan service area of a quarter-million people.-------------------------------------------------------------------------------------------------- POSITION SUMMARY:The Utilization Review (UR) Nurse is a registered nurse responsible for applying standardized, evidenced-based, medical necessity criteria to form utilization review determinations, communicate relevant information to third party payors, and secure authorization to facilitate the patient's treatment and discharge plan.-- The UR Nurse communicates with physicians to obtain necessary information as requested by the payor, or to inform the physician of a potential payor denial.-- The UR Nurse functions as an advocate and contact person for the patient with the insurance company and outside agencies to assure optimal clinical and resource outcomes.--The UR Nurse clarifies treatment plans as needed to support the patient needs, treatment and discharge plan and reimbursement for services rendered.-- Proactively mitigate denials by engaging the physician, physician advisor or other members of the patient's healthcare team in concurrent and/or retrospective payor discussions. Collaborates with members of the patient's healthcare team to promote appropriate patient care progression; and analyzes current systems to prevent avoidable delays and identify opportunities for improvement. ResponsibilitiesDUTIES, ACCOUNTABILITIES AND RESPONSIBILITIES include the following:
  • Conducts initial and concurrent utilization reviews, applies evidence-based, standardized medical necessity criteria for review determination, and relays information to third party payor.
  • Serves as a patient advocate, effectively communicating and striving to obtain authorization for necessary services during the patient's hospitalization.
  • Addresses potential denials from payors by communicating with physicians the need for additional information/documentation and/or peer-to-peer contact with the payor.-- Tracks, monitors, and reports denials and appeal status as indicated.
  • Utilizes internal information systems to communicate with payors, case management and business office team members.-- Monitors and reports on specific case types as indicated, e.g. short stays, MS-DRGs, etc.
  • Makes appropriate referrals, and serves as a patient representative.-- QualificationsQUALIFICATIONS / REQUIREMENTS:Education:
    • Registered Nurse with an Associates, Bachelor's or Master's Degre required.Experience:
      • A minimum of three (3) years of--clinical experience is required.
      • Experience in utilization review,--discharge planning, quality programs preferred.Certification and Licensure:
        • Current RN license in the state of----Texas required and Case Management certification desired.--Skills:-- Demonstrates proficiency in applying advanced decision making, communication and negotiation.-- Interacts well with all levels of internal and external customers.-- Possesses working knowledge of nursing practice, reimbursement methodologies, payor requirements and regulatory guidelines.-- Clinically knowledgeable of the disease process specific to assigned population.-- Demonstrates knowledge of the principles of growth and development related to the different life cycles.-- Specific age groups served include Neonates, Infants, Pediatric, Adolescent, Adult and Geriatric.--BEHAVIORAL STANDARDS:
          • Service-Patient Centered Customer Service: Genuinely care about people.-Cultivate a compassionate environment: Changing lives for the better together.
            • Quality-Clinical and Operational Excellence: A relentless drive to be the best.-Holistic Approach: Think and act for the benefit of the whole.
              • People-Promote a collaborative environment: Build effective working relationships with others.-Identify and Develop Talent: Prepare others to deliver excellence.
                • Financial-Business Acumen: Know, own and drive our business.-Continually Simplify and Improve: Work to make everything as efficient as possible.
                  • Growth-Foster Innovation: Seek and apply leading edge solutions.-Set Clear Direction: Tell others where you are going, how to get there and why.--PHYSICAL REQUIREMENTS:
                    • The physical demands described are representative of those that must be met by an employee to successfully perform the essential functions of a Case Manager.-- Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions of this role.-- While performing the duties of this job, the employee is regularly required to: sit, stand, walk, use written, auditory and verbal sources of information, exhibit digital dexterity, process information and prioritize work, occasionally lift supplies, and make general decisions in the absence of specific directions.--ENVIRONMENTAL CONDITIONS: The work environment characteristics described here are representative of those as employee encounters while performing the essential functions of this job.-- Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions.While performing the duties of this job, the employee may be exposed to infectious disease, moving mechanical parts, fumes or airborne particles, toxic or caustic chemicals, and violent or erratic behaviors.-- The noise level in the work environment is usually moderate.--Now that you read about what you will be doing and the experience we seek, it is time to apply and make a difference in the lives of our patients.--UT Health East Texas is an equal opportunity employerAbout UT Health East TexasArdent Health Services--prides itself in--quality health care--by--investing in--people, technology, facilities and--communities, to--produce--extraordinary results.----To date, those investments total more than $1.4 billion since 2001. From newly constructed facilities and expanded services to lifesaving technology and outstanding opportunities for employees, Ardent is committed to providing its hospitals and clinics the tools they need to succeed.--Recapitalized and supported by the financial strength of Ventas, Inc., an S&P 500 company and leading real estate investment trust, and Equity Group Investments, a private investment firm founded by Sam Zell more than 45 years ago, Ardent is expanding its network and bringing its unique combination of resources and proven management expertise to new communities.---------Ardent includes: 4,718 licensed beds,--More--than 1,000 employed providers,--and--$3 billion in revenues.-------Healthcare systems within Ardent include:-------BSA Health System--- Amarillo,--Texas---------Seton Medical Center--- Harker Heights,--Texas-------Hillcrest Healthcare System - Oklahoma--(8 Hospitals) - Hillcrest Medical Center, Hillcrest Hospital South, Tulsa Spine & Specialty Hospital, Bailey Medical Center, Hillcrest Hospital Cushing, Hillcrest Hospital Claremore, Hillcrest Hospital Henryetta, Hillcrest Hospital Pryor-------Lovelace Health System - Albuquerque, New Mexico--(5 Hospitals) ---Lovelace Medical Center, Lovelace UNM Rehabilitation Hospital, Lovelace Women's Hospital, Lovelace Westside Hospital, Lovelace Regional Hospital-------UT Health - East Texas--(9 Hospitals):--UT Health,--Tyler, UT Health North Campus--Tyler, UT Health East Texas--Long-Term Acute Care, UT Health East Texas Rehabilitation--Center, UT Health Athens, UT Health Carthage, UT Health Henderson, UT Health Jacksonville, UT Health Pittsburg-------Americas Division-----Hackensack Meridian Health - Mountainside Medical Center (Montclair, New Jersey) and Pascack Valley Medical Center (Westwood, New Jersey)--The University of Kansas Health System, St. Francis--Campus--(Topeka, Kansas)----Portneuf Medical Center--(Pocatello, Idaho)--Benefits
                      • Dental benefits
                      • Life insurance
                      • Continuing Education
                      • 401k retirement plan
                      • Discount program
                      • Wellness and fitness programs
                      • Employee assistance programs
                      • Medical benefits
                      • Vision benefits

Keywords: UT Health East Texas, Tyler , Registered Nurse (RN) - Case Manager, Acute Care Case Management - $28+ per hour, Executive , Tyler, Texas