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
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