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RN, Registered Nurse - Case Management ( Utilization Review )

Company: Christus Health
Location: Tyler
Posted on: October 12, 2021

Job Description:

Description

Summary:

This position is responsible for the coordination of care for the patient and their support systems. Collaborations with physicians, social work, nursing, and all disciplines of care are crucial in determining not only appropriateness of care, but also the continuum of care, discharge planning, and post discharge/transfer. A working knowledge of resource contacts for continued care is also pertinent. Clinical outcomes management and monitoring is also an element of this position. This position is also responsible for the concurrent review and data abstraction of the medical record. Patients are assessed for clinical documentation reflecting continuum of care and medical necessity according to criteria established by TMF, Medicare, Medicaid, Managed Care agencies, and Clinical Path resources [Interqual, M&R]. Such criteria are used only as a guide in determining medical necessity for continued stay for individualized patients. Demonstrates mastery and competence in computer skills. Demonstrates knowledge of disease processes, normal vs. abnormal clinical findings, and usual and customary healthcare treatment. Demonstrates excellent communication skills and quality management skills. Participates as a member of the inter-disciplinary healthcare team.


Requirements:

  • BSN required
  • TX RN license
  • Current CPR
  • Knowledge of Medicare, Medicaid, TMF, TDH, M&R, Interqual criteria.
  • Minimum of 3 - 5 years acute care RN experience in a clinical area of expertise.
  • 3-5 years of experience in Case management. preferred but not required
  • Case Management preferred
  • Proficient in Windows, Word, Excel
  • Proficient in keyboarding & mouse use
  • Disease Management knowledge
  • Critical thinking skills / judgments
  • Customer service communications

Work Type: 

Full Time

M-F 8 -5, rotating weekends 

ER Utilization review care coordinator



Keywords: Christus Health, Tyler , RN, Registered Nurse - Case Management ( Utilization Review ), Other , Tyler, Texas

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