RN, Registered Nurse - Case Management ( Utilization Review )
Company: Christus Health
Posted on: October 12, 2021
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
- BSN required
- TX RN license
- Current CPR
- Knowledge of Medicare, Medicaid, TMF, TDH, M&R, Interqual
- 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
- Case Management preferred
- Proficient in Windows, Word, Excel
- Proficient in keyboarding & mouse use
- Disease Management knowledge
- Critical thinking skills / judgments
- Customer service communications
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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