Unfortunately, this job posting is expired.
Don't worry, we can still help! Below, please find related information to help you with your job search.
Don't worry, we can still help! Below, please find related information to help you with your job search.
Related keywords
- Utilization Management Auditor
- Utilization Management Processor
- Utilization Review Rn
- Remote Utilization Management Nurse Rn
- Supervisor Utilization Management Rn
- Utilization Management Clinical Supervisor Rn
- Case Management Utilization Review Rn
- Utilization Management Rn
- Utilization Management Rn Per Diem
- Rn Utilization Management Reviewer
Some similar recruitments
Rn Supervisor Jobs
Recruited by Touchstone Communities 9 months ago
Address Helotes, TX, United States
Rn Supervisor Jobs
Recruited by Touchstone Communities 9 months ago
Address Hondo, TX, United States
Utilization Review Registered Nurse (Rn), Care Coordination, Full Time, Days
Recruited by MarinHealth Medical Center 9 months ago
Address , Greenbrae
$66.03 - $99.04 an hour
Behavioral Health, Utilization Management Review, Lcmhc/Lcsw/ Rn
Recruited by AmeriHealth Caritas 9 months ago
Address , Greensboro
Utilization Review Representative Jobs
Recruited by Ethos 9 months ago
Address Dallas, TX, United States
Social Worker Msw - Utilization Review
Recruited by Providence 9 months ago
Address , Napa, 94581
Utilization Management Coordinator Jobs
Recruited by Ascension 9 months ago
Address , Austin, 78736
From $22.28 an hour
Rn Utilization Management Reviewer
Recruited by Commonwealth Care Alliance 9 months ago
Address , Boston, 02108
Rn, Clinical Supervisor Jobs
Recruited by Northside Hospital Inc. 9 months ago
Address , Atlanta, 30342
Rn Coordinator Utilization Management (1.0 Fte)
Recruited by Network Health 9 months ago
Address , Menasha, 54952
Utilization Management Clinical Consultant
Recruited by CVS Health 9 months ago
Address , Galveston
$28.25 - $60.50 an hour
Rn Utilization Management Nurse Cst Est Location Remote
Recruited by Optum 9 months ago
Address , Atlanta, 30319
Rn Supervisor Jobs
Recruited by NaphCare, Inc. 9 months ago
Address , Atlanta
Rn Utilization Management Nurse 2 - Se Region - Remote
Recruited by Humana 9 months ago
Address , , Tx
Utilization Management Coordinator Jobs
Recruited by University Hospital, Newark NJ 9 months ago
Address , Newark, 07103, Nj
Medical Review Rn -Experienced - Home Or Office Based
Recruited by Qlarant 10 months ago
Address Dallas, TX, United States
Director Of Utilization Management
Recruited by Ethos 10 months ago
Address Houston, TX, United States
Utilization Review Specialist Jobs
Recruited by Within Health 11 months ago
Address Houston, TX, United States
Rn Utilization Review - Patient Access
Recruited by Penn State Health 1 year ago
Address , Enola, 17025, Pa
Utilization Management Nurse Consultant
Recruited by CVS Health 1 year ago
Address , , Tx
$28.25 - $60.50 an hour
Utilization Management Director Jobs
Recruited by Bluebonnet Trails Community Services 1 year ago
Address , Round Rock, 78664, Tx
Utilization Management Rn Jobs
Company | Children's Health |
Address | , Dallas, 75390, Tx |
Employment type | FULL_TIME |
Salary | |
Expires | 2023-07-27 |
Posted at | 1 year ago |
This position is hybrid (remote and will require some meetings onsite in Dallas)
ABOUT THE JOB:Summary:
The Utilization Management Nurse is responsible for determining and managing medical necessity of acute inpatient admissions utilizing clinical criteria. This includes communication with the Physician's admitting patients to a Children's Health System of Texas (CHST) facility and collaboration with the Physician Advisor during the review process.
Responsibilities:
WORK EXPERIENCE
Children’s Health values the role each member of our team plays in helping us make life better for children. We employ more than 7,500 people and provide rewarding career opportunities that help them reach their highest potential.
We also hold Magnet recognition from the American Nurses Credentialing Center for nursing excellence, we serve as the primary pediatric teaching facility for the University of Texas Southwestern Medical Center , and we are widely recognized for delivering high quality care .
Children’s Health has also been named one of the 150 Top Places to Work in Healthcare by Becker’s Healthcare for nine consecutive years.
We invite you to learn more about Children’s Health.
Benefits
Children’s Health offers competitive pay, a comprehensive benefits program and opportunities for learning and career development. We promote a diverse and inclusive workplace, and our team members have a voice in their work through surveys and town halls.
We invite you to learn more about Children’s Health.
ABOUT THE JOB:Summary:
The Utilization Management Nurse is responsible for determining and managing medical necessity of acute inpatient admissions utilizing clinical criteria. This includes communication with the Physician's admitting patients to a Children's Health System of Texas (CHST) facility and collaboration with the Physician Advisor during the review process.
Responsibilities:
- Proactively intervenes with medical necessity, or level of care denials by exercising all real-time options to overturn decision. Actions include, but not limited to,
- Performs initial, concurrent, discharge, and retrospective reviews on assigned caseload. Reviews inpatient medical necessity criteria utilizing Indicia or Interqual, CHST clinical pathways, and clinical knowledge to determine appropriateness of admission, level of care, and continued stay.
- Advances clinical expertise through attendance at in-hours education opportunities, reading journals, and attendance at conferences.
- Maintains a level of productivity and quality consistent with: complexity of the assignment; facility policies and guidelines; established principles, ethics and standards of practice of professional nursing;
- Analyzes patient records to determine legitimacy of admission, treatment, and length of stay in health-care facility to comply with government and insurance company reimbursement policies: Analyzes insurance, governmental, and accrediting agency standards to determine criteria concerning admissions, treatment, and length of stay of patients.
- Attends department/program meetings regularly.
- Escalate payer problems to UM RN II or Denials Management Specialist
- Maintains productivity and optimum case load, delegating appropriately to maximize skills set, productivity and effectiveness.
- Maintain accurate documentation of all communication and interventions in EMR.
- Requesting expedited appeal, use of third party Physician Advisor, facilitation of peer to peer with CHST Physician.
- Combines clinical, business and regulatory knowledge and skill to reduce significant financial risk and exposure caused by concurrent and retrospective denial of payments for services provided.
- Other job duties as assigned
- Accountable for current knowledge of utilization management responsibilities, including: payer information; business rules; regulatory guidelines; and policies and procedures.
- Identifies issues and strategies to modify and/or enhance the utilization management program.
- Collaborates with Patient Access Services as it relates to inpatient authorization, predetermination, pre/prior authorization, and status changes.
- Communicates with Commercial or MMC (Medicaid Managed Care) payers to certify inpatient days as required. Utilizes various methods to obtain necessary information: telephone, fax, secure email, secure web portal. Removing completed cases from the Midas worklist.
WORK EXPERIENCE
- At least 1 year Utilization Review or Case Management experience Preferred
- Previous experience with Interqual or Milliman Preferred
- At least 4 years clinical nursing experience. For those employees hired after 4/1/2022 experience must be in the following areas: CCBD (Oncology), NICU, PICU, Heart Center (Cardiology, Pulmonary and/or Emergency Department) Required
- BSN required
- Accredited Case Manager (ACM) or Certified Case Manager (CCM) certification Preferred
- Registered Nurse Required
Children’s Health values the role each member of our team plays in helping us make life better for children. We employ more than 7,500 people and provide rewarding career opportunities that help them reach their highest potential.
We also hold Magnet recognition from the American Nurses Credentialing Center for nursing excellence, we serve as the primary pediatric teaching facility for the University of Texas Southwestern Medical Center , and we are widely recognized for delivering high quality care .
Children’s Health has also been named one of the 150 Top Places to Work in Healthcare by Becker’s Healthcare for nine consecutive years.
We invite you to learn more about Children’s Health.
Benefits
Children’s Health offers competitive pay, a comprehensive benefits program and opportunities for learning and career development. We promote a diverse and inclusive workplace, and our team members have a voice in their work through surveys and town halls.
We invite you to learn more about Children’s Health.
-
Systems Analyst - Excel, Xml, Sql, Scripting
By CyberCoders At Salt Lake City, UT, United States 8 months ago
-
(Senior) Finance & Shared Services Manager
By Catholics For Choice At Washington, DC, United States 8 months ago
-
Paralegal - Probate Administration
By CyberCoders At Miami, FL, United States 8 months ago
-
Account Executive - Automotive Software
By ECW Search At United States 8 months ago
-
Construction Project Coordinator Jobs
By CyberCoders At River Falls, WI, United States 8 months ago