Comprehensively plans for case management of a targeted patient population.
Holds joint accountability with social worker for facilitating psychosocial and continuing care.
Works with the physicians and multidisciplinary care team to facilitate efficient, quality care and achievement of desired treatment outcomes.
Communicates clinical information to payers to ensure reimbursement. Works closely with the business office.
1. Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization and/or written communication to payers to ensure certification/authorization for inpatient and post acute services.
2. Facilitates payor/physician contact when indicated for concurrent denial management processes.
3. Identifies and plans strategies to reduce length of stay and resource consumption within the care management population. Coordinates and facilitates patient progression throughout the continuum of care.
4. Refers cases and issues to the appropriate channels to elicit assistance to overcome medical management barriers. Facilitates communication with payors and external case managers and assists physicians, care providers, and patient/family in understanding payor plans and benefits.
5. Participates in discharge planning is in place following a needs assessment and determining the appropriate goals for discharge for those patients requiring case management. Works closely with Social Worker and other health care providers to initiate and facilitate referrals for home health care, hospice, other care facilities, durable medical equipment and supplies.
6. Performs utilization management and monitors appropriate resource utilization, continued stay authorization. Communicates to resolve authorization issues, identifies potential denial issues, and facilitates discharge planning as provided by the payor.
7. Demonstrates the components of the ICARE values statement (Integrity, Compassion, Accountability, Respect, Excellence).
8. Demonstrates ServicePride standards (smiles and makes eye contact; greets each patient and visitor; seeks out patient and visitor contact; displays appropriates body language at all times; takes 5 minutes each day to go above and beyond for 1 patient or visitor; honors diversity; thanks every customers).
9. Follows all safety rules while on the job. Reports all accidents promptly and correct minor safety hazards. Communicates with peers and management regarding any hazards identified in the workplace. 10. Performs other duties as assigned.
EDUCATION REQUIREMENTS Bachelor of Science (BSN) preferred; Diploma or Associate degree in nursing. Certified Professional Utilization Manager (CPUM) or Certified Professional in Utilization Review (CPUR) preferred.
EXPERIENCE REQUIREMENTS 3 years acute care clinical experience required. 1-2 years case management experience or quality or utilization management preferred.
CERTIFICATES, LICENSES AND REGISTRATIONS REQUIRED Current license to practice as an RN in the state of Texas. Certification in Case Management, Certified Professional Utilization Manager (CPUM) or Certified Professional in Utilization Review (CPUR) preferred.
1. Critical thinking, advanced communication, negotiation and collaboration skills.
2. Computer skills, Organization/time management, and prioritization skills.

Are you a non -smoker?
Do you have a minimum of three (3) years of clinical nursing experience.
Do you have Case Manager experience?
Are you willing to work in Baytown, TX. ?

2+ to 5 years experience

Relocation Assistance Available - Yes

Base Salary - $68,000 to $100,000


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