Doctor's Hospital at Renaissance
Posted 1 week ago
Listing Type: Nursing
Employment Type: Nursing
Education Level: BSN Required
Certificates: Not Stated
Experience Level: All|Experienced
Job Title: (RN Only) Case Manager
Job Req # 22617
Department: 7590-RESOURCE MGMT
Location: Doctors Hospital at Renaissance
Type of Position: Full-Time
Under the general supervision of the Case Management Manager, the RN Case Manager acts as a patient advocate to hospital clients. An autonomous role that coordinates, negotiates, procures services and resources for, and manages the care of complex patients to facilitate achievement of quality and cost efficient patient outcomes. The RN Case Manager identifies opportunities to reduce cost while ensuring the highest quality of care is maintained. Review criteria is applied to determine medical necessity for admission and continued stay. The RN Case Manager provides clinically based case management, discharge planning, and care coordination to facilitate the delivery of cost-effective quality healthcare and assists in the identification of appropriate utilization of resources across the continuum of care.
The RN Case Manager works collaboratively with interdisciplinary staff internal and external to the organization, andparticipates in quality improvement and evaluation processes related to the management of patient care. The case manager is on-site and available seven days a week, as well as holidays and, therefore, is required to work a weekend rotation and an occasional holiday and will required to be on call.
• An RN license, BSN preferred or Bachelors degree in healthcare related field is required.
• Current license/valid permit to practice in the State of Texas will be required of all certified individuals.
• Certification in Case Management (CCM) is highly desired.
• Candidate must demonstrate proficiency in both the English and Spanish language.
• Knowledge in the areas of case management and utilization management,experience with Managed Care and utilization management as it relates to third-party payers preferred.
• Three to five years clinical experience is required, with experience in a Hospital or acute care setting being strongly preferred
• Experience in use of InterQual and or Milliman criteria and review processes highly desorab;e.
• Knowledge and understanding of Medicare and Medicaid guidelines and regulations pertaining to utilization review and discharge planning