Nurse Case Manager - Utilization Review - Nights (Fri-Sun, 7p-7a)

About the role

The Nurse Case Manager - Utilization Review position plays a crucial role in coordinating patient care and service, ensuring appropriate levels of care, and facilitating discharge planning.

Responsibilities

• Assesses patients for observation status and determines if they should be converted to inpatient status.
• Initializes level of care placement for inpatients using medical appropriateness criteria and third-party payer regulations.
• Conducts initial clinical assessments and discharge planning assessments for patients.
• Maintains ongoing communication with patients, families, representatives, and healthcare team members to manage patient care effectively.
• Collaborates with the multidisciplinary care team to ensure comprehensive discharge plans are developed and implemented.
• Generates referrals to the Case Management Physician Advisor as necessary.
• Serves as an educational resource for healthcare professionals on case management strategies.

Requirements

• Bachelor’s Degree in Nursing from an accredited college or university.
• 3-5 years of clinical experience and/or case management, utilization review, and/or discharge planning experience in an acute care setting.
• RN licensure through the Texas State Board of Nurse Examiners.

Qualifications

• Master’s Degree in Nursing from an accredited college or university preferred.
• ACM Certification preferred.