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Minimum of 5 years acute hospital experience with a minimum of 3 years of utilization review, discharge planning, or case management preferred (Will consider ER and ICU experience). These goals are achieved through facilitation of interdisciplinary team collaboration, and acting as a liaison between the patient, physician, and payor in regards to care coordination.
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The Utilization Management Nurse is responsible for determining and managing medical necessity of acute inpatient admissions utilizing clinical criteria. We are committed to delivering culturally effective care, creating meaningful partnerships in the communities we serve, and equipping and developing our team members to make Childrens Health a place where everyone can contribute.
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Summary: The Utilization Management Nurse is responsible for determining and managing medical necessity of acute inpatient admissions utilizing clinical criteria. Maintain accurate documentation of all communication and interventions in EMR. Escalate payer problems to UM RN II or Denials Management Specialist Proactively intervenes with medical necessity, or level of care denials by exercising all real-time options to overturn decision.
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The Case Manager will be the leader in navigating the patient through the care coordination process. This process requires the case manager to have direct contact with the patient, their family, the patient’s physicians, and the appropriate multidisciplinary health team members to ensure care coordination.
Full-timeExpandApply NowActive JobUpdated 14 days ago - UpvoteDownvoteShare Job
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Methodist Charlton Medical Center is a 314-bed, full-service, acute care teaching hospital that serves Cedar Hill, DeSoto, Duncanville, and Lancaster in southwestern Dallas County. The Care Transitions Navigator will coordinate activities that promote quality outcomes, patient throughput, and discharge planning while supporting a balance of optimal care and appropriate resource utilization.
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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.
Full-timeExpandApply NowActive JobUpdated 23 days ago - UpvoteDownvoteShare Job
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1+ years of Telemetry experience in a acute care with inpatient in a hospital setting. Facilitation of Learning: Facilitates learning for patients and families, nursing staff, other members of the health care team and community; integrating appropriate education throughout the continuum of care to help them participate and/or make informed conclusions about their health care and treatments, including health promotion and disease prevention.
TemporaryExpandApply NowActive JobUpdated 23 days ago - UpvoteDownvoteShare Job
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As a critical member of the Trauma & Emergency Medicine sales team, the focus of the Regional Sales Manager (RSM) (Dallas or Houston) is on the acute care hospital market ensuring the sales of our life-saving Arrow® EZ-IO® Intraosseous Vascular Access System and Z-Medica hemostatic products (QuikClot®, QuickClot Control+®) medical devices and that they meet Teleflex and client/customer needs with a high standard of excellence, urgency, and predictability.
$250,000 a yearExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Solid clinician skills with in-depth knowledge of all aspects of care coordination, long-term care, acute care, and pharmacy services. Facilitates integration of care coordination, long-term care, acute and pharmacy services.
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Knowledge of utilization management principles and healthcare managed care. 2+ years of clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience in a managed care setting.
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Minimum one (1) year of case management and/ or utilization review in acute care or insurance related role. Prior experience with clinical review, case management, utilization review.
Full-timeExpandApply NowActive JobUpdated 29 days ago - UpvoteDownvoteShare Job
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Communicates with Commercial or MMC (Medicaid Managed Care) payers to certify inpatient days as required. Children's Health (Dallas) is seeking a Registered Nurse (RN) Utilization Review for a nursing job in Dallas, Texas.
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Facilitate bi-directional communication to enhance the handover of care from one setting and arrange/ensure all elements of the transition plan are implemented and communicated to key stakeholders including, not limited to, the health care team, patient/family/caregiver, payers, and post-acute providers.
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