Job Description

Join Our Team as a Utilization Management Nurse II!

Summary:

Are you ready to make a meaningful impact in patient care? As a Utilization Management Nurse II , you will play a crucial role in ensuring that patients receive the right care at the right time. Your expertise will help us optimize hospital resources while maintaining the highest standards of clinical appropriateness.

In this dynamic position, you will:

• Conduct pre-admission, concurrent, and retrospective reviews to assess the necessity of care.
• Utilize approved screening criteria (InterQual/MCG/CMS Inpatient List) to guide your decisions.
• Stay updated on regulations and guidelines from commercial and government payors.
• Communicate effectively with clinical professionals and insurance providers to ensure seamless patient care.

Your Responsibilities Include:

• Exceeding the expectations of OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Performing comprehensive assessments of clinical information and treatment plans.
• Assessing medical necessity and appropriateness of care settings using MCG/InterQual guidelines.
• Collaborating with interdisciplinary teams to make informed decisions about patient status.
• Maintaining compliance with regulatory requirements and advocating for best practices.
• Proactively identifying and resolving issues related to clinical appropriateness and payor denials.
• Documenting all findings in accordance with regulatory and departmental guidelines.
• Participating in multidisciplinary rounds and contributing to patient care progression.

What We’re Looking For:

Education & Skills:

• Graduate of an accredited School of Nursing or equivalent experience in the Utilization Management Nurse I role for at least five years.

Experience:

• Two or more years of clinical experience, with at least one year in an acute care setting.

Licenses & Certifications:

• Active RN License in the state of employment or compact required.
• LPN or LVN license accepted for associates with 5+ years of experience in the Utilization Management Nurse I role.
• Certification in Case Management and BLS preferred.

Working Conditions:

This is a Full-Time position that requires flexibility and adaptability in a fast-paced environment. You may be asked to work overtime or travel to other facilities as needed.

Why Join Us?

At CHRISTUS, we believe in fostering a supportive and collaborative work environment. Here’s what you can expect:

• Opportunities for professional growth and development.
• A chance to make a real difference in the lives of patients.
• A culture that values teamwork, innovation, and excellence.

If you’re passionate about patient care and ready to take your career to the next level, we want to hear from you!

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