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Utilization Management Nurse II - Case Management

Christus Health

Corpus Christi, TX
1 month ago

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Job Description

The Utilization Management Nurse II is key in ensuring proper hospital resource utilization and determining the clinical appropriateness of patient care. This role involves conducting various utilization management reviews, collaborating with healthcare teams, and communicating effectively with insurance providers to optimize patient outcomes.

Key Responsibilities

  • Determine clinical appropriateness of care provided to patients
  • Perform pre-admission, concurrent, and retrospective UM related reviews
  • Utilize approved screening criteria (InterQual/MCG/CMS Inpatient List)
  • Manage a diverse workload in a fast-paced environment
  • Communicate with clinical professionals and insurance providers
  • Collaborate with healthcare team to ensure proper patient care progression
  • Evaluate care and advocate for standards of practice

Required Qualifications

  • Graduate of an accredited School of Nursing
  • RN License in state of employment or compact required
  • Two or more years of clinical experience
  • At least one year in the acute care setting

Preferred Qualifications

  • Certification in Case Management
  • BLS preferred
  • LPN or LVN license accepted for associates with 5+ years of demonstrated success in the Utilization Management Nurse I role