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Utilization Management Nurse Ii-Case Management-Full Time

Christus Health

Coushatta, LA
1 month ago

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This job listing is no longer available for applications. The position may have been filled or the posting period has ended.

Job Description

The Utilization Management Nurse II ensures patients receive appropriate care by performing comprehensive assessments and managing hospital resources efficiently. This role involves collaborating with healthcare teams and communicating with payors to facilitate patient care and compliance with regulations.

Key Responsibilities

  • Determine clinical appropriateness of care provided to patients
  • Perform pre-admission, concurrent, and retrospective UM related reviews
  • Utilize screening criteria (InterQual/MCG/CMS Inpatient List)
  • Communicate with clinical professionals and organize financial insurance care
  • Collaborate with healthcare team for patient care progression
  • Analyze clinical documentation to support level of care
  • Maintain knowledge of regulatory requirements for compliance

Required Qualifications

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

Preferred Qualifications

  • Certification in Case Management
  • BLS certification
  • LPN or LVN license accepted for associates with 5+ years of experience

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