The RN Case Manager - Utilization Review effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers to obtain approved certification days. They critically think for appropriateness of care provided the patients within the scope of care of the healthcare center, effectively multitasks the work day, accurately inputs computer info, and successfully accomplishes difficult tasks as assigned
Graduate of an Registered Nursing Program, Bachelor Degree preferred
Proficient word processing skills in a Windows environment required.
Ability to analyze and create reports and presentations via software applications
Familiarity with MIDAS and Meditech systems preferred.
Bilingual (English/Spanish) preferred.
A minimum of 3 years in acute clinical practice as an RN.
Case management/Resource Management and discharge planning experience preferred
Milliman (MCG) Guideline and Interqual criteria experience highly preferred.
Negotiating skills which support the ability to interact with physicians, nursing staff, administrative staff, discharge planners, and payers.
Excellent verbal and written communication skills, Knowledge of clinical protocol, normative data and health benefit plans, particularly coverage and limitation clauses.
Ability to manage several projects and cases simultaneously
Basic computer knowledge
Ability to communicate effectively, both verbally and in writing
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.