Job Summary:

Each day is a fresh opportunity to impact the lives of our patients, families, co-workers, and communities. We promote excellence, optimism, respect, and professional growth. If you are looking for a rewarding and positive workplace, look no further than in your own community!

To be successful in this role, you will be responsible for using sound professional judgment and best practices to ensure quality case management services are provided to the service population especially in crisis situations while maintaining compliance with established state and federal standards.

Responsibilities:

• Coordination of clinical care (medical necessity, appropriateness of care and resource utilization for admission, continued stay, discharge and post- acute care) compared to evidence-based practice, internal and external requirements. (40% daily, essential).
• Identify and report variances in appropriateness of medical care provided, over/under utilization of resources compared to evidence-based practice and external requirements. This priority includes work with relevant software and communicating information through clear, complete and concise documentation in eCCM (40% daily, essential).
• Effective collaboration with physicians, nurses, ancillary staff, payors, patients and families to achieve optimum clinical outcomes (10% daily, essential).
• Remain current with relevant clinical/case management practices. (10% daily, essential).
• InterQual reviews , Observation hours, Excess Days/ALOS, Clinical disputes - incidence and dollars, Number and type of avoidable days, Resource Utilization, at least 5 hours of CEUs per year on topics related to Case Management.

Job Requirements

Education:

• BSN preferred
• Current Professional Nurse License issued and/or recognized by Board of Nurse Examiners for the State of Texas
• BLS from American Heart Association.

Experience:

• At least 1-2 years of acute care experience required
• Utilization Management supporting medical necessity, denial prevention and knowledge of Interqual criteria preferred
• Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
• Care Coordination by demonstrating efficient throughput while assuring care is sequenced and at appropriate level of care