Job Description
Our patients are our number one priority! We're committed to giving children back their childhood!
Job Posting Title: Case Manager and Utilization Review Coordinator
Location: Dallas - Hospital
Additional Posting Details: Monday - Friday
8:00am - 4:30pm
Job Description: Duties/Responsibilities - Maintain effective communication with patient care team members related to utilization management
- Verify medical necessity of all Inpatients using established criteria
- Document findings and actions taken according to departmental guidelines; prepare reports and maintain records as required
- Act as an educational resource and provide consultation to Scottish Rite for Children medical personnel regarding applicable federal, state and local regulations
- Provide concurrent review and follow up with appropriate personnel regarding denials
- Collect denial data for trending
- Work with appropriate staff to develop processes to prevent denials and optimize use of Scottish resources
- Collect, analyze, and report data for resource utilization, compliance, Performance Improvement and other areas as assigned
- Serve on the Utilization Review Committee for the Scottish
- Provide feedback that will enhance negotiations with payers
- Develop and maintain positive relationships with customers internal and external to Scottish
- Coordinate and facilitate patient care through assessment, evaluation, planning, and implementation
- Communicating patient needs to a variety of care team members and follow up accordingly
- Manage discharge plans upon completion of treatment
- Work collaboratively with patients, families, physicians, and nurses to ensure high quality care
- Act as the patient's advocate as it relates to insurance coverage and financial assistance
- Maintain the patient's comprehensive clinical record through detailed documentation
- Coordinate with third party payors on a regular basis
- Assess patients' medical and psychosocial needs
- Develop and implement individualized care plans
- Coordinate medical services and resources
- Monitor and evaluate patient progress
- Communicate with healthcare providers, patients, and families
- Facilitate transitions between care settings
- Advocate for the patient's needs and preferences
- Ensure compliance with healthcare regulations and standards
- Document all case management activities accurately
- Provide education and support to patients and their families
- Identify and address barriers to care
- Collaborate with insurance companies for authorization of services
Required Skills/Abilities - Must be a graduate of an accredited school of professional nursing
- Hold current Texas RN license or is eligible for reciprocity and holds a temporary permit from the Texas Board of Nurse Examiners to practice professional nursing
- Minimum 2 years of precertification experience
- Certified Case Manager, preferred
- 3-5 years of clinical experience, preferably in case management, or related experience
- Proficient computer skills including experience with Microsoft Excel
- Strong written and verbal communication skills
- Excellent clinical assessment and analytical skills
Working Environment - Working conditions: Inside
- Working Position: Sitting,
- Physical Demands: Light
- Physical Requirements: Repetitive Movement, Lifting/Carrying, Stooping/Kneeling/Bending
- An Individual in this position will be required to list or carry weight in this group: Up to 11-24lbs
- Sensory/Communicative activities essential to the performance of this position: Feeling, Hearing, Seeing, Speaking
- An Individual in this position will be exposed to: Inside environment
Scottish Rite for Children
Job Tags
Temporary work, Local area, Monday to Friday,