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Utilization Management Coordinator

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San Antonio, TX, United States

Description

SHIFT: No Weekends

SCHEDULE: Full-time

Methodist Specialty and Transplant Hospital

Registered Nurse (RN)

Utilization Management Coordinator - FT - Days


Methodist Specialty and Transplant Hospital is licensed for 382 beds and has been nationally recognized by Leapfrog’s Hospital Safety Grade A. It receives international acclaim for its outstanding and dynamic kidney, liver and pancreas transplant programs, setting record numbers for volume and outcomes. Methodist Specialty and Transplant Hospital is home to the Texas Transplant Institute, a nationally recognized center that recently performed the world’s first 16-way kidney donor exchange chain during three consecutive days at a single hospital.


Methodist Specialty and Transplant Hospital earned designation as a Center of Metabolic and Bariatric Surgery Excellence from the American Society for Bariatric Surgery in 2008. Our Sexual Assault Response Team provides a compassionate environment for sexual assault survivors ages 13 and up. This program serves as a model for hospitals and agencies all over the world. For more information, please visit our website at www.sahealth.com and select Methodist Specialty and Transplant Hospital under Locations.

 
We offer you a generous benefits package including:
  • Medical, Dental, disability and life insurance
  • Flexible Spending Accounts
  • Paid Time Off
  • Employee Discount Program
  • 401K
  • Employee Stock Purchase Program
  • Tuition Reimbursement
  • Student Loan Repayment Program

Your Role: Registered Nurse (RN) - Utilization Management Coordinator

 

The Utilization Management Coordinator coordinates and monitors the daily utilization management function of the Psychiatric Unit, ensuring the appropriate allocation of hospital resources while maintaining quality of patient care. The Utilization Management Coordinator collaborates with other members of the behavioral health and multidisciplinary team to advocate for patients and families within the health care continuum. The Utilization Management Coordinator ensures regulatory compliance with CMS guidelines and coordinates utilization management processes from numerous payer sources. The Utilization Management Coordinator assists in managing length of stay and insuring documentation of medical

necessity for admission and continued stay.

  • Assesses charts to review discharge needs of all high-risk patients (and others referred).
  • Works collaboratively with the interdisciplinary health care team to identify patients’ treatment goals and progress toward achieving desired outcomes.
  • Performs admission and continued stay reviews. Provides clinical information to payers upon request for certification and reimbursement of care. Discusses alternate level of care with physician. Refers cases not meeting acute care criteria to Physician Advisor as needed.
  • Facilitates and or provides education of hospital staff, and physicians for purposes of efficient resource utilization
  • Keeps current of requirements by JCAHO, HCFA and other state/federal agencies on provision of care, planning and documenting.
  • Tracks resource statistics to identify improvement opportunities. Attends medical staff and other hospital committee meetings to report findings. 


Qualifications

Education: 
  • Graduate of an accredited diploma, associates, or baccalaureate degree nursing program.
Experience: 
  • Minimum of 2 years clinical experience in area in which Utilization Management will be performed.
  • Prefer at least one year experience in utilization review, resource management, discharge planning or case management.

Employee completes initial and ongoing training and competencies as defined by service line, facility and department/unit which are specific to the needs of the patient population served (if applicable).

 
License and Certification:
  • Required: Current Texas licensure as a Registered Nurse
  • Preferred: Bachelor of Science in Nursing

Notice

Our Company’s recruiters are here to help unlock the next possibility within your career and we take your candidate experience very seriously. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Gmail or Yahoo Mail. If you feel suspicious of a job posting or job-related email, let us know by clicking here.

For questions about your job application or this site please contact HCAhrAnswers at 1-844-422-5627 option 1.

Apply Now

Facility: Methodist Specialty & Transplant Hospital
Job ID: 01588-96589
Category: Nursing - Professional
Contract: Full-time
Shift: No Weekends
Job Class: Regular

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