Care Manager/ UR Nurse

Department: Case Management
Shift: Days M-F
Openings: 1

Under the general supervision of the Director of Case Management, the care management/utilization review nurse facilitates continuity of care and discharge for the specific population of assigned unit(s), identifies barriers to discharge and analyzes the use of resources. The care management/utilization review nurse applies clinical expertise, medical appropriateness criteria and ICD-9-CM coding skills in completion of concurrent medical record review and coordinates referrals with social services, hospice and outside agencies. He/she is an active member of multidisciplinary/interdisciplinary team and as such assists in the development, implementation and documentation of actions/interventions taken and patient's progress toward discharge. Educates and serves as a resource/consultant to providers, medical staff and hospital staff regarding issues of reimbursement, prior authorization, discharge planning and other documentation requirements. Communicates care issues to the utilization management team, tracks and records barriers to discharge and variances affecting quality and continuity of care and follows through on recommendations as indicated.

LICENSURE/CERTIFICATION:
DESIRED: Current license to practice nursing in the State of Texas
PREFERRED: CCM, CPUR, CPHQ designation or other related specialty certification

EXPERIENCE:
REQUIRED: Minimum of five (5) years of clinical experience in the acute care setting

PREFERRED: One year of ICD-9-CM/CPT Coding
Two years experience in discharge planning, care management, utilization review, or quality assurance