Case Mgt Utilization Review RN - REMOTE

The Care Manager assumes primary responsibility for documentation of appropriate medical necessity for the inpatient status or placement in observation. Communicates with the physicians and clinicians. Assures clinical information is sent to the payor timely to complete the authorization of the patient stay. Collaborates and coordinates with other allied health professionals to ensure quality care is provided and desired outcomes are achieved in a timely and cost-effective manner.

KEY RESPONSIBILITIES:

• Utilizes a complete and systematic methodology/process to assess, plan, implement, evaluate and provide patient care coordination from pre-hospital through post-hospital care.
• Assists in the development of physician profiles to identify over/under utilization patterns.
• Supports Steward Health Care's and hospital goals and objectives. Works within regulatory compliance guidelines.
• The Care Manager works collaboratively with all healthcare disciplines to assure appropriate and timely services.
• Assesses the medical appropriateness, quality, and cost-effectiveness of proposed hospital, medical, and surgical services.
• Collaborates with the multidisciplinary team to assist patient with benefits management.
• Communicates with payers to obtain authorization.
• Identifies and plans strategies to optimize inpatient length of stay and resource utilization.

REQUIRED KNOWLEDGE and SKILLS:

• Ability to work competently with computer-based charting and other clinical and non-clinical software programs.
• Adaptability to change and good organizational skills required. Ability to read and communicate effectively in English.
• Can be expected to do presentations as directed. Working knowledge of criteria for Medicare, Medicaid, HMO, and private insurance carrier’s coverage details.
• Ability to advocate for patients. Ability to operate office equipment. Possess critical thinking skills.
• Leadership skills required for role include effective mentoring, coaching, counseling, time management, problem solving, and strategic planning.
• Demonstrates initiative and proactive approach to problem resolution.
• Ability to effectively interact with insurance companies and community healthcare recourses.
• Ability to work in a stressful, fast paced environment.
• Must master Microsoft Office Products, i.e. Excel, Word etc.
• Understand CMI, patient status, InterQual Criteria, Milliman Criteria, and Transfer DRGs.
• Has the maturity to work independently and remotely.

EDUCATION/EXPERIENCE/LICENSURE/TECHNICAL/OTHER:

1. Education: Bachelor’s degree required; Master’s degree preferred.
2. Experience (Type and Length): Three to five years of acute medical/surgical experience plus three to five years of Case Management experience.
3. Certification/Licensure: RN license required; Certification in Case Management (CCM) strongly preferred.
4. Software/Hardware: Strong knowledge in Microsoft Office applications – Word, Excel, Access, PowerPoint.
5. Other: Understanding of the health care delivery setting.

About Steward Health Care
Over a decade ago, Steward Health Care System emerged as a different kind of health care company designed to usher in a new era of wellness. One that provides our patients better, more proactive care at a sustainable cost, our providers unrivaled coordination of care, and our communities greater prosperity and stability.

As the country's largest physician-led, minority-owned, integrated health care system, our doctors can be certain that we share their interests and those of their patients. Together we are on a mission to revolutionize the way health care is delivered - creating healthier lives, thriving communities and a better world.

Based in Dallas, Steward currently operates more than 30 hospitals across Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, and Texas.

For more information, visit steward.org

Steward Health Care is proud to be a minority, physician owned organization. Diversity, equity, inclusion and belonging are at the foundation of the care we provide, the community services we support and all our employment practices. We do not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, and or expression or any other non-job-related characteristic.

Steward Health Care Culture:

Located in the dynamic community of Mesquite, TX, Steward Health Care is a beacon in the healthcare industry, offering diverse job opportunities for those dedicated to making a difference in healthcare services. As a premier healthcare provider, we are dedicated to excellence and innovation across various healthcare sectors, positioning us as a top choice for professionals seeking healthcare jobs near Mesquite, TX. Our mission is to deliver unparalleled healthcare services to our community, a commitment that is at the core of our culture and motivates our ongoing search for passionate individuals to join our team.

Steward Health Care has become a key player in the Mesquite, TX healthcare landscape, not only by providing exceptional care but also by generating extensive employment opportunities for healthcare professionals. Whether you are a seasoned Case Mgt Utilization Review RN - REMOTE or a recent graduate ready to embark on your healthcare career, Steward Health Care offers a supportive and dynamic environment where your talents are valued and your professional development is encouraged. With our broad operations in Mesquite, TX, we are continually seeking skilled individuals to fill roles in various categories, ensuring a steady demand for healthcare professionals in our community.

Steward Health Care is at the forefront of addressing the growing need for quality healthcare in Mesquite, TX, offering numerous job openings for those searching for healthcare positions in their vicinity. Our dedication to adopting the latest healthcare technologies and methodologies means our team is ever-expanding, with a keen interest in hiring professionals such as (RN) Case Managers for Assisted Living, Associate Dentists, Clinical Pharmacists, Field Training Audiologists, Occupational Therapists, Social Workers, and Staff Physical Therapists, who are eager to positively impact our patients' lives. Joining Steward Health Care places you among a group of dedicated professionals committed to delivering the best healthcare in Mesquite, TX, and beyond.

For individuals in Mesquite, TX seeking healthcare jobs near them, Steward Health Care offers a unique chance to work in a cutting-edge facility that prioritizes both the professional growth of its staff and the health of its patients. We recognize the significance of local employment opportunities in building a strong community and proudly provide a variety of positions that accommodate the diverse expertise within the healthcare field. From clinical roles like (RN) Case Managers, Associate Dentists, and Clinical Pharmacists to specialized positions such as Field Training Audiologists, Occupational Therapists, Social Workers, and Staff Physical Therapists, Steward Health Care is eager to attract and retain top talent in and around Mesquite, TX.

In conclusion, Steward Health Care is more than a leader in healthcare; we are a significant employer in the healthcare sector within Mesquite, TX. Our dedication to excellence in healthcare services is paralleled by our commitment to creating job opportunities for those seeking healthcare positions close to home. By choosing to grow your career with Steward Health Care, you're not just joining a team of exceptional healthcare professionals; you're also contributing to the well-being of the Mesquite, TX community. We invite you to explore the exciting career opportunities at Steward Health Care and take the first step toward a rewarding healthcare career, right here in Mesquite, TX.

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