RN Case Manager performing utilization reviews and discharge planning at Methodist Hospital for Surgery. Collaborating with healthcare teams to ensure compliance with regulations and effective patient care.
Responsibilities
Responsible for performing prospective, concurrent, and post-discharge utilization reviews.
Supports accurate admission status determinations and active denial management.
Assists with discharge planning activities and contributes to performance improvement initiatives.
Conducts comprehensive medical record reviews and ensures compliance with hospital policy and regulations.
Facilitates appropriate admission status determinations based on clinical documentation and payer requirements.
Requirements
Bachelor of Science in Nursing preferred.
Active RN license in Texas; current CPR certification.
Case Management Certification(s) preferred.
At least five years of experience with Case Management, Discharge Planning, and Utilization Review.
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