Hybrid RN Case Manager – Utilization Review

Posted 2 weeks ago

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About the role

  • 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.

Benefits

  • Health insurance
  • Paid time off
  • Professional development opportunities
  • 401(k) retirement plan

Job title

RN Case Manager – Utilization Review

Job type

Experience level

Mid levelSenior

Salary

Not specified

Degree requirement

Bachelor's Degree

Location requirements

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