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Our patients are our number one priority! We're committed to giving children back their childhood!

Job Posting Title:

Case Manager and Utilization Review Coordinator

Location:

Dallas - Hospital

Additional Posting Details:

Monday - Friday

8:00am - 4:30pm

Job Description:

Duties/Responsibilities

+ Maintain effective communication with patient care team members related to utilization management

+ Verify medical necessity of all Inpatients using established criteria

+ Document findings and actions taken according to departmental guidelines; prepare reports and maintain records as required

+ Act as an educational resource and provide consultation to Scottish Rite for Children medical personnel regarding applicable federal, state and local regulations

+ Provide concurrent review and follow up with appropriate personnel regarding denials

+ Collect denial data for trending

+ Work with appropriate staff to develop processes to prevent denials and optimize use of Scottish resources

+ Collect, analyze, and report data for resource utilization, compliance, Performance Improvement and other areas as assigned

+ Serve on the Utilization Review Committee for the Scottish

+ Provide feedback that will enhance negotiations with payers

+ Develop and maintain positive relationships with customers internal and external to Scottish

+ Coordinate and facilitate patient care through assessment, evaluation, planning, and implementation

+ Communicating patient needs to a variety of care team members and follow up accordingly

+ Manage discharge plans upon completion of treatment

+ Work collaboratively with patients, families, physicians, and nurses to ensure high quality care

+ Act as the patient's advocate as it relates to insurance coverage and financial assistance

+ Maintain the patient's comprehensive clinical record through detailed documentation

+ Coordinate with third party payors on a regular basis

+ Assess patients' medical and psychosocial needs

+ Develop and implement individualized care plans

+ Coordinate medical services and resources

+ Monitor and evaluate patient progress

+ Communicate with healthcare providers, patients, and families

+ Facilitate transitions between care settings

+ Advocate for the patient's needs and preferences

+ Ensure compliance with healthcare regulations and standards

+ Document all case management activities accurately

+ Provide education and support to patients and their families

+ Identify and address barriers to care

+ Collaborate with insurance companies for authorization of services

Required Skills/Abilities

+ Must be a graduate of an accredited school of professional nursing

+ Hold current Texas RN license or is eligible for reciprocity and holds a temporary permit from the Texas Board of Nurse Examiners to practice professional nursing

+ Minimum 2 years of precertification experience

+ Certified Case Manager, preferred

+ 3-5 years of clinical experience, preferably in case management, or related experience

+ Proficient computer skills including experience with Microsoft Excel

+ Strong written and verbal communication skills

+ Excellent clinical assessment and analytical skills

Working Environment

+ Working conditions: Inside

+ Working Position: Sitting,

+ Physical Demands: Light

+ Physical Requirements: Repetitive Movement, Lifting/Carrying, Stooping/Kneeling/Bending

+ An Individual in this position will be required to list or carry weight in this group: Up to 11-24lbs

+ Sensory/Communicative activities essential to the performance of this position: Feeling, Hearing, Seeing, Speaking

+ An Individual in this position will be exposed to: Inside environment

At Scottish Rite for Children, we work together with the common goal of helping give children back their childhood. Scottish Rite is a unique place to work because we believe in a collaborative approach, utilizing the care and expertise from all departments. We are always looking for caring, energetic individuals to join our team. We currently have locations in Dallas and Frisco and is an equal opportunity employer.

For questions, contact [email protected].