staff - Registered Nurse (RN) - Manager, Utilization Review - $46 per hour

Cook Children’s Health Care System is seeking a Registered Nurse (RN) Manager, Utilization Review for a nursing job in Remote, Texas.

Job Description & Requirements

• Specialty: Utilization Review
• Discipline: RN
• Start Date: ASAP
• Duration: Ongoing
• 40 hours per week
• Shift: 8 hours
• Employment Type: Staff

Location:

Remote - TX

Department:

Utilization

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

Additional Information:

The RN Reviewer/Utilization Management will coordinate the efficient utilization of health care resources for Cook Children's Health Plan (CCHP) members. This role will mainly coordinate members needing Behavioral Health and outpatient procedures but must be willing to cross-train in different areas. The RN will work closely with the Department Manager and Team Lead to assure the timely provision of quality care throughout the continuum of care. The RN Reviewer facilitates clinically appropriate and fiscally responsible care through communication with the providers and health plan medical directors. Will assess and identify the members clinical information and determine, in conjunction with the Medical Director, medical necessity and appropriateness of requested services. Utilizes Medical Management Committee (MMC) approved clinical criteria to authorize requested services for the member. The UM/ECM - RN Reviewer communicates with providers of care/services to facilitate appropriate care transitions. The UM/ECM - RN Reviewer assures adherence to regulatory/contractually required timeliness standards for authorization request processing, associated communications and notice of adverse determinations are met for CCHP.

Education/Experience:

• Associate degree of Nursing required, BSN preferred.
• RN with a minimum of five (5) years clinical experience.
• 2 years utilization management or case management experience required.
• Critical Care and discharge planning experience preferred.
• Experience with Behavioral Health preferred.

Skills Required:

• Strong organizational and time-management skills, with the ability to effectively prioritize multiple tasks and work efficiently across a variety of electronic platforms and systems.
• Demonstrates exceptional oral and written communication, applies strong critical-thinking and problem-solving skills, and delivers responsive, customer-focused service while effectively managing diverse needs and priorities.
• Ability to work in fast-paced environment and meet deadlines.

Certification/Licensure:

• Current unrestricted RN licensure in the State of Texas.

About Us:

Cook Children’s is an equal opportunity employer. As such, Cook Children’s offers equal employment opportunities without regard to race, color, religion, sex, age, national origin, physical or mental disability, pregnancy, protected veteran status, genetic information, or any other protected class in accordance with applicable federal laws. These opportunities include terms, conditions and privileges of employment, including but not limited to hiring, job placement, training, compensation, discipline, advancement and termination.

Cook Children’s is a Texas-only employer. If you are hired, you will need to maintain your primary residence within the state of Texas, along with all licenses and credentials required for your position throughout your employment.

The RN Reviewer/Utilization Management will coordinate the efficient utilization of health care resources for Cook Children's Health Plan (CCHP) members. This role will mainly coordinate members needing Behavioral Health and outpatient procedures but must be willing to cross-train in different areas. The RN will work closely with the Department Manager and Team Lead to assure the timely provision of quality care throughout the continuum of care. The RN Reviewer facilitates clinically appropriate and fiscally responsible care through communication with the providers and health plan medical directors. Will assess and identify the members clinical information and determine, in conjunction with the Medical Director, medical necessity and appropriateness of requested services. Utilizes Medical Management Committee (MMC) approved clinical criteria to authorize requested services for the member. The UM/ECM - RN Reviewer communicates with providers of care/services to facilitate appropriate care transitions. The UM/ECM - RN Reviewer assures adherence to regulatory/contractually required timeliness standards for authorization request processing, associated communications and notice of adverse determinations are met for CCHP.

Education/Experience:

• Associate degree of Nursing required, BSN preferred.
• RN with a minimum of five (5) years clinical experience.
• 2 years utilization management or case management experience required.
• Critical Care and discharge planning experience preferred.
• Experience with Behavioral Health preferred.

Skills Required:

• Strong organizational and time-management skills, with the ability to effectively prioritize multiple tasks and work efficiently across a variety of electronic platforms and systems.
• Demonstrates exceptional oral and written communication, applies strong critical-thinking and problem-solving skills, and delivers responsive, customer-focused service while effectively managing diverse needs and priorities.
• Ability to work in fast-paced environment and meet deadlines.

Certification/Licensure:

• Current unrestricted RN licensure in the State of Texas.

Cook Children’s Health Care System Job ID #JR-119131. Posted job title: RN Reviewer, Health Plan/Utilization Mgmt.

About Cook Children’s Health Care System

About Cook Children's

When you work here, you grow here.

Promise is a strong word with deep meaning that everyone understands-especially kids. This is what drives us to blaze new trails with innovative technology, research, exceptional medical care and competitive programs that benefit children who don’t otherwise have access to quality health care. Cook Children's employees come to work every day to keep that Promise, connecting the dots between caregivers, families and communities.

Surpassing 105 years, with more than 10,000 employees, we are here for every child, every day. Our not-for-profit organization includes two medical centers, a large physician network, a home health company, three surgery centers, a health plan, health services and a health foundation. We are proud to be Forbes' #1 Best Large U.S. Employer in Health Care with nearly 100 clinical locations throughout Texas, where we invite you to call home.

Apply now and be part of this magic.

Benefits

• Holiday Pay
• Continuing Education
• 403b retirement plan
• Pet insurance
• Sick pay
• Wellness and fitness programs
• Mileage reimbursement
• Medical benefits
• Dental benefits
• Vision benefits
• Life insurance
• Discount program
• Employee assistance programs