Registered Nurse (RN) - Med Surg - $46 per hour

Cook Children’s Health Care System is seeking a Registered Nurse (RN) Med Surg for a nursing job in Fort Worth, Texas.

Job Description & Requirements

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

Location:

Calmont Operations Building

Department:

Utilization

Shift:

First Shift (United States of America)

Standard Weekly Hours:

40

Summary:

Responsible for the coordination and efficient utilization of health care resources for Cook Childrens Health Plan (CCHP) members. Works with the Department Manager and Team Lead to assure the timely provision of quality care throughout the continuum of care. The Registered Nurse Utilization Management/Episodic Case Manager (UM/ECM - RN) Reviewer facilitates clinically appropriate and fiscally responsible care through communication with the providers and health plan medical directors. The UM/ECM - RN Reviewer assesses and identifies the members clinical information and determines, 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.

Additional Information:

Responsible for the coordination and efficient utilization of health care resources for Cook Childrens Health Plan (CCHP) members. Works with the Department Manager and Team Lead to assure the timely provision of quality care throughout the continuum of care. The Registered Nurse Utilization Management/Episodic Case Manager (UM/ECM - RN) Reviewer facilitates clinically appropriate and fiscally responsible care through communication with the providers and health plan medical directors. The UM/ECM - RN Reviewer assesses and identifies the members clinical information and determines, 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/Education:

• Associate degree of Nursing required, BSN preferred.

• Minimum of five (5) years clinical experience.

• 2 years utilization management or case management experience required.

Strong skills in the following areas : Oral and written communication; Critical thinking; Organization and time management; Customer service.

Certification/Licensure:

• Current unrestricted Registered Nurse licensure in the State of Texas.

About Us:

Cook Children's Health Plan

Cook Children's Health Plan provides vital coverage to nearly 120,000 people in low-income families who qualify for government-sponsored programs in our six county service region. Cook Children's Health Plan provides health coverage for CHIP, CHIP Perinatal, STAR (Medicaid) and STAR Kids Members in the Tarrant county service area. The counties we serve includes Tarrant, Johnson, Denton, Parker, Hood and Wise.

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.

Responsible for the coordination and efficient utilization of health care resources for Cook Childrens Health Plan (CCHP) members. Works with the Department Manager and Team Lead to assure the timely provision of quality care throughout the continuum of care. The Registered Nurse Utilization Management/Episodic Case Manager (UM/ECM - RN) Reviewer facilitates clinically appropriate and fiscally responsible care through communication with the providers and health plan medical directors. The UM/ECM - RN Reviewer assesses and identifies the members clinical information and determines, 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/Education:

• Associate degree of Nursing required, BSN preferred.

• Minimum of five (5) years clinical experience.

• 2 years utilization management or case management experience required.

Strong skills in the following areas : Oral and written communication; Critical thinking; Organization and time management; Customer service.

Certification/Licensure:

• Current unrestricted Registered Nurse licensure in the State of Texas.

Cook Childrens Health Care System Job ID #31bb81a9bc121000ca1e4f1f3fbf0001. Posted job title: UM/ECM - RN Reviewer HP

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.

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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