Top 15 Utilization management nurse Jobs in Mcallen, Tx

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utilization management nurse jobs near mcallen, tx

RN Case Manager

Mission Regional Medical Center -
Mission, TX

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Job Details

Full-time

Benefits

Health insurance

Qualifications

Computer operation
RN License
BLS Certification
Computer skills

Full Job Description

Overview:

We are seeking an RN Case Manager, also referred to as a Registered Nurse Case Manager or RN Clinical Case Manager. An RN Case Manager will oversee and coordinate patient care from admission through discharge to ensure quality, cost-effective outcomes. They assess patients’ needs, develop care plans, and collaborate with physicians, nurses, social workers, and other providers to manage care transitions. RN Case Managers also conduct discharge planning, utilization review, and helping patients navigate insurance and healthcare systems.

Shift’s Available: Days

Employment Type: Full Time

Hours: 8 hour

Location: Mission Regional Medical Center - Mission, TX

Responsibilities:

Essential Duties and Responsibilities (includes, but not limited to):

Patient Assessment: evaluate patients’ medical, psychosocial, and discharge needs upon admission and throughout their stay
Care Coordination: develop and implement individualized care plans in collaboration with the healthcare team to ensure effective treatment and timely interventions
Discharge Planning: coordinate safe and appropriate discharge plans, including referrals to rehab, home health, or long-term care facilities
Utilization Review: monitor the use of hospital resources and services to ensure appropriate care and avoid unnecessary treatments or extended stays
Patient and Family Education: help patients and families understand care plans, post-discharge instructions, and available resources
Advocacy: advocate for patient needs and preferences, ensuring care is aligned with their goals and values

Qualifications:

Before we go any further, we do have some deal-breakers. You must have:

Starting April 1 2015. Minimum 5 years work experience post-graduation of an accredited school of nursing and a current state Registered Nurse license.
Grandfathered prior to April 1, 2015. Minimum 5 years post graduate of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.
Five years acute care nursing experience preferred. At least one year experience in case management, discharge planning or nursing management, preferred.
Current BCLS (AHA) certificate upon hire and maintain current;.
Knowledge of Milliman Criteria and InterQual Criteria preferred.
Experience and knowledge in basic to intermediate computer skills.
Behavioral Violence Prevention Training within 3 months of hires and maintain current.

#LI-AG1

Employment Status: Full Time Shift: Days Equal Employment Opportunity:

Company is an equal employment opportunity employer. Company prohibits discrimination against any applicant or employee based on race, color, sex, sexual orientation, gender identity, religion, national origin, age (subject to applicable law), disability, military status, genetic information or any other basis protected by applicable federal, state, or local laws. The Company also prohibits harassment of applicants or employees based on any of these protected categories. Know Your Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC_KnowYourRights_screen_reader_10_20.pdf

Full benefits at Prime Healthcare: https://www.primehealthcare.com/careers/benefits/

#LI-OZ1

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utilization management nurse jobs in mcallen, tx

RN Case Manager

RN Transitional Care Navigator - FT - Days - Transitional Care Management

Case Manager RN

LVN Case Manager- FT - Days - Res Mgmt

RN Case Manager -FT - Days - Res Mgmt

RN Case Manager - FT - Days - Res Mgmt

RN Transfer Coordinator - PRN - Days - Patient Intake Center

RN Transfer - PRN - Varies - Patient Intake Care

Appeal Analyst RN | Remote | Contract

Physician Assistant/Nurse Practitioner (D), CVOR - Regional

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