- Houston, TX
What you'll be doing
- Assesses the total picture of every patient through patient/family, physical assessment as indicated, and review of the medical record including H&P, lab and other test results/findings, plans of care, physician orders, nursing and progress notes to identify needs and develop a plan. Applies approved utilization criteria to monitor appropriateness of admissions, level of care, resource utilization and continued stay; documents findings based on standards on UR Worksheet. Works collaboratively and maintains active communication with physicians, nursing and other members of the multidisciplinary care team to effect timely patient management, addresses and resolves process problems impeding diagnostic or treatment progress. Proactively identifies and resolves delays and obstacles to discharge. Identifies barriers affecting timely patient management and documents avoidable days. Facilitate communication with payers and external case managers by documenting days certified proactively and concurrently resolving any denied days or delays. Assist physicians, care providers, and patient/family in understanding payer plans / benefits and working within patient`s payer plans in order to maximize patients benefits and minimize out of pocket expense for patients.
What your background should be
- 3-5 years clinical experience in direct patient care setting. Prefer 2-5 years case management experience. Registered nurse (RN) with current Texas license.
Required Schooling / Training
- Bachelor degree in nursing required
Who is the client company
- Concern about hospital & healthcare services.
- If you are interested in this position, send your resume to email@example.com