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Baylor Scott & White Medical Center - Trophy Club is hiring a Registered Nurse Case Manager to join our team!
Day Shift
Welcome to Baylor Scott & White Medical Center - Trophy Club, TX , where we are dedicated to providing the pinnacle of excellence you've come to expect from Baylor – right within your own community!
Overview
Registered Nurse Case Manager responsibilities include coordinating patient care throughout the continuum of care using approved criteria to determine patients’ criteria for the ordered level of care and status on admission. This role follows the Standards of Practice and guiding principles from the Case Management Society of America.
Responsibilities
The Case Manager will coordinate patient care across the continuum of care and determine criteria for level of care and admission status.
Perform ongoing continued stay reviews and report reviews to insurance carriers as required for certification.
Collaborate with physicians and other practitioners to adjust admission status or level of care as needed and educate staff on care coordination activities.
Manage utilization of resources and report issues to the Utilization Review Committee; refer outliers to peer review.
Review medical records for InterQual/Milliman compliance, quality improvement, and utilization review per CMS guidelines and hospital policy.
Begin discharge planning on admission and follow the patient through discharge with appropriate post-acute care arrangements.
Ensure program activities align with Joint Commission, CMS and other applicable federal, state and local guidelines.
Qualifications
Education: Graduate of an accredited school (RN, LVN, or Social Services).
Licensure/Certification: Current Texas License; CCM certification preferred.
Required Experience: Minimum 1 year of hospital experience in quality management, case management, and/or utilization review preferred. Strong communication and leadership skills; excellent organizational skills; computer skills (Excel). Knowledge of Joint Commission/CMS standards and medical record documentation. Ability to lead meetings and instruct staff. Working knowledge of InterQual/Milliman criteria.
What We Offer
Medical, dental, vision, and prescription coverage
Life and AD&D coverage
Short- and long-term disability
Flexible financial benefits including FSAs and HSAs
401(k) and retirement planning
Paid holidays and vacation
Who We Are
At USPI, we create relationships that create better care. We partner with physicians and healthcare systems to provide first-class ambulatory solutions throughout the United States. We are committed to providing surgical services in the most efficient and clinically excellent manner. USPI is committed to and proud of our inclusive culture. A diverse workforce, combined with an inclusive culture, strengthens us to meet the needs of our diverse patient and physician population.