REGISTERED NURSE CASE MANAGER AT BAYLOR SCOTT & WHITE MEDICAL CENTER - TROPHY CLUB:

• The Case Manager will be responsible for 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 job description incorporates the Standards of Practice and guiding principles from the Case Management Society of America.
• The CM performs ongoing continued stay reviews and appropriately reports reviews to insurance carriers as required for certification.
• Works with physicians and other practitioners to change admission status or level of care as needed and as allowed by law and educates medical staff on care coordination activities and needs.
• Manages the utilization of resources and reports issues and findings to the Utilization Review Committee for improvement referring outliers to peer review.
• Reviews medical records for ongoing InterQual/Milliman compliance, quality improvement, and utilization review per CMS guidelines and hospital policy.
• Performs reviews and data collection and other functions under the direction of the CQO.
• The CM begins discharge planning on admission and follows the patient through discharge making appropriate discharge post-acute care arrangements.
• All program activities will be in accordance with Joint Commission, CMS and all other applicable federal, state and local guidelines.

EDUCATION:

• Graduate of an accredited school RN, LVN, or Social Services

REQUIRED EXPERIENCE:

• Minimum 1-year experience in a hospital setting in quality management, case management and/or utilization review preferred.
• Good communication and leadership skills
• Excellent organizational skills; computer training (Excel)
• Strong knowledge base relative to surgical procedures.
• Demonstrates knowledge of Joint Commission/CMS standards including medical record documentation
• Excellent teaching skills, detail oriented, and ability to lead meetings required
• Working knowledge of InterQual/Miliman criteria

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. An inclusive culture, in our view, is respectful of differences and nurtures and supports the contributions of each individual, while also embracing and leveraging diversity. A diverse workforce, combined with an inclusive culture, makes USPI stronger and better able to meet the needs of our diverse patient and physician population.

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Required Experience:

Please refer the Job description for details