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CLINICAL NURSE/UTILIZATION MANAGEMENT

Nursing | San Antonio, TX | Full Time

Job Description

CLINICAL NURSE/UTILIZATION MANAGEMENT

SAN ANTONIO, TEXAS

An established and successful Texas based Workforce Solutions Company is accepting applications for a full time CLINICAL NURSE/UTILIZATION MANAGER to service our military and their families in San Antonio, Texas.   The opportunity allows for a great work/life balance with a 40/hour work week.  Also, a great opportunity to gain valuable work experience while earning a great salary.

QUALIFICATIONS

  • Knowledge of medical privacy and confidentiality (HIPAA)

  • Knowledge of computer applications/software to include Microsoft Office programs, MS Outlook (email) and internet familiarity

  • Knowledge of Ambulatory Procedure Grouping (APGs), Diagnostic Related Grouping (DRGs), International Classification of Diseases-Current Version (ICD), and Current Procedural Terminology-Current Version (CPT) coding; and McKesson (InterQual) and/or Milliman Care Guidelines

  • Experience in Patient Advocacy, Patient Privacy, and Customer Relations

  • 36 months of nursing experience in a direct patient care clinical setting

  • 24 consecutive months of Utilization Management OR Utilization Review OR Case Management experience

  • Certified/Certification Eligible in relevant specialty

  • ALL additional qualifications outlined in Position Description provided to applicants for their review

JOB FUNCTIONS (INCLUDE BUT ARE NOT LIMITED TO)

  • Develops and implements a comprehensive UM plan/program in accordance with the facilities goals and strategic objectives

  • Performs data/metrics collection on identified program areas; analyzes and trends results

  • Analyzes medical referrals/appointments and general hospital procedures

  • Performs medical necessity review for planned in-patient and out-patient surgery

  • ALL additional job functions as outlined in the Position Description provided to all applicants for their review