RN

STAR Kids Utilization   Corpus Christi, TX   Part-time
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STAR Kids Utilization Review RN
Corpus Christi

This is a Full Time -
Temporary position located in Corpus Christi, TX
The Utilization Review RN is responsible for the coordination and efficient utilization of health care resources for the provision of quality care for all patients throughout the Continuum of Care. The Utilization Review RN assesses and identifies the patient's clinical findings and determines, in conjunction with the Physician Advisor/Health Plan Administration, established benefits, protocols, pathways, and evidence based medicine tools the health care services and level of care appropriate for the patient. Management is prospective through the outpatient and admission process, concurrent during hospitalization and retrospective through review of individual cases and identification of trends and patterns. The Utilization Review RN communicates with providers of care/services to ensure appropriate levels of care.
Education and/or Experience:
Bachelor of Science in Nursing (BSN) degree from four-year college or university or equivalent combination of education and experience in managed care, STAR+Plus, children with special health care needs, or Long Term Supports and Services (LTSS) for individual enrolled in various waiver programs through the Department of Aging and Disability Services (DADS) preferred.
Certified Case Manager (CCM) certification preferred.
Minimum of 3 years of clinical experience as a Registered Nurse with one year of acute inpatient case management or managed care case/utilization management experience preferred.
Must have an in depth knowledge of the State of Texas' managed care and managed Medicaid process preferred.
Previous experience with the State of Texas STAR+PLUS program or similar programs dealing with SSI and disabled children preferred.
Knowledge of Medicare preferred.
MNLOC/RUG certification preferred
Licenses, Certifications, Registrations:
Current, active, and unrestricted RN, NP, or PA licensure in the State of Texas
Certified Case Manager (CCM) designation preferred
Must have a Registered Nursing Licensure in the State of Texas.
Certification in Case Management or Managed Care preferred or must be obtained within two years of employment.
Current Texas driver's license and insurance maintained throughout the term of employment
Visit
www.driscollchildrens.org/employment
361-694-5682
Contact: Heather Rodriguez
361-694-4766
Heather.Rodriguez@dchstx.org

EOE
This job is no longer available.

STAR Kids Utilization

Corpus Christi, TX