Case-Management LVN: Care Coordination & Utilization Review

Tenet Healthcare; San Antonio (TX); On-site; USD 85,000 - 105,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

401(k) with employer match

Generous paid time off

Career development opportunities

Health savings accounts

Job summary

Baptist Health System Hospital, part of Tenet Healthcare, is seeking a skilled case management professional to coordinate utilization management and ensure medically necessary care within policy. The role emphasizes collaboration with payers, physicians, and hospital staff to optimize patient care and resource use.

The position involves medical necessity screening, payer authorizations, documentation, and continuous quality improvements, with potential sign-on bonus in this dynamic healthcare

Qualifications

• Graduate of an accredited School of Nursing.
• Active LVN/LPN license for state(s) covered.
• Minimum 2 years acute hospital or behavioral health patient care experience.
• 1 year utilization review in an acute hospital or commercial/managed care payer setting.
• ACM certification is preferred.

Responsibilities

• Accurate medical necessity screening and submission for Physician Advisor review.
• Secure and document authorization for services from payers.
• Manage concurrent disputes and coordinate with payers, physicians, office staff and ancillary departments.
• Ensure timely, complete and concise documentation in the Tenet Case Management system.
• Maintain accurate patient demographic and insurance information; identify potentially avoidable days and reporting of utilization patterns.

Education

Graduate of an accredited School of Nursing

Associates in Nursing

Job description

Baptist Health System Hospital, part of Tenet Healthcare, is seeking a skilled case management professional to coordinate utilization management and ensure medically necessary care within policy. The role emphasizes collaboration with payers, physicians, and hospital staff to optimize patient care and resource use.

The position involves medical necessity screening, payer authorizations, documentation, and continuous quality improvements, with potential sign-on bonus in this dynamic healthcare