LVN Case Manager: Utilization & Payer Coordination

Baptist Health System; San Antonio (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

Baptist Health System in San Antonio, TX is seeking a Registered Nurse with case management experience to coordinate patient care across the continuum, ensuring appropriate utilization and medical necessity. You will work with payers, physicians, and hospital staff to secure timely authorizations and optimize patient outcomes.

The role emphasizes collaboration, comprehensive documentation in the Tenet Case Management system, and adherence to regulatory standards, with a potential sign-on bonus

Qualifications

• Graduate of an accredited School of Nursing.
• Associates in Nursing preferred.
• Active LVN/LPN license for state(s) covered is required.

Responsibilities

• accurate medical necessity screening and submission for Physician Advisor review
• securing and documenting authorization for services from payers
• managing concurrent disputes
• collaborating with payers, physicians, office staff and ancillary departments
• timely, complete and concise documentation in the Tenet Case Management documentation system
• maintenance of accurate patient demographic and insurance information
• identification and documentation of potentially avoidable days
• identification and reporting over and underutilization
• other duties as assigned

Education

Graduate of an accredited School of Nursing

Associates in Nursing

Job description

Baptist Health System in San Antonio, TX is seeking a Registered Nurse with case management experience to coordinate patient care across the continuum, ensuring appropriate utilization and medical necessity. You will work with payers, physicians, and hospital staff to secure timely authorizations and optimize patient outcomes.

The role emphasizes collaboration, comprehensive documentation in the Tenet Case Management system, and adherence to regulatory standards, with a potential sign-on bonus