RN Case Management Lead: Utilization & Care Coordination

HUMBLE VASCULAR SURGICAL CENTER INC; Addison (TX); On-site; USD 70,000 - 90,000; Full time

Job summary

HUMBLE VASCULAR SURGICAL CENTER INC is looking for an experienced Registered Nurse (RN) to manage the Case Management team with an emphasis on Utilization Review. This position requires a capable leader to oversee daily operations ensuring compliance and optimal patient outcomes.

The ideal candidate should have at least 3 years of hospital case management experience, an RN license with a BSN, and preferably a certification in Case Management. They’ll work closely with medical staff to improve care coordination.

Qualifications

• Minimum of 3 years of case management experience in a hospital setting.
• Familiar with CMS guidelines and payor medical policies.
• Experience with coding principles and chargemaster operations.

Responsibilities

• Lead and mentor the case management team.
• Oversee the utilization review process.
• Collaborate with healthcare professionals for patient-centered care.

Skills

Utilization Review

Leadership

Critical thinking

Communication

Teamwork

Education

RN license with BSN

Certification in Case Management (CCM) or Utilization Review (ACM)

Tools

EPIC

MCG Indicia

InterQual

Milliman

Job description

HUMBLE VASCULAR SURGICAL CENTER INC is looking for an experienced Registered Nurse (RN) to manage the Case Management team with an emphasis on Utilization Review. This position requires a capable leader to oversee daily operations ensuring compliance and optimal patient outcomes.

The ideal candidate should have at least 3 years of hospital case management experience, an RN license with a BSN, and preferably a certification in Case Management. They’ll work closely with medical staff to improve care coordination.