RN Case Manager: Utilization & Care Coordination

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

Benefits offered by this job

Health insurance

Dental

Vision

401(k)

Paid time off

Career development

HSAs & FSAs

EAP

Pet insurance

Job summary

Baptist Health System is seeking a Registered Nurse to coordinate patient care resources and ensure appropriate utilization of services. The role emphasizes medical necessity, payer negotiations, and adherence to Tenet standards.

Required RN licensure with 2 years of acute care experience; ACM preferred. You will complete InterQual training within 30 days of hire and demonstrate proficiency with Tenet Case Management systems.

Qualifications

• Graduate of an accredited School of Nursing.
• Bachelor's or Master's in Nursing preferred.
• Minimum 2 years acute hospital or behavioral health patient care experience with at least 1 year utilization review in an acute hospital or commercial/managed care payer setting.
• Accredited Case Management (ACM) certification preferred.
• Must complete Tenet’s InterQual education course within 30 days of hire and pass with a score of 85 or better. Must complete and demonstrate competency in using the Tenet Case Management documentation system within 30 days of hire.

Responsibilities

• Facilitate effective resource coordination to help patients achieve optimal health and appropriate utilization of resources.
• Manage medical necessity process for accurate and timely payment for services; may require payer negotiation on a case-by-case basis.
• Support utilization management services to ensure medical necessity and denial prevention.
• Coordinate with payers to authorize appropriate level of care and length of stay for medically necessary services.
• Educate payers, physicians, hospital staff and ancillary departments about covered services and administration of benefits.

Job description

Baptist Health System is seeking a Registered Nurse to coordinate patient care resources and ensure appropriate utilization of services. The role emphasizes medical necessity, payer negotiations, and adherence to Tenet standards.

Required RN licensure with 2 years of acute care experience; ACM preferred. You will complete InterQual training within 30 days of hire and demonstrate proficiency with Tenet Case Management systems.