RN Lead: Utilization & Care Coordination

University Health Careers; Hondo (TX); On-site; USD 70,000 - 95,000; Full time

Job summary

University Health Careers is seeking a Registered Nurse to support Community First Health Plan members, ensuring access to needed services efficiently, and coordinating care across the continuum. The role emphasizes collaboration with primary care physicians, family, resources, and other health care team members.

The ideal candidate holds an RN license in Texas, BSN or higher preferred, and at least 3 years in acute care, quality management, or managed care.

Qualifications

• Registered Nurse (RN) required.
• BSN or Master’s degree preferred.
• Minimum 3 years nursing, acute care, quality management or managed care experience required.

Responsibilities

• Oversee allocation of resources, cost and quality of health care for members.
• Coordinate care between the primary care physician, community resources, family and member; coordinate care across the health care continuum while monitoring and managing benefit utilization.

Skills

Nursing

Care coordination

Medicaid/Medicare knowledge

Education

BSN preferred

Master’s degree preferred

Tools

InterQual

Job description

University Health Careers is seeking a Registered Nurse to support Community First Health Plan members, ensuring access to needed services efficiently, and coordinating care across the continuum. The role emphasizes collaboration with primary care physicians, family, resources, and other health care team members.

The ideal candidate holds an RN license in Texas, BSN or higher preferred, and at least 3 years in acute care, quality management, or managed care.