RN Utilization & Care Coordination Specialist

University Health; Hondo (TX); On-site; USD 65,000 - 90,000; Full time

Job summary

University Health seeks a Registered Nurse to support Community First Health Plan members in regaining optimum health. You will oversee resource allocation, ensure access to necessary services, and coordinate care between primary care physicians, family, and community resources.

The ideal candidate holds an active RN license in Texas, with BSN or MSN preferred, and at least three years in nursing, acute care, quality management or managed care.

Qualifications

• RN required with current Texas licensure.
• BSN or Master’s degree preferred.
• Minimum 3 years nursing, acute care, quality or managed care experience.
• Basic knowledge of Medicaid/Medicare and community resources desired.
• Familiarity with InterQual criteria and DRG/ICD/CPT coding preferred.

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 benefit utilization.
• Collaborate with multidisciplinary health care team to identify educational and discharge needs.

Skills

Care coordination

Resource allocation

Quality management

Medicare/Medicaid knowledge

Medical coding awareness

Education

Registered Nurse (RN) license

BSN preferred

MSN preferred

Tools

InterQual criteria

DRG/ICD/CPT coding knowledge

Job description

University Health seeks a Registered Nurse to support Community First Health Plan members in regaining optimum health. You will oversee resource allocation, ensure access to necessary services, and coordinate care between primary care physicians, family, and community resources.

The ideal candidate holds an active RN license in Texas, with BSN or MSN preferred, and at least three years in nursing, acute care, quality management or managed care.