RN Utilization Management & Care Coordination

University Health Careers; Seguin (TX); On-site; USD 65,000 - 85,000; Full time

Job summary

University Health Careers in Seguin, TX is seeking a Registered Nurse to support CFHP members in accessing the health services they need, through coordinated, efficient care. You will work across the care continuum with physicians, families, and community resources to optimize outcomes.

Texas RN licensure is required; BSN or Master’s degree preferred. A minimum of three years in nursing, acute care, quality management, or managed care is expected, with familiarity of Medicaid/Medicare and

Qualifications

• Registered Nurse licensure in Texas.
• Minimum 3 years in nursing, acute care, quality management or managed care.
• Knowledge of Medicaid/Medicare and community resources preferred.
• InterQual criteria, DRG, ICD and CPT knowledge preferred.

Responsibilities

• Oversee allocation of resources and monitor cost and quality of care.
• Coordinate care between the primary care physician, resources, family, and member.
• Coordinate care across the health care continuum while monitoring benefit utilization.
• Collaborate with multidisciplinary team to identify education and discharge needs.

Skills

Care coordination

Quality management

Medicaid/Medicare knowledge

Education

BSN

Master’s degree

Job description

University Health Careers in Seguin, TX is seeking a Registered Nurse to support CFHP members in accessing the health services they need, through coordinated, efficient care. You will work across the care continuum with physicians, families, and community resources to optimize outcomes.

Texas RN licensure is required; BSN or Master’s degree preferred. A minimum of three years in nursing, acute care, quality management, or managed care is expected, with familiarity of Medicaid/Medicare and