Utilization Management Nurse II: Care Optimization

CHRISTUS Health; Beaumont (TX); On-site; USD 90,000 - 120,000; Full time

Benefits offered by this job

Full-time role

Day shift 8AM - 5PM

Job summary

CHRISTUS Health in Beaumont, TX seeks an experienced Utilization Management Nurse II to determine clinical appropriateness and optimize hospital resource use. The role conducts pre-admission, concurrent, and retrospective UM reviews, applying InterQual/MCG and CMS guidelines while coordinating with providers and payors for timely authorizations.

The nurse will work with the interdisciplinary team, ensure compliance with regulatory requirements, and support patient care progression across the

Qualifications

• Graduate of an accredited School of Nursing or equivalent experience.
• Two or more years of clinical experience; at least one year in the acute care setting or Utilization Management Nurse I role at CHRISTUS Health.
• RN license in state of employment or compact required; LPN/LVN accepted for associates with 5+ years of UM experience.

Responsibilities

• Determines medical necessity and appropriate level of care using approved criteria.
• Coordinates with physicians and care team to obtain necessary documentation for authorization.
• Communicates with payors and vendors to obtain certification for services.
• Maintains knowledge of HIPAA, CMS guidelines, and Joint Commission regulations.
• Reviews admission and concurrent care to ensure proper placement and utilization.
• Identifies and escalates issues affecting utilization management and payer denials.
• Participates in interdisciplinary rounds and care progression discussions.
• Documents clinical data accurately and timely in the medical record.

Skills

Clinical judgment

Regulatory knowledge

Communication skills

Multitasking

Team collaboration

Education

RN license (Texas)

Bachelor of Science in Nursing

Case Management Certification (preferred)

Job description

CHRISTUS Health in Beaumont, TX seeks an experienced Utilization Management Nurse II to determine clinical appropriateness and optimize hospital resource use. The role conducts pre-admission, concurrent, and retrospective UM reviews, applying InterQual/MCG and CMS guidelines while coordinating with providers and payors for timely authorizations.

The nurse will work with the interdisciplinary team, ensure compliance with regulatory requirements, and support patient care progression across the