Utilization Management Nurse II: Care Optimization Pro

CHRISTUS Health; Corpus Christi (TX); On-site; USD 75,000 - 105,000; Full time

Job summary

CHRISTUS Health seeks a Utilization Management Nurse II to determine clinical appropriateness and ensure proper hospital resource use. You will perform pre-admission, concurrent, and retrospective reviews using InterQual/MCG criteria and coordinate with payors to obtain approvals.

You will communicate with the care team, review documentation for medical necessity, and support discharge planning while complying with CMS and Joint Commission guidelines.

Qualifications

• RN license in state of employment or compact required.
• Two+ years of clinical experience; acute care preferred.

Responsibilities

• Determine medical necessity and level of care using approved criteria.
• Collaborate with physician and treatment team to obtain documentation.
• Coordinate discharge planning and placement decisions.
• Maintain compliance with regulatory requirements and hospital policies.
• Communicate with payors and document clinical data for approvals.

Skills

InterQual/MCG criteria

Communication skills

Multitasking

Analytical thinking

Education

RN license

Tools

CMS Inpatient List

InterQual/MCG tools

Job description

CHRISTUS Health seeks a Utilization Management Nurse II to determine clinical appropriateness and ensure proper hospital resource use. You will perform pre-admission, concurrent, and retrospective reviews using InterQual/MCG criteria and coordinate with payors to obtain approvals.

You will communicate with the care team, review documentation for medical necessity, and support discharge planning while complying with CMS and Joint Commission guidelines.