Weekend Nurse Care Manager: Clinical Review & Utilization

Children's Mercy Kansas City; Kansas City (MO); Presencial; USD 43.000 - 61.000; Jornada completa

Descripción de la vacante

Children's Mercy Kansas City is seeking a Clinical Review Nurse Care Manager to ensure appropriate utilization and reimbursement from admission through discharge. You will secure authorizations, evaluate medical necessity, and work with physicians and a multidisciplinary team to optimize care and reduce delays.

The role emphasizes evidence-based practice, strong communication, and collaboration with Revenue Cycle to improve outcomes and patient satisfaction.

Formación

• BSN required and current RN licensure in MO or KS preferred
• Experience as a care manager or leadership experience in healthcare setting desired
• Knowledge of payer authorization and medical necessity criteria helpful
• Strong collaboration with physicians and multidisciplinary teams required

Responsabilidades

• Evaluate admission appropriateness using evidence-based guidelines
• Facilitate timely patient throughput and secure continued stay authorizations
• Mitigate denials and coordinate with physicians and insurance/payers
• Collaborate with Revenue Cycle to improve financial processes
• Participate in professional development and quality improvement initiatives

Conocimientos

Clinical expertise

Evidence-based practice

High communication skills

Team collaboration

Adaptability

Educación

BSN (Bachelor of Science in Nursing)

Descripción del empleo

Children's Mercy Kansas City is seeking a Clinical Review Nurse Care Manager to ensure appropriate utilization and reimbursement from admission through discharge. You will secure authorizations, evaluate medical necessity, and work with physicians and a multidisciplinary team to optimize care and reduce delays.

The role emphasizes evidence-based practice, strong communication, and collaboration with Revenue Cycle to improve outcomes and patient satisfaction.