RN Case Manager/Utilization Review

Job Description

Position: PRN Case Manager (Weekends)

Responsibilities:

• Evaluate the appropriateness and medical necessity of healthcare services.
• Review medical records for admission criteria compliance.
• Ensure patients receive appropriate care based on clinical guidelines.
• Perform pre-authorization and ongoing reviews for medical treatments.
• Collaborate with healthcare providers for care alignment with coverage guidelines.
• Coordinate transitions of care with providers, patients, and families.
• Monitor hospital admissions, extended stays, and discharges.

Requirements:

• Graduate of an accredited Professional Nursing program.
• Registered Nurse in Texas with current BLS certification.
• Three years of nursing or social work experience required.
• Effective communication and educating skills.

Equal opportunity employer committed to diversity and ethics.