Registered Nurse; RN - Med Surg

staff - Registered Nurse (RN) - Med Surg - $46 per hour at Cook Children’s Health Care System summary:
The Registered Nurse (RN) Med Surg at Cook Children's Health Care System coordinates healthcare resources and manages utilization for health plan members, ensuring timely and appropriate care. This role assesses medical necessity, authorizes services using approved clinical criteria, and communicates with providers to facilitate efficient care transitions. Candidates must have an active RN license, clinical experience, and skills in communication, critical thinking, and time management.
Cook Children’s Health Care System is seeking a Registered Nurse (RN) Med Surg for a nursing job in Fort Worth, Texas.

Job Description & Requirements

• Specialty:
Med Surg

• Discipline: RN

•

Start Date:

ASAP

• Duration:
Ongoing

• 40 hours per week

• Shift: 8 hours

•

Employment Type:

Staff

Location:

Calmont Operations Building
Department:
Utilization

Shift:
First Shift (United States of America)
Standard Weekly

Hours:

40

Summary:

Responsible for the coordination and efficient utilization of health care resources for Cook Childrens Health Plan (CCHP) members. Works with the Department Manager and Team Lead to assure the timely provision of quality care throughout the continuum of care. The Registered Nurse Utilization Management/Episodic Case Manager (UM/ECM - RN) Reviewer facilitates clinically appropriate and fiscally responsible care through communication with the providers and health plan medical directors.

The UM/ECM - RN Reviewer assesses and identifies the members clinical information and determines, in conjunction with the Medical Director, medical necessity and appropriateness of requested services. Utilizes Medical Management Committee (MMC) approved clinical criteria to authorize requested services for the member. The UM/ECM - RN Reviewer communicates with providers of care/services to facilitate appropriate care transitions. The UM/ECM - RN Reviewer assures adherence to regulatory/contractually required timeliness standards for authorization request processing, associated communications and notice of adverse determinations are met for CCHP.
Additional Information:
Responsible for the coordination and efficient utilization of health care resources for Cook Childrens Health Plan (CCHP) members. Works with the Department Manager and Team Lead to assure the timely provision of quality care throughout the continuum of care. The Registered Nurse Utilization Management/Episodic Case Manager (UM/ECM - RN) Reviewer facilitates clinically appropriate and fiscally responsible care through communication with the providers and health plan medical directors.

The UM/ECM - RN Reviewer assesses and identifies the members clinical information and determines, in conjunction with the Medical Director, medical necessity and appropriateness of requested services. Utilizes Medical Management Committee (MMC) approved clinical criteria to authorize requested services for the member. The UM/ECM - RN Reviewer communicates with providers of care/services to facilitate appropriate care transitions. The UM/ECM - RN Reviewer assures adherence to regulatory/contractually required timeliness standards for authorization request processing, associated communications and notice of adverse determinations are met for CCHP.

Education:

• Registered Nurse; BSN preferred.

• Minimum of five (5) years clinical experience

• 2 years utilization management or case management experience required.
Strong skills in the following areas:
Oral and written communication;
Critical thinking;
Organization and time management;
Customer service.
Certification/Licensure:

• Current unrestricted Registered Nurse licensure in the State of Texas.

About Us:

Cook Children's Health Plan
Cook Children's Health Plan provides vital coverage to nearly 120,000 people in low-income families who qualify for government-sponsored programs in our six county service region. Cook Children's Health Plan provides health coverage for CHIP, CHIP Perinatal, STAR (Medicaid) and STAR Kids Members in the Tarrant county service area. The counties we serve includes Tarrant, Johnson, Denton, Parker, Hood and Wise.
Cook…