Job Description
DescriptionSummary:
The RN Utilization Review II is responsible for determining the clinical
appropriateness of care provided to patients and ensuring proper hospital resource utilization of
services. This RN is responsible for performing a variety of pre-admission, concurrent, and
retrospective UM related reviews and functions. They must competently and accurately utilize
approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services “CMS”
Inpatient List). They effectively and efficiently manage a diverse workload in a fast pace, rapidly
changing regulatory environment and are responsible for maintaining current and accurate knowledge
regarding commercial and government payors and Joint Commission regulations and guidelines related
to UM. This RN effectively communicates with internal and external clinical professionals,
efficiently organizes the financial insurance care of the patients, and relays clinical data to
insurance providers and vendors to obtain approved certification for services. The RN Utilization
Review Nurse collaborates as necessary with other members of the health care team to ensure the
above according to the mission of CHRISTUS.
Requirements:
BSN Degree from an accredited nursing
program or proven success as Registered Nurse Utilization Review I role.Familiarity with criteria
sets including InterQual and MCG preferred.Excellent verbal and written communication.Critical and
analytical thinking skills.Demonstrated clinical competency.Three to Five years of experience in
case management or utilization review or proven success as Registered Nurse Utilization Review I
role.RN License in state of employment or compact required.CPR certification preferred.Certification
in Case Management preferred.
Work Schedule:
PRN
Work Type:
Per Diem As Needed
EEO is the
law - click below for more
information:
https://www.eeoc.gov/sites/default/files/2023-06/22-088_EEOC_KnowYourRights6.12ScreenRdr.pdf
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endeavor to make this site accessible to any and all users. If you would like to contact us
regarding the accessibility of our website or need assistance completing the application process,
please contact us at (844) 257-6925.
Additional Information:
- Specialty: RN
- Location: 3330 Masonic DriveAlexandria, Louisiana 71301
- Contact:
About the Company:
CHRISTUS Health is an international Catholic, faith-based, not-for-profit health system comprised of
more than 600 services and facilities, including more than 60 hospitals and long-term care
facilities, 350 clinics and outpatient centers, and dozens of other health ministries and
ventures.
Sponsored by the Sisters of Charity of the Incarnate Word in Houston and San Antonio and
the Sisters of the Holy Family of Nazareth, the mission of CHRISTUS Health is to extend the healing
ministry of Jesus Christ.
To support our healthcare ministry, CHRISTUS Health employs approximately
45,000 Associates and has more than 15,000 physicians on staff who provide care and support for
patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United
States.
EXTENDING THE HEALING MINISTRY OF JESUS CHRIST
We are inspired by our mission, vision and
core values to deliver compassionate, high quality health care, improving the health of the
communities we serve. Above all, we are committed to providing our customers and their family
members with a truly unique healing experience, one that embodies our values and respects the
dignity and worth of each person. Creating a health care system that is truly excellent in all areas
is an ongoing effort.