Job description

TOPS Surgical Specialty Hospital

Collaborates in the process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality, cost effective care.

The case management process begins when the patient enters the health care system continues through discharge planning, discharge and post-discharge follow-up.

The case manager performs utilization management and review functions, peer review relating to utilization review, and follows best practices including CMS, JC and State laws governing medical necessity. All utilization review functions are reported by the case manager to the utilization review committee.

Qualifications

• Graduate of an accredited school of Nursing
• Previous experience in case management required; Certification preferred; acute care experience
• required.
• Experience in InterQual or Milliman utilization preferred.
• Recovery Audit Contractor process management and appeals experience preferred.
• Current Texas RN License required
• BLS
• Ability to work independently; working knowledge of Microsoft Word and Excel preferred; willingness to learn computer applications necessary for work functions including the MIDAS Case Management module and Milliman or InterQual; ability to adapt to changing situations and various personalities with a positive attitude.

Job Type: Full-time

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Health insurance
• Life insurance
• Paid time off
• Referral program
• Retirement plan
• Vision insurance

Education:

• Associate (Preferred)

Experience:

• InterQual or Milliman: 1 year (Preferred)
• case management: 2 years (Preferred)

License/Certification:

• BLS (Preferred)
• Texas RN License (Preferred)
• Case Manager Certification (Preferred)

Work Location: In person

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