Job Title: Case Manager • Registered Nurse • Day Shift
We're looking for a dedicated Registered Nurse for a Case Manager role. This day shift position requires a current TX RN Compact license and operates from 08:00 • 17:00, Monday through Friday.
As an RN Case Manager, you'll ensure appropriate clinical care and resource utilization. This involves pre•admission, concurrent, and retrospective utilization management reviews.
Key Responsibilities:
• Accurately apply approved screening criteria (InterQual/MCG/CMS Inpatient List).
• Manage diverse workload in a dynamic regulatory environment.
• Stay updated on commercial and government payor regulations.
• Communicate effectively with clinical professionals.
• Coordinate patient's financial insurance care and obtain service certifications.
• Collaborate with our health care team.
The ideal candidate will perform comprehensive assessments of clinical information and treatment plans, apply medical necessity criteria, and assess patient population for medical necessity and appropriateness of care. This is a temp•to•perm position for local candidates only.
