Description

Comprehensively plans for case management services for a targeted patient population. Carries out activities related to utilization management, discharge planning, care coordination and referral to other levels of care. Works with physician, Social Worker and interdisciplinary team to facilitate clinical pathways and achievement of desired treatment outcomes. Promotes interdisciplinary collaboration and champions service excellence. Works collaboratively to ensure patient needs are met and care delivery is coordinated across the continuum at the appropriate level of care.

Required qualifications:

• Bachelor’s Degree for RN Clinical Audit and Denial Care Manager: Nursing
• Texas Registered Nurse License upon hire
• Certification as an Accredited Case Manager (ACM) or Certified Case Manager (CCM), or willing to obtain within 2 years (for RN Clinical Audit and Denial Care Manager-Unit Educator) upon hire
• Certification as an Accredited Case Manager (ACM) or Certified Case Manager (CCM), or willing to obtain within 2 years (for RN Clinical Audit and Denial Care Manager) upon hire
• Certification as an Accredited Case Manager (ACM) or Certified Case Manager (CCM), or willing to obtain within 2 years (for RN Case Manager Auditor) upon hire
• RN Clinical Audit & Denial Care Manager-Unit Educator:
• 1 year experience as a case manager in a hospital setting, managed care setting or clinical setting
• Experience with the use of nationally recognized medical necessity screening tools
• RN Clinical Audit and Denial Care Manager:
• Significant experience in the healthcare field, including 3 years of Utilization Review/Case Management experience in an acute care or managed care setting
• 2 years of experience in the denial management process
• Experience in the application of medical necessity screening criteria tools (MCG and/or InterQual)
• RN Case Manager Auditor:
• 1 year experience as a case manager in a hospital setting, managed care setting or clinical setting
• Experience with the use of nationally recognized medical necessity screening tools

Preferred qualifications:

• Bachelor’s Degree in Nursing/healthcare related field
• 3 years Direct patient care experience in an acute care hospital in a leadership role
• Case management or utilization management experience

Our best-in-class benefits are uniquely designed to support you and your family in staying well, growing professionally and achieving financial security. We take care of you, so you can focus on delivering our Mission of caring for everyone, especially the most vulnerable in our communities.

About Providence

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.

About the Team

Since 1918, Covenant has been driven by a mission of providing a Christian ministry of healing and caring for the whole person through our integrated health network in West Texas/eastern New Mexico. As an expression of our mission, we believe we hold an important Covenant with our patients and try and treat every interaction as Sacred Encounters.

Our award-winning and comprehensive medical centers are located in the cities of Lubbock, Levelland, Plainview and Hobbs. Our not-for-profit network also provides a full spectrum of care with leading-edge diagnostics and treatment, outpatient health centers, physician groups and clinics, outreach programs, hospice and home care, and even schools for nursing and radiography.

We are committed to the principle that every workforce member has the right to work in surroundings that are free from all forms of unlawful discrimination and harassment.

We are committed to cultural diversity and equal employment for all individuals. It is our policy to recruit, hire, promote, compensate, transfer, train, retain, terminate, and make all other employment-related decisions without regard to race, color, religious creed (including religious dress and grooming practices), national origin (including certain language use restrictions), ancestry, disability (mental and physical including HIV and AIDS), medical condition (including cancer and genetic characteristics), genetic information, marital status, age, sex (which includes pregnancy, childbirth, breastfeeding and related medical conditions), gender, gender identity, gender expression, sexual orientation, genetic information, and military and veteran status or any other applicable legally protected status. We will also provide reasonable accommodation to known physical or mental limitations of an otherwise qualified caregiver or applicant for employment, unless the accommodation would impose undue hardship on the operation of our business.

We are a community where all people, regardless of differences, are welcome, secure, and valued. We value respect, appreciation, collaboration, diversity, and a shared commitment to serving our communities. We expect that all workforce members in our community will act in ways which reflect a commitment to and accountability for, racial and social justice and equality in the workplace. As such, we will maintain a workplace free of discrimination and harassment based on any applicable legally protected status. We also expect that all workforce members will maintain a positive workplace free from any unacceptable conduct which creates an intimidating, hostile, or offensive work environment.

Requsition ID: 172044

Company: Covenant Jobs

Job Category: Care Management

Job Function: Clinical Care

Job Schedule: Full time

Job Shift: Day

Career Track: Nursing

Department: 8008 POPULATION HEALTH SERVICES TX CHP BUILDING

Address: TX Lubbock 3606 21st St

Pay Range: $33.82 - $54.61

The amounts listed are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.

Check out our benefits page for more information about our Benefits and Rewards.

Covenant Health is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.