Utilization Review Manager - Home Care jobs in Fort Worth, TX

Utilization Review Manager - Home Care ensures quality and level of care for patients are up to established standards and comply with federal, state, and local regulations. Investigates and resolves reports of inappropriate care. Being a Utilization Review Manager - Home Care may require a bachelor's degree. Typically reports to a head of a unit/department. To be a Utilization Review Manager - Home Care typically requires 4 to 7 years of related experience. Contributes to moderately complex aspects of a project. Work is generally independent and collaborative in nature. (Copyright 2024 Salary.com)

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Nurse Case Manager - Inpatient Utilization Review
  • JPS Health Network
  • Fort Worth, TX FULL_TIME
  • Who We Are
    JPS Health Network is a $950 million, tax-supported healthcare system in North Texas. Licensed for 582 beds, the network features over 25 locations across Tarrant County, with John Peter Smith Hospital a Level I Trauma Center, Tarrant County's only psychiatric emergency center, and the largest hospital-based family medical residency program in the nation. The health network employs more than 7,200 people.

    Acclaim Multispecialty Group is the medical practice group featuring over 300 providers serving JPS Health Network. Specialties range from primary care to general surgery and trauma. The Acclaim Multispecialty Group formed around a common set of incentives and expectations supporting the operational, financial, and clinical performance
    outcomes of the network. Our goal is to provide high quality, compassionate clinical care for every patient, every time.

    Why JPS?
    We're more than a hospital. We're 7,200 of the most dedicated people you could ever meet. Our goal is to make sure the people of our community get the care they need and deserve. As community stewards, we abide by three Rules of the Road:

    1. Own it. Everyone who wears the JPS badge contributes to our journey to excellence.
    2. Seek joy. Every day, every shift, we celebrate our patients, smile, and emphasize positivity.
    3. Don't be a jerk. Everyone is treated with courtesy and respect. Smiling, laughter, compassion - key components of our everyday experience at JPS.

    When working here, you're surrounded by passion, diversity, and dedication. We look forward to meeting you!

    For more information, visit www.jpshealthnet.org.
    To view all job vacancies, visit www.jpshealthnet.org, www.jpshealthnet.org/careers, or www.teamacclaim.org.


    Job Title:


    Nurse Case Manager - Inpatient Utilization Review


    Requisition Number:


    33693


    Employment Type:


    Full Time


    Division:


    CLINICAL INTEGRATION


    Compensation Type:


    Hourly


    Job Category:


    Nursing / LVN


    Hours Worked:


    Sat-Mon 7A-7:30P


    Location:


    John Peter Smith Hospital


    Shift Worked:


    Weekend Shift


    Job Description:

    Description: The Nurse Case Manager - Inpatient is responsible for coordinating the care and service of assigned patients with physicians, nurses, social workers and other members of the healthcare team to facilitate the progression of care from hospital admission through discharge. The Nurse Case Manager- Inpatient is also responsible for ensuring that the patient is placed in the appropriate level of care while monitoring the utilization of healthcare resources and discharge planning to achieve the desired clinical, financial, and resource utilization outcomes.

    Typical Duties:

    Provides an assessment for all observation status patients prior to observation placement. The patient is to be assessed throughout the shift to determine discharge readiness or the need to convert to an inpatient status by using the approved medical appropriateness criteria and all third-party payer regulatory requirement.

    Performs initial status review and level of care placement on all patients in an inpatient status using approved medical appropriate criteria in addition to third-party payer regulatory requirements.

    Conducts an initial clinical assessment on assigned patients as well as discharge planning assessment prior to admission, at the time of admission, or at discharge.

    Meets directly with the patient, family, and/or representative to assess needs and develop an individualized discharge plan based on the patient’s medical diagnosis, treatment plan, financial resources, and psychosocial issues, etc.

    Reassesses the discharge plan throughout the patient’s hospitalization with input from the healthcare team and patient, family, and/or representative and modifying as needed.

    Collaborates with the multi-disciplinary care team to ensure all needed clinical information is provided to the appropriate entities for the assigned level of care and supports the concurrent appeal process for any reduction in level of care or denial as requested.

    Maintains active communication with the patient, family, and/or representative, physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient management; documents each component of the case management process and related activities.

    Identifies appropriate services not related to admission and assists in arrangement of services on an outpatient basis.

    Leads the Unit’s daily interdisciplinary rounds to ensure a comprehensive plan of care is developed, including identification of patient needs, assignment of tasks to resolve clinical issues, review of discharge barriers, and identification of discharge planning options.

    Generates referrals to the Case Management Physician Advisor according to departmental policies.

    Serves as an educational resource for physician, nursing staff and others concerning case management strategies essential in meeting the organization’s quality, utilization, financial and customer satisfaction objectives.

    • Performs other related job duties as assigned.


    Qualifications:


      Required Education and Experience:
    • Bachelor’s Degree in Nursing from an accredited college or university.
    • 3-5 years of clinical experience and/or case management, utilization review, and/or discharge planning experience in an acute care setting.

    • Required Licensure/Certification/Specialized Training:
    • RN licensure through the Texas State Board of Nurse Examiners.

    • Preferred Education and Experience:
    • Master’s Degree in Nursing from an accredited college or university.

    • Preferred Licensure/Certification:
    • ACM Certification.


    Location Address:
    1500 S. Main Street
    Fort Worth, Texas, 76104
    United States

  • 17 Days Ago

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Utilization Review Specialist
  • Mesa Springs
  • Worth, TX FULL_TIME
  • Overview Mesa Springs is a 72-bed behavioral hospital located in Fort Worth, TX. The hospital offers inpatient and outpatient mental health and addiction treatment to adults, adolescents and their fam...
  • Just Posted

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Utilization Review Specialist
  • Springstone, Inc.
  • Worth, TX FULL_TIME
  • Overview Mesa Springs is a 72-bed behavioral hospital located in Fort Worth, TX. The hospital offers inpatient and outpatient mental health and addiction treatment to adults, adolescents and their fam...
  • 1 Day Ago

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Director - Utilization Review/ MGMT
  • Universal Health Services, Inc.
  • Denton, TX FULL_TIME
  • Responsibilities Mayhill Hospital located in Denton, TX just north of Dallas and Fort Worth, is a 59-bed private psychiatric hospital specializing in mental health and chemical dependency care for adu...
  • 27 Days Ago

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Utilization Review Specialist
  • Mesa Springs
  • Arlington, TX FULL_TIME
  • Overview Mesa Springs Utilization Review Specialist Mesa Springs is a 72-bed behavioral hospital located in Fort Worth, TX. The hospital offers inpatient and outpatient mental health and addiction tre...
  • 1 Month Ago

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Utilization Review Coordinator
  • LifeCare Health
  • Fort Worth, TX FULL_TIME
  • We have an immediate opportunity for a Utilization Review Coordinator. General Summary: The Utilization Review Coordinator will monitor adherence to the hospital's utilization review plan to ensure th...
  • 1 Month Ago

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0 Utilization Review Manager - Home Care jobs found in Fort Worth, TX area

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Utilization Management RN
  • Adecco Medical & Science
  • Dallas, TX
  • We are seeking an experienced Utilization Management RN to join our esteemed surgical center in the one and only, Dallas...
  • 4/25/2024 12:00:00 AM

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REMOTE: Medical Director, Utilization Management and Medical Policy
  • Evry Health
  • Fort Worth, TX
  • About the Role Evry Health is hiring a tech-savvy Medical Director to lead medical policy and utilization management. As...
  • 4/24/2024 12:00:00 AM

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Utilization Management RN
  • Adecco Medical & Science
  • Dallas, TX
  • We are seeking an experienced Utilization Management RN to join our esteemed surgical center in the one and only, Dallas...
  • 4/24/2024 12:00:00 AM

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REMOTE: Medical Director, Utilization Management and Medical Policy
  • Evry Health
  • Dallas, TX
  • About the Role Evry Health is hiring a tech-savvy Medical Director to lead medical policy and utilization management. As...
  • 4/24/2024 12:00:00 AM

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REMOTE: Medical Director, Utilization Management and Medical Policy
  • Evry Health
  • Garland, TX
  • About the Role Evry Health is hiring a tech-savvy Medical Director to lead medical policy and utilization management. As...
  • 4/24/2024 12:00:00 AM

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Utilization Management RN
  • Adecco US, Inc.
  • Dallas, TX
  • We are seeking an experienced Utilization Management RN to join our esteemed surgical center in the one and only, Dallas...
  • 4/23/2024 12:00:00 AM

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Utilization Management Nurse - Dallas TX
  • Adecco Medical & Science
  • Dallas, TX
  • Join Our Team as a Utilization Management Nurse! Experience Required: Five years inpatient clinical nursing experience i...
  • 4/22/2024 12:00:00 AM

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Sr Product Manager - UM/CM/Rx - Remote ($135K)
  • Confidential
  • Fort Worth, TX
  • Remote potential | Green Card or Citizen requirement This Sr. Product Manager will support customer implementation of ou...
  • 4/21/2024 12:00:00 AM

Fort Worth is located in North Texas, and has a generally humid subtropical climate. It is part of the Cross Timbers region; this region is a boundary between the more heavily forested eastern parts and the rolling hills and prairies of the central part. Specifically, the city is part of the Grand Prairie ecoregion within the Cross Timbers. According to the United States Census Bureau, the city has a total area of 349.2 square miles (904 km2), of which 342.2 square miles (886 km2) is land and 7.0 square miles (18 km2) is covered by water. It is a principal city in the Dallas–Fort Worth metropl...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Utilization Review Manager - Home Care jobs
$74,278 to $94,698
Fort Worth, Texas area prices
were up 2.2% from a year ago