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CHRISTUS Health Physician Jobs

RN Job In Santa Fe, New Mexico

Utilization Review Coordinator / Case Management / PRN

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Company: CHRISTUS Health Profession/Specialty: RN Location: 455 St Michaels Drive
Santa Fe, New Mexico 87505
Type of Facility: Hospital
Job Description
Description

POSITION SUMMARY:  Registered Nurse uses approved screening criteria (MCG®/CMS Inpatient List) to determine the medical necessity of a requested hospitalization and the appropriate level of care for that patient. Actively involved in the continued management of patient status/LOC. Provides consultative role as utilization management nurse to clinical and non-clinical departments.    Documents objective findings against approved indicators.  Assists with retrospective reviews and medical necessity denials per communication with third party payors.  Follows UR policies and procedures and assists with continually improving the quality and effectiveness of the utilization management program at CSVRMC.



Requirements

EDUCATION: Graduate of an approved school of nursing, BSN preferred.

CERTIFICATION/LICENSES: Current licensure as an RN in New Mexico mandatory.

SKILLS:

  • Excellent reading, writing, and editing skills in English.
  • Strong organizational skills.
  • Knowledge of or ability to learn MCG® for determining criteria.
  • Ability to effectively evaluate physician orders and medical records.
  • Competent computer skills for word processing, data collection, and retrieval.
  • Ability to analyze and create reports.

EXPERIENCE: Minimum of five years of experience in a health care setting, of which a minimum of two years has been spent in an acute care setting.  Experience with utilization management, knowledge of MCG ®/ criteria, managed care language, and CMS rules and regulations preferred.

NATURE OF SUPERVISION:

-Responsible to:  Manager of Case Management

 ENVIRONMENT:  Blood borne Pathogens: A

Office setting.  Rotating shifts and weekends when necessary.  Must be able to adjust to frequently changing workloads and frequent interruptions. 

PHYSICAL REQUIREMENTS:

Ability to move around the hospital to all units/departments for about 10% of the day, in office 90% of the day.  Requires close work, good vision, dexterity to write as well as to use computer keyboard.

EOE
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Job Map - 455 st michaels drive Santa Fe, New Mexico 87505 United States
CHRISTUS Health Physician Jobs
About CHRISTUS Health

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.

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