RN Concurrent Review - UM - Remote - Kelsey Seybold Clinic

About the position Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation’s leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together. The Concurrent Review Case Manager is responsible for telephonic monitoring and the documentation of medical treatment and comparing it to established criteria to determine if treatment meets established guidelines. In addition, the Concurrent Review Case Manager monitors patients progress toward recovery for early identification of continuing care needs in an attempt to facilitate discharge for specified populations. This position works closely with Medical Management Physician leadership and various internal departments. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Responsibilities

• Telephonic monitoring and documentation of medical treatment
• Comparing medical treatment to established criteria to determine if treatment meets established guidelines
• Monitoring patients progress toward recovery for early identification of continuing care needs
• Facilitating discharge for specified populations
• Working closely with Medical Management Physician leadership and various internal departments

Requirements

• Associate Degree in Nursing or higher
• Active Texas RN license or multistate compact RN license
• 5+ years of nursing experience in concurrent review
• Managed Care knowledge

Nice-to-haves

• Certification in area of specialization, BSN
• ACP certification
• Case Management Certification
• 2+ years in area of specialization
• 2+ years of Case Management/Utilization Review experience
• Proven program development skills
• Proven communication and problem-solving skills
• Computer literate

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution

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