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Utilization Review Case Manager

Plaza Medical Center of Fort Worth - Fort Worth - Fort Worth, Texas

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Job Code: 00073-86422


Days (rotating weekends)

RN Utilization Review Case Manager
Medical City Fort Worth
Days (Rotating Weekends)

Why work for HCA?
Learn more about our commitment to our providers both culturally and professionally by checking out our mission/values and our benefits.

Medical City- Fort Worth is a 320 bed medical facility located in downtown Fort Worth.  We are a Magnet hospital specializing in tertiary care, teaching and research, and have been recognized for our cardiology, oncology, neuroscience and orthopedic programs.

Our case management  department facilitates the achievement of patient wellness and autonomy through advocacy, assessment, planning, communication, education, resource management, and service facilitation. Based on the needs and values of the patient, and in collaboration with all service providers, the case manager links patients with appropriate providers and resources throughout the continuum of health and human services and care settings, while ensuring that the care provided is safe, effective, patient centered, timely, efficient, and equitable. This approach achieves optimum value and desirable outcomes for all—the patients, their support systems, the providers, and the payers. We are looking for a seasoned, team oriented; Utilization Review Case Manager to join our team.

Essential Job Functions

  • This position performs case management, utilization review and discharge planning responsibilities.
  • Admission/pre-admission screening for appropriateness of admission and continued stay.
  • Concurrent review of inpatients; assess patients for discharge planning and community resource needs.
  • Identifies under-utilization and over-utilization of services.
  • Assist in identifying problem diagnoses and practice patterns.
  • Participates in committees as required.
  • Communicates with care providers of appropriateness of admission, treatment, and length of stay.
  • Monitors patients for appropriateness of level of care.
  • Participates in development and implementation of QI programs.
  • Acts as patients' advocate.
  • Performs case management assessment and makes appropriate referrals as needed.
  • Provide social service consult and follow up as needed.
  • Assess for quality of patient care; acts as consultant to the Health Information coders when clinical questions arises.
  • Assist in the development of case management policies and procedures.
  • Prepares education materials for in-service and training of physicians, hospital personnel and the community as needed.
  • Enters data and maintains the appropriate reports.
  • Performs other special duties within the case management scope of work as assigned by the Department Director.            

  • Minimum Professional Qualifications
    • TX RN license
    • BSN degree/current enrollment considered
    • 2 years of direct patient care experience 
    • Case Management Certification preferred
    • Minimum two years utilization review focused case management experience.

    Contact our corporate recruiter Shelley Gabriel at (972)345-1587 or, if you have questions about this position and others that might be coming up.

Last Edited: 03/20/2017

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