Utilization Review RN in Behavioral Medicine - 780006

Description Demonstrates knowledge and skills necessary to provide services based on the physical, psychosocial, educational, safety, and other related criteria for appropriate population in his/her assigned area. Maintains required core competencies. Complies with set Policies and Procedures (i.e. name tag, dress code, parking, smoking, etc.) Submits appeals in a timely manner, upon request by the Director. Monitors for the efficient use of resources and reports to leadership when there are actual or potential sources of under- or over-utilization. Collaborates with providers, nurses, patients, families, and other care providers in the development and implementation of patient care plans, including discharge planning, across the continuum of care in support of the GCRMC Mission. Communicates with providers regarding patient status and assists him/her in ensuring proper utilization of resources. Conducts utilization review using nationally recognized medical necessity criteria and documents the review. Utilization management, assurance of comprehensive clinical documentation, utilization procedures, appropriate clinical documentation for utilization review and communication with third party payors. Refers cases for second level reviews when medical necessity criteria are not met. RequirementsEducationRequired:    Associate of SciencePreferred:    Bachelor of ScienceLicenses & CertificationsRequired:    L-RN SinglestatePreferred:    L-RN Multistate Additional Information: - Specialty: RN - Location: 2669 Scenic DriveAlamogordo, New Mexico 88310 - Contact: About the Company: 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.