Prime Healthcare

Case Manager - KMC Utilization Management

Facility Knapp Medical Center
Location
US-TX-Weslaco
ID
2021-76160
Category
Clinical Professional
Position Type
Full Time
Shift
Days

Responsibilities

Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works on behalf of the advocate, promoting cost containment and demonstrates leadership to integrate the health care providers to achieve a perceived seamless delivery of care. The methodology is designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.

Qualifications

Education and Work Experience


Required qualifications:

 

1. BSW or other Bachelor degree in a related field. At least one year experience in case management, discharge planning or nursing management;
2. CCM or obtained within 6 months of hire.
3. Experience and knowledge in basic to intermediate computer skills.
4. Behavioral Violence Prevention Training within 3 months of hire and maintain current.

 

Preferred qualifications:

 

1. Minimum 5 years of acute care experience preferred.
2. At least one-year experience in case management, discharge planning or management, preferred.
3. Current BCLS (AHA) certificate preferred.
4. Knowledge of Milliman Criteria and InterQual Criteria preferred.

 

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law: https://www.eeoc.gov/sites/default/files/migrated_files/employers/poster_screen_reader_optimized.pdf

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