Utilization Management Clinical Registered Nurse

Job not on LinkedIn

🔥 14 minutes ago

🤠 Texas – Remote

🤠 Texas – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 11%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.Why this score:

• Just posted.
• Jobs at this company usually fill in 21 days.
• No salary listed.

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St. Jude Children's Research Hospital

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

🤝 Non-profit

Healthcare • Non-profit

St. Jude Children's Research Hospital is a global leader in the research and treatment of pediatric cancer and other life-threatening diseases of childhood. Headquartered in Memphis, Tennessee, it is the first and only National Cancer Institute-designated Comprehensive Cancer Center devoted solely to children. Recognized as one of the world’s premier pediatric research and treatment institutions, St. Jude focuses on conditions like acute lymphoblastic leukemia and brain tumors. The hospital treats about 8,600 children each year and shares research and treatments to improve survival rates for children worldwide through its global initiatives.

📋 Description

• Provide precertification of inpatient hospitalizations and outpatient procedures and services requiring authorization • Perform telephonic and/or concurrent review of inpatient hospitalizations and extended courses of outpatient treatment • Analyze each request and identify appropriate guidelines and regulatory requirements • Apply clinical decision-making to assess clinical acuity and treatment/service appropriateness • Create case summary evaluations for requests failing medical necessity criteria • Collaborate with the medical director or designee for review and disposition • Ensure denial letters are issued within mandated regulatory timelines • Create provider communications meeting accrediting and regulatory requirements, including clinical content and readability standards • Notify providers in writing of decision-making rationales • Collaborate with health plan disciplines and meet routinely with contracting and provider relations • Screen, identify, and refer potential members to case management and program or coverage evaluations • Identify and refer potential quality-of-care issues and fraud and abuse to the appropriate department

🎯 Requirements

• Diploma in nursing required, or an associate degree in nursing, or an associate degree in a related field accepted by the Texas Board of Nursing for obtaining and maintaining an RN license • RN license by the Texas Board of Nursing or Nursing Licensure Compact required • 3 years of nursing experience required • Respiratory fit testing required for successful candidates • Bachelor's degree in nursing preferred

🏖️ Benefits

• Equal opportunity employer • HEART values workplace emphasizing that teammates feel valued, supported, and empowered • Respiratory fit testing in compliance with occupational health and safety standards

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