Hours of Work :

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Part Time (United States of America)

Job Description :

Your Job: In conjunction with and in support of the physician-led multidisciplinary care team, assures the appropriate use of clinical resources to accomplish the optimal clinical outcomes. The above is accomplished through the use of medical staff or organizational accepted criteria for determining appropriateness for admission, level of care, and discharge, coordination of patient care through coaching and mentoring care givers, case managing selected cases, and facilitating discharge/transition planning. Participates in ongoing clinical improvement, hospital, and medical staff quality initiatives while supporting the mission, vision, value and strategic goals of Methodist Health System. Your Requirements: • Bachelors of Science degree in Nursing — PREFERRED • Associates Degree in Nursing with insurance or hospital case management experience will be considered. • Current license to practice professional nursing in the state of Texas — REQUIRED for Nursing professionals • Current license from respective agency for non-nurse professionals- PREFERRED • CCM in Case Management — PREFERRED Your Responsibilities: • Assures that appropriate application of internal and external utilization criteria for MMC patients • Acts as resource for staff regarding these criteria and presents education regarding application of the criteria and issuance of HINN letters • Maintains general medical-surgical clinical knowledge; 16 CEUs /year related to med-surg population or Medical Management topics • Identifies opportunities for improved performance to Medical Management staff regarding denial management • Leads orientation of new staff in accordance with departmental guidelines • Identifies methods to avoid denials and reports trends to individual care units and to pertinent nursing leadership staff • Coordinates tracking and monitoring of all activities related to denial/ appeal process within departmental standards and time frames; Identifies reason for denials • Returns appeal requests for denials determined to be technical or those received after the deadline has passed to CBO with explanation • Tracks and analysis’s denials into categories ;reason, day of stay, physician, payer, DRG or MDC, care unit; Incorporates PAD analysis of findings in appropriate manner • Identifies barriers to achievement of departmental goals related to denial management and appropriately reports those suggestions for improvement

Methodist Celina Medical Center is located on a 40+ acre campus just off of Dallas Parkway, and will serve as the community’s first full-service hospital, serving Celina and surrounding communities. The four-story medical center will open with 51 beds, with plans for expansion, and will feature a range of services including cardiology, women’s services, orthopedics, robotic surgery, and more. The campus will also include a 40,000-square-foot medical office building.

The $237 million facility will be one of Celina’s largest employers in the fastest growing city in the country. We strive to have a diverse workforce that reflects the communities we serve.