CSI Companies is hiring for a Clinical Case Manager (Utilization Review) for our healthcare client based Little Rock, Arkansas.
Hours: Full-time; rotating holidays
Location: Onsite – Little Rock, AR 72211
Pay: $70-75K based on experience and credentials
Position Type: Direct Hire
Why This Opportunity?
- Top Healthcare System: CSI partners with leading healthcare systems that are committed to innovation and operational excellence.
- Professional Growth: Gain experience working with a renowned healthcare organization while working remotely from any location.
Job Summary:
We are seeking an experienced Clinical Case Manager (UM) who will be responsible for the management and oversight of care coordination and utilization review for a designated patient caseload. Using the nursing process, the Case Manager ensures that clinical and financial outcomes are optimized, focusing on age-appropriate care and diagnosis for specific populations.
This role involves applying medical necessity criteria and guiding clinical staff in their appropriate use. The Case Manager works closely with interdisciplinary teams to achieve the best care outcomes while ensuring efficient resource utilization. This role is perfect for those seeking to make an impact through efficient care coordination and financial optimization in a dynamic hospital setting
Job Responsibilities:
Utilization Review:
- Maximize positive financial outcomes by analyzing resource utilization.
- Ensure appropriate coding and optimize reimbursement.
- Monitor clinical paths and address inefficiencies in interdepartmental systems.
- Conduct admission and continued stay reviews in a timely manner.
- Apply consistent utilization review criteria for admission, continued stay, and discharge readiness.
- Collaborate with attending physicians regarding case denials and appeals.
- Work with the Case Management Director to improve processes and address inefficiencies.
- Maintain clear and accurate communication with patients, families, physicians, and staff.
- Contribute to modifying nurse and physician practice patterns to improve quality and patient satisfaction.
Other:
- Keep the Case Management Director informed of any challenges and suggest potential solutions.
- Actively participate in peer education and development.
- Develop and follow work plans, adhering to deadlines.
- Prioritize assignments and manage workload efficiently.
- Maintain knowledge of hospital policies and procedures and adhere to age-specific competencies.
- Attend departmental meetings and in-services (80% attendance required).
- Demonstrate teamwork and communicate effectively in a professional manner.
- Uphold safety standards and handle stress effectively.
- Develop strong customer relationships, meeting their needs in a professional manner.
- Stay current with professional knowledge and trends in the area of expertise.
- Effectively communicate information to staff and stakeholders.
- Maintain positive working relationships with internal and external customers.
- Demonstrate a willingness to take on additional tasks as needed.
Qualifications
- 2+ years clinical experience in utilization review
- 2+ years in cardiovascular nursing and case management experience is highly preferred
- Strong knowledge of disease processes and treatment protocols to drive guidelines and determinations for appropriate level of care; Millman care guidelines
- Registered Nurse (RN) from an accredited nursing program required, Bachelor of Science in Nursing (BSN) preferred.
- Current RN license required that includes Arkansas (Nurse may hold licensure from a state within the Nurse Licensure Compact)
- Technically savvy: Proficient Microsoft Office (including creating and generating reports in Excel), familiarity with EMR systems
- Ability to interact effectively with staff, physicians, patients, and families, exhibiting tact, patience, and professionalism. Sensitivity to cultural and bilingual issues is essential.
- Ability to comprehend and interpret complex clinical material. Must be able to read, write, and comprehend instructions at a college level.
Who Should Apply?
If you're a RN with at least 2 years of clinical experience, preferably in cardiovascular nursing, and a background in case management, we encourage you to apply!
About Us
The CSI Companies is a recruiting firm established in 1994 that has been awarded “Best of Staffing” for nearly a decade. We provide outstanding services to the world's leaders in the healthcare field as well as other organizations. For consideration, please submit your resume with all of your relevant experience included on it for immediate consideration.
Benefits Offered:
- Weekly pay
- Medical, dental, and vision coverage
- Voluntary Life and AD&D coverage
- Paid Training
- Opportunity for advancement upon performance and availability