Registered Nurse - Utilization Case Management - FT

UVALDE MEMORIAL HOSPITAL•Uvalde, TX

17d•Onsite

About The Position

Uvalde Memorial Hospital is seeking a compassionate and experienced Registered Nurse for its Case Management Department. The role combines clinical expertise, critical thinking, care coordination, and patient advocacy to help patients receive appropriate care and prepare for a safe transition after hospitalization. The nurse works with physicians, nurses, social workers, therapists, payers, and community resources to support appropriate utilization of healthcare services, reduce unnecessary hospital stays, and develop individualized discharge plans. The position is full-time, non-exempt, and based at the hospital in Uvalde, Texas, with a Monday–Friday schedule from 8 a.m. to 5 p.m.

Requirements

Active Texas Registered Nurse (RN) license.
Current Basic Life Support (BLS) certification.
Certification in Case Management (CCM) or Accredited Case Manager (ACM) required within 24 months of hire.
Two to five years of acute care clinical nursing experience.
Strong clinical assessment, critical thinking, and problem-solving abilities.
Excellent communication and interpersonal skills when working with patients, families, providers, and interdisciplinary teams.
Strong organizational skills and ability to manage multiple cases, documentation requirements, and follow-up needs.
Understanding of hospital operations, clinical guidelines, medical necessity criteria, and payer requirements, including Medicare, Medicaid, and private insurance.
Ability to balance patient advocacy, quality care, appropriate resource utilization, and timely discharge planning.

Nice To Haves

Bachelor of Science in Nursing (BSN) is strongly preferred.
Experience involving case management, utilization review, or discharge planning in a hospital setting is preferred.
Additional relevant certifications, such as Certified Discharge Planner, are a plus.

Responsibilities

Perform utilization reviews for admissions, continued stays, and services to evaluate medical necessity and appropriate use of healthcare resources.
Review care against clinical guidelines, payer requirements, and hospital protocols.
Document utilization findings, care decisions, authorizations, and denials accurately.
Identify opportunities to reduce unnecessary interventions and lengths of stay while maintaining quality patient care.
Complete comprehensive patient assessments considering medical, psychosocial, and functional needs.
Develop individualized care and discharge plans with the interdisciplinary healthcare team.
Begin discharge planning early in hospitalization and continually assess readiness for the next level of care.
Coordinate post-discharge resources, including home health, rehabilitation, outpatient services, physical therapy, and durable medical equipment.
Work with insurance providers to facilitate authorizations and ensure services meet payer requirements.
Educate patients and families about care plans, treatment needs, medications, discharge instructions, and follow-up care.
Advocate for patients and identify and address barriers to safe discharge.
Collaborate with physicians, nursing staff, social workers, therapists, and other team members to promote continuity of care.
Provide leadership with timely updates on utilization patterns, patient progress, discharge efficiency, and outcomes.
Participate in quality improvement initiatives focused on reducing readmissions, improving care delivery, and strengthening discharge processes.
Maintain compliance with HIPAA, The Joint Commission, federal and state regulations, hospital policies, and other applicable standards.