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Role Description

This role involves evaluating medical necessity for admissions and service requests to ensure patients receive the most appropriate care at the right time.

• Lead the discharge planning process by collaborating with the healthcare team to create seamless transitions and safe returns home for patients.
• Navigate complex case management scenarios, providing expert consultation to resolve barriers to care and optimize patient outcomes.
• Ensure full compliance with federal and third-party regulations, protecting the integrity of our clinical services and reimbursement processes.
• Resolve documentation and reimbursement challenges to support the department in reducing claim denials and improving operational efficiency.

Qualifications

• Licensed Registered Nurse credentialed from the Texas Board of Nursing or current home state license for multi-state license recognition "Compact State" obtained prior to hire date or job transfer date required.
• Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire.

Requirements

• Pediatric Utilization Management experience required.

Benefits

• Comprehensive health coverage: medical, dental, vision, prescription coverage and HSA/FSA options
• Financial security & retirement: employer-matched 403(b), planning and hardship resources, disability and life insurance
• Time to recharge: pro-rated paid time off (PTO) and holidays
• Career growth: Ascension-paid tuition (Vocare), reimbursement, ongoing professional development and online learning
• Emotional well-being: Employee Assistance Program, counseling and peer support, spiritual care and stress management resources
• Family support: parental leave, adoption assistance and family benefits
• Other benefits: optional legal and pet insurance, transportation savings and more