Responsibilities

This position supervises the Case Manager – Concurrent Review (RN’s). It is responsible for the evaluation of members in a Hospital, Skilled Nursing Facility, LTAC or Acute Inpatient Rehab for benefit determination, medical necessity and appropriate level of care. The Supervisor is responsible for ensuring the Concurrent Review Nurses complete medical necessity and level of care reviews for requested services using sound clinical judgment and appropriately refer cases to the Hospitalist team, Medical Directors or Supportive Medicine for review depending on case findings. The Supervisor, Concurrent Review Nurse will attend all relevant meetings with Medical Directors and other members of the care team and provide input as needed. The Supervisor is responsible for the daily management of caseloads assignment of duties to the individual member of the team. The Supervisor is to ensure that the Case Manager – Concurrent Review nurses are complying with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable (i.e TDI).

Job Title: Supervisor Concurrent Review (RN) – KCA Utilization Management

Clinic Location: Pearland Administrative Office

Department: KCA Utilization Management

Job Type: Full Time

Salary Range: $97,219 – $120,099 (Pay is based on several factors including but not limited to education, work experience, certifications, etc.)

Qualifications

Education

Required: Registered Nurse, CEU requirements

Preferred: Certification in area of specialization, BSN ACP Certification

Experience

Required: 5-7 years of nursing experience in an acute hospital setting OR, equivalent experience in a palliative care or supportive medicine program.

5-7 years of case management or inpatient / outpatient concurrent review experience. EMR experience is required.

Preferred: NA

License(s)

Required: TX RN license, Driver’s license

Preferred: Case Management Certification

Special Skills

Required: Excellent verbal and communication skills, organizational and communication skills.

Preferred: 3 years of Inpatient Concurrent Review experience. Prior leadership/supervisory experience

Other

Required: Experience working with insurance companies to obtain authorizations and pre-certification for medical services.

Ability to work from designated office for collaborative/interactive fulfillment of duties; concentrate in an open-office ‘cubicle’ environment; appropriately and directly interact with other staff members and/or outside associates; perform telephone and/or computer work for extended periods of time; operate office equipment such as a computer, telephone, and copy/scan/fax machine; attend and participate in meetings via phone, computer or in person.

Consistent and prompt attendance at employer worksite is an essential job requirement.

Preferred: Bilingual

Working Environment: Office

About Us

Start your career journey and become a part of a community of renowned Healthcare professionals. Kelsey-Seybold Clinic is Houston’s fastest growing, multispecialty organization with more than 40 premier locations and over 65 specialties. Our clinics are comprised of more than 600 physicians and as we continue to grow, our focus is providing quality patient care by adding to our team of clinical and non-clinical professionals that work together in a convenient, coordinated, and collaborative manner. Enjoy the rewards of a successful career while maintaining a work/life balance by joining our team today and changing the way health cares.

Why Kelsey-Seybold Clinic?

• Medical, Vision, and Dental
• Tuition Reimbursement
• Company Matching 401K
• Employee Reward and Recognition Program
• Paid time off for vacation, sick, and holidays
• Employee Assistance Program
• Continuing Medical Education allowance