Texas Licensed Case Manager RN

Job Summary

Supporting denials, appeals, and compliance activities, the part-time Per Diem Texas Licensed Case Manager RN will conduct patient chart reviews, write appeal letters, and perform audits to ensure regulatory compliance within the Care Management Department.

Key responsibilities

• Conduct patient chart reviews and write appeal letters to address denials and compliance issues
• Perform various audits to support departmental and hospital regulatory requirements
• Utilize sound decision-making and prioritization skills to address patient needs effectively

Required qualifications

• Active LVN CA and TX licenses; RN CA and TX licenses preferred
• Minimum of 2 years acute hospital experience
• Proficiency with main-frame and personal computers
• Knowledge of medical terminology and third-party payor reimbursement methodologies
• Experience in managed care and case management is a plus