Utilization Management Assistant Jobs in Dallas, TX

Palm Primary Care is a rapid growing company currently seeking an experienced RN Clinical Coordinator with leadership experience to join our team.

The RN Clinical Coordinator performs a variety of tasks and coordinates the plans of care for hospital and nursing home patients, from admission to discharge to ensure the continuation of care is provided effectively and efficiently.

Reports directly to the Senior Director of Utilization Management in the Utilization Management Department.

Responsibilities include:

• Admit new clients by reviewing records and applications; conduct orientations.
• Communicate the daily tracking of all hospital/nursing home admissions and discharge for both statistical and cost management purposes.
• Determine clients' requirements by completing intake interviews; Determine need for therapeutic medical, psycho-social, and psychiatric evaluations, review therapist evaluations, treatment objectives, and plans.
• Establish treatment programs by setting schedules and routines; coordinate services being provided; arrange resources- including transportation and escort.
• Monitor cases by verifying clients' attendance; observe and evaluate treatments and responses; advocate for needed services and entitlements; obtain additional resources; ability to intervene in moments of crises by providing personal support.
• Maintain clients' records by reviewing case notes, logging events and progress.
• Communicates with PMC managers on members discharged from inpatient facilities to assure appropriate medical care follow up
• Obtain weekly update on all nursing home patients
• Communicate potential catastrophic and stop loss patients
• Identify patients related to possible subrogation and/or cost allocations
• Coordinate the transfers of patients as instructed by the Medical Director or PCP.
• Arrange direct admissions to hospitals and placement in nursing homes
• Assist PCP in placing patients at SNF
• Monitor length of stay (LOS) for both hospital and nursing home patients and make necessary discharge arrangements
• Communicate clients' progress by conducting weekly interdisciplinary meetings and evaluations, disseminating results and obstacles to therapeutic team and family, identify treatment influences.
• Improve staff competence by providing educational resources; balancing work requirements with learning opportunities; evaluating the application of learning to changes in treatment results.
• Improve treatment results by studying, evaluating, and re-designing processes, implementing changes, rewriting policies and procedures.
• Improve financial status by analyzing results, monitoring variances, identifying trends, and recommending actions to management.

Requirements:

• Proven working experience in case management- including as an RN, medical, mental health care manager or a related job experience
• Excellent knowledge of case management principles, management and reimbursement
• Previous experience with psychological aspects of care
• Effective communication skills
• Excellent organizational and time management skills
• Familiarity with professional and technical emerging knowledge
• Problem solving skills and ability to multi-task
• Compassionate with teamwork skills
• Knowledge of terminology CPT codes and ICD 10
• Bilingual preferred
• Knowledge of InterQual or Milliman Care Guidelines preferred

Minimum Qualifications: Active TX RN license, minimum 3 years of RN Clinical Coordinator experience.

Job Type: Full-time

Salary: From $75,000.00 per year (negotiable based on experience)

Benefits:

• 401(k)
• Dental insurance
• Employee assistance program
• Flexible spending account
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• Day shift
• Monday to Friday

Ability to commute/relocate:

• Dallas Area: Reliably commute or planning to relocate before starting work (Required)

Experience:

• Case management: 3 years (Required)

Work Location: Hybrid  (In-office, On-site 3 locations)
Palm is an equal opportunity employer that is committed to diversity and inclusion in the workplace. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
This policy applies to all employment practices within our organization, including hiring, recruiting, promotion, termination, layoff, recall, leave of absence, compensation, benefits, training, and apprenticeship. Palm makes hiring decisions based solely on qualifications, merit, and business needs at the time.

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