Performs technical and administrative work required to evaluate the necessity, appropriateness and efficiency of the use of medical services, procedures and facilities. Supports the North Texas Medical Center utilization management program and the care transitions program utilizing clinical knowledge, expertise, and criteria guidelines. Coordinates care with interdisciplinary team to provide a safe and effective transfer of the patient from the hospital setting to home or post acute care.
- A highly motivated Registered Nurse (RN) experienced with patient flow, resource management, RAC audits, transitional and discharge planning in an acute care setting.
- Assists with the development of and implements the organization's utilization/case management/care transition plans/programs in accordance with the mission and strategic goals of the organization, federal and state law and regulations, and accreditation standards.
- Assists in the development of and implements policies and procedures for prospective, concurrent, and retrospective case review, and reporting quality of care issues identified and reported in the occurrence system
- Reviews each admission for medical necessity.
- Collects, analyzes, and maintains data on the utilization of medical services and resources. Prepares a monthly report summarizing data for quality reporting with length of stay and denials.
- Registered Nurse (RN) in the State of Texas required
- a minimum of three (3) years experience in utilization management, health information management, quality improvement, or a related field.
- Bachelor's degree preferred
Licensed Master Social Worker
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North Texas Medical Center (NTMC) is a 60-bed acute care hospital located in Gainesville, Texas, situated on 52 acres approximately 60 miles north of Dallas-Fort Worth and five miles south of the Texas-Oklahoma border. Governed by the Gainesville Hospital District, the original hospital opened in 1975. In 2004, NTMC celebrated the opening of a new facility to better serve the citizens of Gainesville, Cooke County as well as neighboring counties. Today, the hospital campus has grown to include two professional office buildings housing physicians and medical services.
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NTMC is proud to be accredited by The Joint Commission, a status recognized nationwide as a symbol of quality and our commitment to meeting high performance standards. Dedicated NTMC employees along with skilled physicians provide compassionate care to patients and area residents every day.
Facility services include inpatient medical and surgical care, an intensive care unit, advanced imaging, laboratory, cardiac rehabilitation and outpatient services. The Women’s Center offers customized care for pre-baby needs, labor and delivery, and maternal newborn care. The hospital also provides 24-hour emergency care as a Level IV trauma facility. Throughout the year, NTMC offers a variety of education programs focused on community health and wellness.
The North Texas Medical Center Foundation, a non-profit organization, supports the hospital through donations and gifts to purchase medical equipment and expand needed services.