About Us

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At Baylor Scott & White Health, we support the health of people, families, and communities. Baylor Scott and White is Texas's largest not-for-profit healthcare system, encouraging healthy living.

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Our Core Values are:

\n\nWe serve faithfully by doing what's right with a joyful heart.\nWe never settle by constantly striving for better.\nWe are in it together by supporting one another and those we serve.\nWe make an impact by taking initiative and delivering exceptional experience.\n\n

Benefits

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Our competitive benefits package empowers you to live well and provides:

\n\nEligibility on day 1 for all benefits\nDollar-for-dollar 401(k) match, up to 5%\nDebt-free tuition assistance, offering access
to many no-cost and low-cost degrees, certificates and more\nImmediate access to time off benefits\n\n

At Baylor Scott & White Health, your well-being is our top priority. 

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Note: Benefits may vary based on position type and/or level

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Job Summary

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You will review patient cases for medical necessity and help establish inpatient and outpatient service suitability. You'll educate healthcare team on resource use to ensure timely care plan follow-through. Your job includes staying in contact with the patient's health plan and provider's care coordination departments. Your expertise is needed for reviewing medical necessity. Working with the team, you'll verify medical records reflect services provided, ensuring quality care and efficient resource use.

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What You'll Do

\n\nYou will review medical services. Use guidelines to assess appropriateness. \nEvaluate patient needs and requirements.\nYour duties will include reviewing medical records to confirm that the content supports an appropriate level of care.\nShould you encounter cases not meeting medical appropriateness criteria, you'll alert relevant teams and coordinate actions during denials.\nAs part of your role, you'll also streamline the authorization process and anticipate discharge requirements.\nClear communication of issues or trends impacting specific entities to the appropriate management is expected.\nPart of your work will involve identifying and conveying potential quality assurance or risk management issues.\nTo improve patient care, join projects to enhance care coordination and implement evidence-based procedures for best standards.\nIn order to enhance the relationship with providers and members, you'll also perform service recovery tasks.\n\n

What Will Make You Successful In The Role

\n\nAn advanced understanding of healthcare procedures, treatments, terms, conditions, and equipment.\nAn ability to see the world from our customers' eyes and find resolutions to fit their needs.\nProficiency in discharge planning, setting case management referral standards, reviewing utilization, and categorizing levels of care.\nExcellent communication skills with a knack for expressing your thoughts clearly, whether orally or in writing.\nEffective interpersonal abilities to interact positively and cooperatively with a variety of people.\nExceptional critical thinking and problem-solving skills for dealing with complex situations.\nThe ability to juggle multiple tasks and responsibilities while sticking to deadlines.\nProficiency in scrutinizing, understanding, and applying detailed clinical care documentation.\nComputer literacy, especially in Microsoft Office and medical documentation systems.\nCase management certifications, such as Certified Case Manager, are beneficial but not necessary for this position.\n\n

Belonging Statement

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We believe everyone should feel welcomed, valued, and supported. Our workforce should reflect our communities.

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Qualifications

\n\nCompletion of an Associates degree in Nursing is necessary.\nAt least three years of professional experience is required.\nYou must hold a valid Registered Nurse License.\n