Utilization Review Nurse - Texas (Remote)
*REMOTE - Candidates must be based in Texas: Travis/Williamson/Dallas/Collin Counties*
JOB DESCRIPTION:
RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan.
JOB RESPONSIBILITIES:
- This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services, and serving as liaison between providers and medical and network management divisions.
- Collects clinical and non-clinical data.
- Verifies eligibility.
- Determines benefit levels in accordance to contract guidelines.
- Provides information regarding utilization management requirements and operational procedures to members, providers, and facilities.
- Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations.
- 3 years of clinical experience in a Physician's office, Hospital/Surgical setting, or Health Care Insurance Company.
- Knowledge of medical terminology and procedures.
- Verbal and written communication skills.
- Utilization Management experience.
- MCG or InterQual experience