AUSTIN TX Utilization Review RN

Job Description

Job Description

About the Role:
Bracane Company is seeking a dedicated and detail-oriented Utilization Review RN to join our team in Austin, TX. This is an exciting opportunity for a clinical professional to make a meaningful impact by ensuring patients receive the right care at the right time. If you're passionate about healthcare quality and patient advocacy, we want to hear from you!

Responsibilities:

• Conduct utilization review assessments to evaluate medical necessity and appropriateness of care
• Perform concurrent, prospective, and retrospective reviews of patient cases
• Collaborate with physicians, case managers, and healthcare teams to coordinate patient care plans
• Apply evidence-based clinical criteria (e.g., InterQual, Milliman) to support review decisions
• Document and communicate review findings accurately and in a timely manner
• Identify opportunities for care improvement and ensure compliance with payer guidelines
• Support denial management and appeals processes as needed

Requirements:

• Active and unrestricted RN license in the state of Texas
• Minimum 2-3 years of clinical nursing experience required
• Prior utilization review, case management, or managed care experience strongly preferred
• Familiarity with InterQual or Milliman clinical criteria
• Strong knowledge of medical terminology, coding, and payer guidelines
• Excellent analytical, communication, and critical thinking skills
• Ability to work independently and manage a high-volume caseload efficiently

About Us:
Bracane Company is a trusted name in healthcare staffing and management solutions, committed to connecting top clinical talent with organizations that need them most. Our clients rely on us for our expertise, integrity, and dedication to quality care outcomes. At Bracane Company, employees thrive in a supportive environment that values their skills and invests in their professional growth.