Utilization Review Nurse

Job Description

Job Description

***REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson area - 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.

JOB QUALIFICATIONS (Required):

• 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.

JOB QUALIFICATIONS (Preferred):

• MCG or InterQual experience
• Utilization management experience

LOCATION: REMOTE in Texas ( Richardson area ? Dallas/Collin Counties).

POSITION: 6-month assignment