Utilization Review Nurse(Austin/Richardson TX) (Remote)
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AI Summary
The Utilization Review Nurse is responsible for performing initial and concurrent review activities, as well as discharge care coordination. They serve as a liaison between providers and medical management divisions to ensure the quality and effectiveness of medical services.
***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 (Austin area – Travis/Williamson Counties or Richardson area – Dallas/Collin Counties).
POSITION: 6-month assignment
SALARY: $38 - $40 hourly
HOURS PER WEEK: 40
HOURS PER DAY: 8
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