Remote Utilization Review Nurse Drive Quality Care

Telenett; Texas City (TX); Remote; USD 85,000 - 120,000; Full time

Benefits offered by this job

Health insurance

401(k) plan with company match

Paid time off and holidays

Flexible schedule and remote work

Collaborative team environment

Job summary

Telenett is seeking a Remote Utilization Review Nurse to review medical records from a home office and determine medical necessity and care appropriateness. You will work with providers to develop compliant care plans and ensure high-quality, cost-efficient services for clients nationwide.

Ideal candidates have a Texas RN license, 3+ years of clinical experience, strong medical knowledge, and proficient EMR skills.

Qualifications

• Active, unrestricted RN license in Texas is required.
• Minimum 3 years of clinical experience in hospital or managed care.
• Strong medical terminology and treatment modality knowledge.

Responsibilities

• Review medical records to assess medical necessity and appropriateness of services.
• Communicate with providers to gather information and clarify plans.
• Collaborate with care teams to implement patient care plans.
• Apply evidence-based guidelines to ensure quality and cost-effective care.
• Document reviews and communications accurately and timely.
• Identify potential quality-of-care issues and report them.
• Participate in meetings and training to stay current with best practices.

Skills

Independent work

Critical thinking

Communication

Analytical skills

Education

Texas RN license

Tools

EMR systems

Microsoft Office

Job description

Telenett is seeking a Remote Utilization Review Nurse to review medical records from a home office and determine medical necessity and care appropriateness. You will work with providers to develop compliant care plans and ensure high-quality, cost-efficient services for clients nationwide.

Ideal candidates have a Texas RN license, 3+ years of clinical experience, strong medical knowledge, and proficient EMR skills.