Utilization Management RN - Clinical Care & Cost Control

WebTPA Employer Services, LLC; Irving (TX); On-site; USD 90,000 - 110,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Retirement plan

Paid time off & holidays

Wellness program

Job summary

WebTPA Employer Services, LLC is seeking an experienced Utilization Management RN to join our team in Texas. You will oversee pre-certification, concurrent review, discharge planning, and cost-effective care management for self-funded employer populations.

The ideal candidate has 5+ years of clinical nursing, a BSN, and an active RN license. Collaboration with providers and cross-functional teams, strong communication, and a patient-centered approach are essential to drive appropriate

Qualifications

• RN with 5+ years clinical nursing and patient assessment experience.
• Graduate of accredited nursing program; RN license in good standing (compact state preferred).
• Knowledge of medical terminology and cost containment practices.
• Strong communication and teamwork across clinical and non-clinical staff.
• Experience in managed care or self-funded employer populations preferred.

Responsibilities

• Pre-certification of emergency, urgent and elective admissions with L0ng stay determinations.
• Concurrent review and extension decisions based on illness severity and service needs.
• Discharge planning to ensure benefit plan compliance and network use.
• Identify alternative care plans approved by all parties within cost constraints.
• Interpreting health plans and coordinating care per plan provisions.
• Evaluate cost effectiveness of treatment plans and post-implementation outcomes.

Skills

RN

Utilization Management

Pre-certification

Discharge planning

Collaboration

Communication skills

Cost containment

Medical terminology

Education

Bachelor's degree in nursing

RN license (Compact state)

Job description

WebTPA Employer Services, LLC is seeking an experienced Utilization Management RN to join our team in Texas. You will oversee pre-certification, concurrent review, discharge planning, and cost-effective care management for self-funded employer populations.

The ideal candidate has 5+ years of clinical nursing, a BSN, and an active RN license. Collaboration with providers and cross-functional teams, strong communication, and a patient-centered approach are essential to drive appropriate