Utilization Review Nurse(Austin / Richardson TX) (Remote)

Bracane Company; Richardson (TX); Remote; USD 70,000 - 95,000; Full time

Job summary

A leading insurance company is seeking a Remote RN to work in the managed care industry. The successful candidate will validate treatment plans and ensure quality and efficiency in medical services. This role requires a valid RN license and significant clinical experience, offering a competitive salary based on expertise.

Qualifications

• 3 years of clinical experience required.
• Knowledge of medical procedures.
• Experience in a Physician's office, Hospital, or Health Care Insurance Company.

Responsibilities

• Performing initial and concurrent review activities.
• Discharge care coordination and liaison duties.
• Collecting clinical and non-clinical data.

Skills

Medical terminology

Verbal communication

Written communication

Education

Registered Nurse (RN) license

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.
• 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

LOCATION : REMOTE in Texas (Austin area - Travis / Williamson Counties or Richardson area - Dallas / Collin Counties).