Job Summary

A global healthcare company is seeking a Remote Prior Authorization Utilization Management Registered Nurse.

Core Responsibilities Include:

• Performing utilization review activities, including pre-certification, concurrent, and retrospective reviews according to guidelines
• Conducting rate negotiation with non-network providers, utilizing appropriate reimbursement methodologies
• Documenting rate negotiation accurately for proper claims adjudication

Qualifications Include:

• Current, unrestricted Texas RN license or compact license
• 2+ years of experience in managed care OR 5+ years nursing experience
• Proficient in PC Software computer skills
• Telephonic and/or telecommute experience
• Excellent communication skills both verbal and written skills
• Prior Authorization experience