Job Summary

A professional services firm specializing in IT, healthcare, and accounting is seeking a Remote UM Nurse.

Core Responsibilities of this position include:

• Performing concurrent reviews of inpatient & inpatient sub-acute claims as well as performing prior authorization reviews
• Ensuring proper utilization of health services by assessing the member’s needs
• Identifying solutions that promote quality and cost-effective care

Position Requirements Include:

• Current unencumbered LPN license in Texas or compact license
• Minimum of 3+ years of acute clinical experience and 2-3+ years of utilization management experience
• Experience performing utilization management for Medicare Advantage, Managed Medicaid, Duals, & Commercial Lines of Business
• Proficiency working with Milliman “MCG” guidelines
• In-depth knowledge of current standard of medical practices and insurance benefit structures
• Strong knowledge of utilization management processes, standards, and an understanding of managed care