Job Summary
A staffing agency is searching for a person to fill their position for a Remote Utilization Review Registered Nurse.
Candidates will be responsible for the following:
- Performing utilization review activities, including pre-certification, concurrent, and retrospective reviews according to guidelines
- Determining medical necessity of each request by applying appropriate medical criteria to first level reviews
- Utilizing decision-making and critical-thinking skills in the review and determination of coverage for medically necessary healthcare
Applicants must meet the following qualifications:
- Current, unrestricted Texas RN license or compact license
- 2+ years of experience in managed care OR 5+ years nursing experience
- Strong problem solving and analytical skills
- Proficient in PC Software computer skills
- Excellent communication skills both verbal and written skills
- Ability to interact productively with individuals and with multidisciplinary teams with minimal guidance
