Texas Licensed Utilization Manager

Job Summary

A company is looking for a Manager of Utilization Management.

Key Responsibilities

• Oversee utilization review activities, including pre-certification and concurrent reviews, to manage inpatient care and discharge planning
• Lead the development of processes and workflows to enhance quality outcomes and ensure compliance with regulatory standards
• Collaborate with cross-functional teams to analyze utilization patterns and implement solutions for quality improvement

Required Qualifications

• Bachelor's Degree in Nursing or equivalent experience
• Registered Nurse (RN) license in Texas and valid Texas driver's license
• 8+ years of nursing experience in Utilization Review or Case Management
• 5+ years in a supervisory or management role, or equivalent experience in Utilization Review or Case Management
• Knowledge of ICD-10 coding, managed care payment methodologies, and proficiency in MS Office