Texas Licensed Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review Nurse (RN).

Key Responsibilities

• Conducts clinical reviews and presents recommendations based on guidelines and organizational policies
• Performs prior authorization and concurrent reviews focusing on utilization management and care coordination
• Monitors clinical quality concerns and escalates issues as necessary

Required Qualifications

• Current, unrestricted nursing license (Texas or Compact License)
• Diploma from an accredited nursing school
• 1-2 years of experience in utilization management at a health plan
• 3-5 years of clinical experience in a hospital or ambulatory setting
• Knowledge of medical and insurance terminology, including CPT/ICD10