Texas Licensed Utilization Review Nurse

Job Summary

A company is looking for a Utilization Review RN.

Key Responsibilities

• Prepare clinical reviews and present recommendations to physician reviewers
• Conduct prior authorization and retrospective reviews focusing on utilization management and care coordination
• Monitor clinical quality concerns and assist with coding and reimbursement issues

Required Qualifications

• Current, unrestricted nursing license (Texas or Compact License)
• Diploma from an accredited school/college of nursing
• 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