Texas Licensed Utilization Review Nurse

Job Summary

To support optimal patient health and resource utilization, the full-time Texas Licensed Utilization Review Nurse will manage medical necessity processes, secure authorizations from payers, and collaborate with healthcare teams in a remote setting.

Key responsibilities

• Provide accurate medical necessity screening and submit for Physician Advisor review
• Secure and document authorization for services from payers and manage concurrent disputes
• Maintain timely and complete documentation in the case management system, including patient demographics and insurance information

Required qualifications

• Graduate of an accredited school of nursing
• 2 years of acute hospital or behavioral health patient care experience, with at least 1 year in utilization review
• Current RN license for the state of practice
• Preferred: Academic degree in nursing (bachelor's or master's)
• Preferred: Accredited Case Manager (ACM) certification