Texas Licensed Utilization Review Nurse
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Job Summary
To support the Health Services Department, a Texas Licensed Utilization Review Nurse will work remotely, managing a high volume of outpatient and inpatient case reviews while maintaining open availability from 8:00 AM to 8:00 PM, Monday through Sunday, including rotating weekend and holiday coverage.
Key responsibilities
- Complete prior authorization and retrospective reviews for various medical services and equipment
- Refer cases to Medical Directors as necessary and maintain compliance with regulations and internal policies
- Perform additional duties as requested to support the department's needs
Required qualifications
- Active and unrestricted LVN license in Texas; compact license preferred
- Proficiency in Microsoft applications, including Word, Excel, and Outlook
- Minimum of two years of experience in health plans, IPAs, or MSOs
- Strong interpersonal skills and ability to collaborate effectively with team members and leadership
- Experience in educating and training staff
Complete Job Description
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