Texas Licensed Utilization Review RN

Job Summary

A company is looking for a Utilization Review RN to fill a remote position in Houston, TX.

Key Responsibilities

• Review clinical information to authorize medically necessary inpatient and outpatient care using approved medical guidelines
• Assist in discharge planning and coordinate care for hospitalized and medically complex members
• Maintain knowledge of referral and provider software systems, ensuring accurate processing of authorization requests

Required Qualifications

• Current RN license in Texas
• Three years of clinical experience in an acute setting, with three years in Utilization Review/Management
• Experience with Texas Medicaid, CHIP, and marketplace
• Proficiency in Microsoft Office (Word, Outlook, Excel)