Texas RN Utilization Review

This job has been removed
Location: Remote
Compensation: To Be Discussed
Reviewed: Mon, May 05, 2025
This job expires in: 9 days
Utilization Management Medical Necessity Resource Coordination Payer Negotiation

Job Summary

A company is looking for a Texas RN Utilization Review professional.

Key Responsibilities
  • Facilitate effective resource coordination to optimize patient health and access to care
  • Manage the medical necessity process to ensure accurate and timely payment for services
  • Educate payers, physicians, and staff on covered services and benefits administration
Required Qualifications
  • Associate's Degree/College Diploma required
  • Experience in Utilization Management and case management
  • Knowledge of state and federal regulatory requirements
  • Familiarity with TJC accreditation standards
  • Ability to negotiate with payers on a case-by-case basis
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