Texas RN Utilization Review

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