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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
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COMPLETE JOB DESCRIPTION
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