Medical Intelligence Lead Nurse RN
Posting Date: 04/18/2018
Closing Date: Until Filled
Reports to: Medical Intelligence Supervisor/Manager
Qualifications / Skills Required
Conducts prospective, concurrent and retrospective utilization management.
Assists Population Health with Case Management and Health Coaching.
Assists with training and orientation of staff, physician consultants, health service providers and covered Individuals to specific areas within the Medical Intelligence Dept. which includes Utilization Review; Utilization Management and Population Health.
Develops new guidelines and workflow processes for Medical Intelligence staff on a regular basis, which includes creating technical training and documentation.
Assist Supervisors and /or Manager with Medical Intelligence departmental reports, including quality and assurance, necessary for data analysis and workflow improvement.
Participates in NCQA activities which includes: gathering data, assisting with analysis necessary for qualitive and quantitative reports.
Knowledge of Case management, Utilization Management/Utilization Review and Population Health/Coaching concepts.
Familiarity with health care delivery system and managed care methodology.
Familiarity with health care review criteria and ICD-10, CPT and LOS coding reference.
Familiar with Health Plan Accreditation standards such as NCQA.
Working knowledge of MS Office and other assigned software products.
Preferred: Bilingual skills (Spanish). Preferable to effectively service primary member population. BSN or MSN preferred.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. eoe,
Please submit your resume with a cover letter to Human Resources. Indicate the position you are applying for
and detail how you meet the qualifications listed. You may fax this information to (512) 719-6717
, email us at Email Us
, or mail it
TML MultiState IEBP
Attn: Human Resources
P.O. Box 140644
Austin, TX 78714-0644