CareersUtilization Management RN

Current Job Openings

Utilization Management RN

Posting Date: 10/12/2018
Closing Date: Until Filled

Reports to: Medical Intelligence Manager
Exempt, Non-Supervisory

Responsibilities

Posting is for Registered Nurses Only In the Austin, Texas Area

 

RNs, are you looking for a place with daytime hours, awesome co-workers, opportunities for advancement and excellent benefits? We are proud to be and equal opportunity workplace and an affirmative action employer. TML MultiState IEBP offers a retirement plan thru the Texas Municipal Retirement System as well as an impressive benefits package that includes healthcare benefits, life benefits, Long Term Disability and paid vacations/personal time for our employees.

 

Here is the job:

 

Posting is for Registered Nurses Only for this onsite position in Austin, Texas

  • Must have experience in Utilization Management which includes one or more of the following: Oncology /Chemotherapy and Radiation plan of care knowledge; Complex Medical-Surgical disease states;
  • Transplants and NICU. • Submit reviews to Medical Director and/or to Independent Review Organizations.
  • Conducts prospective, concurrent, retrospective and appeals for utilization management including inpatient services, outpatient services, surgeries and behavioral health
  • Document clinical information from faxed clinical along with verbal clinical obtained and creates related authorizations, denial and declination letters.
  • Work with facility Case Managers/Discharge Planners regarding the most appropriate Level of Care for members
  • Adheres to department guidelines and NCQA standards.
  • Some weekends may be required.


Qualifications / Skills Required

• Must have current, unrestricted Texas RN license.

• Payor based Utilization Review or Case Management Experience, CCM preferred.

• Oncology; Medical/Surgical; ICU experience.

• Must be able to multi-task/prioritize and be organized.

• Works well under pressure and can meet strict timelines.

• Ability to work independently and in a team environment as well.

• Knowledge of InterQual; Word and Excel.

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. eoe.



To Apply
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 to:
TML MultiState IEBP
Attn: Human Resources
P.O. Box 140644
Austin, TX 78714-0644