CareersUtilization Review Nurse

Current Job Openings

Utilization Review Nurse

Posting Date: 03/01/2017
Closing Date: 06/30/2017

Reports to: Supervisor/Manager
Exempt/Non-Supervisory

Responsibilities
THIS POSITION IS ONSITE AND MAY REQUIRE WORKING EVERY OTHER WEEKEND • Conducts prospective, concurrent and retrospective utilization management including inpatient services, outpatient services, surgeries and behavioral health • Submit reviews to Medical Director and/or to Independent Review Organizations • Creates authorization, denial and declination letters • Document clinical information from faxed clinical along with verbal clinical obtained • Adheres to department guidelines turnaround time in regards to processing events, sending letters, documentation, referring cases and transferring cases • Administrative duties as assigned • Protects the confidentiality, integrity and availability of information and records that TML MultiState IEBP creates, receives, maintains or transmits by complying with IEBP policies and procedures, including policies and procedures on physical, administrative and technical safeguards

Qualifications / Skills Required
• A Texas Licensed RN with 3-5 Prior Utilization Review experience • Med Surg/ICU experience • MultiTask- Organizational skills • Knowledge of ICD 10 and CPT codes • Ability to work independently and within a team environment • Knowledge of Excel and Word • Knowledge of Interqual • Familiarity with health care delivery system, utilization management activities and managed care methodology • 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