Texas Licensed Utilization Review RN

A company is looking for a RN Utilization Review Remote. Key Responsibilities Review clinical information to authorize inpatient and outpatient care, referring cases to the Medical Director as necessary Assist in discharge planning and coordinate care for hospitalized and medically complex members Maintain knowledge of referral systems, verify member eligibility, and meet performance and quality metrics Required Qualifications Current RN license in Texas Three years of clinical experience in an acute setting, including three years in Utilization Review/Management Experience with Texas Medicaid, CHIP, and marketplace lines of business Proficient in Microsoft Office (Word, Outlook, Excel) Must have personal equipment including dual screens and high-speed internet

Mar 20, 2025 - 23:50

A company is looking for a RN Utilization Review Remote. Key Responsibilities Review clinical information to authorize inpatient and outpatient care, referring cases to the Medical Director as necessary Assist in discharge planning and coordinate care for hospitalized and medically complex members Maintain knowledge of referral systems, verify member eligibility, and meet performance and quality metrics Required Qualifications Current RN license in Texas Three years of clinical experience in an acute setting, including three years in Utilization Review/Management Experience with Texas Medicaid, CHIP, and marketplace lines of business Proficient in Microsoft Office (Word, Outlook, Excel) Must have personal equipment including dual screens and high-speed internet