Texas RN Utilization Review
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
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
