Utilization Review LVN/Practical Nurse
Posting Date: 11/09/2017
Closing Date: Until Filled
Reports to: Team Supervisor
Qualifications / Skills Required
Utilization Review for DME, Surgical, Imaging, (Inpatient/Outpatient) Cases and other Ancillary Services.
Adheres to all Turnaround Time timelines per NCQA Standards.
Assisting with Intake staff in taking calls and transferring/assigning notification events and calls to Utilization Review Nurses.
Utilization of established systems necessary for Medical Necessity and Evidence Base Medicine determinations.
Performs other duties as assigned by Supervisor and/or Manager.
Maintains CEUs for current licensure and independently updates knowledge on job related duties.
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.
Texas Licensed Vocational/Practical Nurse with at least five years of hospital experience, at least two years recent experience in health services, quality assurance, utilization management or insurance/employee benefits.
Proficient in MS office; Excel. Must have excellent computer skills.
Recent knowledge of the following: Case Management concepts; Surgical procedures; DME equipment.
Familiar with health care review criteria and ICD-9, CPT, and LOS coding reference.
Ability to work independently and within a team environment.
Effective interpersonal and strong organizational skills.
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