Utilization Management RN
Posting Date: 10/12/2018
Closing Date: Until Filled
Reports to: Medical Intelligence Manager
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
Qualifications / Skills Required
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.
• 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.
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