CareersUtilization Management RN or RN Case Manager

Current Job Openings

Utilization Management RN or RN Case Manager

Posting Date: 08/17/2017
Closing Date: Until Filled

Reports to: Team Manager
Exempt, Non-Supervisory

Responsibilities
• 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.

Qualifications / Skills 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.

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