CareersUtilization Management RN or RN Case Manager Plus

Current Job Openings

Utilization Management RN or RN Case Manager Plus

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

Reports to: Team Manager
Exempt, Non-Supervisory

Responsibilities

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:

  • 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.

**Flexible hours and Working from home are available!

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