Utilization Management RN or RN Case Manager
Posting Date: 08/17/2017
Closing Date: Until Filled
Reports to: Team Manager
• 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.
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