Texas Licensed Utilization Review Nurse

Job Summary

A company is looking for a Registered Nurse Utilization Review Full Time Days.

Key Responsibilities

• Facilitate effective resource coordination for optimal patient health and access to care
• Manage the medical necessity process for accurate and timely payment for services
• Ensure compliance with regulatory requirements and provide education related to covered services

Required Qualifications, Training, and Education

• Associate's Degree or College Diploma
• Experience in utilization management and medical necessity processes
• Knowledge of state and federal regulatory requirements
• Understanding of TJC accreditation standards
• Ability to negotiate with payers on a case-by-case basis