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 to optimize 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 on covered services

Required Qualifications

• Associate's Degree or College Diploma in Nursing
• Registered Nurse (RN) licensure
• Experience in utilization management or case management
• Knowledge of state and federal regulatory requirements
• Familiarity with payer negotiation processes