Top 14 Utilization review nurse Jobs in Georgetown Tx

Utilization Management Nurse
TEXAS INDEPENDENCE HEALTH PLAN INC —Austin, TX
- Weekends as needed
- Hybrid work
- Nursing
- Microsoft Excel
- Microsoft Outlook
Quick Apply
Clinical Quality & Utilization Review Specialist
Central Health —Austin, TX
- Full-time
- Nursing
- Doctoral degree
- RN License
Nurse Reviewer
Health & Human Services Comm —Austin, TX
- $4,801.16 - $7,761.50 a month
- Online Application
- Nursing
- Microsoft Outlook
- RN License
- Health insurance
- Opportunities for advancement
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Registered Nurse Case Manager
Ascension —Austin, TX
- Full-time
- Nursing
- RN License
- Hospital
- Disability insurance
- Health insurance
10d
Registered Nurse Case Manager
true true —Pflugerville, TX
- $71,206.36 - $85,753.89 a year
- Full-time
- Vital signs
- HIPAA
- Inpatient
Quick Apply
9d
Nurse Educator
Health & Human Services Comm —Austin, TX
- $7,532.75 - $8,886.16 a month
- Extended hours
- 18 years or older
- CPR Certification
- Nursing
- Health insurance
- Opportunities for advancement
Quick Apply
7d
Home Health Clinical Manager
Centerwell —Austin, TX
- $84,900 - $116,800 a year
- Full-time
- CPR Certification
- Nursing
- RN License
- Paid parental leave
- Paid holidays

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utilization review nurse jobs near georgetown tx

Utilization Management Nurse

TEXAS INDEPENDENCE HEALTH PLAN INC -
Austin, TX

Quick Apply

Job Details

Full-time

Qualifications

Nursing
Microsoft Excel
Microsoft Outlook
Medicare
LVN
RN License
Managed care organization experience
Word embeddings
Medicaid health insurance
Utilization management
Resource utilization in healthcare
Acute care experience

Full Job Description

Primary Responsibilities

The Utilization Management Nurse will determine the medical appropriateness of inpatient and outpatient services by evaluating medical guidelines, benefit determination and compliance with state mandated regulations.

Essential Functions

Perform concurrent, retroactive and pre-service authorization reviews for inpatient and outpatient services.
Follow and maintain compliance with CMS requirements, may include after-hours, holiday and weekend coverage.
Collaborate with staff, physicians, care/service coordinators, and medical directors to coordinate and provide the level of care necessary to meet member’s health need.

Educational/Training Requirements

Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2+ years of clinical nursing experience.
Payor Utilization Management: 3 years recommended experience
Proficiency with Microsoft Office applications, specifically Word, Excel, and Outlook
Proficiency using Milliman Care Guidelines (MCG) and/ or InterQual criteria.

Licensing Requirements

Current unencumbered LVN or RN license in Texas or compact license.

Experience Requirements

2+ years Utilization management experience with a health insurance company (managed care/payer experience required).
UM for Medicare Advantage, Managed Medicaid, Dual SNP Lines of Business, on the payer side.
5+ years of acute clinical experience.
The ability to effect change, perform critical analyses, promote positive outcomes, and facilitate empowerment for members/families.

Location

This position is remote, but requires the employee to live within our service area which can include any of the following areas within Texas: Rio Grande Valley, DFW, greater Austin, greater Houston, greater San Antonio, Coastal Bend, or Laredo.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing the duties of this job, the employee is regularly required to talk and hear. Specific vision abilities required by this job include close vision, distance vision, and ability to adjust focus. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Work Location: Hybrid remote in Austin, TX 78789

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Refine Your Search

utilization review nurse jobs in georgetown tx

Utilization Management Nurse

Clinical Quality & Utilization Review Specialist

Nurse Reviewer

Registered Nurse Case Manager

Registered Nurse Case Manager

Nurse Educator

Home Health Clinical Manager

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