UM Nurse Specialist (HYBRID) in Dallas, Texas at TEXASCONNECT INC

Open to Texas residents ONLY.

The UM Nurse Specialist provides organizational support in the Utilization Management Department; efficiently processes Pre-Service Authorization requests within regulated turn-around times. Works closely and efficiently with UM Coordinators.

Texas Connect, Inc. (TCI) is a Management Services Organization (MSO). As an MSO, we are dedicated to providing business and administrative services for healthcare providers, such as medical practices and hospital systems, allowing them to focus on patient care. TCI handles crucial backend functions, such as Information Technology, Billing, and Medical Coding. This allows our client healthcare organizations to delegate these and other essential, but non-medical tasks to TCI to improve operational efficiency. 
SPECIFIC SKILLS NEEDED

• Current knowledge of Managed Care and Health Plan Division of Financial Responsibilities (DOFR)
• Ability to apply appropriate UM criteria
• Excellent communication skills
• Strong organizational capabilities.

EDUCATION/EXPERIENCE/TRAINING

Required:
• High school diploma or GED
• Active California LVN License
• Minimum two years’ experience in a health plan or managed care IPA or Medical Group in UM.

Preferred:
• Passed the Bilingual Fluency Assessment for Clinicians (BFAC Certified) by Language Line Solutions