UM Nurse Specialist, LVN (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.

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, or willingness to obtain
• 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