Utilization Management RN at TEXASCONNECT INC – Lubbock, Texas

This position will be on-site in Dallas, Texas.

There are 6 open positions for this role.

The Utilization Management (UM) RN performs utilization review activities, including, but not limited to, precertification, ensures appropriate level of care and status (Inpatient, Outpatient, and Observation) throughout admission and performs initial reviews, concurrent reviews, and retrospective reviews according to guidelines. Determines the medical necessity of requests by performing first level reviews. The UM nurse ensures a process that is efficient for providing care, ensuring timely and appropriate levels of care for the incoming patients. UM RN is responsible for preparing cases for Physician Advisor for 2nd level review. UM RN delegates accordingly to LVN and works in conjunction with a multi-disciplinary team to manage the care of patients in an ethical and fiduciary responsible manner. This position is hybrid with remote and in-office assignment.

SPECIFIC SKILLS NEEDED

• Knowledge of payer requirements
• Excellent verbal and written communication skills
• Ability to follow chain of command
• Highly developed ability to multi-task and maintain focus
• Proactive, can-do approach and desire to build positive working relationships through collaborative
problem-solving
• Self-motivated and results oriented. Must be able to demonstrate sound decision making, flexibility
and prioritization skills with minimal supervision.
• Strong organizational skills
• Basic computer skills: Word, Excel, PowerPoint, Outlook. Able to utilize multiple electronic systems.
Type 50 WPM
• Ability to apply appropriate UM criteria

EDUCATION/EXPERIENCE/TRAINING

Required:
• Current licensure as an RN in the state of California.
• A minimum of 2 years of bedside nursing experience in an acute care setting.
• A minimum of 2 years of case management experience.

Preferred:
• Certified Case Manager or Accredited Case Manager
• BSN
• Experience with Milliman Care Guidelines (MCG)