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RN-Utilization Nurse


  • Tailored Management
  • 06/06/22
  • Bedford, TX
  • 76021
  • 40.00 / Hourly
  • Full-Time
Schedule: Mon-Fri 8:00AM-5:00PM
Contract: 2/24/2020 - 9/04/2020

Duties:
-Delivers specific tasks assigned by a supervisor in the Utilization Management job family.
-Evaluates services provided to plan members are medically necessary.
-Develops and maintains knowledge of provider organization review procedures.
-Maintains reporting system for Utilization Review.
-Completes day-to-day Utilization Review tasks without immediate supervision, tasks involve a degree of forward planning and anticipation of needs/issues.
-Resolves non-routine issues escalated from more junior team members.

Skills:
-Strong clinical knowledge
-Knowledge of ICD-10 and CPT coding guideline
-Demonstrates strong verbal and written communication skills, negotiations and interpersonal skills.
-Shows leadership (organizational) skills in team orientation, problem-solving, decision-making, conflict resolution, and the ability to work independently.
-Experience with Medicaid and insurance processing and coding, strongly preferred.
-Demonstrated organizational skills, time management, detail orientation, flexibility and ability to work with minimal supervision.
-Strong interpersonal skills
-Intermediate knowledge with Microsoft Office including Outlook, Word, Excel, and PowerPoint

Education:
Registered Nurse (RN) with no restrictions
5 years clinical experience
3 years in utilization review/discharge planning

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