Utilization Management RN/ Supplemental

Houston, Texas, This a Supplemental/Hourly Position – No Benefits The UM RN performs utilization review of Community members requiring authorization for health services. The UM RN helps ensure proper data entry of authorization in the managed care platform, and initiate the approval process for requested services/treatments utilizing nationally recognized evidenced based clinical criteria and/or internal policy. s, protocols, and procedures. This position screens and reviews clinical information for the most appropriate service areas within Community; makes referrals to high risk perinatal team, complex case management and disease management. The UM RN works closely with the Medical Directors and refers requests that do not meet medical necessity criteria. The UM RN has heavy telephonic and facsimile contact with providers and their representatives and is responsible for meeting required performance and quality metrics within established timelines. QUALIFICATIONS: RN, Associates Degree required, BSN preferred, unrestricted TX license required Two years’ clinical experience in an acute care setting. One year of utilization management experience in a managed care environment required. OTHER SKILLS: Above Average Verbal (Heavy Public Contact) Writing /Composing: Correspondence / Reports Analytical, Mathematics, Medical Terminology, MS Word Able to work independently under general instructions and working within a team environment, Able to apply the nursing process and use critical thinking.

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