Utilization Review Nurse

Utilization Review Nurse

Top-rated Health Administration Company offers excellent opportunity to grow in a dynamic business. We are located in Katy, just off of Highway 99 and Westpark Tollway.

Essential Functions and Responsibilities:

  • Assuring high quality, cost efficient medical outcomes for those members needing inpatient and/or outpatient preauthorization
  • Reviewing records for medical necessity, level of care, length of stay, experimental/investigational treatment and appropriate coding.
  • Screening for Case Management and Disease Management
  • Assist in maintaining accurate records as well as preparation of reports

Qualifications:

  • Current, unrestricted RN or LVN license in the state of Texas
  • Minimum 2 years of clinical experience as a RN/LVN working directly with patients
  • Knowledge of ICD-9/10, CPT and HCPC coding preferred.
  • Experience with Deerwalk software a plus.
  • Ability to navigate a Windows based environment and create, edit, save and send documents utilizing Microsoft Word & Excel. Ability to navigate Outlook and conduct Internet searches.
  • Proficiency with navigating multiple computer programs simultaneously while talking on the phone.
  • Ability to work independently toward established priorities and goals.
  • Previous experience in a telephonic role is a plus.
  • Bilingual in English and Spanish is a plus.

Please submit resume to HR.T3@90DegreeBenefits.com

Posted 04/14/22

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