Utilization Review Nurse - Texas (Remote) Job at Bracane Company, San Antonio, TX

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  • Bracane Company
  • San Antonio, TX

Job Description

***REMOTE - Candidates must be based in Texas: Travis/Williamson/Dallas/Collin Counties***

JOB DESCRIPTION:

RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan.

JOB RESPONSIBILITIES:
  • This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services, and serving as liaison between providers and medical and network management divisions.
  • Collects clinical and non-clinical data.
  • Verifies eligibility.
  • Determines benefit levels in accordance to contract guidelines.
  • Provides information regarding utilization management requirements and operational procedures to members, providers, and facilities.
JOB QUALIFICATIONS (Required):
  • Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations.
  • 3 years of clinical experience in a Physician's office, Hospital/Surgical setting, or Health Care Insurance Company.
  • Knowledge of medical terminology and procedures.
  • Verbal and written communication skills.
  • Utilization Management experience.
JOB QUALIFICATIONS (Preferred):
  • MCG or InterQual experience

LOCATION: REMOTE in Texas (Austin area - Travis/Williamson Counties and Richardson area - Dallas/Collin Counties).

POSITION: 6-month assignment (Contract to Hire)

SALARY: $38 - $40 hourly

HOURS PER WEEK: 40

HOURS PER DAY: 8 Bracane Company

Job Tags

Hourly pay, Contract work,

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