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RN Utilization Review

Company: Christus Health
Location: Irving
Posted on: July 13, 2018

Job Description:

This position is responsible for analyzing clinical information submitted by medical providers to evaluate the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Is responsible for clinical review of all requested services for appropriateness based on clinical criteria. Performs selected member calls to address post hospital discharge services, ongoing durable medical equipment usage and other telephonic follow up identified by UM/CM Management.
This position will facilitate with negotiations for out of network care.

Position Qualifications:

Education/Skills:Graduate of an accredited Registered Nursing Program, Bachelor Degree preferredBasic Knowledge of computer systemsGood typing skillsExcellent customer service skillsExcellent negotiation skills

ExperienceMinimum of three years diverse clinical experience as RNMinimum of two years case management and/or utilization review experience

Licenses, Registrations, or Certifications:Current/Active Texas RN Licensure

Keywords: Christus Health, Irving, RN Utilization Review, Healthcare, Irving, Texas

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