Utilization Management Nurse

Utilization Management Nurse

$52/hr.

South Loop West

8 am – 5 pm OT weekends are an option

Contract Possible Hire

A busy healthcare organization in Houston off the South Loop West is seeking a Utilization Management Nurse who will assist with case management or caseloads for managed care. In this role, you will compile and review authorizations, review discharge documentation, and coordinate medical plan with medical providers while verifying Medicare/Medicaid criteria sets and standards. Your goal is to balance the quality of patient care with cost efficiency, ultimately maximizing the continuity of care a patient receives.

As part of this role, you will have a strong understanding of the necessity of services before authorizing or preparing cases as well as denials and appeals, and work with patients to help them understand their benefits. Applicants must have an RN license and clinical nursing experience. This is an administrative role, not a bedside role.

Utilization Review Nurse Duties and Responsibilities:

• Balance quality of care with cost efficiency
• Obtaining authorization on the provider side
• Coordinate discharge orders
• Review the patient’s discharge information
• Work directly with insurance providers within the Utilization Criteria
• Compile and review medical information and insurance coverage
• Authorize requested medical services and prepare cases for physician review
• Inform patients about their benefits and coverage limits
• Identify alternative, cost-effective resources

Utilization Review Nurse Requirements and Qualifications:

• Bachelor’s or master’s degree in nursing
• Registered Nurse (RN) license
• Clinical nursing experience (2-4 years)
• Experience in care or utilization management (2+ years), Case Management, and Home Health Case management is needed
• BLS certification
• Computer proficiency including
• Organizational skills
• InterQual, Epic, and/or MCG-Milliman is a huge plus

Benefits During This Contract:

• Direct Deposit options
• Weekly Pay Periods
• Easy access to freeway
• Located in the heart of shopping and restaurants
• Located near Metro Transit
• Gain excellent experience with a major healthcare organization
• Opportunity to become permanent

If you feel you would be an asset by reviewing, authorizing, and handling patient loads, apply today for immediate consideration.

About Resource Staffing

Resource Staffing is an affiliate of The Reserves Network, a family-owned and veteran-founded company. Since 1989, we have been bringing employers and job seekers together in a variety of industries and positions throughout the great state of Texas. As an equal-opportunity employer, we value our employees and foster an environment of respect, integrity, and trust in every aspect of employment. However you identify and whatever your background, we encourage you to .

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