CareersMedical Intelligence Lead Nurse RN

Current Job Openings

Medical Intelligence Lead Nurse RN

Posting Date: 04/18/2018
Closing Date: Until Filled

Reports to: Medical Intelligence Supervisor/Manager
Exempt, Non-Supervisory

  • Conducts prospective, concurrent and retrospective utilization management.
  • Assists Population Health with Case Management and Health Coaching.
  • Assists with training and orientation of staff, physician consultants, health service providers and covered Individuals to specific areas within the Medical Intelligence Dept. which includes Utilization Review; Utilization Management and Population Health.
  • Develops new guidelines and workflow processes for Medical Intelligence staff on a regular basis, which includes creating technical training and documentation.
  • Assist Supervisors and /or Manager with Medical Intelligence departmental reports, including quality and assurance, necessary for data analysis and workflow improvement.
  • Participates in NCQA activities which includes:  gathering data, assisting with analysis necessary for qualitive and quantitative reports.

Qualifications / Skills Required
  • Knowledge of Case management, Utilization Management/Utilization Review and Population Health/Coaching concepts. 
  • Familiarity with health care delivery system and managed care methodology.
  • Familiarity with health care review criteria and ICD-10, CPT and LOS coding reference.
  • Familiar with Health Plan Accreditation standards such as NCQA.
  • Working knowledge of MS Office and other assigned software products. 
  • Preferred:  Bilingual skills (Spanish). Preferable to effectively service primary member population.  BSN or MSN preferred.
  • Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.   eoe,



To Apply
Please submit your resume with a cover letter to Human Resources. Indicate the position you are applying for and detail how you meet the qualifications listed. You may fax this information to (512) 719-6717, email us at Email Us, or mail it to:
TML Health
Attn: Human Resources
P.O. Box 140644
Austin, TX 78714-0644