CareersUtilization Review RN

Current Job Openings

Utilization Review RN

Posting Date: 10/12/2018
Closing Date: Until Filled

Reports to: Medical Intelligence Manager
Exempt, Non-Supervisory


You must be a Registered Nurse in the AUSTIN, TEXAS area.

RNs, are you looking for a place with daytime hours, awesome co-workers, opportunities for advancement and excellent benefits? We are proud to be and equal opportunity workplace and an affirmative action employer. TML MultiState IEBP offers a retirement plan thru the Texas Municipal Retirement System as well as an impressive benefits package that includes healthcare benefits, life benefits, Long Term Disability and paid vacations/personal time for our employees.

Here is the job:

This position has the following responsibilities, and others may be assigned.

• Conducts prospective, concurrent, retrospective and appeals, including inpatient services, outpatient services and behavioral health

• Document Clinical information within from faxed clinical along with verbal clinical obtained and creates related authorizations, for prior authorizations, concurrent reviews, denials and appeals

• Submit reviews to Medical Director an d/or to Independent Review Organizations

• Create letters associated with the review outcomes for both approved services and denied services

• Work with facility Case Managers/Discharge Planner regarding obtaining the clinical updates and the Level of Care for members

• Adheres to department guidelines and NQA standards

• Effectively interfaces with Alliance members, partners, and vendors to provide successful outcomes for the TML MultiState IEBP membership

• Protects the confidentiality, integrity and availability of information and records that TML MultiState IEBP creates, receives, maintains or transmits by complying with TML MultiState IEBP policies and procedures, including policies and procedures on physical, administrative and technical safeguard

Qualifications / Skills Required

• Must have current, unrestricted Texas Registered Nurse (RN) license.

• Minimum 3 years Medical/surgical experience, Prior Utilization experience

• Must be able to multi-task/prioritize and be organized

• Works well under pressure and can meet strict timelines

• Ability to work independently and in a team environment as well

• Good communication skills

• Knowledge of InterQual; Word and Excel

• 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