Utilization Review Nurse
Location: Austin Texas
Description: Texas Mutual Insurance Company is at present looking to employ Utilization Review Nurse right now, this vacancy will be placed in Texas. More complete informations about this vacancy opportunity kindly read the description below. At Texas Mutual, our people and their commitment to customer service make the difference. Join us in this commitment as a Workers’ Compensation Utilization Review Nurse.!
In this role, you will:
Ensure proper delivery and regulator compliance of workers’ compensation medical services provided by Texas Mutual and our vendor partners.
Perform quality assurance reviews on network-provided services.
Identify process errors and then create, implement, and monitor solutions.
Review and audit samples of vendors’ preauthorization and case management services.
Approve requests for case management on lost-time cases.
Ensure vendor telephonic case management services are delivered in a quality and compliant manner.
Ensure compliance with URA requirements.
Serve as a subject matter expert for the company on issues related to utilization review, medical disputes, and compliance.
Document quality assurance findings and report them in a timely manner.
Handle sensitive issues and maintain appropriate confidentiality.
The successful candidate! must have:
Texas RN or LVN license.
Professi! onal experience in critical care decision making, orthopedic rehabilitation, workers’ compensation, pre-authorization, and/or compliance management.
Excellent organizational, time-management, judgment, and problem-solving skills.
Excellent communication and interpersonal skills.
Desire to work in a professional office setting with a traditional Monday through Friday daytime schedule.
Texas 03 Adjuster’s license a plus.
With us, you will find:
Important work without the physical and emotional stress of direct patient care.
A schedule that provides you with steady and predictable work-life balance.
The opportunity to work for the market leader in a respectful environment.
A commitment to providing top tier service.
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If you were eligible to this vacancy, please email us your resume, with salary requirements and a resume to Texas Mutual Insurance Company.
If you interested on this vacancy just click on the Apply button, you will be redirected to the official website
This vacancy starts available on: Mon, 20 May 2013 18:33:43 GMT
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