Utilization Manager Reviewer - Registered Nurse - RN - SWHR CIN - Remote
The ideal candidate will possess the following qualifications:
• Associate's Degree Nursing required Or
• Bachelor's Degree Nursing preferred
• Master's Degree Nursing preferred
• 3 Years Utilization management experience in an acute or post-acute provider, health plan or other care company experience required and
• 2 Years of experience in direct patient care as an RN required
• 5 Years of experience in Health Plan Utilization Review, Discharge Planning and Medical Case Management preferred.
• Registered Nurse license upon hire required
Skills
• Experience and knowledge of Milliman Guidelines or similar clinical guidelines preferred
• Strong analytical and organizational skills
• Working knowledge and ability to apply professional standards of practice in work environment.
• Knowledge of specific regulatory, managed care requirements, and strong attention to detail.
• Working knowledge of computers and basic software applications used in job functions such as word processing, graphics, databases, spreadsheets, etc
Southwestern Health Resources Clinically Integrated Network (SWHR CIN) is a partner company of Texas Health. If hired for this position, you will become a SWHR CIN employee rather than a Texas Health employee.