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.

•  Recent or strong background in prior authorization preferably with Medicare or Medicaid experience.

•  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.