Utilization Manager Reviewer Registered Nurse - SWHR CIN - Fort Worth

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’ experience in direct patient care as an RN, preferred acute care (ER, ICU, or Medical/ Surgical) required and

• 5 years’ 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