NICU Utilization Management RN

5 days ago


Houston, Texas, United States HireOps Staffing LLC Full time

The HireOps Staffing LLC is seeking a highly skilled Registered Nurse to join their team in a Utilization Management role. This position offers the opportunity to work with Medicaid and utilize medically accepted criteria to validate medical necessity and appropriateness of treatment plans.

Job Summary:

This RN will perform initial, concurrent review activities and discharge care coordination to determine efficiency, effectiveness, and quality of medical/surgical services. They will serve as a liaison between providers and medical and network management divisions, collecting clinical and non-clinical data, verifying eligibility, and determining benefit levels according to contract guidelines.

About the Role:

This Utilization Management RN will provide information regarding utilization management requirements and operational procedures to members, providers, and facilities. They must have valid, current, unrestricted licensure in the state of operations and at least 3 years of clinical experience in a physician office, hospital/surgical setting, or healthcare insurance company.

Key Responsibilities:

  • Perform initial, concurrent review activities and discharge care coordination
  • Collect clinical and non-clinical data
  • Verify eligibility and determine benefit levels according to contract guidelines
  • Provide information regarding utilization management requirements and operational procedures

Requirements:

  • Valid, current, unrestricted licensure in the state of operations
  • At least 3 years of clinical experience in a physician office, hospital/surgical setting, or healthcare insurance company
  • Knowledge of medical terminology and procedures
  • Verbal and written communication skills
  • PREFERRED: Utilization management experience and MCG or InterQual experience

Benefits:

This full-time remote position offers a competitive salary of $40/hour and provides opportunities for growth and development within the company. The ideal candidate will be based in TX and possess excellent communication and problem-solving skills.



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