To support the Health Services Department, a Texas Licensed Utilization Review Nurse will work remotely, managing a high volume of outpatient and inpatient case reviews while maintaining open availability from 8:00 AM to 8:00 PM, Monday through Sunday, including rotating weekend and holiday coverage.
Key responsibilities Complete prior authorization and retrospective reviews for various medical services and equipment Refer cases to Medical Directors as necessary and maintain compliance with regulations and internal policies Perform additional duties as requested to support the department's needs Required qualifications Active and unrestricted LVN license in Texas; compact license preferred Proficiency in Microsoft applications, including Word, Excel, and Outlook Minimum of two years of experience in health plans, IPAs, or MSOs Solid interpersonal skills and ability to collaborate effectively with team members and leadership Experience in educating and training staff