Utilization Management Clinical Registered Nurse (RN) - REMOTE

 
Position: Utilization Management Clinical Registered Nurse (RN) - REMOTE

Job ID: 160080

Location: US-TX-Houston

Department: UM Initial Authorizations

Talent Area: Registered Nurse

Full/Part Time: Full-Time

Regular/Temporary: Regular

Shift: 9a - 6p

About Texas Children's Hospital

Founded in 1996, Texas Children’s Health Plan is the nation's first health maintenance organization (HMO) created just for children. We provide STAR/Medicaid and Children's Health Insurance Program (CHIP) to pregnant women, teens, children and adults in Houston and surrounding areas. Currently, the Health Plan has more than 375,000 members who receive care from our network of more than 1,100 primary care physicians, 3,200 specialists, and 70 hospitals. Texas Children's Health Plan is also the largest combined STAR/CHIP Managed Care Organization in the Harris County service area.    To join our community of 14,000+ dedicated team members, visit texaschildrenspeople.org for career opportunities. You can also learn more about our amazing culture at infinitepassion.org.   Texas Children’s is proud to be an equal opportunity employer. All applicants and employees are considered and evaluated for positions at Texas Children's without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, gender identity, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved. 

Summary:

We are searching for a Utilization Management Clinical RN -- someone who works well in a fast-paced setting. In this position, you will provide precertification of inpatient hospitalizations and all outpatient procedures and services requiring authorization. This role performs telephonic and/or concurrent review of inpatient hospitalizations and extended courses of outpatient treatment. This process includes clinical judgement, utilization management, application of product benefits, understanding of regulatory requirements, and verification of medical necessity utilizing nationally recognized criteria. In addition, discharge planning and provider education are major components of this process. 

 

Think you’ve got what it takes?



Responsibilities :

  • Being fully vaccinated against COVID-19 is required for all employees unless approved for a medical or religious exemption
  • Diploma in or associate’s degree in Nursing, or an associate’s degree in a related field accepted by the Texas Board of Nursing for the purposes of obtaining and maintaining an RN license
  • Bachelor’s degree in Nursing preferred
  • RN license from the Texas Board of Nursing or Nursing Licensure Compact required
  • 3 years nursing experience required


Qualifications:

  • Being fully vaccinated against COVID-19 is required for all employees unless approved for a medical or religious exemption
  • Diploma in or associate’s degree in Nursing, or an associate’s degree in a related field accepted by the Texas Board of Nursing for the purposes of obtaining and maintaining an RN license
  • Bachelor’s degree in Nursing preferred
  • RN license from the Texas Board of Nursing or Nursing Licensure Compact required
  • 3 years nursing experience required
  • Experience with Utilization Management or Case Management preferred 


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