Utilization Management Nurse
TEXAS Independence Health Plan INC
Austin, Texas
RN
Posted Jun 25 · Not open to new grads
- Unit
- Utilization Management
What the listing says
Role
- Accepts
- RN
- Experience
- 2+ years
Ratio not posted. Ask in the interview.
Pay
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About this role
The Utilization Management Nurse will determine the medical appropriateness of inpatient and outpatient services by evaluating medical guidelines, benefit determination and compliance with state mandated regulations. Essential functions include performing concurrent, retroactive and pre-service authorization reviews for inpatient and outpatient services, following and maintaining compliance with CMS requirements, and collaborating with staff, physicians, care/service coordinators, and medical directors to coordinate and provide the level of care necessary to meet member's health need.
Sourced from a public job board.
“* Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred. 2+ years of clinical nursing experience. * Payor Utilization Management: 3 years recommended experience * Proficiency with Microso…” · from this posting
Requirements
- Graduate from an Accredited School of Nursing
- Bachelor's degree in Nursing preferred
- 2+ years of clinical nursing experience
- Payor Utilization Management: 3 years recommended experience
- Proficiency with Microsoft Office applications, specifically Word, Excel, and Outlook
- Proficiency using Milliman Care Guidelines (MCG) and/or InterQual criteria
- Current unencumbered LVN or RN license in Texas or compact license
- 2+ years Utilization management experience with a health insurance company (managed care/payer experience required)
Place
- City
- Austin, Texas
- Median rent
- $1,729/mo
- Local household income
- $93,658/yr
- Metro price level
- 2% below the national average
rent and tenant-paid utilities · Census ACS 2024
all local households, not nurse pay · Census ACS 2024
Austin area index 98.1, where 100 is the national average.
Austin blends Texas charm with live-music energy, outdoor living along Lady Bird Lake, and a booming tech-driven economy. Nurses relocating here will find a sun-sooked city where food trucks, hiking trails, and a friendly, fast-growing community define the lifestyle.
Cost figures from U.S. Bureau of Economic Analysis · 2024 metro Regional Price Parities · Census ACS 2024.
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About the employer
Texas Independence Health Plan Inc is a health insurance/managed care organization based in Austin, Texas. This is not a direct patient care facility but rather a health plan administrator that employs nurses in administrative, review, and coordination capacities. The organization…
Worth asking
We can’t answer these from the listing we have. Good ones to ask a recruiter or in the interview.
- Can you walk me through base pay range and differentials?
- What should I expect for shifts, weekly hours, weekend, holiday, call, and rotation?
- What orientation, preceptor time, and ongoing unit support are included?
- How are patient load, floating, and staffing support handled day to day?
