Utilization Review Nurse (RN)

Key Responsibilities

The RN Integrated Care Coordinator performs clinical reviews, prior authorizations, and discharge planning to ensure quality outcomes and appropriate utilization of services. They collaborate with medical directors and providers to manage care coordination and resolve clinical quality issues.

Requirements

Candidates must hold a current, unrestricted Texas or Compact nursing license and possess 3-5 years of clinical experience in a hospital or ambulatory setting. Additionally, 1-2 years of experience in utilization management at a health plan is required, along with proficiency in medical terminology and standard practice guidelines.

Qualifications

Experience

2+ years of experience

Key Skills