Travel Nurse RN - Case Manager - $1,759 per week in Austin, TX

Job Title: RN Utilization Review Profession: RN Utilization Review Specialty: RN Utilization Review Duration: 13 weeks Shift: 08:30 AM - 05:00 PM Hours per Shift: 8 Experience: Minimum 2 years acute care UM experience (or equivalent) License: Licensed RN (multistate or TX RN) Certifications: BLS Must-Have: Proficiency with InterQual/MCG and CMS regulations Description: Provides health care services regarding admissions, case management, discharge planning, and utilization review. Reviews admissions and service requests within assigned unit for prospective, concurrent, and retrospective medical necessity and compliance with reimbursement policy criteria.

Job Title: RN Utilization Review Profession: RN Utilization Review Specialty: RN Utilization Review Duration: 13 weeks Shift: 08:30 AM - 05:00 PM Hours per Shift: 8 Experience: Minimum 2 years acute care UM experience (or equivalent) License: Licensed RN (multistate or TX RN) Certifications: BLS Must-Have: Proficiency with InterQual/MCG and CMS regulations Description: Provides health care services regarding admissions, case management, discharge planning, and utilization review. Reviews admissions and service requests within assigned unit for prospective, concurrent, and retrospective medical necessity and compliance with reimbursement policy criteria. Provides case management and consultation for complex cases. Assists departmental staff with issues related to coding, medical records/documentation, precertification, reimbursement, and claim denials/appeals. Assesses and coordinates discharge planning needs with healthcare team members. May prepare statistical analysis and utilization review reports as necessary. Oversees and coordinates compliance with federally mandated and third-party payer utilization management rules and regulations. Requires critical thinking skills, decisive judgment, and the ability to work with minimal supervision. Must be able to work in a stressful environment. Utilization Management department focuses on centralized acute admission utilization review across multiple facilities. Familiarity with payer portals and experience with managed Medicare and Medicaid insurers is preferred. Proficient and adaptable with multiple technologies simultaneously.