Utilization Review Nurse
Location
Texas
Posted
1 day ago
Salary
$90K - $98K / year
Seniority
Senior
Job Description
Utilization Review Nurse
Cobalt Benefits Group, LLC (DBA: Blue Benefit Administrators, CBA Blue & EBPA)
• Perform utilization and concurrent reviews of inpatient cases using Milliman, Aetna, and BCBS criteria. • Conduct medical necessity reviews for services requiring prior authorization, applying utilization-specific criteria. • Request and evaluate clinical information needed to review requested services. • Discuss cases and determinations with healthcare professionals and physician reviewers. • Identify cases requiring intervention and collaborate with Case Managers as needed. • Maintain appropriate and accurate documentation, ensuring compliance with audit standards. • Participate in team meetings, educational sessions, and related activities. • Review medical claims and pre-determinations for medical necessity and appropriateness. • Identify opportunities for process improvement and enhance communication among departments. • Consult with Physician Reviewers for complex or challenging cases.
Job Requirements
- Current, unrestricted RN license (State license required).
- Minimum 3 years of clinical nursing experience.
- Minimum 1 year of Utilization Management (UM) or Utilization Review (UR) experience.
- Strong analytical, critical thinking, and problem-solving skills.
- Proficiency in Microsoft Office Suite (Excel, Word, Outlook) and familiarity with utilization management systems.
- Excellent verbal and written communication skills, with the ability to interact effectively with internal and external stakeholders.
- Strong organizational and time management skills, with the ability to handle multiple priorities independently.
Benefits
- Fantastic medical, dental, and vision insurance*
- Twice annual employer HSA contributions, covering 50% of the HDHP plan’s annual deductible!
- Company-provided Basic Life and AD&D
- Company-paid Short-Term and Long-Term Disability**
- Flexible Spending Accounts*
- 401(k) Retirement Plan with up to a 6% employer match** (100% fully vested after 3 years)
- 10+ paid holidays
- Half-day Summer Fridays
- Generous paid vacation and sick time
- Annual paid Volunteer Day
- Annual Tuition reimbursement
- Annual Health and Wellness reimbursement
- Lots of fun company events
Related Guides
Related Categories
Related Job Pages
More General Jobs
Psychiatric Nurse Practitioner
Valera HealthPersonalized mental health services combining meditation, therapy, and medications wrapped around with technology.
Role Description Are you a Psychiatric Nurse Practitioner ready to revolutionize mental healthcare from the comfort of your home? Join Valera Health, a leader at the forefront of tele-mental health, where your passion for compassionate, evidence-based care meets purpose. We are dedicated to making high-quality mental health care accessible and affordable for all. We’re currently expanding our team and looking for exceptional, driven Psychiatric Nurse Practitioners (PMHNPs) for part-time roles. The Valera Advantage: Focus on Care, Not Clutter. We believe clinicians should focus on what they do best: delivering outstanding patient care. Our collaborative model and robust technology are designed to eliminate administrative burdens, allowing you to maximize your clinical impact. What You'll Do (The Role): - Be a Clinical Leader: Provide high-quality psychiatric telehealth services, including initial assessments and follow-up appointments, adhering to APA and AACAP evidence-based guidelines. - Deliver Comprehensive Care: Masterfully diagnose, provide psychoeducation, offer supportive psychotherapy, and prescribe psychotropic medications using cutting-edge psychopharmacology. - Empower Patients: Educate patients thoroughly on the risks, benefits, and alternatives of treatment, setting reasonable outcome expectations. - Collaborate and Connect: Work seamlessly within our multidisciplinary care team (Psychiatrists, Therapists, Health Coaches) and with dedicated Health Navigators who handle patient engagement and logistics. - Maintain Clinical Excellence: Manage a caseload, swiftly check your inbox daily, respond to non-urgent clinical questions within two business days, and ensure timely documentation (notes signed within 48 hours). Qualifications - Active Psychiatric Mental Health Nurse Practitioner (PMHNP) licensure in New York - Active DEA licensure - Medicaid ID# - Minimum of two (2) years of experience as a Psychiatric Nurse Practitioner - Experience working with children and adolescents in a clinical setting Requirements - Commitment of at least 15 clinical hours per week (including supervision) - Targeting 15-28 hours a week of direct patient care - Active participation in our team-based approach with clinicians and navigators Benefits - Flexibility & Freedom: Enjoy the flexibility of working remotely with part-time or full-time hours that fit your life. - Unwavering Support: Benefit from collaborative agreements and regular clinical rounds with licensed psychiatrists, including regular supervision during your first two months. - Protected Practice: Malpractice insurance is provided by Valera. - Technology Forward: We equip you with the best EMR and technology systems to ensure efficient and effective care delivery. - Growth Opportunities: Participate in clinical training to continually refine your skills (CEUs may be available).
Role Description Perform end-to-end tactical sourcing activities and transactions, to reduce errors, achieve higher compliance, and realize savings. - Perform spot buys in accordance with internal control standards and procurement policies, procedures and processes. - Initiate competitive bidding, spot buy negotiations, and supplier management for requested inventory. - Identify opportunities to incorporate spot buying into future strategic sourcing plans. - Mentor staff and may assign, monitor and review work/progress while staying within set deadlines. - Provide level two customer service support for health ministry associates, responding to inquiries and requests and resolving issues or errors. Escalate issues that cannot be resolved. Qualifications - High School diploma equivalency with 2 years of cumulative experience OR Associate's degree/Bachelor's degree with 1 year of experience OR 5 years of applicable cumulative job specific experience required. - 2 years of leadership or management experience preferred. Benefits - Paid time off (PTO) - Various health insurance options & wellness plans - Retirement benefits including employer match plans - Long-term & short-term disability - Employee assistance programs (EAP) - Parental leave & adoption assistance - Tuition reimbursement - Ways to give back to your community Company Description Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 97,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you’ll find an inclusive and supportive environment where your contributions truly matter.
Intake Coordinator – LVN Preferred
LifeCare Home Health FamilyWe strive to help you recover safely and independently in the environment you feel most comfortable in...your home.
• Assists in the coordination of patient care under the direction of the Business Office Manager. • Promote/exemplify Company mission, vision and values at all times. • Receive all intake information and enter the appropriate information in the computer. • Complete intake forms and route them appropriately for admission approval. • Contact patients to verify correct contact information and that HHC has been ordered by their physician. • Communicate with the business development team, discharge planners, and facility contacts to receive new and returning patients in a timely manner. • Comply with all areas of the Agency’s Compliance Program and HIPAA regulations. • Assist in maintaining case management notes while maintaining the confidentiality of patient records. • Provide effective communication to clients, their families, team members, and other health care professionals. • Demonstrate commitment and professional growth by participating in in-service programs and maintaining/improving competency.
Takeoff & Estimating Assistant, Electrical, Construction
The Hello TeamManaged global staffing across 30 plus countries with enterprise recruiting, oversight, training, and performance manage
• Perform electrical takeoffs from construction drawings • Enter and maintain quantity data in Excel spreadsheets • Interpret project scopes from plans and specifications • Assist in preparing estimates and pricing proposals • Support proposal development and final submission activities • Collaborate with management throughout the estimating process • Learn and follow client-specific estimating procedures • Review drawings and specifications to identify project requirements • Verify quantity takeoff accuracy and maintain organized project documentation • Communicate with internal team members to clarify scope, pricing, and proposal details • Perform other duties related to the position as assigned




