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Utilization Management Nurse_Health Plan (UM/UR RN)

Company: Baylor Scott & White Health
Location: Lubbock
Posted on: August 16, 2019

Job Description:

The Scott & White Health Plan (SWHP) UM Nurse II RN performs utilization management, utilization review, and/or concurrent review for the SWHP Leading Change Care Coordination Team. The UM Nurse II RN communicates with practitioners and members on complex cases and determines medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines. Manage the utilization functions within the following areas: Out-of-Network, Transplants, High-Risk, Skilled, LTAC, Rehab, and all other outpatient approvals and denials.

The ideal SWHP UM Nurse II RN candidate should have broad medical surgical experience and takes personal responsibility to understand, complete and maintain the professional and technical licensures/certifications required of the position.

------ Location/Facility ------ Scott & White Health Plan at Lubbock, TX

For more information on the facility, please click our Locations link.

------ Specialty/Department/Practice - Health Plan / Managed Care / Insurance

------ Shift/Schedule ------ Full-time / Weekdays

------ Benefits ------ Our competitive benefits package includes*:

------ Immediate eligibility for health and welfare benefits

------ 401(k) savings plan with dollar-for-dollar match up to 5%

------ Tuition Reimbursement

------ PTO accrual beginning Day 1

*Note: Benefits may vary based upon position type and/or level.

------ Associate------s degree

------ Registered Nurse

------ 3 years of experience

Keywords: Baylor Scott & White Health, Lubbock , Utilization Management Nurse_Health Plan (UM/UR RN), Executive , Lubbock, Texas

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