Utilization Review Nurse / Nurse Coordinator

Minimum Qualifications: Active and unrestricted RN license to practice medicine in Texas (individual must be licensed in the state in which they reside) is required (Compact Licensure acceptable). [1] Managed care experience preferred. 4+ years of clinical practice experience in the areas of either emergency room, ICU, critical care or flight nursing experience sufficient to enable person to make medical judgments as to appropriateness of care and medical necessity.[2] Previous administrative medical experience such as clinical coordination, medical management, utilization review preferred. Demonstrated understanding of the health care delivery system including, but not limited to, familiarity with outpatient, outpatient facility, inpatient care, and ambulance transportation business models including reimbursement. Good communication skills, primarily over the phone in requesting and receiving medical information to determine the medical necessity of ambulance services and levels of care. Demonstrated ability to make evidence based decisions – review past history, benefit information, applicable policies as well as other data to make sound, informed decisions in a timely manner. Computer skills such as a working basic and operational knowledge of Microsoft Outlook and Word. Demonstrated effective written and verbal communication skills with the ability to engage and influence all levels of audiences. RELATIONSHIPS: Interfaces To: Executive staff, employees, vendors, healthcare providers, and customers QUALIFICATIONS: PREFERRED: Education: Bachelor’s degree in Nursing. Master’s degree in healthcare related field (MPH, MHA, MBA) Experience: 4+ years of nursing experience, acute care, ambulance/transport, or managed care preferred Licenses & Certificates: Texas Licensed or Compact State RN, unrestricted licensure. JOB SPECIFICATIONS: Language Skills: Highest Mathematical Skills: Very High Reasoning Ability: Highest PHYSICAL DEMANDS: Physical demands described here are representative of those that must be met by an employee to successfully perform essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. While performing duties of this job, the employee is frequently required to sit. The employee is occasionally required to stand, walk, climb or balance, stoop, kneel, crouch or crawl, reach with hands and arms, use hands to finger, handle or feel, talk, hear and smell. The employee is required to maintain adequate physical conditioning to be able to perform job duties. Job duties are often performed at high stress levels requiring employee to function effectively and independently while maintaining good working relationships with partners, employees, and customers. The employee may frequently lift and/or move up to 25 pounds and may occasionally lift and/or move between 26-100 pounds. There are no specific vision abilities required to perform this job. WORK ENVIRONMENT: Work environment characteristics described here are representative of those an employee encounters while performing essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. Employee shall typically be working from a home environment.

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