*** Must be a Registered Nurse in the State of Texas ***
** Need to have Case Management Experience **
** This is a Fully Remote Role **
Day to day responsibilities of this the role and a description of the project (Outside of Workday JD):
- They will be responsible for looking over handwritten and computer-generated documents while prioritizing tasks effectively. TX has a very tight time frame and authorization reviews are expected to be completed within 24-hours. If criteria does not meet medical necessity for an inpatient stay, the nurse is expected to send to a medical director for review. If an authorization is denied the nurse will be expected to follow up with UM department (by phone/fax) at hospital to offer a peer to peer before sending an official denial.
- The nurse is expected to work about 12-20 authorizations per day. They will get a mixture of new and concurrent reviews. The goal is to reach individual hourly weighted productivity of 2.49-3.21 to meet expectations