Texas Licensed Registered Nurse

Comprehensive Care Program experience highly preferred. The Registered Nurse conducts pre-service, concurrent/ retrospective reviews. They will collaborate with healthcare providers to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. They will ensure medically appropriate, high quality, cost effective care through assessing the medical necessity of outpatient services, out of network services, and appropriateness of treatment setting within the scope of professional limitations by utilizing the applicable rules of the Texas Administrative Code (TAC), Texas Health and Human Services Commission (HHSC) approved medical policy, and industry standards, accurately interpreting benefits and managed care products. They may educate providers on programs or community resources that may benefit the member. The Registered Nurse will work with physicians in interpreting appropriateness of care. Conducts pre-service, concurrent/ retrospective

Must be able to pass a background and drug screen