Madea Home Care Services·Richardson County, Nebraska
The Utilization Review Nurse is responsible for performing initial and concurrent review activities, as well as discharge care coordination. They serve as a liaison between providers and medical management divisions to ensure the quality and effectiveness of medical services.
Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties***
RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. JOB RESPONSIBILITIES: This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services, and serving as liaison between providers and medical and network management divisions. Collects clinical and non-clinical data. Verifies eligibility. Determines benefit levels in accordance to contract guidelines. Provides information regarding utilization management requirements and operational procedures to members, providers, and facilities. JOB QUALIFICATIONS (Required): Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations. 3 years of clinical experience in a Physician's office, Hospital/Surgical setting, or Health Care Insurance Company. Knowledge of medical terminology and procedures. Verbal and written communication skills.
JOB QUALIFICATIONS (Preferred): MCG or InterQual experience Utilization management experience
Candidates must be a Registered Nurse with a valid license and have at least 3 years of clinical experience in relevant healthcare settings. Knowledge of medical terminology and strong communication skills are also required.
Market context
In Nebraska, nursing support roles like medication aides and technicians are often driven by ongoing staffing needs in long-term care, assisted living, and similar settings. These jobs can be competitive because employers usually want a high school diploma plus current state-approved medication aide or technician certification, with insulin and CPR/BLS credentials preferred. Review the AI-summarized requirements and benefits here to save research time, and confirm your certifications are current before applying.
