RN Utilization Review/ Referral Management

Empowered Management Solutions
San Antonio, TX
Jul 13, 2017
Jobs Outside Higher Education
Other Jobs Outside Higher Education
Institution Type
Outside Academe

Job Description

SUMMARY: Registered Nurse will provide Referral Management (RM) activities include timely processing of Right of First Refusal (ROFR) requests, screening of specialty care referrals, sustaining up-to-date MTF/ Managed Care Support Contact ( MCSC ) Memorandums of Understanding (MOUs), comply with Referral and Authorization Business rules, tracking, accounting, and resulting of referrals, and full use of RM information management systems. Individual will conduct reviews for medical necessity, pre-authorization, medical appeals, collection and recovery from insurance carriers, and right of first refusal activities. Must be familiar with Tri-Care.


Education- Baccalaureate of Science in Nursing from an approved National League of Nursing.

Experience- 6 years of clinical nursing experience is required. One year of previous experience in Utilization

Management is required. Full time employment in nursing field withing the last 36 months is mandatory.

LICENSE/CERTIFICATION- Current, active, full and unrestricted License to practice Nursing in accordance with State Board requirements. Nurse applicants must be a current U.S. licensed Registered Nurse. License can not be under investigation nor have any adverse action pending from a Nursing State Board or national licensing/ certification agency.

Company Description
Empowered Management Solutions LLC ["EMS"] is a DIRECT HIRE & STAFFING SERVICE PROVIDER that specializes in one major area: PEOPLE!

We are experts in Sourcing, Recruiting, and Hiring nationwide for ALL types of professional, executive, and specialty positions.

EMS is a group of passionate individuals who share a common denominator...We want to make a positive impact on the lives of those around us by helping people and organizations connect. Simply put, we are " Changing the Way You Are Hired" by putting your needs first.

If you are interested in EMS helping you find a new career or a company interested in our Direct Hire or Staffing Services, contact us today!

San Antonio, TX


Sat, 24 Jun 2017 15:24:38 PDT