Business and Technology Center, OK30+ days ago
Education and Experience • Bachelor's degree in nursing from an accredited college or university • 5+ years of experience in utilization review, clinical review, and authorizations • Knowledge of CMS Medicare Part A, B, & C billing requirements • Advanced experience with national evidence-based screening guidelines (MCG, formerly Milliman Care Guidelines) • Viseo software experienced user, is preferred Required Licensures/Certifications/Registrations • Valid Texas RN License/Eligible Compact License Knowledge, Skills and Abilities • Well-versed in ICD10 diagnosis codes and payer regulations • Expert level analytical and process mapping skills • High level knowledge of Medicare, managed care, and commercial insurance payment requirements • Excellent attention to detail, communication and reporting skills • Highly organized with the ability to multi-task and prioritize work • Self-starter with the ability to think outside-the-box to solve problems • Customer service focus, critical thinker, and excellent interpersonal skills Interaction with Other Departments and Other Relationships Collaborate with colleagues in patient financial services, practice management, and other relevant departments. Benefits: Resilience program Emotional Physical Spiritual Financial Career Community On-Site Professional Counselors (EAP) Discounted Pharmacy Cost Cash Retention Bonus (only one in our region) Retirement Benefits w/Employer Match PTO & Extended Illness Medical, Dental, & Vision Insurance And more at: https://apps.umchealthsystem.com/documents/wellness.pdf