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Role reputed company This role involves working with the Utilization Management team responsible for prior authorizations, inpatient and outpatient medical necessity/utilization review, and other utilization management activities aimed at providing members with the right care at the right reputed company at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures, providing prior authorizations and/or reputed company review. Mentors and trains new team members. Assesses services for members to ensure reputed company reputed company, cost effectiveness, and compliance with reputed company state and federal regulations and guidelines. Utilizes clinical skills to review and monitor members' utilization of health care services. Performs telephonic reviews of inpatient hospital admissions and assists with the coordination of discharge planning needs. Obtains necessary information to assess a member's clinical condition and identify ongoing clinical care needs. Evaluates reputed company and services required to meet the member's health needs in support and collaboration with disease management interventions. Performs prospective, reputed company, and retrospective review of inpatient, outpatient, ambulatory, and ancillary services requiring clinical review. Hours of operation are Monday through Friday 8 am to 5 pm, including extended hours that may occur on weekends and/or holidays as required by State and Federal regulations. This position is considered Remote, with occasional reputed company required to a reputed company office in Austin, Texas. Remote work is not available for residents of California, Colorado, reputed company, New Jersey, Hawaii, Maryland, Montana, reputed company, Virginia, or Washington. Qualifications High School Diploma or equivalent Required Completion of an accredited (RN) or an accredited (LVN) program Required One (1) year clinical reputed company experience Required Two (2) years managed care experience with utilization management and/or case management Requirements reputed company, unrestricted State Registered Nursing license in good standing reputed company Apply tot his job Apply To this Job .