- Professional
**Please make sure your application is complete, including your education, employment history, and any other applicable sections. Initial screening is based on the minimum requirements as defined in the job posting, such as education, experience, licenses, and certifications. Your experience should also address the knowledge, skills and abilities needed for the role. Incomplete applications will not be considered.**
*This position is located Remote- Texas*
Position Purpose:
Conducts contract activities in accordance with state agencies and the state policies and requirements.
Essential Responsibilities:
- Obtains and reviews medical records to determine compliance with review and program policies.
- Documents review findings and recommends adjustments or denials of services for each claim detail.
- Obtains physician/dentist decisions on medical necessity-related findings.
- Composes narrative summary of record review findings and writes education or recoupment letters as directed.
- Works with State customer on review findings.
- Performs actions for case disposition which may include, but is not limited to, assisting in conducting provider
Minimum Qualifications
Education
- Diploma Nurse or Associates degree in nursing or related discipline from an accredited college or university
License and Certification
- Registered Nurse (RN) with an active Texas license
- Coding Certification, preferred
Experience
- Three (3) years healthcare
- Two (2) years clinical in a healthcare setting
- One (1) year utilization management, retrospective review, medical record review, or claims review
Benefits
TMF offers an excellent benefits package, including:
- Medical, dental, vision, life, accidental death and dismemberment, and short and long-term disability insurance
- Section 125 plan
- 401K
- Competitive salary
- License/credentials reimbursement
- Tuition Reimbursement
EOE Vet/Disability
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