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Form of workPosition Summary: The UR Team Lead Registered Nurse provides leadership and direction to the Utilization Review team. The UR Team Lead is responsible for leading the team in effectively conducting Utilization Review activities. This individual works with the Utilization Review RNs to prioritize workloads, ensure timely review and application of medical necessity criteria, appropriate status determinations and communications with payers and providers.
The UR Team Lead monitors routine and ad hoc reports and caseloads and oversees daily Utilization Review activities. In addition, the UR Team Lead maintains current knowledge with all applicable regulatory and payer related guidelines related to Utilization Review activities and serves as the departmental resource for UR guidance. The UR Team Lead supports the UR staff by providing updates, education and ensuring competency of all UR staff participating in Utilization Review activities.
The UR Team Lead participates in the Utilization Review Committee and provides support in the collection, analysis, and reporting of performance data related to UR activities. The UR Team Lead assists with the development, implementation, and evaluation of action plans and performance improvement activities related to Utilization Review. Education: A current licensure as a RN with the Texas State Board of Nurse is required.
A Bachelor's Degree in Nursing is preferred. Training and Experience: At least two years as a Utilization Management RN. A cur
