New 
Utilization Management RN - Remote In TX
 TEKsystems | |
$39.00 - $47.00 / hr
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life insurance, sick time, 401(k), retirement plan
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 United States, Texas, Austin | |
 Apr 10, 2026 | |
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*Job Summary* The Utilization Management RN works collaboratively with the Utilization Management team to ensure members receive the right care, at the right time, in the right setting. This role is responsible for prior authorizations, inpatient and outpatient medical necessity reviews, and concurrent, prospective, and retrospective utilization reviews. The RN applies clinical judgment and established criteria to evaluate medical services, supports discharge planning, ensures regulatory compliance, and promotes quality, cost-effective outcomes. In addition, this role mentors and trains new team members and serves as a clinical resource within the department.
*Key Responsibilities* Utilization Review & Medical Necessity * Perform prior authorization, concurrent, prospective, and retrospective utilization reviews for inpatient, outpatient, ambulatory, ancillary, and facility-based services. * Conduct telephonic reviews of inpatient hospital admissions and continued stays across acute, skilled, and long-term care settings. * Apply national standardized medical criteria, internal medical policies, and state and federal regulations to determine medical necessity. * Identify appropriate benefits, eligibility, and expected length of stay for requested services and procedures. * Manage utilization for acutely and chronically ill members to support optimal clinical and cost-effective outcomes. * Review and process all levels of appeal requests requiring clinical review. Care Coordination & Discharge Planning * Collaborate with facility and provider case managers to support safe and timely discharge planning. * Obtain and evaluate clinical documentation necessary to assess member condition and ongoing care needs. * Coordinate transitions between levels of care to ensure continuity and appropriateness of services. * Act as a member and family advocate by facilitating access to medically necessary care within benefit plans. Clinical Collaboration & Quality * Consult with Medical Directors on cases requiring physician review or those not meeting clinical criteria. * Maintain effective communication with care management, disease management, and other internal teams. * Support accreditation, quality, and performance improvement initiatives (HEDIS, NCQA, URAC, QIA). * Monitor productivity and quality benchmarks and contribute to departmental performance goals. Training & Professional Practice * Mentor and train new Utilization Management team members. * Attend staff meetings and complete assigned projects and work objectives on time. * Perform other related duties as assigned while maintaining professional conduct at all times. *Job Type & Location*This is a Contract to Hire position based out of Austin, TX. *Pay and Benefits*The pay range for this position is $39.00 - $47.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: * Medical, dental & vision * Critical Illness, Accident, and Hospital * 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available * Life Insurance (Voluntary Life & AD&D for the employee and dependents) * Short and long-term disability * Health Spending Account (HSA) * Transportation benefits * Employee Assistance Program * Time Off/Leave (PTO, Vacation or Sick Leave) *Workplace Type*This is a fully remote position. *Application Deadline*This position is anticipated to close on Apr 23, 2026. h4>About TEKsystems: We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company. The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. About TEKsystems and TEKsystems Global Services We're a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We're a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We're strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We're building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. | |