Boon-Chapman is strongly committed to equal employment opportunity offering a full range of benefits. We are a company of professionals, dedicated to building a stable business with opportunity for personal and professional growth while providing quality service for our clients. Headquartered in the capitol city of Austin, Texas, we offer a pleasant, non-smoking office environment. Over 100 employees, 35% with more than five years' service, make up our Boon-Chapman family. Find out more about joining our employment team below or call us at 512.454.2681, extension 7136.

Our recent growth has created several new positions. To join our growing staff, look over the following job descriptions. Send your resume to MonicaG@boonchapman.com and complete our pre-employment screening at www.testreporting.com/boonchapman/

UR Nurse
Summary Description
This position performs prospective, concurrent, and retrospective utilization review of specified health services. Performs case management functions for complex and/or high dollar cases.

Must Know and Understand
• Internal policies and procedures.
• Have a strong working knowledge of current health care
protocols.
• Must be able to properly interpret plan documents for
utilization review, case management, and health care elements.
• Must be familiar with state and federal laws and
resource materials as they pertain to utilization management.

Responsibilities:
• Perform telephonic utilization review; answer telephone
inquiries regarding precertification/authorization for all inpatient and selected outpatient procedures.
• Respond to phone calls in a timely manner.
• Direct claims, benefit, and eligibility inquiries.
• Makes telephone contact with hospital UR departments,
hospital admitting departments and physician offices to current status on all inpatient admissions.
• Generates letters to insured clients re: precertified
stays, outpatient procedures, and maternity notification. Prepares letters for mailing.
• Negotiates out of network pricing, determine "reasonable
and customary"/AWP, as appropriate; negotiate discount for plan savings.
• Assist the Director of UM in processing denials and
appeals.
• Develop, implement and maintain case management plans for complex and/or large cases.
• Review early warning claims cases for possible case
management opportunities.
• Communicate with physician advisor on any
inpatient/outpatient stays, services, or procedures that are believed to be questionable in any way.
• Maintains client and subscriber confidentiality at all
times.
• Assists Benefits/Claims Department with review of claims
and predetermination requests.

Qualifications
• Current RN license in State of Texas
• Five years medical/surgical/hospital experience
• Organizational skills
• Experience performing utilization review (preferred)
• Experience with ICD-9 and/or CPT-4 codes (preferred)

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