US
0 suggestions are available, use up and down arrow to navigate them
PROCESSING APPLICATION
Hold tight! We’re comparing your resume to the job requirements…
ARE YOU SURE YOU WANT TO APPLY TO THIS JOB?
Based on your Resume, it doesn't look like you meet the requirements from the employer. You can still apply if you think you’re a fit.
Job Requirements of Utilization review nurse (RN):
-
Employment Type:
Contractor
-
Location:
Richardson, TX (Onsite)
Do you meet the requirements for this job?
Utilization review nurse (RN)
Careers Integrated Resources Inc
Richardson, TX (Onsite)
Contractor
Job Title: Utilization review nurse (RN)
Location: Fully Remote must reside in - TX/IL/NM/OK/MT/TN
Duration: 6 months Contract (Possible Extension)
Monday – Friday, 8:00 AM – 5:00 PM
Job Description:
Required Experience:
Location: Fully Remote must reside in - TX/IL/NM/OK/MT/TN
Duration: 6 months Contract (Possible Extension)
Monday – Friday, 8:00 AM – 5:00 PM
Job Description:
- This is full time remote, but candidates must reside in the either of the five business plans: Il, TX, NM, MT or OK
- RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan.
- This Position Is Responsible for Performing Accurate and Timely Medical Review of Claims Suspended for Medical Necessity, Contract Interpretation, Pricing; And to Initiate And/Or Respond to Correspondence from Providers or Members Concerning Medical Determinations.
Required Experience:
- Knowledge of accreditation, i.e. URAC, NCQA standards and health insurance legislation. Awareness of claims processes and claims processing systems.
- PC proficiency to include Microsoft Word and Excel and health insurance databases.
- Verbal and written communication skills with ability to communicate to physicians, members and providers and compose and explain document findings.
- Organizational skills and prioritization skills
- Registered Nurse (RN) with unrestricted license in state.
- 3 years clinical experience with at least.
- 2 years within the hospital setting or direct patient care.
Get job alerts by email.
Sign up now!
Join Our Talent Network!