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Nurse Utilization - Review Nurse

Careers Integrated Resources Inc Remote, OR (Onsite) Contractor
Job Title: Utilization Review Nurse
Location: Fully Remote must reside in - TX/IL/NM/OK/MT/TN
Duration: 3 months+ Contract (Possible Extension) 

Schedule: Monday – Friday, 8:00 AM – 5:00 PM
 
Pay Rate: $41 - $42/hr. on W2
 
Job Description
  • This is full time remote, but candidates must reside in the either of the five business plans: IL, TX, NM, MT,TN 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.
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Job Snapshot

Employee Type

Contractor

Location

Remote, OR (Onsite)

Job Type

Nurse

Experience

Not Specified

Date Posted

02/10/2026

Job ID

26-03452

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