Utilization Review Nurse – Contract

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🔥 0 minutes ago

🌽 Illinois, Texas – Remote

🌽 Illinois – Remote 🤠 Texas – Remote

💵 $41 / hour

⏳ Contract/Temporary

🟡 Mid-level

🟠 Senior

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HireOps

WebsiteLinkedInAll Job Openings

11 - 50 employees

Founded 2021

👥 HR Tech

🎯 Recruiter

☁️ SaaS

HR Tech • Recruitment • SaaS

HireOps is a company that provides software and services to optimize recruitment operations for employers. The platform centralizes applicant tracking, interview scheduling, candidate sourcing and collaborative hiring workflows, and offers reporting and integrations with HR systems to reduce time-to-hire and improve hiring quality.

📋 Description

• RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. • Performing accurate and timely medical review of claims suspended for medical necessity, contract interpretation, pricing; • Initiating and/or responding to correspondence from providers or members concerning medical determinations. • 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 the ability to communicate to physicians, members and providers and compose and explain document findings. • Organizational skills and prioritization skills.

🎯 Requirements

• Registered Nurse (RN) with unrestricted license in state. • 3 years clinical experience. • Needs to be able to navigate MCG and Medical policies with the reviews.