Remote Utilization Review RN - 9 Month Contract

Visa Hunt; United States; Remote; USD 80,000 - 90,000; Full time

Job summary

Visa Hunt is seeking a Registered Nurse contract reviewer to perform medical review of claims suspended for medical necessity and pricing. The role requires navigating medical policies and communicating findings to providers and members.

Remote position with residency in Texas or Illinois; about 9 months, paying $41/hour. Clinical experience and strong documentation skills are essential.

Qualifications

• Registered Nurse with unrestricted license in state.
• 3 years clinical experience.
• Knowledge of medical necessity review criteria and claims processing.

Responsibilities

• Perform accurate and timely medical review of claims suspended for medical necessity, contract interpretation, and pricing.
• Initiate and respond to correspondence from providers or members concerning medical determinations.
• Navigate MCG, medical policies, URAC and NCQA standards during reviews.

Skills

RN license

Medical review

Communication

Organization

RN experience

Education

RN license

Tools

Microsoft Word

Microsoft Excel

Job description

Visa Hunt is seeking a Registered Nurse contract reviewer to perform medical review of claims suspended for medical necessity and pricing. The role requires navigating medical policies and communicating findings to providers and members.

Remote position with residency in Texas or Illinois; about 9 months, paying $41/hour. Clinical experience and strong documentation skills are essential.