Remote Utilization Review RN - 9-Month Contract (TX/IL)

HireOps Staffing, LLC; Dallas (TX); Remote; USD 46,597 - 66,365; Full time

Job summary

An established industry player is seeking a dedicated Registered Nurse for a remote contract position focused on reviewing medical claims within the insurance sector. This role involves validating treatment plans using accepted criteria and requires strong communication skills to interact with providers and members. Ideal candidates will possess a solid understanding of accreditation standards and claims processes, along with the ability to navigate medical policies effectively. Join a dynamic team where your expertise will directly impact healthcare outcomes and ensure the appropriateness of treatment plans. This opportunity is perfect for those looking to make a meaningful difference in the managed care industry.

Qualifications

• 3 years clinical experience required for this RN position.
• Knowledge of claims processes and health insurance legislation is essential.

Responsibilities

• Perform medical review of claims for medical necessity and appropriateness.
• Initiate and respond to correspondence regarding medical determinations.

Skills

Verbal and written communication skills

Organizational skills

Prioritization skills

PC proficiency (Microsoft Word, Excel)

Knowledge of accreditation standards (URAC, NCQA)

Claims processes awareness

Education

Registered Nurse (RN) with unrestricted license

Tools

MCG

Health insurance databases

Job description

An established industry player is seeking a dedicated Registered Nurse for a remote contract position focused on reviewing medical claims within the insurance sector. This role involves validating treatment plans using accepted criteria and requires strong communication skills to interact with providers and members. Ideal candidates will possess a solid understanding of accreditation standards and claims processes, along with the ability to navigate medical policies effectively. Join a dynamic team where your expertise will directly impact healthcare outcomes and ensure the appropriateness of treatment plans. This opportunity is perfect for those looking to make a meaningful difference in the managed care industry.