Remote Utilization Review RN – Insurance/URAC Expertise

Innovative Systems Group; Richardson (TX); Remote; USD 70,000 - 90,000; Full time

Job summary

A leading healthcare organization is seeking a full-time remote RN responsible for validating medical necessity in the insurance industry. This role involves performing medical reviews on claims and requires a nursing license, alongside experience in claims processing and knowledge of accreditation standards. Candidates must reside in IL or TX and possess strong communication skills to interact with providers and members.

Qualifications

• Knowledge of URAC, NCQA standards, and health insurance legislation.
• Awareness of claims processes and systems.
• 3 years of clinical experience required.

Responsibilities

• Validate the medical necessity of treatment plans.
• Perform medical review of claims for medical necessity.
• Communicate findings to physicians and providers.

Skills

Knowledge of accreditation

Claims processing

PC proficiency

Communication skills

Organizational skills

Education

Registered Nurse (RN) license

Tools

Microsoft Word

Microsoft Excel

Health insurance databases

Job description

A leading healthcare organization is seeking a full-time remote RN responsible for validating medical necessity in the insurance industry. This role involves performing medical reviews on claims and requires a nursing license, alongside experience in claims processing and knowledge of accreditation standards. Candidates must reside in IL or TX and possess strong communication skills to interact with providers and members.