Utilization Review Nurse

Integrated Resources, Inc ( IRI ); Illinois; Remote; Full time

Job summary

A leading healthcare company is seeking an RN for contract work focused on validation of treatment plans in insurance. This fully remote position requires specific knowledge in claims processing and medical necessity, along with strong computer skills. Ideal candidates should hold an unrestricted RN license and have at least three years of clinical experience.

Qualifications

• 3 years of clinical experience required.
• Knowledge of URAC, NCQA standards needed.
• Proficient in Microsoft Word and Excel.

Responsibilities

• Validate medical necessity and appropriateness of treatment plans.
• Perform accurate and timely medical review of claims.
• Initiate and respond to correspondence regarding medical determinations.

Skills

Medical Review

Claims Processing

Computer Proficiency

Education

Registered Nurse (RN)

Job description

2 days ago Be among the first 25 applicants

Integrated Resources, Inc ( IRI ) provided pay range

This range is provided by Integrated Resources, Inc ( IRI ). Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$40.00/hr - $41.00/hr

Direct message the job poster from Integrated Resources, Inc ( IRI )

Lead Recruiter at Integrated Resources Inc.(Scientific/ Clinical/Life Sciences /Pharmaceuticals /Engineering/Healthcare/ Business Professionals)

Location: REMOTE- (But candidates must reside in IL or TX)

Duration: 4+ months

Note: Training is for 2 weeks and will be Mon-Fri 8-430

Summary:

• 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.
• 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.
• Registered Nurse (RN) with unrestricted license in state.
• 3 years of clinical experience.

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Contract

Job function

• Job function

  Science, Research, and Health Care Provider

• Industries

  Insurance, Hospitals and Health Care, and Health and Human Services

Referrals increase your chances of interviewing at Integrated Resources, Inc ( IRI ) by 2x

Get notified about new Utilization Review Nurse jobs in Illinois, United States.

Naperville, IL $75,000 - $85,000 5 days ago

Arlington Heights, IL $70,000 - $75,000 2 days ago

Elgin, IL
$70,000.00
-
$75,000.00
2 days ago

Park Ridge, IL
$70,000.00
-
$75,000.00
2 days ago

Quincy, IL
$70,000.00
-
$75,000.00
2 days ago

Palatine, IL
$70,000.00
-
$75,000.00
2 days ago

Des Plaines, IL
$70,000.00
-
$75,000.00
2 days ago

Cicero, IL
$70,000.00
-
$75,000.00
2 days ago

Decatur, IL
$70,000.00
-
$75,000.00
2 days ago

Downers Grove, IL
$76,207.00
-
$117,662.00
1 month ago

Registered Nurse - RN / Step Down Unit - TELE-P

Manager, Clinical Care Case Management - Remote

Registered Nurse - RN / Step Down Unit - TELE-P

Registered Nurse - RN / Step Down Unit - TELE-P

Registered Nurse - RN / Intermediate Care Unit - TELE-P

Manager, Clinical Care Case Management - Remote

Maryville, IL $2,144.44 - $2,144.44 2 days ago

Registered Nurse - RN / Intermediate Care Unit - TELE-P

Springfield, IL $66,575 - $142,576 2 days ago

We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI.