Utilization Review Nurse

EPITEC; Illinois; Remote; USD 60,000 - 80,000; Full time

Job summary

EPITEC is seeking a full-time Utilization Review Nurse to work remotely in Illinois or Texas. The role involves validating treatment plans, performing medical reviews, and communicating with healthcare providers and members. Ideal candidates will have a Registered Nurse license and at least three years of clinical experience.

Benefits

Vision insurance

401(k)

Qualifications

• Knowledge of accreditation and health insurance legislation.
• 3 years clinical experience required.
• Familiarity with claims processes and systems.

Responsibilities

• Validate medical necessity and appropriateness of treatment plans.
• Perform medical reviews of claims suspended for medical necessity.
• Correspond with providers or members on medical determinations.

Skills

Verbal communication

Written communication

Organizational skills

Prioritization skills

PC proficiency

Education

Registered Nurse (RN) license

Tools

Microsoft Word

Microsoft Excel

Job description

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This range is provided by EPITEC. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$38.00/hr - $41.00/hr

Direct message the job poster from EPITEC

**This is full time remote, but candidates must reside in IL or TX**

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.
• 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.

Job Requirements:

• 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 ability to communicate to physicians, members and providers and compose and explain document findings.
• Organizational skills and prioritization skills.
• Registered Nurse (RN) with unrestricted license in state.
• 3 years clinical experience.

Seniority level

• Seniority level

  Associate

Employment type

• Employment type

  Contract

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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Inferred from the description for this job

Vision insurance

401(k)

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