Utilization Review Nurse-Remote-Contract

HireOps Staffing; United States; Remote; USD 45,000 - 65,000; Full time

Benefits offered by this job

Remote work

Job summary

Himalayas in TX seeks a licensed RN for a 6-month, full-time remote contract. The role focuses on initial and concurrent reviews, discharge coordination, and liaison activities to determine medical necessity and appropriate treatment plans.

Requirements include an active RN license, 3 years of clinical experience in a healthcare setting, and strong communication skills. Preferred: utilization management experience with MCG or InterQual.

Qualifications

• RN license required in state of operations.
• 3 years of clinical experience in physician office, hospital, or health insurance company.
• Verbal and written communication skills.

Responsibilities

• Perform initial and concurrent review activities.
• Discharge care coordination for efficiency and quality of medical/surgical services.
• Serve as liaison between providers and medical/network management divisions.
• Collect clinical and non-clinical data; verify eligibility and determine benefits.
• Provide information on utilization management requirements and procedures to members, providers, and facilities.

Skills

RN license

Clinical experience

Utilization management

Education

RN license

Job description

$40/hour - Contract for 6 months Must reside in TX Full time remote Candidates must be based in TX.

RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. pay rate is $40/hour

This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness and quality of medical/surgical services and serving as liaison between providers and medical and network management divisions. Collects clinical and non-clinical data. Verifies eligibility. Determines benefit levels in accordance to contract guidelines. Provides information regarding utilization management requirements and operational procedures to members, providers and facilities.

Registered Nurse (RN) with valid, current, unrestricted license in the state of operations.

• 3 years of clinical experience in a physician office, hospital/surgical setting or health care insurance company.
• Knowledge of medical terminology and procedures.
• Verbal and written communication skills.

PREFERRED JOB REQUIREMENTS:

• Utilization management experience
• MCG or InterQual experience

Salary: $40/hour

Originally posted on Himalayas