Utilization Review Nurse - Remote - Contract Job at HireOps Staffing LLC, Dallas, TX

MEJKSHVlYnpQTCsrRzhYR1BQamhpSm83TGc9PQ==
  • HireOps Staffing LLC
  • Dallas, TX

Job Description

Remote position, however, candidates must reside in the State of TX or State of IL

This position is a contract for about 9 months.

Pay: $41/hour

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. 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.

Needs to be able to navigate MCG and Medical policies with the reviews.

Job Tags

Contract work,

Similar Jobs

FACE FOUNDRIÉ

Spa Manager Job at FACE FOUNDRIÉ

 ...exceeding FACE FOUNDRI sales through staff recruiting, productivity development, service promotions; and demonstrations. A Salon Manager is responsible for creating an environment that maintains and exceeds standards of excellence in guest services, client retention skills... 

Kinetic Innovations

Entry Level Solar Sales Representative Job at Kinetic Innovations

 .... We are looking for self-driven and ambitious leaders who have the desire to create a greener planet, and who want to win at every level of their career!We are making a positive difference in peoples lives and improving the environment, one install at a time. We are... 

HelloSubs

ECE Teacher Castle Rock Job at HelloSubs

 ...care to Castle Rock classrooms? Apply today at HelloSubs.co and start picking up shifts as soon as your onboarding is complete. CO Childcare Job Requirements Requirements for Childcare Teacher Castle Rock, CO ~1+ year of teaching experience preferred; less can be... 

Erie Insurance Group

Liability Specialist Job at Erie Insurance Group

 ...Department of Position: Claims Department Work From Home within ERIEs Footprint Salary Range...  ...day of work. Low contributions to medical and prescription premiums. We...  ...Driving; Occasional (~ Manual Keying/Data Entry/inputting information/computer use; Frequent... 

Apple Inc.

SoC Physical Design Engineer, PnR Job at Apple Inc.

We are seeking a seasoned Physical Design technical leader with deep expertise in high-performance & low-power design. In this highly visible role, you will work closely with cross-functional teams to come up with efficient chip and IP physical architecture taking into...