Utilization Review Nurse - RN Job at 24HRPO, Richardson, TX

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  • 24HRPO
  • Richardson, TX

Job Description

We're Hiring: Utilization Review Nurse - RN!

We are seeking a dedicated and experienced Utilization Review Nurse (RN) to join our team. The ideal candidate will possess clinical expertise and a strong understanding of healthcare regulations to ensure optimal patient care while managing resource utilization effectively.

Location: 100% remote - but ust be residing and licensed in IL or TX

Role: Utilization Review Nurse - RN

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.

Required Qualification:

  • 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.

Job Tags

Contract work,

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