Utilization Review Nurse-Remote

Job Title

$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. 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 Inter Qual experience