Utilization Review Nurse - Remote

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

The RN will work 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 knowledge includes accreditation standards (i.e., URAC, NCQA) and health insurance legislation. Awareness of claims processes and claims processing systems is essential. PC proficiency is required, including Microsoft Word, Excel, and health insurance databases. Strong verbal and written communication skills are necessary to effectively communicate with physicians, members, and providers, as well as to compose and explain document findings. Organizational and prioritization skills are also important.

Minimum Requirements: