Utilization Review Nurse - Texas (Remote) - ID-5453
JOB 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.
RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan.
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JOB RESPONSIBILITIES:
- 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.
JOB QUALIFICATIONS (Required):
- Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations.
- 3 years of clinical experience in a Physician's office, Hospital/Surgical setting, or Health Care Insurance Company.
- Knowledge of medical terminology and procedures.
- Verbal and written communication skills.
- Utilization Management experience.
JOB QUALIFICATIONS (Preferred):
- MCG or InterQual experience
LOCATION: REMOTE in Texas (Austin area - Travis/Williamson Counties and Richardson area - Dallas/Collin Counties).
POSITION: 6-month assignment (Contract to Hire)
SALARY: $38 - $40 hourly
HOURS PER WEEK: 40
HOURS PER DAY: 8
SALARY: $38 - $40 hourly
HOURS PER WEEK: 40
HOURS PER DAY: 8
