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

aEdDMXRCUytPWG1Cbk1ENFBBa1J1R3hhS2c9PQ==
  • 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, Remote work,

Similar Jobs

Excellence Services, LLC

Senior Personal Assistant / Chauffeur (2025) Job at Excellence Services, LLC

 ...breaks ~ Regular reviews & advancement opportunities ~ Travel as needed INTRODUCTION: We are looking for a Senior Personal Assistant/Chauffeur to work under our House Manager in a dynamic private household setting. The role involves hands-on management of... 

Demandbase

Chief Information Security Officer (CISO) (San Francisco) Job at Demandbase

 ...Chief Information Security Officer (CISO) Join to apply for the Chief Information Security Officer (CISO) role at Demandbase . Introduction to Demandbase Demandbase helps B2B companies hit their revenue goals using fewer resources by leveraging AI to identify... 

Delaware North

Cleaner, Wheeling Island Casino Job at Delaware North

 ...fixtures Ability to work quickly under pressure Ability to make simple addition and subtraction calculations No high school diploma or GED required Physical requirements Frequent walking and standing for the entire length of the shift Frequent climbing of... 

Construction Execs

Project Manager Job at Construction Execs

 ...years of construction experience. OSHA 30 certification. Proficient in MS Project scheduling software. Working knowledge of BIM processes, software Strong communication skills. The Offer: ~ Excellent Salary ~ Full benefits ~ Employee Stock Ownership... 

Heartland Hospice

Hospice Certified Nursing Assistant - Hospice Aide Job at Heartland Hospice

 ...Overview Join us to make a difference when life matters most ***$2,500 Sign On Bonus!!!*** Are you a Hospice Aide or Certified Nursing Assistant (CNA) who finds purpose in providing compassionate, hands-on care during lifes most meaningful moments? We believe...