Job Description
One of the largest health insurers in the nation is focused on continuously building an industry-defining, world-class IT capability. Healthcare is forever evolving, especially due to emerging technologies, making this a great experience to add to your resume. Come join their winning team!
This contract role as a Remote Utilization Review Nurse in Richardson, TX must be a Registered Nurse working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan.
Pay rate: 38.45 – 41.45 per hour
Responsibilities:
• Responsible for performing accurate and timely medical review of claims suspended for medical necessity, contract interpretation and pricing.
• Initiate and/or respond to correspondence from providers or members concerning medical determinations.
Job Requirements:
• 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.
This contract role as a Remote Utilization Review Nurse in Richardson, TX must be a Registered Nurse working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan.
Pay rate: 38.45 – 41.45 per hour
Responsibilities:
• Responsible for performing accurate and timely medical review of claims suspended for medical necessity, contract interpretation and pricing.
• Initiate and/or respond to correspondence from providers or members concerning medical determinations.
Job Requirements:
• 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.
💡 Quick Summary
Seeking a career-building opportunity? The Remote Psychiatric Nurse Practitioner position is now open for candidates interested in the Nurse / Compounder Jobs sector. This role in New Boston offers a professional environment and growth potential.
Requirement Snapshot: Candidates should possess basic communication skills, a proactive attitude, and the ability to work in a team. Experience in Nurse / Compounder Jobs is a plus.