Utilization Review Nurse - RN

This a Full Remote job, the offer is available from: Texas (USA) We're Hiring: Utilization Review Nurse - RN! We are seeking a dedicated and experienced Utilization Review Nurse (RN) to join our team. The ideal candidate will possess clinical expertise and a strong understanding of healthcare regulations to ensure optimal patient care while managing resource utilization effectively. Location:100% remote - but ust be residing and licensed in IL or TX Role: Utilization Review Nurse - RN 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. • 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 Qualification: • 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 offer from "24HRPO" has been enriched by Jobgether.com and got a 72% flex score. Apply tot his job Apply To this Job