hireops
Utilization Review Nurse - Remote - Contract
Chicago, Illinois, United States
Sponsorship not specifiedDetected 20 days ago
ExcelCommunicationOrganizational SkillsMicrosoft OfficeClaims Management
About the role
- Remote position, however, candidates must reside in the State of TX or State of IL This position is a contract for about 9 months.
- Knowledge of accreditation, i.e. URAC, NCQA standards and health insurance legislation.
- Awareness of claims processes and claims processing systems.
Responsibilities
- Verbal and written communication skills with ability to communicate to physicians, members and providers and compose and explain document findings.
Compensation
- Awareness of claims processes and claims processing systems.
- 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.
Benefits
- RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan.
- PC proficiency to include Microsoft Word and Excel and health insurance databases.
- Needs to be able to navigate MCG and Medical policies with the reviews.
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