Utilization Review Nurse - RN Job at TapTalent.ai, Richardson, TX

R2NhRnNLSlg1VHBhOVI4Q0xxMTZMRVlKWkE9PQ==
  • TapTalent.ai
  • Richardson, TX

Job Description

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.

Job Tags

Contract work,

Similar Jobs

Upflow Jobs

Data Analyst Intern Job at Upflow Jobs

 ...inhibited. Upflow is the modern collections hub that manages all data, analytics, communications and payments to improve cash flows....  ...industry Defined pathway : This is a structured 6-month internship designed to immerse you deeply in the workings of Upflows data... 

MRA Recruiting Services

Community Day Program Assistant - Summer Job at MRA Recruiting Services

 ...Position Title: Community Day Program Assistant, Summer Location: Wauwatosa, SE WI Reports To: Community Day Program...  ...through awareness, education, information, programs, services, and exchanging ideas and experiences. DSAW provides programs... 

Uber

Product Manager, Grocery Shopper Experience Job at Uber

 ...with minimal interventions on their part. To accomplish this, you will define and execute the product strategy to ensure that the shopper experience is simple, while prioritizing accuracy and quality - every time.In this role, you will be working with a broad set of cross... 

Eighti Republic

Audio Engineer, Internship Job at Eighti Republic

Eighti Republic is looking for a reliable and motivated individual to assist in daily studio operations and audio management responsibilities. The audio engineer assistant will assist Eighti Studios (location) in administrating task, scheduling studio sessions, tracking... 

Lensa

Remote Medical Transcriptionist Job at Lensa

 ...Salary: $380 / Week Amergis Healthcare Staffing is seeking a Medical Transcriptionist to transcribe dictation from physicians or...  ...equivalent. Certification by the AmericanAssociation for Medical Transcription preferred; Certification may be required for specific...