Remote Utilization Review Nurse RN – TX, NM, MT, OK

Job Title : Utilization Review Nurse

Duration : 6+ Months Assignment

Locations : Fully Remote (WFH).

Schedule : Mon-Fri 8:00 AM – 4:30 PM

Start Date : ASAP

this is full time remote, but candidates must reside in the either of the five business plans: Il, TX, NM, MT or OK

Responsibilities:

• 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 with at least 2 years within the hospital setting or direct patient care.

EEO:

“Mindlance is an Equal Opportunity Employer and does not discriminate in employment on the basis of – Minority/Gender/Disability/Religion/LGBTQI/Age/Veterans.”