Remote Utilization Review Nurse

Location: CHICAGO, IL, USA

Salary: $39.00 USD Hourly - $40.00 USD Hourly

Description

Our client is seeking a Utilization Review RN to join their team!

Job Title: Registered Nurse (RN) - Utilization Review (Remote)

Location: Remote **Candidates must reside in Illinois or Texas**

Job Type: Contract (6 months)

Pay Rate: $40/hour

Job Description

We are seeking a dedicated Registered Nurse (RN) with experience in the insurance or managed care industry to join our team. The role involves utilizing medically accepted criteria to validate the medical necessity and appropriateness of treatment plans. Key responsibilities include:

• Conducting accurate and timely medical reviews of claims for medical necessity, contract interpretation, and pricing.
• Initiating and responding to correspondence from providers or members regarding medical determinations.
  
  

Qualifications

• Licensure: Active and unrestricted RN license in the state of residence (Illinois or Texas).
• Experience: Minimum of 3 years of clinical experience and prior utilization review experience in a health plan setting.
• Technical Skills: Proficiency in Microsoft Word, Excel, and health insurance databases.
• Knowledge: Familiarity with accreditation standards (e.g., URAC, NCQA) and health insurance legislation.
• Claims Expertise: Awareness of claims processes and claims processing systems.
• Communication Skills: Strong verbal and written communication skills, with the ability to effectively interact with physicians, members, and providers, and to compose and explain findings.
  
  

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Contact: lbraccio@judge.com

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