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

K2NQLzhZWGRoMXBBVmRHR1hlYWxUaUlLSWc9PQ==
  • 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

General Tool Co

NDT Inspector II/III Job at General Tool Co

 ...First and second shift positions available. FUNCTION: Performs NDT inspections (Penetrant, Magnetic Particle, X-Ray, Ultrasonic or visual inspections) as required and as personal certifications apply. Must have achieved national recognition as Level II or III by... 

Axius Technologies Inc

Network Cable and Telephony Technician Job at Axius Technologies Inc

Network Cable and Telephony Technician Location: Phoenix, AZ, 85007 (Onsite) Contract Job Description: Position Description The Network...  ...patch cable connection, tracing, labeling), hardware installation and removal to/from data closets, processing customer... 

Revak Keene Turbomachinery

NDT Level III Technician/QC Inspector Job at Revak Keene Turbomachinery

 ...Job Reports To Quality Manager Purpose of Job As Quality Inspector NDT Level III, you are responsible for ensuring the products we produce are of consistently high quality and adhere to relevant specifications. Training and mentoring Level II NDT Inspectors. Also, you... 

Cox Automotive Mobility Fleet Services

Mobile Diesel & Trailer Mechanic II Job at Cox Automotive Mobility Fleet Services

 ...mobile on-site fleet service for light medium, and heavy-duty trucks and trailers. Fleet Services also services customers utilizing its 50+...  ...accident repair, painting, refurbishment, and heavy mechanical repair. We are supported by a 24/7 in-house call-center and... 

TalentOla

Data Analyst Engineer Job at TalentOla

 ...Title: Data Analyst Engineer Location: Jersey City, Wilmington, Chicago, Plano, Seattle, Palo Alto. Job Description: ~5+ years working for technology companies ~ Experience collaborating with a globally distributed team ~ Ability to adapt to...