Title: Utilization Review Nurse Location: Fully Remote must reside in - TX/IL Duration: 6 months Contract (Possible Extension) Schedule: Monday – Friday, 8:00 AM – 5:00 PM Pay Rate : $40/hr - $41/hr on W2 Job 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. 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.
...Benefits Job Summary We are seeking a combination Triage Registered Nurse to join our team. In this role, you will performing a a preliminary... ...or treats the condition themselves Managing the triage telephone system to answer patient questions. Reviewing a patient...
...applicability. Other information: Education Requirements: Graduation from a school of professional nursing. Licensed to practice... ...(BLS) for Healthcare Provider certification Professional Experience Requirements: No prior experience required. Job Details...
...medical consultations, training sessions, and other critical communications. Languages Needed Spanish (Critical) Tagalog Chinese (Mandarin and Cantonese) Haitian Creole Korean Farsi Japanese Thai Vietnamese Polish Russian French...
...Mobile Phlebotomist We are seeking a reliable and customer-focused Mobile Phlebotomist to join our team. This role is responsible for... ...and reliable transportation. ~ Flexibility to work nights and weekends. ~ Positive attitude, a strong work ethic, and the ability...
...analytical skills Excellent written, verbal and interpersonal communication skills Covenant Health Mission Statement: We are a Catholic health ministry, providing healing and care for the whole person, in service to all in our communities. Our Core Values:...