Utilization Review Nurse

This contract role as a Remote Utilization Review Nurse must be a Registered Nurse working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan.

Responsibilities:

· Responsible for performing accurate and timely medical review of claims suspended for medical necessity, contract interpretation and pricing.

· Initiate and/or respond to correspondence from providers or members concerning medical determinations.

Job Requirements:

· 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 Type: Contract

Pay: $35.00 - $40.00 per hour

Benefits:

• 401(k)
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Location:

• Illinois (Required)

Work Location: Remote