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Illinois or Texas Licensed Utilization Review Nurse
A company is looking for a Remote Utilization Review Nurse. Key Responsibilities 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 Required Qualifications Active and unrestricted RN license in the state of residence (Illinois or Texas) Minimum of 3 years of clinical experience and prior utilization review experience in a health plan setting Proficiency in Microsoft Word, Excel, and health insurance databases Familiarity with accreditation standards (e.g., URAC, NCQA) and health insurance legislation Awareness of claims processes and claims processing systems
A company is looking for a Remote Utilization Review Nurse.
Key Responsibilities
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
Required Qualifications
Active and unrestricted RN license in the state of residence (Illinois or Texas)
Minimum of 3 years of clinical experience and prior utilization review experience in a health plan setting
Proficiency in Microsoft Word, Excel, and health insurance databases
Familiarity with accreditation standards (e.g., URAC, NCQA) and health insurance legislation
Awareness of claims processes and claims processing systems