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Utilization Review Nurse – Contract

GeneralGeneralContractRemoteSeniorTeam 11-50Since 2021H1B No SponsorCompany SiteLinkedIn

Location

Texas

Posted

13 hours ago

Salary

$40 / hour

Seniority

Senior

Associate Degree3 yrs expEnglish

Job Description

Utilization Review Nurse – Contract

HireOps

• Performing initial, concurrent review activities • Discharge care coordination for determining efficiency, effectiveness and quality of medical/surgical services • Serving as liaison between providers and medical and network management divisions • Collecting clinical and non-clinical data • Verifying eligibility • Determining benefit levels in accordance to contract guidelines • Providing information regarding utilization management requirements and operational procedures to members, providers and facilities

Job Requirements

  • RN working in the insurance or managed care industry using medically accepted criteria
  • 3 years of clinical experience in a physician office, hospital/surgical setting or health care insurance company
  • Knowledge of medical terminology and procedures
  • Verbal and written communication skills
  • Utilization management experience (preferred)
  • MCG or InterQual experience (preferred)

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