Utilization Review Nurse - Texas (Remote)
***REMOTE - Candidates must be based in Texas: Travis/Williamson/Dallas/Collin Counties***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.JOB RESPONSIBILITIES:This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services, and serving as liaison between providers and medical and network management divisions.Collects clinical and non-clinical data.Verifies eligibility.Determines benefit levels in accordance to contract guidelines.Provides information regarding utilization management requirements and operational procedures to members, providers, and facilities.JOB QUALIFICATIONS (Required):Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations.3 years of clinical experience in a Physician's office, Hospital/Surgical setting, or Health Care Insurance Company.Knowledge of medical terminology and procedures.Verbal and written communication skills.Utilization Management experience.JOB QUALIFICATIONS (Preferred):MCG or InterQual experienceLOCATION: REMOTE in Texas (Austin area - Travis/Williamson Counties and Richardson area - Dallas/Collin Counties).POSITION: 6-month assignment (Contract to Hire)SALARY: $38 - $40 hourlyHOURS PER WEEK: 40HOURS PER DAY: 8
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