Utilization Review NurseInnovative Systems Group • Richardson, Texas, United States
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Utilization Review Nurse
Innovative Systems Group
- Richardson, Texas, United States
- Richardson, Texas, United States
À propos
This is full-time remote, but candidates must reside in IL or TX
Contract: 12/22/2025 to 03/31/2026
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.
Qualifications:
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 .
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Compétences linguistiques
- English
Avis aux utilisateurs
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