Utilization Review Nurse - Texas (Remote)

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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, reputed company 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, reputed company, 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 experience LOCATION: REMOTE in Texas (Austin area - Travis/Williamson Counties and Richardson area - Dallas/Collin Counties). POSITION: 6-month assignment (Contract to Hire) SALARY: $38 - $40 hourly HOURS PER WEEK: 40 HOURS PER DAY: 8 Apply Job!