Title: Utilization Review Nurse Location: Fully Remote must reside in - TX/IL Duration: 6 months Contract (Possible Extension) Schedule: Monday – Friday, 8:00 AM – 5:00 PM Pay Rate : $40/hr - $41/hr on W2 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. 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. 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.aa415a4b-8b21-40fc-a65c-70d2b25ca29a
...RN - GI/ Endoscopy Per Diem Day at Providence Health and Services summary: This Per Diem RN position at Providence Saint John's Health Center involves providing specialized nursing care in the Gastrointestinal (GI) and Endoscopy departments during day shifts, including...
...About Eisterhold Associates Inc : Eisterhold Associates, Inc. specializes in the planning and design of interpretive exhibitions, with a focus on museums and cultural institutions. Our projects include the International Civil Rights Center & Museum, Rosa Parks Museum...
...Cleaning & Waste Cluster Manager, FIFA World Cup 2026 Department: Technical & Infrastructure Employment Type: Fixed Term - Full Time Location: Miami Description The Cleaning & Waste (CLW) Cluster Manager is responsible for the planning, coordination, delivery...
...Service Representatives to join our team immediately! If you love interacting with people and... ...this is the perfect opportunity. No experience required we provide paid training ,... ...required What We Offer Immediate hire opportunities Paid training and ongoing...
...career outcomes for a more just future for all. ELSO seeks to reduce the achievement gap in STEAMED (Science, Technology, Engineering, Arts, Math, Environment, Design) education and professions while creating a sense of belonging for Black, Indigenous, and People of Color...