Company Description
Mindlance, established in 1999, is a leading provider of Talent, Teams, Projects, and Workforce Solutions on a global scale, serving top-tier enterprises across industries. With a presence in multiple countries and a team of over 5,000 professionals, Mindlance leverages AI-driven solutions to optimize and transform workforce operations. The company’s expertise spans diverse areas, including contingent staffing, direct sourcing, managed capacity teams, and outcome-based IT project solutions. Recognized by SIA among the largest and fastest-growing U.S. staffing firms, Mindlance emphasizes partnerships, performance, and innovation.
Job Details:
Job Title: Utilization Review Nurse
Location: Remote
Duration: 6+ Months (Contract Assignment)
This is full time remote, but candidates must reside in the either of the Six business plans: IL, TX, NM, MT, OK or TN.
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 with at least 2 years within the hospital setting or direct patient care.