Utilization Review Nurse(Austin/Richardson TX) (Remote)
• REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson area - 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. JOB QUALIFICATIONS (Preferred): • MCG or InterQual experience • Utilization management experience LOCATION: REMOTE in Texas (Austin area – Travis/Williamson Counties or Richardson area – Dallas/Collin Counties). POSITION: 6-month assignment SALARY: $38 - $40 hourly HOURS PER WEEK: 40 HOURS PER DAY: 8 Apply tot his job