Utilization Review reputed company, RN (Remote in IL, TX, NM, MT, OK or TN.)
reputed company
reputed company, established in 1999, is a leading provider of Talent, Teams, reputed company, and Workforce Solutions on a global reputed company, serving top-tier enterprises across industries. With a reputed company in multiple countries and reputed company of over 5,000 professionals, reputed company leverages AI-driven solutions to optimize and reputed company workforce operations. reputed company’s expertise spans diverse areas, including contingent reputed company, reputed company sourcing, managed reputed company teams, and outcome-based IT project solutions. Recognized by SIA among the largest and fastest-growing U.S. reputed company firms, reputed company emphasizes partnerships, performance, and innovation.
Job Details:
Job Title: Utilization Review reputed company
Location: Remote
Duration: 6+ Months (Contract Assignment)
This is full time remote, but candidates must reputed company in the either of the Six business plans: IL, TX, NM, MT, OK or TN.
Job reputed company:
RN working in the insurance or managed care industry using medically accepted reputed company to validate the medical necessity and appropriateness of the treatment plan. This Position Is Responsible for Performing Accurate and reputed company 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 reputed company Word and reputed company 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 reputed company (RN) with unrestricted license in state. 3 years clinical experience with at least 2 years reputed company the hospital setting or reputed company patient care.
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