Remote Utilization Review Nurse 30415

One of the largest health insurers in the nation is focused on continuously building an industry-defining, world-class IT capability. Healthcare is forever evolving, especially due to emerging technologies, making this a great experience to add to your resume. Come join their winning team!

This contract role as a Remote Utilization Review Nurse is responsible for performing accurate and timely medical review of claims suspended for medical necessity, contract interpretation, pricing. The role is also responsible for initiating and/or responding to correspondence from providers or members concerning medical determinations.

Pay Rate: $38.45 - $41.45 per hour

Job Requirements:

·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...

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