Utilization Review Nurse-Remote-Contract

HireOps Staffing is hiring a Utilization Review Nurse for a full-time remote contract position. This role is for a Registered Nurse with a current, unrestricted license who has worked in the insurance or managed care industry, reviewing treatment plans against medically accepted criteria. You must live in Texas to be considered.

The contract runs for 6 months at $40 per hour.

What you will do

You will perform initial and concurrent review activities and discharge care coordination, looking at the efficiency, effectiveness and quality of medical and surgical services. You will act as a liaison between providers and the medical and network management divisions.

• Collect clinical and non-clinical data
• Verify eligibility
• Determine benefit levels according to contract guidelines
• Give members, providers and facilities information about utilization management requirements and operational procedures

What they are looking for

• Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations
• 3 years of clinical experience in a physician office, hospital or surgical setting, or at a health care insurance company
• Knowledge of medical terminology and procedures
• Verbal and written communication skills

Preferred

• Utilization management experience
• MCG or InterQual experience

Pay and hours

The pay rate is $40 per hour. This is a full-time remote contract for 6 months.

Location

Candidates must be based in Texas. The listing states this requirement three times: you must reside in TX.

About the company

HireOps Staffing is the employer for this contract role. The position was originally posted on Himalayas.