Utilization Review Nurse – Contract

This is a fully remote position, open to applicants in Texas.

📋 Description

• Conducting initial and concurrent review activities

• Coordinating discharge care to assess the efficiency, effectiveness, and quality of medical/surgical services

• Acting as a liaison between healthcare providers and the medical and network management divisions

• Gathering clinical and non-clinical data

• Confirming eligibility

• Assessing benefit levels in accordance with contractual guidelines

• Offering information regarding utilization management requirements and operational procedures to members, providers, and facilities

⛳️ Requirements

• Registered Nurse with experience in the insurance or managed care sector utilizing medically accepted criteria

• Minimum of 3 years of clinical experience in a physician's office, hospital/surgical environment, or healthcare insurance company

• Familiarity with medical terminology and procedures

• Strong verbal and written communication abilities

• Experience in utilization management (preferred)

• Familiarity with MCG or InterQual guidelines (preferred)

🏝️ Benefits

• Comprehensive health insurance coverage

• Retirement plan options

• Paid time off and holiday pay

• Opportunities for professional development and growth