Job Description

REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties 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 #J-18808-Ljbffr Madea Home Care Services

Job Tags

Hourly pay, Contract work, Work at office,

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