Remote position, however, candidates must reside in the State of TX or State of IL. This position is a contract for about 9 months. Pay: $41 / hour The RN will work in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. This position is responsible for performing accurate and timely 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. Required knowledge includes accreditation standards (i.e., URAC, NCQA) and health insurance legislation. Awareness of claims processes and claims processing systems is essential. PC proficiency is required, including Microsoft Word, Excel, and health insurance databases. Strong verbal and written communication skills are necessary to effectively communicate with physicians, members, and providers, as well as to compose and explain document findings. Organizational and prioritization skills are also important. Minimum Requirements: Registered Nurse (RN) with unrestricted license in state. 3 years clinical experience. Ability to navigate MCG and medical policies during reviews. #J-18808-Ljbffr HireOps Staffing, LLC
...As an Endocrinologist with Rochester Regional Health, you are shaping the future of healthcare in central and western New York and making the lives of our patients better; easier and healthier. At Rochester Regional Health you can define your career goals, lead others...
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...the first 25 applicants Join to apply for the Senior Retail Property Underwriter / Boston or Philadelphia role at Everest Title: Senior Retail Property Underwriter / Boston or Philadelphia Company: Everest Insurance Company Job Category: Underwriting...
...in Data Analytics for Economics, minors in Psychology, History, and Environmental Studies, and courses in sociology, psychology, anthropology, economics, geography, government, history, and philosophy. Candidates with expertise in law and society and/or science and...