Offer summary

Qualifications:

Registered Nurse (RN) with a valid, current, unrestricted license in Texas., 3 years of clinical experience in a Physician's office, Hospital/Surgical setting, or Health Care Insurance Company., Knowledge of medical terminology and procedures is essential., Strong verbal and written communication skills are required..

Key responsabilities:

Perform initial and concurrent review activities for treatment plans.

Coordinate discharge care to assess the efficiency and quality of medical services.

Act as a liaison between providers and medical/network management divisions.

Collect clinical and non-clinical data and verify eligibility for benefits.

Job description

REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties***

JOB DESCRIPTION:

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

Required profile