$40/hour - Contract for 6 months Must reside in TX
Full time remote Candidates must be based in TX. RN working 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 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.
Registered Nurse (RN) with valid, current, unrestricted license in the state of operations.
* 3 years of clinical experience in a physician office, hospital/surgical setting or health care insurance company.
* Knowledge of medical terminology and procedures.
* Verbal and written communication skills.
PREFERRED JOB REQUIREMENTS:
* Utilization management experience
* MCG or InterQual experience
...In support of our mission to improve health every day, this is a tobacco-free environment. For positions that are available as remote work, Sentara Health employs associates in the following states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas,...
...Marketing SpecialistThis profile outlines the typical duties, responsibilities, and necessary qualifications for a Digital Marketing Specialist... ...Marketing Specialist manages and executes the company's online marketing initiatives across search engines, AI discovery platforms...
...DescriptionWe are seeking a highly motivated and experienced computational chemist to join our Computational Drug Design group in Boston... ...Sciences group to provide expertise in data analysis, computational chemistry and AI method development. This individual must demonstrate...
...occupational therapy treatment plans designed to alleviate pain, restore function, prevent disabilities, and promote overall fitness and health of patients. Serves as a role model in delivery of professional services and as a clinical resource for staff and students....
...the Washington, DC metropolitan area, specializes in providing network and network security solutions in complex environments to a select... ...leader in its field, is composed of an elite team of engineers and business consultants, each of whom is recognized and highly...