Remote Psychiatric Nurse Practitioner

One of the largest health insurers in the nation is focused on continuously building an industry-defining, world-class IT capability. Healthcare is forever evolving, especially due to emerging technologies, making this a great experience to add to your resume. Come join their winning team!



This contract role as a Remote Utilization Review Nurse in Richardson, TX must be a Registered Nurse working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan.



Pay rate: 38.45 – 41.45 per hour



Responsibilities:



• Responsible for performing accurate and timely medical review of claims suspended for medical necessity, contract interpretation and pricing.

• Initiate and/or respond to correspondence from providers or members concerning medical determinations.



Job Requirements:



• Knowledge of accreditation, i.e. URAC, NCQA standards and health insurance legislation.

• Awareness of claims processes and claims processing systems.

• PC proficiency to include Microsoft Word and Excel and health insurance databases.

• Verbal and written communication skills with ability to communicate to physicians, members and providers and compose and explain document findings.

• Organizational skills and prioritization skills.

• Registered Nurse (RN) with unrestricted license in state.

• 3 years clinical experience.