Join to apply for the Utilization Review Nurse - RN role at 24HRPO Continue with Google Continue with Google 3 days ago Be among the first 25 applicants Join to apply for the Utilization Review Nurse - RN role at 24HRPO Get AI-powered advice on this job and more exclusive features. Sign in to access AI-powered advices Continue with Google Continue with Google Continue with Google Continue with Google Continue with Google Continue with Google Continue with Google Continue with Google Continue with Google Continue with Google Continue with Google Continue with Google We're Hiring: Utilization Review Nurse - RN! We are seeking a dedicated and experienced Utilization Review Nurse (RN) to join our team. The ideal candidate will possess clinical expertise and a strong understanding of healthcare regulations to ensure optimal patient care while managing resource utilization effectively. We're Hiring: Utilization Review Nurse - RN! We are seeking a dedicated and experienced Utilization Review Nurse (RN) to join our team. The ideal candidate will possess clinical expertise and a strong understanding of healthcare regulations to ensure optimal patient care while managing resource utilization effectively. Location: 100% remote - but ust be residing and licensed in IL or TX Role: Utilization Review Nurse - RN 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. 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 Qualification: 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. Ready to make an impact? Apply now and let’s grow together! Seniority level Seniority level Mid-Senior level Employment type Employment type Full-time Job function Job function Other Industries IT Services and IT Consulting Referrals increase your chances of interviewing at 24HRPO by 2x Sign in to set job alerts for “Utilization Review Nurse” roles. Continue with Google Continue with Google Continue with Google Continue with Google Arlington Heights, IL $70,000 - $75,000 3 days ago Park Ridge, IL $70,000 - $75,000 3 days ago Des Plaines, IL $70,000 - $75,000 3 days ago Downers Grove, IL $76,207.00 - $117,662.00 1 month ago Registered Nurse - RN / Step Down Unit - TELE-P Manager, Clinical Care Case Management - Remote Registered Nurse - FT Day - 2N: Cardiac Tele On-Call Registered Nurse (RN) - 7 on 7 off (Nights) Lemont, IL $75,000.00 - $85,000.00 4 weeks ago Cicero, IL $70,000.00 - $75,000.00 2 days ago Arlington Heights, IL $70,000.00 - $75,000.00 2 days ago Registered Nurse - FT Night - 2N: Cardiac Tele Park Ridge, IL $70,000 - $75,000 2 days ago Des Plaines, IL $70,000 - $75,000 2 days ago Registered Nurse (RN) Telemetry- .9 FTE 7pm-7:30am Registered Nurse-Telemetry Full Time Days $2000 Sign On Chicago, IL $81,000 - $116,000 4 hours ago Registered Nurse (RN)-Telemetry .6 7p to 7a We’re unlocking community knowledge in a new way. Experts add insights directly into each article, started with the help of AI. #J-18808-Ljbffr 24-Hour HR Process Outsourcing, Inc.
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