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 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. 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. Needs to be able to navigate MCG and Medical policies with the reviews. HireOps Staffing LLC
At Sunline, safety is more than a checklist. Its how we take care of our drivers, our equipment, and our reputation. Were looking for someone who is curious, detail oriented, and ready to roll up their sleeves to keep our fleet compliant and our team on track. The...
...Master Window Treatment Installer Full-Time W2 Position - Luxury Family Business. Join our award-winning team serving the famous Jersey Shore area! We're a respected family-owned luxury window treatment company seeking a skilled craftsperson to deliver...
...Job Description Job Description We control the operations of our client's marketing promotions. Our Verizon Customer Service Associate team assist our clients in providing them with a generation of consumers interest or inquiry into the products or services of their...
FastMed is one of the largest urgent care providers in North Carolina where we proudly serve 34 counts across the state at more than 50 locations. We aim to provide patients with the best end-to-end healthcare experience in terms of quality, accessibility, affordability...
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