Utilization Review Nurse

Job Title: Utilization Review Nurse

Location: Remote in IL, TX, NM, MT or OK

Duration: 6+ months contract (possible extension)

Pay: $40.00/hr on W2

Registered Nurse responsible for collaborating with healthcare providers, members, and business partners, to optimize member benefits, evaluate medical necessity and promote effective use of resources. Medical necessity reviews may include: drugs and biologics, inpatient admissions, outpatient services, surgical and diagnostic procedures, home health, durable medical equipment and out of network services. Conduct reviews in compliance with medical policy, member eligibility, benefits, and contracts.

Essential Duties and Responsibilities:

• Responsible for the effective and sufficient support of all Utilization Management activities to include review of inpatient and outpatient medical services for medical necessity and appropriateness of setting ...