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 The RN will work 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 knowledge includes accreditation standards (i.e., URAC, NCQA) and health insurance legislation. Awareness of claims processes and claims processing systems is essential. PC proficiency is required, including Microsoft Word, Excel, and health insurance databases. Strong verbal and written communication skills are necessary to effectively communicate with physicians, members, and providers, as well as to compose and explain document findings. Organizational and prioritization skills are also important. Minimum Requirements: Registered Nurse (RN) with unrestricted license in state. 3 years clinical experience. Ability to navigate MCG and medical policies during reviews. #J-18808-Ljbffr HireOps Staffing, LLC
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...5:00 AM | Expires Saturday, January 31, 2026 at 4:59 AMWe have an incredible opportunity for a dynamic, energetic, and eager Food Production Supervisor in Detroit.About DO & CO:We have a passion for hospitality culinary delights on every banquet floor and in the sky...
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...provide dynamic guest service at the Denali Backcountry Lodge. As a Massage Therapist, you will plan, coordinate and accomplish a variety of... ...exercise sessions, dances, and classes Provide professional spa massage and body treatments to Lodge guests Organize and supervise...