REMOTE - Candidates must be based in Texas: Austin area - Travis/Williamson Counties or Richardson area - Dallas/Collin Counties RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan. JOB RESPONSIBILITIES This position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services, and serving as liaison between providers and medical and network management divisions. Collects clinical and non-clinical data. Verifies eligibility. Determines benefit levels in accordance to contract guidelines. Provides information regarding utilization management requirements and operational procedures to members, providers, and facilities. JOB QUALIFICATIONS (Required) Registered Nurse (RN) with a valid, current, unrestricted license in the state of operations. 3 years of clinical experience in a Physician's office, Hospital/Surgical setting, or Health Care Insurance Company. Knowledge of medical terminology and procedures. Verbal and written communication skills. JOB QUALIFICATIONS (Preferred) MCG or InterQual experience Utilization management experience LOCATION REMOTE in Texas (Austin area – Travis/Williamson Counties or Richardson area – Dallas/Collin Counties). POSITION 6-month assignment SALARY $38 - $40 hourly HOURS PER WEEK 40 HOURS PER DAY 8 #J-18808-Ljbffr
...procedures, equipment, and exam to ensure patient's understanding and cooperation. When ordered, prepares and administers contrast media and/or medications within the scope of practice. Monitors patient condition continually and reports/responds to changes in status...
...Electrical Engineer in West Milton, NY. An active DOE L clearance or DOD equivalent is required to be considered for this position. Navarro Research & Engineering is an award-winning federal contractor dedicated to partnering with clients to advance clean energy and...
A Catholic school in Lemont is seeking a Junior High Math Teacher for the 2026-2027 school year. This role emphasizes teaching in alignment with Catholic values and educating the whole child. The ideal candidate will hold a Bachelor's degree and be a practicing Catholic...
...Senior Associate At PwC, our people in audit and assurance focus on providing independent and objective assessments of financial statements, internal controls, and other assurable information enhancing the credibility and reliability of this information with a variety...
...; Process and audit paperwork for sales, auctions, and registrations; Manage multiple pay types, handle deposits and cash securely; Answer multi-line phone system and direct calls as appropriate; Mentor new Business Office Associates and train other store departments...