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
...them to succeed today, while growing professionally and preparing for the challenges of tomorrow. A Brief Overview The Kitchen and Bath Designer will work in a retail environment with customers and builders to assist with the design and product selection process....
...work successfully and collaboratively with a team Ability to read and understand electrical schematic High proficiency in Solidworks Electrical Hands-on experience with 3D modeling tools such as Auto CAD and Inventor Desired Qualifications: Autocad electrical...
...Monday - Friday; 4 hours daily. This position does not work weekends or holidays. Pay Rate: $14.95 - $18.67 Duties:... ...relating to maintenance & housekeeping Perform routine cleaning of patient rooms, office, clinical areas, waiting areas, and lobbies in a clean,...
...Job Description Infosys is seeking an experienced Workday Security Lead Consultant to join our Workday team. The ideal candidate will have expertise in designing, implementing, and managing Workday security frameworks to ensure compliance, data integrity, and secure...
Patrique Mercier Recruitment ES is seeking a Swedish Speaking Marketplace Customer Representative to join our committed team! In this role, you will be the primary point of contact for our Swedish-speaking customers, providing them with outstanding support and a positive...