Utilization Review Nurse
Company: Innovative Systems Group
Location: Richardson
Posted on: July 5, 2025
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Job Description:
Job Description This is full-time remote, but candidates must
reside in IL or TX Contract: 2025-08-11 to 2025-12-31 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. Qualifications: - 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.
Keywords: Innovative Systems Group, Cedar Hill , Utilization Review Nurse, Administration, Clerical , Richardson, Texas
