3 days ago Be among the first 25 applicants This is full-time remote, but candidates must reside in IL or TX Contract: 12/22/2025 to 03/31/2026 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 . #J-18808-Ljbffr
...Job Description: Proofreader Job Responsibilities: Review and proofread various types of documents for errors in grammar, spelling, punctuation, and formatting Ensure all content is accurate, consistent, and adheres to company standards Collaborate with the...
Job Description Job Description About Us: VOALA Helping Our Most Vulnerable Change Their Life Stories Volunteers of America is a non-profit human services organization committed to serving people in need, strengthening families, and building communities. VOALA...
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