Medical Necessity Reviewer

2 weeks ago


Chicago, Illinois, United States HireOps Staffing LLC Full time

About This Role

HireOps Staffing LLC is seeking a skilled Medical Necessity Reviewer to join our team. As a key member of our insurance industry team, you will play a critical role in reviewing medical claims and ensuring that treatment plans are medically necessary.

Key Responsibilities

  • Perform thorough reviews of medical claims to validate their medical necessity and appropriateness
  • Collaborate with healthcare providers and members to ensure accurate and timely medical determinations
  • Stay up-to-date on accreditation standards and health insurance legislation to inform your work
  • Analyze claims data and identify trends to optimize our review processes

Requirements

  • RN licensure in good standing in the state where you reside
  • 3+ years of clinical experience in a related field
  • Excellent communication and organizational skills
  • Strong analytical and problem-solving abilities

What We Offer

  • A competitive hourly rate of $41 per hour
  • The opportunity to work remotely from anywhere in IL or TX
  • A dynamic and supportive work environment


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