Medical Necessity Reviewer
2 weeks ago
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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