Job summary
Job post source
This job is from a recruiting firm hiring for a separate company.
Job overview
The Utilization Review Nurse (RN) role involves reviewing medical claims to ensure appropriate patient care and resource use in the insurance or managed care industry.
Responsibilities and impact
The nurse will perform medical reviews of claims for medical necessity, contract interpretation, and pricing, and communicate with providers and members about medical determinations.
Experience and skills
Requires an RN license with 3 years clinical experience, knowledge of URAC and NCQA standards, claims processes, proficiency in Microsoft Word and Excel, and strong communication and organizational skills.
Work environment and culture
The position is fully remote but requires residency and licensure in IL or TX, indicating a flexible work environment.
Company information
TapTalent.ai appears to be a recruiting or staffing firm rather than the direct employer.
Job location and travel
100% remote work with the requirement to reside and be licensed in Illinois or Texas.
Unique job features
The role uniquely combines clinical nursing expertise with insurance claims review in a remote setting.
Company overview
TapTalent.ai is an AI-powered talent ecosystem that streamlines the recruitment process through automated multi-channel outreach and talent discovery. The company, backed by Iterative Capital and Salesforce Startup Programme, offers tools for effortless talent outreach, including auto-enrichment of contact details and integration with company databases. Founded by Dhruv Bhagat and Shubham Kumar, TapTalent.ai operates out of Singapore and employs 100-200 people. It is a product of Consultagora Solutions Pvt. Ltd. and focuses on enhancing hiring efficiency for modern recruiters.
How to land this job
Position your resume to highlight your clinical expertise as a Registered Nurse and your experience with utilization review or managed care settings, emphasizing knowledge of medical necessity criteria and insurance regulations.
Focus on showcasing your familiarity with URAC, NCQA standards, health insurance legislation, and claims processing systems, as well as your proficiency with Microsoft Word, Excel, and healthcare databases.
Apply through multiple channels including TapTalent.ai's corporate careers page and LinkedIn to maximize your application visibility and track multiple openings or updates.
Connect with professionals working in the utilization review or managed care divisions at TapTalent.ai on LinkedIn, using ice breakers like commenting on recent healthcare regulation changes or asking about their experience working remotely in this role.
Optimize your resume for ATS by incorporating keywords such as 'utilization review,' 'medical necessity,' 'claims processing,' 'URAC,' 'NCQA,' 'health insurance legislation,' and 'clinical nursing experience' to ensure your resume passes initial screenings.
Leverage Jennie Johnson's Power Apply feature to automate applying across multiple platforms, tailor your resume with relevant keywords, and identify LinkedIn contacts to network with, so you can focus your energy on preparing for interviews and refining your skills.
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