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
...Focus Staff is seeking a travel Pediatric Occupational Therapist for a travel job in Murrieta, California. Job Description & Requirements ~ Specialty: Pediatric Occupational Therapist ~ Discipline: Therapy ~ Start Date: 06/08/2026~ Duration: 13 weeks ~4...
...Translator-1 (PNA) # 1052118 Job Description: The Interpreter is proficient in spoken/written Japanese and English. This person is bilingual or a native speaker of Japanese or English and has a minimum of equivalent to the ILR Level 3+ proficiency (Professional...
...Production Scheduler Montgomery, Illinois, United States, 60538 Your Career Begins at Timken If you're ready for a challenging career that provides you with the ability to advance personally and professionally, look to Timken. Our employees make the world more...
...Overview: ServiceNow Developer 8+ yrs, only local - Strong experience with ServiceNow form design and configuration. - Proficiency in JavaScript, Glide scripting, and UI scripting within ServiceNow. - Familiarity with ServiceNow modules like Incident, Change...
...Job Description Job Description Job Title: Outside Sales Representative-Food Service Equipment Classification: Exempt... ...the unique needs of our customers, ranging from restaurants and hotels to institutions and catering services. As we continue to grow, we...