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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:
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