Clinical Data Services Representative
Clinical Data Services Representative
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Job Description
We have built our reputation on partnering with our clients and candidates to achieve the desired results. Our recruiting professionals have extensive experience matching the right candidate to the right client for the right position. We provide the best opportunities to the most talented candidates in a multitude of industries.
MMC is a privately owned business with corporate headquarters in Irving Texas. With 2000 employees working in 40 states MMC is able to support all United States locations and some international locations.
We appreciate your interest in reviewing this particular position and we encourage you to visit our website where you can always search and apply for opportunities at
MMC strives to ensure all job posting confirm details of the position the rate of pay and acknowledge medical benefits are offered.
Get started on your career journey today! Apply to become a part of the MMC Team!
We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race color religion sex national origin disability status protected veteran status or any other characteristic protected by compliance with federal law all persons hired will be required to verify identity and eligibility to work in the United States and to complete the required employment eligibility verification document form upon hire.
Registered Nurse - Utilization Review (Remote - Austin TX)
Local Candidates Preferred No Visa Restrictions
Schedule:Must be available for shifts between 7:00 AM and 7:00 PM (8-hour shifts standard schedule 10:00 AM - 7:00 PM). Overtime may be required with prior approval.
Work Location: Remote (Austin TX area)
Pay:$88004.00 per year
Position Overview
We are seeking a Registered Nurse to perform utilization review activities including pre-service concurrent and retrospective reviews. This role involves collaborating with healthcare providers to promote high-quality outcomes optimize member benefits and ensure the effective use of healthcare resources. The RN will be responsible for assessing the medical necessity of outpatient services out-of-network requests and appropriateness of treatment settings all within professional scope and applicable regulatory guidelines.
Key Responsibilities
- Conduct pre-service concurrent and retrospective utilization reviews.
- Collaborate with providers to ensure quality member outcomes and optimize benefits.
- Promote effective use of healthcare resources while maintaining cost efficiency.
- Assess medical necessity of outpatient and out-of-network services.
- Evaluate appropriateness of treatment settings in alignment with professional standards and regulations.
- Apply the rules of the Texas Administrative Code (TAC) in all reviews.
Required Skills & Qualifications
- Active Registered Nurse (RN) license in good standing.
- Experience in utilization review case management or clinical review.
- Strong knowledge of medical necessity criteria and TAC regulations.
- Proficiency in Microsoft Word and Excel.
- Excellent analytical communication and collaboration skills.
- No direct patient care required.
- Stable schedule with full-time hours.
Required Experience:
Unclear Seniority
Employment Type
Full-Time
