Our utilization review teams conduct medical necessity reviews for medical, dental, and other healthcare services under Medicaid.

This position support them by:

  • Perform follow up on denials, missing payments, correct claims, post payments, post charges, etc.
  • Helping providers to submit documentation of requests for case management, utilization review, and other medical management services.
  • Loading cases submitted via the web, fax, or phone into the care management system for clinical review.
  • Conveying case information and other notifications to providers via inbound and outbound phone calls.
  • May perform scripted clinical review.
  • Refers reviews requiring further action to clinical review staff or supervisor.

Key abilities we seek include:

  • Reliability, Dependability, Customer focus, Flexibility, Detail Oriented, Excellent communication (verbal and written), Team oriented, Positive Attitude


  • 3 years of medical claims/medical billing
  • Must have strong Medicaid experience
  • Strong Medical terminology
  • Microsoft Office (Word, Excel and Outlook)
  • Type 45 wpm

Location: Metro Center Station

Hours: Monday through Friday / 8:30am to 5:00pm

Type: Contract

Pay Rate: $23.28 per hour

Please email resume to mrobinsonnri-staffing.com .

Additional Information

NRI is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, among other things, or status as a qualified individual with disability.

Meet Your Recruiter

Marian Robinson
Senior Account Manager

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