To support a mission-driven health organization, the full-time Utilization Review Nurse - RN will conduct medical necessity reviews, escalate non-certifications for secondary clinical review, and analyze clinical records to ensure timely and compliant care determinations. Key responsibilities Conduct medical-necessity reviews to evaluate services against benefit language and medical policy Escalate non-certifications to the Medical Director, ensuring timely and defensible adverse determinations Analyze clinical documentation for completeness and manage a caseload based on urgency and member impact Required qualifications Current, unrestricted RN license in the United States or a U.S. territory Graduate of an accredited nursing program (ADN or diploma required; BSN preferred) 1-2+ years of recent clinical experience in acute care, med-surg, ICU/ED, or similar settings Utilization review or utilization management experience preferred Proficiency with Microsoft Word, Excel, and Outlook, along with knowledge of ICD-10, CPT, and HCPCS coding
...JOB OVERVIEW Seeking skilled and dedicated Journeyman Tile Installers to join our team. In this role, you will be working exclusively on luxury residential projects in the Greater St. Louis and St. Charles areas. This is not production or basic tile work. Your expertise...
A top cancer research institution in Houston seeks a Postdoctoral Fellow in Computational Genomics & Cancer Epidemiology. Responsibilities include developing methods for identifying precursor conditions and characterizing cancer risk factors. Applicants should have a Ph...
...Job Description Job Description Part-Time Bookkeeper Job Description Location: McHenry, MD Job Type: Part-Time (10-20 hours per week) Pay Rate: $22 - $30 per hour (based on experience) Job Overview: We are seeking a detail-oriented and experienced...
...based, network solutions and professional services to the Federal Government. We are dedicated to recruiting, developing and empowering a... ...and operational handoffsEnsure quality activities align with program governance expectations, contract requirements, and SLA...
...then we invite you to apply to our Legal Nurse Consultant position in our Stamford... ...office days in our Stamford location. No remote applicants will be accepted at this time.... ...Key Responsibilities: Order, Review, identify, and organize relevant medical...