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
...Pizza, the nation's fastest-growing pizza chain, is looking for drivers. Drivers are paid hourly as well as mileage. Drivers also keep all of their own tips and mileage Paid cash daily. All Drivers must pass a motor vehicle report to be considered for hire. Restaurant...
...A Cake Decorators responsibilities include, but are not limited to providing excellent customer service, including greeting customers, responding to questions, and taking special orders.They will also be required to ice, decorate, package, label, and price products...
...complex and/or sensitive projects. Ensure adherence to federal, state and local laws, codes, regulations and guidelines relating to... ...in a full-time position in any city, county, state, or federal government entity or a government special district within the United...
...Labor Relations Manager NYC Health + Hospitals is the largest public health care system in the United States. We provide essential outpatient, inpatient and home-based services to more than one million New Yorkers every year across the city's five boroughs. Our large...
Hillcrest HealthCare System in Tulsa seeks a Clinical Research Coordinator RN to support cardiovascular studies across our integrated network. In this role, you will coordinate all aspects of clinical trials, including patient screening, enrollment, informed consent, and...