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
...career! Federal Express Corporation (FEC) is part of the rapidly growing warehouse and... ....00 paid weekly for both full and part time opportunities \n ~$5,250 tuition reimbursement... ...after a short waiting period. \n ~ Flexible scheduling that helps balance your work...
...business that provides construction, program management, real estate & site development, and architecture & engineering services for restaurant, grocery... ..., TX (in office + travel) Our Construction Management Intern assists our general contracting division and supports...
...skills, a passion for storytelling, and an interest in content marketing. This position will report to the Content Marketing Manager... ...Responsibilities:Research and write compelling blog posts, social media content, and other marketing materials that align with the company...
...Good American is the first fully inclusive fashion brand that celebrates all dimensions of female power. Offering quality, style, and... ...driving for sales results and KPI goals. The Sales Associate/ Stylist reports to the Store Manager/Store Director....
Get in touch with a Weatherby consultant today to learn more about this and other opportunities available now. ~ Call only coverage with 30-minute response time requirement ~10 - 20 patient encounters per shift ~ Both inpatient and outpatient rounding required ~...