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
...states. We have over 200 trained technicians, over $7,000,000 in parts inventory and utilize state of the art facilities. Our large... ...and motivated.Transteck has an immediate opening for a Parts Delivery Driver at our Freightliner of York heavy duty truck dealership.What...
...Position Overview Successful State Farm Agent is seeking a qualified professional to join their winning team for the role of Intern - State Farm Agent Team Member. We seek an energetic professional interested in helping our business grow through value-based conversations...
...New DDS Staff.Assist in conducting scheduled audits of each ICF, IRA and Family Care home in the DDS network to assure compliance with TSA, NYS and NYC policies, directives and laws.Assist in conducting unscheduled inspections of each ICF and IRA and Family Care homes in...
...Explore a World of Career Opportunities as a Mail Carrier with USPS Role Overview USPS is accepting applications for Rural Carrier Associates nationwide. This role involves delivering and collecting mail while interacting with customers along the route. USPS offers...
Our Company Spring Valley Hospice Overview Office Location: Tupelo, MS Schedule: Monday-Friday from 8 a.m. - 5 p.m. Are you a CNA looking for a new opportunity? Spring Valley Hospice is seeking a passionate, dedicated Hospice CNA to join our team in...