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
...Description Job Description Dental Assistant General Dentistry - Tri-... ...to grow, contribute, and be part of a strong clinical team.... ...providing an excellent patient experience. This role is ideal for someone... ...bonus opportunities ~ Full-time and part-time positions available...
Skyway Behavioral Health seeks an Art Therapist to develop and implement expressive arts therapy within specialized treatment areas. You... ...plan and deliver art-therapy programming and engage patients with trauma and co-occurring disorders, emphasizing compassionate care and...
...Independently coordinate and lead fit sessions. Communicate fit comments, corrections, and technical revisions clearly to overseas patternmakers. Develop grading for costing and pricing purposes. Create bulk grading for production. Maintain accuracy and...
A leading educational platform is looking for entry-level College Political Science Tutors to provide instant online assistance. Tutors will engage directly with students based on immediate needs, leveraging a proprietary learning platform while working from home. Ideal...
...resources, and professional support of a large organization while maintaining the close-knit feel of a local care center. With an overall CMS rating of 4 stars , Quality Measures rating of 4 stars , and Staffing rating of 5 stars , our facility is committed to...