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
This role requires the ability to work lawfully in the U.S. without employment-based immigration... ..., you play a pivotal part in guiding Spectrums success through meaningful analytics.... .... Eligible employees can work from home up to one day each week.How Youll Make an...
...find products and services that fit their needs. \n \n As a Junior Marketing Trainee , you will be responsible for providing a... ...This entry-level opportunity is ideal for anyone who wants to develop real-world business skills in sales, marketing, and customer...
...Job Title Lead assigned projects ensuring delivery on-time, within scope and within budget. Define and track project milestones while... ...resource capacity and actuals analysis. Liaise with resource managers to ensure resources are available to support the timelines within...
Skills Trainer - DESE Program The Arc of Bristol County provides innovative services and programs that empower individuals with intellectual and developmental disabilities to live their best lives. Through advocacy, community partnerships, and exceptional support, we...
...commitment to quality care and service in a Christian environment. Facility: GSS SD Tyndall... ...in a setting where residents can call home. We offer great benefits to our... ...- Growth opportunities - Work/life balance benefits Job Summary...