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
...A prominent technology company is seeking a QA Engineer with a focus on ETL/BI/DW testing processes. The ideal candidate will have over 5 years of experience in relevant testing and strong skills in SQL, as well as familiarity with Agile methodology. This role involves...
...hr . PLUS, you get a percentage of everything you collect!! Not only that, but you ALSO have the opportunity to collect cash DAILY (in hand) for every account that you collect on the spot!! There is also a monthly bonus for those that are able to hit the Monthly...
...personal approach to customer experience. Were looking for a Product Photographer to join our in-house studio team and help capture... ...lighting, texture, and compositionExperienced in studio product photography, ideally with small-scale or luxury itemsProficient in...
Position Summary:Leidos is seeking an experienced Security Manager to provide senior-level security management support for classified government and defense programs. The selected candidate will oversee and manage security operations, personnel security, physical security...
...Library Assistant Howard Community College (HCC) is an exciting place to work, learn, and grow! We are proud to have received the Great Colleges to Work For honor for 12 consecutive years, 2009-2020. Howard Community College values diversity among its faculty, staff...