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
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...of the Pre-Press team is to translate card designs to beautiful, error-free, and quality-checked forms that are ready for press. Fanatics Collectibles is looking for a Pre-Press Retouching Operator to support imaging, color correction and retouching of card images / designs...
...Bilingual speakers of Indian languages and English to record and review the speech data frontier AI labs train and evaluate on. AfterQuery builds the expert evaluation data that frontier AI labs use to measure and improve their models. We're hiring bilingual speakers...
...naturally occurring methane and decarbonize the economy, please visit Position Summary We are hiring for a Plant Operator to work in our Renewable Power Plant. The Plant Operator/Generator Mechanic is responsible for the safe, reliable, and efficient daytoday...
...About the job Flight and Hotel Scheduler We are seeking organized and enthusiastic individuals to join our team as Remote Flight and Hotel Schedulers. In this role, you will assist clients by coordinating and booking their flight and hotel arrangements, ensuring...