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
Flyer Distributor We are seeking energetic and reliable individuals to join our team as Flyer Distributors. As a Flyer Distributor, you will be responsible for promoting our company's services by distributing promotional materials, such as flyers, brochures, or promotional...
...OTR Box Truck DriverChicago, Illinois, United States Or refer someone Job Openings OTR Box Truck DriverAbout the Job OTR Box Truck DriverWe... ...truck lease opportunities (26ft, non-CDL) for over-the-road drivers seeking substantial income and flexibility. You'll haul loads nationwide...
...ASL Interpreter In support of the Commonwealth's commitment to inclusion, we are encouraging individuals with disabilities to apply through... ...Website - Contact Name Email - ****@*****.*** Phone Number - (***) ***-**** Title IX Coordinator: Beth Styers 1 College...
...FocusGroupPanel is seeking a Remote Work From Home Data Entry Clerk for an entry-level position. This role offers maximum flexibility,... ...a computer with internet access. This is a great opportunity for stay-at-home moms, retirees, and anyone looking for supplementary income...
...Aspen CO 81611, United StatesVIEW ON MAP Schedule Full Time Located Remotely? N Position Type Non-Management Pay Range: $17.00-$17.00 per hour Tip Eligible: Y Expiration Date: 10/19/2026 POSITION SUMMARY Complete opening and closing duties...