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
...Jevco Electrical Services is actively looking for a motivated apprentice to join our dynamic team. At Jevco, we are committed to... ...development. Work under the supervision of experienced electricians to assist in the installation and maintenance of electrical...
...practices.Duties include:Check in patients, obtaining vital signs & medication reconciliationPatient medical history informationNavigating... ...excellence.Minimum Requirements:Upon hire, all Medical Assistants will undergo a clinical competency assessment and must...
...If your goals and values align with Hondas, we want you to join our team to Bring the Future! Job Purpose Perform Paint Materials activities utilizing strategic planning and execution to achieve (KPI) Key Performance Indicators and meet or exceed internal and...
...Job Description Job Title: UI/UX Designer Job Type: Contract Location: Remote Job Summary: Join our customers team as a UI/UX Designer and help shape visually stunning, worldclass user experiences for marketing websites and digital products. This is an...
...experience preferredNode.js , ExpressMicroservices based systemsAbility to run a platform teamAbility to ask questions, drive investigation, good communication skillsExperience in OAuthPrior experience in leading or working with offshore team Cosha Staffing & Consulting