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
...and chain grocers, e-commerce retailers, U.S. military commissaries and exchanges, and the Companys own brick-and-mortar grocery stores, pharmacies and fuel centers.Ready to contribute to the success of our food solutions company?Location 1100 13th Ave. East - West...
...choices?Can you show job-ready project depth, not just toy examples?SynergisticIT focuses on roles such as entry-level software programmers, Java full stack developers, Python/Java developers, Data Analysts, Data Engineers, Data Scientists, and Machine Learning Engineers....
* Proficient English is a must* We are looking for a detailed, tech-savvy **SEO & Social Media Coordinator** to oversee our routine digital marketing operations, off-page SEO efforts, and social media syndication. In this role, you will split your time roughly 50/50...
Unbox Your Potential:Our customers see us as the industry leader for trusted, high quality food service essentials and supply chain solutions and our employees see the value in what they do each day. We offer a culture supported by integrity, growth, relationships, and...
...Housekeepers and Managers, Sales and Marketing! Our customers pay our PROs the best tips in the area! Our company is THE ONLY 5-Star... ...where positivity is the normnot the exception. We offer weekly pay, and opportunities to advance and grow. Step into a workplace...