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
...Overview: Ilderton Conversion of Charleston is seeking a reliable independent contract driver in the Charleston, SC area to transport vehicles for the dealership. It will be the responsibility of the contractor to safely and efficiently deliver vehicles to various...
...Were looking for a skilled Commercial Sheet Metal Mechanic! If youre dependable, detail-oriented, and ready to work on a variety of commercial projects, this is a great opportunity to use your tin knocking skills. We offer benefits, 401K, and more. Sheet Metal Mechanic...
At TE, you will unleash your potential working with people from diverse backgrounds and industries to create a safer, sustainable and more connected world. Why you should joinGrow Your Career: Join our team as an R2R Accountant and be part of an international group where...
...Janitorial Cleaner Night Shift Sun-Wed or Wed-Sat at $18.00 per hour We are looking for a reliable and experienced Janitorial Cleaner to perform a variety of cleaning duties to ensure a clean, safe, and orderly environment across assigned facilities. This role plays...
...This Endoscopy travel nurse job in Farmington, New Mexico, with Advantis Medical is a 13-week Travel Endoscopy Registered Nurse (RN) contract at San Juan Regional Medical Center. This role pays $2,377 per week and follows a Days shift with a 5x8 schedule. Read more...