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
...Job Description Job Description Job description Engineering Technician MEP Commercial HVAC / Refrigeration Technician Location: Hudson, FL Job Type: Full-Time Schedule: MondayFriday, 7:30 AM4:00 PM Pay: $23$28/hour, based on experience...
...Job Description Job Description Description: HR Generalist / Recruiter Race Winning Brands (RWB) | Full-Time, Onsite | Mentor & Berea, Ohio Our people build what wins races. You'll help find them. At RWB, our brands make performance parts that riders...
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...precise clinical data. What qualifications you will need: Graduate from school of nursing required; BSN preferred Current RN... ...supporting the advancement of nursing's future." Erica Rossitto, MBA/HCM, BSN, RN, NEA-BC Senior Vice President and Chief Nurse...
Job-ID31785860Reference26-00155 Responsibilities: The Associate Regulatory Affairs Manager will support the development, review, and submission of regulatory documents for medical device and IVD products. This role will assist in managing regulatory projects, ensuring...