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
...Customer Service Representative Inbound Calls & Appointment Scheduling First Ring BDC | Waite Park, MN $18-$21/hour | Great... ...customers get connected with the right person. No automotive experience is needed. We will train you! No cold calling. Customers are...
Merry Maids Cleaning ServicesMerry Maids is currently looking for enthusiastic, hard-working employees to clean homes in Cherokee County. A full work week is Monday - Friday from 8:00 to 4:00. We do not work nights, weekends or holidays. We begin and end each day at our...
...Your new company A public sectororganisation is seeking an experienced Personal Assistant to join their team ona 9-month maternity cover contract. This is a predominantly remote role, withoccasional travel required for meetings and collaborative working. The position...
...fulfilling? Look no further than the housekeeping industry! Our cleaners work Monday-Friday from 7:45 am - 4:30/5:30 pm and are off on... ...hands-on training with one of our experienced and professional house cleaning trainers.Responsibilities At The Cleaning Authority, we...
...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...