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
...tools: Utilize cutting-edge tools like Microsoft Copilot to enhance your productivity and efficiency.Job Description:IT ManagerSummaryThe position of IT Manager is responsible for the overall management of IT infrastructure and services at the different offices/locations of...
...As one of the largest not-for-profit health systems in the United States, Sanford Health... ...compassionate, hardworking registered nurses (RN) who can provide the high-quality care... ...generous time off package to maintain a healthy home-work balance. For more information about...
...Job Description Job Description Summary: Responsible for the smooth operation of Dells Nursing and Rehab Center and Colton Retirement Living by performing various duties in and around the building and grounds. Duties include preventative maintenance, repairs and...
...Pharmacist Location: Boone, NC Agency: TGL MedStaff Pay: $2,882 per week Shift Information: Days - 4 days x 10 hours... ...Mountains. Banking, technology, agriculture, and manufacturing. Research Triangle Park major technology and pharmaceutical hub....
...producing ready-to-eat meals for national retail and foodservice customers. We are seeking an experienced Second Shift Production Supervisor to oversee daily manufacturing operations in a fast-paced food production facility. This role is responsible for supervising...