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
The ideal candidate will be responsible for timely and accurate preparation of financial accounting data in a variety of areas. It is essential that this candidate brings analytical and organizational skills in order to best support the accounting team. Responsibilities...
CVS Health is seeking a Case Management Coordinator to support members in Illinois by coordinating care, scheduling, and benefits education. You will use care management tools and collaborate with providers and community organizations to address healthcare and social needs...
...Bosch, Thermador & Gaggenau Home Appliance Service Technician Oceanside, CA/ Full-time Ready to get hands-on, solve problems, and make our customers... ...focused technicians that are motivated to diagnose and repair BSH appliances in the field. If you love fixing things,...
...Registered Nurse (RN) | Cardiovascular Operating Room Location: Hershey, PA Agency: Cynet Health Pay: $3,177 per week Shift Information: Days - 4 days x 10 hours Contract Duration: 13 Weeks Start Date: 10/26/2026 About the Position Job...
...Details Client Name Select Specialty Physical Therapy - Sports & Orthopedic Rehab Services Fourth Street Job Type Travel Offering Allied Profession Physical Therapy Specialty Acute Care Job ID 37954550...