To support a centralized Utilization Management department, the full-time Utilization Review Nurse will conduct timely utilization review activities, ensuring appropriate patient status determinations and compliance with regulatory requirements while working remotely. Key responsibilities: Conduct medical necessity reviews and patient status determinations using approved clinical criteria and organizational policies Manage payer authorization processes to promote timely approvals and reduce financial risk Collaborate with interdisciplinary teams to support appropriate patient progression and discharge planning Required qualifications: Registered Nurse license is required Bachelor's degree is required 2+ years of Acute Hospital Care experience is required Experience with Interqual and MCG is preferred Previous Utilization Management, Appeals, or Denials Management experience is preferred
...Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career...
...time series analysis. Additional Information: ~ Candidates need to meet client skill requirements to be selected, even for junior or entry-level roles. Additional skills help candidates stand out. ~ We do not accept applications from third-party candidates...
...the team and youll lead major training initiatives across both flight and ground school. Youll be part of one of the most... ...Programs. At least five (5) years of experience in part 121 Pilot Operations. A320 type rating preferred. Professional demeanor with the...
...PepsiCo generated more than $67 billion in net revenue in 2019, driven by a complementary food and beverage portfolio that includes Frito-Lay, Gatorade, Pepsi-Cola, Quaker and Tropicana. PepsiCo's product portfolio includes a wide range of enjoyable foods and beverages,...
...Join Our Team at Costco Whole-Meats Morris Facility! Position: Sanitation Worker Pay: $21.50/hr Location: Morris, IL 60450 Were hiring reliable and hardworking individuals to join our sanitation team at our food processing facility. Help us maintain a clean...