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 Opportunity As a Sustainability CP&I - Intern, you will engage in projects that focus on sustainability-focused capital projects... ...least a 3.0 overall GPA Client service intern positions are entry-level and job seekers are traditionally either in their 3rd year...
...partners. At Darkhive, we are a high-growth team of U.S. Special Operations veterans, aerospace engineers, robotics perception experts, and... ...Darkhive today! About the Role: Darkhive is seeking a Flight Operations Manager to lead our UAS flight test program, field...
...Working remotely from North America or Spain, the full-time Midcore Design Verification Engineer will develop verification strategies, build robust test environments, and debug failures for next-generation high-performance RISC-V CPU cores.Key responsibilitiesDevelop...
...Federal Express Corporation (FEC) is part of the rapidly growing warehouse and... ...Competitive wages beginning at $22.00 paid weekly for both full and part time opportunities ~$5,250 tuition... ...and physical warehouse work why pay for a gym membership when you can get...
Overview Carle Health is seeking a full-time, Radiation Oncology physicist to join our team in Peoria, Illinois. Opportunity... ...distance of Peoria Education/Qualifications Masters degree or PhD in Physics or a related field Certified Specialist...