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
...to deliver preventive care and improve overall health outcomes. Role Description This is a full-time, on-site role for a Nutritionist based in Brooklyn, NY. The Nutritionist will provide nutritional counseling and education to patients, focusing on weight...
...If you can work these hours, are friendly, interact well with people and are looking for a new or additional career this could be for you. Potential but not necessary to go fulltime. Immediate hire! MUST BE ABLE TO COMMUTE TO PARK SLOPE SECTION OF BROOKLYN!...
...position is field based in the Mississippi Delta Region. Territory includes Mississippi,... ...Illinois, Arkansas and Louisiana. Remote work from certain states may be permitted in accordance... ...with the flexibility to also work from home. We believe this will optimize the most...
...one day in Newark NJ rest of role will be remote This position is responsible for... ...Responsibilities: 1. Conducts on-site reviews at participating provider offices to assess... ...industry. 2. Requires License Practical Nurse License or an active New Jersey Registered...
...Job Description Job Description D.W. Distribution an SBP company, is currently looking for an Inside Sales Rep - Doors division to join our VALUES based organization. This role will be based out of our Lancaster, TX Door Shop. In this role you will: Field inbound...