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
..., gait modification training, etc. in accordance with The Ohio Athletic Training Practice Act and the NATA physician practice value model... ...patient care through the special skill set of an athletic trainer that augments and supports the services of the physicians and other...
...rapidly growing consumer technology firmoperating a suite of healthcare businesses, including our flagship brandsBlueChew & MOD. Our... ...and technology. We areseekinga highly skilled Supply Chain Planner with experience in supply planning, demand planning,...
...Certified Athletic Trainer. PRN Certified Athletic Trainer, PRN About Hopedale Medical Complex For more than 70 years, Hopedale Medical Complex has provided exceptional, patient-centered healthcare close to home. We are an independent, nonprofit Critical...
...Housing Specialist Non-profit staff can work anywhere.The BEST work with US! $30.21 - $32.96 per hour A nationally recognized... ...housing needs while ensuring each resident's housing needs are included in the resident's comprehensive treatment plan. Provides individual...
...enthusiastic individuals to partake in a hands-on agricultural apprenticeship. The role includes mastering skills in plant propagation, harvesting, and field operations while participating in educational workshops and discussions.This full-time position offers $17/hour with...