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
DescriptionPosition at Pilgrim'sMaintenance SuperintendentAt Pilgrims, Safety Is A Condition, which means the safety of our team members comes first - always.SUMMARY:Responsible for all maintenance planning, coordination of maintenance department at a Pilgrims facility...
...To support a dynamic global marketing team, the full-time Marketing Communications Manager will shape and execute integrated marketing communications strategies, develop compelling campaigns, and create customer-focused content to enhance brand positioning and drive engagement...
...limited positions available for 14- and 15-year-olds. Pay rates are different for minors. If... ...We reward hardworking students! Paid Time Off You've earned it! Flexible Schedules... ... Available for both full-time and part-time employees McD Perks So many more...
...Competitive Compensation Great Work Environment Career Advancement Opportunities Job Summary We are seeking a Tow Truck Driver to join our team! As a Tow Truck Driver on our team, you will be responding to calls from stranded motorists in the area and...
UNFI - - Responsibilities: Identify pick locations and safely pick items; Palletize orders and stage pallets; Operate pallet jack/pushcart safely; Inspect equipment for safety issues; Label and shrink-wrap cases