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
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...Job Summary: ~ The purpose of the Service Internship I isfor high school students who have an interest in exploring a path to becoming a diesel technician. Student will learn about the knowledge, skills and abilities required in becoming a service and diesel...
...Job Description Job Overview - Oncology Pharmacist Compensation: $65 - $95/hour (Dependent on Experience) Location: Westchester County, NY Schedule: Monday to Friday (Alternating Weekends and Holidays) TAG MedStaffing is hiring an Oncology Pharmacist...
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...A leading environmental firm in Florida is seeking a Senior Civil Engineer/Solid Waste Engineer to lead and design projects in the solid waste sector. This role requires managing large projects, mentoring teams, and maintaining client relationships. Ideal candidates have...