Location: Fully remote (PA RN License or Compact including PA Required), Must Reside in PA, NJ, or DE Employment type: Contract to full-time hire Position Overview: We are seeking a skilled and detail-oriented Utilization Review RN with a valid PA license (or Compact)to join our team. This position is ideal for an RN with prior work in insurance utilization review. Key Responsibilities: Conduct clinical reviews to determine medical necessity and appropriateness of care Apply evidence-based criteria to assess patient treatment plans and services Collaborate with healthcare providers and insurance partners to ensure efficient, quality patient care Document review findings accurately and in a timely manner Maintain compliance with internal and external regulatory standards Required Qualifications: Active and unrestricted PA RN license (or Compact license including PA) 2-5+ years ofprior experience in insurance utilization review Strong clinical judgment and knowledge of hospital workflows Proficient in using clinical review tools and electronic health records Familiarity with InterQual or Milliman criteria. #J-18808-Ljbffr
...seeking a Claims Resolution Specialist (Insurance Biller) to work from home. The ideal candidate will have strong computer skills,... ...maintaining a positive company image. The position is full-time, Monday through Friday, with the use of personal phone required for calls.J-1880...
...Job Description Job Description The Utilization Review Nurse plays a key role in evaluating patient admissions to ensure appropriate levels of care, efficient resource utilization, and compliance with third-party payer requirements. This position involves reviewing...
Shift: Monday to Friday 9am to 5pm (Remote) What you bring: You are an HR professional with excellent communications skills both written and oral Your education/work history reflects experience and knowledge in staffing and recruitment You are...
...Our client is currently seeking a Manufacturing Engineer (Aerospace) About the Role In this hands-on role, you will develop engineering solutions for nonconforming parts and systems on aircraft during production. You'll work across disciplines to ensure safety,...
...Cyber Network Defense Analyst II page is loaded## Cyber Network Defense Analyst IIlocations: Arlington, VAtime type: Full timeposted on: Posted Yesterdayjob requisition id: JR101442Nightwing provides technically advanced full-spectrum cyber, data operations, systems integration...