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
...Remote Medical BillerCompany: Rooted Talent SolutionsLocation: Remote (Work From Home)Job Type: Independent Contractor (1099)Schedule: Flexible | Part-Time and Full-Time OpportunitiesMedical Billing & Coding Career OpportunityLooking for a career with long-term growth...
## Utilization Review NurseApplylocations: 43 New Scotland Avenue Albany, NY 12208time type: Full timeposted on: Posted Todayjob requisition... ...and health care team.**Minimum Qualifications:** Registered nurse with a New York State current license. Associate's degree required...
...WesTex Urgent Care is seeking an experienced Nurse Practitioner (NP) or Physician Assistant... ...Join a growing organization where you'll practice in beautiful, state-of-the-art... ...modern treatment rooms, onsite digital X-ray, advanced technology, and efficient clinical workflows...
...I hope you re doing well. I m reaching out regarding a new Emergency Medicine locum opportunity for an APP (NP/PA) in Cut Bank, Montana. We are seeking an experienced EM provider to assist with 24-hour ER shifts (8a 8a). Please see details below: Position Details...
...certifications. ~ Tuition reimbursement opportunities. ~401(k) with company match. ~ Vision and dental coverage. ~ On-demand pay (daily pay) program available. Join a team where your personality, ambition, and passion for helping people can make a real impact...