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
Location: Latham, NY, US 12110 Job Type: Full Time Job Classification: Hourly Exemption Type: Non-Exempt Education: Associate Degree Travel: Up to 25% Description Working collaboratively with the project design team, this individual will lead...
...Lift Operator The Ski Lift Operator plays an essential role in ensuring the smooth and efficient operation of the ski lifts, which are important to the functioning of ski resorts. As a lift operator you will have to report to work 1 hour before the slope is opened...
...Yeshiva Elementary School is seeking a 4th grade secular studies teacher to for a part time position in the boy division, beginning August 2026. The ideal candidate will demonstrate a strong background in elementary education, with proven success in delivering engaging...
...patients. The ideal provider will have the passion to making Piedmont and our patients better and be interested in building a Rheumatology practice. New grads are encouraged to apply. Requirements: Medical Degree (MD or DO) Active license in Georgia...
...Crothall Healthcare + We are hiring immediately for part time VALET ATTENDANT positions. + Location : Saint Vincent Hospital - 232 West 25th Street, Erie, PA 16544. _Note: online applications accepted_ _only_ _._ + Schedule : Part time schedules; Monday through Friday...