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
...Overview ~ Haul sporting goods to and from retail stores with dry van trailers. ~100% no-touch freight. ~ Regularly perform slow-speed maneuvers and complex backs. ~5-10 loads per week with 1-3 stop-offs per load. ~ Nighttime schedule, work between 2100...
...POSITION Looking for a chance to make a difference? As a Peer Specialist, you'll play an important role in supporting and empowering youth in your community. Through comprehensive sexual health education, outreach, leadership opportunities, and peer support, you'll...
Job Description Job Description Baltimore Country Club in Roland Park, MD is looking to hire an Assistant Pastry Chef to lead the pastry team in preparing delicious cakes, bread, cookies, and other great deserts for our loyal members and guests! ABOUT BALTIMORE...
...Supervisor: Building Administrator(s) General Definition and Conditions of Work Performs complex professional work, providing teaching and/or training services to students in general instruction or in a specialized subject or assigned group of subjects; motivates...
...are successful, the leadership team is strong, the systems and technology are in place, and the foundation has been built thoughtfully.... ...hospitality professionals who want much more than their next restaurant management job. This is an opportunity to join early, make...