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
...Visit our website at to learn more about our organization. What We Offer $18.75-$27.61/hour Additional pay for your bilingual skills! What You'll Do: Handle incoming and outgoing non-professional level phone inquiries and transfer calls to appropriate...
...available.A Bachelor's degree in Supply Chain Management, Business Administration, Logistics, Information Systems, or another related field... .... Learn more. Professional developmentFrom entry-level employees to senior leaders, we believe theres always room...
St. Lukes Health System in Idaho seeks a Medical Interpreter/Translator to provide accurate interpretation for patients and staff across clinical and general settings.You will interpret complex medical information, assess patient understanding, and advise on cultural...
...Description Job Description We are seeking a Class A Hazmat Driverto join our team!You will be responsible for safely operating... ...Inspecttruck before and after trip Qualifications: One year Tanker Drivingexperience with Hazmat TWIC card Commercial...
...Clinical Documentation Integrity (CDI) Specialist Position Type Full-time Description Professional Credit | Ensource specializes in accounts receivable... ...and feelings of isolation that can come with remote work, so we've dialed in on what makes working remotely...