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
...00 per hour Born into a family with 15 children, Jose Ramirez was "lucky number 7." He started his pursuit of this dream as a 13-year-old bagboy at a grocery store in what is known as The Highlands area of Denver. He later worked as a server at Las Palmas, working 60...
...A global sports merchandise company is offering a Summer 2026 Marketing Internship in Los Angeles. This internship provides hands-on experience in marketing operations and project coordination. Interns will support marketing initiatives aimed at improving efficiency and...
...device to perform daily tasks. Responsible to assist warehouse personnel with the efficient execution of order filling, receiving, stocking and returns. May oversee shipping and general operations (UPS, emergency orders or general deliveries). Continues to perform...
...residential communities. From the beginning, Optima aimed to reinvent housing by integrating the functions involved in new construction within one company. Optima controls and executes every aspect of the process in-house development, design, construction, sales and...
Career CategoryScientificJob DescriptionJoin Amgens Mission of Serving PatientsAt Amgen, if you feel like youre part of something bigger, its because you are. Our shared missionto serve patients living with serious illnessesdrives all that we do.Since 1980, weve helped...