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
...Job Summary HOSA-Future Health Professionals is seeking a dependable, detail-oriented Meetings and Conference Coordinator to support the planning and execution of HOSA conferences, meetings, and other organizational activities. This is an excellent opportunity for someone...
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...Position Areas Special Education Description Norman Public Schools26-27 Irving Middle School Special Education Classroom Teacher Job Description Job Title: 26/27 - Special Education Classroom TeacherCredentials: Current Oklahoma...