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
...sponsors, VIPs, executives, and athletes' families while maintaining a secure, welcoming, and professional environment. This role combines... ..., guest relations, private security, executive protection, hotel operations, or a related field preferred.Exceptional interpersonal...
...assist in accurate diagnosis and treatment planning. - Assess gum health, check for signs of periodontal disease, and provide early intervention when needed. - Perform dental cleanings, scaling, and root planing. - Educate patients on proper oral hygiene techniques...
...BFS Delivery Driver Drive for BFS, the #1 name in the industry and America's largest supplier of building materials, value-added... ...School Diploma or GED, 21+ years old, valid driver's license and a class B CDL license. A minimum of 1 year of delivery driving experience. 2...
...Type: Regular Help Job Number: 2611714189 Department: Probation Department Opening Date: 09/04/2026 Closing Date: 10/8/... ...Community Corrections (BSCC) written exam for Juvenile Corrections Officer, Adult Corrections Officer or Probation Officer within the last...
...proven plastic injection molding methodology to produce critical automotive, motive, and essential power battery components. Our light industrial facility in West Lampeter Township has 200 employees committed to living our values of Care, Challenge, Commit, Change, and...