Registered Nurse – Utilization Review – Outpatient Services Location: Fully remote (PA RN License or Compact including PA Required), Must Reside in PA, NJ, or DE Employment type: Contract to full-time hire Position Overview: We are seeking a skilled and detail-oriented Utilization Review RN with a valid PA license (or Compact) to join our team. This position is ideal for an RN with prior work in insurance utilization review. We are hiring for Outpatient Services, Oncology, and Adult Care positions. Key Responsibilities: Conduct clinical reviews to determine medical necessity and appropriateness of care Apply evidence-based criteria to assess patient treatment plans and services Collaborate with healthcare providers and insurance partners to ensure efficient, quality patient care Document review findings accurately and in a timely manner Maintain compliance with internal and external regulatory standards Required Qualifications: Active and unrestricted PA RN license (or Compact license including PA) 2-5+ years of prior experience in insurance utilization review Strong clinical judgment and knowledge of hospital workflows Proficient in using clinical review tools and electronic health records Familiarity with InterQual or Milliman criteria. Preferred Experience: Prior work in payer-side utilization review is highly desirable Prior experience in UM for Outpatient Services, Adult Care, or Oncology (preferred) or bedside experience.
LPN - Licensed Practical Nurse Licensed Practical Nurse - LPN - Senior Living Community Are you a nurturing soul with a passion for... .... Our communities are designed to resemble a home rather than a clinical setting. This creates a more comfortable and familiar atmosphere...
...trial practice. As an Associate Attorney, you will be representing clients charged with a wide range of criminal offenses, including felonies and misdemeanors, and in addition to representing retained, private clients, must also be willing to serve as court-appointed...
...Family Dental-n 1746 KY-44, Shepherdsville, KY 40165 Job Type: Part Time Advance Your Career While Making a Difference in Patient... ...in the state that you're applying to OR be a Dental Hygiene student in an accredited Dental Hygiene program. Ready to Elevate Your...
Job Title: Lab Tech / Food Science Location: Hershey, PA Type: Contract / 6-12 months Compensation: $20-$22 per hour Contractor Work Model: Onsite 1st shift OT on rare occasions Lab TechMain Duties: ~Work with multiple scientists within theR&D team...
...create inclusive learning experiences and support services. Desired qualifications and experience: Valid Special Education teaching certification applicable to the early childhood setting. Experience working with Pre-K aged children in a special education context...