Utilization Management RN - US - Remote (Any location)

Only for registered members US - Remote (Any location), United States

5 days ago

Default job background

Job summary

Conducts comprehensive medical necessity reviews using evidence-based guidelines (Milliman or InterQual) and partners with care managers, social workers, pharmacists, and multidisciplinary care teams to support progression-of-care objectives.

Responsibilities

  • Performs initial, concurrent, and retrospective reviews to ensure accuracy and completeness of documentation supporting medical necessity.
  • Routes cases to Physician Advisors when clinical criteria are not met or potential quality issues are identified.

Lorem ipsum dolor sit amet
, consectetur adipiscing elit. Nullam tempor vestibulum ex, eget consequat quam pellentesque vel. Etiam congue sed elit nec elementum. Morbi diam metus, rutrum id eleifend ac, porta in lectus. Sed scelerisque a augue et ornare.

Donec lacinia nisi nec odio ultricies imperdiet.
Morbi a dolor dignissim, tristique enim et, semper lacus. Morbi laoreet sollicitudin justo eget eleifend. Donec felis augue, accumsan in dapibus a, mattis sed ligula.

Vestibulum at aliquet erat. Curabitur rhoncus urna vitae quam suscipit
, at pulvinar turpis lacinia. Mauris magna sem, dignissim finibus fermentum ac, placerat at ex. Pellentesque aliquet, lorem pulvinar mollis ornare, orci turpis fermentum urna, non ullamcorper ligula enim a ante. Duis dolor est, consectetur ut sapien lacinia, tempor condimentum purus.
Get full access

Access all high-level positions and get the job of your dreams.



Similar jobs

  • Only for registered members US - Remote (Any Location) Full time $86,700 - $151,700 (USD)

    +Job Description: · In this role, you will maintain communication security account management, loading of COMSEC, and inventory control. You will ensure the security and integrity of communication systems and support the Link-16 communication network.Maintenance of up-to-date rec ...

  • Only for registered members US - Remote (Any Location) Full time $86,700 - $151,700 (USD)

    Parsons is looking for an amazingly talented COMSEC Custodian that will maintain communication security account management, loading of COMSEC, and inventory control. This position is located in Ramstein AFB, Germany. · Responsible for supporting the receipt, custody, issue... · ...

  • Only for registered members US - Remote (Any Location) Part time $58.08 - $104.52 (USD)

    We are seeking an experienced Chemical Security Elimination Training SME to join our team in a part-time, on-call capacity. In this role, you will provide overall leadership and guidance for the development and execution of CSE training events under a large, complex international ...

  • Only for registered members US - Remote (Any Location) Full time $29.95 - $52.40 (USD)

    We are seeking an Electronic Security System Manager with logistics experience to join our team in Qatar. The ideal candidate will have experience managing the diversity and complexity of munitions/logistics/supply systems and/or related programs, as well as electronics maintenan ...

  • Only for registered members US - Remote (Any location)

    A Technology Account Lead at Guidehouse is responsible for driving growth and executing the pipeline by owning technology sales and revenue targets across assigned accounts, · Drive Growth and Execute the Pipeline · Serve as senior technology point of contact for client CIOs, CTO ...

  • Only for registered members US - Remote (Any Location)

    Parsons is looking for an amazingly talented Project Manager to join our team In this role you will get to support Parsons on a major program supporting the U.S. Government. · ...

  • Only for registered members US - Remote (Any Location)

    In a world of possibilities, pursue one with endless opportunities. Imagine NextAt Parsons, you can imagine a career where you thrive, work with exceptional people and be yourself. · ...

  • Only for registered members US - Remote (Any location)

    As a ServiceNow Subject Matter Expert with deep experience in regulatory compliance and Integrated Risk Management (IRM), you will devise strategies, design, implement, and optimize IRM solutions for clients using the ServiceNow Platform. · ...

  • Only for registered members US - Remote (Any Location)

    In a world of possibilities, pursue one with endless opportunities. Imagine NextAt Parsons, you can imagine a career where you thrive. · Serve as Parsons' SME for OTA and rapid procurement: advise programs on OTA use cases (research/prototype/production) and pathways (consortia, ...

  • Only for registered members US - Remote (Any Location)

    +We seek a dynamic and experienced Program Director to lead our Facilities Assessment and Planning Group. This position can be based anywhere in the USA, offering flexibility and the opportunity to work with a talented, multidisciplinary team. · ...

  • Engineer II

    1 week ago

    Only for registered members US - Remote (Any Location)

    In a world of possibilities, pursue one with endless opportunities. Imagine NextAt Parsons, you can imagine a career where you thrive, work with exceptional people and be yourself. · We cultivate an innovative culture that empowers you to achieve your full potential. · ...

  • Only for registered members US - Remote (Any Location)

    We are seeking a Chemical Security Elimination Training SME to join our team in this part-time, on-call role. As a senior instructor, you will provide overall leadership and guidance for the development and execution of Chemical Security Elimination (CSE) training events under a ...

  • Only for registered members US - Remote (Any location)

    +Transformar datos en mejoras operativas que impulsan resultados medibles para mejorar la gestión del ciclo recaudatorio. · Responsabilidades:Leverage experticia en revenue integrity, charge capture, and charge reconciliation · Ayudar a los clientes sanitarios a evaluar las opera ...

  • Only for registered members US - Remote (Any Location)

    In this role you will get to assist with delivery of comprehensive Training and Range Support Program services to the Army National Guard (ARNG) in support of the National Guard Bureau (NGB)This high-impact position combines military training expertise with innovative program man ...

  • Only for registered members US - Remote (Any Location)

    We are seeking a highly skilled and experienced Senior Electrical Engineer to join our dynamic team in Southern California. In this role, you will play a key part in designing and delivering innovative electrical solutions for oil and gas, as well as energy projects. · ...

  • Only for registered members US - Remote (Any Location)

    In this role as Transportation Infrastructure PM, you will get to serve our best clients in the industry to deliver challenging NEPA/PD&E projects. · Utilize industry experience and knowledge of client to assist with pursuit strategies · Pursue efforts (pre-sale, teaming, proposa ...

  • Only for registered members US - Remote (Any Location)

    Imagine a career where you thrive and work with exceptional people. Parsons is looking for an amazingly talented Senior Construction Estimator to join our team. · Develop comprehensive estimates in accordance with common construction estimating practices and software · Perform de ...

  • Only for registered members US - Remote (Any Location)

    We are seeking an experienced Principal Construction Estimator to join our team. In this role, you will perform estimating activities for various project types and delivery methods. · ...

  • Only for registered members US - Remote (Any Location)

    We're looking for a Subcontract Program Manager who will serve as the lead for an integrated set of subcontractors and matrixed-in subject matter expert support. You'll be joining a growing team to help modernize the US industrial defense. · ...

  • Only for registered members US - Remote (Any location)

    The Insurance Patient Account Representative is an extension of a client's business office staff. Representatives are responsible for taking in-coming and making out-going calls to patients and insurance companies to resolve account balances. · Facilitates the billing and collec ...