To ensure appropriate resource utilization and minimize payment denials, the full-time remote Maryland Licensed Utilization Review Nurse will conduct initial, concurrent, and retrospective chart reviews while coordinating with healthcare teams and third-party payers. Key responsibilities: Review medical records using utilization review criteria to assess clinical and financial resource consumption Maintain communication with external reviewers and perform certification activities as required by payors Document actions taken to coordinate care, avoid denials, and assist in communicating with patients regarding discharge plans Required qualifications: ADN required; BSN preferred 3-5 years of Utilization Review experience, preferably in an acute hospital setting Current Maryland Registered Nurse License or eligibility to obtain
...Corporate Investigator Location: Canada or U.SCompany: lululemon Athletica We are looking for a skilled and ethical Corporate Investigator to help us protect our organization from internal and external threats, misconduct, fraud, and other illegal activities. The...
...more than 38,000 trials and 12 million patients, Medidata offers industry-leading expertise... ...end-to-end platform to improve patient experiences, accelerate clinical breakthroughs, and... ..., including data analytics, study management, and foundational design systems, to drive...
Perkins&Will in Boston is seeking a Marketing Coordinator who thrives in creative storytelling and multimedia design. Collaborating with various teams, you will develop proposals and marketing materials, ensuring they are impactful and engaging. The ideal candidate ...
...Patient Experience Manager Crothall Healthcare, a Compass Healthcare company, provides specialized, high-quality, innovative, and responsive support services exclusively to the healthcare industry. Crothall serves many of the Top 100 Hospitals throughout its over 9...