Job Summary: As a Utilization Management Nurse, you'll play a crucial role in our multidisciplinary team, ensuring that patients progress seamlessly through their care journey according to appropriate admission statuses. Proficient in Utilization Review processes, you'll maintain effective procedures to meet regulatory and reimbursement requirements for various payers, both commercial and government. 100% Remote - However, Only candidates on EST Time Zone are considered. Key Responsibilities: Conduct concurrent and continued stay Utilization Management reviews, ensuring accurate data tracking, evaluation, and reporting. Lead or participate actively in process improvement initiatives, collaborating with various departments and multi-disciplinary teams. Efficiently manage a diverse workload in a fast-paced, ever-evolving regulatory environment. Foster positive collaboration with the Care team to facilitate timely patient progression during their stay. Job Requirements: Current PN Nurse license Associate's degree preferred. 2 years of Utilization Management experience in large health organization. Hospital case management experience is advantageous. Proficiency in federal and state regulations (DOH, Medicaid/Medicare) and familiarity with third-party payers and managed care principles. Salary Range: $75,000+ Benefits: Yes- Full benefit package available with employer contribution. Join our dynamic team and be part of our commitment to efficient Utilization Management and patient-focused care. Date of Original Job Posting: 1/25/25 Morgan Stephens
Job ID: 2503884 Job Description: Role Summary/Purpose: The VP, Fraud/GEN AI Validation COE is responsible for performing model validation for all the fraud models, and ensure they are meeting the related MRM policies, standards, procedures as well as regulations (SR 11-...
...that all proper credit and pertinent information is obtained. Responsible for issuing safety deposit boxes. Prepare daily cash reports, balancing payments and disbursements. Assists reservations by accepting and confirming reservations. Performs duties as cashier, petty...
...WP Buffs is looking for an experienced WordPress developer with good communication and customer service skills. This role will be working with a large number of clients through a support ticket system. Common tasks include: Managing support tickets Site edits...
...practices and lead the SBK operations team in focusing on quality, food safety, maximizing customer service levels while minimizing... ...improvements efforts in work group organization and manufacturing process methodology 9. Develop and implement cost control procedures...
Job Description Starting hiring pay at: $$14 As a Cook at Raising Canes, you will set the pace of the Restaurant by ensuring all of the food we serve meets our high standards. Working in the Kitchen at Raising Canes is a fun and fast paced environment. Crank up...