Schedule: Monday – Friday | 8:00 AM – 5:00 PM
Work Model: 100% Remote (Onsite visit required for equipment pickup)
Employment Type: Contract
The Utilization Review Nurse is responsible for monitoring and providing clinical oversight to ensure compliance with contractual, regulatory, and statutory requirements related to members’ physical/acute care and behavioral health services. This role supports appropriate utilization of healthcare services and serves as a clinical resource to internal and external stakeholders.
Key ResponsibilitiesMonitor overutilization and underutilization of healthcare services
Conduct utilization reviews, case file reviews, and audits
Provide technical assistance and clinical oversight to ensure compliance with applicable regulations and guidelines
Gather, analyze, organize, and evaluate information from multiple sources, including utilization data and medical records
Coordinate care with internal teams and external providers as needed
Make referrals for medically necessary covered services
Participate in clinical staffing and interdisciplinary reviews as required
Serve as a clinical resource for utilization management and covered service determinations
Bachelor of Science in Nursing (BSN)
Minimum 2 years of experience working as a Registered Nurse
Minimum 1 year of experience in behavioral health
Active Registered Nurse (RN) license in the applicable state
FPCC certification
No weekends required
Fully remote role with limited onsite requirement for equipment setup
...Position: Live Chat Support Agent Location: Remote Job Overview: We are seeking a highly motivated and customer-oriented Live Chat Support Agent to join our team. As a Live Chat Support Agent, you will be responsible for providing real-time support to our...
...Position: 2nd Shift Forklift Operator / Warehouse Associate Salary: $22 per hour Hours: Monday-Friday, 3:00pm-11:30pm Location: Ayer, MA The leading provider of conventional, Non-GMO Project verified and organic oils to the ingredients, foodservice and retail...
...Information Systems Agency (DISA) . This role is critical to delivering tested, secure, and hardened software solutions. The ideal candidate... ...quality across integration, regression, performance, and user acceptance testing. A current active SECRET DoD Clearance is...
Material Handler (Forklift Driver)- Production Job Description and ResponsibilitiesPerforms functions directed towards successfully... ...products to the Packaging lines, and finished goods to the Warehouse. Other related duties assigned as required by the production...
...Retirement: Competitive retirement package to secure your future. Responsibilities The Chief Information Security Officer (CISO) provides strategic leadership for Mayo Clinics global information security program by balancing the preservation of trust by...