Supporting the WISeR Prior Authorization Program, the full-time RN Clinical Quality Reviewer will perform comprehensive clinical reviews, validate documentation accuracy, and assist in physician determination activities, all while working remotely within the US. Key responsibilities Conduct clinical reviews of prior authorization requests in compliance with CMS and internal policies Participate in quality assurance activities to ensure regulatory compliance and identify documentation gaps Collaborate with cross-functional teams to optimize workflows and support operational continuity in a 24/7 environment Required qualifications Active clinical licensure as a Registered Nurse (RN) Experience in reviewing clinical documentation for medical necessity and appropriateness of care Working knowledge of CPT and ICD 10 coding Ability to apply clinical judgment within utilization management or prior authorization workflows Proficiency with healthcare technology platforms and electronic clinical systems
...polymer products. All of our products are backed by complete technical support that ensures quality, reliability, and value.The Commercial Manager Accelerated Growth is Americhems North American lead hunter for markets and applications where the company has meaningful...
...Description Key Responsibilities: Attend site walkthroughs, pre-bid meetings, and project inspections Assist in developing and maintaining project schedules Prepare, track, and manage submittals, RFIs, and project documentation Perform regular site visits to...
Class A HIRING NOW - CDL-A Dedicated Truck Driver - 4,766 per Month JobWith more than 5,000 employees nationwide, we know what it means to recruit and retain qualified employees. Over 750 of our drivers have been with us for over 20 years!The secret sauce? Investing...
...valued, youre empowered to do your best work. Are you amilitary service memberwithin or nearing your 180-day window for separation... ...role is made through the service member's current enlistment contract based on pay guidelines set by theDepartment of Defense (DoD)...
...Licensed Clinical Social Worker (LCSW) Location: Plainsboro Township, NJ Agency: Jackson Therapy Partners Pay: $1,930 to... ...provides NJ Transit and Amtrak service, while Newark Liberty International Airport is roughly 45 miles northeast. Travelers can also reach...