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
...Position Summary: Swank Construction Company, LLC is seeking a reliable and hardworking individual to join our team as a General Laborer for our Construction division Key Responsibilities: Ability to perform physical labor activities which includes, but...
...(DPC) is a trusted provider of integrated security solutions for private and public entities. We offer a full spectrum of services from training and risk assessments to armed... ...Army and Department of State, Bureau of Diplomatic Security (DoS/DS) National Aeronautics and...
...could be just the right applicant for this job Read all associated information and make sure to apply.POSITION SUMMARYThe Accounts Receivable Manager will lead and develop the AR team while partnering closely with Finance, Sales, Operations, and other departments to...
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...Gamma Team Security Inc. provides professional security services across multiple states. We are currently hiring active and retired police officers from all departments (Part Time). Gamma Team Security uses a self-scheduling system, in which officers can schedule...