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
A leading digital AI solutions company is seeking a Remote Data Contributor in Birmingham, AL. This part-time, entry-level role does not require prior experience, allowing you to enhance digital maps from home while participating in a vibrant global community. You will...
...QA Duplicate Promoted DISTRO-326, QA Test Engineer, United States, Remote. Create a simple quality assurance testing role for this sandbox fixture. #BrightpathTechnologies #LI-PROMOTED #LI-Remote $0 - $0 a year We may use artificial intelligence (AI) tools...
...HIRING TRAINEES/ NEW DRIVERS / HOME WEEKLY | TOUCH FREIGHT | MAKE $1,500 AVERAGE WEEKLY Position Details Average Weekly... ...Approximately 1,100 miles per week Requirements No experience required Must pass a hair follicle drug test Clean...
...Injection Mold OperatorWET (Design)Sun Valley, CaliforniaWelcome to WET , the pioneering force behind groundbreaking fountain designs... ...Operator is responsible for producing parts using our Arburg Plastic Injection Molding Machines. Operate 77, 275 and 750 ton machines...
...the 5000 fastest-growing private companies. Interested in working with the Siege team? We currently have a spot open for a talented Freelance Content Writer to help us continue to deliver great content for our world-class clients. Learn more about working at Siege by...