Utilization Review Nurse-RN Job at Personify Health

Utilization Review Nurse-RN

The Utilization Review Nurse will provide professional assessments and review fo...

Location

United States

Salary:

30.00 - 38.00 USD / Hour

Personify Health

Expiration Date

Until further notice

Requirements

Current RN license in the United States or U.S. territory
Associate’s degree or diploma (Nursing program) required
1+ year clinical experience required
Ability to perform the essential job functions safely and successfully with or without reasonable accommodation, including meeting qualitative and/or quantitative productivity standards
Ability to maintain regular, punctual attendance
Ability to sit for 6-8 hours
Constant use of computer keyboard and mouse
repetitive use of both hands
Occasional to frequent twisting of neck
occasional bending of neck and at waist

Job Responsibility

Provide professional assessment and review for the medical necessity of treatment requests and plans
Provide first level review for all outpatient and ancillary pre-certification requests for medical appropriateness
inpatient hospital stay including mental health, substance abuse, skilled nursing, and rehabilitation for medical necessity
and post claim or post service reviews
Work to the top of the RN license and ensure proper referral to medical director for denial authorizations through independent review organizations (IRO)
Work with hospital staff to prepare patients for discharge and ensure a smooth transition to the next level of care
Refer requests that fall outside of established guidelines to advance review or senior care consultants
Process appeals for non-certification of services, complete non-certification letters when appropriate
Review plan document for benefit determinations
attempt to redirect providers and patients to PPO providers

What we offer

Competitive base salary and benefits effective day one
Comprehensive medical and dental through our own health solutions
Paid Time Off
Mental health support, retirement planning, and financial protection
Professional development with clear career progression and learning budgets

Fulltime

New

Case Manager Nurse-RN

We are seeking Case Manager Nurse, RN, to join our team part-time. As a Case Man...

Location

United States

Salary:

36.00 - 38.00 USD / Hour

Personify Health

Expiration Date

Until further notice

Requirements

Graduation from an accredited Registered Nursing (RN) program
Possession of a current California RN license
a multi-state license will also be required
Minimum of five (5) years medical/surgical or acute care experience, including two years’ experience in case management, or an equivalent combination of education and experience
Prior case management experience, emergency room, critical care background or other relevant clinical care experience pertinent to case management
Knowledge of medical claims and ICD-10, CPT, HCPCS coding
Ability to critically evaluate claims data and determine treatment plan, discharge planning experience
Ability to work independently making decisions and problem solving
Knowledge of community resources and alternate funding programs
Computer proficiency or working knowledge of Microsoft Office Suite

Job Responsibility

Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs
Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health and identify for participation in appropriate programs
Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short- and long-term goals
Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner
report measurable outcomes that record effectiveness of interventions
Initiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of care
Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs
provide patient/family with emotional support and guidance
Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis
Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports

What we offer

Part-time schedule designed around your availability and life priorities
Access to learning and development opportunities alongside full-time colleagues
Mentorship and skill-building that translates to career advancement
Competitive hourly compensation that values your expertise
Technology and equipment support to set you up for success

Parttime

Case Manager Nurse-RN

We are seeking Case Manager Nurse, RN, to join our team part-time. As a Case Man...

Location

United States

Salary:

36.00 - 38.00 USD / Hour

Personify Health

Expiration Date

Until further notice

Requirements

Graduation from an accredited Registered Nursing (RN) program
Possession of a current California RN license
a multi-state license will also be required
Minimum of five (5) years medical/surgical or acute care experience, including two years’ experience in case management, or an equivalent combination of education and experience
Prior case management experience, emergency room, critical care background or other relevant clinical care experience pertinent to case management
Knowledge of medical claims and ICD-10, CPT, HCPCS coding
Ability to critically evaluate claims data and determine treatment plan, discharge planning experience
Ability to work independently making decisions and problem solving
Knowledge of community resources and alternate funding programs
Computer proficiency or working knowledge of Microsoft Office Suite

Job Responsibility

Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs
Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health and identify for participation in appropriate programs
Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short- and long-term goals
Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner
report measurable outcomes that record effectiveness of interventions
Initiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of care
Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs
provide patient/family with emotional support and guidance
Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis
Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports

What we offer

Part-time schedule designed around your availability and life priorities
Access to learning and development opportunities alongside full-time colleagues
Mentorship and skill-building that translates to career advancement
Competitive hourly compensation that values your expertise
Technology and equipment support to set you up for success

Parttime

Case Manager Nurse-RN

As a Case Manager RN, you will provide telephonic case management between provid...

Location

United States

Salary:

36.00 - 38.00 USD / Hour

Personify Health

Expiration Date

Until further notice

Requirements

Graduation from an accredited Registered Nursing (RN) program
Possession of a current California RN license
a multi-state license will also be required
Minimum of five (5) years medical/surgical or acute care experience, including two years’ experience in case management, or an equivalent combination of education and experience
Prior case management experience, emergency room, critical care background or other relevant clinical care experience pertinent to case management
Knowledge of medical claims and ICD-10, CPT, HCPCS coding
Ability to critically evaluate claims data and determine treatment plan, discharge planning experience
Ability to work independently making decisions and problem solving
Knowledge of community resources and alternate funding programs
Computer proficiency or working knowledge of Microsoft Office Suite

Job Responsibility

Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs
Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health and identify for participation in appropriate programs
Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short- and long-term goals
Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner
report measurable outcomes that record effectiveness of interventions
Initiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of care
Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs
provide patient/family with emotional support and guidance
Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis
Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports

What we offer

Competitive base salary and benefits effective day one
Comprehensive medical and dental through our own health solutions
Paid Time Off
Mental health support, retirement planning, and financial protection
Professional development with clear career progression and learning budgets
Mission-driven culture where diverse perspectives drive real impact on people's health

Fulltime

New

IT Training Lead

The IT Training Lead will drive technology learning and user adoption across the...

Location

United States , Delray Beach

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Experience in IT training, instructional design, technical enablement, or learning and development
Strong knowledge of Microsoft 365
Excellent communication, facilitation, and content development skills
Ability to translate technical concepts into practical, user-friendly training.

Job Responsibility

Design, develop, and deliver IT training programs in instructor-led, virtual, and self-paced formats
Take lead in the Microsoft Copilot and AI training strategy, including onboarding, advanced use cases, responsible AI usage, and ongoing enablement
Partner with IT leadership to support new technology rollouts, system upgrades, and digital transformation initiatives
Create and maintain training content, including videos, guides, tutorials, and job aids
Identify skill gaps and develop targeted learning solutions to improve adoption and productivity
Gather feedback and measure training effectiveness to continuously improve programs.

New

K Kitchen Representative

The position includes, but is not limited to, the following essential job duties...

Location

United States , New Albany

Salary:

Not provided

Circle K

Expiration Date

Until further notice

Requirements

Excellent communication skills
Team player who can work well with others or independently
Acts with integrity
keeps commitments
Contagious positive attitude
Focuses on achieving results while having fun
Frequently bend, twist at waist, kneel, squat, stand, and walk
Occasionally climb and descend ladders
Tolerate extreme cold and hot temperatures and work in and around fryers, ovens, grills, coolers, freezers, sharp objects, and loud noises
Reach, grasp, and manipulate objects with hands for entire shift, including reaching for objects overhead

Job Responsibility

Provides excellent guest service in a fast and friendly manner
Maintains a clean restaurant environment by cleaning and performing general housekeeping duties
Prepares and serves food items in accordance with all Brand, Company, and health department regulations
Ensures product quality, food safety, and operational standards are met
Keeps accurate cash, sales, and inventory control records
Follows all government laws and safety codes
Completes reports on all incidents following our 5-minute rule policy
Lives our Company values: One Team, Do the Right Thing, Takes Ownership, Play to Win

What we offer

Medical, Dental, Vision, Term Life and AD&D plans
Flexible spending and health savings accounts (FT)
Vacation paid time off
Company holidays paid at time and a half
Matching 401(k)
Tuition Reimbursement
Stock Purchase Plan
Employee Discount Program
Discount Meal Benefit
Wellness Plan

New

K Kitchen Representative

Location

United States , Decatur

Salary:

Not provided

Circle K

Expiration Date

Until further notice

Requirements

Excellent communication skills
Team player who can work well with others or independently
Acts with integrity
keeps commitments
Contagious positive attitude
Focuses on achieving results while having fun
Frequently bend, twist at waist, kneel, squat, stand, and walk
Occasionally climb and descend ladders
Tolerate extreme cold and hot temperatures and work in and around fryers, ovens, grills, coolers, freezers, sharp objects, and loud noises
Reach, grasp, and manipulate objects with hands for entire shift, including reaching for objects overhead

Job Responsibility

Provides excellent guest service in a fast and friendly manner
Maintains a clean restaurant environment by cleaning and performing general housekeeping duties
Prepares and serves food items in accordance with all Brand, Company, and health department regulations
Ensures product quality, food safety, and operational standards are met
Keeps accurate cash, sales, and inventory control records
Follows all government laws and safety codes
Completes reports on all incidents following our 5-minute rule policy
Lives our Company values: One Team, Do the Right Thing, Takes Ownership, Play to Win

What we offer

Medical, Dental, Vision, Term Life and AD&D plans
Flexible spending and health savings accounts (FT)
Vacation paid time off
Company holidays paid at time and a half
Matching 401(k)
Tuition Reimbursement
Stock Purchase Plan
Employee Discount Program
Discount Meal Benefit
Wellness Plan

New

Restaurant Assistant Manager

This position assists the Restaurant Manager (RM) with daily operations of the r...

Location

United States , Holly Springs

Salary:

Not provided

Circle K

Expiration Date

Until further notice

Requirements

Full time required
availability during all hours of operation and at least one hour pre-opening and post-closing required
Valid state Driver's License required
Excellent communication skills
Motivates, coaches, and leads team members
Acts with integrity
keeps commitments
Contagious positive attitude
Focuses on achieving results while having fun
Ability to gain control during stressful situations

Job Responsibility

Assists the Restaurant Manager with daily operations of the restaurant and supervises the team in their absence
Leads and coaches Restaurant Team Members and partners with the management team to maintain the Company and Brand operational standards
Provides excellent guest service in a fast and friendly manner
coaches and corrects team
Conducts second interviews for team members and shift leads
Maintains a clean restaurant environment by cleaning and performing general housekeeping duties
Assigns shift duties to team members and follows up to ensure completion
Directs team and ensures all food items are prepared and served in accordance with all Brand, Company, and health department regulations
Coaches team members to follow guidelines for food preparation and production management
Cascades relevant information to team members and assists with new product training

What we offer

Unlimited tip pooling
Medical, Dental, Vision, Term Life and AD&D plans
Flexible spending and health savings accounts
Short-Term Disability
Vacation paid time off
Company holidays paid at time and a half
Matching 401(k)
Tuition Reimbursement
Stock Purchase Plan
Employee Discount Program

Fulltime

Select Country

Utilization Review Nurse-RN

Job Description

Job Responsibility

Requirements

What we offer

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