This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Utilization Management LVN supports the UM team by conducting medical necessity reviews, coordinating authorizations, and ensuring appropriate utilization of healthcare services in accordance with established guidelines. This role requires strong clinical judgment, attention to detail, and excellent communication skills to effectively collaborate with providers, members, and internal teams. - Conduct prospective, concurrent, and retrospective reviews to determine medical necessity and appropriateness of care - Apply established criteria such as MCG or InterQual to assess clinical documentation - Assist with processing prior authorization requests and determining level of care - Collaborate with RNs, physicians, and other clinical staff to ensure coordinated, timely reviews - Communicate determinations to providers and members in a timely and professional manner - Maintain accurate documentation of clinical reviews, determinations, and communications in the system - Identify and escalate cases that do not meet criteria to the appropriate clinical reviewer - Ensure compliance with regulatory and accreditation standards including NCQA, CMS, and state-specific guidelines - Participate in team meetings, trainings, and audits to ensure quality and consistency - Support special projects or initiatives as assigned by leadership Qualifications - Active and unrestricted LVN license in an eNLC (Enhanced Nurse Licensure Compact) state with multistate privileges - 3+ years of Nursing experience - 1+ years of Utilization Management experience - Familiarity with medical terminology, utilization management guidelines, and clinical documentation standards - Proficiency in Microsoft Office and experience working with healthcare systems or electronic medical records - Strong organizational and time management skills with the ability to work independently - Excellent written and verbal communication skills Requirements - Base Pay: up to $35 per hour - Pay frequency: Weekly pay - Training Schedule: 2 weeks, Monday – Friday; 8:00 AM - 5:00 PM CST - Production Schedule: Monday – Friday; 8:00 AM - 5:00 PM CST Benefits - Medical, Dental, and Vision coverage - Life Insurance - Short-Term and Long-Term Disability options - Flexible Spending Account (FSA) - Employee Assistance Program - 401(k) with employer contribution - Paid Time Off (PTO) - Tuition Reimbursement Company Description Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Skagit Radiology, Inc. / North Star Radiology is seeking board-certified or board-eligible Radiologists to join our collaborative, forward-thinking team in beautiful Washington State and Alaska. This is a shareholder-track opportunity with a clearly defined path to partnership, remote flexibility, and a supportive infrastructure built for physician success. - All subspecialties are being considered; positions are 80% subspecialized. - Lucrative, remote internal teleradiology moonlighting is available on your days off. - Both shareholder-track (1-year) and employee positions are available. Qualifications - Board-certified or board-eligible Radiologists. Requirements - Ability to work in a collaborative and forward-thinking environment. Benefits - For W-2 Employee Physicians: - Competitive compensation model. - 401(k) with immediate eligibility and employer match. - Comprehensive benefits package including medical, dental, vision. - CME allowance and full coverage of licensure fees. - Malpractice insurance coverage. - Paid time off. - For 1099 Independent Contractor Physicians: - Competitive compensation structure. - Flexible scheduling aligned with block preferences. - Malpractice coverage. - Ability to tailor workload and schedule. - Final structure (W-2 or 1099) may be adjusted based on candidate preference and practice needs. Company Description Skagit Radiology is a physician-owned practice committed to clinical excellence, operational stability, and collegial collaboration. With deep community roots and a reputation for quality, we provide high-level imaging services while maintaining a supportive and innovative environment for our physicians.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Skagit Radiology, Inc. / North Star Radiology is seeking board-certified or board-eligible Radiologists to join our collaborative, forward-thinking team in beautiful Washington State and Alaska. This is a shareholder-track opportunity with a clearly defined path to partnership, remote flexibility, and a supportive infrastructure built for physician success. - All subspecialties are being considered; positions are 80% subspecialized. - Lucrative, remote internal teleradiology moonlighting is available on your days off. - Both shareholder-track (1-year) and employee positions are available. Qualifications - Board-certified or board-eligible Radiologists. Requirements - Physician-owned and led practice. - Long-standing hospital and clinic partnerships across Washington State and Alaska. - Modern workflow and strong administrative support. - Technology-enabled remote environment. - Culture focused on physician autonomy, stability, and long-term success. - Predictable shift window with flexibility in how weeks are structured. - Designed to support true work-life balance. Benefits For W-2 Employee Physicians: - Competitive compensation model. - 401(k) with immediate eligibility and employer match. - Comprehensive benefits package including medical, dental, vision. - CME allowance and full coverage of licensure fees. - Malpractice insurance coverage. - Paid time off. For 1099 Independent Contractor Physicians: - Competitive compensation structure. - Flexible scheduling aligned with block preferences. - Malpractice coverage. - Ability to tailor workload and schedule. Final structure (W-2 or 1099) may be adjusted based on candidate preference and practice needs. Company Description Skagit Radiology is a physician-owned practice committed to clinical excellence, operational stability, and collegial collaboration. With deep community roots and a reputation for quality, we provide high-level imaging services while maintaining a supportive and innovative environment for our physicians.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description The Utilization Review (UR) Specialist is a Registered Nurse responsible for conducting thorough medical necessity reviews to assist with determining appropriate patient class designation. The UR Specialist will perform timely and comprehensive reviews of the patient chart utilizing InterQual Criteria accurately in conjunction with the UR Department workflows/processes, clinical nursing judgement, and when necessary, discussions with the provider team and/or Medical Director of UR. - Operational Support: - Conducts thorough medical necessity reviews to assist with determining appropriate patient class designation. - Performs timely and comprehensive reviews of the patient chart utilizing InterQual Criteria accurately in conjunction with the UR Department workflows/processes, clinical nursing judgement, and when necessary, discussions with the provider team and/or Medical Director of UR. - Performs appropriate and accurate initial, admission (episode day one) and concurrent utilization reviews as guided by InterQual Criteria and UR Department workflows on all observation, inpatient, and extended recovery admissions as required based on Emory Healthcare's Utilization Management Plan and the UR Department’s processes. - Ensures that all InterQual reviews are supported with provider team documentation and/or clinical data. - When appropriate, utilizes the UR Department's Severity of Illness/Intensity of Service template to document the medical necessity of the admission or continued stay. - Identifies any Avoidable Delays and accurately documents the delay(s) based on the workflow. - Follows the UR Department’s denial workflows as appropriate. - Prioritizes work with minimal guidance for optimal reimbursement and to avoid financial risk to both patient and hospital. - Compliance: - Identifies and completes Medicare Outpatient Observation Notices (MOON), Medicare Change of Status Notice (MCSN), Condition Code 44s and Medicare Hospital Issued Notices of Non-Coverage (HINNs) for Medicare beneficiaries as appropriate. - Ensures compliance with all state of Georgia and Federal regulatory requirements as designated in Emory Healthcare's Utilization Management Plan. - Maintains all required annual competencies, metrics, and fully participates and engages in department process improvements. - Collaboration: - Responsible for timely communication to the provider team and interdisciplinary team as it relates to patient class designation and medical necessity of an admission or continued stay on individual patient basis based on UR Department workflows. - Works closely with the UR Department's Case Management Authorization Specialist IP to ensure that authorized days and patient actual LOS are reconciled to ensure appropriate reimbursement for services provided. - Communicates medical necessity denials for in-house patients to the Medical Director of UR, and when designated to the provider team. - Serves as a resource to the provider team, Interdisciplinary Care Team, and patient to explain external UR regulations. - Provides effective and efficient proactive communication to internal and external customers. - Assists in collaborative efforts with the Case Management Department, Revenue Cycle, Physician Advisors, and other required departments. - Additional Responsibilities: - Ability to multi-task in a fast-paced environment while efficiently handling multiple priorities and ensuring deadlines are met. - Performs other duties and tasks as assigned. Travel: Less than 10% of the time may be required. Work Type: This position is a remote position outside traditional office, often from home or another remote setting. Qualifications - Education: Associate degree in nursing. - Experience: Minimum of 5 years of recent acute hospital experience or a minimum of two years of previous utilization review experience. - Licensure: Must have a valid, active unencumbered Registered Nurse license approved by the Georgia Licensing Board. - Skills: Must meet all quality and productivity expectations and successfully complete yearly competencies. Requirements - Education: Bachelor's degree in Nursing strongly preferred. - Certification: Case Management certification preferred. - Skills: InterQual Level of Care Criteria experience. Previous utilization review experience strongly preferred. Benefits - Comprehensive health benefits that start day 1. - Student Loan Repayment Assistance & Reimbursement Programs. - Family-focused benefits. - Wellness incentives. - Ongoing mentorship, development, and leadership programs. - And more. Company Description Emory is an equal opportunity employer, and qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or other characteristics protected by state or federal law. Emory Healthcare is committed to providing reasonable accommodations to qualified individuals with disabilities upon request. Please contact Emory Healthcare’s Human Resources at careers@emoryhealthcare.org. Please note that one week's advance notice is preferred.