Solutions that Matter
Utilization Review Nurse
Location
United States
Posted
73 days ago
Salary
$76K - $85K / year
Seniority
Mid Level
No structured requirement data.
Job Description
Utilization Review Nurse
Public Consulting Group
Role Description PCG is currently seeking a Utilization Review Nurse. The Utilization nurse will also be responsible for utilizing a medical management software system on a day-to-day basis. The purpose of the Fund is to provide a funding source for future health care costs associated with birth‐related neurological injuries. - Performs prior authorization, concurrent and retrospective reviews - Uses clinical documentation and clinical review criteria to make determinations regarding qualifying health care costs - Accurately records all review determinations and supporting documentation - Contacts providers and members according to established timeframes - Identifies and refers cases that do not meet established clinical or other criteria to the Case Management Supervisor - Identifies and communicates quality issues to the Case Management Supervisor - Communicates information to other team members - Utilizes knowledge of community resources and the member’s benefit structure - Interacts with providers, vendors, and facilities in a professional and respectful manner - Recognizes quality of care issues and escalates the issues appropriately - Understands and facilitates the Appeals and Grievances process - Assists members with the coordination of services from various settings as appropriate - Performs other duties as assigned Qualifications - Graduated from an accredited School of Nursing, Associate Degree, Bachelor’s preferred - Minimum of 2 years of direct clinical nursing experience - Minimum of 2 years of experience with medical management activities in a managed care environment, Medicaid or hospital utilization management - RN required Requirements - Possesses effective verbal/written communication skills, especially via phone, with the ability to interact with various levels of personnel - Able to work in a fast-paced environment, demonstrate excellent problem solving, critical thinking, and organizational skills - Performs multiple tasks efficiently and accurately, has exceptional attention to detail and performs consistent work product - Self-motivated, self-directed, team oriented, and responsible, with a positive attitude and a proactive style - Possesses the ability to operate in a highly variable work environment - Presents a courteous and competent demeanor to our clients and teammates - Excellent customer service skills - Strong computer skills - Ability to easily navigate through website research Benefits - Medical and dental care benefits - 401k - PTO - Parental leave - Bereavement leave Compensation Range: $76,000 - $85,000 Compensation for roles at Public Consulting Group varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, PCG provides a reasonable range of compensation for this role. EEO Statement Public Consulting Group is an Equal Opportunity Employer dedicated to celebrating diversity and intentionally creating a culture of inclusion. We believe that we work best when our employees feel empowered and accepted, and that starts by honoring each of our unique life experiences. At PCG, all aspects of employment regarding recruitment, hiring, training, promotion, compensation, benefits, transfers, layoffs, return from layoff, company-sponsored training, education, and social and recreational programs are based on merit, business needs, job requirements, and individual qualifications. We do not discriminate on the basis of race, color, religion or belief, national, social, or ethnic origin, sex, gender identity and/or expression, age, physical, mental, or sensory disability, sexual orientation, marital, civil union, or domestic partnership status, past or present military service, citizenship status, family medical history or genetic information, family or parental status, or any other status protected under federal, state, or local law. PCG will not tolerate discrimination or harassment based on any of these characteristics. PCG believes in health, equality, and prosperity for everyone so we can succeed in changing the ways the public sector, including health, education, technology and human services industries, work.
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UNICEF/HAITI: Consultant- Prestataire en vidéo d’animation, Remote
UNICEFUNICEF supports people in 190 countries and territories across the globe, working in some of the world's toughest places to reach while defending the rights and saving the lives of
UNICEF works in over 190 countries and territories to save children’s lives, defend their rights, and help them fulfill their potential, from early childhood through adolescence. At UNICEF, we are committed, passionate, and proud of what we do for as long as we are needed. Promoting the rights of every child is not just a job – it is a calling. UNICEF is a place where careers are built. We offer our staff diverse opportunities for professional and personal development that will help them reinforce a sense of purpose while serving children and communities across the world. We welcome everyone who wants to belong and grow in a diverse and passionate culture., coupled with an attractive compensation and benefits package. Visit our website to learn more about what we do at UNICEF. For every child, the right to hope Haiti is facing one of the most complex humanitarian crises in the world. Armed violence, which extends far beyond the Port-au-Prince metropolitan area, continues to devastate entire communities and expose children to serious violations of their rights. As of early 2026, approximately 1.4 million people were internally displaced, nearly half of whom were children, while 2.6 million children were in need of humanitarian assistance. Nearly 5.7 million people—more than half of Haiti’s population—faced high levels of acute food insecurity, including 1.2 million children under the age of five. More than 1,600 schools were closed during the 2024–2025 school year, depriving more than 240,000 students of their right to education. In light of these realities, and recognizing that the experiences of children can be highly sensitive, UNICEF aims to produce a series of four short animated videos based on real-life testimonies and/or situations. These videos aim to raise awareness among potential donors about the situation of Haitian children and to mobilize the resources needed to address their most urgent needs. How can you make a difference? Support Senior Management in identifying and addressing the following: - What approaches can be used to communicate complex humanitarian issues in a clear and compelling way to diverse audiences? - How will you conceptualize and propose creative storytelling approaches aligned with UNICEF’s messaging? - How can children’s voices, experiences, and needs be better represented and amplified? - How can the current situation of children in Haiti be more effectively highlighted to inform decision-making? To qualify as an advocate for every child you will have… Minimum requirements: - Degree or certification in audiovisual production, 2D/3D animation, or a related field. - At least five (5) years of proven experience in the design and production of animated videos, supported by a strong portfolio. - Experience managing audiovisual projects in a humanitarian context, ensuring quality and meeting deadlines. - Good understanding of UNICEF’s mandate and the situation of children in Haiti. - Proficiency in animation software such as Adobe After Effects or other specialized tools, with expertise in 2D and 3D techniques. - Ability to develop creative and innovative concepts aligned with communication and advocacy objectives. - Strong understanding of current trends in animation and the ability to incorporate them effectively. - Ability to ensure smooth communication throughout the creative process, in accordance with UNICEF’s guidelines and communication and visibility manual. - Project management skills, including planning, stakeholder coordination, and meeting deadlines. - Proficiency in technical standards for video production, including formats, resolutions, and the latest technologies. - Ability to adapt to technological advances and the changing demands of the context. Evaluation Criteria for proposal: A) Technical Evaluation (e.g. maximum 75 Points) B) Financial Proposal (e.g. maximum of 25 Points) If you would like to know more about this position, please review the complete Job Description here: SSA HR_Animation Videos-Job Description.pdf For every Child, you demonstrate... UNICEF’s Core Values of Care, Respect, Integrity, Trust and Accountability and Sustainability (CRITAS) underpin everything we do and how we do it. Get acquainted with Our Values Charter: UNICEF Values The UNICEF competencies required for this post are… (1) Builds and maintains partnerships (2) Demonstrates self-awareness and ethical awareness (3) Drive to achieve results for impact (4) Innovates and embraces change (5) Manages ambiguity and complexity (6) Thinks and acts strategically (7) Works collaboratively with others Familiarize yourself with our competency framework and its different levels. UNICEF promotes and advocates for the protection of the rights of every child, everywhere, in everything it does and is mandated to support the realization of the rights of every child, including those most disadvantaged, and our global workforce must reflect the diversity of those children. The UNICEF family is committed to include everyone, irrespective of their race/ethnicity, disability, gender identity, sexual orientation, religion, nationality, socio-economic background, minority, or any other status. UNICEF encourages applications from all qualified candidates, regardless of gender, nationality, religious or ethnic backgrounds, and from people with disabilities, including neurodivergence. We offer a wide range of benefits to our staff, including paid parental leave, breastfeeding breaks and reasonable accommodation for persons with disabilities. UNICEF provides reasonable accommodation throughout the recruitment process. If you require any accommodation, please submit your request through the accessibility email button on the UNICEF Careers webpage Accessibility | UNICEF. Should you be shortlisted, please get in touch with the recruiter directly to share further details, enabling us to make the necessary arrangements in advance. UNICEF does not hire candidates who are married to children (persons under 18). UNICEF has a zero-tolerance policy on conduct that is incompatible with the aims and objectives of the United Nations and UNICEF, including sexual exploitation and abuse, sexual harassment, abuse of authority and discrimination based on gender, nationality, age, race, sexual orientation, religious or ethnic background or disabilities. UNICEF is committed to promote the protection and safeguarding of all children. All selected candidates will, therefore, undergo rigorous reference and background checks, and will be expected to adhere to these standards and principles. Background checks will include the verification of academic credential(s) and employment history. Selected candidates may be required to provide additional information to conduct a background check, and selected candidates with disabilities may be requested to submit supporting documentation in relation to their disability confidentially. UNICEF appointments are subject to medical clearance. Issuance of a visa by the host country of the duty station is required for IP positions and will be facilitated by UNICEF. Appointments may also be subject to inoculation (vaccination) requirements, including against SARS-CoV-2 (Covid). Should you be selected for a position with UNICEF, you either must be inoculated as required or receive a medical exemption from the relevant department of the UN. Otherwise, the selection will be canceled. Remarks: As per Article 101, paragraph 3, of the Charter of the United Nations, the paramount consideration in the employment of the staff is the necessity of securing the highest standards of efficiency, competence, and integrity. UNICEF is committed to fostering an inclusive, representative, and welcoming workforce. For this position, eligible and suitable female candidates are encouraged to apply. Government employees who are considered for employment with UNICEF are normally required to resign from their government positions before taking up an assignment with UNICEF. UNICEF reserves the right to withdraw an offer of appointment, without compensation, if a visa or medical clearance is not obtained, or necessary inoculation requirements are not met, within a reasonable period for any reason. UNICEF does not charge a processing fee at any stage of its recruitment, selection, and hiring processes (i.e., application stage, interview stage, validation stage, or appointment and training). UNICEF will not ask for applicants’ bank account information. Humanitarian action is a cross-cutting priority within UNICEF’s Strategic Plan. UNICEF is committed to stay and deliver in humanitarian contexts. Therefore, all staff, at all levels across all functional areas, can be called upon to be deployed to support humanitarian response, contributing to both strengthening resilience of communities and capacity of national authorities. All UNICEF positions are advertised, and only shortlisted candidates will be contacted and advance to the next stage of the selection process. An internal candidate performing at the level of the post in the relevant functional area, or an internal/external candidate in the corresponding Talent Group, may be selected, if suitable for the post, without assessment of other candidates. Additional information about working for UNICEF can be found here.



