Job Closed
This listing is no longer active.
Because health is personal
Lead Utilization Review-RN
Location
United States
Posted
15 days ago
Salary
$38 - $43 / hour
Seniority
Lead
No structured requirement data.
Job Description
Lead Utilization Review-RN
Personify Health
Role Description The RN Utilization Management (UM) Team Lead provides clinical and operational leadership to support timely, and evidence-based coverage determinations. This role leads day-to-day UM execution through: - Coaching and development of clinical reviewers - Auditing of clinical reviewers - Quality oversight - Case escalation support - Partnership with internal and external stakeholders to promote appropriate level of care and smooth transitions The Team Lead reinforces compliance with applicable regulatory, contractual, and accreditation requirements, supports audit readiness and consistency in decision-making, and contributes to continuous improvement of UM workflows and member/provider experience. This Candidate will have to work between PST hours. Qualifications - Knowledge of medical claims and ICD-10, CPT, HCPCS coding - Ability to critically evaluate claims data and determine treatment plan - Excellent interpersonal and communication skills - Strong customer orientation - Good time management skills - Highly organized - Proficiency in software applications including Microsoft Word, Excel, PowerPoint, and Outlook - Excellent verbal and written communication skills - Ability to speak clearly and convey complex or technical information in an understandable manner - Ability to understand and interpret complex information from others - RN Licensure required - Licensed in the state of California preferred - Prior supervisory experience in utilization review, case management, or an equivalent combination of education and experience - 5+ years combined clinical experience required - 2+ years utilization review experience required Requirements - Serve as a visible first-line leader for assigned UM staff by setting daily priorities and reinforcing expectations - Coach reviewers on consistent application of medical-necessity criteria, medical policy, and benefit plan language - Monitor daily workflow health (intake volume, aging, and turnaround risks) and coordinate coverage plans - Reinforce documentation and communication standards by reviewing work for completeness and audit readiness - Support onboarding and skill development through shadowing plans and competency check-ins - Partner with providers, facilities, and internal teams to resolve barriers to timely determinations - Maintain confidentiality and comply with HIPAA and company privacy/security policies - Complete required training and attestations within established timelines Benefits - Competitive base salary and benefits effective day one - Comprehensive medical and dental through our own health solutions - Paid Time Off—rest and recharge time is non-negotiable - 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 Visit personifyhealthbenefits.com to explore our complete benefits package, wellness programs, and other employee perks. Company Description Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes.
Related Guides
Related Categories
Related Job Pages
More General Jobs
Vacation Planning Coordinator
Journey with HayleeGreat Fit For: Stay-at-home parents Military spouses Hospitality or customer service backgrounds Individuals seeking flexible remote work Anyone who enjoys organization and travel-related experiences What Happens Next? Selected applicants will be invited to a brief informational session where we'll provide: A closer look at day-to-day responsibilities Training and support details Available tools and resources Next steps and onboarding information Apply Today: If you enjoy helping people, staying organized, and being part of meaningful travel experiences, we'd love to connect with you.
Role Description We're currently looking for organized, reliable individuals to help support clients by coordinating details, managing schedules, and ensuring everything runs smoothly from start to finish. This is a fully remote position with flexible hours, making it a great fit for anyone looking to work independently while building valuable skills. No prior experience is required — training is provided. - Communicating with clients to understand their needs and preferences - Organizing schedules, confirmations, and important details - Providing clear, timely updates and support - Keeping everything on track to ensure a smooth experience - Assisting with coordination from start to finish Qualifications - Strong communication and organizational skills - Attention to detail and ability to stay on top of tasks - Comfortable working independently in a remote environment - Basic tech skills (email, apps, online systems) - Positive attitude and willingness to learn - Experience in customer service or coordination is helpful, but not required Requirements - Applicants must be authorized to work in: United States, United Kingdom, Mexico, Australia, or LATAM regions Benefits - 100% remote — work from anywhere - Flexible schedule options - Structured training provided - Supportive team environment - Opportunities for growth based on performance Who This Is Great For - Stay-at-home parents - Military spouses - Anyone looking for flexible, remote work - Individuals wanting to build new skills while working from home If you're organized, dependable, and enjoy helping others, we'd love to hear from you.
Photo Retoucher
Time to hireTime to Hire is a boutique recruitment partner for companies that value precision, speed, and exceptional talent. We specialize in tech, e-commerce, and digital roles — connecting ambitious businesses with people who elevate performance and drive lasting growth.
Role Description For my client, Moon Magic Jewelry, I'm looking for a talented Jewelry Photo Retoucher to join the team on a long-term basis. Moon Magic is an established direct-to-consumer jewelry brand specializing in natural gemstone jewelry. We're looking for someone who understands how to make gemstones look their absolute best while maintaining a premium, authentic aesthetic. - Retouch high-end jewelry product photos for e-commerce and marketing - Enhance the natural beauty, glow, and brilliance of gemstones such as moonstones, opals, diamonds, and other precious stones - Improve shine, reflections, and overall visual appeal while keeping the final result realistic and true to the product - Ensure consistent color accuracy and premium image quality across all assets Qualifications - Proven experience in jewelry photo retouching (gemstone experience is a strong plus) - Exceptional eye for detail, lighting, and color - Ability to create luxurious, high-end imagery without making it look over-edited - Advanced proficiency in Adobe Photoshop (or equivalent professional retouching tools) - Availability of 20+ hours per week - Reliable communication and ability to meet deadlines Requirements - Nice to have: Experience working with DTC/eCommerce brands - Understanding of luxury product photography and gemstone characteristics Benefits - 🌍 100% Remote – work from anywhere - ⏰ Flexible working hours with a results-driven culture - 💎 Up to 50% employee discount on Moon Magic jewelry - 🚀 Steep learning curve with opportunities to develop your skills in premium eCommerce and luxury product imagery - 🤝 Supportive, international team with a collaborative and positive work environment - 📈 Long-term collaboration with consistent work for the right candidate To apply Please include: - A portfolio with before & after examples of your jewelry retouching work (applications without relevant portfolio samples are unlikely to be considered) - A short introduction about your experience - Your hourly rate and weekly availability We're looking for someone we can build a long-term partnership with and who takes pride in creating beautiful, premium imagery. Company Description Time to Hire is a boutique recruitment partner for companies that value precision, speed, and exceptional talent. We specialize in tech, e-commerce, and digital roles — connecting ambitious businesses with people who elevate performance and drive lasting growth.
Role Description As an Account Executive, you will be responsible for territory growth and development within the small-to-medium-sized business (SMB) segment. This is a high-impact, outbound sales role where you will engage decision-makers through cold calling and proactive outreach, consulting with business leaders on tailored shipping solutions. You will deliver exceptional service and competitive rates to C-level executives and senior stakeholders at businesses with frequent shipping volumes, focusing on long-term partnerships and recurring revenue growth. Qualifications - 3 - 5 years Experience in a similar position - Proven ability or strong interest in cold calling and outbound sales - Comfortable working in a fast-paced, metrics-driven environment - Competitive, motivated, and results-oriented mindset - Strong communication skills with solid business acumen - Self-starter with excellent organizational, time management, and presentation skills Requirements - Build, maintain, and grow a designated territory through cold calling, outbound dialing, lead generation, and strategic outreach - Conduct a high volume of outbound calls daily to prospect, qualify, and engage potential clients - Research prospective accounts, uncover business needs, and secure meetings with key decision-makers - Deliver consultative, solution-based sales presentations supported by cost-benefit analysis - Lead and manage all aspects of the proposal, closing, and onboarding process - Close new business, activate accounts, and train clients on the shipping platform - Partner with operations and account management teams to ensure a seamless client experience and long-term customer satisfaction Benefits - Fully remote role - Base salary plus uncapped residual commission - In-depth training and professional development - Ongoing leadership support and mentorship
General Helper
AramarkAramark is an award-winning facilities management, foodservice, and uniform provider founded in 1959. The company serves wide-ranging industries, and its client
• Coffee service, stocking beverage coolers, snacks, filling napkin dispensers, condiments, etc • Cleaning and organizing the kitchen, coolers, freezers, and dry storage as directed • Sweeping and mopping floors, wiping tables and counters • Washing dishes, pots, pans and changing garbage • Report to supervisor concerning all issues related to food, safety and equipment • Maintain and monitor inventory and records • Set-up dry breakfast line, lunch, and snack station • Ensure sandwich cooler, beverage cooler, condiments, napkins, and utensils are sanitized and stocked • Prepare, portion and wrap snacks as per the Chef's requirements • Clean and sanitize dining room tables and re-stock supplies • Ensure all equipment is turned off and empty, cleaned and sanitized • General cleaning never stops, always touch up areas that you see need to be cleaned

