Get Hired Faster With COMPANY_NAME!
Don't you ever think you landed here by any accident, You are here because you are searching for something bigger. You know what?
- A better Job
- A better Future
- A better Knowledge
- A better Paycheck
- A greater Path to walk on.
And COMPANY_NAME is here to give you exactly what you've been missing for so long. The reality is that most job seekers chase job postings, but successful job seekers attract job offers by chasing the accurate information. Therefore, that's the shift COMPANY_NAME is going to help you make. Here are the top 10 ideas to up-skill yourself, so lean in to begin:
1: COMPANY_NAME Smart Tools and Direct Employer Connections Help Speed Up Your Hiring Process
COMPANY_NAME is a career-changing advantage that most seekers never get access to. Imagine...
- Instead of applying for job after job and still not getting any callbacks, you suddenly bump into a tool that can do the heavy lifting for you.
- Instead of wondering, "What do employers actually want?", you are getting insights straight from the employer's desk.
- Instead of hoping your resume gets noticed, it’s kept on the table of decision-makers who are hiring right now.
That's the difference COMPANY_NAME makes. Our tools will let you reach employers directly, which automatically speeds up your hiring process.
2: With Better Matches, Real-time Job Alerts, and Direct Employer Responses, COMPANY_NAME Helps Many Candidates Secure Interviews and Job Offers Within 15 to 30 Days!
How does COMPANY_NAME make this possible?
On COMPANY_NAME, you get notified for roles aligned with your profile right from the start. When an employer posts a role that matches your qualifications and skills, you’ll know first. When you apply early, your chances of getting noticed and shortlisted increase by 20%.
COMPANY_NAME also offers direct employer responses—no more waiting for weeks. Here you engage with hiring managers who are actively looking for candidates.
When all these features combine in one place, you move from your first match to your first interview within days. And ultimately, from application to offer—all within 15 to 30 days!
3: The Type of Resume You Need to Get Priority Placement
With COMPANY_NAME, you don’t just need a resume—you need a strategy. A system that pushes your name to the right tables. We’ll show you exactly how the most successful candidates take initiative and get noticed.
4: Browse Full-Time, Part-Time, and Freelancing Roles With COMPANY_NAME
The job market isn’t one-size-fits-all—and your career shouldn’t be either. COMPANY_NAME gives you access to a wide range of opportunities including full-time, part-time, and freelancing roles all in one place.
5: COMPANY_NAME Helps You Grow Your Career
COMPANY_NAME provides insights, tools, and role-matching that help you find the right direction, the right skills, and the opportunities aligned with your ambition.
6: The Easiest Way To Find A Job
COMPANY_NAME cuts the noise, the endless scrolling, and the confusion. With accurate matches, direct employer connection, and real-time updates, you get a clear and simple path from application to interview.
7: Find Roles That Offer Growth, Culture & Benefits
COMPANY_NAME helps you find roles where you grow, feel supported, and thrive—not just survive. With us, you discover opportunities that elevate your professional life.
8: Get Support With Resume, Interviews & Career Planning
COMPANY_NAME provides expert guidance on resumes, interviews, and planning so employers instantly recognize your strengths and value.
9: Your Future Starts Today
COMPANY_NAME gives you everything you need—tools, guidance, and opportunities—to step forward confidently and begin a new chapter where your potential is seen and supported.
10: Get Hired Within 15 to 30 Days With COMPANY_NAME
COMPANY_NAME follows a smart, strategic, and proven approach that gets your profile noticed faster and moves you toward interviews and offers within 15 to 30 days.
Clinical Denials Prevention & Appeals Specialist RN- PART TIME
- Review all inpatient admission and observation cases using InterQual, or Milliman Care Guidelines or CMS 2 Midnight Rule (depending on payer) within 12-24 hours of admission, seven days a week for assigned shifts.
- Complete an initial screening review within the first few hours of decision to admit from ED and communicate with appropriate Provider if initial status is to be re-considered.
- Identify incomplete clinical reviews in work queues and complete them within two hours whenever possible. If clinical information is not available by the time the lack of a review may result in a denial, escalate to the appropriate Provider/VPMA.
- Identify and complete clinical reviews required for submission to specific payers.
- Validate admission orders for all new admits/observations/outpatients daily.
- Ensure that the patient status order documented in the chart aligns with the MCG and/or InterQual criteria, or the CMS Two- Midnight Rule, to support the appropriate status and level of care.
- Prioritize review of all outpatient observation and outpatient bedded cases at least every 8 hours for conversion to inpatient status or discharge opportunities.
- Participate in daily Observation Huddles.
- Conduct concurrent reviews for all payers daily for the first three days of admission, then every 2-3 days, or more frequently if criteria are waning.
- Submit concurrent reviews to payers to ensure authorization of all days for per diem and percentage of charge reimbursement payers.
- If concurrent inpatient case does not meet medical necessity review criteria during the first level review, discuss with the attending MD to obtain additional clinical information and documentation to support inpatient level of care. If the case still does not meet, send to the Physician Advisor (PA) for a second level review.
- Forward cases that require secondary physician review to appropriate resource (e.g., Physician Advisor).
- Resolve any discrepancy at the time of review. If unable to resolve, escalate to the PA and Utilization Review (UR) Leadership.
- Coordinate with the care team in changing patient status, as needed. � Notify the care team when patient does not meet medical necessity per InterQual or MCG guidelines or 2 MN Rule and escalate appropriately.
- Document and proactively communicate relevant clinical information to payers for authorizations for treatments, procedures, and Length of Stay � submit clinical information as required by payers.
- Ensure completion and delivery of required patient notices (by onsite team member). These include but are not limited to: HINNs, Condition Code 44, MOON, Connecticut notice of conversion, etc.
- Tracking and trending all appeals and communicating on a daily/regular basis with the Denials Management team.
- Assists with informing Managed Care contracting team with necessary contractual language to protect organization financial position specific to inpatient medical necessity requirements.
- Employs creative solutions with team members and leadership to prevent denials.
- Performs other duties as assigned.
- Bachelor’s Degree (BSN) is highly preferred.
- Minimum of Associate’s Degree in Nursing required when accompanied by strong demonstrated competencies and significant experience.
- Minimum of 5 years experience in acute care Nursing
- Proficiency in Milliman and InterQual Guidelines required
- Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting required, minimum of 4 years experience required for Associate’s Degreed individuals.
- PREFER: Master’s Degree in related field
- Required: Current RN License in Connecticut and New York
- InterQual/MCG proficiency testing completed (preferred); required within 1 year of hire. As certification becomes available, requirement will be revisited.
- Knowledge of regulatory requirements for CMS
- Have the positive attitude and aptitude to adapt to the continuing change in payer behaviors
- Recognizes that education is the responsibility of the individual as well as the organization
- Seeks external knowledge on payers (such as free email services as Becker’s)
- Must have analytical abilities to assist in obtaining solutions to problems
- Self-starter and highly motivated
- Must be able to work independently in a fast-paced environment, manage workload and prioritize work
- Must be able to manage multiple competing priorities and maintain calm professional demeanor during peak demand
- Must possess a high degree of prioritization skills
- Exceptional interpersonal skills to effectively communicate with the physicians, payers, and other members of the interdisciplinary care team
- Current working knowledge of utilization management, performance improvement and managed care reimbursement.
