Jobs in Mount Lucas, TX

Wireless CCTV LLC (“WCCTV”) located in Richardson, Texas, is a subsidiary of Wireless CCTV Ltd originally established and located in the UK. WCCTV is the market leader for rapid deployment, mobile surveillance systems specifically designed to deliver video securely and efficiently via 4G LTE networks. The Company prides itself on developing innovative, customer-focused products and providing world-class customer support services. The Company's range of video surveillance solutions includes:

• Rapid deployment pole cameras
• Mobile surveillance trailers
• Time lapse video services

WCCTV is currently recruiting for an experienced Territory Sales Executive based in the Dallas/Ft. Worth metroplex. This role is responsible for driving new business growth within the assigned territory by proactively prospecting, developing, and closing opportunities in the field with commercial General Contractors mainly in construction and infrastructure related businesses. The role is highly field-focused, requiring consistent in‑person engagement at active commercial construction and/or infrastructure sites to identify opportunities, build relationships and convert prospects into long-term customers.

This is truly a sales "hunter" role and requires the incumbent to spend 4 to 5 days per week in the field, actively prospecting within the assigned territory.

Candidates must have the ability to drive throughout the assigned territory in the DFW metropolitan area for sales calls and site surveys. Mileage reimbursement provided. In addition, candidates must be able to navigate active construction sites. Primary responsibilities include:

New Business & Territory Development

• Develop and execute a territory sales plan to grow market share and sales volume within the commercial general contractor construction and infrastructure verticals.
• Identify, qualify, and close new business opportunities aligned to monthly and quarterly revenue targets, including new installations, contract value and contract length.
• Build a robust pipeline of prospects through consistent outbound activity and field engagement.

In‑Field Prospecting & Job‑Site Activity

• Conduct in‑field prospecting by walking active construction and infrastructure sites, engaging with site managers, project managers, and decision-makers.
• Generate opportunities through face-to-face cold calling, site visits, and on‑site relationship building.
• Represent WCCTV professionally and credibly on job sites, understanding construction and infrastructure workflows and site protocols.

Lead Generation & Relationship Building

• Identify new customers using direct methods such as in‑person and telephone cold calling.
• Identify new customers using indirect methods including referrals, networking events, CRM insights, and industry intelligence.
• Work closely with the Inside Sales / Sales Development team to maximize lead conversion and follow-up activity.
• Develop long-term relationships with customers to support repeat business and account expansion.

Sales Execution & Customer Solutions

• Identify, qualify, and assess customer needs to recommend appropriate products and services.
• Prepare and manage quotes, proposals, and sales documentation using the Company’s CRM system.
• Maintain accurate pipeline management, forecasts, and activity tracking within CRM.

Planning, Reporting & Market Intelligence

• Effectively plan and manage daily and weekly activity to achieve required sales targets.
• Provide regular reporting on sales activity, pipeline, and performance to internal Sales Management.
• Gather and share market intelligence, including competitor activity, customer trends, and emerging opportunities or threats.

Qualifications:

• High school diploma or equivalent required. Associates degree in Business, Marketing or related discipline preferred.
• Minimum of 2 to 3 years experience in a quota-carrying, outside/field sales role required.
• Previous experience selling or renting into the construction/infrastructure industry (e.g. contractors, equipment rental, site services, security, or related sectors) to include experience selling solutions into project-based or site-based environments required.
• Experience managing a defined sales territory with minimal supervision also required.
• Proven track record of new business development and meeting or exceeding sales targets.
• Must have a strong “Hunter” mentality - comfortable with cold calling, prospecting, and face-to-face sales conversations.
• In-depth knowledge of sales strategies, sales planning process, pipeline development and forecasting.
• An excellent communicator who can build, develop and maintain relationships with both new and existing customers and internal staff with ease.
• Prior experience effectively utilizing CRM systems such as Salesforce/Sugar and structured sales processes required. Effective computer skills to include MS Office, Outlook, Teams and other related software required.
• Excellent organization, negotiation, time management and attention to detail are a must.
• Demonstrated ability to prepare complete accurate quotes and proposals as well as sales orders is required.

Compensation & Benefits:

• Competitive base salary up to $75,000 per year depending upon experience and up to $50,000 bonus per year for total on-target earnings (OTE) of up to $125,000.
• 10 days paid vacation (increases with length of service) + seven (7) paid Company holidays.
• Company provided medical, dental, vision, short-term disability and life insurance plans.
• 401k Plan with Company match of up to 4% and immediate vesting.
• Mileage reimbursement for use of a personal vehicle.

Candidates must already have a work authorization that would permit them to work in the US.

WCCTV is committed to the success of its employees and demonstrates this through our development of people. The successful candidates can expect to receive comprehensive coaching and support through detailed and ongoing internal training programs designed to help grow your own personal success in your career within the Company.

Benefits Account Executive - Frisco at the Star

Our client, a successful benefits broker has a full-time opportunity for an experienced Account Executive to join their team! This position requires benefits brokerage industry experience to be considered for this role.

The Account Executive role is client facing and will lead the team for all implementations, renewals, open enrollment, etc. This will include taking the lead on the RFP process, onsite client presentations, onboarding new clients, ensuring compliance and/or ACA requirements.

• Role is 100% onsite with flexibility
• Casual dress with a "dress for your day" guideline
• Beautiful, brand-new offices overlooking the Star in Frisco
• Fully stocked break room, catered lunches
• Opportunity to work with great people in a highly collaborative environment where your voice will be heard and employees are provided with an excellent platform to learn and grow their career and skills

Successful candidates will have the following experience....

• A minimum of 5+ years of experience with mid-market groups from 100 to 1000 lives and can maintain an average book of business of 13-15 accounts in NY, CA, MN, TX and GA
• Strong compliance background - knowledge of ACA requirements, 5500 requirements, HIPAA, COBRA and Section 125 requirements
• Must have experience partnering with executives and stakeholders, presenting to potential clients, etc.
• MUST be open to travel up to 30%

Welcoming all qualified candidates to submit their resume to -

About Goosehead

Since 2003, Goosehead Insurance has been disrupting the insurance industry by giving clients the power of choice, utilizing a smarter marketing approach, and delivering world-class service. This is all powered by our focus on hiring and retaining extraordinary people. Our clients trust us with their most valuable possessions, so we’re more than just a bit selective when it comes to hiring new team members. In 2012, we began franchising our business model. This role is for one of our successful franchise partners in Frisco Tx.

Job Summary

The team is responsible for new business revenue generation monthly and works to achieve these on an individual and team level. Account Executives are equipped with extensive training in Salesforce, sales process management, business development and more.

Principal Duties and Responsibilities

The primary responsibility of an Account Executive is to build a book of business through:

Prospecting and establishing referral partner relationships with professionals from the real estate and mortgage industry.

Work with clients to understand their insurance needs, analyze options with a large carrier portfolio, and provide a custom solution to mitigate household risk.

Compensation Summary

The first year’s earnings potential ranges from $53,000 - $90,000, varying based on performance. Our compensation package slightly varies by agency but offers uncapped new business commissions and renewal commissions year-over-year. Renewal commissions provide passive earnings and can exponentially increase your annualized income. Additionally, top performers can qualify for an annual President’s Club trip.

Experience and Education

• Passing the state licensing exam, once hired
• Legally authorized to work in the United States

Required Skills and Abilities

• Exceptional written and verbal communication
• Experience in a fast-paced work environment
• B2B or B2C sales experience or related college major
• Competitive attitude
• Networking abilities
• Entrepreneurial spirit
• Problem-solving mentality
• Self-motivated, hands on, self-starter mindset that can do the work
• Strong time management
• Strong attention to detail and organization

Benefits Summary

• High quality voluntary health, vision, dental insurance programs
• Paid holidays, vacation, and sick leave
• Benefit offerings vary per agency*

This job posting is for an opportunity at a Goosehead Insurance agency independently owned and operated by a local franchised Agency Owner. If you choose to apply for this position, you understand and acknowledge that your application and any information included with it will be submitted to the Agency Owner. If you are hired for this position, you also understand and acknowledge that the Agency Owner’s franchised business will be your employer, not Goosehead Insurance Agency, LLC, and that the Agency Owner is solely responsible for all decisions related to your employment, including hiring, firing, discipline, compensation, scheduling, and supervision.

To learn more about our job opportunities, apply here. We look forward to speaking with you!

Wireless CCTV LLC ("WCCTV"), located in Richardson, Texas, is a subsidiary of Wireless CCTV Ltd originally established and located in the UK. WCCTV is the market leader for rapid deployment, mobile surveillance systems specifically designed to deliver video securely and efficiently via 4G LTE networks.

The Company prides itself on developing innovative, customer-focused products and providing world-class customer support services. The Company's range of video surveillance solutions includes:

• Rapid deployment pole cameras
• Mobile surveillance trailers
• Time lapse video services

The Company currently has an opportunity for a National Key Account Manager for our mobile surveillance systems selling into the Retail industry. The role requires an ambitious and results-driven sales "hunter" as the role's emphasis is on cold calling and prospecting efforts leading to new logo acquisition and expanded strategic presence within the Retail sector. Specific responsibilities include:

New Business and Expand Existing Business Revenue

• Responsible for identifying and generating new business opportunities by cold calling and prosecting key accounts in the Retail vertical nationwide.
• Research and identify potential customers using various direct methods such as cold calling and indirect methods such as networking, referrals and industry databases. Schedule and conduct self-generated sales meetings and fully explore the customer’s needs/requirements. Identify, qualify and assess customers' needs to determine suitable products and services. Demonstrate the most relevant products and services that will support each customer’s needs.
• Work closely with the internal Sales support team in scheduling and conducting scheduled sales presentations with customers. Conduct meetings booked by the internal Inside Sales (BDE) team and fully explore the customer’s needs/requirements. Demonstrate the most relevant products and services that will support each customer’s needs.
• Perform in-depth and informative reporting on activities for review by internal Sales management. Provide regular updates on market conditions and competitor activity, including upcoming threats/opportunities, as necessary to assist new product development and marketing efforts.
• Utilize the Company's CRM system to prepare all new equipment sales or rental quotes and maintain up to date status of pipeline development, business development activities, customer contact information, notes and any other relevant customer information.

Sales Planning and Administration

• In conjunction with the National Sales Manager and internal Business Development team, plan an effective sales strategy for the vertical, execute plan and deliver monthly sales activity and revenue targets.
• Provide internal Sales management with accurate weekly pipeline of activity and sales forecast and opportunities.
• Maintain all sales, customer information and activity in the CRM.
• Provide additional data, sales and/or customer information to internal Sales management when requested.

Marketing

• Attend regular marketing strategy meetings with Marketing and Sales management to discuss marketing plans and lead generation activity. Provides feedback to Marketing on effectiveness of all marketing campaigns and programs.

Qualifications:

• Associate’s degree in Business, Marketing or related discipline or equivalent required. Bachelor's degree in Business, marketing or related discipline preferred.
• Minimum of four to six years of previous B2B commercial sales experience in the CCTV, access control, electronics or related industry selling into the Retail industry required.
• Must be competent in cold calling and have key characteristics of a ‘hunter’.
• Must have proven track record in achieving activity-based sales targets on short and/or medium sales cycle.
• Proven ability to identify sales opportunities and leverage internal & external resources appropriately. Strong qualification skills are a must to be successful in this role along with a proven ability in meeting and exceeding sales revenue targets.
• Strong knowledge and understanding of the sales planning process, pipeline development, sales forecasting and marketing strategy.
• An excellent communicator who can build, develop and maintain relationships with both new and existing customers and internal staff with ease.
• Excellent presentation skills required and experience conducting customer sales meeting virtually and in person.
• Excellent organization, time management and attention to detail are a must.
• Demonstrated ability to prepare complete and accurate quotes and proposals as well as sales orders is required.
• Effective computer skills to include MS Office (Word, Powerpoint and Excel), Outlook and Teams. Previous experience using CRM such as Salesforce required.
• Ability to work independently as well as part of a team.

Ability to travel nationally up to 10% required.

Compensation & Benefits:

• An annual base salary up to $80,000 basic salary per year DOE and up to $50,000 bonus per year, with a projected OTE of $130,000 per year for high performing sales incumbents.
• 10 days paid vacation (increases with length of service) + seven (7) paid Company holidays.
• Company provided medical, dental, vision, short-term disability and life insurance plans.
• 401k Plan with Company match of up to 4% and immediate vesting.
• Mileage reimbursement for use of a personal vehicle.

WCCTV is committed to the success of its employees and demonstrates this through our development of people. The successful candidates can expect to receive comprehensive coaching and support through detailed and ongoing internal training programs designed to help grow your own personal success in your career within the Company.

Wireless CCTV LLC is an equal opportunity employer and supports a diverse, inclusive work environment. All qualified applicants will receive consideration for employment without regard to race, religion, creed, disability, genetic information, national origin, gender, gender identity and expression, age, sexual orientation, marital status, veteran status, or any other characteristic protected by federal, state, or local laws.

Office Hub is the world’s leading marketplace for flexible workspaces — from coworking hubs to serviced offices and shared spaces. Proptech is our game; our cutting-edge platform combined with next-level customer service has made us the ultimate disruptor in the real estate industry.

With teams across Sydney, Singapore, London, Dallas, Toronto, Angeles, Karachi and Bangalore, we’ve helped over 300,000 companies find their dream office spaces... And we’re just getting started!

What’s the Opportunity?

This is a rare chance to kick-start your career at a fast-growing global company. As part of our dynamic Sales team, you'll work across inbound opportunities with one mission: help tenants find their perfect office space. It’s busy, it’s fast but you’ll learn and laugh every single day.

After full training, you’ll be set up for success doing what you do best:

• Respond to enquiries from businesses looking for office space across your local market (and globally!).
• Book tours for clients to view suitable offices.
• Manage and update our CRM like a pro: qualifying leads, recording feedback, and keeping everything sharp.
• Own your pipeline: chase feedback, drive deals, and celebrate wins.
• Negotiate like a boss: overcome objections with quick thinking and creativity.
• Stay connected with clients and workspace partners to boost engagement and success.
• Assist in onboarding new workspace partners, ensuring a smooth and professional experience.
• Deliver 5-star customer service; we want to hear your smile over the phone!

Who Are We Looking For?

• Excellent communicator, both on the phone and in writing
• A “phone warrior” and “keyboard ninja”
• Naturally curious and always keen to learn
• Enthusiastic, positive, and passionate
• Resilient, ethical, and values-driven
• Ambitious self-starter and committed to excellence

Bonus points for:

• A good sense of humour — we love a good laugh!
• A natural competitive spirit

What Are the Perks?

• Base salary + commission structure + health benefits
• Hands-on experience in business, commercial real estate, and sales
• Modern offices in a prime location
• Hybrid working: 4 days in the office, 1 day work-from-home
• Inclusive, supportive, and high-energy team environment
• Regular team celebrations, travels and fun outings
• Career opportunities in a booming industry and international growth company

A bit more about us!

Office Hub came to life in Australia in 2014 to provide tenants and workspaces with independent expertise, genuine advice and a bit of light-hearted banter every now and again as we make the perfect match between tenants and workspaces.

We’ve been likened to Airbnb, we’ve been dubbed the Tinder of office spaces – whichever way you look at it, we’re not your usual commercial broker!

About Goosehead

Since 2003, Goosehead Insurance has been disrupting the insurance industry by giving clients the power of choice, utilizing a smarter marketing approach, and delivering world-class service. This is all powered by our focus on hiring and retaining extraordinary people. Our clients trust us with their most valuable possessions, so we’re more than just a bit selective when it comes to hiring new team members. In 2012, we began franchising our business model. This role is for one of our successful franchise partners.

Job Summary

The team is responsible for new business revenue generation monthly and works to achieve these on an individual and team level. Account Executives are equipped with extensive training in Salesforce, sales process management, business development and more.

Principal Duties and Responsibilities

The primary responsibility of an Account Executive is to build a book of business through:

• Prospecting and establishing referral partner relationships with professionals from the real estate and mortgage industry.
• Work with clients to understand their insurance needs, analyze options with a large carrier portfolio, and provide a custom solution to mitigate household risk.

Compensation Summary

The first year’s earnings potential ranges from $53,000 - $90,000, varying based on performance. Our compensation package slightly varies by agency but offers uncapped new business commissions and renewal commissions year-over-year. Renewal commissions provide passive earnings and can exponentially increase your annualized income. Additionally, top performers can qualify for an annual President’s Club trip.

Experience and Education

• Passing the state licensing exam, once hired
• Legally authorized to work in the United States

Required Skills and Abilities

• Exceptional written and verbal communication
• Experience in a fast-paced work environment
• B2B or B2C sales experience or related college major
• Competitive attitude
• Networking abilities
• Entrepreneurial spirit
• Problem-solving mentality
• Self-motivated, hands on, self-starter mindset that can do the work
• Strong time management
• Strong attention to detail and organization

Benefits Summary

• High quality voluntary health, vision, dental insurance programs
• Paid holidays, vacation, and sick leave
• Benefit offerings vary per agency*

This job posting is for an opportunity at a Goosehead Insurance agency independently owned and operated by a local franchised Agency Owner. If you choose to apply for this position, you understand and acknowledge that your application and any information included with it will be submitted to the Agency Owner. If you are hired for this position, you also understand and acknowledge that the Agency Owner’s franchised business will be your employer, not Goosehead Insurance Agency, LLC, and that the Agency Owner is solely responsible for all decisions related to your employment, including hiring, firing, discipline, compensation, scheduling, and supervision.

To learn more about our job opportunities, apply here. We look forward to speaking with you!

Pharmacy Prior Authorization Specialist

Plano, TX (Fully Onsite)

$21 – $28 per hour

Monday – Friday | 8:30 AM – 5:00 PM

About the Role

We are seeking a Pharmacy Prior Authorization Specialist to support complex specialty medication workflows and ensure timely access to therapy for patients. This role plays a critical part in managing prior authorization processes, coordinating with insurance payers, and collaborating with clinical and pharmacy teams.

The ideal candidate is detail-oriented, proactive, and comfortable navigating insurance systems while communicating with payers, patients, and healthcare professionals. Candidates with pharmacy or healthcare insurance experience who enjoy problem-solving and working in a fast-paced environment will thrive in this role.

Key Responsibilities

Prior Authorization & Benefits Coordination

• Contact insurance companies to obtain real-time status updates on prior authorization requests
• Run benefit investigations and gather documentation needed for commercial insurance authorizations
• Check status daily on pending authorizations and ensure timely follow-up
• Assist with continuation authorizations for existing patients

Documentation & Data Management

• Accurately enter approval letters, authorization numbers, and related documentation into internal systems such as CareTend
• Enter patient demographics, diagnosis information, and payor data into the electronic medical record
• Maintain detailed records of payer interactions including reference numbers and next steps

Denial Review & Workflow Management

• Review denial letters and ensure documentation is complete before routing cases to clinical teams for review and appeals
• Monitor authorization queues to prevent delays in patient therapy initiation or continuation
• Conduct patient chart audits and maintain current documentation files

Collaboration & Communication

• Coordinate with pharmacy operations, intake teams, clinical staff, and revenue cycle teams
• Communicate authorization outcomes and documentation needs to internal teams
• Maintain professional communication with insurance representatives, patients, and referral sources

Required Qualifications

• High School Diploma or GED
• 1+ year of experience in a pharmacy, healthcare, or medical insurance environment
• Experience with prior authorizations, benefits verification, or insurance coordination
• Strong attention to detail and data entry accuracy
• Ability to manage multiple tasks and changing priorities in a fast-paced environment
• Experience with Microsoft Office (Excel, Outlook, Word, Teams)

Preferred Qualifications

• Pharmacy Technician Certification (preferred but not required)
• Experience with CareTend or similar pharmacy/authorization platforms
• Knowledge of Medicare, Medicaid, and commercial insurance plans
• Experience in pharmacy billing, specialty pharmacy, or medical insurance verification

We are seeking a highly organized and proactive Executive Assistant to provide comprehensive support to several members of our executive leadership team and oversee the daily operations of our administrative office. This individual will be a trusted partner to senior leaders, ensuring seamless scheduling, communication, and follow-through, while also fostering a professional, efficient, and welcoming office environment. The ideal candidate thrives in a fast-paced environment, can balance multiple priorities, and demonstrates strong judgment, discretion, and attention to detail.

Key Responsibilities

• Provide high-level administrative support to multiple executives, including calendar management, scheduling meetings, preparing agendas, and coordinating travel.
• Coordinate regular meetings routines with both internal and external stakeholders.
• Assist with expense reports, invoice coding and process, and other expense management tasks
• Track and follow up on action items to ensure commitments are met.
• Maintain confidentiality and handle sensitive information with discretion.
• Serve as the primary point of contact for office operations, including vendor management, supplies, and facilities.
• Coordinate office logistics (meetings, visitor management, IT support coordination, mail, deliveries).
• Ensure the office is well-organized, professional, and equipped to support productivity.
• Organize team meetings, events, and celebrations as needed
• Coordinate and execute special projects as needed.

Qualifications

• 5+ years of experience as an Executive Assistant, Office Manager, or similar administrative role; experience supporting multiple executives strongly preferred.
• Strong organizational skills with the ability to prioritize competing demands and anticipate needs.
• Excellent written and verbal communication skills.
• Proficiency in Microsoft Office Suite; experience with expense management and collaboration tools (Zoom, Concur, etc.) a plus.
• Professional presence, discretion, and interpersonal skills to build trust with executives and team members.
• Ability to work independently while exercising sound judgment.

Key Competencies

• Proactive mindset: Anticipates needs before they arise.
• Detail orientation: Ensures accuracy and polish in all deliverables.
• Flexibility: Adapts to shifting priorities in a fast-paced environment.
• Team orientation: Supports not only executives but also helps keep the office running smoothly.
• Problem-solving: Resourceful in finding solutions and resolving issues.

Are you an experienced IT Operations Specialist with a desire to excel? If so, then Talent Software Services may have the job for you! Our client is seeking an experienced IT Operations Specialist to work at their company in Plano, TX.

Position Summary: Following standard operating procedures, Data Centre Operational Services staff provision, operate, monitor, and control a wide variety of sophisticated online computer applications and physical system configurations for a multiple-site, enterprise data processing organisation.

Primary Responsibilities/Accountabilities:

• Staff meet the service needs of both internal and external customers.
• These systems support both patient care and administrative functions throughout *** and affiliations.
• Perform routine tasks to maintain computer equipment and their peripherals.
• Provide prompt and courteous assistance at all times.
• May perform additional functions as detailed by the immediate supervisor, including the installation, move, and de-installation of racks and computer systems.
• Perform shipping and receiving functions for data center hardware and related equipment.
• Inspect deliveries for accuracy and damage; reconcile against purchase orders and packing documentation.
• Process equipment returns (RMA), ensuring proper documentation, packaging, and tracking
• Maintain accurate inventory and asset tracking records
• Assist with diagramming and updating data centre rack configurations
• Ensure proper handling, storage, and physical care of IT equipment. Maintain a clean, organised, and secure data centre staging and storage area
• Equipment racking, connectivity, and cable management. Inventory Management of Onsite Supplies.
• Issue Identification & Escalation: Identify discrepancies, delays, or equipment issues and escalate appropriately to the Project Manager, technical team, or vendor.
• Coordinate with vendors to resolve shipping or hardware issues
• Ensure issues are fully resolved and properly documented
• Documentation & Compliance: Maintain detailed and accurate operational records

Qualifications:

• Knowledge of and proficiency in data center concepts, practices and procedures within field.
• Ability to read, understand and communicate on-line Standard Operations Procedures.
• Ability to understand specified hardware and software used.
• Ability to troubleshoot, prioritize and escalate problems effectively.
• Demonstrates ability to learn and apply new technology.
• Ability to work calmly in difficult situations and form logical conclusions.
• Proficient verbal and written communication skills using English is necessary.
• Associate's degree in Computer Science, Information Systems, Engineering, or a related field.
• Two (2) years of demonstrated technical experience in computer operations.
• High School Diploma or GED.
• Four (4) years of demonstrated IT technical experience focused on computer operations within a large, complex organization.
• Foundational understanding of data center infrastructure, including servers, storage systems, and structured cabling. Basic familiarity with rack layouts and physical hardware configurations.Centre Ability to read and interpret equipment quotes, packing slips, bills of materials, and technical documentation. Understanding of standard data centre safety, compliance, and operational practices. Experience with shipping/receiving operations

Preferred:

• Experience working with healthcare technology.
• Bachelor's degree or higher in Computer Science, Information Systems, Engineering, or a related field.
• This role supports physical infrastructure activities, inventory control, documentation, and coordination with project managers, technical teams, and vendors.

Job Title: Physician Reviewer

Location: Remote in TX or NM

Pay: $110.00/hr on W2

Duration: March 2026 - March 2028 contract to hire

# of openings: 2

Schedule: schedule is M-F, but may need to work 3-4 weekends per year

Evaluates clinical service requests made by an organization's members and providers.

Uses clinical judgment in conjunction with organization's criteria to adjudicate these requests.

May also provide clinical leadership in other areas of the organization. Identifies opportunities to manage members' clinical situations with a view toward creative problem solving and anticipation of possible future clinical problems for the member.

Participates in the process to evaluate clinical service requests.

Practices anticipatory case management for members whose cases come for review, in partnership with case managers.

Participates in the Physician Review Units' appeal process of service denials.

Participates in the development of Physician Review Units' policies and procedures.

Actively participates in all unit continuous quality improvement activities.

Other duties as assigned by the Medical Director.

Board Certified (ABMS) M.D. or D.O, unrestricted and active license to practice medicine requested and 5 years clinical experience to include inpatient experience, or any combination of education/experience that would provide an equivalent background.

Must have understanding of managed care and demonstrate PC proficiency, as file review will be done via computer in most cases. (Note: Position does not provide direct patient care or medical diagnosis.)

Required Qualification(s)

Board Certification in a Medical Specialty, active medical license. TX and NM license within 6 mo

Preferred Qualification(s)

Orthopedics, Genetics, PMR, Allergy Immuniology, Rheumatology, plastic surgery, transplant, HemeOnc