Applied Cloud Computing Thane Reviews Jobs in Usa
9,019 positions found — Page 11
Job Title: Health Service Reviewers (RN)
Pay (openings for each location/market):
- Albany up to $52/hr
- Central Islip up to $60/hr
Overview: These RNs will be doing a mix of standard quality audits, complaint initiated investigations, and more. When they are onsite, the amount of time that they are at the location is dependent on the audit that is required. It is expected that Health Service Reviewers will be traveling onsite about 85% of the time.
These individuals will be traveling to IDD housing to do state required Recertification (must be done every 15 months) or investigating specific complaints (disease outbreak, falls, etc.).
Travel: 85% of this role is traveling to sites. It is more location based and they will be traveling to the counties that surround their location. If anyone is traveling and not able to return home, they are able to coordinate accomodations through the travel office and miles/food will be reimbursed at the federal rate. If they are not onsite, they can work from home or in the DOH office.
Summary: Based in NY, working at the direction of the New York State Department of Health (NYSDOH), Office of Aging and Long-Term Care, this individual will conduct surveillance and investigation activities related to Intermediate Care Facilities for Intermediate Care facilities for Individuals with Intellectual Disabilities (ICF/IDD). Duties include but are not limited to participating in surveys or complaint investigations, document finding, draft Statement of Deficiencies (SOD) within specified timeframes, testifying in administrative hearing ad needed.
The position is majority travel and will be onsite at facilities.
Qualifications:
- Strong interpersonal skills with the ability to communicate professionally with colleagues, supervisors, providers, medical and administrative personnel and residents/patients.
- Excellent communication (verbal & written) skills.
- Ability to work independently with minimal supervision.
- Ability to relate effectively to clinical and administrative personnel and patients.
- Computer proficiency with the ability to learn and understand new review programs and monitoring tools.
- Able to travel to on-site facility within New York State, required.
- Must have a valid driver's license & the ability to travel to on-site facilities review assignments.
Education/Experience:
- Registered Professional Nurse (RN). Currently licensed and registered in New York State, required.
- Bachelor’s degree, in any health care related field.
- Two (2) years clinical experience with individuals with intellectual disabilities or in developmental disability facilities and deemed QIDP (Qualified Intellectual Disability Professional and ability to meets the federal requirements for attaining QIDP Certification with six (6) months of hire date.
Hours: Monday-Friday 8am-5pm
About the Job:
The Applied Analytics Analyst serves as the technical anchor of the Strategic Resource Group. This role is responsible for translating complex business and market questions into structured, executable data outputs using Trilliant Health’s proprietary claims, provider directory, and price transparency datasets.
The Applied Analytics Analyst owns feasibility validation, analytical methodology design, and data integrity across research initiatives and pre-sales support. This individual combines strong technical proficiency with healthcare domain expertise and plays a critical role in standardizing how recurring strategic questions are answered across the organization.
You are our ideal candidate if you:
- Design and execute complex SQL queries and data builds from Trilliant’s data warehouse
- Capture and maintain documentation outlining how and why analytical frameworks are applied to support consistency and institutional knowledge retention
- Validate data integrity and identify gaps, missingness, structural limitations, or edge cases
- Own technical feasibility assessments for research and pre-sales opportunities
- Develop repeatable analytical frameworks for common strategic use cases
- Support research initiatives through structured dataset construction and methodological validation
- Create reusable datasets, templates, and documentation to reduce institutional knowledge concentration
- Maintain high standards of quality control and analytical rigor across all deliverables
- Interface effectively with Sales, SRG, Research, Product, and Data Engineering teams
- Respond to ambiguity with structured problem solving and professional judgment
Technical Skills:
- Advanced proficiency in SQL and experience querying large data warehouses
- Experience working in Databricks or similar environments preferred
- Strong proficiency in Excel and PowerPoint
- Familiarity with Tableau or other BI tools
- Experience working with complex healthcare claims datasets required
Other Skills:
- Strong analytical and critical thinking skills
- Ability to synthesize large datasets into structured outputs
- Excellent documentation and organizational skills
- Strong written and verbal communication skills
- Ability to work independently with minimal supervision
- High attention to detail and commitment to data quality
Position Location:
This position is onsite in Brentwood, TN
*We are unable to provide visa sponsorships for this role.
About Trilliant Health:
Trilliant Health is a high-growth, healthcare technology company. We are on a mission to be the most trusted advisor, dependable partner and provider of analytic insights to key stakeholders in the health economy enabling them to maximize return on invested capital. We do that by providing education and expertise through thought leadership, evidence-based strategy, and predictive analytics. We are looking to grow our team as we strive to influence positive change in healthcare by disrupting the status quo and promoting improved decision-making.
Applied Mental Health Research Assistant
Remote (US – EST hours) or Remote/Hybrid (Cambridge, UK)
Full-Time | Entry-Level | Industry Research
Help shape the future of mental health care.
Our mission is simple but powerful to help people feel better and live fuller lives by making trusted mental-health support accessible to everyone. We are redefining care through innovative, AI-enabled solutions that go beyond today’s capabilities to create meaningful, lasting change.
We’re looking for an early-career researcher who is ready to take their academic training into a fast-moving industry environment. This is a rare opportunity to gain hands-on experience across the full research lifecycle while working alongside experienced clinical and research leaders.
If you enjoy being organised, proactive, and deeply involved in research from concept through to publication this role is for you.
Why Join Us?
- Work across the entire evidence lifecycle in an applied industry setting
- Gain exposure to research requirements for regulators, healthcare partners, and payers
- Develop practical experience in AI safety and clinical governance
- Receive mentorship from a Director of Evidence Generation (PhD Neuroscience) and Head of Clinical (PhD Clinical Psychology)
- Build a strong foundation for future doctoral training
What You’ll Be Doing
Research Operations & Coordination
- Coordinate study activities, timelines, and communications
- Maintain regulatory documentation and version control
- Prepare ethics and governance submissions
- Support data management and research processes
Research Delivery
- Assist with study design and clinical evaluations
- Conduct literature reviews to support protocols and claims
- Collect and manage research data
- Support real-world implementations such as survey deployment
- Engage with lived-experience partners
Analysis & Scientific Communication
- Analyse qualitative and quantitative data
- Prepare internal reports and research summaries
- Contribute to peer-reviewed publications
Clinical Safety Monitoring
- Review safety dashboards and AI-generated outputs under supervision
- Identify trends and flag potential risks in line with protocols
(All clinical monitoring is supervised by a licensed Clinical Psychologist — this role does not involve independent clinical decision-making.)
What We’re Looking For
Essential
- Master’s degree in Psychology, Neuroscience, Mental Health Science, Social Work, or related field
- Experience conducting human-subjects research
- Exceptional organisation and attention to detail
- Proactive mindset with the confidence to take initiative
- Strong scientific writing and communication skills
- Understanding of research ethics and Good Clinical Practice
Desirable
- Exposure to mental health populations through placements, volunteering, or paid roles
- Experience across multiple stages of the research lifecycle
- Familiarity with qualitative methods
- Understanding of mental health in chronic health conditions
- Experience working with patient involvement or lived-experience groups
Who Thrives Here?
You’ll succeed in this role if you:
- Take initiative and naturally step in where needed
- Are comfortable managing multiple moving parts
- Enjoy the operational side of research as much as the scientific thinking
- Are eager to learn and ask questions
- Want to build real-world confidence quickly
If you’re ready to apply your research skills in a role that genuinely impacts lives — we’d love to hear from you.
Apply now and help us transform the future of mental health care.
Please add a cover letter to the front page of your CV.
The Medical Review Specialist is responsible for reviewing, analyzing, and interpreting medical documentation to support eligibility determinations and alternative treatment evaluations in alignment with Christian Healthcare Ministries’ guidelines and values. This role exists to ensure medical review decisions are accurate, evidence-based, and applied consistently while maintaining compassion and clarity in member interactions.
At the highest level, the Medical Review Specialist focuses on clinical analysis, guideline interpretation, and professional judgment, supporting sound decision-making that upholds CHM’s mission, stewardship, and commitment to member care.
WHAT WE OFFER
- Compensation based on experience.
- Faith and purpose-based career opportunity!
- Fully paid health benefits
- Retirement and Life Insurance
- 12 paid holidays PLUS birthday
- Lunch is provided DAILY.
- Professional Development
- Paid Training
PRIMARY RESPONSBILITIES
- Review and analyze complex medical records to assess eligibility, appropriateness of services, and alignment with CHM medical guidelines.
- Apply clinical judgment and established criteria to support consistent, evidence-based eligibility determinations.
- Conduct medical literature reviews and research to support recommendations, alternative treatment considerations, and guideline application.
- Collaborate with the Eligibility Review Supervisor, Medical Director, and Medical Review leadership to ensure alignment and consistency in medical review decisions.
- Communicate clearly and compassionately with members and internal teams regarding medical review outcomes, addressing questions and concerns professionally.
- De-escalate sensitive or emotionally charged interactions while maintaining CHM standards and values.
- Maintain accurate documentation of medical review findings, rationale, and decisions within CHM systems.
- Stay current on medical research, industry standards, and regulatory considerations relevant to medical review activities.
- Uphold strict confidentiality and HIPAA compliance in all handling of protected health information.
CORE COMPETENCIES & SKILLS
- Medical analysis and critical thinking – Interpret complex medical information and applies clinical reasoning.
- Evidence-based decision making – Utilizes research and guidelines to support review outcomes.
- Clear and compassionate communication – Explains medical determinations in an understandable and empathetic manner.
- Case management and prioritization – Manages multiple cases while meeting accuracy and timeliness standards.
- Documentation and compliance – Maintain thorough, accurate records aligned with regulatory and internal requirements.
- Collaboration – Works effectively with leadership, medical reviewers, and cross-functional teams.
REQUIRED QUALIFICATIONS & CONSIDERATIONS
Education
- Bachelor’s degree in a healthcare-related field (e.g., nursing, health sciences, biology) preferred.
- Equivalent clinical or medical review experience may be considered in lieu of a degree.
Experience
- Prior experience in medical record review, utilization review, clinical review, or a related healthcare role preferred.
- Experience applying medical guidelines or clinical criteria to eligibility or treatment determinations strongly preferred.
- Familiarity with HIPAA regulations and protected health information handling required.
- Experience working with EMR/EHR systems, medical coding, or health information systems is a plus.
Certifications
- No certifications required at time of hire.
- Clinical licensure or healthcare-related certifications (e.g., RN, LPN, CPC) are a plus but not required.
About Christian Healthcare Ministries
Founded in 1981, Christian Healthcare Ministries (CHM) is a health care sharing ministry for Christians. CHM is a nonprofit, voluntary cost-sharing ministry through which participating Christians meet each other’s medical bills. The mission of CHM is to glorify God, show Christian love, and experience God’s presence as Christians share each other’s medical bills.
Remote working/work at home options are available for this role.
APPLICATIONS ARE REVIEWED DAILY. YOU CAN EXPECT A RESPONSE WITHIN 24 HOURS.
Why ABC?
1. Our Patients: An intentional focus on small caseloads with a compassionate care approach.
2. Our Culture: ABC Core Values are more than just words on a wall. It's how we strive to live everyday.
3. Our Community: We ground ourselves in our WHY and the impact we have on the lives of others.
Total Compensation Package from $84,500 to $119,000 annually. Opportunity to earn MORE based on center size, mentorship of RBT’s and supervision of assigned trainees.
Your total compensation consists of a competitive base salary, performance bonuses, mentorship bonuses, and long-term ownership in the company.
*BCBA’s become eligible for long-term ownership upon promotion to the Sr. BCBA role. All other roles eligible.
Monthly Performance Bonuses: Bonuses are uncapped and start at just 26 hours of treatment delivery per week, meaning you’ll be rewarded for your impact without waiting months to qualify.
Sign On Bonus: Up to $10,000 based on start date and location.
Mentorship Bonuses: Provide supervision hours to an RBT pursuing their Master’s in ABA and earn bonus pay for your guidance, oversight and impact!
Certification Bonuses: Get rewarded for each therapist who becomes certified under your supervision.
Relocation Packages available: To ease the expenses of your transition.
Conducts comprehensive clinical reviews of adverse determinations related to medical necessity.
Initiates outreach to providers to obtain clarification or additional documentation in alignment with established clinical criteria and organizational policies, to support Medical Director decision making.
Provides support for claim appeals in relation to medical necessity.
Ensures the timely and accurate resolution of appeal cases and supports organizational adherence to all state, federal, and accreditation standards.
Facilitates member second level appeal process.
Graduate from an accredited school of professional nursing is required.
BSN preferred.
Minimum 2 years acute care experience or managed care experience is required.
Basic knowledge of Medicaid, Medicare preferred.
Knowledge of InterQual screening criteria, ICD-10, CPT coding preferred.
Current Registered Nurse (RN) license to practice professional nursing issued by the Board of Nurse Examiners for the State of Texas is required.
Active Certification in Case Management (CCM) is preferred.
The Clinical Data Review Pharmacist would be working for a Major Fortune 500 Company and has career growth potential.
Clinical Data Review Pharmacist Highlights: Schedule: ??? 6am to 2pm Monday to Friday ??? Sunday 3-11pm and Monday-Thursday 1-9pm OFF Friday/Saturday Pay Rate: $65/hr Clinical Data Review Pharmacist Responsibilities: Process prescription orders and perform clinical verification Consult with patients and providers as needed Support pharmacy programs that improve patient health outcomes, medication adherence, and prescription accuracy Clinical Data Review Pharmacist Qualifications: BS in Pharmacy or Doctor of Pharmacy (PharmD) Active Pharmacist License (RPh) Minimum 1 year of experience in a pharmacy environment If you are interested in this Clinical Data Review Pharmacist position, please apply to this posting with Luke H.
at A-Line!
- Sunday 8 – 5 pm PST Pay Range: $43
- $44/hr.
on W2 Description: · The Care Review Clinician is responsible for performing utilization management (UM) reviews, including prior authorization of outpatient services, to ensure medical necessity, appropriate level of care, and compliance with regulatory and organizational guidelines.
· The clinician will review clinical documentation, apply evidence-based criteria, and collaborate with providers to facilitate timely and appropriate care for members.
· This role supports Client’s commitment to quality, cost-effective care and regulatory compliance within the California health plan.
Must Have Skills: · Knowledge of California delegation requirements · Strong understanding of utilization management processes · Experience with prior authorization review (outpatient preferred) · Ability to apply clinical guidelines (e.g.
MEDICAID, MCG) Day to Day Responsibilities: · Process outpatient prior authorization referrals · Review clinical documentation for medical necessity · Apply established UM criteria and guidelines · Communicate with providers for additional clinical information · Ensure compliance with state, federal, and Client policies · Document determinations accurately and timely Required Years of Experience: · Active, unrestricted California RN or LVN license required · Minimum of 3 years of clinical experience in utilization management
Conducts comprehensive clinical reviews of adverse determinations related to medical necessity. Initiates outreach to providers to obtain clarification or additional documentation in alignment with established clinical criteria and organizational policies, to support Medical Director decision making. Provides support for claim appeals in relation to medical necessity. Ensures the timely and accurate resolution of appeal cases and supports organizational adherence to all state, federal, and accreditation standards. Facilitates member second level appeal process.
EDUCATION/EXPERIENCE
Graduate from an accredited school of professional nursing is required. BSN preferred. Minimum 2 years acute care experience or managed care experience is required. Basic knowledge of Medicaid, Medicare preferred. Knowledge of InterQual screening criteria, ICD-10, CPT coding preferred.
LICENSURE
Current Registered Nurse (RN) license to practice professional nursing issued by the Board of Nurse Examiners for the State of Texas is required. Active Certification in Case Management (CCM) is preferred.
Conducts comprehensive clinical reviews of adverse determinations related to medical necessity. Initiates outreach to providers to obtain clarification or additional documentation in alignment with established clinical criteria and organizational policies, to support Medical Director decision making. Provides support for claim appeals in relation to medical necessity. Ensures the timely and accurate resolution of appeal cases and supports organizational adherence to all state, federal, and accreditation standards. Facilitates member second level appeal process.
EDUCATION/EXPERIENCE
Graduate from an accredited school of professional nursing is required. BSN preferred. Minimum 2 years acute care experience or managed care experience is required. Basic knowledge of Medicaid, Medicare preferred. Knowledge of InterQual screening criteria, ICD-10, CPT coding preferred.
LICENSURE
Current Registered Nurse (RN) license to practice professional nursing issued by the Board of Nurse Examiners for the State of Texas is required. Active Certification in Case Management (CCM) is preferred.
