Brooksource Elevate Program Reviews Jobs in Usa

21,204 positions found — Page 3

Registered Nurse Coordinator Stroke Program
Salary not disclosed
McAllen, TX 4 days ago

As a Coord Stroke Program, your voice to influence patient care is valued and empowered at every turn –whether through open, collaborative relationships with your direct manager or more formal opportunities through hospital councils and national nursing initiatives. You'll help shape decisions that elevate both patient outcomes and the future of nursing.

Job Summary and Qualifications

The Stroke Coordinator is responsible for the development, implementation and maintenance of the stroke program as well as achieving and maintaining Primary Stroke Center Certification. Responsibilities include administration of the program under the guidance of the Medical Director, Joint Commission requirements, CMS Core Measure standards and clinical practice guidelines for stroke. 

  • Interpersonal and public speaking skills are necessary in order to communicate effectively with multicultural patients, families, physicians, hospital staff and the public
  • Analytical skills are necessary in order to develop and implement program plans and effective education techniques and evaluate program effectiveness.
  • Ability to concentrate and pay close attention to detail, resolve patient care problems and identify patient needs to nurse and physicians.
  • Basic to advanced computer skills, Microsoft Word, Excel and other database applications.

What qualifications you will need:

  • Two (2) years of relevant experience with stroke care, additional Emergency Dept/Intensive Care Unit experience Required
  • Experience is desirable in acute stroke research or other related areas and interventional studies in order to develop and implement stroke awareness, prevention, risk identification, and stroke scale measurements
  • Must effectively read, write and verbally communicate in the English language 
  • Bachelor’s degree Required
  • ACLS Certification-CCRN, CNRN, SCRN, ASC-BC (1- Critical Care certification required after 2 years)

  • Experience in program development and coordination within a complex organization preferred

Benefits

Rio Grande Regional Hospital, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:

    • Comprehensive benefits for medical, prescription drug, dental, vision, behavioral health and telemedicine services
    • Wellbeing support, including free counseling and referral services
    • Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage and leaves of absence
    • Savings and retirement resources, including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support and financial wellbeing counseling
    • Education support through tuition assistance, student loan assistance, certification support, dependent scholarships and a partnership with Galen College of Nursing
    • Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection and consumer discounts

Learn more about Employee Benefits

Note: Eligibility for benefits may vary by location.

"Nurses play a pivotal role and are the backbone of healthcare delivery. At HCA Healthcare, we are dedicated to ensuring nurses have necessary tools and resources to provide world-class patient care, advocating for the profession and helping to shape the future of nursing."

Sammie Mosier, DHA, MA, BSN, NE-BC

Senior Vice President and Chief Nursing Executive, HCA Healthcare

Rio Grande Regional Hospital in McAllen, Texas has been serving the Rio Grande Valley for more than 30 years. Our full service hospital has 320+ beds and a team of more than 500 physicians representing 35+ specialties. Rio Grande Regional Hospital offers a full range of inpatient and outpatient medical and surgical services. Our Emergency Room is a Level III Trauma Center and we have extended our ER services into the Rio Grande Valley with our three remote ERs in McAllen/Mission, Edinburg, and San Juan. Our Women’s Services include L&D and a 30+ bed NICU. We also have an entire children’s hospital within our main facility to care for the children in our community. We work with the Texas Transplant Institute, which serves local patients in need of organ, tissue or stem cell transplants. Our proven track record of serving the medical needs of the Valley communities we serve has led to Rio Grande Regional Hospital being recognized for patient safety and clinical excellence time and time again.

HCA Healthcare has been recognized as one of the World’s Most Ethical Companies® by the Ethisphere Institute more than ten times. In recent years, HCA Healthcare spent an estimated $3.7 billion in cost for the delivery of charitable care, uninsured discounts, and other uncompensated expenses.

If this opportunity is your next step in your career path, we encourage you to apply for our Coord Stroke Program opening. We review all applications. Qualified candidates will be contacted by a member of our team. We are interviewing, apply today!

We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.

Not Specified
Construction Superintendent Trainee - Elevate
Salary not disclosed
Raleigh 6 days ago
Overview Drees Homes is a family-owned home builder with a passion for making custom homes easy.

For over 95 years, we???ve cared for our employees and customers, which is why we rank as the 19th largest privately-owned builder in the country and have a history of long-tenured employees.

We???re proud to be named a U.S.

Best Managed Company in 2022, 2023, 2024, and 2025???a program sponsored by Deloitte Private and The Wall Street Journal???and to be officially certified as a Great Place to Work for the last three years.

Enrich your career at a company that values integrity, excellence, opportunity, stability, and success.

?? Headquartered in Fort Mitchell, Kentucky, Drees operates in twelve metropolitan areas: Greater Cincinnati (including Northern Kentucky), Cleveland, and Columbus, Ohio; Austin, Dallas, Houston, and San Antonio, Texas; Indianapolis, Indiana; Jacksonville, Florida; Nashville, Tennessee; Raleigh, North Carolina; and Washington, D.C.

Responsibilities Drees Homes, one of the largest privately-owned homebuilders in the nation, is seeking candidates for a Construction Superintendent Trainee position in our Raleigh Division.

If you're interested in building a career with an established leader in the homebuilding industry, this could be the opportunity you have been looking for.

?? As a Construction Superintendent Trainee, you will be to assist an experienced Construction Superintendent on the job in communities of high volume or in multiple communities as part of a structured training program to become a Construction Superintendent.

?? The Construction Superintendent Trainee Program is designed to train, prepare and develop Trainees for future Construction Superintendent positions within the organization.

The expectation is to expose these individuals to every facet of the construction process from customer plan signing through the first year's warranty program.

Training will be in the form of shadowing, classroom and on the job training through a formalized program consisting of 9 modules.

?? Duties and Responsibilities: Oversee the progress and quality of all jobs under construction Set and maintain high standards of performance by subcontractors and suppliers Control costs by managing material usage Be proactive in answering customer questions about the building process Take an active part in subdivision and model maintenance Comply with OSHA regulations and other safety requirements Create framing, mechanical and insulation punch lists Utilize internal software/systems to show progress of job completion Other duties as necessary ?? Knowledge and Skills: The ability to assist with scheduling, cost control and quality control A self-motivated individual with a high energy level as well as a positive attitude The ability to hold subcontractors accountable for their work Strong work ethic, eager to learn and customer focused An individual who is dependable, detail oriented and open to change The ability to read and comprehend blue prints Excellent organizational skills Verbal and written communication proficiencies with internal and external customers Basic computer skills ?? Requirements: 2-4 year college degree in Construction Management/related field is preferred 2-4 years construction related experience preferred (This could be through an internship, short term position while in school, etc.) Experience using an iPad is ideal Passion for homebuilding and driven to succeed ?? Premier Benefits to Support YOU: We offer a comprehensive benefits package, including: Medical, dental and vision Life, AD&D, and critical illness insurance Wellness rewards 401(k) savings plan Profit Sharing Paid time off increasing with tenure Tuition reimbursement Long and short disability and Parental leave Employee discount program on the purchase of a Drees Home Employee Assistance Program and much more! ?? The schedule of this position is typically Monday-- Friday 8 AM
- 5 PM, plus additional hours as necessary.

?? Qualifications ?? Equal Opportunity Employer
- Drug Free Workplace To learn more about Drees Homes, visit our website
- PI282972909
internship
Principal or Senior Principal Program Cost Schedule & Control Analyst
✦ New
$39.13 - 73.17
Melbourne, FL 1 day ago
RELOCATION ASSISTANCE: Relocation assistance may be availableCLEARANCE REQUIRED FOR START: YesCLEARANCE TYPE: SecretTRAVEL: Yes, 10% of the TimeDescriptionAt Northrop Grumman, our employees have incredible opportunities to work on revolutionary systems that impact people's lives around the world today, and for generations to come. Our pioneering and inventive spirit has enabled us to be at the forefront of many technological advancements in our nation's history - from the first flight across the Atlantic Ocean, to stealth bombers, to landing on the moon. We look for people who have bold new ideas, courage and a pioneering spirit to join forces to invent the future, and have fun along the way. Our culture thrives on intellectual curiosity, cognitive diversity and bringing your whole self to work — and we have an insatiable drive to do what others think is impossible. Our employees are not only part of history, they're making history.

Northrop Grumman Aeronautics Systems is seeking a qualified Principal Program Cost Schedule & Control Analyst (Level 3) or Sr. Principal Program Cost Schedule & Control Analyst (Level 4) to join our team of qualified, diverse individuals. This position will be located onsite in Melbourne, FL or Palmdale, CA. An active secret clearance is required to start.

Essential Functions:

This Program Cost Control Analyst position will, under minimal supervision, interface with the program managers, functional management, and cost account managers (CAMs) to provide financial and administrative support and analysis to meet program requirements.

The Program Cost Control Analyst will have experience with Earned Value Management and performance measurement baseline concepts and be able to apply them to multiple contracts for control accounts within an engineering Integrated Product Team (IPT).  This position will be responsible for leading and training other analysts if full level 1 Earned Value contracts.

Earned Value Management (EVM) tasks include:

  • Establishing Work Breakdown Structure for execution of budgeted cost of work scheduled

  • Assessing and maintaining of objective performance criteria – developing, maintaining, analyzing and justification of estimates to complete

  • Supporting internal and external reporting requirements for variance analysis and budgeting baseline

  • Maintaining a solid and accurate cost and schedule integration with business partners and program teams

  • Analyzing funding, cost risk analysis/assessment and visibility reports - Preparing government cost performance reports and preparation and/or review of Performance measurement variance analysis

Additional responsibilities will include:

Perform analysis & prepare reports in order to ensure that contracts are within negotiated and agreed-upon parameters and government cost control guidelines. Be responsible for supporting the preparation and coordination of the monthly and quarterly financial forecasting and reporting processes. Provide internal reporting requirements to include incorporation of forecast, identification of staffing issues related to baseline/ETC, and execution of corrective action or updates using program reporting tools.  This position will interface with Business Managers and support booking rate files and profitability updates.  Good leadership skills & the ability to work with the Program Office while leading a smaller team are essential.

The successful analyst will possess the following traits and abilities: ability to use financial systems, with understanding of DoD financial rhythms; provide strategic guidance as required; develop and implement solutions of moderate scope and complexity; analyze variances/trends and develop new methods and process techniques; work under very general supervision while completing numerous assignments per schedule and elevating potential issues to ensure proper management focus; exert influence on peers and internal customers; good interpersonal skills while representing the finance team on various projects.

We offer phenomenal learning opportunities, exposure to a wide variety of projects and customers, and a very friendly collaborative workplace. We are looking for self-motivated, proactive, and goal-oriented people to help us grow our services and become even better at what we do. Does this sound like you?

Our Employee Resource Groups (ERGs) provide benefits for the member, our leaders and the company. Our ERGs offer opportunities to be a friend, be active, be a volunteer, be a leader, to be recognized and to be yourself! Every ERG is inclusive of all employees!

At Northrop Grumman, we are innovating-- building the next generation of sophisticated aircraft to protect our country. Our diverse portfolio of programs means there are endless paths to cultivate your career. We are well-known for our inclusive, family environment, as well as our excellent work/life balance. We also offer exceptional benefits/healthcare, a 9/80 schedule, and a great 401K matching program.

Basic Qualifications Level 3:

  • Master's degree with 3 years experience or a Bachelor's degree with 5 years of experience in the following areas: business, finance, accounting, program control and/or similar industry related fields.

  • Experience with Microsoft Office suite including Excel and PowerPoint

  • Experience successfully supporting a monthly financial forecasting rhythm

  • Experience with EAC development and analysis

  • Experience with MPM and/or Cobra

  • Experience with Earned Value Management (EVM)

  • Active DOD Secret clearance and Special Program Access required to start

Basic Qualifications Level 4:

  • Master's degree with 6 years experience or a Bachelor's degree with 8 years of experience in the following areas: business, finance, accounting, program control and/or similar industry related fields.

  • Experience with Microsoft Office suite including Excel and PowerPoint

  • Experience successfully supporting a monthly financial forecasting rhythm

  • Experience with EAC development and analysis

  • Experience with MPM and/or Cobra

  • Experience with Earned Value Management (EVM)

  • Active DOD Secret clearance and Special Program Access required to start

Preferred Qualifications:

  • Experience developing CDRLs (IPMR/IPMDAR/CPR/CFSR/CSDR)

Salary ranges will be dependent upon where the position is based and follows our company geographic salary bands aligned with position, as this posting may include multiple locations and provide a variety of salary ranges per location. Specific salary offer for candidate selected will be commensurate with experience and aligned with local geography.

Primary Level Salary Range: $81,400.00 - $152,200.00Secondary Level Salary Range: $94,200.00 - $176,300.00The above salary range represents a general guideline; however, Northrop Grumman considers a number of factors when determining base salary offers such as the scope and responsibilities of the position and the candidate's experience, education, skills and current market conditions.Depending on the position, employees may be eligible for overtime, shift differential, and a discretionary bonus in addition to base pay. Annual bonuses are designed to reward individual contributions as well as allow employees to share in company results. Employees in Vice President or Director positions may be eligible for Long Term Incentives. In addition, Northrop Grumman provides a variety of benefits including health insurance coverage, life and disability insurance, savings plan, Company paid holidays and paid time off (PTO) for vacation and/or personal business.The application period for the job is estimated to be 20 days from the job posting date. However, this timeline may be shortened or extended depending on business needs and the availability of qualified candidates.Northrop Grumman is an Equal Opportunity Employer, making decisions without regard to race, color, religion, creed, sex, sexual orientation, gender identity, marital status, national origin, age, veteran status, disability, or any other protected class. For our complete EEO and pay transparency statement, please visit U.S. Citizenship is required for all positions with a government clearance and certain other restricted positions.
permanent
Program Associate (Contract)
✦ New
Salary not disclosed
Washington, DC 1 day ago

How to Apply:   Submit a single PDF containing your cover letter and resume to by March 27, 2026. Applications without a cover letter will not be considered.


Department: Health Programs

Reports to: Health Programs Director

Location: Remote

Employment Type: Full-Time, One-Year Contract (with potential for renewal based on funding)


About the National Alliance for Caregiving   

The National Alliance for Caregiving (NAC) is a catalyst for change, transforming how the United States recognizes, supports, and values the 63 million family caregivers providing complex care. Through our nationally recognized caregiving research and advocacy, we drive policy, system, and culture change to elevate family caregivers as a national priority. We foster partnerships across aging, disability, healthcare, philanthropy, and the private sector with the goal of making family caregiving more sustainable, equitable, and dignified.   


About the Role   

We are seeking an entry-level Program Associate to provide administrative and logistical support for health program activities. This role is ideal for recent graduates or early-career professionals interested in program management and health equity. You will gain hands-on experience in event coordination, research projects, and cross-sector partnerships.

 

You will work closely with the Senior Health Program Manager and Programs Director to implement initiatives such as the Cancer Caregiving Collaborative and Caregiver Inclusion Value Initiative, as well as other projects that advance NAC’s mission.

 

Key Responsibilities  

 

Program Coordination:

  • Assist in developing and tracking project workplans, timelines, and performance measures to meet project goals and deliverables.
  • Coordinate planning and execution of partner engagements, meetings, events, and hybrid activities.
  • Assess program progress and translate key learnings into clear and engaging reports and presentations. Conduct research and analyze data to inform team and program decisions.
  • Work alongside Senior Health Manager and Programs Director to ensure that project aligns with organizational priorities.
  • Identify opportunities to improve workflows, processes, and tools used in program coordination and implementation.
  • Help strengthen the project’s structure and practices to promote health equity and ensure decision-making processes center caregivers.

 

Partnership Support:

  • Maintain and update partnership assets (presentation decks, newsletters, one-sheets, project webpages).
  • Prepare materials for external meetings and presentations in collaboration with Communications and Events teams.

 

Communication and Outreach:

  • Develop content for internal and external audiences, including partners and funders.
  • Manage, maintain and update partnership assets, including presentation decks, project handouts, and project webpages.


Funder Reporting and Grant Compliance:

  • Support data collection and documentation for funder reports as assigned.
  • Maintain accurate records that contribute to grant compliance and reporting requirements.
  • Learn and apply organizational processes for funder deliverables.

 

Knowledge & Skills:

Required

  • Bachelor’s degree in social work, public health, health policy, or related field.
  • 1–2 years of experience in project coordination, program support, or administrative roles within public health, healthcare, or mission-driven organizations.
  • Candidates in this position must be highly motivated, capable of self-directed work, flexible, and committed to continuous learning and growing in support of team and caregiving.
  • Highly organized, with the ability to prioritize and follow through with multiple tasks while maintaining outstanding attention to detail.
  • Demonstrates excellent communication skills, including strong interpersonal, written, and active listening skills.
  • Proficiency in MS Office Suite, Asana, Canva, and Constant Contact.

 

Preferred

  • Experience collaborating with healthcare systems, patient advocacy groups, and health equity work.
  • Familiarity with program design and implementation.

 

Compensation and Benefits   

  • Salary: $45,000   
  • Monthly stipend for mobile phone usage.  
  • Paid Federal Holidays and Winter Holiday (Office closed 12/24 through 1/1).  
  • Paid Monthly WMATA Smart Benefits or parking up to $130/monthly (DC employees).  

 

Commitment to Diversity & Inclusion

NAC is an equal opportunity employer (EOE). Candidates of diverse backgrounds, minorities, women, people with disabilities, people of LGBT orientation, and Veterans are encouraged to apply.  

contract
Learning Program Manager
✦ New
Salary not disclosed
Schaumburg, IL 1 day ago

Who We Are


The International Warehouse Logistics Association (IWLA) is a trade association dedicated to supporting warehouse logistics providers across North America. We are elevating our educational portfolio, modernizing our LMS and digital learning infrastructure, and building meaningful learning experiences that help members grow. Our team values collaboration, service, clarity, and continuous improvement.


Who We Seek


We are looking for an LMS & Curriculum Development Manager who is passionate about adult learning, digital learning systems, and creating high‑quality educational experiences for industry professionals. This role is ideal for someone who enjoys organizing complex content, working with subject matter experts, and building structured, scalable learning pathways. If you are service‑oriented, detail‑driven, and energized by supporting members and events, we want to hear from you!


What You Will Do


  • Manage and optimize IWLA’s Learning Management System (LMS).
  • Develop and maintain curriculum frameworks, learning pathways, and certificate programs.
  • Collaborate with subject matter experts (SMEs) to source, review, and improve learning content.
  • Lead the development of IWLA’s Essentials Certificate Program.
  • Support educational programming for IWLA’s Annual Convention and live events.
  • Assist in session planning, presenter support, and ensuring a positive member experience.
  • Analyze LMS data to evaluate program effectiveness and implement improvements.
  • Create structure, organize content, and uphold quality standards across all learning products.
  • Stay current on adult learning practices, adult learning theory, and association education trends.


What You Will Need


  • 3–5+ years of experience in adult learning, L&D, LMS administration, or digital learning operations.
  • Hands-on experience managing or configuring an LMS (any platform).
  • Strong understanding of adult learning theory and professional learning design.
  • Experience collaborating with SMEs, speakers, or industry contributors.
  • Excellent communication, organization, and judgment.
  • Ability to manage multiple projects and meet deadlines with consistency.
  • A service‑focused, team‑oriented approach to work.
  • Bachelor’s degree in Education, Instructional Design, L&D, or related field preferred.
  • Willingness to attend IWLA events and support onsite learning experiences.
  • Bilingual candidates encouraged to apply.


What We Offer


  • An engaging role shaping IWLA’s growing digital learning ecosystem.
  • Opportunities to build and refine curriculum, certificates, and learning pathways.
  • A collaborative, mission-driven team with support from IWLA leadership.
  • Exposure to LMS platforms, adult learning strategy, SME relationships, and association education.
  • No-cost health benefits, dental, vision, life, disability insurance, and employee assistance program.
  • 401(k) matching and financial education resources.
  • 22 Work From Home Days.
  • Professional development support and opportunities for advancement.


Job Type & Compensation

Job Type: Full-time

Pay: $76,000 - $90,000

Expected Hours: 40 per week

Location: Schaumburg, IL (On-Site)

Travel: Up to 20% annually (Annual Convention + education events)


Benefits:

  • 401(k) 6% Match
  • Dental insurance
  • Employee assistance program
  • Health insurance
  • Life insurance
  • On-site gym
  • Paid time off
  • Vision insurance


Experience:

  • Non-profit accounting: 1 year (Preferred)


Work Location: Schaumburg, IL 60173

  • In person (Required)
Not Specified
Utilization Review Nurse Health Plans-Hp Utilization Mgmt
✦ New
Salary not disclosed
Irving, TX 1 day ago
Description

Summary:

The Utilization Review Nurse is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This nurse is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services “CMS” Inpatient List). They effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and guidelines related to UM. This nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services. The Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS.

Responsibilities:

  • Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
  • The prior authorization role completes an assessment of a proposed service to determine if the beneficiary has eligible coverage for the service and if it is medically necessary.
  • Promote quality, cost-effective outcomes through prior authorization and concurrent review of requested services for medical necessity based upon evidence-based clinical guidelines.
  • Identify and present cases of possible quality of care deviations, questionable admissions, and prolonged lengths of stay to the Medical Director for further determination.
  • Appropriately refer beneficiaries who have complex or chronic conditions, a need for transition of care, disease management support, or other identifiable needs for coordination of the beneficiary’s member’s health care for behavioral health care management.
  • Follow CHRISTUS Health Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent, or detect unauthorized disclosure of Protected Health Information (PHI).
  • Protect the confidentiality of data and intellectual property;
    assures compliance withnational health information guidelines.
  • Analyze clinical information submitted by medical providers to evaluate the medical necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities.
  • Perform provider outreach to address post-hospital discharge services, redirection to in-network providers for appropriate steerage, durable equipment usage, and utilization of other medical services and/or procedures and other necessary telephonic follow-up.
  • Utilize the nursing process and critical thinking skills to provide oversight of services and evaluation of service options.
  • Ability to work in a variety of settings with culturally diverse communities with the ability to be culturally sensitive and appropriate.
  • Must have excellent communication skills (written and verbal), clinical judgment, initiative, critical thinking, and problem-solving abilities.
  • Must be able to take after hour calls to meet business requirements as needed.

Job Requirements:

Education/Skills

  • Graduate of an accredited school of vocational nursing or equivalent required
  • Associate’s (ADN) or Bachelor’s (BSN) in Nursing preferred

Experience

  • 3 – 5 years of nursing experience preferred
  • Experience in Microsoft software (e.G., Outlook, Teams, Word, and Excel) required
  • General computer knowledge and capability to use computers required

Licenses, Registrations, or Certifications

  • LVN license in the state of employment or compact required
  • RN license in state of employment or compact preferred

Work Schedule:

5 Days - 8 Hours

Work Type:

Full Time

Not Specified
Utilization Review Nurse Health Plans-HP Utilization Mgmt (Hiring Immediately)
🏢 Christus Health
Salary not disclosed
Irving, TX 6 days ago
Description

Summary:

The Utilization Review Nurse is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This nurse is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services “CMS” Inpatient List). They effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and guidelines related to UM. This nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services. The Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS.

Responsibilities:

  • Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
  • The prior authorization role completes an assessment of a proposed service to determine if the beneficiary has eligible coverage for the service and if it is medically necessary.
  • Promote quality, cost-effective outcomes through prior authorization and concurrent review of requested services for medical necessity based upon evidence-based clinical guidelines.
  • Identify and present cases of possible quality of care deviations, questionable admissions, and prolonged lengths of stay to the Medical Director for further determination.
  • Appropriately refer beneficiaries who have complex or chronic conditions, a need for transition of care, disease management support, or other identifiable needs for coordination of the beneficiary’s member’s health care for behavioral health care management.
  • Follow CHRISTUS Health Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent, or detect unauthorized disclosure of Protected Health Information (PHI).
  • Protect the confidentiality of data and intellectual property; assures compliance with national health information guidelines.
  • Analyze clinical information submitted by medical providers to evaluate the medical necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities.
  • Perform provider outreach to address post-hospital discharge services, redirection to in-network providers for appropriate steerage, durable equipment usage, and utilization of other medical services and/or procedures and other necessary telephonic follow-up.
  • Utilize the nursing process and critical thinking skills to provide oversight of services and evaluation of service options.
  • Ability to work in a variety of settings with culturally diverse communities with the ability to be culturally sensitive and appropriate. 
  • Must have excellent communication skills (written and verbal), clinical judgment, initiative, critical thinking, and problem-solving abilities.
  • Must be able to take after hour calls to meet business requirements as needed.

Job Requirements:

Education/Skills

  • Graduate of an accredited school of vocational nursing or equivalent required
  • Associate’s (ADN) or Bachelor’s (BSN) in Nursing preferred

Experience

  • 3 – 5 years of nursing experience preferred
  • Experience in Microsoft software (e.g., Outlook, Teams, Word, and Excel) required
  • General computer knowledge and capability to use computers required

Licenses, Registrations, or Certifications

  • LVN license in the state of employment or compact required
  • RN license in state of employment or compact preferred

 

Work Schedule:

5 Days - 8 Hours

Work Type:

Full Time

permanent
Remote Personal Finance Content Reviewer
$32 per hour - monthly

We are hiring remote contributors to review consumer finance content focused on budgeting and money-saving strategies.

Your role will involve reading short financial guidance pieces and providing feedback on their usefulness for people managing tight budgets. You may also identify which tips are the most practical for everyday situations.

This position is ideal for people interested in personal finance, budgeting, or improving financial literacy.

The work is flexible and completed online.


Remote working/work at home options are available for this role.
temporary
RN Clinical Review Nurse {167271}
Salary not disclosed
Alameda 6 days ago
Clinical Review Nurse Schedule for Clinical Review Nurse Monday – Friday | 8:00 AM – 5:00 PM Interview Process for Clinical Review Nurse One virtual interview Job Overview for Clinical Review Nurse We are seeking an experienced Clinical Review Nurse to support the investigation and resolution of complex member and provider grievances, appeals, and disputes .

This role is responsible for conducting detailed clinical reviews, evaluating medical necessity, and ensuring compliance with applicable regulatory requirements and organizational policies.

The Clinical Review Nurse will collaborate with internal teams and medical leadership to ensure timely and accurate resolution of cases while maintaining high standards of care and service.

Key Responsibilities for Clinical Review Nurse Conduct investigations and clinical reviews of member and provider grievances and appeals related to medical necessity .

Review prospective, inpatient, and retrospective medical records associated with denied services.

Summarize and present medical findings for Medical Directors, consultants, and external reviewers .

Apply clinical guidelines, policies, and benefit plan documentation when evaluating cases.

Prepare recommendations to uphold or overturn determinations and submit to the Medical Director for final approval.

Ensure appeals, grievances, and disputes are resolved within required regulatory timelines .

Evaluate requests for expedited review and determine urgency criteria.

Document case details and maintain accurate records within relevant tracking systems.

Draft written correspondence for members, providers, and regulatory entities .

Communicate with members, providers, and internal staff to support resolution of clinical concerns.

Identify potential quality-of-care concerns and escalate appropriately.

Serve as a clinical resource and subject matter expert to assist team members with appeals and grievance resolution.

Participate in additional projects and duties as assigned.

Essential Functions for Clinical Review Nurse Conduct thorough investigations of appeals, grievances, and provider disputes .

Evaluate the appropriateness of care within contractual, regulatory, and accreditation standards.

Identify system or process issues that may impact member care or service expectations and recommend improvements.

Perform documentation, reporting, and analytical tasks related to case reviews.

Maintain compliance with organizational policies, regulatory requirements, and professional standards .

Minimum Qualifications for Clinical Review Nurse Education / Licensing Active and unrestricted California Registered Nurse (RN) license Bachelor’s degree preferred Experience for Clinical Review Nurse Minimum 3 years of acute care clinical experience Minimum 2 years of appeals and grievances casework Preferred Experience for Clinical Review Nurse Utilization Management or Quality Management Experience applying standardized clinical guidelines Familiarity with Milliman Care Guidelines (MCG) , Managed Care, and NCQA standards Additional Details for Clinical Review Nurse No direct supervisory responsibilities Collaborative role working with clinical, operational, and leadership teams If you are an experienced nurse with strong clinical review and case evaluation skills and are looking to contribute to a team focused on quality care and regulatory excellence, we encourage you to apply.
*
Not Specified
Care Review Clinician I
✦ New
Salary not disclosed
Long Beach 1 day ago
Job Title: Care Review Clinician I Location: 100% Remote Duration: 3 Months+ (temp to hire) Schedule: Wednesday
- 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
Not Specified
jobs by JobLookup
✓ All jobs loaded