Brooksource Elevate Program Reviews Jobs in Usa

Position Title: Medical Reviewer

Work Location: Remote

Assignment Duration: 12 Months

Job Description:

We are seeking a contract Medical Reviewer to support our international Botox Therapeutic Neurotoxin team. The ideal candidate will be responsible for the medical review of clinical and scientific data related to the use of Botox for various therapeutic indications.

Key responsibilities include ensuring the accuracy and compliance of content with regulatory and company standards, providing expert medical input on clinical documents and safety information, and collaborating with cross-functional teams globally.

Qualifications:

The candidate should have a medical degree (MD or equivalent), clinical experience in neurology, physical medicine, or related fields, and a solid understanding of regulatory requirements for therapeutic neurotoxins. Experience with Botox or neurotoxin therapies is strongly preferred. Excellent communication and detail-orientation are essential.

Must have experience as a Reviewer OUS, understanding regulatory complexities of international markets.

Position Title: Clinical Review Clinician - Appeals

Work Location: Remote - Nationally sourced (Preference for 2 candidates in AZ)

Assignment Duration: 6 months

Work Schedule: 8:00 AM - 5:00 PM EST or CST

Work Arrangement: Remote

Schedule is 8-5 EST or CST hours. Staff will work when there are members of the supervisor/leadership on.

Cases are assigned in round robin fashion for staff to review and work.

The Organization's clinical team handles various types of authorization and claim review requests from various markets nationwide, processing clinical reviews to ensure members have the best outcomes and access to care needed.

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  Nurses review case files, add, update or edit authorizations.

  
  
  
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  Work closely with the MD team to make final decisions on cases.

  
  
  
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  Process clinical reviews to ensure members have access to care needed.

  
  
  
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  Help reduce provider abrasion by processing retrospective claim reviews.

  
  
  
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  Work closely with supervisors, senior clinicians, and the coordinator team on end-to-end case processes.

  
  
  
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  Participate in team collaboration via Teams group chats for routine questions.

  
  
  

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  Education/Certification (Required): Associate in nursing, Bachelor's in nursing or higher.

  
  
  
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  Licensure (Required): RN, LPN

  
  
  
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  Licensure (Preferred): LVN

  
  
  
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    Medicare knowledge

    
    
    
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    InterQual or Milliman Experience

    
    
    
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    Clinical reviews for Utilization Management or Appeals

    
    
    
  
  
  
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    Medicare Appeals Experience

    
    
    
  
  
  
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    Not having a valid/active RN/LPN license

    
    
    
  
  
  
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  Performance indicators:

  
  
  
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    Productivity expectations vary based on platform.

    
    
    
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    Prime: 7 CPD

    
    
    
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    iCP: 9 CPD

    
    
    
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    CenPas: 20 CPD cases per day

    
    
    
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    95% quality on all cases
    
    

    
    
    Candidate Requirements
    
    Education/Certification
    Required: Associate in nursing, Bachelor's in nursing or higher.
    Preferred:
    
    Licensure
    Required: RN, LPN
    Preferred: LVN
    
    
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    • Years of experience required
      
    • Disqualifiers
      
    • Best vs. average
      
    • Performance indicators
      
    
    
    Must haves: Medicare knowledge, InterQual or Milliman Experience, Clinical reviews for Utilization Management or Appeals
    
    Nice to haves: Medicare Appeals Experience
    
    Disqualifiers: Not having a valid/active RN/LPN license
    
    Performance indicators: Productivity expectations vary based on platform. Prime 7 CPD, iCP 9 CPD and CenPas is 20 CPD cases per day with 95% quality on all cases
    
    Best vs. average: Productivity expectations are set based on platform.
    
    
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    • Top 3 must-have hard skills
      
    • Level of experience with each
      
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    • Candidate Review & Selection
      
    
    
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    Utilization Management or Appeals review background (1 plus year)
    
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    Medicare NCD/LCD and InterQual/Milliman Software (1 plus year)
    
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    Retrospective claims clinical reviews (1 plus year)
    
    
  
  
  

Ready to Rock Your Document Review Skills?

Hey legal eagles! Are you a newly licensed attorney looking for an exciting, long-term project that lets you flex your document review muscles? A fantastic firm in the Charleston, SC area is on the hunt for sharp onsite Document Review Attorneys to jump into an immediate, 6+ month gig. This isn't just another project; it's a chance to supercharge your resume and gain invaluable experience with a team that truly values you. Please note, if you have done extensive document review for Defense firms, you are likely conflicted out.

What You'll Be Doing as a Document Review Attorney (Your Superpower Moves!):

• Sleuthing through documents with precision and speed, using Relativity or other cool e-discovery software.
• Uncovering crucial information and sharing those "aha!" moments with your team leaders.
• Crafting top-notch litigation documents, like those all-important Deposition Dossiers.
• Tackling other fascinating tasks as your project leaders need a hand.

Who We're Searching For (Are You Our Next Superstar?):

• You've got that shiny JD from an ABA-accredited law school.
• You're either a licensed member of the SC Bar, or have a UBE score ready to transfer to SC, or are licensed in another state.
• You're a detail-oriented dynamo – thorough, organized, and nothing gets past your eagle eyes.
• You're a master of managing your time and can work independently like a pro.
• Your communication skills, both written and verbal, are top-notch.
• Bonus points if you're already a Relativity guru or have document review attorney experience, but no worries if not – we're ready to help you learn!
• You've got that natural knack for problem-solving.

The Sweet Deal (What's In It For You!):

• Competitive hourly rates ranging from $27 to $30.
• Subsidized health insurance for our awesome full-time reviewers!

Be ready to pass a comprehensive conflicts check! And rest assured, your resume is held in the strictest confidence.

Think you're a fit? We can't wait to hear from you! Apply at : This job description is not intended to be all-inclusive. The employee may perform other related duties as negotiated to meet the ongoing needs of the organization.

The Opportunity:

A government agency seeks two admitted Document Review Attorneys for a short-term document review project scheduled to begin in early March with a duration of approximately four months. Must be available to work at least 35 hours weekly and additional hours, if needed. The hourly rate is $50, plus benefits.

Primary Duties:

The Document Review Attorneys will help coordinate the compliance review of filed election documents. Candidates must be comfortable navigating high volume and strict statutory timelines for review, hearings and providing notice and able to utilize the agency's digital systems for viewing scanned documents and generating letters. Additional duties include the following:

• Preparation of letters of non-compliance
• Compiling records for related hearings and litigation

Experience & Qualifications:

• New York State bar admission
• Minimum of 2- 5 years of legal experience
• Experience with digital document management systems

Frink-Hamlett Legal Solutions is an equal employment opportunity employer and all applicants will receive consideration for employment without discrimination based on race, color, creed, national origin, sex, age, disability, marital status, sexual orientation or citizenship status.

Essential Functions of the job:

• Review and validate QC data and test records.
• Support investigations related to Out of Specification (OOS), Out of Trend (OOT), and Out of Expectation (OOE) results.
• Ensure compliance with current Good Manufacturing Practices (cGMP) in the laboratory.
• Assist in the technical documentation of investigations and change control assessments to evaluate the impact on product quality, in alignment with FDA/EU regulations, international standards
• Undertake other duties as required.

This position is ideal for candidates who are detail-oriented and committed to quality assurance in the pharmaceutical industry.

Education/Experience Required:

• Bachelor’s Degree or above in Chemistry, Biochemistry, or Biotechnology related scientific discipline. Scientific degree (ideally chemistry, biochemistry, biotechnology or related).
• Minimum 4 years working experience in an FDA-regulated biotechnology or pharmaceutical company is required.
• Working knowledge and experience with chemistry analytical methods such as HPLC, GC, TOC, Capillary Electrophoresis (CGE-Reduced, CGE-Non-Reduced, and Capillary Zone Electrophoresis), etc.
• Strong working knowledge with USP/EP and cGMP/EU GMP.
• Technical writing experience.
• Familiar with instrument and equipment validation.
• Impressive, demonstrable track record and skills/experience gained within a similar position(s), at a similar level.
• Credible and confident communicator (written and verbal) at all levels.
• Strong analytical and problem-solving ability.
• Hands-on approach, with a ‘can do’ attitude.
• Ability to prioritize, demonstrating good time management skills.
• Excellent attention to detail, with the ability to work accurately in a busy and demanding environment.
• Self-motivated, with the ability to work proactively using own initiative.
• Committed to learning and development
• Self-motivated, with the ability to work proactively using own initiative.

Computer Skills:

• Strong PC literacy required; MS Office skills (Outlook, Word, Excel, PowerPoint).

Travel:

• Must be willing to travel approximately 10%.
• Ability to work on a computer for extended periods of time.

Immediate need for a talented Hospital RN – Care Coordination & Utilization Review . This is a 06+months contract opportunity with long-term potential and is located in San Jose, CA (Onsite). Please review the job description below and contact me ASAP if you are interested.

Job ID: 25-80861

Pay Range: $80 - $95/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Responsibilities:

• Conduct utilization reviews using InterQual® / MCG®
• Support discharge planning and post-acute coordination
• Communicate with physicians, social work, and external providers
• Manage authorizations and payer-related workflows
• Maintain compliance with regulatory standards

Key Requirements and Technology Experience:

• Key Skills; CA RN License (Active)
• Acute inpatient hospital experience
• UM / Case Management / Discharge Planning background

Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.

Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.

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.

PHP Therapist

Schedule: Full-time

Your experience matters 

Triangle Springs is part of Lifepoint Health, a diversified healthcare delivery network with facilities coast to coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. 

As a Partial Hospitalization Program Therapist (PHP) joining our team, you're embracing a vital mission dedicated to making communities healthier. Join us on this meaningful journey where your skills, compassion, and dedication will make a remarkable difference in the lives of those we serve.

How you'll contribute 

A Partial Hospitalization Program Therapist (PHP) who excels in this role:

• Conduct individual and group therapy sessions to educate and treat patients experiencing psychological, emotional, or substance use issues.
• Actively participate in treatment planning, discharge, transition, and after-care processes.
• Provide family therapy sessions as needed to support continuity of care and reduce barriers to treatment.
• Support with patient vitals and urine drug screening (UDS) as needed.
• Communicate proactively with patients, families, and referral sources in accordance with HIPAA and 42 CFR Part 2.
• Collaborate consistently with interdisciplinary teams including physicians, UR, and nursing staff.
• Support UR team functions and provide treatment updates or documentation for authorizations.
• Complete required clinical paperwork including psychosocial assessments, Columbia Suicide Risk Scale, and progress notes.
• Respond appropriately to patient crises and participate in de-escalation procedures.
• Demonstrate knowledge of confidentiality, HIPAA, and clinical regulations (TJC, CARF, Medicaid, etc.).
• Assist care coordination with discharge planning and continuity of care.
• Complete all documentation thoroughly, accurately, and within facility timelines.
• Perform additional duties as assigned by leadership.

Why join us 

We believe that investing in our employees is the first step to providing excellent patient care. In addition to your base compensation, this position also offers: 

• Comprehensive Benefits: Multiple levels of medical, dental and vision coverage for full-time and part-time employees.
• Financial Protection & PTO: Life, accident, critical illness, hospital indemnity insurance, short- and long-term disability, paid family leave and paid time off.
• Financial & Career Growth: Higher education and certification tuition assistance, loan assistance and 401(k) retirement package and company match.
• Employee Well-being: Mental, physical, and financial wellness programs (free gym memberships, virtual care appointments, mental health services and discount programs).
• Professional Development: Ongoing learning and career advancement opportunities.

What we're looking for 

• Education: Master's degree in Social Work, Counseling, or equivalent required.

• License: Current clinical or social work license as required by state regulations.

• Certifications: CPR and De-escalation certification required or obtain within 30 days of hire.

More about Triangle Springs

Triangle Springs is a 77- bed behavioral health hospital that has been offering exceptional care to the Raleigh community for over 8 years. We are proud to be recognized as Joint Commission Accredited and Psych Armor Certified. 

EEOC Statement

"Triangle Springs Hospital is an Equal Opportunity Employer. Triangle Springs Hospital is committed to Equal Employment Opportunity for all applicants and employees and complies with all applicable laws prohibiting discrimination and harassment in employment."

Lifepoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country.

• Bachelor's degree in Nursing.
• Preferred: Master's degree in Nursing.
• State licensure as a Registered Nurse (RN). May require valid driver's license.
• 2 years of related experience.
• BLS through the American Heart Association or the American Red Cross CPR for the Professional Rescuer with card in-hand before start date. BLS or CPR card must be good through sixty days of hire.

• Performance bonus: UCHealth offers a 3-Year Incentive Bonus to recognize employee contributions to our success in quality, patient experience, organizational growth, financial goals and tenure. The bonus accumulates annually each October and is paid out in October during the third year of employment.
• Performance-based pay increase: The Annual Merit Pay Increase recognizes work performance that meets or consistently exceeds performance standards documented through UCHealth's established evaluation process and accounts for increased experience, skills and cost of living.
• Market reviews: All UCHealth positions are reviewed annually to ensure UCHealth base pay aligns with market standards. Base pay rates are adjusted as needed to stay market competitive.

• Medical, dental and vision coverage.
• Access to 24/7 mental health and well-being support for employees and dependents.
• Discounted gym memberships and fitness resources.
• Free membership.
• Voluntary benefits such as accident insurance, critical illness insurance, group legal plan, identity theft protection, pet insurance, auto and home insurance, and employee discount programs.
• Time away from work: Paid time off (PTO), paid family and medical leave (inclusive of Colorado FAMLI), leaves of absence.
  • New employees receive an initial PTO load with first paycheck.
• Employer-provided basic life and accidental death and dismemberment coverage with buy-up coverage options.
• Employer-provided short-term disability and long-term disability with a buy-up coverage option.

• 403(b) plan with employer matching contribution.
• Additional 457(b) plan may be available.
• Flexible spending accounts for health care and dependent day care; health savings account available when enrolled in high-deductible (HD) medical plan.

• UCHealth provides access to academic degrees and certificate programs to promote professional and personal growth.
  • Up to 100% of tuition, books and fees paid for by UCHealth for specific educational degrees.
  • Other programs may qualify for up to $10,000/year pre-paid by UCHealth or up to $5,250/year in the form of tuition reimbursement.
• Access to LinkedIn Learning, which offers thousands of virtual courses and seminars, and internal professional development opportunities.
• Employees have access to free assistance navigating the Public Service Loan Forgiveness program and submitting their federal student loans for forgiveness.