Cloudbuddy Pro Pipe Review Jobs in Usa
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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.
At Javitch Block LLC, we are looking for dependable and enthusiastic people interested in building a career with our great firm. Javitch Block LLC (JB) is looking for a full-time Associate Attorney - Pleading Review to work in our Fairlawn office and your qualifications and skill set may be an ideal match for this exciting career opportunity.
The Pleading Review Attorney will be responsible for reviewing complaints, letters and other pleadings and determining whether we have sufficient grounds to proceed based upon Federal and State and Client regulations. As part of an organization, the Pleading Review Attorney is responsible for remaining in compliance with all protocols in line with our organization goals, strategy, and values. Secondary responsibilities may include court appearances, file management, and collections negotiations.
The Ideal Candidate:
- Attorney will review pleadings for accurate information, including but not limited to, venue, balances, correct named parties, statute of limitations, proper documentation, proper theories of recovery
- Attorney may assist in legal research to ensure pleadings and laws contained therein are up-to-date with applicable laws
- Good communication skills
- Strong pleading and complaint experience with a knowledge of collections related court documents.
- Strong motivation, demonstrated by ability to work both independently and as part of a team.
- Computer and word processing skills including Word, PowerPoint, Excel along with quick ability to learn new technical programs
Education/Training/Experience:
- One (1) to two (2) years of experience in the Creditors’ Rights or Collection fields preferred.
- Juris Doctor Degree (J.D.)
- Must be licensed in state of Ohio
- Intermediate knowledge of Microsoft Word, Excel
Javitch Block offers a comprehensive benefits program including health insurance, paid vacation/personal time, 401(k), life insurance, and short and long-term disability.
You can learn more about Javitch Block LLC at
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.
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
Insight Global is seeking Technical Evaluation Review Board/CCB Coordinator to join our team for an exciting opportunity to work on a unique government contract. The contract assists in acquisition and technical sustainment engineering and will augment government resources. The coordinator manages government technical review board submissions, ensuring all programs meet required deliverables and are fully prepared for review before board meetings. They control document accuracy, track changes, and maintain compliant review packages across all stakeholders. The role requires confidently driving engineers and IPTs to meet requirements and deadlines, including pushing back when inputs are incomplete. This is a highly organized, assertive position focused on accountability, readiness, and execution.
Must Haves:
- BS/MS in engineering/specialty area
- 7 yrs directly related experience (5 yrs with MS degree)
- Active secret level security clearance or higher
- Strong planning, coordination, and organizational skills with the ability to manage multiple priorities
- Demonstrated experience developing, maintaining, and assessing technical baselines within controlled programs
- Familiarity with engineering standards, manufacturing methods, and configuration management practices, including military and ASME-guided environments
- Working knowledge of technical drawing conventions and engineering documentation controls
- Proficiency with Microsoft Office tools to prepare data-driven reports, metrics, and formal documentation
- High attention to detail, strong writing and verbal communication skills, and the ability to manage time effectively
- Ability to sit on-site at Hill AFB in Clearfield, UT Monday-Wednesday
Plusses:
- Experience supporting configuration and data management activities within a defense or government program environment
- Working knowledge of Air Force or DoD engineering release processes, configuration control standards, and technical documentation lifecycle management
- Familiarity with Engineering Change Proposals (ECPs), Interface Control Documents (ICDs), and associated revision and audit activities
- Prior involvement with functional and physical configuration audits, including coordination with suppliers or government facilities
- Training or certification in configuration or data management disciplines (e.g., CMPIC or similar)
- Demonstrated ability to maintain and protect complex engineering baselines for hardware and software systems
- Strong judgment and decision-making skills aligned with regulatory, contractual, and policy requirements
- Commitment to continuous learning and maintaining up-to-date technical proficiency
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
Position Summary
Lead position that requires multi-certification and disciplines necessary to handle project approvals from start to finish through the plan review and inspection processes in accordance with the Division's mission and performance objectives.
Direct and lead Building Inspector/Plans Examiners and seasonal/casual staff. Assist the Division Manager and Building Official with program planning and personnel direction. Oversee the coordination of the building safety plan review and inspection process. Conduct construction code reviews and inspections for residential, commercial, industrial and multi-family development proposals. Depending on the Division's needs, employees in this position may be assigned to focus primarily on plan review or inspection duties. This program is highly visible and often the first contact made with the City from those outside the community. These tasks are illustrative only and may include other related duties.
This recruitment is accepting applications for
Building Inspector/Plans Examiner III
Building Inspector/Plans Examiner IV (Plan Review Lead)
Full-Time 40 hours per week
AFSCME-represented positions
12-month probationary period
Must meet all qualifications and requirements as listed in the position description below.
Building Inspector/Plans Examiner III $38.25 - 48.66 Hourly
Building Inspector/Plans Examiner IV (Plan Review Lead) $41.27 - $52.51 Hourly
These positions are anticipated to be assigned primarily to commercial and residential plan review.Essential Duties
Building Inspector/Plans Examiner III
Leads and coordinates members of the development review and inspection teams to ensure a timely, predictable, comprehensive and accurate plan review and inspection process for any development proposal.
Reviews and inspects residential, commercial, industrial, and multi-family development proposals to ensure compliance with State and City codes/ordinances, engineering/architectural, and fire/life safety principles.
Depending on the Division's needs, performs construction plan review and site inspections:
- Conducts Pre-Development, Plan Intake, and Pre-Construction meetings.
- Takes the lead in coordinating plan reviews and inspections internally, with customers, and with other departments and agencies.
- Maintains communication with contractors to anticipate and resolve onsite issues.
- Performs building safety inspections and plan reviews.
- Calculates and assesses fees.
- Monitors permit and project status and follow-up with expired applications and permits.
- Maintains accurate records and files of construction plan reviews, inspections, and related correspondence. Archives documents as required.
- Manages phased development and deferred submittal process for assigned projects.
- Ensures special inspection and structural observation is accomplished where required.
- Recommends or issues Stop Work Orders, violation notifications, and other building code compliance actions when necessary.
- Issues final approval of construction permits.
Provides technical interpretations of code issues and requirements.
Leads and coordinates teams to investigate and resolve matters of community concern, public health, building safety and dangerous building situations. Examples include fire scene investigations, flooding, mold growth, post-earthquake inspections, electrical hazards, hazardous materials, boiler explosions, sanitation issues, mechanical failures, and any condition identified in the Dangerous Building Code.
Represents the City at national, state and local boards, meetings, hearings, seminars, classes, and public
outreach events involving construction codes or building safety.
Provides training, support and assistance to cross-trained staff, and participates in cross-training programs.
Conducts compliance verifications for appropriate contractor licensing and registration.
Acts ethically and honestly; applies ethical standards of behavior to daily work activities and interactions. Builds confidence in the City through own actions.
Conforms with all safety rules and performs work is a safe manner.
Operates a motor vehicle safely and legally.
Delivers excellent customer service to diverse audiences.
Maintains effective work relationships.
Adheres to all City and Department policies.
Arrives to work, meetings, and other work-related functions on time and maintains regular job attendance.
Building Inspector/Plans Examiner IV (Plan Review Lead)
Assists with and prepares short and long range work plans, and schedules daily activities for Building Inspector/Plans Examiners.
Directs, trains and assists Building Inspector/Plans Examiners. Participates in recruitment process. Provides input concerning performance evaluations.
Performs Construction Plan Reviews and Inspections on complex residential, commercial, industrial, and multi-family development proposals to ensure compliance with State and City codes/ordinances, engineering/architectural, and fire/life safety principles.
Coordinates scheduling and organization of Pre-Development and Pre-Construction and other related meetings. Coordinates review/inspection approvals with internal/external agencies.
Coordinates Over-the-Counter, Rapid Review, and other processes. Ensures adequate staffing and oversight of a timely, predictable, comprehensive, and accurate plan review and inspection process for any development proposal.
Monitors and inspects work and projects completed by Building Inspector/Plans Examiners and contractors. Makes field decisions on procedures and methods.
Conducts quality control and internal audits for building safety code administration and enforcement.
Assists in budget preparation. Monitors expenses. Maintains staff supplies and resources.
Provides technical expertise and guidance in interpretations of code issues and requirements for development proposals.
Leads, guides, and ensures successful staff resolution of matters of community concern, public health, building safety and dangerous building situations. Examples include fire scene investigations, flooding, mold growth, post-earthquake inspections, electrical hazards, hazardous materials, boiler explosions, sanitation issues, mechanical failures, and any condition identified in the Dangerous Building Code. When necessary, issue notices of violation, notices to vacate, dangerous building declarations and stop work orders.
Represents the City at national, state and local boards, meetings, hearings, seminars, classes, and public outreach events involving development, construction codes or building safety.
Conforms with all safety rules and performs work is a safe manner.
Operates and drives a motor vehicle safely and legally.
Delivers excellent customer service to diverse audiences.
Maintains effective work relationships.
Adheres to all City and Department policies.
Arrives to work, meetings, and other work-related functions on time and maintains regular job attendance.
Qualifications and Skills
Building Inspector/Plans Examiner III
Education and Experience
High school diploma, or equivalent required. Associates degree in Building Inspection Technology, Drafting, Engineering, Fire Prevention, or other related field preferred.
Four years of formal education, training, and/or experience in construction management, architecture, structural engineering, building design, construction inspection, and/or plan review providing the knowledge, skills and abilities necessary to perform the essential functions of the position.
Knowledge, Skills and Abilities
Thorough knowledge of construction practices, engineering concepts, and architectural principles.
Excellent customer service, communication, and public relations skills and the ability to mediate adversarial situations. Ability to proactively anticipate and mitigate problem areas before they become issues.
Prioritize and meet multiple demands by the construction industry, the general public and other City staff.
Organize, coordinate, chair, and effectively facilitate high profile meetings.
Interpret, disseminate, and communicate complex technical information, state and local construction regulations, City review process, and City policies effectively with technicians and non-technicians.
Possess a self-directed commitment to maintain current knowledge of construction standards, methods, technologies, and codes.
Get along well and maintain effective work relationships with coworkers and the public.
Special Requirements
Certifications: Incumbent must be certified in accordance with OAR 918-098. Oregon Inspector Certification is required within 60 days of appointment.
Certifications giving the incumbent the legal ability to perform work described in sets A, B, C, or D:
A: Inspection/Plan Review:
Commercial Inspection (A-Level Building, Mechanical)
Residential Inspection (Building , Mechanical)
Residential Plan Review
Commercial Plan Review (A-Level, Mechanical) must be obtained within the probationary period.
OR
B: Residential Multi-Discipline:
Residential Plan Review
Residential Inspection for 4: Building, Mechanical, Plumbing and Electrical
OR
C: Commercial Plan Review:
Commercial Plan Review (A-level, Mechanical)
Fire and Life Safety
Residential Plan Review and Residential Inspection required within the probationary period
D: Specialty Discipline- Commercial and Residential Inspection and Plan Review to include:
- Plumbing - Commercial and Residential Plumbing Inspector; obtain a Medical Gas Certification within the probationary period; or
- Electrical - Commercial and Residential Electrical Inspector; obtain a Fire Investigation Certificate within the probationary period.
Experience in use of permit tracking systems. Excellent ability to use computer hardware, printers, and computer programs to conduct inspections, complete plan reviews, communicate and present information, track progress, schedule projects, and to perform the essential functions of the position. Demonstrable commitment to quality and timely customer service.
Possession or ability to obtain a valid Oregon Drivers License.
Demonstrable commitment to sustainability.
Demonstrable commitment to promoting and enhancing equity, diversity and inclusion.
The individual shall not pose a direct threat to the health or safety of the individual or others in the workplace.
Building Inspector/Plans Examiner IV (Plan Review Lead)
Education and Experience
High school diploma, or equivalent required. Bachelor's degree in Architecture, Engineering, Construction Management, Public Administration or a closely related field preferred. Two years of experience in construction management, architecture, structural engineering, building design, construction inspection, and/or plan review.
Six years of formal education, training and/or experience in construction management, architecture, structural engineering, building design, construction inspection, and/or plan review providing the knowledge, skills and abilities necessary to perform the essential functions of the position.
Knowledge, Skills and Abilities
Thorough knowledge of construction practices, engineering concepts, and architectural principles.
Excellent customer service, communication, and public relations skills and the ability to mediate adversarial situations, and proactively anticipate and mitigate problem areas before they become issues.
Prioritize and meet multiple demands by the construction industry, the general public and other City staff.
Organize, coordinate, chair, and effectively facilitate high profile meetings.
Travel among City worksites, off-site meetings and presentations.
Interpret, disseminate, and communicate complex technical information, state and local construction regulations, City review process, and City policies effectively with technicians and non-technicians.
Experience in use of permit tracking systems. Excellent ability to use computer hardware, printers, and computer programs to conduct inspections, complete plan reviews, communicate and present information, track progress, schedule projects, and to perform the essential functions of the position.
Get along well and maintain effective work relationships with coworkers and the public.
Demonstrable commitment to quality and timely customer service.
Special Requirements
Certifications: Incumbent must be certified in accordance with OAR 918-098. Oregon Inspector Certification is required within 60 days of appointment.
State of Oregon Building Official Certification; or State of Oregon Inspector Certification and International Code Council Certified Building Official Certification, must be obtained within the probationary period.
Certifications giving the incumbent the legal ability to perform work described in sets A, B, or C:
A: Inspection/Plan Review:
Commercial Inspection (A-Level Building, Mechanical)
Commercial Plan Review (A-Level, Mechanical, Fire and Life Safety)
Residential Inspection (Building , Mechanical)
Residential Plan Review
OR
B: Residential Multi-Discipline:
Residential Plan Review
Residential Inspection for 4: Building, Mechanical, Plumbing and Electrical
OR
C: Specialty Discipline - Commercial and Residential Inspection and Plan Review to include:
- Plumbing - Commercial and Residential Plumbing Inspector plus obtain a Medical Gas Certification within the probationary period; or
- Electrical - Commercial and Residential Electrical Inspector plus obtain a Fire Investigation Certificate within the probationary period.
Demonstrable commitment to diversity and promote diversity principles with employees in day to day operations.
The individual shall not pose a direct threat to the health or safety of the individual or others in the workplace.
Ability to pass a background check and/or criminal history check
Possession or ability to obtain a valid Oregon Drivers License.
How to Apply
Qualified applicants must submit an online application located on the City of Corvallis website(click on "Apply" above).
Position is open until filled.
First review of applications will occur after 8:00 AM on Friday March 6, 2026.
Resumes will not be accepted in lieu of a completed online application.
Late or incomplete applications will not be accepted/considered.
*Please do not include personal or protected information in attached resumes or cover letters, this includes your birth date, age, dates of education, and graduation dates.*
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
Position Summary
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.
Background & Context
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.
Key Responsibilities
Nurses review case files, add, update or edit authorizations.
Work closely with the MD team to make final decisions on cases.
Process clinical reviews to ensure members have access to care needed.
Help reduce provider abrasion by processing retrospective claim reviews.
Work closely with supervisors, senior clinicians, and the coordinator team on end-to-end case processes.
Participate in team collaboration via Teams group chats for routine questions.
Qualification & Experience
Education/Certification (Required): Associate in nursing, Bachelor's in nursing or higher.
Licensure (Required): RN, LPN
Licensure (Preferred): LVN
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
CenPas: 20 CPD cases per day
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- 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.- Top 3 must-have hard skills
- Level of experience with each
- Stack-ranked by importance
- Candidate Review & Selection
1
Utilization Management or Appeals review background (1 plus year)
2
Medicare NCD/LCD and InterQual/Milliman Software (1 plus year)
3
Retrospective claims clinical reviews (1 plus year)
At MVP Health Care, we're on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference-every interaction, every day. We've been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team.
What's in it for you:
- Growth opportunities to uplevel your career
- A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team
- Competitive compensation and comprehensive benefits focused on well-being
- An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace.
You'll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities.
About the Opportunity
As a Professional, Prospective Review in Health Management - UM Prospective Review, you will play a crucial role in ensuring the quality and efficiency of our prospective review process. You will work closely with the healthcare team to review and assess the appropriateness of medical services, treatments and high dollar medical equipment. This is an exciting opportunity to contribute to the improvement of patient care and outcomes.
What You'll Do
- Conduct comprehensive reviews of medical records and treatment plans to determine if the requested services are appropriate based on established guidelines and medical criteria across multiple lines of business.
- Utilize your clinical expertise to evaluate medical necessity and collaborate with MVP Medical Directors to determine the effectiveness of proposed treatments/equipment.
- Document clinical summations, recommendations and send appropriate correspondences accurately and within regulatory timeframes.
- Communicate with healthcare providers and members to collect pertinent information, discuss review outcomes and provide appropriate referrals within MVP.
- Remain up to date with industry standards and guidelines, complete required competency training and proficiency examinations to ensure compliance and best practice.
- Participate in team meetings and training sessions to enhance your knowledge and skills.
- Contribute to process improvement initiatives to streamline the prospective review process.
- Other duties as assigned by leadership.
Skills and Experience
- Education, Licensures, & Certifications
- Current RN (NY or VT)
- Years of Experience (Required & Preferred)
- Minimum of 3-5 years clinical experience required
- Case management certification preferred
- Required Job Skills
- Able to manage multiple tasks in a fast-paced environment.
- Strong clinical knowledge, critical thinking skills and understanding of medical terminology, procedures, concepts.
- Ability to work independently to analyze complex medical information.
- Effective communication skills, both written and verbal.
- Ability to work independently and collaboratively in a team environment.
- Proficiency in using computer systems and software for documentation, data entry and day-to-day work functions.
- Preferred Job Skills
- Prior Utilization review experience
- Knowledge of Government Insurance Programs (Medicare, Medicaid)
Working Conditions
Secure, Quiet area for Desk/Computer to maintain HIPPA compliance
Travel Requirements
Potential for travel to regional offices
Worksite Designation
- Virtual based out of Schenectady NY
Pay Transparency
MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role.
We do not request current or historical salary information from candidates.
$69,383.00-$92,279.00
MVP's Inclusion Statement
At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration.
MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications.
To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at .