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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 .
The Utilization Review Physician collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical records for the patient population and Hackensack University Medical Center.
These include but are not limited to utilization review, hospital reimbursement, clinical compliance, case management, and transitions of care, as outlined in the responsibilities below.
Education, Knowledge, Skills and Abilities Required: 1.
JOB DESCRIPTION
We are seeking detail‑oriented Document Reviewers to ensure documents meet defined standards for accuracy, formatting, and compliance. In this role, you will systematically review and compare documents against established guidelines using structured checklists, identify inconsistencies, and proofread for quality and clarity. This position is ideal for individuals with strong attention to detail and experience in editing, proofreading, or document quality review.
Key Responsibilities:
- Meet productivity and quality benchmarks in a deadline‑driven environment of 100 assets/items per week.
- Review documents against predefined guidelines and standards using structured checklists..
- Compare documents for accuracy, consistency, and compliance with requirements.
- Identify and document errors, omissions, formatting issues, and inconsistencies.
- Proofread content for grammar, spelling, punctuation, and overall clarity.
- Verify document formatting, layout, and presentation align with established standards.
- Confirm documents have incorporated recommended changes
- Record findings clearly and escalate issues as needed.
- Maintain accuracy and consistency while handling repetitive review tasks.
REQUIRED:
- 2+ years of experience reviewing documents for accuracy on a daily basis.
- Strong attention to detail and ability to spot inconsistencies or errors.
- Excellent reading comprehension and written communication skills.
- Comfort working with structured checklists and completing repetitive tasks.
PREFERRED:
- Degree or coursework in English, Communications, Journalism, Writing, or a related field.
- Experience working with style guides or compliance‑based documentation.
- Familiarity with educational formatting standards and document comparison processes.
LOCATION:
- This role requires you to live in Houston, TX or a surrounding area, so you can be on-site at least once every three months for meetings etc.
- When not on-site, you can work from home.
HOURS:
- 7am – 3:30pm or 7:30am – 4pm CST.
- Monday – Friday.
DURATION:
- This is a contract job through April of 2027.
The Review Assistant II is responsible for inbound and outbound communication in support of case review activities including collection and confirmation of data integrity in support of clinical review services.
Essential functions include interpreting review guidelines to facilitate forward movement of the case review process including requests for clinical information, treatment plans, and more.
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.
Paralegal (Contracts & SOW Review)
Our client is seeking a Paralegal to support contract review and remediation initiatives across third-party vendor agreements. This role is ideal for a paralegal with experience reviewing and revising Statements of Work (SOWs) and corporate vendor contracts in a fast-paced enterprise environment. You will work closely with procurement, legal, and business stakeholders to ensure agreements are accurate, compliant, and aligned with corporate governance standards.
As part of our process after applying, you may receive an invitation from our AI Recruiter Avery for a short conversation that lets you share more about your background beyond your resume. For questions, contact
• Location: Atlanta, GA (Hybrid)
• Compensation: This job is expected to pay about $32–$36/hr W2
• Job Type: Contract
• Duration: 12+ Month Contract (Potential to extend or convert to full-time)
• No Visa Sponsorship Available for this role
What You'll Do:
• Review and revise Statements of Work (SOWs) and vendor agreements to ensure contract terms align with internal policies and governance standards.
• Support ongoing contract remediation initiatives, analyzing contract language and coordinating updates with legal and procurement teams.
• Partner with procurement, category management, finance, and legal teams to ensure contracts accurately reflect scope, pricing, and service terms.
• Track contract revisions and maintain documentation throughout the contract lifecycle.
• Serve as a point of contact for stakeholders regarding contract updates, compliance questions, and agreement changes.
What Gets You the Job:
• 3–5 years of experience reviewing and revising corporate contracts or Statements of Work (SOWs).
• Paralegal experience required, preferably supporting corporate contracts or vendor agreements.
• Experience working in an enterprise or professional services environment.
• Bachelor's degree required; Paralegal certificate or legal studies background is a plus.
• Strong attention to detail with the ability to review and update contract language accurately.
• Excellent communication and stakeholder management skills.
Irvine Technology Corporation (ITC) connects top talent with exceptional opportunities in IT, Security, Engineering, and Design. From startups to Fortune 500s, we partner with leading companies nationwide. Our AI recruiter, Avery helps streamline the first step of your journey—so we can focus on what matters most: helping you grow. Join us. Let us ELEVATE your career!
Irvine Technology Corporation provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Irvine Technology Corporation complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities.
Job DescriptionAt Boeing, we innovate and collaborate to make the world a better place.
We're committed to fostering an environment for every teammate that's welcoming, respectful and inclusive, with great opportunity for professional growth.
Find your future with us.Boeing Commercial Airplanes (BCA) is hiring for Entry-Level Product Review Engineers (Liaison Engineers) to join the 787 Production Engineering team located in North Charleston, SC.This position includes a 9-to-12-month Boeing Training Rotation Program and will require a flexible schedule, which may involve assignments on 1st, 2nd, or 3rd shift, as well as occasional overtime, weekends, or holidays based on business needs.The Product Review Engineers will perform/support troubleshooting, Root Cause Corrective Action (RCCA) technical analysis, and provide solutions to non-conforming products.
They will work directly with cross functional and production engineering teams to meet production program objectives.This position involves daily exposure to a factory environment which includes stairs, trip hazards, high noise areas, chemical hazards (breathing and handling), and entering airplanes during their many stages of building.Position Responsibilities:Researches and builds knowledge of Boeing and engineering design principles to develop solutions to product/process issues for production or simple technical in-service issuesAssists with analyses, root cause analysis and drafting dispositions for design non-conformancesAssists system owner in preparation of technical communicationsIdentifies analyses fleet data, collects and evaluates data on customer findings for product/process improvement opportunities that may include recurrent product support issuesSupports activities to identify deviations that could impact design intent and safetyParticipates in Material Review Boards and Integrated Product Teams (IPTs)Assists with the design of interim structural repairs to restore damaged structure to original design strength capabilityBasic Qualifications (Required Skills/Experience):Bachelor of Science degree in Engineering, Engineering Technology (including Manufacturing Technology), Computer Science, Data Science, Mathematics, Physics or Chemistry.
Applicants must have completed all degree requirements by the application date.Experience in reading, interpreting, and generating electrical schematics and technical specificationsExperience with or knowledge of structural design principles for aircraft primary structure (e.g., fatigue, damage tolerance, corrosion, stress analysis, statics, materials strength, material characteristics, and repair techniques)Must be willing to work variable shifts, including weekends, holidays, and overtimePreferred Qualifications (Desired Skills/Experience):ABET accredited degreeExperience gathering data and performing a Root Cause Corrective Action (RCCA)Aerospace, fabrication, manufacturing, and/or additive manufacturing experienceProduction engineering experience with relevant technological knowledgeExperience in solving simple to complex problemsElectrical/mechanical system knowledge, troubleshooting, fault isolation, and repair methodologyExperience with Material Review Board / Liaison Engineering (MRB / LE) Authority (including participating in Material Review Board activities related to aircraft/component/system/circuit card repairs)Functional system level and component level testingConflict of Interest: Successful candidates for this job must satisfy the Company's Conflict of Interest (COI) assessment process.Drug Free Workplace:Boeing is a Drug Free Workplace where post offer applicants and employees are subject to testing for marijuana, cocaine, opioids, amphetamines, PCP, and alcohol when criteria is met as outlined in our policies.Pay & Benefits:At Boeing, we strive to deliver a Total Rewards package that will attract, engage and retain the top talent.
Elements of the Total Rewards package include competitive base pay and variable compensation opportunities.The Boeing Company also provides eligible employees with an opportunity to enroll in a variety of benefit programs, generally including health insurance, flexible spending accounts, health savings accounts, retirement savings plans, life and disability insurance programs, and several programs that provide for both paid and unpaid time away from work.The specific programs and options available to any given employee may vary depending on eligibility factors such as geographic location, date of hire, and the applicability of collective bargaining agreements.Pay is based upon candidate experience and qualifications, as well as market and business considerations.Summary Pay Range: $71,400
- $96,600Applications for this position will be accepted until Mar.
23, 2026Export Control Requirements:This position must meet U.S.
export control compliance requirements.
To meet U.S.
export control compliance requirements, a "U.S.
Person" as defined by 22 C.F.R.
§120.62 is required.
"U.S.
Person" includes U.S.
Citizen, U.S.
National, lawful permanent resident, refugee, or asylee.Export Control Details:US based job, US Person requiredEducationBachelor's Degree or Equivalent RequiredRelocationThis position offers relocation based on candidate eligibility.Visa SponsorshipEmployer will not sponsor applicants for employment visa status.ShiftThis position is for variable shiftEqual Opportunity Employer:Boeing is an Equal Opportunity Employer.
Employment decisions are made without regard to race, color, religion, national origin, gender, sexual orientation, gender identity, age, physical or mental disability, genetic factors, military/veteran status or other characteristics protected by law.
We're committed to fostering an environment for every teammate that's welcoming, respectful and inclusive, with great opportunity for professional growth.
Find your future with us.Boeing Commercial Airplanes (BCA) is hiring for Product Review Engineers (Associate or Mid-Level) (Liaison Engineers) to join the 787 Production Engineering team located in North Charleston, SC.This position includes a 9-to-12-month Boeing Training Rotation Program and will require a flexible schedule, which may involve assignments on 1st, 2nd, or 3rd shift, as well as occasional overtime, weekends, or holidays based on business needs.The Product Review Engineers will perform/support troubleshooting, Root Cause Corrective Action (RCCA) technical analysis, and provide solutions to non-conforming products.
They will work directly with cross functional and production engineering teams to meet production program objectives.This position involves daily exposure to a factory environment which includes stairs, trip hazards, high noise areas, chemical hazards (breathing and handling), and entering airplanes during their many stages of building.Our team is currently hiring for a broad range of experience levels including Associate (Level 2) and Mid-Level (Level 3) Product Review Engineers.Position Responsibilities:Applies knowledge of Boeing design principles to assess and resolve product/process issues through the product lifecycleAnalyzes, conducts root cause analysis and develops dispositions for design non-conformancesApplies engineering principles to research technical, operational and quality issues that cannot be resolved by customer and designs interim and final engineering solutionsIdentifies documents, analyzes reported problems and communicates deviations that could impact design intent and safety; recommends and manages resolutionDevelops and implements product/process improvementsSupports Integrated Product Teams (IPT) and participates in design reviewsRepresents the engineering community in the build through postproduction environmentEnsures supplier and build partner compliance with Boeing standardsDevelops customer correspondence for continued safe operation and maintenance of equipmentParticipates in on-site disabled product repair teams and accident investigation or support teamAnalyzes damage repair or structural modification to determine appropriate jacking and shoring, prevent collateral damage and assure a safe work environmentDesigns interim structural repairs and conducts static strength analysis.
Develops non-destructive test procedures, tools and standardsConducts simple static strength analysisDevelops and implements product/process improvementsBasic Qualifications (Required Skills/Experience):Bachelor of Science degree in Engineering, Engineering Technology (including Manufacturing Technology), Computer Science, Data Science, Mathematics, Physics or Chemistry.
Applicants must have completed all degree requirements by the application date.2+ years of experience in a professional engineering role2+ years of experience in one or more of the following engineering fields: (airplane systems, aerodynamics, structures, propulsion, systems engineering, certification, or safety)1+ years of experience in reading, interpreting, and generating electrical schematics and technical specifications Experience with or knowledge of structural design principles for aircraft primary structure (e.g., fatigue, damage tolerance, corrosion, stress analysis, statics, materials strength, material characteristics, and repair techniques)Must be willing to work variable shifts, including weekends, holidays, and overtimePreferred Qualifications (Desired Skills/Experience): Level 3: 5+ years of related work experience or an equivalent combination of education and experienceABET accredited degreeCurrent or Previous Member of the Materials Review Board (MRB)Previous Aerospace or Marine repair, overhaul, maintenance, and/or engineering experienceExperience troubleshooting complex integrated systemsExperience interpreting and creating strength analyses for metals and composite materialsConflict of Interest: Successful candidates for this job must satisfy the Company's Conflict of Interest (COI) assessment process.Drug Free Workplace: Boeing is a Drug Free Workplace where post offer applicants and employees are subject to testing for marijuana, cocaine, opioids, amphetamines, PCP, and alcohol when criteria is met as outlined in our policies.Pay & Benefits:At Boeing, we strive to deliver a Total Rewards package that will attract, engage and retain the top talent.Elements of the Total Rewards package include competitive base pay and variable compensation opportunities.The Boeing Company also provides eligible employees with an opportunity to enroll in a variety of benefit programs, generally including health insurance, flexible spending accounts, health savings accounts, retirement savings plans, life and disability insurance programs, and several programs that provide for both paid and unpaid time away from work.The specific programs and options available to any given employee may vary depending on eligibility factors such as geographic location, date of hire, and the applicability of collective bargaining agreements.Pay is based upon candidate experience and qualifications, as well as market and business considerations.Summary Pay Range:Associate Level (Level 2): $85,000
- $115,000Mid-Level (Level 3): $103,700
- $140,300Applications for this position will be accepted until Mar.
23, 2026Export Control Requirements: This position must meet U.S.
export control compliance requirements.
To meet U.S.
export control compliance requirements, a "U.S.
Person" as defined by 22 C.F.R.
§120.62 is required."U.S.
Person" includes U.S.
Citizen, U.S.
National, lawful permanent resident, refugee, or asylee.Export Control Details: US based job, US Person requiredEducation Bachelor's Degree or Equivalent RequiredRelocation This position offers relocation based on candidate eligibility.Visa Sponsorship Employer will not sponsor applicants for employment visa status.Shift This position is for variable shiftEqual Opportunity Employer:Boeing is an Equal Opportunity Employer.
Employment decisions are made without regard to race, color, religion, national origin, gender, sexual orientation, gender identity, age, physical or mental disability, genetic factors, military/veteran status or other characteristics protected by law.
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.
