Code Red Reviews Jobs in Usa

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

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.

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.

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.

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.*

NOVA Engineering is currently seeking afully-certified Commercial Building Code Inspector in Panama City Beach FL. Primary duties will include performing building code inspections and/or plans review (building / structural, mechanical, electrical, and plumbing – as licensed) on residential and commercial buildings, as well as managing specific projects related to these types of code inspections. Some travel may be required for inspections and/or managing projects in the assigned area. The inspector positions are predominately located in the field but may occasionally include office assignments.

Essential Functions:

• Building Code Review and/or Quality Control Inspections on commercial construction projects (Building, Mechanical, Electrical, and Plumbing)
• Prepare written and electronic reports, and issue notices of correction
• Explain and interpret code and/or quality control regulations or requirements
• Recognize, evaluate and properly resolve unique problems or situations
• Maintain effective customer service relationship with clients and the public
• Assist the inspection management team with business development
• Perform other related duties as assigned by the Manager

Qualifications:

• Required state of Florida commercial building inspection license (BN#) in two or more of the following disciplines: Building (Structural), Mechanical, Electrical, and Plumbing.
• 3+ years’ experience performing plan review and/or inspections

Check out our Perks:

In addition to our welcoming company culture and competitive compensation packages, our employees enjoy the below benefits:

• Use of take-home Company Vehicle and gas card for daily travel to work sites
• Comprehensive group medical insurance, including health, dental and vision
• Opportunity for professional growth and advancement
• Certification reimbursement
• Paid time off
• Company–observed paid holidays
• Company paid life insurance for employee, spouse and children
• Company paid short term disability coverage
• Other supplemental benefit offerings including long-term disability, critical illness, accident and identity theft protection
• 401K retirement with company matching of 50% on the first 6% of employee contributions
• Wellness program with incentives
• Employee Assistance Program

NOVA is an Equal Opportunity Employer. All qualified candidates are encouraged to apply. NOVA does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, ancestry, marital status, veteran status or any other characteristic protected by law.

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.

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

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

Job Description

At 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.

Job Description

The Boeing Commercial Airplanes Liaison Engineering Organization is seeking Consultant (Level 5) Liaison Engineers to support operations in Everett, Seattle, Auburn, and or Renton Washington. We are looking for a proactive individual who can make prompt engineering decisions and who want to go beyond their desk and into the factory for hands on engineering.

This position requires excellent communication and collaboration skills as the candidate will be partnering closely with production personnel.  The candidate will be the engineering representative on the factory floor transforming design into reality.

Position Responsibilities: 

• Analyzes, conducts root cause analysis and develops dispositions for production non-conformances.
• Applies knowledge of Boeing design principles to assess and resolve product/process issues through the product lifecycle.
• Applies engineering principles to research technical, operational and quality issues in support of executing final engineering solutions.
• Identifies documents, analyzes reported problems and communicates deviations that could impact design intent and safety; recommends and manages resolution.
• Develops and implements product/process improvements.
• Supports Integrated Product Teams (IPT) and participates in design reviews.
• Represents the engineering community from initial build through the production and post-production environment.
• Ensures supplier and build partner compliance with Boeing standards.
• Develops customer correspondence for continued safe operation and maintenance of equipment.
• Participates in on-site disabled product repair teams, accident investigation and support teams.
• Analyzes damage repair or structural modification to determine appropriate jacking and shoring, prevent collateral damage and assure a safe work environment.
• Designs interim structural repairs and conducts static strength analysis.
• Develops non-destructive test procedures, tools and standards.

This position is fully onsite. The selected candidate will be required to work onsite at one of the listed locations. This position involves daily exposure to factory environment which includes stairs, trip hazards, high noise areas, chemical hazards (breathing and handling), and entering airplanes during their many stages of build.

This position participates in the approximately 9-month Boeing Company Training Rotation Program, which may involve assignments to the first, second, or third shift, as well as weekend or daily overtime. The specific requirements for shift assignments and overtime vary between sites and are typically covered on a rotation basis. Additionally, there may be travel involved between Boeing Puget Sound sites during the training rotation.

Basic Qualifications (Required Skills/Experience): 

• Bachelor's or Masters of Science Degree from an ABET OR ABET equivalent accredited course of study in Engineering
• 14+ years of experience in structures, systems, design, or production engineering

Preferred Qualifications (Desired Skills/Experience): 

• Hands-on experience with materials and manufacturing processes.
• Prior BCA Engineering Material Review Board (MRB) Certification

Conflict 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.  

Shift:

This position is for multiple shifts and may require off shift, weekend, and travel assignments.

The candidate may periodically be assigned to first, second, or third shift as well as weekend or daily overtime. This requirement varies from site to site and is typically covered on a rotation basis.

Union:

This is a union represented position.

In locations where SPEEA representation applies, this job family will be covered by the terms of the collective bargaining agreement. Applicable and appropriate educational/certification credentials from an accredited institution and/or equivalent experience is required.
 

Pay and 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 a number of 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 for Expert (level 5): $165,750 - $224,250

Applications for this position will be accepted until Mar. 20, 2026

Export 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 required

Relocation

This position offers relocation based on candidate eligibility.

Visa Sponsorship

Employer will not sponsor applicants for employment visa status.

Shift

This position is for 1st shift

Equal 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 challenges of affordable healthcare continue to create new opportunities.

Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs.

These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.

Care Management Supervisor of Quality Review & Staff Education is responsible for quality assurance, accuracy, and overall integrity of the care management records completed by Care Management staff. This role is to ensure compliance with NYS DOH and CMS regulations through development of auditing tools and data validation. This Supervisor will analyze collected audit data, identify trends for staff re-training, and implement corrective action plans in collaboration with Clinical Management and Staff Education. They will oversee and conduct orientation, training, and education to all members of the Care Management team. Provides support to Director and Managers of Coordinated Care to ensure that all reporting requirements are prepared, submitted, and maintained in a professional and well-coordinated manner.

• Baccalaureate Nursing Degree from an NLN-Accredited School of Nursing
• Experience and knowledge of Managed Care: A minimum of two years nursing experience in Community Health or related field and/or minimum of two years of progressive job-related experience, including care management and coordination, education and supervision
• Demonstrates strong critical-thinking, problem-solving skills, and knowledge of Medicare and Medicaid
• Effective communication skills both written and oral
• Possesses strong critical thinking skills and knowledge of Medicare and Medicaid regulations
• Excellent analytical skills, interpretation of data
• Ability to set priorities and to handle multiple assignments
• Working knowledge of audit techniques and methodologies
• Secures relevant information to identify potential problems and makes recommendations for appropriate solutions
• Work effectively within interdisciplinary team environment
• Computer literate, Windows, Excel, Word, Visio and data base programs required. PowerPoint preferred
• Working knowledge of State and Federal regulations

• 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.

• 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.

• 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)

• Virtual based out of Schenectady NY

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.