Codex Github Review Jobs in Usa
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This role is responsible for conducting detailed clinical reviews, evaluating medical necessity, and ensuring compliance with applicable regulatory requirements and organizational policies.
The Clinical Review Nurse will collaborate with internal teams and medical leadership to ensure timely and accurate resolution of cases while maintaining high standards of care and service.
Key Responsibilities for Clinical Review Nurse Conduct investigations and clinical reviews of member and provider grievances and appeals related to medical necessity .
Review prospective, inpatient, and retrospective medical records associated with denied services.
Summarize and present medical findings for Medical Directors, consultants, and external reviewers .
Apply clinical guidelines, policies, and benefit plan documentation when evaluating cases.
Prepare recommendations to uphold or overturn determinations and submit to the Medical Director for final approval.
Ensure appeals, grievances, and disputes are resolved within required regulatory timelines .
Evaluate requests for expedited review and determine urgency criteria.
Document case details and maintain accurate records within relevant tracking systems.
Draft written correspondence for members, providers, and regulatory entities .
Communicate with members, providers, and internal staff to support resolution of clinical concerns.
Identify potential quality-of-care concerns and escalate appropriately.
Serve as a clinical resource and subject matter expert to assist team members with appeals and grievance resolution.
Participate in additional projects and duties as assigned.
Essential Functions for Clinical Review Nurse Conduct thorough investigations of appeals, grievances, and provider disputes .
Evaluate the appropriateness of care within contractual, regulatory, and accreditation standards.
Identify system or process issues that may impact member care or service expectations and recommend improvements.
Perform documentation, reporting, and analytical tasks related to case reviews.
Maintain compliance with organizational policies, regulatory requirements, and professional standards .
Minimum Qualifications for Clinical Review Nurse Education / Licensing Active and unrestricted California Registered Nurse (RN) license Bachelor’s degree preferred Experience for Clinical Review Nurse Minimum 3 years of acute care clinical experience Minimum 2 years of appeals and grievances casework Preferred Experience for Clinical Review Nurse Utilization Management or Quality Management Experience applying standardized clinical guidelines Familiarity with Milliman Care Guidelines (MCG) , Managed Care, and NCQA standards Additional Details for Clinical Review Nurse No direct supervisory responsibilities Collaborative role working with clinical, operational, and leadership teams If you are an experienced nurse with strong clinical review and case evaluation skills and are looking to contribute to a team focused on quality care and regulatory excellence, we encourage you to apply.
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This role supports interdisciplinary care teams serving individuals with complex medical, behavioral health, and social needs, including people experiencing homelessness, serious mental illness, substance use disorders, chronic disease, and socioeconomic instability.
The Clinical Consultant – RN partners with Care Managers, Behavioral Health clinicians, Primary Care Providers, hospitals, Managed Care Plans, and community-based organizations to ensure high-quality, whole-person, and evidence-based care.
This position plays a critical role in care planning, clinical decision-making, transitions of care, medication management, quality improvement, and staff development while addressing social determinants of health and system barriers to care.
Essential Duties and Responsibilities Clinical Oversight & Consultation Provide clinical support and consultation to Care Managers, and interdisciplinary care teams across care management programs.
Serve as a clinical resource for chronic disease management, medication monitoring, and complex case review.
Guide staff in ensuring member safety and provide immediate consultation and escalation support for high-risk clinical situations.
Ensure clinical services align with evidence-based practices, regulatory standards, and program contracts, including requirements with Managed Care Plans (MCPs).
Care Planning & Coordination Provide clinical oversight and tracking of comprehensive intake assessments.
Participate in the development, review, and approval of patient-centered care plans, including initial plans and required updates.
Monitor progress toward care plan goals and recommend adjustments based on clinical findings and data.
Collaborate with Primary Care Providers, Behavioral Health clinicians, specialists, ACOs, MCOs, hospitals, and community partners to ensure services outlined in care plans are delivered.
Coordinate hospital admissions, discharges, and transitions of care to promote continuity, safety, and prevent avoidable readmissions.
Perform timely medication reconciliation following transitions of care and support medication adherence.
Data, Quality Improvement & Compliance Use data to evaluate outcomes of targeted interventions and assist in modifying care plans and care strategies accordingly.
Participate in quality improvement initiatives, audits, peer reviews, and program evaluations conducted by internal leadership, health plans, or external administrators.
Monitor continuous quality improvement measures through documentation review, clinical consultation, and chart audits.
Oversee charting and documentation standards to ensure compliance with contracts, program requirements, and organizational policies.
Documentation & Systems Complete and review care plans, assessments, and case notes using required systems (e.g., Salesforce, EHRs, or health plan platforms).
Maintain accurate, timely, and compliant documentation using SMART format where applicable.
Ensure confidentiality and compliance with HIPAA and all applicable federal and state regulations.
Staff Development & Team Collaboration Provide staff development training, coaching, and clinical guidance for care management staff.
Participate in weekly, bi-weekly, and monthly interdisciplinary care team meetings to review client progress, evaluate program effectiveness, and develop strategies to enhance care delivery.
Present cases and clinical insights during scheduled case conferences.
Attend required trainings, webinars, meetings, and conferences to maintain clinical excellence and program knowledge.
Support and expand programming that addresses social determinants of health and strengthens connections to community-based organizations.
Promote monthly health promotion topics and materials aligned with program priorities.
Expectations & Professional Standards Prioritize client health, safety, dignity, and self-determination.
Communicate with professionalism, tact, and cultural humility.
Demonstrate the ability to work under pressure and manage multiple complex priorities.
Maintain strict confidentiality and ethical standards.
Adapt effectively to change and support continuous improvement.
Model openness, honesty, accountability, and teamwork.
Demonstrate sensitivity to cultural, linguistic, and socioeconomic diversity.
Adhere to organizational safety policies, compliance standards, and guiding principles.
Required Qualifications Active and unrestricted Registered Nurse (RN) license in the State of California, in good standing.
Experience working with vulnerable populations, including individuals with histories of trauma, homelessness, substance use disorders, serious mental illness, or socioeconomic stress.
Strong clinical assessment, critical thinking, and problem-solving skills.
Comfort working autonomously in community-based and outreach settings.
Experience using data to track outcomes and measure performance.
Basic computer proficiency, including email, spreadsheets, and electronic documentation.
Valid California Driver’s License and proof of auto liability insurance meeting state of California minimum requirements.
Knowledge and applied practice of HIPAA compliance and healthcare regulations.
Preferred Qualifications Bilingual in English and Spanish.
Partners in Care Foundation is an equal opportunity employer.
We are committed to complying with all federal, state, and local laws providing equal employment opportunities, and all other employment laws and regulations.
It is our intent to maintain a work environment which is free of harassment, discrimination, or retaliation because of age, race (including hair texture and protective hairstyles, such as braids, locks, and twists), color, national origin, ancestry, religion, sex, sexual orientation, pregnancy (including childbirth, lactation/breastfeeding, and related medical conditions), physical or mental disability, genetic information (including testing and characteristics, as well as those of family members), veteran status, uniformed service member status, gender, gender identity, gender expression, transgender status, arrest or conviction record, domestic violence victim status, credit history, unemployment status, caregiver status, sexual and reproductive health decisions, salary history or any other status protected by federal, state, or local laws.
All qualified applicants will receive consideration for employment and reasonable accommodations may be made to enable qualified individuals to perform the essential functions of the position.
Remote working/work at home options are available for this role.
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
The Senior Loan Review Associate resides in the Loan Review team, within Enterprise Risk Management. This position will help conduct loan reviews across the Bank’s non-consumer loan portfolios. This role involves analyzing financial information, collateral, and underwriting decisions to ensure compliance with Bank policies and regulatory guidelines. The analyst will evaluate the quality and condition of individual credit and determine appropriateness of risk ratings. The Senior Loan Review Associate consults and timely provides the VP, Loan Review an objective assessment of the credits reviewed.
Internal loan review provides management and the board with an objective, independent, and timely assessment of the overall quality of the non-consumer loan portfolios. The Senior Loan Review Associate is expected to validate the loan risk ratings based on the timely identification of problem loans by the business units so that necessary action can be taken to strengthen credit quality and minimize the Bank's credit loss. An effective credit risk review system identifies relevant trends that affect the quality of the loan portfolio and highlights portfolio segments that are potential problem areas.
After one year as our Senior Loan Review Associate you should be able to do the following confidently and independently...
- Conduct loan review analysis of non-consumer loans in the Bank's various portfolios. These reviews include:
1- Analyses of financial information, cash flow, collateral, loan documentation and underwriting decisions.
2- Analyzing Debt Service Coverage Ratio and/or covenant trends, and classified asset update/action plans.
3- Ensuring individual loan transactions are adequately underwritten and properly graded, conforming to Policy.
- Make recommendations for adjustments to the loan risk grade. Collaborate, confer and discuss results and recommendations with the VP, Loan Review and applicable credit personnel.
- If applicable, participate in targeted reviews as directed by the VP, Loan Review. For example, complete retrospective reviews (postmortem reviews) and lessons learned to identify issues/trends that may need improved in underwriting and/or asset management (control break downs), to prevent similar credit issues from occurring in the future.
- Identify relevant portfolio trends that may indicate changes in the credit risk.
- Work to develop and maintain functional partnerships with colleagues in the line of business to ensure effective communication and understanding of credit related processes.
- Promotes and maintains a positive work atmosphere by behaving and communicating in a positive, professional manner to work effectively with co-workers, management, partners, and vendors.
- Ensure compliance with all banking laws, rules, regulations, and prescribed policies/practices/procedures necessary to reduce risk and uphold ethical standards related to and required by one’s duties.
Requirements:
What we are looking for...
- Bachelor’s degree in a business-related or accounting field required with minimum of 5 years’ experience as a credit analyst, loan review associate or risk analyst of a steadily growing commercial portfolio.
- Knowledge in SBA, commercial & industrial, multi-family and healthcare lending and experience in banking or a financial services industry background preferred.
- Strong analytical and organization skills.
- Ability to influence at all levels of the organization through strong verbal and written communication skills as well as confidentiality required.
Our Benefits: Health, Vision, Dental, 401K, ESOP, 100% Tuition Assistance, 4 weeks paid time off, plus a few more.
About Merchants
Ranked as a top performing U.S. public bank by S&P Global Market Intelligence, Merchants Bancorp is a diversified bank holding company headquartered in Carmel, Indiana operating multiple segments, including Multi-family Mortgage Banking that offers multi-family housing and healthcare facility financing and servicing; Mortgage Warehousing that offers mortgage warehouse financing; and Banking that offers retail and correspondent residential mortgage banking, agricultural lending, and traditional community banking. Merchants Bancorp, with $18.8 billion in assets and $11.9 billion in deposits as of December 31, 2024, conducts its business primarily through its direct and indirect subsidiaries, Merchants Bank of Indiana, Merchants Capital Corp., Merchants Capital Investments, LLC, Merchants Capital Servicing, LLC, Merchants Asset Management, LLC, and Merchants Mortgage, a division of Merchants Bank of Indiana.
Merchants Bank and Merchants Capital have recently been honored with the 2025 USA Today Top Workplaces recognition, ranking 22nd nationally within the 500-999 employee category. This is the second year that Merchants has been recognized with this award. These accolades build on our strong history of workplace recognition, including being named a Best Place to Work in Indiana for seven consecutive years (2016–2022). For more information read the entire article here.
PM20 #CL
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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 .
Position Title: Medical Reviewer
Work Location: Remote
Assignment Duration: 12 Months
Job Description:
We are seeking a contract Medical Reviewer to support our international Botox Therapeutic Neurotoxin team. The ideal candidate will be responsible for the medical review of clinical and scientific data related to the use of Botox for various therapeutic indications.
Key responsibilities include ensuring the accuracy and compliance of content with regulatory and company standards, providing expert medical input on clinical documents and safety information, and collaborating with cross-functional teams globally.
Qualifications:
The candidate should have a medical degree (MD or equivalent), clinical experience in neurology, physical medicine, or related fields, and a solid understanding of regulatory requirements for therapeutic neurotoxins. Experience with Botox or neurotoxin therapies is strongly preferred. Excellent communication and detail-orientation are essential.
Must have experience as a Reviewer OUS, understanding regulatory complexities of international markets.
Position 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)
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.
