Durasein Solid Surface Reviews Jobs in Usa
6,899 positions found — Page 3
C
Data Reviewer, QC
Salary not disclosed
Essential Functions of the job:
- Review and validate QC data and test records.
- Support investigations related to Out of Specification (OOS), Out of Trend (OOT), and Out of Expectation (OOE) results.
- Ensure compliance with current Good Manufacturing Practices (cGMP) in the laboratory.
- Assist in the technical documentation of investigations and change control assessments to evaluate the impact on product quality, in alignment with FDA/EU regulations, international standards
- Undertake other duties as required.
This position is ideal for candidates who are detail-oriented and committed to quality assurance in the pharmaceutical industry.
Education/Experience Required:
- Bachelor’s Degree or above in Chemistry, Biochemistry, or Biotechnology related scientific discipline. Scientific degree (ideally chemistry, biochemistry, biotechnology or related).
- Minimum 4 years working experience in an FDA-regulated biotechnology or pharmaceutical company is required.
- Working knowledge and experience with chemistry analytical methods such as HPLC, GC, TOC, Capillary Electrophoresis (CGE-Reduced, CGE-Non-Reduced, and Capillary Zone Electrophoresis), etc.
- Strong working knowledge with USP/EP and cGMP/EU GMP.
- Technical writing experience.
- Familiar with instrument and equipment validation.
- Impressive, demonstrable track record and skills/experience gained within a similar position(s), at a similar level.
- Credible and confident communicator (written and verbal) at all levels.
- Strong analytical and problem-solving ability.
- Hands-on approach, with a ‘can do’ attitude.
- Ability to prioritize, demonstrating good time management skills.
- Excellent attention to detail, with the ability to work accurately in a busy and demanding environment.
- Self-motivated, with the ability to work proactively using own initiative.
- Committed to learning and development
- Self-motivated, with the ability to work proactively using own initiative.
Computer Skills:
- Strong PC literacy required; MS Office skills (Outlook, Word, Excel, PowerPoint).
Travel:
- Must be willing to travel approximately 10%.
- Ability to work on a computer for extended periods of time.
Not Specified
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Hospital RN – Care Coordination & Utilization Review
Salary not disclosed
Immediate need for a talented Hospital RN – Care Coordination & Utilization Review . This is a 06+months contract opportunity with long-term potential and is located in San Jose, CA (Onsite). Please review the job description below and contact me ASAP if you are interested.
Job ID: 25-80861
Pay Range: $80 - $95/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
- Conduct utilization reviews using InterQual® / MCG®
- Support discharge planning and post-acute coordination
- Communicate with physicians, social work, and external providers
- Manage authorizations and payer-related workflows
- Maintain compliance with regulatory standards
Key Requirements and Technology Experience:
- Key Skills; CA RN License (Active)
- Acute inpatient hospital experience
- UM / Case Management / Discharge Planning background
Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.
Not Specified
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Health Service RN Reviewer - 251156
🏢 Medix™
Salary not disclosed
Job Title: Health Service Reviewers (RN)
Pay (openings for each location/market):
- Albany up to $52/hr
- Central Islip up to $60/hr
Overview: These RNs will be doing a mix of standard quality audits, complaint initiated investigations, and more. When they are onsite, the amount of time that they are at the location is dependent on the audit that is required. It is expected that Health Service Reviewers will be traveling onsite about 85% of the time.
These individuals will be traveling to IDD housing to do state required Recertification (must be done every 15 months) or investigating specific complaints (disease outbreak, falls, etc.).
Travel: 85% of this role is traveling to sites. It is more location based and they will be traveling to the counties that surround their location. If anyone is traveling and not able to return home, they are able to coordinate accomodations through the travel office and miles/food will be reimbursed at the federal rate. If they are not onsite, they can work from home or in the DOH office.
Summary: Based in NY, working at the direction of the New York State Department of Health (NYSDOH), Office of Aging and Long-Term Care, this individual will conduct surveillance and investigation activities related to Intermediate Care Facilities for Intermediate Care facilities for Individuals with Intellectual Disabilities (ICF/IDD). Duties include but are not limited to participating in surveys or complaint investigations, document finding, draft Statement of Deficiencies (SOD) within specified timeframes, testifying in administrative hearing ad needed.
The position is majority travel and will be onsite at facilities.
Qualifications:
- Strong interpersonal skills with the ability to communicate professionally with colleagues, supervisors, providers, medical and administrative personnel and residents/patients.
- Excellent communication (verbal & written) skills.
- Ability to work independently with minimal supervision.
- Ability to relate effectively to clinical and administrative personnel and patients.
- Computer proficiency with the ability to learn and understand new review programs and monitoring tools.
- Able to travel to on-site facility within New York State, required.
- Must have a valid driver's license & the ability to travel to on-site facilities review assignments.
Education/Experience:
- Registered Professional Nurse (RN). Currently licensed and registered in New York State, required.
- Bachelor’s degree, in any health care related field.
- Two (2) years clinical experience with individuals with intellectual disabilities or in developmental disability facilities and deemed QIDP (Qualified Intellectual Disability Professional and ability to meets the federal requirements for attaining QIDP Certification with six (6) months of hire date.
Hours: Monday-Friday 8am-5pm
Not Specified
I
Technical Evaluation Review Board/CCB Coordinator
Salary not disclosed
Insight Global is seeking Technical Evaluation Review Board/CCB Coordinator to join our team for an exciting opportunity to work on a unique government contract. The contract assists in acquisition and technical sustainment engineering and will augment government resources. The coordinator manages government technical review board submissions, ensuring all programs meet required deliverables and are fully prepared for review before board meetings. They control document accuracy, track changes, and maintain compliant review packages across all stakeholders. The role requires confidently driving engineers and IPTs to meet requirements and deadlines, including pushing back when inputs are incomplete. This is a highly organized, assertive position focused on accountability, readiness, and execution.
Must Haves:
- BS/MS in engineering/specialty area
- 7 yrs directly related experience (5 yrs with MS degree)
- Active secret level security clearance or higher
- Strong planning, coordination, and organizational skills with the ability to manage multiple priorities
- Demonstrated experience developing, maintaining, and assessing technical baselines within controlled programs
- Familiarity with engineering standards, manufacturing methods, and configuration management practices, including military and ASME-guided environments
- Working knowledge of technical drawing conventions and engineering documentation controls
- Proficiency with Microsoft Office tools to prepare data-driven reports, metrics, and formal documentation
- High attention to detail, strong writing and verbal communication skills, and the ability to manage time effectively
- Ability to sit on-site at Hill AFB in Clearfield, UT Monday-Wednesday
Plusses:
- Experience supporting configuration and data management activities within a defense or government program environment
- Working knowledge of Air Force or DoD engineering release processes, configuration control standards, and technical documentation lifecycle management
- Familiarity with Engineering Change Proposals (ECPs), Interface Control Documents (ICDs), and associated revision and audit activities
- Prior involvement with functional and physical configuration audits, including coordination with suppliers or government facilities
- Training or certification in configuration or data management disciplines (e.g., CMPIC or similar)
- Demonstrated ability to maintain and protect complex engineering baselines for hardware and software systems
- Strong judgment and decision-making skills aligned with regulatory, contractual, and policy requirements
- Commitment to continuous learning and maintaining up-to-date technical proficiency
Not Specified
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RN Clinical Review Nurse {167271}
Salary not disclosed
Clinical Review Nurse Schedule for Clinical Review Nurse Monday – Friday | 8:00 AM – 5:00 PM Interview Process for Clinical Review Nurse One virtual interview Job Overview for Clinical Review Nurse We are seeking an experienced Clinical Review Nurse to support the investigation and resolution of complex member and provider grievances, appeals, and disputes .
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 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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Not Specified
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Registered Nurse Clinical Review-Hybrid-Los Angeles, California
Salary not disclosed
The Clinical Consultant – RN provides clinical leadership, consultation, and oversight across care management programs.
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.
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.
Not Specified
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Clinical Data Review Pharmacist (onsite)
Salary not disclosed
A-Line Staffing is now hiring a Clinical Data Review Pharmacist in West Jordan, UT 84084.
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!
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!
Not Specified
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Care Review Clinician I
✦ New
Salary not disclosed
Job Title: Care Review Clinician I Location: 100% Remote Duration: 3 Months+ (temp to hire) Schedule: Wednesday
- 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
- 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
Not Specified
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Professional, Prospective Review RN
✦ New
$33.36 - 44.36
Join Us in Shaping the Future of Health Care
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 .
permanent
I
Proofreader/Document Reviewer
✦ New 🏢 Insight Global
Salary not disclosed
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.
Not Specified
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