Elevated Remodeling Reviews Jobs in Usa

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

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.

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.

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  Nurses review case files, add, update or edit authorizations.

  
  
  
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  Work closely with the MD team to make final decisions on cases.

  
  
  
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  Process clinical reviews to ensure members have access to care needed.

  
  
  
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  Help reduce provider abrasion by processing retrospective claim reviews.

  
  
  
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  Work closely with supervisors, senior clinicians, and the coordinator team on end-to-end case processes.

  
  
  
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  Participate in team collaboration via Teams group chats for routine questions.

  
  
  

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  Education/Certification (Required): Associate in nursing, Bachelor's in nursing or higher.

  
  
  
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  Licensure (Required): RN, LPN

  
  
  
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  Licensure (Preferred): LVN

  
  
  
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  Must haves:

  
  
  
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    Medicare knowledge

    
    
    
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    InterQual or Milliman Experience

    
    
    
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    Clinical reviews for Utilization Management or Appeals

    
    
    
  
  
  
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  Nice to haves:

  
  
  
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    Medicare Appeals Experience

    
    
    
  
  
  
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  Disqualifiers:

  
  
  
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    Not having a valid/active RN/LPN license

    
    
    
  
  
  
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  Performance indicators:

  
  
  
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    Productivity expectations vary based on platform.

    
    
    
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    Prime: 7 CPD

    
    
    
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    iCP: 9 CPD

    
    
    
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    CenPas: 20 CPD cases per day

    
    
    
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    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
    
    
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    • 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.
    
    
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    • Top 3 must-have hard skills
      
    • Level of experience with each
      
    • Stack-ranked by importance
      
    • Candidate Review & Selection
      
    
    
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    Utilization Management or Appeals review background (1 plus year)
    
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    Medicare NCD/LCD and InterQual/Milliman Software (1 plus year)
    
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    Retrospective claims clinical reviews (1 plus year)
    
    
  
  
  

• 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

Essential Functions:

• Knows, understands, incorporates and demonstrates the Trinity Mission, Vision and Values in behaviors, practices, standards policies procedures and decisions.
• Demonstrates understanding of appropriate clinical documentation to ensure the severity of illness, risk of mortality, quality indicators and level of services provided are accurately reflected in the health record.
• Communicates with and educates physicians and all other member of the healthcare team in clinical documentation and monitors provider engagement.
• Conducts concurrent reviews of selected patient health records to address legibility, clarity, completeness, consistency and precision of clinical documentation.
• Formulates compliant clarifications/queries following Trinity Health's documentation integrity procedures.

Minimum Qualifications:

• Must possess an Associate/Diploma Degree in Health Information Technology (HIT) or Advanced degree in nursing (NP, APN) or Physician Assistant. In absence of college degree, must have three (3) years' experience as an inpatient code or documentation specialist.
• Preferred Certifications: RN, RHIA, RHIT, CCS, CCDS or CDIP
• Experienced in critical care, medical or surgical inpatient care nursing as an RN, PA, NP, APN or inpatient coder preferred
• Excellent communication, interpersonal, collaboration and relationship building skills. Strong critical thinking skills, and ability integrate knowledge. Prioritization and organizations skills required.
• Demonstrated ability to use standardized desktop and Windows based computer system. Data entry and typing skills at minimum 30 wph.

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

JOB DESCRIPTION

We are seeking detail‑oriented Document Reviewers to ensure documents meet defined standards for accuracy, formatting, and compliance. In this role, you will systematically review and compare documents against established guidelines using structured checklists, identify inconsistencies, and proofread for quality and clarity. This position is ideal for individuals with strong attention to detail and experience in editing, proofreading, or document quality review.

Key Responsibilities:

• Meet productivity and quality benchmarks in a deadline‑driven environment of 100 assets/items per week.
• Review documents against predefined guidelines and standards using structured checklists..
• Compare documents for accuracy, consistency, and compliance with requirements.
• Identify and document errors, omissions, formatting issues, and inconsistencies.
• Proofread content for grammar, spelling, punctuation, and overall clarity.
• Verify document formatting, layout, and presentation align with established standards.
• Confirm documents have incorporated recommended changes
• Record findings clearly and escalate issues as needed.
• Maintain accuracy and consistency while handling repetitive review tasks.

REQUIRED:

• 2+ years of experience reviewing documents for accuracy on a daily basis.
• Strong attention to detail and ability to spot inconsistencies or errors.
• Excellent reading comprehension and written communication skills.
• Comfort working with structured checklists and completing repetitive tasks.

PREFERRED:

• Degree or coursework in English, Communications, Journalism, Writing, or a related field.
• Experience working with style guides or compliance‑based documentation.
• Familiarity with educational formatting standards and document comparison processes.

LOCATION:

• This role requires you to live in Houston, TX or a surrounding area, so you can be on-site at least once every three months for meetings etc.
• When not on-site, you can work from home.

HOURS:

• 7am – 3:30pm or 7:30am – 4pm CST.
• Monday – Friday.

DURATION:

• This is a contract job through April of 2027.

The Review Assistant II is responsible for inbound and outbound communication in support of case review activities including collection and confirmation of data integrity in support of clinical review services.

Essential functions include interpreting review guidelines to facilitate forward movement of the case review process including requests for clinical information, treatment plans, and more.

Ready to Rock Your Document Review Skills?

Hey legal eagles! Are you a newly licensed attorney looking for an exciting, long-term project that lets you flex your document review muscles? A fantastic firm in the Charleston, SC area is on the hunt for sharp onsite Document Review Attorneys to jump into an immediate, 6+ month gig. This isn't just another project; it's a chance to supercharge your resume and gain invaluable experience with a team that truly values you. Please note, if you have done extensive document review for Defense firms, you are likely conflicted out.

What You'll Be Doing as a Document Review Attorney (Your Superpower Moves!):

• Sleuthing through documents with precision and speed, using Relativity or other cool e-discovery software.
• Uncovering crucial information and sharing those "aha!" moments with your team leaders.
• Crafting top-notch litigation documents, like those all-important Deposition Dossiers.
• Tackling other fascinating tasks as your project leaders need a hand.

Who We're Searching For (Are You Our Next Superstar?):

• You've got that shiny JD from an ABA-accredited law school.
• You're either a licensed member of the SC Bar, or have a UBE score ready to transfer to SC, or are licensed in another state.
• You're a detail-oriented dynamo – thorough, organized, and nothing gets past your eagle eyes.
• You're a master of managing your time and can work independently like a pro.
• Your communication skills, both written and verbal, are top-notch.
• Bonus points if you're already a Relativity guru or have document review attorney experience, but no worries if not – we're ready to help you learn!
• You've got that natural knack for problem-solving.

The Sweet Deal (What's In It For You!):

• Competitive hourly rates ranging from $27 to $30.
• Subsidized health insurance for our awesome full-time reviewers!

Be ready to pass a comprehensive conflicts check! And rest assured, your resume is held in the strictest confidence.

Think you're a fit? We can't wait to hear from you! Apply at : This job description is not intended to be all-inclusive. The employee may perform other related duties as negotiated to meet the ongoing needs of the organization.

The WeCARE Physician is the role of Review Physician supports the Medical Director in the implementation of standard operation policies and procedures to ensure that UBA WeCARE complies with all New York City's HRA contractual requirements.

Key Responsibilities are:-To conduct medical reviews of Clinical Assessments/Clinical Reassessments for finalization, complete Wellness Plans dispositions for UBA WeCARE clients, and act as a clinical support for UBA WeCARE staff in the fulfillment of funder, (NYC HRA), contracted goals.

-Conduct medical reviews of Clinical Assessments completed by Qualified Health Professionals -Displays knowledge of medical conditions and SSA disability criteria.-Review prior WeCARE documentation, documentation provided by the client, prior and current Clinical Assessment/Clinical Reassessments, previous Medical Evaluation and Substance Use Assessment (when indicated).-Review, address, and correct any inconsistencies in the history obtained by the QHP-Order and review additional specialty assessments as indicated -Review and update Reasonable Accommodations and work limitations.-Determine appropriate medical diagnoses.

Assess the stability of client's medical issues.-Obtain medical documentation from EPIC, PSYCKES, and Bronx RHIO.-Enter information/complete appropriate forms in HRA (funder) database (SEAMS).

-Complete off-line/paper when medical record system SEAMS, is not functioning completely or is partially working.

-Ensure all off-line paper documents and medical records obtained from outside sources are scanned into SEAMS within 24 hours.

-Review the SSA sequential evaluation process conducted by the QHP to ensure accuracy.-Review provided wellness documentation from treatment providers -Check for medical documentation in EPIC, PSYCKES, and Bronx RHIO-Update and review reasonable accommodations and limitations-Ensure the FCO is correct and that the FCO justification contains relevant information -Review Wellness extensions with Medical Director and provide summary justifications for same-Able to assist and motivate clients to comply with WeCARE process.

Able to assist clients to access services to reduce barriers to compliance with WeCARE appointments.

-Knowledge of medical and behavioral health diagnoses.-Knowledge of various software systems including SEAMS, EPIC, PSYCKES, Bronx RHIO, etc.

-Possess strong computer skills with knowledge of Microsoft Office applications.

-Knowledge of SSA disability application process is preferred.Experience with NYC HRA preferred.Two years of professional experience in medical or clinical practice.Complete Wellness Enhancement Forms as indicated for Wellness track clients Medical and computer software (SEAMS, EPIC) and medical depository information databases (example PSYCKES, Bronx RHIO)In addition to a competitive salary of $180,000-220,000, we offer LTD, STD, paid malpractice, health, dental, vision and a 403(b).

Interested candidates should have a current unrestricted NYS Doctor of Medicine license to practice and American Board of Medical Specialties or American Osteopathic Association Board Certification and send an updated CV to Senior Recruiter, Desiree Aulet at Montefiore is an equal employment opportunity employer.

Montefiore will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.

The Opportunity:

A government agency seeks two admitted Document Review Attorneys for a short-term document review project scheduled to begin in early March with a duration of approximately four months. Must be available to work at least 35 hours weekly and additional hours, if needed. The hourly rate is $50, plus benefits.

Primary Duties:

The Document Review Attorneys will help coordinate the compliance review of filed election documents. Candidates must be comfortable navigating high volume and strict statutory timelines for review, hearings and providing notice and able to utilize the agency's digital systems for viewing scanned documents and generating letters. Additional duties include the following:

• Preparation of letters of non-compliance
• Compiling records for related hearings and litigation

Experience & Qualifications:

• New York State bar admission
• Minimum of 2- 5 years of legal experience
• Experience with digital document management systems

Frink-Hamlett Legal Solutions is an equal employment opportunity employer and all applicants will receive consideration for employment without discrimination based on race, color, creed, national origin, sex, age, disability, marital status, sexual orientation or citizenship status.