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Professional, Prospective Review RN
$33.36 - 44.36
Schenectady, NY 2 days ago
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
Physician / Non Clinical Physician Jobs / New York / Permanent / Utilization Review Physician
Salary not disclosed

The Utilization Review Physician collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical records for the patient population and Hackensack University Medical Center.

These include but are not limited to utilization review, hospital reimbursement, clinical compliance, case management, and transitions of care, as outlined in the responsibilities below.

Education, Knowledge, Skills and Abilities Required: 1.

permanent
Proofreader/Document Reviewer
✦ New
Salary not disclosed
Houston, TX 1 day ago

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
Review Assistant/CSR
✦ New
Salary not disclosed
Des moines, IA 1 day ago
Review Assistant II

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.

Not Specified
Document Review Attorney (Onsite Only)
Salary not disclosed

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.

Not Specified
Paralegal (Contracts & SOW Review)
✦ New
Salary not disclosed
Atlanta, Georgia 1 day ago

Paralegal (Contracts & SOW Review)

Our client is seeking a Paralegal to support contract review and remediation initiatives across third-party vendor agreements. This role is ideal for a paralegal with experience reviewing and revising Statements of Work (SOWs) and corporate vendor contracts in a fast-paced enterprise environment. You will work closely with procurement, legal, and business stakeholders to ensure agreements are accurate, compliant, and aligned with corporate governance standards.

As part of our process after applying, you may receive an invitation from our AI Recruiter Avery for a short conversation that lets you share more about your background beyond your resume. For questions, contact

• Location: Atlanta, GA (Hybrid)

• Compensation: This job is expected to pay about $32–$36/hr W2

• Job Type: Contract

• Duration: 12+ Month Contract (Potential to extend or convert to full-time)

• No Visa Sponsorship Available for this role

What You'll Do:

• Review and revise Statements of Work (SOWs) and vendor agreements to ensure contract terms align with internal policies and governance standards.

• Support ongoing contract remediation initiatives, analyzing contract language and coordinating updates with legal and procurement teams.

• Partner with procurement, category management, finance, and legal teams to ensure contracts accurately reflect scope, pricing, and service terms.

• Track contract revisions and maintain documentation throughout the contract lifecycle.

• Serve as a point of contact for stakeholders regarding contract updates, compliance questions, and agreement changes.

What Gets You the Job:

• 3–5 years of experience reviewing and revising corporate contracts or Statements of Work (SOWs).

• Paralegal experience required, preferably supporting corporate contracts or vendor agreements.

• Experience working in an enterprise or professional services environment.

• Bachelor's degree required; Paralegal certificate or legal studies background is a plus.

• Strong attention to detail with the ability to review and update contract language accurately.

• Excellent communication and stakeholder management skills.

Irvine Technology Corporation (ITC) connects top talent with exceptional opportunities in IT, Security, Engineering, and Design. From startups to Fortune 500s, we partner with leading companies nationwide. Our AI recruiter, Avery helps streamline the first step of your journey—so we can focus on what matters most: helping you grow. Join us. Let us ELEVATE your career!

Irvine Technology Corporation provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, sex, national origin, age, disability or genetics. In addition to federal law requirements, Irvine Technology Corporation complies with applicable state and local laws governing non-discrimination in employment in every location in which the company has facilities.

Not Specified
Attorney - Document Review
Salary not disclosed
New York, NY 3 days ago

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.

Not Specified
Associate Attorney - Pleading Review
Salary not disclosed
Akron, OH 3 days ago

At Javitch Block LLC, we are looking for dependable and enthusiastic people interested in building a career with our great firm. Javitch Block LLC (JB) is looking for a full-time Associate Attorney - Pleading Review to work in our Fairlawn office and your qualifications and skill set may be an ideal match for this exciting career opportunity.


The Pleading Review Attorney will be responsible for reviewing complaints, letters and other pleadings and determining whether we have sufficient grounds to proceed based upon Federal and State and Client regulations. As part of an organization, the Pleading Review Attorney is responsible for remaining in compliance with all protocols in line with our organization goals, strategy, and values. Secondary responsibilities may include court appearances, file management, and collections negotiations.


The Ideal Candidate:

  • Attorney will review pleadings for accurate information, including but not limited to, venue, balances, correct named parties, statute of limitations, proper documentation, proper theories of recovery
  • Attorney may assist in legal research to ensure pleadings and laws contained therein are up-to-date with applicable laws
  • Good communication skills
  • Strong pleading and complaint experience with a knowledge of collections related court documents.
  • Strong motivation, demonstrated by ability to work both independently and as part of a team.
  • Computer and word processing skills including Word, PowerPoint, Excel along with quick ability to learn new technical programs


Education/Training/Experience:

  • One (1) to two (2) years of experience in the Creditors’ Rights or Collection fields preferred.
  • Juris Doctor Degree (J.D.)
  • Must be licensed in state of Ohio
  • Intermediate knowledge of Microsoft Word, Excel


Javitch Block offers a comprehensive benefits program including health insurance, paid vacation/personal time, 401(k), life insurance, and short and long-term disability.


You can learn more about Javitch Block LLC at

Not Specified
Licensed Practitioner of the Healing Arts (LPHA) Reviewer
✦ New
Salary not disclosed
Peoria, Illinois 1 day ago
Overview
$10.000 sign on bonus and $2.500 relocation (greater than 50 miles). - External Applicants Only.
Under the general supervision of the Manager, Outpatient Community Services will serve as the Licensed Practitioner of the Healing Arts (LPHA) authorizing Integrated Assessment and Treatment Plans. Will complete thorough review of each document, provide clinical guidance to team members, and ensure compliance with IATP standards. LPHA reviewer provides behavioral health assessment, intervention, and consultation to individuals and/or groups identified as having behavioral health needs, plans treatment modalities, coordinates and follows treatment plans. Will provide crisis evaluation and intervention as needed. The LPHA Reviewer is recognized as a Licensed Practitioner of the Healing Arts under Medicaid Community-Based Mental Health Services Rule 140.
Qualifications
License/Certifications: LCPC, LCSW, LMFT
Education: Master's Degree
Other Knowledge/Skills:
Two years of experience in a behavioral health setting
Demonstrates an ability to apply critical thinking and problem-solving abilities to a range of client situations; has the ability to accurately assess and diagnose; can develop treatment plans and interventions with clients; possesses interpersonal skills, professional attitude and understands the ethical standards of behavioral healthcare. Able to interpret rules and regulations. Possesses good written and oral communication skills. Ability to provide clinical guidance to others. Has the ability to plan and organize their work. Is able to recognize signs of suicidal behavior, assess for lethality, and respond in a clinically appropriate manner.
Responsibilities
  • Serves as the LPHA for Integrated Assessment and Treatment Plan (IATP) Ensures the IATP is compliant with regulations and best practices
  • Provides clinical feedback and guidance to clinicians to ensure medical necessity and diagnosis are supported.
  • Ensures appropriate treatment recommendations Ensures completion of risk assessment and appropriate safety planning steps.
  • Ensures completion of all required screening and/or assessment tools and utilization of results in treatment planning.
  • Completes documentation supporting all activities related to review and authorization of the IATP.
  • Performs diagnostic assessments, collects diagnostic information, and determines immediate treatment plan needs with patients.
  • Requests medical consultation, where indicated, in a diligent and timely manner.
  • Completes treatment plan in conjunction with patient, identifying goals/objectives that are connected to needs identified in the assessment.
  • Provides behavioral health therapy to individuals, families and/or groups identified as having behavioral health needs.
  • Coordinates with Emergency Response Service and other crisis service teams for clients presenting who may be a danger to self or others.
  • Maintains records in accordance with TrilliumPlace policies, as well as state and federal oversight agencies and accreditation agencies including Joint Commission, Medicaid, Medicaid Rehabilitation Option, Illinois Department of Public Health, and Commercial Insurances.
  • Acts as a liaison and resource between the community and patient needs; coordinates treatment goals with community agencies, primary care physicians, court system, and managed-care entities.
  • May provide supervision to Carle Health clinicians who provide assessment and treatment.
  • May supervise counseling or social work students assigned to department.
  • Participates in in-service and competency training of students or staff. Prepares special reports as needed on activities, and work group activities.
  • Meets clinical productivity standards and compliance standards for all documentation and clinical charts.

About Us
Find it here.
Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. Find it all at Carle Health.
Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois. We've grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. We're developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world's first engineering-based medical school, and Methodist College. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet designations, the nation's highest honor for nursing care.
We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.
We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information:
Compensation and Benefits
Not Specified
Health Service RN Reviewer - 251156
Salary not disclosed
Albany, NY 3 days ago

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
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