Framework Desktop Review Jobs in Usa

Conducts comprehensive clinical reviews of adverse determinations related to medical necessity.

Initiates outreach to providers to obtain clarification or additional documentation in alignment with established clinical criteria and organizational policies, to support Medical Director decision making.

Provides support for claim appeals in relation to medical necessity.

Ensures the timely and accurate resolution of appeal cases and supports organizational adherence to all state, federal, and accreditation standards.

Facilitates member second level appeal process.

Graduate from an accredited school of professional nursing is required.

BSN preferred.

Minimum 2 years acute care experience or managed care experience is required.

Basic knowledge of Medicaid, Medicare preferred.

Knowledge of InterQual screening criteria, ICD-10, CPT coding preferred.

Current Registered Nurse (RN) license to practice professional nursing issued by the Board of Nurse Examiners for the State of Texas is required.

Active Certification in Case Management (CCM) is preferred.

Conducts comprehensive clinical reviews of adverse determinations related to medical necessity.

Initiates outreach to providers to obtain clarification or additional documentation in alignment with established clinical criteria and organizational policies, to support Medical Director decision making.

Provides support for claim appeals in relation to medical necessity.

Ensures the timely and accurate resolution of appeal cases and supports organizational adherence to all state, federal, and accreditation standards.

Facilitates member second level appeal process.

Graduate from an accredited school of professional nursing is required.

BSN preferred.

Minimum 2 years acute care experience or managed care experience is required.

Basic knowledge of Medicaid, Medicare preferred.

Knowledge of InterQual screening criteria, ICD-10, CPT coding preferred.

Current Registered Nurse (RN) license to practice professional nursing issued by the Board of Nurse Examiners for the State of Texas is required.

Active Certification in Case Management (CCM) is preferred.

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.

This position coordinates utilization review service for defined patient populations across the acute care continuum. This includes discharge planning, utilization management, care coordination collaboration, and support for resource utilization. This position works collaboratively with an interdisciplinary team to improve patient care through the effective utilization of the facility's resources.

1. Current licensure as a Registered Nurse (RN) in the state of California is required.

2. Current American Heart Association (AHA) Healthcare Provider CPR card is preferred.

3. Degree from an accredited baccalaureate nursing program (BSN) is preferred.

4. Certified Case Manager (CCM) national certification is preferred.

5. Interquel training must be obtained within six (6) months of hire into position.

6. Previous experience in at least two (2) areas of clinical specialty in an acute care setting is required.

7. Excellent communication skills, critical thinking, creative problem-solving skills, and competent organizational and planning skills are required.

8. The incumbent must be self-directed and able to tolerate frequent interruptions with a demanding workload.

9. Knowledge regarding hospital protocol and procedures, clinical standards and outcomes, funding options, familiarity with community resources and outside professional agencies, familiarity with federal and state regulations governing hospital and home care, as well as understanding of the financial structure of health plan and delivery system is preferred.

Pay Range:

$49.47 - 71.74

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.

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.

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.

At Tata Technologies we make product development dreams a reality by designing, engineering, and validating the products of tomorrow for the world's leading manufacturers. Due to our continued growth, we are now recruiting for a Quality Review Coordinator (Quality Engineer) to strengthen our team in Columbus, GA.

Quality Review Coordinator (Quality Engineer)

Job Location: Columbus, GA

Duration: Full time

Citizenship Requirement: U.S. Citizen

Key Responsibilities:

Good understanding of Engine Manuals and other pertinent instruction and/or Approved Technical Data

Perform necessary mathematical computations to determine extent of nonconformance and complete appropriate paperwork.

Review and document previous history including part characteristic yield information when required by procedure or determining disposition recommendation.

Disposition basic Rework, Scrap, RTV tasks; Invoke repairs authorized by MRB via approved SRP and recommended Accept/Repair under the guidance of lead.

(Verifies/documents nonconforming characteristic classification of features being dispositioned.

Attach/record partner MRB dispositions.

Basic Qualifications:

High School Diploma or equivalent

U.S. citizenship is required, as only U.S. citizens are authorized to access information under this program/contract.

Preferred Qualifications:

1 year of inspection/quality experience required.

Previously approved by the MRB

Additional Information:

Must be a U.S. Citizen. This position may require access to systems/tools that are restricted to individuals who possess US citizenship.

Equal Opportunity Statement:

Tata Technologies Inc. is an Equal Opportunity/ Affirmative Action employer. We provide equal employment opportunities to all qualified employees and applicants for employment without regard to race, religion, sex, age, marital status, national origin, sexual orientation, citizenship status, veteran status, disability, or any other legally protected status. We prohibit discrimination in decisions concerning recruitment, hiring, compensation, benefits, training, termination, promotions, or any other condition of employment or career development.

Tata Technologies: Engineering a better world.

Tata Technologies would like to thank all applicants for their interest, each application will be reviewed against the set criteria for the role. We would like to advise that only candidates under consideration will be contacted. If you do not hear from us within 10 working days following the closing date it will mean that unfortunately your application has not been successful. We will however retain your details for any suitable future opportunities.

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.

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.

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