Ghost Rx Reviews Jobs in Usa
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Join the team leading the next evolution of virtual care.
At Teladoc Health, you are empowered to bring your true self to work while helping millions of people live their healthiest lives.
Here you will be part of a high-performance culture where colleagues embrace challenges, drive transformative solutions, and create opportunities for growth. Together, we're transforming how better health happens.
Summary of Position
The RX Fulfillment Coordinator plays an integral part in ensuring superior care of patients treated through Teladoc. The RX Fulfillment Coordinator will apply professional knowledge in processing prescriptions ordered by Teladoc providers (either via telephone or electronically), support Teladoc providers as dictated by established policies and guidelines, and provide member support by phone or electronic messages.
Essential Duties and Responsibilities
Deliver exceptional service to members, providers, and pharmacies, representing Teladoc in a professional and courteous manner through a variety of communication channels including incoming and outgoing calls and emails.
Apply professional knowledge to ensure prescriptions are processed accurately and in a timely manner under supervision of prescriber and supervisor in a call-center environment.
Provide direct support to Teladoc providers as needed
Receive escalated calls from patients or providers and de-escalate these calls to a reasonable outcome for all parties.
Initiate and submit prior-authorization requests on-line to health insurance carriers.
Manage daily task list to meet department performance metric goals.
Maintain detailed and accurate case documentation in admin system, including description of issue and resolution.
Maintain confidentiality of issues and adheres to all applicable regulations, including HIPAA.
Other duties, as assigned.
Required Qualifications
High school diploma required
Active Pharmacy Technician (National) Certification, Medical Assistant Certification, or Licensed Practical/Vocational nurse license.
Prior experience in a call center environment preferred
Minimum 2-year experience as a Pharmacy Tech, Medical Assistant or LPN/LVN
Minimum of 1-year experience in a call center environment
Bilingual (English/Spanish) a plus
Ability to receive work instruction and maintain department productivity standards
Team player with ability to work in a fast-paced call-center environment while maintaining focus and sense of accuracy
Knowledge of Healthcare and medical terminology, with a high level of prescription medication familiarity
Must be able to work independently but recognize when escalation is warranted
Exceptional customer service skills
Excellent written and verbal communications skills
Must possess strong time management and organizational skills
Possess high degree of computer literacy and ability to manage multiple systems
Ability to learn new procedures and adapt to changes in working environment
Able to multitask with regular interruptions while maintaining a high degree of accuracy
Ability to handle confidential information with discretion
Willing to work outside of established hours when needed
The base salary range for this position is $20/hr - $22/hr.In addition to a base salary, this position is eligible for a performance bonus and benefits (subject to eligibility requirements) listed here:Teladoc Health Benefits 2026.Total compensation is based on several factors including, but not limited to, type of position, location, education level, work experience, and certifications.This information is applicable for all full-time positions.
During your first year of service, you will accrue 5.84 hours of PTO for each bi-weekly pay period. In addition, you will receive 80 hours of Paid Sick, Safe, and Caregiver Leave annually. This applies to full-time positions only. If you are applying for a part-time role, your recruiter can provide additional details.
As part of our hiring process, we verify identity and credentials, conduct interviews (live or video), and screen for fraud or misrepresentation. Applicants who falsify information will be disqualified.
Teladoc Health will not sponsor or transfer employment work visas for this position. Applicants must be currently authorized to work in the United States without the need for visa sponsorship now or in the future.
Why join Teladoc Health?
Teladoc Health is transforming how better health happens. Learn how when you join us in pursuit of our impactful mission.
Chart your career path with meaningful opportunities that empower you to grow, lead, and make a difference.
Join a multi-faceted community that celebrates each colleague's unique perspective and is focused on continually improving, each and every day.
Contribute to an innovative culture where fresh ideas are valued as we increase access to care in new ways.
Enjoy an inclusive benefits program centered around you and your family, with tailored programs that address your unique needs.
Explore candidate resources with tips and tricks from Teladoc Health recruiters and learn more about our company culture by exploring #TeamTeladocHealth on LinkedIn.
As an Equal Opportunity Employer, we never have and never will discriminate against any job candidate or employee due to age, race, religion, color, ethnicity, national origin, gender, gender identity/expression, sexual orientation, membership in an employee organization, medical condition, family history, genetic information, veteran status, marital status, parental status, or pregnancy). In our innovative and inclusive workplace, we prohibit discrimination and harassment of any kind.
Teladoc Health respects your privacy and is committed to maintaining the confidentiality and security of your personal information. In furtherance of your employment relationship with Teladoc Health, we collect personal information responsibly and in accordance with applicable data privacy laws, including but not limited to, the California Consumer Privacy Act (CCPA). Personal information is defined as: Any information or set of information relating to you, including (a) all information that identifies you or could reasonably be used to identify you, and (b) all information that any applicable law treats as personal information. Teladoc Health's Notice of Privacy Practices for U.S. Employees' Personal information is available at this link.
Who We Are
As the nation's largest producer of clean, carbon-free energy, Constellation is focused on our purpose: accelerating the transition to a carbon-free future. We have been the leader in clean energy production for more than a decade, and we are cultivating a workplace where our employees can grow, thrive, and contribute.
Our culture and employee experience make it clear: We are powered by passion and purpose. Together, we're creating healthier communities and a cleaner planet, and our people are the driving force behind our success. At Constellation, you can build a fulfilling career with opportunities to learn, grow and make an impact. By doing our best work and meeting new challenges, we can accomplish great things and help fight climate change. Join us to lead the clean energy future.
Total Rewards
Constellation offers a wide range of benefits and rewards to help our employees thrive professionally and personally. We provide competitive compensation and benefits that support both employees and their families, helping them prepare for the future. In addition to highly competitive salaries, we offer a bonus program, 401(k) with company match, employee stock purchase program comprehensive medical, dental and vision benefits, including a robust wellness program paid time off for vacation, holidays, and sick days and much more.
Expected salary range of $117,900 to $131,000, varies based on experience, along with comprehensive benefits package that includes bonus and 401(k).
Primary Purpose of Position
Performs advanced technical/engineering problem solving in support of nuclear plant operations. Responsible for technical decisions. Possesses excellent knowledge in functional discipline and its practical application and has detailed knowledge of applicable industry codes and regulations.
Primary Duties and Accountabilities
- Provide in-depth technical expertise to develop, manage and implement engineering analysis, activities and programs.
- Provide technical expertise and consultation through direct involvement to identify and resolve equipment and system problems.
- Provide complete task management of engineering issues.
- Perform engineering and technical tasks as assigned by supervision applying general engineering principles
- Accountable for the accuracy, completeness, and timeliness of work ensuring proper configuration management and assuring that standard design criteria, practices, procedures and codes are used in preparation of plans and specifications.
- Perform independent research, reviews, studies and analyses in support of regulatory/technical projects and programs.
- Recommend equipment, new concepts and techniques to improve performance, simplify construction, reduce costs, correct design or material flaws, or comply with changes in codes or regulations.
- Must be willing to travel 10-50% of time, which may be to another Constellation Clean Energy Center.
- All other job assignments and/or duties pursuant to company policy or as directed by management to include but not limited to: (positions outside of department in support of outage activities etc.)
Minimum Qualifications
- Bachelor's degree in engineering (chemical, civil/structural, electrical, industrial, mechanical or nuclear) or technical discipline (e.g. chemistry, computer science, mathematics, or physics) with 5 years of industry experience or 3 years of Constellation Reactor Services department experience OR
- Current or previous Senior Reactor Operator license with 5 years of industry experience or 3 years of Constellation Reactor Services experience department OR
- Associates/non-technical 4-year degree/completion or a relevant, skilled trades apprenticeship program (e.g., boilermaker, pipefitter, operating engineer) with 7 years of industry experience or 5 years of Constellation Reactor Services department experience OR
- High school diploma/GED with 9 years of industry experience or 7 years Constellation Reactor Services experience department
- Maintain minimum access requirement or unescorted access requirements, as applicable, and favorable medical examination and/or testing in accordance with position duties
Preferred Qualifications
- Professional Engineer Certification
- Advanced technical degree or related coursework
- Design Engineering Qualifications
- Fuel Handling Qualifications and Experience
- Lifting and Rigging Experience
- Master Rigger Qualification
- Work Planning Qualifications
- Procedure Revision Experience
- Supervisory Qualifications and Experience
- P6 Scheduling Experience
Who We Are
As the nation's largest producer of clean, carbon-free energy, Constellation is focused on our purpose: accelerating the transition to a carbon-free future. We have been the leader in clean energy production for more than a decade, and we are cultivating a workplace where our employees can grow, thrive, and contribute.
Our culture and employee experience make it clear: We are powered by passion and purpose. Together, we're creating healthier communities and a cleaner planet, and our people are the driving force behind our success. At Constellation, you can build a fulfilling career with opportunities to learn, grow and make an impact. By doing our best work and meeting new challenges, we can accomplish great things and help fight climate change. Join us to lead the clean energy future.
Total Rewards
Constellation offers a wide range of benefits and rewards to help our employees thrive professionally and personally. We provide competitive compensation and benefits that support both employees and their families, helping them prepare for the future. In addition to highly competitive salaries, we offer a bonus program, 401(k) with company match, employee stock purchase program comprehensive medical, dental and vision benefits, including a robust wellness program paid time off for vacation, holidays, and sick days and much more.
Expected salary range of $117,900 to $131,000, varies based on experience, along with comprehensive benefits package that includes bonus and 401(k).
Primary Purpose of Position
Performs advanced technical/engineering problem solving in support of nuclear plant operations. Responsible for technical decisions. Possesses excellent knowledge in functional discipline and its practical application and has detailed knowledge of applicable industry codes and regulations.
Primary Duties and Accountabilities
- Provide in-depth technical expertise to develop, manage and implement engineering analysis, activities and programs.
- Provide technical expertise and consultation through direct involvement to identify and resolve equipment and system problems.
- Provide complete task management of engineering issues.
- Perform engineering and technical tasks as assigned by supervision applying general engineering principles
- Accountable for the accuracy, completeness, and timeliness of work ensuring proper configuration management and assuring that standard design criteria, practices, procedures and codes are used in preparation of plans and specifications.
- Perform independent research, reviews, studies and analyses in support of regulatory/technical projects and programs.
- Recommend equipment, new concepts and techniques to improve performance, simplify construction, reduce costs, correct design or material flaws, or comply with changes in codes or regulations.
- Must be willing to travel 10-50% of time, which may be to another Constellation Clean Energy Center.
- All other job assignments and/or duties pursuant to company policy or as directed by management to include but not limited to: (positions outside of department in support of outage activities etc.)
Minimum Qualifications
- Bachelor's degree in engineering (chemical, civil/structural, electrical, industrial, mechanical or nuclear) or technical discipline (e.g. chemistry, computer science, mathematics, or physics) with 5 years of industry experience or 3 years of Constellation Reactor Services department experience OR
- Current or previous Senior Reactor Operator license with 5 years of industry experience or 3 years of Constellation Reactor Services experience department OR
- Associates/non-technical 4-year degree/completion or a relevant, skilled trades apprenticeship program (e.g., boilermaker, pipefitter, operating engineer) with 7 years of industry experience or 5 years of Constellation Reactor Services department experience OR
- High school diploma/GED with 9 years of industry experience or 7 years Constellation Reactor Services experience department
- Maintain minimum access requirement or unescorted access requirements, as applicable, and favorable medical examination and/or testing in accordance with position duties
Preferred Qualifications
- Professional Engineer Certification
- Advanced technical degree or related coursework
- Design Engineering Qualifications
- Fuel Handling Qualifications and Experience
- Lifting and Rigging Experience
- Master Rigger Qualification
- Work Planning Qualifications
- Procedure Revision Experience
- Supervisory Qualifications and Experience
- P6 Scheduling Experience
Who We Are
As the nation's largest producer of clean, carbon-free energy, Constellation is focused on our purpose: accelerating the transition to a carbon-free future. We have been the leader in clean energy production for more than a decade, and we are cultivating a workplace where our employees can grow, thrive, and contribute.
Our culture and employee experience make it clear: We are powered by passion and purpose. Together, we're creating healthier communities and a cleaner planet, and our people are the driving force behind our success. At Constellation, you can build a fulfilling career with opportunities to learn, grow and make an impact. By doing our best work and meeting new challenges, we can accomplish great things and help fight climate change. Join us to lead the clean energy future.
Total Rewards
Constellation offers a wide range of benefits and rewards to help our employees thrive professionally and personally. We provide competitive compensation and benefits that support both employees and their families, helping them prepare for the future. In addition to highly competitive salaries, we offer a bonus program, 401(k) with company match, employee stock purchase program comprehensive medical, dental and vision benefits, including a robust wellness program paid time off for vacation, holidays, and sick days and much more.
Expected salary range of $117,900 to $131,000, varies based on experience, along with comprehensive benefits package that includes bonus and 401(k).
Primary Purpose of Position
Performs advanced technical/engineering problem solving in support of nuclear plant operations. Responsible for technical decisions. Possesses excellent knowledge in functional discipline and its practical application and has detailed knowledge of applicable industry codes and regulations.
Primary Duties and Accountabilities
- Provide in-depth technical expertise to develop, manage and implement engineering analysis, activities and programs.
- Provide technical expertise and consultation through direct involvement to identify and resolve equipment and system problems.
- Provide complete task management of engineering issues.
- Perform engineering and technical tasks as assigned by supervision applying general engineering principles
- Accountable for the accuracy, completeness, and timeliness of work ensuring proper configuration management and assuring that standard design criteria, practices, procedures and codes are used in preparation of plans and specifications.
- Perform independent research, reviews, studies and analyses in support of regulatory/technical projects and programs.
- Recommend equipment, new concepts and techniques to improve performance, simplify construction, reduce costs, correct design or material flaws, or comply with changes in codes or regulations.
- Must be willing to travel 10-50% of time, which may be to another Constellation Clean Energy Center.
- All other job assignments and/or duties pursuant to company policy or as directed by management to include but not limited to: (positions outside of department in support of outage activities etc.)
Minimum Qualifications
- Bachelor's degree in engineering (chemical, civil/structural, electrical, industrial, mechanical or nuclear) or technical discipline (e.g. chemistry, computer science, mathematics, or physics) with 5 years of industry experience or 3 years of Constellation Reactor Services department experience OR
- Current or previous Senior Reactor Operator license with 5 years of industry experience or 3 years of Constellation Reactor Services experience department OR
- Associates/non-technical 4-year degree/completion or a relevant, skilled trades apprenticeship program (e.g., boilermaker, pipefitter, operating engineer) with 7 years of industry experience or 5 years of Constellation Reactor Services department experience OR
- High school diploma/GED with 9 years of industry experience or 7 years Constellation Reactor Services experience department
- Maintain minimum access requirement or unescorted access requirements, as applicable, and favorable medical examination and/or testing in accordance with position duties
Preferred Qualifications
- Professional Engineer Certification
- Advanced technical degree or related coursework
- Design Engineering Qualifications
- Fuel Handling Qualifications and Experience
- Lifting and Rigging Experience
- Master Rigger Qualification
- Work Planning Qualifications
- Procedure Revision Experience
- Supervisory Qualifications and Experience
- P6 Scheduling Experience
Who We Are
As the nation's largest producer of clean, carbon-free energy, Constellation is focused on our purpose: accelerating the transition to a carbon-free future. We have been the leader in clean energy production for more than a decade, and we are cultivating a workplace where our employees can grow, thrive, and contribute.
Our culture and employee experience make it clear: We are powered by passion and purpose. Together, we're creating healthier communities and a cleaner planet, and our people are the driving force behind our success. At Constellation, you can build a fulfilling career with opportunities to learn, grow and make an impact. By doing our best work and meeting new challenges, we can accomplish great things and help fight climate change. Join us to lead the clean energy future.
Total Rewards
Constellation offers a wide range of benefits and rewards to help our employees thrive professionally and personally. We provide competitive compensation and benefits that support both employees and their families, helping them prepare for the future. In addition to highly competitive salaries, we offer a bonus program, 401(k) with company match, employee stock purchase program comprehensive medical, dental and vision benefits, including a robust wellness program paid time off for vacation, holidays, and sick days and much more.
Expected salary range of $117,900 to $131,000, varies based on experience, along with comprehensive benefits package that includes bonus and 401(k).
Primary Purpose of Position
Performs advanced technical/engineering problem solving in support of nuclear plant operations. Responsible for technical decisions. Possesses excellent knowledge in functional discipline and its practical application and has detailed knowledge of applicable industry codes and regulations.
Primary Duties and Accountabilities
- Provide in-depth technical expertise to develop, manage and implement engineering analysis, activities and programs.
- Provide technical expertise and consultation through direct involvement to identify and resolve equipment and system problems.
- Provide complete task management of engineering issues.
- Perform engineering and technical tasks as assigned by supervision applying general engineering principles
- Accountable for the accuracy, completeness, and timeliness of work ensuring proper configuration management and assuring that standard design criteria, practices, procedures and codes are used in preparation of plans and specifications.
- Perform independent research, reviews, studies and analyses in support of regulatory/technical projects and programs.
- Recommend equipment, new concepts and techniques to improve performance, simplify construction, reduce costs, correct design or material flaws, or comply with changes in codes or regulations.
- Must be willing to travel 10-50% of time, which may be to another Constellation Clean Energy Center.
- All other job assignments and/or duties pursuant to company policy or as directed by management to include but not limited to: (positions outside of department in support of outage activities etc.)
Minimum Qualifications
- Bachelor's degree in engineering (chemical, civil/structural, electrical, industrial, mechanical or nuclear) or technical discipline (e.g. chemistry, computer science, mathematics, or physics) with 5 years of industry experience or 3 years of Constellation Reactor Services department experience OR
- Current or previous Senior Reactor Operator license with 5 years of industry experience or 3 years of Constellation Reactor Services experience department OR
- Associates/non-technical 4-year degree/completion or a relevant, skilled trades apprenticeship program (e.g., boilermaker, pipefitter, operating engineer) with 7 years of industry experience or 5 years of Constellation Reactor Services department experience OR
- High school diploma/GED with 9 years of industry experience or 7 years Constellation Reactor Services experience department
- Maintain minimum access requirement or unescorted access requirements, as applicable, and favorable medical examination and/or testing in accordance with position duties
Preferred Qualifications
- Professional Engineer Certification
- Advanced technical degree or related coursework
- Design Engineering Qualifications
- Fuel Handling Qualifications and Experience
- Lifting and Rigging Experience
- Master Rigger Qualification
- Work Planning Qualifications
- Procedure Revision Experience
- Supervisory Qualifications and Experience
- P6 Scheduling Experience
Who We Are
As the nation's largest producer of clean, carbon-free energy, Constellation is focused on our purpose: accelerating the transition to a carbon-free future. We have been the leader in clean energy production for more than a decade, and we are cultivating a workplace where our employees can grow, thrive, and contribute.
Our culture and employee experience make it clear: We are powered by passion and purpose. Together, we're creating healthier communities and a cleaner planet, and our people are the driving force behind our success. At Constellation, you can build a fulfilling career with opportunities to learn, grow and make an impact. By doing our best work and meeting new challenges, we can accomplish great things and help fight climate change. Join us to lead the clean energy future.
Total Rewards
Constellation offers a wide range of benefits and rewards to help our employees thrive professionally and personally. We provide competitive compensation and benefits that support both employees and their families, helping them prepare for the future. In addition to highly competitive salaries, we offer a bonus program, 401(k) with company match, employee stock purchase program comprehensive medical, dental and vision benefits, including a robust wellness program paid time off for vacation, holidays, and sick days and much more.
Expected salary range of $117,900 to $131,000, varies based on experience, along with comprehensive benefits package that includes bonus and 401(k).
Primary Purpose of Position
Performs advanced technical/engineering problem solving in support of nuclear plant operations. Responsible for technical decisions. Possesses excellent knowledge in functional discipline and its practical application and has detailed knowledge of applicable industry codes and regulations.
Primary Duties and Accountabilities
- Provide in-depth technical expertise to develop, manage and implement engineering analysis, activities and programs.
- Provide technical expertise and consultation through direct involvement to identify and resolve equipment and system problems.
- Provide complete task management of engineering issues.
- Perform engineering and technical tasks as assigned by supervision applying general engineering principles
- Accountable for the accuracy, completeness, and timeliness of work ensuring proper configuration management and assuring that standard design criteria, practices, procedures and codes are used in preparation of plans and specifications.
- Perform independent research, reviews, studies and analyses in support of regulatory/technical projects and programs.
- Recommend equipment, new concepts and techniques to improve performance, simplify construction, reduce costs, correct design or material flaws, or comply with changes in codes or regulations.
- Must be willing to travel 10-50% of time, which may be to another Constellation Clean Energy Center.
- All other job assignments and/or duties pursuant to company policy or as directed by management to include but not limited to: (positions outside of department in support of outage activities etc.)
Minimum Qualifications
- Bachelor's degree in engineering (chemical, civil/structural, electrical, industrial, mechanical or nuclear) or technical discipline (e.g. chemistry, computer science, mathematics, or physics) with 5 years of industry experience or 3 years of Constellation Reactor Services department experience OR
- Current or previous Senior Reactor Operator license with 5 years of industry experience or 3 years of Constellation Reactor Services experience department OR
- Associates/non-technical 4-year degree/completion or a relevant, skilled trades apprenticeship program (e.g., boilermaker, pipefitter, operating engineer) with 7 years of industry experience or 5 years of Constellation Reactor Services department experience OR
- High school diploma/GED with 9 years of industry experience or 7 years Constellation Reactor Services experience department
- Maintain minimum access requirement or unescorted access requirements, as applicable, and favorable medical examination and/or testing in accordance with position duties
Preferred Qualifications
- Professional Engineer Certification
- Advanced technical degree or related coursework
- Design Engineering Qualifications
- Fuel Handling Qualifications and Experience
- Lifting and Rigging Experience
- Master Rigger Qualification
- Work Planning Qualifications
- Procedure Revision Experience
- Supervisory Qualifications and Experience
- P6 Scheduling Experience
Who We Are
As the nation's largest producer of clean, carbon-free energy, Constellation is focused on our purpose: accelerating the transition to a carbon-free future. We have been the leader in clean energy production for more than a decade, and we are cultivating a workplace where our employees can grow, thrive, and contribute.
Our culture and employee experience make it clear: We are powered by passion and purpose. Together, we're creating healthier communities and a cleaner planet, and our people are the driving force behind our success. At Constellation, you can build a fulfilling career with opportunities to learn, grow and make an impact. By doing our best work and meeting new challenges, we can accomplish great things and help fight climate change. Join us to lead the clean energy future.
Total Rewards
Constellation offers a wide range of benefits and rewards to help our employees thrive professionally and personally. We provide competitive compensation and benefits that support both employees and their families, helping them prepare for the future. In addition to highly competitive salaries, we offer a bonus program, 401(k) with company match, employee stock purchase program comprehensive medical, dental and vision benefits, including a robust wellness program paid time off for vacation, holidays, and sick days and much more.
Expected salary range of $117,900 to $131,000, varies based on experience, along with comprehensive benefits package that includes bonus and 401(k).
Primary Purpose of Position
Performs advanced technical/engineering problem solving in support of nuclear plant operations. Responsible for technical decisions. Possesses excellent knowledge in functional discipline and its practical application and has detailed knowledge of applicable industry codes and regulations.
Primary Duties and Accountabilities
- Provide in-depth technical expertise to develop, manage and implement engineering analysis, activities and programs.
- Provide technical expertise and consultation through direct involvement to identify and resolve equipment and system problems.
- Provide complete task management of engineering issues.
- Perform engineering and technical tasks as assigned by supervision applying general engineering principles
- Accountable for the accuracy, completeness, and timeliness of work ensuring proper configuration management and assuring that standard design criteria, practices, procedures and codes are used in preparation of plans and specifications.
- Perform independent research, reviews, studies and analyses in support of regulatory/technical projects and programs.
- Recommend equipment, new concepts and techniques to improve performance, simplify construction, reduce costs, correct design or material flaws, or comply with changes in codes or regulations.
- Must be willing to travel 10-50% of time, which may be to another Constellation Clean Energy Center.
- All other job assignments and/or duties pursuant to company policy or as directed by management to include but not limited to: (positions outside of department in support of outage activities etc.)
Minimum Qualifications
- Bachelor's degree in engineering (chemical, civil/structural, electrical, industrial, mechanical or nuclear) or technical discipline (e.g. chemistry, computer science, mathematics, or physics) with 5 years of industry experience or 3 years of Constellation Reactor Services department experience OR
- Current or previous Senior Reactor Operator license with 5 years of industry experience or 3 years of Constellation Reactor Services experience department OR
- Associates/non-technical 4-year degree/completion or a relevant, skilled trades apprenticeship program (e.g., boilermaker, pipefitter, operating engineer) with 7 years of industry experience or 5 years of Constellation Reactor Services department experience OR
- High school diploma/GED with 9 years of industry experience or 7 years Constellation Reactor Services experience department
- Maintain minimum access requirement or unescorted access requirements, as applicable, and favorable medical examination and/or testing in accordance with position duties
Preferred Qualifications
- Professional Engineer Certification
- Advanced technical degree or related coursework
- Design Engineering Qualifications
- Fuel Handling Qualifications and Experience
- Lifting and Rigging Experience
- Master Rigger Qualification
- Work Planning Qualifications
- Procedure Revision Experience
- Supervisory Qualifications and Experience
- P6 Scheduling Experience
Who We Are
As the nation's largest producer of clean, carbon-free energy, Constellation is focused on our purpose: accelerating the transition to a carbon-free future. We have been the leader in clean energy production for more than a decade, and we are cultivating a workplace where our employees can grow, thrive, and contribute.
Our culture and employee experience make it clear: We are powered by passion and purpose. Together, we're creating healthier communities and a cleaner planet, and our people are the driving force behind our success. At Constellation, you can build a fulfilling career with opportunities to learn, grow and make an impact. By doing our best work and meeting new challenges, we can accomplish great things and help fight climate change. Join us to lead the clean energy future.
Total Rewards
Constellation offers a wide range of benefits and rewards to help our employees thrive professionally and personally. We provide competitive compensation and benefits that support both employees and their families, helping them prepare for the future. In addition to highly competitive salaries, we offer a bonus program, 401(k) with company match, employee stock purchase program comprehensive medical, dental and vision benefits, including a robust wellness program paid time off for vacation, holidays, and sick days and much more.
Expected salary range of $117,900 to $131,000, varies based on experience, along with comprehensive benefits package that includes bonus and 401(k).
Primary Purpose of Position
Performs advanced technical/engineering problem solving in support of nuclear plant operations. Responsible for technical decisions. Possesses excellent knowledge in functional discipline and its practical application and has detailed knowledge of applicable industry codes and regulations.
Primary Duties and Accountabilities
- Provide in-depth technical expertise to develop, manage and implement engineering analysis, activities and programs.
- Provide technical expertise and consultation through direct involvement to identify and resolve equipment and system problems.
- Provide complete task management of engineering issues.
- Perform engineering and technical tasks as assigned by supervision applying general engineering principles
- Accountable for the accuracy, completeness, and timeliness of work ensuring proper configuration management and assuring that standard design criteria, practices, procedures and codes are used in preparation of plans and specifications.
- Perform independent research, reviews, studies and analyses in support of regulatory/technical projects and programs.
- Recommend equipment, new concepts and techniques to improve performance, simplify construction, reduce costs, correct design or material flaws, or comply with changes in codes or regulations.
- Must be willing to travel 10-50% of time, which may be to another Constellation Clean Energy Center.
- All other job assignments and/or duties pursuant to company policy or as directed by management to include but not limited to: (positions outside of department in support of outage activities etc.)
Minimum Qualifications
- Bachelor's degree in engineering (chemical, civil/structural, electrical, industrial, mechanical or nuclear) or technical discipline (e.g. chemistry, computer science, mathematics, or physics) with 5 years of industry experience or 3 years of Constellation Reactor Services department experience OR
- Current or previous Senior Reactor Operator license with 5 years of industry experience or 3 years of Constellation Reactor Services experience department OR
- Associates/non-technical 4-year degree/completion or a relevant, skilled trades apprenticeship program (e.g., boilermaker, pipefitter, operating engineer) with 7 years of industry experience or 5 years of Constellation Reactor Services department experience OR
- High school diploma/GED with 9 years of industry experience or 7 years Constellation Reactor Services experience department
- Maintain minimum access requirement or unescorted access requirements, as applicable, and favorable medical examination and/or testing in accordance with position duties
Preferred Qualifications
- Professional Engineer Certification
- Advanced technical degree or related coursework
- Design Engineering Qualifications
- Fuel Handling Qualifications and Experience
- Lifting and Rigging Experience
- Master Rigger Qualification
- Work Planning Qualifications
- Procedure Revision Experience
- Supervisory Qualifications and Experience
- P6 Scheduling Experience
Who We Are
As the nation's largest producer of clean, carbon-free energy, Constellation is focused on our purpose: accelerating the transition to a carbon-free future. We have been the leader in clean energy production for more than a decade, and we are cultivating a workplace where our employees can grow, thrive, and contribute.
Our culture and employee experience make it clear: We are powered by passion and purpose. Together, we're creating healthier communities and a cleaner planet, and our people are the driving force behind our success. At Constellation, you can build a fulfilling career with opportunities to learn, grow and make an impact. By doing our best work and meeting new challenges, we can accomplish great things and help fight climate change. Join us to lead the clean energy future.
Total Rewards
Constellation offers a wide range of benefits and rewards to help our employees thrive professionally and personally. We provide competitive compensation and benefits that support both employees and their families, helping them prepare for the future. In addition to highly competitive salaries, we offer a bonus program, 401(k) with company match, employee stock purchase program comprehensive medical, dental and vision benefits, including a robust wellness program paid time off for vacation, holidays, and sick days and much more.
Expected salary range of $117,900 to $131,000, varies based on experience, along with comprehensive benefits package that includes bonus and 401(k).
Primary Purpose of Position
Performs advanced technical/engineering problem solving in support of nuclear plant operations. Responsible for technical decisions. Possesses excellent knowledge in functional discipline and its practical application and has detailed knowledge of applicable industry codes and regulations.
Primary Duties and Accountabilities
- Provide in-depth technical expertise to develop, manage and implement engineering analysis, activities and programs.
- Provide technical expertise and consultation through direct involvement to identify and resolve equipment and system problems.
- Provide complete task management of engineering issues.
- Perform engineering and technical tasks as assigned by supervision applying general engineering principles
- Accountable for the accuracy, completeness, and timeliness of work ensuring proper configuration management and assuring that standard design criteria, practices, procedures and codes are used in preparation of plans and specifications.
- Perform independent research, reviews, studies and analyses in support of regulatory/technical projects and programs.
- Recommend equipment, new concepts and techniques to improve performance, simplify construction, reduce costs, correct design or material flaws, or comply with changes in codes or regulations.
- Must be willing to travel 10-50% of time, which may be to another Constellation Clean Energy Center.
- All other job assignments and/or duties pursuant to company policy or as directed by management to include but not limited to: (positions outside of department in support of outage activities etc.)
Minimum Qualifications
- Bachelor's degree in engineering (chemical, civil/structural, electrical, industrial, mechanical or nuclear) or technical discipline (e.g. chemistry, computer science, mathematics, or physics) with 5 years of industry experience or 3 years of Constellation Reactor Services department experience OR
- Current or previous Senior Reactor Operator license with 5 years of industry experience or 3 years of Constellation Reactor Services experience department OR
- Associates/non-technical 4-year degree/completion or a relevant, skilled trades apprenticeship program (e.g., boilermaker, pipefitter, operating engineer) with 7 years of industry experience or 5 years of Constellation Reactor Services department experience OR
- High school diploma/GED with 9 years of industry experience or 7 years Constellation Reactor Services experience department
- Maintain minimum access requirement or unescorted access requirements, as applicable, and favorable medical examination and/or testing in accordance with position duties
Preferred Qualifications
- Professional Engineer Certification
- Advanced technical degree or related coursework
- Design Engineering Qualifications
- Fuel Handling Qualifications and Experience
- Lifting and Rigging Experience
- Master Rigger Qualification
- Work Planning Qualifications
- Procedure Revision Experience
- Supervisory Qualifications and Experience
- P6 Scheduling Experience
Who We Are
As the nation's largest producer of clean, carbon-free energy, Constellation is focused on our purpose: accelerating the transition to a carbon-free future. We have been the leader in clean energy production for more than a decade, and we are cultivating a workplace where our employees can grow, thrive, and contribute.
Our culture and employee experience make it clear: We are powered by passion and purpose. Together, we're creating healthier communities and a cleaner planet, and our people are the driving force behind our success. At Constellation, you can build a fulfilling career with opportunities to learn, grow and make an impact. By doing our best work and meeting new challenges, we can accomplish great things and help fight climate change. Join us to lead the clean energy future.
Total Rewards
Constellation offers a wide range of benefits and rewards to help our employees thrive professionally and personally. We provide competitive compensation and benefits that support both employees and their families, helping them prepare for the future. In addition to highly competitive salaries, we offer a bonus program, 401(k) with company match, employee stock purchase program comprehensive medical, dental and vision benefits, including a robust wellness program paid time off for vacation, holidays, and sick days and much more.
Expected salary range of $117,900 to $131,000, varies based on experience, along with comprehensive benefits package that includes bonus and 401(k).
Primary Purpose of Position
Performs advanced technical/engineering problem solving in support of nuclear plant operations. Responsible for technical decisions. Possesses excellent knowledge in functional discipline and its practical application and has detailed knowledge of applicable industry codes and regulations.
Primary Duties and Accountabilities
- Provide in-depth technical expertise to develop, manage and implement engineering analysis, activities and programs.
- Provide technical expertise and consultation through direct involvement to identify and resolve equipment and system problems.
- Provide complete task management of engineering issues.
- Perform engineering and technical tasks as assigned by supervision applying general engineering principles
- Accountable for the accuracy, completeness, and timeliness of work ensuring proper configuration management and assuring that standard design criteria, practices, procedures and codes are used in preparation of plans and specifications.
- Perform independent research, reviews, studies and analyses in support of regulatory/technical projects and programs.
- Recommend equipment, new concepts and techniques to improve performance, simplify construction, reduce costs, correct design or material flaws, or comply with changes in codes or regulations.
- Must be willing to travel 10-50% of time, which may be to another Constellation Clean Energy Center.
- All other job assignments and/or duties pursuant to company policy or as directed by management to include but not limited to: (positions outside of department in support of outage activities etc.)
Minimum Qualifications
- Bachelor's degree in engineering (chemical, civil/structural, electrical, industrial, mechanical or nuclear) or technical discipline (e.g. chemistry, computer science, mathematics, or physics) with 5 years of industry experience or 3 years of Constellation Reactor Services department experience OR
- Current or previous Senior Reactor Operator license with 5 years of industry experience or 3 years of Constellation Reactor Services experience department OR
- Associates/non-technical 4-year degree/completion or a relevant, skilled trades apprenticeship program (e.g., boilermaker, pipefitter, operating engineer) with 7 years of industry experience or 5 years of Constellation Reactor Services department experience OR
- High school diploma/GED with 9 years of industry experience or 7 years Constellation Reactor Services experience department
- Maintain minimum access requirement or unescorted access requirements, as applicable, and favorable medical examination and/or testing in accordance with position duties
Preferred Qualifications
- Professional Engineer Certification
- Advanced technical degree or related coursework
- Design Engineering Qualifications
- Fuel Handling Qualifications and Experience
- Lifting and Rigging Experience
- Master Rigger Qualification
- Work Planning Qualifications
- Procedure Revision Experience
- Supervisory Qualifications and Experience
- P6 Scheduling Experience
We are hiring remote contributors to review consumer finance content focused on budgeting and money-saving strategies.
Your role will involve reading short financial guidance pieces and providing feedback on their usefulness for people managing tight budgets. You may also identify which tips are the most practical for everyday situations.
This position is ideal for people interested in personal finance, budgeting, or improving financial literacy.
The work is flexible and completed online.
Remote working/work at home options are available for this role.
The challenges of affordable healthcare continue to create new opportunities.
Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs.
These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.
Supervises the assessment of all acute and sub-acute inpatient care for appropriateness of setting and services, according to pre-established criteria and guidelines and ensure a 95% compliance or greater.
Supervises the assessment and coordination of the members physical, psychosocial and discharge planning needs through communication with appropriate hospital staff including treating physician, PCP, utilization managers, social workers, discharge planners.
Assures appropriate staffing to support departmental/agency services.
Ensures all employees are oriented to their department/agency and job and provided with appropriate training, development and continuing education.
Correctly interprets and applies all Human Resources policies and procedures relative to discipline, recruitment and selection, performance appraisals, salary reviews and staffing.
Bachelor's Degree in Nursing.
Minimum one to three years previous management experience preferred.
Previous managed care experience in the areas of utilization management and/or case management required.
Working knowledge of Windows, Word, Excel.
Knowledge of Federal and State regulations, managed care regulations and concepts, and CQI methodologies.
The challenges of affordable healthcare continue to create new opportunities. Elderplan and HomeFirst, our Medicare and Medicaid managed care health plans, are outstanding examples of how we are expanding services in response to our patients' and members' needs. These high-quality healthcare plans are designed to help keep people independent and living life on their own terms.
Care Management Supervisor of Quality Review & Staff Education is responsible for quality assurance, accuracy, and overall integrity of the care management records completed by Care Management staff. This role is to ensure compliance with NYS DOH and CMS regulations through development of auditing tools and data validation. This Supervisor will analyze collected audit data, identify trends for staff re-training, and implement corrective action plans in collaboration with Clinical Management and Staff Education. They will oversee and conduct orientation, training, and education to all members of the Care Management team. Provides support to Director and Managers of Coordinated Care to ensure that all reporting requirements are prepared, submitted, and maintained in a professional and well-coordinated manner.
- Baccalaureate Nursing Degree from an NLN-Accredited School of Nursing
- Experience and knowledge of Managed Care: A minimum of two years nursing experience in Community Health or related field and/or minimum of two years of progressive job-related experience, including care management and coordination, education and supervision
- Demonstrates strong critical-thinking, problem-solving skills, and knowledge of Medicare and Medicaid
- Effective communication skills both written and oral
- Possesses strong critical thinking skills and knowledge of Medicare and Medicaid regulations
- Excellent analytical skills, interpretation of data
- Ability to set priorities and to handle multiple assignments
- Working knowledge of audit techniques and methodologies
- Secures relevant information to identify potential problems and makes recommendations for appropriate solutions
- Work effectively within interdisciplinary team environment
- Computer literate, Windows, Excel, Word, Visio and data base programs required. PowerPoint preferred
- Working knowledge of State and Federal regulations
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.
EDUCATION/EXPERIENCE
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.
LICENSURE
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.
EDUCATION/EXPERIENCE
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.
LICENSURE
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.
EDUCATION/EXPERIENCE
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.
LICENSURE
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.
This position requires excellent communication and collaboration skills as the candidate will be partnering closely with production personnel. The candidate will be the engineering representative on the factory floor transforming design into reality.
Analyzes, conducts root cause analysis and develops dispositions for production non-conformances.
Applies engineering principles to research technical, operational and quality issues in support of executing final engineering solutions.
Identifies documents, analyzes reported problems and communicates deviations that could impact design intent and safety; Develops and implements product/process improvements.
Represents the engineering community from initial build through the production and post-production environment.
Ensures supplier and build partner compliance with Boeing standards.
Develops customer correspondence for continued safe operation and maintenance of equipment.
Participates in on-site disabled product repair teams, accident investigation and support teams.
Designs interim structural repairs and conducts static strength analysis.
This position involves daily exposure to factory environment which includes stairs, trip hazards, high noise areas, chemical hazards (breathing and handling), and entering airplanes during their many stages of build.
This position participates in the approximately 9-month Boeing Company Training Rotation Program, which may involve assignments to the first, second, or third shift, as well as weekend or daily overtime. The specific requirements for shift assignments and overtime vary between sites and are typically covered on a rotation basis. Additionally, there may be travel involved between Boeing Puget Sound sites during the training rotation.
Bachelor's or Masters of Science Degree from an ABET OR ABET equivalent accredited course of study in Engineering
~14+ years of experience in structures, systems, design, or production engineering
Hands-on experience with materials and manufacturing processes.
Prior BCA Engineering Material Review Board (MRB) Certification
Boeing is a Drug Free Workplace where post offer applicants and employees are subject to testing for marijuana, cocaine, opioids, amphetamines, PCP, and alcohol when criteria is met as outlined in our policies.
Shift:
This position is for multiple shifts and may require off shift, weekend, and travel assignments.
The candidate may periodically be assigned to first, second, or third shift as well as weekend or daily overtime. This requirement varies from site to site and is typically covered on a rotation basis.
Union:
This is a union represented position.
The Boeing Company also provides eligible employees with an opportunity to enroll in a variety of benefit programs, generally including health insurance, flexible spending accounts, health savings accounts, retirement savings plans, life and disability insurance programs, and a number of programs that provide for both paid and unpaid time away from work.
Pay is based upon candidate experience and qualifications, as well as market and business considerations.
~ Applications for this position will be accepted until Mar. S. export control compliance requirements. S. export control compliance requirements, a “U.Citizen, U.National, lawful permanent resident, refugee, or asylee.
Relocation
This position offers relocation based on candidate eligibility.
Visa Sponsorship
Employer will not sponsor applicants for employment visa status.
Shift
This position is for 1st shift
Employment decisions are made without regard to race, color, religion, national origin, gender, sexual orientation, gender identity, age, physical or mental disability, genetic factors, military/veteran status or other characteristics protected by law.
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.
Summary:
The Utilization Review Nurse is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services. This nurse is responsible for performing a variety of pre-admission, concurrent, and retrospective UM related reviews and functions. They must competently and accurately utilize approved screening criteria (InterQual/MCG/Centers for Medicare and Medicaid Services “CMS” Inpatient List). They effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing regulatory environment and are responsible for maintaining current and accurate knowledge regarding commercial and government payors and guidelines related to UM. This nurse effectively communicates with internal and external clinical professionals, efficiently organizes the financial insurance care of the patients, and relays clinical data to insurance providers and vendors to obtain approved certification for services. The Utilization Review Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS.
Responsibilities:
- Meets expectations of the applicable OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
- The prior authorization role completes an assessment of a proposed service to determine if the beneficiary has eligible coverage for the service and if it is medically necessary.
- Promote quality, cost-effective outcomes through prior authorization and concurrent review of requested services for medical necessity based upon evidence-based clinical guidelines.
- Identify and present cases of possible quality of care deviations, questionable admissions, and prolonged lengths of stay to the Medical Director for further determination.
- Appropriately refer beneficiaries who have complex or chronic conditions, a need for transition of care, disease management support, or other identifiable needs for coordination of the beneficiary’s member’s health care for behavioral health care management.
- Follow CHRISTUS Health Guidelines related to the Health Insurance Portability and Accountability Act (HIPAA), designed to prevent, or detect unauthorized disclosure of Protected Health Information (PHI).
- Protect the confidentiality of data and intellectual property; assures compliance with national health information guidelines.
- Analyze clinical information submitted by medical providers to evaluate the medical necessity, appropriateness, and efficiency of the use of medical services, procedures, and facilities.
- Perform provider outreach to address post-hospital discharge services, redirection to in-network providers for appropriate steerage, durable equipment usage, and utilization of other medical services and/or procedures and other necessary telephonic follow-up.
- Utilize the nursing process and critical thinking skills to provide oversight of services and evaluation of service options.
- Ability to work in a variety of settings with culturally diverse communities with the ability to be culturally sensitive and appropriate.
- Must have excellent communication skills (written and verbal), clinical judgment, initiative, critical thinking, and problem-solving abilities.
- Must be able to take after hour calls to meet business requirements as needed.
Job Requirements:
Education/Skills
- Graduate of an accredited school of vocational nursing or equivalent required
- Associate’s (ADN) or Bachelor’s (BSN) in Nursing preferred
Experience
- 3 – 5 years of nursing experience preferred
- Experience in Microsoft software (e.g., Outlook, Teams, Word, and Excel) required
- General computer knowledge and capability to use computers required
Licenses, Registrations, or Certifications
- LVN license in the state of employment or compact required
- RN license in state of employment or compact preferred
Work Schedule:
5 Days - 8 Hours
Work Type:
Full Time
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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