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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
The Medical Review Specialist is responsible for reviewing, analyzing, and interpreting medical documentation to support eligibility determinations and alternative treatment evaluations in alignment with Christian Healthcare Ministries’ guidelines and values. This role exists to ensure medical review decisions are accurate, evidence-based, and applied consistently while maintaining compassion and clarity in member interactions.
At the highest level, the Medical Review Specialist focuses on clinical analysis, guideline interpretation, and professional judgment, supporting sound decision-making that upholds CHM’s mission, stewardship, and commitment to member care.
WHAT WE OFFER
- Compensation based on experience.
- Faith and purpose-based career opportunity!
- Fully paid health benefits
- Retirement and Life Insurance
- 12 paid holidays PLUS birthday
- Lunch is provided DAILY.
- Professional Development
- Paid Training
PRIMARY RESPONSBILITIES
- Review and analyze complex medical records to assess eligibility, appropriateness of services, and alignment with CHM medical guidelines.
- Apply clinical judgment and established criteria to support consistent, evidence-based eligibility determinations.
- Conduct medical literature reviews and research to support recommendations, alternative treatment considerations, and guideline application.
- Collaborate with the Eligibility Review Supervisor, Medical Director, and Medical Review leadership to ensure alignment and consistency in medical review decisions.
- Communicate clearly and compassionately with members and internal teams regarding medical review outcomes, addressing questions and concerns professionally.
- De-escalate sensitive or emotionally charged interactions while maintaining CHM standards and values.
- Maintain accurate documentation of medical review findings, rationale, and decisions within CHM systems.
- Stay current on medical research, industry standards, and regulatory considerations relevant to medical review activities.
- Uphold strict confidentiality and HIPAA compliance in all handling of protected health information.
CORE COMPETENCIES & SKILLS
- Medical analysis and critical thinking – Interpret complex medical information and applies clinical reasoning.
- Evidence-based decision making – Utilizes research and guidelines to support review outcomes.
- Clear and compassionate communication – Explains medical determinations in an understandable and empathetic manner.
- Case management and prioritization – Manages multiple cases while meeting accuracy and timeliness standards.
- Documentation and compliance – Maintain thorough, accurate records aligned with regulatory and internal requirements.
- Collaboration – Works effectively with leadership, medical reviewers, and cross-functional teams.
REQUIRED QUALIFICATIONS & CONSIDERATIONS
Education
- Bachelor’s degree in a healthcare-related field (e.g., nursing, health sciences, biology) preferred.
- Equivalent clinical or medical review experience may be considered in lieu of a degree.
Experience
- Prior experience in medical record review, utilization review, clinical review, or a related healthcare role preferred.
- Experience applying medical guidelines or clinical criteria to eligibility or treatment determinations strongly preferred.
- Familiarity with HIPAA regulations and protected health information handling required.
- Experience working with EMR/EHR systems, medical coding, or health information systems is a plus.
Certifications
- No certifications required at time of hire.
- Clinical licensure or healthcare-related certifications (e.g., RN, LPN, CPC) are a plus but not required.
About Christian Healthcare Ministries
Founded in 1981, Christian Healthcare Ministries (CHM) is a health care sharing ministry for Christians. CHM is a nonprofit, voluntary cost-sharing ministry through which participating Christians meet each other’s medical bills. The mission of CHM is to glorify God, show Christian love, and experience God’s presence as Christians share each other’s medical bills.
Remote working/work at home options are available for this role.
JOB TITLE: Clinical Review RN (Medicaid Cost Outlier)
Nurse Background: 2+ years of acute care/medical surgical experience required. Interqual/MCG experience a plus.
GENERAL RESPONSIBILITIES: This individual will complete the full spectrum of activities related to Utilization or Quality reviews as assigned. They will utilize their knowledge and expertise of the review program to conduct clinical level review, supporting Medical Review Analysts, and Physician Consultants to ensure an appropriate and accurate process.
DUTIES:
1. Conduct utilization reviews up to and including the appeal level. This includes chart screen, complete electronic worksheets, enter required information and make level one denial decisions when necessary.
2. Conduct quality and clinical study data collection reviews. This includes chart review, complete detailed electronic data worksheets.
3. Act as a resource for the administrative staff in training, problem solving, and clarifying procedures. Will provide technical assistance and conduct/participate in staff huddles.
4. Participate in collaborative training specific to clinical study objectives.
5. Other activities as may be deemed necessary.
QUALIFICATIONS:
1. Licensed as a Registered Professional Nurse in New York State.
2. Knowledge and experience with electronic medical records including utilization, quality, and clinical charting.
3. Ability to oversee, problem solve and work collaboratively with peers, medical, analytical, and administrative support staff.
4. Excellent written and verbal skills.
5. Ability to work independently with little supervision.
6. Ability and desire to be flexible, innovative, and creative.
EDUCATION & EXPERIENCE:
1. Baccalaureate degree in Nursing or graduate of an approved Registered Professional Nurses training program and licensed to practice in the State of New York.
2. A minimum of 2 years experience in an acute care facility preferably in medical surgical and utilization review experience highly preferable.
LOCATION: Jericho, NY (onsite)
***there is a free shuttle from the Jericho LIRR station + parking onsite
SHIFTS: M-F, 40 hours or 4x10s (no weekends)
PAY: $50-55/hr
DURATION: long term open ended contract includes benefits, sick time, 401k, weekly pay
- Ensure scientific accuracy and clinical appropriateness and validity of promotional materials from a medical/scientific standpoint
- Serve as a member of the Promotional Review Board or PRB
Relationships:
- Reports to a Director level employee in Medical Information and works with stakeholders throughout and at external agencies.
- Key relationships include Marketing, Legal, Regulatory Affairs and Medical Affairs.
Essential Functions:
- Provide critical review of promotional pieces to ensure medical accuracy, validity and appropriateness of content in accordance with approved labeling, scientific data and relevant laws, regulations to support the safe and effective use of products by patients and the medical community.
- Determine appropriateness of data and references used to support promotional claims and marketing messages and provide proactive recommendations and/or guidance for alternative da-ta/references/language where needed
- Align and collaborate with key cross-functional stakeholders including other Promotional Review Board or Promotional Review Board or PRB reviewers and commercial team members on issues or concerns related to promotional materials or claims
- Engage with commercial business partners early in the development of promotional materials to enhance efficiency, when applicable
- Review, provide comments and document verdicts for all assigned promotional materials within PRB workflow system based on assigned deadlines
- Participating in Promotional Review Board or PRB meetings as assigned
- Remain current with medical literature and data in assigned therapeutic area
Education Qualifications:
- PharmD (Doctor of Pharmacy) or MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine) or NP (Nurse Practitioner) with a minimum of two years of relevant professional experience (e.g. academic or clinical or industry experience)
Additional Qualifications:
- Thorough understanding of the US pharmaceutical industry or healthcare landscape, promotional review process and relevant guidance and compliance requirements
- Detail-oriented with demonstrated editorial skills
Medical Promotional Review Specialist
6-month contract
Must be able to work on a W2
Hybrid in Plainsboro, NJ
TOP 3 “MUST HAVES”:
1. Demonstrated expertise in reviewing medical literature and independently evaluating scientific validity and clinical appropriateness of promotional content.
2. Proven ability to clearly and concisely communicate scientific information
3. Demonstrated ability to build and maintain collaborative relationships across multiple disciplines
PURPOSE:
Ensure scientific accuracy and clinical appropriateness and validity of promotional materials from a medical/scientific standpoint
Serve as a member of the Promotional Review Board (PRB)
ESSENTIAL FUNCTIONS:
• Provide critical review of promotional pieces to ensure medical accuracy, validity and appropriateness of content in accordance with approved labeling, scientific data and relevant laws, regulations and NNI policies to support the safe and effective use of products by patients and the medical community.
• Determine appropriateness of data and references used to support promotional claims and marketing messages and provide proactive recommendations and/or guidance for alternative da-ta/references/language where needed
• Align and collaborate with key cross-functional stakeholders including other PRB reviewers and commercial team members on issues or concerns related to promotional materials or claims
• Engage with commercial business partners early in the development of promotional materials to enhance efficiency, when applicable
• Work with the Medical Director for the assigned product(s)/therapeutic area(s) to increase efficiency, medical alignment, and mitigate risk of promotional claims
• Review, provide comments and document verdicts for all assigned promotional materials within PRB workflow system based on assigned deadlines
• Participate in PRB meetings as assigned
• Remain current with medical literature and data in assigned therapeutic area(s)
• Participate in relevant internal and external meetings and trainings on new guidance/regulations, new scientific information and marketing strategy
QUALIFICATIONS:
• PharmD / MD/ DO / NP with a minimum of two years of relevant professional experience (e.g. academic, clinical or industry experience); post-doctoral fellowship may be substituted for professional experience, as appropriate
• Thorough understanding of the US pharmaceutical industry and healthcare landscape, promotional review process and relevant guidance and compliance requirements
• Detail-oriented with demonstrated editorial skills
• Strong organization and prioritization skills
• Ability to work on cross-functional teams
• Ability to critically analyze and apply scientific data in a customer-focused manner
• Strong verbal and written communication skills
• Effective negotiation skills and ability to influence others
Insight Global is seeking Technical Evaluation Review Board/CCB Coordinator to join our team for an exciting opportunity to work on a unique government contract. The contract assists in acquisition and technical sustainment engineering and will augment government resources. The coordinator manages government technical review board submissions, ensuring all programs meet required deliverables and are fully prepared for review before board meetings. They control document accuracy, track changes, and maintain compliant review packages across all stakeholders. The role requires confidently driving engineers and IPTs to meet requirements and deadlines, including pushing back when inputs are incomplete. This is a highly organized, assertive position focused on accountability, readiness, and execution.
Must Haves:
- BS/MS in engineering/specialty area
- 7 yrs directly related experience (5 yrs with MS degree)
- Active secret level security clearance or higher
- Strong planning, coordination, and organizational skills with the ability to manage multiple priorities
- Demonstrated experience developing, maintaining, and assessing technical baselines within controlled programs
- Familiarity with engineering standards, manufacturing methods, and configuration management practices, including military and ASME-guided environments
- Working knowledge of technical drawing conventions and engineering documentation controls
- Proficiency with Microsoft Office tools to prepare data-driven reports, metrics, and formal documentation
- High attention to detail, strong writing and verbal communication skills, and the ability to manage time effectively
- Ability to sit on-site at Hill AFB in Clearfield, UT Monday-Wednesday
Plusses:
- Experience supporting configuration and data management activities within a defense or government program environment
- Working knowledge of Air Force or DoD engineering release processes, configuration control standards, and technical documentation lifecycle management
- Familiarity with Engineering Change Proposals (ECPs), Interface Control Documents (ICDs), and associated revision and audit activities
- Prior involvement with functional and physical configuration audits, including coordination with suppliers or government facilities
- Training or certification in configuration or data management disciplines (e.g., CMPIC or similar)
- Demonstrated ability to maintain and protect complex engineering baselines for hardware and software systems
- Strong judgment and decision-making skills aligned with regulatory, contractual, and policy requirements
- Commitment to continuous learning and maintaining up-to-date technical proficiency
The Estimator is responsible for ensuring all flooring bids are technically accurate, competitively structured, and financially sound before submission to customers. This role serves as the final quality control checkpoint for bid accuracy, scope alignment, and margin protection across new construction and large project bids.
They will work closely with sales, estimating, purchasing, and operations to ensure bids are properly structured, risk is identified early, and projects are prepared for successful execution.
This position requires extensive experience in flooring estimating, construction bidding, and plan/spec review, with the ability to identify scope gaps, quantity errors, and pricing risks before bids are released. This role plays a critical part in protecting company margin, preventing costly project mistakes, and improving bid quality across the organization.
Primary Responsibilities:
Bid Strategy & Quality Control
- Review large and complex flooring bids prior to submission.
- Validate takeoffs, material quantities, labor assumptions, and pricing structures.
- Ensure bids align with project plans, specifications, and scope requirements.
- Identify risk areas such as:
- Scope gaps
- Quantity miscalculations
- Incorrect product specifications
- Margin erosion
- Installation complexity
- Provide feedback and corrections to estimators and sales teams before submission.
Preconstruction Review
- Review architectural plans and specifications for flooring scope.
- Confirm scope alignment between drawings, specifications, and proposals.
- Identify missing scope or potential change order risks prior to bid submission.
- Assist estimating team in improving bid structure and consistency.
Margin Protection
- Ensure bids meet company margin expectations.
- Identify pricing risks before customer submission.
- Flag bids that require leadership review.
Bid Process Improvement
- Identify recurring estimating errors and training opportunities.
- Develop internal bid review standards and checklists.
- Support ongoing estimator training and quality improvement.
Post-Award Project Validation
- Review awarded bids to confirm final scope and pricing accuracy.
- Ensure project setup in ERP reflects the approved bid structure.
- Confirm correct materials, quantities, and pricing before purchasing.
Cross-Department Coordination
- Work closely with sales, estimating, purchasing, operations, and finance to ensure projects are properly prepared for execution.
Required Experience
- 5–10+ years of construction estimating experience
- Extensive flooring estimating experience
- Experience reviewing construction plans and specifications
- Strong knowledge of flooring materials and installation methods
- Experience preparing or reviewing large project bids
- Strong understanding of construction scopes and subcontractor bidding
- Advanced Excel skills
- Experience with estimating software
Preferred
- Experience estimating large multifamily or production builder projects
- Experience with takeoff software such as:
- MeasureSquare
- PlanSwift
- Bluebeam
No Recruiters, please.
The Valley Health System has expanded into an integrated health network that serves more than two million people in Southern Nevada. Starting with Valley Hospital Medical Center in 1979, the Valley Health System has grown to include Centennial Hills Hospital Medical Center, Spring Valley Hospital Medical Center, Summerlin Hospital Medical Center,Henderson Hospital , Valley Health Specialty Hospital and West Henderson Hospital.
Benefit Highlights:
- Comprehensive education and training center
- Competitive Compensation & Generous Paid Time Off
- Excellent Medical, Dental, Vision and Prescription Drug Plans
- 401(K) with company match and discounted stock plan
- Career opportunities within VHS and UHS Subsidies
- Challenging and rewarding work environment
Job Description: Responsible for the overall management of the Performance Improvement processes related to physicians performance.
Qualifications
Education: Bachelors (BSN) degree in nursing or Master's Degree in a healthcare related field from an accredited program.
Experience: Five (5) years clinical experience with two (2) to four (4) years QA or PI experience required, and a minimum of two (2) years progressive management experience required.
Technical Skills: Computer proficiency to include word processing, spreadsheet, and database.
License/Certification: Current RN license in the State of Nevada is required if RN. Certified Professional Healthcare Quality (CPHQ) required for non-RN.
Other: Must be able to demonstrate the knowledge and skills necessary to provide service appropriate to the age of the patient. Travel Required.
EEO Statement
All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.
We believe that diversity and inclusion among our teammates is critical to our success.
Notice
At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: or 1-8
Whether you are searching for a position in your area or in another state, we have professionals to help you achieve your goals through our relationships with facilities nationwide
- in rural settings, small cities, and major metropolitan areas.
Contact your personal consultant to tell them what you are looking for in a telehealth position.
CompHealth can make finding great opportunities simple, less stressful, and personalized to fit your needs.
We have phenomenal relationships with facilities around the country, and a team dedicated to helping you with every step of the hiring process.
Contact Gordon Diaz .
100% remote; open to FM and IM physicians Work at your own pace; must have an active state license Great salary to supplement current work; malpractice coverage via occurrence policy Physician is responsible for learning the aspects of compliance in the company Physician will implement and communicate policies, processes, and procedures Must be board certified or board eligible (if a resident) Great work-life balance; possible relocation assistance Live in a beautiful suburb with access to many shops and restaurants Our services are free for you We help negotiate your salary and contract We coordinate interviews and help with licenses Specialized recruiters match your career preferences Experienced support teams take care of every detail
Whether you are searching for a position in your area or in another state, we have professionals to help you achieve your goals through our relationships with facilities nationwide
- in rural settings, small cities, and major metropolitan areas.
Contact your personal consultant to tell them what you are looking for in a telehealth position.
CompHealth can make finding great opportunities simple, less stressful, and personalized to fit your needs.
We have phenomenal relationships with facilities around the country, and a team dedicated to helping you with every step of the hiring process.
Contact Gordon Diaz .
100% remote; open to FM and IM physicians Work at your own pace; must have an active state license Great salary to supplement current work; malpractice coverage via occurrence policy Physician is responsible for learning the aspects of compliance in the company Physician will implement and communicate policies, processes, and procedures Must be board certified or board eligible (if a resident) Great work/life balance; possible relocation assistance Live in a beautiful suburb with access to many shops and restaurants Our services are free for you We help negotiate your salary and contract We coordinate interviews and help with licenses Specialized recruiters match your career preferences Experienced support teams take care of every detail
