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Join Us for the Wellstar Regional Float Nursing Team – Experienced RN Hiring Event
April 16th | 9AM - 1PM & 3PM - 7PM
Register: WEST Team Virtual Interview Link
Wellstar Health System's Regional Float Team is expanding into the Richmond and Columbia County area, creating new opportunities for experienced RNs with enhanced pay rates.
Medical Centers in this region:
- MCG Health
- Columbia County Medical Center (Opening this fall)
Interview with hiring leaders for permanent positions that offer competitive pay, benefits, and paid time off.
Event Highlights
- On-site interviews with hiring leaders
- Sign-on bonus available based on eligibility
- Relocation assistance available for qualified candidates
About the Regional Float Nursing Team
Join the Wellstar Enterprise Support Team (W.E.S.T.), a highly skilled group of experienced nurses who provide care across multiple Wellstar facilities in the Augusta region. As part of this elite float team, you will support a variety of units based on your specialty while helping meet system-wide patient care needs.
Opportunities Available In
- Emergency Department (ED)
Fast-paced, high-acuity environments where strong critical thinking and rapid response are essential.
- Medical-Surgical (Med Surg)
A foundational specialty that builds strong clinical skills and broad nursing experience.
- Intensive Care Unit (ICU)
Provide advanced, lifesaving care to complex and critically ill patients.
- Operating Room (OR)
Collaborate with surgical teams to provide specialized care before, during, and after surgical procedures.
Wellstar Benefits
- Tuition Reimbursement and Student Loan Assistance to support professional growth
- Employee Concierge Services to support work-life balance
- Career Advancement Programs that open doors to long-term opportunities
Qualifications
Experience
Minimum of 2 years of recent, direct RN experience in your specialty area within a hospital setting.
Education
Graduate of an accredited nursing program (BSN preferred).
Licensure and Certifications (based on specialty)
- Active Georgia RN license or Compact RN license
- BLS – Basic Life Support (AHA)
- ACLS, PALS, or NRP as applicable
Take the Next Step
Advance your career by joining a team that values your professional growth, well-being, and commitment to exceptional patient care.
We look forward to meeting you at the Wellstar Regional Float Nursing Team Hiring Event.
Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.
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
Immediate need for a talented Hospital RN – Care Coordination & Utilization Review . This is a 06+months contract opportunity with long-term potential and is located in San Jose, CA (Onsite). Please review the job description below and contact me ASAP if you are interested.
Job ID: 25-80861
Pay Range: $80 - $95/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
- Conduct utilization reviews using InterQual® / MCG®
- Support discharge planning and post-acute coordination
- Communicate with physicians, social work, and external providers
- Manage authorizations and payer-related workflows
- Maintain compliance with regulatory standards
Key Requirements and Technology Experience:
- Key Skills; CA RN License (Active)
- Acute inpatient hospital experience
- UM / Case Management / Discharge Planning background
Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.
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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Job Description
At Boeing, we innovate and collaborate to make the world a better place. We’re committed to fostering an environment for every teammate that’s welcoming, respectful and inclusive, with great opportunity for professional growth. Find your future with us.
Job Description
The Boeing Commercial Airplanes Liaison Engineering Organization is seeking Consultant (Level 5) Liaison Engineers to support operations in Everett, Seattle, Auburn, and or Renton Washington. We are looking for a proactive individual who can make prompt engineering decisions and who want to go beyond their desk and into the factory for hands on engineering.
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.
Position Responsibilities:
- Analyzes, conducts root cause analysis and develops dispositions for production non-conformances.
- Applies knowledge of Boeing design principles to assess and resolve product/process issues through the product lifecycle.
- 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; recommends and manages resolution.
- Develops and implements product/process improvements.
- Supports Integrated Product Teams (IPT) and participates in design reviews.
- 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.
- Analyzes damage repair or structural modification to determine appropriate jacking and shoring, prevent collateral damage and assure a safe work environment.
- Designs interim structural repairs and conducts static strength analysis.
- Develops non-destructive test procedures, tools and standards.
This position is fully onsite. The selected candidate will be required to work onsite at one of the listed locations. 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.
Basic Qualifications (Required Skills/Experience):
- 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
Preferred Qualifications (Desired Skills/Experience):
- Hands-on experience with materials and manufacturing processes.
- Prior BCA Engineering Material Review Board (MRB) Certification
Conflict of Interest:
Successful candidates for this job must satisfy the Company’s Conflict of Interest (COI) assessment
process
Drug Free Workplace:
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.
In locations where SPEEA representation applies, this job family will be covered by the terms of the collective bargaining agreement. Applicable and appropriate educational/certification credentials from an accredited institution and/or equivalent experience is required.
Pay and Benefits:
At Boeing, we strive to deliver a Total Rewards package that will attract, engage and retain the top talent. Elements of the Total Rewards package include competitive base pay and variable compensation opportunities.
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.
The specific programs and options available to any given employee may vary depending on eligibility factors such as geographic location, date of hire, and the applicability of collective bargaining agreements.
Pay is based upon candidate experience and qualifications, as well as market and business considerations.
- Summary pay range for Expert (level 5): $165,750 - $224,250
Applications for this position will be accepted until Mar. 20, 2026
Export Control Requirements:
This position must meet U.S. export control compliance requirements. To meet U.S. export control compliance requirements, a “U.S. Person” as defined by 22 C.F.R. §120.62 is required. “U.S. Person” includes U.S. Citizen, U.S. National, lawful permanent resident, refugee, or asylee.
Export Control Details:
US based job, US Person required
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
Equal Opportunity Employer:
Boeing is an Equal Opportunity Employer. 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.
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.
This role supports interdisciplinary care teams serving individuals with complex medical, behavioral health, and social needs, including people experiencing homelessness, serious mental illness, substance use disorders, chronic disease, and socioeconomic instability.
The Clinical Consultant – RN partners with Care Managers, Behavioral Health clinicians, Primary Care Providers, hospitals, Managed Care Plans, and community-based organizations to ensure high-quality, whole-person, and evidence-based care.
This position plays a critical role in care planning, clinical decision-making, transitions of care, medication management, quality improvement, and staff development while addressing social determinants of health and system barriers to care.
Essential Duties and Responsibilities Clinical Oversight & Consultation Provide clinical support and consultation to Care Managers, and interdisciplinary care teams across care management programs.
Serve as a clinical resource for chronic disease management, medication monitoring, and complex case review.
Guide staff in ensuring member safety and provide immediate consultation and escalation support for high-risk clinical situations.
Ensure clinical services align with evidence-based practices, regulatory standards, and program contracts, including requirements with Managed Care Plans (MCPs).
Care Planning & Coordination Provide clinical oversight and tracking of comprehensive intake assessments.
Participate in the development, review, and approval of patient-centered care plans, including initial plans and required updates.
Monitor progress toward care plan goals and recommend adjustments based on clinical findings and data.
Collaborate with Primary Care Providers, Behavioral Health clinicians, specialists, ACOs, MCOs, hospitals, and community partners to ensure services outlined in care plans are delivered.
Coordinate hospital admissions, discharges, and transitions of care to promote continuity, safety, and prevent avoidable readmissions.
Perform timely medication reconciliation following transitions of care and support medication adherence.
Data, Quality Improvement & Compliance Use data to evaluate outcomes of targeted interventions and assist in modifying care plans and care strategies accordingly.
Participate in quality improvement initiatives, audits, peer reviews, and program evaluations conducted by internal leadership, health plans, or external administrators.
Monitor continuous quality improvement measures through documentation review, clinical consultation, and chart audits.
Oversee charting and documentation standards to ensure compliance with contracts, program requirements, and organizational policies.
Documentation & Systems Complete and review care plans, assessments, and case notes using required systems (e.g., Salesforce, EHRs, or health plan platforms).
Maintain accurate, timely, and compliant documentation using SMART format where applicable.
Ensure confidentiality and compliance with HIPAA and all applicable federal and state regulations.
Staff Development & Team Collaboration Provide staff development training, coaching, and clinical guidance for care management staff.
Participate in weekly, bi-weekly, and monthly interdisciplinary care team meetings to review client progress, evaluate program effectiveness, and develop strategies to enhance care delivery.
Present cases and clinical insights during scheduled case conferences.
Attend required trainings, webinars, meetings, and conferences to maintain clinical excellence and program knowledge.
Support and expand programming that addresses social determinants of health and strengthens connections to community-based organizations.
Promote monthly health promotion topics and materials aligned with program priorities.
Expectations & Professional Standards Prioritize client health, safety, dignity, and self-determination.
Communicate with professionalism, tact, and cultural humility.
Demonstrate the ability to work under pressure and manage multiple complex priorities.
Maintain strict confidentiality and ethical standards.
Adapt effectively to change and support continuous improvement.
Model openness, honesty, accountability, and teamwork.
Demonstrate sensitivity to cultural, linguistic, and socioeconomic diversity.
Adhere to organizational safety policies, compliance standards, and guiding principles.
Required Qualifications Active and unrestricted Registered Nurse (RN) license in the State of California, in good standing.
Experience working with vulnerable populations, including individuals with histories of trauma, homelessness, substance use disorders, serious mental illness, or socioeconomic stress.
Strong clinical assessment, critical thinking, and problem-solving skills.
Comfort working autonomously in community-based and outreach settings.
Experience using data to track outcomes and measure performance.
Basic computer proficiency, including email, spreadsheets, and electronic documentation.
Valid California Driver’s License and proof of auto liability insurance meeting state of California minimum requirements.
Knowledge and applied practice of HIPAA compliance and healthcare regulations.
Preferred Qualifications Bilingual in English and Spanish.
Partners in Care Foundation is an equal opportunity employer.
We are committed to complying with all federal, state, and local laws providing equal employment opportunities, and all other employment laws and regulations.
It is our intent to maintain a work environment which is free of harassment, discrimination, or retaliation because of age, race (including hair texture and protective hairstyles, such as braids, locks, and twists), color, national origin, ancestry, religion, sex, sexual orientation, pregnancy (including childbirth, lactation/breastfeeding, and related medical conditions), physical or mental disability, genetic information (including testing and characteristics, as well as those of family members), veteran status, uniformed service member status, gender, gender identity, gender expression, transgender status, arrest or conviction record, domestic violence victim status, credit history, unemployment status, caregiver status, sexual and reproductive health decisions, salary history or any other status protected by federal, state, or local laws.
All qualified applicants will receive consideration for employment and reasonable accommodations may be made to enable qualified individuals to perform the essential functions of the position.
Remote working/work at home options are available for this role.
The Clinical Data Review Pharmacist would be working for a Major Fortune 500 Company and has career growth potential.
Clinical Data Review Pharmacist Highlights: Schedule: ??? 6am to 2pm Monday to Friday ??? Sunday 3-11pm and Monday-Thursday 1-9pm OFF Friday/Saturday Pay Rate: $65/hr Clinical Data Review Pharmacist Responsibilities: Process prescription orders and perform clinical verification Consult with patients and providers as needed Support pharmacy programs that improve patient health outcomes, medication adherence, and prescription accuracy Clinical Data Review Pharmacist Qualifications: BS in Pharmacy or Doctor of Pharmacy (PharmD) Active Pharmacist License (RPh) Minimum 1 year of experience in a pharmacy environment If you are interested in this Clinical Data Review Pharmacist position, please apply to this posting with Luke H.
at A-Line!
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.
- duration of 1 yearTotal amount of hours per month is 8 hoursPhysicians will be supervising and collaborating with In-home Nurse Practitioners for program.Supervising/Collaborating physicians must be licensed and located in the StateThe SP candidate must have an active and unrestricted medical license.The SP will not be expected or required to provide any type of direct patient care.The SP candidate should have a preferred specialty designation of Family Practice or Family Medicine, and General Practice will also be considered.
The SP Candidate may have either MD or DO designation.The maximum paid work hours per month are eight (8) based on the calculation of: maximum two (2) paid hours per NP per month x 4 NPs maximum = 8 for the Quality Representative Chart Reviews.
The actual amount of time spent per week to perform the chart reviews may vary depending on the SP as will the weekly paid time submissions.
The expectations for the Supervising Physician are as follows:Family Medicine Physicians only, due to our well child visits.Must be available by phone or other electronic means of communication during the NPs working hours (40 hours per week).Serve as a Supervising Physician in accordance with applicable law and terms and conditions of the Nurse Practitioner Collaborative Practice Protocol AgreementConduct a monthly chart review of a 10% representative sample and meet with NP on a monthly basis in person or by phone or electronic communication per state requirements and review and discuss a 10% representative sample of charts for quality assurance.Liability insurance will be provided for Physicians claims arising solely and exclusively from Physicians delivery of professional services relating to Physicians Supervision and collaboration services provided to NPs.The maximum paid work hours per month are eight (8) based on the calculation of: maximum two (2) paid hours per NP per month x 4 NPs maximum = 8 for the Quality Representative Chart Reviews.
The actual amount of time spent per week to perform the chart reviews may vary depending on the SP as will the weekly paid time submissionsWill not be expected or required to provide any type of direct patient carePlease apply today as this will fill very quickly!
This position is a part time supplimental income position and can be done from the comfort of your home.
You can be licensed in any state as long as the license is in good standing and your are BC.
Hours will be around 10 a week or possibly more if you are looking for more.
Pay is $150 an hour.
Job Duties:Your role as a Clinical Peer Reviewer will be to:
- Review the documents from the requesting physician.
These will have been summarized for you by an Initial Clinical Reviewer, but the full documents are also available.- Review evidence based guidelines and/or scientific medical literature relating to the requested treatment.
This information is gathered for you by the Initial Reviewer, but you have the opportunity to retain, amend, or replace them as you deem necessary.- Review the draft of the determination of medical necessity that has been prepared by an Initial Reviewer.
You will then determine if it is appropriate for the patient or make revisions as necessary, based on your clinical judgment.- Often, we will ask you to conduct a peer-to-phone call to the requesting provider at your convenience.
Typically, the purpose of these calls will be to relay information about the patient's history that may not be included in the documentation or to clarify our process.We have found that successful candidates traditionally share several characteristics:
- Since all work is done via the web, a fast internet connection, good language and computer skills are necessary- A dedication to learning, including an ability to self-teach- A precise attention to detail- Solid clinical judgment
Remote working/work at home options are available for this role.
Our collaborators over see our highly skilled Nurse Practitioners in the field as stated by state law.
This is a Great Opportunity for physician to earn extra income with no out of pocket expense to you, or your current practice situation.
This is a 1099 Contractor position.Type: Collaborating Physician
- 1099 (Chart Reviews)Location: Remote Opportunity
- State of MissouriHours: Flexible HoursRate of Reimbursement: Varies per stateThis is not a full-time position.
This position varies in days and hours.
Remote working/work at home options are available for this role.
This opportunity will consist of reviewing medical data from our comprehensive health assessments.
This chart review can be completed in your office or at home in your spare time.
This opportunity will consist of reviewing medical data from our comprehensive health assessments.
This chart review can be completed in your office or at home in your spare time.
Position Title: Medical Reviewer
Work Location: Remote
Assignment Duration: 12 Months
Job Description:
We are seeking a contract Medical Reviewer to support our international Botox Therapeutic Neurotoxin team. The ideal candidate will be responsible for the medical review of clinical and scientific data related to the use of Botox for various therapeutic indications.
Key responsibilities include ensuring the accuracy and compliance of content with regulatory and company standards, providing expert medical input on clinical documents and safety information, and collaborating with cross-functional teams globally.
Qualifications:
The candidate should have a medical degree (MD or equivalent), clinical experience in neurology, physical medicine, or related fields, and a solid understanding of regulatory requirements for therapeutic neurotoxins. Experience with Botox or neurotoxin therapies is strongly preferred. Excellent communication and detail-orientation are essential.
Must have experience as a Reviewer OUS, understanding regulatory complexities of international markets.
Ready to Rock Your Document Review Skills?
Hey legal eagles! Are you a newly licensed attorney looking for an exciting, long-term project that lets you flex your document review muscles? A fantastic firm in the Charleston, SC area is on the hunt for sharp onsite Document Review Attorneys to jump into an immediate, 6+ month gig. This isn't just another project; it's a chance to supercharge your resume and gain invaluable experience with a team that truly values you. Please note, if you have done extensive document review for Defense firms, you are likely conflicted out.
What You'll Be Doing as a Document Review Attorney (Your Superpower Moves!):
- Sleuthing through documents with precision and speed, using Relativity or other cool e-discovery software.
- Uncovering crucial information and sharing those "aha!" moments with your team leaders.
- Crafting top-notch litigation documents, like those all-important Deposition Dossiers.
- Tackling other fascinating tasks as your project leaders need a hand.
Who We're Searching For (Are You Our Next Superstar?):
- You've got that shiny JD from an ABA-accredited law school.
- You're either a licensed member of the SC Bar, or have a UBE score ready to transfer to SC, or are licensed in another state.
- You're a detail-oriented dynamo – thorough, organized, and nothing gets past your eagle eyes.
- You're a master of managing your time and can work independently like a pro.
- Your communication skills, both written and verbal, are top-notch.
- Bonus points if you're already a Relativity guru or have document review attorney experience, but no worries if not – we're ready to help you learn!
- You've got that natural knack for problem-solving.
The Sweet Deal (What's In It For You!):
- Competitive hourly rates ranging from $27 to $30.
- Subsidized health insurance for our awesome full-time reviewers!
Be ready to pass a comprehensive conflicts check! And rest assured, your resume is held in the strictest confidence.
Think you're a fit? We can't wait to hear from you! Apply at : This job description is not intended to be all-inclusive. The employee may perform other related duties as negotiated to meet the ongoing needs of the organization.
