Moses Singer Reviews Jobs in Usa
7,880 positions found
The city borders the Columbia National Wildlife Refuge, home to many migratory birds and other animals natural to the area.
The Potholes State Park, a popular destination for boating, swimming, and fishing, protects Potholes Lakes.
The Resorts at Moses Pointe is a 400-acre golf club on the west shore of Moses Lake.
The best time to visit Moses Lake is during the Spring Festival, on Memorial Day weekend, and in June, during the Moses Lake Water Sports Festival.
TM-1
This well-known multi-specialty clinic has an excellent reputation and specialists readily available for support.
It is the major medical provider between Seattle and Spokane, with over 300 physicians and 170 advanced practice providers.
If you are caring, compassionate, committed to providing excellent service, and willing to go above and beyond for your patients, this is the place for you! Opportunity Highlights: The system includes two hospitals, more than 40 medical specialties, and primary care, delivering high-quality, safe, compassionate, and cost-effective care close to home Physician leaders and decision-makers at all levels of the organization The provider team consists of six physicians and 2 APP?s J1 Candidates considered Part-time position available in walk-in setting as well Featured Benefits Genuine work/life balance with a four day work week Salary guarantee based on experience with partnership track Internal student loan repayment of up to $125,000 Relocation expenses covered, including packing up to $20,000 Robust benefit package including a nice Signing Bonus Life inMoses Lake Moses Lake is a diverse, connected, and supportive community of innovation and opportunity that values its namesake lake, small-town vibe, growing arts and cultural scene, and abundance of sunshine and outdoor activities.
Residents enjoy over 120 miles of shoreline and the Potholes Reservoir.
The city borders the Columbia National Wildlife Refuge, home to many migratory birds and other animals native to the area.
GB-4
This is a well known multi-specialty clinic with an excellent reputation and specialists readily available for support.
This is the major medical provider between Seattle and Spokane with over 300 physicians and 170 advanced practice providers.
If you are caring, compassionate, committed to providing excellent service, and willing to go above and beyond for your patients then this is the place for you! Opportunity Highlights: System includes two hospitals, more than 40 medical specialties, and primary care delivering high-quality, safe, compassionate, and cost-effective care close to home Physician leaders and decision makers at all levels of the organization Provider team consists of six physicians and 2 APP?s J1 Candidates considered Featured Benefits Genuine work/life balance with a four day work week Salary gaurantee based on experience with partnership track Internal student loan repayment up to $125,000 Relocation expenses covered including packing up to $20,000 Robust benefit package including a nice Signing Bonus Life inMoses Lake Moses Lake is a diverse, connected and supportive community of innovation and opportunity that values its namesake lake, small town vibe, growing arts and clutural scene and an abundance of sunshine and outdoor activities.
Residents enjoy over 120 miles of shoreline and the Potholes Reservoir.
The city borders the Columbia National Wildlife Refuge, home to many migratory birds and other animals natural to the area.
MRM-4
Overview Employed 100% outpatient family practice Average 15-17 patients a day with option for 4-day workweek TOP TIER salary + signing and performance bonuses Stipend paid out for new homeowner in the community within 1 year of start date Federal and State Student Loan Repayment Employee wellness program includes an on-site fitness center, walking trails, and generous paid time off for work/life balance About Moses Lake, Washington A diverse, connected, and supportive community of innovation and opportunity that values its namesake lake, small-town vibe, growing arts and cultural scene, aerospace, manufacturing, and agricultural heritage, and an abundance of sunshine and outdoor activities.
Easy day trips to Seattle! MRM-8
At Genesis Healthcare, we are dedicated to improving the lives we touch through the delivery of high-quality care and exceptional service. As a leading provider in the long-term care industry, we believe in fostering a collaborative, inclusive and supportive work environment where every team member is valued and empowered to make a difference. Whether you're an experienced professional or just starting your career, we offer opportunities for growth, development, and advancement in a range of roles. Join us in our mission to enhance the well-being of our patients and residents while making a meaningful impact in the communities we serve.
Responsibilities:Do you have a specialized interest in skin health and wound management? Do you thrive in a collaborative environment where you can lead, educate, and truly impact the well-being of patients? If so, we have an exciting opportunity for you to join our team as a Skin Health Team Lead!
Genesis is committed to providing exceptional, person-centered care, and skin health is a vital component of our patients' overall quality of life. As our Skin Health Team Lead, you will be a champion for skin integrity, working closely with our interdisciplinary team, patients, and their families to prevent and effectively manage skin and wound concerns. You will be the clinical expert, providing guidance, education, and support to ensure the best possible outcomes for our residents.
Position Highlights
Facilitate a person-centered team approach to skin and wound prevention and management, working alongside nursing center leadership, nursing staff, physicians, therapists, dietitians, and families.
Coordinate and lead weekly wound rounds, ensuring comprehensive assessment, accurate documentation, and effective care planning.
Collaborate on potential admissions with skin/wound needs, ensuring a smooth and well-prepared transition for new residents.
Lead the team review of all new patient admissions and readmissions for skin integrity needs, identifying risk factors, existing impairments, and coordinating necessary interventions and supplies.
Lead the team evaluation of all new skin/wound conditions within 48 hours of admission, providing expert inspection and ensuring accurate reporting and goal setting.
Manage specialty support surfaces, ensuring appropriate utilization, collaborating on audits, and leading quality improvement initiatives related to surface management.
Ensure staff competency, maintain accurate logs, and coordinate clinical reviews for extended negative pressure wound therapy use.
Collaborate to ensure appropriate product utilization and support the nursing process for continence and incontinence management.
Support the collection, comparison, and communication of clinical outcomes related to skin and wounds.
Offer direction on new in-house wounds, survey queries, and drive root cause analysis and process improvement.
Provide bedside training and coaching to all staff on skin and wound care best practices and documentation.
Qualifications:RN; or MPT/DPT with senior operations approval
Must be licensed in the state where position exists
Completion Skin Health Team Lead orientation training within 90 days of hire
Completion of Wound Basics within 90 days of hire
Commitment to complete Advanced Wound Training and completion of a national accredited Wound Certification within 1 year of hire
For those hired with wound certification, completion of a fast-track hybrid program for regulatory wound care requirements will be provided
Knowledge and experience with clinical charting (computerized and paper), incident reporting and investigation response
Strong knowledge base of acceptable standards of care for nurses, providers, therapists, dietitians, and others on the nursing center team
Experience in team building and demonstrating respect for the interprofessional team in wound management
Knowledge of national wound guidelines and wound products
Knowledge of nursing home regulations and survey process
Strong Google and Microsoft skills required
Benefits: Variable compensation plans
Tuition, Travel, and Wireless Service Discounts
Employee Assistance Program to support mental health
Employee Foundation to financially assist through unforeseen hardships
Health, Dental, Vision, Company-paid life insurance, 401K, Paid Time Off
Free 24/7 virtual health care provided by licensed doctors for all Anthem medically-enrolled employees and their immediate family members
On-Demand Pay Program that allows for instant access to a portion of the money you've already earned
We also offer several voluntary insurances such as:
Pet Insurance
Term and Whole Life Insurance
Short-term Disability
Hospital Indemnity
Personal Accident
Critical Illness
Cancer Coverage
Restrictions apply based on collective bargaining agreements, applicable state law and factors such as pay classification, job grade, location, and length of service.
Posted Salary Range: USD $42.00 - USD $50.00 /Hr. Bonus: USD $10,000.00We 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.
Pay Determined by Experience
Worlds of Fun is seeking singers who move well, dancers, and actors, for our 2026 season of shows!
Responsibilities:
LIVE AUDITION DATES
Saturday, February 21
Tivoli Music Hall at Worlds of Fun
4545 Worlds of Fun Ave. Kansas City, MO 64161
Saturday, February 28
Tivoli Music Hall at Worlds of Fun
4545 Worlds of Fun Ave. Kansas City, MO 64161
Upon arrival at Worlds of Fun bypass the main entrance and enter through the Business Entrance. Park in Lot G and walk the path toward the front gate and turn left. Follow signs to the Tivoli Music Hall.
Saturday, March 7
Johnson County Arts and Heritage Center
8788 Metcalf Ave, Overland Park, KS 66212
Enter the Building through the main doors and meet us outside Rehearsal Studio B just inside and toward the back left of the main foyer of the building.
For all dates Singers and Actors registration begins at 12:00pm and Auditions begin at 1:00pm. For Dancers registration begins at 3:00pm and Auditions begins at 4:00pm.
All applicants must be at least 16 years of age to audition. Those 14/15 years of age can be considered for height dependent Costume Character Talent only. All applicants should bring a current resume, headshot, and list of availability from May 1 – November 1, 202
Pay Determined by Experience
Worlds of Fun is seeking singers who move well, dancers, and actors, for our 2026 season of shows!
Responsibilities:
LIVE AUDITION DATES
Saturday, February 21
Tivoli Music Hall at Worlds of Fun
4545 Worlds of Fun Ave. Kansas City, MO 64161
Saturday, February 28
Tivoli Music Hall at Worlds of Fun
4545 Worlds of Fun Ave. Kansas City, MO 64161
Upon arrival at Worlds of Fun bypass the main entrance and enter through the Business Entrance. Park in Lot G and walk the path toward the front gate and turn left. Follow signs to the Tivoli Music Hall.
Saturday, March 7
Johnson County Arts and Heritage Center
8788 Metcalf Ave, Overland Park, KS 66212
Enter the Building through the main doors and meet us outside Rehearsal Studio B just inside and toward the back left of the main foyer of the building.
For all dates Singers and Actors registration begins at 12:00pm and Auditions begin at 1:00pm. For Dancers registration begins at 3:00pm and Auditions begins at 4:00pm.
All applicants must be at least 16 years of age to audition. Those 14/15 years of age can be considered for height dependent Costume Character Talent only. All applicants should bring a current resume, headshot, and list of availability from May 1 – November 1, 202
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.
*
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!
- 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!
