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Watch Commander
✦ New
Salary not disclosed
Seattle, WA 15 hours ago

Position Summary

Tier 1 Watch Commander/Senior Supervisory Security Officers will be the senior operational personnel for their shift and will be responsible for performing functions of a Security Officer, as required, and performing security shift supervision at the required designated Properties.

Pay Transparency/Compensation

$50.94/hour

Responsibilities

  • Report directly to their Contract Managers and/or Assistant Contract Managers
  • Carry out all other supervisory duties as required or directed by their Contract Managers and Assistant Contract Managers
  • Assume responsibility for the completion of assigned tasks
  • Direct Security Officers in the accomplishment of assigned tasks
  • Provide scheduling, training, and counseling for Security Officers
  • Serve as a close, first-line supervisor, monitoring and directing Security Officers and other Triple Canopy personnel as necessary
  • Act as Clients’ liaison with civil authorities responding to crimes, fires, hazardous material spills, etc.
  • Respond to Client personnel in a timely, effective and professional manner
  • In case of after-hours emergency situations, respond to the scene and take initial command, control and communication support role until higher authority and/or emergency responders arrive, with the authority necessary to handle emergency events
  • Perform administrative tasks including timekeeping, scheduling, and report tracking
  • Set the example for Security Officers in the areas of appearance, work habits, skill and attitude
  • Ensure Security Officers follow all work rules, maintain and display good discipline, and present a professional appearance by conducting random, unannounced personnel and post inspections
  • Provide on the job training for Security Officers
  • Oversee, supervise and provide security services during special events, including, without limitation, conducting access control and event guest check-in; enforcing all rules and protocols established by the events security SOPs and security escalation protocols, including engaging and removing anyone who is causing a disruption to an event that is deemed unacceptable and unwelcome by Clients or refusing to depart the event after being requested to depart, interdicting anyone attempting to cause harm to any of the event guests, and reporting and investigating any security anomalies observed by security officers; collaborating with event organizers and venue staff; and performing regular patrols of the event premises to deter unauthorized access and ensure a safe environment
  • Perform other related duties as assigned

Qualifications

  • Must possess an Associate’s degree
  • Must Possess a minimum of 3 years of security supervisory experience
  • Have one of the below experience qualifications:
  • A minimum of 4 years in a U.S. Military Special Operations Unit or U.S. Law Enforcement Special Operations Unit, OR
  • A minimum of 4 years in a combat Military Occupational Specialty (MOS) and a minimum of 2 years as a sworn law enforcement officer/agent, OR
  • A minimum of 6 years as a sworn law enforcement officer/agent. For purposes of this paragraph, a sworn law enforcement officer/agent shall mean a person who is legally authorized to carry a firearm and legally empowered to perform arrests and who has satisfied all applicable legal and training requirements for armed law enforcement officers in the jurisdiction in which they were employed
  • Be a U.S. Citizen with a social security card and a valid driver's license
  • Must meet all medical and physical standards and satisfactorily complete background checks, psychological and drug screening
  • Be able to wear protective body armor as part of the duty uniform
  • Must (A) possess a current firearms certificate issued by the Washington State Criminal Justice Training Commission, (B) be licensed as an armed private security guard under Chapter 18.170 RCW (Revised Code of Washington), (C) have a valid Concealed Pistol License (CPL) in the State of Washington AND/OR be authorized under 18 U.S.C.
  • 926B and 926C to carry a concealed firearm, having satisfied all requirements under the federal Law Enforcement Officers Safety Act of 2004 (LEOSA) (as amended), AKA H.R. 218, to be considered either a Qualified Law Enforcement Officer (QLEO) or a Qualified Retired Law Enforcement Officer (QRLEO), and having been issued photographic identification in accordance with all state and federal requirements under H.R. 218, AND (D) comply with all applicable federal, state and local security personnel registration, certification, and licensing laws (e.g., federal LEOSA and Washington State Department of Licensing)
  • Current CPR/AED/1st Aid Certification
  • Display excellent written and oral communications skills in the English language
  • Be fully computer literate with computer hardware and software used to perform the Services
  • Write and speak clearly and effectively in English
  • Successfully complete all training and certification requirements
  • Maintain all applicable weapons qualifications
  • May be required to lift and carry awkward items weighing up to 50 lbs. Requires intermittent running, continuous and prolonged standing, walking, sitting, squatting, stretching and bending without the aid of any walking assistance device.
  • Must be physically capable of riding a bicycle and/or operating a motor vehicle throughout the course of a workday.
  • May be subject to outdoor conditions including extreme temperatures and weather
  • Regular, in-person attendance required

Benefits

Constellis offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflect its commitment to creating a diverse and supportive workplace.

Not Specified
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Audio-Visual Command Meeting (AVCM) Engineer
Salary not disclosed
Fort Belvoir, VA 2 days ago
About Us

AGE Solutions is a premier technology and professional services company, providing in-depth consulting, advanced technology solutions, and essential services throughout the U.S. government, defense, and intelligence sectors. Prioritizing innovation and client-focused solutions, we assist major agencies in addressing intricate issues and ensuring a more secure future.

AGE Solutions is seeking an Audio-Visual Command Meeting (AVCM) Engineer. In this role, you will travel within their assigned zone to support Senior Executive Services (SES) and Military Officer conference and meeting spaces. This role provides installation, troubleshooting, and sustainment support for enterprise audio-visual systems and will augment support to other zones as required. The ideal candidate is a hands-on AV professional with strong technical expertise, the ability to lead AV efforts on-site, and experience working in classified environments.


This position is based out of Ft. Belvoir, VA with regional CONUS travel.


Key Responsibilities:



  • Travel within assigned zone and provide augmentation support to other zones as needed
  • Support SES and Military Officer conference and meeting spaces
  • Install, pull, terminate, label, and test all AV-related cables, connectors, and interfaces
  • Install projection screens, plasma/LED displays, speakers, and related AV hardware
  • Perform installation of AV systems at client sites, including full room deployments
  • Read and interpret blueprints, drawings, and technical documentation
  • Wire and build AV racks to standard and customer specifications
  • Serve as the Lead Audio Visual Engineer on projects and customer engagements
  • Manage AV projects across various models and makes of equipment
  • Conduct testing, analysis, troubleshooting, and corrective actions on systems, networks, hardware, and software
  • Demonstrate thorough understanding of AV wiring standards and connector types across AV cable types
  • Support internet-based video solutions including switchers, codecs, interfaces, and room design solutions
  • Access classified areas to support Enterprise JWICS installation and troubleshooting of system hardware (user account not required)

Required Qualifications:



  • Five (5) years of relevant experience with AV engineering
  • Have an active DoD Top Secret clearance at a minimum
  • Have one (1) of the following certifications:

    • AMX Technician (Networked AV) Certification, or
    • Crestron CTI Technician Track Certification, or
    • AVIXA CTS Certification


  • Ability to support mission-critical AV/VTC systems under pressure
  • Demonstrated experience working with:

    • Crestron
    • Cisco
    • Biamp / AMX
    • Extron


  • Willingness to travel throughout the zone as required
  • Strong troubleshooting skills to quickly diagnose and restore AV/VTC services
  • Ability to follow escalation procedures and provide status updates and corrective action plans to leadership/PMO
  • Experience using a ticketing system (e.g., ServiceNow) to document troubleshooting, actions taken, and resolution details
  • Ability to provide routine ticket updates until closure and document root cause and resolution steps
  • Ability to provide daily operational status reporting for non-operational rooms, including estimated restoration timelines
  • Location: This position is onsite at our customer's location in Ft. Belvoir, VA and requires up to 50% travel (CONUS).

Compensation: $70,000+

At AGE Solutions, we reward performance, invest in growth, and share success. Our benefits support the whole person, professionally, financially, and personally.



  • 26 Days Paid Leave: Includes vacation, sick, personal time, and holidays. You choose how to use it.
  • Performance Bonuses: Performance bonuses are awarded based on individual contributions and company-wide results, aligning recognition with impact.
  • 401(k) with Match: We match 3% of your contributions with immediate vesting.
  • Financial Protection: Company-paid life insurance up to $300K and options for additional coverage for you and your dependents.
  • Health Benefits: Multiple medical plans, dental, vision, FSA and HSA options to fit your needs.
  • Parental Leave: 15 days of fully paid leave for new parents, because family matters.
  • Military Differential Pay: We bridge the gap for employees on active duty, so they don't take a financial hit while serving.
  • Professional Growth: Paid training and certifications, tuition reimbursement, and the tools and tech to get the job done right.
  • Shared Success: In the event of a company sale, our CEO has committed to returning 80% of net proceeds to employees. This ensures our team shares in the long term value they help create.

At AGE, you'll do work that matters, supported by a company that delivers for its people.

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Remote Personal Finance Content Reviewer
$32 per hour - monthly

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.
temporary
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Supervisor, Concurrent Review (New York)
✦ New
🏢 MJHS
Salary not disclosed
New York 1 day ago

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.

Provides quality, cost-effective care to all members through the direct supervision of staff responsible for the management and coordination of the member's care through the incorporation of interdisciplinary strategies, medicare regulations, and medically accepted standards of care.

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.
permanent
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Quality Review & Staff Education Supervisor (New York)
✦ New
🏢 MJHS
Salary not disclosed
New York 1 day ago

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
permanent
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Clinical Review Nurse Specialist (SEGUIN)
Salary not disclosed
SEGUIN, Texas 3 days ago
POSITION SUMMARY AND RESPONSIBILITIES

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.
temporary
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Clinical Review Nurse PRN (PLEASANTON)
🏢 University Health
Salary not disclosed
PLEASANTON, Texas 3 days ago
POSITION SUMMARY AND RESPONSIBILITIES

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.
temporary
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Medical Necessity Reviewer (HONDO)
🏢 University Health
Salary not disclosed
HONDO, Texas 3 days ago
POSITION SUMMARY AND RESPONSIBILITIES

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.
temporary
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Product Review Engineer (Liaison Engineering) Consultant (Level 5)
🏢 Boeing
$165,750 - 224,250
Arlington, WA 3 days ago
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. 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.

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.
permanent
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Data Reviewer, QC
✦ New
Salary not disclosed
Hopewell, NJ 1 day ago

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.
Not Specified
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Utilization Review Nurse Health Plans-HP Utilization Mgmt (Hiring Immediately)
Salary not disclosed
Irving, TX 5 days ago
Description

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

permanent
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RN Clinical Review Nurse {167271}
Salary not disclosed
Alameda 5 days ago
Clinical Review Nurse Schedule for Clinical Review Nurse Monday – Friday | 8:00 AM – 5:00 PM Interview Process for Clinical Review Nurse One virtual interview Job Overview for Clinical Review Nurse We are seeking an experienced Clinical Review Nurse to support the investigation and resolution of complex member and provider grievances, appeals, and disputes .

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.
*
Not Specified
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Registered Nurse Clinical Review-Hybrid-Los Angeles, California
Salary not disclosed
The Clinical Consultant – RN provides clinical leadership, consultation, and oversight across care management programs.

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.
Not Specified
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Clinical Data Review Pharmacist (onsite)
Salary not disclosed
West Jordan 2 days ago
A-Line Staffing is now hiring a Clinical Data Review Pharmacist in West Jordan, UT 84084.

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!
Not Specified
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Physician / Family Practice / Texas / Locum tenens / Telemedicine - Chart Review Locum Tenens Job
Salary not disclosed
Chicago, Illinois 3 days ago
Hiring a Telemedicine Family Practice, Family Medicine or General Practitioner for a Chart Review Telemedicine position in TexasStart is ASAP
- 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!
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Physician / ENT / Florida / Locum or Permanent / Orthopedic Surgeon Needed for Reviews Remote Job
Salary not disclosed
Our group is looking for an Orthopedic Surgeon to join the team in a remote setting.

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.
permanent
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Physician / Collaborating Physician-(Remote)Chart Reviews PRN Job
Salary not disclosed
Matrix Medical Network is searching for physicians looking for additional income as a collaborating physician (Chart Reviews).

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.
Not Specified
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Physician / Family Practice / Mississippi / Locum tenens / Collaborating Physician for Chart Reviews
✦ New
🏢 Matrix Medical Netowrk
Salary not disclosed
We are looking for physicians to collaborate with our network of providers.

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.
Not Specified
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Physician / Family Practice / Missouri / Locum tenens / Collaborating Physician for Chart Reviews Jo
✦ New
🏢 Matrix Medical Netowrk
Salary not disclosed
Scottsdale, Arizona 1 day ago
We are looking for physicians to collaborate with our network of providers.

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.
Not Specified
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Medical Reviewer
Salary not disclosed
North Chicago, IL 2 days ago

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.



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