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Travel RN Case Manager (Utilization Review)
✦ New
Salary not disclosed
Bakersfield, CA 1 day ago
Job Description

Certification Details
- BLS
- California RN License

Job Details
- Utilization Review Nurse II represents the fully experienced level in utilization review and discharge planning activities.
- Obtains and evaluates medical records for in-patient admissions to determine if required documentation is present.
- Obtains appropriate records as required by payor agencies and initiates Physician Advisories as necessary for unwarranted admissions.
- Conducts on-going reviews and discusses care changes with attending physicians and others.
- Formulates and documents discharge plans.
- Provides on-going consultation and coordination with multiple services within the hospital to ensure efficient use of hospital resources.
- Identifies pay source problems and provides intervention for appropriate referrals.
- Coordinates with admitting office to avoid inappropriate admissions.
- Coordinates with clinic areas in scheduling specialized tests with other health care providers, assessing pay source and authorizing payment under Medically Indigent Adult program as necessary.
- Reviews and approves surgery schedule to ensure elective procedures are authorized.
- Coordinates with correctional facilities to determine appropriate use of elective procedures, durable medical goods and other services.
- Answers questions from providers regarding reimbursement, prior authorization and other documentation requirements.
- Learns the documentation requirements of payor sources to maximize reimbursement to the hospital.
- Keeps informed of patient disease processes and treatment modalities.
- Level II teaches providers the documentation requirements of payor sources to maximize reimbursement to the hospital.
- Level II may assist in training Utilization Review Nurse I's.
- Knowledge of payor source documentation requirements and governmental regulations affecting reimbursement; knowledge of acute care nursing principles, methods and commonly used procedures; knowledge of common patient disease processes and the usual methods for treating them; knowledge of medical terminology, hospital routine and commonly used equipment; knowledge of acute hospital organization and the interrelationships of various clinical and diagnostic services.
- Ability to effectively evaluate the medical records of hospital admissions regarding continuing stay necessity, appropriateness of setting, delivered care, use of ancillary services and discharge plans.
- Ability to assess and judge the clinical performance of physicians and other health professionals.
- Ability to communicate documentation needs in an effective and tactful manner that promotes cooperation.
- Ability to teach co-workers what is needed and required in the medical record for reimbursement and audit purposes.
- Ability to gather and analyze data and prepare reports and recommendations based thereon.
- Ability to get along with physicians, other health providers, outside payor sources and the general public.
- Performs other job related duties as assigned.

Job Requirements
- Possession of a valid license as a Registered Nurse in the State of California.
- Level I: two (2) years of experience or its equivalent as a registered nurse in an acute care hospital, at least one (1) of which was on a medical/surgical ward or unit.
- Level II: one (1) year of utilization review/discharge planning experience in an acute care hospital or as a Case Manager in an alternate medical setting such as a clinic or physician’s office performing utilization review or discharge planning.
- Alternatively, possession of a valid license as a Registered Nurse in the State of California and five (5) years of experience as a Case Manager in an alternate medical setting such as a clinic or physician’s office performing utilization or discharge planning.
- Incumbents may be required to possess and maintain specific certificates competency based on unit specific requirements as a condition of employment.

Additional Details
- Case management experience in California (excluding Kaiser), preferably more than 1 assignment.
- Able to do both Utilization review and Care Coordination/Discharge planning.
- Experience in acute care/ICU/ED units.
- Extra: Trauma facilities experience.
- Experience with teaching facilities.
Not Specified
Document Review Attorney (Onsite Only)
Salary not disclosed

Ready to Rock Your Document Review Skills?

Hey legal eagles! Are you a newly licensed attorney looking for an exciting, long-term project that lets you flex your document review muscles? A fantastic firm in the Charleston, SC area is on the hunt for sharp onsite Document Review Attorneys to jump into an immediate, 6+ month gig. This isn't just another project; it's a chance to supercharge your resume and gain invaluable experience with a team that truly values you. Please note, if you have done extensive document review for Defense firms, you are likely conflicted out.

What You'll Be Doing as a Document Review Attorney (Your Superpower Moves!):

  • Sleuthing through documents with precision and speed, using Relativity or other cool e-discovery software.
  • Uncovering crucial information and sharing those "aha!" moments with your team leaders.
  • Crafting top-notch litigation documents, like those all-important Deposition Dossiers.
  • Tackling other fascinating tasks as your project leaders need a hand.

Who We're Searching For (Are You Our Next Superstar?):

  • You've got that shiny JD from an ABA-accredited law school.
  • You're either a licensed member of the SC Bar, or have a UBE score ready to transfer to SC, or are licensed in another state.
  • You're a detail-oriented dynamo – thorough, organized, and nothing gets past your eagle eyes.
  • You're a master of managing your time and can work independently like a pro.
  • Your communication skills, both written and verbal, are top-notch.
  • Bonus points if you're already a Relativity guru or have document review attorney experience, but no worries if not – we're ready to help you learn!
  • You've got that natural knack for problem-solving.

The Sweet Deal (What's In It For You!):

  • Competitive hourly rates ranging from $27 to $30.
  • Subsidized health insurance for our awesome full-time reviewers!

Be ready to pass a comprehensive conflicts check! And rest assured, your resume is held in the strictest confidence.

Think you're a fit? We can't wait to hear from you! Apply at : This job description is not intended to be all-inclusive. The employee may perform other related duties as negotiated to meet the ongoing needs of the organization.

Not Specified
Physician / Ambulatory Care / New York / Permanent / Review Physician Job
✦ New
Salary not disclosed

The WeCARE Physician is the role of Review Physician supports the Medical Director in the implementation of standard operation policies and procedures to ensure that UBA WeCARE complies with all New York City's HRA contractual requirements.

Key Responsibilities are:-To conduct medical reviews of Clinical Assessments/Clinical Reassessments for finalization, complete Wellness Plans dispositions for UBA WeCARE clients, and act as a clinical support for UBA WeCARE staff in the fulfillment of funder, (NYC HRA), contracted goals.

-Conduct medical reviews of Clinical Assessments completed by Qualified Health Professionals -Displays knowledge of medical conditions and SSA disability criteria.-Review prior WeCARE documentation, documentation provided by the client, prior and current Clinical Assessment/Clinical Reassessments, previous Medical Evaluation and Substance Use Assessment (when indicated).-Review, address, and correct any inconsistencies in the history obtained by the QHP-Order and review additional specialty assessments as indicated -Review and update Reasonable Accommodations and work limitations.-Determine appropriate medical diagnoses.

Assess the stability of client's medical issues.-Obtain medical documentation from EPIC, PSYCKES, and Bronx RHIO.-Enter information/complete appropriate forms in HRA (funder) database (SEAMS).

-Complete off-line/paper when medical record system SEAMS, is not functioning completely or is partially working.

-Ensure all off-line paper documents and medical records obtained from outside sources are scanned into SEAMS within 24 hours.

-Review the SSA sequential evaluation process conducted by the QHP to ensure accuracy.-Review provided wellness documentation from treatment providers -Check for medical documentation in EPIC, PSYCKES, and Bronx RHIO-Update and review reasonable accommodations and limitations-Ensure the FCO is correct and that the FCO justification contains relevant information -Review Wellness extensions with Medical Director and provide summary justifications for same-Able to assist and motivate clients to comply with WeCARE process.

Able to assist clients to access services to reduce barriers to compliance with WeCARE appointments.

-Knowledge of medical and behavioral health diagnoses.-Knowledge of various software systems including SEAMS, EPIC, PSYCKES, Bronx RHIO, etc.

-Possess strong computer skills with knowledge of Microsoft Office applications.

-Knowledge of SSA disability application process is preferred.Experience with NYC HRA preferred.Two years of professional experience in medical or clinical practice.Complete Wellness Enhancement Forms as indicated for Wellness track clients Medical and computer software (SEAMS, EPIC) and medical depository information databases (example PSYCKES, Bronx RHIO)In addition to a competitive salary of $180,000-220,000, we offer LTD, STD, paid malpractice, health, dental, vision and a 403(b).

Interested candidates should have a current unrestricted NYS Doctor of Medicine license to practice and American Board of Medical Specialties or American Osteopathic Association Board Certification and send an updated CV to Senior Recruiter, Desiree Aulet at Montefiore is an equal employment opportunity employer.

Montefiore will recruit, hire, train, transfer, promote, layoff and discharge associates in all job classifications without regard to their race, color, religion, creed, national origin, alienage or citizenship status, age, gender, actual or presumed disability, history of disability, sexual orientation, gender identity, gender expression, genetic predisposition or carrier status, pregnancy, military status, marital status, or partnership status, or any other characteristic protected by law.

permanent
Medical Review Specialist (Hybrid - Local Candidates)
Salary not disclosed

The Medical Review Specialist is responsible for reviewing, analyzing, and interpreting medical documentation to support eligibility determinations and alternative treatment evaluations in alignment with Christian Healthcare Ministries’ guidelines and values. This role exists to ensure medical review decisions are accurate, evidence-based, and applied consistently while maintaining compassion and clarity in member interactions.


At the highest level, the Medical Review Specialist focuses on clinical analysis, guideline interpretation, and professional judgment, supporting sound decision-making that upholds CHM’s mission, stewardship, and commitment to member care.


WHAT WE OFFER


  • Compensation based on experience.
  • Faith and purpose-based career opportunity!
  • Fully paid health benefits
  • Retirement and Life Insurance
  • 12 paid holidays PLUS birthday
  • Lunch is provided DAILY.
  • Professional Development
  • Paid Training


PRIMARY RESPONSBILITIES


  • Review and analyze complex medical records to assess eligibility, appropriateness of services, and alignment with CHM medical guidelines.
  • Apply clinical judgment and established criteria to support consistent, evidence-based eligibility determinations.
  • Conduct medical literature reviews and research to support recommendations, alternative treatment considerations, and guideline application.
  • Collaborate with the Eligibility Review Supervisor, Medical Director, and Medical Review leadership to ensure alignment and consistency in medical review decisions.
  • Communicate clearly and compassionately with members and internal teams regarding medical review outcomes, addressing questions and concerns professionally.
  • De-escalate sensitive or emotionally charged interactions while maintaining CHM standards and values.
  • Maintain accurate documentation of medical review findings, rationale, and decisions within CHM systems.
  • Stay current on medical research, industry standards, and regulatory considerations relevant to medical review activities.
  • Uphold strict confidentiality and HIPAA compliance in all handling of protected health information.


CORE COMPETENCIES & SKILLS


  • Medical analysis and critical thinking – Interpret complex medical information and applies clinical reasoning.
  • Evidence-based decision making – Utilizes research and guidelines to support review outcomes.
  • Clear and compassionate communication – Explains medical determinations in an understandable and empathetic manner.
  • Case management and prioritization – Manages multiple cases while meeting accuracy and timeliness standards.
  • Documentation and compliance – Maintain thorough, accurate records aligned with regulatory and internal requirements.
  • Collaboration – Works effectively with leadership, medical reviewers, and cross-functional teams.


REQUIRED QUALIFICATIONS & CONSIDERATIONS


Education

  • Bachelor’s degree in a healthcare-related field (e.g., nursing, health sciences, biology) preferred.
  • Equivalent clinical or medical review experience may be considered in lieu of a degree.


Experience

  • Prior experience in medical record review, utilization review, clinical review, or a related healthcare role preferred.
  • Experience applying medical guidelines or clinical criteria to eligibility or treatment determinations strongly preferred.
  • Familiarity with HIPAA regulations and protected health information handling required.
  • Experience working with EMR/EHR systems, medical coding, or health information systems is a plus.


Certifications

  • No certifications required at time of hire.
  • Clinical licensure or healthcare-related certifications (e.g., RN, LPN, CPC) are a plus but not required.


About Christian Healthcare Ministries

Founded in 1981, Christian Healthcare Ministries (CHM) is a health care sharing ministry for Christians. CHM is a nonprofit, voluntary cost-sharing ministry through which participating Christians meet each other’s medical bills. The mission of CHM is to glorify God, show Christian love, and experience God’s presence as Christians share each other’s medical bills.


Remote working/work at home options are available for this role.
Not Specified
Clinical Review RN - 249588
Salary not disclosed
Jericho, NY 3 days ago

JOB TITLE: Clinical Review RN (Medicaid Cost Outlier)


Nurse Background: 2+ years of acute care/medical surgical experience required. Interqual/MCG experience a plus.


GENERAL RESPONSIBILITIES: This individual will complete the full spectrum of activities related to Utilization or Quality reviews as assigned. They will utilize their knowledge and expertise of the review program to conduct clinical level review, supporting Medical Review Analysts, and Physician Consultants to ensure an appropriate and accurate process.


DUTIES:

1. Conduct utilization reviews up to and including the appeal level. This includes chart screen, complete electronic worksheets, enter required information and make level one denial decisions when necessary.

2. Conduct quality and clinical study data collection reviews. This includes chart review, complete detailed electronic data worksheets.

3. Act as a resource for the administrative staff in training, problem solving, and clarifying procedures. Will provide technical assistance and conduct/participate in staff huddles.

4. Participate in collaborative training specific to clinical study objectives.

5. Other activities as may be deemed necessary.


QUALIFICATIONS:

1. Licensed as a Registered Professional Nurse in New York State.

2. Knowledge and experience with electronic medical records including utilization, quality, and clinical charting.

3. Ability to oversee, problem solve and work collaboratively with peers, medical, analytical, and administrative support staff.

4. Excellent written and verbal skills.

5. Ability to work independently with little supervision.

6. Ability and desire to be flexible, innovative, and creative.


EDUCATION & EXPERIENCE:

1. Baccalaureate degree in Nursing or graduate of an approved Registered Professional Nurses training program and licensed to practice in the State of New York.

2. A minimum of 2 years experience in an acute care facility preferably in medical surgical and utilization review experience highly preferable.


LOCATION: Jericho, NY (onsite)

***there is a free shuttle from the Jericho LIRR station + parking onsite


SHIFTS: M-F, 40 hours or 4x10s (no weekends)


PAY: $50-55/hr


DURATION: long term open ended contract includes benefits, sick time, 401k, weekly pay

Not Specified
Medical Promotional Review Specialist
✦ New
Salary not disclosed
Plainsboro, NJ 1 day ago

Medical Promotional Review Specialist

6-month contract

Must be able to work on a W2

Hybrid in Plainsboro, NJ


TOP 3 “MUST HAVES”:

1. Demonstrated expertise in reviewing medical literature and independently evaluating scientific validity and clinical appropriateness of promotional content.

2. Proven ability to clearly and concisely communicate scientific information

3. Demonstrated ability to build and maintain collaborative relationships across multiple disciplines



PURPOSE:

Ensure scientific accuracy and clinical appropriateness and validity of promotional materials from a medical/scientific standpoint

Serve as a member of the Promotional Review Board (PRB)


ESSENTIAL FUNCTIONS:

• Provide critical review of promotional pieces to ensure medical accuracy, validity and appropriateness of content in accordance with approved labeling, scientific data and relevant laws, regulations and NNI policies to support the safe and effective use of products by patients and the medical community.

• Determine appropriateness of data and references used to support promotional claims and marketing messages and provide proactive recommendations and/or guidance for alternative da-ta/references/language where needed

• Align and collaborate with key cross-functional stakeholders including other PRB reviewers and commercial team members on issues or concerns related to promotional materials or claims

• Engage with commercial business partners early in the development of promotional materials to enhance efficiency, when applicable

• Work with the Medical Director for the assigned product(s)/therapeutic area(s) to increase efficiency, medical alignment, and mitigate risk of promotional claims

• Review, provide comments and document verdicts for all assigned promotional materials within PRB workflow system based on assigned deadlines

• Participate in PRB meetings as assigned

• Remain current with medical literature and data in assigned therapeutic area(s)

• Participate in relevant internal and external meetings and trainings on new guidance/regulations, new scientific information and marketing strategy


QUALIFICATIONS:

PharmD / MD/ DO / NP with a minimum of two years of relevant professional experience (e.g. academic, clinical or industry experience); post-doctoral fellowship may be substituted for professional experience, as appropriate

• Thorough understanding of the US pharmaceutical industry and healthcare landscape, promotional review process and relevant guidance and compliance requirements

• Detail-oriented with demonstrated editorial skills

• Strong organization and prioritization skills

• Ability to work on cross-functional teams

• Ability to critically analyze and apply scientific data in a customer-focused manner

• Strong verbal and written communication skills

• Effective negotiation skills and ability to influence others

Not Specified
Estimator - Bid Review & Preconstruction
Salary not disclosed
Mesa, AZ 2 days ago

The Estimator is responsible for ensuring all flooring bids are technically accurate, competitively structured, and financially sound before submission to customers. This role serves as the final quality control checkpoint for bid accuracy, scope alignment, and margin protection across new construction and large project bids.  


They will work closely with sales, estimating, purchasing, and operations to ensure bids are properly structured, risk is identified early, and projects are prepared for successful execution. 


This position requires extensive experience in flooring estimating, construction bidding, and plan/spec review, with the ability to identify scope gaps, quantity errors, and pricing risks before bids are released. This role plays a critical part in protecting company margin, preventing costly project mistakes, and improving bid quality across the organization. 


Primary Responsibilities:

Bid Strategy & Quality Control

  • Review large and complex flooring bids prior to submission.
  • Validate takeoffs, material quantities, labor assumptions, and pricing structures.
  • Ensure bids align with project plans, specifications, and scope requirements.
  • Identify risk areas such as:
  • Scope gaps
  • Quantity miscalculations
  • Incorrect product specifications
  • Margin erosion
  • Installation complexity
  • Provide feedback and corrections to estimators and sales teams before submission.

Preconstruction Review

  • Review architectural plans and specifications for flooring scope.
  • Confirm scope alignment between drawings, specifications, and proposals.
  • Identify missing scope or potential change order risks prior to bid submission.
  • Assist estimating team in improving bid structure and consistency.

Margin Protection

  • Ensure bids meet company margin expectations.
  • Identify pricing risks before customer submission.
  • Flag bids that require leadership review.

Bid Process Improvement

  • Identify recurring estimating errors and training opportunities.
  • Develop internal bid review standards and checklists.
  • Support ongoing estimator training and quality improvement.

Post-Award Project Validation

  • Review awarded bids to confirm final scope and pricing accuracy.
  • Ensure project setup in ERP reflects the approved bid structure.
  • Confirm correct materials, quantities, and pricing before purchasing.

Cross-Department Coordination

  • Work closely with sales, estimating, purchasing, operations, and finance to ensure projects are properly prepared for execution.


Required Experience

  • 5–10+ years of construction estimating experience
  • Extensive flooring estimating experience
  • Experience reviewing construction plans and specifications
  • Strong knowledge of flooring materials and installation methods
  • Experience preparing or reviewing large project bids
  • Strong understanding of construction scopes and subcontractor bidding
  • Advanced Excel skills
  • Experience with estimating software


Preferred

  • Experience estimating large multifamily or production builder projects
  • Experience with takeoff software such as:
  • MeasureSquare
  • PlanSwift
  • Bluebeam


No Recruiters, please.

Not Specified
Physician / Oncology - Hematology / Maryland / Locum or Permanent / Pacific Companies, INC Job
✦ New
Salary not disclosed
United States 1 day ago

Good day Are you looking for a change? A way to fill your time while in transition? Or looking for a 1099 independent contractor position? Continue to read below- one of the locum tenens opportunities that we have.

Our firm has a nationwide (locums and permanent) presence so please let me know if you are interested in a different location.The HEMONC locum tenens opportunity in MarylandLocation: Leonardtown, MD Duration: March August (potential for extension or conversion to perm)Reason for coverage: on-going vacancy in department Schedule: may consider part-timeShift: Monday Friday, 8a-4:30pCall: 1:4 weekends, rotating week night (NP triages call prior to getting to MDs)Patient volume: 12-15 patients per dayScope: Hematology 30%, Oncology 60% EMR: CernerHospital: 93 bedsGroup/support: infusion center on-site, NP supportRequirements (boards, license): Board certified with Maryland or compact license at time of application Travel, Accommodations, and Malpractice
- PAID for locum opportunities Assistance with credentialing provide -expedited 45-60 days credentialing with clean NPDB Call or Email for further details If you (or someone you know) are interested, please let me know your availability, and contact information.

Followed with an updated CV.

All information is held strictly confidential.Looking forward to hearing from you.

Thank you, Shawn Faucette

permanent
Project Manager - Performance Door and Hardware, Inc.
Salary not disclosed
Irving, TX 4 days ago

WE ARE PDHGROUP

We are a values-driven company that strives to provide the best quality service and products for the construction industry. As a provider and installer of Division 8, Division 10, Division 27, and Division 28 products, our business is built on honesty, integrity, and the ability to get the job completed on-time and with complete customer satisfaction. Our team brings over 425 years of combined experience and includes some of the most knowledgeable people in the industry.


JOB SUMMARY:

As a Project Manager, you will be accountable for the overall direction, coordination, implementation, execution, control and completion of any given project. Additionally, the Project Manager ensures budget and deadlines are met and consistent with project standards.


DUTIES AND ESSENTIAL JOB FUNCTIONS:

  • Create a Schedule of Values for our pay applications and submit to the General Contractor.
  • Analyze the construction schedule and create a schedule for submittals, material ordering and estimated field labor durations & project completion.
  • Create submittals for doors, frames and hardware from architectural plans and specification.
  • Manage and respond to electronic contractual changes (RFI’s, PC’s, Etc.). Quote changes that affect our material and/or labor cost. Distribute Change Order Due letters to the contractor.
  • Order materials (Purchase orders) from approved submittals for timely delivery according to the construction schedule or as agreed upon with the contractor for billed and stored material.
  • Support the Performance Door project field supervisor for the timely delivery of materials according to the construction schedule. Send field use drawings periodically reflecting updated schedules incorporating project revisions.
  • Provide monthly pay application to the accounting department including back up documentation for stored or FSC materials.
  • Actively pursue contractual “Change Orders” from “price and proceed” CO Due letters. Take an active role in collecting money.
  • Approve weekly vendor invoices for payment. Check vendor costs against our purchase order.
  • Other job duties and responsibilities as needed.


Not Specified
QUALITY PEER REVIEW RN/NON-RN – VHS (FULL-TIME)
Salary not disclosed
Las Vegas, NV 3 days ago
Responsibilities

The Valley Health System has expanded into an integrated health network that serves more than two million people in Southern Nevada. Starting with Valley Hospital Medical Center in 1979, the Valley Health System has grown to include Centennial Hills Hospital Medical Center, Spring Valley Hospital Medical Center, Summerlin Hospital Medical Center,Henderson Hospital , Valley Health Specialty Hospital and West Henderson Hospital.

Benefit Highlights:

- Comprehensive education and training center
- Competitive Compensation & Generous Paid Time Off
- Excellent Medical, Dental, Vision and Prescription Drug Plans
- 401(K) with company match and discounted stock plan
- Career opportunities within VHS and UHS Subsidies
- Challenging and rewarding work environment

Job Description: Responsible for the overall management of the Performance Improvement processes related to physicians performance.

Qualifications

Education: Bachelors (BSN) degree in nursing or Master's Degree in a healthcare related field from an accredited program.

Experience: Five (5) years clinical experience with two (2) to four (4) years QA or PI experience required, and a minimum of two (2) years progressive management experience required.

Technical Skills: Computer proficiency to include word processing, spreadsheet, and database.

License/Certification: Current RN license in the State of Nevada is required if RN. Certified Professional Healthcare Quality (CPHQ) required for non-RN.

Other: Must be able to demonstrate the knowledge and skills necessary to provide service appropriate to the age of the patient. Travel Required.

EEO Statement

All UHS subsidiaries are committed to providing an environment of mutual respect where equal employment opportunities are available to all applicants and teammates. UHS subsidiaries are equal opportunity employers and as such, openly support and fully commit to recruitment, selection, placement, promotion and compensation of individuals without regard to race, color, religion, age, sex (including pregnancy, gender identity, and sexual orientation), genetic information, national origin, disability status, protected veteran status or any other characteristic protected by federal, state or local laws.

We believe that diversity and inclusion among our teammates is critical to our success.

Notice

At UHS and all our subsidiaries, our Human Resources departments and recruiters are here to help prospective candidates by matching skillset and experience with the best possible career path at UHS and our subsidiaries. We take pride in creating a highly efficient and best in class candidate experience. During the recruitment process, no recruiter or employee will request financial or personal information (Social Security Number, credit card or bank information, etc.) from you via email. The recruiters will not email you from a public webmail client like Hotmail, Gmail, Yahoo Mail, etc. If you are suspicious of a job posting or job-related email mentioning UHS or its subsidiaries, let us know by contacting us at: or 1-8
permanent
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