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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.
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.
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.
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!
- Sunday 8 – 5 pm PST Pay Range: $43
- $44/hr.
on W2 Description: · The Care Review Clinician is responsible for performing utilization management (UM) reviews, including prior authorization of outpatient services, to ensure medical necessity, appropriate level of care, and compliance with regulatory and organizational guidelines.
· The clinician will review clinical documentation, apply evidence-based criteria, and collaborate with providers to facilitate timely and appropriate care for members.
· This role supports Client’s commitment to quality, cost-effective care and regulatory compliance within the California health plan.
Must Have Skills: · Knowledge of California delegation requirements · Strong understanding of utilization management processes · Experience with prior authorization review (outpatient preferred) · Ability to apply clinical guidelines (e.g.
MEDICAID, MCG) Day to Day Responsibilities: · Process outpatient prior authorization referrals · Review clinical documentation for medical necessity · Apply established UM criteria and guidelines · Communicate with providers for additional clinical information · Ensure compliance with state, federal, and Client policies · Document determinations accurately and timely Required Years of Experience: · Active, unrestricted California RN or LVN license required · Minimum of 3 years of clinical experience in utilization management
Job Description
At Boeing, we innovate and collaborate to make the world a better place. We’re committed to fostering an environment for every teammate that’s welcoming, respectful and inclusive, with great opportunity for professional growth. Find your future with us.
We are Boeing Global Services (BGS) Engineering team creating and implementing innovative technologies that make the impossible possible and enabling the future of aerospace. We provide engineering design and support, including aftermarket modifications, and are innovating to make product and services safety even stronger. Join us and put your passion, determination, and skill to work building the future! #TheFutureIsBuiltHere #ChangeTheWorld
BGS is seeking an Experienced Mechanical Design Review Engineer within Government Training Engineering (GTE) in Hazelwood, MO or Oklahoma City, OK. The GTE Hardware Design team is responsible for the design and development of aircrew & maintenance training devices.
A successful candidate will have detail-oriented Drawing Quality Check Engineer mindset with strong design fundamentals, cross-discipline engineering insight, and practical PLM experience to ensure accurate, manufacturable documentation and controlled product data. This person influences design early, reduces downstream issues through clear drawings and constructive feedback, maintains reliable part and PLM records, and collaborates effectively with engineers to support smooth product development and production readiness across all GTE Training platforms.
Position Responsibilities:
- Review and validate engineering drawings and markups for completeness, accuracy, and adherence to company standards and specifications
- Maintain PLM user groups and actively manage part catalog records and device application data to ensure up-to-date, auditable configurations
- Provide clear, constructive feedback and training to a multi-discipline engineering team, fostering continuous improvement and knowledge sharing
- Work independently with high motivation and accountability, prioritizing tasks and driving timely resolution with minimal supervision
- Communicate professionally and collaboratively across teams, resolving issues diplomatically and maintaining positive working relationships
Basic Qualifications (Required Skills/Experience):
- Bachelor of Science degree in Engineering or related field
- Experience with product lifecycle
- 5 or more years’ related work experience or an equivalent combination of technical education and experience
- Basic understanding of Microsoft office and tools
Preferred Qualifications (Desired Skills/Experience):
- 10+ years of experience in a design environment
- Deep understanding of design, production, and build processes, enabling you to identify manufacturability improvements, reduce rework, and provide actionable recommendations that influence early product design decisions
- Strong grasp of design principles and techniques, including drafting standards, tolerancing, GD&T, and drawing best practices, to ensure clear, unambiguous documentation and consistent interpretation across teams
- Broad familiarity with multiple engineering disciplines (electrical, mechanical, and systems), allowing you to interpret cross-discipline requirements, anticipate integration issues, and communicate effectively with subject-matter experts
- Experience with PLM tools (ex. CMPRO or Teamcenter), including creating and maintaining part records, managing change processes, configuring user groups, and extracting accurate device application and BOM data for downstream stakeholders
Drug Free Workplace:
Boeing is a Drug Free Workplace where post offer applicants and employees are subject to testing for marijuana, cocaine, opioids, amphetamines, PCP, and alcohol when criteria is met as outlined in our policies.
Pay & Benefits:
At Boeing, we strive to deliver a Total Rewards package that will attract, engage and retain the top talent. Elements of the Total Rewards package include competitive base pay and variable compensation opportunities.
The Boeing Company also provides eligible employees with an opportunity to enroll in a variety of benefit programs, generally including health insurance, flexible spending accounts, health savings accounts, retirement savings plans, life and disability insurance programs, and a number of programs that provide for both paid and unpaid time away from work.
The specific programs and options available to any given employee may vary depending on eligibility factors such as geographic location, date of hire, and the applicability of collective bargaining agreements.
Pay is based upon candidate experience and qualifications, as well as market and business considerations.
Summary pay range: $96,050 - $140,300
Applications for this position will be accepted until Mar. 27, 2026
Export Control Requirements:
This position must meet U.S. export control compliance requirements. To meet U.S. export control compliance requirements, a “U.S. Person” as defined by 22 C.F.R. §120.62 is required. “U.S. Person” includes U.S. Citizen, U.S. National, lawful permanent resident, refugee, or asylee.
Export Control Details:
US based job, US Person required
Education
Bachelor's Degree or Equivalent Required
Relocation
This position offers relocation based on candidate eligibility.
Security Clearance
This position requires the ability to obtain a U.S. Security Clearance for which the U.S. Government requires U.S. Citizenship. An interim and/or final U.S. Secret Clearance Post-Start is required.
Visa Sponsorship
Employer will not sponsor applicants for employment visa status.
Shift
This position is for 1st shift
Equal Opportunity Employer:
Boeing is an Equal Opportunity Employer. Employment decisions are made without regard to race, color, religion, national origin, gender, sexual orientation, gender identity, age, physical or mental disability, genetic factors, military/veteran status or other characteristics protected by law.
The Upfront Review Clerk is responsible for the quality review of all pertinent customer information for accuracy and completeness in order to meet payer requirements for timely and maximum reimbursement.
Responsibilities include:
- Evaluating all received documents to ensure that appropriate information has been obtained to allow for successful Accounts Receivable
- Maintaining Held Sales by assisting customer service representatives weekly in correcting problems so billing may begin or continue
- Responsible for reviewing various reports for quality assurance
- Recording all activity relating to the account in tickler files
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.
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.
$26.61 - $39.92 - The hourly pay rate offered is determined by a candidate's expertise and years of experience, among other factors.
Quality Review Sterile Processing Tech ? Sterile Processing -Mid shift
Position Highlights:
- Position: Quality Review Sterile Processing Tech
- Location: Elmhurst, IL
- Full Time/Part Time: Full time
- Hours: Monday-Friday, 12:00noon-8:30pm, must be flexible to travel to other Endeavor Health locations.
What you will do:
- Ensures daily operational compliance with the standards governing sterile processing activities from such agencies as The Joint Commission, OSHA, AORN, AAMI; as well as state and local ordinances
- Assists in coordination, facilitation and monitoring of new and existing sterile processing staff education, training and orientation via one-on-ones, huddles, staff meetings, in-services and formal orientation in collaboration with department leadership
- Assists with the maintenance, inventory, and implementation of newly acquired and existing instrument trays/sets, instruments, and supplies
- Collaboratively works with the appropriate staff to maintain accurate instrument count sheets and make revisions as necessary
- Provides analysis of reported data and recommendations for improvement
- Assists with identification of staff educational needs and development of programs
What you will need:
- Education: Highschool or GED required, Bachelors Degree Preferred
- Certification: Certified Sterile Processing and Distribution Technician (CSPDT) - Certification Board for Sterile Processing and Distribution (CBSPD) or Certified Registered Central Service Technician (CRCST) ? Healthcare Sterile Processing Association (HSPA), formerly IAHSCMM)
- Experience: 2 years? experience in health care sterile processing (or procedural area) and environment AND experience in project management and staff education
Benefits (For full time or part time positions):
- Career Pathways to Promote Professional Growth and Development
- Various Medical, Dental, Pet and Vision options
- Tuition Reimbursement
- Free Parking
- Wellness Program Savings Plan
- Health Savings Account Options
- Retirement Options with Company Match
- Paid Time Off and Holiday Pay
- Community Involvement Opportunities
Endeavor Health is a fully integrated healthcare delivery system committed to providing access to quality, vibrant, community-connected care, serving an area of more than 4.2 million residents across six northeast Illinois counties. Our more than 25,000 team members and more than 6,000 physicians aim to deliver transformative patient experiences and expert care close to home across more than 300 ambulatory locations and eight acute care hospitals ? Edward (Naperville), Elmhurst, Evanston, Glenbrook (Glenview), Highland Park, Northwest Community (Arlington Heights) Skokie and Swedish (Chicago) ? all recognized as Magnet hospitals for nursing excellence. For more information, visit you work for Endeavor Health, you will be part of an organization that encourages its employees to achieve career goals and maximize their professional potential.
Please explore our website ( ) to better understand how Endeavor Health delivers on its mission to ?help everyone in our communities be their best?.
Endeavor Health is committed to working with and providing reasonable accommodation to individuals with disabilities. Please refer to the main career page for more information.
Diversity, equity and inclusion is at the core of who we are; being there for our patients and each other with compassion, respect and empathy. We believe that our strength resides in our differences and in connecting our best to provide community-connected healthcare for all.
EOE: Race/Color/Sex/Sexual Orientation/ Gender Identity/Religion/National Origin/Disability/Vets, VEVRRA Federal Contractor.
