Simpro Reviews Jobs in Usa

Position Title: Clinical Review Clinician - Appeals

Work Location: Remote - Nationally sourced (Preference for 2 candidates in AZ)

Assignment Duration: 6 months

Work Schedule: 8:00 AM - 5:00 PM EST or CST

Work Arrangement: Remote

Schedule is 8-5 EST or CST hours. Staff will work when there are members of the supervisor/leadership on.

Cases are assigned in round robin fashion for staff to review and work.

The Organization's clinical team handles various types of authorization and claim review requests from various markets nationwide, processing clinical reviews to ensure members have the best outcomes and access to care needed.

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  Nurses review case files, add, update or edit authorizations.

  
  
  
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  Work closely with the MD team to make final decisions on cases.

  
  
  
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  Process clinical reviews to ensure members have access to care needed.

  
  
  
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  Help reduce provider abrasion by processing retrospective claim reviews.

  
  
  
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  Work closely with supervisors, senior clinicians, and the coordinator team on end-to-end case processes.

  
  
  
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  Participate in team collaboration via Teams group chats for routine questions.

  
  
  

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  Education/Certification (Required): Associate in nursing, Bachelor's in nursing or higher.

  
  
  
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  Licensure (Required): RN, LPN

  
  
  
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  Licensure (Preferred): LVN

  
  
  
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  Must haves:

  
  
  
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    Medicare knowledge

    
    
    
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    InterQual or Milliman Experience

    
    
    
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    Clinical reviews for Utilization Management or Appeals

    
    
    
  
  
  
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  Nice to haves:

  
  
  
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    Medicare Appeals Experience

    
    
    
  
  
  
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  Disqualifiers:

  
  
  
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    Not having a valid/active RN/LPN license

    
    
    
  
  
  
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  Performance indicators:

  
  
  
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    Productivity expectations vary based on platform.

    
    
    
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    Prime: 7 CPD

    
    
    
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    iCP: 9 CPD

    
    
    
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    CenPas: 20 CPD cases per day

    
    
    
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    95% quality on all cases
    
    

    
    
    Candidate Requirements
    
    Education/Certification
    Required: Associate in nursing, Bachelor's in nursing or higher.
    Preferred:
    
    Licensure
    Required: RN, LPN
    Preferred: LVN
    
    
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    • Years of experience required
      
    • Disqualifiers
      
    • Best vs. average
      
    • Performance indicators
      
    
    
    Must haves: Medicare knowledge, InterQual or Milliman Experience, Clinical reviews for Utilization Management or Appeals
    
    Nice to haves: Medicare Appeals Experience
    
    Disqualifiers: Not having a valid/active RN/LPN license
    
    Performance indicators: Productivity expectations vary based on platform. Prime 7 CPD, iCP 9 CPD and CenPas is 20 CPD cases per day with 95% quality on all cases
    
    Best vs. average: Productivity expectations are set based on platform.
    
    
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    • Top 3 must-have hard skills
      
    • Level of experience with each
      
    • Stack-ranked by importance
      
    • Candidate Review & Selection
      
    
    
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    Utilization Management or Appeals review background (1 plus year)
    
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    Medicare NCD/LCD and InterQual/Milliman Software (1 plus year)
    
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    Retrospective claims clinical reviews (1 plus year)
    
    
  
  
  

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.

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.

Whether you are searching for a position in your area or in another state, we have professionals to help you achieve your goals through our relationships with facilities nationwide
- in rural settings, small cities, and major metropolitan areas.

Contact your personal consultant to tell them what you are looking for in a telehealth position.

CompHealth can make finding great opportunities simple, less stressful, and personalized to fit your needs.

We have phenomenal relationships with facilities around the country, and a team dedicated to helping you with every step of the hiring process.

Contact Gordon Diaz .

100% remote; open to FM and IM physicians Work at your own pace; must have an active state license Great salary to supplement current work; malpractice coverage via occurrence policy Physician is responsible for learning the aspects of compliance in the company Physician will implement and communicate policies, processes, and procedures Must be board certified or board eligible (if a resident) Great work-life balance; possible relocation assistance Live in a beautiful suburb with access to many shops and restaurants Our services are free for you We help negotiate your salary and contract We coordinate interviews and help with licenses Specialized recruiters match your career preferences Experienced support teams take care of every detail

Whether you are searching for a position in your area or in another state, we have professionals to help you achieve your goals through our relationships with facilities nationwide
- in rural settings, small cities, and major metropolitan areas.

Contact your personal consultant to tell them what you are looking for in a telehealth position.

CompHealth can make finding great opportunities simple, less stressful, and personalized to fit your needs.

We have phenomenal relationships with facilities around the country, and a team dedicated to helping you with every step of the hiring process.

Contact Gordon Diaz .

100% remote; open to FM and IM physicians Work at your own pace; must have an active state license Great salary to supplement current work; malpractice coverage via occurrence policy Physician is responsible for learning the aspects of compliance in the company Physician will implement and communicate policies, processes, and procedures Must be board certified or board eligible (if a resident) Great work/life balance; possible relocation assistance Live in a beautiful suburb with access to many shops and restaurants Our services are free for you We help negotiate your salary and contract We coordinate interviews and help with licenses Specialized recruiters match your career preferences Experienced support teams take care of every detail

Sentinel Underwriting Review is seeking an experienced field inspector to perform exterior insurance underwriting inspections in the following coverage areas:

• Grand Traverse, Benzie, Leelanau Counties (Traverse City / Northwest Michigan)
• Alpena, Presque Isle, Montmorency, Oscoda, & Alcona Counties (Northeast Lower Michigan)
• Escanaba, Delta, Menominee Counties (South-Central Upper Peninsula)
• Houghton, Hancock, Baraga Counties (Western Upper Peninsula / Keweenaw Region)

$25–$30 per inspection | Flexible | Ongoing Volume

This opportunity is ideal for someone already performing field inspections or related work who is looking to add supplemental volume and additional income to their existing route.

• Pay: Typically $25–$30 per completed inspection

• Inspection Type: ~90% exterior-only (drive-by underwriting inspections)

• Interior Inspections: ~10% (scheduled with homeowner)

• Time on Site: Typically 5–10 minutes for exterior inspections

• Scheduling: Flexible – route yourself

• Volume: Ongoing assignments available in the region

• Turnaround: Standard 21–30 days (rush assignments occasionally available)

High-performing inspectors receive priority assignment volume.

These are insurance underwriting condition inspections, not full home inspections.

Responsibilities include:

• Capturing required exterior photos (front, rear, angles, roofline, outbuildings, hazards)

• Identifying visible underwriting concerns (roof condition, debris, liability hazards, etc.)

• Completing a short digital inspection report

• Occasionally preparing a simple property sketch

• Scheduling homeowners for the limited interior inspections

All reports and photos are submitted through Sentinel’s online reporting platform.

This opportunity works well for professionals already working in the field such as:

• Independent home inspectors

• Field service inspectors

• Real estate professionals

• Property appraisers

• Insurance field representatives

• Contractors or property service professionals

• Retired insurance professionals seeking flexible supplemental income

We are specifically seeking individuals already operating in Southwest Michigan who can incorporate these inspections into their existing routing.

• Reliable vehicle

• Smartphone or digital camera

• Computer access for report submission

• Ability to meet turnaround deadlines

• Professional communication and reliability

• Valid driver’s license and proof of insurance

• Background check required

Experience with insurance underwriting inspections or field services preferred but not required.

If you currently perform drive-by underwriting inspections or similar field work and are interested in adding inspection volume in Allegan, Van Buren, Berrien, or Cass County, we would like to hear from you.

Please reply with:

• Your experience
• Counties you currently cover or are willing to cover
• Whether you currently perform underwriting or field inspections

Job Description:

• Early morning dispatch from Rogers, MN.
• Starting rate of $24/hour during brief training period. Component pay after training. 
• 5 day work week within Monday-Saturday. Average 10-12/hour days. Dispatch times within 12a-5a, end times vary.
• $5,000 sign on bonus - Terms Apply - Any person who has worked for a Performance Food Group (PFG) owned company within the last 6 months is not eligible to receive this incentive.

• Competitive pay and benefits, including Day 1 Health & Wellness Benefits, Employee Stock Purchase Plan, 401K Employer Matching, Education Assistance, Paid Time Off, and much more
• Growth opportunities performing essential work to support America’s food distribution system
• Safe and inclusive working environment, including culture of rewards, recognition, and respect

• Performs all required safety checks (i.e., pre/post trip) including inspections of tractor/truck and trailer according to Department of Transportation (DOT) regulations; inspects tractor/truck and trailer to insure they meet company safety standards and take appropriate action as needed.
• Report all safety issues and/or repairs required.
• Follows all DOT regulations and company safe driving guidelines and policies. Immediately reports all safety hazards. Inspects trailer for properly loaded and secured freight.
• Performs count check of items and checks customer invoices of products that have been loaded.
• Checks and completes in an accurate and in legible fashion all required paperwork associated with freight.
• Moves tractor to the loading dock and attach preloaded trailer as needed.
• Drives to and delivers customer orders according to predetermined route delivery schedule.
• Unloads products from the trailer, transports items into designated customer storage areas.
• Performs damage control checks on items, scans, and contacts supervisor about removing orders according to company policy.
• Verifies delivery of items with customer and obtain proper signatures.
• Collects money (cash or checks) where required.
• Loads customer returns on to trailer and secure trailer doors.
• Ensures that tractor, trailer, and freight are appropriately locked and/or always secured.
• Unloads damaged goods and customer returns and bring to the driver check-in and complete necessary paperwork.
• Unloads all equipment, materials and removes trash from trailers as required.
• Completes daily record of hours of service and enter in log in accordance with Federal DOT, state, and company requirements.
• Performs general housekeeping duties in tractor, loading dock area and keeps trailers clear and clean as required.
• At the end of the shift secure all equipment and complete all necessary paperwork.
• Performs other related duties as assigned.

Qualifications:

Company description

Awards and Accolades

Job Description:

Position Details: 

• Local CDL A Delivery Driver position
• Pay: Yearly annual average of $83,500
• Schedule: Primarily Monday-Friday with an occasional Saturday. Average 10-12/hrs a day. Occasional overnights.

We Deliver the Goods: 

• Competitive pay and benefits, including Day 1 Health & Wellness Benefits, Employee Stock Purchase Plan, 401K Employer Matching, Education Assistance, Paid Time Off, and much more 

• Growth opportunities performing essential work to support America’s food distribution system 

• Safe and inclusive working environment, including culture of rewards, recognition, and respect 

Position Purpose:  
 
Food and food service delivery drivers fulfill a critical role in the country’s food supply chain. Our delivery drivers not only make sure the customers’ products arrive at their destination at the arranged times and in good condition, but they are the face of our company – building lasting relationships with our customers! 
 
Driver is responsible for driving a tractor trailer or straight truck on intrastate and interstate local, over-the-road (OTR), shuttle, and overnight and drive and drop routes for the purpose of delivering and/or unloading food and food related products to customers in a safe and timely manner and in accordance with Department of Transportation (DOT) regulations. 
 
Primary Responsibilities: 

• Communicates and interacts with customers, vendors and co-workers professionally ensuring questions are answered accurately and in a timely manner. 

• Functions as a team member within the department and organization, as required, and perform any duty assigned to best serve the company. 

• Performs all required safety checks (i.e., pre/post trip) including inspections of tractor/truck and trailer according to Department of Transportation (DOT) regulations; inspects tractor/truck and trailer to insure they meet company safety standards and take appropriate action as needed. 

• Reports all safety issues and/or repairs required. 

• Follows all DOT regulations and company safe driving guidelines and policies. 

• Immediately reports all safety hazards. Inspects trailer for properly loaded and secured freight. 

• Performs count check of items and check customer invoices of products that have been loaded. 

• Checks and completes in an accurate and in legible fashion all required paperwork associated with freight. 

• Moves tractor to the loading dock and attach preloaded trailer as needed. 

• Drives to and delivers customer orders according to predetermined route delivery schedule. 

• Unloads products from the trailer, transports items into designated customer storage areas. 

• Performs damage control checks on items, scans, and contact supervisor about removing orders according to company policy. 

• Verifies delivery of items with customer and obtain proper signatures. 

• Collects money (cash or checks) where required. Loads customer returns on to trailer and secures trailer doors. 

• Ensures that tractor, trailer, and freight are appropriately locked and/or always secured. 

• Unloads damaged goods and customer returns and bring to the driver check-in and complete necessary paperwork. Unloads all equipment, materials and remove trash from trailers as required. 

• Completes daily record of hours of service and enter in log in accordance with Federal DOT, state, and company requirements. 

• Performs general housekeeping duties in tractor, loading dock area and keep trailers clear and clean as required. 

• At the end of the shift secure all equipment and complete all necessary paperwork. 

• Performs other related duties as assigned.  

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Qualifications:

Company description

Awards and Accolades

Job Description:

• $30.00-$35.00 per hour, depending on experience. 
• Sunday - Thursday 3rd shift hours starting around 6:00 pm:  Flexible on starting time 
• Benefits Day 1 of Employment.  Free Uniforms and Safety Boots

• Competitive pay and benefits, including Day 1 Health & Wellness Benefits, Employee Stock Purchase Plan, 401K Employer Matching, Education Assistance, Paid Time Off, and much more
• Growth opportunities performing essential work to support America’s food distribution system
• Safe and inclusive working environment, including culture of rewards, recognition, and respect

• Complete and perform preventative maintenance on minor repairs and standard component inspections/ repairs of fleet diesel equipment (tractors, trailers, refrigeration units) as well as identifying root causes of basic failures/conditions and perform repairs as required.
• Ensure equipment has required licensing and registration prior to being deemed as “roadworthy”.
• Complete thorough documentation for work orders of repairs and preventative maintenance through the online Enterprise Asset Management system.
• Install, replace, and repair onboard computers.
• Inspect brake systems, steering mechanisms, wheel bearings, and other important parts to ensure that they are in proper operating condition which may require replacement of parts.
• Perform routine maintenance such as changing oil, checking batteries and lubricating equipment and machinery requiring the use of hand tools such as screwdrivers, pliers, wrenches, pressure gauges, and precision instruments, as well as power tools such as pneumatic wrenches, welding equipment, and jacks and hoists.
• Performs other related duties as assigned. 

Qualifications:

Company description

Awards and Accolades