Solid Surface Countertop Reviews Jobs in Usa

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.

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

885522: NP / PA / Independent Reviewer UAS Contractors (New York State)

Med-Scribe, Inc. is a healthcare staffing service recruiting top-notch employees all throughout New York State for over 30 years! We are partnered with a large multi-national company dedicated to strengthening communities and improving the lives of those they serve by facilitating connections to government health and human services.

We are in search of experienced clinicians to join a UAS Home Care Project. In this role, you will be responsible for independent review and evaluation of completed UAS reassessments for appropriateness of long-term care services for consumers, in accordance with Medicare and Medicaid guidelines.

These are contractor positions ? which allow for flexibility in scheduling, at your own pace training, and pay at $100/hr.

In this role, you will be scheduled for in person appointments with members of the long term care population, who are applying for Managed Long Term Care services (MLTC). Your clients will have already completed a UAS evaluation with a Registered Nurse, and your role will be to determine whether MLTC and home care services are adequate for the patient?s care, or if they should instead be admitted to a supportive facility. Each appointment will last approximately 1.5 hours ? 30 minutes of preparation time, 30 minutes meeting with the member, and 30 minutes completing and submitting your determination. Additional compensation is offered for longer appointments.

Schedules are arranged according to your availability; however hours are not guaranteed. You must be willing to work at least 9 hours weekly, within operation hours which run Monday ? Friday 8AM ? 7PM, and Saturday between 10AM-6PM. Candidates who are unable to work during these operation hours, or who cannot commit to 9 hours weekly will not be considered.

Expect to travel! Appointments will be scheduled anywhere within the county or counties of your choice, based on your availability. Candidates covering multiple counties will receive more hours. Please note, you must choose one full county to be considered!

Current openings include:

• Chemung County
• Steuben County

Minimum Qualifications:

• NYS Certified Nurse Practitioner License plus 3600 hours of experience OR
• NYS Certified Physician Assistant License
• An active NYS Medicaid number
• 2 years of prior experience within home care, geriatrics, or community health populations
• Willing to travel for in person appointments, with reliable transportation

Contractors will be compensated for each completed assessment, and will receive partial compensation for interrupted assessments.

These roles are 1099 contractor positions, and do not include benefits.

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To be considered, please visit our website at and reference job number 885522.

Med-Scribe is an equal opportunity employer. In accordance with anti-discrimination law, it is the purpose of this policy to effectuate these principles and mandates. Med-Scribe prohibits discrimination and harassment of any type and affords equal employment opportunities to employees and applicants without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law. Med-Scribe conforms to the spirit as well as to the letter of all applicable laws and regulations.

#IND1

Job Type: Contract

Pay: $100.00 per hour

People with a criminal record are encouraged to apply

Application Question(s):

• Do you currently have an active NYS Medicaid Provider Number?

Experience:

• geriatric, community health, or home care: 1 year (Required)

License/Certification:

• NYS Nurse Practitioner or Physician Assistance License (Required)

Work Location: Hybrid remote in Elmira, NY 14901