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At MVP Health Care, we're on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference-every interaction, every day. We've been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team.
What's in it for you:
- Growth opportunities to uplevel your career
- A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team
- Competitive compensation and comprehensive benefits focused on well-being
- An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace.
You'll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities.
About the Opportunity
As a Professional, Prospective Review in Health Management - UM Prospective Review, you will play a crucial role in ensuring the quality and efficiency of our prospective review process. You will work closely with the healthcare team to review and assess the appropriateness of medical services, treatments and high dollar medical equipment. This is an exciting opportunity to contribute to the improvement of patient care and outcomes.
What You'll Do
- Conduct comprehensive reviews of medical records and treatment plans to determine if the requested services are appropriate based on established guidelines and medical criteria across multiple lines of business.
- Utilize your clinical expertise to evaluate medical necessity and collaborate with MVP Medical Directors to determine the effectiveness of proposed treatments/equipment.
- Document clinical summations, recommendations and send appropriate correspondences accurately and within regulatory timeframes.
- Communicate with healthcare providers and members to collect pertinent information, discuss review outcomes and provide appropriate referrals within MVP.
- Remain up to date with industry standards and guidelines, complete required competency training and proficiency examinations to ensure compliance and best practice.
- Participate in team meetings and training sessions to enhance your knowledge and skills.
- Contribute to process improvement initiatives to streamline the prospective review process.
- Other duties as assigned by leadership.
Skills and Experience
- Education, Licensures, & Certifications
- Current RN (NY or VT)
- Years of Experience (Required & Preferred)
- Minimum of 3-5 years clinical experience required
- Case management certification preferred
- Required Job Skills
- Able to manage multiple tasks in a fast-paced environment.
- Strong clinical knowledge, critical thinking skills and understanding of medical terminology, procedures, concepts.
- Ability to work independently to analyze complex medical information.
- Effective communication skills, both written and verbal.
- Ability to work independently and collaboratively in a team environment.
- Proficiency in using computer systems and software for documentation, data entry and day-to-day work functions.
- Preferred Job Skills
- Prior Utilization review experience
- Knowledge of Government Insurance Programs (Medicare, Medicaid)
Working Conditions
Secure, Quiet area for Desk/Computer to maintain HIPPA compliance
Travel Requirements
Potential for travel to regional offices
Worksite Designation
- Virtual based out of Schenectady NY
Pay Transparency
MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role.
We do not request current or historical salary information from candidates.
$69,383.00-$92,279.00
MVP's Inclusion Statement
At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration.
MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications.
To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at .
Position Summary
Lead position that requires multi-certification and disciplines necessary to handle project approvals from start to finish through the plan review and inspection processes in accordance with the Division's mission and performance objectives.
Direct and lead Building Inspector/Plans Examiners and seasonal/casual staff. Assist the Division Manager and Building Official with program planning and personnel direction. Oversee the coordination of the building safety plan review and inspection process. Conduct construction code reviews and inspections for residential, commercial, industrial and multi-family development proposals. Depending on the Division's needs, employees in this position may be assigned to focus primarily on plan review or inspection duties. This program is highly visible and often the first contact made with the City from those outside the community. These tasks are illustrative only and may include other related duties.
This recruitment is accepting applications for
Building Inspector/Plans Examiner III
Building Inspector/Plans Examiner IV (Plan Review Lead)
Full-Time 40 hours per week
AFSCME-represented positions
12-month probationary period
Must meet all qualifications and requirements as listed in the position description below.
Building Inspector/Plans Examiner III $38.25 - 48.66 Hourly
Building Inspector/Plans Examiner IV (Plan Review Lead) $41.27 - $52.51 Hourly
These positions are anticipated to be assigned primarily to commercial and residential plan review.Essential Duties
Building Inspector/Plans Examiner III
Leads and coordinates members of the development review and inspection teams to ensure a timely, predictable, comprehensive and accurate plan review and inspection process for any development proposal.
Reviews and inspects residential, commercial, industrial, and multi-family development proposals to ensure compliance with State and City codes/ordinances, engineering/architectural, and fire/life safety principles.
Depending on the Division's needs, performs construction plan review and site inspections:
- Conducts Pre-Development, Plan Intake, and Pre-Construction meetings.
- Takes the lead in coordinating plan reviews and inspections internally, with customers, and with other departments and agencies.
- Maintains communication with contractors to anticipate and resolve onsite issues.
- Performs building safety inspections and plan reviews.
- Calculates and assesses fees.
- Monitors permit and project status and follow-up with expired applications and permits.
- Maintains accurate records and files of construction plan reviews, inspections, and related correspondence. Archives documents as required.
- Manages phased development and deferred submittal process for assigned projects.
- Ensures special inspection and structural observation is accomplished where required.
- Recommends or issues Stop Work Orders, violation notifications, and other building code compliance actions when necessary.
- Issues final approval of construction permits.
Provides technical interpretations of code issues and requirements.
Leads and coordinates teams to investigate and resolve matters of community concern, public health, building safety and dangerous building situations. Examples include fire scene investigations, flooding, mold growth, post-earthquake inspections, electrical hazards, hazardous materials, boiler explosions, sanitation issues, mechanical failures, and any condition identified in the Dangerous Building Code.
Represents the City at national, state and local boards, meetings, hearings, seminars, classes, and public
outreach events involving construction codes or building safety.
Provides training, support and assistance to cross-trained staff, and participates in cross-training programs.
Conducts compliance verifications for appropriate contractor licensing and registration.
Acts ethically and honestly; applies ethical standards of behavior to daily work activities and interactions. Builds confidence in the City through own actions.
Conforms with all safety rules and performs work is a safe manner.
Operates a motor vehicle safely and legally.
Delivers excellent customer service to diverse audiences.
Maintains effective work relationships.
Adheres to all City and Department policies.
Arrives to work, meetings, and other work-related functions on time and maintains regular job attendance.
Building Inspector/Plans Examiner IV (Plan Review Lead)
Assists with and prepares short and long range work plans, and schedules daily activities for Building Inspector/Plans Examiners.
Directs, trains and assists Building Inspector/Plans Examiners. Participates in recruitment process. Provides input concerning performance evaluations.
Performs Construction Plan Reviews and Inspections on complex residential, commercial, industrial, and multi-family development proposals to ensure compliance with State and City codes/ordinances, engineering/architectural, and fire/life safety principles.
Coordinates scheduling and organization of Pre-Development and Pre-Construction and other related meetings. Coordinates review/inspection approvals with internal/external agencies.
Coordinates Over-the-Counter, Rapid Review, and other processes. Ensures adequate staffing and oversight of a timely, predictable, comprehensive, and accurate plan review and inspection process for any development proposal.
Monitors and inspects work and projects completed by Building Inspector/Plans Examiners and contractors. Makes field decisions on procedures and methods.
Conducts quality control and internal audits for building safety code administration and enforcement.
Assists in budget preparation. Monitors expenses. Maintains staff supplies and resources.
Provides technical expertise and guidance in interpretations of code issues and requirements for development proposals.
Leads, guides, and ensures successful staff resolution of matters of community concern, public health, building safety and dangerous building situations. Examples include fire scene investigations, flooding, mold growth, post-earthquake inspections, electrical hazards, hazardous materials, boiler explosions, sanitation issues, mechanical failures, and any condition identified in the Dangerous Building Code. When necessary, issue notices of violation, notices to vacate, dangerous building declarations and stop work orders.
Represents the City at national, state and local boards, meetings, hearings, seminars, classes, and public outreach events involving development, construction codes or building safety.
Conforms with all safety rules and performs work is a safe manner.
Operates and drives a motor vehicle safely and legally.
Delivers excellent customer service to diverse audiences.
Maintains effective work relationships.
Adheres to all City and Department policies.
Arrives to work, meetings, and other work-related functions on time and maintains regular job attendance.
Qualifications and Skills
Building Inspector/Plans Examiner III
Education and Experience
High school diploma, or equivalent required. Associates degree in Building Inspection Technology, Drafting, Engineering, Fire Prevention, or other related field preferred.
Four years of formal education, training, and/or experience in construction management, architecture, structural engineering, building design, construction inspection, and/or plan review providing the knowledge, skills and abilities necessary to perform the essential functions of the position.
Knowledge, Skills and Abilities
Thorough knowledge of construction practices, engineering concepts, and architectural principles.
Excellent customer service, communication, and public relations skills and the ability to mediate adversarial situations. Ability to proactively anticipate and mitigate problem areas before they become issues.
Prioritize and meet multiple demands by the construction industry, the general public and other City staff.
Organize, coordinate, chair, and effectively facilitate high profile meetings.
Interpret, disseminate, and communicate complex technical information, state and local construction regulations, City review process, and City policies effectively with technicians and non-technicians.
Possess a self-directed commitment to maintain current knowledge of construction standards, methods, technologies, and codes.
Get along well and maintain effective work relationships with coworkers and the public.
Special Requirements
Certifications: Incumbent must be certified in accordance with OAR 918-098. Oregon Inspector Certification is required within 60 days of appointment.
Certifications giving the incumbent the legal ability to perform work described in sets A, B, C, or D:
A: Inspection/Plan Review:
Commercial Inspection (A-Level Building, Mechanical)
Residential Inspection (Building , Mechanical)
Residential Plan Review
Commercial Plan Review (A-Level, Mechanical) must be obtained within the probationary period.
OR
B: Residential Multi-Discipline:
Residential Plan Review
Residential Inspection for 4: Building, Mechanical, Plumbing and Electrical
OR
C: Commercial Plan Review:
Commercial Plan Review (A-level, Mechanical)
Fire and Life Safety
Residential Plan Review and Residential Inspection required within the probationary period
D: Specialty Discipline- Commercial and Residential Inspection and Plan Review to include:
- Plumbing - Commercial and Residential Plumbing Inspector; obtain a Medical Gas Certification within the probationary period; or
- Electrical - Commercial and Residential Electrical Inspector; obtain a Fire Investigation Certificate within the probationary period.
Experience in use of permit tracking systems. Excellent ability to use computer hardware, printers, and computer programs to conduct inspections, complete plan reviews, communicate and present information, track progress, schedule projects, and to perform the essential functions of the position. Demonstrable commitment to quality and timely customer service.
Possession or ability to obtain a valid Oregon Drivers License.
Demonstrable commitment to sustainability.
Demonstrable commitment to promoting and enhancing equity, diversity and inclusion.
The individual shall not pose a direct threat to the health or safety of the individual or others in the workplace.
Building Inspector/Plans Examiner IV (Plan Review Lead)
Education and Experience
High school diploma, or equivalent required. Bachelor's degree in Architecture, Engineering, Construction Management, Public Administration or a closely related field preferred. Two years of experience in construction management, architecture, structural engineering, building design, construction inspection, and/or plan review.
Six years of formal education, training and/or experience in construction management, architecture, structural engineering, building design, construction inspection, and/or plan review providing the knowledge, skills and abilities necessary to perform the essential functions of the position.
Knowledge, Skills and Abilities
Thorough knowledge of construction practices, engineering concepts, and architectural principles.
Excellent customer service, communication, and public relations skills and the ability to mediate adversarial situations, and proactively anticipate and mitigate problem areas before they become issues.
Prioritize and meet multiple demands by the construction industry, the general public and other City staff.
Organize, coordinate, chair, and effectively facilitate high profile meetings.
Travel among City worksites, off-site meetings and presentations.
Interpret, disseminate, and communicate complex technical information, state and local construction regulations, City review process, and City policies effectively with technicians and non-technicians.
Experience in use of permit tracking systems. Excellent ability to use computer hardware, printers, and computer programs to conduct inspections, complete plan reviews, communicate and present information, track progress, schedule projects, and to perform the essential functions of the position.
Get along well and maintain effective work relationships with coworkers and the public.
Demonstrable commitment to quality and timely customer service.
Special Requirements
Certifications: Incumbent must be certified in accordance with OAR 918-098. Oregon Inspector Certification is required within 60 days of appointment.
State of Oregon Building Official Certification; or State of Oregon Inspector Certification and International Code Council Certified Building Official Certification, must be obtained within the probationary period.
Certifications giving the incumbent the legal ability to perform work described in sets A, B, or C:
A: Inspection/Plan Review:
Commercial Inspection (A-Level Building, Mechanical)
Commercial Plan Review (A-Level, Mechanical, Fire and Life Safety)
Residential Inspection (Building , Mechanical)
Residential Plan Review
OR
B: Residential Multi-Discipline:
Residential Plan Review
Residential Inspection for 4: Building, Mechanical, Plumbing and Electrical
OR
C: Specialty Discipline - Commercial and Residential Inspection and Plan Review to include:
- Plumbing - Commercial and Residential Plumbing Inspector plus obtain a Medical Gas Certification within the probationary period; or
- Electrical - Commercial and Residential Electrical Inspector plus obtain a Fire Investigation Certificate within the probationary period.
Demonstrable commitment to diversity and promote diversity principles with employees in day to day operations.
The individual shall not pose a direct threat to the health or safety of the individual or others in the workplace.
Ability to pass a background check and/or criminal history check
Possession or ability to obtain a valid Oregon Drivers License.
How to Apply
Qualified applicants must submit an online application located on the City of Corvallis website(click on "Apply" above).
Position is open until filled.
First review of applications will occur after 8:00 AM on Friday March 6, 2026.
Resumes will not be accepted in lieu of a completed online application.
Late or incomplete applications will not be accepted/considered.
*Please do not include personal or protected information in attached resumes or cover letters, this includes your birth date, age, dates of education, and graduation dates.*
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
Position Summary
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.
Background & Context
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.
Key Responsibilities
Nurses review case files, add, update or edit authorizations.
Work closely with the MD team to make final decisions on cases.
Process clinical reviews to ensure members have access to care needed.
Help reduce provider abrasion by processing retrospective claim reviews.
Work closely with supervisors, senior clinicians, and the coordinator team on end-to-end case processes.
Participate in team collaboration via Teams group chats for routine questions.
Qualification & Experience
Education/Certification (Required): Associate in nursing, Bachelor's in nursing or higher.
Licensure (Required): RN, LPN
Licensure (Preferred): LVN
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
CenPas: 20 CPD cases per day
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- 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.- Top 3 must-have hard skills
- Level of experience with each
- Stack-ranked by importance
- Candidate Review & Selection
1
Utilization Management or Appeals review background (1 plus year)
2
Medicare NCD/LCD and InterQual/Milliman Software (1 plus year)
3
Retrospective claims clinical reviews (1 plus year)
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.
The Opportunity:
A government agency seeks two admitted Document Review Attorneys for a short-term document review project scheduled to begin in early March with a duration of approximately four months. Must be available to work at least 35 hours weekly and additional hours, if needed. The hourly rate is $50, plus benefits.
Primary Duties:
The Document Review Attorneys will help coordinate the compliance review of filed election documents. Candidates must be comfortable navigating high volume and strict statutory timelines for review, hearings and providing notice and able to utilize the agency's digital systems for viewing scanned documents and generating letters. Additional duties include the following:
- Preparation of letters of non-compliance
- Compiling records for related hearings and litigation
Experience & Qualifications:
- New York State bar admission
- Minimum of 2- 5 years of legal experience
- Experience with digital document management systems
Frink-Hamlett Legal Solutions is an equal employment opportunity employer and all applicants will receive consideration for employment without discrimination based on race, color, creed, national origin, sex, age, disability, marital status, sexual orientation or citizenship status.
Immediate need for a talented Hospital RN – Care Coordination & Utilization Review . This is a 06+months contract opportunity with long-term potential and is located in San Jose, CA (Onsite). Please review the job description below and contact me ASAP if you are interested.
Job ID: 25-80861
Pay Range: $80 - $95/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).
Key Responsibilities:
- Conduct utilization reviews using InterQual® / MCG®
- Support discharge planning and post-acute coordination
- Communicate with physicians, social work, and external providers
- Manage authorizations and payer-related workflows
- Maintain compliance with regulatory standards
Key Requirements and Technology Experience:
- Key Skills; CA RN License (Active)
- Acute inpatient hospital experience
- UM / Case Management / Discharge Planning background
Our client is a leading Healthcare Industry and we are currently interviewing to fill this and other similar contract positions. If you are interested in this position, please apply online for immediate consideration.
Pyramid Consulting, Inc. provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
By applying to our jobs you agree to receive calls, AI-generated calls, text messages, or emails from Pyramid Consulting, Inc. and its affiliates, and contracted partners. Frequency varies for text messages. Message and data rates may apply. Carriers are not liable for delayed or undelivered messages. You can reply STOP to cancel and HELP for help. You can access our privacy policy here.
Job Title: Health Service Reviewers (RN)
Pay (openings for each location/market):
- Albany up to $52/hr
- Central Islip up to $60/hr
Overview: These RNs will be doing a mix of standard quality audits, complaint initiated investigations, and more. When they are onsite, the amount of time that they are at the location is dependent on the audit that is required. It is expected that Health Service Reviewers will be traveling onsite about 85% of the time.
These individuals will be traveling to IDD housing to do state required Recertification (must be done every 15 months) or investigating specific complaints (disease outbreak, falls, etc.).
Travel: 85% of this role is traveling to sites. It is more location based and they will be traveling to the counties that surround their location. If anyone is traveling and not able to return home, they are able to coordinate accomodations through the travel office and miles/food will be reimbursed at the federal rate. If they are not onsite, they can work from home or in the DOH office.
Summary: Based in NY, working at the direction of the New York State Department of Health (NYSDOH), Office of Aging and Long-Term Care, this individual will conduct surveillance and investigation activities related to Intermediate Care Facilities for Intermediate Care facilities for Individuals with Intellectual Disabilities (ICF/IDD). Duties include but are not limited to participating in surveys or complaint investigations, document finding, draft Statement of Deficiencies (SOD) within specified timeframes, testifying in administrative hearing ad needed.
The position is majority travel and will be onsite at facilities.
Qualifications:
- Strong interpersonal skills with the ability to communicate professionally with colleagues, supervisors, providers, medical and administrative personnel and residents/patients.
- Excellent communication (verbal & written) skills.
- Ability to work independently with minimal supervision.
- Ability to relate effectively to clinical and administrative personnel and patients.
- Computer proficiency with the ability to learn and understand new review programs and monitoring tools.
- Able to travel to on-site facility within New York State, required.
- Must have a valid driver's license & the ability to travel to on-site facilities review assignments.
Education/Experience:
- Registered Professional Nurse (RN). Currently licensed and registered in New York State, required.
- Bachelor’s degree, in any health care related field.
- Two (2) years clinical experience with individuals with intellectual disabilities or in developmental disability facilities and deemed QIDP (Qualified Intellectual Disability Professional and ability to meets the federal requirements for attaining QIDP Certification with six (6) months of hire date.
Hours: Monday-Friday 8am-5pm
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.
Insight Global is seeking Technical Evaluation Review Board/CCB Coordinator to join our team for an exciting opportunity to work on a unique government contract. The contract assists in acquisition and technical sustainment engineering and will augment government resources. The coordinator manages government technical review board submissions, ensuring all programs meet required deliverables and are fully prepared for review before board meetings. They control document accuracy, track changes, and maintain compliant review packages across all stakeholders. The role requires confidently driving engineers and IPTs to meet requirements and deadlines, including pushing back when inputs are incomplete. This is a highly organized, assertive position focused on accountability, readiness, and execution.
Must Haves:
- BS/MS in engineering/specialty area
- 7 yrs directly related experience (5 yrs with MS degree)
- Active secret level security clearance or higher
- Strong planning, coordination, and organizational skills with the ability to manage multiple priorities
- Demonstrated experience developing, maintaining, and assessing technical baselines within controlled programs
- Familiarity with engineering standards, manufacturing methods, and configuration management practices, including military and ASME-guided environments
- Working knowledge of technical drawing conventions and engineering documentation controls
- Proficiency with Microsoft Office tools to prepare data-driven reports, metrics, and formal documentation
- High attention to detail, strong writing and verbal communication skills, and the ability to manage time effectively
- Ability to sit on-site at Hill AFB in Clearfield, UT Monday-Wednesday
Plusses:
- Experience supporting configuration and data management activities within a defense or government program environment
- Working knowledge of Air Force or DoD engineering release processes, configuration control standards, and technical documentation lifecycle management
- Familiarity with Engineering Change Proposals (ECPs), Interface Control Documents (ICDs), and associated revision and audit activities
- Prior involvement with functional and physical configuration audits, including coordination with suppliers or government facilities
- Training or certification in configuration or data management disciplines (e.g., CMPIC or similar)
- Demonstrated ability to maintain and protect complex engineering baselines for hardware and software systems
- Strong judgment and decision-making skills aligned with regulatory, contractual, and policy requirements
- Commitment to continuous learning and maintaining up-to-date technical proficiency
Registered Nurse - Transplant Unit
Location: New Haven, CT
Work Address: 20 York Street, New Haven, CT
Position Type: Full Time Benefits Eligible
Overview
To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values integrity, patient-centered, respect, accountability, and compassion guide what we do every day as healthcare professionals.
At Yale New Haven Hospital, a 1,541-bed, nationally ranked, JCAHO-accredited hospital affiliated with the Yale School of Medicine, our patients benefit from access to advanced medical therapies, emerging research, and innovative clinical care. As a Transplant Registered Nurse, you will play a vital role in caring for pre- and post-transplant patients, including those undergoing kidney, liver, heart, and multi-organ transplantation. You will coordinate complex care plans, monitor for early signs of rejection or complications, administer specialized therapies, and provide essential education to patients and families navigating the transplant journey.
Here, your nursing career will include experiences and opportunities unmatched by other hospitals comprehensive orientation, ongoing professional development, clinical advancement pathways, and the chance to care for a uniquely high-acuity and medically complex patient population.
Join the dedicated team at Yale New Haven Hospital as a Transplant RN and make a meaningful impact on patients' lives through expert, holistic, patient-centered care.
Responsibilities:
Patient Assessment & Monitoring
- Perform comprehensive assessments for pre- and post-transplant patients.
- Monitor vital signs, graft function, fluid/electrolyte balance, lab values, and indicators of organ rejection or infection.
- Recognize and respond to early symptoms of transplant complications, such as rejection, sepsis, or medication toxicity.
Transplant-Specific Care
- Administer immunosuppressive therapies, antirejection medications, and other transplant-specific treatments.
- Provide wound care, infection prevention, and management of surgical drains as applicable.
- Support coordination of biopsies, imaging, dialysis, and other procedures related to organ function.
Critical Interventions
- Respond promptly to emergent situations including acute rejection episodes, respiratory distress, or hemodynamic instability.
- Operate specialized equipment such as infusion pumps, telemetry monitors, and devices used in managing immunosuppressive drug therapy.
Collaboration & Communication
- Partner closely with transplant surgeons, nephrologists/hepatologists, pharmacists, social workers, dietitians, and transplant coordinators to ensure seamless care.
- Provide extensive teaching to patients and families regarding medications, lifestyle modifications, post-transplant surveillance, and long-term follow-up expectations.
- Participate in multidisciplinary rounds and contribute to individualized care planning.
Documentation & Compliance:
- Maintain accurate electronic health records (EHR) and adhere to hospital protocols, infection control, and safety standards.
Qualifications
- Education
- Graduation from an accredited school of nursing. BSN preferred. All newly hired registered nurses must have current BCLS certification or must obtain within one month of hire.
- Licensure
- Licensed and a currently registered nurse in the State of Connecticut. Clinical specialty certification highly encouraged.
- BLS required
- Experience
- Registered Nurse is the foundational job description for all RNs. All RNs are encouraged to advance through the SPIRE clinical advancement program.
- Requires prolonged standing; walking; use of sight, hearing, and touch. May be exposed to infectious diseases. Will be exposed to physical, mental and emotional illness as well as end of life conditions and death. Moderate stress and risk of injury from patient care. Standing/walking for more than half of the day. Must be able to assist pushing/pulling/lifting patients ranging from five (5) to three hundred (300) pounds.
Benefits
- Competitive salary based on experience and qualifications.
- Comprehensive health, dental, and vision insurance.
- Retirement savings plan with employer contributions.
- Paid time off and flexible scheduling options.
- Professional development and continuing education opportunities.
- Employee wellness initiatives and support programs.
EEO/AA/Disability/Veteran