Spectraforce Technologies Remote Jobs in Usa

• 
  
• Two-year technical degree or four-year non-technical degree
  
• At least 4 years of relevant experience in telecommunications design and construction industry
  
• Knowledge & application of telecommunications industry association (TIA) standards
  
• Knowledge & application of BICSI (Building Industry Consulting Services International) design practices
  
• Knowledge & application of NFPA 70 (NEC) and electrical design requirements
  
• Experience leading a telecommunications design team
  
• Knowledge of design and construction specifications
  
• Experience estimating and scheduling small to medium size projects
  

• 
  
• Associate degree
  
• At least 3 years of telecommunications design experience in semiconductor or data centers
  
• Project management experience
  
• Working knowledge of 3D BIM software (Revit)
  
• Knowledge and design experience with paging, intercom, and audio-visual systems
  
• Knowledge of control systems and network topology
  
• One or more of the following certifications: RCDD (Registered Communications
  
• Distribution Designer), DCDC (Data Center Design Consultant), OSP (Outside Plant), or RTPM (Registered Telecommunications Project Manager)
  

• 
  
• Bachelor's degree in science, healthcare, communications, or a related field, or equivalent work experience.
  
• Strong editorial and proofreading experience.
  
• Experience reviewing regulated content, preferably in pharmaceutical, healthcare, or medical environments.
  
• Exceptional attention to detail and quality control skills.
  
• Strong written and verbal communication skills.
  
• Ability to collaborate with cross-functional teams and external agencies.
  
• Comfort working within structured review and approval workflows.
  

• 
  
• Medical editing experience within pharmaceutical, biotech, healthcare, or medical communications environments.
  
• Knowledge of the AMA Style Guide.
  
• Experience reviewing promotional or marketing materials in regulated industries.
  
• Experience using Veeva Promomats or similar content approval systems.
  
• Familiarity with FDA advertising and promotional submission processes would be ideal.
  

• 
  
• Review and edit promotional, non-promotional, and internal materials to ensure accuracy, clarity, and consistency.
  
• Perform quality control checks on materials prior to routing them through the approval workflow.
  
• Ensure materials adhere to editorial standards, regulatory guidelines, and style conventions, including the AMA Style Guide when applicable.
  
• Identify necessary edits or revisions and clearly communicate feedback to stakeholders.
  
• Support regulatory and QC reviews during the approval process.
  

• 
  
• Coordinate the review and approval process for marketing and promotional materials.
  
• Maintain knowledge of approval routing processes and SOP requirements and ensure materials are routed appropriately.
  
• Facilitate PRC (Promotional Review Committee) meetings, including preparing agendas, documenting discussions, and capturing meeting outcomes.
  
• Support final approvals, re-approvals, and other review types as required.
  

• 
  
• Work closely with marketing teams, agencies, regulatory teams, and other stakeholders throughout the approval process.
  
• Communicate required edits, feedback, and changes clearly and efficiently.
  
• Partner with marketing operations teams to prioritize review workflows, especially during major campaign launches or label updates.
  

• 
  
• Manage workflows within Veeva Promomats or similar electronic review systems.
  
• Maintain user profiles, training access, and permissions for sponsors, agencies, and reviewers within the system.
  
• Serve as a point of contact for system maintenance and optimization in collaboration with vendors and IT teams.
  
• Assist with system validation activities related to workflow tools.
  

• 
  
• Support FDA Ad Promo submission processes, including preparation of Form 2253 and related documentation.
  
• Coordinate submission materials and collaborate with regulatory operations teams.
  
• Archive regulatory correspondence according to compliance guidelines.
  

• 
  
• Generate workflow and system metrics reports to support process improvements and compliance monitoring.
  
• Contribute to the development and updates of departmental procedures and work instructions.
  
• Develop and maintain training resources related to the review process and workflow tools.
  
• Train internal teams, agencies, and reviewers on editorial workflows and system usage.
  

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• Promotional and advertising content
  
• Marketing campaign materials
  
• Internal training decks and presentations
  
• Educational and informational materials
  
• Internal communications and resources used by internal teams
  

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• Pharmaceutical or biotech companies.
  
• Advertising Agencies supporting regulated healthcare clients.
  

Job Title: Phlebotomist III - Floater

Duration- 3+ months

Location- Nanuet NY 10954

Summary

• 
  
• The Patient Services Representative III Floater PSR III represents the face of our company to patients who come in, both as part of their health routine or for insights into life defining health decisions.
  
• The PSR III draws quality blood samples from patients and prepares those specimens for lab testing while following established practices and procedures.
  
• The PSR III has direct contact with patients and creates an atmosphere of trust and confidence while explaining procedures to patients and drawing blood specimens in a skillful, safe and accurate manner.
  
• The PSR III will demonstrate Leadership Behaviors while focusing on process excellence skills and sensitivity to confidentiality and accuracy to patient information.
  
• Successful applicants may be assigned to a doctors office, a patient service center or as business needs dictate.
  
• Under the direction of the area supervisor, perform daily activities accurately and on time.
  
• Maintain a safe and professional environment.
  
• Performs with confidence, both the forensic and clinical specimen collection and processing duties following established practices and procedures.
  
• Perform verification of patient demographic info initials including patient signature post venipuncture to verify tubes were labeled in their presence and that the name on the label is correct.
  
• Maintains required records and documentation.
  
• Demonstrates organizational commitment and promotes a positive image to patients, clients, employees and the public in general.
  

Job Requirements

• 
  
• Ability to provide quality, error free work in a fast paced environment. Ability to work independently with minimal onsite supervision.
  
• Excellent phlebotomy skills to include pediatric and geriatric.
  
• Flexible and available based on staffing needs, which includes weekends, holidays, on call and overtime.
  
• Committed to all Policies Procedures including Company dress code, Employee Health Safety, and Everyday Excellence Guiding Principles.
  
• Must be able to make decisions based on established procedures and exercise good judgment.
  
• Must have reliable transportation, valid driver license, and clean driving record, if applicable.
  
• Travel and flexible hours required to work multiple locations and required to cover at Patient Service CenterInOffice Phlebotomy locations with minimal notice.
  
• Capable of handling multiple priorities in a high volume setting.
  
• Must demonstrate Superior Customer Focus ability to communicate openly and transparently with peers, supervisors and patients ability to accelerate and embrace change and knowledge of our business.
  
• Training locations may vary based on trainer availability.
  

Required Education

• 
  
• High school diploma or equivalent.
  
• Medical training: medical assistant or paramedic training preferred.
  
• Phlebotomy certification preferred. Required in California, Nevada, and Washington.
  

Work Experience

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• Perform environmental monitoring of cleanrooms.
  
• Collect water samples according to schedule and ensure timely testing.
  
• Perform and review microbiological assays including:
  
  • 
    
  • Gram Stain
    
  • Endotoxin
    
  • Sterility testing
    
  • Microbial identification
    
  • Bioburden testing
    
  • Plate reading
    
  
  
  
• Conduct utility monitoring for purified water systems and compressed gases.
  
• Perform data entry, trending analysis, and prepare reports or slides for management review.
  
• Assist with investigations related to Out-of-Specification (OOS) results and manage deviations related to microbiological procedures.
  
• Perform routine maintenance of laboratory equipment and lab areas.
  
• Review and approve final product release test results.
  
• Perform additional duties as assigned.
  

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• Associate Degree (AA) with 1+ year of experience in a Microbiology Lab or Environmental Monitoring, OR
  
• High School Diploma with 2+ years of experience in a Microbiology Lab or Environmental Monitoring.
  

• 
  
• Experience with microbiological techniques, including:
  
  
  • 
    
  • Environmental air monitoring
    
  • Water testing
    
  • Surface monitoring
    
  
  
  
• Experience with aseptic techniques and cleanroom operations.
  
• Ability to gown for entry into aseptic manufacturing areas and lift approximately 25 lbs.
  
• Knowledge of GMP, SOPs, and quality control processes in commercial manufacturing.
  
• Proficiency in MS Word, Excel, PowerPoint, and other computer applications.
  
• Strong interpersonal, verbal, and written communication skills.
  
• Ability to work in a fast-paced environment with minimal supervision and adapt to changing priorities.
  
• Flexibility to work overtime or adjust schedules as required.
  

• 
  
• Works on assignments that are semi-routine in nature where ability to recognize deviation from accepted practice is required. Basic level systems knowledge.
  
• Performs goods receipts against purchase orders or invoices, maintains records of received goods.
  
• Prepares, verifies and packages goods for shipment. Creates shipping documents for outgoing carriers. Fedex, UPS, DHL etc.
  
• Restocks supplies, delivers goods to offices.
  

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• Packing and shipping both domestic and international QSRs, verifying quantities, MCNs, and necessary paperwork, and processing everything in Precision.
  
• Handling India Sales Orders by processing them in Corp Oracle, creating all required documents, and ensuring their shipment.
  
• Running picks for customer sales orders, packing, and shipping them, and generating all necessary paperwork.
  
• Monitoring emails and the shipping list for sales orders.
  
• Managing and creating purchase orders for onsite crating services, overseeing the crating of equipment, and handling shipping and related documentation.
  
• Providing tracking information for outgoing shipments and monitoring the locations of delivered packages.
  
• Facilitating and managing prepaid orders and vendor prepaid freight shipments.
  
• Shipping and Receiving
  

• 
  
• Capturing information and drivers' logs for all incoming deliveries and pickups.
  
• Maintaining, filing, and storing paperwork properly.
  
• Receiving and verifying deliveries from SP carriers and freight forwarders, noting any damages, and processing received packages in BEARTRACKS before routing them to end users.
  
• Monitoring the customer pickup rack, clearing, and delivering items to the office as needed, and prompting recipients to collect packages timely.
  
• Processing incoming EAG deliveries, emailing recipients, and routing them accordingly.
  
• Coordinating with third-party vendors and contractors for incoming freight and SP deliveries, routing them as needed.
  
• Processing and receiving PO inventory and non-inventory orders, verifying quantities and MCNs, and routing them appropriately.
  
• Receiving QESR orders, verifying quantities and part numbers, and routing them accordingly.
  
• Working closely with buyers on receipt amendments, damaged goods, reversals, and mis-deliveries.
  
• Handling blind receipts for drop-shipped items and managing the storage and notification process for Hazmat room items.
  

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• Review and approve pending client requests to ensure proper authorizations and supporting documentation are in place and meet policy requirements.
  
• Coordinate and process team specific tasks as requested by the business.
  
• Perform quality reviews of other team members completed work and ensure data accuracy.
  
• Work across multiple systems and platforms.
  
• Interface with teams and businesses to resolve on-going issues and answer specific policy questions.
  
• Provide support and work on special projects as requested.
  
• Apply business judgment to identify unusual or suspicious activities and escalate issues as appropriate.
  
• Associate must understand and adhere to all policies and procedures including, but not limited to, quality, client service, information security, and compliance.
  

• 
  
• Bachelor's degree required.
  
• Minimum of 2 years of relevant professional experience.
  
• Proficiency in Microsoft Office, with a strong emphasis on Excel.
  

• 
  
• Candidate must be proactive, enthusiastic and team oriented.
  
• Strong client service orientation with prior work experience in a role handling client outreach.
  
• Ability to remain composed under pressure.
  
• Ability to adapt to new challenges and a fast-changing environment.
  
• Accuracy and attention to detail.
  
• Strong written and verbal communication skills.
  

• 
  
• Interviews: will be done in person
  
• Day to Day: Helping with the HR Process.
  
• Dress Code: Casual to Business Casual - jeans are ok,but not rips or holes. Closed to shoes.
  

• 
  
• Customer Service Skills - working with internal leaders
  
• Communication - written and verbal
  
• Detail Oriented
  

• 
  
• Executing transactional core HR processes (e.g. colleague onboarding process, assist colleagues with using HRIS, support safety initiatives, organizing filing, etc.)
  
• Supporting hiring managers and Talent Acquisition to support recruitment and staffing plans, supporting and maintaining an e-time system and payroll-related activities.
  
• Supporting HRBP to drive an inclusive and diverse culture.
  
• Administer programs to enhance employee engagement and satisfaction levels.
  

• 
  
• 3-5 Years of Experience
  
• Requirements include experience in Human Resources management preferred and/or an equivalent combination of related training and experience and a bachelor's degree with major or emphasis in Human Resources, Business Administration or a closely related field rare preferred.
  

• 
  
• Interviews: will be done in person
  
• Environment: the candidate will be working in an office in the warehouse. Steel Toe Composite shoes will be needed.
  

• 
  
• Supports warehouse receiving shift by handling all clerical duties associated with the receiving function.
  
• Compiles, copies, sorts, and files records of daily receiving and schedules.
  
• Checks communications from other shifts to ensure relevant information is passed on to receiving shift.
  
• Places short-dated product on hold in the system.
  
• Reviews receiving documents to identify date issues and obtains shelf-life approvals.
  
• Compiles information and completes various reports.
  
• Orders supplies, answers phone, responds to requests.
  
• Operates office machines, such as photocopiers, scanner, printer, and computer.
  
• Communicates with supervisors regarding any problems identified.
  
• Completes other warehouse clerical duties as assigned.
  

• 
  
• 1-3 Years of Experience
  
• Basic requirements include a high school diploma.
  
• The ability to read, write, and communicate in English.
  
• 1-year office experience and 1-years' experience in a warehouse environment.
  
• The ability to operate a computer and all Microsoft Office applications, including special proficiency with Excel. Typically reports to a manager or supervisor.
  

• 
  
• Reporting directly to the GM of Compute, the Executive Assistant role provides executive support in a one-on-one working relationship the Compute GM. The Executive Assistant must be creative, solutions oriented, resourceful and enjoy working within a fast-paced, global environment.
  
• The ideal individual will have the ability to exercise good judgment in a variety of situations, with strong written and verbal communication, administrative, and organizational skills, strong attention to details and demonstrated ability to maintain a realistic balance among multiple priorities.
  

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Provide sophisticated calendar management for Compute GM. Prioritize inquiries and requests while troubleshooting conflicts focused on external engagements including customer meetings, conferences and high-profile external meetings; make judgements based on priorities. Ability to rapidly address last minute changes to schedules and ensure stakeholders are kept abreast.

* Manage travel schedule. Ability to book and manage complex domestic and international travel on both commercial and private airplanes. Complete a broad variety of administrative tasks which could include: maintaining contact lists, completing expense reports, and general administrative responsibilities.

* Serve as a point of contact for internal and external constituencies on all matters pertaining to the Compute GM, including those of a highly confidential or critical nature. Prioritize and determine appropriate course of action, referral, or response, exercising strong judgement to reflect GM's style and organization policy.

* Partner closely with the Compute GM's Chief of Staff to align on priorities, flag risks, and adjust plans. Provides administrative support to the Chief of Staff related to calendar management and travel.

* Demonstrates a proactive interest in understanding the business to effectively support strategic initiatives and ensure seamless execution of administrative responsibilities.

* Serves as lead Executive Assistant for Compute, coordinating with Compute's other admin to ensure aligned support needs, implementation of best practices, tools, trainings and overall operational efficiency to support the business.

* Partner and maintain strong working relationships with C-Suite and other department exec admins

* Other projects/duties as assigned for the overall benefit of the organization such as the organization SharePoint site and planning on-site and off-site team events.

KEY COMPETENCIES:

* Integrity: Demonstrated leadership to maintain credibility, trust, and support with the Executive Team.

* Communication: Able to interact with people of all levels in a confident, professional manner.

* Agility: Ability to think outside of the box with a sense of urgency.

* Resilience: Sustainability and resilience under pressure.

Responsive & Collaborative: Ability to collaborate effectively with executive leaders in the company and with other executive admins. Proactive in work style and responsiveness in support of the executive leader and team needs.

* Detail-Oriented: Detail-oriented with a strong focus on accuracy across calendaring, expense reports, and travel planning, while anticipating executive needs and proactively resolving issues to ensure seamless support.

• 
  
• Independently performs and verify a multitude of laboratory techniques for which they are trained on while adjusting to unforeseen technical or logistical obstacles to accomplish assignments.
  
• Understands multiple laboratory techniques and principles and can independently trouble-shoot and resolve analytical techniques and instrument issues.
  
• Takes initiative to be a key player in team activities and decision making including proactive identification, development, and implementation of improvement plans.
  
• Budgets their time independently and effectively to carry out assigned tasks and makes recommendations for improvement.
  
• Recognizes obstacles to completion of assigned testing and can independently resolve them. Consistently achieves commitments despite obstacles.
  
• Takes ownership of special projects as needed to support overall laboratory needs and requirements.
  
• Communicates proactively with supervisor and team members on frequent basis to ensure timely product release.
  
• Interfaces with regulatory agencies during audit activities as needed.
  

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• Bachelor's Degree in the sciences with 0-4 years of laboratory experience
  
• Associate degree with at least 3 years of laboratory experience
  
• Flexibility in shift and workdays highly desirable
  
• Ability to work with general supervision but effectively manages their own time to multi-task based upon their completed training matrix.
  
• Good interpersonal, documentation, and communication skills.
  
• Desired technical competencies (not all required): LC, LCMS, GC, GCMS, ICP, Empower, Karl Fischer, dissolution, IR, titrations, and common wet chemical testing
  

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• Environmental Advisors are responsible for the development, execution and continuous improvement of environmental programs designed to achieve environmental compliance and support environmentally responsible operation of the gas distribution system.
  
• Provide support, expertise and leadership in core Environmental Programs such as: Environmental Compliance Approvals (Air and Noise, Stormwater); Hazardous Waste Management, Spills Management, Environmental Planning (including Environmental Assessments, Screening and Permitting), Contaminated Sites and Excess Soil.
  
• Responsible for preparing environmental reports to regulators (responsibility includes coordination, data collection and evaluation, report writing, review, approvals and final submission)
  
• Developing, sustaining, executing and integrating environmental standards, programs and procedures for application across the company
  
• Supporting and responding to environmental inquiries and emergencies such as spills, suspect soil, and environmental planning/permitting inquires from across the organization
  
• Developing scopes of work and reviewing and interpreting environmental results/reports; applying knowledge and experience to provide sound environmental advice and recommendations to business
  
• Preparing written communication (letters/reports) on environmental matters for stakeholders and regulators
  
• Participating in and leading meetings with project teams including internal/external stakeholders to discuss environmental projects, develop strategies for execution and supporting environmental compliance
  
• Identify opportunities for improvement within environmental programs and environmental aspects of construction projects; develop strategies and solutions to environmental matters and present recommendations to project teams for decision and implementation
  

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• Bachelor's Degree in environmental engineering or environmental science; or related field
  
• Minimum of 5-7 years applied, progressive environmental engineering/science experience
  

• 
  
• Professional designation in environmental field (i.e: P.Eng., P.Geo., EP)
  
• Graduate level degree considered an asset
  

Job Description:

This position supports Patient Data Intake (PDI) organization to achieve its mission of improving patient lives through consistent and accurate delivery of high quality, relevant, and timely adverse event and product quality management by providing effective oversight of external providers of Pharmacovigilance services.

Major Responsibilities:

Core job requirements include:

* Conducting oversight of vendors who identify and collect adverse event information and complete intake of Pharmacovigilance safety reports in Safety System.

Conducting oversight of vendors who identify and collect product quality complaint information and complete intake of Product Quality reports in Product Quality System.

* Conducting oversight of vendors to ensure collection, assessment, and processing of adverse event and product quality complaint information is performed in a compliant and timely manner to comply with global regulations.

* Supporting the business strategy of assisting internal and external customers in collecting information for product safety reports and products complaints related to products.

* Conducting oversight of vendors to ensure company standards for quality, compliance and productivity are met. Remaining current on knowledge and skills required for supporting customers.

* Supporting vendor case quality and productivity metrics by exhibiting the core leadership attributes: Agile and Accountable; Clear and Courageous; Make Possibilities Real; All for One ; Decide Smart and Sure.

* Supporting and participating in audits and inspections as needed.

* Supporting development of materials and delivering training in conjunction with the vendor, including train-the-trainer, special-topics, refresher, and internal trainings as needed.

* Conducting oversight to ensure the vendor is effectively communicating using various mediums and establishing rapport with customers, colleagues, and interdepartmental groups.

* Conducting oversight in the vendors use of multiple databases to document adverse event and product complaint information.

* Supporting implementation of strategies to enhance PDI excellence in providing the highest level of customer experience.

* Acting as an adverse event and product complaint intake subject matter expert.

* Gaining knowledge and expertise to initiate mentoring opportunities of other specialists in PDI.

* Participating in projects/assignments in coordination with management.

* Gaining knowledge and expertise to initiate mentoring opportunities of other specialists in PDI.

* Participating in projects/assignments in coordination with management.

* Other duties may be assigned based on the need or work requirements of the organization.

Experience/Skills:

Bachelor's degree with related health sciences background. Nursing or Pharmacy preferred

3-6 years clinical healthcare and previous pharmaceutical industry experience. Pharmaceutical industry contact center experience preferred

Provides medical support with emphasis on the intake of medical product experiences and processing standard communication requests. Acts as a liaison with Quality Assurance for product quality problems where an adverse event is involved. Works with Customer Service to provide standard information and product replacement as necessary. Provides assistance to the medical and lay community with standard information that is from the package insert or information from the standard letter database that deals with labeled and specific off-label information/indications.

Experience Level = 3-5 Years

• 
  
• The Associate Director, Evidence Generation Compliance is responsible for ensuring that all evidence generating activities (e.g., observational research, clinical outcomes studies, RWE initiatives, investigator sponsored research, and collaborative research programs) are executed in accordance with internal policies, regulatory requirements, and industry best practices. This role safeguards audit readiness, strengthens governance, and drives consistency and rigor in processes and documentation across the Evidence Generation function.
  
• The ideal candidate is a detail oriented compliance leader experienced in medical affairs operations, governance, and documentation management, with the ability to collaborate across cross functional teams and influence best practices globally.
  

• 
  
• Ensure all Evidence Generation documentation is consistently audit ready, complete, current, and compliant with internal standards and external regulatory expectations.
  
• Conduct periodic quality checks and systems-of-record reviews across programs and studies to proactively identify gaps and areas for improvement.
  
• Partner with functional leads and study owners to support robust, accurate, and timely documentation practices.
  

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• Reinforce adherence to Standard Operating Procedures (SOPs), Work Instructions, and controlled documents across Evidence Generation and Medical Affairs.
  
• Lead the update, revision, and creation of SOPs as needed, ensuring alignment with evolving regulatory guidelines and industry best practices.
  
• Develop and deliver targeted training programs to strengthen compliance awareness and procedural consistency across teams.
  

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• Manage and continuously improve Evidence Generation governance documentation, ensuring version control, accessibility, and alignment with organizational quality frameworks.
  
• Support governance body operations (e.g., review committees, oversight boards) by preparing materials, maintaining records, and ensuring compliant decision making processes.
  
• Ensure all proposals, concepts, and new study requests are reviewed by the appropriate governance body in a timely and compliant manner, including triage of submissions, coordination of review schedules, and communication of outcomes to stakeholders.
  
• Implement and monitor compliance KPIs, metrics, and dashboards to ensure ongoing transparency and operational excellence.
  

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• Partner with Legal, Compliance, Regulatory, and Quality Assurance to ensure holistic alignment and timely issue resolution.
  
• Provide compliance guidance during planning and execution of evidence generation activities, including protocol development, contracting, data sharing, authorship, and publication processes.
  

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• Identify opportunities to streamline workflows, reduce procedural burden, and enhance operational efficiency while maintaining compliance rigor.
  
• Support change management efforts, including communication planning and stakeholder alignment, for new or updated processes.
  

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• Support end to end execution of events including webinars, meetings, roundtables, and conferences
  
• Coordinate event logistics such as registration, calendars, venues, AV, catering, and materials
  
• Manage event timelines, checklists, and task tracking to ensure deadlines are met
  
• Assist with speaker coordination, agendas, briefing documents, and content collection
  
• Prepare and distribute event communications, invitations, and follow ups
  
• Liaise with vendors, production teams, and internal stakeholders
  
• Support live and on site execution, including run of show and troubleshooting
  
• Ensure event materials meet branding and compliance requirements
  
• Help track attendance, feedback, and post event reporting
  

• 
  
• Bachelor's degree
  
• 2-4 years of experience in event coordination, marketing, or administrative support roles
  
• Strong organizational skills with high attention to detail
  
• Ability to manage multiple tasks and deadlines simultaneously
  
• Clear written and verbal communication skills
  
• Comfortable working in fast paced, deadline driven environments
  

• 
  
• Experience working at an asset manager or venture capital firm
  
• Experience with virtual event platforms or registration tools
  
• Familiarity with coordinating senior stakeholders or external speakers
  
• Strong Excel, PowerPoint, and calendar management skills
  
• Proactive, solutions oriented mindset
  

Position Title: Appeals Nurse

Work Location: Remote - South Carolina

Assignment Duration: 6 Months with potential of extension or conversion

Work Schedule: 8-5 pm EST Mon - Fri

Position Summary: Facilitate medical necessity appeals and denials including disposition of denials notification letters, review of clinical information to determine if medical necessity criteria are met.

Background & Context: The Clinical Appeals team plays a vital role in supporting our organization's regulatory compliance, operational integrity, and member and provider experience. The team is responsible for timely and accurate review of provider disputes, member grievances, and appeals, with a strong focus on meeting State and NCQA requirements.

Key Responsibilities:

• 
  
• Review clinical data to determine claim payment based on company policies and
  
• National Committee for Quality Assurance (NCQA) guidelines, including overturning denied claims, upholding the denials and submitting cases to the Medical Director for review
  
• Prepare case review for the Medical Director in cases where criteria are not met based on the additional clinical information received
  
• Generate appropriate appeal resolution communication to the member and provider in accordance with company policies and NCQA guidelines. Create system authorization events for overturned denial decisions
  
• Request additional information, as appropriate from provider(s) to facilitate timely appeals resolution
  
• Gather and prepare case information for Administrative Law Hearings
  
• Maintain appeals process within the prescribed NCQA timeframes and appeals turnaround database
  
• Assist the Medical Director with revising, updating and/or creating new policies to satisfy NCQA and contractual requirements.
  

Qualification & Experience:

• 
  
• Years of experience required
  
• Disqualifiers
  
• Best vs. average
  
• Performance indicators
  

• 
  
• Top 3 must-have hard skills
  
• Level of experience with each
  
• Stack-ranked by importance
  
• Candidate Review & Selection
  

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.

• 
  
• 
  

  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.

  
  
  
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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.

  
  
  
• 
  

  Licensure (Required): RN, LPN

  
  
  
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  Licensure (Preferred): LVN

  
  
  
• 
  

  Must haves:

  
  
  
  • 
    
  • 
    

    Medicare knowledge

    
    
    
  • 
    

    InterQual or Milliman Experience

    
    
    
  • 
    

    Clinical reviews for Utilization Management or Appeals

    
    
    
  
  
  
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  Nice to haves:

  
  
  
  • 
    
  • 
    

    Medicare Appeals Experience

    
    
    
  
  
  
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  Disqualifiers:

  
  
  
  • 
    
  • 
    

    Not having a valid/active RN/LPN license

    
    
    
  
  
  
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  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)
    
    
  
  
  

• 
  
• Collaborate with the brand team in the development of project briefs
  
• Recommend key promotional tactics that align with the strategy and goals of the brand
  
• Issue client contact reports to ensure key information is being quickly communicated to all involved stakeholders
  
• Review creative development of a project during concept to completion to ensure specifications, client expectations, budgets, timelines, etc. are being adhered to
  
• Facilitate ongoing, timely and accurate communications to ensure all projects are completed on time and within budget
  
• Develop annual forecasts
  
• Conduct financial reconciliations on a monthly basis
  
• Track time on a daily basis
  

• 
  
• Bachelor degree required
  
• Master's degree or equivalent related project or functional experience is desirable
  
• Total account management experience - 3-4 years preferred
  
• Pharmaceutical ad agency experience or in-house agency experience preferred
  
• Pharmaceutical industry experience preferred (US, Global preferred)
  
• Excellent communications skills: verbal, presentation, written
  
• High energy, positive, organized individual who is comfortable in a high-visibility role Ability to manage high volume project scope in a fast paced creative environment
  
• Great collaborator with ability to focus on both the big picture and small details
  
• Maintain an intimate understanding of the Agency Workflow Process including project initiation and kickoff, collaboration, necessary approvals, production and archiving Demonstrate critical creative thinking and problem solving skills
  
• Demonstrate clear and concise written and verbal communication skills
  
• Demonstrate the ability to prioritize and multi-task to enhance productivity and manage workload
  
• Demonstrate leadership in conflict resolution to facilitate effective outcomes
  
• Possess ability to work in a high-volume, rapidly paced environment
  
• Maintain knowledge of The Organization guidelines including, but not limited to, corporate branding, promotional material development, PromoMats review and corporate compliance Possess a thorough understanding of their accounts' (both U.S. and Global) product attributes, marketing objectives, target audience, competitive environment, market dynamics and medical/regulatory/legal position
  

• 
  
• Reports to client Ad Agency Account Manager
  
• Partners with creative team on project initiatives
  
• Accountable for tactical execution, compliance to all related guidelines and budget Adherence to all company-wide financial policies