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Conducts comprehensive clinical reviews of adverse determinations related to medical necessity.
Initiates outreach to providers to obtain clarification or additional documentation in alignment with established clinical criteria and organizational policies, to support Medical Director decision making.
Provides support for claim appeals in relation to medical necessity.
Ensures the timely and accurate resolution of appeal cases and supports organizational adherence to all state, federal, and accreditation standards.
Facilitates member second level appeal process.
Graduate from an accredited school of professional nursing is required.
BSN preferred.
Minimum 2 years acute care experience or managed care experience is required.
Basic knowledge of Medicaid, Medicare preferred.
Knowledge of InterQual screening criteria, ICD-10, CPT coding preferred.
Current Registered Nurse (RN) license to practice professional nursing issued by the Board of Nurse Examiners for the State of Texas is required.
Active Certification in Case Management (CCM) is preferred.
Conducts comprehensive clinical reviews of adverse determinations related to medical necessity. Initiates outreach to providers to obtain clarification or additional documentation in alignment with established clinical criteria and organizational policies, to support Medical Director decision making. Provides support for claim appeals in relation to medical necessity. Ensures the timely and accurate resolution of appeal cases and supports organizational adherence to all state, federal, and accreditation standards. Facilitates member second level appeal process.
EDUCATION/EXPERIENCE
Graduate from an accredited school of professional nursing is required. BSN preferred. Minimum 2 years acute care experience or managed care experience is required. Basic knowledge of Medicaid, Medicare preferred. Knowledge of InterQual screening criteria, ICD-10, CPT coding preferred.
LICENSURE
Current Registered Nurse (RN) license to practice professional nursing issued by the Board of Nurse Examiners for the State of Texas is required. Active Certification in Case Management (CCM) is preferred.
Conducts comprehensive clinical reviews of adverse determinations related to medical necessity. Initiates outreach to providers to obtain clarification or additional documentation in alignment with established clinical criteria and organizational policies, to support Medical Director decision making. Provides support for claim appeals in relation to medical necessity. Ensures the timely and accurate resolution of appeal cases and supports organizational adherence to all state, federal, and accreditation standards. Facilitates member second level appeal process.
EDUCATION/EXPERIENCE
Graduate from an accredited school of professional nursing is required. BSN preferred. Minimum 2 years acute care experience or managed care experience is required. Basic knowledge of Medicaid, Medicare preferred. Knowledge of InterQual screening criteria, ICD-10, CPT coding preferred.
LICENSURE
Current Registered Nurse (RN) license to practice professional nursing issued by the Board of Nurse Examiners for the State of Texas is required. Active Certification in Case Management (CCM) is preferred.
Conducts comprehensive clinical reviews of adverse determinations related to medical necessity. Initiates outreach to providers to obtain clarification or additional documentation in alignment with established clinical criteria and organizational policies, to support Medical Director decision making. Provides support for claim appeals in relation to medical necessity. Ensures the timely and accurate resolution of appeal cases and supports organizational adherence to all state, federal, and accreditation standards. Facilitates member second level appeal process.
EDUCATION/EXPERIENCE
Graduate from an accredited school of professional nursing is required. BSN preferred. Minimum 2 years acute care experience or managed care experience is required. Basic knowledge of Medicaid, Medicare preferred. Knowledge of InterQual screening criteria, ICD-10, CPT coding preferred.
LICENSURE
Current Registered Nurse (RN) license to practice professional nursing issued by the Board of Nurse Examiners for the State of Texas is required. Active Certification in Case Management (CCM) is preferred.
Conducts comprehensive clinical reviews of adverse determinations related to medical necessity. Initiates outreach to providers to obtain clarification or additional documentation in alignment with established clinical criteria and organizational policies, to support Medical Director decision making. Provides support for claim appeals in relation to medical necessity. Ensures the timely and accurate resolution of appeal cases and supports organizational adherence to all state, federal, and accreditation standards. Facilitates member second level appeal process.
EDUCATION/EXPERIENCE
Graduate from an accredited school of professional nursing is required. BSN preferred. Minimum 2 years acute care experience or managed care experience is required. Basic knowledge of Medicaid, Medicare preferred. Knowledge of InterQual screening criteria, ICD-10, CPT coding preferred.
LICENSURE
Current Registered Nurse (RN) license to practice professional nursing issued by the Board of Nurse Examiners for the State of Texas is required. Active Certification in Case Management (CCM) is preferred.
This position coordinates utilization review service for defined patient populations across the acute care continuum. This includes discharge planning, utilization management, care coordination collaboration, and support for resource utilization. This position works collaboratively with an interdisciplinary team to improve patient care through the effective utilization of the facility's resources.
1. Current licensure as a Registered Nurse (RN) in the state of California is required.
2. Current American Heart Association (AHA) Healthcare Provider CPR card is preferred.
3. Degree from an accredited baccalaureate nursing program (BSN) is preferred.
4. Certified Case Manager (CCM) national certification is preferred.
5. Interquel training must be obtained within six (6) months of hire into position.
6. Previous experience in at least two (2) areas of clinical specialty in an acute care setting is required.
7. Excellent communication skills, critical thinking, creative problem-solving skills, and competent organizational and planning skills are required.
8. The incumbent must be self-directed and able to tolerate frequent interruptions with a demanding workload.
9. Knowledge regarding hospital protocol and procedures, clinical standards and outcomes, funding options, familiarity with community resources and outside professional agencies, familiarity with federal and state regulations governing hospital and home care, as well as understanding of the financial structure of health plan and delivery system is preferred.
Pay Range:
$49.47 - 71.74
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
Join Our Team as a Website Tester at Little Wheel
Little Wheel is a gambling technology company focused on researching and building products that put players first. We are currently hiring Website Testers across Michigan, New Jersey, Pennsylvania, and West Virginia.
This is a great opportunity to earn extra income on a flexible schedule while helping us test online casinos. No prior experience is required, and all training is provided.
This is a short-term contract, with opportunities for ongoing work for high performers.
Role Overview
As a Website Tester, you will:
- Participate in user experience testing on various online casino platforms.
- Follow step-by-step instructions to complete assigned tasks.
- Record feedback and report bugs or usability issues.
- Provide detailed insights into your testing experience.
- Complete all testing assignments within set timelines.
Requirements
To be eligible, you must:
- Be at least 21 years old.
- Reside in one of the following states: Michigan, New Jersey, Pennsylvania, or West Virginia.
- Own a laptop or desktop computer.
- Be able to complete a short, paid online training and onboarding process.
No previous testing or gambling experience is needed. You will not be gambling with your own money, and there are no fees or out-of-pocket costs. All the interactions/game-play would be for testing purposes.
Compensation and Benefits
- Guaranteed earnings of at least $1,000 for approximately 20 hours of testing.
- Minimum of $25/hour, with higher pay for faster testers.
- $100 bonus upon completing the onboarding program.
- Flexible schedule – choose when you want to work.
- Work from home – test websites from the comfort of your own space.
- Fast payments – get paid after each of the 4 testing stages.
- Excellent support – coordinators available daily from 6 AM to 11 PM ET.
What Our Testers Say
"Great side gig for some extra cash. The team is very communicative and will answer any questions/concerns!" – Maria, Trustpilot (2021)
"Tasks are clearly explained with step-by-step instructions. You can work when it's convenient. Support is very helpful and responsive." – Anonymous, Glassdoor (2025)
Read more reviews on Glassdoor, Trustpilot, and Google.
Equal Opportunity Statement
Little Wheel LLC is proud to be an Equal Opportunity Employer. We are committed to creating an inclusive environment for all applicants and employees, regardless of race, religion, color, national origin, gender identity, sexual orientation, age, disability, or veteran status. We celebrate diversity and strive to create a workplace where everyone feels valued.
Company Info
Website: Address: Little Wheel LLC, 250 Pehle Ave, Suite 200, Saddle Brook, NJ 07663 Phone: (833) 313-7490
Join Our Team as a Website Tester at Little Wheel
Little Wheel is a gambling technology company focused on researching and building products that put players first. We are currently hiring Website Testers across Michigan, New Jersey, Pennsylvania, and West Virginia.
This is a great opportunity to earn extra income on a flexible schedule while helping us test online casinos. No prior experience is required, and all training is provided.
This is a short-term contract, with opportunities for ongoing work for high performers.
Role Overview
As a Website Tester, you will:
- Participate in user experience testing on various online casino platforms.
- Follow step-by-step instructions to complete assigned tasks.
- Record feedback and report bugs or usability issues.
- Provide detailed insights into your testing experience.
- Complete all testing assignments within set timelines.
Requirements
To be eligible, you must:
- Be at least 21 years old.
- Reside in one of the following states: Michigan, New Jersey, Pennsylvania, or West Virginia.
- Own a laptop or desktop computer.
- Be able to complete a short, paid online training and onboarding process.
No previous testing or gambling experience is needed. You will not be gambling with your own money, and there are no fees or out-of-pocket costs. All the interactions/game-play would be for testing purposes.
Compensation and Benefits
- Guaranteed earnings of at least $1,000 for approximately 20 hours of testing.
- Minimum of $25/hour, with higher pay for faster testers.
- $100 bonus upon completing the onboarding program.
- Flexible schedule – choose when you want to work.
- Work from home – test websites from the comfort of your own space.
- Fast payments – get paid after each of the 4 testing stages.
- Excellent support – coordinators available daily from 6 AM to 11 PM ET.
What Our Testers Say
"Great side gig for some extra cash. The team is very communicative and will answer any questions/concerns!" – Maria, Trustpilot (2021)
"Tasks are clearly explained with step-by-step instructions. You can work when it's convenient. Support is very helpful and responsive." – Anonymous, Glassdoor (2025)
Read more reviews on Glassdoor, Trustpilot, and Google.
Equal Opportunity Statement
Little Wheel LLC is proud to be an Equal Opportunity Employer. We are committed to creating an inclusive environment for all applicants and employees, regardless of race, religion, color, national origin, gender identity, sexual orientation, age, disability, or veteran status. We celebrate diversity and strive to create a workplace where everyone feels valued.
Company Info
Website: Address: Little Wheel LLC, 250 Pehle Ave, Suite 200, Saddle Brook, NJ 07663 Phone: (833) 313-7490
Essential Functions of the job:
- Review and validate QC data and test records.
- Support investigations related to Out of Specification (OOS), Out of Trend (OOT), and Out of Expectation (OOE) results.
- Ensure compliance with current Good Manufacturing Practices (cGMP) in the laboratory.
- Assist in the technical documentation of investigations and change control assessments to evaluate the impact on product quality, in alignment with FDA/EU regulations, international standards
- Undertake other duties as required.
This position is ideal for candidates who are detail-oriented and committed to quality assurance in the pharmaceutical industry.
Education/Experience Required:
- Bachelor’s Degree or above in Chemistry, Biochemistry, or Biotechnology related scientific discipline. Scientific degree (ideally chemistry, biochemistry, biotechnology or related).
- Minimum 4 years working experience in an FDA-regulated biotechnology or pharmaceutical company is required.
- Working knowledge and experience with chemistry analytical methods such as HPLC, GC, TOC, Capillary Electrophoresis (CGE-Reduced, CGE-Non-Reduced, and Capillary Zone Electrophoresis), etc.
- Strong working knowledge with USP/EP and cGMP/EU GMP.
- Technical writing experience.
- Familiar with instrument and equipment validation.
- Impressive, demonstrable track record and skills/experience gained within a similar position(s), at a similar level.
- Credible and confident communicator (written and verbal) at all levels.
- Strong analytical and problem-solving ability.
- Hands-on approach, with a ‘can do’ attitude.
- Ability to prioritize, demonstrating good time management skills.
- Excellent attention to detail, with the ability to work accurately in a busy and demanding environment.
- Self-motivated, with the ability to work proactively using own initiative.
- Committed to learning and development
- Self-motivated, with the ability to work proactively using own initiative.
Computer Skills:
- Strong PC literacy required; MS Office skills (Outlook, Word, Excel, PowerPoint).
Travel:
- Must be willing to travel approximately 10%.
- Ability to work on a computer for extended periods of time.
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 withnational 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
