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Data Architect - Power & Utilities - Senior Manager- Consulting - Location OPEN
$250 +
San Francisco, CA 3 days ago

Location: Anywhere in Country


At EY, we’re all in to shape your future with confidence.


We’ll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go. Join EY and help to build a better working world.


AI & Data - Data Architecture – Senior Manager – Power & Utilities Sector

EY is seeking a motivated professional with solid experience in the utilities sector to serve as a Senior Manager who possesses a robust background in Data Architecture, Data Modernization, End to end Data capabilities, AI, Gen AI, Agentic AI, preferably with a power systems / electrical engineering background and having delivered business use cases in Transmission / Distribution / Generation / Customer. The ideal candidate will have a history of working for consulting companies and be well-versed in the fast-paced culture of consulting work. This role is dedicated to the utilities sector, where the successful candidate will craft, deploy, and maintain large-scale AI data ready architectures.


The opportunity

You will help our clients enable better business outcomes while working in the rapidly growing Power & Utilities sector. You will have the opportunity to lead and develop your skill set to keep up with the ever-growing demands of the modern data platform. During implementation you will solve complex analytical problems to bring data to insights and enable the use of ML and AI at scale for your clients. This is a high growth area and a high visibility role with plenty of opportunities to enhance your skillset and build your career.


As a Senior Manager in Data Architecture, you will have the opportunity to lead transformative technology projects and programs that align with our organizational strategy to achieve impactful outcomes. You will provide assurance to leadership by managing timelines, costs, and quality, and lead both technical and non-technical project teams in the development and implementation of cutting-edge technology solutions and infrastructure. You will have the opportunity to be face to face with external clients and build new and existing relationships in the sector. Your specialized knowledge in project and program delivery methods, including Agile and Waterfall, will be instrumental in coaching others and proposing solutions to technical constraints.


Your key responsibilities

In this pivotal role, you will be responsible for the effective management and delivery of one or more processes, solutions, and projects, with a focus on quality and effective risk management. You will drive continuous process improvement and identify innovative solutions through research, analysis, and best practices. Managing professional employees or supervising team members to deliver complex technical initiatives, you will apply your depth of expertise to guide others and interpret internal/external issues to recommend quality solutions. Your responsibilities will include:


As Data Architect – Senior Manager, you will have an expert understanding of data architecture and data engineering and will be focused on problem-solving to design, architect, and present findings and solutions, leading more junior team members, and working with a wide variety of clients to sell and lead delivery of technology consulting services. You will be the go-to resource for understanding our clients’ problems and responding with appropriate methodologies and solutions anchored around data architectures, platforms, and technologies. You are responsible for helping to win new business for EY. You are a trusted advisor with a broad understanding of digital transformation initiatives, the analytic technology landscape, industry trends and client motivations. You are also a charismatic communicator and thought leader, capable of going toe-to-toe with the C-level in our clients and prospects and willing and able to constructively challenge them.


Skills and attributes for success

To thrive in this role, you will need a combination of technical and business skills that will make a significant impact. Your skills will include:



  • Technical Skills Applications Integration
  • Cloud Computing and Cloud Computing Architecture
  • Data Architecture Design and Modelling
  • Data Integration and Data Quality
  • AI/Agentic AI driven data operations
  • Experience delivering business use cases in Transmission / Distribution / Generation / Customer.
  • Strong relationship management and business development skills.
  • Become a trusted advisor to your clients’ senior decision makers and internal EY teams by establishing credibility and expertise in both data strategy in general and in the use of analytic technology solutions to solve business problems.
  • Engage with senior business leaders to understand and shape their goals and objectives and their corresponding information needs and analytic requirements.
  • Collaborate with cross-functional teams (Data Scientists, Business Analysts, and IT teams) to define data requirements, design solutions, and implement data strategies that align with our clients’ objectives.
  • Organize and lead workshops and design sessions with stakeholders, including clients, team members, and cross-functional partners, to capture requirements, understand use cases, personas, key business processes, brainstorm solutions, and align on data architecture strategies and projects.
  • Lead the design and implementation of modern data architectures, supporting transactional, operational, analytical, and AI solutions.
  • Direct and mentor global data architecture and engineering teams, fostering a culture of innovation, collaboration, and continuous improvement.
  • Establish data governance policies and practices, including data security, quality, and lifecycle management.
  • Stay abreast of industry trends and emerging technologies in data architecture and management, recommending innovations and improvements to enhance our capabilities.

To qualify for the role, you must have

  • A Bachelor’s degree required in STEM
  • 12+ years professional consulting experience in industry or in technology consulting.
  • 12+ years hands-on experience in architecting, designing, delivering or optimizing data lake solutions.
  • 5+ years’ experience with native cloud products and services such as Azure or GCP.
  • 8+ years of experience mentoring and leading teams of data architects and data engineers, fostering a culture of innovation and professional development.
  • In-depth knowledge of data architecture principles and best practices, including data modelling, data warehousing, data lakes, and data integration.
  • Demonstrated experience in leading large data engineering teams to design and build platforms with complex architectures and diverse features including various data flow patterns, relational and no-SQL databases, production-grade performance, and delivery to downstream use cases and applications.
  • Hands-on experience in designing end-to-end architectures and pipelines that collect, process, and deliver data to its destination efficiently and reliably.
  • Proficiency in data modelling techniques and the ability to choose appropriate architectural design patterns, including Data Fabrics, Data Mesh, Lake Houses, or Delta Lakes.
  • Manage complex data analysis, migration, and integration of enterprise solutions to modern platforms, including code efficiency and performance optimizations.
  • Previous hands‑on coding skills in languages commonly used in data engineering, such as Python, Java, or Scala.
  • Ability to design data solutions that can scale horizontally and vertically while optimizing performance.
  • Experience with containerization technologies like Docker and container orchestration platforms like Kubernetes for managing data workloads.
  • Experience in version control systems (e.g. Git) and knowledge of DevOps practices for automating data engineering workflows (DataOps).
  • Practical understanding of data encryption, access control, and security best practices to protect sensitive data.
  • Experience leading Infrastructure and Security engineers and architects in overall platform build.
  • Excellent leadership, communication, and project management skills.
  • Data Security and Database Management
  • Enterprise Data Management and Metadata Management
  • Ontology Design and Systems Design

Ideally, you’ll also have

  • Master’s degree in Electrical / Power Systems Engineering, Computer science, Statistics, Applied Mathematics, Data Science, Machine Learning or commensurate professional experience.
  • Experience working at big 4 or a major utility.
  • Experience with cloud data platforms like Databricks.
  • Experience in leading and influencing teams, with a focus on mentorship and professional development.
  • A passion for innovation and the strategic application of emerging technologies to solve real-world challenges.
  • The ability to foster an inclusive environment that values diverse perspectives and empowers team members.
  • Building and Managing Relationships
  • Client Trust and Value and Commercial Astuteness
  • Communicating With Impact and Digital Fluency

What we look for

We are looking for top performers who demonstrate a blend of technical expertise and business acumen, with the ability to build strong client relationships and lead teams through change. Emotional agility and hybrid collaboration skills are key to success in this dynamic role.


FY26NATAID


What we offer you

At EY, we’ll develop you with future-focused skills and equip you with world-class experiences. We’ll empower you in a flexible environment, and fuel you and your extraordinary talents in a diverse and inclusive culture of globally connected teams. Learn more.



  • We offer a comprehensive compensation and benefits package where you’ll be rewarded based on your performance and recognized for the value you bring to the business. The base salary range for this job in all geographic locations in the US is $144,000 to $329,100. The base salary range for New York City Metro Area, Washington State and California (excluding Sacramento) is $172,800 to $374,000. Individual salaries within those ranges are determined through a wide variety of factors including but not limited to education, experience, knowledge, skills and geography. In addition, our Total Rewards package includes medical and dental coverage, pension and 401(k) plans, and a wide range of paid time off options.
  • Join us in our team‑led and leader‑enabled hybrid model. Our expectation is for most people in external, client serving roles to work together in person 40-60% of the time over the course of an engagement, project or year.
  • Under our flexible vacation policy, you’ll decide how much vacation time you need based on your own personal circumstances. You’ll also be granted time off for designated EY Paid Holidays, Winter/Summer breaks, Personal/Family Care, and other leaves of absence when needed to support your physical, financial, and emotional well‑being.

Are you ready to shape your future with confidence? Apply today.

EY accepts applications for this position on an on‑going basis.


For those living in California, please click here for additional information.


EY focuses on high‑ethical standards and integrity among its employees and expects all candidates to demonstrate these qualities.


EY | Building a better working world

EY is building a better working world by creating new value for clients, people, society and the planet, while building trust in capital markets.


Enabled by data, AI and advanced technology, EY teams help clients shape the future with confidence and develop answers for the most pressing issues of today and tomorrow.


EY teams work across a full spectrum of services in assurance, consulting, tax, strategy and transactions. Fueled by sector insights, a globally connected, multi-disciplinary network and diverse ecosystem partners, EY teams can provide services in more than 150 countries and territories.


EY provides equal employment opportunities to applicants and employees without regard to race, color, religion, age, sex, sexual orientation, gender identity/expression, pregnancy, genetic information, national origin, protected veteran status, disability status, or any other legally protected basis, including arrest and conviction records, in accordance with applicable law.


EY is committed to providing reasonable accommodation to qualified individuals with disabilities including veterans with disabilities. If you have a disability and either need assistance applying online or need to request an accommodation during any part of the application process, please call 1-800-EY-HELP3, select Option 2 for candidate related inquiries, then select Option 1 for candidate queries and finally select Option 2 for candidates with an inquiry which will route you to EY’s Talent Shared Services Team (TSS) or email the TSS at .


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Not Specified
Software Engineer - Java
✦ New
Salary not disclosed
Cary, NC 1 day ago

Need Local Only , We can Do C2C



Title: Software Engineer

Duration: Long term

Location: Cary , IL



Job Description:

Summary/Objective:

A Software Engineer will develop, maintain, and support new or existing software products while applying the best practices of software development. Responsibilities include the ability to work independently and as part of a larger team to deliver quality solutions across all phases of the software lifecycle and across all layers of a software solution.


Job Accountability/Responsibilities


Quality:

• Meet or exceed test coverage goals set for the project through creation of unit and functional tests.

• Minimize the number of production escapes.

• Support user acceptance testing.

• Support or conduct system testing, performance testing, volume testing, and stress testing.


Usability/User Experience:

• Collaborate with business and/or UX teams to create appropriate application user interfaces.

• Assist with mock-ups and user interface design.

• Incorporate UX components into the application.

• Provide feedback to the UX team.


Product Reliability & Response:

• Ensure the system can meet or exceed defined SLA's.

• When primary on-call, respond to pages within 15 minutes and resolve or escalate issues as necessary.

• Resolve production issues and communicate resolution to appropriate stakeholders.


Development:

• Complete stories within estimates and with quality to ensure release dates are met.

• Conduct necessary analysis, design, and prepare technical documentation.

• Estimate story sizes and task out development for a given story.

• Follow the Railinc development process and suggest improvements.

• Work with infrastructure services to make configuration changes and deploy applications.


Leadership (Technical):

• Evangelize Railinc common practices and development procedures.

• Exhibit technical leadership in a given technical subject domain.

• Mentor peers and junior developers.

• Delegate and coordinate functional development tasks as needed.

• Drive innovation in the development, release, and operations processes.


Key Measures:

• Coverage, production escapes.

• Customer satisfaction score.

• System SLA, number of outages.

• Release scope, schedule, and budget.

• Releases.


Knowledge, Skills, Abilities / Minimum Requirements / Competencies

• Works under deadlines and is subject to a heavy project load.

• Ability to explain concepts to technical staff.

• Ability to work independently but also effectively with all co-workers; must be a team player.

• Ability to multitask and prioritize (professionally handle issues and assignments in various stages of resolution on an ongoing basis).

• Ability to communicate and follow up professionally (written and oral) both internally and externally within the organization.

• Demonstrated ability to identify and resolve issues effectively.

• Demonstrated high degree of accuracy and attention to detail.

• Strong Java fundamentals and good design skills.


Education, Experience, Certification/Training

• Bachelor’s degree n Computer Science or equivalent field desired.

• Minimum of 3 years of technical experience.

• Full lifecycle project experience; Agile preferred.

• Experience with Spring, Spring Boot, Hibernate (ORM), Oracle, and Postgres preferred.

• Experience working with Docker and Kubernetes environments preferred.

• UI experience – Angular 2 and above, JavaScript, jQuery, CSS preferred.

• Exposure to AWS technologies preferred (especially serverless technologies such as Lambda, S3, DynamoDB, etc.).

Not Specified
Senior java Developer
✦ New
Salary not disclosed
Rancho Cordova, CA 1 day ago

Location: Oakland, GA or Alpharetta, GA(Hybrid)


Job Responsibility:

API Development (Spring Boot, Oracle, Azure):

· Developed and maintained RESTful Java APIs using Spring Boot for enterprise insurance applications.

· Integrated services with Oracle Database, ensuring high performance and scalability.

· Deployed applications on Microsoft Azure, leveraging cloud-native features for reliability and resilience.

· Applied Datadog for observability, implementing custom metrics, distributed tracing, and dashboards to improve monitoring and incident response.

· Collaborated cross-functionally with product managers and QA to deliver secure and efficient API services.

Not Specified
ARCHITECTE APPLICATIF JAVA (F/H)
✦ New
Salary not disclosed
Springfield, MA 3 hours ago
Join an industry leading EA function within MassMutual that creates alignment between technology and business strategy. You will have an opportunity to guide the process of planning and designing capabilities to maximize the value of IT and enable the company to make high impact, long-term decisions. This will be accomplished through architecture strategies, blueprints and road maps that standardize technology stacks which create engineering speed and agility through the innovative use of data science, data analytics, cloud and API’s. The EA will work with a team that embrace diversity in all of its forms, respect and have fun.

The MassMutual Enterprise Architecture team in the Enterprise Technology and Experience organization is seeking an outstanding Enterprise Architect (Application) to join our team. Enterprise Architecture is composed of Business, Application, Infrastructure, Technology & Design and Security architecture domains. Joining this team will give the Application EA a unique perspective and opportunity to partner with best-in-class architects on enterprise wide technology initiatives.

This role will work with IT and Business stakeholders of business delivery teams, engineers, application operations, product managers, and enterprise stakeholders to help deliver innovative, data-driven systems aimed at transforming the insurance industry. As part of the application architecture team, incumbents may be responsible for any of the following:
Partner with senior leaders to develop and maintain the Technology strategies & roadmap focused on Wealth Management
Manage a domain(s) of the MassMutual Application Portfolio Management data for quality
Technical evaluations and benchmarking of core application platforms, frameworks and technologies
Specification and publication of standards around application design and software engineering best practices
Thought leadership and active participation in conferences and research with strategic partners and academic institutions
Partner with business executives and senior architects to identify data and process issues, then provide solution options and recommends options
Provide recommendations on system options, risks, cost/benefit analysis, and impact on cross-domain systems, business strategy, goals and processes
Engage in SA problem solving, snapshots and full architecture documents
Actively publish deliverables, and utilizes multi-media to educate and engage with federated solution architecture community members
Collaborate with extended enterprise architecture, business, and IT support teams to communicate architecture strategies, standards, and direction
Bachelors degree in Computer Science, Engineering or related Technical degree
~8+ years of related IT Solutions Architecture or Technical Lead experience

10+ years of related IT Architecture or IT consulting experience
~ P referred job experience includes some knowledge of Insurance and Wealth Management  
~ Financial Planning, Order Management, Lending, Wealth Investment Products, etc.
~ Understanding of the impact of IT on business results  
~ Experience in Public Cloud platforms (preferably AWS), solution design and development using Cloud-native services, and understanding of cost rationalization. 
~ AWS/Azure Cloud Certification  
~ Strong experience with event streaming design and implementation using Kafka, along with web service protocols and patterns like SOAP, REST, JSON, XML/XSDs. 
~ Experience with REST API for data interchange and API-driven systems integration decoupling digital and backend systems. 
~ Track record of designing architectural reference material  

Networking opportunities including access to Asian, Hispanic/Latinx, African American, women, LGBTQ, veteran and disability-focused Business Resource Groups
Access to learning content on Degreed and other informational platforms
If you need an accommodation to complete the application process, please contact us and share the specifics of the assistance you need.
California residents:
permanent
Behavioral Health Utilization Management Medical Case Manager
Salary not disclosed
Orange, CA 4 days ago
Behavioral Health Utilization Management Medical Case Manager

CalOptima

Join Us in this Amazing Opportunity

The Team You'll Join

We are a mission driven community‐based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

More About the Opportunity

We are hoping you will join us as a Behavioral Health Utilization Management Medical Case Manager and help shape the future of healthcare where you'll be an integral part of our BHI ‐ BH Utilization Management team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. This position has been approved to be Full Telework.

- If telework is approved, you are required to work within the State of California only and if Partial Telework, also come in to the Main Office in Orange, CA, at least two (2) days per week minimum.

The Medical Case Manager (BHI Utilization Management) will be responsible for reviewing and processing requests for authorization and notification of behavioral health services from health professionals, clinical facilities and ancillary providers. You will be responsible for prior authorizations, concurrent review and related processes. You will utilize CalOptima Health's medical criteria, policies and procedures to authorize referral requests from behavioral health professionals, clinical facilities and ancillary providers. You will directly interact with providers and facilities and serve as a resource for their needs. Together, we are building a stronger, more equitable health system.

Your Contributions To the Team:

- 85% ‐ Utilization Management Services

- Participates in a mission‐driven culture of high‐quality performance, with a member focus on customer service, consistency, dignity and accountability.

- Assists the team in carrying out department responsibilities and collaborates with others to support short‐ and long‐term goals/priorities for the department.

- Reviews requests for medical appropriateness by using established clinical protocols to determine the medical necessity of the request.

- Responsible for mailing rendered decision notifications to the provider and member, as applicable.

- Screens inpatient and outpatient requests for the Medical Director's review, gathers pertinent medical information prior to submission to the Medical Director, follows up with the requester by communicating the Medical Director's decision and documents follow‐up in the utilization management system.

- Completes the required documentation for data entry into the utilization management system at the time of the telephone call or fax to include any authorization updates.

- Contacts the health networks and/or CalOptima Health Customer Service regarding health network enrollments.

- Identifies and reports any complaints to the immediate supervisor utilizing the call tracking system or through verbal communication if the issue is of an urgent nature.

- Refers cases of possible over/under utilization to the Medical Director for proper reporting.

- Completes care coordination activities as related to Transition Care Management (TCM) activities.

- Reviews International Classification of Diseases (ICD‐10), Current Procedural Terminology (CPT‐4) and Healthcare Common Procedure Coding System (HCPCS) codes for accuracy and the existence of coverage specific to the line of business.

- 10% ‐ Administrative Support

- Assists manager with identifying areas of staff training needs and maintains current data resources.

- Complies with data tracking protocols.

- 5% ‐ Other

- Completes other projects and duties as assigned.

Do You Have What the Role Requires?

- Current California unrestricted license such as LCSW, LPCC, LMFT or RN and related required education PLUS 3 years of clinical experience required; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying.

You'll Stand Out More If You Possess the Following:

- Utilization management reviewer experience.

- Managed care experience.

- Behavioral health clinical experience.

What the Regulatory Agencies Need You to Possess?

- Current California unrestricted license such as LCSW, LPCC, LMFT or RN.

Your Knowledge & Abilities to Bring to this Role:

- Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds.
- Work independently and exercise sound judgment.
- Communicate clearly and concisely, both orally and in writing.
- Work a flexible schedule; available to participate in evening and weekend events.
- Organize, be analytical, problem‐solve and possess project management skills.
- Work in a fast‐paced environment and in an efficient manner.
- Manage multiple projects and identify opportunities for internal and external collaboration.
- Motivate and lead multi‐program teams and external committees/coalitions.
- Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment.

Your Physical Requirements (With or Without Accommodations):

- Ability to visually read information from computer screens, forms and other printed materials and information.
- Ability to speak (enunciate) clearly in conversation and general communication.
- Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face‐to‐face interactions.
- Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting.
- Lifting and moving objects, patients and/or equipment 10 to 25 pounds

Ways We Are Here For You

- You'll enjoy competitive compensation for this role.

- Our current hiring range is: Pay Grade: 313 ‐ $90,820 ‐ $145,312 ($43.66 ‐ $69.8615).

- The final salary offered will be based on education, job‐related knowledge and experience, skills relevant to the role and internal equity among other factors.

- This position is approved for Full Telework (**If the position is Telework, it is eligible in California only**)
- A
Not Specified
Director, Utilization Management
✦ New
Salary not disclosed
OAKLAND, CA 1 day ago

Summary



  • 100% employer health plan for employees and their eligible dependents
  • Unique benefit offerings that are partially or 100% employer-paid
  • Rich and varied retirement plans and the ability to participate in multiple plans.
  • Generous paid time off plans


Role Overview:


Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight, strategic planning, compliance, and collaboration. Their responsibilities span from managing admissions to ensuring clean claims, identifying trends, and optimizing resource utilization. This role supports patient care coordination, fosters physician collaboration, and aligns with organizational objectives while adapting to ad hoc duties as needed. In essence, they orchestrate efficient utilization management to deliver high-quality patient care.



DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: Following are the duties performed by employees in this classification. However, employees may perform other related duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.



  • Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations.
  • Monitor and evaluate the utilization of healthcare services, including appropriateness, efficiency, and medical necessity of treatments and procedures.
  • Analyze data and generate reports on utilization trends, outcomes and quality indicators to support decision-making and process improvement initiatives. Reports to appropriate committees.
  • Manage quality of performance criteria, policies and procedures, and service standards for the utilization management operations. Evaluate utilization reviews and determine program improvements.
  • Develop and implement utilization review policies and procedures in accordance with industry standards and regulatory requirements.
  • Direct and coordinate data gathering and record keeping legally required by federal and state agencies, the Joint Commission, and hospital policies; participates in the risk mitigation, process of implementing new or revised processes, and projects
  • Foster effective communication and collaboration with internal departments, external agencies, and insurance providers to facilitate the utilization review process.
  • Participate in interdisciplinary committees and meetings to contribute to the development and implementation of quality improvement initiatives.
  • Oversees the secondary review process; actively appeals denied cases when necessary and assists physicians with appeals. Maintains minimal denial rates by Medicare, MediCal, private and contracted payers through appropriate direction of utilization practices; assists physicians and hospital personnel in understanding UM matters.
  • Perform all other duties as assigned.
  • Prepares cost analysis reports and other data needed for the preparation of the departmental budget.
  • Provides in-house educational programs as needed for both staff and physicians.
  • Responsible for the recruitment, orientation, evaluation, counseling and disciplinary action of UM and administrative staff.
  • Serves as a content expert to staff and internal departments and external partners; networks with other hospitals, nursing organizations, and professional organizations to keep abreast of changes within the profession.

MINIMUM QUALIFICATIONS:


Required Education: Bachelor's degree in Nursing


Preferred Education: Master's degree in Nursing


Required Experience: Three years of utilization review experience. Health insurance company and/or acute care hospital, post-acute and psych; three years of InterQual and/or MCG. Strong clinical nursing background.


Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California.


Preferred Licenses/Certifications: UM / CM certifications



Highland General Hospital
SYS Utilization Management
Full Time
Day
Nursing
FTE: 1
PDN-a14facc7-9c67-4b29-aafb-57a95a1d020b
permanent
Utilization Review Nurse Health Plans-Hp Utilization Mgmt
Salary not disclosed
Irving, TX 2 days ago
Description

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

Not Specified
Clinical Nurse III, Acute Inpatient Behavioral Health Utilization Management
✦ New
🏢 Alameda Health System
Salary not disclosed
SAN LEANDRO, CA 1 day ago

Summary


SUMMARY:Under general direction, works in collaboration with treatment team and other disciplines to assure the appropriate admit status and medical necessity for admission, concurrent, and discharges, securing the appropriate documentation and planning for continuing care. Identifies care issues and conveys barriers to discharge to appropriate disciplines while intervening to assure progression in the treatment planning. Follows AHS (Alameda Health System) and Behavioral Health Department Alameda County Utilization Review Plan to obtain authorization of acute inpatient services. Provides medical necessity and patient Care related documentation to non Medi-Cal payor sources. Documents authorization status and patient care related significant details in EHR. All tasks can be completed virtually and with minimal supervision.


DUTIES & ESSENTIAL JOB FUNCTIONS:NOTE: The following are the duties performed by employees in this classification. However, employees may perform other duties at an equivalent level. Not all duties listed are necessarily performed by each individual in the classification.


1. Assures clinical interventions are appropriate for the admitting diagnosis and reflect the standard of care, as defined by The Joint Commission (TJC), Centers for Medicare and Medicaid Services, and AHS and Behavioral Health Department of Alameda County Utilization Plan.


2. Collaborates with the treatment team; reviews all inpatient admissions for appropriate admit status based on medical necessity criteria of Medi-Cal and/or commercial insurances and ensures the patient is registered at the appropriate level of care.


3. Communicates with treatment team members to provide the continuity of care while supporting and maintaining the treatment team approach to ensure effective resource utilization.


4. Actively participates in treatment team meeting to discuss discharge planning.


5.During the initial review, screens for discharge needs and makes the appropriate recommendations to ensure a safe transition to a post-acute level of care.


6. Initiates authorization and follow up process with Behavioral Health Department of Alameda County and AHS Admissions/Eligibility/Enrollment services for uninsured patients.


7. Works with patient care team and vendors to procure DME (Durable Medical Equipment).


8. Notifies denials to the attending MD and treatment team members via EHR.


9. Reviews patient Account notes in EHR as needed for account updates and insurance accuracy.


10.Completes the DHCS PASSR for patients being referred to a SNF or Morton Bakar Center.


11.Independently processes the denial Work Ques and Patient Account Work Ques in EHR.


12. Identifies and escalates the complex cases at the appropriate level and coordinates case conferences as needed.


13.Actively participates in the quarterly URC meeting and discusses trends, patterns, and problem cases.


14.Identifies high utilization risk patients and notifies the treatment team.


15.Communicates with the treatment team via Care management report and Likely no medical necessity report daily.


16.Documents medical necessity and patient care related information in the identified fields in EHR.


17.Maintains current knowledge of clinical practice and Utilization Management by literature review, membership in a professional organization.


18.Maintains continuing education related to specialty or pursuing certification.


19.Makes appropriate referrals to homecare specialists or social work when clinically indicated.


20. Monitors ongoing patient care and makes suggestions to achieve optimal outcomes, based on vidence based best practice.


21.Participates in outcome data monitoring and audits as needed.


22.Performs concurrent reviews assigning acute, administrative and denied days as per ACBH concurrent review policy.


23. Utilizes clinical knowledge and defined standards of care to proactively identify inappropriate resource consumption and reports as appropriate.


MINIMUM QUALIFICATIONS:


Education: Graduate of an accredited Nursing Program required; Bachelor's degree in Nursing preferred.


Minimum Experience: Previous Behavioral Health Utilization Management or Care Management experience in inpatient acute setting required.


Minimum Experience: Two to five years recent clinical experience in acute inpatient behavioral health setting required.


Required Licenses/Certifications: BLS - Basic Life Support Certification issued by the American Heart Association.


Required Licenses/Certifications: TEAM training Techniques for Effective Aggression Management (required for all positions at John George Psychiatric Pavilion; and certain positions in the Emergency Department).


Required Licenses/Certifications: Valid license to practice as a Registered Nurse in the State of California.\



Pay Range $89.32- $131.08


The pay range for this position reflects the base pay scale for the role at Alameda Health System. Final compensation will be determined based on several factors, including but not limited to a candidate's experience, education, skills, licensure and certifications, departmental equity, applicable collective bargaining agreements, and the operational needs of the organization. Alameda Health System also offers eligible positions a generous comprehensive benefits program.



John George Psychiatric Hospital
JGP Care Coordination
Services As Needed / Per Diem
Day
Nursing
FTE: 0.01
PDN-a1566216-ed00-4ad6-bae9-9d1ce49b9ccf
permanent
Utility Machinist - 2nd Shift ( Onsite)
Salary not disclosed
Middletown, CT 5 days ago

Date Posted:

2025-11-26

Country:

United States of America

Location:

PW102: Middletown Aircraft Rd P.O. Box 611, Middletown, CT, 06457 USA

Position Role Type:

Onsite

U.S. Citizen, U.S. Person, or Immigration Status Requirements:

The ability to obtain and maintain a U.S. government issued security clearance is required.​ U.S. citizenship is required, as only U.S. citizens are eligible for a security clearance

Security Clearance:

DoD Clearance: Secret

Pratt & Whitney is working to once again transform the future of flight—designing, building and servicing engines unlike any the world has ever seen. And because transformation begins from within, we’re seeking the people to drive it. So, calling all curious. 

Come ready to explore and you’ll find a place where your talent takes flight—beyond the borders of title, a country or your comfort zone. Bring your passion and commitment and we’ll welcome you into a tight-knit team that takes our mission personally. Channel your drive to make a difference into shaping an organization and an industry that’s evolving fast to the future.

At Pratt & Whitney, the difference you make is on display every day. Just look up. Are you ready to go beyond?

What You Will Do:

  • Follow specific directions of Leader/Supervisor to carry out repair and restoration projects for engine parts.
  • Layout work requirements and obtain needed equipment to perform routine repair and alteration operations.
  • Perform bench repair operations to restore parts where close tolerances are not normally required and specifically defined criteria are used.
  • Recognize need and arrange for repair or replacement of equipment used in performing the work as necessary.
  • .Perform routine servicing throughout the assigned area following specified procedures and written instructions such as operator’s check list for upkeep and to assure equipment operates properly.
  • Assist others responsible for new process tryout, and other specialized assignments within the scope and skill level of this job description.
  • .Refer difficulties to Leader/Supervisor.
  • Maintain logs and records as requested to communicate findings and prepare requests for approval.
  • May be required to train for, obtain and maintain licenses, operator permits, and certifications within assigned area.
  • May be assigned to carry out tasks not specifically listed, within the scope and skill level of this job description in support of department objectives and to develop individual’s skills.

2nd shift hours are Monday through Friday from approximately 3 pm to 12 am.

Qualifications You Must Have:

  • High School Diploma or GED.

  • U.S. citizenship is required, as only U.S. citizens are authorized to access information under this program/contract.

  • Able to obtain/ maintain active Security Clearance after Day 1 of work.

  • 2 years of experience in blueprint reading, CNC manual machining & reading. Knowledge of shop math.

Qualifications We Prefer: In compliance with the collective bargaining agreement, priority consideration is given to candidates who are INTERNAL (and recall) to the Pratt & Whitney IAM Bargaining Unit members of District Lodge 26 and Affiliated Locals 700 and 1746 (Connecticut Operations).

 Pratt & Whitney in Middletown, CT is a FAA regulated facility and as such under the U.S. Departments of Transportation’s Federal Aviation Administration (FAA). This position is considered safety sensitive in accordance with FAA Guidelines. Candidate will be subject to drug and alcohol testing per FAA’s regulation 14 CFR part 120, as well as 49 CFR part 40.

As part of our commitment to maintaining a secure hiring process, candidates may be asked to attend select steps of the interview process in-person at one of our office locations, regardless of whether the role is designated as on-site, hybrid or remote.

Hired applicants may be eligible for benefits, including but not limited to, medical, dental, vision, life insurance, short-term disability, long-term disability, 401(k) match, flexible spending accounts, flexible work schedules, employee assistance program, Employee Scholar Program, parental leave, paid time off, and holidays. Specific benefits are dependent upon the specific business unit as well as whether or not the position is covered by a collective-bargaining agreement.Hired applicants may be eligible for annual short-term and/or long-term incentive compensation programs depending on the level of the position and whether or not it is covered by a collective-bargaining agreement. Payments under these annual programs are not guaranteed and are dependent upon a variety of factors including, but not limited to, individual performance, business unit performance, and/or the company’s performance.This role is a U.S.-based role. If the successful candidate resides in a U.S. territory, the appropriate pay structure and benefits will apply.RTX anticipates the application window closing approximately 40 days from the date the notice was posted. However, factors such as candidate flow and business necessity may require RTX to shorten or extend the application window.

RTX is 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, age, disability or veteran status, or any other applicable state or federal protected class. RTX provides affirmative action in employment for qualified Individuals with a Disability and Protected Veterans in compliance with Section 503 of the Rehabilitation Act and the Vietnam Era Veterans’ Readjustment Assistance Act.

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Click on this link to read the Policy and Terms

permanent
Extrusion Utility Operator
Salary not disclosed
Rochester, NY 3 days ago

Apply

Description

At American Packaging Corporation (APC), you'll find the packaging career you've been looking for. With competitive salaries, excellent benefits, 401(k) plans and tuition reimbursement programs, we nurture our employees while advancing and promoting diversity and inclusion. As the leading flexible packaging converter in North America for over a century, APC's longstanding success is fueled from the inside out. We're constantly seeking to improve our internal operations and were named a "Best of the Best" in the Best workplaces in the America's awards for 12 years in a row. It's how and why we engage the best and brightest talent to continue propelling our shared success into the future.


LOCATION: Rochester, NY


SUMMARY: An Extrusion Utility Operator is responsible for safely and effectively contributing to team a of 4-5 individuals supporting the operation of extrusion lamination manufacturing equipment. Maintaining a strong work ethic while demonstrating good communication skills are important to exceeding customer expectations, productivity standards, and personal career growth. Extrusion Utility Operators are expected to be able to independently prioritize their time and duties to contribute to the team running efficiently.

ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.

  • Performs duties in a manner that adheres to safety policies and procedures.
  • Participate in the training curriculum, learning new aspects of extrusion line operations while completing assigned duties required for operation.
  • Maintain quality standards by reviewing product specifications and ensuring thorough completion of assigned production paperwork.
  • Operate as a member of a larger team responsible for aspect of overall process. Team members will rely on attention to detail and proper communication to ensure entirety of process is safe and efficient.
  • Exercise cautious approach to heavy equipment including use over overhead hoists.
  • Completes tasks to ensure area around the machine is clean to GMP & Food Safety standards
  • Visual acuity for identifying minor imperfections and material defects.
  • Basic understanding of general tool usage including tape measurers, utility knives and screw drivers.
  • Good communication skills, both verbal and written with working knowledge of Microsoft Office.

Requirements

QUALIFICATION REQUIREMENTS:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


EDUCATION and/or EXPERIENCE

High school diploma or general education degree (GED); and one to three years related manufacturing experience and/or training; or equivalent combination of education and experience.


LANGUAGE SKILLS

Ability to read and comprehend simple instructions and short correspondences. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to peers and supervisors within the organization. Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals.


MATHEMATICAL SKILLS

Ability to read/use a tape measurer and apply concepts of basic algebra.


REASONING ABILITY

Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to reach out for assistance and communicate if instructions or assignments are not clear. Ability to retain information and apply to future situations of similar manner.


PHYSICAL DEMANDS

The physical demands described here are representatives of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to use hands to finger, handle, or feel and talk or hear. The employee frequently is required to sit and reach with hands and arms. The employee is occasionally required to stand; walk; climb or balance; and stoop, kneel, crouch, or crawl. This position may require manual lifting not to exceed 50 lbs - reference your department-specific JHA (job hazard analysis) for departmental lifting restrictions.


WORK ENVIRONMENT

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.


American Packaging Corporation is committed to equal opportunity for all, without regard to race, religion, color, national origin, citizenship, sex, sexual orientation, gender identity, age, veteran status, disability, genetic information, or any other protected characteristic. American Packaging Corporation will make reasonable accommodations for known physical or mental limitations of otherwise qualified employees and applicants with disabilities unless the accommodation would impose an undue hardship on the operation of our business. EOE/AA Disability/Veteran.

If you are interested in applying for an employment opportunity and need special assistance or an accommodation to apply for a posted position, please contact our Human Resources department at:

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Salary Description
$23.99/hr
Not Specified
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