Clinical Care Reviewer II - Must reside in Nevada
Interviewer job in Nevada
**MUST work PST HOURS ***
Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services, assisting with discharge planning activities (i.e. DME, home health services) and care coordination for members enrolled with a CareSource Management Group line of business, as well as monitoring the delivery of healthcare services in a cost effective manner.
Essential Functions:
Complete prospective, concurrent and retrospective review of acute inpatient admissions, post acute admissions, elective inpatient admissions, outpatient procedures, homecare services and durable medical equipment
Coordinate care and facilitate discharge to an appropriate level of care in a timely and cost-effective manner
Refer cases to CareSource Medical Directors when clinical criterial is not met or case conference is needed/appropriate
Maintain knowledge of state and federal regulations governing CareSource, State Contracts and Provider Agreements, benefits, and accreditation standards
Identify and refer quality issues to Quality Improvement
Identify and refer appropriate members for Care Management
Document, identify and communicate with Health Partners, Care Managers and Discharge Planners to establish safe discharge planning needs and coordination of care
Provide guidance to non-clinical medical management staff
Provide guidance to and assist with oversight of LPN medical management staff
Attend medical advisement and State Hearing meetings, as requested
Assist Team Leader with special projects or research, as requested
Perform any other job-related instructions, as requested
Education and Experience:
Completion of an accredited registered nursing (RN) degree program is required
Minimum of three (3) years clinical experience is required
Med/surgical, emergency acute clinical care or home health experience is preferred
Utilization Management/Utilization Review experience is preferred
Medicaid/Medicare/Commercial experience is preferred
MSL highly preferred
If does not reside in Nevada, must be able to obtain a Nevada license
Competencies, Knowledge and Skills:
Basic data entry skills and internet utilization skills
Working knowledge of Microsoft Outlook, Word, and Excel
Effective oral and written communication skills
Ability to work independently and within a team environment
Attention to detail
Familiarity of the healthcare field
Proper grammar usage and phone etiquette
Time management and prioritization skills
Customer service oriented
Decision making/problem solving skills
Strong organizational skills
Change resiliency
Licensure and Certification:
Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice is required
MCG Certification is required or must be obtained within six (6) months of hire
Working Conditions:
General office environment; may be required to sit or stand for extended periods of time
Compensation Range:
$61,500.00 - $98,400.00
CareSource takes into consideration a combination of a candidate's education, training, and experience as well as the position's scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee's total well-being and offer a substantial and comprehensive total rewards package.
Compensation Type (hourly/salary):
Hourly
Organization Level Competencies
Create an Inclusive Environment
Cultivate Partnerships
Develop Self and Others
Drive Execution
Influence Others
Pursue Personal Excellence
Understand the Business
This is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an inclusive environment that welcomes and supports individuals of all backgrounds.#LI-JM1
Auto-ApplyMEPS - Field Interviewer
Interviewer job in Las Vegas, NV
Westat is currently seeking motivated and detail-oriented individuals to work as Field Interviewers for the Medical Expenditure Panel Survey (MEPS). MEPS is a study of health care costs and usage in the United States, sponsored by the Agency for Healthcare Research and Quality (AHRQ), a part of the Department of Health and Human Services. MEPS is a panel survey, which features several rounds of interviewing the same respondents to collect information for two full calendar years.
Field Interviewers (FIs) conduct in-person and computer-assisted video interviews with adult members of households, drawn from a nationally representative sample, using a Westat-provided laptop computer. FIs are responsible for contacting the households in-person and/or by phone to gain cooperation, setting appointments, completing the interview, and collecting and following up with electronic and hard-copy signed documents.
Traveling to the MEPS in-person training in January 2026 is a mandatory job requirement. In addition, FIs may be required to travel to local, and, at times, long-distance households, with some assignments requiring overnight travel.
This is a part-time position that runs yearly, with two data collection periods. One period runs from January through mid-July, and the other from late July through early December. Start and stop dates vary with caseloads; however, all data collectors will have a break between rounds, during which time there is no work. Between the spring and fall rounds, the break is typically 1-2 weeks; between the fall and spring rounds, it is approximately a month.
Field Interviewers report to a field supervisor and complete and submit administrative paperwork. On days when Field Interviewers work, they will be expected to transmit electronic data daily. FIs must comply with all required data security and confidentiality requirements.
Interested in more information about MEPS? Click here.
Basic Qualifications
Candidates must
Be 18 or older (or an emancipated minor) with the ability to enter binding confidentiality agreements to protect project information.
Be available to complete mandatory web-based home study training, including a Teams video call, prior to the in-person training.
Be available to travel to and attend mandatory in-person training. Traveling on January 12th, 2026, and completing a five and a half day in-person training that starts on January 13th, and ends on January 18th, 2026.
Be available to complete additional mandatory web-based and virtual training activities, following the in-person training, including a post-training home study between January 19th and January 23rd, 2026.
Minimum Requirements
Reside in and travel to the geographic locations determined by the project in order to contact the households in your assignment and to conduct in-person interviews.
Be available to begin work for the data collection period, starting January 2026. The current expected end date of the study is December 2030.
Be available to work a minimum of 20 hours per week, when work is available, mostly evening and weekend hours, with limited daytime work based on the preferences of the households in your assignment. At times, based on caseload and survey sample size, there will not be 20 hours of work available.
Be willing to travel locally for project work, with the possibility of some overnight travel as needed.
Be able to meet the physical requirements of the position with or without reasonable accommodation:
Lift and carry 20 pounds of equipment and materials,
Walk several blocks, and
Climb stairs while carrying equipment to gain entry to sampled households.
Have consistent access to a fully insured, reliable vehicle; and
Have a current and valid driver's license that is not under suspension.
Preferred Criteria
Have in-person interviewing experience and/or computer-assisted video interviewing experience.
Have public contact and/or cold calling experience; and
Be comfortable working in unfamiliar locations, knocking on doors and communicating with people from all kinds of backgrounds. We value our diverse respondent base and expect our interviewers to always treat them with respect.
MS Teams may be used to conduct interviews with candidates for this position.
Any offer of employment may be contingent upon receipt of acceptable results from a post-offer background screening, if required for the specific position, which may include, for example, identity verification, employment history, motor vehicle driving record history, and criminal or sexual offender records history.
This is a part-time variable-hour non-exempt position. This position is not initially eligible for health insurance or a health savings account (HSA). To be eligible for health insurance and an HSA, you must work 1,560 hours from September through September of the following year, with coverage beginning January 1 of the year after eligibility is satisfied.
This federal government project is subject to the Service Contract Act (SCA). The hourly rate for this position is determined by the location where work is performed. In addition to hourly pay, a health and welfare payment of $4.93, which may be reduced based on group benefit election, will be paid weekly for up to 40 work hours per week. This position is eligible for paid vacation and holiday leave based on hours worked.
All field positions accrue sick leave (based on hours worked) and are eligible to participate in the 401(k) program (employer matching is dependent on hours worked and disbursement is subject to program rules).
This opportunity will be posted for a minimum of seven days and applications will be accepted on an ongoing basis.
Upon successful completion of this assignment, you will be eligible for consideration for reassignment on other Westat field data collection projects if they become available.
Working on this study can be a fascinating, rewarding experience. If you are a reliable self-starter, this position may be right for you.
Westat is an Equal Opportunity Employer and does not discriminate on the basis of race, creed, color, religion, sex, national origin, age, veteran status, disability, marital status, sexual orientation, citizenship status, genetic information, or any other protected status under applicable law.