Now Hiring: Transition of Care Registered Nurse (RN) 🚨
📍 San Diego County, CA (Remote + ~10% Field Visits)
💼 Contract: 3+ Months (Potential for Extension)
🕗 Schedule: Monday-Friday | 8:30 AM - 5:30 PM PST
💰 Pay Rate: $42/hour
We're seeking a Transition of Care Registered Nurse (RN) to support high-risk members through safe, effective care transitions across the healthcare continuum. This role is primarily remote with limited local travel.
🩺 Role Overview
The Transition of Care RN follows members through a 30-day care transition program, beginning at hospital admission and continuing post-discharge. The goal is to reduce readmissions and ensure members receive coordinated, high-quality, and cost-effective care.
🔑 Key Responsibilities
Coordinate care transitions from hospital to home or post-acute settings
Collaborate with hospital discharge planners, providers, facilities, and family/support systems
Conduct face-to-face hospital visits and home visits for high-risk members
Educate members using the Transition of Care (ToC) Pillars, including:
Apply the Coleman Care Transitions Model for post-discharge follow-up
🎓 Qualifications Required:
Active, unrestricted CA RN license
Must reside in California (San Diego County focus)
Valid CA Driver's License with reliable transportation
1-3 years of experience in hospital discharge planning or home health
Ability to work remotely with dual monitors and docking station
Approximately 5-10% local travel for hospital and home visits
$42 hourly 1d ago
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CRM Specialist / Software Engineer
Integrated Resources 4.5
Scottsdale, AZ jobs
Our mission is to service with Integrity as Both an employer of choice to our associates and a strategic partner to our clients. IRI's vision is to become an industry leading staffing services organization by maintaining ethical business practices, a passion for customer service, a commitment to quality, and our continued efforts to exceed expectations.
Job Description
Title: CRM Specialist / Software Engineer
Duration: Till December with greater possibility of extension
Location: Scottsdale, AZ 85260.
Description:
· Senior
CRM Specialist / Software Engineer
needed for
Microsoft Dynamics CRM upgrade
& deployment.
· Performs high-level software application development and serves as lead to support team for open ticket items and product upgrades.
· Analyzes problems in terms of detailed requirements. Designs detailed flow charts.
· Verifies program logic by preparing tests data for trial runs. Tests and debugs programs. Prepares run sheets for routine programs.
· May also do coding from flow charts, assist in determining the causes of computer or program malfunctions, and confer with technical personnel in systems analysis and application planning.
Requirements/Certifications:
·
Contractor will be able to work remotely from home once they are trained
, and they will be
required to come to the office 3-4 days a month
, or as needed.
· Resource needed to assist in a heavy backlog of projects, and to support a CRM upgrade and deployment. The ideal candidate will have strong skills in
SQL Server
,
CRM Tools like Microsoft Dynamics
(is desired, but not required),
NET development skills
,
JavaScript
, and
database management
&
data integrity
.
· There are currently 1,000 users of CRM at Companywide.
· Bachelor's degree required.
Additional Information
Job Type: Contract W2
$48k-82k yearly est. 2d ago
Director of Clinical Quality
Integrated Resources 4.5
Cambridge, MA jobs
Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.
Overview:
Candidates may need to travel to investigator sites
Candidates can sit remote but need to be able to travel to Cambridge
Local candidates preferred but they can work from home occasionally
1 year assignment to start. Not a perm assignment. Interim position.
Person must be able to coordinate other QA contractors for audits
Must
also be able to deliver SOP's and processes and
This
is ONLY in the GCP area
Must have GCP experience
Must have Pharma Experience within Quality Assurance
Coordinating
audits (internal, external)
Inspection experience (FDA)
Need to have worked in a development program so they know how to coordinate audits for a development program
Job Description:
Job Title: Director, Vaccines Clinical Compound Support Quality Assurance
OBJECTIVES:
• Plays a leadership role in ensuring that investigator, vendor, facility and system audits are conducted, for communicating any critical compliance risks noted from these activities to senior management, and ensuring that corrective actions are implemented.
• Serves as a senior strategic GCP/PV quality resource to VBU for its vaccine development activities, and takes a lead role for the preparation, conduct, and responses to FDA audits of VBU's Clinical Research effort.
• This position provides leadership and strategy in line with global strategic objectives. Collaborates with all VBD functional areas to ensure all assigned global clinical trial activities sponsored by VBU are in compliance with Good Clinical Practice (GCP) regulations, the International Conference on Harmonization (ICH) and Policies and Procedures.
ACCOUNTABILITIES:
• Ensures the development and implementation of strategies regarding the processes, procedures and quality standards required to maintain compliance to applicable regulations.
• Responsible to develop and implement a strategic audit plan for a VBU vaccines development program.
• Analyze audit program results, quality issues and investigations in order to optimize regional operations and overall regional state of compliance.Ensure that activities are conducted and reports written according to applicable SOPs and regulations.
• Represents VBU and serves as Inspection Administrator during regulatory inspections. Provides strategic organizational direction to assure that responses are timely and appropriate to maintain VBU's (US) good standing with regulatory agencies.
• Oversees all GCP QA, PVQA, and GCLP QA activities (including internal or external audit observations and development of adverse trends) in US and LATAM in order to ensure patient safety and data integrity.
• Identifies and mitigates GCP/PV/GCLP quality and compliance issues with potential impact across multiple compounds, sites, or functional groups within or outside of VBU .
• Collaborates with the R&D QA, and other global entities to provide a consistent quality approach, including:
o Develops and presents periodic reports for assigned project describing VBU compliance trends and identifying areas of potential risk to VBU senior management.
• Determines acceptability of vendors for potential use by VBD and provides direction, guidance and strategy for VBU Quality.
EXPERIENCE, KNOWLEDGE AND SKILLS:
Knowledge and Skills:
In-depth knowledge of the applicable GXP regulations, FDA Good Clinical Practices, ICH Guidelines, FDA Regulations and Guidances and Computer System Validation
• Auditing Knowledge: Demonstrates advanced knowledge in the conduct and reporting of audits and the translation of findings into corrective actions plans that mitigate risks to the company, to safety and data integrity.
• Clinical Development: Understands the phases, processes and techniques used to execute a clinical development program.
• Product Knowledge: Understands the medical impact of vaccines.
• Science Knowledge: Possess the necessary science education and knowledge to manage related clinical trials and to assure ethical treatment of subjects. Understands medical terminology and is familiar with standards of care and disease states.
• Communication skills: Must professionally, clearly, concisely and consistently communicate to external and internal customers via phone, e-mail, fax, and written documents. Must also be able to demonstrate professional presentation skills deliver fair balanced presentations and, when applicable, facilitate resolution of differing opinions.
• Negotiation Skills: Demonstrates proficiency in negotiation and conflict resolution.
• Project Management: Must demonstrate proficiency in managing complex projects, delivering all expected deliverables in a timely manner, and proactively communicating changes in pre-established goals and deadlines.
• Organizational skills: Must be able to prioritize work effectively to meet timelines.
• Interpersonal: Must be able to adapt to other personalities in a respectful manner that is conducive to goal achievement and team building.
• Computer skills: Must be able to efficiently utilize the computer hardware and software programs provided to plan, manage, conduct and track deliverables and to communicate with internal and external team members.
LICENSES/CERTIFICATIONS:
• ASQ Certified Quality Auditor (CQA), ASQ Certified Manager of Quality/Organizational Excellence, or SQA Registered Quality Assurance Professional preferred.
TRAVEL REQUIREMENTS:
• Ability to drive to or fly to various meetings or client sites, including overnight trips. Some international travel may be required.
• Requires approximately 20 % travel.
Qualifications
Education:
• B.S. in Biology, Nursing, Pharmacy, or related scientific field. MS preferred.
Experience:
• Minimum of 10 years of increasing responsibility in pharmaceutical, GCP-related Quality environment.
• Minimum 7 years indirect management level experience in GCP Quality Assurance including senior level project planning/budget management.
Additional Information
Kind Regards,
Sabanaaz Shaikh
Clinical Recruiter
Integrated Resources, Inc.
IT Life Sciences Allied Healthcare CRO
Gold Seal JCAHO Certified ™
for Health Care Staffing
“INC
5
0
0
0
's FASTEST GROWING, PRIVATELY HELD COMPANIES” (8th Year in a Row)
$135k-177k yearly est. 2d ago
Case Manager
Integrated Resources 4.5
San Diego, CA jobs
Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.
Job Description
This is a TEMP-TO-PERM Care Manager position. The need for this position is due to new business. This is a remote position with hours from 8am - 5pm, EST.
The manager is flexible with a 30 or 60 minute typical day will consist of scheduling reviews that could take up to 45 minutes. These outbound calls are to providers to discuss quality improvement measures, clinical practices and medical necessity guidelines. The selected candidate will discuss cases with the manager or psychologist. The manager is looking for more outpatient behavioral health experience, but inpatient behavioral health experience is good to have. There will be a 4-5 week virtual training. To be successful in this position, the candidate must have a can do attitude, have excellent time management skills, have strong organizational skills, able to work independently and an excellent communicator. A Master's degree is required and a LCSW or LCPC license is required
Qualifications
The candidate must have a can do attitude, have excellent time management skills, have strong organizational skills, able to work independently and an excellent communicator. A Master's degree is required and a LCSW or LCPC license is required
Additional Information
Riya Khem
Clinical Recruiter
Integrated Resources, Inc.
IT Life Sciences Allied Healthcare CRO
Certified MBE |GSA - Schedule 66 I GSA - Schedule 621I
DIRECT # - 732 -844-8721 | (W) # 732-549-2030 - Ext - 311 |(F) 732-549-5549
$47k-68k yearly est. 60d+ ago
Business Analyst with Vantage
Integrated Resources 4.5
Jersey City, NJ jobs
A Few Words About Us Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.
Hi,
Hope you are doing well,
I am sending you below job open with one of my direct client, if you are available in market,
Send me your most updated copy of your resume in word document ASAP
Position: Sr. Vantage/wmA Senior Business Analyst
Duration: 6 Months
Preferred location - Lenexa, KS; Alternate location - Jersey City, NJ.
Remote work
Job description:
15+ years of Annuity insurance domain
15+ years of experience on CSC IP Annuity admin processing Products, with minimum 10 years in Vantage and 5 years in wmA.
Should have worked on designing new business products
Strong communication skills to work directly with client business users
having experience of worked for AXA client would be an added advantage
Additional Information
Regards,
Nagesh
Sr.Technical Recruiter
Integrated Resources, Inc.
IT Life Sciences Allied Healthcare CRO
Certified MBE |GSA - Schedule 66 I GSA - Schedule 621I
DIRECT # - 732 - 429 -1641 | (W) # 732-549-2030 - Ext - 305 | (F) 732-549-5549
$89k-131k yearly est. 60d+ ago
Director of Business Development
Integrated Resources 4.5
Princeton, NJ jobs
A Few Words About Us Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.
This is a Direct Hire role with the client
Job Description
*THIS POSITION CAN BE 100% REMOTE*
The Director of Business Development has senior level responsibility for client strategy, satisfaction and retention. Key elements to successfully managing an assigned territory are building a strong sales pipeline, advancing sales opportunities and growing relationships with selected accounts. PRIMARY
RESPONSIBILITIES Identifies business opportunities within Post Marketing Clinical Research by
• Generating new leads and prospects through prospecting, conducting initial research and phone contact
• Prospecting qualified sales leads from other sources including inside sales, trade show, etc.
• Leading new business development efforts
• Managing corporate meetings and exhibitions
• Representing the company - Post Approval Services at local, national and international meetings pertinent to public relations and future business development Develops and secures business
• Generating Request for Proposals (RFPs) based on new and existing clients
• Writing business and technical proposals
• Negotiating client contracts
• Closing deals profitably Maintains relationships with clients
• Providing support, information and guidance
• Recommending new opportunities
• Recommending profit and service improvements
• Establishing and maintaining industry and client contacts for continuing good relations and business opportunity development
• Developing and maintaining client profiles including updating contacts management system
• Ensuring ongoing understanding of services, services offered by competitors and market/industry trends
• Reading, understanding and adhering to organizational Standard Operating Procedures (SOPs)
• Assisting in establishing and enforcing departmental standards
• Participating in the modification of company SOPs related to Business Development
SECONDARY RESPONSIBILITIES Contributes to team effort by • Exploring new opportunities to add value to organization and departmental processes • Helping others to achieve results • Performing other duties as assigned Maintains Technical Knowledge by • Attending and participating in applicable company-sponsored training • Maintaining a strong understanding of Industry trends and applicable regulations
Qualifications
QUALIFICATIONS:
Education:
• Bachelors degree in Life Sciences or related field
• Sales/Business Development training preferred
Experience:
• 5+ years of business development experience in CRO industry is required. Experience in Post Approval Research segment is highly desirable.
• Operations experience in clinical trials preferred
• Thorough knowledge of medical and pharmaceutical industry, terminology and practices
• Proven ability in presenting and negotiating
Additional skill set:
• Ability to work independently or in team setting; ability to adjust to changing priorities
• Strong presentation and negotiating skills
• Strong interpersonal and communication skills, both verbal and written
• Ability to project and maintain a professional and positive attitude
WORKING CONDITIONS:
Travel: 30-50% (some weekends required)
Lifting: 0-20lbs
Other: Computer work for long periods of time
Additional Information
All your information will be kept confidential according to EEO guidelines.
$97k-157k yearly est. 60d+ ago
Clinical Care Reviewer
Integrated Resources 4.5
Philadelphia, PA jobs
A Few Words About Us Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.
Job Description
Location: Lester, PA
Duration: 3 + Months (Contract to Hire)
Job Summary:
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review. It is within the nurse's discretion to pend requests for additional information and/or request clarification. The nurse will use his/her professional judgment to evaluate the request to ensure that appropriate services are approved and recognize care coordination opportunities and refer those cases as needed. The nurse will apply medical health benefit policy and medical management guidelines to authorize services and appropriately identify and refer requests to the Medical Director when guidelines are not met. The nurse will maintain current knowledge and understanding of the laws, regulations, and policies that pertain to the organizational unit's business and uses clinical judgment in their application.
Qualifications
Job-Related Experience and Skills:
• Three to five years - 3 or more years' experience in a related clinical setting.
• Registered Nurse / LPN
• Licensed Practical Nurse or Registered Nurse graduated from an accredited program .
• Current unrestricted PA Practical Nurse license or PA Registered Nurse license.
• Valid Driver's License and reliable automobile transportation for on-site assignments and off-site work related activities.
Competencies:
• Excellent oral and written communication skills.
• Ability to identify problems and recommend solutions.
• Self-directed/Ability to work independently.
• Excellent decision making skills.
• Excellent time management skills, prioritizing work and meeting timelines.
• Ability to advocate for member/member family needs.
• Dedicated to meeting the expectations and requirements of internal and external customers.
• Obtains continuing education required to maintain professional licensure.
• Ability to achieve required performance results on all audits and Inter Rater Reliability (Peer to Peer).
Additional Information
Regards
Pooja Mishra
Clinical Recruiter
Integrated Resources, Inc.
IT Life Sciences Allied Healthcare CRO
Certified MBE |GSA - Schedule 66 I GSA - Schedule 621I
Tel: 732 429 1636
(W) 732-549-2030 x 214 | (F) 732-549-5549
Gold Seal JCAHO Certified ™ for Health Care Staffing
“INC 5000's FASTEST GROWING, PRIVATELY HELD COMPANIES” (8th Year in a Row)
$58k-90k yearly est. 60d+ ago
Remote Clinical Research Specialist
Integrated Resources 4.5
New Haven, CT jobs
Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.
70% of an average work week, so about 28 hours/week.
Preferably working from New Haven, CT.
Contractor will need to train onsite and then be able to work remote
Job description:
Provide product training and support to clinical sites for the pill cam procedure.
Support the randomization process and act as the IWRS PRIMARY Administrator
Arranging and participating in the organization of study team meetings Taking minutes and distributing
Managing and maintaining study documents and trial supplies, colonoscopy forceps, FedEx envelop, IWRS User information.
Administer, Maintain and coordinate the logistic aspects of clinical trials according to GCP and Sop's
Ensure That any clinical trial databases/tracking tools are set up and maintained throughout the trial
Assist with collating, tracking & shipping CRFs & Data queries to data management
Maintaining study data control table
Review and approve monitoring reports in Siebel
CTM SW update
Coordinating archiving of study documentation
Perform and support study site qualification, Initiation interim monitoring and closeout visits according to SOP's GCP's, FDA regulation and ICH guidelines at multiple investigational sites
Ensure safety and welfare of Patient enrolled in clinical study
Site management to ensure Compliance
Ensure integrity of data reported
Helping in setting up the Study centers, Which includes ensuring each center has the trial materials and training site staff to trial-specific standards
Administrative support for CA and date management team including: shipment training records and inventory control.
Qualifications
Bachelor's degree Engineering/ (B.A./B.S.C./Other)
Experience required:
0-2 years
Additional Information
Feel free to forward my email to your friends/colleagues who might be available. We do offer referral bonus
Thank you for your time and consideration. I look forward to hearing from you!
Warm Regards,
Nisha
Integrated Resources, Inc.
IT REHAB CLINICAL NURSING
Inc. 5000
-
2007, 2008, 2009, 2010, 2011, 2012 ,2013 and 2014 (8th Year)
Certified MBE I GSA - Schedule 66 I GSA - Schedule 621I I GSA - Schedule 70
Direct: (732)-429-1649
Tel: (732) 549 2030 x 230
Fax: (732) 549 5549
$52k-78k yearly est. 60d+ ago
Behavioral Health Care Coordinator-Remote
Integrated Resources 4.5
Washington, DC jobs
Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.
We've stayed true to our focus of finding qualified and experienced professionals in our specialty areas. Our partner-employers know that they can rely on us to find the right match between their needs and the abilities of our top-tier candidates. By continually exceeding their expectations, we have built successful ongoing partnerships that help us stay true to our commitments of performance and integrity.
Our team works hard to deliver a tailored approach for each and every client, critical in matching the right employers with the right candidates. We forge partnerships that are meant for the long term and align skills and cultures. At IRI, we know that our success is directly tied to our clients' success.
Job Description
Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources. This role promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction.
Essential Functions:
- Conducting in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters.
- Communicating and developing the treatment plan for authorization of services, and serves as point of contact to ensure services are rendered appropriately, (i.e. during transition to home care, back up plans, community based services.
Qualifications
MUST have 5 TOTAL years of Post Masters Experience.
Required licenses are: Licensed as a LCSW-C or LCPC or LCMFT
HOURS: Mon-Thurs 8a-7p and Fri 8a-6p. With that being said they need to be flexible. He /She WILL work 2 evening shifts/week (evening shift defined as staying until 7 pm Mon-Thurs or staying until 6 pm on Friday).
After the training a schedule will be developed for the worker. Training is 3 weeks Mon - Fri from 8:30 am - 5:00. However, the candidate will be assigned his/her fixed work schedule between the 4th and 6th week on the assignment.
Additional Information
All your information will be kept confidential according to EEO guidelines.
$57k-78k yearly est. 2d ago
Remote Case Manager - Integrated Care
Integrated Resources 4.5
Fort Lauderdale, FL jobs
TITLE: REMOTE CASE MANAGER - INTEGRATED CARE. DURATION: 6+ MONTHS. LICENSE : LCPC, LCSW OR RN. THE RN REQUIRES A MIN. BACHELOR'S DEGREE. ALL OF OTHER LICENSES REQUIRES A MASTER'S DEGREE. . HOURS: 8 AM - 5 PM.
ESSENTIAL FUNCTIONS:
·
Completes relevant screening and assessment. Ensures continuity of care for newly enrolled members. - Identifies and prioritizes the members' needs and preferences. Develops quantifiable goals and desired outcomes, and promotes the member ability to self-manage to the greatest extent possible.
·
Develops, implements and monitors the Person-Centered Service Plan, assisting members in obtaining reasonable accommodations when appropriate. - Manages case load, including risk stratification of members, monitoring reassessment needs and facilitating transitions of care settings. - Serves as the primary point of member contact.
·
Assesses member needs, manages care and services, and ensures effective communication among members, caregivers, providers and community supports. - As the lead of the interdisciplinary team facilitates the activities and communication within an interdisciplinary team of providers, vendors, facilities, discharge planners, field nurses, social workers, care coordinators, and member/caregivers to effectively manage care plans and transitions of care settings.
·
Maintains timely, complete and accurate documentation using both hard copy and technology based solutions in compliance with regulatory policies and procedures. - Gathers and summarizes data for reports. - Supports initiatives of the Quality Assessment and Performance Improvement Committee. - All other duties as assigned.
Additional Information
REQUIREMENTS/CERTIFICATIONS:
·
Candidates must be local to the Fort Lauderdale, FL area, which is in Broward, County. There are occasional field visits with an average of 1 or 2/week.
ADDITIONAL INFORMATION:
·
Coordinating Care, Case Management, Clinical, and Medicaid experience will stand out of the resumes for the manager. Candidates must be comfortable with working in a cubicle environment, comfortable with typing and talking at the same time and comfortable navigating through multiple systems.
·
MUST be computer literate. To be successful in the position, the selected candidate must be able to apply principals of Care Management and Person Centered Service Planning, apply Care Guidelines and other applicable, evidenced-based clinical guidelines, understand and apply coverage guidelines and benefit limitations, be familiar with clinical needs and disease processes for the member and lead an interdisciplinary care team.
·
Responsible for the assessment, reassessment, care planning and coordination of care and services. Includes ongoing monitoring of an appropriate and effective person-centered care plan, member education, and care management. Regularly communicates with the members, PCP and other.
·
The successful candidate will have strong organizational skills and have the ability to prioritize and follow through on multiple projects in a timely manner.
LICENSE:
LCPC, LCSW OR RN
.
THE RN REQUIRES A MIN. BACHELOR'S DEGREE
. All of other licenses requires a Master's Degree.
$31k-39k yearly est. 2d ago
Business System Analyst
Integrated Resources 4.5
Nashville, TN jobs
A Few Words About Us Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.
Job Description
Assists in the research/assessment of business goals, objectives and needs to align information technology solutions with business initiatives on small less complex accounts. Serves as the liaison between technical personnel and business area. Assists in planning and designing business processes; assists in formulating recommendations to improve and support business activities. Assists in analyzing and documenting client's business requirements and processes; communicates these requirements to technical personnel by constructing basic conceptual data and process models, including data dictionaries and volume estimates. Assists in creating basic test scenarios to be used in testing the business applications in order to verify that client requirements are incorporated into the system design. Assists in developing and modifying systems requirements documentation to meet client needs. Participates in meetings with clients to gather and document requirements and explore potential solutions. Executes systems test from existing test plans.
Required Skills:
Insurance Industry Knowledge: Life Policies-Experienced,
Insurance Mathematics-Experienced,
1. Minimum 5 years actuarial experience
2. Experience with administration systems
3. Strong knowledge of life insurance
4. Must be expert at Excel, Access experience preferred
Life insurance product experience is required
Qualifications
Education:
Bachelor's Degree with 1 to 3 years' experience.
Remote work authorized
Travel: 20%
Additional Information
Regards,
Nagesh
Sr.Technical Recruiter
Integrated Resources, Inc.
IT Life Sciences Allied Healthcare CRO
Certified MBE |GSA - Schedule 66 I GSA - Schedule 621I
Direct# 732-429-1641
(BOARD) # 732-549-2030 - Ext - 305
Gold Seal JCAHO Certified ™ for Health Care Staffing
“INC 5000's FASTEST GROWING, PRIVATELY HELD COMPANIES” (8th Year in a Row)
$70k-106k yearly est. 60d+ ago
CRM Specialist / Software Engineer
Integrated Resources 4.5
Scottsdale, AZ jobs
Our mission is to service with Integrity as Both an employer of choice to our associates and a strategic partner to our clients.
IRI's vision is to become an industry leading staffing services organization by maintaining ethical business practices, a passion for customer service, a commitment to quality, and our continued efforts to exceed expectations.
Job Description
Title: CRM Specialist / Software Engineer
Duration: Till December with greater possibility of extension
Location: Scottsdale, AZ 85260.
Description:
· Senior CRM Specialist / Software Engineer needed for Microsoft Dynamics CRM upgrade & deployment.
· Performs high-level software application development and serves as lead to support team for open ticket items and product upgrades.
· Analyzes problems in terms of detailed requirements. Designs detailed flow charts.
· Verifies program logic by preparing tests data for trial runs. Tests and debugs programs. Prepares run sheets for routine programs.
· May also do coding from flow charts, assist in determining the causes of computer or program malfunctions, and confer with technical personnel in systems analysis and application planning.
Requirements/Certifications:
· Contractor will be able to work remotely from home once they are trained, and they will be required to come to the office 3-4 days a month, or as needed.
· Resource needed to assist in a heavy backlog of projects, and to support a CRM upgrade and deployment. The ideal candidate will have strong skills in SQL Server, CRM Tools like Microsoft Dynamics (is desired, but not required), NET development skills, JavaScript, and database management & data integrity.
· There are currently 1,000 users of CRM at Companywide.
· Bachelor's degree required.
Additional Information
Job Type: Contract W2
$48k-82k yearly est. 60d+ ago
Director of Clinical Quality
Integrated Resources 4.5
Cambridge, MA jobs
Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.
Overview:
Candidates may need to travel to investigator sites
Candidates can sit remote but need to be able to travel to Cambridge
Local candidates preferred but they can work from home occasionally
1 year assignment to start. Not a perm assignment. Interim position.
Person must be able to coordinate other QA contractors for audits
Must also be able to deliver SOP's and processes and
This is ONLY in the GCP area
Must have GCP experience
Must have Pharma Experience within Quality Assurance Coordinating audits (internal, external)
Inspection experience (FDA)
Need to have worked in a development program so they know how to coordinate audits for a development program
Job Description:
Job Title: Director, Vaccines Clinical Compound Support Quality Assurance
OBJECTIVES:
• Plays a leadership role in ensuring that investigator, vendor, facility and system audits are conducted, for communicating any critical compliance risks noted from these activities to senior management, and ensuring that corrective actions are implemented.
• Serves as a senior strategic GCP/PV quality resource to VBU for its vaccine development activities, and takes a lead role for the preparation, conduct, and responses to FDA audits of VBU's Clinical Research effort.
• This position provides leadership and strategy in line with global strategic objectives. Collaborates with all VBD functional areas to ensure all assigned global clinical trial activities sponsored by VBU are in compliance with Good Clinical Practice (GCP) regulations, the International Conference on Harmonization (ICH) and Policies and Procedures.
ACCOUNTABILITIES:
• Ensures the development and implementation of strategies regarding the processes, procedures and quality standards required to maintain compliance to applicable regulations.
• Responsible to develop and implement a strategic audit plan for a VBU vaccines development program.
• Analyze audit program results, quality issues and investigations in order to optimize regional operations and overall regional state of compliance.Ensure that activities are conducted and reports written according to applicable SOPs and regulations.
• Represents VBU and serves as Inspection Administrator during regulatory inspections. Provides strategic organizational direction to assure that responses are timely and appropriate to maintain VBU's (US) good standing with regulatory agencies.
• Oversees all GCP QA, PVQA, and GCLP QA activities (including internal or external audit observations and development of adverse trends) in US and LATAM in order to ensure patient safety and data integrity.
• Identifies and mitigates GCP/PV/GCLP quality and compliance issues with potential impact across multiple compounds, sites, or functional groups within or outside of VBU .
• Collaborates with the R&D QA, and other global entities to provide a consistent quality approach, including:
o Develops and presents periodic reports for assigned project describing VBU compliance trends and identifying areas of potential risk to VBU senior management.
• Determines acceptability of vendors for potential use by VBD and provides direction, guidance and strategy for VBU Quality.
EXPERIENCE, KNOWLEDGE AND SKILLS:
Knowledge and Skills:
In-depth knowledge of the applicable GXP regulations, FDA Good Clinical Practices, ICH Guidelines, FDA Regulations and Guidances and Computer System Validation
• Auditing Knowledge: Demonstrates advanced knowledge in the conduct and reporting of audits and the translation of findings into corrective actions plans that mitigate risks to the company, to safety and data integrity.
• Clinical Development: Understands the phases, processes and techniques used to execute a clinical development program.
• Product Knowledge: Understands the medical impact of vaccines.
• Science Knowledge: Possess the necessary science education and knowledge to manage related clinical trials and to assure ethical treatment of subjects. Understands medical terminology and is familiar with standards of care and disease states.
• Communication skills: Must professionally, clearly, concisely and consistently communicate to external and internal customers via phone, e-mail, fax, and written documents. Must also be able to demonstrate professional presentation skills deliver fair balanced presentations and, when applicable, facilitate resolution of differing opinions.
• Negotiation Skills: Demonstrates proficiency in negotiation and conflict resolution.
• Project Management: Must demonstrate proficiency in managing complex projects, delivering all expected deliverables in a timely manner, and proactively communicating changes in pre-established goals and deadlines.
• Organizational skills: Must be able to prioritize work effectively to meet timelines.
• Interpersonal: Must be able to adapt to other personalities in a respectful manner that is conducive to goal achievement and team building.
• Computer skills: Must be able to efficiently utilize the computer hardware and software programs provided to plan, manage, conduct and track deliverables and to communicate with internal and external team members.
LICENSES/CERTIFICATIONS:
• ASQ Certified Quality Auditor (CQA), ASQ Certified Manager of Quality/Organizational Excellence, or SQA Registered Quality Assurance Professional preferred.
TRAVEL REQUIREMENTS:
• Ability to drive to or fly to various meetings or client sites, including overnight trips. Some international travel may be required.
• Requires approximately 20 % travel.
Qualifications
Education:
• B.S. in Biology, Nursing, Pharmacy, or related scientific field. MS preferred.
Experience:
• Minimum of 10 years of increasing responsibility in pharmaceutical, GCP-related Quality environment.
• Minimum 7 years indirect management level experience in GCP Quality Assurance including senior level project planning/budget management.
Additional Information
Kind Regards,
Sabanaaz Shaikh
Clinical Recruiter
Integrated Resources, Inc.
IT Life Sciences Allied Healthcare CRO
Gold Seal JCAHO Certified ™ for Health Care Staffing
“INC 5000's FASTEST GROWING, PRIVATELY HELD COMPANIES” (8th Year in a Row)
$135k-177k yearly est. 60d+ ago
Clinical Care Reviewer
Integrated Resources 4.5
Des Moines, IA jobs
Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.
Job Description
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews. Using clinical knowledge and nursing experience, the nurse reviews provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review. It is within the nurse's discretion to send requests for additional information and/or request clarification. The nurse will use his/her professional judgment to evaluate the request to ensure that appropriate services are approved and recognize care coordination opportunities and refer those cases as needed. The nurse will apply medical health benefit policy and medical management guidelines to authorize services and appropriately identify and refer requests to the Medical Director when guidelines are not met. The nurse will maintain current knowledge and understanding of the laws, regulations, and policies that pertain to the organizational unit's business and uses clinical judgment in their application.
Qualifications
• Three to five years - 3 or more years' experience in a related clinical setting.
• Registered Nurse
• Registered Nurse graduated from an accredited program.
• Current unrestricted IA Registered Nurse license.
• Valid Driver's License and reliable automobile transportation for on-site assignments and off-site work related activities.
Additional Information
Thank you!!
Kind Regards,
Kavita
Tel: (732) 549 2030 x 326
$37k-53k yearly est. 2d ago
Director of Business Development
Integrated Resources 4.5
Princeton, NJ jobs
A Few Words About Us Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.
This is a Direct Hire role with the client
Job Description
*THIS POSITION CAN BE 100% REMOTE*
The Director of Business Development has senior level responsibility for client strategy, satisfaction and retention. Key elements to successfully managing an assigned territory are building a strong sales pipeline, advancing sales opportunities and growing relationships with selected accounts.
PRIMARY
RESPONSIBILITIES
Identifies business opportunities within Post Marketing Clinical Research by
• Generating new leads and prospects through prospecting, conducting initial research and phone contact
• Prospecting qualified sales leads from other sources including inside sales, trade show, etc.
• Leading new business development efforts
• Managing corporate meetings and exhibitions
• Representing the company - Post Approval Services at local, national and international meetings pertinent to public relations and future business development
Develops and secures business
• Generating Request for Proposals (RFPs) based on new and existing clients
• Writing business and technical proposals
• Negotiating client contracts
• Closing deals profitably
Maintains relationships with clients
• Providing support, information and guidance
• Recommending new opportunities
• Recommending profit and service improvements
• Establishing and maintaining industry and client contacts for continuing good relations and business opportunity development
• Developing and maintaining client profiles including updating contacts management system
• Ensuring ongoing understanding of services, services offered by competitors and market/industry trends
• Reading, understanding and adhering to organizational Standard Operating Procedures (SOPs)
• Assisting in establishing and enforcing departmental standards
• Participating in the modification of company SOPs related to Business Development
SECONDARY RESPONSIBILITIES
Contributes to team effort by
• Exploring new opportunities to add value to organization and departmental processes
• Helping others to achieve results
• Performing other duties as assigned
Maintains Technical Knowledge by
• Attending and participating in applicable company-sponsored training
• Maintaining a strong understanding of Industry trends and applicable regulations
Qualifications
QUALIFICATIONS:
Education:
• Bachelors degree in Life Sciences or related field
• Sales/Business Development training preferred
Experience:
• 5+ years of business development experience in CRO industry is required. Experience in Post Approval Research segment is highly desirable.
• Operations experience in clinical trials preferred
• Thorough knowledge of medical and pharmaceutical industry, terminology and practices
• Proven ability in presenting and negotiating
Additional skill set:
• Ability to work independently or in team setting; ability to adjust to changing priorities
• Strong presentation and negotiating skills
• Strong interpersonal and communication skills, both verbal and written
• Ability to project and maintain a professional and positive attitude
WORKING CONDITIONS:
Travel: 30-50% (some weekends required)
Lifting: 0-20lbs
Other: Computer work for long periods of time
Additional Information
All your information will be kept confidential according to EEO guidelines.
$97k-157k yearly est. 2d ago
Behavioral Health Care Coordinator-Remote
Integrated Resources 4.5
Washington, DC jobs
Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.
We've stayed true to our focus of finding qualified and experienced professionals in our specialty areas. Our partner-employers know that they can rely on us to find the right match between their needs and the abilities of our top-tier candidates. By continually exceeding their expectations, we have built successful ongoing partnerships that help us stay true to our commitments of performance and integrity.
Our team works hard to deliver a tailored approach for each and every client, critical in matching the right employers with the right candidates. We forge partnerships that are meant for the long term and align skills and cultures. At IRI, we know that our success is directly tied to our clients' success.
Job Description
Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources. This role promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction.
Essential Functions:
- Conducting in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters.
- Communicating and developing the treatment plan for authorization of services, and serves as point of contact to ensure services are rendered appropriately, (i.e. during transition to home care, back up plans, community based services.
Qualifications
MUST have 5 TOTAL years of Post Masters Experience.
Required licenses are: Licensed as a LCSW-C or LCPC or LCMFT
HOURS: Mon-Thurs 8a-7p and Fri 8a-6p. With that being said they need to be flexible. He /She WILL work 2 evening shifts/week (evening shift defined as staying until 7 pm Mon-Thurs or staying until 6 pm on Friday).
After the training a schedule will be developed for the worker. Training is 3 weeks Mon - Fri from 8:30 am - 5:00. However, the candidate will be assigned his/her fixed work schedule between the 4th and 6th week on the assignment.
Additional Information
All your information will be kept confidential according to EEO guidelines.
$57k-78k yearly est. 60d+ ago
Clinical Research Specialist
Integrated Resources 4.5
New Haven, CT jobs
Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.
Job Description
Contractor will need to train onsite for 3 months and then be able to work remote.
· Provide product training and support to clinical sites for the pill cam procedure.
· Support the randomization process and act as the IWRS PRIMARY Administrator
· Arranging and participating in the organization of study team meetings Taking minutes and distributing
· Managing and maintaining study documents and trial supplies, colonoscopy forceps, FedEx envelop, IWRS User information.
· Administer, Maintain and coordinate the logistic aspects of clinical trials according to GCP and Sop's
· Ensure That any clinical trial databases/tracking tools are set up and maintained throughout the trial
· Assist with collating, tracking & shipping CRFs & Data queries to data management
· Maintaining study data control table
· Review and approve monitoring reports in Siebel
· CTM SW update
· Coordinating archiving of study documentation
· Perform and support study site qualification, Initiation interim monitoring and closeout visits according to SOP's GCP's, FDA regulation and ICH guidelines at multiple investigational sites
· Ensure safety and welfare of Patient enrolled in clinical study
· Site management to ensure Compliance
· Ensure integrity of data reported
· Helping in setting up the Study centers, Which includes ensuring each center has the trial materials and training site staff to trial-specific standards
· Administrative support for CA and date management team including: shipment training records and inventory control.
Qualifications
Bachelor's degree Engineering/ (B.A./B.S.C./Other)
Experience required:
0-2 years
Additional Information
Kind Regards,
Sasha Sharma
Clinical Recruiter
Integrated Resources, Inc.
IT Life Sciences Allied Healthcare CRO
DIRECT # - 732-662-7964
$52k-78k yearly est. 60d+ ago
Case Manager
Integrated Resources 4.5
Alpharetta, GA jobs
Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.
Job Description
Education Level: Master's
This is a TEMP-
TO-PERM Care Manager RN position. The position is created to meet and exceed the service level requirements to their customers.
These positions require a Master's Degree and a LCSW or LCPC license.
Candidates need 2-3 years of Behavioral Health Experience, and 3-5 years of Utilization Management or Manager Care Experience. She is also looking for candidates with inpatient, outpatient, and behavioral health clinic experience.
Description:
Under general supervision, and in collaboration with other members of the clinical team, reviews utilization of mental health and substance abuse services provided in inpatient and intermediate care settings. Collects and analyzes utilization data. Assists with discharge planning and ambulatory follow up activity. Provides member assistance with mental health and substance abuse issues, and participates in special quality improvement projects. Monitors level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness.- Performs concurrent reviews for inpatient care and other levels of care as allowed by scope of practice and experience. In conjunction with providers and facilities, develops discharge plans and oversee their implementation.- Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria.- Interacts with Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases.- Participates in quality improvement activities, including data collection, tracking, and analysis Works with community agencies as appropriate. Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria. Advocates for the patient to ensure treatment needs are met. Interacts with providers in a professional, respectful manner that facilitates the treatment process.
Requirements/Certifications:
Strong organization, time management and communication skills. Knowledge of utilization management procedures, mental health and substance abuse community resources and providers.
Knowledge and experience in inpatient setting.
Knowledge of DSM V or most current diagnostic edition. Ability to analyze specific utilization problems, plan and implement solutions that directly influence quality of care.
Candidates need 2-3 years of Behavioral Health Experience, and 3-5 years of Utilization Management or Manager Care Experience.
She is also looking for candidates with inpatient, outpatient, and behavioral health clinic experience.
The manager will give preference to candidates located in the Alpharetta, GA area; however, she is open to remote candidates as well.
The Alpharetta, GA candidate will also have the ability to work remote.
This is an inbound telephonic position and the selected candidate will manager about 25 calls/day.
The majority of the calls are from providers and the other calls are from members and their family members.
The selected candidate will have 1-2 years of Managed Care/Clinical Review experience and 3-5 clinical experience.
There are 55 people on this team and it is divided into 3 clusters.
The training will be web based and it will be about 2-3 weeks long. The hours will be from 8am - 5pm.
The selected candidate MUST be comfortable with navigating through multiple systems and comfortable with Outlook, Instant Messenger and Email. The manager will conduct telephone intervie
Qualifications
LCSW or LCPC license
Additional Information
Riya Khem
Life Science Recruiter
Integrated Resources, Inc.
IT Life Sciences Allied Healthcare CRO
Certified MBE |GSA - Schedule 66 I GSA - Schedule 621I
DIRECT # - 732 -844-8721 | (W) # 732-549-2030 - Ext - 311 |(F) 732-549-5549
$32k-41k yearly est. 2d ago
Business Analyst
Integrated Resources 4.5
Garland, TX jobs
A Few Words About Us Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.
Position: Business Analyst
Duration: 6 Months
Location: Garland, TX or El Segundo, CA
Remote Work
Job Description:
The successful Business Analyst will work as part of a project team and with the customer to understand the Business needs and translate them into meaningful requirements that can be used by the software development team to develop a business solution. They may additionally manage UA testing and complete applicable project documents such as Architecture Documents, Design Documents, and SOW's. They must be able to clearly communicate in the language of the business to internal customers while simultaneously communicate technically with the development and architecture teams.
Job Duties:
• Elicit requirements using interviews, document analysis, requirements workshops, surveys, site visits, business process descriptions, use cases, scenarios, business analysis, task and workflow analysis.
• Critically evaluate information gathered from multiple sources, reconcile conflicts, decompose high-level information into details, abstract up from low-level information to a general understanding, and distinguish user requests from the underlying true needs.
• Proactively communicate and collaborate with external and internal customers to analyze information needs and functional requirements and deliver the following artifacts as needed: (Functional requirements (Business Requirements Document), iii. Use Cases, GUI, Screen and Interface designs)
• Successfully engage in multiple initiatives simultaneously
• Work independently with users to define concepts and under direction of project managers
• Strong analytical and product management skills required, including a thorough understanding of how to interpret customer business needs and translate them into application and operational requirements.
• Excellent verbal and written communication skills and the ability to interact professionally with a diverse group, executives, managers, and subject matter experts.
• Serves as the conduit between the customer community (internal and external customers) and the software development team through which requirements flow.
• Develop requirements specifications according to standard templates
• Collaborate with developers and subject matter experts to establish the technical vision and analyze tradeoffs between usability and performance needs.
• Successful delivery of projects utilizing the Agile software development methodology
• Document requirements as User Stories and Tasks in both TFS and/or HP Quality Center.
Qualifications
Minimum Education is BS in MIS, Computer Science, or related field.
Exposure to IDPS, EVMS, RTN Six Sigma, and LEAN methodologies.
3-5 years' experience working as a Business Analyst utilizing the Skills listed above
CBAP Certification a plus
Knowledge of both Agile and Waterfall software development methodologies
Ability to pass a background check
Additional Information
Regards,
Nagesh
Sr.Technical Recruiter
Integrated Resources, Inc.
IT Life Sciences Allied Healthcare CRO
Certified MBE |GSA - Schedule 66 I GSA - Schedule 621I
Direct# 732-429-1641
(BOARD) # 732-549-2030 - Ext - 305
Gold Seal JCAHO Certified ™ for Health Care Staffing
“INC 5000's FASTEST GROWING, PRIVATELY HELD COMPANIES” (8th Year in a Row)
$70k-106k yearly est. 2d ago
Clinical Care Reviewer UM (RN/LPN)
Integrated Resources 4.5
Des Moines, IA jobs
Integrated Resources, Inc is a premier staffing firm recognized as one of the tri-states most well-respected professional specialty firms. IRI has built its reputation on excellent service and integrity since its inception in 1996. Our mission centers on delivering only the best quality talent, the first time and every time. We provide quality resources in four specialty areas: Information Technology (IT), Clinical Research, Rehabilitation Therapy and Nursing.
Duration:
3 Months+ (Possible Extension)
Our client is looking to hire Clinical Care Reviewer UM.
Job description:
The primary purpose of the job is to:
Under the direction of the unit Supervisor, the Clinical Care Reviewer is responsible for completing medical necessity reviews.
sing clinical knowledge and nursing experience, the nurse reviews provider requests for inpatient and outpatient services, working closely with members and providers to collect all information necessary to perform a thorough medical necessity review.
It is within the nurse's discretion to send requests for additional information and/or request clarification.
The nurse will use his/her professional judgment to evaluate the request to ensure that appropriate services are approved and recognize care coordination opportunities and refer those cases as needed.
The nurse will apply medical health benefit policy and medical management guidelines to authorize services and appropriately identify and refer requests to the Medical Director when guidelines are not met. The nurse will maintain current knowledge and understanding of the laws, regulations, and policies that pertain to the organizational unit's business and uses clinical judgment in their application.
Job-Related Experience and Skills:
Registered Nurse graduated from an accredited program .
Current unrestricted Iowa Registered Nurse license or LPN
Valid Driver's License and reliable automobile transportation for on-site assignments and off-site work related activities.
Physical Effort/Working Conditions
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.
Primarily works in a climate controlled office based setting. May require driving or commuting to health care facilities. Some positions may require a large amount of walking within the health care facility
Qualifications
3 or more years' experience in a related clinical setting.
Registered Nurse or LPN
Excellent oral and written communication skills.
Ability to identify problems and recommend solutions.
Self-directed/Ability to work independently.
Excellent decision making skills.
Excellent time management skills, prioritizing work and meeting timelines.
Ability to advocate for member/member family needs.
Dedicated to meeting the expectations and requirements of internal and external customers.
Obtains continuing education required to maintain professional licensure.
Ability to achieve required performance results on all audits and Inter Rater Reliability (Peer to Peer).
Additional Information
Feel free to forward my email to your friends/colleagues who might be available.
We do have referral bonus , if you refer any of your friends or colleague who are looking out for the same job.
Kind Regards,
Nisha
732-429-1649