Veteran appeals reviewer jobs near me - 110 jobs

Appeals Referee
Commonwealth of Pennsylvania 3.9
Remote veteran appeals reviewer job
Are you a fair-minded and fact-oriented professional with experience in the determination of unemployment compensation (UC) claims, the application of taxing or benefit-paying provisions of the UC Law, or the practice of labor law? The UC Board of Review is searching for qualified and dedicated candidates like you to join our Springfield Referee Office team in this Appeals Referee position. Apply now and advance your career by sharing your professional experience and judgement with a team that provides a consistent process for UC appeals cases while ensuring that the decisions made are consistent, fair, and just. DESCRIPTION OF WORK As an Appeals Referee, you will hear and decide first level appeals of UC service center determinations. This involves presiding over hearings and following rules of evidence, due process standards, and standard administrative practice to move the proceedings to conclusion; informing parties to appeals about policies, procedures, and rights; and ensuring each appellant's case is processed in a timely, consistent, and impartial manner. You will be expected to conduct hearings as scheduled, review case files to prepare for each hearing, and use digital recording equipment to record hearings and dictate decisions, as well as supervise clerical and legal assistant staff who assist with these duties. This includes training, advising, and overseeing the activities of these staff members; preparing performance reviews; and completing other supervisory duties. Our team will rely on you to issue clear and concise decisions reflecting your evaluation of evidence and to interpret policy and procedure from UC Law and regulations, precedent decisions in case law, and other instructions. You may also be expected to serve as a hearing officer for second level appeals and travel to other hearing locations to provide assistance or attend trainings and conferences. Take your career to the next level and help ensure due process for UC appeals with us! Interested in learning more? Additional details regarding this position can be found in the position description. Work Schedule and Additional Information: Full-time employment Work hours are 8:00 AM to 4:00 PM, Monday - Friday. Work hours are negotiable with a 30-minute lunch break. Telework: You may have the opportunity to work from home (telework) part-time, upon successful completion of the training period. In order to telework, you must have a securely configured high-speed internet connection and work from an approved location inside Pennsylvania. If you are unable to telework, you will have the option to report to the headquarters office in Springfield, PA. The ability to telework is subject to change at any time. Additional details may be provided during the interview. Salary: In some cases, the starting salary may be non-negotiable. You will receive further communication regarding this position via email. Check your email, including spam/junk folders, for these notices. REQUIRED EXPERIENCE, TRAINING & ELIGIBILITY QUALIFICATIONS Minimum Experience and Training Requirements: Graduation from an approved school of law and certification of admission to the bar of the Supreme Court of Pennsylvania and one year of experience in the practice of labor law; or Four years of experience in the determination of unemployment compensation claims, including adjustments, overpayments, and appeals supplemented by 6 college level credits in English composition or other related English courses; or Four years of professional experience which involves the application of taxing or benefit-paying provisions of the Unemployment Compensation Law in order to determine compliance, to improve Unemployment Compensation program operations, or to train others in the application of the law supplemented by 6 college level credits in English composition or other related English courses; or An equivalent combination of experience and training which includes 6 college level credits in English composition or other related English courses. Other Requirements: You must meet the PA residency requirement. For more information on ways to meet PA residency requirements, follow the link and click on Residency. You must be able to perform essential job functions. How to Apply: Resumes, cover letters, and similar documents will not be reviewed, and the information contained therein will not be considered for the purposes of determining your eligibility for the position. Information to support your eligibility for the position must be provided on the application (i.e., relevant, detailed experience/education). If you are claiming education in your answers to the supplemental application questions, you must attach a copy of your college transcripts for your claim to be accepted toward meeting the minimum requirements. Unofficial transcripts are acceptable. Your application must be submitted by the posting closing date . Late applications and other required materials will not be accepted. Failure to comply with the above application requirements may eliminate you from consideration for this position. Veterans: Pennsylvania law (51 Pa. C.S. *7103) provides employment preference for qualified veterans for appointment to many state and local government jobs. To learn more about employment preferences for veterans, go to ************************************************ and click on Veterans. Telecommunications Relay Service (TRS): 711 (hearing and speech disabilities or other individuals). If you are contacted for an interview and need accommodations due to a disability, please discuss your request for accommodations with the interviewer in advance of your interview date. The Commonwealth is an equal employment opportunity employer and is committed to a diverse workforce. The Commonwealth values inclusion as we seek to recruit, develop, and retain the most qualified people to serve the citizens of Pennsylvania. The Commonwealth does not discriminate on the basis of race, color, religious creed, ancestry, union membership, age, gender, sexual orientation, gender identity or expression, national origin, AIDS or HIV status, disability, or any other categories protected by applicable federal or state law. All diverse candidates are encouraged to apply. EXAMINATION INFORMATION Completing the application, including all supplemental questions, serves as your exam for this position. No additional exam is required at a test center (also referred to as a written exam). Your score is based on the detailed information you provide on your application and in response to the supplemental questions. Your score is valid for this specific posting only. You must provide complete and accurate information or: your score may be lower than deserved. you may be disqualified. You may only apply/test once for this posting. Your results will be provided via email.
$43k-61k yearly est. 2d ago

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Plans Reviewer (Code Specialist II)
Fairfax County Government 4.3
Veteran appeals reviewer job in Fairfax, VA
Job Announcement This position performs the full professional work in the interpretation and enforcement of applicable codes, ordinances, regulations, and internal policies. Evaluates fire and life safety plans and associated documentation and performs related inspections for new construction and alterations to existing construction to ensure compliance with the Virginia Uniform Statewide Building Code (USBC), Statewide Fire Prevention Code ((VSFPC), County Code, and related policies. Prepares appropriate correspondence to architects, engineers, designers, installers, owners, contractors addressing any code-related deficiencies noted during plan reviews. Enforces the Virginia Statewide Fire Code, portions of the Virginia Construction Code and referenced NFPA standards by conducting plan reviews to include associated report preparation. Ensures up-to-date technical documents and will assist with internal code-related projects. Performs other duties as assigned to further the goals and objectives of the department. Works under general supervision. Illustrative Duties (The illustrative duties listed in this specification are representative of the class but are not an all-inclusive list. A complete list of position duties and unique physical requirements can be found in the position description.) Serves as a technical assistant in the interpretation, development, or enforcement of applicable codes, ordinances, and related internal policies; Provides technical interpretation for citizens, staff, and county officials, and ensures compliance and consistency in code ordinance, and regulatory enforcement; Evaluates plan submissions for code compliance and completeness and communicates deficiencies; Assists in the design and presentation of technical training concerning applicable codes, ordinances, policies, and regulatory requirements; Conducts reviews and/or inspections of projects designed or installed by contractors, developers, or individuals to verify compliance with applicable contracts, agreements, county and state codes and regulations; Engages in safe working practices and complies with safety programs and guidelines; Reports and monitors unsafe working conditions; Complies with safety competencies. Required Knowledge Skills and Abilities (The knowledge, skills and abilities listed in this specification are representative of the class but are not an all- inclusive list.) Working knowledge of the industry and of the codes and ordinances that apply to the type of work being regulated; Working knowledge of the process by which violations of applicable codes, ordinances, and related internal policies are resolved and the legal procedures for prosecuting such violations; Working knowledge of real property descriptions; Working knowledge of inspection methods: Ability to resolve conflicts and negotiate agreements using tact, diplomacy, and persuasion; Ability to speak clearly and concisely in front of various size groups and to effectively conduct group meetings; Ability to prepare clear and concise technical reports and suggested code and policy changes and to present findings in a clear and concise format; Ability to review site plans and communicate deficiencies; Ability to establish and maintain effective relationships with others; Ability to handle interpersonal conflict situations with tact and diplomacy; Ability to negotiate and solve problems; Ability to comprehend and comply to safety practices. Employment Standards MINIMUM QUALIFICATIONS: Any combination of education, experience, and training equivalent to the following: (Click on the aforementioned link to learn how Fairfax County interprets equivalencies for "Any combination, experience, and training equivalent to") Graduation from an accredited four year college or university with a bachelor's degree in a field of study directly related to the industry being regulated such as engineering, architecture, urban planning, biological or environmental science, public administration, law enforcement, legal studies or a related field; plus two years of progressively more responsible complaint resolution and/or code enforcement experience in the industry being regulated. CERTIFICATES AND LICENSES REQUIRED: Driver's License (Required) Virginia Department of Housing and Community Development Building Code Academy (CORE Module) (Required within 12 months) Fire Inspector I/II (NFPA 1031) from the Virginia Department of Fire Programs (Required within 12 months) VDHCD Fire Protection Plans Examiner (Required within 18 months) NECESSARY SPECIAL REQUIREMENTS: The appointee to this position will be required to complete a criminal background check, sanctions screening and driving record check to the satisfaction of the employer. PREFERRED QUALIFICATIONS: Virginia Department of Housing and Community Development Building Code Academy (CORE Module) Certification Virginia Department of Housing and Community Development Fire Protection Plans Examiner Certification Fire Inspector I/II (NFPA 1031) from the Virginia Department of Fire Programs certification Knowledge of the Virginia Uniform Statewide Building Code, Virginia Statewide Fire Prevention Code and referenced standards. Experience with review of building and tenant drawings for construction type, structural fire resistance, means of egress, and fire protection system requirements. Experience, including laboratory and classroom experience, with fire protection systems, water distribution systems, building construction materials, processes and techniques, fire alarm systems, (including circuits and devices), codes, and standards. Experience with engineering calculation techniques for occupant loads, egress capacity, exit access travel distance, hydraulics, fire alarm circuitry, and for structural fire resistance. PHYSICAL REQUIREMENTS: Ability to sit, stand, walk, climb stairs and terrain features, drive motor vehicles. All duties may be performed with or without reasonable accommodations. SELECTION PROCEDURE: Panel interview; may include exercise. Fairfax County is home to a highly diverse population, with a significant number of residents speaking languages other than English at home (including Spanish, Asian/Pacific Islander, Indo-European, and many others.) We encourage candidates who are bilingual in English and another language to apply for this opportunity. Fairfax County Government prohibits discrimination on the basis of race, color, religion, national origin, sex, pregnancy, childbirth or related medical conditions, age, marital status, disability, sexual orientation, gender identity, genetics, political affiliation, or military status in the recruitment, selection, and hiring of its workforce. Reasonable accommodations are available to persons with disabilities during application and/or interview processes per the Americans with Disabilities Act. TTY . . EEO/AA/TTY. #LI-SP1
$44k-63k yearly est. 2d ago
IBR Clinical Appeals Reviewer - Remote
Unitedhealth Group 4.6
Remote veteran appeals reviewer job
Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start **Caring. Connecting. Growing together.** The **Itemized Bill Review (IBR) Clinical Appeals Reviewer ** will analyze and respond to client and/or hospital claim review appeal inquiries. Handles medical record review, analyzes data, and completes the response resolution for clients and the business unit. Must utilize expertise in auditing to review and provide response to appeals. We are seeking self-motivated, solution-oriented and skilled problem solver who provides clinical reviews with written documentation under tight deadlines. This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Analyze scope and resolution of IBR Appeals + Respond to Level one, two or higher appeals + Perform complex conceptual analyses + Identifies risk factors, comorbidities', and adverse events, to determine if overpayment or claim adjustment is needed + Reviews governmental regulations and payer protocols and / or medical policy to recommend appropriate actions + Researches and prepares written appeals + Exercises clinical and/or coding judgment and experience + Collaborates with existing auditors, quality and leadership team to seek to understand, and review medical records pertaining to impacted claims + Navigates through web-based portals and independently utilizes other online tools and resources including but not limited to word, adobe, excel + Serve as a key resource on complex and / or critical issues and help develop innovative solutions + Define and document / communicate business requirements You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + Undergraduate nursing degree + Unrestricted RN (registered nurse) license + 2+ years of appeals experience (coding or auditing) + Experience with CPT-4 coding, NCCI edit resolution and appropriate modifier use + Advanced experience with regulations, compliance and composing professional appeal responses + Advanced experience with ICD10 CM coding and ICD 10 PCS coding + Willing or ability to work our normal business hours of 8:00am - 5:00pm + Proven ability to keep all company sensitive documents secure (if applicable) + Have a dedicated work area established that is separated from other living areas and provides information privacy + Live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service **Preferred Qualifications:** + Clinical claim review experience + Managed care experience + Investigation and/or auditing experience + Advanced experience using Microsoft Excel with the ability to create/edit spreadsheets, use sort/filter function, and perform data entry + Knowledge of health insurance business, industry terminology, and regulatory guidelines *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $35.00 to $62.50 per hour based on full-time employment. We comply with all minimum wage laws as applicable. **Application Deadline:** This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._
$35k-51k yearly est. 13d ago
Bill Reviewer III
Intermed 4.2
Remote veteran appeals reviewer job
Full-time Description Employee will work under limited supervision, meets daily production quotas in processing and auditing medical bills in accordance with the appropriate workers' compensation fee schedule by performing the following duties. This position may be considered to work from home under the following criteria: Essential Duties and Responsibilities: Codes medical bills into the company system with speed and accuracy, maintaining company production standards related to quantity and quality of output. Performs preliminary screening for appropriateness and medical necessity of services rendered. Uses CPT and ICD9/ICD10 codes, fee schedules, and other resource materials to determine appropriate reimbursement of billed services, including applicable fee schedule and/or repricing rational. Flags any problem bills to the BR supervisor. Communicates with clients and/or providers to clarify information. Forwards to Bill Review supervisor any unidentifiable unlisted procedure numbers. Ability to price hospital and surgery bills to applicable fee schedules. Ability to process reconsideration requests as assigned. May specialize in state specific or client specific areas of responsibility. Assists with bill review reporting functions (internal and external reports) May specialize in state specific or client specific areas of responsibility May assist is answering provider calls. May travel to other offices to assist with training Requirements Competency: To perform the job successfully, an individual should demonstrate the following competencies: Design - Demonstrates attention to detail. Oral Communication- Speaks clearly and persuasively in positive or negative situations; Listens and gets clarification; Responds well to questions. Team Work - Supports everyone's efforts to succeed. Quality - Demonstrates accuracy and thoroughness; Looks for ways to improve and promote quality; Applies feedback to improve performance; Monitors own work to ensure quality. Quantity - Meets productivity standards; Completes work in timely manner; Strives to increase productivity; Works quickly. 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), plus minimum of one year data entry/medical billing experience; additional two years bill review experience in a workers' comp environment. Strong knowledge of CPT and ICD9/ICD10 coding and workers compensation fee schedules. Must be familiar with workers' compensation regulations and have good comprehension of company software system process. Certificates and Licenses: Must have Medical Bill Reviewer Designation - 40 hour initial certification plus continuing education hours of 16 hours every 2 years. We're an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status. Pursuant to the Los Angeles and San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest or conviction records. Salary Description $25.00 - $30.00
$57k-72k yearly est. 60d+ ago
Medical Content Reviewer - Remote - Nationwide
Vituity
Remote veteran appeals reviewer job
Remote, Nationwide - Seeking Medical Content Reviewer Everybody Has A Role To Play In Accelerating Healthcare Innovation If you want to be part of changing healthcare to better serve patients, you are in the right place. With Inflect Health you will join a team of individuals dedicated to optimizing healthcare for all. Join the Inflect Health Team. At Inflect Health, Vituity's Innovation Hub, we identify, develop, and invest in leading-edge technologies and solutions that strengthen Vituity's history of healthcare transformation. When you join our team, you are part of a community that is committed to sharing the future of healthcare by prioritizing the human element in innovation - focusing on the provider and patient outcomes, not just the technology. The Opportunity * Craft expert responses, showcasing your deep knowledge of medical principles to enhance machine learning of healthcare data. * Analyze samples based on provided information, demonstrating your ability to apply your expertise effectively. * Evaluate samples in sequential descending priority in a multi-step project, which will be used as inputs for a model. Required Experience and Competencies * Resume and cover letter required upon applying. * Eligibility to work in the U.S. * Expertise and experience in healthcare. * Experience using G-Suite (e.g. Google Sheets, etc.). * English language proficiency. We are excited to share the base salary range for this position is $60.00, exclusive of fringe benefits or potential bonuses. This position is also eligible to participate in our annual corporate Success Sharing bonus program, which is based on the company's annual performance. If you are hired at Vituity, your final base salary compensation will be determined based on factors such as skills, education, and/or experience. We believe in the importance of pay equity and consider internal equity of our current team members as a part of any final offer. Please speak with a recruiter for more details. Innovation and transformation are required to navigate and improve the evolving landscape of healthcare, and we believe everyone can play a role in that. We strive to be a catalyst for that transformation through improvement in healthcare delivery and the development of health technologies. If you want to make a difference, Inflect Health is the place to do it. Inflect Health does not discriminate against any person on the basis of race, creed, color, religion, gender, sexual orientation, gender identity/expression, national origin, disability, age, genetic information (including family medical history), veteran status, marital status, pregnancy or related condition, or any other basis protected by law. Inflect Health is committed to complying with all applicable national, state and local laws pertaining to nondiscrimination and equal opportunity. Applicants only. No agencies please.
$60 hourly 26d ago
Medical Reviewer, Surgical Dressings
Verse Medical
Remote veteran appeals reviewer job
Our Mission: Hospital-Quality Care, Everywhere. The healthcare industry still relies on faxes and phone tag to coordinate critical care for patients at home. We think patients and the clinicians who serve them deserve better than a system stuck in 1995. Verse Medical is building the modern software infrastructure to make it happen. We're a well-funded Series C company (backed by General Catalyst, SignalFire, and Sapphire Ventures) on a mission to heal a fragmented system. Our platform connects the dots between providers, payors, and patients, ensuring people get the high-quality care they need, reliably and right where they live. We're growing fast and looking for people who are driven by this mission to join us! Our Values: The Principles That Guide Us Our values are the operating system for how we work together and with our partners. They aren't just words on a wall; they are the principles we bring to every decision, every day. We are transparent, upfront and direct. We operate with honesty and clarity. We share information openly, the good and the bad, and believe that direct, respectful feedback is the foundation of trust and progress. We value speed of iteration. We are building something new, which means we learn by doing. We prioritize rapid iteration and getting solutions into the hands of users, believing that progress is more valuable than perfection. We give 110% effort, 30% of the time. We are passionate about our mission, and there are moments that require us to go the extra mile. We believe in focused intensity when it counts, balanced by a sustainable pace that keeps our team energized for the long run. We empathize with customers to a fault. When our users face a problem, we own it. Instead of asking them to change, we ask ourselves, "How can we make this better?" We believe true innovation comes from deep empathy and a relentless focus on solving the real-world challenges of healthcare. Your Impact: How You'll Help Us Heal a Broken System This isn't just a job; it's a chance to build something that matters. As DME Medical Reviewer, you'll be shaping the future of at-home care. You'll be a key part of the team, working to ensure each surgical dressing order is fully compliant with every CMS regulation, including regulation/ policies as they are applied by MACs & UPICs. You'll translate LCDs/ Articles and MAC playbooks into checklists, fix packet defects pre‑bill, and run our ADRs/appeals processes. What You'll Achieve: A Glimpse into Your Contributions Within your first year, you will have the opportunity to: Policy → Practice Interpret and operationalize LCD L33831 + Policy Article for surgical dressings; publish practical rules (when covered, limits, documentation phrases). Stand up “go/no‑go” criteria for collagen, alginate/fiber‑gelling, foam, film, hydrocolloid; codify A‑modifier (wound count) usage, KX/GA/GZ/EY, sizing, quantity/frequency math. Pre‑Bill Controls Build a 2‑gate QA (1: clinical completeness; 2: billing correctness) and pilot it on all surgical‑dressing claims. Create/upgrade templates for various outreach. Audit & Appeals Lead UPIC/MAC ADR responses (pre‑ and post‑pay). Coach internal billing team; establish a reusable appeals library with policy citations and exemplars. Enablement & Analytics Train customer-facing team members (30‑min modules) and billers on the specific documentation that satisfies the LCD. Define and track metrics: initial denial %, appeal win %, ADR turnaround, % packets with signed POD, top‑defect Pareto. What You'll Bring: The Skills and Experience You'll Leverage We believe that diverse experiences and backgrounds lead to better solutions. While we have an idea of what will help someone succeed in this role, we are open to being convinced by your unique story and skills. If you believe you can achieve the outcomes above, we encourage you to apply. Core Skills & Experience: 3-5+ years medical‑review experience at a UPIC or MAC (e.g., Safeguard Services, Qlarant, CoventBridge; Noridian, CGS, NGS, WPS, Novitas, Palmetto). Hands‑on adjudication of surgical dressings (A6021 collagen; A6196-A6199 alginate/fiber‑gelling; A6209-A6215 foam; A6212-A6214 bordered foam; A6216-A6221 gauze; A6257-A6259 film). Expert with proof‑of‑delivery standards, SWO requirements, frequency/sizing rules, and common denial rationales (e.g., two‑cover stacking, over‑frequency without rationale, DOS/POD mismatch). Most of our interview process is focused on your practical experience with the coverage guidelines. Crisp, policy‑anchored writing; calm under deadline; disciplined with PHI. The Rewards & Reality: Compensation, Benefits & Logistics We believe in taking care of our team, both professionally and personally. Here's what we offer: Meaningful Compensation: up to $110,000 base salary (depending on experience and expertise) Comprehensive Health & Wellness: We cover 100% of your health insurance premium and provide access to high-quality dental and vision insurance plans for you and your dependents. Plan for the Future: We offer a 401(k) plan to help you save for your future. At this time, the company does not offer a 401(k) match. Career Growth: You'll have opportunities for rapid career advancement in a company that's at a major inflection point. We want you to grow with us. Work Environment & Location: This is a remote position. Please note that at this time, we are not able to provide visa sponsorship for this position. All candidates must be authorized to work in the United States. Our Pledge for an Equitable Future At Verse Medical, our mission is to deliver equitable, hospital-quality care to everyone, regardless of their background or where they live. We can only achieve this if our own team reflects the diversity of the patients we serve. We are committed to building a workplace where everyone feels a sense of belonging, where their contributions are valued, and where they can do their best work. We embrace diversity of all kinds: race, gender, age, religion, identity, experience. We are actively working to build a more inclusive and equitable world, starting from within our own walls. We are an equal opportunity employer. We are also committed to providing a positive and accessible interview experience. If you require any accommodations to participate in our process, please contact us at ***************************.
$110k yearly Auto-Apply 50d ago
Medical Reviewer/Safety Reviewer III
Actalent
Remote veteran appeals reviewer job
Job Description: Responsibilities as applicable: Take part in post-market safety surveillance activities for assigned medical devices and contribute to area projects and objectives. Identify issues and escalate them to the manager as necessary. Conduct medical safety assessments MSA for medical device complaints involving reported adverse events and occasionally technical events. This involves evaluating the seriousness of adverse events determining device relatedness and assessing whether a recurring malfunction could cause or contribute to serious injury or death. Maintain oversight of all incoming MSAs for timely completion to assist in on-time reporting Skills pharmaceutical, clinical research, regulatory Top Skills Details pharmaceutical,clinical research,regulatory Additional Skills & Qualifications Qualifications: BSN Degree or higher with active RN license Minimally 5-7 years of hands-on clinical experience Able to apply clinical knowledge to adverse event data collection and assessment. Competent in ability to present device safety event data orally and in writing. Adheres to policies and regulations. Must be Computer proficient Windows Word Excel. Experience Level Expert Level Job Type & Location This is a Contract position based out of North Chicago, IL. Pay and Benefits The pay range for this position is $40.00 - $50.00/hr. Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: • Medical, dental & vision • Critical Illness, Accident, and Hospital • 401(k) Retirement Plan - Pre-tax and Roth post-tax contributions available • Life Insurance (Voluntary Life & AD&D for the employee and dependents) • Short and long-term disability • Health Spending Account (HSA) • Transportation benefits • Employee Assistance Program • Time Off/Leave (PTO, Vacation or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to close on Jan 27, 2026. About Actalent Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500. The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law. If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.
$40-50 hourly 8d ago
Distribution Reviewer
Nova 401 4.1
Remote veteran appeals reviewer job
Are you looking for a position where you can utilize your experience processing retirement plan distributions and loans? Do you excel at attention to detail and catching oversights? Do you want the flexibility and convenience of working from home? Nova 401(k) Associates is looking to fill a fully remote Distribution Reviewer position. The ideal candidate for this position has at least five years of experience processing distributions and loans for qualified retirement plans, with at least two years working in a remote working environment. In this position, you will provide work quality review for retirement plan loan and distribution requests. Nova 401(k) Associates is a vibrant and growing national third party, non-producing administration ﬁrm. We have a nationally recognized sales team allowing us to grow continuously and provide advancement opportunities for our professionals. Job Responsibilities: Review distribution and loan packages, including vesting verifications Work on more complicated distributions such as QDROs, death benefits, disability benefits, and Roth conversions as needed Assist with reviewing minimum required distributions and/or ADP/ACP refunds as needed Consider cyber security issues throughout review process Exemplify thorough understanding and interpretation of plan documents regarding distributions and loans Update account managers, management, and plan sponsors as necessary on requests and progress Pursue and attain NIPA's Distribution Administrator and Loan Administrator Certificates within one month of hire Perform other related duties as required Qualifications: Five or more years of experience processing retirement plan loans and distributions Strong knowledge of ERISA and Internal Revenue Code and Regulations specific to distributions Ability to establish priorities, work independently, and proceed with objectives without supervision Superior organizational and coordination skills Flexibility, adaptability, and ability to multi-task Coachable and committed to professional development Knowledge of Corbel Documents & Pension Pro is a plus Bachelor's degree preferred Compensation and Benefits: Base Pay: $55,000 - $70,000 Salaried, non-exempt Medical, dental, disability, and life insurance 401(k) plan with Employer Match Work Location/Hours: Work from Home Must work from USA and be authorized to work for any US employer We will supply all necessary computer equipment 40 hour work week Must work each day, Monday through Friday Must work a regular schedule during normal business hours We get it. We listen. We communicate. Click Here to review our Privacy Policy
$55k-70k yearly Auto-Apply 13d ago
Clinical Reviewer - SCA (Remote - RN/LPN)
Acentra Health
Remote veteran appeals reviewer job
Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes - making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector. Job Summary and Responsibilities Acentra seeks a Clinical Reviewer to join our growing team. Job Summary: The Clinical Reviewer utilizes clinical expertise during beneficiary interaction in conjunction with contract requirements, critical thinking and utilize decision-making skills to assist with communicating medical appropriateness, while maintaining production goals and QA standards. Ensures day-to-day processes are conducted in accordance with NCQA and other regulatory standards. * Shift Information: This position requires availability to work between 12pm - 8:30pm EST for an 8-hour shift and 10am - 8:30pm EST for a 10-hour shift. This position may also require a weekend and holiday rotation.* Job Responsibilities: * Assures accuracy and timeliness of all applicable review type cases within contract requirements * Assesses, evaluates, and addresses daily workload and call queues; adjusts work schedules daily to meet the workload demands of the department * In collaboration with Supervisor, responsible for the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas * Maintains current knowledge base related to review processes and clinical practices related to the review processes, functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns * Functions as providers' liaison and contact/resource person for provider customer service issues and problem resolution * Performs all applicable review types as workload indicates * Fosters positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process * Attends training and scheduled meetings and for maintenance and use of current/updated information for review * Cross trains and perform duties of other contracts to provide a flexible workforce to meet client/customer needs * Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules The list of accountabilities is not intended to be all-inclusive and may be expanded to include other education- and experience-related duties that management may deem necessary from time to time. Qualifications Required Qualifications * Active, unrestricted LPN or RN license in the applicable state and/or a Compact State license. * Knowledge of the organization of medical records, medical terminology, and disease process required * Strong clinical assessment and critical thinking skills required * Medical record abstracting skills required * 2+ years of clinical experience in a hospital or post-acute environment required. Preferred Qualifications * Minimum of one year UR and/or Prior Authorization or related experience. * Requires excellent written and verbal communication skills * Must be proficient in Microsoft Office and internet/web navigation * Bachelor's Degree from an accredited college or university in a related field * Some knowledge of Case Management, UR and/or Prior Authorization or related experience is preferred * Experience in call center environment a plus * Experience in a behavioral health setting a plus * Bilingual (English/Spanish) a plus Why us? We are a team of experienced and caring leaders, clinicians, pioneering technologists, and industry professionals who come together to redefine expectations for the healthcare industry. State and federal healthcare agencies, providers, and employers turn to us as their vital partner to ensure better healthcare and improve health outcomes. We do this through our people. You will have meaningful work that genuinely improves people's lives nationwide. Our company cares about our employees, giving you the tools and encouragement, you need to achieve the finest work of your career. Thank You! We know your time is valuable, and we thank you for applying for this position. Due to the high volume of applicants, only those who are chosen to advance in our interview process will be contacted. We sincerely appreciate your interest in Acentra Health and invite you to apply to future openings that may interest you. Best of luck in your search! ~ The Acentra Health Talent Acquisition Team Visit us at ******************************** EOE AA M/F/Vet/Disability Acentra Health 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, disability, status as a protected veteran, or any other status protected by applicable Federal, State, or Local law. Benefits Benefits are a key component of your rewards package. Our benefits are designed to provide additional protection, security, and support for your career and life away from work. Our benefits include comprehensive health plans, paid time off, retirement savings, corporate wellness, educational assistance, corporate discounts, and more. Compensation The pay range for this position is below: "Based on our compensation philosophy, an applicant's placement in the pay range will depend on various considerations, such as years of applicable experience and skill level." Pay Range USD $28.37 - USD $33.00 /Hr.
$28.4-33 hourly 8d ago
PEER REVIEWER - ORTHOPEDIC SPINE - REMOTE
Michigan Peer Review Organization 4.3
Remote veteran appeals reviewer job
iMPROve Health is seeking a Orthopedic Spine Physician to serve as an independent contractor (1099) performing independent external medical reviews remotely on an ad hoc basis. As a peer reviewer, you will apply your clinical expertise to evaluate cases, specific to your specialty, medical necessity and/or standard of care, supporting efforts to enhance the overall quality and integrity of health care and your profession. Please note, this is not an employed position and our contracted fee is based on credential and specialty type. BENEFITS: * Make a Difference: Use your clinical knowledge to improve the quality of care patients receive. * Professional Recognition: Join a network of highly respected experts in your specialty. * Competitive Compensation: Receive fair pay for your time and expertise. * Protect Standards of Care: Help uphold the integrity of your profession. * Work Remotely: Review cases from the convenience of your home or office. DUTIES AND RESPONSIBILITIES: * Conduct objective, evidence-based peer reviews of clinical cases. * Make final determinations regarding medical necessity and quality of care. * Ensure decisions are fair, unbiased, and aligned with current standards of practice. * Submit reviews in a timely and professional manner using the IT systems provided. QUALIFICATIONS: * Medical License: Must hold an unrestricted medical license in any U.S. state. * Board Certification:Required (if applicable), through a board recognized by: * The American Board of Medical Specialties (ABMS), * The American Osteopathic Association (AOA), or * Another nationally recognized board granting certification. * Clinical Experience: * Have at least five (5) years full-time equivalent experience providing direct clinical care to patients. * Have experience providing direct clinical care to patients within the past three (3) years. * Knowledgeable of the issue under review, or of the current, evidence-based clinical guidelines and novel treatments for the medical or behavioral health condition, disease, treatment, or procedure under review. * Have the clinical expertise to manage the medical or behavioral health condition or disease under review. * Must be actively engaged in direct or virtual patient care for at least 20 hours per week. Administrative work does not qualify. TECHNOLOGY REQUIREMENTS: * Reliable Wi-Fi access. * Proficiency with Microsoft Word. * Access to a computer compatible with iMPROve Health's IT systems. OTHER REQUIREMENTS: * Must complete the electronic credentialing application and receive organizational approval prior to performing a case review. * Must complete a conflict of interest attestation upon credentialing and prior to performing a case review. * Active hospital medical staff privileges may be required, as applicable. * Notify the organization in a timely manner of an adverse change in licensure or certification status, including board certification status. * Cannot have current employment or affiliation with any Veterans Affairs (VA) hospital, health care system, or medical center if applying to perform VA-related peer reviews. EOE/VET/Disability
$43k-63k yearly est. 17d ago
Elsevier Clinical Content Reviewer, Specialty Specific (Part-Time, Fixed Term Contract)
Osmosis 3.8
Remote veteran appeals reviewer job
Job Title: Clinical Content Reviewer - PT Fixed Term Contract About Elsevier A global leader in information and analytics, we help researchers and healthcare professionals advance science and improve health outcomes for the benefit of society. Building on our publishing heritage, we combine quality information and vast data sets with analytics to support visionary science and research, health education and interactive learning, as well as exceptional healthcare and clinical practice. At Elsevier, your work contributes to the world's grand challenges and a more sustainable future. We harness innovative technologies to support science and healthcare to partner for a better world. About our Team Elsevier Health is a division of Elsevier that is committed to supporting clinicians, health leaders, educators and students to overcome the challenges they face every day. We support healthcare professionals throughout their career journey from education through to clinical practice. We believe that by providing evidence-based information, we can help empower clinicians to provide the best healthcare possible. About the Role In this role, you will work closely with Elsevier Health data and content teams to ensure accuracy of content. You will play a critical role in reviewing content that will support clinicians at the point of care and providing as-needed feedback throughout the content and product development cycle. We are only hiring MDs/DOs from the following specialties: Family Medicine, Radiology, Pathology, Anesthesiology, OB/GYN, and General Surgery Responsibilities * Collaborate with our multidisciplinary team to create and curate content focused on emerging medical technologies * Create, rate, and rank queries based on their relevance, safety, and efficacy, helping healthcare professionals make informed decisions. * Review and assess the potential impact of various technologies on medical practice, patient care, and clinical outcomes. * Stay abreast of the latest advancements in the field of healthcare technology to ensure the content remains current and up-to-date. * Provide expert insights and perspectives on the integration of emerging technologies in clinical settings. Requirements This is a part-time, fixed term PRN role. * Terminal medical degree (MD or DO), specializing in one of the following: Family Medicine, Radiology, Pathology, Anesthesiology, OB/GYN, and General Surgery * At least 2 years of post-residency clinical experience * Active and unencumbered US-based license * Direct point of care experience within the US * Demonstrated interest and engagement with emerging technologies * Be comfortable working autonomously in a fully remote environment, must have proficiency in Microsoft Office (Outlook, Teams, and Excel) Compensation and Benefits: * Pay: This role will pay between $70-$80 USD / hour depending on the type of projects. * Perks: Gain access to Elsevier Health products, join a community of talented clinicians, and have an impact on the next generation of health solutions Work in a way that works for you We promote a healthy work/life balance across the organization. With an average length of service of 9 years, we are confident that we offer an appealing working prospect for our people. With numerous wellbeing initiatives, shared parental leave, study assistance and sabbaticals, we will help you meet your immediate responsibilities and your long-term goals. Working flexible hours - flexing the times when you work in the day to help you fit everything in and work when you are the most productive Working with us We are an equal opportunity employer with a commitment to help you succeed. Here, you will find an inclusive, agile, collaborative, innovative and fun environment, where everyone has a part to play. Regardless of the team you join, we promote a diverse environment with co-workers who are passionate about what they do, and how they do it. Why join us? * Purposeful Work When you work with us, your work matters. You are part of an organization that nurtures your curiosity to stimulate innovation for the communities that we serve. * Growing Every Day Like the communities we serve, you are on a constant path of discovery to shape your career and personal development. * Colleagues Who Care You will be part of the Elsevier family. We will support your well-being and provide the flexibility you need to thrive at work and home.
$49k-68k yearly est. Auto-Apply 60d+ ago
Title Reviewer - Remote Work from Home!
Aldridge Pite LLP 3.8
Remote veteran appeals reviewer job
Aldridge Pite, LLP is a multi-state law firm that focuses heavily on the utilization of technology to create work flow synergies with its clients and business partners. Aldridge Pite is a full-service provider of legal services to depository and non-depository financial institutions including banks, credit unions, mortgage servicing concerns, institutional investors, private firms, and other commercial clients. Aldridge Pite is dedicated to providing best-in-class representation across all of its Practice Areas through its unwavering subscription to three fundamental tenets: Partnership, Integrity, and Innovation. Purpose Review title reports on properties referred for foreclosure and identify any defects that may exist in the chain of title to determine whether title is clear to proceed with foreclosure or if title curative work may be needed. In addition to reviewing Georgia titles, this position will also have exposure to titles from Alabama and Tennessee properties. Specific Duties, Activities and Responsibilities Analyze and summarize title abstracts and recorded documents which affect condition of title to property (e.g., security deeds, conveyancing deeds, liens, UCCs etc.) Examine any probate documents in the chain of title Review to confirm that the legal description is valid. Experience with reading long legal descriptions and familiarity with survey terms required. May need to use Deed Plotter to check descriptions for closure Be familiar with Georgia Title Standards and identify title issues/defects (Alabama and Tennessee a plus) Compare descriptions in the chain of title to determine if vesting deed is correct and if the security deed encumbers the correct property Determine conditions required to obtain clear title through a foreclosure Examine security deeds, liens, orders, easements, plats, tax maps and surveys to verify legal description, ownership, restrictions, or conformity to requirements Review and confirm assignment chain is complete Review tax searches Verify that the information in the title search and accompanying documentation is accurate and complete Analyze encumbrances to title, familiarity with title statutes and standards, and prepare report outlining exceptions and actions required to clear title Prepare documentation of review and correspondence to transmit same with requirements to clear title to Vendor and Clients Initiate and follow-up on title issue resolution with Vendors, Attorneys and Clients to resolve title issues. Work closely with the Title Curative department Completes title related steps assigned to the firm within the client systems Assist with other duties and special projects as needed Job Requirements Bachelor's Degree Four to Six years of experience with residential real estate title and title insurance. Commercial experience a plus. Background with information technology a plus Ability to manage and prioritize large caseload Knowledge of Georgia title law and procedures Knowledge of Alabama and Tennessee title law and procedures a plus Knowledge of typical electronic default services platforms preferred (e.g. LPS, Tempo, Vendorscape) Working knowledge of general title policy underwriting standards In addition to remote work for most positions, we offer a comprehensive benefit program including: Company Paid Life and Disability Insurance plans Medical, Dental and Vision Plans with Prescription coverage 401K Retirement Savings Plan Flexible scheduling (within reason, depending on position) Generous PTO plan for all full-time employees Full equipment station at no cost for remote employees, including dual monitors Employee Assistance Plan, offering free 24/7 counseling and consulting services to support emotional health and wellbeing Wellness programs and employee discounts Learning and development training opportunities for both personal and professional growth And so much more! Aldridge Pite, LLP is fully committed to Equal Employment Opportunity and to attracting, retaining, developing and promoting the most qualified employees without regard to race, gender, color, religion, sexual orientation, national origin, age, physical or mental disability, citizenship status, veteran status, or any other characteristic prohibited by federal, state or local law. We are dedicated to providing a work environment free from discrimination and harassment, and where employees are treated with respect and dignity.
$65k-82k yearly est. Auto-Apply 60d+ ago
Coding & OASIS Reviewer- 1099 Contract Role/Remote Position
Healthcare Provider Solutions
Remote veteran appeals reviewer job
Our Company is seeking a RN or licensed therapist coder/OASIS reviewer to join our team for home health, or home health and hospice coding, needed for immediate work in remote/work from home setting. Requirements: Must have home health or home health and hospice coding experience (cannot only be hospice experienced) Must be coding certified (BCHH-C or HCS-D), and OASIS certified (COS-C, COQS or HCS-O) Must have minimum of 3 year of routine coding and OASIS review experience Must be a career Coder focuses on coding /OASIS at present and for at least the past year. Knowledge of more than 1 EMR system and must have the ability to learn others quickly and work in them efficiently and productively Must have reliable high-speed internet and computer less than 3 years old Must have basic computer skills Must have experience with the following EMR's: WellSky, My Unity, Axxess, Kantime, MatrixCare, HHMD, HCHB, Synergy, and DSL Must be able to use Microsoft Teams, Microsoft Outlook and know how to screen share Organization and Time Management Skills: Excellent verbal & written communication skills (must be able to read, write, and follow directions in English) Work and make decisions independently Ability to work well with others Works well under pressure Adaptable and flexible Detail oriented Job Type: 1099 Contract Role Medical Specialty: Home Health Education: Bachelor's (Preferred) Experience: Coding/OASIS: 3 years (Preferred) License/Certification: One of the following: RN/PT/OT/ST Medical Coding Certification (Preferred) OASIS certification (Preferred) Coding Certified (BCHH-C or HCS-D) OASIS Certified (COS-C, COQS or HCS-O) Application Question(s): Have you used Microsoft Office and/or Microsoft Teams? Are you able to navigate multiple tabs at once? Do you have basic computer skills? Work Location: Remote Healthcare Provider Solutions is an equal opportunity employer. We prohibit discrimination and harassment of any kind based on race, color, sex, religion, sexual orientation, national origin, disability, genetic, information, pregnancy, or any other protected characteristic as outlined by federal, state, or local laws.
$41k-59k yearly est. 60d+ ago
Enrollment Reporting Reviewer (onsite)
Keiser University
Remote veteran appeals reviewer job
The Enrollment Reporting Reviewer works under the Associate Vice Chancellor for Student Financial Services. The key contribution of the Enrollment Reporting Reviewer is to review, amend, and return accurate enrollment rosters to the NSLDS. Responsibilities: * Reviewing student enrollment rosters provided by NSLDS monthly * Tracking and revising all files in a timely manner * Assisting with the reporting of Gainful Employment and Financial Value Transparency (GE/FVT) data * Maintaining compliance with all federal regulations and university policies & procedures ESSENTIAL FUNCTIONS: The Enrollment Reporting Reviewer must be knowledgeable in Department of Education (ED) compliance regulations and follow the NSLDS Enrollment Reporting Guide and other ED regulations. The Reviewer must use various software tools to carry out the review and analysis of the following: * Rosters forwarded to the institution each month by the NSLDS * The institutional student information system (SIS) to match the rosters received * Internal systems to review, amend and return files to the NSLDS * Error Reports provided by the NSLDS stemming from submitted rosters * Reviewer will work with Registrar, Deans and others to resolve Enrollment data conflicts * Reviewer imports/exports files via the EdConnect System * Reviewer will work online, as needed, in NSLDS and COD and other systems as needed to validate accuracy of data * Reviewer will work Gainful Employment & Financial Value Transparency reporting Knowledge, Skills, and Experience: The Enrollment Reporting Reviewer role is primarily focused on the review of data related to federal enrollment reporting in higher education. The Enrollment Reporting Reviewer works closely with other Enrollment Reporting Reviewers to review multiple files for different schools and campuses throughout the organization. Below is an inclusive, but not exhaustive, list of various knowledge, skills, and other characteristics that are necessary for effective performance as the Enrollment Reporting Reviewer. Knowledge: * Understanding of data mining and data interpretation * Familiarity with database management systems to extract, transform & load data * Understanding of file formats and best practices for uploading & downloading data Skills: * Strong verbal and written communication for collaboration and reporting findings * Strong problem-solving skills and the ability to interpret complex data sets * Proficiency in data analysis, database management tools and file transfer protocols * Managing time effectively while maintaining a high degree of data analysis accuracy Experience: * 2 years of experience in data analysis including managing data files and troubleshooting transfer issues * 2 years quality assurance to ensure data accuracy through detailed review and data validation * 2 years working collaboratively across departments and teams Education, Experience, and Training: * Associate's degree required * Bachelor's degree preferred This is an onsite position located at the Office of the Chancellor in Fort Lauderdale, FL.
$38k-57k yearly est. 60d+ ago
Coding & OASIS Reviewer (PRN)
Netsmart
Remote veteran appeals reviewer job
Are you a certified clinical documentation professional looking for flexible PRN work? Join our team as a Coding & OASIS Reviewer where your expertise in ICD-10 coding and OASIS review will help drive accuracy, compliance, and quality in post-acute care documentation. What You'll Do Review OASIS and document recommended changes in approved system Review ICD-10 coding and sequencing from documentation in the patient chart Complete documentation of results review; ensure workflow processes are timely and accurate Document reason for change and recommended reimbursement impact. Consistently meet chart equivalent targets and quality metrics What You'll Bring Required At least 1 year of experience medical coding or OASIS review work experience HCS-D certification HCS-O OR COS-C certification Proven ability to consistently meet deadlines High attention to detail with excellent organization skills Demonstrates learning agility; seeks out opportunities for teaching, support, and professional growth Preferred Quality assurance work experience in a post-acute setting Expectations Comfortable with remote work arrangements and virtual collaboration tools Physical demands include extended periods of sitting, computer use, and telephone communication Netsmart is proud to be an equal opportunity workplace and is an affirmative action employer, providing equal employment and advancement opportunities to all individuals. We celebrate diversity and are committed to creating an inclusive environment for all associates. All employment decisions at Netsmart, including but not limited to recruiting, hiring, promotion and transfer, are based on performance, qualifications, abilities, education and experience. Netsmart does not discriminate in employment opportunities or practices based on race, color, religion, sex (including pregnancy), sexual orientation, gender identity or expression, national origin, age, physical or mental disability, past or present military service, or any other status protected by the laws or regulations in the locations where we operate. Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart's sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart's third party screening provider. If you are located in a state which grants you the right to receive information on salary range, pay scale, description of benefits or other compensation for this position, please use this form to request details which you may be legally entitled. All applicants for employment must be legally authorized to work in the United States. Netsmart does not provide work visa sponsorship for this position. Netsmart's Job Applicant Privacy Notice may be found here.
$39k-59k yearly est. Auto-Apply 60d+ ago
Authorization Management Clinical Reviewer
Wellsky
Remote veteran appeals reviewer job
As an Authorization Management Clinical Reviewer, you'll play a vital role in ensuring patients receive the right care at the right time. Your primary responsibility will be reviewing acute and post-acute authorizations before submission to the payer and verify medical necessity is met using InterQual guidelines. In this role, you'll collaborate with physicians, healthcare providers, and both internal and external stakeholders to support improved health outcomes. By following InterQual guidelines, you will ensure care is medically appropriate, high-quality, and cost-effective throughout the medical management process. What we're looking for: Strong acute-care clinical background with the ability to apply evidence-based guidelines. Proficiency with technology solutions, including Microsoft Office and utilization management support tools, familiarity with CarePort Care Management preferred. Licensed RN, with the ability to obtain other clinical state licensures, as needed. Flexibility to work up to two weekend shifts per month and in alignment with the following business hours: 8:00a - 8:00p (staggered shifts) eastern time on weekdays, 8:00a - 4:00p on Saturdays, and 12:00p - 4:00p on Sundays, except for WellSky-recognized holidays. Join us in shaping the future of healthcare - apply today! Key Responsibilities: Review acute and post-acute authorizations for medical necessity using InterQual guidelines. Collaborate with case managers, physicians, and medical directors to ensure appropriate levels of care. Participate in team meetings, educational activities, and interrater reliability testing to maintain review consistency and professional growth. Ensure compliance with federal, state, and accreditation standards, and identify opportunities to enhance communication or processes. Utilize knowledge of resources available in the healthcare system to assist physicians and patients effectively. Perform other job duties as assigned. Required Qualifications: Bachelor's Degree or equivalent work experience. Active RN License. At least 4-6 years relevant work experience. 2 years clinical acute nursing experience. 1-2 years' of hospital-based utilization management experience. Preferred Qualifications: Bachelor's Degree in Nursing. Denials and Appeals experience. Experience with managed care and CMS standards. UM/CM Knowledge of ICD / CPT / DRG's. Proficient in the use of window-based computer programs. Excellent verbal, written, and interpersonal communication skills. Critical thinking skills, creative problem solving, and proficient organization and planning skills. Experience with InterQual guidelines for acute-care and/or other clinical decision support tools, especially in utilization management and prior authorization processes. Experience with CarePort Care Management. Job Expectations: Willing to travel up to 30% based on business needs. Willing to work additional or irregular hours as needed. Must work in accordance with applicable security policies and procedures to safeguard company and client information. Must be able to sit and view a computer screen for extended periods of time. WellSky is where independent thinking and collaboration come together to create an authentic culture. We thrive on innovation, inclusiveness, and cohesive perspectives. At WellSky you can make a difference. WellSky provides equal employment opportunities to all people without regard to race, color, national origin, ancestry, citizenship, age, religion, gender, sex, sexual orientation, gender identity, gender expression, marital status, pregnancy, physical or mental disability, protected medical condition, genetic information, military service, veteran status, or any other status or characteristic protected by law. WellSky is proud to be a drug-free workplace. Applicants for U.S.-based positions with WellSky must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Certain client-facing positions may be required to comply with applicable requirements, such as immunizations and occupational health mandates. Here are some of the exciting benefits full-time teammates are eligible to receive at WellSky: Excellent medical, dental, and vision benefits Mental health benefits through TelaDoc Prescription drug coverage Generous paid time off, plus 13 paid holidays Paid parental leave 100% vested 401(K) retirement plans Educational assistance up to $2500 per year
$39k-59k yearly est. Auto-Apply 10d ago
Scientific Project Reviewers
Carbon Direct
Remote veteran appeals reviewer job
Join us on the journey to get to net zero At Carbon Direct, we dedicate our scientific, software, and business expertise to empower organizations around the world to take climate action. Our Mission Enable organizations to reduce, remove, and utilize their emissions with carbon science We are a purpose-driven carbon management firm dedicated to helping organizations around the world reach their climate goals. We make carbon science accessible and actionable with our end-to-end platform. Global citizens with global impact Whether a scientist, developer, or carbon markets expert, we are united by our mission to take climate action now. We are experts in our fields and we act with confidence. Located across 4 countries and in states all across the U.S., we offer both remote-friendly work options and dynamic, in-person experiences with offices located in Seattle, WA, Oakland, CA, and NYC. Diverse backgrounds bring diverse perspectives We recognize that teams with diverse backgrounds and different experiences are powerful. Bringing together a variety of perspectives only enhances how we can effectively address the climate crisis. Together, we are creating an environment where everyone is celebrated and anyone can succeed. About Carbon Direct Carbon Direct is a science-first organization that combines technology with deep expertise in climate science, data, and policy to deliver actionable climate strategies, and high-quality carbon dioxide removal to decarbonize the global economy. We have built a reputation as a trusted arbiter of high-quality strategy for carbon reduction, removal, and utilization throughout value chains, working with leading organizations. Our team of over 40 scientists includes thought leaders who actively contribute to the science of climate mitigation with novel assessment methodologies and public resources to facilitate action. With Carbon Direct, clients can set and equitably deliver on their climate commitments, streamline compliance, and manage risk through transparency and scientific credibility. Carbon Direct has applied its expertise to the completion of: Over 600 engineered, hybrid, and nature-based carbon credit project assessments, deep diligences for multi-year off-take agreements, and project co-design engagements. Over 150 unique emerging technology diligence reviews. Deep technical diligence de-risking engagements in improved forest management, reforestation, BECCS, and DAC, with commercial strategy support in collaboration with carbon credit developers to ensure that their products are best-in-class. Overview of the Opportunity Carbon Direct receives many client requests to diligence carbon projects. We are looking to bring on additional contractors to assist with project reviews. These cover a wide range of carbon dioxide removal and reduction technologies and would be appropriate for advanced graduate students (Masters or PhD level) in climate science fields (e.g., forestry, engineering, chemistry, environmental science, ecology) who are interested in gaining work experience. A review is generally a short report that follows a set template and examines the project proposal in the context of six quality criteria. Work is conducted with the oversight of a Carbon Direct senior scientist and subject to rigorous QA/QC. We operate a deliverable-based payment schedule based on the anticipated length and complexity of each assigned review. Equal Opportunity Employer Carbon Direct is an equal opportunity employer and does not discriminate on the basis of race, color, gender, religion, age, sexual orientation, national or ethnic origin, disability, marital status, veteran status, or any other occupationally irrelevant criteria. We adhere rigorously to our equal employment opportunity policies in connection with all employment decisions, including hiring, compensation and promotion.
$39k-59k yearly est. Auto-Apply 60d+ ago
Medical Reviewer (Medicare)
Broadway Ventures 4.2
Remote veteran appeals reviewer job
At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we're more than a service provider-we're your trusted partner in innovation. Job Type: Full-time (40 hours/week) Schedule: Monday-Friday, 8:00 AM - 5:00 PM EST (core hours) (Flex between 6am/7pm EST) Location: Remote (U.S. - Work from home) Remote Work Requirements: High-speed internet (non-satellite) and a private, lockable home office Equipment: You will be provided with all necessary equipment to perform your job effectively, including but not limited to a desktop computer, dual monitors, a headset, an ethernet cable, and additional accessories as needed. About the Role: We are seeking a dedicated Registered Nurse (RN) to join our Medical Review team. This role involves conducting pre- and post-payment medical reviews to ensure compliance with established clinical criteria and guidelines. The ideal candidate will use their clinical expertise to assess medical necessity, appropriateness, and reimbursement eligibility while documenting decisions in accordance with regulatory and organizational requirements. Key Responsibilities: Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals. Assess payment determinations using clinical information and established guidelines. Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement. Provide clear, well-documented rationales for service approvals or denials. Educate internal and external teams on medical review processes, coverage determinations, and coding requirements. Support quality control activities to meet corporate and team objectives. Assist with special projects and additional responsibilities as assigned. Minimum Qualifications: Licensure: Active, unrestricted RN license in the U.S. and in the state of hire OR Active compact multistate RN license (as defined by the Nurse Licensure Compact). Education: Associate Degree in Nursing OR Graduate of an accredited School of Nursing. Experience: Two years of clinical experience plus at least two years in one of the following: Inpatient/Outpatient settings (i.e. medical-surgical, rehabilitation, SNF, etc..) Utilization/Medical Review Quality Assurance Skills & Competencies: Strong clinical background in managed care and/or inpatient/outpatient settings. Ability to interpret and apply medical review criteria and clinical guidelines. Proficiency in Microsoft Office and word processing software. Strong analytical, organizational, and decision-making skills. Ability to work independently while managing priorities effectively. Excellent customer service, communication, and critical thinking skills. Ability to handle confidential information with discretion. Preferred Qualifications: Three years of clinical nursing experience in Inpatient/Outpatient settings, Utilization Review, Medical Review, or Quality Assurance (strongly preferred). Proficiency in using multiple screens and software programs simultaneously. Training and experience in ICD coding. What to Expect Next: After submitting your application, our recruiting team will review your qualifications. This may include a brief telephone interview or email communication to verify resume details and discuss compensation expectations. Interviews will be conducted with the most qualified candidates. Broadway Ventures conducts background checks and drug testing prior to the start of employment. Some positions may also require fingerprinting. Broadway Ventures is an equal opportunity employer and a VEVRAA federal contractor. We do not discriminate against applicants or employees on the basis of race, color, religion, sex, national origin, age, disability, protected veteran status, or any other status protected by applicable law. Reasonable accommodations are available for applicants with disabilities. Broadway Ventures utilizes the OFCCP-approved Voluntary Self-Identification of Disability Form (CC-305).
$42k-60k yearly est. Auto-Apply 2d ago
New York Real Estate Curriculum Reviewer (Contract)
Study.com 3.9
Remote veteran appeals reviewer job
New York Real Estate Curriculum Reviewer (Contract) Study.com is looking for Real Estate experts to evaluate and update Study.com's Real Estate content to ensure it meets current academic standards and industry requirements. Our ideal expert is knowledgeable in their field, detail-oriented, and capable of analyzing content organization. This is an online, remote contract role. Work will be paid hourly. Project Description Your role would include the following responsibilities: Research and Analysis: • Conduct comprehensive research on state-specific real estate licensing requirements • Stay updated on changes in real estate laws, regulations, and exam content outlines in the target states Course Auditing: • Review and audit existing courses for brokers and salespersons to ensure content accuracy and compliance with state requirements • Identify gaps or outdated information in course materials and recommend updates Question Bank Management: • Audit the existing practice question bank to ensure alignment with current state exam questions and formats • Review and evaluate new practice questions for relevance, accuracy, and compliance with state-specific regulations • Revise and update practice questions as needed to maintain the highest quality standards Required Skills: Active real estate license in good standing Minimum of five years of experience in the real estate industry Demonstrated expertise in state-specific real estate licensing requirements, particularly in NY Proficiency in using educational technology tools and platforms Additional Preferred Skills: Familiarity with online training courses for licensing and continuing education What We Offer: Reliable Payments: You'll receive payments twice a month and automated invoicing for your work. Remote Work: This is a fully online contracted work-from-home opportunity. Flexibility: Basically, there are no requirements! Work when you want, where you want, as often as you want, with no minimums/maximums. Support: Our supportive staff is available answer your questions and help you get up and running. About Study.com The mission of Study.com is to make education accessible, and over the last two decades we've become the leading online education platform, delivering a personalized learning experience across a broad continuum of education for over 30 million students, instructors, and professionals every month. We help empower millions of learners to achieve their education and career goals. We focus on increasing access to education because we know information is the ultimate equalizer and that education is key to upward mobility. Feel free to share this opportunity with any friends you think would be interested, too.
$40k-60k yearly est. Auto-Apply 60d+ ago
BPO reviewer
Infinity International Processing Services 3.9
Remote veteran appeals reviewer job
Infinity International Processing Services, Inc. is a leading provider of Broker Price Opinion (BPO) Quality Assurance ( Clerical Review) services to BPO/Appraisal Management Companies and Mortgage Lenders. We also provide Knowledge Process Outsourcing (KPO) and Business Process Outsourcing (BPO) services to 120+ global clients in Mortgage, Logistics, Finance & Accounting and Insurance industry. We are a global outfit having offices in Rockville, MD and India employing 1000+ employees. Towards our rapid expansion plan, we are recruiting clerical/administrative Broker Price Opinion (BPO) Reviewer cum Trainer. Job Description Responsibilities will involve reviewing of externally prepared broker price opinion reports for Clerical/Administrative errors and assuring compliance. Qualifications • Minimum of 10+ years of BPO review experience • Must be able to employ proper application of valuation techniques and methodologies • Travelling 30% ( Domestic/ International) • May have to travel to client's place for process training/transition • Handle client relation during test and ramp-up phase of new projects • Travel to offshore delivery centers in India and assist in training, project transition & ramp-up • Once offshore resources are ramped up, perform quality control • Must be able to work in a high volume production environment and meet deadlines • Good telephonic etiquette • Self prioritize tasks & work towards the same • Perform other related duties as assigned or directed by the management Additional Information Key Responsibilities:  Reviews BPOs for compliance with applicable USPAP, Fannie Mae, FHA, and client reporting guidelines, as well as completeness, consistency, logic, and appropriate valuation methodology  Approve or reject reports, requesting additional information as needed, and re-reviewing revised reports as they are received back from outside appraisers Job Type: Permanent / Work from home
$44k-61k yearly est. 2d ago

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Updated January 20, 2026

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