• Functions in a clinical review capacity to evaluate all cases, which do not pass the authorization approval process at first call while promoting a supportive team approach with call center staff. • Renders authorization approval based on established clinical criteria; escalates to a Field Medical Director (FMD) if authorization cannot be approved during initial review. • Reviews charts and analyzes clinical record documentation in order to approve services that meet clinical review criteria. • Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for other clinical staff. • Converses with medical office staff to obtain additional pertinent clinical history/information; notifies of approvals and denials, giving clinical rationale, while providing optimum customer service through professional/accurate communication and maintaining NCQA and health plans required timeframes. • Documents all communication with medical office staff and/or treating provider. • Practices and maintains the principles of utilization management by adhering to policies and procedures. • Participates in on-going training programs to ensure quality performance in compliance with applicable standards and regulations, as well as, being audited to ensure guidelines are applied appropriately.

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. Max Salary: W-2 ($65,000/$31.25) 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. - Provide guidance to LPN team members and support non-clinical staff through training and discussions. - 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 hireOR - Active compact multistate RN license (as defined by the Nurse Licensure Compact). Education: - Associate Degree in NursingOR - Graduate of an accredited School of Nursing. Experience: - Two years of clinical experience. Skills & Competencies: - Strong clinical background in managed care, home health, rehabilitation, and/or medical-surgical 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. 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).

Job DetailsLevel: ExperiencedJob Location: Coppell, Needham Heights, or Remote - Needham Heights, MA 02494Position Type: Full TimeEducation Level: Graduate DegreeSalary Range: $440,000.00 - $460,000.00 Salary/yearJob Category: Health CareAbout Us Inform Diagnostics, a Fulgent Genetics Company, is a nationally recognized diagnostics laboratory focused on anatomic pathology subspecialties including gastrointestinal pathology, dermatopathology, urologic pathology, hematopathology, and breast pathology. Founded in 2011, our parent entity, Fulgent Genetics, has evolved into a premier, full-service genomic testing company built around a foundational technology platform. Through our diverse testing menu, Fulgent is focused on transforming patient care in oncology, anatomic pathology, infectious and rare diseases, and reproductive health. We believe that by providing a wide range of effective, flexible testing options in conjunction with best-in-class service and support, we can redefine the way medicine is managed for patients and clinicians alike. Since integrating with our therapeutic development business, Fulgent is also developing drug candidates for treating a broad range of cancers using a novel nanoencapsulation and targeted therapy platform. By merging our fields of expertise, we aim to become a fully integrated precision medicine company. Summary of Position The Pathologist, with expertise and/or fellowship training in Dermatopathology, will analyze and understand the clinical aspect of dermatologic diseases in order to provide superior and up-to-date clinically relevant pathological diagnoses and be capable of explaining the clinical and pathological significance of his/her interpretations. Key Job Elements Conduct routine pathologic examination of Dermatologic biopsies. Evaluate surgical Dermatopathology specimens and render insightful and comprehensive diagnoses to enable clinicians to best treat their patients. Consult with peer Pathologists on cases as requested or needed. Participate in Quality Assurance programs, i.e., serve as reviewer for cases and participate in intradepartmental conferences to ensure and improve accuracy of diagnoses and quality of care. May train and supervise pathology assistants, residents and fellows engaged in specialty training. May be involved in research activities. Follows established policies, procedures, and objectives, continuous quality improvement objectives, safety, environmental, and/or infection control standards. Promote and work to improve relationships with clinicians and the pathology community. Enhance personal and company reputation through one or more of the following activities: research/publishing, marketing, training, and/or leadership. QualificationsKnowledge/Experience Medical Doctor with Anatomical Pathology Board certification or eligibility and relevant experience and/or fellowship training in Dermatopathology. Medical Doctor or equivalent medical professional degree. Board Certified or eligible in AP or AP/CP by the American Board of Pathology. Significant expertise or fellowship training in Dermatopathology is preferred. Hold or be eligible to obtain unrestricted medical licensure in Massachusetts and other states. Strong scientific skills in surgical pathology, particularly Dermatopathology. Ability to effectively present ideas, findings, and document complex concepts in both written and oral communication. Environment Fulgent Therapeutics LLC is an Equal Employment Opportunity Employer. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. The term “qualified individual with a disability” means an individual with a disability who, with or without reasonable accommodation, can perform the essential functions of the position. Benefits include: Health, dental, vision, disability, life and AD&D insurance FSA and HSA plans Employee Assistance Program 401K plan Vacation time Annual sick leave Company-paid holidays Continuous education allowance Employee referral bonus program Childcare and commute allowance Voluntary elective benefits such as pet insurance, legal plan, accident, critical illness, and hospital indemnity insurance For California residents, please see the link below to access our CCPA Privacy Notice. CCPA Privacy Notice for California Residents https://tinyurl.com/FulgentCCPA Please note that Fulgent (and its affiliated companies, including Inform Diagnostics and CSI Laboratories) does not accept unsolicited information and/or resumes from search firms or agencies for our job postings. Search firms or agencies without an applicable contract and/or express approval to recruit for the role in question — that choose to submit a resume or client information to our career page or to any employee of Fulgent — will not be eligible for payment of any fee(s), and any associated shared data will become the property of Fulgent.

Medical Review Coordinator USX HEADQUARTERS 8:00am-5:00pm Position open to remote: Limited Grade: HR09 Compensation Range: $19.08-$22.47 Who We Are: Relentlessly Delivering Big Ideas. U.S. Xpress is one of the nation’s largest asset-based trucking companies. But the most valuable asset we offer isn’t tractors, trailers, or even our exclusive, cutting-edge technology. It’s the collective brainpower of thousands of visionaries and problem-solvers. Together, we are revolutionizing the transportation industry by providing innovative, custom solutions. And, here, we believe in the sanctity of a promise—both to our customers, and our people. When we focus our varied talents on reshaping the future of transportation, that’s what we call the POWER OF U.S. Why U.S. Xpress? Right Role. Right Tools. Right People. We invest in our talent starting on day one. You will be provided with personal and professional development opportunities that complement your interests and encourage you to build a career you’re passionate about. Whether it is employee stock options, profit-sharing, 401K, professional development, or our competitive pay, we help prepare you for the future. Be part of an organization that values out-of-the-box thinking and rewards employees for going above and beyond. Curious about the other benefits of working with us? Check out other perks below! - Medical, Dental, and Vision - Basic/Supplemental Life - Accidental Death/Dismemberment - Health Savings Accounts - Flexible Savings Accounts - Company Paid Holidays - Paid Time Off - 401k with Employer Matching Contribution - Employee Stock Purchase Plan - Paid Parental Leave - Short Term Incentive Program - Employee Assistance Program - Pet Insurance Primary Position Purpose: Dedicated to the well-being of our trucking team, the Medical Review Coordinator plays a pivotal role in ensuring optimal health support. Responsibilities include coordinating medical services, managing health records, and facilitating timely access to healthcare resources for our drivers. The role involves proactive engagement with drivers to assist in scheduling medical appointments, promoting wellness programs, and ensuring strict adherence to health and safety protocols. By cultivating a culture of health and care, the aim is to contribute significantly to the overall well-being and productivity of our valued trucking professionals. Will interact with Safety team members, Operations, internal USX departments, drivers, and third-party entities to keep drivers’ qualifications current and DOT-compliant. Position Functions: · Assist driver compliance with the coordination of driver medical exams with drivers and operations team leaders in advance of any driver whose qualifications are scheduled to expire. · Review and triage incoming medical documents and reports for accuracy and relevance. · Coordinate with healthcare providers to gather necessary information and documentation. · Monitor and update patient records and databases to ensure information is current. · Support the medical review process by organizing and prioritizing tasks. · Support human resources with conducting follow ups for drivers on medical hold. · Provide education to USX employees regarding driver physical qualification requirements. · Update driver profile after any extended absence. Issue authorization or denial for driver to return to truck. · Request, coordinate, and/or review driver qualification records within the timelines specified by DOT regulations and USX policy. · Review driver medical release forms, discharge paperwork, and medication statements to ensure adequate documentation to return to work. · Understand driver job responsibilities and communicate physical job requirements with medical personnel. · Coordinate drivers return to work by assisting with next steps to ensure compliance with regulations and company policies. · Collaborate with human resources and claims to ensure return to work processes are properly administered and followed. · Document all pertinent driver interactions and/or safety information within designated systems. · Establish and maintain effective business relationships with third-party partners and agencies involved in the driver qualification process. · Analyze trends and historical information to identify areas where compliance issues are occurring. · Review area processes and procedures to identify and communicate improvement opportunities. · Assist in administering other safety programs and/or functions as directed by management. · Provide backup support for specialists/managers in their roles to ensure continuity and efficiency in operations. · Maintain and manage confidential personal information and Company records per established guidelines. · Prepare and summarize medical reviews for further analysis and decision-making. · Assist with email communications for the medical inbox, ensuring timely and accurate responses. · Perform other duties as assigned. · Collaborate in-person with all levels of the organization to harness collective intelligence of the workforce. · Attend all in-person meetings and trainings on recent developments, goals, and objectives. Participate in such discussions by offering input and advice. · Regularly engage remotely and in-person with customers and potential customers to establish rapport, open communication, and expectations. What We’re Looking For: Education · High school diploma or equivalent required. · Equivalent years of experience are defined as one year of professional experience for each year of college requested. Experience · 1+ year in medical field preferred - Safety/Compliance background preferred · Transportation, Logistics, and/or Tech experience a plus Skills & Abilities · Knowledge of prescription medications and drug interactions · Knowledge of physical examination and medical history practices · Knowledge of DOT regulations preferred · Proficient with Microsoft suite (Word, Excel, PowerPoint, Outlook, Power BI) · Strong organizational and time management skills · Strong communication and interpersonal skills · Confident decision making skills · Ability to quickly adapt to changing regulations and guidelines · Motivated to achieve results · Adept at assessing organizational dynamics and managing change · Works quickly and efficiently. Able to test solutions, learn, and iterate quickly · Proactive and pragmatic problem solver · Communicates effectively across multiple mediums · Adept at assessing organizational dynamics and managing change · Works quickly and efficiently. Able to test solutions, learn, and iterate quickly · Proactive and pragmatic problem solver · Communicates effectively across multiple mediums Licenses & Certifications · CMA, EMT, or LPN preferred Supervisory Responsibility · N/A Work Environment / Physical Requirements – Normal office settings. This job description indicates the general nature and level of work expected for this position. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities. Employees performing this job may be asked to perform other duties as required and the responsibilities of the position may change. Reasonable accommodations will be made to enable individuals with disabilities to perform the essential functions. U.S. Xpress is an Equal Opportunity Employer committed to creating and maintaining a diverse workforce. This role will remain open until it has been filled. #LI-Hybrid