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Connected care. Smarter care.
Utilization Review Clinician
Location
United States
Posted
62 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Utilization Review Clinician
WellSky
Role Description This role will require the successful candidate to work the shift of Thursday to Sunday, 6AM to 5PM OR 7AM to 6PM Central time. The Utilization Review Clinician is responsible for reviewing medical records to determine medical necessity. This includes: - Conducting patient evaluations - Managing admissions and informational visits - Ensuring timely post-discharge follow-ups with completed assessments to help prevent acute care readmissions In this role, you will also: - Review requests for post-acute services promptly, using established clinical guidelines and coverage criteria to assess appropriateness - Collaborate with physicians, healthcare providers, and both internal and external stakeholders to support improved health outcomes - Apply clinical expertise to coordinate care with facilities and providers - Follow standard operating procedures and organizational policies - Consult with peer reviewers, Medical Directors, or delegated clinical reviewers to ensure care is medically appropriate, high-quality, and cost-effective throughout the medical management process The ideal candidate will have working knowledge of Microsoft Office applications (e.g., Word, Excel) and be comfortable using clinical decision support tools and operational software. Join us in shaping the future of healthcare - apply today! Qualifications - Bachelor's degree or equivalent work experience - 4-6 years of clinical nursing or therapy experience - Active RN, OT, or PT license Requirements - 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 Benefits - Excellent medical with Rx, dental, and vision benefits - Mental Health support through EAP - Generous paid time off, plus 13 paid holidays - 100% vested 401(K) retirement plans - Educational assistance up to $2500 per year
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Are you someone who thrives on organization, communication, and making a meaningful impact behind the scenes? MEM Insurance is seeking a Medical Services Coordinator to support our Nurse Case Management (NCM) team within the Claims department. In this role, you will play an important part in coordinating non‑clinical administrative activities that allow our nurses to focus on delivering high‑quality, patient‑centered care. You will serve as a key connector—working closely with healthcare providers, vendors, injured workers, and internal partners to ensure medical appointments, documentation, and care coordination activities are completed accurately and on time. Your contributions will help improve workflow efficiency, reduce administrative burden on clinical staff, and support MEM’s mission of helping people recover and move forward. Essential Duties and Responsibilities - Coordinate scheduling and logistics for medical appointments, diagnostic testing, and therapy services related to workers’ compensation claims. - Communicate with healthcare providers, vendors, and injured workers to confirm appointments and ensure all required documentation is obtained. - Track scheduled services and proactively follow up to ensure timely completion and receipt of reports. - Request, obtain, organize, and maintain medical records and reports from healthcare providers and vendor partners. - Prepare and manage case documentation related to referrals, appointments, and care coordination activities. - Accurately enter and update case information in electronic systems in accordance with departmental standards and compliance requirements. - Monitor data accuracy and assist with reporting or audit requests as needed. - Serve as an administrative liaison between the Nurse Case Management team and external partners to support non‑clinical aspects of care coordination. - Provide general administrative and organizational support to ensure efficient day‑to‑day operations of the NCM team. - Act in alignment with MEM Insurance’s vision, mission, and values. Qualifications Education - High school diploma or equivalent required - Bachelor’s degree preferred Experience - Minimum of 2 years of administrative experience, preferably in a healthcare, insurance, or case management environment Licenses - Valid driver’s license required Company Culture and Values At MEM Insurance, we are committed to our vision, mission, and values. We foster a culture of collaboration, integrity, and innovation. Our team is passionate about delivering exceptional service to our customers while supporting each other’s growth and success. We believe in accountability, continuous learning, and creating an environment where employees feel valued and empowered. Diversity Statement MEM Insurance is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We believe that varied perspectives drive innovation and strengthen our ability to serve our customers and communities. Total Rewards Overview - Competitive base salary - Annual performance bonus - Company car - Health Plans: Medical, Dental, and Vision Includes fertility benefits, fully paid preventative care, and adult orthodontia. - Employer-Paid Life and Disability Benefits: Life Insurance (3x base salary), AD&D, Short and Long-term Disability. - Wellness and Recognition Program: Employer-paid incentives for employees and spouses. - Flexible Spending Account and Dependent Care options - Health Savings Account: Generous employer contribution. - Time Away from Work: Generous PTO, 11 Holidays + 4 Early Releases, 16 Hours Volunteer Time Off, 20 Days Paid Parental Leave, Marriage, Bereavement, and Jury Duty leave. - Employee Assistance Programs - 401k Retirement Plan: Employer match and profit sharing. - Adoption Assistance and Tuition Assistance Notice Regarding Use of Artificial Intelligence MEM may use artificial intelligence (AI) tools to more efficiently facilitate and assist in decisions involving recruitment, hiring, promotion, renewal of employment, selection for training or apprenticeship, discharge, discipline, tenure, or the terms, privileges, or conditions of employment. Any such use of AI tools will comply with all applicable laws.
Senior Medical Science Liaison- Hematology/LSD (West)
TakedaTakeda is proud in its commitment to creating a diverse workforce and providing equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, sexual orientation, gender identity, gender expression, parental status, national origin, age, disability, citizenship status, genetic information or characteristics, marital status, status as a Vietnam era veteran, special disabled veteran, or other protected veteran in accordance with applicable federal, state and local laws, and any other characteristic protected by law.
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Supervisory Principal - Central Supervision Principal
LPL FinancialWe take care of our advisors, so they can take care of their clients.
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Company Description At Intelerad, we believe the path to answers in healthcare should be clear-whether you are waiting for a diagnosis or trying to expedite one. Our medical imaging solutions streamline the flow of information, simplifying complex processes, maximizing efficiencies, and shining a light on the unknown. We empower physicians to get patients the answers they need faster and improve outcomes for everyone. With more accessible imaging, we are getting patients out of the dark. Headquartered in Raleigh, NC and Montreal, Intelerad has nearly 800 employees located in offices across four countries. The company empowers nearly 2,000 healthcare organizations around the world with the speed, scalability, and simplicity needed to increase business performance while, most importantly, improving patient outcomes. Intelerad’s modern enterprise solutions have been acknowledged by a Best in KLAS recognition, ranking #1 for PACS Asia/Oceania in the 2021 Best in KLAS: Global Software (Non-US) report. Job Description The Site Reliability Specialist III plays a critical role in maintaining the performance, availability, and scalability of Intelerad's mission-critical healthcare imaging platforms. This position combines deep technical expertise in SQL database administration, system administration, software deployments, and cloud infrastructure to ensure our PACS, RIS, and enterprise imaging solutions deliver the reliability that healthcare providers depend on 24/7. In addition to core database responsibilities, the role includes hands-on system administration tasks and software deployment activities typically performed by a system administrator. As healthcare IT continues its evolution toward cloud-based architectures, this role will be instrumental in supporting and advancing our cloud transformation initiatives while maintaining the high standards of system performance our clients expect. 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Qualifications Required Qualifications & Experience - Bachelor's degree in Computer Science, Information Technology, or equivalent experience - 5+ years of experience in system administration, site reliability engineering, database administration, or similar technical operations roles supporting enterprise production environments - Strong SQL Server experience including performance tuning, query optimization, index management, backup/recovery procedures, and database maintenance in production environments - Demonstrated system administration experience, including Windows and/or Linux server management, OS installation/configuration/upgrades, patching, security hardening, user and permission management, and hardware/software troubleshooting - Hands-on experience with software deployments, release management, and application rollout processes in production environments (including change control, rollback planning, and post-deployment validation) - Proficiency with Windows and/or Linux server administration, including scripting and automation (PowerShell, Bash, Python) for both database and general system tasks - Demonstrated experience with cloud platforms (AWS, Azure, or GCP) including compute services, storage solutions, networking, and cloud-native monitoring tools - Experience with monitoring and observability tools (Prometheus, Grafana, Splunk, DataDog, or similar) - Strong troubleshooting and analytical skills with ability to diagnose complex technical issues under pressure - Excellent communication skills with ability to collaborate across technical and non-technical teams Preferred Qualifications & Special Requirements - Cloud certifications (AWS Solutions Architect, Azure Administrator, Google Cloud Professional, or equivalent) - Experience with healthcare IT systems, particularly PACS, RIS, or medical imaging platforms - Knowledge of healthcare data standards and compliance requirements (HIPAA, DICOM, HL7) - Experience with infrastructure-as-code tools (Terraform, CloudFormation, ARM templates) - Familiarity with containerization technologies (Docker, Kubernetes) - Experience with SQL Server high availability solutions (Always On, clustering, replication) - Understanding of DevOps practices and CI/CD pipelines (especially as they relate to software deployments and system updates) - Experience with virtualization technologies (VMware, Hyper-V) and server hardware management Additional Information All your information will be kept confidential according to EEO guidelines. Applicants may be required to complete an online technical and/or personality assessment as part of your application. #LI-REMOTE Intelerad uses SmartRecruiters’ platform, which includes optional AI-assisted features (such as Winston Match, Screen, and Companion) to help our Talent Acquisition team streamline and enhance parts of the recruitment process. These tools are designed to support, not replace, human judgment and decision-making. All hiring decisions are ultimately made by our recruiters and hiring leaders. To learn more about how SmartRecruiters uses AI within its system and how it complies with applicable regulations, please review SmartRecruiters’ AI Addendum. https://www.smartrecruiters.com/legal/artificial-intelligence-addendum/ The base pay for this position ranges from $90,000-110,000 USD per year within any geographic market in the USA. Pay may vary depending on job-related knowledge, skills, and experience. Intelerad is a total compensation company. Pay is dependent on the position offered. Bonus and other forms of compensation may be provided as part of a total compensation package, in addition to a full range of medical, financial, retirement, PTO, and/or other benefits. Intelerad is committed to the principles of equal employment. We are committed to complying with all federal, state and local laws providing equal employment opportunities and all other employment laws and regulations. Applicants, employees and former employees are protected from employment discrimination based on race, color, religion, sex (including pregnancy, sexual orientation, or gender identity), national origin, age , disability and genetic information (including family medical history). Intelerad is dedicated to the fulfillment of this policy regarding all aspects of employment, including but not limited to recruiting, hiring, placement, transfer, training, promotion, rates of pay, and other compensation, termination, and all other terms, conditions, and privileges of employment. Intelerad is committed to ensuring equal employment opportunity for qualified individuals with disabilities. Intelerad uses the Americans with Disabilities Act (“ADA”)as a standard for global recruiting and hiring purposes. This prohibits discrimination against qualified individuals with disabilities. The ADA defines “disability” as a physical or mental impairment that substantially limits one or more of the major life activities of an individual, a record of such impairment, or being regarded as having such an impairment - Compensation: USD 90000 - USD 110000 - yearly

