Role Description The Clinical Claim Review Manager is responsible for managing a team that is performing clinical reviews post service utilizing established guidelines and clinical criteria along with state and federal mandates and applicable benefit language to make determinations that drive better provider and member outcomes and lower the cost of care. The Clinical Claim Review Manager works in a fast paced, ever changing environment with a vigilant focus on improving the member and provider experience. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Managing a team that is performing clinical claim reviews, which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information. - Gathers metric data on staff performance, communicates metric results to direct reports via monthly scorecard and one-on-one meetings. Follows performance management guidelines. - Ensures company policies are followed such as but not all inclusive of Attendance, Telecommuting, etc. - Communicates process and policy updates to staff timely and clearly. - Ensures adequate training, precepting and coaching is provided to direct reports as needed. - Completes all operational reporting and data tracking timely and accurately. - Ensures work directions and assignments are appropriately communicated and adhere to business metrics. - Ensures staff development goals are established and supported and align with the MCR One Team growth mindset. - Participates in pilots, project development, and process changes as requested or when needed. - Handles manager level issues. - Actively involved in appropriate management meetings and projects. - Communicates priorities to the team and embraces a growth mindset. - Coordinates work activities with other Clinical Claim Review Managers. - Guides and leads a team to meet individual and team performance metrics. - Communicates well in writing and verbally. - Work independently and collaboratively with Medical Directors and non-clinical partners. - Adapt to a highly changing environment. Qualifications - A current unrestricted RN license in the state of residency. - 3+ years of total RN experience including some clinical experience in an inpatient / acute setting. - Leadership or Supervisory experience. - Demonstrate a proficiency in computer skills - Windows, Instant Messaging, Microsoft Suite including Word, Excel and Outlook. - Proven exemplary clinical documentation skills. - Proven excellent organizational, analytical, and critical thinking skills. - Must have a quiet secure designated work space and access to install secure high speed internet (minimum speed 1.5 download mps & 1 upload mps) via cable / DSL in home (wireless / cell phone provider, satellite, microwave, etc. does NOT meet this requirement). - Proven self-starter with the ability to handle a fast-paced production environment and multiple review types. Preferred Qualifications - Bachelor's Degree. - Have an RN License in a NLC (Nurse License Compact) state or the ability to apply and meet requirements for one. - Current knowledge of MCR processes. - Medicaid or Government Program experience for certain government positions. - Familiarity with Milliman Care Guidelines or Interqual. - Proven solid clinical judgement while applying medical necessity based on approved clinical resources and understanding of ICD-10 and CPT/HCPCS codes. - Proven background involving utilization review for an insurance company, experience in case management, or previous experience with clinical claim review. - Proven excellent verbal and written communication skills. - Proven ability to be flexible and willing to adapt to an ever changing environment. Benefits - A comprehensive benefits package. - Incentive and recognition programs. - Equity stock purchase. - 401k contribution (all benefits are subject to eligibility requirements). 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.

Role Description Resource Innovations is seeking a Market Research & Evaluation Sr. Manager or Principal to join our team. This position will be part of a dynamic, cross-functional team developing and executing market research, developing evaluation plans, and overseeing third party evaluators for California’s new market transformation program (CalMTA). CalMTA is focused on developing initiatives that accelerate adoption of emerging and underutilized energy efficiency technologies, services, and practices resulting in significant environmental and social benefits. California residents preferred, but remote candidates with California experience will be considered. As a Market Research & Evaluation Sr. Manager or Principal with Resource Innovations, you will work with other members of a cross-functional market research and evaluation team to design research and evaluation plans to support key planning, program implementation and investment decisions. This is a senior level position for a professional with a deep understanding of effective research processes, and experience with the evaluation of demand side management programs. As a Sr. Manager or Principal with Resource Innovations, you will be responsible for providing technical oversight and project management, as well as business development and team development for the Advisory Services business unit, working on energy efficiency (EE), demand response (DR), and distributed energy resource (DER) program analysis and measurement. Candidates who meet the minimum related work experience requirements are encouraged to apply. Duties and Responsibilities - Design research and evaluation plans for Market Transformation Initiatives (MTIs) to support key planning, program implementation, and investment decisions. - For assigned MTIs, serve the cross-functional team as the lead on research and evaluation methods aligning the objectives of research activities with initiative goals. - Provide technical expertise and quality management for the team’s market research, evaluation, analysis, and reporting activities. - Mentor team members, as appropriate, to ensure application of best practices in research, evaluation, and analysis of MTIs. - Serve as a liaison between MTI market research, evaluation, forecasting, and strategy leads – to ensure that MTI forecasts, plans, and implementation align with market research and evaluation findings. - Review research and evaluation plans and key deliverables. - Manage the communication of research and evaluation findings both internally and externally. - Manage third-party contractors commissioned to provide primary market research and/or MTI evaluations. - Lead a team of energy program-focused process evaluation and market research professionals. - Fully lead and manage projects from concept to implementation, including the development of plans, budgets, deliverables, and presentations. - Organize, lead and participate in client and stakeholder meetings. - Actively seek new opportunities for growing/expanding work with existing clients. - Identify and develop business with new clients, including lead generation and supporting proposal development. - Oversee primary and secondary data collection efforts as well as conducting data analysis. - Provide guidance to junior and mid-level staff on methods; conduct quality check of results and deliverables. - Lead and support technical report writing; contribute to draft reports, including results and actionable recommendations. - Communicate with clients in a timely manner and exhibit sound consulting business practices (timely delivery, managing to budget, margins, invoicing, aging). - Other duties as assigned. Qualifications - A minimum of 10 years’ experience working in a professional environment, with at least 5 years in market research or evaluation. - Bachelor’s degree in a relevant field (i.e. Social and Environmental Sciences, Public Policy, or Economics); Master's degree preferred. - Experience developing and leading the implementation of research, evaluation, and analysis plans – using appropriate methods to address research objectives. - Experience leading and interpreting quantitative and qualitative analysis. - Experience conducting market research based on secondary sources. - Experience conducting primary market research using a variety of qualitative and quantitative methods. - Research Instrument design, using a variety of research techniques. - Working knowledge of statistics and sampling and their relevance to developing high value research. - Competency with one or more data analysis software packages. - Excellent writing, and data analysis, interpretation, and presentation skills. - A minimum of 3 years’ experience supervising research and analysis professionals is preferred. Benefits - Competitive salaries based on a candidate's skills, experience, and qualifications for the position. - Compensation range for the base salary for this position is $109,000-$174,000. - Eligibility for a discretionary annual bonus. - Comprehensive benefits package designed to promote health, financial security, and work-life balance. - Three weeks of paid vacation annually. - Paid holidays. - 401(k) retirement plan with employer match. - Medical, dental, and vision coverage. - Parental leave. - Employee assistance program. - Commuter benefits and additional supplemental offerings. Company Description Resource Innovations (RI) is a women-led energy transformation firm focused on impact. Building on our expertise in energy efficiency, we're constantly expanding our portfolio of clean energy solutions to guide utilities through increasingly complex, connected challenges. Load flexibility. Electrification. Carbon reduction. With every step, we're leading the charge to power change. Resource Innovations is an Equal Opportunity Employer, committed to ensuring equal employment opportunities for all job applicants and employees without regard to race, color, religion, national origin, gender, age, disability, marital status, genetics, protected veteran status, sexual orientation, or any other protected status.

Role Description Resource Innovations is seeking a Market Research & Evaluation Sr. Manager or Principal to join our team. This position will be part of a dynamic, cross-functional team developing and executing market research, developing evaluation plans, and overseeing third party evaluators for California’s new market transformation program (CalMTA). CalMTA is focused on developing initiatives that accelerate adoption of emerging and underutilized energy efficiency technologies, services, and practices resulting in significant environmental and social benefits. California residents preferred, but remote candidates with California experience will be considered. As a Market Research & Evaluation Sr. Manager or Principal with Resource Innovations, you will work with other members of a cross-functional market research and evaluation team to design research and evaluation plans to support key planning, program implementation and investment decisions. This is a senior level position for a professional with a deep understanding of effective research processes, and experience with the evaluation of demand side management programs. As a Sr. Manager or Principal with Resource Innovations, you will be responsible for providing technical oversight and project management, as well as business development and team development for the Advisory Services business unit, working on energy efficiency (EE), demand response (DR), and distributed energy resource (DER) program analysis and measurement. Candidates who meet the minimum related work experience requirements are encouraged to apply. Duties and Responsibilities: - Design research and evaluation plans for Market Transformation Initiatives (MTIs) to support key planning, program implementation, and investment decisions. - For assigned MTIs, serve the cross-functional team as the lead on research and evaluation methods aligning the objectives of research activities with initiative goals. - Provide technical expertise and quality management for the team’s market research, evaluation, analysis, and reporting activities. - Mentor team members, as appropriate, to ensure application of best practices in research, evaluation, and analysis of MTIs. - Serve as a liaison between MTI market research, evaluation, forecasting, and strategy leads – to ensure that MTI forecasts, plans, and implementation align with market research and evaluation findings. - Review research and evaluation plans and key deliverables. - Manage the communication of research and evaluation findings both internally and externally. - Manage third-party contractors commissioned to provide primary market research and/or MTI evaluations. - Lead a team of energy program-focused process evaluation and market research professionals. - Fully lead and manage projects from concept to implementation, including the development of plans, budgets, deliverables, and presentations. - Organize, lead and participate in client and stakeholder meetings. - Actively seek new opportunities for growing/expanding work with existing clients. - Identify and develop business with new clients, including lead generation and supporting proposal development. - Oversee primary and secondary data collection efforts as well as conducting data analysis. - Provide guidance to junior and mid-level staff on methods; conduct quality check of results and deliverables. - Lead and support technical report writing; contribute to draft reports, including results and actionable recommendations. - Communicate with clients in a timely manner and exhibit sound consulting business practices (timely delivery, managing to budget, margins, invoicing, aging). - Other duties as assigned. Qualifications - A minimum of 10 years’ experience working in a professional environment, with at least 5 years in market research or evaluation. - Bachelor’s degree in a relevant field (i.e. Social and Environmental Sciences, Public Policy, or Economics); Master's degree preferred. - Experience developing and leading the implementation of research, evaluation, and analysis plans – using appropriate methods to address research objectives. - Experience leading and interpreting quantitative and qualitative analysis. - Experience conducting market research based on secondary sources. - Experience conducting primary market research using a variety of qualitative and quantitative methods. - Research Instrument design, using a variety of research techniques. - Working knowledge of statistics and sampling and their relevance to developing high value research. - Competency with one or more data analysis software packages. - Excellent writing, and data analysis, interpretation, and presentation skills. - A minimum of 3 years’ experience supervising research and analysis professionals is preferred. Benefits - Competitive salaries based on a candidate's skills, experience and qualifications for the position. - The compensation range for the base salary for this position is $109,000-$174,000. - In addition to base pay, employees may be eligible for a discretionary annual bonus. - Three weeks of paid vacation annually. - Paid holidays. - 401(k) retirement plan with employer match. - Medical, dental and vision coverage. - Parental leave. - Employee assistance program. - Commuter benefits. - Additional supplemental offerings. Company Description Resource Innovations (RI) is a women-led energy transformation firm focused on impact. Building on our expertise in energy efficiency, we’re constantly expanding our portfolio of clean energy solutions to guide utilities through increasingly complex, connected challenges. Load flexibility. Electrification. Carbon reduction. With every step, we’re leading the charge to power change. Resource Innovations is an Equal Opportunity Employer, committed to ensuring equal employment opportunities for all job applicants and employees without regard to race, color, religion, national origin, gender, age, disability, marital status, genetics, protected veteran status, sexual orientation, or any other protected status. In addition to federal law requirements, Resource Innovations complies with applicable state and local laws governing non-discrimination in employment in every location in which the company does work.

Title: Data Protection and Privacy Senior Associate Location: Anywhere in Country Job Description: Location: Anywhere in Country At EY, we’re all in to shape your future with confidence. We’ll help you succeed in a globally connected powerhouse of diverse teams and take your career wherever you want it to go. Join EY and help to build a better working world. Ethics, Compliance, and Risk Management (ECRM) supports our people in managing the risks that arise during our daily working lives. We work closely with all parts of the organization to identify, manage and monitor risk, providing coordinated advice and assistance on independence, conflicts, compliance, regulatory, policy, security issues, as well as dealing with claims and any queries regarding ethics. The opportunity We are operating in an increasingly connected world that is changing how to manage risk. With fast-paced technology advancements, new innovations within emerging technologies, and an ever-challenging regulatory environment, it is business critical for our organization to identify not only the risks but the opportunities these present to us. As a Data Protection & Privacy Senior Associate, you will support processes within the Ethics, Compliance, and Risk Management (ECRM). Our brand depends on it. It’s all part of our long-term commitment to building a better working world and in return, you can expect plenty of opportunities to take on new responsibilities and develop your career. Your key responsibilities As part of the EY Americas Data Protection (Confidentiality, Data Privacy) function, you will maintain visibility over and perform data protection due diligence activities around business processes and processing activities (i.e., Activity Privacy Impact Assessments (APIAs)). You will help to interpret data protection and privacy laws and policies, determine required actions to standard and non-standard situations, and make recommendations based on firm guidance, professional standards, subject matter expertise, and acquired experience. Skills and attributes for success - Supports the Compliance function of the Data Protection program as needed, including but not limited to: - - Conducting data protection due diligence reviews of business processes and data processing activities in order to enable EY compliance with legal/regulatory, EY firm, and EY client data protection and privacy requirements, - Developing procedures operationalizing data protection compliance measures, and monitoring and assessing adherence to implemented controls, - - Collaborating with various functions within the organization, such as Talent, Finance, Service Line Quality, and business teams to maintain visibility over evolving and new processing activities and bake in Data Protection compliance measures as appropriate, and - Creating reports on various data protection compliance activities to be delivered to key program stakeholders, including senior leaders within the organization; - Assists the Data Risk Management function of the Data Protection program as needed, including but not limited to: - - Documenting, conducting, and assisting others with investigations of data incidents (i.e., instances of loss, theft, or inappropriate disclosure of confidential/personal information); collaborating with clients, internal functions, and EY service lines to understand root cause, assess impact, and develop remediation plans, and - Developing and maintaining EY confidential and personal information inventory, in partnership with EY internal functions and service lines, to understand types of information that require protection and to fulfil data protection regulatory requirements (e.g., Records of Processing Activities (ROPA)). - Continuously maintains and expands knowledge of field of expertise and communicates new developments and resulting impact to program stakeholders and team members; and - Participates in various ad-hoc Data Protection and Privacy projects, as needs develop. To qualify for the role, you must have - Strong verbal and written communication skills - Solid understanding of relevant firm business and area wide data protection issues and concerns - Strong problem-solving skills - Flexibility and the ability to take the initiative - Ability to right-size risk - Strong research skills - Strong project management skills; ability to successfully handle multiple tasks - Good working knowledge of information systems and common software packages - Bachelor’s degree or equivalent work experience; Graduate degree or Juris Doctorate preferred - 1-4 plus years related experience Ideally, you’ll have - Ability to reference existing firm data protection and privacy policies as well as knowledge and experience to review complex situations and assist in proposing solutions - Strong knowledge of relevant global, national, and local data protection laws, regulations, and standards, as well as familiarity with other risk management initiatives outside of their specific area - Sound understanding of high-level technology trends and issues surrounding data protection - Privacy certification from ISACA or the International Association of Privacy Professionals (e.g., CIPP, CIPM, CDPSE, AIGP) What we look for We’re interested in people that will be able to right-size risk and recommend creative solutions to complex problems, as well as make significant contributions to complex Risk Management projects. What working at EY offers We offer a competitive compensation package where you’ll be rewarded based on your performance and recognized for the value you bring to our business. In addition, our Total Rewards package includes medical and dental coverage, both pension and 401(k) plans, a minimum of 18 days of paid time off with additional time based on your level and years of service plus 12 observed holidays, and a range of programs and benefits designed to support your physical, financial and social well-being. About EY As a global leader in assurance, tax, transaction and advisory services, we hire and develop the most passionate people in their field to help build a better working world. This starts with a culture that believes in giving you the training, opportunities and creative freedom to make things better. So that whenever you join, however long you stay, the exceptional EY experience lasts a lifetime. If you can confidently demonstrate that you meet the criteria above, please contact us as soon as possible. Join us in building a better working world. Apply now. What we offer you At EY, we’ll develop you with future-focused skills and equip you with world-class experiences. We’ll empower you in a flexible environment, and fuel you and your extraordinary talents in a diverse and inclusive culture of globally connected teams. Learn more. - We offer a comprehensive compensation and benefits package where you’ll be rewarded based on your performance and recognized for the value you bring to the business. The base salary range for this job in all geographic locations in the US is $71,700 to $130,100. The base salary range for New York City Metro Area, Washington State and California (excluding Sacramento) is $86,000 to $147,900. Individual salaries within those ranges are determined through a wide variety of factors including but not limited to education, experience, knowledge, skills and geography. In addition, our Total Rewards package includes medical and dental coverage, pension and 401(k) plans, and a wide range of paid time off options. - Join us in our team-led and leader-enabled hybrid model. Our expectation is for most people in external, client serving roles to work together in person 40-60% of the time over the course of an engagement, project or year. - Under our flexible vacation policy, you’ll decide how much vacation time you need based on your own personal circumstances. You’ll also be granted time off for designated EY Paid Holidays, Winter/Summer breaks, Personal/Family Care, and other leaves of absence when needed to support your physical, financial, and emotional well-being. Are you ready to shape your future with confidence? Apply today. EY accepts applications for this position on an on-going basis. For those living in California, please click here for additional information. EY focuses on high-ethical standards and integrity among its employees and expects all candidates to demonstrate these qualities. EY | Building a better working world EY is building a better working world by creating new value for clients, people, society and the planet, while building trust in capital markets. Enabled by data, AI and advanced technology, EY teams help clients shape the future with confidence and develop answers for the most pressing issues of today and tomorrow. EY teams work across a full spectrum of services in assurance, consulting, tax, strategy and transactions. Fueled by sector insights, a globally connected, multi-disciplinary network and diverse ecosystem partners, EY teams can provide services in more than 150 countries and territories. EY provides equal employment opportunities to applicants and employees without regard to race, color, religion, age, sex, sexual orientation, gender identity/expression, pregnancy, genetic information, national origin, protected veteran status, disability status, or any other legally protected basis, including arrest and conviction records, in accordance with applicable law.