Role Description Dane Street wants you to join our dynamic team of expert reviewers! In this role, you will have the opportunity to utilize your medical expertise to conduct thorough reviews of clinical cases. This telework opportunity allows you to customize your schedule as a 1099 independent contractor. - Evaluate medical records - Provide clinical summaries - Engage in peer communications - Answer specific questions posed by our clients We are on the lookout for talented professionals in the following area: - Allergy - Immunology Be a part of a team that values your skills and dedication to improving patient care. Your expertise is vital to helping us deliver high-quality healthcare assessments. Qualifications - Board Certified - Current, unrestricted Medical License - 5+ years of clinical practice experience/actively practicing - Attends all required orientation and training - Maintains proper credentialing, state licenses, and any certifications or requirements necessary to perform the job Requirements - PLEASE BE AWARE: In the interest of maintaining the security of all involved parties, Dane Street will never conduct interviews via text or request checks from candidates for any reason, including the purchase of equipment. Benefits - Dane Street supports all referral processes - Scheduling and preparation of cases extensively - Preparation of all medical records - Provides transcription services as applicable - Facilitates all client communications - Ensures the quality and timeliness of all reports and report delivery

Role Description Responsible for identifying, researching, processing, resolving, and responding to inquiries from internal and external customers with emphasis on excellence, privacy, compliance and versatility within the health insurance industry. Qualifications - 2 years of experience in clinical field of practice, health insurance, or other health care related field - Associate’s Degree in general field of study or Post High School Nursing Diploma or Certification (LPN only) from an approved program - Active, current, and unrestricted license to practice in the State of Arizona (or an endorsement to work in Arizona) as a behavioral health professional such as LCSW, LPC, LISAC LMFT, or licensed psychologist (Psy.D. or Ph.D.), OR an active, current, and unrestricted license to practice nursing in either the State of Arizona or another state in the United States recognized by the Nursing Licensure Compact (NLC) as an RN, OR an active, current, and unrestricted license to practice in the State of Arizona as an LPN. Requirements - Identify, research, process, resolve and respond to customer inquiries and correspondence via telephone, written communication and/or in person. - Answer a diverse and high volume of health insurance related customer calls or correspondence on a daily basis. - Analyze medical records and apply medical necessity criteria and benefit plan requirements to determine the appropriateness of benefit requests. - Maintain complete and accurate records per department policy. - Meet quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines and required by State, Federal and other accrediting organizations. - Explain to customers a variety of information concerning the organization’s services, including but not limited to, contract benefits, changes in coverage, eligibility, claims, BCBSAZ programs, provider networks, etc. - Demonstrate ability to apply plan policies and procedures effectively. - Consult and coordinate with various internal departments, external plans, providers, businesses, and government agencies to obtain information and ensure resolution of customer inquiries. - Collaborate with team to distribute workload/work tasks; Monitor and report team tasks; Communicate team issues and opportunities for improvement to supervisor/manager; Support/mentor team members. - Participate in continuing education and current developments in the fields of medicine and managed care. - Maintain all standards in consideration of State, Federal, BCBSAZ and other accreditation requirements. - Perform all other duties as assigned. Benefits - Onsite expectation of 0 days per week and requires a full-time work schedule. - Full-time is defined as working at least 40 hours per week, plus any additional hours as requested or as needed to meet business requirements. Company Description Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the diverse needs of individuals, families, and small and large businesses as well as providing information and tools to help individuals make better health decisions. At AZ Blue, we have a hybrid workforce strategy, called Workability, that offers flexibility with how and where employees work. Our positions are classified as hybrid, onsite or remote. - Hybrid People Leaders: must reside in AZ, required to be onsite at least twice per week - Hybrid Individual Contributors: must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per week - Hybrid 2 (Operational Roles such as but not limited to: Customer Service, Claims Processors, and Correspondence positions): must reside in AZ, unless otherwise cited within this posting, required to be onsite at least once per month - Onsite: daily onsite requirement based on the essential functions of the job - Remote: not held to onsite requirements, however, leadership can request presence onsite for business reasons including but not limited to staff meetings, one-on-ones, training, and team building Please note that onsite requirements may change in the future, based on business need, and job responsibilities. Most employees should expect onsite requirements and at a minimum of once per week. This remote work opportunity requires residency, and work to be performed, within the State of Arizona.

Role Description The Medical Review Nurse is a registered nurse who can assist Novacore’s Claim and Underwriting Departments in managing risk and mitigating claims exposure. - Assist underwriters in the timely evaluation of clinical and claim data during the disclosure process to identify potential risk. - Work with Third-Party Administrators and producers as a medical resource for discussion and assistance with potential catastrophic claim management. - Assist Case Managers, either employed by Carbon’s TPAs, or with outside firms, with high dollar catastrophic claimants. - Evaluate claims reporting for potential exposure and reserve recommendations. - Clinical review and claims analysis to assess claim trends and possible group resources. - Maintain patient confidentiality in compliance with standards set forth by Carbon as well as HIPAA. - Work with the department manager in seeking and employing new business partners to promote health care resources and mitigate claims exposure. - Serve as a back-up for other department medical staff as needed. - Maintain licensure and certifications as indicated to promote personal professional advancement. Qualifications - Registered Nurse active license required - BSN preferred. - CCM certification, preferred. - At least one year of acute care clinical experience. - UM or CM experience on either the payer or provider side. - Prior TPA, MGU or Stop loss carrier experience is highly preferable. - Prior experience analyzing health care claims and coding. - Prior experience working with catastrophic health care claims. - Experience with data entry and analysis of medical reporting. - Provide risk assessment and communicate the analysis succinctly in reporting. - Ability to conduct independent medical research as an adjunct to medical underwriting tasks. - Ability to meet tight time frames. - Strong organizational and time management skills. - Ability to work independently in a remote setting. - Ability to work with multiple offices and underwriters and prioritize time frames. - Proficient with MS Office software. - Ability to communicate effectively and professionally both internally and with external clients. Benefits - A collaborative, results-driven environment. - Competitive compensation and comprehensive benefits. - Year-round social and community events. - Ongoing mentorship and professional development. - Endless opportunities for upward mobility.

Role Description The DVM Selections Reviewer will review applicants to the TAMU College of Veterinary Medicine & Biomedical Sciences and utilize standard rubrics to assign scores to each candidate packet. - Applicant Packet Review: Reviews each component of applicant packets using a standardized scoring rubric; maintains strict confidentiality, follows FERPA laws. Debriefs after the process is completed. - Discrepancy Resolution: Resolves any review flags or discrepancies in packet review with the co-reviewer. - Training Activities: Develops mastery of the rubrics used for assessing applicants; attends training regarding packet review; learns scoring rubric for each portion of the application. - Other Duties: Performs other duties as assigned. Qualifications - Bachelor’s Degree (or equivalent combination of education and experience) - Master's degree or higher (or equivalent years of experience) - Knowledge of FERPA - Experience using a standardized rubric in previous positions. Requirements - Must be detail-oriented, able to follow a standard rubric, and work independently. - This is a remote position, and the applicant must have a reliable internet connection and computer access. Additional Information - Machines or equipment used in the performance of essential duties: Computer (35 hours per week); phone collaboration (1 hour per week). - This position is security sensitive. - This position requires compliance with state and federal laws/codes and Texas A&M University System/TAMU policies, regulations, rules and procedures. - All tasks and job responsibilities must be performed safely without injury to self or others in compliance with System and University safety requirements. Instructions to Applicants - Applications received by Texas A&M University must either have all job application data entered, or a resume attached. Failure to provide all job application data or a complete resume could result in an invalid submission and a rejected application. - We encourage all applicants to upload a resume or use a LinkedIn profile to pre-populate the online application. - All positions are security-sensitive. Applicants are subject to a criminal history investigation, and employment is contingent upon the institution’s verification of credentials and/or other information required by the institution’s procedures, including the completion of the criminal history check.