This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Greenlife Healthcare Staffing is seeking an experienced Registered Nurse Clinical Reviewer (IDR) to join a Non-profit organization located in New York. Responsibilities include conducting comprehensive medical-legal reviews and appeals. - Conduct reviews up to and including the appeal level, including chart screening, compiling regulatory guidance, researching insurer requirements, completing electronic worksheets, and preparing final determinations. - Act as a resource for the administrative and clinical staff in training, problem-solving, and clarifying determinations. - Provide technical assistance and conduct/participate in staff huddles. - Participate in collaborative training. - Other activities as may be deemed necessary. Qualifications - Baccalaureate degree in Nursing or a graduate of an approved RN program. - Current New York State RN license. - At least 3 years of experience in a Med-Legal review setting. - 1-3 years of experience in acute care utilization review/appeals background. - Experience with electronic medical records; strong research capabilities. - Excellent written/verbal communication; ability to work independently; flexible and innovative; meets deadlines in sensitive environments; strong collaborative and problem-solving skills. Requirements - Full-time employment. Benefits - Hourly Rate: $60/hr - Paid Vacation (after 6 months of employment) - 6 Major Paid Holidays per year (after 6 months of employment) - 5 Sick Days (40 Hours) subject to the provisions of NYS Paid Sick Leave Act - License Reimbursement after 1 year of employment - Health insurance is subject to plan eligibility requirements - 401(k) Matching eligibility after 1 year of employment - Benefits from Paychex, such as Payactiv - 93% retention of employees 2 years+, Google reviews, great company culture, etc. How to Apply If you are ready to advance your career, we want to hear from you! Submit your Resume/CV to hr@glhstaffing.com or call our office at (800) 608-4025 to learn more about this opportunity.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description 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? Administrative Fiduciary Services is looking to fill a full-time, 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. Job Responsibilities: - Review of 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 - Assist in training and mentoring of junior staff members throughout the year - 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 Requirements - Work from Home - Must work from USA and be authorized to work for any US employer - We will supply all necessary computer equipment - Must work a regular schedule during normal business hours (7:30 am – 4 pm) Benefits - Base Salary $60,000 - $65,000 - Salaried, non-exempt - Medical, dental, disability, and life insurance - Paid time off - 401(k) plan with employer match

Role Description Physician Assistant: - Completes medical histories and physical exams. - Provides treatment to HMSS patients and consultative services to appropriate specialty groups in accordance with the medical plan of care. - Follows critical pathways established by Self Regional Healthcare, Self-Medical Group, and Medical/Nursing Policies/Procedures/Protocols and Standards of Care. - Completes admission/discharge medication reconciliation. - Orders and interprets labs and imaging studies. - Completes discharge summaries. - Works in collaboration with Physicians, Case Management, patients, and families. - Initiates advance care planning and works with supportive care and hospice teams to assist patients and families with end-of-life decisions. - Performs any other assigned duties per HMSS Physician, VP of Medical Affairs, and Self Medical Group Administration. - Maintains continuing medical education requirement in accordance with hospital requirements. - Maintains BLS and ACLS certifications. - Minimum 1-year clinical Physician Assistant experience required. Nurse Practitioner: - Completes medical histories and physical examinations to provide care to patients in accordance with the medical plan of care and within own scope of practice. - Uses a systematic approach in assessing the patient’s physical, psychological, and social status to determine the need for care, the type of care to be provided, and the need for reassessment/follow-up. - Demonstrates ability to perform and/or assist physician(s) and other healthcare providers with routine procedures within scope of practice and expertise. - Delivers care in a non-judgmental/non-discriminatory manner sensitive to the linguistic, cultural, and spiritual needs of the patient, family, and other caretakers. - Uses Epic electronic medical record system proficiently as primary source of documentation of all patient visits and correspondence. - Completes all required training when scheduled, ensuring none become delinquent. - Maintains current licensure at all times, ensuring no suspension or lapse occurs. - Practices work in a safe manner, following proper protocols of infection control, accident prevention, proper body mechanics, etc. - Attends meetings/training sessions as directed. - Performs other duties as assigned. Qualifications - Graduate of an accredited PA program. - Certified by the National Commission on Certification of Physician Assistants (NCCPA). - National Certification Exam completion and passing. - Current licensure. - Clinical expertise, leadership, and organizational ability. - Must be able to communicate effectively and work collaboratively with others. - Must be self-motivated. - Significant practice experience in private practice or institutional setting. Requirements - Graduate of an accredited school of advanced nursing. - Currently licensed to practice as an advanced nurse practitioner by the State Board of Nursing for South Carolina.

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description As the Utilization Management (UM) Physician Reviewer, you will report to the Medical Director of UM and provide clinical expertise to ensure high-quality, medically necessary, and efficient patient care aligned with regulatory requirements. This role involves making direct decisions in prior authorization, concurrent review of hospitalized patients, and discharge planning. - Clinical review of prior authorization, concurrent review, and retrospective review requests using critical thinking and established guidelines. - Interpreting benefit language and ensuring accurate documentation. - Engaging in peer-to-peer discussions with providers and collaborating with other healthcare professionals. - Handling appeals and grievances while ensuring compliance with federal, state, and accreditation standards. - Acting as a clinical liaison and participating in case reviews and fair hearing processes. - Identifying utilization trends and contributing to policy development and quality improvement. - Guiding UM nurses and clinical staff while staying current with evidence-based medical literature and healthcare trends. This position is remote, but will be expected to work PST business hours. This position is part-time, working approximately 20 hours/week, with flexible days/hours. The schedule includes weekend and holiday rotations ensuring coverage for urgent reviews. Qualifications - Clear and current California MD or DO license. - Proficiency in using electronic health records and UM software platforms (after training). Requirements - 2+ years of experience in a direct patient care setting, Primary care specialty preferred. - Experience in utilization management, medical review, or managed care setting preferred. - Strong knowledge of clinical standards of care, NCQA requirements, CMS guidelines, and Medicaid / Medicare programs and dual eligible populations, and benefit systems preferred. Benefits - Competitive pay with a flexible Health & Welfare benefits package. - Cafeteria-style benefit program allowing employees to choose benefits from various options, including medical, dental, and vision plans for employees and their dependents. - Health Spending Account (HSA), Life Insurance, and Long Term Disability. - 401k retirement plan with a generous employer-match. - Paid Time Off and Sick Leave.