Role Description - Performs concurrent inpatient utilization review using InterQual criteria to determine if the request meets medical necessity criteria, including: - Admission reviews - Continued stay reviews - Transitional care reviews (Skilled Nursing Facility, Inpatient Rehabilitation Facility, Long-Term Acute Care Hospital) - Related follow-up activities and documentation updates - Engage in clinical collaboration with attending physicians, hospitalists, and care teams to obtain clinical information, discuss medical necessity determinations, and support appropriate level-of-care decisions. - Capable of communicating clinical rationale to attending physicians, hospitalists, and facility staff during real-time concurrent review interactions. - Facilitates resolution of escalated cases that may require special handling. - Refers cases to a Physician Reviewer or to a Specialty Program Medical Director per guidelines. - Assists Physician Reviewers and Medical Directors, as necessary, to ensure compliance with review timeframes. - Maintains written documentation according to HealthHelp’s documentation policy. - Has a working knowledge of regulations, accreditation requirements, and payer-specific guidelines by state and market; applies InterQual level-of-care criteria and applicable HealthHelp or client medical policies to inpatient review determinations. - Adheres to all HIPAA, state, and federal regulations pertaining to the clinical programs. - Complies with URAC & NCQA standards or other requisite regulating bodies. - Ensures consistency in implementation of policy, procedure, and regulatory requirements in collaboration with Nursing Management. - Keeps current with regulation changes as provided by Compliance Department and Nursing Management. - Functions as subject matter expert to support Compliance Department initiatives and updates. - Collects and enters confidential information ensuring the highest level of confidentiality in all areas. - Performs clinical intake and reviews cases according to the policies and procedures of HealthHelp for markets and cases requiring expedited turnaround times. - Maintains availability to support concurrent review coverage requirements, which may include non-standard business hours, weekends, or holidays as determined by client contractual obligations and regulatory review timeframes. - Ability to perform multiple tasks simultaneously, prioritize projects, work independently under pressure, and meet critical deadlines. - Appropriately identifies and refers quality issues to UM Leadership. - Collaborates with client personnel to resolve customer concerns. - Provides quality customer service through interaction with providers, administrative staff, and others. - Creates, encourages, and supports an environment that fosters teamwork, respect, diversity, and cooperation with others. - Promotes business focus which demonstrates an understanding of the company’s vision, mission, and strategy. - Participates in the HealthHelp Quality Management Program, as required. - Performs other related duties and projects as assigned to meet business needs. Qualifications - RN graduate from an accredited school of nursing (BSN preferred). - Current, active unrestricted RN license in the state or territory of the U.S. (USRN equivalent). - Two (2) years of experience in an acute care setting, required. - Two (2) years of inpatient clinical nursing, utilization management, or case management experience, preferred. - Experience with InterQual or similar evidence-based clinical decision support criteria, preferred. - Willingness to complete and maintain InterQual certification and ongoing competency requirements. - Familiarity with inpatient level-of-care criteria, observation versus inpatient status determinations, and transitional care planning, preferred. - Working knowledge of medical necessity criteria, level-of-care determination standards, and payer-specific utilization review requirements. - Knowledge of insurance terminology. - Experience working with state and federal regulatory and compliance standards, preferred. - Proficient technical skills in Microsoft Office (Word, Excel, and PowerPoint), required. - Good organizational and time management skills. - Excellent written and verbal communication skills. - Ability to utilize critical thinking skills. - Highly motivated, self-starter who can work efficiently and independently, or as a team member. Requirements - The base salary for this position is $75,000 annually. - Final compensation will be determined based on a variety of factors, including but not limited to: - Geographic location - Overall professional experience - Directly relevant experience - Education and certifications - Industry knowledge and expertise - Skills and competencies - In addition to base pay, this role may be eligible for performance-based bonuses, incentive pay, or commissions, which are not included in the listed base salary range. - WNS complies with all applicable federal, state, and local pay transparency laws, including those in California, Colorado, New York, Washington, and Illinois. - Note: For complete compensation information, please refer to the job posting on our official careers page. Benefits - Medical, dental, and vision insurance. - Paid time off (PTO), holidays, and sick leave. - 401(k) with company match or other retirement plan. - Life and AD&D Insurance. - Employee Assistance Program.

Role Description Acrisure Mortgage is seeking a detail-oriented Mortgage Post-Closing Auditor to join our team. In this role, you will review closed mortgage loan files to ensure Closing Disclosures are accurate, compliant, and aligned with TRID regulations. The ideal candidate has strong analytical skills, enjoys working with financial documents, and takes pride in identifying and resolving discrepancies. This is an excellent opportunity for someone with mortgage operations experience—or a motivated professional looking to expand their knowledge of mortgage compliance and post-closing quality control—in a collaborative, remote work environment. In this post-closing auditing role, you'll review fully closed mortgage files to ensure that Closing Disclosures (CDs) are accurate, compliant, and error-free in line with TRID regulations. You’ll follow up with internal and external contacts to resolve any discrepancies, track documentation, and support your team on special projects as needed. Key Responsibilities - Manage a steady pipeline of closed loan files and perform detailed audits from start to finish - Review each Closing Disclosure line by line for accuracy and compliance with TRID guidelines - Communicate with title companies via email and phone to request documentation and clarify discrepancies - Collaborate with internal team members and escalate any complex issues to your supervisor - Use basic math, critical thinking skills, and simple accounting techniques to compare disbursement ledgers between lender and title company - Handle sensitive financial and customer information with the highest level of attention and care Qualifications - Basic understanding of the mortgage loan process or a strong interest in learning the industry - Excellent attention to detail and accuracy when reviewing financial documents - Strong organizational and time management skills; ability to manage multiple files at once - Comfortable working independently in a remote environment and as part of a virtual team - Good written and verbal communication skills - Proficiency with basic computer applications, including Microsoft Outlook, Excel, and Word - Willingness to adapt to changing procedures and regulatory guidelines - Ability to maintain confidentiality and handle sensitive information responsibly Preferred Qualifications - Prior experience in mortgage post-closing, loan processing, or quality control - Familiarity with Encompass or similar loan origination systems - Working knowledge of common mortgage documents (e.g., Closing Disclosure, Deed of Trust, Settlement Statement/ALTA) - Awareness of compliance topics such as TRID, RESPA, TILA Company Description Acrisure Mortgage is an Equal Employment Opportunity/Affirmative Action Employer and maintains a Drug-Free Workplace. Applicants must complete all interviews without the use of AI or automated tools.

Title: Staff Auditor (II) Location San Antonio, Texas; Charlotte, North Carolina; Plano, Texas; Tampa, Florida Job ID R0118139 Why USAA? At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families. Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful. We are proud to support active-duty military spouses. USAA roles may offer remote or hybrid flexibility for active-duty military spouses consistent with applicable policy and business needs. The Opportunity As a dedicated Staff Auditor, you will perform audit assignments and identify problems for resolution in support of risk-based assurance and advisory engagements across the organization. Applies learning knowledge of financial services regulations to audit assignments. Performs risk and control identification and evaluation, increasingly complex audit techniques, research and analysis, and conducts client meetings and interviews. Adheres to the Institute of Internal Auditors' International Standards for the Professional Practice of Internal Auditing (Standards) and Code of Ethics. We offer a flexible work environment that requires an individual to be in the office 4 days per week. This position can be based in one of the following locations: San Antonio, TX, Plano, TX, Charlotte, NC or Tampa, FL. Relocation assistance is not available for this position. What you'll do: - Executes audit program assignments timely and professionally with guidance and support from the Auditor-in-Charge (AIC) in support of the annual audit plan and audit priorities. - Independently and accurately tests basic business, application, and/or IT general controls (ITGC). - Identifies control deficiencies in testing, discusses with Auditor-in-Charge (AIC) and/or Audit management and begins to understand how to initiate control improvement recommendations for assigned work. - Reviews, analyzes, and interprets data collected from multiple sources to ensure valid conclusions are drawn during testing. - Attends and participates in team audit activities like planning and scoping, business understanding/walkthroughs, review of risk assessment and testing for assigned areas of responsibility and demonstrates critical thinking ability. - Executes on audit documentation techniques including key risks and controls alignment to audit test objectives and conclusions; is accountable for completing own work paper documentation within quality standards. - Communicates effectively and shares findings and audit reports with AIC, team members, and may present to business leaders. - Provide updates to the engagement level risk & control matrix and other audit documentation as deemed appropriate by AIC or team leadership. What you have: - Bachelor's degree in Business, Finance, Accounting, Business, Information Technology or related field; OR 4 years of relevant education and/or experience. - If Bachelor's degree, 2 years of audit, financial, insurance, banking, information technology or related business experience. - Experience applying audit, risk or compliance acumen in a business/professional environment. - If advanced degree, up to 2 years of experience applying audit, risk, or compliance acumen in a business/professional environment. - Experience effectively communicating Controls with business partners. What sets you apart: - US military experience through military service or a military spouse/domestic partner. - Current or previous participant in a USAA HOH Cohort. - Military experience in financial management, auditing, and/or Inspector General roles across all branches, including internal controls, compliance reviews, risk assessments, and fraud/waste detection. Compensation range: The salary range for this position is: $69,920.00 - $133,620.00. USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.). Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location. Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors. The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job. Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.

Title: UM Review Nurse Department HS - UM Employment Type Full Time Location 1600 Corporate Center Dr., Monterey Park, CA 91754 Workplace type Fully remote Compensation $34.00 - $42.00 / hour Reporting To Sandra Castellon Job Description: Astrana Health is looking for a CA-licensed Utilization Review Nurse to assist our Health Services Department. In this position, you will utilize your clinical judgement to approve or deny outpatient medical services for patients based on Medical Necessity Criteria, respective to various Health Plans. This position requires open availability between Monday through Sunday, 8 A - 8 P. You would be scheduled for 5 shifts per week. This is a remote position for CA-licensed nurses. Candidates must live in California. We are seeking nurses with at least one year of outpatient Utilization Management experience in a fast-paced setting. Our Values: - Put Patients First - Empower Entrepreneurial Provider and Care Teams - Operate with Integrity & Excellence - Be Innovative - Work As One Team - What You'll Do - Complete prior authorization/retrospective review of elective inpatient admissions, outpatient procedures, post-homecare services, and durable medical equipment - Refer cases to Medical Directors as needed/appropriate - Maintain knowledge of state and federal regulations and accreditation standards - Comply with internal policies and procedures - Perform any other job duties as requested Qualifications - Active and unrestricted LVN license in CA. - 1+ years of outpatient UM experience - Experience with Microsoft applications such as Word, Excel, and Outlook - You’ll be Great for this Role If: - Two (2) years of health plan, IPA or MSO experience - Strong interpersonal skills - Ability to collaborate with co-workers, senior leadership, and other management - Experience educating and training staff - Environmental Job Requirements and Working Conditions - This is a remote position. Our office is located at 1600 Corporate Center Drive in Monterey Park, CA. Candidates who live within a 30 mile radius of the office may be expected to work hybrid. - Typical business hours are Monday - Friday from 8:30 AM to 5 PM, however, this position requires open availability between 8 AM - 8 PM PST, M-Su. Your schedule will be compromised of 5 shifts per week. Nurses rotate weekend and holiday coverage. Overtime is required in this position. - The national target pay range for this role is $34.00 - $42.00 per hour. Actual compensation will be based on job level, geographic location (current or future), experience, and other job-related factors. Astrana Health is proud to be an Equal Employment Opportunity and Affirmative Action employer. We do not discriminate based on race, religion, color, national origin, gender (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity, gender expression, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics. All employment is decided based on qualifications, merit, and business need. If you require assistance in applying for open positions due to a disability, please email us at humanresourcesdept@astranahealth.com to request an accommodation. Additional Information: The job description does not constitute an employment agreement between the employer and employee and is subject to change by the employer as the needs of the employer and requirements of the job change. About Astrana Health, Inc. Astrana Health (NASDAQ: ASTH) is a physician-centric, technology-powered healthcare management company. We are building and operating a novel, integrated, value-based healthcare delivery platform to empower our physicians to provide the highest quality of end-to-end care for their patients in a cost-effective manner. Our mission is to combine our clinical experience, best-in-class delivery network, and technological expertise to improve patient outcomes, increase access to healthcare, and make the US healthcare system more efficient. Our platform currently empowers over 20,000 physicians to provide care for over 1.7 million patients nationwide. Our rapid growth and unique position at the intersection of all major healthcare stakeholders (payer, provider, and patient) gives us an unparalleled opportunity to combine clinical and technological expertise to improve patient outcomes, increase access to quality healthcare, and reduce the waste in the US healthcare system.