Role Description Acts as Team Lead for specialty programs, medical review, utilization management, and case management areas by providing assistance and support to unit supervisor/manager by giving direction/guidance/training to staff. Ensures appropriate levels of healthcare services are provided. This position is part of the End-Stage Renal Disease QIP Contract. Logistics: - Palmetto GBA - one of BlueCross BlueShield's South Carolina subsidiary companies. Functions as a team leader/senior-level Medical Reviewer. Provides leadership/guidance/direction/training to staff. Maintains a working knowledge of unit functions and the ability to interpret to new hires, department interworking, and workflow. Acts as a resource for staff/external entities troubleshooting as well as resolving issues. Keeps manager informed of any problems/issues that need resolving. - Assists management with monitoring workflow and workloads (including reassignment of work to meet timelines, redirecting work intake source to balance workloads), reporting, and addressing aging issues. - Participates in departmental quality reviews. - Follows a process to ensure quality plan is adhered to and communicated to all parties. - Gives/receives feedback regarding medical review decision making and technical claims processing issues. - Ensures that quality work instructions/forms/documents are developed/revised as needed. - Provides quality service and communicates effectively with external/internal customers in response to inquiries. - Obtains information from internal departments, providers, government, and/or private agencies, etc. to resolve discrepancies/problems. - Participates in compliance initiatives and other directed activities. - Participates/oversees special projects as requested by management. Qualifications - Associate Degree - Nursing OR Graduate of Accredited School of Nursing. Requirements - Four years of clinical experience, OR - Two years of clinical and two years of medical review/utilization review, OR - Combination of health plan, clinical, and business experience totaling four years. Preferred Requirements - ESRD/renal dialysis experience. - Five or more years’ clinical, quality management, or leadership experience as a registered nurse in a Dialysis setting. - Three or more years’ education/training/consulting experience related to Dialysis services (may be concurrent). - Three or more years’ experience in quality management coordination related to Dialysis services (may be concurrent). Required Skills and Abilities - Working knowledge of managed care and various forms of healthcare delivery systems. - Strong clinical experience to include home health, rehabilitation, and/or broad medical surgical experience. - Knowledge of specific criteria/protocol sets and the use of the same. - Working knowledge of word processing and spreadsheet software. - Ability to work independently, prioritize effectively, and make sound decisions. - Good judgment skills. - Demonstrated customer service, organizational, and presentation skills. - Demonstrated proficiency in spelling, punctuation, and grammar skills. - Demonstrated oral and written communication skills. - Ability to persuade, negotiate, or influence others. - Analytical or critical thinking skills. - Ability to handle confidential or sensitive information with discretion. - Ability to lead/direct/motivate others. Required Software and Tools - Microsoft Office. Required License and Certificate - Active, unrestricted RN licensure from the United States and in the state of hire, OR - Active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).

Role Description We are rapidly expanding our Medical Records Team and are looking for a detail-oriented Documents Reviewer to join us immediately. This is a long-term opportunity for professionals with a healthcare background who are passionate about quality, accuracy, and innovation. As a Records Reviewer, you will serve as the final quality checkpoint before medical records are delivered to clients. You'll work closely with our proprietary AI technology to review, validate, and improve medical summaries, chronologies, and case insights while collaborating with internal teams to continuously enhance our review processes. If you have experience reviewing medical records, strong clinical knowledge, and exceptional attention to detail, we'd love to hear from you. Qualifications - Healthcare or Medical Records Experience (Required) - Previous experience reviewing medical records - Professional healthcare background such as: - Registered Nurse (RN) - Licensed Practical/Vocational Nurse (LPN/LVN) - Medical Assistant - Healthcare Administrator - Medical Records Specialist - Health Information Management (HIM) - Or a similar healthcare-related role - Strong understanding of: - Medical terminology - Clinical documentation - Medical record structures - Healthcare workflows - Technical Skills: - Comfortable working with modern software platforms and AI-powered tools. - Quick learner with the ability to adapt to new technologies. - Strong computer literacy and attention to digital workflows. - Communication Skills: - Excellent written English communication skills. - Ability to write clear, concise, and professional documentation. - Comfortable communicating issues and recommendations to internal teams. - Core Competencies: - Exceptional attention to detail with a commitment to producing high-quality work. - Strong analytical and critical thinking skills to interpret medical information accurately. - Clinical judgment to evaluate the relevance and accuracy of medical events and documentation. - Dependability and accountability with the ability to work independently in a remote environment. - Proactive communication by identifying issues early and collaborating with the team. - Long-term commitment and a desire to grow with our company as we continue to scale our AI and medical review capabilities. Requirements - Experience reviewing medical records. - Strong clinical knowledge. - Exceptional attention to detail. Benefits - Long-term opportunity. - Remote work flexibility. How to Apply If you have a healthcare background, experience reviewing medical records, and a passion for quality and accuracy, we'd love to hear from you. Please Apply here: https://operationsarmy.com/application Qualified applicants will be contacted for the next stage of the hiring process.

Role Description Provide remote diagnostic radiology interpretations for the Emergency Department during overnight hours (11:00 PM – 7:00 AM EST). - Interpret and report on an average of 80–130 mixed cases per shift using Sectra PACS and Powerscribe dictation. - Supervise and teach 2–3 radiology residents, ensuring clinical guidance and educational feedback. - Ensure accurate, timely reporting in Cerner EMR, adhering to facility protocols. - Submit required case logs, NPDB report (within past 30 days), and maintain clean malpractice history. Qualifications - Board Certified - Licensed in MI - DEA waiver required (DEA not required) - BLS certification Requirements - Average Daily Volume: 80-130 cases per 8-hour shift - Rounding: Unassigned Patients - EMR System: Cerner - Hospital Privileges Required: No - Temporary Privileges Available: No Benefits - Travel, Lodging, and Malpractice Insurance: Covered by Agency

Role Description The incumbent reviews medical bills utilizing professional knowledge and clinical experience to determine the relationship of services billed to the covered injury; applies appropriate review guidelines, assesses appropriate use of medical coding; identifies over-utilization of treatment and makes appropriate reimbursement recommendations. The incumbent is also responsible for the quality, timeliness, and customer service for assigned accounts. Essential Functions - Reviews medical bills and documentation according to guidelines and RW policies and procedures. - Determines if treatment is related and necessary to the covered injury. - Advises reimbursement recommendations are appropriate. - Provides customer service to adjusters, providers, and claimants regarding bill review. - Assesses appropriateness and duration of care provided, for possible utilization review. - Recommends independent medical evaluations (IME) to adjusters when necessary. - Acts as a resource to other staff members to facilitate completion of a quality product. - Uses appropriate reference material as necessary to perform professional review. - Meets company productivity standards. - Meets company quality standards. Qualifications - Certified Professional Coder – a plus but not required. - 1+ years medical coding experience – CPT, ICD-10 - preferred. - 1+ years’ experience in Medical Bill Repricing – preferred. - Michigan Workers' Compensation experience - preferred. Skills and Abilities - Ability to apply clinical knowledge and/or coding expertise in bill review. - Ability to read, write, speak, and understand English well. - Ability to understand and follow written and oral instructions. - Possess strong verbal and interpersonal skills. - Ability to multi-task. - Possess problem-solving skills. - Ability to sit for long periods at a computer terminal keyboarding. - PC skills – required. - Knowledge of Microsoft Office Products – required. - Ability to operate standard office equipment including telephone. Personal Characteristics - Initiative, drive, creativity, and persistence. - Good organizational skills. - Highest professional ethics. - Ability to work independently. EEOC Statement Medlogix is an Equal Opportunity Employer. Medlogix does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, disability, national origin, veteran status, or any other basis covered by appropriate law. We will continue to maintain our commitment to making all employment-related decisions based on the merit of each individual.