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clinical appeals - r11356 Jobs in Indiana

clinical appeals - r11356

clinical pharmacist

3rdLine.Studio Inc.

<div>
 We are seeking a graduate architect to fill a permanent position within our firm. You would be working with a young energetic team, in a studio setting, working through design, plans, details, elevations, construction documentation, specifications, 3D modeling, perspectives and work with consultants and staff. You will become a well-balanced individual who will gain experience in all architectural processes and construction types. The studio environment in our firm is a dynamic open environment that offers mentorship and support.
 
 
 The successful candidate will have a Master of Architecture from an accredited university. The successful candidate will be experienced in using Revit 2018, AutoCAD 2018, Microsoft and have strong technical skills related directly to building construction, materials and methods of construction. You will need to have excellent communication and interpersonal skills.
 
 
 In return the successful candidate will have a competitive base salary, benefits, pension, and opportunities for growth with the company. Please contact us for a confidential discussion on your career.
 
 
 
 Qualifications
 
 
 
 <ul>
 <li>
 University or college graduate who has graduated within the last three years from an accredited college or university. The candidate must be a graduate of a post-secondary degree or diploma program. The position will be a first full-time employment in the candidate&rsquo;s field of study. Once hired, the candidate must reside in the Greater City of Sudbury community in which they are employed.
 
 
 </li>
 </ul>
 
 Apply Online Or Please Email Applications To
 
 
 
 careers@3rdline.studio
 
 
 
 Or Submit Application To
 
 
 
 289 Cedar St., Suite 300, Sudbury ON P3B 1M8
 
 
 
 For the Workforce Development Stream.
 
 
 
 This opportunity is proudly supported by Northern Ontario Heritage Fund Corporation and is funded through the Workforce Development Program. Eligibility requirements of the program can be found here: https://nohfc.ca/en/pages/programs/people-talent-program/workforce-development-stream
 
 
 How to apply
 
 
 Apply below or submit resume by mail or in person.
 
 
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 This field is hidden when viewing the form Position*
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 Name* First Last
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 Email*
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 Resume* Accepted file types: pdf, png, jpg, gif, doc, docx, txt, Max. file size: 300 MB.
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</div>

DataAnnotation

<div>
 We are looking for a Physical Therapy Assistant to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of each model.
 
 
 
 Physicians &amp; Advanced Practice Clinicians
 
 
 
 In this role you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include:
 
 
 Physicians of all specialties (e.g., Internists, Cardiologists, Oncologists), Physician Assistants, Nurse Practitioners, Certified Nurse-Midwives, Certified Registered Nurse Anesthetists, Clinical Nurse Specialists, Registered Nurses.
 
 
 
 Therapists
 
 
 
 Physical Therapists, Occupational Therapists, Speech-Language Pathologists, Respiratory Therapists, Athletic Trainers, Massage/Recreational Therapists.
 
 
 
 Diagnostic &amp; Laboratory Professionals
 
 
 
 Radiologic Technologists, Sonographers, MRI &amp; Nuclear Medicine Technologists, Medical Laboratory Scientists, Phlebotomists, Histology &amp; Genetics Technicians.
 
 
 
 Public Health &amp; Specialized Roles
 
 
 
 Dietitians/Nutritionists, Genetic Counselors, Epidemiologists, Public Health Nurses.
 
 
 
 Benefits
 
 
 
 <ul>
 <li>
 This is a full-time or part-time REMOTE position
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 You&rsquo;ll be able to choose which projects you want to work on
 </li>
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 You can work on your own schedule
 </li>
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 Projects are paid hourly starting at $50-$60 USD per hour, with bonuses on high-quality and high-volume work
 
 
 </li>
 </ul>
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Give AI chatbots diverse and complex healthcare related problems and evaluate their outputs
 </li>
 <li>
 Evaluate the quality produced by AI models for correctness and performance
 </li>
 <li>
 Ensure the medical accuracy of model performance
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Fluency in English (native or bilingual level)
 </li>
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 A current or in progress medical degree
 
 
 </li>
 </ul>
 Notes: Payment is made via PayPal. We will never ask for any money from you. PayPal will handle any currency conversions from USD. Only applicants in the United States will be considered for this role. This is an independent contract position.
 
 
 #medicine
</div>

Physical Therapy Assistant

<div>
 We are looking for a Nurse to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of each model.
 
 
 
 Physicians &amp; Advanced Practice Clinicians
 
 
 
 In this role you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include:
 
 
 Physicians of all specialties (e.g., Internists, Cardiologists, Oncologists), Physician Assistants, Nurse Practitioners, Certified Nurse-Midwives, Certified Registered Nurse Anesthetists, Clinical Nurse Specialists, Registered Nurses.
 
 
 
 Therapists
 
 
 
 Physical Therapists, Occupational Therapists, Speech-Language Pathologists, Respiratory Therapists, Athletic Trainers, Massage/Recreational Therapists.
 
 
 
 Diagnostic &amp; Laboratory Professionals
 
 
 
 Radiologic Technologists, Sonographers, MRI &amp; Nuclear Medicine Technologists, Medical Laboratory Scientists, Phlebotomists, Histology &amp; Genetics Technicians.
 
 
 
 Public Health &amp; Specialized Roles
 
 
 
 Dietitians/Nutritionists, Genetic Counselors, Epidemiologists, Public Health Nurses.
 
 
 
 Benefits
 
 
 
 <ul>
 <li>
 This is a full-time or part-time REMOTE position
 </li>
 <li>
 You&rsquo;ll be able to choose which projects you want to work on
 </li>
 <li>
 You can work on your own schedule
 </li>
 <li>
 Projects are paid hourly starting at $50-$60 USD per hour, with bonuses on high-quality and high-volume work
 
 
 </li>
 </ul>
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Give AI chatbots diverse and complex healthcare related problems and evaluate their outputs
 </li>
 <li>
 Evaluate the quality produced by AI models for correctness and performance
 </li>
 <li>
 Ensure the medical accuracy of model performance
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Fluency in English (native or bilingual level)
 </li>
 <li>
 A current or in progress medical degree
 
 
 </li>
 </ul>
 Notes: Payment is made via PayPal. We will never ask for any money from you. PayPal will handle any currency conversions from USD. Only applicants in the United States will be considered for this role. This is an independent contract position.
 
 
 #medicine
</div>

Nurse

<div>
 We are looking for a Pharmacy Technician to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of each model.
 
 
 In this role, you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include Revenue Cycle Management &amp; Patient Finance, Pharmacy Operations (Pharm Tech), Laboratory Services and Operations (Lab Tech), and Clinical Support &amp; Ambulatory Operations.
 
 
 
 Benefits
 
 
 
 <ul>
 <li>
 Full-time or part-time remote position
 </li>
 <li>
 Choose which projects you want to work on
 </li>
 <li>
 Flexible schedule
 </li>
 <li>
 Projects are paid hourly starting at $25-$30+/hr, with bonuses on high-quality and high-volume work
 
 
 </li>
 </ul>
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Provide AI chatbots with diverse and complex healthcare-related problems
 </li>
 <li>
 Evaluate AI outputs for logic, accuracy, and performance
 </li>
 <li>
 Ensure the medical accuracy and overall quality of model responses
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Fluency in English (native or bilingual level)
 </li>
 <li>
 A current or in-progress medical or healthcare-related degree
 
 
 </li>
 </ul>
 Notes: Payment is made via PayPal. We will never ask you for any money. PayPal will handle any currency conversions from USD. Only applicants in the United States will be considered for this role. This is an independent contractor position.
 
 
 #generalist
</div>

Pharmacy Technician

CareSource

<div>
 
 Job Summary
 
 
 
 The Clinical Appeals Nurse is responsible for processing clinical appeals and attending state hearings within compliance and regulatory standards, clinical guidelines, and contractual obligations.
 
 
 
 Essential Functions
 
 
 
 <ul>
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 Responsible for the completion of clinical appeals and state hearings from all states
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 Perform clinical reviews of member and provider appeals for medical, dental, behavioral health, pharmacy, and waiver services
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 Analyze medical records, supporting documentation, and applicable guidelines to make informed decisions
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 Document clinical rationale clearly and accurately in alignment with organizational and regulatory standards
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 Work closely with medical directors, and pharmacists to resolve complex cases.
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 Communicate outcomes effectively to members, and providers.
 </li>
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 Review and complete all provider clinical appeals within required timeframes
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 Review and complete member clinical appeals within required timeframes
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 Communicate with state agencies and internal departments to prepare for State Hearings
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 Apply CareSource Medical Policy and Milliman guidelines when processing clinical appeals
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 Issue administrative denials appropriately
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 Refer denials based on medical necessity to medical director
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 Collaborate with the Quality Improvement and Clinical Operations teams to prepare all requests for Independent External Review
 </li>
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 Participate in training programs to maintain clinical and regulatory expertise.
 </li>
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 Perform any other job duties as requested
 
 
 </li>
 </ul>
 
 Education And Experience
 
 
 
 <ul>
 <li>
 Associate&rsquo;s Degree required
 </li>
 <li>
 Managed care, appeals, Medicare, and Medicaid experience preferred
 </li>
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 Prior clinical appeals, and/or Utilization review experience is strongly preferred
 
 
 </li>
 </ul>
 
 Competencies, Knowledge And Skills
 
 
 
 <ul>
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 Intermediate proficiency with Microsoft Office products and Facets
 </li>
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 Knowledge of NCQA, URAC, OAC, and MDCH regulations
 </li>
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 Strong clinical judgment
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 Attention to detail
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 Ability to navigate complex regulations while maintaining a commitment to high-quality care
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 Strong written and oral communication skills
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 Ability to work independently and within a team environment
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 Critical listening and thinking skills
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 Proper grammar usage
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 Time management skills
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 Proper phone etiquette
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 Customer Service oriented
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 Decision making/problem solving skills
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 Knowledge of Medicaid, and Medicare,
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 Flexibility
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 Change resiliency
 
 
 </li>
 </ul>
 
 Licensure And Certification
 
 
 
 <ul>
 <li>
 Current, unrestricted license as a Registered Nurse (RN) is required
 </li>
 <li>
 Multi-state RN license is preferred
 </li>
 <li>
 MCG Certification is required or must be obtained within six (6) months of hire
 
 
 </li>
 </ul>
 
 Working Conditions
 
 
 
 <ul>
 <li>
 General office environment; may be required to sit or stand for extended periods of time
 </li>
 <li>
 Position requires the flexibility to work weekends, evenings, and/or holidays, as needed
 
 
 </li>
 </ul>
 
 Compensation Range
 
 
 
 $62,700.00 - $100,400.00 CareSource takes into consideration a combination of a candidate&rsquo;s education, training, and experience as well as the position&rsquo;s scope and complexity, the discretion and latitude required for the role, and other external and internal data when establishing a salary level. In addition to base compensation, you may qualify for a bonus tied to company and individual performance. We are highly invested in every employee&rsquo;s total well-being and offer a substantial and comprehensive total rewards package.
 
 
 
 Compensation Type
 
 
 
 Hourly
 
 
 
 Competencies
 
 
 
 <ul>
 <li>
 Fostering a Collaborative Workplace Culture - Cultivate Partnerships - Develop Self and Others - Drive Execution - Influence Others - Pursue Personal Excellence - Understand the Business
 
 
 </li>
 </ul>
 This job description is not all inclusive. CareSource reserves the right to amend this job description at any time. CareSource is an Equal Opportunity Employer. We are dedicated to fostering an environment of belonging that welcomes and supports individuals of all backgrounds.
 
 
</div>

Clinical Appeals - R11356

<div>
 We are looking for a
 
 Clinical Pharmacist
 
 to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of each model.
 
 
 In this role, you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include Clinical Documentation &amp; HIM, Medication Management (PharmD), Laboratory Medicine and Pathology Services (MLS, MD), Quality Improvement &amp; Patient Safety, Regulatory Compliance, Accreditation &amp; Medical Staff, Care Coordination &amp; Case Management, Population Health &amp; Value-Based Care, and Managed Care &amp; Utilization Management.
 
 
 
 Benefits
 
 
 
 <ul>
 <li>
 Full-time or part-time remote position
 </li>
 <li>
 Choose which projects you want to work on
 </li>
 <li>
 Flexible schedule
 </li>
 <li>
 Projects are paid hourly starting at $50+ per hour
 </li>
 <li>
 Bonuses available for high-quality and high-volume work
 
 
 </li>
 </ul>
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Provide AI chatbots with diverse and complex healthcare-related problems
 </li>
 <li>
 Evaluate AI outputs for logic, accuracy, and performance
 </li>
 <li>
 Ensure the medical accuracy and overall quality of model responses
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Fluency in English (native or bilingual level)
 </li>
 <li>
 A current or in-progress medical or healthcare-related degree
 
 
 </li>
 </ul>
 
 Notes:
 
 Payment is made via PayPal. We will never ask you for any money. PayPal will handle any currency conversions from USD. Only applicants in the United States will be considered for this role. This is an independent contractor position.
 
 
 
 #medicine
 
</div>

Clinical Pharmacist

Talented Medical Solutions

<div>Cath Lab Tech 
Location: Indiana, PA 
Facility Type: Acute Care Hospital 
Assignment Length: 13 Weeks 
Shift: Days (8-hour shifts)<h3 class="jobSectionHeader">
Job Description</h3>
We are seeking a skilled Cath Lab Tech to join our acute care hospital team in Indiana, PA for a 13-week assignment. The ideal candidate will assist physicians during cardiac catheterization and interventional procedures, ensure patient safety, and operate imaging and monitoring equipment in a fast-paced cath lab environment.<h3 class="jobSectionHeader">
Responsibilities</h3><ul><li>
Assist with diagnostic and interventional cardiac procedures</li><li>
Prepare and maintain sterile field and equipment</li><li>
Monitor patient vitals and document procedures</li><li>
Operate fluoroscopy and related imaging equipment</li><li>
Ensure compliance with hospital safety standards</li></ul><h3 class="jobSectionHeader">
Required Certifications</h3><ul><li>
ARRT (R) or RCIS (Registered Cardiovascular Invasive Specialist)</li><li>
BLS (Basic Life Support) &ndash; AHA</li><li>
ACLS (Advanced Cardiovascular Life Support) &ndash; AHA</li><li>
Active Pennsylvania state license</li></ul>
Experience: Minimum 1&ndash;2 years of recent Cath Lab experience preferred.
If you're a dedicated Cath Lab Tech looking for your next opportunity, apply today! Send your most updated resume to p.soriano@talentedmedicalsolutions.com or call/text (520) 762-6168
#Workwolf</div>

Cath Lab Tech

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