medical nurse

Albawani | البواني

<div>
 
 
 Al Bawani Construction.
 
 
 
 
 
 
 
 
 
 
 Job Title:
 
 Medical Nurse II
 
 
 
 Division:
 
 HSSE Division
 
 
 
 Department:
 
 HSSE
 
 
 
 
 
 
 
 
 
 Role Purpose
 
 
 
 The Medical Nurse II provides high-quality nursing care within the workplace, focusing on occupational health, employee wellness, and workplace safety. This role involves conducting health assessments, administering treatments, monitoring health occupational hazards, and collaborating with health care and safety teams to ensure the well-being of employees.
 
 
 
 
 
 
 Key Activities:
 
 
 
 &bull; Assist in managing occupational health programs, including medical surveillance, fitness-for-duty evaluations, and preventive health initiatives.
 
 
 &bull; Provide primary medical care, first aid, and emergency treatment to employees for work-related and non-work-related medical concerns.
 
 
 &bull; Conduct routine health assessments, screenings, and medical check-ups to monitor employee well-being and detect potential health risks.
 
 
 &bull; Administer medications and treatments as prescribed.
 
 
 &bull; Monitor and record employee health conditions.
 
 
 &bull; Collaborate with multidisciplinary teams to ensure coordinated patient care.
 
 
 &bull; Work closely with the HSE team to report and manage occupational illnesses, workplace injuries, and health-related incidents.
 
 
 &bull; Communicate effectively with patients and their families regarding care plans and health education.
 
 
 &bull; Participate in safety meetings and contribute to discussions on improving workplace health standards.
 
 
 &bull; Liaise with external healthcare providers, hospitals, and clinics to facilitate referrals and ensure proper medical treatment for employees.
 
 
 &bull; Ensure that the medical inventory is maintained as per the Ministry of Health (MOH) directives, adhering to regulatory storage and handling requirements for medications and medical equipment.
 
 
 &bull; Maintain records for medical inventory, track stock levels, monitor expiry dates of medications and medical supplies, and ensure timely replenishment to prevent shortages.
 
 
 &bull; Ensure accurate documentation of all medical records, including employee health assessments, incident reports etc.
 
 
 &bull; Document incidents, treatments, and follow-ups in compliance with occupational health standards.
 
 
 &bull; Prepare reports on workplace health trends and recommend improvements.
 
 
 &bull; Ensure compliance with health care regulations and organizational policies.
 
 
 &bull; Participate in audits and quality improvement initiatives.
 
 
 &bull; Develop and deliver health awareness programs on various occupational health and wellness topics to promote a healthy and safe work environment.
 
 
 &bull; Create educational materials (e.g., posters, newsletters, intranet content) to promote wellness and safety awareness.
 
 
 &bull; Stay updated on medical advancements, occupational health trends, and regulatory changes to provide the best healthcare practices within the workplace. &bull; Promote wellness initiatives, including vaccination programs and mental health support.
 
 
 &bull; Lead and actively participate in corporate health campaigns, ensuring awareness and engagement among employees on key health and wellness topics.
 
 
 &bull; Train employees on first aid and medical emergency response procedures.
 
 
 &bull; Mentor and support junior nursing staff and nursing students.
 
 
 &bull; Participate in continuing education and professional development activities.
 
 
 
 
 
 
 Necessary Knowledge and Experience:
 
 
 
 &bull; Minimum of 3-5 years of nursing experience, preferably in occupational health or industrial settings.
 
 
 &bull; Strong knowledge of occupational health regulations, workplace hazards, and emergency response procedures
 
 
 
 
 
 
 Education and Certification Minimum Requirements:
 
 
 
 
 
 
 &bull; Bachelor&rsquo;s degree in nursing (BSN) preferred; associate&rsquo;s degree in nursing (ADN) acceptable with relevant experience.
 
 
 &bull; Current nursing license (RN) in the state of practice.
 
 
 &bull; Heart-saver First Aid, Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) certifications is advantageous.
 
 
 
 
 
 
 Hiring Date:
 
 
 
 Hiring Till 12/11/2025
 
</div>

Medical Nurse I

State of South Carolina

<div><div><div><h2 class="jobSectionHeader">Job Responsibilities</h2></div>
<div><div>Are you passionate about making a real difference in people's lives? Join our team at the Office of Mental Health where we are dedicated to providing compassionate and accessible care to our community. We are seeking a Medical Nurse Practitioner, Institutional who is motivated to help individuals and families navigate life's challenges and achieve long-term wellness. If you want to use your skills to build a healthier, more resilient community, we encourage you to apply.</div><div></div><div> 
These two (2) positions are located at the SC Department of Behavioral Health and Developmental Disabilities (DBHDD) - Office of Mental Health, G. Werber Bryan Psychiatric Hospital, 220 Faison Drive, Columbia SC 29203.</div> 
As the Nurse Practitioner, Institutional, under the supervision of the Medical Director and Medical Primary Care Chief of Bryan - Civil Inpatient Services, you will provide direct patient care at Bryan Psychiatric Hospital - Civil. Assist in the organization and monitoring of the evaluation and treatment of the patients consistent with the mission of South Carolina Department of Behavioral Health and Developmental Disabilities - Office of Mental Health (SCDBHDD-OMH). Plan, direct and execute delegated medical care activities for Bryan-Civil patients including the prescription of medications, pursuant to approved written protocols developed in collaboration with a physician preceptor. 
 
Responsibilities for the Medical Nurse Practitioner, Institutional:<ul><li>
Collaborate with the supervising Medical Physician and attending Psychiatrists to provide medical care to patients at Bryan Psychiatric Hospital-Civil. This includes but is not limited to, the admission history and physical examination, treatment of chronic medical conditions, evaluation of new medical complaints, and coordination of indicated consultations and ancillary evaluations.</li><li>
Medically manage an assigned caseload of patients and devise/coordinate monitoring protocols for labs, imaging and medical problems to improve quality of care. Provide education to staff and patients regarding health care issues of the population served throughout concerned groups and in-services presentations.</li><li>
Maintain medical records and proper documentation on assigned patients as required by Bryan Psychiatric Hospital and OMH - Division of Inpatient Services policies. Including the history &amp; physical, progress notes, acknowledgement of consultations and test results, documentation of supervisory contact and timely completion of discharge summaries. Attend treatment team meetings, interventional meetings and medical staff meetings routinely. Also serve on committees as appointed by the Facility Director or Medical Directory.</li><li>
Comply with all SCBHDD-OMH Division of inpatient and Bryan Psychiatric Hospital policies and procedures. Complete all mandatory training annually to include CPR and MANDT. Maintain Annual SCEIS trainings to include Corporate Compliance, Harassment-Free Workplace, and Time and Attendance policies.</li></ul></div>
<div><h2 class="jobSectionHeader">Minimum and Additional Requirements</h2></div>
<div><ul><li>Graduation from an accredited school of nursing at the master's level or doctoral level acceptable to the Board to include clinical experience.</li><li>
Nursing license and official recognition by the Board as a Nurse Practitioner practicing in the extended role and authorized for prescriptive authority in South Carolina.</li></ul><div>
Additional Requirements</div><ul><li>
Must be flexible in regard to work environment and travel.</li><li>
Must be able to work with repetitive unusual patient behaviors, including but not limited to, combative, threatening, acting out and unpredictable violence.</li><li>
Ability to lift a minimum of fifty (50) lbs., may be required to lift more during times of emergencies.</li><li>
Ability to squat, push, kneel, bend, and maneuver to assist patients.</li></ul></div>
<div><h2 class="jobSectionHeader">Preferred Qualifications</h2></div>
<div><ul><li>Bilingual abilities in English and Spanish (or another language) are a plus.</li></ul></div>
<div><h2 class="jobSectionHeader">Additional Comments</h2></div>
<div>Post hire, employees must:<ul><li>
Have the ability to diagnose, treat and manage general medical conditions including, but not limited to diabetes. hypertension, back pain, dyslipidemia adrenal disease.</li></ul>
The Department of Behavioral Health and Developmental Disabilities is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth, or related medical conditions including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.
Supplemental questions are considered part of your official application. Any misrepresentation will result in your disqualification from employment. Please complete the state application to include all current and previous work history and education. A resume will not be accepted nor reviewed to determine if an applicant has met the qualifications for the position.
The Department of Behavioral Health and Developmental Disabilities offers an exceptional benefits package for full time (FTE) employees:<ul><li>
Health, dental, vision, long-term disability, and life insurance for employees, spouse, and children. Click here for additional information.</li><li>
15 days annual (vacation) leave per year</li><li>
15 days sick leave per year</li><li>
13 paid holidays</li><li>
Paid Parental Leave</li><li>
S.C. Deferred Compensation Program available (S.C. Deferred Compensation)</li><li>
Retirement benefit choices *<ul><li>
State Retirement Plan (SCRS)</li><li>
State Optional Retirement Program (State ORP)</li></ul></li></ul><ul><li>Enrollment in one of the listed plans is required for all FTE employees; please refer to the contribution section of hyperlinked retirement sites for the current contribution rate of gross pay.</li></ul></div></div></div>

Medical Nurse Practitioner, Institutional (BPH-Civil)

Novacore

<div>
 
 Why join the Novacore team?
 
 
 
 
 Because your next stellar chapter starts here &mdash; and we&rsquo;re building something bold and meaningful.
 
 
 
 At Novacore, we&rsquo;re not your average insurance company. We&rsquo;re a team of driven professionals passionate about redefining the specialty insurance experience for our agents, carrier partners &mdash; and for each other.
 
 
 We specialize in tailored solutions for niche industries, powered by advanced analytics, modern technology and a culture of innovation. Backed by strong leadership and strategic growth initiatives, Novacore is poised to scale and lead in the specialty insurance market.
 
 
 But at our core, we believe it&rsquo;s not just what we do &mdash; it&rsquo;s
 
 how
 
 we do it and
 
 who
 
 we do it with.
 
 
 Recognized as a top workplace, Novacore is a place where ambition is supported, growth is continuous and culture matters. From day one, you&rsquo;ll find mentorship, hands-on learning and clear paths for advancement. You&rsquo;ll grow your skills, expand your expertise and become even more exceptional &mdash; because when you succeed, we all do.
 
 
 
 We Offer
 
 
 
 <ul>
 <li>
 A collaborative, results-driven environment
 </li>
 <li>
 Competitive compensation and comprehensive benefits
 </li>
 <li>
 Year-round social and community events
 </li>
 <li>
 Ongoing mentorship and professional development
 </li>
 <li>
 Endless opportunities for upward mobility
 
 
 </li>
 </ul>
 So if you're ready to be part of something extraordinary &mdash; with a team that&rsquo;s transforming commercial insurance &mdash; we want to meet you.
 
 
 Reinsurance Nurse Case Manager
 
 
 
 Overview
 
 
 
 Carbon Stop Loss Solutions is a leading managing general underwriter (MGU) in the field of employer stop loss and managed care insurance.
 
 
 Carbon&rsquo;s team of experts are known as the industry leader in delivering best-in-class risk solutions to effectively lower healthcare costs. Carbon&rsquo;s offerings support clients and brokers in a rapidly changing healthcare market with best-in-class service, underwriting, claims support and effective cost containment strategies.
 
 
 Carbon Stop Loss Solutions makes up Novacore&rsquo;s Healthcare Segment.
 
 
 The Medical Review Nurse is a registered nurse who can assist Novacore&rsquo;s Claim and Underwriting Departments in managing risk and mitigating claims exposure.
 
 
 <ul>
 <li>
 We are open to candidates local to the Philadelphia-area Home Office or fully remote.
 
 
 </li>
 </ul>
 
 Responsibilities
 
 
 
 <ul>
 <li>
 Assist underwriters in the timely evaluation of clinical and claim data during the disclosure process to identify potential risk.
 </li>
 <li>
 Work with Third-Party Administrators and producers as a medical resource for discussion and assistance with potential catastrophic claim management.
 </li>
 <li>
 Assist Case Managers, either employed by Carbon&rsquo;s TPAs, or with outside firms, with high dollar catastrophic claimants.
 </li>
 <li>
 Evaluate claims reporting for potential exposure and reserve recommendations.
 </li>
 <li>
 Clinical review and claims analysis to assess claim trends and possible group resources.
 </li>
 <li>
 Maintain patient confidentiality in compliance with standards set forth by Carbon as well as HIPAA.
 </li>
 <li>
 Work with the department manager in seeking and employing new business partners to promote health care resources and mitigate claims exposure.
 </li>
 <li>
 Serve as a back-up for other department medical staff as needed.
 </li>
 <li>
 Maintain licensure and certifications as indicated to promote personal professional advancement.
 
 
 </li>
 </ul>
 
 Qualifications
 
 
 
 <ul>
 <li>
 Registered Nurse active license required - BSN preferred.
 </li>
 <li>
 CCM certification, preferred.
 </li>
 <li>
 At least one year of acute care clinical experience.
 </li>
 <li>
 UM or CM experience on either the payer or provider side.
 </li>
 <li>
 Prior TPA, MGU or Stop loss carrier experience is highly preferable.
 </li>
 <li>
 Prior experience analyzing health care claims and coding.
 </li>
 <li>
 Prior experience working with catastrophic health care claims.
 </li>
 <li>
 Experience with data entry and analysis of medical reporting.
 </li>
 <li>
 Provide risk assessment and communicate the analysis succinctly in reporting.
 </li>
 <li>
 Ability to conduct independent medical research as an adjunct to medical underwriting tasks.
 </li>
 <li>
 Ability to meet tight time frames.
 </li>
 <li>
 Strong organizational and time management skills.
 </li>
 <li>
 Ability to work independently in a remote setting.
 </li>
 <li>
 Ability to work with multiple offices and underwriters and prioritize time frames.
 </li>
 <li>
 Proficient with MS Office software. Ability to communicate effectively and professionally both internally and with external clients.
 </li>
 </ul>
</div>

Medical Review Nurse (Insurance)

Machinify

<div>
 
 About Machinify
 
 
 
 In October 2025, Machinify acquired Performant and we are now part of the Machinify organization. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify&rsquo;s AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We&rsquo;re reshaping healthcare payment through seamless intelligence.
 
 
 
 About The Opportunity
 
 
 
 Expected Hiring Range: $72-78k, may be adjusted to reflect applicant experience
 
 
 The
 
 Medical Review Nurse II - Readmissions
 
 primarily performs medical claims audit reviews. As a MR Nurse, you will join a team of experienced medical auditors and coders performing retrospective and prepayment audits on claims for Government and Commercial Payers. You will work remotely in a fast paced and dynamic environment and be part of a multi-location team.
 
 
 
 Key Responsibilities
 
 
 
 <ul>
 <li>
 Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules.
 </li>
 <li>
 Document all findings referencing the appropriate policies and rules.
 </li>
 <li>
 Generate letters articulating audit findings.
 </li>
 <li>
 Supporting your findings during the appeals process if requested.
 </li>
 <li>
 Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse.
 </li>
 <li>
 Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits.
 </li>
 <li>
 Keep abreast of medical practice, changes in technology, and regulatory issues that may affect our clients.
 </li>
 <li>
 Work with the team to minimize the number of appeals; Suggest ideas that may improve audit workflows; Assist with QA functions and training team members.
 </li>
 <li>
 Participate in establishing edit parameters, new issue packets and development of Medical Review Guidelines.
 </li>
 <li>
 Interface with and support the Medical Director and cross train in all clinical departments/areas.
 </li>
 <li>
 Other duties as required to meet business needs.
 
 
 </li>
 </ul>
 
 Knowledge, Skills And Abilities Needed
 
 
 
 <ul>
 <li>
 Knowledge of insurance programs, particularly the coverage and payment rules.
 </li>
 <li>
 Ability to maintain high quality work while meeting strict deadlines.
 </li>
 <li>
 Excellent written and verbal communication skills.
 </li>
 <li>
 Ability to manage multiple tasks including desk audits and claims review.
 </li>
 <li>
 Must be able to independently use standard office computer technology.
 </li>
 <li>
 Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload
 </li>
 <li>
 Effectively work independently and as a team, in a remote setting.
 
 
 </li>
 </ul>
 
 Required And Preferred Qualifications
 
 
 
 <ul>
 <li>
 Active unrestricted RN license in good standing, is required.
 </li>
 <li>
 Must not be currently sanctioned or excluded from the Medicare program by the OIG.
 </li>
 <li>
 Minimum of five (5) years diversified nursing experience providing direct care in an inpatient setting.
 </li>
 <li>
 One (1) or more years' experience performing medical records review.
 </li>
 <li>
 One (1) or more years' experience in health care claims that demonstrates expertise in, ICD-9/ICD-10 coding, HCPS/CPT coding, DRG and medical billing experience for an Insurance Company or hospital required.
 </li>
 <li>
 Other qualifications may be required and would be discussed during an interview.
 
 
 </li>
 </ul>
 
 What We Offer
 
 
 
 Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually. For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview.
 
 
 
 Physical Requirements &amp; Additional Notices
 
 
 
 
 If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required
 
 . Proof of such may be required prior to an offer being made. It is the Employee&rsquo;s responsibility to maintain this Internet access at their home office location.
 
 
 The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary.
 
 
 <ul>
 <li>
 Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse.
 </li>
 <li>
 Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).
 </li>
 <li>
 Regularly sit/stand 8 or more hours per day.
 </li>
 <li>
 Occasionally lift/carry/push/pull up to 10lbs.
 
 
 </li>
 </ul>
 
 Requirements
 
 
 
 Machinify is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position:
 
 
 <ul>
 <li>
 Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.
 </li>
 <li>
 Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists.
 </li>
 <li>
 Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.
 </li>
 <li>
 Other requirements may apply.
 
 
 </li>
 </ul>
 All employees and contractors for Machinify may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Machinify's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.
 
 
 Machinify is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Machinify will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Machinify&rsquo;s Human Resources team to discuss further.
 
 
 Our diversity makes Machinify unique and strengthens us as an organization to help us better serve our clients. Machinify is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.
 
 
 THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED UNLESS EXPLICITY AGREED TO IN WRITING
</div>

Medical Review Nurse - Readmissions

Olympic Medical Center

<div>ABOUT OLYMPIC MEDICAL CENTER:
Imagine working on Washington State&rsquo;s beautiful North Olympic Peninsula where recreational opportunities abound. Whether you enjoy hiking, camping, fishing, kayaking or cycling, the Olympic Peninsula is home to numerous adventures for outdoor enthusiasts. It's a great place to live, work, play and raise a family.
Bordered by the scenic Olympic National Park, the Strait of Juan de Fuca and the Pacific Coast - with Seattle and Victoria, BC just a ferry ride away - you won&rsquo;t find a better location. You&rsquo;ll receive a competitive salary, excellent benefits, relocation assistance plus an amazing PNW lifestyle &ndash; a perfect combination!
FTE:
0%
WORK SHIFT
Days
PAY RANGE:
$37.09 - $58.02
UNION:
SHIFT DIFFERENTIALS/PREMIUMS:
Weekends &amp; Holiday Shifts:
On Call Shifts:
JOB DESCRIPTION:
Works under the direction of Physician and/or Advanced Registered Nurse Practitioner (ARNP) or Physician Assistant-Certified (PA-C) in outpatient practice. Assesses, plans, implements and evaluates the nursing care of patients in the clinic. Provides coordination of care for patients. Possesses the ability to assess data reflecting the patient&rsquo;s status. Interprets the appropriate information needed to identify each patient's requirements concerning his or her age-specific needs. Advocates for patient centered care. Provides the care needed in accordance with the department policies and procedures. Participates in patient and family teaching. Maintains standards for professional nursing practice in the outpatient clinical setting. Demonstrates the values contained in the Olympic Medical Center mission and philosophy statements. Supports and promotes a positive image of professional nursing.
EDUCATION
 RN required. BSN or equivalent preferred.
EXPERIENCE
Minimum of one year experience in an ambulatory medical clinic preferred. Experience working with specific clinic patients is preferred, e. g, oncology experience for oncology clinic, urology experience for urology clinic, OB-GYN experience for women&rsquo;s clinic.
LICENSURE/CREDENTIALS
 Current Washington State Registered Nurse licensure and CPR certification.
BENEFITS INFORMATION:
Click here for information about our benefits.
Equal Employment Opportunity (EEO) Statement:
Olympic Medical Center is an Equal Opportunity Employer that values workplace diversity. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, or protected veteran status and will not be discriminated against on the basis of disability. For more information, please visit www.eeoc.gov.</div>

Medical Office Nurse Coord, Primary Care Clinic

Performant Financial Corporation

<div>ABOUT MACHINIFY:
In October 2025, Machinify acquired Performant and we are now part of the Machinify organization. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify&rsquo;s AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We&rsquo;re reshaping healthcare payment through seamless intelligence.
ABOUT THE OPPORTUNITY:
Expected Hiring Range: $84,000 - $100,000 (based on experience)
The Medical Review Nurse II - SNF/MDS primarily performs medical claims audit reviews. As a MR Nurse, you will join a team of experienced medical auditors and coders performing retrospective and prepayment audits on claims for Government and Commercial Payers. You will work remotely in a fast paced and dynamic environment and be part of a multi-location team.
Key Responsibilities:<ul><li>
Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules.</li><li>
Document all findings referencing the appropriate policies and rules.</li><li>
Generate letters articulating audit findings.</li><li>
Supporting your findings during the appeals process if requested.</li><li>
Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse.</li><li>
Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits.</li><li>
Keep abreast of medical practice, changes in technology, and regulatory issues that may affect our clients.</li><li>
Work with the team to minimize the number of appeals; Suggest ideas that may improve audit workflows; Assist with QA functions and training team members.</li><li>
Participate in establishing edit parameters, new issue packets and development of Medical Review Guidelines.</li><li>
Interface with and support the Medical Director and cross train in all clinical departments/areas.</li><li>
Other duties as required to meet business needs.</li></ul>
Knowledge, Skills and Abilities Needed:<ul><li>
Experience with utilization management systems or clinical decision-making tools such as Medical Coverage Guidelines (MCG) or InterQual.</li><li>
Experience with and deep knowledge of ICD-9, ICD-10, CPT-4 or HCPCS coding.</li><li>
Knowledge of insurance programs program, particularly the coverage and payment rules.</li><li>
Ability to maintain high quality work while meeting strict deadlines.</li><li>
Excellent written and verbal communication skills.</li><li>
Ability to manage multiple tasks including desk audits and claims review.</li><li>
Must be able to independently use standard office computer technology (e.g. email telephone, copier, etc.) and have experience using a case management system/tools to review and document findings.</li><li>
Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload</li><li>
Effectively work independently and as a team, in a remote setting.</li></ul>
Required and Preferred Qualifications:<ul><li>
Active unrestricted RN license in good standing, is required.</li><li>
Must not be currently sanctioned or excluded from the Medicare program by the OIG.</li><li>
Minimum of five (5) years diversified nursing experience providing direct care in an inpatient or outpatient setting.</li><li>
One (1) or more years' experience performing medical records review.</li><li>
One (1) or more years' experience in health care claims that demonstrates expertise in, ICD-9/ICD-10 coding, HCPS/CPT coding, DRG and medical billing experience for an Insurance Company or hospital required.</li><li>
Strong preference for experience performing utilization review for an insurance company, Tricare, MAC, or organizations performing similar functions.</li></ul>
WHAT WE OFFER:
Machinify offers a wide range of benefits to help support a healthy work/life balance. These benefits include medical, dental, vision, HSA/FSA options, life insurance coverage, 401(k) savings plans, family/parental leave, paid holidays, as well as paid time off annually. For more information about our benefits package, please refer to our benefits page on our website or discuss with your Talent Acquisition contact during an interview.
Physical Requirements &amp; Additional Notices:
If working in a hybrid or fully remote setting, access to reliable, secure high-speed Internet at your home office location is required. Proof of such may be required prior to an offer being made. It is the Employee&rsquo;s responsibility to maintain this Internet access at their home office location.
The following is a general summary of the physical demands and requirements of an Office/Clerical/Professional or similar job, whether completed remotely at a home office or in a typical on-site professional office environment. This is not intended to be an exhaustive list of requirements, as physical demands of each individual job may vary.<ul><li>
Regularly sits at a desk during scheduled shift, uses office phone or headset provided by the Company for phone calls, making outbound calls and answering inbound return calls using an office phone system; views a computer monitor, types on a keyboard and uses a computer mouse.</li><li>
Regularly reads and comprehends information in electronic (computer) or paper form (written/printed).</li><li>
Regularly sit/stand 8 or more hours per day.</li><li>
Occasionally lift/carry/push/pull up to 10lbs.</li></ul>
Machinify is a government contractor and subject to compliance with client contractual and regulatory requirements, including but not limited to, Drug Free Workplace, background requirements, and other clearances (as applicable). As such, the following requirements will or may apply to this position:<ul><li>
Must submit to, and pass, a pre-hire criminal background check and drug test (applies to all positions). Ability to obtain and maintain client required clearances, as well as pass regular company background and/or drug screenings post-hire, may be required for some positions.</li><li>
Some positions may require the total absence of felony and/or misdemeanor convictions. Must not appear on any state/federal debarment or exclusion lists.</li><li>
Must complete the Machinify Teleworker Agreement upon hire and adhere to the Agreement and all related policies and procedures.</li><li>
Other requirements may apply.</li></ul>
All employees and contractors for Machinify may and/or will have access to Sensitive, Proprietary, Confidential and/or Public data. As such, all employees and contractors will have ownership and responsibility to report any violations to the Confidentiality and Integrity of Sensitive, Proprietary, Confidential and/or Public data at all times. Violations to Machinify's policy related to the Confidentiality or Integrity of data may be subject to disciplinary actions up to and including termination.
Machinify is committed to the full inclusion of all qualified individuals. In keeping with our commitment, Machinify will take the steps to assure that people with disabilities are provided reasonable accommodations. Accordingly, if you believe a reasonable accommodation is required to fully participate in the job application or interview process, to perform the essential functions of the position, and/or to receive all other benefits and privileges of employment, please contact Machinify&rsquo;s Human Resources team to discuss further.
Our diversity makes Machinify unique and strengthens us as an organization to help us better serve our clients. Machinify is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, age, religion, gender, gender identity, sexual orientation, pregnancy, age, physical or mental disability, genetic characteristics, medical condition, marital status, citizenship status, military service status, political belief status, or any other consideration made unlawful by law.
THIRD PARTY RECRUITMENT AGENCY SUBMISSIONS ARE NOT ACCEPTED UNLESS EXPLICITY AGREED TO IN WRITING</div>

Medical Review Nurse - SNF/MDS Auditor (Government-CMS RAC))

<div>
 
 
 Al Bawani Construction.
 
 
 
 
 
 
 With three decades of contracting experience, Al Bawani Construction is proud to hold a Class-1 rating &ndash; this is the highest ranking in the Saudi turnkey-project classification system. The company is also ISO9001:2015 certified for its Quality Management System.
 
 
 
 
 
 
 Job Title:
 
 Medical Nurse II
 
 
 
 Division:
 
 HSSE Division
 
 
 
 Department:
 
 HSSE
 
 
 
 Direct Reporting Relationships:
 
 Project HSE Manager
 
 
 
 
 
 
 Role Purpose
 
 
 
 The Medical Nurse II provides high-quality nursing care within the workplace, focusing on occupational health, employee wellness, and workplace safety. This role involves conducting health assessments, administering treatments, monitoring health occupational hazards, and collaborating with health care and safety teams to ensure the well-being of employees.
 
 
 
 
 
 
 Key Activities:
 
 
 
 &bull; Assist in managing occupational health programs, including medical surveillance, fitness-for-duty evaluations, and preventive health initiatives.
 
 
 &bull; Provide primary medical care, first aid, and emergency treatment to employees for work-related and non-work-related medical concerns.
 
 
 &bull; Conduct routine health assessments, screenings, and medical check-ups to monitor employee well-being and detect potential health risks.
 
 
 &bull; Administer medications and treatments as prescribed.
 
 
 &bull; Monitor and record employee health conditions.
 
 
 &bull; Collaborate with multidisciplinary teams to ensure coordinated patient care.
 
 
 &bull; Work closely with the HSE team to report and manage occupational illnesses, workplace injuries, and health-related incidents.
 
 
 &bull; Communicate effectively with patients and their families regarding care plans and health education.
 
 
 &bull; Participate in safety meetings and contribute to discussions on improving workplace health standards.
 
 
 &bull; Liaise with external healthcare providers, hospitals, and clinics to facilitate referrals and ensure proper medical treatment for employees.
 
 
 &bull; Ensure that the medical inventory is maintained as per the Ministry of Health (MOH) directives, adhering to regulatory storage and handling requirements for medications and medical equipment.
 
 
 &bull; Maintain records for medical inventory, track stock levels, monitor expiry dates of medications and medical supplies, and ensure timely replenishment to prevent shortages.
 
 
 &bull; Ensure accurate documentation of all medical records, including employee health assessments, incident reports etc.
 
 
 &bull; Document incidents, treatments, and follow-ups in compliance with occupational health standards.
 
 
 &bull; Prepare reports on workplace health trends and recommend improvements.
 
 
 &bull; Ensure compliance with health care regulations and organizational policies.
 
 
 &bull; Participate in audits and quality improvement initiatives.
 
 
 &bull; Develop and deliver health awareness programs on various occupational health and wellness topics to promote a healthy and safe work environment.
 
 
 &bull; Create educational materials (e.g., posters, newsletters, intranet content) to promote wellness and safety awareness.
 
 
 &bull; Stay updated on medical advancements, occupational health trends, and regulatory changes to provide the best healthcare practices within the workplace. &bull; Promote wellness initiatives, including vaccination programs and mental health support.
 
 
 &bull; Lead and actively participate in corporate health campaigns, ensuring awareness and engagement among employees on key health and wellness topics.
 
 
 &bull; Train employees on first aid and medical emergency response procedures.
 
 
 &bull; Mentor and support junior nursing staff and nursing students.
 
 
 &bull; Participate in continuing education and professional development activities.
 
 
 
 
 
 
 Necessary Knowledge and Experience:
 
 
 
 &bull; Minimum of 3-5 years of nursing experience, preferably in occupational health or industrial settings.
 
 
 &bull; Strong knowledge of occupational health regulations, workplace hazards, and emergency response procedures
 
 
 
 
 
 
 Education and Certification Minimum Requirements:
 
 
 
 &bull; Bachelor&rsquo;s degree in Nursing (BSN) preferred; Associate&rsquo;s degree in Nursing (ADN) acceptable with relevant experience.
 
 
 &bull; Current nursing license (RN) in the state of practice.
 
 
 &bull; Heart-saver First Aid, Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS) certifications is advantageous.
 
 
 
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Nurse

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