medical reviewer

Bureau Veritas

<div>
 <ul>
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   Position Details
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    Position
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 RCL Reviewer
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    Office / Department
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 Regional Critical Location
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    Reporting to
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 RCL Manager
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    Key Working Relationship
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 Certification Managers of Operational Countries
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 Technical Manager of Operational Countries
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 Auditors of Operational Countries
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 Sales Team of Operational Countries
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 Coordinators of Operational Countries
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   Minimum Required Qualifications
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    Specialty
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 Relevant standard Lead Auditor qualification, Application reviewer qualification and decision maker qualification
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    Education
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 University degree (or similar educational institute level) is required
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    Training
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 Be a Lead Auditor for the scheme he/she is technically reviewing
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 On Job training in CR, File and competency cases knowledge related to the management system qualification is required.
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    Technical knowledge
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 Knowledge of Certification cycle process (initial audit, main audit, surveillance audits, recertification, transfer audit, extension/ reduction of scope/sites).
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 Knowledge of Certification that can be offered.
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 Knowledge of specific management system standards/normative documents
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 Knowledge of client&rsquo;s business sector
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 Knowledge of client technological sector (i.e. products, processes and organization); PQC, PEC and SAF.
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   For ISO 14001 environmental terminology, aspects and associated impacts.
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   For ISO 45001 OH&amp;S terminology, principles, process, concepts and context of organization.
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  </li>
 </ul>
 Knowledge of Standards and normative documents as per the applicable accreditation scheme, Accreditation rules, CER MS procedures, applicable MDs and guidance related to the standard
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 Knowledge of Auditing principles, practices, techniques and local laws related to the chosen standard
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 Knowledge of Contact details of local certification personnel to clarify issues.
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    Experience
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 <strong>
  Skills
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 </strong>
 The candidate should have at least 5 years total work experience where the activities undertaken contribute to the development of knowledge and skills in:
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   The Quality management field (for QMS Auditors);
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   The Environmental Management field (for EMS Auditors);
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   The Occupational Health and Safety Management field (for OH&amp;SMS Auditors).
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    Skills
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 <strong>
  Languages
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 </strong>
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   Fluent in English reading, writing and speaking
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   Responsibilities / Authorities / Accountabilities
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    Primary Functions
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    Ability to detect technical defects in audit reports against the certification documentation requirements before it is presented to Certification Decision maker
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    Ability to take a certification decision
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    Ability to handle the critical matter in a fair manner
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 </ul>
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    Technical Expertise
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    Technical expertise in the fields of Engineering, Science and Technology is required as per the sector specific requirements.
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  </ul>
  <strong>
   Application Review
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  </strong>
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    Review of the submitted contract review for correctness and completeness in line with requirements.
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    Seek additional information / corrections as applicable based on review
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    Approve the contract review once all the required elements are found in line with the requirements.
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    Review and evaluate, using appropriate checklist, the technical content, accuracy, and relevance of audit report.
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    Identifying gaps, inconsistencies, or areas for improvement in audit reports.
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    Makes certification decisions for products they are authorized for. They take decisions as described in the certification process.
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   File Review
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  </strong>
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    Review and evaluate, using appropriate checklist, the technical content, accuracy, and relevance of audit report.
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    Identifying gaps, inconsistencies, or areas for improvement in audit reports in the form of defects and queries.
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    Provide feedback to Auditors and Technical Managers regarding queries.
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    Collaborate with other Technical Reviewers to ensure consistency and alignment.
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    Maintain comprehensive documentation and records of their review activities and recommendations
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   Competence Review
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    Review and evaluate requested competence against the procedures of BVCME
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    Identifying gaps, inconsistencies, or areas for improvement in audit reports in the form of defects and queries.
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    Provide approvals for auditor status and code allocations as per BVCME procedures
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    Maintain record and update the tracker.
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   Suspension And Withdrawal
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    Review and evaluate requested suspension and withdrawal request
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    Identifying gaps, inconsistencies, in suspension and withdrawal request received
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    Maintain record and update the tracker.
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  <strong>
   General Responsibilities
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  </strong>
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    Ensure compliance with iso 17021 Standard, Mandatory documents and BVCME Procedures
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    Maintain data integrity, accuracy and confidentiality within the management system certification
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    Ensure relevant data collected from all countries relevant to complaints and appeals, Surveillance audits, Incident (internal external), Countries customer feedback, RCL Customer satisfaction and Auditors peer review etc.
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    Develop, implement and maintain a robust system for sorting, tracking and retrieving data related to accreditation activities
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    Generate quarterly report regarding review activities, trend and performance metrics
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    Collaborate with internal and external stakeholders to ensure smooth flow of accreditation and certification related activities.
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    Identify and mitigate risk related to data management
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    Complete all assigned E-learning in timely manner.
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    Maintain key performance indicators as stipulated through service level agreements (SLA)
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    Remain responsible for clarification regarding any doubt pertaining to defect or query
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    Participate in technical discussions, meets and other events as organized by BV from time to time
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    Participate in audit to maintain Lead Auditor qualification and improve technical skills
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    Keep and continuously improve the knowledge towards technical and regulatory aspects of industry sectors, to be able to review the audit reports in an ongoing context
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    Business Requirements
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    Having adequate communication and leadership skills
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    Ensuring quality of Audit according to ISO 17021 requirements
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    Interpretation of results of auditing
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    Ability to communicate complex findings clearly to stakeholders.
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    Customer Focus
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    Focussed to meet the requirements of Operational countries
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    Develop trust and open communication with team.
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    HSE Requirements
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    Maintain up-to-date awareness of Corporate HSE policy, procedures and practices
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    Comply at all times with all applicable legal requirements, BV HSE Policies and procedures, client&rsquo;s HSE procedures and practices.
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    Maintain personal work areas tidy and hazard free and report any deviation/fault/hazard immediately to the location manager/line manager/supervisor
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    Report immediately any newly identified hazard and participate in devising suitable operational control to eliminate/minimize the pertinent risk.
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    Report immediately any HSE incident and cooperate in investigation
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    Take care of your own health and safety and that of people who may be affected by what you do (or do not do).
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    Co-operate with others on health and safety, and not interfere with, or misuse, anything provided for your health, safety or welfare.
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    Communicate to their RCL manager and local HSE representative about any unsafe work practice or condition and opportunities for improvement of HSE practices.
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    Comply with client&rsquo;s site specific HSE regulations.
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    Always comply with all applicable legal requirements, BV Group HSE policies and procedures, clients HSE procedures and practices.
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    Maintain up-to-date awareness of Corporate HSE policy, procedures and practices
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    Performance Monitoring
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    Continual Development
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 As per the Performance Management Process (PMP) form from time to time on yearly basis.
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   Complete requirements for appropriate professional trainings in specified time frames.
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   Attend appropriate courses/seminars/Training
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   Progress towards developing individual distinctive competence targets.
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    KPI&rsquo;s
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  Technical Review KPI
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 <ul>
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   Response time for CR review, Files review, competence, suspension and withdrawal with respect to SLA signed with countries
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   Accurate and clear technical review
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  Achieve Production KPIs For Auditors
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 Timely Submission of audit plans. (If SF15 sent timely) 2 weeks prior to the audit
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 Timely Submission of audit reports. 7 days after the last day of the audit
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 Ensuring customer satisfaction - Zero customer complaint (justified)
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 ICC Defects resulting from Audit Reporting - Below 5 %
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 Average NCR raised in the audit -1
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    Monitored By
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 </ul>
 RCL Manager
</div>


QHSE Scheme Reviewer

TELUS Digital

<div>
 <p>
  Looking for a freelance opportunity where you can make an impact on technology from the comfort of your home? If you are dynamic, tech-savvy, and always online to learn more, this part-time flexible project is the perfect fit for you!
 </p>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   A Day in the Life of a Content Reviewer - US:
  </strong>
 </p>
 <ul>
  <li>
   In this role, you&rsquo;ll be analyzing and providing feedback on texts, pages, images, and other types of information for top search engines, using an online tool
  </li>
  <li>
   Through reviewing and rating search results for relevance and quality, you&rsquo;ll be helping to improve the overall user experience for millions of search engine users, including yourself.
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  Join our team today and start putting your skills to work for one of the world's leading search engines.
 </p>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   The estimated hourly earnings for this role are 14 USD per hour.
  </strong>
 </p>
 <p>
  <br/>
 </p>
 <p>
  Please note only one member per household can work on this program. If at a later stage it is identified that more than one person in your household is working on the TELUS Digital Rating Program, it will result in removal from the program.
 </p>
 <p>
  <br/>
 </p>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   TELUS Digital AI Community
  </strong>
 </p>
 <p>
  Our global AI Community is a vibrant network of 1 million+ contributors from diverse backgrounds who help our customers collect, enhance, train, translate, and localize content to build better AI models. Become part of our growing community and make an impact supporting the machine learning models of some of the world&rsquo;s largest brands.
 </p>
 <p>
  <br/>
 </p>
 <p>
  Qualification path
 </p>
 <p>
  <br/>
 </p>
 <p>
  No previous professional experience is required to apply to this role, however, working on this project will require you to pass the basic requirements and go through a standard assessment process. This is a part-time long-term project and your work will be subject to our standard quality assurance checks during the term of this agreement.
 </p>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   Basic Requirements
  </strong>
 </p>
 <ul>
  <li>
   Working as a freelancer with excellent communication skills in English
  </li>
  <li>
   Being a resident in the United States for the last 3 consecutive years and having familiarity with current and historical business, media, sport, news, social media, and cultural affairs in the US.
  </li>
  <li>
   Active use of Gmail and other forms of social media and experience in the use of web browsers to navigate and interact with a variety of content
  </li>
  <li>
   Daily access to a broadband internet connection, a smartphone (Android 5.0, iOS 14 or higher), and a personal computer to work on.
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   Assessment
  </strong>
 </p>
 <p>
  In order to be hired into the program, you&rsquo;ll take a language assessment and an open book qualification exam that will determine your suitability for the position and complete ID verification. Don&rsquo;t worry, our team will provide you with guidelines and learning materials before your exam. You will be required to complete the exam in a specific timeframe but at your convenience!
 </p>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   Equal Opportunity
  </strong>
 </p>
 <p>
  All qualified applicants will receive consideration for a contractual relationship without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status. At TELUS Digital AI, we are proud to offer equal opportunities and are committed to creating a diverse and inclusive community. All aspects of selection are based on applicants&rsquo; qualifications, merits, competence, and performance without regard to any characteristic related to diversity.
 </p>
</div>


Content Reviewer - US | WFH

Tanaq Health

<div>
 <strong>
  Description
  <br/>
  <br/>
 </strong>
 <strong>
  Overview
  <br/>
  <br/>
 </strong>
 Tanaq Support Services (TSS) delivers professional, scientific, and technical services and information technology (IT) solutions to federal agencies in health, agriculture, technology, and other government services. TSS is a subsidiary of the St. George Tanaq Corporation, an Alaskan Native Corporation (ANC) committed to serving Federal customers while also giving back to the Tanaq native community and shareholders.
 <br/>
 <br/>
 <strong>
  About The Role
  <br/>
  <br/>
 </strong>
 We are seeking a
 <strong>
  Clinical Appeals Reviewer
 </strong>
 to support a contract with our federal client. The Clinical Appeals Professional performs complex (senior-level) work. Provides dissatisfied parties with the opportunity to present documentation to demonstrate why an appeal should be allowed. Provides an independent second level determination based on the documentation, facts, laws, regulations, and guidelines. Works under general supervision, with moderate latitude for the use of initiative and independent judgment. Qualified candidates must be licensed health care professionals capable of rendering independent clinical judgment, including but not limited to Registered Nurses (RN), Physical Therapists (PT), Occupational Therapists (OT), and Respiratory Therapists (RT).
 <br/>
 <br/>
 This is a remote position that can be based anywhere in the United States. Must be able to work on a rotating schedule on weekends and holidays.
 <br/>
 <br/>
 <strong>
  Responsibilities
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Reviews medical records/case files, writes reconsideration decision letters that are clear, concise, and impartial, and support the determination made, and documents the review.
  </li>
  <li>
   Makes sound, independent decisions based on medical evidence in accordance with statutes, regulations, rulings, and policy.
  </li>
  <li>
   Responds to and ensures that all appeal issues raised by the beneficiary/patient, representative, and provider/supplier have been addressed.
  </li>
  <li>
   Provides a fair and impartial decision based on current evidence, regulations, policies, and procedures.
  </li>
  <li>
   Conducts research using online federal regulations, contract policy, standards of medical practice, contract manuals, coverage issues manuals, medical literature, and other related resources to complete an accurate and well-supported decision.
  </li>
  <li>
   Stays abreast of changes in regulations, medical and healthcare practices, policies, and procedures.
  </li>
  <li>
   Participates in case-specific verbal discussions.
  </li>
  <li>
   Conducts reviews of appeals/disputes with multiple beneficiaries/services in one case.
  </li>
  <li>
   Plans responses to statistical analysis challenges with assistance from statisticians.
  </li>
  <li>
   Attends meetings and participates in workgroups at management's direction.
  </li>
  <li>
   Conducts quality reviews, as needed.
  </li>
  <li>
   Serves as a subject matter expert.
  </li>
  <li>
   Mentors and/or trains staff.
  </li>
  <li>
   May conduct quality reviews and audits.
  </li>
  <li>
   Participates in special projects and performs other duties as assigned.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Requirements
  <br/>
  <br/>
 </strong>
 <strong>
  Required Skills and Experience
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Three (3) years of experience in medical dispute resolution, Medicare appeals, medical review, clinical work, or related healthcare roles.
  </li>
  <li>
   Healthcare Professional with experience in Nursing, Physical Therapy, Respiratory Therapy, or Occupational Therapy experience.
  </li>
  <li>
   Demonstrated experience writing or making medical necessity decisions.
  </li>
  <li>
   Proficiency in research techniques, medical terminology, and analyzing and interpreting policies, along with knowledge of state and federal laws and regulations.
  </li>
  <li>
   Must have experience and working knowledge of the Medicare program, including coverage and payment rules.
  </li>
  <li>
   Experience with Medicare regulations, claims processing, and the medical review process, as well as applicable laws, rules, and regulations.
  </li>
  <li>
   Prioritize and organize work tasks to handle multitasking and meet deadlines.
  </li>
  <li>
   Ability to prepare correspondence and documents using correct spelling, grammar, and punctuation; proofreading and reviewing documents for clarity and consistency.
  </li>
  <li>
   Practice logic and reasoning to identify problems, verify facts, and reach valid conclusions.
  </li>
  <li>
   Experience in making decisions that support business objectives and goals.
  </li>
  <li>
   Ability to identify and resolve problems or refer issues appropriately.
  </li>
  <li>
   Communicate effectively verbally and in writing.
  </li>
  <li>
   Adapt to the needs of internal and external customers.
  </li>
  <li>
   Show integrity and ethical behavior, respect confidentiality, business ethics, and organizational standards.
  </li>
  <li>
   Ensure compliance with company policies, procedures, and guidelines, including cybersecurity, regulatory, contractual, and accreditation entities.
  </li>
  <li>
   Experience directly relevant to Medicare managed care appeals or utilization management activities, preferred.
  </li>
  <li>
   Must have resided in the United States for a minimum of three (3) years out of the last five (5) years. This is a contractual requirement.
  </li>
  <li>
   Must possess a valid driver's license with a clear and satisfactory driving record.
  </li>
  <li>
   Ability to obtain and maintain public trust clearance and customer approval.
  </li>
  <li>
   Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Education and Training
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Associate's degree or 60 or more credit hours towards a Bachelor&rsquo;s degree from an accredited college or university in healthcare or related discipline.
  </li>
  <li>
   Additional experience in Medicare appeals, medical review, clinical, or other related experience in a healthcare setting may be substituted for an Associate&rsquo;s degree on a year per year basis. (Experience requirements may be satisfied by full-time experience or the prorated part-time equivalent.)
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Physical Requirements And Work Environment
  <br/>
  <br/>
 </strong>
 <ul>
  <li>
   Requires working in an office/cubicle environment; sitting, standing, walking, bending, twisting, and/or reaching.
  </li>
  <li>
   Prolonged periods of sitting at a desk and working on a computer. May need to lift 25 pounds occasionally.
  </li>
  <li>
   May require the ability to operate a motor vehicle and travel by motor vehicle and commercial airline. May require overnight travel. Travel may be less than 5% annually.
   <br/>
   <br/>
  </li>
 </ul>
 <strong>
  Who We Are
  <br/>
  <br/>
 </strong>
 Tanaq Management Services (TMS) is a public health contractor, certified 8(a) business, owned by St. George Tanaq Corporation, an Alaska Native Corporation. (ANC). We listen to our stakeholders and leverage our science, technology, communication, and program expertise to understand and provide feedback as we develop solutions.
 <br/>
 <br/>
 <strong>
  Our Commitment to Non-Discrimination
  <br/>
  <br/>
 </strong>
 Tanaq is an Equal Employment Opportunity Employer. All qualified applicants will receive consideration for employment without regard to disability, status as a protected veteran or any other status protected by applicable federal, state, or local law. Tanaq complies with the Drug-free Workplace Act of 1988 and E-Verify.
 <br/>
 <br/>
 If you are an individual with a disability and need assistance completing any part of the application process, please email accommodation@tanaq.com to request a reasonable accommodation. This email is for accommodation requests only and cannot be used to inquire about the status of applications.
 <br/>
 <br/>
 <strong>
  Notice on Candidate AI Usage
  <br/>
  <br/>
 </strong>
 Tanaq is committed to ensuring a fair and competitive interview process for all candidates based on their experience, skills and education. To ensure the integrity of the interview process, the use of artificial intelligence (AI) tools to generate or assist with responses during phone, in person and virtual interviews is not allowed. However, candidates who require a reasonable accommodation that may involve AI are required to contact us prior to their interview at accommodation@tanaq.com.
 <br/>
 <br/>
 <strong>
  To Apply For This Positions, Visit
  <br/>
  <br/>
 </strong>
 https://recruiting.paylocity.com/Recruiting/Jobs/Details/4071254
</div>


Clinical Appeals Reviewer (Licensed Healthcare Professional)

TEEMA

<div><p><b>Claims Reviewer Opportunity</b></p><p>
Join a dynamic team where your expertise in claims review can make a real difference! We're looking for a detail-oriented Claims Reviewer who can apply clinical and coding knowledge to ensure accurate claims processing. If you have a strong foundation in medical claims and are passionate about quality, we want to hear from you!</p><p><b>
Position Highlights</b></p><ul><li><p><b>
Role</b>: Conduct retrospective review of medical, surgical, and behavioral health claims.</p></li><li><p><b>
Focus</b>: Evaluate claims for medical necessity, appropriateness, and adherence to program benefits.</p></li><li><p><b>
Collaboration</b>: Work closely with medical directors, providers, peer reviewers, and various internal teams.</p></li></ul><p><b>
Key Responsibilities</b></p><ul><li><p>
Review and validate claims using established criteria and processing guidelines.</p></li><li><p>
Prepare cases for payment or further review.</p></li><li><p>
Identify opportunities for process improvement and flag quality or fraud concerns.</p></li><li><p>
Support peers and clinical/non-clinical staff with claims and coding inquiries.</p></li></ul><p><b>
What You Bring</b></p><ul><li><p><b>
Required</b>:</p><ul><li><p>
High School Diploma or GED.</p></li><li><p>
2+ years of experience in medical claims review.</p></li><li><p>
Familiarity with medical claims processing and terminology.</p></li></ul></li><li><p><b>
Preferred</b>:</p><ul><li><p>
Coding experience.</p></li><li><p>
Knowledge of behavioral health claims.</p></li></ul></li></ul><p><b>
Skills for Success</b></p><ul><li><p>
Strong technical skills in claims tools (e.g., CDST, Supercoder).</p></li><li><p>
Organizational and team-building abilities.</p></li><li><p>
Resilience in a fast-paced, high-intensity environment.</p></li><li><p>
Effective communication and problem-solving.</p></li></ul><p><b>
Additional Requirements</b></p><ul><li><p>
Must pass background, credit, and drug screening.</p></li><li><p>
Adherence to federal THC policies (medical card required if applicable).</p></li></ul><p><b>
Eligible Locations</b><br>
The position is remote, but you can only reside in the following states: AK, AR, AZ, CO, DC, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NC, ND, NE, NM, NV, OK, OR, SC, SD, TN, TX, UT, VA, WA, WI, WY.</p><p>
Ready to bring your claims expertise to a rewarding role? Apply today to be part of our team!</p>
#Workwolf #BCDC_Consulting</div>

Claims Reviewer

PTCL.Official

<div>
 <p>
  <strong>
   ARE YOU READY TO RISE WITH PTCL GROUP
  </strong>
 </p>
 <p>
  <br/>
 </p>
 <p>
  We are not just industry leaders; we are redefining excellence with groundbreaking solutions. PTCL Group stands out in the technology industry with its commitment to high-end innovation and leading the way in delivering integrated ICT and Cellular Network services in Pakistan, all rooted in our journey of Culture Transformation &amp; Change Management.
 </p>
 <p>
  <br/>
 </p>
 <p>
  <em>
   PTCL Group actively cultivates an inclusive &amp; diverse culture that values and uplifts every individual, regardless of their gender, social background, religion, belief, or disability
  </em>
  .
 </p>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   PTCL Group Vision &amp; Values:
  </strong>
 </p>
 <p>
  <br/>
 </p>
 <p>
  With a clear vision to become the largest technology player and champion driving the digital transformation of Pakistan, PTCL Group is guided by a set of our unified core values:
 </p>
 <p>
  <br/>
 </p>
 <ul>
  <li>
   Be Resilient
  </li>
  <li>
   Think Big
  </li>
  <li>
   Win Every Battle
  </li>
  <li>
   Value Success
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   IN THIS ROLE YOU WILL:
  </strong>
 </p>
 <p>
  <br/>
 </p>
 <p>
  The purpose of this position is to ensure the quality, security, and maintainability of software applications by performing systematic source code reviews. The role involves analyzing code for compliance with coding standards, identifying potential vulnerabilities, improving performance and readability, and ensuring adherence to best practices in software development. The Source Code Reviewer collaborates with development, QA, and security teams to deliver reliable, efficient, and secure software products
 </p>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   HOW CAN YOU EXPRESS YOUR TALENT:
  </strong>
 </p>
 <ul>
  <li>
   Carefully examines software source code to ensure accuracy, efficiency, and alignment with established coding standards. This involves reviewing logic, structure, naming conventions, and adherence to best practices. The reviewer identifies deviations or potential issues early in the development process to maintain high-quality, reliable code before deployment.
  </li>
  <li>
   To detect defects, inefficiencies, and security vulnerabilities within the codebase. The reviewer documents each finding clearly, describing the issue, its potential impact, and recommended corrective actions. This systematic documentation ensures traceability, accountability, and compliance with organizational and security standards.
  </li>
  <li>
   Works closely with developers to discuss findings, explain coding issues, and suggest effective solutions. This collaboration helps build shared understanding and promotes consistent application of best practices across the development team. Constructive feedback is provided to improve both individual coding skills and overall software quality.
  </li>
  <li>
   Beyond syntax and structure, the reviewer ensures that the code meets defined functional and performance requirements. This includes verifying logic correctness, evaluating code efficiency, and ensuring that changes do not introduce regressions or performance bottlenecks. This step helps guarantee that the final product performs as intended and meets user expectations.
  </li>
  <li>
   Maintains detailed records of review outcomes, including issues identified, corrective actions taken, and final approval status. These reports serve as essential documentation for internal audits, compliance checks, and process improvement initiatives. Accurate recordkeeping supports transparency and continuous quality assurance.
  </li>
  <li>
   To ensure a seamless development lifecycle, the reviewer collaborates regularly with Quality Assurance, Security, and Project Management teams. This coordination helps align review activities with testing cycles, security assessments, and release schedules. By maintaining open communication, the reviewer contributes to timely, secure, and high-quality software delivery.
  </li>
 </ul>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   WHAT YOU NEED TO BE SUCCESSFUL:
  </strong>
 </p>
 <p>
  <strong>
   Qualification
  </strong>
 </p>
 <p>
  <br/>
 </p>
 <p>
  Bachelors in relevant field.
 </p>
 <p>
  <br/>
 </p>
 <p>
  <strong>
   <em>
    PTCL Group's family-centric policies, offering 6-month maternity and 30-day paternity leave, along with a hybrid work model, redefine the workplace for a balanced and fulfilling career.
   </em>
  </strong>
 </p>
 <p>
 </p>
</div>


Executive Software Security & Source Code Review

Staffing Solutions Organization LLC (SSO)

Staffing Solutions Organization LLC (SSO), an affiliate of Public Consulting Group LLC (PCG), is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed to a diverse workforce, which is a reflection of our clients and the people they serve.
<br><br>
Nurse Reviewer – State of Illinois
<br><b>Location:</b> Remote with on site visits across Illinois
<br>We are currently seeking Nurses who reside in Central Illinois - preferably in McLean and Sangamon Counties.
<br><br>
Position Overview
<br>The Nurse Reviewer conducts provider compliance reviews to ensure adherence to state regulations, quality standards, and program requirements. This role includes conducting onsite visits, evaluating documentation, and determining provider compliance. The Nurse Reviewer works independently, exercises sound judgment, and provides recommendations that guide provider improvement and support statewide oversight efforts.
<br><br>
Duties & Responsibilities
<br><ul>
<li>Build and maintain effective relationships with providers and users to support high quality customer service.</li>
<li>Evaluate providers for compliance with applicable state and program regulations.</li>
<li>Coordinate and schedule on site provider visits; clearly communicate visit requirements.</li>
<li>Conduct compliance interviews with providers and gather all necessary information.</li>
<li>Review provider documentation, policies, and business practices for regulatory alignment.</li>
<li>Collect, organize, and submit documentation supporting compliance findings.</li>
<li>Utilize technology and web based systems to convert paper documentation to electronic format.</li>
<li>Conduct in person assessments of provider sites to evaluate compliance with oversight requirements.</li>
<li>Summarize on site visit findings accurately and professionally.</li>
<li>Exercise independent judgment to evaluate compliance and make final determinations based on documented evidence.</li>
<li>Identify deficiencies and recommend appropriate next steps to support provider improvement.</li>
<li>Analyze trends in non compliance and identify gaps in provider business processes.</li>
<li>Provide timely recommendations and updates to the Supervisor.</li>
<li>Maintain HIPAA standards and confidentiality at all times.</li>
<li>Perform other duties as assigned.</li>
</ul>
Required Skills
<br><ul>
<li>Strong interpersonal skills with the ability to relate well to staff and providers.</li>
<li>Active listening and effective communication skills.</li>
<li>Proficiency in MS Word, Excel, Outlook, and web based applications.</li>
<li>Process oriented and results driven work approach.</li>
<li>Ability to foster teamwork and collaborate across levels of management and staff.</li>
<li>Ability to work independently and within a team environment.</li>
<li>Excellent written and verbal communication skills and customer service techniques.</li>
<li>High accuracy, strong attention to detail, and commitment to quality.</li>
<li>Proven ability to meet deadlines and follow strict standards.</li>
<li>Ability to travel regularly to provider sites across Illinois.</li>
</ul>
Qualifications
<br>Experience
<br><ul>
<li>Minimum 2 years of clinical experience working with critical care providers, public health providers, or providers serving children, older adults, individuals with traumatic brain injury, or individuals with developmental disabilities.</li>
<li>Minimum 1 year of experience conducting quality assurance reviews.</li>
</ul>
Education
<br><ul>
<li>Bachelor’s degree preferred</li>
</ul>
Certification
<br><ul>
<li>Active Illinois Registered Professional Nurse (RN) license required.</li>
</ul>
Working Conditions
<br><ul>
<li>Remote work with 2–3 on site provider visits per week throughout the state of Illinois.</li>
</ul>
Benefits (Through SSO)
<br>SSO offers a competitive benefits package that supports your health, financial well being, and long term growth, including:
<br><ul>
<li>Medical, dental, and vision insurance</li>
<li>401(k) with discretionary employer match</li>
<li>Paid time off and holidays</li>
<li>Flexible spending accounts</li>
<li>Additional employee perks</li>
</ul>
Keyword Search Terms
<br>Nurse Reviewer, RN Reviewer, Provider Management Specialist, Compliance Nurse, Healthcare Quality Review, Provider Compliance, Medicaid Compliance, Clinical Reviewer, Illinois RN, Site Visit Nurse, Healthcare Auditor, Public Health Nursing, QA Nurse, Provider Monitoring.
<br><br>
Compensation for roles at Staffing Solutions Organization LLC (SSO) varies depending on a wide array of factors including, but not limited to, the specific office location, role, skill set, and level of experience. As required by applicable law, SSO provides a reasonable range of compensation for this role. In addition, SSO provides a range of benefits for this role.
<br><br>
Applicants must be authorized to work in the U.S. This position is not eligible for work authorization sponsorship (including H-1B sponsorship) by SSO and under the federal laws relating to the F-1 STEM EAD program, this position is not eligible to support a STEM EAD extension application.
<br><br>
All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, marital status, age, national origin, protected veteran status, or disability. Staffing Solutions Organization LLC is an E-Verify participant.

Nurse Reviewer

EGBank

<div></div><div><div><div><div><div><div><div><div><b>KEY ACCOUNTABILITIES</b></div></div></div><div><br>
<div>
<div><b>Description</b></div></div></div><div><br>
<div>
<div><ul><li><div>Ensure credit applications are processed within the approved time frame and approved lending parameters while maintaining deviation caps approved by policy.</div>
</li></ul>
<ul><li><div>Verify all credit applications related documents are complete and complying with approved policy and CBE regulations</div>
</li></ul>
<ul><li><div>Must be able to detect fraud applications &amp; ensure that good quality of credit applications is processed</div>
</li></ul>
<ul><li><div>Ensure the standard Operating Procedures for credit underwriting, verification, documentation, delegation is compliant with policy and any exceptions are to be regularly reported to management.</div>
</li></ul>
<ul><li><div>Communicate major deficiencies &amp; policy violations to direct manager to take the needed corrective actions to maintain a good healthy retail credit portfolio.</div>
</li></ul>
<ul><li><div>Provide the needed support with Recommendations with additions &amp; modifications to credit policy, product manual &amp; Operational procedures.</div>
</li></ul>
<ul><li><div>Thrive to maintain good healthy retail credit portfolio through checking various reports such as I-Score reports, CBE Negative list to check credit history and DBR calculations</div>
</li></ul>
<ul><li><div>Conducting contact point verification (CPV) with customer, STL/HR checks with employer, residence verification and mobile verification (If required by credit policy)</div>
</li></ul>
<ul><li><div>Ensure quality of service to Internal &amp; External customers by adhering to the committed turnaround time.</div></li></ul></div></div><br>
</div><br>
<div><div><div><b>Policies, processes and procedures:</b></div>
<div>
Follow all relevant approved department&rsquo;s policies, and procedures and monitor adherence so that work is carried out in a controlled manner.</div></div></div><div><br>
<div>
<div><b>Day-to-Day Management:</b></div>
<div>
Follow the day-to-day operations related to own jobs in the department to ensure continuity of work</div></div></div><div><br>
<div>
<div><b>Compliance:</b></div>
<div>
Comply with all relevant CBE regulations, banking laws, AML regulations and internal EG Bank policies and code of conduct to maintain EG Bank&rsquo;s sound legal position and mitigate any potential risks</div></div></div></div></div><br>
</div>
<p></p><br>
<br>
<div><div><div><div><div><div><b>5. COMMUNICATION &amp; WORKING RELATIONSHIPS</b></div></div></div><div><br>
<div>
<div><b>Internal: Retail Business, Portfolio management, Fraud unit, Legal, compliance,</b></div>
<div><b>
Collection, HR and internal Audit.</b></div>
<div><b>
External:</b> External Clients (call verifications)</div></div></div></div></div><br>
</div>
<p></p><br>
<br>
<div><div><div><div><div><div><b>6. QUALIFICATIONS, EXPERIENCE AND SKILLS</b></div></div></div><div><br>
<div>
<div><b>Qualifications and Experience:</b></div>
<div>
<ul><li><div>Bachelor&rsquo;s degree in Business Administration, Accounting, Economics or a related field.</div>
</li></ul>
<ul><li><div>For the Retail Credit Reviewer role 0-3 years of experience of relevant experience</div>
</li></ul>
<ul><li><div>For the Retail Credit Senior Reviewer role 3-5 years of relevant experience</div>
</li></ul>
<ul><li><div>Experience within the Banking Industry is preferred for the credit reviewer role and is a must for the senior reviewer role.</div>
</li></ul>
</div><div><b>Skills:</b></div>
<div>
<ul><li><div>Excellent command of English and Arabic languages (written and spoken)</div>
</li></ul>
<ul><li><div>Excellent decision making and negotiation skills
</div></li></ul><ul><li><div>Excellent communication skills</div>
</li></ul>
<ul><li><div>Excellent planning and organizing skills</div>
</li></ul>
<ul><li><div>Good Use of Microsoft office tools</div>
</li></ul>
<ul><li><div>Good Business Acumen of external market and up-to date market trends and practices</div></li></ul></div></div></div></div></div></div></div></div><p></p>

Retail Credit Reviewer - Senior Reviewer (3899)

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