nurse reviewer

Commence

<div>
 Job Type
 
 
 Part-time
 
 
 
 Description
 
 
 
 At Commence, we&rsquo;re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care.
 
 
 With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.
 
 
 The Nurse Reviewer position is responsible for supporting and conducting reviews and determinations for independent dispute resolutions at both the Federal and State levels. This role involves analyzing medical records, ensuring proper documentation, and providing quality assurance checks to support the final determination. IDRE Nurse Reviewers must ensure that their decisions are well-supported with robust rationale and comply with Federal or State guidelines. This position will be responsible for resolving claim disputes submitted by various parties, such as physicians, hospitals, institutions, pharmacies, and other licensed healthcare providers. Additionally, responsibilities will include resolving disputes submitted to the Federal Independent Review (IDR) process. IDRs conduct impartial reviews of healthcare services to resolve disputes between healthcare providers. facilities and payers. IDRs provide objective assessments of billing, coding, and other issues related to disputed claims. The role requires conducting all job duties efficiently, promptly, productively, consistently, and courteously while maintaining a high level of professionalism.
 
 
 
 Requirements
 
 
 
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 Conduct an initial assessment of documentation from both the initiating and responding parties.
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 Review submitted documentation to identify missing documents and determine what is required to resolve the dispute. Follow procedures to obtain the appropriate documentation.
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 Determine the appropriate type of clinical reviewer necessary to complete the case, such as a medical coder or a physician.
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 Prepare documents for the arbitrator reviewer assigned and provide instructions as needed.
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 Collaborate with the legal team to facilitate resolution of disputes.
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 Draft professional determination correspondence.
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 Perform quality assurance checks on determinations according to Federal or State guidance.
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 Audit and analyze patient records to ensure appropriate determination.
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 Stay current with regulation changes and perform research on a case-by-case basis.
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 Deliver high-quality, professional determinations free of grammar and spelling errors.
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 Amend reports with additional clinical information when necessary.
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 Participate in an interdisciplinary health care team to achieve positive outcomes.
 
 
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 Required Qualifications
 
 
 
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 Maintain an active license in nursing ( at a minimum, RN required)
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 Five years of full-time equivalent experience providing direct care to patients
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 Hold a non-restricted nursing license in any state in the US.
 
 
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 Preferred Qualifications
 
 
 
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 Ability to analyze clinical documentation and apply appropriate guidelines.
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 Strong oral and written communication skills with excellent customer service.
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 Ability to multitask and adapt to a fast-paced environment.
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 Strong organizational skills and attention to detail
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 Knowledge of claim review processes includes billing, Current Procedural Terminology (CPT) coding, and Explanation of Benefits.
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 Familiarization with navigating electronic documents like PDFs, Microsoft Excel, Microsoft Word, and experience using Microsoft Outlook.
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 Familiarization with electronic data repositories such as SharePoint and/or ShareFile.
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 Exceptional skills in managing sensitive and confidential information.
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 Strong organizational abilities, written, and verbal communication skills in English.
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 Ability to work both independently and collaboratively with other team members to include clinical reviewers, physicians, and attorneys.
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 Skilled in prioritizing tasks to align with business needs and assignments.
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 Appeal and/or claim dispute-related experience.
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 Medical Coding Certification preferred
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 Experience with Utilization Review preferred
 
 
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 </ul>
 
 Organizational "Fit" Considerations:
 
 
 
 Schedules may vary and may include weekend and holiday shifts. This position requires established, professional relationships with internal personnel at all levels within the company and with beneficiaries, representatives, providers, and other stakeholders.
 
 
 
 Work Environment/Physical Demands
 
 
 
 The work environment and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 
 
 This is an office/remote position. While performing the duties of this job, the employee regularly works in a climate-controlled environment. Candidates must be able to sit, read, work on a computer, and watch a computer screen for extended periods of time. Occasionally required to stand, walk, use hands and fingers, kneel or crouch.
 
 
 This is a remote position. Candidates must be able to sit, read, work on a computer, and watch a computer screen for extended periods of time. Occasionally required to stand, walk, use hands and fingers, kneel or crouch.
 
 
 
 Commence is an equal employment opportunity employer. All personnel processes are merit-based and applied without discrimination on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military and veteran status or any other characteristic protected by applicable law.
 
 
 
 
 Commence.AI is committed to providing equal employment opportunities to all applicants, including individuals with disabilities. If you require a reasonable accommodation to participate in the application process due to a disability, please contact Human Resources at (757) 306-4920 or hr@commence.ai.
 
 
 Please note that unless you are requesting an accommodation, all applications must be submitted through our online application system.
 
 
 
 Salary Description
 
 
 $45-$55/hr
</div>

IDR Nurse Reviewer

Briljent

<div>
 
 Description
 
 
 
 We are seeking a detail-oriented
 
 Clinical Auditor Registered Nurse
 
 to support medical record reviews, billing compliance audits for the Indiana Health Coverage Programs. This role is responsible for evaluating quality of care, reviewing medical records and program policies and identifying compliance issues, preparing audit documentation and reports, and supporting appeals activities. The ideal candidate brings clinical knowledge, regulatory awareness, and strong analytical and writing skills. This is a remote position with occasional travel required within Indiana.
 
 
 
 Key Responsibilities
 
 
 
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 Review medical records and related documentation to evaluate provider compliance with Indiana Health Coverage Programs, CMS, AMA, and other applicable standards and regulations.
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 Conduct medical record and compliance reviews independently and provide preliminary findings to the Lead Reviewer.
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 Identify potential documentation deficiencies, and billing compliance issues.
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 Maintain detailed workpapers documenting procedures performed, records reviewed, findings identified, and conclusions reached.
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 Assist with audit responses and appeals as needed.
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 Ensure all work aligns with state, federal, and national healthcare and Medicaid guidelines.
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 Stay current on clinical guidelines, policies, regulations, and Indiana Medicaid program and policy updates.
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 Research Indiana Medicaid rules and maintain internal repositories of bulletins, policies, and procedures.
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 Adapt quickly to changing priorities, policies, regulatory updates, and review requirements while maintaining accuracy and meeting deadlines.
 
 
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 </ul>
 
 Requirements
 
 
 
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 RN license preferred; Indiana license or compact license accepted.
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 Coding certification such as CCS or CPC strongly preferred.
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 Candidate located in or near the Indianapolis area is preferred.
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 At least 1 year of Medicaid claims review, billing compliance, or healthcare reimbursement experience.
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 Familiarity with Indiana Medicaid policies, payer guidelines, and documentation requirements preferred.
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 Knowledge of CPT coding guidelines and ICD-10 standards.
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 Proficiency in Microsoft Excel, Word, and Outlook.
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 Strong analytical, critical thinking, problem-solving, and technical writing skills.
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 Ability to work independently and collaboratively in a fast-paced environment.
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 Experience working with healthcare providers strongly preferred.
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 Knowledge of healthcare claims data and fraud, waste, and abuse preferred.
 
 
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 </ul>
 
 Physical Requirements &amp; Environmental Conditions:
 
 An employee must meet these physical demands to successfully perform the essential functions of this job. Employee is regularly required to talk or hear, sit, and utilize technology tools such as a laptop computer for extended periods of time. Specific vision abilities include close vision and the ability to adjust focus. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
 
 
 
 Briljent is a solutions-based company. Solutions come from creative ideas; ideas come from being creative with differences. Briljent believes diversity and inclusion are critical to the success of the company. Employment at Briljent is based on merit and professional qualifications. We do not discriminate against any employee or applicant because of race, creed, color, religion, gender, sexual orientation, national origin, disability, age, veteran status, marital status or any other basis protected by federal, state or local law, regulation or ordinance.
 
</div>

Clinical Auditor - RN

Rising Medical Solutions

<div>
 Have you ever looked a medical bill and immediately noticed something was wrong? Were you itching to use your expertise to fix it? We've been there, too. In fact, that's how our business was born - and continues to thrive. Rising Medical Solutions is looking for a Nurse Auditor who wants to make their mark in the world of medical cost containment.
 
 
 Join our team and maximize client savings by reviewing medical bills from a nurse perspective, including appropriate billing, coding and treatment, fee schedule compliance, over-utilization, and erroneous charges. We pride ourselves on outstanding customer service and work hard to keep our impeccable reputation in the industry.
 
 
 In this role, you'll be a part of our mission by giving clients the information they need to determine case value based on evaluation of medical records and medical billing statements, and will:
 
 
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 Audit medical and billing records to determine if services provided are reasonable, appropriate and necessary
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 Clinically identify and evaluate any charges not related to the occurrence
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 Verify that charges are in accordance with the services ordered and authorized
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 Initiate appropriate contacts with clients and medical providers as appropriate and necessary
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 Negotiate bills and conduct re-evaluation reviews as required
 
 
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 All while maintaining a human touch, demonstrating sensitivity to culturally-diverse people and situations.
 
 
 
 Requirements
 
 
 
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 RN (or LPN) with active professional license or equivalent within states of operation
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 CPC and/or CPC-H certification(s) strongly desired
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 Specialized training in hospital coding, ortho, neuro, rehab, or ER procedures
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 3-5 years of clinical experience in acute care, surgery and/or orthopedic
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 Workers' Compensation medical bill review experience a major plus
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 Understanding of CPT and ICD-10 codes and Medicare guidelines
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 Ability to apply knowledge to state fee schedules
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 A customer service orientation, including strong communication skills
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 Experience in any deposition or litigation cases a plus
 
 
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 Benefits
 
 
 
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 Competitive benefits package, including health insurance, 401(k) with company match, paid time off, paid holidays, and more
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 Flexible hybrid schedule with in-office days reserved for training and collaborative meetings
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 Employment within a firm committed to core values, staff development, emerging technology, private ownership, and controlled growth/reinvestment in the future - we frequently promote from within!
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 Opportunity to make a difference in reducing health care costs and increasing the value of health care to individuals and their employers
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 A relaxed, yet upbeat work environment
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 And for those in the office: casual dress code with unlimited coffee!
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</div>

Nurse Auditor - Medical Bill Review (Remote)

Deeplight

<div>DeepLight AI is a specialist AI and data consultancy with extensive experience implementing intelligent enterprise systems across multiple industries, with particular depth in financial services and banking. Our team combines deep expertise in data science, statistical modeling, AI/ML technologies, workflow automation, and systems integration with a practical understanding of complex business operations.
At DeepLight, we don't believe in &quot;off-the-shelf&quot; fixes. We deliver tailored AI solutions designed to integrate seamlessly into existing enterprise architectures, ensuring that innovation is both scalable and secure. From building robust data foundations to deploying sophisticated AI platforms, we empower our clients to lead in an increasingly automated world.
The Full Stack Developer builds the human-facing surfaces of the Agentic Workflow Automation (AWA) platform&mdash;specifically the Human-in-the-Loop (HITL) reviewer interface, the AgentOps operational dashboard, and internal AWA developer portals. Operating within the AI Centre of Excellence (AICoE) at a Band 7 / Mid-level capacity, this position works directly at the boundary between complex AI pipelines and end-users (including operations reviewers, business analysts, bank customers, and engineering teams). The role translates complex agent states, confidence scores, and exception data into high-performance, intuitive user interfaces that enable fast, informed human decisions.
Responsibilities<ul><li>
HITL Reviewer Interface: Design and build the operations reviewer queue interface, incorporating high-resolution native document image displays, extracted field overlays with per-field confidence indicators, clear exception reasoning, and optimized keyboard-shortcut workflows.</li><li>
AgentOps Dashboard: Build and maintain real-time operational dashboards that consume Azure Monitor metrics and Log Analytics data to track STP (Straight-Through Processing) rates, HITL rates, token consumption, and latency metrics (P50/P95/P99).</li><li>
System &amp; API Integration: Establish secure communication between AI core services and core banking apps via the AWA Conversation Orchestrator backend API. Connect applications to APIM-governed LLM endpoints and Orkes Conductor job status APIs.</li><li>
Internal Tooling &amp; Portals: Build and maintain the AWA Use Case Manifest authoring tool, the Prompt Management System (PMS) UI, and ground-truth annotation interfaces used by the operations team for test data preparation.</li><li>
Performance &amp; Accessibility Optimization: Ensure all web interfaces meet institutional accessibility standards, optimize application performance for lower-bandwidth branch locations, and implement graceful error handling for AI pipeline latency.</li><li>
Design System Maintenance: Build and maintain a unified, consistent AWA component library and design system across all interfaces, ensuring strict alignment with corporate brand guidelines.</li></ul> 

Requirements 
We need you to have:<ul><li> 
An advanced proficiency in building highly responsive web applications using React, TypeScript, and modern CSS frameworks.</li><li>
Mastery of complex asynchronous data flows and state synchronization using tools like Redux, Zustand, or React Query.</li><li>
A strong capability to build interactive, performance-optimized operational dashboards using charting libraries such as Recharts or D3.js.</li><li>
Be competency in implementing WebSockets or Server-Sent Events (SSE) for streaming updates and live data synchronization.</li><li>
The ability to design and consume structured REST APIs and construct Backend-for-Frontend (BFF) layers using Node.js or Python (FastAPI/Express).</li><li>
A minimum of 5 years of professional full-stack software development experience, with a clear focus on enterprise web applications.</li><li>
Hands-on experience integrating secure identity providers and authentication protocols, specifically OAuth2, OIDC, and Microsoft Entra ID.</li><li>
Practical experience working with Docker and deploying/managing frontend container workloads within Kubernetes environments (specifically Azure Kubernetes Service - AKS).</li><li>
Holder of a Bachelor's degree in Computer Science, Software Engineering, or an equivalent technical field.</li></ul>
It would also be great if you have:<ul><li>
Familiarity with React Native or native iOS/Android development to facilitate mobile banking application integrations.</li></ul><ul><li>
Experience developing complex overlay layers, drawing tools, and bounding-box annotations on high-resolution canvas scans.</li><li>
Knowledge of configuring Azure Static Web Apps, Azure Front Door, and Content Delivery Networks (CDNs).</li><li>
A practical understanding of rendering live LLM token streams smoothly within conversational or chat interfaces.</li><li>
A conceptual understanding of machine learning metrics, loss functions, and probability distributions to improve data visualization designs.</li></ul> 

Benefits 
The benefits you'll enjoy as part of this role include: 
<ul><li>
Competitive salary
</li><li>Comprehensive personal health insurance
</li><li>Visa Sponsorship for the successful individual</li><li>
Professional development and certification support</li><li>
Subscription reimbursement relating to your role</li><li>
Opportunity to work on cutting-edge AI projects</li><li>
Monthly Employee Incentive program</li><li>
Career advancement opportunities in a rapidly growing AI company</li></ul> 
This position offers a unique opportunity to shape the future of AI implementation while working with a talented team of professionals at the forefront of technological innovation. The successful candidate will play a crucial role in driving our company's success in delivering transformative AI solutions to our clients. 
 
At DeepLight AI, we recognise that diversity drives innovation. We are committed to fostering an inclusive environment where individuals with different thinking styles can thrive and contribute their unique strengths to our specialised AI and data solutions.
Our goal is to ensure our application and interview process is accessible, predictable, and fair for all candidates.
If you require any specific adjustments to the application process, or if you require any reasonable adjustments should you be successful in being processed to the interview stage, please do let us know. This information will be kept strictly confidential and will not impact hiring decisions.</div>

Full Stack Developer

Quest Global

<div>Job Requirements 
 
At Quest Global, it&rsquo;s not just what we do but how and why we do it that makes us different. With over 25 years as an engineering services provider, we believe in the power of doing things differently to make the impossible possible. Our people are driven by the desire to make the world a better place&mdash;to make a positive difference that contributes to a brighter future. We bring together technologies and industries, alongside the contributions of diverse individuals who are empowered by an intentional workplace culture, to solve problems better and faster. 
<ul><li>
Provide Safety and Quality excellent across Controls Alliance</li><li>
Lead System Level Integration</li><li>
Complex Project reviewer across value streams</li><li>
Ensure Project Risks Identified</li><li>
Approve Project Risk Mitigation Plan</li><li>
Support development of system level solutions</li><li>
Lead RCAs Across Value Streams</li><li>
Establish controls standards road map for Value Stream</li><li>
Mentor and Coach Technical Architects</li><li>
Input on Technical Depth Heat Map</li><li>
Identify Technical gaps</li><li>
Develop and Teach System Level Training</li><li>
Overall Project Quality Ownership</li><li>
Share Best Practices Across Value Streams</li><li>
Design Practices</li><li>
Lead Kaizen Events</li></ul> 
We are known for our extraordinary people who make the impossible possible every day. Questians are driven by hunger, humility, and aspiration. We believe that our company culture is the key to our ability to make a true difference in every industry we reach. Our teams regularly invest time and dedicated effort into internal culture work, ensuring that all voices are heard. 
We wholeheartedly believe in the diversity of thought that comes with fostering a culture rooted in respect, where everyone belongs, is valued, and feels inspired to share their ideas. We know embracing our unique differences makes us better, and that solving the worlds hardest engineering problems requires diverse ideas, perspectives, and backgrounds. We shine the brightest when we tap into the many dimensions that thrive across over 21,000 difference-makers in our workplace. 
Work Experience
 
<ul><li>Bachelor's degree in engineering or higher with minimum 15 years of experience HMI / User Interface Screens Development.</li><li>
Minimum 6 years of experience in performing technical reviews</li><li>
Excellent knowledge about New Units and Services Upgrade processes</li><li>
Hands-on experience on use of physics based simulation platforms for software validation.</li><li>
Demonstrated the capability of having system level knowledge</li><li>
Demonstrated global mindset and ability to collaborate effectively across cultures</li></ul> 

Benefits 
 
Perks best in company standard as per regional laws.</div>

Senior Architect - HMI Screens Development

Hiring Talent

We are looking for a Full Stack Developer for our client based in Dubai.Responsibilities:<ul><li>Design, develop and maintain full-stack web applications, APIs and platform services for ShaikhTech.</li><li>Build investor, issuer/promoter, administrator, Shariah reviewer and regulator-facing dashboards and workflows.</li><li>Develop secure onboarding flows covering account creation, KYC/AML status, eligibility checks, investor classification and risk disclosures.</li><li>Support tokenisation platform features including issuance workflows, token registry, cap table, wallet permissions, distributions, voting and transfer controls.</li><li>Work on blockchain integrations, smart-contract logic and ERC-3643-style security-token requirements with compliance embedded at code level.</li><li>Integrate identity, registry, payment and asset data layers including approved ID flows and title anchoring concepts, PSP/SAR payment flows and document repositories.</li><li>Build portfolio, income, statements, transaction history, governance, document and audit-log features for investors and internal teams.</li><li>Implement security, performance, testing, CI/CD, monitoring, error handling, incident-readiness and maintainable development practices.</li></ul>Requirements:<ul><li>3+ years of full-stack development experience, ideally in fintech, proptech, tokenisation, blockchain, digital assets, marketplaces or regulated platforms.</li><li>Strong front-end skills in JavaScript/TypeScript and React, Next.js, Angular or Vue, with ability to create clean, responsive and user-friendly interfaces.</li><li>Strong back-end experience with Node.js/NestJS, Python, Java or similar; REST/GraphQL APIs; authentication; role-based access; and scalable service architecture.</li><li>Experience with databases such as PostgreSQL, MySQL, MongoDB or Redis, including secure data modelling, reporting and reconciliation workflows.</li><li>Familiarity with smart contracts, wallets, token standards, Solidity/EVM concepts, auditability and blockchain-based transaction records.</li><li>Good understanding of cybersecurity basics: encryption, secure coding, access control, secrets management, logging, pen-test remediation and secure SDLC.</li><li>Experience with cloud hosting and DevOps on AWS, Azure, Google Cloud or approved local infrastructure; Docker and CI/CD experience preferred.</li><li>Organized, proactive and comfortable working remotely with product, compliance, legal, Shariah, design and business teams across UAE and KSA.</li><li>Relevant experience should include modern web architecture, API-first development, secure authentication, investor dashboards, admin portals, data workflows, payment/settlement integrations, document management, audit logs and cloud deployment.</li><li>Additional advantage will be given for experience with tokenisation engines, ERC-3643 or regulated security-token logic, KYC/AML workflows, digital identity, wallet permissions, SAR/mada/SARIE or PSP integrations, AI-assisted document/search features, digital twin/3D asset data and NCA-aligned cybersecurity practices.</li></ul>Interested candidates may share CVs along with a GitHub profile, or links to live platforms.Education:<ul><li>Bachelor's (Preferred)</li></ul>Experience:<ul><li>full stack development: 3 years (Preferred)</li><li>React JS: 3 years (Preferred)</li><li>Node JS / Python or Java: 3 years (Preferred)</li><li>blockchain integrations: 3 years (Preferred)</li><li>ERC-3643-style security-token: 1 year (Preferred)</li><li>DevOps: 1 year (Preferred)</li><li>3D Visualization, Digital Twin or Immersive Web Applicaton: 1 year (Preferred)</li><li>building apps for real estate, tourism, or construction: : 1 year (Preferred)</li></ul>Work Location: Remote

Full Stack Developer - Remote

General Attorney (Tax) - Senior Technician Reviewer (Financial Institutions & Products)

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