Job Results
Life Sciences
Posted 5 days
Clinical Laboratory Technologist
Labcorp - Saint Johns, FL 32259
Labcorp is a global leader in laboratory services, providing the insights and answers that help healthcare providers, patients, researchers, pharmaceutical companies and health systems make confident decisions and improve outcomes. Through our unparalleled science, data, technology and laboratory network, we advance diagnostics, accelerate innovation and help address some of the world’s most important health challenges. As we shape the future of healthcare, we are leveraging advanced technologies, intelligent digital solutions and data-driven innovation across our operations to enhance how work gets done and deliver greater value to customers and patients. With our global scale and deep expertise, you’ll have the opportunity to do meaningful work, grow your career and make a real impact on people’s health around the world. Together, we’re improving health and improving lives. LabCorp is seeking a Clinical Lab Professional to join our team at at Ascension St Vincent's St John county , St. Johns, FL . Work Schedule: This is a Casual/Per Diem position; hours will be"as needed" and the start and end times will vary . Job Responsibilities: Determine the acceptability of specimens for testing according to established criteria Perform routine and complex technical procedures and functions according to departmental Standard Operating Procedures Monitor, operate and troubleshoot instrumentation to ensure proper functionality Demonstrate the ability to make technical decisions regarding testing and problem solving. Prepare, test and evaluate new reagents or controls Report accurate and timely test results in order to deliver quality patient care Perform and document preventive maintenance and quality control procedures Identify and replenish testing bench supplies as necessary Assist with processing of specimens when needed Maintain a safe work environment and wear appropriate personal protective equipment Minimum Qualifications: Bachelor’s degree in a Chemical or Biological science, Clinical Laboratory Science, Medical Technology 1 year or more of clinical laboratory testing experience OR an MLS degree FL Medical Technologist (MT) license Preferred Qualifications: ASCP or AMT certification Additional Job Standards: In lieu of education requirements listed above, non-traditional degrees with applicable science credits that meet CLIA standards may meet education requirement Ability to work independently and within a team environment Familiarity with laboratory information systems Proficient with computers High level of attention detail along with strong communication and organizational skills Able to pass a standardized color blindness test Flexibility to work overtime or other shifts depending on business needs At Labcorp we have a passion in helping people live happy and healthy lives. Every day we provide vital information that helps our clients and patients understand their health. If you are passionate about helping people and have a drive for service, then Labcorp could be a great next career step! This role works in a high volume, production based environment performing a vital component of clinical lab science. Benefits: Employees regularly scheduled to work 20 or more hours per week are eligible for comprehensive benefits including: Medical, Dental, Vision, Life, STD/LTD, 401(k), Paid Time Off (PTO) or Flexible Time Off (FTO), Tuition Reimbursement and Employee Stock Purchase Plan. Employees regularly scheduled to work less than 20 hours, Casual, Intern, and Temporary employees are only eligible to participate in the 401(k) Plan. Employees who are regularly scheduled to work a 7 on/7 off schedule are eligible to receive all the foregoing benefits except PTO or FTO. For more detailed information, please click here. If you're looking for a career that offers opportunities for growth, continual development, professional challenge and the chance to make a real difference, apply today! Labcorp is proud to be an Equal Opportunity Employer: Labcorp strives for inclusion and belonging in the workforce and does not tolerate harassment or discrimination of any kind. We make employment decisions based on the needs of our business and the qualifications and merit of the individual. Qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex (including pregnancy, childbirth, or related medical conditions), family or parental status, marital, civil union or domestic partnership status, sexual orientation, gender identity, gender expression, personal appearance, age, veteran status, disability, genetic information, or any other legally protected characteristic. Additionally, all qualified applicants with arrest or conviction records will be considered for employment in accordance with applicable law. We encourage all to apply If you are an individual with a disability who needs assistance using our online tools to search and apply for jobs, or needs an accommodation, please visit our accessibility site or contact us at Labcorp Accessibility. For more information about how we collect and store your personal data, please see our Privacy Statement.
Posted 5 days
Compounding Pharmacy Technician I
Option Care Health - Jacksonville, FL 32207
A Day in the Life at Option Care Health Extraordinary Careers. Endless Possibilities. With the nation’s largest home infusion provider, there is no limit to the growth of your career. Option Care Health, Inc. is the largest independent home and alternate site infusion services provider in the United States. With over 8,000 team members including 5,000 clinicians, we work compassionately to elevate standards of care for patients with acute and chronic conditions in all 50 states. Through our clinical leadership, expertise and national scale, Option Care Health is re-imagining the infusion care experience for patients, customers and team members. Join a company that is taking action to develop an inclusive, respectful, engaging and rewarding culture for all team members. At Option Care Health your voice is heard, your work is valued, and you’re empowered to grow. Cultivating a team with a variety of talents, backgrounds and perspectives makes us stronger, innovative, and more impactful. Our organization requires extraordinary people to provide extraordinary care, so we are investing in a culture that attracts, hires and retains the best and brightest talent in healthcare. Job Description Summary: Under the direction of a licensed Pharmacist, the compounding technician I works in a clean room compounding medication at least 50% of the time in order to help ensure safe, accurate, and smooth compounding operations. Job Description: Job Responsibilities (listed in order of importance and/or time spent) Prescription Compounding, Preparation, & Processing - Assists pharmacist with the preparation and dispensing of medications and supplies in accordance with OCH policies & procedures, and in accordance with state regulations & standards. - Prepares medications so they are accurately compounded. - Performs basic pharmaceutical calculations in order to obtain correct dosages of medications. - Accurately labels and packages medications. - Participates in the process for assessing, managing, and reporting medication related incidents. Site & Supplies/Equipment Maintenance - Ensures pharmacy surfaces and laminar flow hoods are cleaned and sanitized. - Inspects equipment and documents any equipment failures or defects. - Assists with recording and maintaining pharmacy temperature & cleaning logs. Supervisory Responsibilities Does this position have supervisory responsibilities? (i.e. hiring, recommending/approving promotions and pay increases, scheduling, performance reviews, discipline, etc.) No - X Yes Basic Education and/or Experience Requirements High School Diploma or GED. Minimum of 1 year of pharmacy technician experience. Must be licensed or registered (if required by the state) Basic Qualifications Experience providing customer service to internal and external customers, including meeting quality standards for services, and evaluation of customer satisfaction. Able to perform basic & intermediate level mathematical calculations. Excellent organizational skills. Basic level skill in Microsoft Word (for example: opening a document, cutting, pasting, and aligning text, selecting font type and size, changing margins and column width, sorting, inserting bullets, pictures, and dates, using find and replace, undo, spell check, track changes, review pane and/or print functions). Basic level skill in Microsoft Excel (for example: opening a workbook, inserting a row, selecting font style and size, formatting cells as currency, using copy, paste and save functions, aligning text, selecting cells, renaming a worksheet, inserting a column, selecting a chart style, inserting a worksheet, setting margins, selecting page orientation, using spell check and/or printing worksheets). Basic skill level in Microsoft PowerPoint (for example: inserting, rearranging, hiding, and deleting slides, navigating between slides, increasing list level, adding, centering, and editing text, changing views, inserting a table or a note, moving objects, printing outline view and/or running a slide show). Physical Demand Requirements Ability to stand for extended periods of time. Frequent bending, stooping, reaching. Ability to carry at least 30lbs Travel Requirements: (if required) None Preferred Qualifications & Interests (PQIs) Successful enrollment and completion of the OCH designated training course within 6 months of hire (if licensure and/or training course is required by the state). May perform other duties as assigned Due to state pay transparency laws, the full range for the position is below: Salary to be determined by the applicant's education, experience, knowledge, skills, and abilities, as well as internal equity and alignment with market data. Pay Range is $18.20-$30.32 Benefits: -Medical, Dental, & Vision Insurance -Paid Time off -Bonding Time Off -401K Retirement Savings Plan with Company Match -HSA Company Match -Flexible Spending Accounts -Tuition Reimbursement -myFlexPay -Family Support -Mental Health Services -Company Paid Life Insurance -Award/Recognition Programs Option Care Health subscribes to a policy of equal employment opportunity, making employment available without regard to race, color, religion, national origin, citizenship status according to the Immigration Reform and Control Act of 1986, sex, sexual orientation, gender identity, age, disability, veteran status, or genetic information. Posted: Aug 21, 2026
Posted 5 days
Pharmacist
JRA HEALTH - Hawthorne, FL 32640
*Overview* JRA Health is an emerging home infusion company committed to excellence, innovation, and delivering the highest standards of service to our patients. As we continue to grow, we are seeking skilled Clinical Pharmacist to join and grow with our dynamic team in a full time capacity. Must be licensed and registered as a Pharmacist in the State of Florida before hire. *Clinical Responsibilities: * * Interpret physician orders to prepare medication dosage forms for treatment according to Federal and State Drug Laws. * Identify and report suspected adverse drug reactions accurately and on time. * Review patient medication records and profiles for allergies, drug interactions and therapeutic duplications. * Organize daily operational duties and supervise pharmacy technicians, aides and other personnel. * Adhere to regulatory requirements, professional standards and quality management policies. * Communicate with physicians and nurses to clarify unclear orders. * Provide drug information and educational programs to healthcare professionals. * Fill prescription orders according to State and Federal regulations. * Perform other duties as assigned. *Sterile IV Preparation Responsibilities:* * Oversees the preparation of sterile compounded medications, including intravenous (IV) admixtures, in accordance with USP <797> guidelines * Performs order verification processes ensuring accuracy, quality, safety, stability and sterility of Sterile IV Admixtures in accordance to USP <797> guidelines and JRA Health standard operating procedures. * Performs pharmaceutical calculations as needed. * Document all compounding activities and maintain precise records in compliance with state and federal regulations *Basic Education and/or Experience Requirements* * PharmD/RPh * Inpatient/outpatient clinical pharmacist experience (preferred) * USP 797/800 Sterile IV Preparations/compounding experience (preferred) * Home Infusion experience (preferred) * Must be licensed or registered in the State of Florida *Physical Demand Requirements* * Ability to stand for extended periods of time. * Frequent bending, stooping, reaching. * Ability to carry at least 30lbs Job Types: Full-time, Part-time Benefits: * 401(k) * 401(k) matching * Dental insurance * Health insurance * Life insurance * Paid time off * Vision insurance Work Location: In person
Posted 5 days
Registered Nurse Care Management PRN
AdventHealth Palm Coast - Palm Coast, FL 32164
Our promise to you: Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better. All the benefits and perks you need for you and your family: Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance Paid Time Off from Day One 403-B Retirement Plan 4 Weeks 100% Paid Parental Leave Career Development Whole Person Well-being Resources Mental Health Resources and Support Pet Benefits Schedule: PRN Shift: Day (United States of America) Address: 60 MEMORIAL MEDICAL PKWY City: PALM COAST State: Florida Postal Code: 32164 Job Description: Actively participates in multi-disciplinary rounds to review changes in patient status, progression and level of care, and discharge plans for all assigned patients to identify resources necessary at discharge and ensure a timely transition, escalating care delays to leadership as appropriate. Communicates with and educates patients and families regarding emotional, social, and financial impacts of illness and mobilizes family/community resources to meet identified needs while advocating for patient and family empowerment in making health care decisions and accessing needed services. Assesses readmitted patients for the patient’s and family’s perceived reasons for the readmission. Organizes and facilitates patient and family care conferences with the multidisciplinary team. Documents discharge planning evaluation, ongoing assessment, discharge plans, MDRs, barriers to progression of care, avoidable days, and patient and family needs according to standard work. Knowledge, Skills, and Abilities: Leadership skills Process and Outcome data analysis skills Critical thinking and problem-solving skills Ability to manage multiple tasks and prioritize levels of importance Customer service skills Education: Associate's of Nursing [Required] Bachelor's of Nursing [Preferred] Field of Study: Nursing Work Experience: 2+ medical/hospital nursing experience [Required] Prior Care Management/Utilization Management experience [Preferred] Licenses and Certifications: Registered Nurse (RN) [Required] Certified Case Manager (CCM) [Preferred] Accredited Case Manager (ACM) [Preferred] Physical Requirements: (Please click the link below to view work requirements) Physical Requirements - https://tinyurl.com/2vvwrzem Pay Range: $32.76 - $57.47 Background Screening Requirement (Florida Law) Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law. Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse: https://info.flclearinghouse.com/ This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.
Posted 5 days
Onsite Utilization Management Primary Care Physician – Lake Butler, FL (RMC)
Centurion Health - Lake Butler, FL 32054
Centurion Health contracts with state and local governments nationwide to provide comprehensive healthcare services to correctional facilities, state hospitals, and other community settings. Our dedication to making a difference and our passionate team of the best and the brightest healthcare employees has made us one of the leaders of the correctional health industry. Whether you are driven by purpose and impact or on a journey of professional growth, our opportunities can offer both. We are currently seeking a full-time physician as the Specialty Care Reviewing Provider to join our team at Reception and Medical Center (hospital setting) located in Lake Butler, Florida. Reception and Medical Center is located 35 miles north of Gainesville and 21 miles south of Lake City. This provider is responsible for reviewing all specialty consults and prior approvals written at RMC Main, Hospital, and West units under the direction of the Regional Medical Director. This person will receive recommendations from the Specialty Providers that must be reviewed timely. This provider would then clinically decide what follow ups, diagnostics, imaging, etc. are ordered based on clinical need and FDC policy. This person is responsible for either approving these consults/prior approvals or providing alternative treatment plans to be followed by the onsite medical providers. This provider must be able to prioritize cases based on acuity level (routine, urgent, emergent). This person will have to work closely with the Regional Medical Director and onsite providers to offer education/advice for treatment. They will also work closely with the WFH Consult Coordinators to ensure the consult/prior approvals are complete and accurate prior to submission. Schedule: Onsite at our Institution - Monday-Friday 8am-5pm. • Medical degree (MD or DO) from an accredited medical school required • Board certification or eligibility in Family Medicine, Internal Medicine, or Emergency Medicine required • Must show/be able to obtain active Drug Enforcement Administration (DEA) registration with prescriptive authority • Ability to pass credentialing and background check Contact [email protected], 571-762-4790, to learn more about Centurion Health and the full time employed physician opportunity. indmhm
Posted 5 days
Primary Care Physician | Adults 65+ | $250K–$260K
Purple Cow Recruiting - Jacksonville, FL
Description: Primary Care Physician | Adults 65+ | $250K–$260K Value-Based Primary Care | 15 Patients Per Day Elizabeth Banzhaf, LPN Co-Founder & COO | Heartline Staffing Call or Text: 272-230-3157 LinkedIn: View Elizabeth's LinkedIn Prefer a confidential conversation instead of applying? Call or text Elizabeth directly at 272-230-3157. Heartline Staffing is recruiting a Primary Care Physician to provide preventive primary care for adults 65+ within a value-based care model. The patient population is primarily Medicare Advantage, with a focus on chronic disease management and preventive care. Physicians see approximately 15 patients per day. Value-Based Care experience is preferred but is not required; training is provided. POSITION OVERVIEW • Primary care for adults 65+ • Majority Medicare Advantage patient population • Chronic disease and preventive care focus • Approximately 15 patients per day • No RVU pressure • Integrated care team including NP/PA, Medical Assistants, Social Workers, lab and pharmacy support, and referral coordination COMPENSATION • $250,000–$260,000 base salary • Competitive sign-on bonus • Annual performance bonus: 20% of base salary ROLE • Provide preventive primary care for adults 65+ • Focus on chronic disease management and preventive care • Practice within a Value-Based Care model • Work with an integrated care team including NP/PA, Medical Assistants, Social Workers, lab and pharmacy support, and referral coordination BENEFITS • Full benefits beginning Day 1 • Occurrence-based malpractice coverage Requirements: Requirements • Board Certified or Board Eligible in Internal Medicine or Family Medicine REQUIRED Preferred • Geriatric experience • Value-Based Care experience; training provided if needed • HEDIS experience is a plus Not ready to formally apply? That's completely fine. Many professionals prefer a confidential conversation first. Call or text Elizabeth directly at 272-230-3157.
Posted 5 days
Licensed Practical Nurse- LPN 7p to 7a
Jacksonville, FL 32217
Licensed Practical Nurse (LPN) - 12 Hours Shifts Full-time or Part-time Only Job Summary: We are seeking a compassionate and skilled Licensed Practical Nurse (LPN) to join our Vivo Healthcare Taylor team. As an LPN, you will assist the Director of Nursing Services in planning, organizing, developing, and directing the day-to-day functions of the Nursing Service Department. If you are dedicated to providing exceptional patient care and have a strong ability to work in a fast-paced environment, we encourage you to apply for this rewarding opportunity. Responsibilities: Assist the Director of Nursing Services in planning, developing, organizing, implementing, evaluating, and directing the day-to-day functions of the nursing service department Assist in obtaining staffing information that must be posted on a daily basis Demonstrate customer service and professionalism at all times and lead by example with unit supervisors Make rounds with physicians as necessary and schedule physician visits Participate in committees and attend various meetings Prepare written and/or oral reports of the nursing service programs and activities Determine the staffing needs of the nursing service department and calculate staffing needs daily Develop work assignments and schedule duty hours Make daily rounds of the nursing service department to ensure that all nursing service personnel are performing their work assignments in accordance with acceptable nursing standards Requirements: Must possess a current, unencumbered, active license to practice as a Licensed Nurse in this state Must be able to read, write, speak, and understand the English language and be able to utilize computer system for job tasks Must demonstrate the knowledge and skills necessary to prove care appropriate to the age-related needs of the residents served Must have, as a minimum, two (2) years of experience as a supervisor in a hospital, nursing care facility, or other related health care facility Must have, as a minimum of six (6) months experience in rehabilitative and restorative nursing practices Physical and Sensory Requirements: Must be able to move intermittently throughout the workday Must be able to see and hear or use prosthetics that will enable these senses to function adequately to ensure that the requirements of this position can be fully met Must function independently, and have flexibility, personal integrity, and the ability to work effectively with residents, personnel, and support agencies Working Conditions: Works in office area(s) as well as throughout the nursing service area Moves intermittently during working hours Is subject to frequent interruptions Is involved with residents, personnel, visitors, government agencies/personnel, etc., under all conditions and circumstances Benefits: Competitive hourly rate: $28.50 - $33 Opportunity to work in a dynamic and growing organization Professional development and growth opportunities Collaborative and supportive work environment How to Apply: If you are a motivated and compassionate LPN looking for a new challenge, please apply for this exciting opportunity. We look forward to hearing from you! https://info.flclearinghouse.com/ #snfcorp
Posted 5 days
BPO Clinical Review Senior Specialist
NTT DATA - Jacksonville, FL
Req ID: 385874 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are currently seeking a BPO Clinical Review Senior Specialist to join our team in Jacksonville, Florida (US-FL), United States (US). The Clinical Reviewer Quality Analyst (QA) is responsible for conducting quality audits of clinical appeal reviews and providing subject matter expertise to support the accurate and timely processing of member and provider appeals. This role evaluates clinical reviews, medical records, and appeal determinations to ensure compliance with organizational policies, regulatory requirements, Medicaid guidelines, and NCQA standards. The QA Analyst partners with operations leadership to improve quality, consistency, and operational effectiveness across the appeals review process. This position is eligible for company benefits including medical, dental, and vision insurance with an employer contribution, flexible spending or health savings account, life and ADD insurance, short- and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits. Position is fully remote only in the state of Florida. Must live in State of Florida and have a valid address. P.O Boxes will not be allowed. Salary for this role is $81,120 Required Qualifications • 3 years of experience in appeals processing, clinical review, or utilization management. • 1 year of experience in an advanced role as: • Quality Analyst (QA) • Team Lead • Trainer • Subject Matter Expert (SME) • Strong knowledge of utilization management and appeals processes. • Working knowledge of NCQA standards, Medicaid regulations, and medical necessity review guidelines. • Ability to review and interpret medical records and clinical documentation. • Excellent analytical, critical thinking, and problem-solving skills. • Strong written and verbal communication skills, including reading comprehension and professional documentation. • Ability to provide constructive feedback and influence quality improvement initiatives. • Strong organizational skills with the ability to manage multiple priorities independently. • Proficiency in conducting audits, identifying trends, and presenting findings. • Experience performing quality audits in a healthcare, managed care, health plan, or healthcare BPO environment. • Experience supporting Medicaid appeals and utilization management operations. • Familiarity with quality management methodologies and continuous improvement practices. • Required to work U.S. daytime business hours. • Flexibility may be required based on business and client needs. • Strong attention to detail and commitment to quality. • Ability to identify compliance risks and process improvement opportunities. • Sound clinical judgment and decision-making skills. • Effective coaching and communication capabilities. • Commitment to regulatory compliance, member advocacy, and operational excellence. Education Licensure • Active Licensed Practical Nurse (LPN) license required. (Not encumbered only) • Florida State-required LPN licensure and/or Compact State LPN License required. (Not encumbered only) Key Responsibilities • Conduct quality audits of clinical appeals reviews to ensure accuracy, consistency, and compliance with established standards. • Evaluate medical records, clinical documentation, and appeal determinations to assess adherence to medical necessity criteria and utilization management guidelines. • Identify quality trends, defects, and opportunities for improvement within the appeals process. • Provide feedback, coaching, and corrective action recommendations to team members based on audit findings. • Support quality calibration sessions and contribute to the development of quality improvement initiatives. • Serve as a subject matter expert (SME) on appeals processing, utilization management, and medical necessity review. • Provide guidance to Clinical Reviewers on preparing cases for Medical Director review, including researching appeals, reviewing applicable criteria, and analyzing supporting documentation. • Review service appeals for reconsideration and recommend approvals or denials based on established determination guidelines. • Prepare complex cases for Medical Director review when required. • May perform clinical reviews and appeal determinations as needed to support operational demands. • Ensure appeal reviews and determinations comply with State, Federal, Medicaid, and NCQA requirements. • Verify timely review, processing, and resolution of appeal requests in accordance with contractual and regulatory turnaround times. • Generate and review appeal resolution communications to members and providers for accuracy, completeness, and compliance. • Maintain thorough documentation and audit records related to appeal reviews and quality evaluations. • Communicate with providers, facilities, Medical Directors, and internal departments regarding appeal reviews and determinations. • Partner with leadership to improve the consistency, quality, efficiency, and appropriateness of appeal review decisions. • Collaborate with cross-functional teams to identify and implement process improvements based on industry best practices. • Analyze quality findings and provide recommendations to prevent recurring issues and enhance operational performance. • Maintain files and records for appeal reviews, including the collection, analysis, and reporting of verbal and written member and provider appeals. • Track quality metrics and contribute to performance reporting and quality dashboards. • Utilize sound clinical judgment in evaluating non-routine and complex appeals while ensuring compliance with service-level agreements and contractual requirements. New hire must have a working device (such as cell phone or tablet) for the 2-Factor Authentication process Must Pass Drug screen Must Pass a background check with Education check and employment verification check. This job posting is for active vacancies. Applications are pre-screened using artificial intelligence technology and reviewed by NTT DATA recruiters. NTT Data does not allow Job stacking Remote Working and Technology Requirements To work remote, individuals must meet all the established Remote requirements including those pertaining to a home workspace and related technology. Technology • NTT DATA will provide a computer and headset for remote work. • Employees are responsible for the care and security of all equipment provided. They must return it immediately upon separation from the company following company protocols. • Failure to return equipment may result in collection actions and/or other consequences. • Individuals must provide their own high speed internet access with speeds at or above 50 Mbps. • A hard-wired ethernet connection is required. Wi-Fi, mobile, wireless and public internet connections are forbidden as are connections outside of one’s personal dwelling or location. Technical Performance and Issue Tracking • Management monitors all technical issues and agent downtime. Consistent availability is critical to business operations. • Remote employees must adhere to all technical support procedures and protocols. • Chronic connectivity issues or recurring downtime that impede job performance, including internet outages, may result in the remote status changing to onsite. Remote Workspace Remote work demands a high degree of professionalism, self-discipline, and accountability. The following workspace standards are vital to delivering exceptional service. • Employees must have a dedicated, professional workspace conducive to servicing Customer Service customers with the same quality as an onsite environment. • The workspace must be a permanent, unencumbered location used daily for work. • Employees must work with minimal distractions that do not interfere with business operations or service delivery. • Ideally, the workspace is isolated from other household members and used exclusively for job duties. • Background noise, interruptions from people or pets, and other distractions must be kept to an absolute minimum to avoid disruptions to customer service. • Employees must work from the same location consistently unless prior approval is obtained. • If a change in work location is necessary: • The new location must meet all Remote Workspace and Technology Requirements. • Notification to NTT DATA Management is required before relocating #INDBPO #LI-MIWS About NTT DATA NTT DATA is a $30 billion business and technology services leader, serving 75% of the Fortune Global 100. We are committed to accelerating client success and positively impacting society through responsible innovation. We are one of the world's leading AI and digital infrastructure providers, with unmatched capabilities in enterprise-scale AI, cloud, security, connectivity, data centers and application services. our consulting and Industry solutions help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have experts in more than 50 countries. We also offer clients access to a robust ecosystem of innovation centers as well as established and start-up partners. NTT DATA is a part of NTT Group, which invests over $3 billion each year in RD. Whenever possible, we hire locally to NTT DATA offices or client sites. This ensures we can provide timely and effective support tailored to each client’s needs. While many positions offer remote or hybrid work options, these arrangements are subject to change based on client requirements. For employees near an NTT DATA office or client site, in-office attendance may be required for meetings or events, depending on business needs. At NTT DATA, we are committed to staying flexible and meeting the evolving needs of both our clients and employees. NTT DATA recruiters will never ask for payment or banking information and will only use @nttdata.com, @nttdatafed.com and @talent.nttdataservices.com email addresses. If you are requested to provide payment or disclose banking information, please submit a contact us form, https://us.nttdata.com/en/contact-us. NTT DATA endeavors to make https://us.nttdata.com accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at https://us.nttdata.com/en/contact-us. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. NTT DATA is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. For our EEO Policy Statement, please click here. If you'd like more information on your EEO rights under the law, please click here. For Pay Transparency information, please click here.
Posted 5 days
BPO Clinical Review Specialist
NTT DATA - Jacksonville, FL
Req ID: 385835 NTT DATA strives to hire exceptional, innovative and passionate individuals who want to grow with us. If you want to be part of an inclusive, adaptable, and forward-thinking organization, apply now. We are currently seeking a BPO Clinical Review Specialist to join our team in Jacksonville, Florida (US-FL), United States (US). Position Summary The Clinical Reviewer Specialist is responsible for performing clinical and medical necessity reviews to support the timely and accurate processing of member and provider appeals. This role evaluates medical records, clinical documentation, and applicable criteria to determine medical necessity and prepare recommendations for Medical Director review. The Clinical Reviewer Specialist ensures compliance with organizational policies, State and Federal regulations, Medicaid requirements, and NCQA standards while delivering high-quality appeal determinations and communications. This position is eligible for company benefits including medical, dental, and vision insurance with an employer contribution, flexible spending or health savings account, life and ADD insurance, short- and long-term disability coverage, paid time off, employee assistance, participation in a 401k program with company match, and additional voluntary or legally required benefits. Position is fully remote only in the state of Florida. Must live in State of Florida and have a valid address. P.O Boxes will not be allowed. Salary for this role is $76,000 Required Qualifications • 3 years of experience in appeals processing, utilization management, case management, or clinical review operations. • Knowledge of utilization management and medical necessity review processes. • Understanding of NCQA standards, Medicaid regulations, and healthcare appeals requirements. • Strong analytical and critical-thinking skills with the ability to interpret medical records and clinical documentation. • Excellent written and verbal communication skills, including strong reading comprehension and documentation abilities. • Ability to work independently while managing multiple priorities and deadlines. • Strong organizational and problem-solving skills. • Proficiency in researching clinical criteria and preparing concise case summaries and recommendations. • Experience supporting Medicaid appeals and utilization management programs. • Previous experience in a managed care, health plan, healthcare, or healthcare BPO environment. • Familiarity with regulatory and accreditation requirements governing appeals and grievance processes. • Required to work U.S. daytime business hours. • Flexibility may be required based on operational and business needs. • Strong clinical assessment and medical necessity review skills. • Attention to detail and commitment to quality and compliance. • Ability to make sound decisions in complex and non-routine appeal situations. • Effective communication and collaboration with internal and external stakeholders. • Commitment to timely, accurate, and member-focused appeal resolution. Education Licensure • Active Registered Nurse (RN) license required. (Not encumbered only) • Florida State-required RN licensure and/or Compact State RN License required. (Not encumbered only) Key Responsibilities • Conduct comprehensive clinical reviews of medical records and supporting documentation to evaluate medical necessity for appealed services. • Research appeal cases and prepare detailed case reviews for Medical Directors by analyzing clinical information, applicable criteria, and the basis for the appeal. • Review claim and service appeals for reconsideration and recommend approvals or denials based on established guidelines and determination authority. • Prepare case recommendations and supporting documentation for Medical Director review as required. • Apply sound clinical judgment when evaluating routine and complex appeal cases. • Ensure timely review, processing, and resolution of appeals in accordance with company policies, contractual requirements, State and Federal regulations, Medicaid guidelines, and NCQA standards. • Generate accurate appeal determination letters, communications, and reports for members and providers. • Maintain complete and accurate appeal records and documentation throughout the review process. • Ensure appeal decisions and supporting documentation meet quality and compliance requirements. • Communicate effectively with providers, healthcare facilities, Medical Directors, and internal departments regarding appeal requests and supporting clinical information. • Collaborate with leadership and operational teams to improve the consistency, accuracy, and appropriateness of appeal review outcomes. • Partner with cross-functional teams to identify opportunities for process improvement and enhanced operational performance. • Participate in discussions regarding complex cases and escalation reviews. • Support initiatives to improve clinical appeals processes, workflows, and service quality. • Identify trends and recurring issues within appeals and recommend process improvements based on best practices. • Maintain current knowledge of medical necessity guidelines, utilization management practices, Medicaid requirements, and NCQA standards. • Contribute to achieving departmental quality, productivity, and turnaround-time objectives. New hire must have a working device (such as cell phone or tablet) for the 2-Factor Authentication process Must Pass Drug screen Must Pass a background check with Education check and employment verification check. This job posting is for active vacancies. Applications are pre-screened using artificial intelligence technology and reviewed by NTT DATA recruiters. NTT Data does not allow Job stacking Remote Working and Technology Requirements To work remote, individuals must meet all the established Remote requirements including those pertaining to a home workspace and related technology. Technology • NTT DATA will provide a computer and headset for remote work. • Employees are responsible for the care and security of all equipment provided. They must return it immediately upon separation from the company following company protocols. • Failure to return equipment may result in collection actions and/or other consequences. • Individuals must provide their own high speed internet access with speeds at or above 50 Mbps. • A hard-wired ethernet connection is required. Wi-Fi, mobile, wireless and public internet connections are forbidden as are connections outside of one’s personal dwelling or location. Technical Performance and Issue Tracking • Management monitors all technical issues and agent downtime. Consistent availability is critical to business operations. • Remote employees must adhere to all technical support procedures and protocols. • Chronic connectivity issues or recurring downtime that impede job performance, including internet outages, may result in the remote status changing to onsite. Remote Workspace Remote work demands a high degree of professionalism, self-discipline, and accountability. The following workspace standards are vital to delivering exceptional service. • Employees must have a dedicated, professional workspace conducive to servicing Customer Service customers with the same quality as an onsite environment. • The workspace must be a permanent, unencumbered location used daily for work. • Employees must work with minimal distractions that do not interfere with business operations or service delivery. • Ideally, the workspace is isolated from other household members and used exclusively for job duties. • Background noise, interruptions from people or pets, and other distractions must be kept to an absolute minimum to avoid disruptions to customer service. • Employees must work from the same location consistently unless prior approval is obtained. • If a change in work location is necessary: • The new location must meet all Remote Workspace and Technology Requirements. • Notification to NTT DATA Management is required before relocating #INDBPO #LI-MIWS About NTT DATA NTT DATA is a $30 billion business and technology services leader, serving 75% of the Fortune Global 100. We are committed to accelerating client success and positively impacting society through responsible innovation. We are one of the world's leading AI and digital infrastructure providers, with unmatched capabilities in enterprise-scale AI, cloud, security, connectivity, data centers and application services. our consulting and Industry solutions help organizations and society move confidently and sustainably into the digital future. As a Global Top Employer, we have experts in more than 50 countries. We also offer clients access to a robust ecosystem of innovation centers as well as established and start-up partners. NTT DATA is a part of NTT Group, which invests over $3 billion each year in RD. Whenever possible, we hire locally to NTT DATA offices or client sites. This ensures we can provide timely and effective support tailored to each client’s needs. While many positions offer remote or hybrid work options, these arrangements are subject to change based on client requirements. For employees near an NTT DATA office or client site, in-office attendance may be required for meetings or events, depending on business needs. At NTT DATA, we are committed to staying flexible and meeting the evolving needs of both our clients and employees. NTT DATA recruiters will never ask for payment or banking information and will only use @nttdata.com, @nttdatafed.com and @talent.nttdataservices.com email addresses. If you are requested to provide payment or disclose banking information, please submit a contact us form, https://us.nttdata.com/en/contact-us. NTT DATA endeavors to make https://us.nttdata.com accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact us at https://us.nttdata.com/en/contact-us. This contact information is for accommodation requests only and cannot be used to inquire about the status of applications. NTT DATA is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status. For our EEO Policy Statement, please click here. If you'd like more information on your EEO rights under the law, please click here. For Pay Transparency information, please click here.
Posted 5 days
RN| 6SP Med/Surg | Full Time | Nights
UF Health - Jacksonville, FL 32209
Overview: The Registered Nurse (RN) provides nursing care to patients utilizing the nursing process and standards of practice for a professional nurse. The RN is expected to perform all staff nurse activities and function as charge nurse when assigned. The RN maintains overall accountability/responsibility for assigned patients, even though some activities/tasks may be delegated to Technical Nurses, Patient Care Associates, and/or Sitters. Assignments are performed appropriately to age and developmental level of patients being served. Qualifications: Age of Patients Served: All Age Groups. Required Education: Associate's Degree Specific course work: Graduate of an accredited school of nursing. New hires effective June 14, 2017, must have a BSN degree from an accredited school of nursing within three (3) years of hire or transfer into the position. New hires or transfers into in the position between August 1, 2013 and June 13, 2017 must abide with the conditions in his or her offer letter and the verbiage in the job description signed upon hire or transfer into the position. Current employees who were hired or transferred into the position prior to August 1, 2013 will be grandfathered. Preferred Education: BSN Necessary Skills: 1. Demonstrates teamwork and communicates in a professional manner with all members of the healthcare team. 2. Demonstrates the ability to learn and apply computer technologies and procedures that affect patient care delivery. Required Licensure/Certifications: Licensed to practice nursing in the state of Florida or confirmation letter establishing eligibility for issuance upon receipt of SSN. BLS from the American Heart Association or American Red Cross on the first day of employment is required for all areas. ACLS from the American Heart Association is required at hire or transfer for the following departments: Cardiac Holding Area (730501), CVICU (730400), MICU (700400), PICU (660401), North Pre Op/PACU (633680) and Trauma Center (713100). ACLS from the American Heart Association is required within six (6) months of hire or transfer for the following departments: 3 ICU-North (620480), 5N CCU (730301), Cardiac Rehab (733100), Non Invasive Cardiology North (733080), and Noninvasive Cardiac Lab (733000). ACLS from the American Heart Association is required within six (6) months of hire or transfer for Progressive Registered Nurses in Intensive Care Units. PALS from the American Heart Association is required within six (6) months of hire or transfer for the following departments: PICU (660401) and Trauma Center (713100). Fellowship RN's must obtain their ACLS, PALS and NRP within six (6) months of hire or transfer if required by the department. Crisis Prevention Institute training within ninety (90) days, and then annually, is required for Psych Unit. Preferred Licensure/Certifications: Professional certification preferred. Required Experience: Less than one year of related experience. Preferred Experience: One (1) year of clinical experience.