• Nurse Auditor - Medical Bill…

    Rising Medical Solutions (Chicago, IL)
    …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 ... Join our team and maximize client savings by reviewing medical bills from a nurse perspective, including...in acute care, surgery and/or orthopedic + Workers' Compensation medical bill review experience a major plus… more
    Rising Medical Solutions (09/07/24)
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  • Remote Utilization Review

    Actalent (Omaha, NE)
    …to claims and preauthorization processing. This role involves accurate and timely medical review of claims, preauthorizations, and customer service inquiries. ... We are seeking a dedicated and detail-oriented Utilization Management Nurse to join our team. The ideal candidate will...medical policy. + Verify member eligibility prior to medical review . + Foster constructive relationships with… more
    Actalent (10/30/24)
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  • Clinical Nurse Auditor, HEDIS…

    Providence (Beaverton, OR)
    …Effectiveness and Data Information Set (HEDIS) program + Conduct Audits, which include review of outpatient medical records, hospital records, clinical lab and ... fill in for staff vacancies. **_Providence Health Plan welcomes remote work for applicants who reside in:_** + Washington...program evaluation, team facilitation, data analysis and or case review + Experience working as a Nurse more
    Providence (10/30/24)
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  • Remote Nurse Coach

    Actalent (Tampa, FL)
    Coach Nurse Job Description As a Coach Nurse , you will utilize clinical expertise to manage assigned post-ate Care patients' transition from an acute care ... closely with the Post-Acute Care patient home health agency nurse and physicians to facilitate education and adherence to...goals and care plans. + Use clinical expertise to review utilization information concerning patient care and match those… more
    Actalent (10/30/24)
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  • Acute Access Nurse Practitioner/Physician…

    CenterWell (Austin, TX)
    …part of our caring community and help us put health first** The Nurse Practitioner (VSP/PT) applies advanced education and clinical competencies to achieve optimal ... patient outcomes. The Nurse Practitioner (VSP/PT) works on problems of diverse scope...serve. + Engages with patients through a variety of remote virtual visits including acute same day visits, patient… more
    CenterWell (10/30/24)
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  • REMOTE | Care Manager II Registered…

    AmeriHealth Caritas (Florence, SC)
    ** REMOTE | Care Manager II Registered Nurse (BSN) - Foster Care Program -SC** Location: Florence, SC Primary Job Function: Medical Management ID**: 34390 ... Counties preferred are York, Florence, Darlington, Williamsburg and Horry. RN required. ** Remote to qualified candidates living in South Carolina wa preference of… more
    AmeriHealth Caritas (10/24/24)
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  • Infusion Referral Nurse - REMOTE

    Prime Therapeutics (Columbus, OH)
    …and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for ... program is provided by the Manager, Patient Programs. **Responsibilities** + Registered Nurse (RN). + 5 years of post-degree clinical experience. + Experience in… more
    Prime Therapeutics (09/15/24)
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  • Nurse Navigator 1 - Site Disease Group…

    University of Miami (Miami, FL)
    …staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . Location: ... provider(s) and assures timely scheduling of initial appointments.2. Reviews outside medical records for appropriate scheduling.3. Assess barriers to care and refers… more
    University of Miami (10/11/24)
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  • Remote Registered Nurse

    315 health (Warner Robins, GA)
    …confidence in navigating their healthcare. We are looking for a qualified Registered Nurse (RN) to serve our patient population in the navigation, prevention and ... management of their health through continuous care programs like Remote Patient Monitoring and Chronic Care Management. Our team works fervently to anticipate the… more
    315 health (08/20/24)
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  • Clinical Medical Review Nurse

    System One (Baltimore, MD)
    …requirements. + Medical Record Retrieval, Abstraction and Research during the Medical Record Review Project + Medical Record Retrieval for ... line with NCQA guidelines. Additional tasks involve helping with Medical Record Retrieval for HEDIS and Risk Adjustment, participating...other needs within the Quality Department. Pay: $37/HR 90% Remote May need to go onsite in Baltimore, MD… more
    System One (09/27/24)
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  • Conduit Registered Nurse (RN) - Triage…

    Bon Secours Mercy Health (Cincinnati, OH)
    …provider communication. + ​​Ensures accurate, timely documentation in the EMR (Electronic Medical Record) according to best practice, guidelines, or workflows _._ + ... in process improvement, professional development, peer development and peer review Licensing/Certification RN license required in applicable state(s). ​​Multistate/Compact… more
    Bon Secours Mercy Health (10/29/24)
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  • Case Manager Registered Nurse , IN…

    McLaren Health Care (Indianapolis, IN)
    …This includes but is not limited to the following: participates in the medical management of members in assigned product lines, including case specific and disease ... of high risk, and under and overuse of services. Collaborates with Medical Director and senior management on complex cases and special projects. **This… more
    McLaren Health Care (10/29/24)
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  • Clinical Review Nurse - Prior…

    Actalent (Dallas, TX)
    …ensure timely review of services and/or requests. + Assess the medical necessity of care in coordination with healthcare providers and interdepartmental teams. + ... Job Title: Prior Authorization NurseJob Description The Prior Authorization Nurse is responsible for analyzing all prior authorization requests to determine the … more
    Actalent (10/31/24)
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  • Clinical Review Nurse - Concurrent…

    Centene Corporation (Austin, TX)
    …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... competitive benefits including a fresh perspective on workplace flexibility. **Registered Nurse Strongly Preferred** **Must reside and be licensed in the state of… more
    Centene Corporation (11/02/24)
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  • HEDIS Review Nurse

    Actalent (Chicago, IL)
    …and provider clean-up. - Will be part of the HEDIS team during the Jan-May season. Review medical records from all 5 states. Abstracting 6 medical records ... care set forth by the insurance company. Experience with medical record review required. Hard Skills +...of 5 Month(s). Work Site This is a fully remote position. Work Environment Will be working remote more
    Actalent (10/27/24)
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  • Youth Corrections Medical Operations…

    State of Colorado (Denver, CO)
    Youth Corrections Medical Operations Coordinator ( Nurse V) Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/4573875) Apply  Youth ... Corrections Medical Operations Coordinator ( Nurse V) Salary $108,540.00 - $151,968.00 Annually Location Denver Metro, CO Job Type Full Time Job Number IKA 02221… more
    State of Colorado (10/19/24)
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  • Nurse Practitioner-Assistant Medical

    Veterans Affairs, Veterans Health Administration (Greenville, NC)
    …the EDRP application. Former EDRP participants ineligible to apply. Responsibilities The Nurse Practitioner-Assistant Medical Director of a Durham VA Primary ... is a dual clinical and non-supervisory administrative role to support the local Medical Director of Clinic. The Nurse Practitioner-Assistant Medical Director… more
    Veterans Affairs, Veterans Health Administration (10/26/24)
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  • RN Clinical Review Nurse

    Centene Corporation (Sacramento, CA)
    …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... competitive benefits including a fresh perspective on workplace flexibility. **Fully Remote position that requires a CA RN Licensure.** **Position Purpose** :… more
    Centene Corporation (10/31/24)
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  • Supervisor Clinical Pharmacist Review

    Prime Therapeutics (Columbus, OH)
    …managerial and clinical oversight of the Clinical Pharmacist and Registered Nurse Review Team, playing a key role in medical and pharmacy management. Leads ... and drives every decision we make. **Job Posting Title** Supervisor Clinical Pharmacist Review - Remote in California **Job Description Summary** This position… more
    Prime Therapeutics (10/22/24)
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