Clinical Assessor, Registered Nurse - (Hybrid Remote - Springfield, MA) Maximus IncClinical Assessor, Registered Nurse - (Hybrid Remote - Springfield, MA)Springfield, MARemoteIn this field-based role, you'll conduct comprehensive in-person assessments in members' homes, hospitals, and other community settings, evaluate medical, functional, behavioral health, and social needs, develop person-centered service plans, and collaborate with healthcare providers and community partners to coordinate care. Maximus compensation is based on various factors including but not limited to job location, a candidate's education, training, experience, expected quality and quantity of work, required travel (if any), external market and internal value analysis including seniority and merit systems, as well as internal pay alignment.
NewQuality Engineer - AI & Automation, Hybrid-Remote UnitedHealth GroupQuality Engineer - AI & Automation, Hybrid-RemoteHartford, CTRemoteThe ideal candidate will have a bachelor's degree in Computer Science and over 3 years of experience in test automation, particularly with Python and Selenium. A multinational healthcare organization is seeking a QA Engineer to ensure quality assurance for software applications.
NewSenior Advisor, Care Model & Payment Innovation - The Cigna Group - Hybrid The Cigna GroupSenior Advisor, Care Model & Payment Innovation - The Cigna Group - HybridBloomfield, CTRemote$116,200–$193,600 / yearThe role helps shape strategic partnerships, build and manage an innovation pipeline, evaluate external market opportunities, and strengthen relationships with intermediaries and high-performing provider partners, accelerating strategy development, partnership readiness, and execution alignment across markets and business units. This role supports the development of market-relevant care model and payment concepts and strategic partnerships across Cigna Healthcare and Evernorth stakeholders, including providers, employers, health plans, enablers, disruptors, pharmaceutical manufacturers, pharmacies, PBMs, specialty pharmacy, and intermediaries.
Senior Advisor, Data Science - Medical Cost Trend & Forecasting - Hybrid/Remote The Cigna GroupSenior Advisor, Data Science - Medical Cost Trend & Forecasting - Hybrid/RemoteCTRemote$131,200–$218,600 / yearThese states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
UM BH Registered Nurse Humana IncUM BH Registered NurseCTRemoteYou will utilize training and engage formerly acquired skillsets to complete medical necessity reviews for behavioral health requested services using clinical judgment and provides referrals to internal stakeholders for further review depending on case findings. The DOW SkillBridge Internship Program provides transitioning military service members time to gain civilian work experience while still on active duty with an employer for a period approved by their command and the DOW, with an average timeline of 90 days.
Remote Registered Nurse (RN) Case Manager ValerisRemote Registered Nurse (RN) Case ManagerHartford, ConnecticutRemoteBacked by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. calling and working with the patient’s insurance payer to determine coverage benefits, anticipated out-of-pocket costs associated with their therapy and resources for financial assistance, where applicable based upon needs communicated by the patient.
NewPotential Quality of Care (PQOC) Quality Management Behavioral Health Nurse Consultant - Remote CVS Health CorpPotential Quality of Care (PQOC) Quality Management Behavioral Health Nurse Consultant - RemoteCTRemote$60,522–$129,615 / yearThe PQOC team reviews quality of care concerns by reviewing documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues. Additional responsibilities to include but not limited to the following: Works BH Potential Quality of Care cases, along with Patient Safety Events across all lines of business (Commercial, Medicare, and Medicaid).
RN Health Care Facility Surveyor Greenlife Healthcare StaffingRN Health Care Facility SurveyorAmherst, MARemote$75,000–$90,000The Surveyor will serve as a team member or team leader on various types of surveys (i.e. re-certification, comparative, complaint investigation, and revisits) for long-term care and non-long-term care surveys, which can include; ambulatory surgical centers (ASC), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID), end-stage renal disease (ESRD), Psychiatric Residential Treatment Facility (PRTF), hospital, critical access hospital, and hospice facilities. Impact Recruiting Solutions is currently seeking a RN Health Care Facility Surveyor to fill an opening with a Quality Improvement Consulting Company and will work in a technically exciting environment supporting internal and external customers nationwide.
Clinical Documentation Spec 1 / HIM Clinical Document Mgmt Hartford HealthCare CorpClinical Documentation Spec 1 / HIM Clinical Document MgmtFarmington, CTRemotePosition Summary: The Clinical Documentation Specialist (CDS) 1 is responsible for extensive record review, and interaction with physicians, HIM coding professionals, nursing staff and other patient care givers to ensure the accurate representation of patient severity of illness and quality of care. Collaborates with inpatient coders to determine appropriate Diagnosis Related Groups (MS-DRG, APR-DRGs, etc.) and ICD-10 code assignment for compliance, reimbursement, and quality outcomes.
Urgent Care Nurse Practitioner Included Health IncUrgent Care Nurse PractitionerCTRemoteIn this role, you'll deliver virtual comprehensive care to patients of all ages across a wide range of conditions, while working closely with our provider and support teams. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care.