NewLead Healthcare Product Owner System OneLead Healthcare Product OwnerBaltimore, MDRemote$72.18 / hourPrior Authorization (PA) | Utilization Management | Product Owner | Business Integration | FACETS | Claims matching | GuidingCare | EDI 278 | UAT | Requirements | User stories | Acceptance criteria System One, and its subsidiaries including Joulé and Mountain Ltd., are leaders in delivering outsourced services and workforce solutions across North America. This is a true hybrid role (Product Owner + Business Integration Lead) focused on fixing real breakdowns in the PA-to-claims flow—identifying failure points, driving corrective action, and delivering improvements that impact accuracy, turnaround time, and provider experience .
Nurse Practitioner Oak Crest Village by Erickson Senior LivingNurse PractitionerParkville, MDRemoteSee Erickson Senior Living Privacy Policy at https://www.ericksonseniorliving.com/privacy-policy and SonicJobs Privacy Policy at https://www.sonicjobs.com/us/privacy-policy and Terms of Use at https://www.sonicjobs.com/us/terms-conditions. Oak Crest helps people live better lives by fulfilling our promises of a vibrant lifestyle, financial stability, and focused health and well-being services for those who live and work with us.
Outpatient Counselor (Graduate Level - LGPC required) Remote or Hybrid Ellie Mental Health - 016Outpatient Counselor (Graduate Level - LGPC required) Remote or HybridRockville, MDRemoteWe are looking for Therapists: The perfect candidate will share our passion for improving and expanding access to quality mental health care and will thrive in a culture that emphasizes: autonomy, flexibility, creativity, authenticity, humor, compassion, acceptance and determination. Ellie makes the clinician’s experience the best it can be; providing excellent schedules while also providing centralized administrative, technology, referral and inquiry support, scheduling, client/therapist matching, billing and collections, and even CEU programs.
Lead Healthcare Data Analyst (Post-sale) HealthVerityLead Healthcare Data Analyst (Post-sale)Washington, DCRemoteAs a Lead Analyst, Real World Data (RWD) Insights you will serve as a strategic partner to clients and internal teams, leveraging deep expertise in healthcare data analytics to drive complex, high-impact real-world data (RWD) solutions. Success in this role requires deep subject matter expertise in real world data, exceptional communication skills, and a genuine interest in building trusted client relationships.
Lead Healthcare Data Analyst (Pre-sale) HealthVerityLead Healthcare Data Analyst (Pre-sale)Washington, DCRemoteAs a Lead Healthcare Data Analyst, Real World Data Solutions (RWDS), you will apply your healthcare data analytics expertise to support pre-sales solutioning, helping clients and internal teams assess data feasibility, shape analytic approaches, and identify the right data assets to support prospective licensing opportunities. Efficiently query multiple data types (medical and pharmacy claims, EMR, lab, chargemaster) using SQL to identify populations of interest in HVM data, apply appropriate inclusion and exclusion criteria, and assess outputs using univariate analysis, distributions, trends, and data investigations.
China Research Intern PT – Defense (Hybrid) BluePath LabsChina Research Intern PT – Defense (Hybrid)Washington, DCRemotePart timeChina Research Interns at BluePath contribute to our research and translation work at all stages, including by performing administrative tasks, gathering data, conducting open-source research and analysis, editing reports, proofreading translations, generating data visualizations, and testing software tools. We are actively seeking a China Research Intern to support open-source research and translation products relating to China's military, defense industrial base, technological development, and foreign policy.
Principal Software Engineer - Remote or Hybrid in MN and DC UnitedHealth Group IncPrincipal Software Engineer - Remote or Hybrid in MN and DCDCRemote$132,200–$226,600 / yearThe fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. Serving all of UnitedHealth Group"s digital technology needs, the CDO team is responsible for driving outcomes across nearly 30 million+ human lives with UnitedHealthcare insurance, a number which puts UHC at the top of the pack as the largest managed care provider in the United States.
Senior Healthcare Network Consultant Humana IncSenior Healthcare Network ConsultantMDRemote$78,400–$107,800 / yearWork at Home Requirements To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested.
Advanced Practice Provider (Hybrid) TapestryHealthAdvanced Practice Provider (Hybrid)Rockville, MarylandRemoteThey ensure proactive patient care through the review and discussion of Chronic Care Management (CCM), Remote Patient Monitoring (RPM), Behavioral Health Integration (BHI) & daily risk reports with facility healthcare professionals, including physicians, nurse practitioners, and social workers. Job Description: Tapestry Management Providers (TMPs) play a crucial role in delivering comprehensive, in-person clinical support to healthcare facilities.
Principal Threat Surface Analyst - Remote or Hybrid in MN or DC UnitedHealth Group IncPrincipal Threat Surface Analyst - Remote or Hybrid in MN or DCWashington, DCRemote$112,700–$193,200 / yearThe fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. Experience implementing and supporting enterprise endpoint platforms such as: Microsoft Defender for Endpoint, Trend Micro, CrowdStrike, SentinelOne, Carbon Black.
Lead Software Engineer - Remote or Hybrid in MN and DC UnitedHealth Group IncLead Software Engineer - Remote or Hybrid in MN and DCDCRemote$112,700–$193,200 / yearThe fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. We have received recent reports of fraudulent LinkedIn messages and emails alleging or claiming to be sent from UnitedHealth Group, UnitedHealthcare, or Optum Executives.
NewSystems Engineer II (Systems Integration & Interoperability) :: Harrisburg, PA (Hybrid) ARK Solutions, Inc.Systems Engineer II (Systems Integration & Interoperability) :: Harrisburg, PA (Hybrid)Washington, DCRemoteThis role involves working closely with technical teams, clinical stakeholders, and vendors to ensure system readiness and operational success. The Systems Engineer II supports the design, integration, testing, deployment, and sustainment of enterprise health information technology solutions.
Sr Software Engineering Manager - Remote or Hybrid in MN or DC UnitedHealth Group IncSr Software Engineering Manager - Remote or Hybrid in MN or DCDCRemote$112,700–$193,200 / yearExperience with modern technology stacks, including: Cloud platforms (Azure preferred), Java and Spring Framework, GitHub Actions and DevOps pipelines, MongoDB and modern frontend frameworks (e.g., React), Data engineering tools (ADF, Databricks), Experience working with vendor-managed delivery - Understand implementations at a technical level, validate and verify technical deliverables and milestones. The fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount.
NewPrincipal Data Engineering - Remote or Hybrid in MN or DC UnitedHealth Group IncPrincipal Data Engineering - Remote or Hybrid in MN or DCWashington, DCRemote$112,700–$193,200 / yearThe fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. Work within Optum"s Enterprise Data Strategy to consume and share data in the most efficient manner - data mesh enablement, data mastering, data governance, data certification and self- service.
Senior Manager, Technology Product Management - Technology & Cyber Governance - Remote or Hybrid in MN or DC UnitedHealth Group IncSenior Manager, Technology Product Management - Technology & Cyber Governance - Remote or Hybrid in MN or DCDCRemote$112,700–$193,200 / yearThe fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. As part of governance, collaborate with Technology and Cybersecurity teams to ensure they define Key Risk Indicators (KRIs), Key Control Indicators (KCIs), and performance metrics, including thresholds aligned to risk appetite that support the GRC metrics framework.
Sr Manager, Software Engineering - Remote or Hybrid in MN or DC UnitedHealth Group IncSr Manager, Software Engineering - Remote or Hybrid in MN or DCWashington, DCRemote$112,700–$193,200 / yearThe fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
Nurse Practitioner Hybrid-Remote DaVita IncNurse Practitioner Hybrid-RemoteTowson, MDRemote$85,000–$135,000 / yearPreferred Qualifications: • Experience in Value-Based Care or Population Health, including Medicare Advantage documentation and Health Risk Assessments • 5+ years' experience as a Family NP, Primary Care NP, or in Internal Medicine, Cardiology, Nephrology, or Endocrinology • Experience managing population health with a focus on reducing hospitalizations • Prior experience with Cerner or similar EHR systems. Clinical Care & Evaluation: The primary responsibility is completing Comprehensive Health Evaluations (CHEs) to assess and manage comorbid conditions while addressing medical, social, emotional, and financial needs.
China Research Intern PT - Defense (Hybrid) BluePath LabsChina Research Intern PT - Defense (Hybrid)DCRemoteWork Description: China Research Interns at BluePath contribute to our research and translation work at all stages, including by performing administrative tasks, gathering data, conducting open-source research and analysis, editing reports, proofreading translations, generating data visualizations, and testing software tools. We are actively seeking a China Research Intern to support open-source research and translation products relating to China's military, defense industrial base, technological development, and foreign policy.
Principal Analytics Analyst - Healthcare Data SureScripts LLCPrincipal Analytics Analyst - Healthcare DataDCRemote$152,900–$186,900 / yearEvidence of leading complex, cross-functional analytics that drove material product, commercial, or strategic outcomes; preferred experience with medication adherence analytics, prior authorization and utilization management analytics, health economics and outcomes research (HEOR), and/or growth marketing analytics. Masters degree in Data Science, Statistics, Epidemiology, Health Economics, or related field required; 8+ years of experience in advanced analytics, with substantial healthcare analytics experience preferred.
NewExecutive Assistant - Hybrid in Minneapolis MN, Washington DC, or Remote UnitedHealth Group IncExecutive Assistant - Hybrid in Minneapolis MN, Washington DC, or RemoteWashington, DCRemote$34–$60 / hourThe fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. Leverage enterprise-approved artificial intelligence (AI) and digital automation tools to streamline administrative workflows, automate routine tasks, and drive continuous operational improvement.
Seeking an Independently Licensed Psychotherapist for a Flexible Remote/Hybrid Position Capitol Hill Consortium for Counseling & ConsultationSeeking an Independently Licensed Psychotherapist for a Flexible Remote/Hybrid PositionDCRemoteWe provide a wide range of services, including individual, couples, family, and group therapy, as well as psychological testing for clients across the lifespan. Join CapitolHill Consortium for Counseling & Consultation LLC (CCCC), a growing multidisciplinary practice seeking licensed clinicians to expand our team.
Senior Design Engineer – Wastewater & Hydraulic Modeling (Remote/Hybrid) Talent Consulting ExpertsSenior Design Engineer – Wastewater & Hydraulic Modeling (Remote/Hybrid)Arlington, VirginiaRemoteWastewaterEngineer #WaterInfrastructure #EnvironmentalEngineering #HydraulicModeling #StormwaterManagement #EPACompliance #Sustainability #CivilEngineering #RemoteWork #HiringNow #EngineeringCareers . Collaborate with Multidisciplinary Teams: Work with project managers, environmental engineers, and construction teams to deliver innovative water infrastructure solutions.
Summer Therapist - Contract/1099 Remote/Hybrid Optional Blackbird HealthSummer Therapist - Contract/1099 Remote/Hybrid OptionalVienna, VARemote$70–$100 / hourAs a Summer Therapist, you will provide evidence-based telehealth therapy services to children, adolescents, and young adults while working collaboratively within an interdisciplinary pediatric behavioral health team. In recruiting for our team, we welcome the unique contributions that you can bring in terms of your education, opinions, culture, ethnicity, race, sex, gender identity and expression, nation of origin, age, languages spoken, veteran status, color, religion, disability, sexual orientation and beliefs.
Lead AI/ML Engineer-Remote Nationwide or Hybrid in MN/DC UnitedHealth Group IncLead AI/ML Engineer-Remote Nationwide or Hybrid in MN/DCDCRemote$145,500–$249,500 / yearThe fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. The Lead AI/ML Engineer will provide hands-on technical leadership to build scalable, production-ready AI/ML solutions that convert complex healthcare data into actionable workflows for care, quality, finance, and provider enablement teams.
Utilization Management Registered Nurse Humana IncUtilization Management Registered NurseMDRemote$71,100–$97,800 / yearWork-at-Home Information: To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Through our Humana insurance services and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it.
UM BH Registered Nurse Humana IncUM BH Registered NurseMDRemoteYou 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.
Supervisor, Integrated Care Management/ Registered RN (RN) for Partners in Pregnancy & Member Engagement Teams for Commercial Health Plan - Remote in Virginia Sentara Healthcare IncSupervisor, Integrated Care Management/ Registered RN (RN) for Partners in Pregnancy & Member Engagement Teams for Commercial Health Plan - Remote in VirginiaVARemoteKeywords: Care Coordination, Case Management, RN, Case Manager, Registered Nurse, BSN, ADN, Nursing, Managed Care, MCO, Health Plan, high-risk pregnant members, Maternal Health, Perinatal, OB-GYN, Labor and Delivery, Mother-Baby, Postpartum, Maternity, L&D, Winchester, Shenandoah, Frederick, Rockingham, VA, Virginia, Member Engagement, Discharge Planning. Experience working with low and high risk pregnant population (Maternal Health / Perinatal / OB-GYN /Labor and Delivery / Mother-Baby / Postpartum) experience highly preferred.
Integrated Case Manager- Registered Nurse Sentara Healthcare IncIntegrated Case Manager- Registered NurseVARemoteThe Integrated Case Manager is responsible for case management services within the scope of licensure; develops, monitors, evaluates, and revises the members care plan to meet the members needs, with the goal of optimizing member health care across the care continuum. Demonstrates the minimum knowledge, skills and abilities to care for the individualized needs of the patient to include physical, psychological, socio-cultural, spiritual and cognitive needs as well as functional abilities including the need for diversified use of such practices.
Integrated Case Manager- Registered Nurse Sentara HospitalsIntegrated Case Manager- Registered NurseWoodbridge, VirginiaRemoteThe Integrated Case Manager is responsible for case management services within the scope of licensure; develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum. Demonstrates the minimum knowledge, skills and abilities to care for the individualized needs of the patient to include physical, psychological, socio-cultural, spiritual and cognitive needs as well as functional abilities including the need for diversified use of such practices.
Field Registered Nurse (RN) Wellness Health ServicesField Registered Nurse (RN)Washington, DCRemoteIn this dynamic role, you will provide high-quality, compassionate care while working closely with a dedicated team of healthcare professionals. Our commitment to quality care and patient satisfaction has earned us a loyal clientele and a supportive work environment where employees thrive and grow.
Remote Registered Nurse RN RylemRemote Registered Nurse RNBaltimore, MDRemote$25–$28 / hourFull timePart timeWe’re looking for an experienced Registered Nurse Clinical Documentation Specialist to join a high-performing healthcare team in a fully remote role! If you have a strong CDI background and acute care experience, this is your chance to work from home while earning competitive travel pay.
Clinical Quality Performance Specialist Senior AmeriHealth CaritasClinical Quality Performance Specialist SeniorWashington, DCRemote$92,200–$125,600 / yearManages activities related to plan accreditation, preventive health improvement, business analysis, and clinical and service quality improvement, including state withholds, Healthcare Effectiveness Data and Information Set (HEDIS), and Consumer Assessment of Healthcare Providers and Systems (CAHPS). The Senior Clinical Quality Performance Specialist is responsible for overseeing, designing, and implementing quality initiatives, identifying root causes, establishing and executing work plans to implement effective interventions.
Health Care | Life Sciences, Senior Associate - Registered Nurse / Certified Coder Ankura Consulting GroupHealth Care | Life Sciences, Senior Associate - Registered Nurse / Certified CoderWashington DC, District of ColumbiaRemoteOur clients include academic medical centers, health systems, physician practice groups, post- and sub-acute providers, health plans, pharmacies, and pharmacy benefit management companies, as well as pharmaceutical and medical device manufacturers. Our practitioners provide expert witness testimony on commercial disputes involving payers and providers, as well as in matters involving False Claims Act, Anti-kickback, Stark, and FDA disputes and investigations.
Virtual Nurse Practitioner VA DC MD Baseline MedicalVirtual Nurse Practitioner VA DC MDFairfax, VARemoteThis role is well suited for an experienced Nurse Practitioner who is comfortable practicing autonomously within a collaborative, hybrid virtual–in-home care model and values flexible, part-time virtual work with predictable base pay. The NP reviews RN-collected clinical data, performs virtual medical assessments, develops treatment plans, and provides medical decision-making and prescriptions in real time.
Pediatric Clinical Nursing Faculty Covista IncPediatric Clinical Nursing FacultyBaltimore, MDRemoteFrom individual professor support and student-led study groups to diverse clinical and career networking opportunities, the institution"s community shares a common goal: to give each other the care we need to succeed and make a difference by transforming healthcare. With more than 135 years of history in healthcare education and as the largest nursing school in the country, Chamberlain University is committed to delivering a high-value education that prepares students to thrive as healthcare professionals.
RN Health Care Facility Surveyor Impact Recruiting SolutionsRN Health Care Facility SurveyorBaltimore, MarylandRemote$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 Specialist RN Johns Hopkins Medical Management CorporationClinical Documentation Specialist RNBaltimore, MarylandRemoteOverview: Johns Hopkins Intrastaff is the internal staffing agency for the Johns Hopkins Health System and partner hospitals, providing temporary support to a variety of the Johns Hopkins locations. Operating at competent level with, but not limited to: Microsoft Office Suite, web-browsers,email, electronic health records, online collaboration software, virtual meeting applications.
Program Integrity Clinical Specialist (RN or PA Req'd) TriWest Healthcare AllianceProgram Integrity Clinical Specialist (RN or PA Req'd)Baltimore, MDRemoteFull timeTechnical Skills: Knowledge of TRICARE policies and procedures, knowledge of Case Management, Utilization Management, and Quality Management practices and principles, and knowledge of Managed Care concepts, alternative care treatments, and community resources. • Research and investigate medical issues as they relate to potential fraud and abuse cases, to include perform anti-fraud and abuse pre-payment reviews or post-payment reviews.
Director, Medical Document Optimization TriWest Healthcare AllianceDirector, Medical Document OptimizationBaltimore, MDRemoteFull timeLeadership: Ability to set strategic direction and translate organizational goals into operational plans; successfully leads and develops staff across varying styles and levels; provides clear expectations, effective coaching, and timely feedback; leads through a subordinate manager and drives accountability at all levels of the department. Problem Solving / Analysis: Ability to solve complex operational and systems-related problems through systematic analysis of data, workflows, and processes; exercises sound judgment in ambiguous or high-stakes situations; identifies root causes and implements durable solutions with a realistic understanding of organizational constraints.
NewRegistered Nurse (RN) - Day Triage Runner (Not Remote) Capital CaringRegistered Nurse (RN) - Day Triage Runner (Not Remote)Washington, District of ColumbiaRemoteTriage RN's who experience technical issues not caused by the company equipment or network (i.e. offsite power outage, personal internet outage) are required to report the situation to leadership immediately, and have 30 minutes to resolve the technical issue. Clients include current and prospective patients, friends, or family members, Powers of Attorney, care providers, physicians, nursing staff, nursing homes and Assisted Living Facilities (ALFs), hospital staff, and others, as appropriate.
Utilization Management Nurse Consultant (Weekend) CVS Health CorpUtilization Management Nurse Consultant (Weekend)MDRemote$29.10–$62.32 / hourEducation: Diploma RN acceptable; Associate degree/BSN preferred, 3+ years of experience as a Registered Nurse, 1+ years of clinical experience in acute or post-acute setting, and 1+ years of Utilization Management / Care Management Experience. Position Summary: Utilize your clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor, and evaluate options to facilitate appropriate healthcare services and benefits for members.
NewRN Case Manager - HouseCalls - Remote - EST or CST - Compact license Required UnitedHealth Group IncRN Case Manager - HouseCalls - Remote - EST or CST - Compact license RequiredColumbia, MDRemote$60,200–$107,400 / yearThe fraudulent LinkedIn messages and emails, which do not originate from any Executives LinkedIn account or of UnitedHealth Group's email domains, or those of any of its operating divisions, supposedly conducts an interview via a Zoom meeting, offers a work from home job at Optum, emails an application, sends a fake check by next day delivery through USPS and asks recipients to pay a vendor a large dollar amount. The NCM interacts via telephonic consult with members and providers to assist with education and clarification on any concerns raised during the HouseCalls visit and ensure the member has/or assist in obtaining an appointment with the provider to transition care.
Quality Improvement Coordinator /Registered Nurse (RN) - Remote in Virginia Sentara Healthcare IncQuality Improvement Coordinator /Registered Nurse (RN) - Remote in VirginiaVARemoteAssists in developing focused and/or specialized studies based on high volume, high risk, high cost, and/or problem prone areas, and periodically monitors and evaluates related performance goals. Quality Improvement Coordinator, Registered Nurse, RN, Nursing, Remote, Health Plan, Healthcare, MCO, Managed Care, Health Insurance, Quality Improvement, Regulation, Accreditation, DMAS, CMS.
Director, Real World Data Insights HealthVerityDirector, Real World Data InsightsBaltimore, MDRemoteYour clients and colleagues will rely on you for your real world data and evidence subject matter expertise, your deep understanding of the questions life science companies are asking, your strategic and consultative decisiveness in evaluating and confidently recommending appropriate data for research needs, and your seasoned approach to helping clients get the best use out of data. At least 3 years experience in a consultative, client-facing role with participation as a core team member participating in RFI/RFP response, and prospective client meetings, with preference for customers in the government and life sciences industries.
Clinical Navigator (Remote) Blue Cross and Blue Shield AssociationClinical Navigator (Remote)Baltimore, MDRemote$72,216–$143,429 / yearUtilizing experience and skills in both care management and utilization management, the Clinical Navigator will leverage proficiency in established MCG, in addition to administrative/regulatory considerations, to determine medical necessity, appropriate levels of care, and case management to engage members/enrollees, their families, and other support systems in discharge planning. The role will function as a liaison, working telephonically with the hospital care team, including case managers, social workers, and discharge planners, to ensure CareFirst members/enrollees receive the appropriate level of care and partner to address any potential barriers to discharge.
RN Health Care Facility Surveyor Greenlife Healthcare StaffingRN Health Care Facility SurveyorBaltimore, MDRemote$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.
Site Visit Lead/Investigator General Dynamics CorpSite Visit Lead/InvestigatorWashington, DCRemote$89,250–$120,750 / yearKey Responsibilities: The Site Visit Lead/Investigator is responsible for: Compliance Monitoring: Plan and conduct both routine and investigative onsite and desk audits of transplant hospitals, Organ Procurement Organizations (OPOs), and other OPTN member institutions. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available.
Clinical Appeals Nurse (Remote) Blue Cross and Blue Shield AssociationClinical Appeals Nurse (Remote)DCRemote$67,320–$133,705 / yearESSENTIAL FUNCTIONS: Investigates, interprets, and analyzes written appeals and reconsideration requests from multiple sources including applicants, subscribers, attorneys, group administrators, internal stake holders and any other initiators. Investigates, interprets, analyzes and prioritizes appeal requests using nursing expert knowledge and all available clinical information for both medical and behavioral health conditions, as well as medical policies, to determine if the adverse coverage and adverse decisions are appropriate.
Remote Care Management Nurse Cambia Health Solutions IncRemote Care Management NurseWashington, DCRemote$36.80–$49.80 / hourAs a member of the Clinical Services team, our Care Management RN's provide clinical care management (such as case management, disease management, and/or care coordination) to best meet the member's specific healthcare needs and to promote quality and cost-effective outcomes. Collaborates with physician advisors, internal and external customers, and other departments to resolve claims, quality of care, member or provider issues, and identifies problems or needed changes, recommending resolutions and participating in quality improvement efforts.
NewMedical Records Technician (Clinical Documentation Improvement Specialist (CDIS - Inpatient)) U.S. Department of Veterans AffairsMedical Records Technician (Clinical Documentation Improvement Specialist (CDIS - Inpatient))Fort Belvoir, VARemote$61,722–$80,243 / yearAn associates degree from an accredited college or university recognized by the U.S. Department of Education with a major field of study in health information technology/health information management, or a related degree with a minimum of 12 semester hours in health information technology/health information management (e.g., courses in medical terminology, anatomy and physiology, medical coding, and introduction to health records); OR, 3- Completion of an AHIMA approved coding program, or other intense coding training program of approximately one year or more that included courses in anatomy and physiology, medical terminology, basic ICD diagnostic/procedural, and basic CPT coding. Examples of creditable experience at the GS-08 journey grade level of a MRT (Coder-inpatient) are: A comprehensive review of documentation within the health record to assign ICD codes for diagnosis, complications/major complications, comorbid/major comorbid conditions, surgery, and procedures for accurate assignment of diagnosis related groups (DRG), and/or assigning CPT/HCPCS codes for inpatient professional services.