Registered Nurse - Fully Remote MercorRegistered Nurse - Fully RemoteNew York, New YorkRemote$55–$65 / hourExperience reviewing charts for quality improvement, utilization review, CDI, or clinical informatics. For details about the interview process and platform information, please check: https://talent.docs.mercor.com/welcome.
Case Manager Registered Nurse - Field (Middlesex County, New Jersey) CVS HealthCase Manager Registered Nurse - Field (Middlesex County, New Jersey)Middletown, New JerseyRemoteWith compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Collaborates with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences.
NewRN Health Care Facility Surveyor Impact Recruiting SolutionsRN Health Care Facility SurveyorNew York, New YorkRemote$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 an 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.
Senior Manager, Patient Access Advocate, West Revolution Medicines IncSenior Manager, Patient Access Advocate, WestNYRemote$187,200–$208,000 / yearBy acting as a single point of contact, the RNCM will proactively manage and work individual patient cases to ensure access and financial barriers are compliantly overcome -including benefit verifications, Prior Authorization (PA) delays, denials, appeals hurdles, specialty pharmacy (SP) and non-commercial pharmacy routing issues, affordability barriers, complex Center for Medicare and Medicaid cases (CMS), community resources and more. RNCMs will work directly with patients, healthcare providers, insurers, field reimbursement team, and other key stakeholders to help patients understand their coverage, access the company's patient support programs, and connect with external resources that help overcome access barriers.
Senior Manager, Patient Access Advocate, East Revolution Medicines IncSenior Manager, Patient Access Advocate, EastNYRemote$187,200–$208,000 / yearBy acting as a single point of contact, the RNCM will proactively manage and work individual patient cases to ensure access and financial barriers are compliantly overcome -including benefit verifications, Prior Authorization (PA) delays, denials, appeals hurdles, specialty pharmacy (SP) and non-commercial pharmacy routing issues, affordability barriers, complex Center for Medicare and Medicaid cases (CMS), community resources and more. RNCMs will work directly with patients, healthcare providers, insurers, field reimbursement team, and other key stakeholders to help patients understand their coverage, access the company's patient support programs, and connect with external resources that help overcome access barriers.
Remote Nurse Practitioner, Palliative Care at Home - Mount Sinai Home Health - Full Time - Day Mount Sinai Health SystemRemote Nurse Practitioner, Palliative Care at Home - Mount Sinai Home Health - Full Time - DayNew York, NYRemote$123,576–$197,400 / yearWe are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. The team works in collaboration with patients' healthcare teams to provide high quality evidence based complex palliative care and chronic care management and is designed to improve symptoms and QOL, reduce caregiver burden, reduce unnecessary inpatient utilization, and facilitate hospice when appropriate.
Appeal Analyst RN # 26-21019 US Tech Solutions, Inc.Appeal Analyst RN # 26-21019Hopewell, NJRemote$42–$45 / hourInteracts and communicates with facilities, physicians and or members/families, either telephonically and or on site striving for continuity and efficiency as the member is managed along the continuum of care. Job Description: Appeal Analyst RN who will train new hire in the clinical role to complete Utilization Management Appeals and act as an RN I on the team.
NewRN Infusion - Transition Associate (Travel) American Oncology Network IncRN Infusion - Transition Associate (Travel)NYRemote$29.52–$42.39 / hourAbility to build an engaging culture of quality, performance effectiveness and operational excellence through best practices, strong business and political acumen, collaboration and partnerships, as well as a positive employee, physician and community relations. Telephone triage: Includes prioritizing incoming calls and messages from patients, family members, hospitals, nursing facilities, pharmacies and physician offices from emergent to non-urgent.
Clinical Clearance Specialist RN Charlie Health IncClinical Clearance Specialist RNNYRemote$48–$52 / hourThis RN serves as the dedicated clinical reviewer for escalated admissions cases involving eating disorder (ED) and substance use disorder (SUD) presentations - cases that require nursing-level clinical expertise beyond the independent decision-making scope of the CAT team, but that do not require physician review. You will own the clearance review queue, interpret labs, vitals, and EKGs, issue timely admission determinations, and serve as the primary clinical bridge between the admissions team and medical leadership.
Clinical Review & Correspondence RN Cohere Health Technologies LLCClinical Review & Correspondence RNNYRemote$31–$35 / hourBy unifying pre-service authorization data with post-service claims validation, we're creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately. Opportunity Overview: The Clinical Review & Correspondence RN plays a critical role in supporting utilization management operations by conducting medical necessity reviews, preparing clear and compliant clinical determinations, and ensuring accurate member and provider communications.
NewDental Network Content Manager Government Employees Health AssociationDental Network Content ManagerSummit, New JerseyRemoteCollaborate with the dental network team and cross-functional GEHA teams to produce all CDN marketing and administrative collateral required for provider acquisition and ongoing provider administration. While this is a remote opportunity, at this time G.E.H.A does not hire employees from U.S. territories or the following states: Alaska, Hawaii, California, Washington, Oregon, Colorado, Wyoming, Montana, New York, Connecticut, Vermont, Pennsylvania, Maine.
Clinical Clearance Specialist (RN) Charlie HealthClinical Clearance Specialist (RN)New York, NYRemote$48–$52 / hourThis RN serves as the dedicated clinical reviewer for escalated admissions cases involving eating disorder (ED) and substance use disorder (SUD) presentations — cases that require nursing-level clinical expertise beyond the independent decision-making scope of the CAT team, but that do not require physician review. You will own the clearance review queue, interpret labs, vitals, and EKGs, issue timely admission determinations, and serve as the primary clinical bridge between the admissions team and medical leadership.
NewComplex Discharge Planner Centene Corporation GroupComplex Discharge PlannerNJRemote$27.02–$48.55 / hourAssists with the facilitation of a smooth transition from the acute care setting to the next level of care and educates members and their families/caregivers on discharge plan to ensure appropriate high-quality transitional care. Assists with providing education to members and their families on discharge plan and utilization processes to ensure high quality appropriate care to members, as applicable.
Pediatric Triage RN - Overnight 9pm - 9am ET Pomelo Care IncPediatric Triage RN - Overnight 9pm - 9am ETNYRemote$78,000–$83,000 / yearWith the increase of remote work and digital hiring, phishing and job scams are on the rise with malicious actors impersonating real employees and sending fake job offers in an effort to collect personal or financial information. Reporting to a Nurse Lead, your key responsibilities will include: Assessment of urgent pediatric concerns and proactively triaging patients to support appropriate utilization of Pomelo Care and/or emergency services.
Remote Care Manager, LTSS (RN) NEW YORK Molina Healthcare IncRemote Care Manager, LTSS (RN) NEW YORKLong Island, NYRemoteAt least 2 years of experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals.
Clinical Visiting Professor Covista IncClinical Visiting ProfessorNorth Brunswick Township, NJRemoteWith 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. Chamberlain College of Nursing clinical educators experience the powerful satisfaction that comes from helping educate, empower and embolden students and advance the health of people, families, and communities as we face new challenges ahead together.
NewDirector of Compliance (Remote) Ennoble CareDirector of Compliance (Remote)Hackensack, NJRemoteEnnoble Care offers a variety of programs including, remote patient monitoring, behavioral health management, and chronic care management, to ensure that our patients receive the highest quality of care by a team they know and trust. Ennoble Care is a mobile primary care, palliative care, and hospice service provider with patients in New York, New Jersey, Maryland, DC, Virginia, Oklahoma, Kansas, Pennsylvania, Texas, Florida, and Georgia.
Advanced Practice Nurse - Fully Remote MercorAdvanced Practice Nurse - Fully RemoteNew York, New YorkRemote$70–$110 / hour4+ years of experience as a Nurse Practitioner (NP), Advanced Practice Registered Nurse (APRN), Family Nurse Practitioner (FNP), Acute Care Nurse Practitioner (ACNP), Pediatric Nurse Practitioner (PNP), or another closely related advanced practice nursing role. Experts who complete their first task within the required timeline will then be qualified to be paid hourly for the remainder of the project.
RN Health Care Facility Surveyor Greenlife Healthcare StaffingRN Health Care Facility SurveyorAvenel, NJRemote$75,000–$90,000 / yearThe 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 Validation Audit (CVA) Trainer ExlService Holdings IncClinical Validation Audit (CVA) TrainerNYRemote$85,000–$110,000 / yearThis role partners closely with Clinical Auditors, Quality Analysts, and Subject Matter Experts to ensure training content reflects current coding guidelines, clinical validation requirements, and audit expectations. The CVA Trainer plays a critical role in improving audit consistency, accuracy, and completeness by translating audit outcomes into effective learning experiences.