Fraud AI / Data Healthcare Senior Consultant (remote) Guidehouse IncFraud AI / Data Healthcare Senior Consultant (remote)McLean, VARemote$113,000–$188,000 / yearHands-on experience with financial crime compliance technology and data solutions, e.g., Oracle Mantas, Actimize, Fircosoft, LexisNexis Bridger, World-Check, Dow Jones, Chainalysis, Elliptic, TRM Labs, etc. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.
Integrated Care Manager/ Registered Nurse (RN) LTSS Waiver Members/Medicaid - Remote in NOVA (Fairfax, Springfield and Alexandria, VA) Sentara Healthcare IncIntegrated Care Manager/ Registered Nurse (RN) LTSS Waiver Members/Medicaid - Remote in NOVA (Fairfax, Springfield and Alexandria, VA)Alexandria, VARemoteKeywords: Medicaid, Managed Care, Health Plan, Health Insurance, MCO, Integrated Case Manager, Registered Nurse, RN, Nursing, Fairfax, Springfield, and Alexandria, VA, Northern Virginia, NOVA, Long-Term Services and Supports (LTSS), Waiver, Home Health. The position requires in person/face-to-face assessments with remote/home office for the Long-Term Services and Supports (LTSS) Waiver Members/Medicaid in Northern Virginia (Fairfax, Springfield, and Alexandria, VA), and the surrounding areas!
NewSr Nurse Director of Connected & Remote Care MedStar HealthSr Nurse Director of Connected & Remote CareColumbia, MarylandRemote$142,064–$287,996 / yearFull timeDefines and monitors nursing-sensitive outcome measures associated with connected virtual and remote nursing care programs including remote patient monitoring patient access care experience quality and safety cost effectiveness staffing models and workloads and nurse engagement and productivity. Assumes leadership for the planning development execution day-to-day operations and ongoing evaluation of patient care services within the assigned clinical areas/departments according to MedStar Health/entity mission vision and SPIRIT Values and Nursing's philosophy strategic plan and annual goals.
Registered 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.
Advanced Practice Registered Nurse (AGNP or FNP) (Remote) Sunday HealthAdvanced Practice Registered Nurse (AGNP or FNP) (Remote)District of Columbia, DCRemoteThis includes 1) individuals who are interested in understanding their current brain health and how they can promote their brain health as they age; 2) those who are experiencing symptoms of cognitive decline and seeking a diagnostic evaluation and early intervention to delay disease progression; and, 3) those with an established diagnosis of mild cognitive impairment or mild dementia who are seeking early intervention to delay disease progression and tailored care plans. Performing new and follow-up patient visits, including acquiring a cognition-focused history, completing cognitive, psychological, behavioral, functional, and caregiver assessments, ordering and interpreting labs and imaging, and developing care plans.
Behavioral Health Utilization Management Clinician/LCSW/LPC/LMFT/RN/LSATP for Substance Abuse - Remote in VA and NC Sentara Healthcare IncBehavioral Health Utilization Management Clinician/LCSW/LPC/LMFT/RN/LSATP for Substance Abuse - Remote in VA and NCVARemoteManaged Care, MCO, Health Plan, Healthcare, Masters, Social Work, Counseling Field, BSN, Nursing, Licensed Clinical Social Worker (LCSW), Licensed Professional Counselor (LPC), Licensed Marriage and Family Therapist (LMFT), Registered Nurse License (RN), Clinical, behavioral health, care coordination, discharge planning, continuity of care, transitions of care, Remote, Virginia, Weekends, Days, North Carolina, Licensed Substance Abuse Treatment Practitioner, LSATP, Certified Substance Abuse Counselor, CSAC, Licensed Chemical Dependency Counselors, LCDC, American Society of Addiction Medicine (ASAM). Registered Nurse (RN) Single State - Nursing License - Virginia Department of Health Professionals (VADHP) OR Registered Nurse (RN) Single State - Nursing License - North Carolina Board of Nursing (NCBON) OR Registered Nurse (RN) Multi State - Nursing License - Virginia Department of Health Professionals (VADHP) OR Registered Nurse (RN) Multi State - Nursing License - North Carolina Board of Nursing (NCBON) OR.
Integrated Care Manager/ Registered Nurse (RN) LTSS Waiver Members/Medicaid - Remote in NOVA (Fairfax, Springfield and Alexandria, VA) Sentara HospitalsIntegrated Care Manager/ Registered Nurse (RN) LTSS Waiver Members/Medicaid - Remote in NOVA (Fairfax, Springfield and Alexandria, VA)Fairfax, VirginiaRemoteKeywords: Medicaid, Managed Care, Health Plan, Health Insurance, MCO, Integrated Case Manager, Registered Nurse, RN, Nursing, Fairfax, Springfield, and Alexandria, VA, Northern Virginia, NOVA, Long-Term Services and Supports (LTSS), Waiver, Home Health. The position requires in person/face-to-face assessments with remote/home office for the Long-Term Services and Supports (LTSS) Waiver Members/Medicaid in Northern Virginia (Fairfax, Springfield, and Alexandria, VA), and the surrounding areas!
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.
Manager, Integrated Care Management- Nursing Facility/ HCBS / LTSS Waiver - Remote! Sentara Healthcare IncManager, Integrated Care Management- Nursing Facility/ HCBS / LTSS Waiver - Remote!VARemote$48.79–$81.31 / hourCare Coordination, Case Management, RN, Case Manager, Registered Nurse, BSN, Nursing, Managed Care, MCO, Health Plan, Virginia, Remote, Licensed Clinical Social Worker (LCSW) - State license - Virginia Department of Health Professionals (VADHP), Licensed Professional Counselor (LPC) - State license - Virginia Department of Health Professionals (VADHP), Registered Nurse (RN) License (Compact or Virginia), Long-Term Services and Supports, LTSS, Home and Community-Based Services (HCBS), Nursing Facility. We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services-all to help our members improve their health.
NewSolutions Architect (Healthcare Payer and PBM Operations) MindlanceSolutions Architect (Healthcare Payer and PBM Operations)Baltimore, MDRemote3 Healthcare Payer and PBM Operations: Deep knowledge of and experience with health insurance and Pharmacy Benefit Management (PBM) business models, processes, capabilities, and supporting information systems, including pharmacy benefit design, formulary management, drug pricing, pharmacy networks, eligibility, claims, rebates, utilization management, specialty pharmacy, and member/provider services. 4. Pharmacy Benefit Administration: Strong understanding of the end-to-end pharmacy benefit lifecycle, including benefit configuration, formulary and drug list management, prior authorization, step therapy, quantity limits, accumulator management, specialty drugs, pharmacy network administration, claims adjudication, reversals, coordination of benefits, and payment/reconciliation.
Care Manager (Remote) Blue Cross and Blue Shield AssociationCare Manager (Remote)DCRemote$72,360–$143,715 / yearThe Care Manager works closely with members and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to optimal health and cost-effective outcomes. Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
NewHealthcare Ins Contact Admin RadNet IncHealthcare Ins Contact AdminMaryland, MDRemote$30–$35 / hourWorks collaboratively with the Regional Directors of Contracting, Operations and Credentialing departments to maintain/update the RadNet East Coast Facility List, (sometimes referred to as the "Source of Truth" draft/distribute the corresponding payor notifications, document correspondent received from the payer and performs follow up to ensure the updates have been completed in the payor systems. Job Summary: Under minimal supervision, assists the Contracting and Payor Relations team, the Reimbursement Operations team and the authorization team in a support role handling departmental projects as assigned, facilitating communications to and from insurance companies, and internal/external contacts regarding updates on physician staff and facility information.
Urgent Care Nurse Practitioner - Remote Included HealthUrgent Care Nurse Practitioner - RemoteWashington DC, DCRemote$98,400–$108,450 / hourIn this role, youll deliver virtual comprehensive care to patients of all ages across a wide range of conditions, while working closely with our provider and support teams. Were seeking board certified Nurse Practitioners licensed in Florida AND 3 other states with broad clinical expertise and a passion for improving healthcare access and quality.
Commercial & Healthcare Regulatory Counsel Alto IncCommercial & Healthcare Regulatory CounselMDRemote$135,000–$185,000 / yearPhysical requirements for this role include the ability to work at a computer terminal with monitor, keyboard and mouse for extended periods of time, stoop, bend, and reach for equipment and supplies, make frequent repetitive motions required to operate a computer that include the wrists, hands and fingers, and lift, carry, push, pull, and move light objects up to 20 pounds. Issue-spot and provide practical guidance on applicable laws and regulations, such as the Anti-Kickback Statute (AKS), Stark Law, False Claims Act, FDA/DEA requirements relevant to pharmacy and telehealth operations, state pharmacy/professional licensing, PBM contracting/network participation, and HIPAA/HITECH.
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.
NewHealthcare Ins Contact Admin RadNetHealthcare Ins Contact AdminMarylandRemote$30–$35 / hourFull timeWorks collaboratively with the Regional Directors of Contracting, Operations and Credentialing departments to maintain/update the RadNet East Coast Facility List, (sometimes referred to as the “Source of Truth” draft/distribute the corresponding payor notifications, document correspondent received from the payer and performs follow up to ensure the updates have been completed in the payor systems. Job Summary: Under minimal supervision, assists the Contracting and Payor Relations team, the Reimbursement Operations team and the authorization team in a support role handling departmental projects as assigned, facilitating communications to and from insurance companies, and internal/external contacts regarding updates on physician staff and facility information.
Licensed Practical Nurse (LPN) Runner - Not Remote Capital CaringLicensed Practical Nurse (LPN) Runner - Not RemoteWashington, District of ColumbiaRemotePerforms Central Venous Line (CVL) site observation/inspection; venous access device dressing, cap change and flushing venous access device; IV medication and fluid administration, IV pushes (per procedure) and venipuncture. Job Responsibilities: Under the direction of an RN, provides nursing tasks to patients and families such as continuous care, dressing changes, catheter changes as identified in the plan of care developed by the Interdisciplinary Group (IDG).
Licensed Clinical Social Worker - Remote BetterHelpLicensed Clinical Social Worker - RemoteColumbia, MDRemote$55–$70 / hourAlso, we are unable to accept substance abuse counselors, school counselors, registered nurses, career counselors, Christian counselors, and business coaches (unless they have an additional license as a mental health counselor). BetterHelp is one of the world's largest online therapy platforms for mental health professionals who want to focus on client care — not admin or overhead.
Licensed Independent Clinical Social Worker - Remote BetterHelpLicensed Independent Clinical Social Worker - RemoteWashington, DCRemoteAlso, we are unable to accept substance abuse counselors, school counselors, registered nurses, career counselors, Christian counselors, and business coaches (unless they have an additional license as a mental health counselor). BetterHelp is one of the world's largest online therapy platforms for mental health professionals who want to focus on client care — not admin or overhead.
Licensed Mental Health Counselor - Remote BetterHelpLicensed Mental Health Counselor - RemoteColumbia, MDRemote$55–$70 / hourAlso, we are unable to accept substance abuse counselors, school counselors, registered nurses, career counselors, Christian counselors, and business coaches (unless they have an additional license as a mental health counselor). BetterHelp is one of the world's largest online therapy platforms for mental health professionals who want to focus on client care — not admin or overhead.