CCM Case Management RN Oscar HealthCCM Case Management RNDallas, TXRemote$32.60–$42.79 / hourTelephonic case management role in which you will educate members on improving health outcomes, assist with transitions from care settings, participate in process improvement and other pilot programs as they arise, and work with the Clinical Concierge Specialist and other Oscar teams to ensure exceptional care for our members. Work with non-clinical teammates in assisting members to navigate the healthcare system, including coaching non-clinicians on how they can add value to all member interactions.
Senior Manager Clinical Audit CorVel CorpSenior Manager Clinical AuditFort Worth, TXRemote$92,673–$143,587 / yearThe Senior Manager, Clinical Audit is responsible for planning, leading, and coordinating multiple teams of auditors and associated billing staff in a fast paced, productivity-based environment to achieve organizational goals. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions.
Itemization Review Nurse II CorVel Healthcare CorporationItemization Review Nurse IIFort Worth, TXRemote$61,053–$98,334 / yearPart timePay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role.
Hospital Bill Audit Nurse I CorVel Healthcare CorporationHospital Bill Audit Nurse IFort Worth, TXRemote$63,739–$95,264 / yearPart timePay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Review medical records to verify services were provided and charges are accurate – identify overcharges/undercharges, unbundled items, errors, duplicates, routine services, and equipment/supplies.
Director, Pre-bill DRG Validation Program CorroHealth IncDirector, Pre-bill DRG Validation ProgramTXRemoteThis role owns the strategy, operations, quality, and financial performance of CorroHealth's pre-bill DRG validation service line, which reviews inpatient encounters prior to claim submission to ensure that assigned MS-DRGs and APR-DRGs are fully supported by clinical documentation, accurately coded, and compliant with CMS, Official Coding Guidelines, and payer requirements. The Director leads a multidisciplinary team of clinical validation reviewers, coding auditors, and CDI specialists; partners with client hospital and health system leadership; and is accountable for program outcomes including accuracy rates, turnaround times, denial prevention, and net revenue impact.
Clinical Practice Consultant HCSCClinical Practice ConsultantRichardson, TexasRemoteThis position is a field-based quality role responsible for supporting HCSC's quality imperatives, value-based care models, and provider relationships by collaboratively working with assigned medical practices or individual PCPs, the appropriate Medical Director and Clinic Directors, and all medical and non-medical quality staff to improve key targeted HEDIS measures. This position involves model and program development, clinical readiness assessments, entity- and network-management-led joint operating committees, obtaining EMR access, implementing provider-based member outreach initiatives and provider supplemental data submissions, and retrieving key medical records throughout the year.
Senior Consultant, Employee Experience Press Ganey Associates LLCSenior Consultant, Employee ExperienceTXRemote$116,000–$170,000 / yearHowever, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. This role contributes across consulting engagements by leading delivery workstreams, developing high-quality client deliverables, fostering executive-level client relationships, and identifying opportunities for ongoing partnership and growth.
NewClinical Practice Consultant Health Care Service CorpClinical Practice ConsultantRichardson, TXRemote$70,600–$149,600 / yearThis position is a field-based quality role responsible for supporting HCSC''s quality imperatives, value-based care models, and provider relationships by collaboratively working with assigned medical practices or individual PCPs, the appropriate Medical Director and Clinic Directors, and all medical and non-medical quality staff to improve key targeted HEDIS measures. This position involves model and program development, clinical readiness assessments, entity- and network-management-led joint operating committees, obtaining EMR access, implementing provider-based member outreach initiatives and provider supplemental data submissions, and retrieving key medical records throughout the year.
Field Reimbursement Manager - South Region (TX, AZ, LA, NM) Inspire Medical Systems Inc.Field Reimbursement Manager - South Region (TX, AZ, LA, NM)Dallas, TXRemote$160,000–$190,000 / yearYou will be working independently in a fast paced, highly visible environment as well as collaboratively with the internal program prior authorization support services and field sales to ensure all customer needs are met supporting patient therapy access and communicating coverage challenges across specific payer channels with guidance on how to navigate and minimize those potential hurdles. Both proactively and reactively navigate and address individual account and patient access issues that occur by partnering with external and internal stakeholders including internal reimbursement team and field sales colleagues.
Utilization Review Nurse Bracane CoUtilization Review NursePlano, TexasRemoteThis position is responsible for performing initial, concurrent review activities; discharge care coordination for determining efficiency, effectiveness, and quality of medical/surgical services, and serving as liaison between providers and medical and network management divisions. RN working in the insurance or managed care industry using medically accepted criteria to validate the medical necessity and appropriateness of the treatment plan.
Patient Education Liaison Texas SanofiPatient Education Liaison TexasDallas, TXRemote$122,250–$176,583.33 / yearCollaborate effectively, building and maintaining strong relationships with the Strategic Account Management cross-functional team (including Commercial, Medical, Marketing, and Case Management) to exchange insights and foster innovative ideas that enhance strategies for key account success. Job Responsibilities: Lead strategy and execute the communication and coordination of both branded and unbranded education encompassing disease, inheritance, and product information to patients and families, covering the existing Rare Disease portfolio as well as potential future launches within the assigned territory.
Case Management Supervisor RN CorVel CorpCase Management Supervisor RNDallas, TXRemote$77,960–$120,368 / yearPay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. The Case Management Supervisor is responsible for directing the operations of their designated department, which may include one or more of the following functions: human resources, customer service, and limited sales management.
Clinical Specialist - Dallas Reflow Medical, Inc.Clinical Specialist - DallasDallas, TXRemoteThis role partners with the Regional Sales Director (RSD) and Territory Managers (TM) to support procedural success, product education, and regional sales objectives. The Clinical Specialist provides clinical and technical support for peripheral vascular medical devices in commercial and pre-commercial settings.
Medical Case Manager I - Spanish Speaking Part-Time CorVel CorpMedical Case Manager I - Spanish Speaking Part-TimeDallas, TXRemote$63,739–$95,264 / yearIn addition, Medical Case Managers are eligible for bonus and will be provided state-of-the-art technological devices to ensure ready access to CorVel's proprietary Case Management application, enabling staff to retrieve documents on the go and log activities as they occur. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions.
NewPCS Quality and Compliance Analyst - RN/LPN Elara CaringPCS Quality and Compliance Analyst - RN/LPNDallas, TexasRemoteAs PCS Quality and Compliance Analyst, you’ll contribute to our success in the following ways : Ensures that all activities performed align with the vision of Elara Caring’s board of directors, executive team, and the leadership of the Compliance team. We know there’s no place like home, and that’s why our teams continue to provide high-quality care to more than 60,000 patients each day in their preferred home setting.
RN Care Manager – Cardiac SeamlessassistRN Care Manager – CardiacDallas, TexasRemote$45–$60 / hourThis is a full-time, remote, hourly contract position focused on delivering advanced clinical support through clinical triage, care plan development, and high-risk care management, including Transitional Care Management (TCM), Principal Care Management (PCM), Complex Care Management (CCM), Remote Patient Monitoring (RPM), and other applicable clinical programs. CCA is seeking experienced Registered Nurse (RN) Care Managers to support a high-acuity population of patients with complex cardiac conditions, including congestive heart failure (CHF) and other comorbidities.
Medical Management Specialist I Bracane CoMedical Management Specialist IPlano, TexasRemoteFor a compact licensee changing permanent residence to the state of operations, you must obtain active, unrestricted RN licensure in the state of operations within 90 days of hire. * Verbal and written communication skills including discussing medical needs with members and interfacing with internal staff/management and external vendors and community resources.
Palliative Care Advanced Practice Provider (Texas) Tuesday HealthPalliative Care Advanced Practice Provider (Texas)Dallas, TXRemoteThey will work with the Head of Clinical Delivery, Head of Operations, market operations team, provider partnership team, and product and clinical teams ensuring the delivery of high-quality supportive care services to our patients and their families. The Advanced Practice Provider will serve as a creative and experienced leader of clinical care delivery in partnership with the Head of Clinical Delivery and other Tuesday Health clinicians.
Home Health Licensed Vocational Nurse BOUNDLESS HOME HEALTH LLCHome Health Licensed Vocational NurseFort Worth, TXRemote$40–$50 / hourPart timePreferred minimum of 1 years of clinical nursing experience, preferably in home health or a related field with a minimum of 2 hours of general, critical care, or emergency hospital experience. Graduate of an accredited school of nursing with a valid and current Licensed Vocational Nurse (LVN) Licensed by the Texas State Board of Nurse Examiners.
RN Care Manager – Cardiac Seamless AssistRN Care Manager – CardiacDallas, TexasRemote$45–$60 / hourThis is a full-time, remote, hourly contract position focused on delivering advanced clinical support through clinical triage, care plan development, and high-risk care management, including Transitional Care Management (TCM), Principal Care Management (PCM), Complex Care Management (CCM), Remote Patient Monitoring (RPM), and other applicable clinical programs. CCA is seeking experienced Registered Nurse (RN) Care Managers to support a high-acuity population of patients with complex cardiac conditions, including congestive heart failure (CHF) and other comorbidities.