Clinical Director, Pre-Bill DRG Review - Quality Assurance, Training & Education (RN, MD/DO, or PA) (FT/Remote) CorroHealthClinical Director, Pre-Bill DRG Review - Quality Assurance, Training & Education (RN, MD/DO, or PA) (FT/Remote)New JerseyRemoteThis role is responsible for designing, implementing, and continuously improving the quality assurance framework that governs pre-bill coding review, as well as building and leading the training and education infrastructure that supports coding staff, clinical documentation integrity (CDI) specialists, and auditors. The Director partners closely with HIM leadership, CDI, Compliance, Revenue Cycle, and Physician Advisors to reduce DRG mismatches, denials, and revenue leakage while maintaining strict adherence to Official Coding Guidelines, CMS regulations, and payer-specific requirements.
Utilization Management Registered Nurse Humana IncUtilization Management Registered NurseNJRemote$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.
Appeals Registered Nurse Wisconsin Physicians Service Insurance CorpAppeals Registered NurseTrenton, NJRemoteWe are open to remote work in the following approved states: Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin. The Appeals Nurse examines medical records and claims information for first-level appeal cases to determine whether services provided were medically necessary and meet Medicare coverage guidelines in accordance with Medicare regulations and policies.
Case Manager Registered Nurse - Field (Somerset County, New Jersey) - New Hire Bonus Available CVS HealthCase Manager Registered Nurse - Field (Somerset County, New Jersey) - New Hire Bonus AvailableNew 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.
Case Manager Registered Nurse - Field (Somerset County, New Jersey) CVS Health CorpCase Manager Registered Nurse - Field (Somerset County, New Jersey)Somerset County, NJRemote$66,575–$142,576 / yearWith 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.
Registered Field Nurse Homewatch CareGivers of Cape MayRegistered Field NurseAtlantic County, NJRemotePart timeWe believe exceptional care begins with caring relationships and a culture of clinical and service excellence that empowers individuals and improves the quality of life for the clients, families, and caregivers who serve alongside us. Supportive Leadership: Work alongside a Registered Nurse with more than 25 years of clinical and healthcare leadership experience who understands the value of teamwork and professional support.
NewCare Manager (RN) Centene Corporation GroupCare Manager (RN)NJRemote$56,200–$101,000 / yearPosition Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families. Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs.
Patient Education Liaison, Community - East (NJ, PA, VA, MD, NC, SC, DE) SanofiPatient Education Liaison, Community - East (NJ, PA, VA, MD, NC, SC, DE)Bridgewater, NJRemote$122,250–$176,583.33 / yearThe PEL will be building expertise for 7 brands, 5 therapeutic areas, understanding market conditions that impact the patient journey, understanding rare competitive products, engage in account strategy and planning with galaxy and constellation teams, advise the cross functional teams on the patient perspective, consider the account direction when making execution decisions, and developing skills sets that will allow them to compliantly bring patient insights back to leadership reducing the need for external insights gathering. Collaborate 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.
Patient Education Liaison, Community - East (Nj, PA, VA, MD, NC, SC, DE) SanofiPatient Education Liaison, Community - East (Nj, PA, VA, MD, NC, SC, DE)Bridgewater, NJRemote$122,250–$176,583.33 / yearThe PEL will be building expertise for 7 brands, 5 therapeutic areas, understanding market conditions that impact the patient journey, understanding rare competitive products, engage in account strategy and planning with galaxy and constellation teams, advise the cross functional teams on the patient perspective, consider the account direction when making execution decisions, and developing skills sets that will allow them to compliantly bring patient insights back to leadership reducing the need for external insights gathering. Collaborate 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.