Director, Healthcare Services - REMOTE Molina Healthcare IncDirector, Healthcare Services - REMOTEAkron, OHRemoteRegistered Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family Therapist (LMFT), Licensed Professional Clinical Counselor (LPCC), or Licensed Master of Social Work (LMSW). At least 8 years of health care experience, and at least 5 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience.
Case Manager Registered Nurse - Remote CVS Health CorpCase Manager Registered Nurse - RemoteOHRemote$60,522–$129,615 / yearAssesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client's appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care.
NewCase Manager Registered Nurse (Remote - New York License) CVS Health CorpCase Manager Registered Nurse (Remote - New York License)OHRemote$66,575–$142,576 / yearJob Summary: The Care Manager-Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH) needs. Additionally, the Care Manager develops and implements individualized care plans, monitors member progress, advocates for necessary services, and collaborates with the interdisciplinary care team to ensure optimal health outcomes.
Licensed Psychologist- Remote BetterHelpLicensed Psychologist- RemoteCleveland, OHRemoteAlso, 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 Social Worker- Remote BetterHelpLicensed Independent Social Worker- RemoteCleveland, OHRemoteAlso, 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 Marriage and Family Therapist- Remote BetterHelpLicensed Independent Marriage and Family Therapist- RemoteCleveland, OHRemoteAlso, 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 Professional Clinical Counselor- Remote BetterHelpLicensed Professional Clinical Counselor- RemoteCleveland, OHRemoteAlso, 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 Marital and Family Therapist-Remote BetterHelpLicensed Marital and Family Therapist-RemoteCleveland, OHRemoteAlso, 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.
Utilization Management Registered Nurse Humana IncUtilization Management Registered NurseOHRemote$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.
Registered Nurse (Ohio) Tuesday HealthRegistered Nurse (Ohio)Akron, OHRemoteAs a key member of the multidisciplinary team, the RN is responsible for developing individualized care plans and leading care coordination efforts through active participation in internal and joint rounds. A dynamic and inclusive team environment where you can lean on your teammates, offer candid feedback, bring your true self to work each day, and deliver tremendous impact while having fun along the way.
NewStella Health Navigator - Registered Nurse GallagherStella Health Navigator - Registered NurseFairlawn, OhioRemoteFull timeWe simplify the healthcare journey, enhance partner solutions, and build trust-based relationships, supported by advanced analytics and integration with high-value partners. Whether you're managing claims, supporting clients, or improving processes, you’ll play a vital role in helping businesses and individuals move forward with confidence.
Denials RN Coordinator Ensemble Health PartnersDenials RN CoordinatorOHRemote$62,500–$79,800 / yearJob duties include but are not limited to: understanding insurance contract terms, reviewing claim denials and underpayments to determine if additional payment amounts can be expected, analyzing medical records and determining if a member or an Independent Review organization (IRO) appeal is necessary, understanding payer medical policy guidelines, preparing IRO appeal documentation which may include correcting and resubmitting claims, gathering additional information, reviewing medical records, acting as a liaison between healthcare providers for any additional medical documentation or clarification, and submitting provider, member and IRO/ALJ appeals in a timely manner. Extensive review of medical records for medical necessity criteria, filing written letters of appeal on denied claims, filing complaints with state Department of Insurance, acting as a liaison between healthcare providers for any additional medical documentation or clarification, and submitting appeals in a timely manner.
Area Business Manager, Hemophilia - OH SanofiArea Business Manager, Hemophilia - OHCleveland, OHRemote$125.25–$180.92 / hourUnderstand and apply knowledge of health care industry, trends, applicable laws and regulations, market conditions, and the market access environment (including but not limited to pharmacy-economics, payer/ reimbursement landscape and patient flow/influence between institutions and community practices) and analyze these factors in the development of business plans and in daily execution of sales calls within compliance guidelines. Minimum 2 years of demonstrated success in a hospital/institutional or specialty pharmaceutical sales position or 2 years clinical experience such as an Advanced Registered Nurse Practitioner, Physician Assistant, Registered Nurse, Physical Therapist and/or Social Worker combined with sales experience.