Case Manager, Registered Nurse - Fully Remote CVS Health CorpCase Manager, Registered Nurse - Fully RemoteMDRemote$54,095–$155,538 / yearBenefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
Licensed Clinical Social Worker - Remote BetterHelpLicensed Clinical Social Worker - RemoteWashington, DCRemote$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 Mental Health Therapist - Remote BetterHelpLicensed Mental Health Therapist - RemoteSilver Spring, 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 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.
Mental Health Therapist - Remote BetterHelpMental Health Therapist - RemoteBaltimore, MDRemoteAlso, 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 Marriage and Family Therapist - Remote BetterHelpLicensed Marriage and Family Therapist - RemoteBaltimore, 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 Psychologist - Remote BetterHelpLicensed Psychologist - 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).Experience counseling adults, couples, and/or teens.. Private practice with no doors and no overhead..Licensed Clinical Marriage and Family Therapist - Remote BetterHelpLicensed Clinical Marriage and Family Therapist - RemoteBaltimore, 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 Certified Social Worker - Remote BetterHelpLicensed Certified Social Worker - RemoteBaltimore, MDRemoteAlso, 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 Clinical Professional Counselor - Remote BetterHelpLicensed Clinical Professional Counselor - RemoteBaltimore, 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 Professional Counselor - Remote BetterHelpLicensed Professional Counselor - 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.Care Manager - RN (Remote) Blue Cross and Blue Shield AssociationCare Manager - RN (Remote)Baltimore, MDRemote$72,216–$143,429 / 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. Federal Disclosure Physical Demand 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.Utilization Management Nurse Consultant - Fully Remote CVS Health CorpUtilization Management Nurse Consultant - Fully RemoteDCRemote$26.01–$74.78 / hourBenefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.Care Manager (Remote) Blue Cross and Blue Shield AssociationCare Manager (Remote)Baltimore, MDRemote$72,216–$143,429 / yearThe Care Manager partners closely with members and the interdisciplinary care team to develop and implement person-centered plans of care that promote a positive member experience, improved health outcomes, and cost-effective service delivery. 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.Clinical Navigator (Remote) Blue Cross and Blue Shield AssociationClinical Navigator (Remote)Baltimore, MDRemote$72,360–$143,715 / yearPURPOSE: The Post- Acute Care Clinical Navigator (RN) manages the timely and smooth transition from inpatient care to home or other levels of care utilizing experience and skills in both care management and utilization management including proficiency in established MCG guidelines to determine medical necessity, appropriate level of care, and case management to engage members/enrollees, their families and other support systems in discharge planning. The role will function as a liaison telephonically (occasional weekend work may be required) with the hospital care team including case managers, social workers and discharge planners to ensure CareFirst members/enrollees receive the appropriate level of care and partner to address any potential barriers to discharge.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.Utilization Management Registered Nurse Humana IncUtilization Management Registered NurseMDRemote$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.Medical Review Manager - Federal Health (CMS) DOMA TechnologiesMedical Review Manager - Federal Health (CMS)DCRemoteThis individual owns the quality assurance process for all medical record reviews, manages inter-reviewer reliability to ensure consistent and defensible clinical decisions across the review team, and serves as the primary point of contact with CMS on medical review operations. Maintain current working knowledge of Medicare coverage rules, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), Medicare payment policy, and applicable CMS program integrity guidance.Field Registered Nurse (RN) Wellness Health ServicesField Registered Nurse (RN)Washington, DCRemoteIn this dynamic role, you will provide high-quality, compassionate care while working closely with a dedicated team of healthcare professionals. Our commitment to quality care and patient satisfaction has earned us a loyal clientele and a supportive work environment where employees thrive and grow.Health Care | Life Sciences, Senior Associate - Registered Nurse / Certified Coder Ankura Consulting GroupHealth Care | Life Sciences, Senior Associate - Registered Nurse / Certified CoderWashington DC, District of ColumbiaRemoteOur clients include academic medical centers, health systems, physician practice groups, post- and sub-acute providers, health plans, pharmacies, and pharmacy benefit management companies, as well as pharmaceutical and medical device manufacturers. Our practitioners provide expert witness testimony on commercial disputes involving payers and providers, as well as in matters involving False Claims Act, Anti-kickback, Stark, and FDA disputes and investigations.Clinical Documentation Specialist RN Johns Hopkins Medical Management CorporationClinical Documentation Specialist RNBaltimore, MarylandRemoteOverview: Johns Hopkins Intrastaff is the internal staffing agency for the Johns Hopkins Health System and partner hospitals, providing temporary support to a variety of the Johns Hopkins locations. Operating at competent level with, but not limited to: Microsoft Office Suite, web-browsers,email, electronic health records, online collaboration software, virtual meeting applications.Program Integrity Clinical Specialist (RN or PA Req'd) TriWest Healthcare AllianceProgram Integrity Clinical Specialist (RN or PA Req'd)Baltimore, MDRemoteFull timeTechnical Skills: Knowledge of TRICARE policies and procedures, knowledge of Case Management, Utilization Management, and Quality Management practices and principles, and knowledge of Managed Care concepts, alternative care treatments, and community resources. • Research and investigate medical issues as they relate to potential fraud and abuse cases, to include perform anti-fraud and abuse pre-payment reviews or post-payment reviews.Director, Medical Document Optimization TriWest Healthcare AllianceDirector, Medical Document OptimizationBaltimore, MDRemoteFull timeLeadership: Ability to set strategic direction and translate organizational goals into operational plans; successfully leads and develops staff across varying styles and levels; provides clear expectations, effective coaching, and timely feedback; leads through a subordinate manager and drives accountability at all levels of the department. Problem Solving / Analysis: Ability to solve complex operational and systems-related problems through systematic analysis of data, workflows, and processes; exercises sound judgment in ambiguous or high-stakes situations; identifies root causes and implements durable solutions with a realistic understanding of organizational constraints.Utilization Management Nurse Specialist Lumen Solutions Group, Inc.Utilization Management Nurse SpecialistBaltimore, MDRemoteWe are seeking an experienced Utilization Management Nurse Specialist to support care management and utilization review activities for Medicare, Medicaid, and other government healthcare programs. This role requires an independent, detail-oriented nursing professional who can effectively collaborate with interdisciplinary teams while ensuring appropriate utilization of healthcare services and adherence to clinical and regulatory requirements.Utilization Review Nurse - Managed Care Johns Hopkins HospitalUtilization Review Nurse - Managed CareHanover, MDRemoteAs a Utilization Review Registered Nurse for Johns Hopkins Health Plans, you have the opportunity to use your clinical, managed care, utilization review, and verbal/written communication skills to make a difference in our members' lives. Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States.Primary Care Advanced Practice Provider (NP OR PA) Devoted Health ServicesPrimary Care Advanced Practice Provider (NP OR PA)WashingtonRemoteThat’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.Clinical Documentation Specialist II Johns Hopkins HospitalClinical Documentation Specialist IIBaltimore, MDRemoteRHIT.RHIA: Requires successful completion of the academic requirements for the Registered Health Information Technician (RHIT) certification or Registered Health Information Administrator (RHIA) certification accredited by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) and be a Certified Coding Specialist (CCS). We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.Clinical Quality Reviewer TriWest Healthcare AllianceClinical Quality ReviewerBaltimore, MDRemoteFull timeo Bachelor's in Nursing or Certified Professional in Healthcare Quality (CPHQ) o 1 or more years team lead or supervisory experience o 1 year experience in Quality Management o 1 year experience with data analysis and reporting o Experience with InterQual or similar criteria sets o General knowledge of Medicare, Veterans Administration, or other government health care programs. Technical Skills: General knowledge of Medicare, Veterans Administration, or other government health care programs; knowledge in the application of clinical criteria: InterQual, Milliman, PAS-LOS, ICD-9-CM, DSM, CPT-4, and HCPCs; Proficient with Microsoft Word and Excel.NewClinical Quality Performance Specialist Senior AmeriHealth CaritasClinical Quality Performance Specialist SeniorWashington, DCRemote$92,200–$125,600 / yearManages activities related to plan accreditation, preventive health improvement, business analysis, and clinical and service quality improvement, including state withholds, Healthcare Effectiveness Data and Information Set (HEDIS), and Consumer Assessment of Healthcare Providers and Systems (CAHPS). The Senior Clinical Quality Performance Specialist is responsible for overseeing, designing, and implementing quality initiatives, identifying root causes, establishing and executing work plans to implement effective interventions.Pediatric Clinical Nursing Faculty Covista IncPediatric Clinical Nursing FacultyBaltimore, MDRemoteFrom individual professor support and student-led study groups to diverse clinical and career networking opportunities, the institution"s community shares a common goal: to give each other the care we need to succeed and make a difference by transforming healthcare. With 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.Clinical Quality Study Analyst TriWest Healthcare AllianceClinical Quality Study AnalystBaltimore, MDRemoteFull timeTechnical Skills: General knowledge of Medicare, Veteran's Administration, TRICARE, or other government health care programs; knowledge in the application of clinical criteria; proficient with Microsoft Word, Excel, and PowerPoint. Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.Urgent Care Nurse Practitioner Included Health IncUrgent Care Nurse PractitionerMDRemoteIn this role, you'll deliver virtual comprehensive care to patients of all ages across a wide range of conditions, while working closely with our provider and support teams. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care.Clinical Quality Review Team Lead TriWest Healthcare AllianceClinical Quality Review Team LeadBaltimore, MDRemoteFull timeThe team lead supports clinical and non-clinical staff supporting CQM programs by providing training and onboarding of new staff; determining work assignments; performing audits for clinical records and/or work accuracy; and ensuring effective, consistent and accurate workflow. Technical Skills: Comprehensive knowledge of research methodology; proficient applying appropriate data analysis processes; knowledge of managed care principles and methods; knowledge in the application of clinical criteria; proficient with Microsoft Word, Excel, and PowerPoint.Clinical Education Training Specialist TriWest Healthcare AllianceClinical Education Training SpecialistBaltimore, MDRemoteFull timeAssist with training department-specific needs, such as, maintaining required training documentation, maintaining both clinical and non-clinical training and orientation curriculum, participating in clinical operations leadership meetings, process improvement meetings, and other duties as appropriate and requested. In addition, this position requires designing, developing and presenting synchronous training courses relating to clinical and operational topics, and includes content, visual aides, exercises for the student and examinations.Clinical Learning Educator 2, Hybrid BETH & BOCA, Clinical Learning, FT, 08A-4:30P Baptist Health South Florida IncClinical Learning Educator 2, Hybrid BETH & BOCA, Clinical Learning, FT, 08A-4:30PBethesda, MDRemote$87,755.20–$116,714.42 / yearThe Clinical Learning Educator II utilizes skilled communication and true collaboration to partner with clinical leadership across Baptist Health to establish and sustain a cohesive network aimed at assessing individual entity and system needs, developing, planning, coordinating, implementing, and facilitating educational programs or initiatives, and evaluating the outcomes and implications. Baptist Health is the region''s largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties.Mental Health Clinical Nursing Instructor (PT) Covista IncMental Health Clinical Nursing Instructor (PT)Arlington, VARemoteWith 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. We are presently accepting applications to meet potential future need in the following areas of specialization: Mental Health Psych Nursing: Students will be demonstrating nursing skills and procedures in an inpatient healthcare center.Maternal Child Clinical Nursing Instructor (PT) Covista IncMaternal Child Clinical Nursing Instructor (PT)Arlington, VARemoteOur College of Nursing offers a Bachelor of Science in Nursing (BSN) degree program at 23 locations and online post-licensure degree programs and certificates including RN to BSN, RN to MSN, a Master of Science in Nursing (MSN) with six Specialty Tracks, and a Doctor of Nursing Practice (DNP). Chamberlain Visiting Professor Position - Online: In support of the pay transparency laws enacted across the country, the expected compensation rate for this position is between $715/Earned Credit Hour to $1,950/Earned Credit Hour, depending on the candidate's education and experience.Licensed Clinical Marriage and Family Therapist BetterHelpLicensed Clinical Marriage and Family TherapistMarylandRemoteAlso, 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 Clinical Professional Counselor BetterHelpLicensed Clinical Professional CounselorMarylandRemoteAlso, 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 Clinical Social Worker BetterHelpLicensed Clinical Social WorkerMarylandRemoteAlso, 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 Certified Social Worker BetterHelpLicensed Certified Social WorkerMarylandRemoteAlso, 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.Load moreResume ResourcesFree Resume TemplatesFree Resume Builder
Licensed Clinical Marriage and Family Therapist - Remote BetterHelpLicensed Clinical Marriage and Family Therapist - RemoteBaltimore, 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 Certified Social Worker - Remote BetterHelpLicensed Certified Social Worker - RemoteBaltimore, MDRemoteAlso, 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 Clinical Professional Counselor - Remote BetterHelpLicensed Clinical Professional Counselor - RemoteBaltimore, 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 Professional Counselor - Remote BetterHelpLicensed Professional Counselor - 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.
Care Manager - RN (Remote) Blue Cross and Blue Shield AssociationCare Manager - RN (Remote)Baltimore, MDRemote$72,216–$143,429 / 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. Federal Disclosure Physical Demand 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.
Utilization Management Nurse Consultant - Fully Remote CVS Health CorpUtilization Management Nurse Consultant - Fully RemoteDCRemote$26.01–$74.78 / hourBenefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access and many other benefits depending on eligibility. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.
Care Manager (Remote) Blue Cross and Blue Shield AssociationCare Manager (Remote)Baltimore, MDRemote$72,216–$143,429 / yearThe Care Manager partners closely with members and the interdisciplinary care team to develop and implement person-centered plans of care that promote a positive member experience, improved health outcomes, and cost-effective service delivery. 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.
Clinical Navigator (Remote) Blue Cross and Blue Shield AssociationClinical Navigator (Remote)Baltimore, MDRemote$72,360–$143,715 / yearPURPOSE: The Post- Acute Care Clinical Navigator (RN) manages the timely and smooth transition from inpatient care to home or other levels of care utilizing experience and skills in both care management and utilization management including proficiency in established MCG guidelines to determine medical necessity, appropriate level of care, and case management to engage members/enrollees, their families and other support systems in discharge planning. The role will function as a liaison telephonically (occasional weekend work may be required) with the hospital care team including case managers, social workers and discharge planners to ensure CareFirst members/enrollees receive the appropriate level of care and partner to address any potential barriers to discharge.
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.
Utilization Management Registered Nurse Humana IncUtilization Management Registered NurseMDRemote$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.
Medical Review Manager - Federal Health (CMS) DOMA TechnologiesMedical Review Manager - Federal Health (CMS)DCRemoteThis individual owns the quality assurance process for all medical record reviews, manages inter-reviewer reliability to ensure consistent and defensible clinical decisions across the review team, and serves as the primary point of contact with CMS on medical review operations. Maintain current working knowledge of Medicare coverage rules, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), Medicare payment policy, and applicable CMS program integrity guidance.
Field Registered Nurse (RN) Wellness Health ServicesField Registered Nurse (RN)Washington, DCRemoteIn this dynamic role, you will provide high-quality, compassionate care while working closely with a dedicated team of healthcare professionals. Our commitment to quality care and patient satisfaction has earned us a loyal clientele and a supportive work environment where employees thrive and grow.
Health Care | Life Sciences, Senior Associate - Registered Nurse / Certified Coder Ankura Consulting GroupHealth Care | Life Sciences, Senior Associate - Registered Nurse / Certified CoderWashington DC, District of ColumbiaRemoteOur clients include academic medical centers, health systems, physician practice groups, post- and sub-acute providers, health plans, pharmacies, and pharmacy benefit management companies, as well as pharmaceutical and medical device manufacturers. Our practitioners provide expert witness testimony on commercial disputes involving payers and providers, as well as in matters involving False Claims Act, Anti-kickback, Stark, and FDA disputes and investigations.
Clinical Documentation Specialist RN Johns Hopkins Medical Management CorporationClinical Documentation Specialist RNBaltimore, MarylandRemoteOverview: Johns Hopkins Intrastaff is the internal staffing agency for the Johns Hopkins Health System and partner hospitals, providing temporary support to a variety of the Johns Hopkins locations. Operating at competent level with, but not limited to: Microsoft Office Suite, web-browsers,email, electronic health records, online collaboration software, virtual meeting applications.
Program Integrity Clinical Specialist (RN or PA Req'd) TriWest Healthcare AllianceProgram Integrity Clinical Specialist (RN or PA Req'd)Baltimore, MDRemoteFull timeTechnical Skills: Knowledge of TRICARE policies and procedures, knowledge of Case Management, Utilization Management, and Quality Management practices and principles, and knowledge of Managed Care concepts, alternative care treatments, and community resources. • Research and investigate medical issues as they relate to potential fraud and abuse cases, to include perform anti-fraud and abuse pre-payment reviews or post-payment reviews.
Director, Medical Document Optimization TriWest Healthcare AllianceDirector, Medical Document OptimizationBaltimore, MDRemoteFull timeLeadership: Ability to set strategic direction and translate organizational goals into operational plans; successfully leads and develops staff across varying styles and levels; provides clear expectations, effective coaching, and timely feedback; leads through a subordinate manager and drives accountability at all levels of the department. Problem Solving / Analysis: Ability to solve complex operational and systems-related problems through systematic analysis of data, workflows, and processes; exercises sound judgment in ambiguous or high-stakes situations; identifies root causes and implements durable solutions with a realistic understanding of organizational constraints.
Utilization Management Nurse Specialist Lumen Solutions Group, Inc.Utilization Management Nurse SpecialistBaltimore, MDRemoteWe are seeking an experienced Utilization Management Nurse Specialist to support care management and utilization review activities for Medicare, Medicaid, and other government healthcare programs. This role requires an independent, detail-oriented nursing professional who can effectively collaborate with interdisciplinary teams while ensuring appropriate utilization of healthcare services and adherence to clinical and regulatory requirements.
Utilization Review Nurse - Managed Care Johns Hopkins HospitalUtilization Review Nurse - Managed CareHanover, MDRemoteAs a Utilization Review Registered Nurse for Johns Hopkins Health Plans, you have the opportunity to use your clinical, managed care, utilization review, and verbal/written communication skills to make a difference in our members' lives. Johns Hopkins Health Plans (JHHP) is the managed care and health services business of Johns Hopkins Medicine, one of the premier health delivery, academic, and research institutions in the United States.
Primary Care Advanced Practice Provider (NP OR PA) Devoted Health ServicesPrimary Care Advanced Practice Provider (NP OR PA)WashingtonRemoteThat’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. The actual base salary offered will depend on a variety of factors, including the qualifications of the individual applicant for the position, years of relevant experience, specific and unique skills, level of education attained, certifications or other professional licenses held, and the location in which the applicant lives and/or from which they will be performing the job.
Clinical Documentation Specialist II Johns Hopkins HospitalClinical Documentation Specialist IIBaltimore, MDRemoteRHIT.RHIA: Requires successful completion of the academic requirements for the Registered Health Information Technician (RHIT) certification or Registered Health Information Administrator (RHIA) certification accredited by the Commission on Accreditation for Health Informatics and Information Management Education (CAHIIM) and be a Certified Coding Specialist (CCS). We are committed to creating a welcoming and inclusive environment, where we embrace and celebrate our differences, where all employees feel valued, contribute to our mission of serving the community, and engage in equitable healthcare delivery and workforce practices.
Clinical Quality Reviewer TriWest Healthcare AllianceClinical Quality ReviewerBaltimore, MDRemoteFull timeo Bachelor's in Nursing or Certified Professional in Healthcare Quality (CPHQ) o 1 or more years team lead or supervisory experience o 1 year experience in Quality Management o 1 year experience with data analysis and reporting o Experience with InterQual or similar criteria sets o General knowledge of Medicare, Veterans Administration, or other government health care programs. Technical Skills: General knowledge of Medicare, Veterans Administration, or other government health care programs; knowledge in the application of clinical criteria: InterQual, Milliman, PAS-LOS, ICD-9-CM, DSM, CPT-4, and HCPCs; Proficient with Microsoft Word and Excel.
NewClinical Quality Performance Specialist Senior AmeriHealth CaritasClinical Quality Performance Specialist SeniorWashington, DCRemote$92,200–$125,600 / yearManages activities related to plan accreditation, preventive health improvement, business analysis, and clinical and service quality improvement, including state withholds, Healthcare Effectiveness Data and Information Set (HEDIS), and Consumer Assessment of Healthcare Providers and Systems (CAHPS). The Senior Clinical Quality Performance Specialist is responsible for overseeing, designing, and implementing quality initiatives, identifying root causes, establishing and executing work plans to implement effective interventions.
Pediatric Clinical Nursing Faculty Covista IncPediatric Clinical Nursing FacultyBaltimore, MDRemoteFrom individual professor support and student-led study groups to diverse clinical and career networking opportunities, the institution"s community shares a common goal: to give each other the care we need to succeed and make a difference by transforming healthcare. With 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.
Clinical Quality Study Analyst TriWest Healthcare AllianceClinical Quality Study AnalystBaltimore, MDRemoteFull timeTechnical Skills: General knowledge of Medicare, Veteran's Administration, TRICARE, or other government health care programs; knowledge in the application of clinical criteria; proficient with Microsoft Word, Excel, and PowerPoint. Independent Thinking / Self-Initiative: Critical thinkers with ability to focus on things which matter most to achieving outcomes; commitment to task to produce outcomes without direction and to find necessary resources.
Urgent Care Nurse Practitioner Included Health IncUrgent Care Nurse PractitionerMDRemoteIn this role, you'll deliver virtual comprehensive care to patients of all ages across a wide range of conditions, while working closely with our provider and support teams. We offer our members care guidance, advocacy, and access to personalized virtual and in-person care for everyday and urgent care, primary care, behavioral health, and specialty care.
Clinical Quality Review Team Lead TriWest Healthcare AllianceClinical Quality Review Team LeadBaltimore, MDRemoteFull timeThe team lead supports clinical and non-clinical staff supporting CQM programs by providing training and onboarding of new staff; determining work assignments; performing audits for clinical records and/or work accuracy; and ensuring effective, consistent and accurate workflow. Technical Skills: Comprehensive knowledge of research methodology; proficient applying appropriate data analysis processes; knowledge of managed care principles and methods; knowledge in the application of clinical criteria; proficient with Microsoft Word, Excel, and PowerPoint.
Clinical Education Training Specialist TriWest Healthcare AllianceClinical Education Training SpecialistBaltimore, MDRemoteFull timeAssist with training department-specific needs, such as, maintaining required training documentation, maintaining both clinical and non-clinical training and orientation curriculum, participating in clinical operations leadership meetings, process improvement meetings, and other duties as appropriate and requested. In addition, this position requires designing, developing and presenting synchronous training courses relating to clinical and operational topics, and includes content, visual aides, exercises for the student and examinations.
Clinical Learning Educator 2, Hybrid BETH & BOCA, Clinical Learning, FT, 08A-4:30P Baptist Health South Florida IncClinical Learning Educator 2, Hybrid BETH & BOCA, Clinical Learning, FT, 08A-4:30PBethesda, MDRemote$87,755.20–$116,714.42 / yearThe Clinical Learning Educator II utilizes skilled communication and true collaboration to partner with clinical leadership across Baptist Health to establish and sustain a cohesive network aimed at assessing individual entity and system needs, developing, planning, coordinating, implementing, and facilitating educational programs or initiatives, and evaluating the outcomes and implications. Baptist Health is the region''s largest not-for-profit healthcare organization, with 12 hospitals, over 29,000 employees, 4,500 physicians and 200 outpatient centers, urgent care facilities and physician practices across Miami-Dade, Monroe, Broward and Palm Beach counties.
Mental Health Clinical Nursing Instructor (PT) Covista IncMental Health Clinical Nursing Instructor (PT)Arlington, VARemoteWith 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. We are presently accepting applications to meet potential future need in the following areas of specialization: Mental Health Psych Nursing: Students will be demonstrating nursing skills and procedures in an inpatient healthcare center.
Maternal Child Clinical Nursing Instructor (PT) Covista IncMaternal Child Clinical Nursing Instructor (PT)Arlington, VARemoteOur College of Nursing offers a Bachelor of Science in Nursing (BSN) degree program at 23 locations and online post-licensure degree programs and certificates including RN to BSN, RN to MSN, a Master of Science in Nursing (MSN) with six Specialty Tracks, and a Doctor of Nursing Practice (DNP). Chamberlain Visiting Professor Position - Online: In support of the pay transparency laws enacted across the country, the expected compensation rate for this position is between $715/Earned Credit Hour to $1,950/Earned Credit Hour, depending on the candidate's education and experience.
Licensed Clinical Marriage and Family Therapist BetterHelpLicensed Clinical Marriage and Family TherapistMarylandRemoteAlso, 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 Clinical Professional Counselor BetterHelpLicensed Clinical Professional CounselorMarylandRemoteAlso, 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 Clinical Social Worker BetterHelpLicensed Clinical Social WorkerMarylandRemoteAlso, 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 Certified Social Worker BetterHelpLicensed Certified Social WorkerMarylandRemoteAlso, 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.