Case Manager Registered Nurse - Field (Middlesex County, New Jersey) CVS HealthCase Manager Registered Nurse - Field (Middlesex County, New Jersey)Middletown, New 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.
Clinical Validation Audit (CVA) Trainer ExlService Holdings IncClinical Validation Audit (CVA) TrainerNYRemote$85,000–$110,000 / yearThis role partners closely with Clinical Auditors, Quality Analysts, and Subject Matter Experts to ensure training content reflects current coding guidelines, clinical validation requirements, and audit expectations. The CVA Trainer plays a critical role in improving audit consistency, accuracy, and completeness by translating audit outcomes into effective learning experiences.
RN Health Care Facility Surveyor Greenlife Healthcare StaffingRN Health Care Facility SurveyorAvenel, NJRemote$75,000–$90,000 / yearThe Surveyor will serve as a team member or team leader on various types of surveys (i.e. re-certification, comparative, complaint investigation, and revisits) for long-term care and non-long-term care surveys, which can include; ambulatory surgical centers (ASC), Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID), end-stage renal disease (ESRD), Psychiatric Residential Treatment Facility (PRTF), hospital, critical access hospital, and hospice facilities. Impact Recruiting Solutions is currently seeking a RN Health Care Facility Surveyor to fill an opening with a Quality Improvement Consulting Company and will work in a technically exciting environment supporting internal and external customers nationwide.
Clinical Clearance Specialist RN Charlie Health IncClinical Clearance Specialist RNNYRemote$48–$52 / hourThis RN serves as the dedicated clinical reviewer for escalated admissions cases involving eating disorder (ED) and substance use disorder (SUD) presentations - cases that require nursing-level clinical expertise beyond the independent decision-making scope of the CAT team, but that do not require physician review. You will own the clearance review queue, interpret labs, vitals, and EKGs, issue timely admission determinations, and serve as the primary clinical bridge between the admissions team and medical leadership.
Complex Oncology Nurse Navigator (11:30AM - 8:00PM EST) Thyme Care IncComplex Oncology Nurse Navigator (11:30AM - 8:00PM EST)NYRemoteToday, Thyme Care is a market-leading value-based oncology care enabler, partnering with national and regional health plans, providers, and employers to deliver better outcomes and lower costs for thousands of people across the country. In it, you will conduct clinical assessments, monitor for changes in health, coordinate care, including transitions, and educate members and caregivers about their diagnosis and treatment over the phone to support our higher-acuity members as they move through the oncology care continuum.
Oncology Transitions of Care Nurse (11:30AM - 8:00PM EST) Thyme Care IncOncology Transitions of Care Nurse (11:30AM - 8:00PM EST)NYRemoteToday, Thyme Care is a market-leading value-based oncology care enabler, partnering with national and regional health plans, providers, and employers to deliver better outcomes and lower costs for thousands of people across the country. In it, you will conduct clinical assessments, monitor for changes in health, coordinate care, including transitions, and educate members and caregivers about their diagnosis and treatment over the phone to support our members as they move through the oncology care continuum.
Clinical Clearance Specialist (RN) Charlie HealthClinical Clearance Specialist (RN)New York, NYRemote$48–$52 / hourThis RN serves as the dedicated clinical reviewer for escalated admissions cases involving eating disorder (ED) and substance use disorder (SUD) presentations — cases that require nursing-level clinical expertise beyond the independent decision-making scope of the CAT team, but that do not require physician review. You will own the clearance review queue, interpret labs, vitals, and EKGs, issue timely admission determinations, and serve as the primary clinical bridge between the admissions team and medical leadership.
Psychiatric Nurse Practitioner (Full-Time W2) ReKlame HealthPsychiatric Nurse Practitioner (Full-Time W2)New York, New YorkRemoteWe are a clinician-led, tech-enabled provider group that exists to provide culturally competent behavioral health care addiction care, medication management, crisis intervention, and care coordination for people working towards taking back control of their lives, while expanding access to care. Psychiatric Evaluations and Medication Management : Deliver compassionate and high-quality psychiatric care, addiction care, and medication management through a convenient telehealth platform, ensuring members receive accessible and effective care.
NewSenior Manager, Clinical Product Quality - Medical Device/Complaint Handling & Cardiovascular RN Edwards Lifesciences CorpSenior Manager, Clinical Product Quality - Medical Device/Complaint Handling & Cardiovascular RNNew Jersey, NJRemote$145,000–$205,000 / yearAs a Senior Manager, Clinical Product Quality, you will be a member of Complaint Handling and Post Market Surveillance/Risk Management team to provide clinical guidance/clinical expert knowledge to Quality, Engineering and other cross functional teams to understand the nature of complaints and possible health risks. How you will make an impact: Provides medical/clinical guidance to complaint investigators and engineers related to event interpretation, event investigation, proper coding, required regulatory reporting (Medical Device Reports, Medical Device Vigilance, etc.), and complaint closure.
Quality Analyst - Clinical Validation Audit ExlService Holdings IncQuality Analyst - Clinical Validation AuditNYRemote$85,000–$100,000 / yearResponsible for reviewing the accuracy and consistency of clinical DRG auditing auditors to ensure audits are appropriately marked for findings and no findings. For positions based in higher-cost zones (e.g., California, New York, New Jersey), actual compensation may exceed the posted range; your recruiter will share specifics during the process.
Senior Manager, Patient Access Advocate, West Revolution Medicines IncSenior Manager, Patient Access Advocate, WestNYRemote$187,200–$208,000 / yearBy acting as a single point of contact, the RNCM will proactively manage and work individual patient cases to ensure access and financial barriers are compliantly overcome -including benefit verifications, Prior Authorization (PA) delays, denials, appeals hurdles, specialty pharmacy (SP) and non-commercial pharmacy routing issues, affordability barriers, complex Center for Medicare and Medicaid cases (CMS), community resources and more. RNCMs will work directly with patients, healthcare providers, insurers, field reimbursement team, and other key stakeholders to help patients understand their coverage, access the company's patient support programs, and connect with external resources that help overcome access barriers.
Senior Manager, Patient Access Advocate, East Revolution Medicines IncSenior Manager, Patient Access Advocate, EastNYRemote$187,200–$208,000 / yearBy acting as a single point of contact, the RNCM will proactively manage and work individual patient cases to ensure access and financial barriers are compliantly overcome -including benefit verifications, Prior Authorization (PA) delays, denials, appeals hurdles, specialty pharmacy (SP) and non-commercial pharmacy routing issues, affordability barriers, complex Center for Medicare and Medicaid cases (CMS), community resources and more. RNCMs will work directly with patients, healthcare providers, insurers, field reimbursement team, and other key stakeholders to help patients understand their coverage, access the company's patient support programs, and connect with external resources that help overcome access barriers.
Clinical Specialist, Pain Interventions - Long Island, NY Medtronic PlcClinical Specialist, Pain Interventions - Long Island, NYLong Island, NYRemoteThe following benefits and additional compensation are available to those regular employees who work 20+ hours per week: Health, Dental and vision insurance, Health Savings Account, Healthcare Flexible Spending Account, Life insurance, Long-term disability leave, Dependent daycare spending account, Tuition assistance/reimbursement, and Simple Steps (global well-being program). If you are applying to perform work for Medtronic, Inc. ("Medtronic") in any position which will involve performing at least two (2) hours of work on average each week within the unincorporated areas of Los Angeles County, you can find here a list of all material job duties of the specific job position which Medtronic reasonably believes that criminal history may have a direct, adverse and negative relationship potentially resulting in the withdrawal of a conditional offer of employment.
Clinical Specialist, Pain Interventions - Long Island, NY MedtronicClinical Specialist, Pain Interventions - Long Island, NYLong Island, New YorkRemoteThe following benefits and additional compensation are available to those regular employees who work 20+ hours per week: Health, Dental and vision insurance, Health Savings Account, Healthcare Flexible Spending Account, Life insurance, Long-term disability leave, Dependent daycare spending account, Tuition assistance/reimbursement, and Simple Steps (global well-being program). If you are applying to perform work for Medtronic, Inc. (“Medtronic”) in any position which will involve performing at least two (2) hours of work on average each week within the unincorporated areas of Los Angeles County, you can find here a list of all material job duties of the specific job position which Medtronic reasonably believes that criminal history may have a direct, adverse and negative relationship potentially resulting in the withdrawal of a conditional offer of employment.
Physician Bilingual - Virtual Urgent Care Oscar Health IncPhysician Bilingual - Virtual Urgent CareNYRemote$227,226–$298,233 / yearParticipate in collaborative care model with various care team members including but not limited to registered nurses, medical assistants, PCPs, behavioral health clinicians, and clinical supervisor where applicable. Compact license from IMLCC or eligible for a compact license (hold a full, unrestricted medical license in a state that is a member of the Compact).
Bilingual Spanish - BH Counselor - Evernorth - Remote NY State CignaBilingual Spanish - BH Counselor - Evernorth - Remote NY StateNew York, NYRemote$67,100–$111,800 / yearThese states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
RCM Specialist - Healthcare Revenue Cycle ATI Physical Therapy IncRCM Specialist - Healthcare Revenue CycleNYRemote$22.40–$26.98 / hourThe RCM Specialist will need understanding of all revenue cycle processes but will be assigned to one of the following focused areas: Financial Clearance, Central Business Office, Commercial/Gov't/SP AR Follow-up, or WC/API AR Follow-up. Performs timely reviews of patient accounts, vendor work products, and remittances for denials to determine root cause of issue and appropriateness of actions taken, and assists in corrective action plan development.
Clinical Review & Correspondence RN Cohere Health Technologies LLCClinical Review & Correspondence RNNYRemote$31–$35 / hourBy unifying pre-service authorization data with post-service claims validation, we're creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately. Opportunity Overview: The Clinical Review & Correspondence RN plays a critical role in supporting utilization management operations by conducting medical necessity reviews, preparing clear and compliant clinical determinations, and ensuring accurate member and provider communications.
(RN) Registered Nurse Coding Auditor - HCS-D, COS-C - Full Time Northwell Health Inc(RN) Registered Nurse Coding Auditor - HCS-D, COS-C - Full TimeGarden City, NYRemoteWhen determining a team members base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity). Validates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record.
(RN) Registered Nurse Coding Auditor - HCS-D, COS-C Northwell Health Inc(RN) Registered Nurse Coding Auditor - HCS-D, COS-CGarden City, NYRemoteWhen determining a team members base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity). Validates Acute Inpatient coded charts to ensure the diagnostic information leading to the assignment can be substantiated by the documentation in the Medical Record.