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Manage CMS and State Administering Agency audits for PACE compliance.Ensure audit readiness and serve as point with audit teams.Champion compliance culture across the organization.Key Responsibilities:Monitor audit universe data and review...

Nurse Consultant I (NS) The North Carolina Department of Health and Human Services (DHHS) is one of the largest, most complex agencies in the state, and has approximately 17,000 employees. It is responsible for ensuring the health,...

The position is work from home with field visits. JOB PURPOSE: This position is responsible for conducting medical management and health education programs for customers on government health care programs. Accountabilities include...

Compliance Nurse Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. We manage services for individuals with serious mental health needs, substance use disorders,...

CenterWell Home Health is seeking a Telephonic Nurse (Care Manager) to support patients transitioning into and out of our services. You will liaise with the clinical team to facilitate follow-up and ensure appropriate post-acute care options,...

Ardent Health is seeking a Patient Safety Manager to coordinate safety initiatives across its PSO. The role requires analyzing safety events, leading just culture, and disseminating best practices throughout the organization. The manager...

Join UnitedHealthcareAt UnitedHealthcare, we are simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build...

After Hours Service Answer Line Rn The Answer Line After Hours Service provides after-hours exchange and nurse triage services for over 300 subscribing community pediatricians in the St. Louis and surrounding areas. Answer Line RNs...

Location: Orion Building - 6630 Orion Drive Fort Myers FL 33912 Department: Utilization Management - Corporate Work Type: Full Time Shift: Shift 1/7:00:00 AM to 3:30:00 PM Minimum to...

Get AI-powered advice on this job and more exclusive features. This range is provided by Medix. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more. Base pay range $37.00/hr...

Registered Nurse (RN) – Remote Care Management & Coordination Location: remote Job type: Contract Job Summary: The Registered Nurse (RN) plays a critical role in delivering remote patient support, care management, and care...

Your passion belongs at UNC Health. Join more than 56,000 teammates working together to improve the health and well-being of the communities we serve across North Carolina. Summary: The Care Manager RN plays a crucial role in...

Registered Nurse – Care Management (Remote) (Day Schedule) United States Job Title: Registered Nurse – Care Management (Day Schedule) Location: 100% Remote - United States Employment...

Opco-Skilled-Management- is seeking a Central Intake Nurse to coordinate initial and ongoing referral documentation from physicians, insurers, and providers to determine service appropriateness and facility placement. You will develop patient care...

Humana is seeking a remote Utilization Management Behavioral Health Professional 2 in Indiana. The role requires an active RN license in Indiana, an ASN (BSN preferred), and 1+ year of clinical and managed care experience. You will...

Registered Nurse Clinical Annotator Location: Remote Job Type: Full-time Experience Level: Mid-Senior Level Department: Clinical Operations Pay Rate: $37-$39/hr ...

ISYS Case Management is seeking a Telephonic Case Manager (RN, RN-BC) to operate remotely from Tampa or surrounding areas. You will provide telephonic case management for injured workers, coordinating care with providers, carriers, employers and...

Sr Utilization Management Nurse Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting...

Humana is seeking a Utilization Management Clinical Pharmacist 2 (VSP/PT) to perform medical necessity reviews and comprehensive medication reviews for prescriptions requiring pre-authorization. The role involves analyzing care plans, identifying...

Crawford & Company is seeking an experienced RN Telephonic Case Manager to work remotely providing case management services for patients and employees. You will navigate their healthcare journeys, align with URAC standards, CMSA Standards of...

Continuing Care Coordinator RN Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit...

Umpqua Health in remote Oregon seeks a Care Coordinator to manage care for Medicaid/Medicare members. You will conduct in-home assessments, develop care plans with families and providers, and coordinate services across LTSS, behavioral health, and...

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process. Part Time Southborough, MA, US Salary Range: $38.00 To $40.00...

Job Title: Clinical Quality Assurance Nurse Pay: see below Registered Nurse - $28.50/hr (Non-negotiable) LPN/LVN- $26.50/hr (non-negotiable) Regular Schedule after training: M-F 11:30am...

Workers' Compensation Telephonic Nurse Case Manager The Workers' Compensation Telephonic Nurse Case Manager is responsible for evaluating and expediting appropriate, cost-effective medical treatment of injured employees with the goal of...