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Overview 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.

Resp & Qualifications PURPOSE: The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding adverse and adverse coverage decisions. The...

CVS Health Aetna Case Manager RN At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health...

Job Description: Sharecare is the leading digital health company that helps people – no matter where they are in their health journey – unify and manage all their health in one place. Our comprehensive and data-driven...

Clinical Documentation Improvement (CDI) Specialist Registered Nurse (RN) When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives. This position is remote. Candidates must be local...

Description 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...

Job Summary The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies...

Job Summary The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies...

Registered Nurse: Review and Evaluation Are you a registered nurse ready to take your career in an exciting new directionone where your expertise truly makes a difference? Join Pennsylvania's premier Quality Improvement Organization and...

Job Summary The RN Clinical Appeals Nurse provides support for internal appeals clinical processes - ensuring that appeals requests are reevaluated in alignment with applicable federal and state regulatory requirements, Molina policies...

Care Manager Rn Job Responsibilities: The care manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person centric care management program to a diverse health plan population with a variety of health and...

A healthcare organization in Manchester, NH, seeks a Nursing professional to provide centralized medication access support. Responsibilities include reviewing medication requests, communicating with patients, and adhering to clinical guidelines.

A leading healthcare organization in California is seeking a Registered Nurse, Out-Patient Case Manager. This role involves coordinating care for patients with chronic diseases and leading a team of case managers. Candidates should have a valid RN...

Job Description: Responsible for specialty care management for assigned clinics/geographical areas and other appropriate referrals within the Intermountain system. Assess, plan, educate, and advocate for patients' health...

Bickford of Worthington - Join our DYNAMIC team at Bickford Senior Living as a Wellness Nurse! The Wellness Nurse supports resident care within the branch, ensuring that Resident's daily medications needs are met in a compassionate...

The RN Case Manager is responsible for coordinating continuum of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical regime. Minimum...

ORGANIZATION INFORMATION: Established in 1984, Equitas Health is a regional not-for-profit community-based healthcare system and federally qualified community health center look-alike. Its expanded mission has made it one of...

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their...

Hospice Clinical Liaison Connect care. Guide families. Make every day count. We are seeking an experienced and compassionate Hospice Clinical Liaison to join our team. In this role, you will ensure that intake and referral...

City/State Suffolk, VA Work Shift First (Days) Overview: Sentara Homecare and Hospice Services Newport News is seeking to hire a qualified individual to join our team as a Quality Assurance Coordinator Registered Nurse. Position Status: Full Time,...

Healthcare Consulting Manager Accenture is a global leader in professional services, helping organizations worldwide transform their operations, enhance their growth, and deliver sustainable outcomes across industries. With a...

Nurse Case Manager The nurse case manager works within the context of a primary care medical home, from a team approach, and in continuous partnership with families and physicians to promote timely access to needed care, comprehension and...

A healthcare services provider is seeking an RN Care Manager to improve patient outcomes in kidney care. This hybrid-remote role involves creating personalized care plans, conducting assessments, and maintaining relationships with patients and...

TPAPT is seeking dedicated and knowledgeable Nursing School Admissions Coaches to help aspiring nursing students navigate the admissions process for competitive nursing programs. You will work one-on-one with students to provide...

Explore Opportunities With Agency Name As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each...