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Job Description:
* Responsible for the review and evaluation of clinical information and documentation.
* Reviews documentation and interprets data obtained from clinical records or systems to apply appropriate clinical criteria and policies in line with regulatory and accreditation requirements for member and/or provider issues.
* Independently coordinates the clinical resolution ...

JOB SUMMARY
The Revenue Cycle Clinician for the Appellate Solution is responsible for:
a) Recovering revenue associated with disputed/denied clinical claims or those eligible for clinical review
b) Preparing and documenting appeal based on industry accepted criteria.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
* Performs retrospective (post –d...

Job Description
JOB SUMMARY
The Revenue Cycle Clinician for the Appellate Solution is responsible for:
a) Recovering revenue associated with disputed/denied clinical claims or those eligible for clinical review
b) Preparing and documenting appeal based on industry accepted criteria.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Include the following. Others may be assigned.
* Performs retrospectiv...

We have an opportunity to join the Alliance as a Quality Improvement Nurse PQI (RN) in the QI and Population Health Department.
WHAT YOU'LL BE RESPONSIBLE FOR
Reporting to the Clinical Safety Supervisor, this position:
* Develops, manages, and measures a comprehensive healthcare strategy in alignment with Department of Health Care Services (DHCS) standards of care and in collabor...

Hi, we’re Gravie. Our mission is to improve the way people purchase and access healthcare through innovative, consumer-centric health benefit solutions that people can actually use. Our industry-changing products and services are developed and delivered by a diverse group of unique people. We encourage you to be your authentic self - we like you that way.
A Little More About The role:
The Sen...

Everlywell is a digital health company pioneering the next generation of biomarker intelligence—combining AI-powered technology with human insight to deliver personalized, actionable health answers. We transform complex biomarker data into life-changing insights—seamlessly integrating advanced diagnostics, virtual care, and patient engagement to reshape how and where health happens.
Over the p...

Overview
Elevate your career with a team that truly cares. Join a company that sees a better way for healthcare by being patient advocates, following evidenced-based clinical practices, caring for people holistically, improving continuity of care and providing nurturing surroundings that encourage and inspire.
The Quality Assurance (QA) Nurse is a Registered Nurse (RN) or Licensed Practical ...

Overview
Are you looking for a place where you can make a genuine difference in our patient’s lives?
With over 20 locations and growing, Bridge Home Health & Hospice’s culture of love for our patients and employees is the top priority. Our commitment to our Core Values allows us to be the provider and employer of choice. We embrace a diverse workforce and understand that our employees are key...

CLINICAL QUALITY NURSE SPECIALIST- WORK AT HOME- ACCREDO
Excited to grow your career?
We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position, you see is right for you, we encourage you to apply!
Our people make all the difference in our success.
Full time...

Details
* Remote - PFS Denial Nurse Auditor
* PFS Billing-Follow Up-Denials
* Full Time Status
* Day Shift
* Pay: $60,382.40 - $96,616.00 / year
Summary
* Candidates residing in the following states will be considered for remote employment: Alabama, Colorado, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Minnesota, Missouri, Mississippi, Nebr...

Overview
To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
At Bridgeport Hospital, we are committed to providing quality medical care and treatment that is...

Employment Type:
Full time
Shift:
12 Hour Day Shift
Description:
Job Title: Virtual Registered Nurse
Employment Type: Full time
Shift: Day; 7am – 7pm
This position rotates weekends and holidays.
Location: Please note that this is a Virtual RN position but the employee will physically work on-site at the central HUB located at Holy Cross Health in Silver Spring, Maryland. This is...

Overview
To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
At Bridgeport Hospital, we are committed to providing quality medical care and treatment that is...

OUR MISSION
We exist to create a more connected, compassionate, and confident experience for people with cancer and those who care for them. We make it easier to get answers, access high-quality care quickly, and feel supported throughout treatment and beyond.
Today, Thyme Care is a market-leading value-based oncology care enabler, partnering with national and regional health plans, provider...

Job Introduction
Maximus is currently hiring for Sr. Regional Nurse Managers to support the New York Independent Assessor Program (NYIA). The NYIA Program serves the State of New York by conducting UAS assessments to determine eligibility for community-based long-term services. The Sr. Regional Nurse Manager will have the opportunity to lead and support a team of Nurse Managers who are on the...

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Essential Functions: * Under general guidance form Senior Quality Practice Advisors and management, educate...

Responsibilities
* Job Responsibilities: The Nurse Practitioner (APRN) Nocturnist is to provide healthcare to patients with an emphasis on disease prevention, health promotion, health maintenance, and supportive care. The APRN works independently as well as collaboratively to diagnose, prescribe treatment, manage and evaluate patient care. The APRN functions as an educator, healthcare resou...

JOB DESCRIPTION
Job Summary
The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for overseeing delegated activities to ensure compliance with the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all other standards and requirements pertainin...

Location:
Remote - TX
Department:
Quality
Shift:
First Shift (United States of America)
Standard Weekly Hours:
40
Summary:
The Provider Performance Liaison -Clinical (PPL) will develop partnerships with providers to close identified gaps in care and achieve targeted thresholds in Provider Incentive Programs, Alternative Payment Model (APM) programs Performance Improvement Projects. The PPL ...

About RPM
Roman Pennsylvania Medical, P.C. (RPM) is a telehealth practice dedicated to providing high-quality, patient-centric care. RPM is part of the provider network affiliated with Ro, a direct-to-patient healthcare company. Providers help patients seeking care through Ro’s platform for their mental health, women’s health, men’s health, fertility, metabolic health, and skincare needs.
RPM...