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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 ...

Hims & Hers is the leading health and wellness platform, on a mission to help the world feel great through the power of better health. We are redefining healthcare by putting the customer first and delivering access to care that is affordable, accessible, and personal, from diagnosis to treatment to delivery. No two people are the same, so we provide access to personalized care designed for res...

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 people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career deve...

Overview
What you can expect!
Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!
Reporting to the Grievance & Appeals (G&A) Quality Supervisor, the G&A Quality Assurance/Continuous Improvement (QA/CI) Nurse, RN is responsible for ensuring the highest quality process...

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...

Valor Healthcare is looking for a Quality Assurance program manager to join our proposal team for a government contract to support the Global Nurse Advice Line (NAL) which is a service to Military Health System (MHS) eligible beneficiaries.
Position Summary
The Global NAL will provide access to telehealth registered nurses for triage services, self-care advice, and general health inquiries 2...

Job Description
Job Description
JOB SUMMARY:
The Senior Specialist, Quality Program Management & Performance RNensures quality monitoring audits and investigations are performed in accordance with prescribed quality standards. Informs data collection, reporting, and analysis to monitor key quality management activity and provides direction and implementation of federal/state quality management ...

Start the day excited to make a difference…end the day knowing you did. Come join our team.
Job Summary:
The Virtual Registered Nurse (VRN) is responsible for providing professional nursing care with collaboration from the bedside nurse through two-way audio/visual technology and performing assessments of vital signs and monitoring data through specialized software.
The VRN position provides p...

Chronic Care Management Nurse/RN
Reports to Chief Quality Officer
Cahaba Medical Care Foundation
Position: Chronic Care Management Nurse/RN
Supervised by: Chief Quality Officer
Chronic Care Management Nurse:
Position Overview:
The Chronic Care Management Nurse plays a pivotal role in providing personalized care for patients with chronic conditions, including but not limited...

JOB DESCRIPTION
Job Summary
Responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with NCQA, CMS and State Medicaid requirements including delegation standards and requirements contained in the delegation agreement.
KNOWLEDGE/SKILLS/ABILITIES
The Delegation Oversight Nurse is responsible for e...

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...

JOB DESCRIPTION
Job Summary
The Delegation Oversight Nurse is responsible for ensuring that Molina Healthcare's UM delegates are compliant with all applicable State, CMS, and NCQA requirements, as well as Molina Healthcare business needs. In addition, the Delegation Oversight Nurse will assist the Delegation Oversight Manager with additional duties of the team. We are looking for LVN's with a...

Assistant Nurse Manager, OR
Onsite
12p-8:30p Mon, Tue, Wed, Thu, Fri *Administrative call rotated every 8 weeks. Monday thru Friday
San Jose, CA
Manages activities of the unit(s), monitors quality, service and utilization standards. Supervises the day to day shift activities.
Essential Responsibilities:
* Manages the units day to day clinical operations including practice st...

Valor Healthcare is looking for a senior program manager to join our proposal team for a government contract to support the Global Nurse Advice Line (NAL) which is a service to Military Health System (MHS) eligible beneficiaries.
Position Summary
The Global NAL will provide access to telehealth registered nurses for triage services, self-care advice, and general health inquiries 24 hours a ...

Job Introduction
Maximus is currently seeking Quality Assurance Clinical Analysts to support the Independent Practitioner Panel (IPP) Program, which completes assessment reviews and issues practitioner orders for New Yorkers who qualify for long-term in-home care. The QA Clinical Analyst is responsible for reviewing assessments to ensure accuracy and consistency and collaborating with other pr...

Heartbeat Health is a venture-backed health tech startup revolutionizing the delivery of cardiovascular care. Our vision is a world where cardiac conditions are detected early, care coordination is friction-free, and at-risk individuals are empowered to live long, heart-healthy lives. Powered by a connected ecosystem of heart health providers, Heartbeat delivers a range of clinical services, in...

VIRTUAL INTERVIEW DAY: RNs, LVNs, & CNAs – Loan Forgiveness & Sign-on Bonus
July 5th, 2023 from 2pm to 5pm (Los Angeles)
Apply now to Register for the event.
We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer o...

VIRTUAL Hiring Event: RNs, LVNs, & CNAs – Loan Forgiveness & Sign-on Bonus
June 27th from 12pm to 2pm (Culver City)
Apply now to Register for the event.
Note: No registration required; Walk - Ins Welcome! Click on this link to join the job fair directly: CLICK HERE TO JOIN
We are hospitals and affiliated medical groups, working closely together for the benefit of ever...

What you can expect!
Find joy in serving others with IEHP! We welcome you to join us in “healing and inspiring the human spirit” and to pivot from a “job” opportunity to an authentic experience!
Reporting to the Supervisor, Grievance & Appeals, the Grievance & Appeals Nurse, RN (G&A Nurse, RN) is responsible for working directly with the IPAs, Hospitals, internal IEHP departments, a...