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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 ...

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 solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choo...

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
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...

Department Name:
Quality
Work Shift:
Day
Job Category:
Risk, Quality and Safety
Estimated Pay Range:
$31.53 - $52.55 / hour, based on location, education, & experience.
In accordance with State Pay Transparency Rules.
Great careers are built at Banner. We understand that talented professionals appreciate having options. We are proud to offer our team members many career and lifestyle cho...

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 ...

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.
Position Purpose: Plans, organizes, and monitors quality related projects to deliver defined requirements ...

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 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...

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...

Job Description
Responsible for review of clinical documentation to ensure documentation in the visit note supports a skill was provided and services are medically necessary. They must be able to communicate effectively, while influencing and motivating company personnel who do not directly report to the Documentation Specialist.
Licensed Practical/Vocational Nurse, Licensed Registered Nurse, L...

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...

Position: Nurse Practitioner - Virtual
Monogram Health is looking for skilled Nurse Practitioners and Physician Assistants eager for the opportunity to make a difference in patients' lives. The Advanced Practitioner at Monogram Health is a key member of an integrated Care Team which includes a Registered Nurse and a Social Worker. The patients we serve often struggle with multiple serious di...