Remote RN Investigator: Medicaid Compliance & Care Quality
Staffing Solutions Organization LLC
Staffing Solutions Organization LLC (SSO) seeks a Registered Nurse Healthcare Investigator to join their Ohio-based remote team. The role focuses on investigating incidents involving Medicaid recipients and providers to protect health and welfare in Ohio. The successful candidate will work fully remote within Ohio, hold an Ohio RN license, and conduct thorough investigations, document findings, and coordinate with law enforcement, child services, and other agencies as needed, while maintaining #J-18808-Ljbffr
- ...Staffing Solutions Organization LLC is seeking a Healthcare Investigator I to conduct investigations of Medicaid-related incidents while ensuring compliance with Ohio regulations. This fully remote Ohio position requires collaboration with internal and external stakeholders...Remote work
- ..., a subsidiary of Peraton, is seeking a Medicaid Fraud Auditor to join the SGS team. The... ...focuses on researching laws, conducting compliance audits across Medicaid cases, and identifying... ...in team settings to ensure timely, high-quality work. The position requires 2 years with...Remote workQuality
$53k - $55k
...Nurse Healthcare Investigator - State of Ohio Work Location: Remote - Must be a licensed RN in the State of... ...incidents involving Medicaid recipients and/... ..., and ensures compliance with Ohio... ...health and welfare Quality assurance or clinical... ...Assessment, Care Coordination, Utilization...Remote workQualityWork at officeFlexible hours- Vaya Health is seeking a Personal Care Services Assessor Registered Nurse to perform needs-based assessments for Medicaid beneficiaries in home or community settings. The role... ...PCS eligibility determinations and high-quality care coordination. #J-18808-Ljbffr Vaya HealthRemote jobQuality
- ...Services in Phoenix, AZ is seeking an LPN to join the Quality Management Unit to conduct quality-of-care investigations in alignment with contractual obligations. The... ...training, with subsequent onboarding conducted remotely. You will investigate member-centric and...Remote workQuality
$71.1k - $97.8k
...Become a part of our caring community. Great nursing... ...members setting. Work remotely from your home and travel... ...are leading to a better quality of life for people with Medicare and Medicaid, families, individuals,... ...affirmative action, in compliance with Section 503 of the...Remote workQualityFull timeContract workTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to FridayWeekend work- ...seeking an HSS Clinical Coordinator RN to conduct clinical reviews and evaluations related to Medicaid appeals, ensuring compliance and accuracy in assessments. This remote role is ideal for experienced RNs seeking meaningful patient-care impact. You will review...Remote workFull time
- ...Integrity Systems is seeking a Medicaid Medical Review RN (Medical Reviewer III) for a remote role, based from Grove City, OH... ...reviews of medical records for fraud investigations and applies Medicare/Medicaid... ...+ years in Medicaid or managed care, plus ICD-10-CM/CPT coding...Remote work
$29 - $52 per hour
...Integrity Clinical Compliance AuditorOptum... ...between care providers and payers... ...risk management, quality and revenue... ...and confidential investigations in order to document... ...position is Remote in... ...experienceNurse licensure (RN or LPN) with a... ...terminologyFamiliarity with Medicaid program and/or...Remote workQualityHourly payMinimum wageFull timeContract workWork experience placementLive inLocal areaMonday to FridayShift work$75k - $90k
...RN Health Care Facility Surveyor - New Mexico (#... ...an opening with a Quality Improvement Consulting... ...position is 100% remote with up to 75%... ..., complaint investigation, and revisits) for... ...surveys to assess compliance with requirements... ...surveys of Medicare-Medicaid certified health...Remote workQualityFull timeWork at officeImmediate startMonday to FridayFlexible hours$62.7k
...departments in the areas of compliance, process improvement,... ...to the potential of quality medical care and service to... ...credentialing, member complaint investigations, Medical Director... ...~ Current state RN or LPN license or... ...management experience ~ Medicaid/Medicare experience...Remote workQualityFor contractorsWork at officeLocal area$145k - $175k
...of All-Inclusive Care for the Elderly (PACE... ..., visit Location Remote (with ability to... ...The Habitat Health Compliance Manager has... ...s for Centers for Medicaid & Medicare Services... ...teams, submission quality assurance, and corrective... ...Registered Nurse (RN) License....Remote workQualityContract workTemporary workLocal areaFlexible hours- **\"Hybrid (Remote / Regional Travel) – Based... ...About Activate Care: At Activate Care... ...to training and quality improvement. Responsibilities... ...Maintain strict compliance with HIPAA,... ...Current, active RN license (or other... ...in an FQHC, Medicaid, or rural healthcare...Remote workQualityLocal areaVisa sponsorshipWork visa
$45 per hour
...Nurse Coordinator (RN or LVN) needed... ...a temp 6+ month, remote contract opportunity... ...with Yoh’s managed care health plan client... ...to support quality, cost-effective healthcare... ...while maintaining compliance with regulatory... ...with CMS, Medicare, Medicaid, and commercial...Remote workQualityContract workTemporary workMonday to FridayWeekend work- ...Reunion Plaza Senior Care and Rehabilitation Center in Texarkana, TX seeks an RN MDS Coordinator to lead Medicaid/Medicare reimbursement efforts,... ...Plans, and ensure regulatory compliance. You will support the care team and drive high-quality resident outcomes in a patient...Quality
$71.1k - $97.8k
Become a part of our caring community The... ...Registered Nurse (RN) license in your state... ...in a fully remote, metrics-focused role... ...Plan or Medicare / Medicaid Experience Call... ...leading to a better quality of life for people... ...action, in compliance with Section 503 of...Remote workQualityBi-weekly payFull timeTemporary workApprenticeshipWork at officeHome office$71.1k - $97.8k
...Become a part of our caring community Great... ...life, too! As an RN Care Manager, you... ...members setting. Work remotely from your home and... ...to a better quality of life for people... ...with Medicare and Medicaid, families, individuals... ...action, in compliance with Section 503 of...Remote workQualityContract workTemporary workApprenticeshipWork at officeWork from homeHome officeMonday to FridayWeekend work$50k - $70k
...commercial clients in compliance and program... ...solutions, audit, investigation, and medical review... ...offers an exceptional quality of life and... ...complex Medicare and Medicaid investigations and... ...Accredited Health Care Fraud Investigator... ...screening checks. ~ For remote work, required to...Remote workQualityFull timeContract workTemporary workFor contractorsLocal areaFlexible hours$25k
...Become a part of our caring community The... ...with Medicare and Medicaid members within a 3... ...Responsibilities The RN Field Care Manager... ...; and ensure compliance with state Medicaid... ...: While this is a remote position, occasional... ...leading to a better quality of life for people...Remote workQualityFull timeTemporary workApprenticeshipWork at officeHome officeMonday to Friday$45 per hour
...experienced Registered Nurse (RN) to serve as a contracted... ...living and memory care communities. The role focuses... ...clinical oversight, regulatory compliance, staff education, and quality improvement to ensure... ...site community visits and remote work, compensation at $45...Remote workQualityHourly payPart time$78k - $85k
Overview Medicaid Medical Review RN (Medical Reviewer III) - REMOTE The Medicaid Medical Review RN (Medical... ...the course of fraud investigations or other program... ...meets or exceeds the quality assurance goal of 98%... ...Medicaid agency or Managed Care Organization focused in...Remote workQualityFor contractorsH1bH2bWork at officeLocal areaHome office- ...a Registered Nurse to perform needs-based PCS assessments for Medicaid beneficiaries in home or community settings. The role involves... ...to determine eligibility, educate beneficiaries, and maintain high standards of privacy and quality in assessments. #J-18808-LjbffrRemote workQuality
- ...accuracy, support facility payments, and promote quality patient care. Must travel daily within Massachusetts and maintain HIPAA compliance. The role emphasizes collaboration with... ...clinical expertise to optimize outcomes. Remote work may occur based on business needs. #J-...Remote workQuality
- ...seeking a Case Manager Nurse for a remote position. Candidate must... ...California and have a valid California RN license with 3+ years of RN... ...case management, develop care plans, and coordinate care with... .../external resources to ensure quality care and adherence to...Remote workQuality
- ...Health is seeking an experienced RN Utilisation Management Nurse... ...– Joint Procedures) to work remotely in a full-time role. You will... ...to ensure appropriate care decisions and collaborate with... ...-driven team that emphasizes quality, compliance, and patient-focused outcomes...Remote workQualityFull timeFlexible hoursWeekday work
- ...render coverage decisions. Collaboration with providers supports care pathways and program integration. The role emphasizes quality, HIPAA compliance, and effective communication in a full-time, remote setup requiring residency in Colorado; strong computer skills are...Remote workQualityFull time
- ...staffing agency is seeking an RN Case Manager to supervise LPNs and ensure compliance with Medicare guidelines. This fully remote position requires at least... ...maintaining clinical quality standards and providing coordinated... ...will have Chronic Care Management experience. Join...Remote workQuality
$75k - $90k
...healthcare staffing agency is seeking a RN Health Care Facility Surveyor to work remotely with up to 75% travel. The role involves... ...surveys of health care facilities, ensuring compliance with federal regulations, and evaluating quality of care. Required qualifications include...Remote workQuality$50k
...Emergency Department RN Manager We are seeking a dedicated... ...the delivery of high-quality patient care while fostering a collaborative... ...department activities - Ensure compliance with healthcare regulations,... ...Georgia DPH Designated Remote Stroke Treatment Center Expanded...Remote workQualityTemporary work$65k - $75k
...bringing exceptional care to patients living with... ...based approach focused on quality care management and... ...colleagues who work remotely or at our corporate offices... ...Center for Medicare/Medicaid Services (CMS)... ...Office of Federal Contract Compliance Programs (OFCCP) website...Remote workQualityFull timeContract workTemporary workFor contractorsFor subcontractorWork at officeLocal areaHome officeMonday to ThursdayFlexible hoursWeekend workAfternoon shift
Do you want to receive more vacancies?
Subscribe and receive similar vacancies to Remote RN Investigator: Medicaid Compliance & Care Quality. Be the first to apply!



