Remote Nurse Leader: Clinical Review & Healthcare Integrity
Centene Corporation
- Remote job
Centene Corporation is hiring a Manager of Clinical Review for a remote leadership role in healthcare integrity. You will lead clinical investigators, oversee complex FWA cases, and collaborate with providers across markets to ensure proper utilization of services. The role requires a strong clinical background with coding, nursing experience, and team management skills. Pay range and remote options are provided; 100% remote across multiple markets. #J-18808-Ljbffr Centene Corporation
$69.3k - $78k
A healthcare payment integrity company is seeking a Medical Review Nurse II - Clinical Validation to perform medical claims audits for Government and Commercial Payers. The... ...auditing claims and documenting findings, all in a remote work environment. This role offers a...Remote job$69.3k - $78k
Overview Medical Review Nurse II - Clinical Validation At Performant, we’re focused on... ...are the premier independent healthcare payment integrity company in the US and a leader across several markets, including... ...Payers. You will work remotely in a fast paced and dynamic environment...Remote workFor contractorsWork at officeWork from homeHome officeShift work- ...Solutions is seeking a Payment Integrity Nurse I to perform post-service claims reviews, ensuring accurate... ...within a flexible remote model across certain western... ...position emphasizes clinical judgment, coding knowledge... ...and improve healthcare outcomes. #J-18808-Ljbffr...Remote jobFlexible hours
- ...Solutions is seeking an Utilization Management Nurse to perform medical necessity and benefit reviews remotely. The role requires current LPN licensure and expertise... ...The successful candidate will collaborate with healthcare partners, triage cases, and prepare...Remote work
- Commence is seeking a Medical Review Manager to lead the Program Integrity medical reviews nationwide. You will supervise a clinical review team of RNs, LPNs, coders and support... ...and a master’s or bachelor’s in nursing. This fully remote/office role collaborates with CMS...Remote workWork at office
- ...Providing support for inpatient and outpatient clinical claim review activities, the full-time Remote Registered Nurse Clinical Reviewer will verify coded diagnoses,... ...guidelines while assessing medical records for clinical integrity. Key responsibilities Reviews inpatient and...Remote workFull time
- ...and experienced Registered Nurse - Integrated Care Manager (ICM) for a temporary... ...to conduct face-to-face clinical assessments with members... ...coordination, or utilization/care review Experience conducting... ...that are available as remote work, Sentara Health employs...Remote workTemporary workShift work
$44.42 - $65.7 per hour
...Job Description: The Nurse Clinical Leader provides leadership and clinical... ...employee performance reviews. The Nurse Clinical Leader... ...and patient experience. Integrates legal and ethical standards... ...Support (BLS) certification for Healthcare Providers. Bachelor’s degree...Hourly payShift work$290k - $320k
...Infectious Disease outpatient healthcare center and wellness... ...On-Site Position Only (No remote work options)Job Type: Full... ...Healthcare Center Wellness Clinic is in need of a Family Practice... ..., care coordinators, and nursing staff for urgent care.Review consultant reports,...Remote workFull timeRelocation packageShift workWeekend workAfternoon shift$35 - $37 per hour
...Lead RN Reviewer Cohere's Service Operations... ...ensuring that our healthcare partners are... ...and report to the Clinical Supervisor of Service... ...supervision over the nursing staff. This... ...style suited for a remote, fast-paced environment... ...our Payment Integrity Suite, anchored by...Remote workHourly payFlexible hours$78k - $119k
...completeness of outpatient clinical documentation.... ...documentation integrity team, this... ...providers, coders, and healthcare professionals to ensure... ...clinical chart reviews to ensure documentation... ...as a Registered Nurse (adult-geriatric... ...~ Fully remote with the ability to...Remote workMinimum wageFull timeWork at office- ...IHCS provides an Integrated Delivery System in... ...the trusted market leader in Home Health, Durable... ...Management Nurse, you will ensure that... .... By continuously reviewing and auditing... ...unnecessarily extensive home healthcare. Concurrent review of patient’s clinical information for...Full timeTemporary work
$152k - $242k
...Assistant Vice President, Global Healthcare Product Leader serves as the senior... ...split between a CNA office and remote work from home. While... ...underwriting guidance, or governance review.Leads product assessments... ...by sound judgment, integrity, accountability, collaboration...Remote workFull timeWork experience placementWork at officeWork from home$285.7k
...working world.The opportunityThe Global Integrated Planning Leader is responsible for designing,... ...sessions, planning workshops, and strategy reviews globally.Act as a senior advisor on ambitious... ...certification beneficial.Location: Remote, with flexibility across global time...Remote workSummer holidayLocal areaFlexible hours$27.02 - $48.55 per hour
...million members as a clinical professional on our Medical... ...position is fully remote/work from home; applicants... ...management/review experience are helpful... ...guidelines Works with healthcare providers to approve medical... ...Accredited School of Nursing or Bachelor’s degree...Remote workHourly payFull timePart timeWork at officeWork from homeMonday to FridayFlexible hours- ...doing business with integrity and making a... ...holidays, and hybrid or remote work options for... ...company conducting clinical investigations to... ...any direct reports).Review monitoring visit... ...in life sciences, nursing, pharmacy or a related... ...within science, healthcare or quality....Remote workH1bLocal area
- ...is looking for an Integrative Oncology Physician... ...inaugural physician leader for Integrative... ...opportunity to provide clinical leadership within... ...counselors, nurses, and caregivers are... ...ranked a national healthcare leader in safety,... ...Safety & Education: Review patient use of herbs...Full timeTraineeshipRelocation packageFlexible hours
- ...Clinical Medical Review NurseAmpcus Inc. is a certified global provider of a... ....Qualifications:Registered Nurse (RN) – active state or compact... ...experience plus 2 years of healthcare data analysis.Proficiency... ...and a collaborative mindset.Remote work environment with minimal...Remote work
$44 per hour
...Clinical Review Nurse - Prior Authorization Various, NV Clinical Review Nurse - Prior Authorization... ...NV All On-site Location: Fully Remote – Prefer Candidates reside in NV, but... ...guidelines and criteria Works with healthcare providers and authorization team to...Remote workPermanent employmentContract workLive inShift work- ...Position Title : Clinical Review Nurse - Concurrent Review Work Location : Remote (Compact Nursing License Required, Central Time Zone) Assignment Duration : 12... ...management policies and guidelines * Works with healthcare providers to approve medical determinations or provide...Remote workShift workWeekend work
$45 per hour
...CVP is seeking a PRN Registered Nurse Clinical Documentation Integrity Specialist to provide back up coverage... ...inpatient and outpatient services Review health records concurrently to... ...as appropriate Collaborate with healthcare providers through written, verbal,...Contract workReliefMonday to Friday$27.02 - $48.55 per hour
...About This Role The Clinical Review Nurse performs concurrent reviews to determine members' overall... ...: $27.02 - $48.55 per hour Location: Remote, NY Schedule: Full-time, Monday-Friday... ...management systems. Collaborate with healthcare providers to approve medical determinations...Remote workHourly payFull timeMonday to FridayFlexible hours- ...CLINICAL REVIEW NURSE - REMOTE ARC Group has multiple positions open for Clinical Review Nurses!... ...This may involve discussion with CMS leaders and leaders in the provider community... ...needs and goals and serving both with integrity and a shared desire to succeed....Remote workPermanent employmentWork at officeLocal area
- UW Medicine is seeking a Revenue Integrity Manager to lead the RI Analyst team and ensure... ...systems expertise and collaboration with clinical leadership to resolve issues affecting charge... .... Ideal candidates have 6-8 years in healthcare finance/revenue integrity, strong...Remote job
- ...currently recruiting CDI Nursing Advisor at the Lt. Col... ...services Review health records concurrently... ...coding accuracy using clinical knowledge and critical... ...appropriate Collaborate with healthcare providers through... ...Documentation Integrity Specialists (ACDIS)...Monday to FridayShift work
- ...seeking a Medical Revenue Manager to oversee charge capture and revenue integrity functions within a remote setting. The role requires at least 5 years of experience in related fields, such as healthcare compliance and charge integrity. The successful candidate will...Remote job
- Avalon Healthcare Solutions seeks a Client Integration Lead to guide clients through Lab Benefit Management implementations. You’ll act as the primary liaison from kickoff through go-live, coordinating with internal teams to translate requirements into actionable delivery...Remote job
- A healthcare solutions company is seeking a Senior Tech Lead in Atlanta, GA, to serve as the technical authority for all Workday integrations. The role requires in-depth expertise in Workday integrations, API engineering, and strong leadership skills to mentor other engineers...Remote job
$84 per hour
...Role Overview Lead clinical documentation integrity programs and evaluate AI-generated... ...revenue capture. In this remote, hourly role you will... ...generation AI systems for healthcare documentation. Key Responsibilities... ...and retrospective review workflows. Evaluate AI-...Remote workHourly pay$34 - $40 per hour
...Job Title: Clinical Review Nurse (Remote) Position Summary: We are seeking a detail-oriented and clinically... ...clinical documentation, assessing healthcare services, and ensuring compliance with... ...About Actalent Actalent is a global leader in engineering and sciences services...Remote workContract workTemporary work
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