RN Clinical Claims Reviewer & Quality Advocate
CVS Health
CVS Health Corporation is seeking a licensed Registered Nurse to interpret clinical documentation, apply decision-making for post-service claims, and coordinate resolutions with clinical support. The role emphasizes adherence to state and organizational policies, training teammates, and identifying trends for quality assurance. Upholding regulatory compliance and delivering reliable customer service, this full-time position offers a comprehensive benefits package as part of CVS Health's #J-18808-Ljbffr
$53.46k
...appeal or retrospective review requests including pre-... .... Provides thorough clinical review or benefit analysis... ...to identify quality of care issues To Qualify... ...An active, unrestricted RN license from the United... ...skills Knowledge of claims systems Presentation...QualityClaimsFull timeFor contractorsWork experience placementLocal areaRemote workMonday to FridayShift work- ...customers. Provides thorough clinical review or benefit analysis to determine... ...information to identify quality of care issues Associate Degree... ...An active, unrestricted RN license from the United States... .../regulations Knowledge of claims systems 401(k) retirement savings...QualityClaimsFull timeFor contractorsWork experience placementLocal areaRemote workMonday to FridayShift work
$72k - $94k
...0 Annually Join Our Team: Clinical Quality Lead About Us: Central Vermont... ...team, you'll: Review and verify patient charts, OASIS... ...lead to survey deficiencies, claim denials, or negative patient... ...current license to practice as an RN, PT, or OT in the State of...QualityClaimsTemporary workWork at officeLocal area$54.1k - $155.54k
...prioritize safety and quality in everything we do. Join... ...criteria and clinical guidelines, standardized... ...focus to benefit overall claim management. Using a... ...Perform medical necessity reviews. Required Qualifications... ...hospital setting. ~ The AHH RN Case manager position...QualityClaimsHourly payFull timeLocal areaRemote workWork from homeFlexible hours$17 - $34.15 per hour
...purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger -... ...Company Oak Street Health Title Contact Center Service Advocate I Location Remote Role Description The CC (Contact...QualityHourly payFull timeWork experience placementWork at officeLocal areaRemote workHome officeFlexible hoursShift work$54.1k - $142.58k
...and prioritize safety and quality in everything we do. Join... ...any state with a compact RN license can apply. This... ...integration. Through the use of clinical tools and information/data review, conducts an evaluation of... .... Reviews prior claims to address potential impact...QualityClaimsHourly payFull timeTemporary workWork at officeLocal areaRemote workWork from homeMonday to Friday- ...coordinate preadmission/admission reviews, prior approvals and referral... ...NCQA (National Committee for Quality Assurance), and URAC (... ...authorizations to ensure appropriate claims processing, and maintaining... ..., MHS, AS400) for review by clinical reviewers. Identify and...QualityClaimsOngoing contractContract work
$138.9k - $191k
...and abuse laws, including the Anti-kickback statute and False Claims Act; Drafting contract provisions to address regulatory concerns... ...Demonstrated knowledge of risk adjustment and the Stars quality program Experience in managed care and value-based contracting...QualityClaimsFull timeContract workTemporary workApprenticeshipWork at officeRemote workWork from homeHome office- ...services. We investigate all types of insurance claims including workers' compensation,... ...expenses for our clients and delivering high-quality results. We are seeking a detail-... ...upon the case manager's instructions Review all case materials prior to conducting investigative...QualityClaimsFlexible hours
$19.8 - $27 per hour
...dispensed. Prepare and complete manual insurance claim forms if needed. Maintain organized... ...report and reports from Control D. Review and understand ACIS reports. Assist in third... ...fairness, dignity and respect. Maintain the quality of department's appearance and...QualityClaimsLocal areaNight shift$17 - $28.46 per hour
...ourselves accountable and prioritize safety and quality in everything we do. Join us and be part... ...community at a time. Position Summary Review, research, and enter grievance and appeal... ...grievancesProvider grievancesProvider/claim appeals (post-service). Review incoming...QualityClaimsHourly payFull timeLocal area- ...celebrated for our drive, supportive atmosphere, and dedication to quality. Honored twice by Entrepreneur Magazine for our outstanding... ...directly aligned with the results you generate. If you are eager to claim ownership of your professional path, unlock uncapped earning...QualityClaimsRemote work
- ...licensed pharmacist to implement Kinney standards and ensure top-quality care. You will dispense prescriptions, counsel patients, and... ...guarantee accuracy. The role includes managing third-party claims, inventory control, and coordination with Kinney Warehouse and...QualityClaims
- ...-Force, Service, policy administration, claims, or customer operations. Experience shaping... ...appropriate, to improve the efficiency, quality, and impact of their work. Stay... ...working. Exercise sound judgment by reviewing and validating AI-generated content....QualityClaimsHourly payTemporary workWork experience placementWork at officeShift work
$70k - $90k
...resolution. ESSENTIAL RESPONSIBLITIES MAY INCLUDE Reviews/acts on reports/forms; responds to... ...as assigned, Supports the organization's quality program(s). QUALIFICATIONS Education &... ...handling litigation including 5 years of claims management experience or equivalent combination...QualityClaimsFull timeLocal areaRemote workFlexible hours$126.3k - $173.7k
...through EHR platforms. This role owns the Claims Status and Happy Together with Health... ...integration Knowledge of provider workflows and clinical operations Experience presenting to... .... These efforts are leading to a better quality of life for people with Medicare and...QualityClaimsFull timeTemporary workApprenticeshipWork at officeRemote workWork from homeHome office$30 per hour
...including training, onboarding, coaching, discipline, and ensure high-quality and efficient job performance.Plan and assign tasks based on... ..., and completed work.Investigate incident reports and damage claims as assigned.Monitor and control crew costs through efficient...QualityClaimsFor contractorsApprenticeshipLocal areaImmediate startNight shift$27.07 - $41.23 per hour
...related experience in medical claims and follow-up Preferred... ...While HiredScore assists in reviewing applications, all final decisions... ...system of 34 hospitals, 400+ clinics, a medical group of more than... ...as a leader in clinical quality improvement and efficient healthcare...QualityClaimsHourly payFull timeWork at officeRemote workFlexible hours- ...Registered Nurse (RN) | Oncology Location: Berlin, VT Agency: Titan Medical... ...healthcare organizations that rely on us for quality candidates. Founded by experienced... ...to traditional hospitals, specialty care clinics and other centers of care. 30758177EXPPLAT...QualityWeekly payFull timeShift work
$65k - $70k
...financial analytics, reporting, and modeling. This role performs claims projections, benchmarking, renewal analysis, and other... ...analytical capabilities Strong attention to detail and commitment to quality assurance Focus on operational excellence and accuracy Coaching...QualityClaimsTemporary workInternshipLocal areaRemote workFlexible hours$2,296 per week
...Registered Nurse (RN) | Oncology Location: Berlin, VT Agency: Advantis Medical Staffing Pay: $2,296 per week Shift... ...Oncology travel nurse, you will provide compassionate and high-quality care to patients ensuring their well-being and recovery. Job...QualityFull timeContract workImmediate startShift workDay shift$2,296 per week
...Registered Nurse (RN) | Oncology Location: Berlin, VT Agency: Advantis Medical Staffing Pay: $2,296 per week Shift... ...Oncology travel nurse, you will provide compassionate and high-quality care to patients ensuring their well-being and recovery. Job...QualityFull timeContract workImmediate startShift workDay shift- ...in Berlin, VT. The role focuses on delivering high-quality patient care in a fast-paced dermatology clinic, coordinating with physicians and staff to support seamless... ...visits. The ideal candidate has active Vermont RN licensure, BLS (preferred), and about one year of...Quality
$50k - $55k
...Workplaces in Financial Services & Insurance Claims Representative, Auto | Property Damage... ...assigned. Supports the organization's quality program(s). Travels as required. QUALIFICATIONS... ...policies and endorsements Ability to review and assess Property Damage estimates,...QualityClaimsFull timeContract workWork at officeLocal areaFlexible hours$160.16k - $177.95k
...core systems of record (policy, billing, claims), the enterprise data platform, and downstream... ...data governance, lineage, metadata, quality, privacy, and security requirements in partnership... ...Leadership Lead the Architecture Review process for data and AI initiatives;...QualityClaimsHourly payH1bRemote workWork from homeFlexible hours- ...Standard of Practice, dispense prescriptions, counsel patients, and supervise staff to deliver high-quality service. Responsibilities include QA processes, managing third-party claims, inventory control, regulatory compliance, and coordinating with auditors. #J-18808-LjbffrQualityClaims
- ...experienced Psychiatric Registered Nurse II for night shift. You will be a full member of a multidisciplinary team, delivering high-quality psychiatric nursing care to vulnerable patients. We offer a strong benefits package including tuition reimbursement, a defined...QualityNight shift
- ...Registered Nurse (RN) About The Center for Living & Rehabilitation The Center for Living & Rehabilitation is committed to revolutionizing... ...commitment to delivering exceptional patient outcomes and high-quality care Participate in ongoing education and professional...QualityFull timePart timeFlexible hours
$2,726 per week
...Registered Nurse (RN) | Oncology Location: Berlin, VT Agency: Coast Medical Service Pay: $2,726 per week Shift Information... ...in 1979, we are guided by our commitment to providing quality service to make it easier for healthcare providers to focus on patients...QualityDaily paidFull timeContract workShift work$86.3k - $118.7k
...and/or significant experience in pharmacy claims operations, including risk identification... ..., development of recommendations, and review of audit outputs and corrective actions.... ...of everything we do. The result is high-quality healthcare that is accessible, comprehensive...QualityClaimsFull timeContract workTemporary workApprenticeshipWork at officeRemote workWork from homeHome office
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