Sign up to access all features of our service.
  • Job search
  • Favorites
  • Create a CV
    New
  • Salaries
  • Subscriptions

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

Vacancy posted 3 days ago
Similar jobs that could be interesting for youBased on the RN Clinical Claims Reviewer & Quality Advocate in Montpelier, VT vacancy
  • $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... 
    Quality
    Claims
    Full time
    For contractors
    Work experience placement
    Local area
    Remote work
    Monday to Friday
    Shift work

    Palmetto GBA

    Montpelier, VT
    3 days ago
  •  ...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... 
    Quality
    Claims
    Full time
    For contractors
    Work experience placement
    Local area
    Remote work
    Monday to Friday
    Shift work

    Palmetto GBA

    Montpelier, VT
    2 days ago
  • $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... 
    Quality
    Claims
    Temporary work
    Work at office
    Local area

    Central Vermont Home Health & Hospice

    Berlin, VT
    3 days ago
  • $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... 
    Quality
    Claims
    Hourly pay
    Full time
    Local area
    Remote work
    Work from home
    Flexible hours

    CVS Health

    Montpelier, VT
    5 days ago
  • $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... 
    Quality
    Hourly pay
    Full time
    Work experience placement
    Work at office
    Local area
    Remote work
    Home office
    Flexible hours
    Shift work

    CVS Health

    Montpelier, VT
    3 days ago
  • $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... 
    Quality
    Claims
    Hourly pay
    Full time
    Temporary work
    Work at office
    Local area
    Remote work
    Work from home
    Monday to Friday

    CVS Health

    Montpelier, VT
    5 days ago
  •  ...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... 
    Quality
    Claims
    Ongoing contract
    Contract work

    EPITEC

    Berlin, VT
    2 days ago
  • $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... 
    Quality
    Claims
    Full time
    Contract work
    Temporary work
    Apprenticeship
    Work at office
    Remote work
    Work from home
    Home office

    Humana

    Montpelier, VT
    4 days ago
  •  ...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... 
    Quality
    Claims
    Flexible hours

    J T Becker & Co Inc

    Montpelier, VT
    21 days ago
  • $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... 
    Quality
    Claims
    Local area
    Night shift

    Hannaford Supermarkets

    Montpelier, VT
    15 hours ago
  • $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... 
    Quality
    Claims
    Hourly pay
    Full time
    Local area

    CVS Health

    Montpelier, VT
    3 days ago
  •  ...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... 
    Quality
    Claims
    Remote work

    Stratford Davis LLC

    Montpelier, VT
    2 days ago
  •  ...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... 
    Quality
    Claims

    Priority Dispatch

    Waterbury, VT
    19 hours ago
  •  ...-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.... 
    Quality
    Claims
    Hourly pay
    Temporary work
    Work experience placement
    Work at office
    Shift work

    National Life Insurance Company Limited

    Montpelier, VT
    1 day ago
  • $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... 
    Quality
    Claims
    Full time
    Local area
    Remote work
    Flexible hours

    Sedgwick

    Montpelier, VT
    3 days ago
  • $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... 
    Quality
    Claims
    Full time
    Temporary work
    Apprenticeship
    Work at office
    Remote work
    Work from home
    Home office

    Humana

    Montpelier, VT
    3 days ago
  • $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... 
    Quality
    Claims
    For contractors
    Apprenticeship
    Local area
    Immediate start
    Night shift

    LEWIS

    Montpelier, VT
    15 hours ago
  • $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... 
    Quality
    Claims
    Hourly pay
    Full time
    Work at office
    Remote work
    Flexible hours

    Intermountain Healthcare

    Montpelier, VT
    5 days ago
  •  ...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... 
    Quality
    Weekly pay
    Full time
    Shift work

    TravelNurseSource

    Berlin, VT
    5 days ago
  • $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... 
    Quality
    Claims
    Temporary work
    Internship
    Local area
    Remote work
    Flexible hours

    IMA Financial Group

    Montpelier, VT
    1 day ago
  • $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... 
    Quality
    Full time
    Contract work
    Immediate start
    Shift work
    Day shift

    TravelNurseSource

    Berlin, VT
    1 day ago
  • $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... 
    Quality
    Full time
    Contract work
    Immediate start
    Shift work
    Day shift

    Advantis Medical Staffing

    Berlin, VT
    1 day ago
  •  ...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

    UVM Health

    Montpelier, VT
    2 days ago
  • $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,... 
    Quality
    Claims
    Full time
    Contract work
    Work at office
    Local area
    Flexible hours

    Sedgwick

    Montpelier, VT
    5 hours ago
  • $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;... 
    Quality
    Claims
    Hourly pay
    H1b
    Remote work
    Work from home
    Flexible hours

    CSAA Insurance Group, a AAA Insurer

    Montpelier, VT
    4 days ago
  •  ...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-Ljbffr
    Quality
    Claims

    Priority Dispatch

    Waterbury, VT
    18 hours ago
  •  ...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... 
    Quality
    Night shift

    State of Vermont

    Montpelier, VT
    4 days ago
  •  ...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... 
    Quality
    Full time
    Part time
    Flexible hours

    Centerforlivinghc

    Montpelier, VT
    3 days ago
  • $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... 
    Quality
    Daily paid
    Full time
    Contract work
    Shift work

    TravelNurseSource

    Berlin, VT
    1 day ago
  • $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... 
    Quality
    Claims
    Full time
    Contract work
    Temporary work
    Apprenticeship
    Work at office
    Remote work
    Work from home
    Home office

    Humana

    Montpelier, VT
    4 days ago

Do you want to receive more vacancies?

Subscribe and receive similar vacancies to RN Clinical Claims Reviewer & Quality Advocate. Be the first to apply!