Opportunity Overview: The Clinical Review & Correspondence RN plays a critical role in supporting utilization management operations by conducting medical necessity reviews, preparing clear and compliant clinical determinations, and ensuring accurate member and provider communications. In collaboration
Awarded a Healthiest Employer, Blue Cross Blue Shield of Arizona aims to fulfill its mission to inspire health and make it easy. AZ Blue offers a variety of health insurance products and services to meet the
Hello, we’re Belong. We partner with regional payers to deliver Medicare Advantage and Special Needs Plan products. With a dual focus on data-driven, proactive clinical intervention and unwaveringly empathetic patient experience, Belong has completely reimagined health
Department: 10172 Advocate Aurora Health Corporate - WI Transitional Care Status: Part time Benefits Eligible: Yes Hours Per Week: 20 Schedule Details/Additional Information: Fully Remote at home position. High speed Internet is required. Weekend only position
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Job Description A bit about this role: The Post-Acute UM Supervisor will oversee utilization management activities across post-acute settings (SNF, ARU, LTACH), including audits, quality reviews, and clinical oversight. This role will partner with medical leadership to implement
The Clover Care Services organization delivers proactive support and care to our members through our clinical Clover Home Care teams, and quality improvement services to our aligned providers through our practice engagement team. Clover has built
Site: Wentworth-Douglass Hospital Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research,
Our team members are at the heart of everything we do. At Cencora, we are united in our responsibility to create healthier futures, and every person here is essential to us being able to deliver on
This position offers the flexibility of being fully remote, but the selected candidate must be currently residing within the United States. Imagine how your ideas and expertise can change a patient’s life. Our Quality teams help
Job Summary: The Care Manager collaborates with members of an inter-disciplinary care team (ICT), providers, community and faith-based organizations to improve quality and meet the needs of the individual, natural supports and the population with culturally
Job Description: PG County Cityblock’s Transition of Care (TOC) program helps members safely navigate their post-discharge journey from acute care and hospital settings back into the community. The TOC Registered Nurse Care Manager (RNCM) coordinates with hospital
Job Description: Cityblock’s Transition of Care (TOC) program helps members safely navigate their post-discharge journey from acute care and hospital settings back into the community. The TOC Registered Nurse Care Manager (RNCM) coordinates with hospital case managers
Site: Brigham and Womens Faulkner Hospital, Inc. Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we
Its more than a career, its a calling.OK-REMOTE Worker Type:Regular Job Summary:Evaluates the medical necessity and appropriateness of hospital admissions and surgical procedures. Ensures payors receive clinical information to support services provided by hospital. Ensures hospital
Department: 39733 Enterprise Corporate - Care Transitions Status: Part time Benefits Eligible: Yes Hours Per Week: 20 Schedule Details/Additional Information: This is a salaried exempt position. Must be within a hour of Mint Hill Primary Care
Opportunity Overview: Cohere’s Service Operations team is responsible for ensuring that our healthcare partners are supported throughout their lifecycle of using the platform. The RN Supervisor, Clinical Operations position is a crucial role in our organization. In
Our team members are at the heart of everything we do. At Cencora, we are united in our responsibility to create healthier futures, and every person here is essential to us being able to deliver on
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united
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