Clinical review coordinator jobs

Mar 31, 2023

Care Coordinator - Work from Home - New York

Job DescriptionHelp us elevate our patient care to a whole new level Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our"Dual Eligible Special Needs Plan"(DSNP) members, who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs. Join us in this exciting opportunity as we grow and expand DSNP to change lives in new markets across the country. " Position Summary/Mission:""The Case Management Coordinator utilizes critical thinking and judgment to collaborate and inform the case management process, The Case Management Coordinator facilitates appropriate healthcare outcomes for members by providing...

CVS Remote * (NY, USA)

BS

Mar 31, 2023

Member Care Coordinator - Start remote, benefits from day 1!

The Opportunity Description We're looking for a Member Care Coordinator , working in the Healthcare Systems & Services industry in Downers Grove, Illinois, United States . Manage home health assessments and system updates. Perform outreach and follow up attempts to members on their health care plan. Build relationships with members to encourage compliance with care plans and to alert the Case Manager quickly when issues arise. Inform and educate members on their program, may use supplied scripts. Complete records in system by performing data entry. Encourage member usage of our programs, including arranging appointments and additional member services (e.g., transportation). Generate appropriate correspondence and send to member manually, electronically, or telephonically. Conduct check-ins with members to review individual care plan goals. Maintain production requirements based on established department business needs. Provide support to the clinical team...

Bluestone Staffing Solutions Downers Grove, IL, USA

Mar 31, 2023

Quality Care Coordinator - Medical Assistant - HYBRID WORK FROM HOME - Full Time - Days

Medical Assistant / MA- Quality Care Coordinator - Full Time - DaysThe Care Coordination Team is seeking an experienced Certified/Registered Medical Assistant who has working knowledge of physician practice protocols and procedures and is committed to the continuous improvement of the patient experience, patient safety, quality of care, and excellent service. The Care Coordinator will support the ongoing development of patient-centered, team-based care by serving as a professional liaison, advocate, and informational resource for patients and families, clinicians, and Care Teams to enhance patient-centered care coordination and continuity of care. Essential Job Functions Assess and meet the needs of patients, while helping them navigate effectively and efficiently across the health care continuumProvide episodic care coordination for patients discharged from the Emergency Room; coordinate follow-up care, assess SDOH needs, and communicate with Care Team as appropriateIdentify risk...

Promedica Remote * (Holland, MI, USA)

Mar 31, 2023

Principal Statistical Programmer Analyst - Remote

About ClinChoice ClinChoice is a Global CRO dedicated to offering high-quality one-stop service to biopharmaceutical, medical device, and consumer products clients. Some of these services include clinical operations, project management, biostatistics, data management, regulatory affairs, medical affairs, and pharmacovigilance. ClinChoice has established major delivery centers across US, Canada, China, Europe, India, Japan and the Philippines. It has over 3,000 employees globally, with a strong and talented team, and a growing clinical operations presence in seven countries across Asia, North America and Europe. This is a remote Principal Statistical Programmer Analyst or Associate Manager level position in our Statistical Programming department. Great opportunity to work remote for growing company in Life Science industry in supportive team environment on diverse client projects. Key responsibilities may include but are not limited to: Programming edit checks for Data...

ClinChoice Remote * (USA)

Mar 31, 2023

Prior Authorization LVN Remote PST Hours

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)Under the general direction of the Director of UM, UM Administrative Manager, and the Prior Authorization LVN Supervisor, the Prior Authorization LVN ensures that prior authorization requests from patients and providers are completed in a timely fashion to meet the contractual and regulatory requirements while acting within the scope of the Board of Vocational Nursing and Psychiatric Technicians of the State of California. The Prior Authorization LVN will promote the quality and cost effectiveness of medical care provided to patients by...

UnitedHealth Group Remote * (Redlands, CO, USA)

Mar 31, 2023

Developer/Programmer (Hybrid-Remote work)

Klute is growing and we are looking to add a full-time Developer/Programmer to our team. This position can be remote after initial training and requiring only onsite work when necessary. PRIMARY PURPOSE AND FUNCTION Responsible for troubleshooting, debugging, maintaining, and improving existing software by compiling and assessing user feedback to improve software performance. ESSENTIAL FUNCTIONS AND RESPONSIBILITIES Work with Structural Engineers and Detailers to enhance workflow through proprietary programs and software systems. Ensure accuracy and program stability through robust programming. Work on projects both large and small to simplify complex tasks with software automation. QUALIFICATIONS Position requires an organized/detail-oriented person with critical thinking skills. Work both in independently and in a team-oriented environment. Work directly with Detailing Manager, Administrative Employees, Shop Foreman, and Production Staff. Fluent in Microsoft...

KLUTE Remote * (York, PA, USA)

Mar 31, 2023

Care Transitions Nurse, Full time/REMOTE (Evergreen Park)

Care Transitions Nurse, Full time/REMOTE (Evergreen Park) Job ID: R65355 Shift: 1st Full/Part Time: Full_time Location: 9730 S Western Ave Evergreen Park, IL 60805 Benefits Eligible: Yes Hours Per Week: 40 Full Time Care Transitions Nurse 100% REMOTE POSITION, some evening and weekend coverage. Must have current Illinois license High-speed internet required Care Transitions role for 30 day program Medicare/ACO patient population/Medicare FFS program post-hospital discharge. Performs telephonic utilization management and associated discharge planning/authorization for AAH delegated risk and ACO members, to ensure appropriate level of care, excellent clinical outcomes, and to optimize the appropriate use of resources in the most cost-effective setting. Major Responsibilities: Responsible for performing telephonic utilization management for network and non-network hospital admissions. Ensures appropriate admissions are...

Advocate Christ Medical Center Remote * (Evergreen Park, IL, USA)

Mar 31, 2023

Grievance & Appeals Regulatory Nurse, LVN (Remote)

Job Requisition ID: 8775Position Summary/PositionUnder the general direction of the Grievance & Appeals Regulatory Manager, the Grievance & Appeals Regulatory Nurse is responsible for working directly with providers, delegated entities and internal IEHP departments in investigating and resolving cases, and responding to regulatory agencies to ensure compliance with internal Policy & Procedures and Department of Managed Health Care (DMHC)/ Department of Health Care Services (DHCS)/ Center for Medicare and Medicaid Services (CMS) regulations. Coordinate Member care in conjunction with the Member's Providers to provide continuous quality care and assist in the development of quality initiatives. The Grievance & Appeals Regulatory Nurse serves as a resource to IEHP personnel and providers.Major Functions (Duties and Responsibilities)1. Responsible for the processing of all DMHC cases (Consumer Complaints and Independent Medical Reviews) and monitoring timeliness of...

IEHP Remote * (Rancho Cucamonga, CA, USA)

Mar 31, 2023

Quality Care Coordinator - Medical Assistant - HYBRID WORK FROM HOME - Full Time - Days

Medical Assistant / MA- Quality Care Coordinator - Full Time - DaysThe Care Coordination Team is seeking an experienced Certified/Registered Medical Assistant who has working knowledge of physician practice protocols and procedures and is committed to the continuous improvement of the patient experience, patient safety, quality of care, and excellent service. The Care Coordinator will support the ongoing development of patient-centered, team-based care by serving as a professional liaison, advocate, and informational resource for patients and families, clinicians, and Care Teams to enhance patient-centered care coordination and continuity of care. Essential Job Functions Assess and meet the needs of patients, while helping them navigate effectively and efficiently across the health care continuumProvide episodic care coordination for patients discharged from the Emergency Room; coordinate follow-up care, assess SDOH needs, and communicate with Care Team as appropriateIdentify risk...

Promedica Remote * (Tontogany, OH, USA)

Mar 31, 2023

Quality Care Coordinator - Medical Assistant - HYBRID WORK FROM HOME - Full Time - Days

Medical Assistant / MA- Quality Care Coordinator - Full Time - Days The Care Coordination Team is seeking an experienced Certified/Registered Medical Assistant who has working knowledge of physician practice protocols and procedures and is committed to the continuous improvement of the patient experience, patient safety, quality of care, and excellent service. The Care Coordinator will support the ongoing development of patient-centered, team-based care by serving as a professional liaison, advocate, and informational resource for patients and families, clinicians, and Care Teams to enhance patient-centered care coordination and continuity of care. Essential Job Functions Assess and meet the needs of patients, while helping them navigate effectively and efficiently across the health care continuum Provide episodic care coordination for patients discharged from the Emergency Room; coordinate follow-up care, assess SDOH needs, and communicate...

Promedica Remote * (MI, USA)

Mar 31, 2023

Systems Technician- Remote

Description LifePoint Health has an opportunity for a Systems Technician to join our team! This position is Remote. About LifePoint Health: LifePoint Health is a leader in community-based care and driven by a mission of Making Communities Healthier. Our diversified healthcare delivery network spans 29 states and includes 63 community hospital campuses, 32 rehabilitation and behavioral health hospitals, and more than 170 additional sites of care across the healthcare continuum, such as acute rehabilitation units, outpatient centers and post-acute care facilities. We believe that success is achieved through talented people. We want to create places where employees want to work, with opportunities to pursue meaningful and satisfying careers that truly make a difference in communities across the country. Essential Functions: Provides customer service, technical support, surveillance, troubleshooting, maintenance, and repair at the...

LifePoint Health Remote * (Louisville, KY, USA)

Mar 31, 2023

Remote Medical Case Manager CARE - 2023-1250 (Remote)

Medical Case Manager (Remote) - CARE Unit Overview Do you enjoy using your excellent writing skills as a Medical Case Manager to influence the actions of others? Does the thought of sharing your passion for finding answers within that large "pile" of documents intrigue you? As a Medical Case Manager with Managed Care Advisors, working in your home office on Federal contracts, you will be responsible for a professional assessment of long-term cases. Using your clinical knowledge and nursing experience, you will provide detailed case review summaries while collaborating with a dedicated team. Ideal candidates will possess critical thinking skills with the ability to organize, and articulate in writing and verbally, and are motivated to work independently in a home office setting while still being part of a supportive team. Nurse Case Manager Responsibilities Utilize strong reading and writing skills to conduct retrospective case reviews. Prepare professional reports, letters,...

Auzmor Remote * (Omaha, NE, USA)

Mar 31, 2023

Licensed Behavioral Health Clinician - Nights and Weekends - Remote in Louisiana

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm) You're looking for something bigger for your career. How about inventing the future of health care? UnitedHealthcare is offering an innovative new standard for care management. We're going beyond counseling services and verified referrals to behavioral health programs integrated across the entire continuum of care. Our growth is fueling the need for highly qualified professionals to join our elite team. Bring your skills and talents to a role where you'll have the opportunity to make an impact on a huge scale. As a Behavioral Health...

UnitedHealth Group Remote * (Baton Rouge, LA, USA)

Mar 31, 2023

Network Pricing Analyst - Remote

Exciting opportunity for a recent finance, math or computer science graduate to join our team as a Network Pricing Analyst . This is an entry level role ideal for candidates with analytical problem-solving skills and drive to contribute to a high performing Pharmacy Analytics team. The Network Pricing Analyst participates and assesses network pricing strategy as well as the execution, implementation, and optimization of current, new, and future network / pricing innovation. Assists in creation and maintenance of complex financial modeling and process development to establish business insight, quality assurance, and execution to achieve departmental goals.In partnership with team leaders and members, supports the development of reimbursement strategy, execution of network pricing, and perform pharmacy analytics reporting and modeling that fall under the Maximum Allowable Cost (MAC) Management umbrella.Develops capabilities specifically targeted to achieve the efficient and effective...

Maxor Remote * (Plano, TX, USA)

Mar 31, 2023

REMOTE Claims Analyst

Adecco is currently assisting a local client in their search to fill a REMOTE Medical Claims Analyst position. We are looking for a dynamic candidate to be a part of our team! Apply now if you meet the qualifications listed below! Type: Fulltime (40 hours/week) Temp Length: 11 Months Pay: $19.00/HR Shift/Hours: 8:00AM-5:00PM Monday-Friday Primary Responsibilities: Review and process all incoming claim referrals. Ensure completeness and legibility of documents, coordinating with customer service, internal departments and/or facilities to obtain additional information as needed Communicate with staff and Account Coordinators (AC) to gather pertinent claim information as assigned Assign claims to data entry if the manual conversion process is not possible Contact facilities to obtain information needed to process claims; escalate to customer service and Account Management (AM) when appropriate Review and categorize incoming medical records according to defined process including saving...

Career Staffing Remote * (Minneapolis, MN, USA)

Mar 31, 2023

Right Hand to CEO- Must Love Dogs (Remote Executive Assistant)

We are looking for an exceptional right hand Executive Assistant for our CEO who manages a portfolio of businesses focused on dog lovers. We're poised for exponential growth in 2022 and our CEO James Jacobson needs help, pronto. Note: since we're focused on improving the quality of life of dogs and the people who love them, being a dog lover with a capital D and capital L is really important. As the CEO's Right Hand, you will: Interface with him multiple times a day via phone, video chat and Microsoft Teams. Help the CEO manage our distributed team of contractors all over the world. Help manage projects in areas as diverse as operations, marketing, customer relations, sales initiatives, podcasting, publishing and public relations. You must be a quick professional with great time-management and multitasking abilities. A Critical Member of Our Team Your diligence and competence can help our CEO focus on growing the enterprise without worrying about whether other tasks may be falling...

Functional Nutriments Remote * (Kihei, HI, USA)

KEPRO (The Keystone Peer Review Organization)

Mar 31, 2023

Claims Manager (Remote)

Claims Manager (Remote) Are you an experienced Claims Manager looking for a new challenge? Do you value care management and quality improvement? Are you motivated, energetic, and excited to become part of the Kepro team? If so, you might be our next new team member! Why us? Kepro is a rapidly growing national quality improvement and care management organization. We work to ensure that over 20 million people receive the right care, at the right time, in the right setting. People Focused. Mission Driven. Shape the future of healthcare with us. We are mission driven to improve lives through healthcare quality and clinical expertise. We do this through our people. At Kepro, you can do meaningful work that makes a real difference for the lives of individuals across the country. We are an organization that cares deeply about our employees and we provide the training and support to do the best work of your career. Benefits are a key component of your rewards package at Kepro. These...

KEPRO (The Keystone Peer Review Organization) Remote * (Harrisburg, PA, USA)

Mar 31, 2023

Senior Manager, Demand Planning (Remote Role)

OLAPLEX, Inc. (Nasdaq: OLPX) is an innovative, science-enabled, technology-driven beauty company. We are founded on the principle of delivering effective, patent-protected and proven performance in the categories where we compete. We strive to empower our consumers to look as beautiful on the outside as they feel on the inside. We believe every person deserves to have healthy, beautiful hair, whether they are visiting a salon or caring for their hair at home. OLAPLEX has been able to achieve phenomenal growth and we continuously seek exceptionally talented individuals who can support our innovation and creativity. We currently operate in a fully remote environment; because of this, collaboration and flexibility are at the core of our commitment to each other and to the success of OLAPLEX. About the Role: The Senior Demand Planning Manager will be responsible for developing demand-based sales forecasts for all products within a Channel; by analyzing point of sales, market,...

Olaplex Remote * (Los Angeles, CA, USA)

Mar 31, 2023

Payroll Specialist - Full Time - Remote

Job Description Summary: Community Health Center, Inc. (CHC), with offices in Connecticut, Colorado and California, is one of the country's most creative and dynamic providers of primary medical, dental, and behavioral health services, and a leader in practice-based research, health professionals training, and use of innovative technologies to advance health and healthcare. CHC is designated as a federally qualified health center and a patient-centered medical home by HRSA, the Joint Commission, and NCQA, respectively. We deliver more than 500,000 patient visits per year from primary care hubs and community clinics across the state of CT, all connected by technology and common standards for quality. We employ several hundred medical, dental, and behavioral health providers who are engaged in practice, teaching, and research. Our Weitzman Institute is devoted to research and practice transformation and is recognized around the country as one of the premier research institutes...

Community Health Systems Remote * (USA)

Mar 31, 2023

SQL Developer I (Hybrid or Remote Option Available)

Competitive Compensation & Benefits Package! Position eligible for - Annual incentive bonus plan Medical, dental, and vision insurance with low deductible/low cost health plan Generous vacation and sick time accrual 12 paid holidays State Retirement (pension plan) 401(k) Plan with employer match Company paid life and disability insurance Wellness Programs See attachment for additional details. Location: Negotiable for any of our office locations; Hybrid or Remote Option Available Projected Hiring Range: Depending on Experience Closing Date: Open Until Filled Primary Purpose of Position: This position performs complex professional work in the creation and maintenance of the relational databases utilized by the LME/MCO. Role and Responsibilities: Design, develop or implement SQL databases and analytical procedures necessary to satisfy the needs of the agency as outlined by policies and procedures and to meet the requirements of North Carolina...

Partners Behavioral Health Management Remote * (Gastonia, NC, USA)

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90 clinical review coordinator jobs found