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nursing Philadelphia, PA

182 nursing jobs found in Philadelphia, PA

Jun 02, 2023  
Clinical Reviewer - RN - (Remote)
Clinical Reviewer (Remote) Are you an experienced Clinical Reviewer 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! Note: This position is a part-time, PRN position. Work can be performed from home. Who we need: The Clinical Reviewer utilizes clinical expertise for the review of medical records against appropriate criteria in conjunction with contract requirements, critical thinking and decision-making skills to determine medical appropriateness, while maintaining production goals and QA standards. Ensures day-to-day processes are conducted in accordance with NCQA, URAC and other regulatory standards. 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...
Keystone Peer Review Organization Remote * (Philadelphia, PA, USA)
Jun 02, 2023  
HEDIS Coordinator - REMOTE
Description Requisition Status: Pending Status Reason: Pending Sourcing Reason: New Position Reason Detail: Manager: Department: AMHDE_1031_154 : Quality Management Job Category: NonClinical - Nursing/Tech Job Code: HEDIS Coordinator:HEDIS Coordinator Job Title: HEDIS Coordinator - REMOTE Keywords: Number of Positions: 1 Remaining Positions: 1 Duties: Under the direction of the Lead HEDIS Reviewer the HEDIS Coordinator is responsible for: Will participate in and provide guidance and support for the development and maintenance of the HEDIS Medical Record Review platform(s) to support all plans. Coordinate the ongoing Medical Record collection and archiving of documents that support the Medical Record Review Projects, regulatory audits and accreditation standards. Work collaboratively with the Manager, HEDIS to maintain the Department SharePoint site, drives, medical records, blogs, newsletters and other program materials as deemed necessary. Participate...
vTech Solution Remote * (Philadelphia, PA, USA)
Jun 02, 2023  
Registered Nurse, Clinical Documentation Improvement Specialist - Remote in Madison WI
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 is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)  Health care isn't just changing. It's growing more complex every day. ICD10 replaces ICD9. Affordable Care adds new challenges and financial constraints. Where does it all lead? Hospitals and health care organizations continue to adapt, and we are a vital part of their evolution. And that's what fueled these exciting new opportunities. Optum360 is a dynamic new partnership formed by Dignity Health and Optum to...
UnitedHealth Group Philadelphia, PA, USA
Jun 02, 2023  
Care Manager II, Pediatric Shift Care, RN, REMOTE
Job Brief Current and unrestricted Registered Nurse licensure in Pennsylvania.  3+ years of clinical experience at the bedside (as a Registered Nurse) working with medically fragile pediatric patients. Your career starts now. We’re looking for the next generation of health care leaders. At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven...
Amerihealth Philadelphia, PA, USA
Jun 02, 2023  
Clinical Director, Health System Performance Improvement - Workforce - Remote
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 care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. The Clinical Director of Health System Performance Improvement- Workforce Optimization will serve as the lead clinical expert collaborating with a consulting team that performs assessments, identifies opportunities, designs solutions and partners with the client to implement workforce staffing efficiency initiative action plans. This individual will work alongside client teams across the...
UnitedHealth Group Philadelphia, PA, USA
Jun 02, 2023  
Sales Account Manager - Remote in Seattle, WA
Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs – helping patients access and navigate care anytime and anywhere.  As a team member of our Senior Community Care (SCC) product, we work with a team to provide care to patients at home in a nursing home, assisted living for senior housing. This life-changing work adds a layer of support to improve access to care. We’re connecting care to create a seamless health journey for patients across care settings. Join our team, it’s your chance to improve the lives of millions while doing  your life’s best work.(sm) The Sales and Account Manager (SAM) is a field-based position charged with enrolling Medicare beneficiaries, residing in a senior living facility, into the UnitedHealthcare...
UnitedHealth Group Philadelphia, PA, USA
Jun 02, 2023  
Nurse Advocate - Remote
At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life's best work.(sm) This position is responsible for administration of onsite wellness initiatives for high profile customer in Little Rock, AR. It includes accountability for the onsite programs supporting the health of site population; resolving issues; and relationships with the members and customer.  You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: Using clinical knowledge, review various reports, including risk assessment reports, and claims data; identify and report on trends and gaps in coverage, offer...
UnitedHealth Group Philadelphia, PA, USA
Jun 01, 2023  
Director and Clinical Consultant - CDI-Advisory Services - Remote
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 care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  The Director and Clinical Consultant, Clinical Documentation Integrity in Optum Advisory Services, Finance & Operations serves as a clinical consultant and subject matter expert for large, complex engagements with healthcare provider clients across a range of projects, primarily focused on acute care and ambulatory clinical documentation integrity and provider engagement and education in...
UnitedHealth Group Philadelphia, PA, USA
Jun 01, 2023  
DRG Coding & Clinical Validation RN Auditor - Remote
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 care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. Energize your career with one of Healthcare’s fastest growing companies.   You dream of a great career with a great company – where you can make an impact and help people.  We dream of giving you the opportunity to do just this.  And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies,...
UnitedHealth Group Philadelphia, PA, USA
Jun 01, 2023  
Utilization Management Director - Remote - State of OH
At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life's best work.(sm) If you are located in the state of Ohio, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: Oversee the plan’s implementation and evaluation of utilization management based on a deep understanding utilization management principle and practice  Coordinate extensively with the Ohio Department of Medicaid Regulator on policy and procedure for UnitedHealthcare’s Utilization Management Program as directed by the Chief Medical Officer (CMO) Ensure timely updates of United Healthcare clinical coverage determination...
UnitedHealth Group Philadelphia, PA, USA
Jun 01, 2023  
Sr Network Engineer - OptumServe - Remote
There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Nursing here isn't for everybody. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Start doing your life's best work.(sm) The Sr Network engineer will manage and maintain LHI's IT infrastructure environment to support OptumServe’ s business operations.  Work as a lead on IT projects that involve technology and product evaluation, implementation, deployment and troubleshooting as assigned.  Act as one of the team’s technical points of contact for specific aspects of the data center operations, such as network infrastructure, WAN, LAN, load balancers, Firewalls and various hardware appliances. Ensure efficient, balanced, secure and uninterrupted operation of OptumServe network infrastructure.  You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some...
UnitedHealth Group Philadelphia, PA, USA
Jun 01, 2023  
Associate, CDI Specialist, RN - Remote
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 care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  Health care isn't just changing. It's growing more complex every day. ICD10 replaces ICD9. Affordable Care adds new challenges and financial constraints. Where does it all lead? Hospitals and health care organizations continue to adapt, and we are a vital part of their evolution. And that's what fueled these exciting new opportunities. Optum360 is a dynamic new partnership formed by Dignity...
UnitedHealth Group Philadelphia, PA, USA
Jun 01, 2023  
Manager Care Management - Remote
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 care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.  The Manager, Optum Advisory Services, Provider opportunity for a self-driven, collaborative case manager to partner with Optum leadership, remote and onsite teams to lead, assess, develop and implement an integrated, cohesive solution across Optum business units and key client services. This role is critical to ensuring Optum meets and exceeds our client expectations to Care Management and...
UnitedHealth Group Philadelphia, PA, USA
May 26, 2023  
Nurse Case Manager - Remote - Temple, TX
Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs – helping patients access and navigate care anytime and anywhere.    As a team member of our Landmark product, we help bring home-based medical care to complex, chronic patients. This life-changing work helps give older adults more days at home.   We’re connecting care to create a seamless health journey for patients across care settings. Join our team, it’s your chance to improve the lives of millions while doing your life’s best work.(sm)  Do you want to make a difference in healthcare? Landmark Health was created to transform how healthcare is delivered to the most medically vulnerable members in our community.  Our medical group provides home-based medical care to chronically ill...
UnitedHealth Group Philadelphia, PA, USA
May 22, 2023  
Sales Account Manager - Remote in Charlotte, NC
Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs – helping patients access and navigate care anytime and anywhere.  As a team member of our Senior Community Care (SCC) product, we work with a team to provide care to patients at home in a nursing home, assisted living for senior housing. This life-changing work adds a layer of support to improve access to care. We’re connecting care to create a seamless health journey for patients across care settings. Join our team, it’s your chance to improve the lives of millions while doing  your life’s best work.(sm) The Sales Account Manager (SAM) is a field based position charged with enrolling Medicare beneficiaries, residing in a skilled nursing facility, into the UnitedHealthcare...
UnitedHealth Group Philadelphia, PA, USA
Jun 02, 2023  
REMOTE | Corporate Medical Policy Writer Analyst [ RN, MS or PhD [Expert in research, writing, evidence-based principles & health policy]
Your career starts now. We’re looking for the next generation of health care leaders. At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services....
Amerihealth Newtown Square, PA, USA
Jun 02, 2023  
Supervisor, Prior Authorization, UM Review, REMOTE
Job Brief BSN and current PA RN req'd. Your career starts now. We’re looking for the next generation of health care leaders. At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health...
Amerihealth Newtown Square, PA, USA
Jun 02, 2023  
Community Health Navigator - LTSS - DE remote
Your career starts now. We’re looking for the next generation of health care leaders. At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services....
Amerihealth Wilmington, DE, USA
Jun 02, 2023  
Community Health Navigator - DE Remote
Job Brief Qualified candidates must live in Delaware or close to in surrounding areas (Maryland, PA) Your career starts now. We’re looking for the next generation of health care leaders. At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation's leaders in health care solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together we can build healthier communities. If you want to make a difference, we’d like to hear from you. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit...
Amerihealth Newark, DE, USA
Jun 02, 2023  
Physical Security Program Manager - 100% Remote
See yourself at Radian? We see you here too. At Radian, we see you. For the person you are and the potential you hold. That's why we've embraced a new way of working that lets our people across the country be themselves, be their best and be their boldest. Because when each of us is truly seen, each of us gives our best - and at Radian, we'll give you our best right back. Studies have shown that job seekers may hesitate to apply for jobs unless they meet every single qualification listed. We strive to see the potential in each applicant, so if you're excited about this role but your experience or education level doesn't align perfectly with every qualification in the job description, we encourage you to apply anyway. You may be just the right candidate for this or other roles. See Yourself as a Physical Security Program Manager The Physical Security Program Manager is responsible for establishing, monitoring, and maintaining the physical security controls and functions for...
Radian Group Remote * (Philadelphia, PA, USA)