-
Senior Accountant
2 weeks ago
Thriveworks Remote, United States Full timeSenior Accountant - Remote · About Thriveworks · Thriveworks is one of the leading mental healthcare companies in the USA, with over 2,800 employees, and was founded by and is still led by clinicians. Having just launched a new vision to be America's most valued mental healthca ...
-
Associate Manger, Global Events
2 days ago
Dexcom Remote, United StatesAbout Dexcom · Founded in , Dexcom, Inc. (NASDAQ: DXCM), develops and markets Continuous Glucose Monitoring (CGM) systems for ambulatory use by people with diabetes and by healthcare providers for the treatment of people with diabetes. The company is the leader in transforming di ...
-
UX Researcher
5 days ago
marigold Health Remote, United States Full timeMarigold Health is looking for a UX Researcher to lead user experience research for the platform that powers our virtual mental health and substance use recovery program. Marigold provides a combination of 1-1 coaching and 24/7 anonymous chat support groups accessed over phone, S ...
-
Primary Care Physician
1 week ago
Herself Health Remote, United StatesPrimary Care Physician - Job Description · Who we are: · At Herself Health, we're on a mission to help women get more life out of life, together. We are building a new model of primary care for women 65+ to solve long-standing problems: rushed appointments, long wait times, and c ...
-
Accounts Payable Specialist
4 weeks ago
Curo Health Services Remote, United StatesOur Company · Gentiva is an industry leader in hospice, palliative, home health, and personal home care. Our place is by the side of those who need us, offering physical, spiritual and emotional support to patients and their families so they may make the most of every moment. We ...
-
Senior Clinical Informatics Analyst
4 weeks ago
Emerus Remote, United StatesAbout Us · Emerus is the nation's first and largest operator of small-format hospitals, also known as community or neighborhood hospitals. Emerus' leading national health system partners include Allegheny Health Network, Ascension, Baptist Health System, Baylor, Scott & White Hea ...
-
Backend Engineer
4 weeks ago
Optimize Health Remote, United States Full timeWe are seeking Platform Engineers to help us integrate more partners' systems with ours, introducing new data to store and exchange, while ensuring the system can continue scaling well with our ever-growing population of users. Today Optimize Health offers a platform for remote c ...
-
The Cigna Group Remote, United States OTHERThe job profile for this position is Technical Training Senior Analyst, which is a Band 3 Senior Contributor Career Track Role.Excited to grow your career? · We value our talented employees, and whenever possible strive to help one of our associates grow professionally before rec ...
-
Backend Engineer
4 weeks ago
Optimize Health Remote, United States Full timeWho we are: · At Optimize Health, we believe that it's time to rethink brick-and-mortar-only healthcare visits. With our powerful combination of the leading platform technology, patient-friendly devices, and trusted support, we are pioneering how medical groups use technology and ...
-
Senior Design Quality Assurance Engineer
2 weeks ago
Glooko Remote, United States Full timeThis position is responsible for developing, establishing, and maintaining quality and compliance programs, policies, processes, procedures, and controls ensuring that performance and quality of products conform to established standards, agency regulations, Glooko's Quality Polic ...
-
Director, Behavioral Care
3 weeks ago
Cerebral Remote, United States Part time· Our Company: · At Cerebral, we're on a mission to democratize access to high-quality mental health care for all. We believe that everyone everywhere deserves to get the care they need, and are striving to make care convenient and accessible, while tackling the stigmas that sur ...
-
Senior UI Engineer
3 weeks ago
Protenus Remote, United States Full timeThe Protenus Healthcare Compliance Analytics platform is powered by a data pipeline that ingests robust and varied feeds to provide visibility into potential patterns of suspicious behavior that may otherwise go unnoticed. Our AI empowers subject matter experts to mitigate and ul ...
-
Finance Associate
2 days ago
Carda Health Remote, United States Full timeAbout Carda · Rehab is a pain. So much so that only 10% of qualifying heart patients attend, which results in complications for patients and at least $190B in excess costs. At Carda Health, we have reimagined the care model for heart and lung patients. Our program allows patients ...
-
Senior People Partner
2 weeks ago
Midi Health Remote, United States Full timeMidi Health · Midi is on a mission to bring compassionate, high quality medical care to women 40+, and to offer a new standard of care for women in midlife. · Midi Health is the only comprehensive virtual care clinic health solution for women ages 40 to 65 navigating midlife horm ...
-
Data Analyst
3 weeks ago
Glooko Remote, United States Full timeReport: This position reports to Director of Data and ML Solutions · Position: · We are looking for a data analyst to support the Glooko Data Products team. This includes: · conducting analyses to help us better understand our users, clinics, and devices, · identifying and inte ...
-
Site Care Partner
1 week ago
Parexel Remote, United States RemoteParexel FSP is hiring multiple Site Care Partners across the US--these are great opportunities for experienced CRAs seeking career advancementJob Summary The Site Care Partner is the main client point of contact for investigative sites throughout a study life cycle; accountable f ...
-
Senior Statistical Programmer
4 weeks ago
Telix Pharmaceuticals Limited Remote, United States Full time· Telix Pharmaceuticals is a dynamic, fast-growing radiopharmaceutical company with offices in Australia (HQ), Belgium, Japan, Switzerland, and the United States. Our mission is to deliver on the promise of precision medicine through targeted radiation. At our core, we exist to ...
-
Data Engineer
5 days ago
M13 Remote, United States Full timeRedefining Healthcare with Carenostics · At Carenostics, we're at the forefront of healthcare AI, forging a path to address chronic diseases with transformative solutions. Our work, starting in Chronic Kidney Disease at Hackensack Meridian Health (HMH), has garnered prestigious a ...
-
RN - Clinical Documentation Specialist
1 week ago
SSM Health Remote, United States Full timeIt's more than a career, it's a calling · MO-REMOTEWorker Type: · RegularJob Highlights: · At SSM Health, we believe in providing our employees with a fulfilling career. We strive to create an environment where individuals can grow both personally and professionally. Our company ...
-
Sr. Software Engineer
1 week ago
Spok Remote, United States Full timeDescription · Overview · Join our dynamic software engineering team at Spok We seek a passionate and innovative Senior Software Engineer to contribute to our projects in Platform and Alerting. This is an excellent opportunity to grow your skills in a cutting-edge environment. · R ...
Healthcare - Care Review Clinician II - Remote, United States - APN Consulting, Inc
Description
Location: Remote (Must possess a CA State RN License)
Duration: 4 Months
Job Description:
- Is the role fully remote? Yes
- Specific location requirements? None
- Time zone requirements? PST
- Must-have requirements? CA State License, RN
- Day-to-day responsibilities? Conduct inpatient pediatric authorization reviews using MCG criteria. Previous pediatric experience is a plus
- Specific licensure required to qualify for the role? CA- RN
- Desired work hours? 8:00-5:00
- Additional equipment needed? 1 extra monitor
This position is to cover a LOA with a potential extension.
Summary:
Collaborates with the Utilization Management team, focusing on inpatient medical necessity/utilization review to ensure Client Healthcare members receive appropriate care at the appropriate time.
Conducts daily assessment of hospitalized members, offering prior authorizations and/or concurrent reviews. Evaluates services to guarantee optimal outcomes, cost efficiency, and compliance with regulations.
Essential Functions:
- Conducts concurrent reviews and prior authorizations based on Client policy
- Determines benefits, eligibility, and expected treatment length
- Engages in interdepartmental cooperation to enhance continuity of care
- Sustains department productivity and quality standards
- Attends regular staff meetings
- Mentors new team members
- Completes work plan objectives and projects promptly
- Builds professional relationships with providers and customers
- Consults with Client medical directors as needed
- Adheres to workplace safety standards
Knowledge/Skills/Abilities:
- Proficient in communication, problem-solving, and teamwork
- Strong organizational and multitasking skills
- Knowledgeable about state and federal regulations
- Familiar with Interqual and other length of stay references
- Experience with NCQA
- Takes initiative and ensures task completion
- Computer literate (Microsoft Office)
- Excellent verbal and written communication
- Adheres to Client policies
- Maintains attendance for quality work
- Upholds confidentiality and HIPAA compliance
- Establishes positive work relationships
Required Education:
Completion of an accredited Nursing program
(Experience may substitute for a Nursing degree)
Required Experience:
2-4 years of clinical practice
Preferred experience in hospital nursing, utilization management, or case management
Required Licensure/Certification:
Active, unrestricted State Nursing (RN, LVN, LPN) license
