• CIC Advanced Practice Clinician - NP / PA - Hybrid

    Commonwealth Care Alliance (Springfield, MA)
    …as NP or PA in primary care or care management AND 3+ years' experience as Registered Nurse or EMT-P in a high touch clinical environment or home care; OR ... assigned catchment area. + COVID-19 vaccination is required + Compliance with all Community Clinician Occupational Health Requirements **Other:**...or PA graduate, must have 5+ years' experience as Registered Nurse or EMT-P in a high… more
    Commonwealth Care Alliance (07/09/25)
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  • Utilization Review Nurse

    US Tech Solutions (May, OK)
    …experience as an RN . 1+ years of inpatient hospital experience . Registered Nurse in state of residence . Must have prior authorization utilization ... to obtain additional information. . Evaluates documentation/information to determine compliance with clinical policy, regulatory and accreditation guidelines. .… more
    US Tech Solutions (07/18/25)
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  • Compliance Coding Auditor - Integrity…

    Guthrie (Sayre, PA)
    Option to be Hybrid/Remote. Summary: A senior level compliance coding auditor conducting assessments in accordance with The Guthrie Clinic's policies and procedures ... accepted guidelines for medical coding. Works closely with the Compliance Officer and Compliance coding Audit Coordinator...(RHIA, RHIT, or CCS) or AAPC (CPC) required + RN /LPN or CPMA preferred + Required to sit for… more
    Guthrie (09/13/25)
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  • Manager, Quality Assurance (Medicaid)

    Humana (Lansing, MI)
    …Qualifications** + **Must reside in the state of Michigan.** + An active, unrestricted Registered Nurse ( RN ) license or an active, unrestricted Licensed ... of Quality Assurance Professionals responsible for ensuring consistency of use and compliance to state and Humana requirements for Long-Term Services and Supports… more
    Humana (10/01/25)
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  • Medical Case Manager - Delaware

    Highmark Health (Dover, DE)
    …**Required** + Licensed Social Worker (LSW)-Non-Specific - State **(OR)** Registered Nurse - Non-Specific **(OR)** Licensed Professional Counselor ... as assigned or requested. **QUALIFICATIONS** **Minimum** + Bachelor's degree in nursing or RN certification in lieu of bachelor's degree or Master's degree in Social… more
    Highmark Health (09/27/25)
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  • Care Manager

    Calvert Memorial Hospital (Prince Frederick, MD)
    …Nursing degree: BSN/MSN is preferred. + Registration/Certification/Licensure : + Current Maryland Registered Nurse license + Unexpired driver's license + Basic ... coordinating, performing and completing or supporting the Welcome to Medicare (WTM) and Annual Wellness Visit (AWV) to a...Life Support certification required + Experience : + RN with a minimum 5 years of clinical experience… more
    Calvert Memorial Hospital (09/25/25)
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  • Care Coach (Transition/Custodial Prevention)

    Humana (Burlington, IA)
    …+ An active, unrestricted Licensed Professional Counselor (LPC), Licensed Social Worker (LSW) or Registered Nurse ( RN ) in Illinois. + Nursing home diversion ... + Two (2) years of prior experience working with Medicare and Medicaid recipients, long-term care services, Home and...the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and… more
    Humana (09/08/25)
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  • Clinical Revenue Auditor-CDM Patient Financial…

    Mount Sinai Health System (New York, NY)
    …at all levels throughout the organization. **License** ? Current NYS licensure ( Registered Nurse ( RN ), Occupational Therapist (OT), Physical Therapist ... payment. This position plays a key role in ensuring the financial health and compliance of the organization and bridges the gap between clinical care and medical… more
    Mount Sinai Health System (09/24/25)
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  • Utilization Review Nurse Supervisor II

    The County of Los Angeles (Los Angeles, CA)
    …AED) Programs. LICENSE(S) AND CERTIFICATE(S) REQUIRED: A current license to practice as a Registered Nurse issued by the California Board of Registered ... for certification of approved hospital days reimbursable under the Medicare and MediCal programs. Essential Job Functions + Plans,...in a state other than California must provide their Registered Nurse License Number from that state… more
    The County of Los Angeles (09/27/25)
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  • Clinic Staff Asst

    UnityPoint Health (Storm Lake, IA)
    …maintain current Iowa license as a Certified Medical Assistant (AAMA) or Licensed Practical Nurse or Registered Nurse . + Mandatory Reporter certification or ... Health Center - Storm Lake Care Clinical Care Attendant: RN , LPN, or CMA FTE: .9 (Full-time, 36 hours...compliance requirements for federally funded healthcare programs (eg Medicare and Medicaid) regarding fraud, waste and abuse. Brings… more
    UnityPoint Health (09/04/25)
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