28 results
FiltersThe Quality Care Manager is responsible for reviewing patient assessments to ensure appropriate and effective care is provided to each patient in compliance with agency policies, procedures, and regulatory requirements. Trends or patterns of inaccuracy identified by the QCM will be communicated to the Quality Director to assist in the development of the performance improvement and education plan.
Are you a Utilization Review Nurse who loves making a real impact from the comfort of your home? This position requires a master-level critical thinker and problem-solver to join a collaborative remote team; experience with Cerner, InterQual, and Xsolis programs is required. If you're eager to leverage your expertise, work autonomously, and be part of a supportive, 100% remote team dedicated to quality patient outcomes, apply now!
As a Clinical Coordinator (CC) at Midi, you’ll split your time between direct clinical RN duties and team coordination to support efficient and safe clinical workflows. You’ll be the go-to for RN onboarding, coaching, daily staffing flow, clinical escalations, and quality assurance. This is a great fit for a nurse who loves blending patient care with operational leadership in a virtual-first environment.
The Lead RN Reviewer in Service Operations position is a crucial role, responsible for coaching, mentoring, evaluating and developing the RN team. You will use operational tools to ensure all RN staff are meeting performance metrics and quality standards. As a Lead RN Reviewer, you will work closely with the leadership team and provide supervision to meet operational objectives.
The UM Nurse Specialist conducts clinical reviews to ensure that services provided to members meet clinical criteria and are delivered in appropriate settings. Using clinical expertise, coordinates, documents, and communicates all aspects of utilization and benefit management, handling both prospective (pre-service and concurrent) and retrospective care reviews. They assist providers and members in coordinating care with in-plan providers and preferred out-of-plan providers.
Leads a team of clinical staff responsible for delivering high-quality, efficient, and patient-centered virtual imaging support. This role blends operational oversight, people leadership, and clinical expertise to ensure the team meets performance, quality, and service standards aligned with Included Health’s values. As part of a broader care coordination function, the team manages internal and external referrals for specialty and imaging orders.
Registered Nurse (RN) needed to join the Medical Review team. This role involves conducting pre- and post-payment medical reviews to ensure compliance with established clinical criteria and guidelines. The ideal candidate will use their clinical expertise to assess medical necessity, appropriateness, and reimbursement eligibility while documenting decisions in accordance with regulatory and organizational requirements.
You will virtually visit with members within Wyoming and conduct a virtual health risk assessment including an evaluation of past medical history, review of systems, medication reconciliation, and a wellness exam. This evidence-based practice screening will include point-of-care testing (as appropriate), the identification of diagnoses to be used in care management and active medical management in the furtherance of treatment. You will formulate a list of current and past medical conditions using clinical knowledge and judgment.