Home Health Nursing Jobs

Position Summary Maintaining the enterprise or market accreditation readiness plan. Coordinating the NCQA Steering Committee and its relationship to QMC, QMOC, and other oversight bodies. Maintaining committee calendars, charters, membership, agendas, minutes, action plans,…

Position Summary Collaborates with the plan sponsor implementation team regularly. Gather and analyze client requirements, alongside the plan sponsor implementation team. Assists in developing implementation plans, alongside the plan sponsor implementation team. Works with…

Position Summary This position is responsible for developing and maintaining databases, data sources, and analytical tools used to support and inform Actuarial, Finance and Medical Economics. Commercial, Medicare. Looking for driven, high-performance colleague to join our team.…

Position Summary The Senior Customer Service Representative serve as a primary point of contact for members, patients, providers, and third-party administrator (TPA) clients. Responsible for handling inbound and outbound calls, responding to email inquiries, providing claim…

Join a team of architects driving the modernization of CVS Health’s enterprise customer communications ecosystem. This role will help define and enable the platforms that support high-volume outbound communications across CVS Health businesses, connecting marketing, customer…

Position Summary Review, research, and adjust complex Reinsurance/Stoploss medical claims, splitting claims into multiple claim statuses; adjudicates high-dollar complex, sensitive, and/or specialized medical claims in accordance with claim processing guidelines. Collaborate and…

Position Summary : This is an individual contributor role. The Contract Manager serves as the subject matter expert in support of contracting initiatives and data audits to enhance provider networks while meeting and exceeding accessibility, compliance, quality, and financial…

Utilization Management Nurse Consultant (RN) Remote | Prior Authorization | Utilization Management Are you an experienced RN with utilization management or prior authorization experience looking to make an impact beyond bedside care? Join our team and help ensure members receive…

Position Summary This Case Manager RN position is 100% remote, and the employee can live in any state. No travel is expected with this position. Normal Working Hours: Monday- Friday between 8:00am – 5:00pm in time zone of residence with rotational coverage of evenings, weekends,…

Case Manager RN (100% Remote – Nationwide) Full‑Time | Work from Anywhere Nationwide | No Travel Required We’re seeking a compassionate and results‑driven Case Manager RN to support members through personalized, high‑quality care coordination. In this fully remote role, you’ll…

Position Summary This position supports the daily processing of appeals in the Commercial Member Clinical Appeals (CMCA). Job functions include but not limited to, completing appeals determination letters, intake and launching of expedited requests, verbal expedited…

Position Summary The Senior Software Development Engineer is responsible for leading the design, development, and implementation of innovative digital solutions that power exceptional member experiences. In this role, you will leverage advanced technical expertise to architect…

We are seeking an experienced and highly motivated Senior Manager, Business Controls & Governance to support the Service Operations Compliance organization by strengthening and overseeing the business control environment, leading governance activities, and partnering with…

Position Summary This is a remote work from home role anywhere in the US with virtual training. American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease…

This is a full-time, 40-hour/week position with a shift time from 2:30p - 11p. Ideal candidates will hold a current, unrestricted license in CT, GA, NC, ND, NJ, NY, PA, SC, SD, VA, WI, WV. If hired, candidates must be willing and able to obtain additional licensure as needed.…