UNKNOWN

FEED

The Clinical Claim Review RN will be responsible for performing compliance reviews of medical and administrative documentation to identify instances of healthcare fraud and/or wasteful and abusive conduct by health care providers who submit claims for payment. Preferred Qualifications: Clinical or administrative experience in long term care, for example, nursing facility care delivery/administration and/or community-based LTC service programs like Home Health.

HOUR

UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions worldwide. We are comprised of two distinct and complementary businesses, UnitedHealthcare and Optum, working to build a better health system for all. Here, your contributions matter as they will help transform health care for years to come. Make an impact with a diverse team that shares your passion for helping others.

What we do

Gain insights on how we work to help people live healthier lives and help make the health system work better for everyone by watching this video.

<a href="https://www.youtube.com/watch?v=5PbNyi2IDkY">https://www.youtube.com/watch?v=5PbNyi2IDkY</a> 

Caring. Connecting. Growing together. 

Being a part of UnitedHealth Group means working to improve health outcomes for everyone, including yourself. Here is how:

• Caring. Your total health and well-being are important to us. Whatever matters most to you — we have resources to help you be your best at work and at home. The benefits range from free Peloton courses to financial counseling. <a href="https://careers.unitedhealthgroup.com/culture/what-we-offer/">Learn more about what we offer.</a> 

• Connecting. We recognize our collective power to make an impact across our communities because we believe the health of any society is measured by the overall health of its people. <a href="https://careers.unitedhealthgroup.com/culture/">Learn more about our culture.</a> 

• Growing together. UnitedHealth Group is full of inspiring career stories, and we offer a lifetime of opportunities. <a href="https://careers.unitedhealthgroup.com/career-areas/">Discover all the ways you can learn, grow and develop.</a>

UnitedHealth Group Inc

Clinical Claim Review RN

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Positions in this function investigates Optum Waste and Error stopped claims by gathering information, researching state and federal guidelines, and following internal procedure to determine the viability of the claim for further review in a production environment. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

RN Clinical Reviewer (CPC Medical Coding Academy) - San Juan, PR

ADAPTED_NOW

The ideal candidate should have knowledge of EMR, excel, and other data collection tools, work well in a team setting, recruit and enroll subjects in on-going clinical trials, coordinate history and physicals on clinical trial subjects, assist with continuing care of those subjects as well as maintain all regulatory and sponsor required documentation. The Clinical Research Nurse will also assist physicians in obtaining and recording research data in conjunction with physicians and other professionals on the research team; interview subjects; enroll study subjects; review medical records; document research related findings and data in research forms and EMR.

YEAR

University of Florida

Clinical Research Nurse - Lead Gator MOMitor

Minimum of three (3) years of prospective utilization management experience making medical necessity determinations (prior authorization, pre-service review or precertification) at a health plan, utilization management organization, or specialty or radiology benefit manager. Monitors case inventory, queues and turnaround times throughout the day, and adjusts the nurse assignment tool based on staffing, proficiency, request type and volume so client service levels and regulatory turnaround times are met.

WNS (Holdings) Ltd

Nurse Team Lead - Clin Rev

Department Information: Performing an average of 7,000 cases each year, the Operating Room at SMJH has 8 OR suites and offers a variety of service lines including; Complex GYN, Neurosurgery, Vascular/Thoracic and Orthopedic surgery. Since its founding more than 100 years ago, Sentara Martha Jefferson has constantly evolved to meet the diverse healthcare needs of the patients who trust us with their care.

Sentara Healthcare employees strive to make our communities healthier places to live, and we're setting the standard for medical excellence within a vibrant, creative, and highly productive workplace. Sentara hospitals, programs, and employees are consistently recognized for innovation, clinical achievements, and overall excellence.

Sentara Healthcare Inc

Service Line Coordinator (RN Unit Coordinator) Main Operating Room

NCH is transforming into an Advanced Community Healthcare System(TM) and we're proud to: Provide higher acuity care and Centers of Excellence; Offer Graduate Medical Education and fellowships; Have endowed chairs; Conduct research and participate in national clinical trials; and partner with other health market leaders, like Hospital for Special Surgery, Encompass, and ProScan. This position manages the research related care of these patients, assists in project initiation, facilitates patient enrollment, encourages patient retention in trials, reports to sponsors on progress/status, and coordinates study participation with other clinical care plans.

NCH Healthcare System Inc

RN Research

Obtain and record research data in conjunction with physicians and other professionals on the research team; enroll study subjects, interview subjects; review medical records; assist in planning nursing aspects of medical team research; complete data collection tools. Job Description: The Clinical Research Nurse will be responsible for, responding to patient alerts, assessing patient symptoms, following clinical protocols, documenting findings, plan, outcome in EMR and data collection tools.

Lead Gator MOMitor

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Strong verbal and written communication skills are important in this position, as these trainers not only create and edit written training material, but also interface with existing nurses at all levels to ascertain their training. The goal of this process is to ensure that the triage program has adequate substance to determine whether existing nurses are adequately meeting job requirements and to equip all potential new nurses with the information and experience necessary to fulfill their new roles.

CorVel is a leader of risk and healthcare management solutions to employers, third party administrators, insurance companies and government agencies. We are publicly traded (NASDAQ:CRVL) and annual revenues exceeded $493 million in FY2015. Our continued customer growth is a testament to our financial stability and our significant investments in new systems and technologies allows us to continue to deliver industry-leading solutions to the marketplace. CorVel has approximately 3,500 associates who serve more than 2,000 customers through a national branch office network covering all 50 states.

CorVel Corp

Nurse Trainer

We implement the Newark Opportunity Youth Network (NOYN) school model, supporting the unique academic and non-academic needs of students who have disengaged from traditional schooling. dentist, non-certified nurses, optometrist), members of the staff, parents and community health professionals to ensure a healthy school climate and to minimize absence due to illness.

LEAD Charter School

Part-Time School Nurse

Works in cooperation with the school physician, other school health professionals (i.e. dentist, non-certified nurses, optometrist, nurse practitioners), members of the staff, parents and community health professionals to ensure a healthy school climate and to minimize absence due to illness. Schedules and supervises health surveys of students and staff, Assists the school physician and nurse practitioner with physical examinations, makes referrals, and conducts follow-up activities as necessary.

Long Branch High School

Substitute School Nurse (2026 - 2027 School Year)

As the face of the Shearwater Domestic Clinical Education and Quality program, you will be responsible for designing, delivering, evaluating, and continuously improving training programs while also evaluating the quality, accuracy, compliance, and effectiveness of care management activities. As the founder of the nation’s first Clinical Process Outsourcing (CPO®) model and a Great Place to Work®-certified company, we help the world’s top healthcare organizations work smarter – scaling their teams, strengthening care, and solving real problems every day.

Shearwater Health

RN Clinical Quality & Education Specialist

Working closely with Quality Auditors, Educators, and local leadership, the Resource Nurse identifies trends through chart audits and transforms those insights into meaningful improvements in practice, documentation, and regulatory compliance. At Day City Hospice, we are a locally operated, Ohio-based hospice provider committed to delivering compassionate, patient-centered end-of-life care.

Addus HomeCare Corp

Hospice Resource RN

Overview As an RN Clinic Supervisor, you will lead the daily operations of our on-site clinic, ensuring that participants receive high-quality care. This role involves coaching and mentoring a dynamic team while collaborating with other leaders to enhance workflows and participant experiences.

Health Talent Pro

RN Clinic Supervisor

Core Values: In the spirit of good Stewardship, we heal by practicing Justice in fostering right relationships to promote common good, Reverence in honoring the dignity of every person, Excellence in expecting the best of ourselves and others; Integrity in being faithful to who we say we are. Mission Statement: We, St Joseph's Health and Trinity Health, serve together in the spirit of the Gospel as a compassionate and transforming healing presence within our communities.

Trinity Health is one of the largest not-for-profit, faith-based health care systems in the nation. It is a family of 121,000 colleagues and nearly 36,500 physicians and clinicians caring for diverse communities across 27 states. Nationally recognized for care and experience, the Trinity Health system includes 101 hospitals, 126 continuing care locations, the second largest PACE program in the country, 136 urgent care locations and many other health and well-being services. In fiscal year 2023, the Livonia, Michigan-based health system invested $1.5 billion in its communities in the form of charity care and other community benefit programs.

Trinity Health

RN Performance Excellence Consultant

The Quality Assurance Nurse is responsible for case management quality assurance and mentorship of operations staff, providing tools and calibrating processes, while ensuring consistent delivery of CorVel's case management services. ABOUT CORVEL: CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries.

Quality Assurance Nurse

With the Hilltop Campus located in the heart of the historic Georgetown neighborhood, and the Capitol Campus, just minutes from the U.S. Capitol and U.S. Supreme Court, Georgetown University offers rigorous academic programs, a global perspective, and unparalleled opportunities to engage with Washington, D.C. Our community is a close-knit group of remarkable individuals driven by intellectual inquiry, a commitment to social justice, and a shared dedication to making a difference in the world. Lombardi Clinical Trials Office team members: Clinical Research Nurses, Clinical Research Coordinators, Data Coordinators, Regulatory Coordinators, Laboratory and Tissue Technicians.

Georgetown University

Clinical Research Nurse 1

Clinical Research Nurse I

FULL_TIME

Participates in the continuous systematic monitoring of all MedStar Family Choice participating provider processes and outcomes; directs problem focused studies; implements and maintains department objectives to ensure compliance of NCQA accreditation Federal/State regulations licensing or reviewing agency requirements; liaison for Quality Improvement Committees. The ideal candidate should be a critical thinker with practical experience in patient care public health quality improvement and the assessment of quality improvement initiatives as well as writing for diverse audiences and can independently assess which data management and statistical strategies when needed to optimally report outcomes.

MedStar Health

RN Quality Improvement Coordinator

[AW]-iCims

Strong command of IRF coverage and documentation requirements: IRF PPS, qualifying conditions under the 60%/75% compliance rule, pre-admission screening, IRF-PAI completion timelines, 3-hour therapy rule and exceptions, interdisciplinary team conference documentation, FIM scoring context, and CMG assignment. Translate complex clinical, regulatory, and payer-specific requirements into clear, audit-ready training content appropriate for the intended audience — including IPF PPS, IRF PPS, DSM-5 diagnostic criteria, level of care distinctions, and facility-specific billing rules, and other relevant training.

Machinify

Training Specialist, Medical Review Audit – Clinical RN

4. Assist nursing management with the coordination, management, and review of nurse’s notes to determine if the care plan is being followed. 2. Assist with the development of comprehensive care plans for Guests in coordination with the MDS that accurately addresses the needs of the Guest.

<h4>Overview</h4>
We specialize in providing the healthcare community with contract, temp-to-perm and direct hire staffing solutions. We invite you to discover what makes Cure Healthcare Staffing different – our consultative approach! Our team has a strong background in healthcare with over 25 years of experience. We have a passion for people and developing strong, long lasting relationship with both clients and employees. We look forward to partnering with you to earn your business and help CURE your healthcare staffing needs.

Nurse Auditor Jobs in the United States

Clinical Claim Review RN UnitedHealth Group Inc

RN Clinical Reviewer (CPC Medical Coding Academy) - San Juan, PR UnitedHealth Group Inc

Clinical Research Nurse - Lead Gator MOMitor University of Florida

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Service Line Coordinator (RN Unit Coordinator) Main Operating Room Sentara Healthcare Inc

RN Research NCH Healthcare System Inc

Clinical Research Nurse - Lead Gator MOMitor Lead Gator MOMitor

Nurse Trainer CorVel Corp

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RN Clinical Quality & Education Specialist Shearwater Health

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RN Performance Excellence Consultant Trinity Health

Quality Assurance Nurse CorVel Corp

Clinical Research Nurse 1 Georgetown University

Clinical Research Nurse I Georgetown University

RN Quality Improvement Coordinator MedStar Health

Training Specialist, Medical Review Audit – Clinical RN Machinify

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