Job Closed

This listing is no longer active.

Gravie logo
Gravie

We partner with brokers across the nation to improve the way people purchase and access healthcare.

Care Navigation Nurse

Medical ReviewerMedical ReviewerOtherRemoteMid LevelTeam 51-200H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

100 days ago

Salary

$11.8K - $71.4K / year

Seniority

Mid Level

No structured requirement data.

Job Description

Care Navigation Nurse

Gravie

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description We are seeking an experienced Care Navigation RN to provide direct, patient-centered support to our members. In this role, you will be the primary point of contact for members navigating complex health journeys. You will utilize your clinical expertise to improve health outcomes, reduce barriers to care, reduce costs, and provide compassionate advocacy within a high-performance, virtual environment. - Deliver coordinated, patient-centered virtual Care Navigation by telephone and digital channels to improve member health outcomes and satisfaction. - Lead proactive outreach efforts to identify high-risk individuals; complete comprehensive clinical assessments and develop tailored care plans for enrolled members. - Utilize the Nursing Process and a holistic "whole person" approach—including pharmacy interventions, crisis support, and disease-specific education—to support members. - Assist members in navigating the complexities of the healthcare system, providing education and empowerment to help them meet their healthcare goals. - Provide longitudinal Care Navigation during acute episodes, such as hospitalizations and rehabilitation stays, supporting both the member and their family through the transition of care. - Identify clinical or social barriers to health and provide targeted interventions, connecting members to relevant health benefit resources and social determinants of health (SDOH) support. - Work alongside other stakeholders and partners on co-managed cases and collaborate with internal teams to resolve complex benefit and claims questions. - Build supportive, trusting relationships through passionate follow-up care and consistent advocacy. - Maintain strict compliance with all regulatory, accreditation, and internal policy standards. - Demonstrate an understanding of the functions of other departments, communicate with other departments appropriately and maintain positive working relationships. Qualifications - Active RN license in a compact state with the ability to obtain licensure in other states as needed. - 2+ years of experience in case management for a health plan or TPA and 2+ years of experience in a hospital or clinical setting. - Experience across multiple specialties, including med/surg, oncology, behavioral health, maternity, critical care/emergency, pediatrics, or community care. - Strong competence in using multiple computer/medical record systems (EMRs), preferably Salesforce, and Google Workspace. - Ability to talk, type, and navigate an electronic chart simultaneously in a remote setting. - Proven ability to prioritize assignments, manage a busy caseload, and meet daily goals independently. - Experience in telephonic care management with no direct/face-to-face patient contact. - A drive for identifying and implementing clinical best practices. Requirements - Knowledge of Managed Care Programs. - Knowledge or certification in Motivational Interviewing. - Case Manager Certification. Benefits - Great overall employee experience with opportunities for career growth. - Meaningful mission-driven work. - Above average total rewards package. - Salary range for this position is $71,400 - $118,000 annually. - Numerous factors including education, skills, work experience, certifications, etc. will be considered when determining compensation. - Alternative medicine coverage. - Generous PTO. - Up to 16 weeks paid parental leave. - Paid holidays. - 401k program. - Transportation perks. - Education reimbursement. - Paid paw-ternity leave.

Job Requirements

  • Active RN license in a compact state with the ability to obtain licensure in other states as needed.
  • 2+ years of experience in case management for a health plan or TPA and 2+ years of experience in a hospital or clinical setting.
  • Experience across multiple specialties, including med/surg, oncology, behavioral health, maternity, critical care/emergency, pediatrics, or community care.
  • Strong competence in using multiple computer/medical record systems (EMRs), preferably Salesforce, and Google Workspace.
  • Ability to talk, type, and navigate an electronic chart simultaneously in a remote setting.
  • Proven ability to prioritize assignments, manage a busy caseload, and meet daily goals independently.
  • Experience in telephonic care management with no direct/face-to-face patient contact.
  • A drive for identifying and implementing clinical best practices.
  • Knowledge of Managed Care Programs.
  • Knowledge or certification in Motivational Interviewing.
  • Case Manager Certification.

Benefits

  • Great overall employee experience with opportunities for career growth.
  • Meaningful mission-driven work.
  • Above average total rewards package.
  • Salary range for this position is $71,400 - $118,000 annually.
  • Numerous factors including education, skills, work experience, certifications, etc. will be considered when determining compensation.
  • Alternative medicine coverage.
  • Generous PTO.
  • Up to 16 weeks paid parental leave.
  • Paid holidays.
  • 401k program.
  • Transportation perks.
  • Education reimbursement.
  • Paid paw-ternity leave.

Related Categories

Related Job Pages

More Medical Reviewer Jobs

Dane Street logo

Medical Advisory Reviewer - Board-Certified Dermatologist (New Jersey)

Dane Street

National Provider of IME and Medical Peer Review Services

Medical Reviewer100 days ago
OtherRemoteTeam 51-200H1B No Sponsor

Description Dermatologist – Independent Clinical Reviewer (New Jersey License Required) Dane Street is seeking experienced Dermatologists licensed in New Jersey to join our growing team of expert clinical reviewers. In this role, you will apply your dermatology expertise to conduct comprehensive reviews of clinical cases and provide objective, evidence-based opinions related to dermatologic conditions, treatments, and procedures. This is a remote telework opportunity that allows you to customize your schedule while working as a 1099 independent contractor. Your primary responsibilities will include reviewing medical records, preparing clear and concise clinical summaries, and responding to specific questions from our clients regarding dermatologic diagnoses, treatment plans, procedures, and medical necessity. Join a team that values your clinical judgment and commitment to improving the quality, accuracy, and consistency of healthcare assessments. Your expertise plays a vital role in supporting high-quality, defensible clinical determinations. Requirements - Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) - Board Certified or Board Eligible in Dermatology - Current, unrestricted New Jersey medical license - Minimum of 5+ years of clinical dermatology experience - Strong understanding of medical, surgical, and cosmetic dermatologic conditions and treatments - Ability to attend required orientation and training sessions - Maintain appropriate credentialing, state licensure, and any certifications required to perform the role Benefits - Independent consultant role offering schedule flexibility and predictable work hours - Ability to choose case types and workload based on your availability - No doctor–patient relationship established; no treatment is provided — all reviews are advisory only - Streamlined case flow through a user-friendly online work portal - Dane Street manages administrative processes, medical record organization, and communications - Fully prepared cases with organized medical records and applicable clinical guidelines - Initial training and ongoing support, including a dedicated point of contact

New Jersey
Job Closed
Dane Street, LLC logo

Medical Advisory Reviewer - Board-Certified Dermatologist

Dane Street, LLC

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers’ Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

Medical Reviewer100 days ago

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Dane Street is seeking experienced Dermatologists licensed in New Jersey to join our growing team of expert clinical reviewers. In this role, you will apply your dermatology expertise to conduct comprehensive reviews of clinical cases and provide objective, evidence-based opinions related to dermatologic conditions, treatments, and procedures. This is a remote telework opportunity that allows you to customize your schedule while working as a 1099 independent contractor. Your primary responsibilities will include: - Reviewing medical records - Preparing clear and concise clinical summaries - Responding to specific questions from our clients regarding dermatologic diagnoses, treatment plans, procedures, and medical necessity Join a team that values your clinical judgment and commitment to improving the quality, accuracy, and consistency of healthcare assessments. Your expertise plays a vital role in supporting high-quality, defensible clinical determinations. Qualifications - Doctor of Medicine (MD) or Doctor of Osteopathic Medicine (DO) - Board Certified or Board Eligible in Dermatology - Current, unrestricted New Jersey medical license - Minimum of 5+ years of clinical dermatology experience - Strong understanding of medical, surgical, and cosmetic dermatologic conditions and treatments - Ability to attend required orientation and training sessions - Maintain appropriate credentialing, state licensure, and any certifications required to perform the role Benefits - Independent consultant role offering schedule flexibility and predictable work hours - Ability to choose case types and workload based on your availability - No doctor–patient relationship established; no treatment is provided — all reviews are advisory only - Streamlined case flow through a user-friendly online work portal - Dane Street manages administrative processes, medical record organization, and communications - Fully prepared cases with organized medical records and applicable clinical guidelines - Initial training and ongoing support, including a dedicated point of contact

United States
Job Closed

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description Impact Recruiting Solutions is currently seeking a Registered Dietitian Health Care Facility Surveyor to fill an opening with a Quality Improvement Consulting Company. This role will work in a technically exciting environment supporting internal and external customers nationwide. Qualifications - Must have an Associate or Bachelor’s degree in Dietetics. - Must have successfully completed CMS’s Long-Term Care Basic Training and passed the Surveyor Minimum Qualifications Test (SMQT). - Must have at least two (2) years of recent experience working as a surveyor accrediting or certifying facilities that serve the residents of long-term care facilities. - Must maintain current licensure to practice as a Registered Dietitian. Requirements - Demonstrated history of independent decision-making skills to direct and effectively manage the survey process. - Ability to set priorities independently and collectively in performing survey tasks. - Ability to openly discuss conflicts/controversy, and to seek assistance when appropriate to make decisions and resolve conflicts. - U.S. Citizenship is required for this position. - Ability to travel up to 75% of the time on a regular basis is required. Benefits - The salary for this position is competitive and negotiable. - This is a Full-time position (Monday - Friday). - Flexible paid vacation days. - Paid holidays. - Company-issued and company-paid Amex card for travel. - All travel expenses paid directly by the company. - Airline and hotel points accumulate for employee's personal use. - Employee discounts. - Employee retirement plan (401k) with a generous match and immediate vesting. - Company-paid tax-free Health Savings Account (HSA). - Health insurance. - Dental insurance. - Vision insurance. - Company-paid life insurance. - Company-paid disability insurance. - Extensive training opportunity. - Predictable work schedule.

United States
Job Closed
Activate Talent logo

Medical Records & Demand Specialist

Activate Talent

We are a dynamic company focused on leveraging data to drive business insights and improve performance across retail and eCommerce channels.

Medical Reviewer101 days ago

Role Description We are seeking a detail-oriented Medical Records & Demand Specialist to support personal injury case preparation by managing medical documentation, organizing treatment records, and assisting with settlement demand packages. This role plays a critical part in helping attorneys and case managers build strong cases by ensuring medical records, bills, and supporting documentation are accurately compiled and organized. The ideal candidate is highly organized, comfortable working with medical documentation, and experienced in preparing structured case files that support settlement negotiations. - Request and track medical records and billing statements from healthcare providers - Maintain organized documentation of medical records, bills, and related case materials - Build and maintain treatment timelines for personal injury cases - Review medical documentation to ensure completeness and accuracy - Assist in preparing settlement demand packages for attorneys - Calculate damages, medical expenses, and supporting financial documentation - Maintain accurate records of case-related expenses and supporting evidence - Coordinate with attorneys and case managers to ensure case files are complete and organized Qualifications - Prior experience supporting personal injury cases or legal case documentation - Bilingual proficiency in English and Spanish - Familiarity with requesting and organizing medical records and medical billing documents - Strong attention to detail and ability to organize large volumes of documentation - Excellent organizational and file management skills - Ability to handle confidential medical and legal information responsibly - Strong written communication skills and ability to follow structured processes - Experience preparing or assisting with personal injury demand packages preferred - Familiarity with treatment timelines, medical summaries, and damage calculations preferred - Experience working with case management systems used by law firms preferred

Philippines
Job Closed