52 nurse jobs found

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Clinical Appeals Nurse completes research, basic analysis, and evaluation of member and provider disputes regarding adverse and adverse coverage decisions. The Clinical Appeals Nurse utilizes clinical skills and knowledge of all applicable State and Federal rules and regulations that govern the appeal process for Commercial and lines of business in order to formulate a professional response to the appeal request. We are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. ESSENTIAL FUNCTIONS: Investigates, interprets, and analyzes written appeals and reconsideration requests from multiple sources including applicants, subscribers, attorneys, group administrators, internal stake holders and any other...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: To support the prevention, reduction of and/or recuperation of losses to CareFirst through the clinical review of medical records and claims, resulting in the savings and/or recovery of funds. Responsible for providing clinical knowledge to the SI team to support both prepayment reviews and/or post-payment investigations. ESSENTIAL FUNCTIONS: Review of medical records and claims. Investigate potential fraud and over-utilization by performing complex medical reviews of claims and medical records. The claims may be in a pre or post payment environment. Provide a detailed but concise analysis to communicate findings about the ability to pay or deny a claim or claim lines using clinical and/or coding, billing, or reimbursement knowledge. Maintain appropriate records and supporting documentation regarding findings in accordance with departmental standards. Process all assigned claims or batch case reviews...

STRATEGIC STAFFING SOLUTIONS (S3) HAS AN OPENING! Strategic Staffing Solutions is currently looking for an RN Case Manager for a contract opportunity with one of our largest clients located in Detroit, MI! Title: RN Case Manager Location: Detroit, MI (Remote however must be local to Michigan) Duration: 12+ Months W2 Schedule: Monday - Friday 8-5 Pay Rate: up to $41/HR Role Summary The Case Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person centric care management program to a diverse health plan population with a variety of health and social needs. They serve as the single point of contact for members, caregivers, and providers using a variety of communication channels including phone calls, emails, text messages and the online messaging platform. The Case Manager RN uses the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the member's health across...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: We are looking for an RN with significant clinical educator experience to work in a hybrid role from within the greater Baltimore/ Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, trainings, provide training support for Care Management employees and/or other business-related activities. This role provides relevant new hire and supportive ongoing training/professional development which create and maintain a motivated, skilled and effective team through which organizational goals are achieved. In this position, the incumbent will be supporting all market segments of the Care Management Department providing training for Care Management employees related to new technology and documentation with our Guiding Care platform, the Care Management process, and interventions to drive outcomes for our members. Demonstrated experience with...

Alkermes, Inc. In February 2026, Alkermes completed the acquisition of Avadel Pharmaceuticals plc. This acquisition added an approved product in the sleep medicine market. Territory Business Manager (TBM) will report directly to the Regional Business Director (RBD). Will be responsible for selling Alkermes products in the Atlanta South territory and supporting promotional efforts on our products approved to treat certain sleep disorders. Ideal candidates should be proven sales achievers and live in the territory. This will be done by having thorough product, disease state and market knowledge and sound selling skills. He/she will utilize available resources to help educate healthcare providers. Finally, he/she will use their analytical ability to determine appropriate targets and will use approved resources accordingly. Responsibilities ESSENTIAL AREAS OF RESPONSIBILITY: * The TBM will demonstrate a strong understanding of all aspects of Alkermes products, related disease...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: a { text-decoration: none; color: #464feb;}tr th, tr td { border: 1px solid #e6e6e6;}tr th { background-color: #f5f5f5;} This role supports the Dual Special Needs Population (DSNP) in Maryland. Under minimal supervision, the Care Manager conducts thorough research and analysis of members medical and behavioral health needs, along with the key drivers influencing healthcare utilization and costs. The Care Manager partners closely with members and the interdisciplinary care team to develop and implement person-centered plans of care that promote a positive member experience, improved health outcomes, and costeffective service delivery. We are seeking a bilingual Care Manager to enhance communication, cultural responsiveness, and engagement with our diverse DSNP member population. This position is remote, with the expectation that the selected candidate resides within the greater Baltimore metropolitan area....

Alkermes, Inc. In February 2026, Alkermes completed the acquisition of Avadel Pharmaceuticals plc. This acquisition added an approved product in the sleep medicine market. Territory Business Manager (TBM) will report directly to the Regional Business Director (RBD). Will be responsible for selling Alkermes products in the Utah territory and supporting promotional efforts on our products approved to treat certain sleep disorders. Ideal candidates should be proven sales achievers and live in the territory. This will be done by having thorough product, disease state and market knowledge and sound selling skills. He/she will utilize available resources to help educate healthcare providers. Finally, he/she will use their analytical ability to determine appropriate targets and will use approved resources accordingly. Responsibilities ESSENTIAL AREAS OF RESPONSIBILITY: * The TBM will demonstrate a strong understanding of all aspects of Alkermes products, related disease states...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Onsite Clinical Navigator (RN) embedded at a partnering hospital will conduct concurrent review of inpatient level of care, managing the timely and smooth transition from inpatient care to home or other levels of care. Utilizing experience and skills in both care management and utilization management, the Onsite Clinical Navigator will leverage proficiency in established MCG, in addition to administrative/regulatory considerations, to determine medical necessity, appropriate level(s) of care and case management to engage members/enrollees, their families and other support systems in discharge planning. The role will function as a liaison working onsite at the assigned hospital up to 5 days per week and occasional weekend work may also be required, both at management's sole discretion. Such work will be conducted with the hospital care team including case managers, social workers and discharge planners...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: We are looking for an experienced professional to live and work remotely from within the greater Baltimore/Washington metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. Under minimal supervision, the Care Manager researches and analyzes a member's medical and behavioral health needs and healthcare cost drivers. The Care Manager works closely with members and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to optimal health and cost-effective outcomes. ESSENTIAL FUNCTIONS: Identifies members with acute/complex medical and/or behavioral health conditions. Engages telephonically with member, family, and providers to develop a comprehensive plan of care to address the members needs at various stages along the care continuum....

We Are Teva We’re Teva, a leading innovative biopharmaceutical company, enabled by a world-class generics business. Whether it’s innovating in the fields of neuroscience and immunology or delivering high-quality medicine worldwide, we’re dedicated to addressing patients’ needs now and in the future. Here, you will be part of a high-performing, inclusive culture that values fresh thinking and collaboration. You'll have the room to grow, the flexibility to balance life with work, and the opportunity to better health worldwide, together. The opportunity Job Summary: The Clinical Research Coordinator Floater is a primary point of contact for study participants, the Primary Investigator (PI), the Clinical Study Manager (CSM), and Department Managers in all study conduct and/or participant-related matters on the clinical research unit floor. Essential Functions Performs conduct procedures in strict compliance to the study protocol, Good Clinical Practice standards,...

CareFirst BlueCross BlueShield Resp & Qualifications (Maryland-DC-Northern VA) PURPOSE: Under minimal supervision, the Care Manager researches and analyzes a member's medical and behavioral health needs and healthcare cost drivers. The Care Manager works closely with members and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to optimal health and cost-effective outcomes. We are looking for an experienced professional to work remotely from within the greater Baltimore/Washington DC metropolitan areas. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. ESSENTIAL FUNCTIONS: Identifies members with acute/complex medical and/or behavioral health conditions. Engages onsite and/or telephonically with member, family and providers to develop a comprehensive plan of care to address the members needs at...

Alkermes, Inc. In February 2026, Alkermes completed the acquisition of Avadel Pharmaceuticals plc. This acquisition added an approved product in the sleep medicine market. Territory Business Manager (TBM) will report directly to the Regional Business Director (RBD). Will be responsible for selling Alkermes products in the San Francisco territory and supporting promotional efforts on our products approved to treat certain sleep disorders. Ideal candidates should be proven sales achievers and live in the territory. This will be done by having thorough product, disease state and market knowledge and sound selling skills. He/she will utilize available resources to help educate healthcare providers. Finally, he/she will use their analytical ability to determine appropriate targets and will use approved resources accordingly. Responsibilities ESSENTIAL AREAS OF RESPONSIBILITY: The TBM will demonstrate a strong understanding of all aspects of Alkermes products, related disease...

Monterey Bay Aquarium At the Monterey Bay Aquarium, we are passionate about creating an inclusive workplace that celebrates and values diversity. We firmly believe that having a team of diverse backgrounds and voices, working together, increases our capacity to serve our visitors and fulfill our mission.We welcome people from all backgrounds into our team and strongly encourage people of color, LGBTQ+ individuals, veterans, and people with disabilities to apply. Priority deadline for applications is March 13, 2026. Due to the volume of incoming applications, the role may be closed earlier than March 13, 2026. Job Summary: Under general supervision, serve as a compassionate advocate and strategic partner in safeguarding the wellbeing of Monterey Bay Aquarium staff, volunteers, and guests. Combine technical expertise with genuine care for people, optimize and administer all EHS onboarding and program maintenance processes including the Workers' Compensation Program,...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Clinical Navigator (RN) conducts concurrent review of inpatient level of care, managing the timely and smooth transition from inpatient care to home or other levels of care. Utilizing experience and skills in both care management and utilization management, the Clinical Navigator will leverage proficiency in established MCG, in addition to administrative/regulatory considerations, to determine medical necessity, appropriate level(s) of care, and case management to engage members/enrollees, their families and other support systems in discharge planning. The role will function as a liaison working telephonically with the hospital care team including case managers, social workers and discharge planners to ensure CareFirst members/enrollees receive the appropriate level of care and partner to address any potential barriers to discharge. The candidate may be required to come to the CareFirst office location...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: The Onsite Clinical Navigator (RN) embedded at a partnering hospital will conduct concurrent review of inpatient level of care, managing the timely and smooth transition from inpatient care to home or other levels of care. Utilizing experience and skills in both care management and utilization management, the Onsite Clinical Navigator will leverage proficiency in established MCG, in addition to administrative/regulatory considerations, to determine medical necessity, appropriate level(s) of care and case management to engage members/enrollees, their families and other support systems in discharge planning. The role will function as a liaison working onsite at the assigned hospital up to 5 days per week and occasional weekend work may also be required, both at management's sole discretion. Such work will be conducted with the hospital care team including case managers, social workers and discharge planners...

CareFirst BlueCross BlueShield Resp & Qualifications PURPOSE: This role manages the appeal process for members and providers who appeal on behalf of members for Commercial lines of business. Ensures quality management of the clinical appeal process to reduce the risk of State and Federal Regulatory fines and sanctions, avoid adverse exposure, reiterate the expectation of a fair and compliant appeal process for our membership, and support NCQA accreditation and the Divisional Goals for Care Management. We are looking for an experienced clinical leader in the greater Baltimore metropolitan area who is willing and able to work in a hybrid model. The incumbent will be expected to work a portion of their week from home and a portion of their week at a CareFirst location based on business needs and work activities/deliverables that week. ESSENTIAL FUNCTIONS: Develops, establishes and implements a compliant appeal process with dynamic goals resulting in the full and...

NASCAR KANSAS SPEEDWAY Kansas Speedway, which opened in 2001, is located in the heart of the Midwest in Kansas City, Kansas. With easy access to major highways, along with the Hollywood Casino at Kansas Speedway, restaurants, shopping and other entertainment, Kansas Speedway has easily become a destination for fans. The track hosts two NASCAR Cup Series races, the NASCAR Xfinity Series, the NASCAR Gander RV and Outdoors Truck Series and the ARCA Menards Series. In addition to two race weekends, Kansas Speedway hosts over 200 event days each year. NASCAR is seeking talented event staff for Fire Rescue located at Kansas Speedway. The Fire Rescue workers provide immediate response to any emergency situation encountered at Kansas Speedway. Duties include but are not limited to: Responding to emergency situations at events. Fire suppression. Accident / incident stabilization. Patient assessment and/or patient care. Track cleanup and insuring the track is reopened as...

STRATEGIC STAFFING SOLUTIONS (S3) HAS AN OPENING! Strategic Staffing Solutions is currently looking for a Case Manager RN for one of our largest clients in Detroit, MI! Job Title: Case Manager RN Duration: 6 months Location: Detroit, MI Schedule: Remote (Must be local to Michigan) W2 pay rate: $38 hourly, no paid days off, no paid holidays. Medical coverage is available. 1-year contract with opportunity for extension and conversion 100% REMOTE Requires Current, active, and unrestricted Michigan Registered Nurse (RN) license. Even though the job is fully remote, the candidate must be licensed in the state of Michigan - not just any compact/multistate license unless it specifically includes Michigan. ENGAGEMENT DESCRIPTION: The Case Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person-centric care management program to a diverse health plan population with a variety of health and social needs. They serve as the single...

STRATEGIC STAFFING SOLUTIONS (S3) HAS AN OPENING! Strategic Staffing Solutions is currently looking for an RN Case Manager for a contract opportunity with one of our largest healthcare clients! Title: RN Case Manager - Compact License Duration: Long-term contract with opportunity to convert to FTE Location(s): Remote (Compact States) Pay Rate: $38-40/HR *100% remote - must reside in a state that is part of the Nurse Compact (multi-state-licensure) Accepted states: Colorado Georgia Indiana Kentucky Mississippi Virginia Washington State Louisiana Iowa Requirements: Must have diverse case management experience; hospice, hospital, home care, medical (acute care, ER, ICU, Med-surg, etc.). Case management experience Must have multi state compact license ROLE SUMMARY The Care Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person centric care management...