Audit & Reimbursement SeniorLocation: This is a virtual position; US based.National Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for Medicare and......
Nurse and CPC - Clinical Fraud Investigator II - SIU Fraud & AbuseLocation: This position will work a hybrid model (remote and office). The ideal candidate will live within 50......
Pharmacy Internal AuditorLocation: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.A proud member of the......
Nurse and CPC - Clinical Fraud Investigator II - SIU Fraud & AbuseLocation: This position will work a hybrid model (remote and office). The ideal candidate will live within 50......
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Location: This is a virtual role. The preferred candidate will live within 50 miles of one of our listed California Elevance Health PulsePoint locations.The Behavioral Health Case Manager 1 is......
***$5,000 Sign On Bonus***LTSS Service CoordinatorLocation: This is primarily a field based position. Candidate would need to reside in one of the following counties: Escambia, Broward, Volusia, Marion, Pinellas, Hillsbor...
Provider Contract Cost of Care Analyst Senior Location: This position will work a hybrid model (remote and in office one day per week). Ideal candidates will live within 50 miles of......
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Audit & Reimbursement SeniorLocation: This is a virtual position; US based.National Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for Medicare and......
JR139503 Genetic Counselor ReviewerThe genetic counselor reviewer (GCR) is responsible for authorization requests and determining their appropriateness per designated clinical guidelines, clinical policies, and client rul...
Location: This is a Virtual role , Must be located within 50 miles of a Pulse PointSchedule: 9:30am-6:00pm , Rotating weekend shifts.Responsible for conducting preauthorization, out of network and appropriateness......
Pharmacy Internal AuditorLocation: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.A proud member of the......
Location: This is a virtual role. The preferred candidate will live within 50 miles of one of our listed California Elevance Health PulsePoint locations.The Behavioral Health Case Manager 1 is......
Winston Salem, North Carolina
13 days
The Children and Families Specialty Plan is looking to hire a Director of Care Management to lead the care management team in Medicaid Regions 1 and 2 in the state of North......
Audit & Reimbursement SeniorLocation: This is a virtual position; US based.National Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for Medicare and......
Manchester, New Hampshire
13 days
Provider Contract/CofC Analyst Sr.Location: This position will work a hybrid model (remote and in-office, 1 - 2 days per week). Candidates must live within 50 miles of one of Elevance’s......
JR140167 Provider Relationship Account Manager (TPA)Carelon Behavioral Health, Inc. is enthusiastically supporting the launch of the Statewide School-Based Fee Schedule project by the Department of Health Care Services (D...
Nurse and CPC - Clinical Fraud Investigator II - SIU Fraud & AbuseLocation: This position will work a hybrid model (remote and office). The ideal candidate will live within 50......
Clinical Provider Auditor IISupports the Payment Integrity line of businessLocation: Alternate locations may be considered. This position will work in a hybrid model (remote and office). The ideal candidate will......
***$6,000 Sign On Bonus***LTSS Service Coordinator - ClinicianLocation: This is a field based position. Candidate would need to reside in one of the following counties: Lee, Sarasota, Hillsborough, Pinellas, Escambia, Duv...
Actuarial Director - Wellpoint GICPreferred Location: Woburn, MA. This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of our......
Audit & Reimbursement SeniorLocation: This is a virtual position; US based.National Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for Medicare and......
Be Part of an Extraordinary Team Medical Management Specialist ILocation: Remote, but candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.Shift: Part-Time Days,......
Location: This is a virtual role. The candidate will live within 50 miles of one of our Florida Elevance Health PulsePoint locations in Miami or Tampa Florida. Schedule: 12 noon- 8:30 pm......
Nurse and CPC - Clinical Fraud Investigator II - SIU Fraud & AbuseLocation: This position will work a hybrid model (remote and office). The ideal candidate will live within 50......
Provider Contract/CofC Analyst Sr.Location: This position will work a hybrid model (remote and in-office, 1 - 2 days per week). Candidates must live within 50 miles of one of Elevance’s......
Location: Field associates spend 4-5 days per week in-person with patients, members or providers in the following counties: Wayne, Fayette, Rush, Union, and Franklin counties.The Case Manager- LCSW/LSW/LMSW/LMHC/LMFT (als...
Centers Health Care is a member of the Elevance Health family of companies, serving as a premier network of skilled nursing, rehabilitation, and senior care services. Our goal is to......
Nurse and CPC - Clinical Fraud Investigator II - SIU Fraud & AbuseLocation: This position will work a hybrid model (remote and office). The ideal candidate will live within 50......
East Hartford, Connecticut
13 days
Bilingual Behavioral Health Care Coordinator***$1,500 Sign-On Bonus******Seeking a BH Care Coordinator in Connecticut with expertise in case management, human services, family and/or community resources.***Location : This...
Location: This position is located in the state of Kansas and must reside within 50 miles of our Topeka or Olathe PulsePoint.The Clinical Quality Program Specialist is responsible for supporting......
Audit & Reimbursement SeniorLocation: This is a virtual position; US based.National Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for Medicare and......
Be Part of an Extraordinary Team Medical Management Specialist ILocation: Remote, but candidates must reside within 50 miles or 1-hour commute each way of a relevant Elevance Health location.Shift: Part-Time Days,......
Title: Utilization Management Representative IILocation: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.The Utilization Management...
The Wellness & Recovery Specialist is responsible for care coordination activities focused on the Wellness and Recovery of members.Location: Remote. The ideal candidates will reside in the following states: Washington...
Pharmacy Internal AuditorLocation: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.A proud member of the......
Nurse and CPC - Clinical Fraud Investigator II - SIU Fraud & AbuseLocation: This position will work a hybrid model (remote and office). The ideal candidate will live within 50......
Location: This is a Virtual role , Must be located within 50 miles of a Pulse PointSchedule: 9:30am-6:00pm , Rotating weekend shifts.Responsible for conducting preauthorization, out of network and appropriateness......
Nurse and CPC - Clinical Fraud Investigator II - SIU Fraud & AbuseLocation: This position will work a hybrid model (remote and office). The ideal candidate will live within 50......
Senior Outreach Care SpecialistLocation : This is a community, field based position (3-5 days per week). We are seeking candidates that reside in the following counties in Indiana : Clark,......
Actuarial Director - Wellpoint GICPreferred Location: Woburn, MA. This position will work a hybrid model (remote and office). The Ideal candidate will live within 50 miles of one of our......
Clinical Provider Auditor IISupports the Payment Integrity line of businessLocation: Alternate locations may be considered. This position will work in a hybrid model (remote and office). The ideal candidate will......
Manchester, New Hampshire
13 days
Nurse and CPC - Clinical Fraud Investigator II - SIU Fraud & AbuseLocation: This position will work a hybrid model (remote and office). The ideal candidate will live within 50......
Bilingual Behavioral Health Care Coordinator***$1,500 Sign-On Bonus******Seeking a BH Care Coordinator in Connecticut with expertise in case management, human services, family and/or community resources.***Location : This...
***$5,000 Sign On Bonus***LTSS Service CoordinatorLocation: This is primarily a field based position. Candidate would need to reside in one of the following counties: Escambia, Broward, Volusia, Marion, Pinellas, Hillsbor...
Location: This position is located in the state of Kansas and must reside within 50 miles of our Topeka or Olathe PulsePoint.The Clinical Quality Program Specialist is responsible for supporting......
Carelon Medical Benefits Management is currently seeking a Board-Certified Surgeon (or other surgical subspecialties beyond general surgery) to participate in pre-authorization and quality improvement solutions for a wide...
Software Engineering ManagerLocation: This position will work a hybrid model (remote & office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint office locations.National......
Location: This position will work in a hybrid model (remote and office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations.The Strategic Sourcing......
Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health PulsePoint location.Schedule: First shift PST daytime hoursThe Behavioral Health Care Manager I is responsible for perfor...
Pharmacy Internal AuditorLocation: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.A proud member of the......
Location: This is a field position and the candidate should reside in Dallas, TX.The LTSS Service Coordinator - Clinician working under the direction/supervision of an RN, with overall responsibility for......
The Med Mgmt Nurse CA is responsible for review of the most complex or challenging cases that require nursing judgment, critical thinking, and holistic assessment of member’s clinical presentation to......
Provider Contract/CofC Analyst Sr.Location: This position will work a hybrid model (remote and in-office, 1 - 2 days per week). Candidates must live within 50 miles of one of Elevance’s......
Provider Relationship Account Manager, Community Engagement Louisiana Crisis HubLocation: This is a field-based position for the state of Louisiana. You must reside within the assigned coverage area within Louisiana.Regio...
***$5,000 Sign On Bonus***LTSS Service CoordinatorLocation: This is primarily a field based position. Candidate would need to reside in one of the following counties: Escambia, Broward, Volusia, Marion, Pinellas, Hillsbor...
Charleston, West Virginia
13 days
Nurse and CPC - Clinical Fraud Investigator II - SIU Fraud & AbuseLocation: This position will work a hybrid model (remote and office). The ideal candidate will live within 50......
Location: This is a field based position. Candidate would need to meet face to face with patients in and around Pottawattamie (and surrounding) Counties, IA. The LTSS Service Coordinator is responsible for conducting......
Location: This is a Virtual role , Must be located within 50 miles of a Pulse PointSchedule: 9:30am-6:00pm , Rotating weekend shifts.Responsible for conducting preauthorization, out of network and appropriateness......
Audit & Reimbursement SeniorLocation: This is a virtual position; US based.National Government Services is a proud member of Elevance Health's family of brands. We administer government contracts for Medicare and......
Manager II GBD Special Programs, LTSSLocation: This position is an Indiana field-based position. This role requires face to face interactions in the field – mileage reimbursed. (hospitals, clinics, members’ homes.)The.....
Title: Concierge Service AssociateLocation: This position will work an onsite model, where candidates will travel to client location in Normal, IL.The Concierge Service Associate will be responsible for assisting national...
LTSS Service CoordinatorLocation: This is a field based position. Candidate would need to meet face to face with patients in and around the following counties. Candidate will be assigned a territory......
LTSS Service Coordinator - RN Telehealth Location: While this position is fully remote, candidate must reside in the tri-state area (NY, NJ, or CT) and within 50 miles of a PulsePoint.The......
Diagnosis Related Group Clinical Validation Auditor-Registered Nurse Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.The....
HEDIS Compliance Audit Specialist / Manager (JR140903)Location: Alternate locations in addition to the posted locations may be considered. This position will work in a hybrid model (remote and office). The......
Location: Field associates spend 4-5 days per week in-person with patients, members or providers.The Case Manager- LCSW/LSW/LMSW/LMHC/LMFT (also called the LTSS Service Coordinator - Clinician) has overall responsibility ...
Diagnosis Related Group Clinical Validation Auditor-RN Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.The Diagnosis......
Staff VP & CIO, Carelon Advanced Primary & Palliative Care Location: Within 50 miles of a PulsePoint office preferably Costa Mesa, CA, Altanta, GA, Indianapolis, IN, or Grand Prairie, TX Summary The Staff......
Location: This is a Virtual role , Must be located within 50 miles of a Pulse PointSchedule: 9:30am-6:00pm , Rotating weekend shifts.Responsible for conducting preauthorization, out of network and appropriateness......
Field Advanced Practice ProviderLocation and position specific details: The successful hire will be a Missouri licensed NP and will provide in-home and virtual remote palliative care in the St.Louis, MO,......
Audit & Reimbursement LeadLocation: This is United States, virtual based position. National Government Services is a proud member of Elevance Health’s family of brands. We administer government contracts for Medicare...
Audit & Reimbursement LeadLocation: This is United States, virtual based position. National Government Services is a proud member of Elevance Health’s family of brands. We administer government contracts for Medicare...
Location: This is a field position and the candidate should reside in Houston, TX.The LTSS Service Coordinator - Clinician working under the direction/supervision of an RN, with overall responsibility for......
Audit & Reimbursement LeadLocation: This is United States, virtual based position. National Government Services is a proud member of Elevance Health’s family of brands. We administer government contracts for Medicare...
Location: This is a virtual position , must be located within 50 miles of the nearest pulse point.Schedule : Monday-Friday 9:30am-6:00pm PSTResponsible for the review of medical records to determine......
Audit & Reimbursement LeadLocation: This is United States, virtual based position. National Government Services is a proud member of Elevance Health’s family of brands. We administer government contracts for Medicare...
Please note: This role has a field component where the successful hire would be meeting with members in-person either in homes and/or in facilities. The hire would need to be......
Referral & Resource SpecialistLocation: This is a remote position. Candidates must reside in one of the following states : MASSACHUSETTS, NEW HAMPSHIRE, CONNECTICUT, RHODE ISLAND OR NEW YORK. Build the......
Location: This is a virtual position , must be located within 50 miles of the nearest pulse point.Schedule : Monday-Friday 9:30am-6:00pm PSTResponsible for the review of medical records to determine......
Oncology Medical Director- Commercial National Division Location: Alternate locations may be considered. This position will work a hybrid model (remote and office). The ideal candidate will must live within 50......
Clinical Operations Associate Medical DirectorInterventional PainCarelon Medical Benefits ManagementLocation: Alternate locations may be considered. The ideal candidate will live within 50 miles of one of our Elevance Hea...
Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health PulsePoint location.Schedule: First shift PST daytime hoursBehavioral Health Case Manager II The Behavioral Health Case M...
Audit & Reimbursement LeadLocation: This is United States, virtual based position. National Government Services is a proud member of Elevance Health’s family of brands. We administer government contracts for Medicare...
Diagnosis Related Group Clinical Validation Auditor-Registered Nurse Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.The....
Location: This is a virtual position , must be located within 50 miles of an Elevance Health Pulse Point.Shift: Monday-Friday , 8am-5pmResponsible for the discovery, validation, recovery, and adjustments of......
Location: This is a virtual position , must be located within 50 miles of the nearest pulse point.Schedule : Monday-Friday 9:30am-6:00pm PSTResponsible for the review of medical records to determine......
Be Part of an Extraordinary Team Centers Health Care is a member of the Elevance Health family of companies, serving as a premier network of skilled nursing, rehabilitation, and senior care......
Diagnosis Related Group Clinical Validation Auditor-RN Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.The Diagnosis......
Clinical Operations Associate Medical DirectorInterventional PainCarelon Medical Benefits ManagementLocation: Alternate locations may be considered. The ideal candidate will live within 50 miles of one of our Elevance Hea...
We are currently seeking a versatile Board Certified Physician to participate in pre-authorization reviews of high-tech diagnostic imaging, cardiac testing and sleep management services. Medical Directors in Clinical Oper...
DLP EngineerLocation: This position will work a hybrid model (remote & office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint office locations.The DLP......
Be Part of an Extraordinary Team A proud member of the Elevance Health family of companies, Paragon Healthcare brings over 20 years in providing life-saving and life-giving infusible and injectable drug......
Location: This is a virtual position , must be located within 50 miles of the nearest pulse point.Schedule : Monday-Friday 9:30am-6:00pm PSTResponsible for the review of medical records to determine......
Staff VP & CIO, Carelon Advanced Primary & Palliative Care Location: Within 50 miles of a PulsePoint office preferably Costa Mesa, CA, Altanta, GA, Indianapolis, IN, or Grand Prairie, TX Summary The Staff......
DLP EngineerLocation: This position will work a hybrid model (remote & office). The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint office locations.The DLP......
Clinical Provider Auditor IISupports Payment Integrity & Behavioral Health Location: This is a field position expected to be in clinic 60% of the time (2-3 days/week) with the other 40%......
Location: This is a Virtual role , Must be located within 50 miles of a Pulse PointSchedule: Monday-Friday 9:30am-6:00pm CST , Rotating weekend shifts.Responsible for conducting preauthorization, out of network......
Diagnosis Related Group Clinical Validation Auditor-RN Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.The Diagnosis......
Consumer Experience Analytics & Insights Analyst SeniorLocation: This position will work a hybrid model (remote and in office 1 - 2 days per week). Ideal candidates will live within 50......
Diagnosis Related Group Clinical Validation Auditor-RN Location: This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of one of our PulsePoint locations.The Diagnosis......
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