Opportunity Overview:

The Clinical Review & Correspondence Nurse plays a critical role in supporting utilization management operations by conducting medical necessity reviews, preparing clear and compliant clinical determinations, and ensuring accurate member and provider communications. In collaboration with Medical Directors and cross-functional partners, this role ensures that clinical decisions are evidence-based, align with regulatory and accreditation standards, and are communicated effectively and timely. Through precise clinical review and documentation, you will help support high-quality care, regulatory compliance, and improved member outcomes.

What you’ll do:

• Consult with Medical Directors on clinical determinations, medical necessity decisions, and related clinical correspondence
• Prepare clear, accurate, and compliant member and provider communications in alignment with regulatory and organizational requirements
• Understand regulatory requirements governing utilization management decisions and ensure appropriate application to clinical determinations and communications
• Understand when and why member and provider notifications are required, including regulatory and clinical triggers for written communication
• Support verbal notification workflows when timely communication of clinical determinations is required
• Document clinical information completely, accurately, and in a timely manner
• Consistently meet or exceed productivity, quality, and turnaround time expectations
• Maintain a thorough understanding of accreditation and regulatory requirements and ensure utilization management decision-making and timeliness standards remain in compliance
• Perform other duties as assigned

What you’ll need:

• LPN with active, unencumbered license in the state of residence
• Experience developing member and provider correspondence within a health plan environment
• Minimum of 3 years of clinical experience
• Utilization Management experience required
• Knowledge of NCQA and CMS standards and requirements
• Thrive in a fast paced, self-directed environment
• Understand how utilization management and case management programs integrate
• Strong communication skills, able to effectively communicate in a positive and engaging manner and able to remain calm and professional under pressure
• Comprehensive thinker/planner with understanding of clinical algorithms, care pathways, and how to effectively manage utilization across the care continuum to achieve optimal patient outcomes
• Highly organized with excellent time management skills
• Thrives on continuous process improvement, always actively seeking out practical solutions
• Demonstrated ownership mentality with a willingness to take on new challenges and contribute beyond defined responsibilities when needed.
• Nursing Certification
• Utilization Review/Utilization Management experience
• Proficiency in using a Mac
• Experienced with G suite applications

Important to know about this role:

• This is a 100% remote role, and requires robust internet speeds (above 50 megabytes/second), including the ability to utilize zoom meeting software and to stream video
• The department is staffed seven days per week, 8am-8pm EST and shifts will be assigned based on need
• This is a full time, 40 hour per week opportunity

Pay & Perks:

💻 Fully remote opportunity with about 5% travel

🩺 Medical, dental, vision, life, disability insurance, and Employee Assistance Program

📈 401K retirement plan with company match; flexible spending and health savings account

🏝️Up to 184 hours (23 days) of PTO per year + company holidays

👶 Up to 14 weeks of paid parental leave

🐶 Pet insurance

The salary range for this position is $31.00 - $35.00/hour; as part of a total benefits package which includes health insurance, 401k and bonus. In accordance with state applicable laws, Cohere is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment.

Interview Process*:

1. Internet Speed Test
2. Behavioral Interview(s) with your Hiring Manager!

*Subject to change

About Cohere Health:

Cohere Health’s clinical intelligence platform and agentic AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing the speed, cost, and quality of care. With an enterprise approach that streamlines payer-provider decision-making across the care continuum–including policy, prior authorization, payment accuracy, and more–the company improves collaboration and reduces burden, resulting in up to 8x ROI and 94% provider satisfaction.

With the acquisition of ZignaAI, we’ve further enhanced our platform by launching our Payment Integrity Suite, anchored by Cohere Validate™, an AI-driven clinical and coding validation solution that operates in near real-time. By unifying pre-service authorization data with post-service claims validation, we’re creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately.

Cohere Health’s innovations continue to receive industry wide recognition. We’ve been named to the 2025 Inc. 5000 list and in the Gartner® Hype Cycle™ for U.S. Healthcare Payers (2022-2025), and ranked as a Top 5 LinkedIn™ Startup for 2023 & 2024. Backed by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners.

The Coherenauts, as we call ourselves, who succeed here are empathetic teammates who are candid, kind, caring, and embody our core values and principles. We believe that diverse, inclusive teams make the most impactful work. Cohere is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone.

We can’t wait to learn more about you and meet you at Cohere Health!

Equal Opportunity Statement:

Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all.  To us, it’s personal.

#LI-Remote

#BI-Remote

Opportunity Overview:

The Clinical Review & Correspondence Nurse plays a critical role in supporting utilization management operations by conducting medical necessity reviews, preparing clear and compliant clinical determinations, and ensuring accurate member and provider communications. In collaboration with Medical Directors and cross-functional partners, this role ensures that clinical decisions are evidence-based, align with regulatory and accreditation standards, and are communicated effectively and timely. Through precise clinical review and documentation, you will help support high-quality care, regulatory compliance, and improved member outcomes.

What you’ll do:

• Consult with Medical Directors on clinical determinations, medical necessity decisions, and related clinical correspondence
• Prepare clear, accurate, and compliant member and provider communications in alignment with regulatory and organizational requirements
• Understand regulatory requirements governing utilization management decisions and ensure appropriate application to clinical determinations and communications
• Understand when and why member and provider notifications are required, including regulatory and clinical triggers for written communication
• Support verbal notification workflows when timely communication of clinical determinations is required
• Document clinical information completely, accurately, and in a timely manner
• Consistently meet or exceed productivity, quality, and turnaround time expectations
• Maintain a thorough understanding of accreditation and regulatory requirements and ensure utilization management decision-making and timeliness standards remain in compliance
• Perform other duties as assigned

What you’ll need:

• LPN with active, unencumbered license in the state of residence
• Experience developing member and provider correspondence within a health plan environment
• Minimum of 3 years of clinical experience
• Utilization Management experience required
• Knowledge of NCQA and CMS standards and requirements
• Thrive in a fast paced, self-directed environment
• Understand how utilization management and case management programs integrate
• Strong communication skills, able to effectively communicate in a positive and engaging manner and able to remain calm and professional under pressure
• Comprehensive thinker/planner with understanding of clinical algorithms, care pathways, and how to effectively manage utilization across the care continuum to achieve optimal patient outcomes
• Highly organized with excellent time management skills
• Thrives on continuous process improvement, always actively seeking out practical solutions
• Demonstrated ownership mentality with a willingness to take on new challenges and contribute beyond defined responsibilities when needed.
• Nursing Certification
• Utilization Review/Utilization Management experience
• Proficiency in using a Mac
• Experienced with G suite applications

Important to know about this role:

• This is a 100% remote role, and requires robust internet speeds (above 50 megabytes/second), including the ability to utilize zoom meeting software and to stream video
• The department is staffed seven days per week, 8am-8pm EST and shifts will be assigned based on need
• This is a full time, 40 hour per week opportunity

Pay & Perks:

💻 Fully remote opportunity with about 5% travel

🩺 Medical, dental, vision, life, disability insurance, and Employee Assistance Program

📈 401K retirement plan with company match; flexible spending and health savings account

🏝️Up to 184 hours (23 days) of PTO per year + company holidays

👶 Up to 14 weeks of paid parental leave

🐶 Pet insurance

The salary range for this position is $31.00 - $35.00/hour; as part of a total benefits package which includes health insurance, 401k and bonus. In accordance with state applicable laws, Cohere is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment.

Interview Process*:

1. Internet Speed Test
2. Behavioral Interview(s) with your Hiring Manager!

*Subject to change

About Cohere Health:

Cohere Health’s clinical intelligence platform and agentic AI-powered solutions connect health plans’ strategic goals and providers’ needs, optimizing the speed, cost, and quality of care. With an enterprise approach that streamlines payer-provider decision-making across the care continuum–including policy, prior authorization, payment accuracy, and more–the company improves collaboration and reduces burden, resulting in up to 8x ROI and 94% provider satisfaction.

With the acquisition of ZignaAI, we’ve further enhanced our platform by launching our Payment Integrity Suite, anchored by Cohere Validate™, an AI-driven clinical and coding validation solution that operates in near real-time. By unifying pre-service authorization data with post-service claims validation, we’re creating a transparent healthcare ecosystem that reduces waste, improves payer-provider collaboration and patient outcomes, and ensures providers are paid promptly and accurately.

Cohere Health’s innovations continue to receive industry wide recognition. We’ve been named to the 2025 Inc. 5000 list and in the Gartner® Hype Cycle™ for U.S. Healthcare Payers (2022-2025), and ranked as a Top 5 LinkedIn™ Startup for 2023 & 2024. Backed by leading investors such as Deerfield Management, Define Ventures, Flare Capital Partners, Longitude Capital, and Polaris Partners.

The Coherenauts, as we call ourselves, who succeed here are empathetic teammates who are candid, kind, caring, and embody our core values and principles. We believe that diverse, inclusive teams make the most impactful work. Cohere is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone.

We can’t wait to learn more about you and meet you at Cohere Health!

Equal Opportunity Statement:

Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all.  To us, it’s personal.

#LI-Remote

#BI-Remote

Role OverviewWe're seeking expert evaluators in Clinical, Biomedical, or Pharma to assess…See this and similar jobs on LinkedIn.

Extraordinary Careers. Endless Possibilities. With the nation’s largest home infusion provider, there is no limit to the growth of your career.

Employment Type:Full timeShift:Day ShiftDescription:Job Title: Specialty Dietitian (Remote) Employment Type: Full - Time (Remote) Shift: Day - Monday – Friday, 7:30 AM – 4:00 PM (with rotating weekends) Location: Holy Cross Hospital, Silver Spring, Maryland Position Purpose:• The Specialty Dietitian​ will manage the nutrition care of critically ill patients, including those requiring enteral and parenteral nutrition support.

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Company Description

PSI is a leading Contract Research Organization with more than 30 years in the industry, offering a perfect balance between stability and innovation to both clients and employees. We focus on delivering quality and on-time services across a variety of therapeutic indications.

Job Description

As a Clinical Research Associate at PSI you will enjoy a variety of monitoring tasks and work on clinical studies in different therapeutic indications, maintaining the highest quality standards in the industry.

You will:

• Act as the main line of communication between the project team, sponsor, and the site
• Build and maintain a good relationship with the site staff involved in the study conduct
• Prepare, conduct, and report site selection, initiation, routine monitoring and close-out visits
• Ensure that subject recruitment targets are timely defined, communicated, recorded and met, and project timelines are followed at site level
• Ensure accurate and timely information flow with trial sites on Adverse Events and protocol/process deviations
• Perform source data verification and follows up on data queries at site level; review and manage study risks on a site level
• Ensure proper handling, use, accountability, reconciliation, and return of all Investigational Product(s) and clinical study supplies on sites
• Review essential study documents and reconcile study Investigator Site File (ISF) / TMF at site level
• Ensures quality (data integrity and compliance) at site level
• Conduct site audit preparation visits and resolve site audit findings
• Participate in study site audits and client onsite visits, as required
• Ensure the flow of documents and study supplies between the project team, site and the Central/ Regional Laboratory/ Central Reviewer/ Warehouse
• Conduct project-specific training of site investigators
• Support preparation of Investigator newsletters
• Assist Site Management Associates in maintaining study-specific and corporate tracking systems at site level
• Support preparation of draft regulatory and ethics committee submission packages
• Support collection of IP-RED packages at site/country level
• Facilitate review and reconciliation of the study TMF on country and site levels

Qualifications

• College/University degree in Life Sciences or an equivalent combination of education, training & experience
• Located in the Central or West Coast regions is preferred
• Must have 2+ years of independent on-site monitoring experience
• Experience in all types of monitoring visits, in phases I-III
• Experience in Oncology mandatory & GI preferred and/or radio-pharm experience preferred.
• Full working proficiency in English
• Proficiency in MS Office applications
• Ability to plan, multitask and work in a dynamic team environment
• Communication, collaboration, and problem-solving skills
• Ability to travel up to 75%
• Valid driver’s license (if applicable)

For this position PSI is not hiring individuals who require work visa for employment or continued employment now or anytime in the future.

Additional Information

This is a great opportunity for you to further develop your skills, widen your therapeutic area experience, and become an expert in clinical research.

For this position, PSI is not hiring individuals who require work visa for employment or continued employment now or anytime in the future.

PRIMARY RESPONSIBILITIES:

Leverage multiple information sources, including LIMS, to review cases for accuracy and completeness of pathology tissue samples for Signatera and Altera testing.

Interpret pathology reports, clinical notes and additional testing reports to complete light data entry for each tissue sample.

Collaborate with team members to work to resolve potential discrepancies.

Ensure that necessary notes and holds are placed on cases for non-conforming samples, discrepancies and/or missing information and escalated to ensure timely resolution.

Confirm cancer types for the reporting team before the report is issued via emails and spreadsheet.

Meet daily case metrics.

Attend interdepartmental meetings.

Provide feedback on the current process or workflow.

Review and understand all SOPs.

This role works with PHI on a regular basis both in paper and electronic form and has access to various technologies to access PHI (paper and electronic) in order to perform the job Employee must complete training relating to HIPAA/PHI privacy.

QUALIFICATIONS:

BS/BA degree (preferred)

High School Diploma (or equivalent) required.

2+ years of medical industry related experience - pathology preferred.

Previous data entry experience is required.

KNOWLEDGE, SKILLS, AND ABILITIES

Trained on all product types and able to QC with high accuracy and efficiency consistently.

Ability to handle most escalations, discrepancies, and holds.

Firm understanding and knowledgeable in all aspects of the Sample Review process and SOPs.

Typing speed of at least 45wpm with high accuracy.

Excellent oral and written communication.

Excellent critical thinking skills and the ability to use good judgment.

Ability to perform required duties with a high degree of accuracy and attention to detail.

Positive attitude and ability to work well with others.

OUR OPPORTUNITY

Natera™ is a global leader in cell-free DNA (cfDNA) testing, dedicated to oncology, women’s health, and organ health. Our aim is to make personalized genetic testing and diagnostics part of the standard of care to protect health and enable earlier and more targeted interventions that lead to longer, healthier lives.

The Natera team consists of highly dedicated statisticians, geneticists, doctors, laboratory scientists, business professionals, software engineers and many other professionals from world-class institutions, who care deeply for our work and each other. When you join Natera, you’ll work hard and grow quickly. Working alongside the elite of the industry, you’ll be stretched and challenged, and take pride in being part of a company that is changing the landscape of genetic disease management.

WHAT WE OFFER

Competitive Benefits - Employee benefits include comprehensive medical, dental, vision, life and disability plans for eligible employees and their dependents. Additionally, Natera employees and their immediate families receive free testing in addition to fertility care benefits. Other benefits include pregnancy and baby bonding leave, 401k benefits, commuter benefits and much more. We also offer a generous employee referral program!

For more information, visit www.natera.com.

Natera is proud to be an Equal Opportunity Employer. We are committed to ensuring a diverse and inclusive workplace environment, and welcome people of different backgrounds, experiences, abilities and perspectives. Inclusive collaboration benefits our employees, our community and our patients, and is critical to our mission of changing the management of disease worldwide.

All qualified applicants are encouraged to apply, and will be considered without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, age, veteran status, disability or any other legally protected status. We also consider qualified applicants regardless of criminal histories, consistent with applicable laws.

If you are based in California, we encourage you to read this important information for California residents.

Link: https://www.natera.com/notice-of-data-collection-california-residents/

Please be advised that Natera will reach out to candidates with a @natera.com email domain ONLY. Email communications from all other domain names are not from Natera or its employees and are fraudulent. Natera does not request interviews via text messages and does not ask for personal information until a candidate has engaged with the company and has spoken to a recruiter and the hiring team. Natera takes cyber crimes seriously, and will collaborate with law enforcement authorities to prosecute any related cyber crimes.

For more information:

- BBB announcement on job scams

- FBI Cyber Crime resource page

Category: Health Care Location: North Branch Minnesota United States Job Title: RN Admissions Nurse – High-Volume, High-Earning Home Health Role Company: Home Health Care, Inc.

ISTA Solutions, an outsourcing/offshoring company, is in search of an experienced PHRN Clinical Auditor to join our rapidly expanding team.

OverviewAs a Part-Time Physician Reviewer, you will conduct utilization reviews to determine medical necessity across our different lines of business, including Post-Acute Care, Home Health, Durable Medical Equipment (DME), Home...

Company DescriptionMontu is Australia’s largest healthtech business with a focus on alternative healthcare. Founded in 2019, it supports patients, doctors and pharmacies through its Alternaleaf clinic, offers accredited healthcare education...

About Us:AdNet/AccountNet, Inc. is an 8(a), WOSB, and WBE-owned management consulting firm founded in 1990.

beschreibung Wir bringen ärztliche Versorgung dorthin, wo sie am meisten gebraucht wird: in die Praxen oder direkt nach Hause via Telemedizin.

At Curana Health, we’re on a mission to radically improve the health, happiness, and dignity of older adults—and we’re looking for passionate people to help us do it.

The Genetic Counselor is responsible for the following: • Laboratory molecular and genetic testing clinical case review activities.

Job Description SummaryThe Revenue Cycle Medical Records Case Manager will support documentation of medical necessity by facilitating medical records (MR) collection and client outreach, by offering expert review and interpretation...

When our values align, there’s no limit to what we can achieve.At Parexel, we all share the same goal – to improve the world’s health. From clinical trials to regulatory,...