Top 19 Net health Jobs in Remote

Clinical Data Audit Consultant
Health Net —Washington, DC
- $33.71 - $60.67 an hour
- Full-time
- Remote
- Nursing
- RN License
- Bachelor of Science
- Paid holidays
- Health insurance
8d
New York Licensed Physical Therapist (Care Navigator) - REMOTE
Net Health —Pittsburgh, PA
- $28.80 - $36.00 an hour
- Remote
- Physical & Rehabilitation Medicine
- Mid-level
- Physical Therapy License
- Health insurance
Quick Apply
Product Support Representative IV - REMOTE
Net Health —Pittsburgh, PA
- $19.62 - $24.52 an hour
- Weekends as needed
- Remote
- Oracle
- 3 years
- High school diploma or GED
- Health insurance
Quick Apply
Compact Licensed Physical Therapist Position #5 (Care Navigator) - REMOTE
Net Health —Pittsburgh, PA
- $38 an hour
- Remote
- Computer literacy
- Physical & Rehabilitation Medicine
- Mid-level
- Health insurance
Quick Apply
Client Success Manager (Client Management II) - REMOTE
Net Health —Pittsburgh, PA
- $83,000 a year
- Remote
- Mid-level
- 3 years
- Bachelor's degree
- Health insurance
Quick Apply
11d
IT Service Desk Representative III (Service Desk Rep III) - REMOTE
Net Health —Pittsburgh, PA
- $31.25 an hour
- Remote
- HIPAA
- 3 years
- High school diploma or GED
- Health insurance
Quick Apply
8d
Copy Writer II - REMOTE
Net Health —Pittsburgh, PA
- $75,985 a year
- Remote
- Marketing
- Research
- Mid-level
- Health insurance
Quick Apply
New York Licensed Physical Therapist Position #2 (Care Navigator) - REMOTE
Net Health —Pittsburgh, PA
- $38 an hour
- Part-time
- Remote
- Computer literacy
- Physical & Rehabilitation Medicine
- Mid-level
- Health insurance
Quick Apply
DevOps Engineer III - REMOTE
Net Health —Pittsburgh, PA
- $150,000 a year
- Remote
- 5 years
- HIPAA
- Windows
- Health insurance
Quick Apply
Sr Product Owner, State & Payer Solutions (Product Owner III) - REMOTE
Net Health —Pittsburgh, PA
- $129,000 a year
- Remote
- Nursing
- Microsoft Outlook
- Computer Science
- Health insurance
Quick Apply
Director, Client Management (Director, Client Relationship) - REMOTE
Net Health —Pittsburgh, PA
- $135,000 a year
- Remote
- 11+ years
- Bachelor's degree
- Organizational skills
- Health insurance
Quick Apply
Field Customer Success Manager (Client Management I) - REMOTE
Net Health —Pittsburgh, PA
- $75,000 a year
- Full-time
- Remote
- Physical & Rehabilitation Medicine
- Clinic experience
- Mid-level
- Health insurance
Quick Apply
California Licensed Physical Therapist (Care Navigator) - REMOTE
Net Health —Pittsburgh, PA
- $37 an hour
- Remote
- Physical & Rehabilitation Medicine
- Mid-level
- Physical Therapy License
- Health insurance
Quick Apply
11d

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New York Licensed Physical Therapist (Care Navigator) - REMOTE
Net Health —Pittsburgh, PA
Active New York PT license. Direct and assist users in therapeutic exercise, neuromuscular re-education, and functional training through our technology platform…
$28.80 - $36.00 an hour
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New York Licensed Physical Therapist Position #2 (Care Navigator) - REMOTE
Net Health —Pittsburgh, PA
Graduated from an accredited physical therapy program · Active PT license in a compact state ( https://www.ptcompact.org/ ). Active PT license in New York.
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Clinical Data Audit Consultant

Health Net -
Washington, DC

Apply Now

Job Details

Full-time
$33.71 - $60.67 an hour
8 days ago

Benefits

Paid holidays
Health insurance
401(k)
Tuition reimbursement
Paid time off

Qualifications

Clinical case management

Full Job Description

Position Purpose: The Clinical Data and Audit Consultant is responsible for the clinical content component of all data collection, account implementations, and audit activities for Clinical Operations to ensure high-quality tracking and performance of the service teams.

Key Details: Registered Nurse - Must be currently licensed in CA. Pacific Time Zone Work Hours

The Consultant gathers and analyzes data, creates workflows, coordinates internal and external audits, and analyzes and documents business processes to meet all clinical, procedural, account, and regulatory requirements.

Demonstrates regular, reliable and predictable attendance.
Leads various data analysis projects to examine and define potential clinically related issues and track productivity and quality measures
Reviews, analyzes, and interprets data for required HEDIS, URAC, NCQA compliance, and related reporting for clinical service teams
Interprets clinical data that does not conform to established/approved, required specifications, including Unity Reports, and assists in corrective action processes
Addresses and participates in training of clinical staff resulting from data tracking and analysis efforts
Identifies, evaluates, recommends and documents clinical business needs and objectives, operational processes and procedures, problems and requirements
Produces documentation, including project plans, analytical reports, decision backup, information research reports, training plans, business justifications, graphics, workflow and business process models
Recommends operational and process improvements based on efficiencies and available technologies
Maintains a repository of performance and audit metrics, and generates management reports illustrating statistical data, text, workflows, and graphics
Conducts secondary research using a variety of publications, services and health statistic databases
May also be assigned lower level management functions and back up supervisors on clinical team
Works with other departments to identify and document business requirements, workflow, policies and procedures
Organizes and compiles cases for all External Health Net, NCQA, URAC, and Account Audits
Participates in Quarterly Health Net Regulatory Audit meetings to assist Clinical Directors
Supports Clinical Supervisors in tracking of monthly Care Manager audit results
Works with Data Analysis Department to design data pulls
Assists with generating HLOC and Outpatient Cost of Care and Target Outlier Reports including trend analysis
Supports staffing analysis with current and forecasted requirements
Investigates current regulations, interprets findings, and makes recommendations to Healthcare Services teams
Conducts complex trend analysis and, based on analysis, creates Corrective Action Plans, and presents recommendations to business teams across department to improve performance

Other duties as required
Performs other duties as assigned
Complies with all policies and standards

Education/Experience:

BA/BS in Psychology, Nursing or other related clinical field; Masters in Social Work, Counseling, Nursing, or related field preferred
Three to five years case management or related clinical experience
Two to three years experience conducting business studies, recommending solutions and/or business analysis, preferably in Healthcare

License/Certification: Licensed Clinician and/or RN required. Must have and maintain current, valid and unrestricted clinical license.

Pay Range: $33.71 - $60.67 per hour

At Centene, we connect people to the care they need to live healthier lives — and the work you do here makes that impact real every day. You’ll take on meaningful challenges that directly support individuals, families, and communities, building your skills while making healthcare more accessible and effective. It’s work with a purpose you can see, backed by a team committed to improving lives well beyond the workday.

Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.

Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Apply Now

Refine Your Search

net health jobs in remote

Clinical Data Audit Consultant

New York Licensed Physical Therapist (Care Navigator) - REMOTE

Product Support Representative IV - REMOTE

Compact Licensed Physical Therapist Position #5 (Care Navigator) - REMOTE

Client Success Manager (Client Management II) - REMOTE

IT Service Desk Representative III (Service Desk Rep III) - REMOTE

Copy Writer II - REMOTE

New York Licensed Physical Therapist Position #2 (Care Navigator) - REMOTE

DevOps Engineer III - REMOTE

Sr Product Owner, State & Payer Solutions (Product Owner III) - REMOTE

Director, Client Management (Director, Client Relationship) - REMOTE

Field Customer Success Manager (Client Management I) - REMOTE

California Licensed Physical Therapist (Care Navigator) - REMOTE

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