Top 92 Claims manager Jobs in Rhode Island

Case Manager, Registered Nurse (Oncology experience required)
CVS Health —Rhode Island
- $54,095 - $155,538 a year
- Full-time
- Remote
- Spanish
- Nursing
- RN License
- Health insurance
- Dental insurance
Case Mgr - DSNP
Blue Cross and Blue Shield of RI Careers —Providence, RI
- $73,600 - $110,400 a year
- Full-time
- Hybrid work
- Bilingual
- RN License
- Mid-level
- Loan repayment program
- Dental insurance
Centralized Billing Manager
Plum Dental Group —North Kingstown, RI
- Mid-level
- Supervising experience
- 2 years
Assistant Project Manager
J.F. Brennan Company, Inc. —North Kingstown, RI
- Construction site
- Writing skills
- Mid-level
- Profit sharing
- Health insurance
Quick Apply
DSNP RN Care Manager
Blue Cross and Blue Shield of RI Careers —Providence, RI
- $73,600 - $110,400 a year
- Full-time
- Hybrid work
- LMFT
- RN License
- Licensed Clinical Social Worker
- Loan repayment program
- Dental insurance
Case Manager - Behavioral Health
Blue Cross and Blue Shield of RI Careers —Providence, RI
- $73,600 - $110,400 a year
- Full-time
- Hybrid work
- Hospital
- Mid-level
- Office
- Loan repayment program
- Dental insurance
Lead Total Cost of Care Implementation Manager
Blue Cross and Blue Shield of RI Careers —Providence, RI
- $102,300 - $163,700 a year
- Full-time
- Hybrid work
- Microsoft Excel
- Mid-level
- Office
- Loan repayment program
- Dental insurance
Medicare Part B Operations Supervisor, Revenue Cycle
CVS Health —Rhode Island
- $43,888 - $102,081 a year
- Full-time
- Remote
- Mid-level
- High school diploma or GED
- Continuous improvement
- Health insurance
- Dental insurance
Lead Provider Payment Integrity Analyst
Blue Cross and Blue Shield of RI Careers —Providence, RI
- $92,700 - $139,100 a year
- Full-time
- Remote
- 7 years
- Mid-level
- Office
- Loan repayment program
- Dental insurance
Operational Risk Manager
Securitas Security Services —Providence, RI
- Full-time
- Hybrid work
- Office
- Bachelor's degree
- Continuous improvement
- Health savings account
- Paid holidays
Market Finance Lead
Humana —Rhode Island
- $104,000 - $143,000 a year
- Full-time
- CPA
- Office
- Master's degree
- Paid parental leave
- Paid holidays
Revenue Cycle Manager
ADIL BUSINESS SYSTEMS —Providence, RI
- $85 - $90 an hour
- Contract
- Hybrid work
- 3 years
- Finance
- US work authorization
- Paid time off
Quick Apply
Lead Director, Healthcare Medicaid Risk Adjustment Analytics
CVS Health —Rhode Island
- $100,000 - $231,540 a year
- Full-time
- Remote
- 3 years
- SQL
- Bachelor's degree
- Health insurance
- Dental insurance
Product Manager, Fraud & Abuse
CVS Health —Providence, RI
- $92,700 - $203,940 a year
- Full-time
- Mid-level
- 3 years
- Bachelor's degree
- Health insurance
- Dental insurance
Revenue Cycle Manager/Revenue Cycle Analyst
ICP solutions —Providence, RI
- $80 - $90 an hour
- Contract
- Hybrid work
- 3 years
- Finance
- US work authorization
Quick Apply
Compensation & Benefits Manager
The Hinckley Company —Portsmouth, RI
- $98,000 - $100,000 a year
- 5 years
- HIPAA
- Office
- Health insurance
Quick Apply
Sr. Mgr, Business Analytics - Zinc
CVS Health —Woonsocket, RI
- $75,400 - $182,549 a year
- Full-time
- 5 years
- Microsoft Office
- SQL
- Health insurance
- Dental insurance
Location Manager
Zūm —Johnston, RI
- $100,000 - $115,000 a year
- Full-time
- Google Workspace
- Inventory management
- 5 years
Quick Apply
Sr Risk Manager
Gilbane Building Company —Providence, RI
- $141,000 - $213,000 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Analysis skills
- Profit sharing
- Health insurance
Safety Supervisor
Zūm —Johnston, RI
- $80,000 - $130,000 a year
- Full-time
- School experience
- Microsoft Outlook
- Customer service
- Health insurance
- Dental insurance
Quick Apply

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claims manager jobs near rhode island

Case Manager, Registered Nurse (Oncology experience required)

CVS Health -
Rhode Island

Apply Now

Job Details

Full-time
$54,095 - $155,538 a year

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance

Qualifications

RN License
Medical records
Typing
Oncology
Hospital experience

Full Job Description

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Position Summary

This is a remote work from home role anywhere in the US with virtual training.

American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members.

Key Responsibilities

This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients.
Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits.
Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues.
Assessments utilize information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality.
Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management.
Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives.
Utilizes case management processes in compliance with regulatory and company policies and procedures.
Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversations.
Identifies and escalates member’s needs appropriately following set guidelines and protocols.
Need to actively reach out to members to collaborate/guide their care.
Perform medical necessity reviews.

Required Qualifications

5+ years’ experience as a Registered Nurse, including at least 1 year in a hospital setting.
The AHH RN Case manager position requires the nurse to support members across multiple states. A RN who resides in a compact state is required to have an active multistate license through the Nurse Licensure Compact (NLC), allowing practice across participating states with one license. Nurses residing in non‑compact states must hold an individual, state‑specific RN license for each state they support
1+ years’ experience documenting electronically using a keyboard.
1+ years’ current or previous experience in Oncology.

Preferred Qualifications

1+ years’ Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience as well as experience with transferring patients to lower levels of care.
1+ years' experience in Utilization Review.
CCM and/or other URAC recognized accreditation preferred.
1+ years’ experience with MCG, NCCN and/or Lexicomp.
Bilingual in Spanish preferred.
Bachelors Degree

Education

Diploma or Associates Degree in Nursing required.

Anticipated Weekly Hours

Time Type

Full time

Pay Range

The typical pay range for this role is:

$54,095.00 - $155,538.00

This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors.

Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.

Great benefits for great people

We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.

This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.

Additional details about available benefits are provided during the application process and on Benefits Moments.

This job does not have an application deadline, as CVS Health accepts applications on an ongoing basis.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Apply Now

Refine Your Search

claims manager jobs in rhode island

Case Manager, Registered Nurse (Oncology experience required)

Case Mgr - DSNP

Centralized Billing Manager

Assistant Project Manager

DSNP RN Care Manager

Case Manager - Behavioral Health

Lead Total Cost of Care Implementation Manager

Medicare Part B Operations Supervisor, Revenue Cycle

Lead Provider Payment Integrity Analyst

Operational Risk Manager

Market Finance Lead

Revenue Cycle Manager

Lead Director, Healthcare Medicaid Risk Adjustment Analytics

Product Manager, Fraud & Abuse

Revenue Cycle Manager/Revenue Cycle Analyst

Compensation & Benefits Manager

Sr. Mgr, Business Analytics - Zinc

Location Manager

Sr Risk Manager

Safety Supervisor

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