Top 263 Medical claims Jobs in West Virginia

Case Manager, Registered Nurse
CVS Health —West Virginia
- $54,095 - $155,538 a year
- Full-time
- Remote
- Spanish
- Nursing
- Addiction Medicine
- Health insurance
- Dental insurance
Case Manager, Registered Nurse (Oncology experience required)
CVS Health —West Virginia
- $54,095 - $155,538 a year
- Full-time
- Remote
- Spanish
- Nursing
- RN License
- Health insurance
- Dental insurance
Audiologist
Loyal Source Government Services —Kanawha, WV
- $112,091.20 - $130,091.20 a year
- BLS Certification
- Mid-level
- Master's degree
Quick Apply
Psychologist
The Locums Company —Beckley, WV
- $750 a day
- Part-time
- Clinic
- Doctor of Philosophy
- Criminal background check
Quick Apply
Licensed Mental Health Therapist - Remote (LICSW, LPC)
Talkspace —West Virginia
- $70 an hour
- Remote
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- Continuing education credits
1d
Patient Accounts Resolution Specialist
Charleston Area Medical Center (CAMC) —Charleston, WV
- Online Application
- Microsoft Excel
- Hospital
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Licensed Pharmacy Technician
P.I.E. Management, L.L.C. —Glenville, WV
- $32.75 an hour
- Full-time
- Psychiatry
- Hospital
- High school diploma or GED
Quick Apply
1d
Mental Health Counselor - Remote
Guideline Healthcare —West Virginia
- Up to $100,000 a year
- Choose your own hours
- Remote
- LMFT
- Licensed Clinical Social Worker
- Mid-level
- Employee discount
- Flexible schedule
Quick Apply
9d
Medical Records Coder 1 -- Coding & Data Registry -- Document Center Building
Mon Health —Charleston, WV
- Overtime
- Surgery
- No experience needed
- Mid-level
Healthcare Encounter Senior Analyst
CVS Health —West Virginia
- $46,988 - $122,400 a year
- Full-time
- Remote
- Research
- Mid-level
- Office
- Health insurance
- Dental insurance
14d
Telephonic Case Manager I
CorVel Corporation —Charleston, WV
- $63,739 - $95,264 a year
- Full-time
- Remote
- Nursing
- RN License
- Computer literacy
- Health savings account
- Disability insurance
Quick Apply
Insurance Claims Representative -- PATIENT FINANCIAL SERVICES -- Hartman Run Road
Mon Health —Morgantown, WV
- Full-time
- Hospital
- BLS Certification
- High school diploma or GED
Lead Insurance Claims Representative PFS -- PATIENT FINANCIAL SERVICES -- Hartman Run Road
Mon Health —Morgantown, WV
- Full-time
- Hospital
- Mid-level
- High school diploma or GED
Medical Records Coder 1 -- Coding & Data Registry -- Document Center Building
CAMC Health System —Charleston, WV
- Overtime
- Surgery
- No experience needed
- Mid-level
Billing Specialist
FamilyCare Health Centers —Scott Depot, WV
- Full-time
- Ability to walk for extended periods
- Office
- High school diploma or GED
Quick Apply
Sr. Manager, Pricing - Pharmacy Appeals
CVS Health —West Virginia
- $67,900 - $182,549 a year
- Full-time
- Remote
- 7 years
- Microsoft Access
- Office
- Health insurance
- Dental insurance
Clinical Audiologist - Full Time Position Available
Commonwealth Medical Services —Huntington, WV
- $135,000 - $175,000 a year
- Full-time
- Entry level
Quick Apply
Network Management Analyst
CVS Health —Charleston, WV
- $43,888 - $102,081 a year
- Full-time
- Microsoft Excel
- Microsoft Outlook
- Research
- Health insurance
- Dental insurance
Revenue Cycle Support Specialist
SYSTEM West Virginia University Health System —Morgantown, WV
- Full-time
- Microsoft Outlook
- HIPAA
- Office
Accounts Receivable/Billing Clerk
VALLEY COMPREHENSIVE COMMUNITY MENTAL HEALTH CENTER INC —Morgantown, WV
- Full-time
- Microsoft Word
- Microsoft Outlook
- Computer literacy
Quick Apply

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medical claims jobs near west virginia

Case Manager, Registered Nurse

CVS Health -
West Virginia

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Job Details

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

Benefits

Health insurance
Dental insurance
Paid time off
Vision insurance

Qualifications

RN License
Typing
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 with at least 1 year of experience 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, Transplant, Specialty Pharmacy, Pediatrics, Medical/Surgical, Behavioral Health/Substance Abuse or Maternity/ Obstetrics experience.

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 preferred.

Education

Nursing 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

medical claims jobs in west virginia

Case Manager, Registered Nurse

Case Manager, Registered Nurse (Oncology experience required)

Audiologist

Psychologist

Licensed Mental Health Therapist - Remote (LICSW, LPC)

Patient Accounts Resolution Specialist

Licensed Pharmacy Technician

Mental Health Counselor - Remote

Medical Records Coder 1 -- Coding & Data Registry -- Document Center Building

Healthcare Encounter Senior Analyst

Telephonic Case Manager I

Insurance Claims Representative -- PATIENT FINANCIAL SERVICES -- Hartman Run Road

Lead Insurance Claims Representative PFS -- PATIENT FINANCIAL SERVICES -- Hartman Run Road

Medical Records Coder 1 -- Coding & Data Registry -- Document Center Building

Billing Specialist

Sr. Manager, Pricing - Pharmacy Appeals

Clinical Audiologist - Full Time Position Available

Network Management Analyst

Revenue Cycle Support Specialist

Accounts Receivable/Billing Clerk

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