Jobs in Oklahoma City Remote
2,603 positions found — Page 153
Why USAA?
At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.
Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful.
The Opportunity
We are looking for a SIU Investigator (mid-level). This is a Field position. Within defined guidelines and framework, protects USAA and our members from potential fraudulent claims by investigating questionable, suspect claims activity in compliance with state insurance fraud-related laws and regulations and policies and procedures. The selected candidate will have a strong Property SIU background and not just auto
This role is remote eligible. However, you must currently live in San Diego metropolitan area. This being a Field position a company car is provided and there is regular business travel.
What you'll do:
Applies knowledge and understanding of fraud schemes and investigation strategies on any questionable or suspect first or third part claims.
Participates in the development of fraud prevention strategies.
Applies knowledge of P&C insurance industry products, services, and processes in investigating claims to include P&C insurance policy contracts, coverages and internal claims handling process and procedures.
Applies knowledge of state laws and regulations pertaining to insurance fraud in investigating claims.
Collects evidence of potential fraud through field or remote interviews and thorough searches of investigative databases, internal resources, Internet resources, public records, and forensic tools.
Makes recommendations within defined authority guidelines.
Prepares and presents detailed and comprehensive verbal and written investigative reports summarizing the results of the investigation and recommended outcome.
Develops and maintains external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection, and prevention.
May serve as a resource team member on specific matters through demonstrated skill or training.
Assists with the delivery of fraud awareness training initiatives in a defined environment.
Handles CAT duty responsibilities as business requires.
Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.
High School Diploma or General Equivalency Diploma (GED).
2+ years claims adjusting experience, or P&C SIU/Fraud Investigation experience OR 4+ years prior investigative law enforcement (to include military) or relevant fraud industry investigation experience.
Proven investigatory skills.
Experience obtaining statements from various parties to incidents, witnesses, and suspects.
Ability to gather broad range of evidence and draw conclusions based on the objective details related to the applicability of fraud.
Demonstrated ability to organize and prioritize workload, performing multiple tasks and devising solutions to problems.
Familiarity with using computers and various software packages to enter and extract data for analysis from relevant data sources and systems.
Knowledge of city, state and local regulations, legal concepts, understanding of contracts, case law, medical treatment, and medical terminology.
SIU experience conducting low to complex P&C fraud investigations OR a combination of Claims and Law Enforcement Investigations OR Military Investigative experience.
Strong Property SIU experience
Designations such as CFE, CIFI, SCLA, ACLS, FCLS, LPCS, AIC, CPCU, CCLS, or other.
US military experience through military service or a military spouse/domestic partner
Compensation range: The annualized range for this position is: $77,120 - $147,390. However, this is an hourly position.
Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.
Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.
The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.
Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.
For more details on our outstanding benefits, visit our benefits page on
Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting.
USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Remote working/work at home options are available for this role.
Why USAA?
At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.
Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful.
The Opportunity
We are looking for a SIU Investigator (mid-level). This is a Field position. Within defined guidelines and framework, protects USAA and our members from potential fraudulent claims by investigating questionable, suspect claims activity in compliance with state insurance fraud-related laws and regulations and policies and procedures. The candidate selected will have strong multi-line SIU Investigation experience.
This role is remote eligible. However, you must live in the Baltimore, Maryland area, as this is a Field position.
What you'll do:
Applies knowledge and understanding of fraud schemes and investigation strategies on any questionable or suspect first or third part claims.
Participates in the development of fraud prevention strategies.
Applies knowledge of P&C insurance industry products, services, and processes in investigating claims to include P&C insurance policy contracts, coverages and internal claims handling process and procedures.
Applies knowledge of state laws and regulations pertaining to insurance fraud in investigating claims.
Collects evidence of potential fraud through field or remote interviews and thorough searches of investigative databases, internal resources, Internet resources, public records, and forensic tools.
Makes recommendations within defined authority guidelines.
Prepares and presents detailed and comprehensive verbal and written investigative reports summarizing the results of the investigation and recommended outcome.
Develops and maintains external relationships with industry, law enforcement and other contacts involved in fraud investigation, detection, and prevention.
May serve as a resource team member on specific matters through demonstrated skill or training.
Assists with the delivery of fraud awareness training initiatives in a defined environment.
Handles CAT duty responsibilities as business requires.
Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.
High School Diploma or General Equivalency Diploma (GED).
2+ years claims adjusting experience, or P&C SIU/Fraud Investigation experience OR 4+ years prior investigative law enforcement (to include military) or relevant fraud industry investigation experience.
Proven investigatory skills.
Experience obtaining statements from various parties to incidents, witnesses, and suspects.
Ability to gather broad range of evidence and draw conclusions based on the objective details related to the applicability of fraud.
Demonstrated ability to organize and prioritize workload, performing multiple tasks and devising solutions to problems.
Familiarity with using computers and various software packages to enter and extract data for analysis from relevant data sources and systems.
Knowledge of city, state and local regulations, legal concepts, understanding of contracts, case law, medical treatment, and medical terminology.
SIU experience conducting low to complex P&C fraud investigations OR a combination of Insurance Claims and (Law Enforcement Investigations OR Military Investigations) experience.
Strong background with multi-line SIU investigations
Designations such as CFE, CIFI, SCLA, ACLS, FCLS, LPCS, AIC, CPCU, CCLS, or other.
US military experience through military service or a military spouse/domestic partner
Compensation range: The annualized range for this position is: $77,120 - $147,390. This is an hourly position.
USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, F-1, STEM OPT Training Plans, etc.).
Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.
Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.
The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.
Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.
For more details on our outstanding benefits, visit our benefits page on
Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting.
USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Remote working/work at home options are available for this role.
Why USAA?
At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.
Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful.
The Opportunity
This posting is for multiple P&C Actuarial Analyst positions on the pricing, indications, and forecasting teams. These roles require experienced analysts to independently apply actuarial methods for accurate pricing and process improvement, mentor colleagues, provide strategic insights, and manage business risks in compliance with internal risk management policies.
We offer a flexible work environment that requires an individual to be in the office 4 days per week. This position can be based in one of the following locations: San Antonio, TX, Plano, TX, Phoenix, AZ, Colorado Springs, CO, Charlotte, NC, or Tampa, FL. Relocation assistance is not available for this position.
Experienced analyst responsible for independently applying actuarial methodologies to complete structured projects and serves as a technical subject matter expert on assigned tasks.
What you'll do:
Independently applies actuarial methodologies to complete structured projects (e.g.)
Builds tools to test and implement new methodologies that improve accuracy of actuarial analysis; utilizes model results to select new variables and refresh existing variables in a rating algorithm; analyzes results from multiple methodologies to propose reserve selections and documenting rationale).
Identifies and improves existing processes utilizing actuarial, mathematical, or statistical techniques.
Proactively resolves technical issues and identifies appropriate issues for escalation.
Assists others with troubleshooting issues.
Creates instructions and training materials for actuarial tools and processes.
Mentors new team members.
Apply business acumen to provide actionable insights that help solve business problems.
Effectively communicates insights and solutions to broad audiences including actuarial and non-actuarial stakeholders.
Ensure risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.
What you have:
Bachelor’s degree OR 4 years of related actuarial/business/analytical experience (in addition to the minimum years of experience required) may be substituted in lieu of degree.
2 years of actuarial or analytical business experience.
3 Casualty Actuarial Society (CAS) exams.
Experience with relevant actuarial, mathematical, and statistical techniques and approaches used to support fact-based decision-making.
Intermediate knowledge of data analysis tools, data visualization, developing analysis queries and procedures in Python, R, SQL, SAS, BI tools or other analysis software, and relevant industry data & methods and ability to connect technical insights to business problems.
What sets you apart:
Familiarity with Excel and at least one programming language or modeling software package (Python, SQL, R, SAS, etc.).
Demonstrated experience with basic actuarial pricing methodologies.
Demonstrated experience aggregating and analyzing data to solve problems.
Ability to effectively communicate insights and solutions to broad audiences including actuarial and non-actuarial stakeholders.
P&C Personal Lines pricing experience.
Familiarity and experience with industry pricing software such as Earnix.
US military experience through military service or a military spouse/domestic partner.
Compensation range: The salary range for this position is: $77,120 - $138,810.
USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.).
Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.
Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.
The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.
Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.
For more details on our outstanding benefits, visit our benefits page on .
Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting.
USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Remote working/work at home options are available for this role.
Identifies Community First Health Plan members with specific health care needs and provides case management interventions.
Analyzes, approves health care services and monitors outpatient care planning for Community First Health Plans members based on established criteria, plan policies and procedures.
Formulates and communicates case management plans that efficiently utilize health care services to move the member along the continuum of care towards optimum outcomes in the safest, most cost effective manner.
Graduation from an accredited school of professional nursing is required, BSN preferred.
Master's degree is preferred.
Minimum three years' acute care experience or managed care experience is required.
Minimum one-year of concurrent review experience is required.
Candidate must have utilization management and/or quality assurance experience.
Basic knowledge of Medicaid, community resources and alternate funding programs is desired.
Knowledge of InterQual screening criteria as well as DRG, ICD-9 and CPT coding is preferred.
Current Registered Nurse license to practice professional nursing issued by the Board of Nurse Examiners for the State of Texas is required.
Active Certification in Case Management (CCM) designation is preferred.
Remote working/work at home options are available for this role.
Why USAA?
At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.
Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful.
The Opportunity
As a dedicated Property Adjuster, you will work within defined guidelines and framework, investigate, evaluate, negotiate, and settle low to moderate complexity property insurance claims. You will confirm/analyze coverage, recognize liability exposure and negotiate equitable settlement in compliance with all state regulatory requirements. You will recognize and empathize with members’ life events, as appropriate.
This hybrid role requires an individual to be in the office 3 days per week. This position can be based in one of the following locations: San Antonio, TX, Phoenix, AZ, Colorado Springs, CO, Tampa, FL or Chesapeake, VA. Relocation assistance is not available for this position.
This is an experienced desk based Property Adjuster role working in a telephone concentrated environment without physical inspection of loss. This is an hourly, non-exempt position with paid overtime available. Training will be approximately 12 weeks, Monday to Friday and hours may vary by location. Upon successful completion of training, employees will transition to an eight-hour work shift ranging between 8:00 am – 5:30 pm (local time) Monday to Friday with availability for occasional evenings and weekends based on business needs.
What you'll do:
Proactively manages assigned claims caseload comprised of claims with low to moderate complexity damages that require commensurate knowledge and understanding of claims coverage.
Partners with vendors and internal business partners to facilitate low to moderate complexity claims resolution. May also involve external regulatory coordination to ensure appropriate documentation and compliance.
Investigates claim damages by conducting research from various sources, including the insured, third parties, and external resources. May identify and resolve potential discrepancies and identifies subrogation potential resulting from unusual characteristics.
Identifies coverage concerns, reviews prior loss history, determines and creates Special Investigation Unit (SIU) referrals, when appropriate. Determines coverage through analyzing investigation information involving low to moderate complexity policy terms and contingencies.
Determines and negotiates low to moderate complexity claims settlement. Coordinates with management for guidance on assessing settlement amounts outside of authority limits to support managing claims outcomes.
Maintains accurate, thorough, and current claim file documentation throughout the claims process.
Applies knowledge of estimating technology platforms and virtual inspection tools to prepare and manage low to moderate complexity property insurance claims estimates
Recognizes and addresses jurisdictional challenges such as applicable legislation and construction considerations.
Supports workload surges and catastrophe (CAT) response operations as needed, including mandatory on-call dates and potential evening, weekend, and/or holiday work outside normal work hours.
May be assigned CAT deployment travel with minimal notice during designated CATs.
Works various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed.
Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.
What you have:
High School Diploma or General Equivalency Diploma.
1 year of customer service, military leadership, construction related industry/insurance experience and/or experience handling low complexity property claims
Knowledge of estimating losses using Xactimate or similar tools and platforms.
Demonstrated negotiation, investigation, communication, and conflict resolution skills.
Working knowledge and understanding of claims contracts as well as application of case law and state laws and regulations.
Ability to prioritize and multi-task, including navigating through multiple business applications.
May need to travel up to 25% of the year (local & non-local) and/or work catastrophe duty when needed.
Acquisition and maintenance of insurance adjuster license within 90 days and 3 attempts.
What sets you apart:
1+ years relevant property adjusting claims of moderate complexity
Experience desk adjusting residential property claims to include water, roof, and personal property
File ownership handling claims from start to finish (scoping the loss, assessing damages, estimating, interpreting policy, making coverage decisions, settlement)
Proficient in estimate writing using Xactimate and virtual tools (such as Claim X, Hover, and Hosta)
Currently hold an active P&C Adjuster license
Experience working directly for a standard insurance carrier
Experience in a all center environment
US military experience through military service or a military spouse/domestic partner
Physical Demand Requirements:
May require the ability to crouch and stoop to inspect confined spaces, to include attics and go beneath homes into crawl spaces.
May need to meet all USAA safe driving requirements including verification of driving record through MVR & possession of valid driver’s license.
May require the ability to lift a minimum of 35 pounds to include lifting a ladder in and out of the trunk of a car.
May require the ability to climb ladders and traverse roofs, this includes the ability to work at heights while inspecting roofs and attics.
Compensation range: The salary range for this position is: $57,970 - $97,820.
USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.).
Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.
Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.
The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.
Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.
For more details on our outstanding benefits, visit our benefits page on
Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting.
USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Remote working/work at home options are available for this role.
Why USAA?
At USAA, our mission is to empower our members to achieve financial security through highly competitive products, exceptional service and trusted advice. We seek to be the #1 choice for the military community and their families.
Embrace a fulfilling career at USAA, where our core values – honesty, integrity, loyalty and service – define how we treat each other and our members. Be part of what truly makes us special and impactful.
The Opportunity
As a dedicated auto adjuster, within defined guidelines and framework, you are responsible to adjust moderately complex auto insurance claims presented by or against our members to include the end-to-end claims process and settling claims in compliance with state laws and regulations. You are accountable for delivering best in class service, through setting appropriate expectations, proactive communications, advice, and empathy.
This hybrid role requires an individual to be in the office 3 days per week, after completing 6 months in office. This position can be based in the following location: Chesapeake, VA. Relocation assistance is not available for this position.
What you'll do:
Investigates liability and applies appropriate coverage, evaluates, negotiates, and settles moderately complex auto claims.
Negotiates liability for comparative negligence (claimant or adverse carrier).
Identifies coverage concerns, reviews prior loss history, determines, and creates Special Investigation Unit (SIU) referrals, when appropriate.
Interacts with multiple parties to gather information needed to determine liability (police reports, recorded statements, witness statements).
Resolves claims through proactive problem solving and decision making, within authority guidelines and under moderate supervision, overcoming obstacles, and effectively prioritizing the workload.
Clearly documents thought process including damage evaluation, investigation, negotiation, and settlement decisions
Collaborates and sets expectations with external and internal business partners to facilitate claims resolution.
Supports members, business partners, and claimants, through use of varying communication channels to include utilization of digital tools to drive timely and effective resolutions through exceptional service.
Applies developing knowledge of P&C insurance industry products, services, to include P&C insurance policy contracts, coverages and internal claims handling process and procedures.
Applies intermediate knowledge of Auto Physical Damage to adjust claims.
Supports workload surges and catastrophe (CAT) response operations as needed, including mandatory on-call dates and potential evening, weekend, and/or holiday work outside normal work hours.
May be assigned CAT deployment travel with minimal notice during designated CATs.
Works various types of claims, including ones of higher complexity, and may be assigned additional work outside normal duties as needed.
Ensures risks associated with business activities are effectively identified, measured, monitored, and controlled in accordance with risk and compliance policies and procedures.
What you have:
High School Diploma or General Equivalency Diploma.
1 year of customer service experience.
Progressive experience handling low complexity auto non injury liability claims.
Acquisition and maintenance of insurance adjuster license within 90 days and 3 attempts.
Developing knowledge and understanding of auto claims contracts as well as application of case law and state laws and regulations.
Demonstrated negotiation, investigation, communication, and conflict resolution skills.
Proficient in prioritizing and multi-tasking, including navigating through multiple business applications.
Successful completion of a job-related assessment may be required.
What sets you apart:
One or more years of auto liability claims experience managing claims from initial contact through resolution
Minimum one year of experience managing a pending inventory with demonstrated organization and prioritization skills
At least two years of customer service experience, demonstrating strong communication and problem-solving skills
Proven experience with comparative negligence and shared liability determinations
Strong analytical and communication skills with the ability to interpret policy language, assess coverages, and make sound decisions
Proficiency with Guidewire or similar claims management systems
Bachelor’s degree or industry designation (e.g., AIC, CPCU)
Military experience through service or as a military spouse
Compensation range: The salary range for this position is: $51,370 - $92,060.
USAA does not provide visa sponsorship for this role. Please do not apply for this role if at any time (now or in the future) you will need immigration support (i.e., H-1B, TN, STEM OPT Training Plans, etc.).
Compensation: USAA has an effective process for assessing market data and establishing ranges to ensure we remain competitive. You are paid within the salary range based on your experience and market data of the position. The actual salary for this role may vary by location.
Employees may be eligible for pay incentives based on overall corporate and individual performance and at the discretion of the USAA Board of Directors.
The above description reflects the details considered necessary to describe the principal functions of the job and should not be construed as a detailed description of all the work requirements that may be performed in the job.
Benefits: At USAA our employees enjoy best-in-class benefits to support their physical, financial, and emotional wellness. These benefits include comprehensive medical, dental and vision plans, 401(k), pension, life insurance, parental benefits, adoption assistance, paid time off program with paid holidays plus 16 paid volunteer hours, and various wellness programs. Additionally, our career path planning and continuing education assists employees with their professional goals.
For more details on our outstanding benefits, visit our benefits page on
Applications for this position are accepted on an ongoing basis, this posting will remain open until the position is filled. Thus, interested candidates are encouraged to apply the same day they view this posting.
USAA is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.
Remote working/work at home options are available for this role.
Serves as member of health care team that provides specialized health care including preventive care and on-going health maintenance for selected groups of patients. Functions in a variety of settings ranging from ambulatory to inpatient. Participates in the care of well, acutely ill and chronically ill patients.
EDUCATION
A Registered Professional Nurse who is prepared for advanced nursing practice by virtue of knowledge and skills obtained through an accredited post basic or advanced educational program of study acceptable to the Board of Nurse Examiners. A Master’s degree in nursing is preferred. Must be a participating Medicare provider or eligible to obtain a Medicare provider number. Three years of nursing experience is required and two years of advanced practice is preferred.
LICENSURE/CERTIFICATION
Must be currently licensed as a Registered Nurse in Texas and credentialed by the State to practice as an Advanced Nurse Practitioner. Must maintain current AHA BLS or higher in accordance with Medical-Dental staff bylaws. Prescriptive authority is required. Valid DEA number must be obtained within 90 days of hire. Certification by a national nursing body is required.
Remote working/work at home options are available for this role.
Conducts comprehensive clinical reviews of adverse determinations related to medical necessity.
Initiates outreach to providers to obtain clarification or additional documentation in alignment with established clinical criteria and organizational policies, to support Medical Director decision making.
Provides support for claim appeals in relation to medical necessity.
Ensures the timely and accurate resolution of appeal cases and supports organizational adherence to all state, federal, and accreditation standards.
Facilitates member second level appeal process.
Graduate from an accredited school of professional nursing is required.
BSN preferred.
Minimum 2 years acute care experience or managed care experience is required.
Basic knowledge of Medicaid, Medicare preferred.
Knowledge of InterQual screening criteria, ICD-10, CPT coding preferred.
Current Registered Nurse (RN) license to practice professional nursing issued by the Board of Nurse Examiners for the State of Texas is required.
Active Certification in Case Management (CCM) is preferred.
Remote working/work at home options are available for this role.
Conducts comprehensive clinical reviews of adverse determinations related to medical necessity.
Initiates outreach to providers to obtain clarification or additional documentation in alignment with established clinical criteria and organizational policies, to support Medical Director decision making.
Provides support for claim appeals in relation to medical necessity.
Ensures the timely and accurate resolution of appeal cases and supports organizational adherence to all state, federal, and accreditation standards.
Facilitates member second level appeal process.
Graduate from an accredited school of professional nursing is required.
BSN preferred.
Minimum 2 years acute care experience or managed care experience is required.
Basic knowledge of Medicaid, Medicare preferred.
Knowledge of InterQual screening criteria, ICD-10, CPT coding preferred.
Current Registered Nurse (RN) license to practice professional nursing issued by the Board of Nurse Examiners for the State of Texas is required.
Active Certification in Case Management (CCM) is preferred.
Remote working/work at home options are available for this role.
The Registered Nurse – Home Health is responsible for providing and documenting skilled nursing care in accordance with the developed care plan and physicians’ orders for each individual patient while adhering to confidentiality standards and professional boundaries at all times.
Sign-On Bonus: $5,000
Opening: Full Time Mon-Fri flexible schedule with limited weekends for on-call
Territory: Waushara and Waupaca County
Essential Job Functions:
- Develop a plan of care through physician orders, client input, and nursing assessment to include medical interventions and measurable goals and outcomes.
- Educate clients and their family members based on client’s specific needs.
- Properly orient and train primary caregivers to ensure the most optimal functioning level for each client.
- Coordinate the continuum of hands on client care through documentation and timely communication with the client's physician and other caregivers.
- Provide care in patients home using a variety of skills such as phone triage, patient education, observation/assessment, wound care, infusions, catheter care, PICC line dressing changes etc.
Why Join Our Team?
- Our clinical team is a family of clinicians who work together to meet the needs of each patient
- Nationwide career opportunities where our leaders encourage advancements
- Our clinicians enjoy the flexibility of getting to build rapport with patients to produce the best clinical outcomes
- We know that our clinicians make or break the organization’s success
Benefits Offerings:
- 401(k) with company match
- Health, dental, vision, life, and pet insurance
- Mileage reimbursement and cell phone allowance
- Generous PTO, sick time, and paid holidays
- Inclusion Day to celebrate what matters to you
- Float Day for extra flexibility and balance
- Up to 8 Hours of Paid Volunteer time yearly
- No-Cost Employee Assistance Program (EAP) - unlimited mental health telephonic counseling sessions, support with identity left, Will preparation and travel assistance
- Robust DEI company program because Inclusion is an Aveanna Core Value
- Tuition discounts and reimbursement
Requirements:
- An active RN License in the state of application
- Valid CPR, Drivers License and Proof of automobile insurnace
Preferred:
- Medicare Skilled Nursing experience
- Basic understanding of Oasis
- 1-year RN experience in a health care setting
HHH
As an employer accepting Medicare and Medicaid funds, employees must comply with all health-related requirements in all relevant jurisdictions, including required vaccinations and testing, subject to exemptions for medical or religious reasons as appropriate.
Notice for Job Applicants Residing in California
Notice for Job Applicants Residing in Florida
Remote working/work at home options are available for this role.
