Managed Care Staffing Jobs in Usa
36,449 positions found
Title: Managed Care Contract Analyst
Duration: Full-Time
Location: Dalton, GA - Remote or Hybrid
Working Schedule: 8:30 AM - 5:00 PM
Position Overview
The Managed Care Contract Analyst is responsible for the day-to-day management, modeling, and performance analysis of payer contracts. This role partners closely with the Director of Managed Care Contracting to support contract negotiations, reimbursement modeling, and ongoing payer performance monitoring. The analyst will interpret complex contract language, identify reimbursement trends and issues, and support revenue cycle optimization initiatives.
Key Responsibilities
- Manage and maintain payer contracts, including inventory of agreements, rate grids, and contract terms.
- Support contract negotiations through data extraction, analysis, and complex reimbursement modeling.
- Model and assess payer reimbursement performance and identify trends in payment practices.
- Identify and assist with revenue cycle reimbursement issues and communicate findings to stakeholders.
- Interpret complex administrative and financial contract language and clearly communicate impacts internally and externally.
- Stay current on payer billing and reimbursement changes and proactively communicate updates.
- Interface with outside vendors and consultants as needed.
- Complete credentialing and re-credentialing applications.
- Ensure accuracy and integrity of contract management systems and data.
Education
- Bachelor’s degree in Business, Accounting, Finance, or Healthcare Management
Experience
- 3–5+ years of healthcare managed care or payer contract management experience.
- Strong understanding of payer contract language and reimbursement methodologies.
- Hands-on experience with:
- CPT, ICD-9, and modifiers
- Hospital Medicare and Medicaid fee schedules
- Third-party billing requirements and claim payment methodologies
- Claim system requirements, procedures, and controls
Skills
- Advanced proficiency in Excel; working knowledge of Word and PowerPoint.
- Strong analytical skills with high attention to detail.
- Excellent written and verbal communication skills.
- Experience with contract management software or strong technical aptitude to learn quickly.
Location: Columbia, SC 29203
Work Environment: (Remote after 4-6 weeks of Onsite training)
Contract length: 4 months assignment with possible conversion
Schedule: Mon - Fri, 40hrs
Job Summary:
Duties/About the role:
Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare continuum to assess, plan, implement, coordinate, monitor, and evaluate medical necessity, options, and services required to support members in managing their health, chronic illness, or acute illness. Utilizes available resources to promote quality, cost effective outcomes.
Day to Day:
- 50% Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal).
- 25% Provides discharge planning and assesses service needs in cooperation with providers and facilities. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Collaborates with client's Care Management and other areas to ensure proper care management processes are executed within a timely manner. Manages assigned members and authorizations through appropriate communication.
- 15% Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members.
- 5% Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. May identify, initiate, and participate in on-site reviews. Promotes enrollment in care management programs and/or health and disease management programs. 5% Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services.
Job Requirements:
Required Education: Associate Degree - Nursing, OR, Graduate of Accredited School of Nursing,
Required Experience: 4 years recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical.
Required License/Certificate: An active, unrestricted RN license from the United States and in the state of hire OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC)
Preferred Education: Bachelor's degree- Nursing.
Preferred Work Experience: 7 years-healthcare program management.
Preferred Licenses and Certificates: Case Manager certification, clinical certification in specialty area.
POSITION SUMMARY/RESPONSIBILITIES Assists Community First Health Plan (CFHP) members regain optimum health or improved functional capacity by ensuring that members have access to all of the health care services they need in the most efficient and effective manner possible.
Responsibilities include but are not limited to overseeing the allocation of resources, cost and quality of health care for members; coordinating care between the primary care physician, community resources, family and member; coordinating care across the health care continuum while monitoring and managing benefit utilization; and, collaborating with multi-disciplinary health care team members in identifying the educational and discharge needs of members.
EDUCATION/EXPERIENCE Registered Nurse (RN) is required.
Bachelor of Science in Nursing (BSN) or Master's degree is preferred.
Minimum three (3) years nursing, acute care, quality management or managed care experience is required.
Basic knowledge of Medicaid, Medicare, community resources and alternate funding programs is desired.
Knowledge of InterQual screening criteria as well as DRG, ICD and CPT coding is preferred.
LICENSURE/CERTIFICATION Current licensure as a Registered Nurse with the Texas State Board of Nurse Examiners is required.
Current certification from an appropriate professional agency, such as Case Management Society, is preferred.
Location: Columbia, SC 29229
Work Environment: Remote (after 1 week of Onsite training)
Schedule: Mon - Fri, 8:30 AM - 5:00 PM (Two late shifts, 11:30 am - 8:00 pm - no late shifts on Fridays)
Contract length: 3 months assignment with possible extension
Job Summary:
Duties/About the role:
Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis, and comprehensive knowledge of healthcare continuum to assess, plan, implement, coordinate, monitor, and evaluate medical necessity, options, and services required to support members in managing their health, chronic illness, or acute illness. Utilizes available resources to promote quality, cost effective outcomes.
Day to Day:
- 60% Provides active case management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Provides telephonic support for members with chronic conditions, high risk pregnancy or other at risk conditions thatconsist of: intensive assessment/evaluation of condition, at risk education based on members' identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement.
- 20% Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but isnot limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal).
- 10% Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. May identify, initiate, and participate in on-site reviews. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and/or health and disease management programs.
- 5% Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services.
- 5% Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members.
Job Requirements:
Required Education:?
Associate Degree - Nursing or Graduate of Accredited School of Nursing or Master's degree in Social Work, Psychology, or Counseling.
Required Work Experience: 4 years recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical.
Required License and Certificate: Active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), OR, active, unrestricted LMSW (Licensed Master of Social Work) licensure from the United States and in the state of hire, OR active, unrestricted licensure as Counselor, or Psychologist from the United States and in the state of hire.
Preferred Education: Bachelor's degree- Nursing.
Preferred Work Experience: 7 years-healthcare program management, utilization review, or clinical experience in defined specialty. Specialty areas are oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedic, general medicine/surgery.
Medical Director Physician Opportunity - Palm Springs, California
Cutting Edge Managed Care Organization
About the Opportunity
Join a well-established group in California with over 40 years of dedicated service, focusing on population health. Become a part of a leadership team at the forefront of advancing health initiatives. This opportunity offers a team-oriented approach to patient care, with excellent sub-specialty support and recognition for an award-winning work environment.
Requirements
- MD/DO degree required
- Licensed in California
Job Highlights
- No direct clinical responsibilities, allowing for a focus on prior authorization, concurrent review, and utilization management
- A part of one of the flagship ACOs, now a 2nd generation ACO
Compensation & Benefits
- $500,000 competitive salary with aggressive incentives
- Comprehensive benefits package
Location
- Palm Springs is known for its beauty, cultural attractions, and community
- Enjoy a scenic environment with year-round sunshine
- Home to various world-class resorts and spas
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.
EDUCATION/EXPERIENCE
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.
LICENSURE/CERTIFICATION
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.
- The RN Director of UAS Assessment will direct and monitor the daily activities of field staff and the clinical department to ensure the delivery of quality care to all members.
- Responsibilities:
- Provides clinical support to UAS RNs
- Performs field supervision of UAS RNs annually and as needed
- Responsible to ensure Universal Assessment Systems of NY (UAS-NY) and other clinical assessments/documents completed by the UAS RNs are meeting quality metrics.
- Responsible to ensure all clinical documentation by UAS RNs are complete, accurate, and submitted timely
- Review UAS RNs performance and productivity to ensure productivity goals and metrics are achieved.
- Identify and assist with UAS RNs continuing education and training procedures for UAS assessment
- Weekly reports
- Participates in hiring and training of new UAS RNs
- Implements disciplinary actions as needed
- Participates in quality assurance performance improvement projects related to UAS department
- Qualifications:
- Active and unrestricted NYS RN license (BSN)
- Minimum 4 years’ experience in UAS reviews and/or UAS assessments for an MLTC
- 2-years of Director or management level experience preferably in an MLTC or LHCSA Home Care setting.
- Excellent written and verbal communication skills.
- Proficiency in the use of Microsoft Office tools (Excel and Outlook)
- Strong problem-solving ability
- Strong Clinical Assessment skills
- Knowledge of MLTC regulatory requirements
- Able to work independently and communicate in a professional manner
- Knowledge of UAS Analyzer
- Knowledge of DOH Quality measurements a plus
Competitive Salary $140,000 plus benefits!
Qualified Candidates Please Apply Now for Immediate Consideration!
MedPro Healthcare Staffing is seeking a travel nurse RN PCU - Progressive Care Unit for a travel nursing job in Oklahoma City, Oklahoma.
Job Description & Requirements
- Specialty: PCU - Progressive Care Unit
- Discipline: RN
- Start Date: 04/06/2026
- Duration: 13 weeks
- 36 hours per week
- Shift: 12 hours, days
- Employment Type: Travel
MedPro Healthcare Staffing, a Joint Commission-certified staffing agency, is seeking a quality Step Down Registered Nurse for a travel assignment with one of our top healthcare clients.
Requirements
- Active RN License.
- Degree from accredited nursing program.
- BLS Certifications.
- Eighteen months of recent experience in an Acute Care PACU setting.
- Other requirements to be determined by our client facility
Benefits
- Weekly pay and direct deposit
- Full coverage of all credentialing fees
- Private housing or housing allowance
- Group Health insurance for you and your family
- Company-paid life and disability insurance
- Travel reimbursement
- 401(k) matching
- Unlimited Referral Bonuses up to $1,000
Duties Responsibilities
- Assesses patient needs, signs and symptoms indicating physiologic and psychosocial changes in the patient's condition Utilizes the nursing process to assess, plan, implement and evaluate patient care.
- Collects, analyzes, and interprets data and information from health care members and documents actual and/or potential nursing diagnoses.
- Documents the patient's plan of care using identified nursing diagnoses, expected patient outcomes, and selected nursing interventions.
- Initiates and evaluates patient and/or family education.
- Revises and documents the plan of care according to evaluation, changes in medical plan of care, and effective/ineffective nursing interventions.
About Agency
MedPro Healthcare Staffing is a Joint Commission certified provider of contract staffing services. Since 1983, we have placed nursing and allied travelers in top healthcare facilities nationwide. Join us today for your very own MedPro Experience®.
If qualified and interested, please call for immediate consideration.
MedPro Staffing is an Equal Opportunity Employer. All applicants will be considered for employment without attention to race, color, religion, national origin, age, sex, disability, marital status or veteran status.
Key Words: Registered Nurse, RN, Step-Down, Contract Nurse, Travel Nurse, Agency RN, Travel RN, Per Diem, Nursing, Contract, Travel Nursing
*Weekly payment estimates are intended for informational purposes only and include a gross estimate of hourly wages and reimbursements for meal, incidental, and housing expenses. Your recruiter will confirm your eligibility and provide additional details.
MedPro Job ID #a0Fcx00000HrGo1EAF. Pay package is based on 12 hour shifts and 36 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: Step Down Registered Nurse Nursing: Step-Down / Transitional Care.
About MedPro Healthcare Staffing
At MedPro Healthcare Staffing, we believe no one cares more for caregivers than we do. Our mission is simple: you focus on your patients, and we’ll take care of the rest.
As a Joint Commission-certified leader in temporary and contract healthcare staffing since 1983, MedPro has proudly connected nursing and allied travelers with top healthcare facilities across the nation. With thousands of job opportunities available nationwide, we make it easy to find assignments that align with your goals and lifestyle.
Our on-staff clinical support team—alongside a compassionate group of experienced recruiters—provides hands-on guidance every step of the way. From Day 1 medical benefits and a 401(k) plan to personalized career support, we’re committed to ensuring every professional we serve feels valued, cared for, and empowered to succeed.
Guided by a CEO who is a Registered Nurse, MedPro is built on a foundation of clinical insight and genuine compassion for the caregiving community. Through The MedPro Experience®, we deliver travel assignments that are rewarding, memorable, and designed to help you DREAM big, EXPLORE often, and ACHIEVE greatness.
Benefits
- Day 1 medical, dental, and vision benefits for you and your family
- Weekly pay and direct deposit
- Unlimited Referral Bonuses starting at $500
- On Staff Clinical Support Team
- Access to nationwide travel assignments
- MPX+ Mobile app -24/7 real-time access to jobs, credentials, assignment details, and more
- Full coverage of all credentialing fees
- Private housing or housing allowance
- Tax Free Per Diems, Housing Stipends and Travel Reimbursements
- Company-paid life and disability insurance
- Travel reimbursement
- 401(k) matching
Benefits
- Weekly pay
- Referral bonus
- Employee assistance programs
THP Healthcare Staffing is seeking a travel nurse RN NICU - Neonatal Intensive Care for a travel nursing job in Lebanon, New Hampshire.
Job Description & Requirements
- Specialty: NICU - Neonatal Intensive Care
- Discipline: RN
- Start Date: 03/30/2026
- Duration: 13 weeks
- 36 hours per week
- Shift: 12 hours, nights
- Employment Type: Travel
Our Client is currently seeking RN - NICU positions in Lebanon, NH for a 3x12 Nights shift. You must have current State Licensure and at least 1 year of recent experience.
Requirements
- Current Resume
- State Licensure
- Current BLS and/or ACLS and/or Specialty Certifications
- 2 Current Clinical References
- Physical (Within 12 Months)
- TB Skin Test (Within 12 Months)
- Titers - MMR/Hep B/Varicella
- Respiratory Fit Test (Within 12 Months)
- Current - Tdap/Flu Vaccinations
- Must be able to pass pre-employment, background and urine drug screening
Compensation and Benefits
- Compettive Pay Packages
- Health Benefit Package
- Travel pay - 1st pay check
- Extending Contract Bonus
- Refer a friend and earn extra cash!
At THP Healthcare Staffing, we take care of you - work with us, not for us!
THP Healthcare Staffing Job ID #17920123. Pay package is based on 12 hour shifts and 36.0 hours per week (subject to confirmation) with tax-free stipend amount to be determined. Posted job title: RN:NICU,19:00:00-07:00:00
About THP Healthcare Staffing
At THP Staffing, we specialize in connecting healthcare facilities with highly skilled travel nurses and allied health professionals who bring exceptional care and expertise wherever they go.
Our mission is to ensure that every healthcare provider has access to top nursing talent, regardless of location, to deliver superior patient outcomes.
Benefits
- Weekly pay
- Life insurance
- Pet insurance
- License and certification reimbursement
- Medical benefits
- Employee assistance programs
- Referral bonus
- Vision benefits
- Holiday Pay
- Health savings account
VHS is looking for a qualified Licensed Nursing Assistant - Long Term Care.
- City: Claremont
- State: NH
- Start Date: 2024-09-09
- End Date: 2024-12-09
- Duration: 13 Weeks
- Shift: 8 Hours Overnight shift.
- Skills: N/A
- Pay Rate: 29.40
Travel and Local Rates available - Certification Requirements: BLS (AHA)
At VieMed, Live Your Life isn't just a company tagline. It's a passionate commitment to improving the lives of every patient and employee.
Benefits Include:- Competitive Pay Packages
- Weekly Pay Schedule via Direct Deposit
- Comprehensive Medical Benefits
- Dental and Vision Supplemental Benefits
- 401(k) with match
- Robust Referral Bonus Program
- 24/7 Dedicated team committed to your success throughout your time with VHS
- Paid sick time in accordance with all applicable state, federal and local laws
- Licensure, certification, travel and other reimbursements when applicable
VHS is an Equal Opportunity Employer ( EEO )/Protected Veterans/Individuals with Disabilities/E-Verify Employer and welcomes all to apply