🧾 Utilization Management – Clinical Nurse 🩺
(Remote – U.S.)
✅ Position Highlights
• 💼 Employment Type: Full-Time
• 🏡 Location: 100% Remote (U.S. only)
• 🩻 Department: Utilization Management
• 🧠 Role Type: Clinical RN – Telephonic & Concurrent Review
📋 What You’ll Own
• Conduct precertification reviews for inpatient/outpatient procedures
• Apply clinical judgment and UM criteria to determine medical necessity
• Collaborate with medical directors for complex case reviews
• Perform telephonic and concurrent reviews for hospitalizations
• Facilitate discharge planning and continuity of care
• Draft compliant denial communications and support appeal processes
• Educate providers on coverage determinations and managed care guidelines
• Document all clinical and provider interactions thoroughly in the UM system
• Identify members for case management programs and coordinate discharge services
• Assist with cost-benefit analyses for exceptional coverage cases
• Report potential quality issues, fraud, or abuse
• Collaborate with UM analysts on appeals, complaints, and inter-rater reviews
• Stay current with Medicaid manual updates and regulatory timelines
🎯 Must-Have Traits
• Active RN license in an eNLC (Enhanced Nurse Licensure Compact) state
• 3+ years of Nursing experience
• 1+ year of Utilization Management experience
• Skilled in reviewing clinical documentation, guidelines, and treatment plans
• Proficient in Microsoft Office and EMR systems
• Excellent organizational, time management, and communication skills
• Independent, self-motivated, and regulatory-compliant
💻 Remote Requirements
• Must reside in the United States
• Active eNLC RN license required
• Reliable high-speed internet and dedicated workspace
💡 Why It’s a Win for Remote Clinicians
This role combines clinical expertise with strategic decision-making in a fully remote setting. You’ll play a vital role in ensuring appropriate, quality care while maintaining work-life flexibility. Plus, you’ll help drive value-based healthcare outcomes without stepping away from your nursing roots.
✍️ Call to Action
If you’re a licensed RN with Utilization Management experience and a passion for delivering smart, patient-centered care from home—this is your opportunity. Apply now and help shape better healthcare delivery with every review you touch.
🧾 Medicaid Claims Processor 🩺
(Remote – U.S.)
✅ Position Highlights
• 💼 Employment Type: Full-Time
• 🏡 Location: 100% Remote (U.S. only)
• 📊 Department: Claims Processing
• 🔧 Software Experience Required: QNXT
📋 What You’ll Own
• Accurately process and adjudicate Medicaid insurance claims
• Enter and verify data using QNXT systems
• Ensure compliance with CMS guidelines and regulatory standards
• Identify and resolve discrepancies or errors within claims
• Maintain thorough documentation and reports to track claim outcomes
• Communicate with internal teams and partners to resolve claim-related issues
• Stay updated on industry policies, regulations, and Medicaid standards
• Support claims team with process improvement initiatives and additional duties
🎯 Must-Have Traits
• Minimum 1 year of Medicaid claims processing experience
• Hands-on proficiency with QNXT claims system
• High attention to detail with strong analytical and organizational skills
• Ability to manage multiple claims under tight deadlines
• Excellent written and verbal communication skills
• Self-motivated and disciplined while working remotely
• High school diploma or equivalent
💻 Remote Requirements
• Reliable internet and home office setup
• Must reside in the United States
• Ability to work independently with minimal supervision
💡 Why It’s a Win for Remote Job Seekers
A great fit for detail-oriented professionals looking to apply their Medicaid claims expertise from home. This role offers the stability of full-time work, the flexibility of remote life, and the satisfaction of helping streamline vital healthcare reimbursements.
✍️ Call to Action
If you’re experienced with QNXT and Medicaid claims and thrive in a remote work environment, this is your opportunity. Apply now to help deliver accuracy, speed, and compliance in health claim processing.
🧾 Data Center Associate 🌙
(Part-Time, Remote – Pacific Time Zone)
✅ Position Highlights
• 💰 Pay Rate:
– Colorado (excl. Denver): $14.81/hr
– Washington (excl. Seattle/SeaTac): $16.66/hr
• 🕒 Part-Time | Casual Employment
• 🌙 Night Shift Only (starts between 6–7 PM PT, must work past midnight)
• 🌎 Remote: Must reside in OR, WA, AZ, NV, ID, CO, or UT
📋 What You’ll Own
• Collect, sort, and input domestic theater and studio-related data
• Monitor theater reporting timelines and escalate issues to day shift when appropriate
• Research and verify pre-release data and missing/incomplete entries
• Contact originators to resolve inconsistencies or incomplete data
• Float between multiple job functions within the Data Center
• Train new hires and assist peers as needed
• Maintain high accuracy in data entry with minimal supervision
• Suggest process improvements and demonstrate initiative in shifting responsibilities
🎯 Must-Have Traits
• High school diploma or GED
• 0–1 year of relevant experience
• Strong data entry skills and attention to detail
• Proficiency with Microsoft Office Suite
• Familiarity with internet-based research
• Strong written and verbal communication skills
• Ability to meet deadlines and multitask in a fast-paced, remote environment
• Willingness to work holidays, weekends, and consistent night shifts
💻 Remote Requirements
• Must reside in one of the following: Oregon, Washington, Arizona, Nevada, Idaho, Colorado, or Utah
• Ability to work late-night hours consistently (starting 6–7 PM PT)
• Stable internet connection and self-motivated workspace
💡 Why It’s a Win for Remote Job Seekers
Perfect for night owls and detail-oriented individuals who enjoy focused, independent work. This flexible, part-time role offers steady late-night hours and a chance to build professional skills in data handling and research—all from home.
✍️ Call to Action
Ready to bring your precision and focus to the team? Apply now and join a remote-first role that keeps the data flowing long after dark.
🧾 Stop Loss Claims Trainer & Process Owner 💼
(Remote / Hybrid – U.S.)
✅ Position Highlights
• 💰 Salary Range: $77,600 – $129,400 + bonus eligibility
• 🕒 Full-Time | Remote or Hybrid Flexibility
• 📌 Department: Stop Loss Claims
• 🌟 Two unique openings focused on training, process optimization, and project leadership
• 💼 Great opportunity for those with stop loss or insurance industry experience
📋 What You’ll Own
• Develop and maintain training materials, workflows, and documentation
• Deliver onboarding and upskilling sessions for new and current employees
• Collaborate cross-functionally to identify, implement, and document best practices
• Lead or support special projects and initiatives that improve process, systems, and outcomes
• Provide claims processing support during peak volume
• Manage data reporting, analytics, and benchmarking
• Coordinate with systems partners to enhance tools and support knowledge-sharing
• Represent the team at conferences and internal strategic meetings
• Document and share meeting notes and project updates with leadership
🎯 Must-Have Traits
• 3–5 years’ experience in stop loss claims or related field
• High School diploma required (Bachelor’s degree preferred)
• Solid grasp of stop loss insurance principles and claims workflows
• Proficiency in MS Office Suite (Outlook, Excel, PowerPoint, Word)
• Familiarity with enterprise databases and process-based tech tools
• Excellent analytical, communication, and facilitation skills
• Comfortable leading change, mentoring peers, and managing projects
• Resourceful and creative in solving complex problems and unifying teams
• Able to travel occasionally (up to 10%)
💻 Remote Requirements
• Fully remote or hybrid roles available
• Must be based in the U.S. and able to support EST time zone business hours
• Ability to maintain confidentiality and performance in a digital workspace
💡 Why It’s a Win for Remote Job Seekers
You’ll join a respected, mission-driven organization with opportunities to impact real operational change. With leadership support, rich learning resources, and a clear career path, Symetra is ideal for professionals who want to grow in the stop loss space while working with flexibility.
✍️ Call to Action
Ready to bring your experience and leadership to the table? Apply today and help shape the future of stop loss claims excellence at Symetra.
🧾 Subject Matter Expert (SME) 🧠
(Remote – U.S.)
✅ Position Highlights
• 💼 Employment Type: Full-Time
• 🏡 Remote (U.S.-based)
• 🧑🏫 Training-focused support role
• 🔄 Collaborates directly with Trainers and Support teams
• 🌍 Inclusive work environment that values diversity
📋 What You’ll Own
• Monitor daily attendance and track agent certification progress
• Observe agent performance during fishbowl and simulated sessions
• Track agent participation and behavior throughout training
• Monitor systems such as BHive, Genesys, and Pulse for updates and activity
• Provide real-time feedback and support to new hires
• Troubleshoot system or technical issues
• Collaborate with trainers and support staff to ensure smooth classroom flow
• Maintain structure and engagement in the virtual training space
🎯 Must-Have Traits
• Strong grasp of UHC’s mission, systems, products, and procedures
• Proven high performance in the agent sales role
• Experience in virtual system navigation (Genesys, Pulse, etc.)
• Strong communication and observation skills
• Comfortable in an adult learning environment
• Able to assist before/after scheduled class hours, when needed
• Proactive and team-oriented mindset
💻 Remote Requirements
• Must be U.S.-based and able to work during assigned training hours
• Reliable internet and home office setup
• Active participation in class activities and agent engagement
• Must monitor multiple platforms (chat, system dashboards, updates)
💡 Why It’s a Win for Remote Job Seekers
If you’re someone who thrives on helping others grow and succeed, this is your opportunity to directly shape the onboarding experience. BroadPath gives you a platform to lead by example, mentor new talent, and maintain excellence from the ground up.
✍️ Call to Action
Ready to be the go-to expert in the virtual classroom? Apply now and join BroadPath’s commitment to creating meaningful, inclusive, and supportive training environments.
Recent Comments