Remote/Hybrid Registered Nurse (RN) Advocacy & Program Integrity (Medical Assistance Expert) Job at The CKHobbie Group, Pittsburgh, PA

QWV5V3ZURjVpOHJ1UnFnM2IvOE5HTnQ4TGc9PQ==
  • The CKHobbie Group
  • Pittsburgh, PA

Job Description

Registered Nurse: Review and Evaluation

Are you a registered nurse ready to take your career in an exciting new directionone where your expertise truly makes a difference? Join Pennsylvania's premier Quality Improvement Organization and step into a dynamic role focused on advocacy and program integrity through compliance management. Here, you'll champion the needs of vulnerable populations, safeguard the quality of care, and influence healthcare outcomes on a meaningful scale. Enjoy the freedom of working from home, the flexibility and autonomy to manage your workday, and the opportunity for continuous professional growthall while being part of a passionate, mission-driven team dedicated to improving healthcare across the Commonwealth. In this rewarding role, you'll use your clinical knowledge outside of the traditional bedside setting to review and audit claims, support program integrity initiatives, and advocate for beneficiaries across the Commonwealth. You'll enjoy the flexibility of working from home, the autonomy to manage your work, and meaningful opportunities for professional growthall while contributing to a mission that truly matters.

What You'll Do:

  • Conduct clinical reviews and ensure quality, appropriateness, and compliance with healthcare standards
  • Support program integrity efforts by identifying trends, risks, and opportunities for improvement
  • Advocate for beneficiaries, with a strong focus on protecting and improving care for vulnerable populations
  • Apply nursing judgment to analyze medical records, documentation, and billing data
  • Collaborate with interdisciplinary teams, providers, and stakeholders to promote best practices
  • Contribute to quality improvement initiatives that strengthen healthcare delivery across Pennsylvania

What We're Looking For:

  • Active, unrestricted Registered Nurse (RN) license
  • Strong clinical background with the ability to apply nursing judgment analytically
  • Interest in advocacy, quality improvement, and healthcare program integrity
  • Excellent written and verbal communication skills
  • Ability to work independently while managing multiple priorities
  • Comfort with technology and electronic medical records
  • Experience in utilization review, case management, quality improvement, compliance, or claims review is a plusbut not required.

Why Join Us:

  • Mission-driven work with Pennsylvania's leading Quality Improvement Organization
  • Make a real impact on healthcare quality and outcomes for vulnerable populations
  • Remote work enjoy the convenience and balance of working from home
  • Autonomy and flexibility in how you manage your workday
  • Advocacy-focused role that values your nursing voice and expertise
  • Career development opportunities to grow beyond traditional nursing roles
  • Supportive, collaborative team culture committed to excellence and integrity

If you're a registered nurse seeking purpose-driven work, professional growth, and the flexibility to balance your life and careerthis is your opportunity. Apply today and help shape the future of healthcare quality in Pennsylvania.

The CKHobbie Group

Job Tags

Remote job

Similar Jobs

Workoo Technologies

Remote Data Entry Clerk - Part-Time, Work From Home Job at Workoo Technologies

 ...leading marketing research company is seeking a Data Entry Representative to participate in surveys and studies from home. This part-time remote position allows you to earn income through paid surveys and offers flexibility with no minimum hours required. Candidates need... 

Califresh of California, LLC.

Harvesting Operator Job at Califresh of California, LLC.

 ...capability to work long hours and work at night. The incumbents must be highly motivated, have good common sense, experience in driving agricultural machinery and good communication skills along with the ability to speak English. These harvest operators must be easy to work... 

Lane Automotive

Marketing Manager Job at Lane Automotive

 ...Marketing Manager The Marketing Manager is responsible for marketing functions and assisting with the development and implementation...  ...digital media campaigns/strategies, including social media, Pay Per Click (PPC), brand websites, email marketing, and Search Engine Optimization... 

HomeWorks Energy, Inc.

Brand Ambassador Job at HomeWorks Energy, Inc.

 ...eligible for overtime, plus commission.HOMEWORKS ENERGY is hiring Brand Ambassadors starting at $23 per hour plus commission ($200-$500 or more...  ...license and reliable form of transportation.Must be okay traveling to territory locations up to 1 hour away (mileage is... 

Stationhouse Grill Mascoutah

Delivery Driver Job at Stationhouse Grill Mascoutah

 ...Job Description Job Description Our Delivery Drivers are the face of Stationhouse beyond the restaurantbringing our food straight to...  ...customer service skills Able to work flexible hours, including nights and weekends Comfortable multitasking between delivery and...