Essentia Health

RN - Registered Nurse (Remote) - Lung Navigator 1.0 FTE

Posted on:

June 7, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Minnesota

We are a top-rated employer offering work-life balance, long term career stability, opportunities for growth, and work you can be passionate about! Our mission guides us every day: We are called to make a healthy difference in people’s lives. This calling resonates deeply for our caregivers and our colleagues working behind the scenes, who all bring high-quality, compassionate care to the patients we are privileged to serve.

Responsible for organizing and providing nursing care to patients through the process of assessment, planning, intervention, and evaluation. Delegates aspects of care to other nursing personnel based upon their licensure, preparation and job descriptions. Contributes to the meeting of the mission and goals of the facility and Essentia and meets the requirements of the Joint Commission if applicable and/or other federal, state and local regulatory or accrediting agencies. Responsible for care coordination, patient education, and decision-making support for patients. Serves as a single point of contact for referring physicians, patients, and caregivers to provide resources and assistance with accessing clinical and supportive care services offered within Essentia and in the community. Participates in conferences and committees, assisting the entire care team in developing optimal care plans for each individual. Collaborates with other service providers/organizations and community supporters in providing patient education and outreach.

Educational Requirements: BSN or ADN degree from an accredited school or college of nursing Required Qualifications: 2 years of related experience Licensure/Certification Qualifications: Bachelor’s of Science in Nursing or Associate Nursing Degree from an accredited school or college of nursing Required Qualifications: 2 years of nursing experience Preferred Qualifications: Minimum of 2 years of nursing experience in the following areas: Pulmonology, Oncology, Navigation, or Care Coordination. Experience in patient navigation, case management, or remote patient monitoring. Familiarity with lung cancer screening guidelines and incidental lung nodule management best practices. Experience with telehealth, remote patient engagement, and Epic EHR. Additional Job Description: Current RN license in state(s) of employment. This role requires RN licensure in Minnesota, North Dakota and Wisconsin. Must earn licensure within 90 days of hire or transfer.

Navigate patients through lung cancer screening and incidental nodule process with adherence to guidelines and standing orders. Coordination of follow up imaging, specialist referrals and multidisciplinary team communication. Collaboration with radiologists, pulmonologists, oncologists, CT surgeons and primary care providers to ensure timely follow up and intervention. Contribute to program development, workflow optimization, and quality improvement initiatives. Ability to work independently, comfortable working in a virtual environment using telehealth tools, remote monitoring systems and EHR documentation. Possesses excellent verbal and written communication skills to support and educate patients remotely, when necessary.

UnitedHealthcare

RN Field Service Coordinator, Remote in Lufkin, TX

Posted on:

June 7, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Texas

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

If you are located within 30-50 miles of Lufkin, TX, you will have the flexibility to work remotely* as you take on some tough challenges. This is a Field Based role with a Home-Based office.

Required Qualifications: Current RN unrestricted license in the state of Texas 2+ years of experience working within the community health setting or in a health care role Familiarity with Microsoft Office, including Word, Excel, and Outlook Reliable transportation and the ability to travel up to 75% throughout Angelina County, TX to visit Medicaid members in their homes and/or other settings, including community centers, hospitals, nursing facilities or providers’ offices High-speed internet at residence Reside within 30-50 miles of Lufkin, TX Preferred Qualifications: 1+ years of experience with long term care services and support, Medicaid or Medicare Ability to create, edit, save and send documents, spreadsheets and emails Knowledge of the principles of most integrated settings, including federal and State requirements like the federal home and community-based settings regulations. Reside within commutable distance of assigned duties

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, at least restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team

CoventBridge Group

Medicaid Medical Review RN (Medical Reviewer III)

Posted on:

June 7, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Ohio

CoventBridge Group is the global leader in full-service investigations providing Surveillance, SIU and Compliance, Claims Investigation, Counter-Fraud Programs, Desktop Investigations, Social Media, Record Retrieval, Canvasses and Vendor Management programs. The company provides top tier data privacy and security practices, deploys robust case management technology customized to clients’ needs and delivers worldwide coverage via its 1000 employees and affiliates worldwide.

The Medicaid Medical Review RN (Medical Reviewer III) will primarily be responsible for conducting clinical reviews of medical records during the course of fraud investigations or other program integrity initiatives such as requests for information or in support of proactive data analysis efforts. In addition, this position applies Medicare and Medicaid guidelines in making clinical determinations as to the appropriateness of payment coverage. In assuming this position, you will be a critical contributor to meeting CoventBridge Group's objective: To provide services to our clients that exceed their expectations and contribute to improved healthcare delivery by identifying and eliminating fraud, waste and abuse. This position will report directly to the Medical Review Supervisor and will work in our Grove City, OH office. If not local, remotely from a home office.

2 years minimum experience with a state Medicaid agency or Managed Care Organization focused in Medicaid 2 years minimum of working knowledge of ICD 10-CM/CPT coding experience 4 years minimum experience auditing claims history or provider files to determine if the claim was payable and if any signed of fraud, waste or abuse are noted Knowledge of, and the ability to correctly identify, Medicare and Medicaid coverage guidelines Advance knowledge of medical terminology and experience in the analysis and processing of Medicare claims, utilization review/ quality assurance procedures, ICD 10-CM and CPT coding, Medicare coverage guidelines and payment methodologies (i.e., Correct Coding Initiative, DRG's, Prospective Payment Systems and Ambulatory Surgical center), NCPCP and other types of prescription drug claims Ability to read Medicaid claims, both paper and electronic, and a basic knowledge of Medicaid is required Should possess excellent verbal and written communication skills with an ability to write professional summary reports Knowledge of and ability to use Microsoft Word, Excel, and Internet applications Able to efficiently organize and manage workload and assignments Must have and maintain a valid driver' license for the state of residence as on-site audits are part of the role as a nurse reviewer Educational/Experience Qualifications: Graduate from an accredited school of nursing and have an active license as a Registered Nurse (RN) required Preference given to BSN or higher prepared nurses with recent medical review claims experience in Medicare or Medicaid reviews

Reviews information contained in Standard Claims Processing System files (e.g., claims history, provider files) to determine provider billing patterns and to detect potentially fraudulent or abusive billing practices or vulnerabilities in Medicare or Medicaid payment policies Utilizes extensive knowledge of medical terminology, ICD-9-CM, ICD-10-CM HCPCS Level II and CPT coding along with analysis and processing of Medicare claims. Utilizes Medicare/Medicaid and Contractor guidelines for coverage determinations Coordinates and compiles the written Investigative Summary Report to the PI Investigator upon completion of the records review Incorporates leadership and communication skills to work with physicians and other health professionals as well as external regulatory agencies and law enforcement personnel Provides training to UPIC staff on medical terminology, reading medical records, and policy interpretation Provides expert witness testimony as required Completes assignments in a manner that meets or exceeds the quality assurance goal of 98% accuracy Maintains chain of custody on all documents and follows all confidentiality and security guidelines Performs other duties as assigned by the Medical Review Supervisor that contribute to UPIC goals and objectives and comply with the Program Integrity Manual and Statement of Work guidelines and CMS directives and regulations

Alignment Health

Nurse Health Specialist

Posted on:

June 7, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Nurse Health provides triaging service for patients who call into the virtual care center. Expected to escalate patient calls to APC when appropriate. Responsible for managing patient care and treatment in collaboration with the Physician and Nurse Practitioner/Physician Assistant. This position follows a 4-day workweek, Four 10-hour shifts per week (4/10 schedule). Shifts are as follow: 6:00 p.m. - 5:00 a.m. PST 7:00 p.m. - 6:00 a.m. PST *Please note, this job posting represents a future opportunity and/or an upcoming class

Experience: Minimum 3 year' experience as an RN Knowledge of clinical standards of care Education/Licensure: Successful completion of an accredited Nursing Program; BSN preferred Current, unrestricted license all states Alignment operates in Must have CPR certification Preferred: Experience in gerontology, adult care, preferred Experience in palliative/hospice and complex care management Experience in Home Health including wound care Knowledge of Medicare Managed Care Plans Excellent administrative, organizational, and verbal skills Effective communication skills with senior population Proficient in basic computer operations and internet navigation Ability to work independently Detail oriented EMR experience Bilingual Spanish preferred Must be flexible with schedule position is active 24 hours 7 days a week Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Answering all in bound calls into the virtual care center Expected to use clinical judgement to address patient concerns Collaborates with primary care physician, Extensivist, and Nurse Practitioner/PA, and Case Manager to develop care plan for members. For non-care anywhere patients Conduct outbound calls and virtual visits to complete patient follow up Daily review of vitals for patients enrolled in remote patient monitoring program Support disease management referrals Interprets and evaluates diagnostic tests to identify and assess patients’ clinical problems and health care needs. Educates members on topics such as disease process, end of life, medication, and compliance. Discusses case with physician/Nurse Practitioner/PA when appropriate. Use of Electronic Medical Records required

Rippl

Bilingual Enrollment Specialist (Remote)

Posted on:

June 7, 2025

Job Type:

Full-Time

Role Type:

License:

None Required

State License:

Washington

At Rippl, we are a passionate, impatient, slightly irreverent, people-obsessed group of optimists & doers intent on building a movement to bring dementia care to our aging population. We believe there is no more noble mission than caring for people at this critical stage of life, and we’re ready to take action. We’re reimagining what dementia care for seniors can be. By leveraging an obsession with supporting our clinicians, a new care model and disruptive technology, we are pioneering an entirely new way to democratize senior access to high quality, wrap-around dementia care, for seniors and their families and caregivers. Helping them stay healthier, at home longer, and out of the ER and hospital. Our Mission: The Rippl Mission is to enable more good days for those living with dementia and their families. Our Core Values: At Rippl, we live and breathe a set of shared, core values that help us build the best team to serve our patients, families and caregivers. We’re fed up. Today’s dementia care isn’t working. Too many families are struggling to find the support they need, and too many seniors are left without the care they deserve. We know it can be done better—so we’re doing it. We’re changemakers. We’re pioneering a new, better care model that actually works for people living with dementia and their families. We use evidence-based care, technology, and human connection to deliver the support that people need—when and where they need it. And we’re proving it works. We’re in a hurry. The need for high-quality dementia care has never been greater. The number of people living with dementia is growing at an unprecedented rate. Families need help now, and we refuse to wait. We start with yes. We don’t let barriers stop us. When faced with a challenge, we figure it out—together. We’re problem-solvers, innovators, and doers who find a way to make things happen for the people who need us. We care for those who care for others. Great care starts with the people delivering it. We are obsessed with supporting our care team—because when they feel valued and empowered, patients and caregivers get the care they deserve.

We’re looking to find other changemakers who are ready to join our movement. The Role: The Bilingual Enrollment Specialist serves as the first point of contact for our patients, and caregivers throughout their robust onboarding experience with Rippl. As the first friendly voice of Rippl, the Bilingual Enrollment Specialist is accountable for patient engagement, outreach, and acceptance of care for patients and caregivers. This is a great opportunity for someone who is excited about being part of the early stages of growing a business, and really cares about making a huge difference with the senior population.

Passion for working with seniors, their families and caregivers 2+ years experience in a healthcare environment required Experienced in patient outreach, engagement, intake, medical reception and/or customer service Proficiency in various systems such as Google Suite, Salesforce, Athena (EHR), and cloud based telephony systems Knowledge of medical and behavioral health terminology Exceptional interpersonal, customer service, problem-solving and conflict resolution skills Comfortable in a high speed, ever changing, start-up environment Strong verbal and written communication skills Excellent organizational and multitasking skills Ability to connect and build relationships with people from diverse backgrounds Access to high-speed, reliable internet and a secure, private workspace conducive to confidentiality required

Providing patients and their caregivers with an engaging, white glove experience Effectively communicate Rippl’s offerings to a senior population Engage with new patients with the goal of having them accept care with Rippl Set patients up for success by scheduling their first appointments with Rippl Care Team, providing a smooth and efficient onboarding experience Communicate and receive patient information by phone, email, e-referral and fax management Be a trusted and knowledgeable resource for patients on Rippl services Maintain accurate and up-to-date patient demographics in CRM/EHR Collaborate with Care Team to ensure a seamless transition of newly onboarded patients are assigned to the Care Pods Ensure required onboarding paperwork has been completed by the patient or Power of Attorney (POA) and obtain any necessary medical documents from healthcare providers, to ensure Rippl’s Care Team has the most up-to-date and comprehensive patient record Meet quality, productivity, and acceptance rate performance metrics Perform other administrative duties as assigned.

Rippl

TX Nurse Practitioner (Virtual - Dementia Care)

Posted on:

June 7, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

NP/APP

State License:

Texas

At Rippl, we are a passionate, impatient, slightly irreverent, people-obsessed group of optimists & doers intent on building a movement to bring dementia care to our aging population. We believe there is no more noble mission than caring for people at this critical stage of life, and we’re ready to take action. We’re reimagining what dementia care for seniors can be. By leveraging an obsession with supporting our clinicians, a new care model and disruptive technology, we are pioneering an entirely new way to democratize senior access to high quality, wrap-around dementia care, for seniors and their families and caregivers. Helping them stay healthier, at home longer, and out of the ER and hospital. Our Mission The Rippl Mission is to enable more good days for those living with dementia and their families. Our Core Values At Rippl, we live and breathe a set of shared, core values that help us build the best team to serve our patients, families and caregivers. We’re fed up. Today’s dementia care isn’t working. Too many families are struggling to find the support they need, and too many seniors are left without the care they deserve. We know it can be done better—so we’re doing it. We’re changemakers. We’re pioneering a new, better care model that actually works for people living with dementia and their families. We use evidence-based care, technology, and human connection to deliver the support that people need—when and where they need it. And we’re proving it works. We’re in a hurry. The need for high-quality dementia care has never been greater. The number of people living with dementia is growing at an unprecedented rate. Families need help now, and we refuse to wait. We start with yes. We don’t let barriers stop us. When faced with a challenge, we figure it out—together. We’re problem-solvers, innovators, and doers who find a way to make things happen for the people who need us. We care for those who care for others. Great care starts with the people delivering it. We are obsessed with supporting our care team—because when they feel valued and empowered, patients and caregivers get the care they deserve.

We’re looking to find other changemakers who are ready to join our movement. The Role: Working in small teams with other highly capable and passionate clinicians, the ARNP will provide comprehensive evaluations, diagnosis, and treatment to patients affected by dementia. This role involves collaborating with an interdisciplinary team and Rippl Medical Director to develop and implement individualized treatment plans that address patients' needs and promote overall well-being. This individual thrives in an innovative environment and desires to improve the health care experience for persons with dementia and their caregivers.

An unrestricted, current Texas state license to work as an advanced practice registered nurse (board certified) Geriatric Medicine, Palliative Care or Chronic Care management experience preferred Unrestricted ability & willingness to license in other 50 states per business needs Active Drug Enforcement Administration (DEA) license or ability to apply for such license prior to or upon hire if requested A deep passion for taking care of older patients and developing longitudinal care relationships with them and their families Interest in learning a new skill set and pioneering a new workforce Comfort and/or experience working with interdisciplinary teams 1-2+ years of experience managing older adult patients in outpatient, inpatient or long-term care settings (preferred but not required) Strong clinical assessment and diagnostic skills, with the ability to formulate comprehensive treatment plans Excellent communication and interpersonal skills, with the ability to establish rapport and build therapeutic relationships with patients and their families Proficiency in electronic health record (EHR) systems and other healthcare technology tools (Athena preferred) Ability to work collaboratively as part of a multidisciplinary team and to function independently with minimal supervision Preferred experience with telehealth Commitment to professional growth and ongoing learning in the field of psychiatric-mental health nursing Fully remote role with limited weekend or after hours work Ability to work 4 - 10 hour days

Develop high-quality therapeutic alliances with patients and their caregivers, providing direct patient care for dementia issues Guide patients and their families through the journey of dementia Lead interdisciplinary team meetings, case conferences, and consultations to discuss patient care and treatment strategies Provide ongoing cognitive, behavioral and psychopharmacological assessments and treatments Evaluate caregiver stress and strain through a validated assessment and support care plan to improve Coordinate patient care with primary care providers and specialists, nurses and home health aides, including handling more complex cases Coordinate patient care and caregiver support with Rippl social workers and Care Navigators Assist in advanced care planning for both patients and families Stay informed about current research, best practices, and evidence-based treatments in dementia care through continuing education and professional development activities Adhere to legal and ethical standards of practice, including maintaining patient confidentiality and upholding professional boundaries

Optum

Preservice Review Nurse RN - Remote PST Hours

Posted on:

June 7, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Preservice Review Nurse RN at UnitedHealth Group, you will make sure our health services are administered efficiently and effectively. You’ll assess and interpret member needs and identify solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. Ready to make an impact? You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. This position must work on PST schedule.

Required Qualifications: Undergraduate degree or equivalent experience Unrestricted RN license required in state of residence 1+ years of Managed Care and/or Clinical experience Work Pacific Standard Time Schedule (PST) Preferred Qualifications: Compact RN License WA State RN License Certified Case Manager (CCM) Pre-authorization experience Utilization Management experience Case Management experience Knowledge of Milliman Criteria

Determine the appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination Identify solutions to non-standard requests and problems Translate concepts into practice Act as a resource for others; provide explanations and information on difficult issues It feels great to have autonomy, and there’s also a lot of responsibility that comes with it. In this role, you’ll be accountable for making decisions that directly impact our members. And at the same time, you’ll be challenged by leveraging technologies and resources in a rapidly-changing, production-driven environment.

Actalent

Remote- Registered Nurse Case Manager

Posted on:

June 7, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Florida

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

The Care Manager plays a pivotal role in providing care management services to beneficiaries, particularly those transitioning from case management or disease management programs. This position is crucial in identifying and addressing fragmented care for patients with acute, real-time needs, tailoring interventions to fill gaps, and ensuring optimal clinical outcomes in a cost-effective manner. Workplace Type: This is a fully remote position. Application Deadline: This position is anticipated to close on Jun 10, 2025.

Essential Skills: Graduate of a Nursing program, BSN Degree preferred, or graduate in Clinical Psychology or Clinical Social Work. Minimum of 2 years of experience. Must have and maintain a current, valid, and unrestricted Registered Nurse license. Additional Skills & Qualifications Proficient in computer skills, including Microsoft Suite (Excel, Outlook, Word). Experience in case management, Telehealth, telephonic care, acute care, and managed care. Strong customer service skills. Spanish speaking - Bilingual capability. Experience in home health, hospice, and hospital environments. Work Environment: This is a remote position requiring strong Wi-Fi and a quiet room with a closed door. Work hours are Monday to Friday, between 8AM-7PM EST initially, with the possibility of transitioning to a 4-day workweek after proving competency on contract.

Conduct pre-admission counseling by contacting patients with upcoming hospital admissions to discuss expectations. Assess the patient's condition to understand illness or injury and evaluate their ability to follow the treatment plan. Advise patients on the probable length of stay and assist in anticipating and arranging for services at discharge. Collaborate with physicians and hospitals to enforce treatment plans and orders, ensuring patients receive specialty care and tests as ordered. Coordinate healthcare team services to avoid duplication and conserve benefit dollars. Evaluate the need for and authorize equipment, supplies, and services. Identify problems and act proactively to avoid complications. Instruct patients and families in proper care, referring them back to physicians or other healthcare team members as needed. Conduct hospital visits and confer with physicians to clarify diagnoses, prognoses, therapies, and daily living activities. Document case summaries in Transitional Care Plans and share appropriately with beneficiaries and providers. Facilitate beneficiary transfers among regions, collaborating with military liaisons to minimize disruption of care or services. Coordinate basic benefits and identify modifications, requests for exceptions, or special programs as warranted. Assess patient's benefit plan coverage and limitations, negotiating cost-effective rates for provider services. Contact patients within 48 hours of discharge to ensure support for full recovery and assess compliance with medications and follow-up appointments.

Diana Health

Telehealth CNM

Posted on:

June 7, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Texas

Diana Health is a network of modern women's health practices working in partnership with hospitals to reimagine the maternity and women's healthcare experience. We are restructuring the traditional approach to care to create an experience that is good for patients and good for providers. We do that by combining a tech-enabled, wellness-focused care program that women love with a clinical system that helps us drive continuous quality improvement and ensure work-life balance for our care team. We work with clients across all life stages to empower and support them to live happier, healthier, more fulfilling lives. With strong collaborative care teams; passionate administrators and a significant investment in operational support, Diana Health providers are well-supported to bring their very best to the work they love. We know that it is our teams that make us special, and we are committed to creating a supportive work environment. Our teams are rigorous and data-driven and drawn together by a relentless commitment to improving outcomes. We value real talk, accountability, empathy, and humor. You will be joining a collaborative environment dedicated to providing excellent patient care & committed to ensuring providers have work-life balance. We are continuing to expand our telehealth presence and options for our patients and are looking for CNMs excited to join our dynamic and growing practice of OB/GYNS and CNMs! Come join us!

Who you are: Compassionate and dedicated Certified Nurse Midwife eager to offer a whole-person approach to care A strong communicator who enjoys working as part of a collaborative care practice Excited about a mission-oriented company seeking to transform women’s health care Passionate about expanding access to care for our patients through telehealth offering Qualifications: Ability to work effectively as part of a collaborative practice model (OB/CNM/NP) Ability to work a schedule mirroring our clinics, Monday through Thursday 8a-5p, Friday 7a-4p Strong communication skills and intrapersonal skills Value patient preferences/choice, shared decision making, and a holistic care approach Current RN and APRN license in TN Prior telehealth experience preferred Active certification with ACNM Must have Texas License

Independently manage and provide outpatient telehealth services including comprehensive obstetric and gynecological services Collaborate with clinical colleagues (including OB/GYNs; RNs; LCSWs, health coaches, lactation counselors, childbirth educators and other specialists)

Mosaic

Licensed Practical Nurse LPN (Remote)

Posted on:

June 7, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

Kansas

At Mosaic, we believe in creating a workplace where everyone has the chance to contribute and succeed. This commitment is not just a policy, it's the way we work. It's good for the workforce, it's good for Mosaic, and it's the right thing to do.

If making a positive impact in the lives of others is a constant on your to-do list — you’ll LOVE working with a team that puts people first. Mosaic is looking for a Licensed Practical Nurse (LPN) to join our team! In this role, you will provide health care to individuals receiving services in the homes by scheduling medical appointments, assessing condition, reviewing medications, completing any necessary medical forms and by updating medical records. Who Will Love This Job A thoughtful mediator - you’re receptive and remain authentic in all situations A collaborative teammate - you love working with others and rely on the strong relationships you build to achieve the best outcomes for the people you serve A natural advocate- you offer reassurance and support throughout day-to-day activities as the liaison between the people we serve and their care teams. A helper - you can easily mend fences and have a knack for winning hearts and minds. Schedule: 8 am - 4 pm or 9am - 5pm/remote flexible hours/in person requirements periodically Associates degree required. Licensed Practical Nursing/Vocational Nursing certification in good standing for the relevant state location of the job. Minimum of one year of LPN experience or 3 years of CNA/CMA required. Certified in CPR & First Aid Valid drivers license if required to transport individuals. Work requires frequent physical activity including extended periods of standing, walking, and bending with occasional periods of sitting, kneeling, climbing, stooping, crouching, squatting and balancing. Work also requires constant reaching between knee and shoulder level as well as frequent reaching below knee level and overhead. Work requires occasional independent lifting up to 25 pounds, frequent push/pull up to 40 pounds of force and the ability to safely transfer 50 pounds.

Licensed Practical Nursing/Vocational Nursing certification in good standing. Minimum of one year of LPN experience or 3 years of CNA/CMA required. - NEW GRADUATES WELCOME! Must be able to lift, push and pull at least 50 pounds. Valid Driver's license Certified in CPR and First Aid (can be obtained after hire)

Coordinate physician and health care services for people served Conduct health care assessments and write health care plans Facility training and orientation of new staff regarding healthcare procedures Provide on call assistance to staff as needed

Managed Staffing, Inc.

Case Management Nurse

Posted on:

June 7, 2025

Job Type:

Contract

Role Type:

Case Management

License:

None Required

State License:

Compact / Multi-State

2-3 years Clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required. 2 years Healthcare and/or managed care industry experience. Case Management experience required.

Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Effective communication skills, both verbal and written. Ability to multitask, prioritize and effectively adapt to a fast-paced changing environment. Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer. Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. Typical office working environment with productivity and quality expectations.

UnitedHealthcare

Utilization Management Nurse RN - Remote - FL

Posted on:

June 6, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Florida

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

If you are located in the state of FL, you will have the flexibility to work remotely* as you take on some tough challenges.

Required Qualifications: Unrestricted RN license required in state of residence 3+ years of Managed Care and / or Clinical experience preferably working within Medicaid and Utilization Management 3+ years of Medicaid Utilization Management experience 2+ years of Microsoft experience (Word, Excel, PowerPoint) Preferred Qualifications: Florida State Medicaid Managed Care experience Pre-authorization experience Case Management experience

Perform utilization management, utilization review, or concurrent review (on-site or telephonic inpatient care management) Oversee private duty nursing authorization reviews, medical complaints, and behavioral staffing Identify solutions to non-standard requests and problems Work with minimal guidance; seeks guidance on only the most complex tasks Translating concepts into practice Provide explanations and information to others on difficult issues Coach, provide feedback and guide others Act as a resource for others with less experience Critical analysis of case manager UM submission with review of supporting tools Communication and collaboration with Medical Director Case preparation and presentation for Medical Director review Documentation in supportive rationale for UM decision Timely and accurate documentation in database of UM decision

Geisinger

RN - Registered Nurse - Clinical Access Specialist - Per Diem

Posted on:

June 6, 2025

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

RN

State License:

Pennsylvania

Founded more than 100 years ago by Abigail Geisinger, the system now includes ten hospital campuses, a 550,000-member health plan, two research centers and the Geisinger Commonwealth School of Medicine. With nearly 24,000 employees and more than 1,700 employed physicians, Geisinger boosts its hometown economies in Pennsylvania by billions of dollars annually.

As one of the Top 8 Most Innovative Healthcare Systems in Becker’s Hospital Review, we’re working to create a national model for improving health. Today, we’re focused on bringing our region services that improve every facet of life to drive total health, inside and out. Through professional growth, quality improvement, and interdisciplinary collaboration, we’ve built an innovative culture that allows nurses to grow their skillsets, develop their practice, and leverage their years of experience to build a rewarding, lasting career with impact. The Clinical Access Specialist RN performs and ensures adherence to state, federal and third-party payer certification requirements for initial, concurrent and retrospective medical record review for medical necessity and level of care determination. This role is Per Diem, varied hours and work from home in the state of PA. At least three (3) years of RN work experience is required. Position Details: Work is typically performed in a clinical environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. Additional competencies and skills outlined in any department-specific orientation will be considered essential to the performance of the job related to that position.

Education: Graduate from Specialty Training Program-Nursing (Required) Experience: Minimum of 3 years-Nursing (Required) Certification(s) and License(s): Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania

Identifies and notifies appropriate staff regarding discrepancy issues with third party payer health insurance coverage and lack of coverage. Maintains a working knowledge of third party payer health plans, working knowledge of nationally recognized review criteria and its application and state and federal regulations and mandates. Reviews cases, using standard parameters, in order to perform precertification requirements as indicated in third party payer contracts. Reviews all admission requests for appropriateness of level of care and compliance with third party pre-admission certification requirements, regulatory and standard ambulatory procedures. Requests additional clinical information and documentation when request does not meet medical necessity for level of care requested. Provides information, suggests alternatives and assists in ensuring documentation integrity. Enters utilization review data into database for tracking and trending audits, billing and reimbursement and Medicare compliance requirements. Reports serious events and incidents in accordance with established hospital policy and procedure. Attends to and ensures to the utmost integrity of the medical necessity chart review and application of review requirements. Acts a resource person for the healthcare team regarding third party payer health plan benefits for transition to next level of care or discharge to home.

Computech Corporation

Nurse Case Manager (Remote)

Posted on:

June 6, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

Job Title: Remote RN Case Manager (EST Time Zone) Job Type: Full-Time, Remote Schedule: Monday–Friday, 8:00 AM – 5:00 PM EST Training Duration: 4–6 weeks Position Summary: The Case Manager will utilize a collaborative process of assessment, planning, facilitation, and advocacy to coordinate services and resources that meet an individual’s health needs and benefit plan. The goal is to promote optimal, cost-effective outcomes in a fully remote work setting.

Candidate must reside in the EST time zone. If residing in North Carolina (NC): Must have an unrestricted active RN license in NC. If residing outside of NC: Must hold an active compact RN license. Candidate’s location must be included at the top of the resume. Required Qualifications: Active, unrestricted Registered Nurse (RN) license as outlined above. Minimum 2–3 years of clinical experience in hospital, home health, or ambulatory care settings. Minimum 2 years of healthcare and/or managed care industry experience. Case Management experience is required. Strong computer literacy with the ability to navigate multiple systems simultaneously. Excellent verbal and written communication skills. Ability to multitask and work effectively in a dynamic, fast-paced environment. Preferred Qualifications: Case Management Certification (e.g., CCM) is preferred. Work Environment: Sedentary work involving extended periods of sitting, telephone communication, and computer use. Must be comfortable performing close inspection of electronic and written documentation. Productivity and quality expectations are applicable as per performance standards.

Conduct comprehensive assessments to determine members' eligibility, needs, and care options. Apply clinical guidelines and benefit criteria to develop case management plans. Collaborate with members, families, healthcare providers, and community resources to coordinate care. Document case activity accurately and in a timely manner in internal systems. Ensure compliance with company policies, regulatory standards, and accreditation requirements. Use multiple systems and tools for case documentation and resource coordination.

Peach State Health Plan

Care Manager (RN)

Posted on:

June 6, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.

Education/Experience: Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 – 4 years of related experience. License/Certification: RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome. Develops ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs. Identifies problems/barriers to care and provide appropriate care management interventions. Coordinates as appropri.ate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services. Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan / service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan / service plan as necessary to meet the member's goals / unmet needs. Provides resource support to members and care managers for local resources for various services (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate. Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources. Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators. Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits. Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner. Other duties or responsibilities as assigned by people leader to meet business needs. Performs other duties as assigned. Complies with all policies and standards.

Partners Health Management

TCL Complex Care Nurse Coordinator, RN (Remote Option)

Posted on:

June 6, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

North Carolina

Office Location: Remote Option; Available for any of Partners' NC locations Projected Hiring Range: Depending on Experience Closing Date: Open Until Filled Primary Purpose of Position: The TCL Complex Care Nurse Coordinator’s primary objective is to gather Behavioral Health and Medical assessment information on eligible members transitioning from Adult Care Homes. This position will provide assessment of the members medical, behavioral health, and functional needs prior to transitioning to the community to provide recommendations to the members treatment team. This position will evaluate medical and behavioral health information provided for each member. This position works with TCL members currently in adult care homes, adult care home staff, Primary Care Doctor, Specialist, family members, service providers and other medical professional to provide informed assessments and recommendations to the members treatment team. This position will assist in coordinating additional medical services and supports as needed. This position will work collaboratively with In-Reach Staff, Transition Coordinators, Care Managers, Service Providers, and Medical Providers. This is a mobile position that will require working in various locations throughout and beyond Partners catchment area.

Knowledge, Skills and Abilities: Extensive understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version) Extensive understanding of medical terms, conditions and treatment. Considerable knowledge of the MH/SU/IDD service array provided through the network of the LME/MCO’s providers Knowledge of Medicaid eligibility determinations. Highly skilled at assuring that both long and short-range goals and needs of the individual are addressed and updated, while assuring through monitoring activities that service implementation occurs appropriately Exceptional interpersonal and communication skills Excellent computer skills including proficiency in Microsoft Office products (Word, Excel, Outlook, and PowerPoint) Excellent problem solving, negotiation, arbitration, and conflict resolution skills Detail-oriented, able to organize multiple tasks and priorities and effectively manage projects from start to finish Ability to make prompt independent decisions based upon relevant facts, to establish rapport and maintain effective working relationships Ability to change the focus of his/her activities to meet changing priorities A high level of diplomacy and discretion is required to effectively negotiate and resolve issues with minimal assistance Education/Experience Required: Licensed to practice as a Registered Nurse in North Carolina and two years of experience in mental health or substance use disorders and medical care. For Dual Diagnosis (MHSU/IDD) – experience in intellectual/developmental disabilities. Other requirements: Must reside in North Carolina. Must have ability to travel regularly as needed to perform the job duties Education/Experience Preferred: Licensed to practice as a Registered Nurse in North Carolina and two years of experience in psychiatric nursing; care management/care coordination experience. Experience in collaborative care. Licensure/Certification Requirements: Must be licensed as a Registered Nurse in North Carolina. Employee is responsible for complying with respective licensure board’s continuing education/training requirements in order to maintain an active license.

Complex Care Nurse to assigned TCL individuals who may have identified needs with behavioral health, physical health, co-occurring, co-morbid or multi-morbid conditions. Complete Medical, Psychosocial, functional assessments. Review assessments and medical records to provide recommendations for services and treatment. Identify disqualifying health conditions, or conditions that will need specific services recommendations if the individual is living in the community. Collaborates with Complex Care Staff to provide integrated care. Educate individuals and referral entities about TCL. Coordinates and gathers assessment information from providers, and other resources. Review medical documentation. Coordinates with Behavioral Health and Medical service providers to ensure additional assessments are completed. Works with referral entities to address and assess the needs of the individuals, educate on appropriate services and levels of care as needed. Identifies gaps in services and intervenes to ensure that the individual receives appropriate care. Ensures that services for the individual are identified and coordinated across the LME/MCO’s system and with other systems, including primary care. Provide members with information on community based services in order for them to make an informed choice. Assures data is tracked and all reporting requirements are met. Develop clear documentation on each individual. Track number of assessment and where the individual went to live. Other specific functions as they relate to Diversion, In-Reach, Transition Process and Post-Transition responsibilities as indicated from DMA/DMH. Performs related tasks as required. Collaboration: Collaborates with other members of TCL team in reviewing information, providing clinical oversight, to determine eligibility within established time frames. Serves as a collaborative partner in identifying system barriers. Manages and facilitates meetings with community stakeholders as appropriate to TCL. Works in partnership with other LME/MCO departments to address identified needs within the catchment area.

UnityPoint Health

RN Call Center - Triage Remote

Posted on:

June 6, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

At UnityPoint Health, you matter. We’re proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row for our commitment to our team members. Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you’re in.  Here are just a few: Expect paid time off, parental leave, 401K matching and an employee recognition program. Dental and health insurance, paid holidays, short and long-term disability and more. We even offer pet insurance for your four-legged family members. Early access to earned wages with Daily Pay, tuition reimbursement to help further your career and adoption assistance to help you grow your family. With a collective goal to champion a culture of belonging where everyone feels valued and respected, we honor the ways people are unique and embrace what brings us together. And, we believe equipping you with support and development opportunities is a vital part of delivering an exceptional employment experience. Find a fulfilling career and make a difference with UnityPoint Health.

RN Call Center 2PM-1230AM - 10 Hour Shifts, Set Schedule, Every Other Saturday 8AM-6:30PM, Holiday Rotation 1.0 FTE, 40 hours/week Full Time Benefits **REMOTE - Candidate must reside in a compact license state** We are adding staff to our growing RN Call Center! The UnityPoint IntelliCenter nurse is an RN who provides care over the telephone by thoroughly assessing symptoms to identify acuity to disposition caller or patient appropriately utilizing best-practice updated protocols. Protocols are embedded within the eMR to support guidance in appropriate care delivery. Nursing services are provided telephonically and, in some cases, virtually. May include triage, care management, referral management and telehealth support. Must have proficient keyboarding/typing skills and have a technical aptitude to learn new computer software systems quickly. Ability to handle a “call center” environment: work quickly and multi-task, utilizing clinical critical skill thinking while navigating computer software to meet the required turnaround time to support key performance indicators which support patient care delivery and operational costs. We are a 24/7 operation with the bulk of our services provided in the evenings and weekends.

Qualifications/Experience: Requires active and unrestricted license to practice nursing in the states of Iowa and Illinois. Requires a minimum of 1-2 years of clinical nursing experience providing direct patient care or equivalent work experience - 2-3 years preferred Strong time management and organizational skills Possesses excellent written and verbal communications. Proficiency in use of computer applications such as Microsoft Office and electronic health systems. Requires knowledge of federal healthcare laws and regulations. Requires highly developed communication skills to effectively work with all levels of management throughout the UnityPoint Health, its subsidiaries and affiliates. Excellent academic credentials with a track record of professional accomplishments, which demonstrate superior performance, leadership and vision. Ability to work as a team member, creating and maintaining effective working relationships. Ability to understand and apply guidelines, policies and procedures. Education: Graduate from an accredited nursing program. Bachelors of Science (BSN) preferred Compliance with Mandatory Child/Adult Abuse Reporting

Primary Function and Relationship to the Total Organization: My UnityPoint Nurse Call Center offers a free health information service for the public, sponsored by UnityPoint Health and staffed by registered nurses 24-hours a day, 7 days a week. The nurses at My UnityPoint Nurse provide medical assessment and triage, up-to-date health information and physician and clinic referral service. My UnityPoint Nurse Call Center is a centralized function of UnityPoint Health providing clinical support to UnityPoint Health and affiliates. Operations: Performs symptom assessment triage utilizing protocols to guide best practice care delivery and disposition. Documents call criteria in eMR within a timely manner. Promotes and educates appropriate callers regarding second level triage and virtual care visits with NP and MDs when appropriate. Serves as a resource to customers seeking physician referral and community-based resource information. Provides health information to customers via UnityPoint Health’s approved resources Maintains strict confidentiality of all employee and customer information Adhere to all UnityPoint Clinic personnel Policies and Procedures and safety guidelines. Supports change transformation initiatives Identifies with shift change requirements as call volume dictates in order to support staffing needs appropriately Perform other duties as assigned. Support team efforts in patient care delivery objectives. Provides assistance with other reasonable related duties as assigned by supervisor or manager. Ability to handle confidential and sensitive information. Ability to communicate effectively on the telephone. Ability to relate to persons with diverse educational, socioeconomic and ethnic backgrounds. Ability to handle a “call Center” environment: work quickly and multi-task. Ability to demonstrate good customer service. Exhibits discretion and sound judgment in all aspects of the job.

ChenMed

Registered Nurse, Telehealth (Remote) (Weekends) (Bilingual Spanish)

Posted on:

June 6, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

We’re ChenMed and we’re transforming healthcare for seniors and changing America’s healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We’re growing rapidly as we seek to rescue more and more seniors from inadequate health care. ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people’s lives every single day.

We’re changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy? We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team. The Registered Nurse, Care Line, is responsible for providing telephonic triage directional patient care advice for general and specific illnesses, health related issues, client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. Providing on-call coverage, the incumbent in this role provides remote clinical advice and Emergency Triage assessments within license and as possible given technology and medium. The registered nurse collaborates with primary caregivers and others on the interdisciplinary care plan team to provide a team approach of care. The schedule for this opening on the team is as follows: Saturdays 0800-1800 Sundays 0800-1800 The training requirement will be for 2 weeks Monday - Friday upon starting. This is a paid training and is in a virtual setting.

Associate Degree in Nursing required, Bachelor’s Degree in Nursing preferred Nurse Licensure Multi-state Compact license required, ability to obtain additional licenses as requested by the organization within 90 days of hire Basic Life Support (BLS) certification from the American Heart Association or American Red Cross required Minimum of 3 years acute clinical nursing work experience preferred Minimum of 2 years experience in Emergency Nursing Services, or Emergency Triage, or Urgent Care highly preferred Experience working with older adult populations highly preferred Minimum of 1 year virtual care experience is a bonus Bilingual fluency in Spanish highly preferred

Connects with patients via phone or video call. Interviews and questions patients to collect health history and uses a computer system to record and store comprehensive and focused data relating to the health needs of patients and families. Provides health assessment and treatment solutions, monitors patient health and at-home care, aids in emergency scenarios and promotes patient wellness. Based on technology available, monitors a patient’s blood oxygen levels, heart rate, respirations, blood pressure and blood glucose as well as other assessment measures. With the help of video chatting, identifies patient’s symptoms and conditions. Analyzes data to determine the appropriate health maintenance and identify appropriate outcomes for patient and family. Collaborate with on-call providers as needed to support expected clinical outcomes for the patient and family. Evaluates and documents progress toward the anticipated outcome. Assist in ensuring achievement of optimal patient outcomes using Telemedicine. Documents interventions in a readable, understandable language. Aids in enhancing the quality and efficacy of the organization’s telehealth practices and professional nursing practice through successful utilization and improvement of outcomes that demonstrate program efficacy. Utilizes appropriate resources to plan and provide services that are safe, effective and fiscally responsible. Performs other duties as assigned and modified at manager’s discretion.

ChenMed

Registered Nurse, Telehealth - Remote- ER Triage (Bilingual Spanish)

Posted on:

June 6, 2025

Job Type:

Part-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

We’re ChenMed and we’re transforming healthcare for seniors and changing America’s healthcare for the better. Family-owned and physician-led, our unique approach allows us to improve the health and well-being of the populations we serve. We’re growing rapidly as we seek to rescue more and more seniors from inadequate health care. ChenMed is changing lives for the people we serve and the people we hire. With great compensation, comprehensive benefits, career development and advancement opportunities and so much more, our employees enjoy great work-life balance and opportunities to grow. Join our team who make a difference in people’s lives every single day.

We’re changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy? We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team. The Registered Nurse, Telehealth is responsible for providing telephonic triage directional patient care advice for general and specific illnesses, health related issues, client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. The incumbent in this role provides remote emergency triage, clinical advice and assessments within license, and as possible given the technology and medium. He/She collaborates with primary caregivers and others on the interdisciplinary care plan team to provide a team approach of care. This role is a part-time, weekend shift. The schedule is listed below. Saturdays and Sundays 0800-1800

KNOWLEDGE, SKILLS AND ABILITIES: Advanced-level business acuity In-depth knowledge and understanding of general/core Nursing-related functions, practices, processes, procedures, techniques and methods Broad nursing knowledge and understanding Ability and willingness to provide extraordinary customer service and professionalism to all customers Maintains current nursing knowledge and competency to stays abreast of budding nursing trends and best practices Excellent written and verbal communication skills through a variety of formats, tools and technologies Capable of building trust and professional relationships to deliver VIP care across the continuum Ability to demonstrate excellent clinical judgement Ability to problem solve Ability to prioritize and work under pressure Ability to provide constructive feedback Ability to effectively collaborate with physicians, patients, family members, colleagues and other team members in a courteous and professional manner Ability to effectively collaborate with a multidisciplinary team Proficient skill in Microsoft Office Suite products including Excel, Word, PowerPoint and Outlook; competent in other systems required for the position Ability and willingness to travel locally, within South Florida, to attend meetings and trainings up to 10% of the time; flexible and available to cover after-hours and to work weekends as needed Spoken and written fluency in English; speaking fluency in Spanish required This job requires use and exercise of independent judgment EDUCATION AND EXPERIENCE CRITERIA: Associate Degree in Nursing required, Bachelor’s Degree in Nursing preferred Nurse Licensure Compact required (multistate license required) Michigan and Illinois Nurse Licensure required within 90 days of hire, ability to obtain additional licenses as requested by the organization within 90 days of hire Basic Life Support (BLS) certification from the American Heart Association or American Red Cross required Minimum of 3 years acute clinical nursing work experience in a triage or emergency services setting highly preferred Minimum of 1 year virtual care experience preferred

Connects with patients via phone or video call. Interviews and questions patients to collect health history and uses a computer system to record and store comprehensive and focused data relating to the health needs of patients and families. Provides health assessment and treatment solutions, monitors patient health and at-home care, aids in emergency scenarios and promotes patient wellness. Based on the technology available, monitors a patient’s oxygen levels, heart rate, respiration, blood glucose and other assessment measures. With the help of video chatting, identifies patient’s symptoms and conditions. Analyzes data to determine the appropriate health maintenance and identify appropriate outcome for the patient and family. Collaborates with on-call PCP as needed to support expected clinical outcomes. Implements the appropriate protocol to attain the expected outcome. Evaluates and documents progress toward the anticipated outcome. Assists in ensuring achievement of optimal patient outcomes through use of Telemedicine. Documents interventions in readable, understandable language. Aids in enhancing the quality and effectiveness of the organization’s telehealth practices and professional nursing practice through successful utilization and improvement of outcomes that demonstrate program effectiveness. Utilizes appropriate resources to plan and provide services that are safe, effective and fiscally responsible. Performs other duties as assigned and modified at manager’s discretion.

Medix

CDI Specialist

Posted on:

June 5, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Utah

We are seeking experienced Clinical Documentation Integrity (CDI) Specialists for a large third party Revenue Cycle Management company. This position is focused on concurrent inpatient review and clinical documentation improvement in a Level 1 trauma/teaching hospital setting. Candidates must be confident critical thinkers, eager to learn, and comfortable with feedback in a fast-paced, collaborative environment. This is a fully Remote opportunity with equipment provided.

Registered Nurse with recent inpatient clinical experience in a Level 1 Trauma Center Software Proficiency: Nuance and JATA (candidates who have worked solely with 3M will not be considered) Hands-on experience with: Critically ill patients Obstetrical and pediatric care Emergency and trauma situations Patients requiring life-sustaining interventions Additional Requirements: Amenable to coaching and feedback Collaboratie, ego-free team player Demonstrates confidence and strong critical thinking Open to continuous learning and quality improvement

Conduct 20-25 concurrent inpatient chart reviews per day Focus primarily on MS-DRG's with working knowledge of APR-DRG, SOI/ROM Collaborate closely with coding staff to reconcile query mismatches Perform retro SLR reviews as needed Help orient and mentor new CDI staff Meet and exceed weekly productivity and quality goals including query and mismatch rates

HEITECH SERVICES

Telehealth Registered Nurse- REMOTE

Posted on:

June 5, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

HeiTech Services is seeking Full-time Registered Nurses to staff a Nurse Advice Line call center 24x7/365 (primarily inbound). The Full-Time Registered Nurse is responsible for providing telehealth clinical assessment, health education, and utilization management services to a variety of beneficiaries. MUST HAVE a Current, Active, Compact License issued by the state of residence and be in good standing with the Board of Registered Nurses. This is a remote, work from home position. Registered Nurses provide telephone triage and health advice to callers across North America remotely, from the comfort of their own home office. In addition to triage calls, we receive questions requesting information on medical conditions, medications, diagnostic tests, etc. All calls are documented electronically, and all telephone encounters are recorded. Work Schedule While there are different shifts available, ALL of them require working at least one weekend day. PLEASE NOTE: the work schedule will begin with 4-6 weeks of paid training, scheduled Monday through Friday, 8:00AM to 4:30PM Central Time, starting July 28th. Candidates must be available to attend all days of training.

An Associates’ degree in nursing (ADN) from accredited College or University (Bachelor of Science in Nursing is preferred). Ability to Triage per triage guidelines and protocols, assessing patients and applying solid decision-making to achieve highest patient outcomes in quick and timely manner. Call Center Experience (Inbound). Metric driven environment work experience and understanding. Must be computer savvy - able to maneuver between multiple windows, application systems simultaneously, ability to create, copy, edit, save and send documents utilizing Microsoft Word, Microsoft Excel, and Microsoft Outlook. Minimum 3 years’ clinical nursing experience as a RN. Must have a Compact License issued by the state of residence. Required to be in good standing with the Board of Registered Nurses. Licensure in other states as required by contract. Must be able to work Weekends and Holidays. Triage, Med-Surge, and Behavioral Health required. Strong verbal and written communication skills. Previous experience working within a military population a plus. RNs who are retired military, family members of Active Duty Service Members (ADSM), working knowledge of/worked at an MTF or VA center a plus. High Speed Internet / direct connection required- Must be able to connect directly into internet?–?via hard wire (either directly to modem or router). Distraction free area to work / professional background - Required to have a dedicated work area established that is separated from other living areas and provides information privacy. Must be US Citizen and able to obtain a clearance. Reasoning Ability: Strong clinical thinking and assessment skills. Ability to deal with and solve problems using solid nursing judgment. Technical Skills: Proficient level of experience with Microsoft Office applications, keyboarding skills, and strong technical aptitude. Previous experience telephone triage using electronic triage software and computerized medical protocols is considered an asset- preferably 1 or more years of experience.

Triage all symptom-based calls and give recommendations according to the approved triage protocol. Communicate with TRICARE beneficiaries primarily by phone, also via text, online (web) chat, email required. Provide professional nursing assessment and intervention to patients with acute and chronic care needs. Mobilize patient and family to employ healthy coping strategies, engage in shared decision- making and utilize community resources. Identify gaps in patient services; develop and utilize alternative resources. Exercise professional nursing judgment and advanced communication skills to network with a variety of professionals, agencies, and systems Demonstrate mandatory and clinical competencies of the position. Serve as a liaison between nursing staff and all providers to improve the clinical experience for the patient, staff, and provider. Provide health education and Prepare individuals for primary care manager/physician visits.

St. Luke's University Health Network

Clinical Triage Specialist RN, Connect to Care, Per Diem, Weekends and nights , Remote

Posted on:

June 5, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Pennsylvania

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care.

The Clinical Triage Specialist (CTS) (RN) - Access Center will compassionately deliver an exceptional patient experience and provide clinical support to CTS-MA team members by serving as a clinical resource. The CTS-RN is responsible for using nursing judgment in answering/returning patient calls related to direct care provided by the practices. When appropriate, the caller’s symptoms will be assessed and triaged using approved nursing protocols and guidelines to assist in obtaining the appropriate level of care and/or self-care advice.

EDUCATION: Graduate of an accredited nursing program required. Registered Nurse with current license to practice in the State of Pennsylvania or seeking Pennsylvania licensure through reciprocity required. TRAINING AND EXPERIENCE: Minimum 2 years recent clinical experience in a physician office, home health, critical care and/or emergency room is required. Strong communication skills Focused on compliance Demonstrates continuous growth Quality-driven Service-oriented Excels at time management Strong problem-solving skills Ability to work from home in accordance with the Network Work from Home Policy if needed.

Answers telephones, prioritizes clinical triage calls, follows clinical protocols, and coordinates services, as needed. Verifies patient demographic information and accurately enters the updated information into electronic health record. Serves as an escalation point for clinical patient issues and other POD team members requiring clinical support, and provides clinical advice based on clinical protocols and procedures. Manages and responds to escalated electronic patient messages whenever not answering inbound patient calls and uses clinical judgment to prioritize and accommodate patients. Creates a positive patient experience at every encounter, attempting to independently resolve any issues or concerns of the patient at the time of the phone call, within the scope of the role. Consistently meets productivity, schedule adherence, and quality standards as set by the Access Center. Utilizes all resources and guidelines at his/her disposal to effectively assess, prioritize, advise, schedule appointments, or refer calls when necessary to the appropriate medical facility or personnel. Accurately documents symptoms/complaints, nursing assessment, advice provided and patient/caller response. Partners with other Access Center teams/PODs and respective practice clinical team on behalf of the patient to assist with clinical concerns, medication refills, or scheduling appointments. Other duties as assigned.

CorVel Corporation

Telephonic Case Manager II

Posted on:

June 5, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Tennessee

CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

The Telephonic Case Manager coordinates resources and creates flexible, cost-effective options for ill or injured individuals on a case-by-case basis to facilitate quality individualized treatment goals, including timely return-to-work if appropriate. The Telephonic Case Manager will rely on their medical knowledge to evaluate the patient’s current treatment plan for medical appropriateness based on their physical and medical status. The Telephonic Case Manager must be able to discuss the patient’s medical and physical conditions with the treating physicians, along with discussing/ recommending alternate treatment plans for the patient. The Telephonic Case Manager must have the ability to explain medical conditions and treatment plans to the patient, family members and adjuster; supporting the goals of the Case Management department, and of CorVel. This is a remote role.

KNOWLEDGE & SKILLS: Effective multi-tasking skills in a high-volume, fast-paced, team-oriented environment Ability to interface with claims staff, attorneys, physicians and their representatives, and advisors/clients and coworkers Excellent written and verbal communication skills Ability to meet designated deadlines Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets Strong interpersonal, time management and organizational skills Ability to work both independently and within a team environment EDUCATION & EXPERIENCE: Bachelor’s degree required, BSN desirable Graduate of accredited school of nursing Current RN Licensure in state of operation 3 or more years’ of recent clinical experience, preferably in rehabilitation URAC recognized Case Management certification (ACM, CCM, CDMS, CMAC, CMC, CRC, CRRN, COHN, COHN-S, RN-BC) required to be obtained within 3 years of hire if no nationally recognized certification is present at time of hire Strong clinical background in orthopedics, neurology, or rehabilitation preferred Strong cost containment background, such as utilization review or managed care helpful Certification as a CIRS or CCM preferred

Provides medical case management to individuals through coordination with the patient, the physician, other health care providers, the employer, and the referral source Provide assessment, planning, implementation, and evaluation of patient's progress Evaluate patient's treatment plan for appropriateness, medical necessity, and cost effectiveness Ability to utilize their medical and nursing knowledge to allow the case manager to discuss the current treatment plan with the physician and discuss alternate treatment plans Ability to make medical recommendations of available treatment plans to the payer Implement care such as negotiating and coordinating the delivery of durable medical equipment and nursing services Ability to make independent medical decisions and recommendations to all parties Devise cost-effective strategies for medical care Required to read extensively Required to prepare organized reports within a specified timeframe Required to use telephone extensively Minimum Productivity Standard is 95% per month Requires regular and consistent attendance Complies with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP) Additional duties as required

Synergy Healthcare USA, LLC

Nurse Advocate - Remote- Kansas

Posted on:

June 5, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Kansas

Synergy Healthcare provides comprehensive risk management solutions that integrate health risk awareness, health coaching, health care navigation, wellness administration and on-site health care. The coordination of these service components, meaningful claim data and Synergy’s unique dedicated provider model, allows Synergy’s team members to address the often-complex needs of each individual through an experience that is compassionate, trustworthy, and simple to access.

We are seeking an experienced Case Manager to join our growing team and serve as a Nurse Advocate for our new client and their employees. The ideal candidate will be located in Kansas, have a thorough understanding of the healthcare system, and will be responsible for providing guidance and support to members in navigating the complex healthcare landscape. As the dedicated Nurse Advocate, you will be responsible for resolving a myriad of issues for their members and allow you the flexibility to “think outside the box”. With your clinical experience and background, you will help members better understand their health status and available treatment options. You will have a unique opportunity to develop valued relationships with members and executive teams with your specific employer clients. While this specific client is based in Kansas and they have locations in other States, this opportunity allows for remote work so can be flexible on location. Minimal travel for periodic client visits may be required. Most if not all work will be done virtually out of the convenience of your own home office. The key to your success will rely on your ability to cultivate trusted relationships with stakeholders, members, and their families. Our growing Synergy team is passionate about delivering an exceptional healthcare experience that is personal, data driven, and value based to help every person live their healthiest life.

Active nursing license with a Bachelor of Science in Nursing (BSN) degree preferred. Minimum of 3 years of experience as a nurse case manager or in a related healthcare field. CCM certification or CCM eligible. Commit to CCM exam within the first year. Bi-lingual- the ability to communicate effectively in both English and Spanish is a plus. In-depth knowledge of the healthcare and insurance systems. Strong analytical and problem-solving skills with the ability to identify and resolve complex healthcare issues. Excellent communication and interpersonal skills with the ability to interact effectively with employees and healthcare professionals. Ability to work remotely, independently, and as part of a team in a fast-paced, dynamic environment. Strong organizational skills with the ability to manage multiple tasks and priorities simultaneously. Proficient in the use of electronic health records (EHRs), Outlook, Excel, and other healthcare-related software.

Serve as the primary point of contact for members seeking assistance with navigating the healthcare system. Work with members to identify their healthcare needs and provide clinical support. Liaison with TPAs and insurance companies to resolve claim and billing issues. Educate members on their healthcare benefits and how to effectively utilize them. Advocate for members so they can receive improved healthcare outcomes, including referrals to specialists and timely access to care. Collaborate with other healthcare professionals, including physicians and nurses to ensure seamless coordination of care. Monitor member health status and progress towards achieving their healthcare goals. Maintain accurate and up-to-date records of member interactions and healthcare interventions. Client facing reporting with the potential for limited travel to client worksites. Health Risk Assessment review to encourage lifestyle modification and improve overall wellness.

MDA Edge

RN CVOR

Posted on:

June 5, 2025

Job Type:

Contract

Role Type:

License:

RN

State License:

Iowa

Desired Skills and Experience: CVOR

Perform scrub functions including the selection and handling of instruments and supplies used during procedure. Perform circulating functions including monitoring, recording, and communicating patient condition and managing overall nursing care of patient before, during and after procedure. Directly assists operating physician with surgical tasks including hemostasis, suturing, and wound exposure as well as patient positioning. Prepare operating rooms and surgical instruments and equipment for use.

IntellaTriage

Remote Hospice Triage RN- PT 2 shifts 3:30p-8:30p + rotating Sat & Sun 7:30a-4p

Posted on:

June 5, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Built around a mission to improve the lives of nurses and patients, IntellaTriage has been providing after-hours nurse triage for hospice and home health providers since 2008. Utilizing best-in-class technology, IntellaTriage provides round-the-clock direct access to licensed, registered nurses using client-customized protocols for patient-centered, compassionate care. We are growing rapidly and excited to support our clients’ nursing staff in the field by leveraging our outsourced team of nurses to manage after-hours care delivery. Our triage nurses become an extension of our clients’ care team, and they trust us to support them and their patients during their non-core hours. Learn more at www.intellatriage.com.

We invite you to join our growing team! IntellaTriage Nurses enjoy the benefits of working from home, providing care, without the stress and expense of commuting each day! **MUST have or be willing to obtain a Compact RN license **MUST live in/work from a Compact US state **Experience with end-of-life care is required **Must have high speed internet **Must be tech savvy, enjoy a fast-paced environment, and have keyboard competence **Part-time nurses only work 6 days out of a 14-day pay period Part- time schedule: Work a minimum 2 evening shift weekly 3:30p-8:30p CST (shift times are set/ week day flexes) Work every other weekend, both Saturday and Sunday 7:30a-4p CST

MUST have or be willing to obtain a Compact RN license (states with pending or future implementation dates are not considered current compact states until the implementation date) You must remain in good standing and ensure your home state license remains active. IntellaTriage will cover the cost of non-compact state licensure if necessary for client support. Hospice, palliative, end-of-life care is strongly preferred Experience in a fast-paced environment: ED, surgical services, or critical care, etc. Must be comfortable accessing multiple technology applications to document during calls Ability and comfort with typing in a fast-paced environment Fluency in English is required, additional languages are a bonus Must physically reside in the U.S. and be legally eligible to work for any employer Must be able to complete three weeks of remote paid training that is conducted during days and evenings Must be available to work every other Saturday & Sunday Must be available to work some Holidays as required Must be able to handle stress and multitask when receiving calls (minimum of 5 calls per hour on weekdays, and up to 8 per hour on weekends) Must be able to communicate empathically with patients while adhering to protocols Must maintain CEU’s as designated by the states in which you are answering calls Must attend any in-services, and additional training on an as needed basis Must pass background check and nurse licensing check

Our Hospice Triage Nurses: Have experience in hospice, palliative, end-of-life care and in fast-paced environments: ED, critical care, surgical services, etc. Part-time nurses work a minimum of 1 week day shift & every other weekend both Saturday & Sunday Receive three weeks of remote paid training. The training schedule varies based on availability You can pick up additional shifts, if available, for the clients’ you are trained to support. We will provide you with a laptop and headset. You’re required to use your own high-speed internet You’ll need a quiet space, away from noise and distraction, while you work (privacy/HIPAA compliant space is required). You’ll access EMRs for charting and utilize our internal applications to perform job functions You MUST be able to follow instructions, read directions, and be confident using technology A minimum of 30 minutes paid shift prep is required prior to taking calls You’ll spend 30 minutes to 2 hours, at the end of your shift, completing remaining charting before clocking out

UNC Health Care

RN Clinical Nurse II - Nurse Connect - Remote

Posted on:

June 5, 2025

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

RN

State License:

North Carolina

Become part of an inclusive organization with over 40,000 teammates, whose mission is to improve the health and well-being of the unique communities we serve.

Provides competent clinical nursing care consistent with professional standards. Reporting and accountable to the Nurse Manager/Director, the Clinical Nurse is responsible for coordinating and delivering patient care utilizing the nursing process in a hospital setting.

Education Requirements: Graduation from a school of professional nursing. If hired after January 6, 2014, must be enrolled within four years of employment, and obtain a Bachelor's degree with a major in Nursing or a Master's degree with a major in Nursing within seven years of employment date. Licensure/Certification Requirements: Licensed to practice as a Registered Nurse in the state of North Carolina. Basic Life Support (BLS) for Healthcare Provider certification Professional Experience Requirements: One (1) year of nursing experience.

Education - Participates in identifying and meeting learning needs of self. Attends education programs based on identified learning needs. With assistance, uses patient education materials relevant to patient population. Assesses readiness to learn of the patient/family/caregivers. Assesses developmental level of patient and factors affecting ability to learn. Evaluation of Care - Identifies expected patient outcomes. Seeks guidance as needed in revision of plan of care. Participates in discussion with members of the interdisciplinary team in evaluation of patient care. Communicates relevant information to promote continuity of care. Implementation - Demonstrates competence in care of patients with complex problems, including population-appropriate physical, psychosocial, educational and safety aspects of care. Performs bedside point of care testing as required for patient care plan. Utilizes healthcare organization and nursing standards, policies and procedures in delivery of care. Organizes and prioritizes care according to patient/family needs. Consults with appropriate resources in a timely fashion regarding patients with complex care issues, unusual teaching needs and/or those at high risk for discharge planning. Leadership - With assistance, develops goals to promote professional growth or minimize limitations. Achieves goals and objectives within identified time frame or renegotiates with supervisor. Is knowledgeable about activities which facilitate intra/interdepartmental collaboration. Participates in development and achievement of unit goals and performance improvement activities. Effectively uses communication systems. Participates in promoting cost-effective care. Gives feedback to co-workers. Is aware of public policy and regulatory guidelines affecting the health care environment. Promotes a safe, clean and secure hospital environment for all. Patient Assessment - Recognizes data from complex situations to determine priorities for care. Includes appropriate physical, psychosocial, education and safety needs. Synthesizes assessment data into meaningful whole prior to communication to others. Assesses and anticipates discharge needs of individual patients and families. Develops relationships with families that promote their ability to advocate for the patient and their own needs. Planning - Collaborates with patient/family to prepare or update the plan of care. Makes use of available multidisciplinary resources in planning care. Begins to use full range of communication as a means to convey planning. Identifies and addresses cultural and ethnic issues in planning patient care. Demonstrates ability to prioritize tasks for patients with complex problems. Research - Reads journals that contain studies or articles that may be applicable to practice. Brings ideas and questions to the staff at large for assessment of applicability.

IMCS Group

RN Case Manager

Posted on:

June 5, 2025

Job Type:

Contract

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

Require Certifications: Active RN licensure to practice in Ohio (can be compact) BLS 2 year of experience required Epic Experience Required Preferred Skills: Case management, UR, and/or precert experience

NeueHealth

Care Manager, RN (Work From Home)

Posted on:

June 4, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

California

We are transforming healthcare to be value-driven, creating a seamless, consumer-centric care experience that maximizes value for all. We believe that all health consumers are entitled to high quality, coordinated healthcare. We uniquely align the interests of health consumers, providers, and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.

The role of the Care Manager is to promote quality, cost-effective outcomes for a population by facilitating collaboration and coordination across settings, assessing member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure member’s receive services and resources required to meet desired health and social outcomes. The Care Manager is responsible for providing patient centered care across the care continuum.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE: Associate’s degree in Nursing, Bachelor’s degree preferred Minimum two (2) years of experience in medical management clinical functions. Working knowledge of MCG, InterQual, and NCQA standards LICENSURES AND CERTIFICATIONS: Active and Unrestricted License as a Registered Nurse (RN) in California Certification in Case Management (CCM) or Managed Care Nursing (CMCN) preferred PROFESSIONAL COMPETENCIES: High level of critical thinking and problem-solving skills Strong work ethic and overall positive attitude Effective communication skills including verbal and written Ability to manage time effectively, understand directions, and work independently in a fast-paced environment Demonstrated flexibility, organization, and self-motivation Highly adaptable to change

Assessment of the medical, social, and behavioral needs of an assigned population Provide Care Plan development and prioritization to transition members to optimal levels of health and self-management. Coordinate interdisciplinary team meetings as required Collaborate across providers and healthcare settings to ensure optimal quality outcomes for an assigned population Provide transition of care interventions as required Facilitate care coordination, self-management planning, discharge planning, and health education for an assigned population. Facilitate linkage to appropriate community resources to address social determinants of health Adjudicate referrals and apply evidence-based clinical criteria to coordinate member care needs across all care setting Able to ensure member communication and notices are composed in a manner consistent with regulatory standards. Adhere to the Policies and Procedures set forth by the Quality Management Committee.

NeueHealth

Care Manager, LVN/LPN (Work From Home)

Posted on:

June 4, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

California

The role of the Care Manager is to promote quality, cost-effective outcomes for a population by facilitating collaboration and coordination across settings, identifying member needs, planning for care, monitoring the efficacy of interventions, and advocating to ensure member’s receive services and resources required to meet desired health and social outcomes. The Care Manager is responsible for providing patient centered care across the care continuum.

EDUCATION AND PROFESSIONAL EXPERIENCE: Associate degree in nursing, preferred. Minimum 2 years of experience in medical management clinical functions. Working knowledge of MCG, InterQual, and NCQA standards Active License as a California Licensed Vocational Nurse (LVN/LPN) Certification in Case Management (CCM) or Managed Care Nursing (CMCN) preferred. PROFESSIONAL COMPETENCIES: High level of critical thinking and problem-solving skills Strong work ethic and overall positive attitude Effective communication skills including verbal and written. Ability to manage time effectively, understand directions, and work independently in a fast-paced environment. Demonstrated flexibility, organization, and self-motivation. Highly adaptable to change.

Collect relevant clinical data to support the care planning process. Provide care plan support, intervention, and prioritization to transition members to optimal levels of health and self-management. Participate in interdisciplinary team meetings as required. Collaborate across providers and healthcare settings to ensure optimal quality outcomes for an assigned population. Provide transition of care interventions as required. Facilitate care coordination, self-management planning, discharge planning, and health education for an assigned population. Facilitate linkage to appropriate community resources to address social determinants of health. Adjudicate referrals and apply evidence-based clinical criteria to coordinate member care needs across all care settings. Ensure member communication and notices are composed in a manner consistent with regulatory standards. Adheres to the Policies and Procedures set forth by the Quality Management Committee and performs all additional duties as assigned.

JOIN

A T Services Inc: Telehealth Nurse

Posted on:

June 4, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

Our years of experience providing transcription services to leading legal, medical and insurance professionals and government agencies is focused and centered on the highest levels of customer service, turnaround time and quality transcription services. Continuing customer loyalty has repeatedly proven to be the hallmark of our success and reputation.

If you're a dedicated Registered Nurse looking to make a meaningful impact through virtual care, we’d love to hear from you. Join our team and help redefine how healthcare is delivered—one patient at a time.

Minimum 1+ year of clinical nursing experience (telehealth, primary care, ER, or case management experience preferred). Proficiency with telehealth platforms and electronic health records. Strong clinical assessment, communication, and critical thinking skills. Comfortable working independently in a remote environment. Must be authorized to work for any employer in the US.

Deliver safe, professional, and patient-centered care through virtual platforms (phone, video, messaging). Conduct remote clinical assessments and triage based on established protocols. Provide education, counseling, and support to patients and caregivers regarding chronic disease management, medication adherence, and lifestyle changes. Document all patient interactions accurately in the electronic health record (EHR) system. Collaborate with physicians, advanced practice providers, and interdisciplinary teams to ensure continuity of care. Respond promptly to patient inquiries and follow up on care plans or referrals. Utilize clinical judgment and established guidelines to escalate cases when needed. Participate in continuous quality improvement and telehealth best practices development.

Veracity Software Inc

RN - Asst Manager ICU

Posted on:

June 4, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Illinois

Registered Nurse (RN) with relevant experience in critical care/ICU. BSN (required) or MSN (preferred). Strong clinical skills and knowledge of ICU care, 3-5 years experience required. Excellent communication, leadership, and interpersonal skills. Ability to work effectively in a fast-paced and demanding environment.

Clearlink Partners

Prior Authorization Utilization Management RN (CA Licensed)

Posted on:

June 4, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

Clearlink Partners is an industry-leading managed care consultancy specializing in end-to-end clinical and operational management services and market expansion initiatives for Managed Medicaid, Medicare Advantage, Special Needs Plans, complex care populations, and risk-adjusted entities. We support organizations as they navigate a dynamic healthcare ecosystem by helping them manage risk, optimize healthcare spend, improve member experience, accelerate quality outcomes, and promote health equity.

Competencies: Ability to translate member needs and care gaps into a comprehensive member centered plan of care Ability to collaborate with others, exercising sensitivity and discretion as needed Strong understanding of managed care environment with population management as a key strategy Strong understanding of the community resource network for supporting at risk member needs Ability to collect, stage and analyze data to identify gaps and prioritize interventions Ability to work under pressure while managing competing demands and deadlines Well organized with meticulous attention to detail Strong sense of ownership, urgency, and drive The ability to effect change, perform critical analyses, promote positive outcomes, and facilitate empowerment for members/families. Excellent analytical-thinking/problem-solving skills. The ability to work effectively in a fast-paced environment with frequently changing priorities, deadlines, and workloads. The ability to offer positive customer service to every internal and external customer Experience: Current unencumbered California RN license required; Compact license preferred in addition to California Minimum of 5+ years of acute clinical experience Minimum 2 years’ experience in a managed care environment across multiple lines of business (Medicare Advantage, Managed Medicaid, Dual SNP, Commercial, etc.) 2+ years of utilization management experience Strong knowledge of utilization management processes and industry best practice In-depth knowledge and experience with the application of standard medical criteria sets (MCG, InterQual) Detailed knowledge and demonstrated competency in all types of medical-necessity decisions, including inpatient care, sub-acute/skilled care, outpatient care, hospice care and home health care. HMO and risk contracting experience preferred In-depth knowledge of current standard of medical practices and insurance benefit structures. Excellent oral and written interpersonal/communication, internal/external customer-service, organizational, multitasking, and teamwork skills. Proficiency in Microsoft Office Physical Requirements: Must be able to sit in a chair for extended periods of time Must be able to speak so that you are able to accurately express ideas by means of the spoken word Must be able to hear, understand, and/or distinguish speech and/or other sounds in person, via telephone/cellular phone, and/or electronic devices Must have ample dexterity which allows entering of text and/or data into a computer or other electronic device by means of a keyboard and/or mouse Must be able to clearly use sight so that you are able to detect, determine, perceive, identify, recognize, judge, observe, inspect, estimate, and/or assess data or other information types Must be able to fluently communicate both verbally and in writing using the English language Time Zone: Mountain or Pacific

Specific: Determine appropriateness of services through the application and evaluation of medical guidelines, benefit determinations and compliance with state mandated regulated based on approved criteria (MCG, InterQual, etc.) Perform 15-30 reviews per day Performs initial and concurrent review of inpatient admissions Performs reviews for outpatient surgeries, and ancillary services Concludes medical necessity and appropriateness of services using clinical review criteria Collaborate with Medical Director(s) for appropriate referrals, complex cases and adverse determinations to ensure timely access to medically necessary/ appropriate services Accurately documents all review determinations, contacting providers and members according to established requirements and timeframes General: Perform daily work with a focus on the core principles of managed care: Patient Education, Wellness and Prevention Programs, Early Screening and Intervention and Continuity of Care Work proactively to expedite the care process Identify priorities and necessary processes to triage and deliver work Empower members to manage and improve their health, wellness, safety, adaptation, and self-care Assess and interpret member needs and identify appropriate, cost-effective solutions Identify and remediate gaps or delays in care/ services Advocate for treatment plans that are appropriate and cost-effective Work with low-income/ vulnerable populations to ensure access to care and address unmet needs Gather and evaluate clinical information to assess and expedite referrals within the healthcare system including consideration of alternate levels of care and services Facilitate timely and appropriate care and effective discharge planning Work collaboratively across the health care spectrum to improve quality of care Leverage experience/ expertise to observe performance and suggest improvement initiatives Ensure understanding of industry standard competencies and performance metrics to optimize decisions and clinical outcomes Ensure individual and team performance meets or exceeds the performance competencies and metrics Contribute actively and effectively to team discussions Share knowledge and expertise, willingly and collaboratively. Provide outstanding customer service, internally and externally Follow and maintain compliance with regulatory agency requirements

Avosys Technology, Inc.

REMOTE Registered Nurse - Medical Review Specialist-Bexar County, Texas

Posted on:

June 4, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Texas

Avosys is a growing integrator of professional, technological and management solutions services. Founded in 1998, Avosys provides services nationwide to Federal, Commercial, Local and State clients. We recognize the foundation of our firm is our people and we continue to rise above our competition by hiring the best.

Avosys is seeking a Bexar County Remote Registered Nurse - Medical Review Specialist to work remotely to review Medicare claims.. Maximize family time with no weekend, Holiday, or on-call requirements Maintain work-life balance with guaranteed 8-hour shifts Take advantage of our competitive, comprehensive benefits package including medical, dental, vision, life, short-term disability, long-term disability & 401(k)

Qualifications: Minimum of two (2) years’ clinical experience Excellent written and oral communication skills Demonstrated experience with evaluating medical and health care delivery issues Strong computer skills to include Microsoft Office proficiency License - Certifications: Active and current Registered Nurse license

Perform clinical reviews of Medicare Part A and Part B claims for Medical Review, Redeterminations/Appeals (Appeals), and Prior Authorization requests (collectively, the “Services”) in accordance with CMS (Centers for Medicare & Medicaid Services) requirements Complete a projected number of clinical review hours while meeting timeliness and accuracy standards and completing documentation of clinical decisions for remittance. Clinical review of services: Review medical record documentation within CMS timeliness parameters (i.e., 20 days from receipt of the medical record for pre-payment reviews and 50 days from receipt of the medical record for post payment reviews) Utilize the applicable Medicare policies (i.e., Local Coverage Determinations, National Coverage Determinations, Internet-Only Manual (IOM) citations, inpatient tools, etc.) to ensure the services comply with all Medicare regulations and documentation requirements Review documentation for medical necessity per guidelines outlined in the Social Security Act 1862(a)(1) Ensure that all documentation includes a valid signature consistent with the signature requirements Documentation of rationale for processing decisions: Provide a claim sample of three (3) claims to Companies via established protocols and timeliness parameters (i.e., 18 days from receipt of the medical record for pre-payment reviews and 48 days from receipt of the medical record for post payment reviews) for quality review prior to finalization of documentation of reason for payment, reduction, or denial of service to ensure accuracy of claim decision making Companies will review the three-claim sample for accuracy of claim decision and will make and return decisions to the MRS within 24 hours or less Complete the documentation of the reason for payment, reduction, or denial of service for all claims on an electronic decision template to be provided by Companies. This rationale must be in sentence format so that it may be inserted directly into the response to the provider, must be clear and well-written, and contain sufficient information to educate the providers on how the review decision was made Return documented decision electronically to Companies via established protocols and timeliness parameters (i.e., 20 days from receipt of the medical record for pre-payment reviews and 50 days from receipt of the medical record for payment reviews) Complete the review results letter in the Companies’ letter writing system within 35 days from receipt of the medical record for pre-payment reviews and no later than 60 days from receipt of the medical record for post payment reviews Document all case activity in Companies’ provider tracking system on the day the activity occurs Complete one-on-one provider education (i.e., webinar, conference call, etc.) within 30 days of sending out review results letter Respond to provider inquiries related to case and/or claims throughout the course (i.e. in 24 hours or less) of review If additional clinical guidance is required, complete the Contractor Medical Director (“CMD”) assistance form, track response, and update review accordingly Conduct telephone development for missing or additional records for easily curable errors Notate date of receipt of additional documentation received in the Companies’ provider tracking system Upon request by Companies, initiate or participate in provider teaching activities, creating written teaching material, providing one-on-one education or education to a group as a result of an MR review If fraud activity is suspected, immediately complete initial referral packet for external entity referral and return the packet to the Companies Complete referrals to Companies’ provider outreach and education (“POE”) area in provider tracking system for cases that have a moderate or major error rate Lead and Alternate Lead will participate in all monthly departmental training and meetings, and all Staff will participate as requested Submit all cases for review and approval for quality and closure of cases

Wellbox Health

LPN/LVN - Care Coordinator

Posted on:

June 4, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Compact / Multi-State

Wellbox is a fast-growing healthcare company on a mission to empower people to lead healthier lives. Through comprehensive, preventative care solutions delivered by an exceptional team of nurses, we help patients manage chronic conditions from the comfort of their homes. If you're a compassionate, tech-savvy LPN who thrives in a remote care setting, we’d love to meet you!

As a Patient Care Coordinator, you’ll play a vital role in our patients’ health journeys by conducting monthly telephonic outreach, assessing their unique needs, and creating individualized care plans.

Active Compact LPN license. At least 2 years of clinical experience (care coordination preferred). Tech confidence: you’re comfortable using EMRs, Microsoft Office, and other digital tools. Strong communication and problem-solving skills.

Manage patient care through scheduled phone conversations. Document visits using technology platforms and electronic health records (EHRs). Develop care plans focused on physical, mental, and preventative health. Coach patients through their treatment plans—including wellness, nutrition, and goal setting. Help patients prepare for medical appointments and connect with resources.

Synergy Healthcare USA, LLC

Nurse Advocate- Remote - Illinois

Posted on:

June 4, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Illinois

SYNERGY HEALTHCARE: Case Manager Advocate – Illinois (Remote) Job Summary: We are seeking an experienced Case Manager to join our growing team and serve as a Nurse Advocate for our new client and their employees. The ideal candidate will be located in Illinois, have a thorough understanding of the healthcare system, and will be responsible for providing guidance and support to members in navigating the complex healthcare landscape. As the dedicated Nurse Advocate, you will be responsible for resolving a myriad of issues for their members and allow you the flexibility to “think outside the box”. With your clinical experience and background, you will help members better understand their health status and available treatment options. You will have a unique opportunity to develop valued relationships with members and executive teams with your specific employer clients. While this specific client is based in Illinois, and they have locations in other States, this opportunity allows for remote work so can be flexible on location. Minimal travel for periodic client visits may be required. Most if not all work will be done virtually out of the convenience of your own home office. The key to your success will rely on your ability to cultivate trusted relationships with stakeholders, members, and their families. Our growing Synergy team is passionate about delivering an exceptional healthcare experience that is personal, data driven, and value based to help every person live their healthiest life.

Active nursing license with a Bachelor of Science in Nursing (BSN) degree preferred. Minimum of 3 years of experience as a nurse case manager or in a related healthcare field. CCM certification or CCM eligible. Commit to CCM exam within the first year. Bi-lingual- the ability to communicate effectively in both English and Spanish is a plus. In-depth knowledge of the healthcare and insurance systems. Strong analytical and problem-solving skills with the ability to identify and resolve complex healthcare issues. Excellent communication and interpersonal skills with the ability to interact effectively with employees and healthcare professionals. Ability to work remotely, independently, and as part of a team in a fast-paced, dynamic environment. Strong organizational skills with the ability to manage multiple tasks and priorities simultaneously. Proficient in the use of electronic health records (EHRs), Outlook, Excel, and other healthcare-related software.

Serve as the primary point of contact for members seeking assistance with navigating the healthcare system. Work with members to identify their healthcare needs and provide clinical support. Liaison with TPAs and insurance companies to resolve claim and billing issues. Educate members on their healthcare benefits and how to effectively utilize them. Advocate for members so they can receive improved healthcare outcomes, including referrals to specialists and timely access to care. Collaborate with other healthcare professionals, including physicians and nurses to ensure seamless coordination of care. Monitor member health status and progress towards achieving their healthcare goals. Maintain accurate and up-to-date records of member interactions and healthcare interventions. Client facing reporting with the potential for limited travel to client worksites. Health Risk Assessment review to encourage lifestyle modification and improve overall wellness.

CircleLink Health

Michigan Registered Nurse Care Coach

Posted on:

June 4, 2025

Job Type:

Contract

Role Type:

Coaching

License:

RN

State License:

Michigan

CircleLink Health is a company of passionate clinicians, technologists and businesspeople tackling the $600B problem of preventable chronic and post-acute complications. We’re building a world-class Care Management platform to enable providers while accelerating the shift to preventative care instead of status quo reactive care.

This is a remote role. CircleLink Health is looking for passionate, tech savvy registered nurses to work remotely and serve patients enrolled in Medicare’s Chronic Care Management Program. In this part time role (20-25 hrs. per week), an RN Care Coach will be assigned a group of patients that they will be following and calling each month. In these monthly calls you will provide education, coordinate care, close preventive care gaps, and coach on strategies for self-management to keep them out of the hospital.

Fluent in English Self-directed, able to work independently with little supervision while meeting performance metrics Passion for nursing and improving patient outcomes Good with technology and eager to learn and use new software Excellent organizational and time management skills Strong communication and telephonic skills Strong critical thinking and problem-solving skills Education and Experience: Current, unrestricted Proficiency with electronic health records and web based applications 3+ years' experience as a Registered Nurse Preferred Education and Experience, but not required: Case Management or Chronic Disease Management experience highly preferred Certified Diabetes Educator Experience with Motivational Interviewing or other behavior change communication techniques Scheduling and Other Requirements: RN needs a STRONG internet-connected computer. Computer and internet speed tests will be required. Minimum of 20-25 hours of availability per week required. You will commit to your own schedule using our software. This is a 1099 contract position with no end date. Care coaches are responsible for their own taxes, equipment, and insurance.

Utilize our specialized care management software to call Medicare patients with 2 or more chronic conditions (Diabetes, CHF, Chronic Pain, COPD, etc.) on a monthly basis Build and maintain rapport with patients to help coach them to improved health through SMART goals and education on self-management strategies Implement and improve the Plan of Care by updating medications, appointments due, biometrics, symptoms, and interventions made Connect the patient with community resources as needed, including transportation, personal care needs, prescription/DME assistance, social services, etc. Conduct Transitional Care Management activities to high risk patients discharged from the hospital and the ER to reduce unnecessary readmissions. Close care gaps by encouraging and assisting with preventive care measures, i.e. annual well visits, vaccines, cancer screens, follow-up/specialist appointments, etc.

HealthAxis Group

Utilization Management Auditor

Posted on:

June 4, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

None Required

State License:

Florida

HealthAxis is a prominent provider of core administrative processing system (CAPS) technology, business process as a service (BPaaS), and business process outsourcing (BPO) capabilities to healthcare payers, risk-bearing providers, and third-party administrators. We are transforming the way healthcare is administered by providing innovative technology and services that uniquely solve critical healthcare payer challenges negatively impacting member and provider experiences. We live and work with purpose, care about others, act with integrity, communicate with transparency, and don’t take ourselves too seriously. We're not just about business – we're about people. Our commitment to a people-first approach shapes everything we do, from collaborating as a team to serving our valued clients. We believe that creating a vibrant and human-centric environment can inspire engagement, empower our team members, and ignite a sense of purpose in all that we accomplish.

The Utilization Management Auditor plays a critical role in ensuring the accuracy, compliance, and effectiveness of the Utilization Management (UM) processes within the health plan. This position is responsible for auditing the results of the full UM lifecycle, including intake, authorization creation, and authorization review and determination. The auditor also evaluates processes impacting other departments such as claims, call centers, administrative & governance (A&G), and others to ensure that operations align with industry standards, regulatory requirements, and organizational policies. By identifying inefficiencies, gaps in compliance, and opportunities for improvement, the Utilization Management Auditor supports the organization's commitment to providing high-quality and cost-effective care while ensuring operational excellence.

EDUCATION, EXPERIENCE AND REQUIRED SKILLS: High school diploma or general education degree (GED) required. Bachelor’s degree in Healthcare Administration, Nursing, Business Administration, or related field (preferred). Certification in Healthcare Compliance (CHC), Certified Professional in Utilization Review (CPUR), or similar certifications are highly desirable. Additional certifications or training in auditing or healthcare quality improvement is a plus. Experience: Minimum of 3-5 years of experience in healthcare operations, Utilization Management, or auditing roles within health plans or managed care organizations. In-depth knowledge of UM processes, including intake, authorization creation, and determination, as well as familiarity with cross-departmental functions like claims, A&G, and call center operations. Experience with healthcare regulations and standards (e.g., CMS, state-specific guidelines, NCQA) and their impact on utilization management. Proven track record in auditing and identifying areas for process improvement within a complex healthcare environment. Experience in developing and implementing reporting systems and documentation related to audit activities. Required Skills: Strong analytical and critical thinking skills, with the ability to identify patterns, discrepancies, and opportunities for improvement. Excellent attention to detail and the ability to maintain high levels of accuracy in all work products. Strong communication skills, both verbal and written, to present audit findings clearly and persuasively to stakeholders at all levels. Ability to work collaboratively across departments, with a customer service-oriented approach to problem-solving. Proficiency in using audit management tools, electronic health records (EHR) systems, and MS Office Suite (Excel, Word, PowerPoint). Knowledge of healthcare claims processing and call center operations is a plus. Ability to manage multiple priorities and meet deadlines in a fast-paced environment.

Audit Utilization Management (UM) Processes: Review and assess all stages of the UM process, including intake, authorization creation, authorization review, and determination, to ensure they comply with internal policies, regulatory guidelines, and industry best practices. Conduct audits of authorization requests and reviews for accuracy, completeness, and timely decision-making in accordance with applicable healthcare regulations. Monitor and audit workflows for intake and authorization activities to identify opportunities for optimization and efficiency improvements. Audit Cross-Departmental Processes: Evaluate workflows and tickets impacting other departments such as Claims, Call Center, Administrative & Governance (A&G), and other operational areas. Identify systemic issues that may affect multiple departments and recommend corrective actions. Ensure that cross-departmental communications and processes are streamlined, accurate, and consistent with UM standards. Reporting and Documentation: Compile audit findings into detailed reports, outlining key observations, discrepancies, and areas of concern. Provide actionable recommendations for improving processes, resolving discrepancies, and ensuring compliance. Maintain clear and accurate records of audit results, follow-up actions, and resolutions. Compliance and Quality Assurance: Ensure all audits align with internal and external compliance requirements, including CMS, state regulations, and industry standards. Track and analyze audit outcomes to ensure continuous improvement and adherence to best practices in UM. Actively participate in quality assurance activities to identify gaps and collaborate with leadership to address areas for improvement. Collaboration and Stakeholder Engagement: Work closely with Utilization Management leadership, Claims, A&G, and other operational departments to facilitate the resolution of audit findings and process improvements. Provide training, guidance, and feedback to departments and teams to improve UM processes and minimize errors. Act as a liaison between departments to ensure smooth coordination of UM and related operations. Continuous Improvement and Training: Stay informed of changes in healthcare regulations, industry standards, and best practices related to Utilization Management and healthcare operations. Recommend process improvements and best practices based on audit outcomes, industry trends, and new regulatory guidance. Support ongoing training efforts for UM staff and other departments impacted by audit results.

SSM Health

Registered Nurse – Phone Triage

Posted on:

June 4, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

It's more than a career, it's a calling MO-REMOTE Worker Type: Regular Job Highlights: Department: Family Medicine Clinic Schedule: M-F Day Shift | No Weekends or Holidays Starting Pay: 29.30+/hr. (Offers are based on years of experience and equity for this role.) Sign On Bonus: Available for external qualified candidates Location: MO-Remote (Must Reside in Missouri) Job Summary: Provides remote care to patients under the direction of a qualified health care provider, functioning within the scope of license to support different clinics and/or specialty clinics. Participates in program development and process improvement.

EDUCATION: Graduate of accredited school of nursing or education equivalency for licensing Experience: One year experience registered nurse experience Physical Requirements:Constant use of speech to share information through oral communication. Constant standing and walking. Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs. Frequent sitting, reaching and keyboard use/data entry. Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors. Frequent use of smell to detect/recognize odors. Frequent use of hearing to receive oral communication, distinguish body sounds and/or hear alarms, malfunctioning machinery, etc. Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs. Occasional lifting/moving of patients. Occasional bending, stooping, kneeling, squatting, twisting, gripping and repetitive foot/leg and hand/arm movements. Occasional driving. Rare crawling and running. Required Professional License And/Or Certifications State of Work Location: Illinois Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR) State of Work Location: Missouri Registered Nurse (RN) - Missouri Division of Professional Registration Or Registered Nurse (RN) Issued by Compact State State of Work Location: Oklahoma Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Oklahoma Board of Nursing (OBN) State of Work Location: Wisconsin Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services

Completes nursing workflows per department protocols including virtual/telephonic patient program admission, virtual/telephonic patient assessments and education, patient care planning and care coordination, and remote patient monitoring (RPM) escalation follow-up. Delivers safe and quality care in line with provider orders, remote patient monitoring department protocols, and established nursing care standards. Provides documentation that follows the established treatment plan, supports coordination of patient care, meets regulatory requirements, and ensures reimbursement. Communicates with management team, patient care team (including clinical staff and providers), and patient/patient caregiver(s) per department protocols. Uses electronic technology for data collection, documentation, information gathering, and communication. Applies the existing body of evidence-based practice and scientific knowledge in health care to nursing practice, ensuring that nursing care is delivered based on patient’s age-specific needs and clinical needs as described in the department's scope of service. Works in a constant state of alertness and safe manner. Performs other duties as assigned.

PeaceHealth

Remote Inbox Clinician

Posted on:

June 3, 2025

Job Type:

Full-Time

Role Type:

Primary Care

License:

NP/APP

State License:

Washington

PeaceHealth, based in Vancouver, Wash., is a nonprofit Catholic health system offering care to communities in Washington, Oregon and Alaska. PeaceHealth has approximately 17,000 caregivers, more than 160 multi-specialty clinics with more than 3,400 clinicians and providers, and 9 medical centers serving both urban and rural communities throughout the Northwest. In 1890, the Sisters of St. Joseph of Peace founded what has become PeaceHealth. Today, PeaceHealth is the legacy of its founding Sisters and remains dedicated to ensuring that every person receives safe, compassionate care; every time, every touch.

PeaceHealth has an opening for a Nurse Practitioner or Physician Assistant to work as a remote inbox clinician. Within scope of practice and in alignment with both hospital staff bylaws and physician supervision expectations, may be responsible for advanced level of evaluation, clinical assessment, prescribing and monitoring medications and follow-up care for patient. Responsible for patient and family teaching.

To be considered the candidate must reside in Oregon, Washington, or Alaska and have a minimum of 5 years' experience in a Primary Care setting. Must be licensed in Oregon or Washington, and be willing to obtain licensure in both states upon starting.

Effectively reviews and responds to electronic inbox messages within the electronic medical record (including but not limited to, patient calls and triage, prescription requests, patient secure messages, and result requests) in real time. Evaluate, make recommendations, co-manage, and treat patients of all ages’ medical needs for safe and high-quality treatment and preventative care. Provides virtual patient care as needed. Works in an independent and interdependent relationship with members of the medical staff, which allows for consultation, collaboration, or referral. Participate in an interdisciplinary team providing care and coordination of our patients with internal and external colleagues including the broader patient centered medical home ensuring the highest level of care is provided for all patients at all times. Prescribes medications and treatments and ongoing medication management. Orders lab and diagnostic tests when appropriate and interprets test results. Educates patients, and/or families, through virtual means, about preventive care, medical issues, and use of prescribed medical treatments and/or medications. Maintains legible, accurate, and confidential medical records. Documents all medical evaluations, diagnoses, procedures, treatment, outcomes, education, referrals, and consultations according to established standards. Analyzes new knowledge gained from conferences, workshops, professional literature, or “hands-on training” and assimilates this knowledge into clinical practice. Performs other duties as assigned.

Enlyte

Triage Clinician

Posted on:

June 3, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Enlyte is the parent brand of Mitchell, Genex and Coventry, an organization unlike any other in the Property & Casualty industry, bringing together three great businesses with a shared vision of using technology innovation, clinical services and network solutions to help our customers and the people they serve. Our suite of products and services enable our employees to help people recover from challenging life events, while providing opportunities for meaningful impact and career growth.

This is a remote position and an anticipated future need. Spanish bilingual preferred. This person must be located in a multi-state compact state and hold a compact RN License in the state you reside. As a 24/7 call center operation, please be advised that our 40-hour work week schedules will vary to ensure continuous coverage for our customers. This means: Shifts may be scheduled across any day of the week Start times will vary based on business needs Schedules may include evenings, weekends, and holidays Our scheduling team works diligently to maintain appropriate staffing levels across all hours of operation while adhering to our 40-hour work week policy. Join our team and help make a positive difference in an injured person's life. As a Worker’s Compensation Telephone Triage Clinician, you will provide inbound telephone triage services remotely to injured workers while following the individual state Worker Compensation rules and regulations.

Unencumbered RN License in state of residence required (must be in a compact state). Minimum of three years’ recent RN experience in one of the following adult clinical areas: Telephone Triage, ER, Urgent Care, Medical Surgical Unit, Occupational Medicine Bilingual in Spanish Preferred Ability to obtain other state licenses as required with fees reimbursed Ability to function independently and learn in a virtual work environment Experience using Microsoft Office Suite The nature of this role requires a certain level of schedule flexibility to best serve our customers and maintain operational efficiency. Key Considerations: Overtime may be required weekly to meet client needs or cover unexpected staffing needs Shift extensions daily may be necessary to provide continuous coverage or respond to high call volume Bi-annual shift bidding allows employees to adjust their schedules based on business needs, scheduled shifts will change during these times This is a remote position and the successful candidate must have a safe and HIPAA compliant home office with high speed internet connection, verified by speed test.

Use clinical expertise and communication skills to triage, consult, and provide recommendations for emergent and non-emergent situations. Focus on conveying compassion and ensuring service excellence is centered on the injured worker. Make safe decisions for appropriate care using critical thinking skills. Use departmental evidence-based protocols to triage patients. Build and maintain solid interdependent relationships within the team. Maintain up-to-date knowledge and skill in professional, clinical, and system areas. Demonstrate effective written and verbal communication skills.

Imagine360

Triage Supervisor, Case Management

Posted on:

June 3, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Compact / Multi-State

Imagine360 is a health plan solution company that combines 50+ years of self-funding healthcare expertise. Over the years, we've helped thousands of employers save billions on healthcare. Our breakthrough total health plan solution is fixing today's one-size-fits-none PPO insurance problems with powerful, customized, member-focused solutions.

Imagine360 is seeking a Triage Supervisor to join the team! The Supervisor, Triage is responsible for leading a team of clinicians who guide members throughout their healthcare experience by providing tailored support and clinical expertise, in order to elevate the member experience. The team of nurses acts as advocates for our members to help them utilize their health plan to the fullest potential. By educating members on resources and services available to them within their medical benefit plan, your support plays a key role in the member's journey navigating through the complexity and cost of healthcare. The Supervisor leads a team of clinicians who perform symptom triages as well as various health assessments to prevent gaps in care. The Supervisor may also interact with members directly and be a hands-on clinician managing the triage process Position Location:100% Remote

Required Education: A nursing degree from an accredited college, university, or school of nursing. Active and unrestricted Registered Nurse License in eNLC compact state. Required Experience: 1+ years' experience in a clinical environment such as in a Hospital, Physician's Office, or similar. Preferred Experience: Experience managing a team of clinicians and motivating employees to produce quality clinical results preferred. Experience managing a remote team of employees preferred. Experience in a telephonic clinical role preferred. Skills and Abilities: Excellent communication skills with a personable and approachable demeanor and a passion for serving others. Ability to motivate and encourage others to deliver superior customer service and quality clinical experiences. Team player who builds effective working relationships and able to handle multiple tasks & assignments. Proficient in typing and Office Software (Word, Excel, PowerPoint) and other programs such as Outlook, Internet Explorer, Database software, and standard office equipment. Ability to work independently in a home office environment. Ability to read and interpret documents such as HIPAA compliance, safety rules, operating and maintenance instructions, and policy & procedure manuals. Ability to draft professional communications and articulate complex ideas clearly in writing. Ability to write routine reports and correspondence. Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages. Ability to apply concepts of basic mathematics and accounting principles. Licenses or Certifications: Maintain active Registered Nurse license and CEU's as required by the State Board of Nursing. Must be willing to obtain and maintain additional license as required to perform the job functions of the organization.

Responsible for managing the team responsible for delivering the clinical triage process and ensuring the member experience is seamless and the members' benefits are utilized to the fullest potential. Responsible for all supervisory duties which could include but not limited to: 1:1 coaching, creating and maintaining team policies and procedures, training of team members, coordinating and support of daily triage activities, maintaining metrics and team statistics as needed, managing staffing schedules, review/approval of team PTO requests, conducting performance reviews, and involvement in hiring and onboarding processes. Lead projects and employee discussions that promote process improvements in the delivery of services within the department. Coordinate and attend meetings throughout the week to maintain project performance. Perform monthly call and chart audits for the triage clinicians. Support member issue and resolution processes as needed. Hands on clinician in the triage process which could include but not limited to: perform real-time symptom triage and appropriate disposition and educational care instructions, using clinical knowledge to provide educational resources to members regarding their medical diagnosis, identify appropriate member referrals to Medical Management programs, resolve gaps in care for members. Collaborate with internal and external stakeholders to ensure a best-in-class service delivery. Adhere to established internal Medical Management policies and procedures, regulations regarding Department of Labor, HIPAA, PHI, and ERISA. Complete and follow HIPAA training/PHI guidelines. Other duties as assigned. Areas of Responsibility: Scope of Practice In addition to performing standard duties, the Registered Nurse is involved in clinical decision making and patient education. The scope of practice for nursing work includes, but is not limited to: Assessment and evaluation of the acquired clinical data to assess the appropriateness of treatment plan based upon Imagine360 clinical guidelines. Coordination of treatment plans, interventions, and outcome measurement. Provide patient education and educational resources. Rationale for the effects of medication and treatments. Accurately report: Client response Contact with other health care team members Evidence-based sources for care plan recommendations Respect the client's right to privacy by protecting confidential information. Promote and participate in education and counseling to a participant based on health needs. Clarify any treatment that is believed to be inaccurate, non-efficacious, or contraindicated by consulting with appropriate practitioners.

Caris Healthcare

Triage Licensed Practical Nurse, LPN PRN

Posted on:

June 3, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

LPN/LVN

State License:

Compact / Multi-State

Caris Healthcare’s mission is to provide hospice care with grace. Serving patients throughout the Southeast region, we support our team members, patients and their families with compassion, accountability, respect, integrity and service. If you are ready for a rewarding career with a company that offers employees a culture of integrity and excellence, consider joining the Caris Healthcare team. At Caris, you will have a career, not just a job. Our mission driven culture is evident by our current employees and the impact made on patients and families. All Caris team members commit to The Better Way, a list of promises we make to each other and our customers. The Better Way commitment is reflected in the benefits we provide. Benefits include: Competitive Salary Bonus Eligibility Eligible for benefits within 60 days Health Benefits (Medical, Dental, Vision); health savings account Earned Time Off 401 (K) plan with company match Paid Training Mileage Reimbursement Tuition Reimbursement Flexible Scheduling Career Advancement Opportunities

The Triage LPN answers, monitors, and returns calls/communications related to Caris Healthcare patients working under the supervision of an RN and/or in consultation with or under the direction of Physicians or Nurse Practitioners. Must recognize physical, psychosocial, and spiritual aspects of care. Accurately identify patients with at-risk conditions, while supporting all triage processes, works within the LPN scope of practice as defined by the Board of Nursing and Caris Healthcare policies and procedures. The LPN may contribute to nursing assessment and development of plan of care but may not independently assess or make clinical decisions based on their singular clinical judgment. This will be a remote position and must be based in our coverage footprint. Flexible schedule however must be available to work from 5pm to 1am.

Current Compact state LPN licensure or licensure for the following states: TN, SC, MO, VA, GA Home Health and or Hospice Experience, required. Graduate of an accredited school of Licensed Practical/Vocational Nursing 2-years of relevant experience in nursing and/or telephone triage Post-acute provider experience preferred Skills Preferred: Training - LPNExpert Licenses & Certifications Required: Licensed Practical Nurse

Addresses patient calls after hours concerning a wide range of symptom/side effect related and other patient care in a timely manner. Asks appropriate questions to assist in the collection/identification of patient’s symptom and side effect management inquiries. Recognizes changes in the patient's status and need for care. Identifies urgency of patient symptoms/side effects and addresses them appropriately, aggressively managing to prevent unnecessary emergency department and hospital use. Responds to emergency situations/calls and coordinates care/EMS response, as necessary. Collaborates with Physicians, Nurse Practitioners, and Registered Nurses to discuss patient care needs that cannot be independently and appropriately addressed using current orders. Completes on call log and distributes to appropriate Caris branch locations by end of shift each night. Provides clear education to patients and caregivers including verifying understanding of plan of care within LPN scope of practice. Counsels patients, family, and/or caregiver about side effects of medication (within LPN scope), applicable referrals, as well as available community resources Assists with obtaining prescription refills if needed. Performs charting and updating of records in the EMR as expected. Acts as a resource for healthcare team, patients, caregivers, and external agencies/organizations Participates in and initiates performance improvement activities as requested.

Sedgwick Government Solutions

Supervisor RN Telephonic Triage Nurse Case Manager (Remote) 2025-1433

Posted on:

June 3, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Compact / Multi-State

Sedgwick Government Solutions is a fully owned subsidiary of Sedgwick. Sedgwick is a leading global provider of technology-enabled risk, benefits, and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. The company provides a broad range of resources tailored to clients' specific needs in casualty, property, marine, benefits, and other lines. At Sedgwick, caring counts; through the dedication and expertise of more than 27,000 colleagues across 65 countries, the company takes care of people and organizations by mitigating and reducing risks and losses, promoting health and productivity, protecting brand reputations, and containing costs that can impact the bottom line. www.sedgwick.com Privacy | Sedgwick Terms and Conditions | Sedgwick

RN Telephonic Triage Nurse Case Manager Supervisor - Remote Nationwide Salary ($83,000- $87,000) depending on experience and qualifications. Are you interested in empowering and sustaining healthy, positive, and measurable differences in the health of individuals while leading a team? Does the thought of leading and motivating a team of exceptionally talented case managers inspire you? Do you thrive in shaping and organizing teams to provide high-quality care that affects individual lives? We believe it takes teamwork and organization to provide medical and care expertise to help those with acute conditions to live their best life, teamwork led by a highly skilled home-based RN Telephonic Triage Nurse Case Manager Supervisor. Your broad responsibilities will include providing supervision of daily operations team while providing medical case services of injured workers' cases. Ideal candidates will possess both a nursing leadership background that enables them to supervise, coach, and easily interact with nurse case managers, as well as a professional background that enables them to easily interact and establish deep professional relationships with team members. As an RN Telephonic Triage Nurse Case Manager Supervisor, you will collaborate with the Manager, RN Telephonic Nurse Case Manager and VP to ensure consistent delivery of case management services.

Bachelor of Science in Nursing National certification in case management or related field is required in one of the following areas: Occupational Health (COHN); Case Management (CCM), Insurance Rehabilitation (CIRS/CRRN), Disability Management (CDMS), and/or Nurse Case Manager Board Certified (ANCC/ANA). National certification in a related field or obtained within 12 months of the date of hire. Possess an active, unrestricted nursing license valid in the United States, Puerto Rico, or other U.S. territories; a Compact License is preferred. 5 years of related clinical experience, including: Minimum of 2 years in adult medical/surgical nursing Minimum of 2 years in case management within the workers’ compensation arena Minimum of 1 year in adult medical/surgical nursing Minimum of 3 years in case management within the workers’ compensation arena Experience with the Federal Employee Compensation Act (FECA) and FECA-related issues preferred. Demonstrated ability to work independently and along with others Attention to detail, timetables, and commitment to completing tasks Experience with Microsoft Windows and computer savvy Must be well organized, efficient, and able to prioritize competing priorities and make sound judgments Ability to define, and resolve problems and challenges in a workplace setting Responsible for having reliable High-Speed Cable or Fiber Optic Internet service Must have Excellent People Skills, and Communication Skills via Phone, E-Mail, Text, Written, and Verbal formats, and provide 24-hour follow-up to all communication Prior to hiring and training you must be able to pass a preliminary credit and background check

Work independently in your home office setting while supervising a team of case managers. Provide direct supervision to case managers in the assigned team in the application of corporate policies and procedures, case management protocols, timesheets, PTO, and expense review and approval. Uses experience and expertise in the Case Management process and coaches the staff on the RN - the patient-physician collaborative process of assessment, planning, implementation, coordination, monitoring, and evaluation to address patients holistically. Provide supplemental support and assistance to Case Managers during staff transition and/or spikes in assigned caseloads. Support the development and enhancement of corporate policies and protocols that relate to case management services. Conduct periodic reviews of designated cases for quality improvement, support implementation, and monitoring of quality improvement plans. Provide Customer Support in designated areas and assists regional CM in the delivery of customer support. Effectively counsel and coach employees on performance and behavioral improvements. Understand and appropriately apply employee disciplinary procedures.

Metasys Technologies

Clinical Review Nurse (RN) /Clinical Informaticist/RN

Posted on:

June 3, 2025

Job Type:

Contract

Role Type:

Utilization Review

License:

RN

State License:

Oregon

Metasys is a global digital consulting firm that specializes in delivering solutions across a variety of business functions, including HR, Procurement, Marketing, Finance, and Technology. With over twenty-five years of experience, we have helped companies of all sizes—from agile startups to established enterprises—achieve sustainable growth and operational efficiency. Our focus on best-in-class practices, cost-efficient strategies, and scalable support has enabled us to become a trusted partner to companies looking to transform their operations and scale effectively. Metasys is a portfolio company of Arkview Capital, a leading private equity firm.

Job Title: Clinical Review Nurse (RN) – Utilization Management Location: Oregon or bordering states Duration: 3+ Months Job Summary: This role uses clinical expertise to review medical records for medical appropriateness based on established criteria and contractual guidelines. The nurse will ensure timely, accurate case handling and serve as a key liaison between providers and internal departments.

Required Qualifications: Active, unrestricted RN license in Oregon Willingness or ability to be licensed in Nebraska if not compact-eligible Bachelor’s degree in a healthcare-related field At least 2 years of experience in Utilization Management or Clinical Review Preferred Qualifications: Experience in Case Management Strong understanding of medical terminology, records, and disease processes Solid clinical assessment and critical thinking abilities Excellent written and verbal communication skills

Conduct medical record reviews in accordance with clinical and contractual standards Prioritize and manage daily case queues to meet workload demands Collaborate with supervisors on quality assurance and continuous improvement Maintain up-to-date knowledge of review processes and clinical best practices Serve as a liaison for provider communications and issue resolution Build and maintain positive relationships with internal and external stakeholders Participate in required training and meetings for updates and compliance Cross-train to support broader team needs and ensure workforce flexibility Comply with HIPAA and all corporate privacy and security policies

UnitedHealth Group

Per Diem Utilization Management RN - National Remote

Posted on:

June 3, 2025

Job Type:

Part-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

Opportunities at Northern Light Health, in strategic partnership with Optum. Whether you are looking for a role in a clinical setting or supporting those who provide care, we have opportunities for you to make a difference in the lives of those we serve. As a statewide health care system in Maine, we work to personalize and streamline health care for our communities. If the place for you is at a large medical center, a rural community practice or home care, you will find it here. Join our compassionate culture, enjoy meaningful benefits and discover the meaning behind: Caring. Connecting. Growing together. 

The Utilization Management RN provides feedback as requested to enhance negotiations with payers. Assesses for accuracy in the assignment of patient class (status) to reflect congruence with clinical condition, physician intent, and utilization review outcomes with current rules and regulatory requirements. Supports the medical chart audit process by ensuring accurate, timely, and informative clinical review documentation and support of medical necessity/level of care. Supports denials management by documenting activities related to denials adjudication according to departmental guidelines and actively works to overturn threatened denial activities. Schedule: 1 weekend a month and the rest of the time as needed and 1 holiday a year; Hours of operation: 7AM-3:30PM or 8AM-4:30PM EST You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Required Qualifications: Associate’s degree (or higher) in Nursing Current and unrestricted RN Compact State licensure OR unrestricted RN license in state of residence and Maine 3+ years of acute clinical practice or related healthcare experience 1+ years of Utilization Management RN experience 1+ years of experience working with Cerner 1+ years of experience working with InterQual 1+ years of experience working with insurance and denials Preferred Qualifications: Bachelor’s Degree in Nursing (BSN) (or higher) ACM, CCM or other certification applicable to utilization management within 3 years of hire Experience in utilization review and concurrent review Soft Skill: Strong communication and interpersonal skills including ability to work collaboratively and cooperatively within a team including internal and external customers Strong organizational skills and ability to set priorities

Validates authorization for all procedure / bedded patients UM pre-admission Ensuring acquisition of pre-certification authorization, urgent/emergent authorizations, continued stay authorizations and authorizations for post-acute services from third-party payers Obtains commercial payer authorization within the contractual timeframe at time of presentation, every third day or as needed Proactively reduces the risk of denials Manages concurrent cases to resolution Partners with Revenue Cycle team to support resolution of retrospective denials Conducts initial review and continued stay review every third day for Medicare Reviews records for medical necessity and collaborates with physician(s) and members of the care team to validate information Confirms that orders reflect level of care, severity of illness and intensity of service utilizing Level of Care Criteria Conducts Level of Care review using electronic system and documents outcomes. Contacts payers as applicable Refers cases with failed criteria to Physician Advisor and appeals as necessary Completes stratification tool to identify simple vs complex patient population Deploys representative within Utilization Review team to handle audits (internal and external) Responsible for coordinating and conducting utilization / medical necessity reviews for all payers upon admission & concurrently throughout the inpatient admission in compliance with the NL EMMC Utilization Management Plan Ongoing collaboration with Care Manager to ensure that patient’s condition meets medical necessity criteria and communicate changes that could affect the discharge plan of care Performs other duties as assigned or required

Optum

Call Center Nurse RN - Part Time - Remote

Posted on:

June 3, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Virginia

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

This is a PART TIME position working Monday / Tuesday / Thursday / Friday 2:00pm to 6:00 pm Eastern Time and Wednesday 3:00pm -7:00pm Eastern Time The Call Center Nurse RN is responsible for providing comprehensive clinical services to our customers located throughout the U.S. and may require multiple licenses to practice across various states. Services provided to our customers include but are not limited to the following telephonic services: clinical triage, transitions of care, medication adherence and reconciliation, management of gaps in care, and other care extension services. The Call Center Nurse assists and guides patients toward self-management and behavior modifications that result in improved patient outcomes. The Call Center Nurse is the primary point of contact for multiple disciplines. Success is measured in terms of improved patient outcomes, prevention of patient adverse events and satisfied customers, meeting or exceeding quality measures, producing consistent and high-quality work, and collaboration with other care team members. The Call Center Nurse is an experience nurse, able to perform tasks independently and once trained, without guidance. This person can provide education to patients, deploying best practices and standard workflow in their daily activities with the ability to apply their expertise across the various areas of responsibility, understanding how their interactions with patients affect customer satisfaction and can make recommendations to improve processes. Positions in this family require a current, unrestricted nursing license (RN) in the applicable state, as indicated in the function description and/or title. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Required Qualifications: Registered Nurse (RN) with a current, active, and unrestricted RN License in VA (state specific or compact) 3+ years of clinical nursing experience Experience with Electronic Medical Records system(s) Proven proficiency using MS Office Suite (i.e. Teams, Outlook, Word, Excel) Willing/able to work a Part Time schedule of Monday / Tuesday / Thursday / Friday 2:00pm to 6:00 pm Eastern Time and Wednesday 3:00pm – 7:00pm Eastern Time regardless of remote base location Preferred Qualifications: Current RN License in DC Telehealth nursing experience Experience with Epic

Provide remote telephonic nursing support to patients, caregivers, and healthcare providers Assess and triage patient calls to determine urgency of medical needs Offer medical advice, guidance, and education to patients and caregivers regarding treatment plans, medication management, and self-care techniques Collaborate with healthcare professionals to coordinate patient care and follow-up Document patient interactions, assessments, and recommendations accurately and timely in electronic health records systems Adhere to established protocols, guidelines, and best practices for telephonic nursing Maintain patient confidentiality and privacy in accordance with HIPPA regulations Participate in ongoing training and professional development activities to stay updated on medical advancements and best practices in telehealth Contribute to quality improvement initiatives to enhance the delivery of telephonic nursing services Provide exceptional customer service and support to ensure a positive experience for patients and clients Ability to adapt nursing interventions and care plans to meet the individualized needs and preferences of diverse patients across the continuum of care Demonstrates the ability to meet deadlines independently and efficiently, requiring minimal to no supervision Actively engage in collaborative efforts within nursing team to ensure seamless communication, shared knowledge, and coordinated patient care delivery Utilizes extensive expertise in chronic illnesses and medication management to effectively treat diseases Works with supervisors to solve more complex problems

IntellaTriage

Remote Hospice Triage RN- 2 PT 4:30a-10a rotating Sat & Sun 4:30a-10a CST

Posted on:

June 2, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Built around a mission to improve the lives of nurses and patients, IntellaTriage has been providing after-hours nurse triage for hospice and home health providers since 2008. Utilizing best-in-class technology, IntellaTriage provides round-the-clock direct access to licensed, registered nurses using client-customized protocols for patient-centered, compassionate care. We are growing rapidly and excited to support our clients’ nursing staff in the field by leveraging our outsourced team of nurses to manage after-hours care delivery. Our triage nurses become an extension of our clients’ care team, and they trust us to support them and their patients during their non-core hours. Learn more at www.intellatriage.com.

We invite you to join our growing team! IntellaTriage Nurses enjoy the benefits of working from home, providing care, without the stress and expense of commuting each day! **MUST have or be willing to obtain a Compact RN license **MUST live in/work from a Compact US state **Experience with end-of-life care is required **Must have high speed internet **Must be tech savvy, enjoy a fast-paced environment, and have keyboard competence Part- time schedule: Work a minimum 2 shifts weekly 4:30a-10a CST (shift times are set/ week day flexes) Work every other weekend, both Saturday and Sunday 4:30a-10a CST

MUST have or be willing to obtain a Compact RN license (states with pending or future implementation dates are not considered current compact states until the implementation date) You must remain in good standing and ensure your home state license remains active. IntellaTriage will cover the cost of non-compact state licensure if necessary for client support. Hospice, palliative, end-of-life care is strongly preferred Experience in a fast-paced environment: ED, surgical services, or critical care, etc. Must be comfortable accessing multiple technology applications to document during calls Ability and comfort with typing in a fast-paced environment Fluency in English is required, additional languages are a bonus Must physically reside in the U.S. and be legally eligible to work for any employer Must be able to complete three weeks of remote paid training that is conducted during days and evenings Must be available to work every other Saturday & Sunday Must be available to work some Holidays as required Must be able to handle stress and multitask when receiving calls (minimum of 5 calls per hour on weekdays, and up to 8 per hour on weekends) Must be able to communicate empathically with patients while adhering to protocols Must maintain CEU’s as designated by the states in which you are answering calls Must attend any in-services, and additional training on an as needed basis Must pass background check and nurse licensing check

Our Hospice Triage Nurses: Have experience in hospice, palliative, end-of-life care and in fast-paced environments: ED, critical care, surgical services, etc. Part-time nurses work a minimum of 1 week day shift & every other weekend both Saturday & Sunday Receive three weeks of remote paid training. The training schedule varies based on availability You can pick up additional shifts, if available, for the clients’ you are trained to support. We will provide you with a laptop and headset. You’re required to use your own high-speed internet You’ll need a quiet space, away from noise and distraction, while you work (privacy/HIPAA compliant space is required). You’ll access EMRs for charting and utilize our internal applications to perform job functions You MUST be able to follow instructions, read directions, and be confident using technology A minimum of 30 minutes paid shift prep is required prior to taking calls You’ll spend 30 minutes to 2 hours, at the end of your shift, completing remaining charting before clocking out

Optum

Utilization Management Nurse RN - Remote in MST Hours

Posted on:

June 2, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Utilization Management Nurse at UnitedHealth Group, you will make sure our health services are administered efficiently and effectively. You’ll assess and interpret member needs and identify solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. Ready to make an impact? Must be available to work on the weekend, Saturday and Sunday as part of a regular work schedule Must work in Mountain Standard Time Zone You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Must work CO Time Zone.

Required Qualifications: Active, unrestrictive RN license in state of residency or Compact RN License if residence is in a Compact State 3+ years of Managed Care and/or Clinical experience Proven basic computer skills with MS Outlook, Word and Excel Weekend availability MST Time Zone Preferred Qualifications: Multi-Specialty experience Utilization Management experience Case Management experience Multiple EMR experience Knowledge of Milliman, Interqual Criteria

Positions in this function require unrestricted compact RN licensure Function is responsible for utilization management which includes Prior Authorization Review of skilled nursing facility, acute inpatient rehabilitation and long-term acute care hospital Determines medical appropriateness of level of care following evaluation of medical guidelines and benefit determination Generally, work is self-directed and not prescribed Works with less structured, more complex issues Identify solutions to non-standard requests and problems Translate concepts into practice Act as a resource for others; provide explanations and information on difficult issues

Optum

Clinical Claim Review RN – Remote

Posted on:

June 2, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Clinical Claim Review RN is responsible for performing clinical reviews post service utilizing established guidelines and clinical criteria along with state and federal mandates and applicable benefit language to make determinations that drive better provider and member outcomes and lower the cost of care. The Clinical Claim Review Nurse works in a fast paced, ever changing environment with a vigilant focus on improving the member and provider experience. Schedule: This position will work 40 hours per week with extensive training and then a flexible schedule upon completion of training You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Required Qualifications: Current unrestricted RN license in the state of residency Minimum of 3 years total RN experience including clinical experience in an inpatient / acute setting Demonstrate proficiency in computer skills – Windows, Instant Messaging, Microsoft Suite including Word, Excel and Outlook Proven exemplary clinical documentation skills Proven to be a self-starter with the ability to handle a fast-paced production environment and multiple review types Proven solid written, verbal, analytic, organizational, time management and problem-solving skills Must have a quiet secure designated work space and access to install secure high speed internet (minimum speed 1.5 download mps & 1 upload mps) via cable / DSL in home (wireless / cell phone provider, satellite, microwave, etc does not meet this requirement) Preferred Qualifications: Bachelor’s Degree RN License in an NLC (Nurse License Compact) state or the ability to apply and meet requirements for one Strong clinical judgement while applying medical necessity based on approved clinical resources Background involving utilization review for an insurance company or previous experience with clinical claim review Medical Claims Review Readmissions Experience The ability to be flexible and willing to adapt to an ever-changing environment Medicaid or Government Program experience for certain government positions Excellent time management, organizational and prioritization skills to balance multiple priorities

Perform Quality Preventable reviews, which require interpretation of state and federal mandates, applicable benefit language, and consideration of relevant clinical information Function as a member of a self-directed team to meet specific individual and team performance metrics Use clinical knowledge, UHC policies and federal regulations for reimbursement determinations Work independently and collaboratively with Medical Directors and non-clinical partners Adapt to a highly changing environment and a heavy case load

Acentra Health

Medicare Regulatory & Coding Expert - LPN/LVN or RN (Remote U.S.)

Posted on:

June 2, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra Health is looking for a Medicare Regulatory and Coding Expert - LPN/LVN or RN to join our growing team. Job Summary: This position utilizes expertise in medical coding and knowledge of Medicare Coverage Guidelines to maintain an internal, client-specific prior authorization guidelines reference tool referred to as the Action Code Database (ACD). Maintaining the database requires monitoring CMS transmittals and regulatory updates, reviewing internal prior authorization trends, and collaborating with the internal team, the client, and the client’s claims administrator. This position also serves as a member of the utilization management team and requires expertise in applying medical necessity criteria, critical thinking, and decision-making skills to determine the medical appropriateness of requested services. Maintaining production goals, QA standards, and compliance with CMS, URAC, ERISA/DOL, ACA requirements/guidelines, and timelines is a critical part of the position. The required work hours for the selected candidate are Monday-Friday 8:00 AM - 5:00 PM Eastern (excluding Company Holidays).

Current Licensure: Active and unrestricted LPN/LVN or RN with a Compact State License. Certification: 2+ years of experience as a Certified Medical Coder OR Certified Professional Coder (CMC/CPC). Education: Graduation from an accredited Nursing Degree Program. Clinical Experience: 2+ years of independent clinical experience post-graduation with a Nursing degree. Utilization Management: 1+ years of experience in Utilization Management (UM), Prior Authorization, or related fields. Medicare Knowledge: 1+ years of experience with Part B Medicare. Regulatory Expertise: 1+ years of knowledge with CMS regulatory requirements, compliance, and quality standards. Medical Records Knowledge: 1+ years of knowledge of medical records organization, medical terminology, and disease processes. Technical Proficiency: Proficient in Microsoft Office and web navigation. Clinical Skills: Strong clinical assessment and critical thinking abilities. Communication: Excellent verbal and written communication skills. Leadership: Experience in hosting and leading meetings, with strong notetaking and follow-up skills. Teamwork and Independence: Ability to work collaboratively in a team or independently, seeking guidance, as necessary. Organizational Skills: Flexible and robust organizational abilities. Preferred Qualifications/Experience: Medicare Advantage: Experience with Medicare Advantage regulations/requirements. URAC Standards: Knowledge of current Utilization Review Accreditation Commission (URAC) standards. Technical Skills: Microsoft Access experience.

Review and accurately interpret CMS medical necessity and prior authorization guidelines. Maintain current knowledge of CMS regulations, guidance documents, and transmittals. Maintain internal Action Code Database (ACD) spreadsheet and ACD database within Microsoft Access. Schedule and host ACD meetings internally and with the client. Review monthly CPT code report and make suggestions based on the data, review with the Manager prior to meetings. Perform ongoing assessment and maintenance of codes within the ACD and update as appropriate in collaboration with the manager and client. Review and interpret patient records and compare against criteria to determine medical necessity and appropriateness of care; determine if the medical record documentation supports the need for services. Approve medically necessary requests; refer those not meeting criteria to the physician reviewer; process physician decisions ensuring the reason for the denial is described in sufficient detail in correspondence. Maintains medical records confidentiality at all times through proper use of computer passwords, maintenance of secured files, and adherence to HIPAA policies. Utilizes proper telephone etiquette and judicious use of other verbal and written communications, following Acentra Health policies, procedures, and guidelines. Actively cross-trains to perform duties of other roles within this contract to provide a flexible workforce to meet client/consumer needs. Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. The list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary from time to time.

Acentra Health

Clinical Reviewer - RN (Remote U.S.)

Posted on:

June 2, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

Acentra Health is looking for a Clinical Reviewer - RN (Remote U.S.) to join our growing team. Job Summary: Review medical records against criteria, contract requirements, and regulatory standards. Employ critical thinking to determine medical appropriateness while meeting production goals and QA standards. Ensure day-to-day processes align with NCQA, URAC, CMS, and other regulatory benchmarks, ensuring precision and compliance in medical record reviews.

Required Qualifications/Experience: Active, unrestricted Registered Nurse (RN) License, or an RN compact state license. Associate’s, Bachelor's degree (or Diploma) in Nursing. 2+ years of clinical experience in an acute OR med-surgical environment. 1+ years of experience in Utilization Review (UR), Utilization Management (UM), OR Prior Authorization. 1+ years of knowledge of medical records, medical terminology, and disease process organization. 1+ years of knowledge of InterQual criteria and/or Milliman Care Guidelines (MCG). Preferred Qualifications/Experience: Knowledge of current National Committee for Quality Assurance (NCQA) standards. Knowledge of Utilization Review Accreditation Commission (URAC) standards. Knowledge of Medicare (CMS) guidelines. Experience with Medical Appeals. Experience with Medicare Advantage plans. Medical Record Abstracting skills. Clinical assessment and critical thinking skills. Excellent verbal and written communication skills. Ability to work in a team environment. Flexibility and strong organizational skills. Proficient in Microsoft Office and Internet/Web Navigation.

Review and interpret patient records, comparing them against criteria to determine medical necessity and appropriateness of care; assess if the medical record documentation supports the need for services. Initiate a referral to the physician consultant and process physician consultant decisions, ensuring the reason for denial is described in sufficient detail in correspondence. Abstract review-related data/information accurately and promptly using the appropriate means on an appropriate review tool. Ensure accurate and timely submission of all administrative and review-related documents to the company. Perform ongoing reassessment of the review process to identify improvement and/or change opportunities. Foster positive and professional relationships and liaise with internal and external customers to ensure effective working relationships and team building, facilitating the review process. Be responsible for attending training and scheduled meetings and maintaining and using current/updated information for review. Maintain medical records confidentiality by properly using computer passwords, maintaining secured files, and adhering to HIPAA policies. Utilize proper telephone etiquette and judicious use of other verbal and written communications, following company policies, procedures, and guidelines. Actively cross-train to perform duties of other contracts within the company network to provide a flexible workforce to meet client/consumer needs. Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules. The above list of accountabilities is not intended to be all-inclusive and may be expanded to include other duties that management may deem necessary.

Elevance Health

Licensed Case Manager I, Northern Region VA Foster Care

Posted on:

June 2, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Virginia

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

LOCATION: This is a remote eligible position for the Virginia Foster Care program. If in Virginia, you must reside within the North region. If in MD, DC, or WV, you must be within 50 miles of the Virginia North Region. HOURS: General business hours, Monday through Friday. TRAVEL: Some travel within your assigned region (facility or home visits) is expected. This position is sign-on bonus eligible!! The Special Programs Case Manager I is responsible for performing case management telephonically and/or by home visits within the scope of licensure for special programs, such as Foster Care. Manages overall healthcare costs for the designated population via integrated (physical health/behavioral health) case management and whole person health.

Required Qualifications: Requires MS/MA in social work, counseling, or a related behavioral health field or a degree in nursing. A minimum of 3 years of clinical experience in social work counseling with broad range of experience with complex psychiatric and substance abuse or substance abuse disorder treatment; or any combination of education and experience, which would provide an equivalent background is required. Requires an active, current and valid license such as an LCSW, LMSW, LPC, LAPC, LMFT LMHC, or RN issued by the Commonwealth of Virginia. ​Preferred Qualifications: Experience working with specialty populations preferred. Case management with a broad range of complex psychiatric/substance abuse and/or medical disorders is very strongly preferred. Knowledge of the Virginia Foster Care is extremely helpful for this role. Prior experience working with the Community Services Board (CSB) and/or Department of Social Services (DSS). Traveling to worksite and other locations when necessary. You must be computer literate and have some experience using Microsoft applications (Word, Excel, Outlook), etc.

Conducts assessments to identify individual needs. Develops comprehensive care plan to address objectives and goals as identified during assessment. Supports member access to appropriate quality and cost effective care and modifies plan(s) as needed. Coordinates with internal and external resources to meet identified needs of the member in terms of integrated (physical and behavioral) whole person care. Coordinates social determinants of health to meet the needs of the member and incorporates that into care planning. Works closely with various state agencies. Maintains knowledge of the system of care philosophy; a spectrum of effective, community-based services and supports for those with or at risk for mental health or other challenges and their families, that is organized into a coordinated network. Builds meaningful partnerships with designated populations and their families, and addresses cultural and linguistic needs, in order to help them function better at home, in the community, and throughout life. Evaluates health needs and identifies applicable services and resources in conjunction with members and their families. Provides important information including patient education, medication reconciliation, and identification of community resources and assists with arrangement of follow-up care.

Elevance Health

Transitions of Care - RN, 100% Virtual, CareBridge (Bilingual Spanish)

Posted on:

June 2, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

Compact / Multi-State

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

Transitions of Care - RN, 100% Virtual, CareBridge (Bilingual Spanish) Location: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Work shift: 4/10 works shift with rotating weekends and holidays per business needs. The Transitions of Care - RN, 100% Virtual, CareBridge (Bilingual Spanish) is responsible for participating in delivery of patient education and disease management interventions and for performing health coaching for members, across multiple lines, for health improvement/management programs for chronic diseases.

Minimum Requirements: Requires AS in nursing and minimum of 2 years of condition specific clinical or home health/discharge planning experience; or any combination of education and experience, which would provide an equivalent background. Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities and Experiences: Bilingual in Spanish is strongly preferred. Current, unrestricted, Compact RN license in applicable state(s) is highly preferred. Experience in care of adult, chronically ill patients, chronically ill pediatric patients, patients with IDD and patients with special needs is preferred. Home Health, Utilization Management or Case Management experience strongly preferred. Previous Transitions of Care experience a plus. Working knowledge of computers and ability to document effectively and efficiently in an electronic system. Expert communicator over the telephone, providing timely, appropriate advice and/or guidance with health care issues. Experience in care of members with multiple chronic medical conditions such as COPD, CHF, CKD, Catheters, Wounds, Psych.

Conducts behavioral or clinical assessments to identify individual member knowledge, skills and behavioral needs. Identifies and/or coordinates specific health coaching plan needs to address objectives and goals identified during assessments. Interfaces with provider and other health professionals to coordinate health coaching plan for the member. Implements and/or coordinates coaching and/or care plans by educating members regarding clinical needs and facilitating referrals to health professionals for behavioral health needs. Uses motivational interviewing to facilitate health behavior change. Monitors and evaluates effectiveness of interventions and/or health coaching plans and modifies as needed. Directs members to facilities, community agencies and appropriate provider/network. Refers member to catastrophic case management.

Cadence

Registered Nurse Coordinator, Triage, Night Shift

Posted on:

June 2, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

At Cadence, we care. We care for patients in their homes seamlessly using technology. We deliver personalized, accessible care that makes a meaningful impact on patients’ health. We believe that all chronic disease patients - regardless of zip code - deserve access to the best possible care. Care is at the core of everything we do. The most important people at Cadence are the people who take care of our patients, our caregivers: nurse practitioners, registered nurses, medical assistants, patient success coordinators, and more. The patient-centric team at Cadence is reliable, responsive, warm, and knowledgeable. We hold ourselves to a high bar to deliver a memorable patient experience; a level of care that we all want for our own family members. At Cadence, unlike most traditional healthcare settings, things change rapidly and that necessitates employees who embrace technology and are committed to helping build an even better service for patients and partner providers than we have today. If you are passionate about putting patients first and changing the way care is delivered in America, join us at Cadence! Together, we’ll make a meaningful impact on the lives of those we serve.

Across the United States, 6 in 10 adults – or 133 million Americans, live with one or more chronic conditions. Chronic disease is today’s leading cause of death and disability in the US and the leading driver of the nation’s $4.1 trillion in annual healthcare costs. Patients who live with chronic conditions require far more touch points than our primary care physicians have time to deliver and the result is countless health emergencies and costly ER visits that could be prevented. Workforce shortages and lack of technologies make it difficult to give patients the attention they need. At Cadence, our mission is to deliver life-changing care to over one million patients living with chronic disease by the end of the decade. We mitigate the impact of chronic disease by using technology and a world-class clinical team to remotely monitor, manage, and support patients at home. Together with our growing network of health system partners, we deliver guideline-directed care to tens of thousands of patients today while producing best-in-class clinical outcomes. The Cadence Health team seeks a Registered Nurse Coordinator to appropriately monitor and triage patients based on vitals supporting the management of patient treatment plans and medications in collaboration with Cadence Nurse Practitioners and the patient's physician/ provider. The required schedule for this role is 7p-7a Thursday - Saturday

4+ years experience treating CHF, hypertension, and Diabetes patients either in an outpatient or inpatient setting. Compact multi-state licensure (RN compact). Experience working in a CHF bridge clinic environment. Experience working with remote patient monitoring technology. Passion for the patient/ customer experience and systematically improving healthcare with digital innovation. Independent thinker/ operator. Ability to monitor patient vitals, symptoms and labs to identify patients in need of clinical interventions. Ability to follow up with patients with abnormal readings to gather more information on their clinical status and triage appropriately. Ability to lead virtual follow-ups with patients to support program enrollment, treatment plan changes, medication adherence and achievement of lifestyle goals.

Monitor patient vitals, symptoms, and labs to identify patients in need of clinical interventions. Follow up with patients with abnormal readings to gather more information on their clinical status and triage appropriately. Respond to inbound patient clinical questions and escalations by phone and text message. Lead virtual follow-ups with patients to support program enrollment, treatment plan changes, medication adherence, and achievement of lifestyle goals. Support clinical documentation and development of care summaries for patients' physicians. Be in charge of making sure every healthcare interaction with Cadence is an exceptional experience that prioritizes the well-being of the patient and aligns with the goals of the health system. Support internal growth efforts to help Cadence scale exceptional care delivery to patients with CHF, hypertension, and other chronic conditions like type 2 diabetes. Be instrumental in shaping the culture of one of the fastest-growing teams at Cadence.

Cadence

Licensed Practical Nurse - CA License Required

Posted on:

June 2, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

Compact / Multi-State

At Cadence, we care. We care for patients in their homes seamlessly using technology. We deliver personalized, accessible care that makes a meaningful impact on patients’ health. We believe that all chronic disease patients - regardless of zip code - deserve access to the best possible care. Care is at the core of everything we do. The most important people at Cadence are the people who take care of our patients, our caregivers: nurse practitioners, registered nurses, medical assistants, patient success coordinators, and more. The patient-centric team at Cadence is reliable, responsive, warm, and knowledgeable. We hold ourselves to a high bar to deliver a memorable patient experience; a level of care that we all want for our own family members. At Cadence, unlike most traditional healthcare settings, things change rapidly and that necessitates employees who embrace technology and are committed to helping build an even better service for patients and partner providers than we have today.If you are passionate about putting patients first and changing the way care is delivered in America, join us at Cadence! Together, we’ll make a meaningful impact on the lives of those we serve

Across the United States, 6 in 10 adults – or 133 million Americans, live with one or more chronic conditions. Chronic disease is today’s leading cause of death and disability in the US and the leading driver of the nation’s $4.1 trillion in annual healthcare costs. Patients who live with chronic conditions require far more touch points than our primary care physicians have time to deliver and the result is countless health emergencies and costly ER visits that could be prevented. Workforce shortages and lack of technologies make it difficult to give patients the attention they need. At Cadence, our mission is to deliver life-changing care to over one million patients living with chronic disease by the end of the decade. We mitigate the impact of chronic disease by using technology and a world-class clinical team to remotely monitor, manage, and support patients at home. Together with our growing network of health system partners, we deliver guideline-directed care to tens of thousands of patients today while producing best-in-class clinical outcomes. The Cadence Health team seeks a Licensed Practical Nurse to join our Care Delivery Team to provide patient care along with our Registered Nurses and Nurse Practitioners and will work with patients to understand their clinical needs. This role will be required to work Mon-Fri 8 am-5 pm (PST). An active CA LPN/LVN License is required.

Active multi-state compact Practical Nurse License. Active CA state LPN/LVN license. 5+ years of clinical experience as a Licensed Practical Nurse. Excellent clinical acumen. Excels at patient support and delivering a high level of service. Exceptional written, verbal, and interpersonal communication skills. EMR experience. Organized, able to set priorities. Works effectively with minimum supervision. Works well as a team member. Ability to support delivery of health care to patients by performing a variety of activities and procedures which are prescribed by and performed under the direction of the Cadence Nurse Practitioner and Cadence clinical policies and procedures. Patient assessment competency. Patient education. Tech fluency and capability to work in multiple systems. Preferred experience in EMRs, excel, project management systems, Zendesk. To ensure that our clinicians have the necessary tools for a successful remote work environment, home office setups must have consistently stable wifi with strong upload and download speeds. A wifi speed test is required before participating in the interview process to verify that these standards are met.

Support delivery of health care to patients by performing a variety of activities and procedures which are prescribed by and performed under the direction of the Cadence Nurse Practitioner and Cadence clinical policies and procedures. Provide one-on-one coaching and support to patients managing chronic conditions, including but not limited to type 2 diabetes, hypertension, and cardiovascular disease. Conduct comprehensive assessments of patients' health status, lifestyle behaviors, nutritional habits, and readiness to change. Help patients execute on their personalized care plans and goals, focusing on behavior modification, nutrition, physical activity, and self-management strategies. Monitor patients' progress, adherence to treatment plans, and health outcomes through regular check-ins and remote monitoring tools. Educate patients on disease management, medication adherence, symptom recognition, and prevention strategies.

Cadence

Licensed Practical Nurse, Alert Board - West Coast hours

Posted on:

June 2, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Compact / Multi-State

At Cadence, we care. We care for patients in their homes seamlessly using technology. We deliver personalized, accessible care that makes a meaningful impact on patients’ health. We believe that all chronic disease patients - regardless of zip code - deserve access to the best possible care. Care is at the core of everything we do. The most important people at Cadence are the people who take care of our patients, our caregivers: nurse practitioners, registered nurses, medical assistants, patient success coordinators, and more. The patient-centric team at Cadence is reliable, responsive, warm, and knowledgeable. We hold ourselves to a high bar to deliver a memorable patient experience; a level of care that we all want for our own family members. At Cadence, unlike most traditional healthcare settings, things change rapidly and that necessitates employees who embrace technology and are committed to helping build an even better service for patients and partner providers than we have today. If you are passionate about putting patients first and changing the way care is delivered in America, join us at Cadence! Together, we'll make a meaningful impact on the lives of those we serve.

Across the United States, 6 in 10 adults – or 133 million Americans, live with one or more chronic conditions. Chronic disease is today’s leading cause of death and disability in the US and the leading driver of the nation’s $4.1 trillion in annual healthcare costs. Patients who live with chronic conditions require far more touch points than our primary care physicians have time to deliver and the result is countless health emergencies and costly ER visits that could be prevented. Workforce shortages and lack of technologies make it difficult to give patients the attention they need. At Cadence, our mission is to deliver life-changing care to over one million patients living with chronic disease by the end of the decade. We mitigate the impact of chronic disease by using technology and a world-class clinical team to remotely monitor, manage, and support patients at home. Together with our growing network of health system partners, we deliver guideline-directed care to tens of thousands of patients today while producing best-in-class clinical outcomes. Cadence Health is seeking a skilled Licensed Practical/Vocational Nurse (LPN/LVN) to join our dynamic team. The LPN/LVN will play a crucial role in our mission by providing support to patients with chronic conditions. This position is remote, operating within the framework of a rapidly evolving healthcare technology startup environment. This role is Monday-Friday 8:00 AM - 5:00 PM PST

Licensed Practical/Vocational Nurse(LPN/LVN) with compact licensure Minimum 5 years of experience as an LPN/LVN Strong ability to think critically and adapt swiftly to a dynamic work environment. Experience working in remote patient monitoring or telemedicine settings is highly desirable. Proficient in reading, writing, and communicating professionally and effectively within clinical documentation and with patients. Familiarity with healthcare technology and a startup environment is a plus.

Conduct remote monitoring of patient vital signs, symptoms, and other health indicators. Identify patients requiring immediate clinical intervention based on monitored data and established criteria. Follow up promptly with patients showing abnormal readings to gather additional clinical information. Collaborate closely with Cadence Nurses and Nurse Practitioners to ensure coordinated care management. Maintain accurate clinical documentation and contribute to the development of comprehensive care summaries for healthcare providers.

Cadence

Care Management RN, Night Shift / Weekend shift

Posted on:

June 2, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

Across the United States, 6 in 10 adults – or 133 million Americans, live with one or more chronic conditions. Chronic disease is today’s leading cause of death and disability in the US and the leading driver of the nation’s $4.1 trillion in annual healthcare costs. Patients who live with chronic conditions require far more touch points than our primary care physicians have time to deliver and the result is countless health emergencies and costly ER visits that could be prevented. Workforce shortages and lack of technologies make it difficult to give patients the attention they need. At Cadence, our mission is to deliver life-changing care to over one million patients living with chronic disease by the end of the decade. We mitigate the impact of chronic disease by using technology and a world-class clinical team to remotely monitor, manage, and support patients at home. Together with our growing network of health system partners, we deliver guideline-directed care to tens of thousands of patients today while producing best-in-class clinical outcomes.

The Cadence Health team seeks a Registered Nurse to support patients in our care management programs and help patients better manage their conditions.

Multi-state RN Compact State Licensure Associate Degree in Nursing Science 5+ years of clinical experience in a chronic care management program. To ensure that our clinicians have the necessary tools for a successful remote work environment, home office setups must have consistently stable wifi with strong upload and download speeds. A wifi speed test is required before participating in the interview process to verify that these standards are met. Skilled in nursing processes. Excellent clinical acumen. Exceptional written, verbal, and interpersonal communication skills. EMR experience, preferably in Athena and EPIC. Works effectively with minimum supervision. Strong collaboration with cross-functional partners. Ability to support the delivery of health care to patients by performing a variety of activities and procedures that are prescribed by and performed under the direction of the Cadence Nurse Practitioner and Cadence clinical policies and procedures. Patient assessment competency. Technical fluency with the ability to work in multiple platforms and systems, including Notion, Athena, EPIC, Zendesk, and G Suite.

Continuously monitor patient vitals, symptoms, and lab results to proactively identify care gaps and patients requiring clinical intervention. Create and manage personalized care plans to address patients' specific health needs, ensuring alignment with treatment goals and physician recommendations. Address patient concerns and escalations via phone and text, providing timely and empathetic responses. Conduct virtual follow-up appointments to guide patients through program enrollment, update treatment plans, support medication adherence, and achieve lifestyle and health goals. Document clinical interactions thoroughly and prepare detailed care summaries to share with patients’ physicians, ensuring seamless care coordination. Assist in developing workflows and processes to enhance our care management programs, ensuring efficiency, scalability, and patient-centered care. Ensure every patient interaction reflects Cadence’s commitment to delivering exceptional care and aligns with the goals of partnering health systems. Collaborate with the team to scale care delivery for patients with chronic conditions, including CHF, hypertension, and type 2 diabetes, as Cadence grows.

CareSource

REMOTE - Triage Nurse - RN - Must be MultiState Licensed - Evening and Every Other Weekend - FT - R8991

Posted on:

June 2, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Health Care with Heart. It is more than a tagline; it’s how we do business. CareSource has been providing life-changing health care to people and communities for 30+ years and we continue to be a transformative force in the industry by placing people over profits. CareSource is and will always be member-first. Even as we grow, we remember the reason we are here – to make a difference in our members’ lives by improving their health and well-being. Today, CareSource offers a lifetime of health coverage to more than 2 million members through plan offerings including Marketplace, Medicare products and Medicaid. With our team of 4,500+ employees located across the country, we continue to clear a path to better life for our members. Visit the "Life"​ section to see how we are living our mission in the states we serve.

The Triage Nurse is responsible for using decision support software to perform telephonic clinical triage and health information service for CareSource managed health plans and external clients.

RN license required Bachelor’s Degree in Nursing preferred Minimum of three (3) years progressive clinical experience as an RN is required Triage, Emergency Nursing, Critical Care, or acute care experience is preferred; Experience within the past 3 years is strongly preferred Behavioral Health experience is preferred Telephone Triage in a call center setting preferred Competencies, Knowledge And Skills: Beginning level computer skills Clinical assessment skills Communication skills Ability to work independently and within a team environment Attention to Detail Critical listening and thinking skills Decision making/problem solving skills Proper phone etiquette Customer service oriented Broad base of clinical knowledge Teaching skills Ability to remain calm under pressure and in member life threatening situations Ability to apply multiple communicative skills while utilizing available tools and resources simultaneously Exemplify CareSource’s Mission in our behavior and member interactions Licensure And Certification: Current, unrestricted RN licensure in state of practice is required; multi-state licensure is preferred Ability to obtain licensure by endorsement in non-compact states when applicable Working Conditions: General office environment; may be required to sit or stand for extended periods of time

Utilize assessment skills and evidence-based triage guidelines for triage of healthy, as well as acutely or chronically ill or injured members, including pediatric, adult, maternity, and geriatric members Utilize provided training, skills and evidence-based triage guidelines to assess and assist members experiencing behavioral health challenges and crises. Function as patient advocate by facilitating accessibility to healthcare and provide linkage to other CareSource departments Educate members to assist them in making informed decisions regarding personal healthcare Assess health status and direct members to the most appropriate level of care Utilize critical reasoning in clinical decision-making Inform callers of preventative healthcare measures due Identify and refer appropriate members for Care Management Provide information about benefits, services and programs that allows members to maximize healthcare resources, as needed Manage telephone interactions with compassion and respect for cultural, educational and psychosocial differences of individuals Utilize multiple computer applications to document all information in an accurate manner Practice in compliance with AAACN,URAC and NCQA standards and regulatory requirements Keep abreast of trends in healthcare delivery and managed care Participate in departmental activities such as quality audits, preceptorship/training as needed Maintains and contributes to a collaborative professional and ethical work environment. Perform any other job duties as requested

Davies

Telephonic Nurse Case Manager (Exposure)

Posted on:

June 2, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Alabama

We are a specialist professional services and technology firm, working in partnership with leading insurance, highly regulated and global businesses. We help our clients to manage risk, operate their core business processes, transform and grow. We deliver professional services and technology solutions across the risk and insurance value chain, including excellence in claims, underwriting, distribution, regulation & risk, customer experience, human capital, digital transformation & change management. Our global team of more than 8,000 professionals operate across ten countries, including the UK & the U.S. Over the past ten years Davies has grown its annual revenues more than 20-fold, investing heavily in research & development, innovation & automation, colleague development, and client service. Today the group serves more than 1,500 insurance, financial services, public sector, and other highly regulated clients.

We're on the lookout for a Telephonic Nurse Case Manager (Exposure) to join our growing team! As a Telephonic Nurse Case Manager (Exposure), you will be responsible for monitoring, evaluating and coordinating the delivery of high quality, timely, cost-effective medical treatment and other health services under Workers’ Compensation law. Reporting to the TCM Supervisor, you will also perform ongoing assessments of the injured employee’s recovery to ensure high quality of care, reduce recovery time and minimize the effects of injury. This role is a full-time, salaried, remote position.

Skills, knowledge & expertise: Registered Nurse RN with a minimum of three years clinical experience (orthopedic, neurological, neuromuscular, ICCU, industrial or occupational) At least one (1) year of Florida Workers’ Compensation or occupational Case Management experience required (per client contract) Bilingual (English/Spanish) preferred Proactive, independent, dependable, and takes initiative with consistent follow through Superb written and verbal communication skills conducted in a timely manner with diverse audiences Superior time management skills with capability of working with and meeting deadlines Exceptional capability to multi-task and prioritize with excellent organization and documentation skills in a fast-paced, dynamic work environment Excellent team player with interpersonal skills High level attention to detail with ability to utilize decision making and problem-solving skills Capable of working collaboratively and independently with minimal supervision Exhibit discretion with sensitive and confidential information

Providing telephonic case-management in a Workers’ Compensation environment; focusing on medical appropriateness of care to injured worker with cost savings by coordination and utilization of all services, ensuring that as soon as medically feasible, return-to-work status is achieved, along with increase in productivity Facilitating communication between the employee, the employee representative, employer, employer representative, insurer, health care provider, the medical services organization and when authorized, any qualified rehabilitation consultant, to achieve the goals Clinically evaluating the recovery needs of an injured employee after the initial contact assessment Evaluating treatment plans and documenting outcomes Tracking protocol management for appropriate utilization and delivery of medical services Serving as a patient advocate adhering to all legal, ethical and accreditation/regulatory standards Exhibit company values of We are Dynamic, We are Innovative, We are Connected, and We Succeed Together Perform other duties as assigned

Vaya Health

Clinical Appeals Specialist RN (Remote NC)

Posted on:

June 1, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

North Carolina

LOCATION: Remote – this is a home based, virtual position that operations Monday-Friday from 8:30am - 5:00pm EST. This person must reside in North Carolina or within 40 miles of the NC border. GENERAL STATEMENT OF JOB: The Clinical Appeals Specialist RN is responsible for the clinical review, consultation and the generation of the Vaya Medicaid and State denial and appeals processes. This includes working with the Appeals Coordinator and Appeals Specialists in preparing Clinical Peer review referrals and Vaya notification letters to members/legal guardians and providers for reductions, suspensions, terminations or denials of services; providing support and information to members seeking to appeal a service request; action and facilitating the appeals process if requested; assist in monitoring and maintaining accurate appeals policies and procedures based on State and Federal regulations; and assist in maintaining/reporting weekly, monthly and quarterly Medicaid and non-Medicaid appeal statistics. This position also provides coordination and representation on behalf of Vaya during Mediation, State Fair Hearing Appeals, and DHHS Appeals of State-funded services processes. The Clinical Appeals Specialist RN reports to the Member Appeals Manager, works with other staff on the Member Appeals Team, will have dotted-line reporting to a medical doctor, and will work with other Vaya departments to report denial and appeal outcomes, and to ensure adherence to quality and accreditation standards. This position also performs additional duties as needed to support the appeals process in collaboration with the Utilization Management Department. This position may offer Remote Work Status. Note: This position requires access to and use of confidential healthcare information or protected health information (PHI) as described in laws addressing patient confidentiality, including, but not limited to, the federal HIPAA law, the Confidentiality of Alcohol and Substance Abuse Patient Records law, 42 CFR Part 2, and various state laws. As such, the individual filling this position shall be required to be trained regarding such laws and shall be required to observe those laws in his/her capacity as an employee of Vaya Health. The individual filling this position shall also sign a confidentiality statement as an employee of Vaya Health.

KNOWLEDGE, SKILLS, & ABILITIES: A demonstrated clinical knowledge of MH, SU and/or I/DD Disabilities and diagnoses, co-occurring conditions, members with such disabilities and the associated services managed by Vaya. Attention to detail, exceptional organizational, interpersonal, and writing skills, good judgment, and discretion on all aspects of work Dynamic individual and strong team player who understands the position, respects boundaries, welcomes collaboration, searches for compromise, remains respectful, maintains a positive attitude, and demonstrates the ability to work harmoniously with a diverse workforce Highly effective communication ability Solution-focused and committed to self-accountability Propensity to make prompt independent decisions based upon relevant facts and established policies, procedures, and business processes Problem solving, negotiation and conflict resolution skills are essential to balance the needs of internal staff, members and their guardians and authorized representatives (including providers) Flexible worker who readily accepts assigned tasks, adapts to unfamiliar situations, and searches for opportunity to help the team Highly productive and motivated individual who takes pride in a job well done Working knowledge, experience and familiarity with behavioral health and physical health conditions, diagnoses and related clinical and administrative documentation Experience in data collection and analysis for technical report writing. Proficient technology skills in Microsoft Office Suite such as Excel, PowerPoint, Teams and Word. Mental flexibility and initiative in learning/teaching new technologies and methods to gain business efficiencies Ability to prioritize competing deliverables and complete projects on time Ability and comfort in adapting and adjusting to multiple demands, shifting priorities and rapid change. Base knowledge of utilization management, authorizations and claims processing and payment concepts. Proficiency in Microsoft Office products (such as Word, Excel, Outlook, etc.) and Vaya information system and Vaya-specific reporting systems is required. EDUCATION & EXPERIENCE REQUIREMENTS: Bachelor’s degree in Nursing (Physical Health) with licensure as an RN. Two years of post-degree professional experience. Licensure/Certification Required: Active RN Licensure in the State of North Carolina. Preferred experience: Knowledge and experience with Integrated Health and Managed Care preferred. PHYSICAL REQUIREMENTS: Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading. Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists, and fingers. Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time. Mental concentration is required in all aspects of work. RESIDENCY REQUIREMENT: The person in this position is required to reside in North Carolina or within 40 miles of the North Carolina border.

Prepare and generate nonclinical and clinical peer review referrals, acknowledgment letters, service authorization and appeal decision letters. During the appeal processes, contact members/ LRPs and providers to gather clinical documentation for review by individuals with the appropriate clinical expertise. Consult with Vaya’s Utilization Management Team, Medical Team, Pharmacy Team, and/or upon request by the Legal Team, the applicable delegated subcontractor in preparation for mediated settlement conferences. Represent, or assist in the representation of, Vaya in mediated settlement conferences concerning medical and pharmaceutical services authorization decisions; Schedule, or assist the Appeals Coordinator in coordinating and scheduling, mediation preparation meetings and mediated settlement conferences, as well as other meetings relating to the appeals processes. Respond to requests from the Legal Team for documentation related to authorization or appeal decisions. Maintain a professional and collaborative working relationship with other staff on the Member Appeals Team, the Utilization Management Team, the Legal Team, and other internal and external persons for a shared goal of advancing the mission, vision, and values of the organization. Answers and responds to the appeals telephone, fax, and email inquiries and to inquiries about the denial and appeal processes. Assists members/ LRPs with filing oral and written appeal requests. Uploads appeals and related documentation in Vaya’s administrative health record and other databases. Provide support in conducting responsibilities in the appeals processes, including performing Personal Care Service appeal reviews, non-clinical appeals reviews, and administrative tasks (reviewing, auditing, logging, submitting, etc.) involved in the denial and appeal processes. Support the work of the Appeals Specialists in generating such correspondence and the accompanying administrative tasks. Support the work of the Appeals Team in maintaining appropriate electronic denials and appeals files. Follow and track cases through all levels of the appeals processes, including at the plan-level, State Fair Hearing level, judicial review, and appellate level. Maintain accuracy and maintenance of the Peer Review and the Denial and Appeal Logs. Regularly communicates with the Utilization Management Team and delegated subcontractors on a daily basis concerning denial and appeal letter requests. Assist Member and Recipient Appeals Manager in monitoring and auditing Appeals Team files. Assist in implementing any corrective action plans as needed to improve denial and appeal processes. Support the Member and Recipient Appeals Manager and Appeals Team in ensuring timely and accurate collection and reporting of data regarding denial and appeal process. This includes generation of notices in a timely manner, appeal rates, appeal outcomes, etc. Assist with analysis of data, reporting of anomalies and generation of report outs.

Optum

RN Call Assist Remote in PST

Posted on:

June 1, 2025

Job Type:

Full-Time

Role Type:

Primary Care

License:

RN

State License:

Compact / Multi-State

At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

Optum WA, (formerly The Everett Clinic) is seeking a RN Call Assist to join our team in Everett, WA. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone. Position in this function is under general supervision, the Staff RN/Consulting Nurse is responsible for providing telephone triage assessment to Primary Care patients by using state of the art telecommunications, information technology and approved protocols; to clients ensuring the efficient use of medical and nursing, facilities and equipment and to provide excellent customer service. If you are able to work in PST time zone, you will have the flexibility to work remotely* as you take on some tough challenges.

Required Qualifications: Unrestricted WA State or Compact RN license 3+ years of experience in a clinical setting (Med/Surg, critical care, ER, etc.), disease management, home health, discharge planning, utilization review, patient education and telephonic nursing Preferred Qualifications: Bachelor of Science in Nursing American Academy of Ambulatory Care Nursing (AAACN) 1+ years of Call Center Nursing experience Case Management experience

Utilizes clinical expertise and approved protocols to provide health advice to consumers with clinical questions and makes referrals for health services as appropriate via telephone Be able to document calls in applicable system in a timely manner and exhibits a willingness to master new work routines and methods Documents all inquiries according to department standards for legal/statistical purposes Excellent written and verbal communication skills Be able to problem solve issues independently as well as work with teams collaboratively situations require assessment, decision-making within the framework of established protocols, excellent listening and communication skills, knowledge of computers, critical thinking skills and the nursing process Speaks with a pleasant, professional phone voice and provides superior customer service to internal and external customers Ensures performance standards are met and accepts constructive feedback

Guidehouse

Clinical Denials and Appeals RN

Posted on:

June 1, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

District of Columbia

The Remote Clinical Denials/Appeals Nurse will be directly responsible for securing pre-service approvals, and reviewing pre/post service denials, medical necessity review and completing appeals and/or coordinating peer to peer reviews as appropriate. This position will perform all related job duties as assigned. Essential Job Functions: Medical Necessity Reviews Ensure documentation integrity Construct warranted appeals Coordinate pre-service authorization approvals

What You Will Need: Requires a Bachelor’s Degree (Relevant experience may be substituted for formal education or advanced degree). Current Registered Nursing License. Minimum 4-6 years of prior clinical experience What Would Be Nice To Have: Utilization Review experience a plus

Conduct comprehensive Denial Root-cause analysis Retrospective Medical Record reviews to assure complete and accurate physician/staff documentation is present to support medical necessity Collaboration with hospital Patient Access and Mid-Revenue Cycle Utilize Evidence -based clinical guideline tool (Milliman ® or InterQual ®) Research and application of regulatory policies to support clinical appeal Telephonic communication with payors, provider, hospital staff and patient/family as necessary to bring the account into resolution. Technical ability to multi-task on various systems, desktop and Microsoft applications while managing inbound calls Working knowledge of basic Coding Guidelines May be required to present oral presentations to client facility or Guidehouse staff and leadership Attention to detail, strong organizational skills and self-motivated. Ability to make decisions and assimilate multiple data sources or issues related to problem solving independently & accurately Ability to work under a timeline/deadline & provide clear & accurate updates to project leader of assignment progress, hours worked & expected outcomes daily Familiarity with medical records assembly & clinical terminology, coding terminology additionally beneficial Personal responsibility, respect for self and others, innovation through teamwork, dedication to caring and excellence in customer service

TALENT Software Services

Nurse RN 4

Posted on:

June 1, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

California

Required Skills (top 3 non-negotiables): Knowledge of Medicare benefits and appeal reviews Requires 2-4 years of health insurance or related experience Demonstrate the ability to act independently using sound clinical judgement Preferred Skills (nice to have): Experience with pharmacy clinical reviews Works well in a fast-paced team environment Excellent communication skills: Desired Skills and Experience REGISTERED NURSE RN MEDI-CAL MEDICARE UTILIZATION MANAGEMENT UM CLINICAL REVIEW CASE MANAGEMENT

The Medicare Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that result from either a preservice, post-service, or claim denial. The Medicare Appeals and Grievances RN will report to the Appeals and Grievances Manager. In this role, you will be responsible for performing first-level appeal reviews for members utilizing the National Coverage Determination (NCD) guidelines, Local Coverage Determination (LCD) Guidelines, pharmacy policies, and nationally recognized sources such as MCG, NCCN, and ACOG. Reviews may also be performed for medical necessity, non-covered benefits, and to meet the criteria for the coding billed. The ideal candidate will have previous insurance/managed care experience and hold at least a Bachelor's Degree in Nursing. Higher-level certifications are highly desirable.

General Medicine

RN Night Telehealth Triage

Posted on:

June 1, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

General Medicine is on a mission to transform outpatient care access—ensuring every patient, regardless of insurance or condition, gets timely, expert guidance on their next best clinical steps.

We’re expanding our virtual care team and seeking a Registered Nurse (RN) to provide night-time telehealth triage.

Active RN license in at least one state; bonus points if you hold multiple state licenses Demonstrated experience in telehealth triage, telephone nursing, or a high-volume call center Strong assessment skills in Family Medicine or Internal Medicine settings Excellent clinical judgment, communication, and customer-service orientation Comfortable navigating EHR/triage tools (e.g., AthenaHealth) and documenting in real time Availability to cover night shifts (e.g., 7 pm–7 am) on a part-time or per-diem basis Bonus: Already licensed in multiple states

You’ll be the first point of contact for patients calling after hours, assessing urgency, guiding self-care, and coordinating next steps—whether it’s scheduling a follow-up, arranging urgent care, or escalating to on-call clinicians.

Brio Primary Care

Triage Nurse Team Lead

Posted on:

June 1, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

South Carolina

Location: Remote but will require on-site orientation and training. Position Overview: Provides accurate and responsive service to all calls received during regular business hours. Appropriately provides telephone triage nursing services and collaborates with provider on an as needed basis to obtain orders to facilitate patient care, and schedules patients as needed for appointments. Responsible for day-to-day operations including promotion of teamwork among all personnel working in triage, adherence to applicable policies and procedures, and delivery of the overall triage experience.

Current SC license RN Required; 2+ years primary care experience; nurse triage or primary care nursing experience preferred. Excellent interpersonal and communication (oral and written) skills with customer service focus required. Work environment and Physical Demands: Requires sitting, standing, and walking associated with a normal physician office environment. This description is intended to provide only basic guidelines for meeting job requirements. Responsibilities, skills and working conditions may change as needs evolve.

Applies professional skills and knowledge of established concepts, principles, and practice to provide telephone triage nursing services including, but not limited to, health information, health education, healthcare assessment and triage. Ensures the Triage team is trained and appropriately uses the Julie K. Briggs Telephone Triage Protocols and other resources to answer calls. Identifies emergent situations and effectively transfers life threatening calls to appropriate agencies per protocol. Accurately communicates information to provider on call as needed. Conducts thorough and sound nursing assessments of caller’s presenting symptoms. Develops, implements, and evaluates a plan of care for each caller’s presenting symptoms. Applies nursing process to identify and prioritize healthcare triage interventions that are appropriate and accurate, effective, and reduces the risk of adverse outcomes. Appropriately schedules patients as needed for appointments. Ensures triage team returns calls in a timely manner. Maintains confidentiality of all caller and personnel issues. Ensures triage team documents call inquiries clearly and thoroughly. Takes ownership of ensuring the Brio Way is experienced by Brio patients, families, and internal team members. Promotes an authentic, transparent work environment with Brio team members. Always providing polite and courteous conversations. Provides direct day-to-day oversight and direction of the triage team with the help of the Triage coordinator. Educates team on all practice policies and procedures, etc. Collaborates operational issues and ideas with the Triage Coordinator. Participates in professional development efforts to ensure currency in health care practices and trends. Monitors in tandem with the coordinator the staffing levels in relationship to workload and adjusts as necessary. Must attend weekly Triage Team’s meetings, and in office meetings as scheduled. Performs additional tasks as assigned by manager.

CareSource

Triage Nurse - RN - Must be MultiState Licensed - Evening and Every Other Weekend - FT

Posted on:

June 1, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

The Triage Nurse is responsible for using decision support software to perform telephonic clinical triage and health information service for CareSource managed health plans and external clients.

Education and Experience: RN license required Bachelor’s Degree in Nursing preferred Minimum of three (3) years progressive clinical experience as an RN is required Triage, Emergency Nursing, Critical Care, or acute care experience is preferred; Experience within the past 3 years is strongly preferred Behavioral Health experience is preferred Telephone Triage in a call center setting preferred Competencies, Knowledge and Skills: Beginning level computer skills Clinical assessment skills Communication skills Ability to work independently and within a team environment Attention to Detail Critical listening and thinking skills Decision making/problem solving skills Proper phone etiquette Customer service oriented Broad base of clinical knowledge Teaching skills Ability to remain calm under pressure and in member life threatening situations Ability to apply multiple communicative skills while utilizing available tools and resources simultaneously Exemplify CareSource’s Mission in our behavior and member interactions Licensure and Certification: Current, unrestricted RN licensure in state of practice is required; multi-state licensure is preferred Ability to obtain licensure by endorsement in non-compact states when applicable Working Conditions: General office environment; may be required to sit or stand for extended periods of time

Utilize assessment skills and evidence-based triage guidelines for triage of healthy, as well as acutely or chronically ill or injured members, including pediatric, adult, maternity, and geriatric members Utilize provided training, skills and evidence-based triage guidelines to assess and assist members experiencing behavioral health challenges and crises. Function as patient advocate by facilitating accessibility to healthcare and provide linkage to other CareSource departments Educate members to assist them in making informed decisions regarding personal healthcare Assess health status and direct members to the most appropriate level of care Utilize critical reasoning in clinical decision-making Inform callers of preventative healthcare measures due Identify and refer appropriate members for Care Management Provide information about benefits, services and programs that allows members to maximize healthcare resources, as needed Manage telephone interactions with compassion and respect for cultural, educational and psychosocial differences of individuals Utilize multiple computer applications to document all information in an accurate manner Practice in compliance with AAACN,URAC and NCQA standards and regulatory requirements Keep abreast of trends in healthcare delivery and managed care Participate in departmental activities such as quality audits, preceptorship/training as needed Maintains and contributes to a collaborative professional and ethical work environment. Perform any other job duties as requested

CVS Health

Case Manager Registered Nurse - RN

Posted on:

May 31, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

This is a 100% remote work from home position and candidates from any state with a compact RN license can apply. The hours are Monday - Friday 8:00am-4:30pm in your time zone with one week rotation 12:30-9 pm est every 3-4 months. This position is for a Fertility Advocate- high-risk maternity case management team and experience with this is required. The Case Manager RN is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness within a high-risk maternity case management program. The Case Manager RN is empowered to take care of all aspects of a member's maternity journey. The Case Manager RN develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration.

Required Qualifications: Must have active, current and unrestricted RN License in state of residence Applicants must be willing and able to pursue multi-state licensure (paid for by the company). Minimum of 3+ years of clinical experience as an RN in an inpatient or outpatient setting focused on women's health, Infertility, maternity and/or OB-GYN office setting. Preferred Qualifications: Preferred RN licensure in a compact state 1+ years of Case Management experience in an integrated model 1+ years of experience with Telephonic Case Management Experience with all types of Microsoft Office including PowerPoint, Excel, and Word Certified Case Manager (CCM) certification Experience with ATV/ASD Education: Associates Degree required BSN preferred

Through the use of clinical tools and information/data review, conducts an evaluation of member's needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. 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 consider information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Reviews prior claims to address potential impact on current case management and eligibility. Assessments include the member’s level of work capacity and related restrictions/limitations. Using a holistic approach assess the need for a referral to clinical resources for assistance in determining 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. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

A-Line Staffing Solutions

Remote RN Case Manager – North Carolina

Posted on:

May 31, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

A-Line Staffing is now a motivated and detail-oriented Remote RN Case Manager – North Carolina Please contact Marcia Hamilton at (586) 710-7979 or mhamilton@alinestaffing.com Remote RN Case Manager – (Full-Time) _ Fully Remote Shift: 8am to 5pm Payrate: $34 to 40 an hour depending on experience If residing in North Carolina: Must hold an active, unrestricted RN license in NC If residing outside North Carolina: Must hold an active compact RN license We are seeking an experienced RN Case Manager to join our fully remote team. This role focuses on the safety and coordination of care for our members through a collaborative and systematic process. The Case Manager will assess, plan, facilitate, and advocate for options and services to meet an individual’s health needs while promoting quality, cost-effective outcomes. Training: Full-time training period of 4 to 6 weeks (remote)

Active RN License (NC or Compact) – Required Case Management Experience – Required Reside in EST Time Zone – Required Bachelor's degree in Nursing or related healthcare field – Preferred Certification in Case Management (CCM, ACM, etc.) – Preferred

Conduct comprehensive clinical assessments of referred members' needs and eligibility Develop and implement individualized case management plans Collaborate with providers, members, and internal departments to facilitate care Interpret and apply benefit plans, clinical guidelines, and regulatory standards Document case activities in accordance with company and accreditation policies Promote member self-management and efficient use of healthcare services

A-Line Staffing Solutions

Licensed Practical/Vocational Nurse – Prior Authorization Specialist (Remote)

Posted on:

May 31, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

Texas

A-Line Staffing is now hiring Licensed Practical Nurse Prior Authorization (LPN/LVN) Remote. If you are interested in this LPN position, please contact Alexis at awordlaw-conley@alinestaffing.com Licensed Practical Nurse Prior Authorization Compensation The pay for this position is 26.00 per hour non-negotiable Benefits are available to full-time employees after 90 days of employment A 401(k) with a company match is available for full-time employees with 1 year of service on our eligibility dates Expected shifts to be 8 hours per day, which will include one weekend day per week. The required availability for this position is EST 12pm-9pm or 11am -8pm,CST 11am-8pm or 10am- 7pm, MST 10a-7pm or 9am-6pm, PST 9am-6pm or 8a-5pm

Required internet speeds test Requires License for Practical Nurse or is eligible to sit for the Practical Nurse Licensure Examination. MUST HAVE prior authorization experience in an MDO or a clinical setting Proficient computer skills to include, but not limited to, Microsoft Office products High School Diploma or GED Attendance is mandatory for the first 90 days

Provide processing and communication of Specialty medication prior authorization (PA) referrals reviewed by the Case Review Unit (CRU) for the Specialty Guideline Management Programs for the Pharmacy and Medical benefits. Responsibilities include answering inbound phone calls, processing cases, loading authorizations, and making follow-up phone calls. Maintaining complete and accurate, documentation of all necessary information is necessary and will involve computer system data entry, data management, and reporting.

HarmonyCares

Nurse Practitioner (NP) PRN - HRA Per Visit - Linn County

Posted on:

May 31, 2025

Job Type:

Role Type:

Telehealth

License:

NP/APP

State License:

Iowa

HarmonyCares is one of the nation’s largest home-based primary care practices. HarmonyCares is a family of companies all dedicated to providing high-quality, coordinated health care in the home. This includes HarmonyCares, HarmonyCares Medical Group, HarmonyCares Home Health and HarmonyCares Hospice. Our Mission – To bring personalized, quality-based healthcare to the home of patients who have difficult accessing care. Our Shared Vision – Every patient deserves access to quality healthcare. Our Values – The way we care is our legacy. Every interaction counts. Go the extra mile. Empower and support each other.

PRN NP position, CHA, 8 - 12 hours/week. See patients within a 30-mile radius of your home - flexible schedule! All equipment provided. $145 per 60-min. in-home visit; $85 per telehealth visit. The Nurse Practitioner delivers annual risk assessment in a residential setting or telehealth, within the scope of practice for a Nurse Practitioner, as delegated by the Collaborative Physician.

Required Knowledge, Skills, and Experience: Active/unrestricted nurse practitioner license to practice in coverage states Board certification in one of the following: American Nurses Credentialing Center (ANCC), American Association of Nurse Practitioners (AANP) or National Commission on Certification of Physician Assistants (NCCPA) Active CPR Certification Current enrollment in Medicare/Medicaid Must maintain a valid driver’s license and good driving record Outstanding EHR skills Preferred Knowledge, Skills and Experience: Geriatric training/experience Skill in teamwork and maintaining effective working relationships with patients, medical staff, and the public Conditions of this role to be aware of: Adaptability to differing weather conditions and patients’ home/residential environments Full range of body motion including handling/lifting patients. Manual and finger dexterity, eye-hand coordination, normal visual acuity, normal hearing, standing, bending, walking and stair climbing Regular lifting/carrying items weighing up to 50 pounds Ability to ride in automobile or van up to 150 miles daily in urban and/or rural settings. Ability to drive, if necessary

Conduct comprehensive in-home health risk assessments to identify all active and chronic disease conditions, as well as determine all physical, mental, and social needs present at the time of the visit Takes history, examines, determines diagnoses. Provides written documentation of patient visit, per NCQA standards Takes patient vital signs, as necessary. Places case management referrals and communicates with PCP as necessary. Communicates with patients, caregivers, agency nurses, other providers and vendors as necessary to assure proper diagnosis. Performs all clinical duties while observing OSHA Universal Precautions Maintains patient confidentiality Attends required meetings and in-services and participates in committees, as requested Participates in professional development activities and maintains professional licenses and affiliations In this role you may work with: Teammates Physicians Medical Staff Patients Caregivers Agency Nurses Providers Vendors

SENIOR CARE SAFE AT HOME, INC.

Registered Nurse

Posted on:

May 31, 2025

Job Type:

Contract

Role Type:

License:

RN

State License:

Virginia

The ideal candidate will be responsible for providing care to patients while adhering to compliance standards. This candidate should be able to recognize patient needs and prioritize those needs with the needs outlined by physicians.

Must be a Registered Professional Nurse with current licensure CPR, ACLS, and BCLS Certification Knowledge of OSHA, FDA, and HIPAA compliance Candidate must be able to lift and position patients on endoscopy stretcher and transport patients

Assure quality care by adhering to standards set by the company Provide care education to patients in person or over the phone Adhere to compliance guidelines throughout processes (OSHA, FDA, HIPAA)

Computech Corporation

Case Management Nurse

Posted on:

May 31, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

Job Title: Registered Nurse (RN) Case Manager – Remote (Missouri Residents Only) Location: Remote (Must reside in Missouri) Schedule: Monday – Friday, 8:00 AM – 5:00 PM CST Position Summary: The Case Manager RN utilizes a collaborative process of assessment, planning, facilitation, and advocacy to coordinate services and resources that align with an individual's benefit plan and/or health needs. This role focuses on promoting optimal, cost-effective outcomes through effective communication and clinical judgment.

Education & Licensing: Registered Nurse (RN) with an active, unrestricted Missouri state license or a valid compact license. Case Management Certification (CCM) preferred. Experience: 2–3 years of clinical practice experience in settings such as hospitals, home health, or ambulatory care. Experience in healthcare and/or the managed care industry. Previous case management experience preferred. Skills: Proficiency in computer use, including navigating multiple systems and efficient keyboarding. Strong verbal and written communication skills. Ability to multitask, prioritize effectively, and adapt to a fast-paced, changing environment. Work Environment: Sedentary work involving extended periods of sitting, phone communication, and computer use. Requires close inspection of written and electronic documents. Remote work environment with established productivity and quality expectations.

Conduct comprehensive assessments of referred members' needs and eligibility using clinical tools and data analysis. Determine the best course of action to address member needs based on benefit plans and internal/external programs. Apply and interpret relevant criteria, guidelines, and standardized case management plans. Ensure the appropriate administration of member benefits in compliance with applicable policies, procedures, and regulatory standards. Utilize case management and quality management processes to support accreditation and regulatory compliance. Maintain effective communication with members and interdisciplinary teams. Navigate multiple systems for documentation, research, and case management tasks.

Lifepoint Health®

Transfer Center Registered Nurse (RN) -Behavioral Health - Remote

Posted on:

May 31, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

Texas

Woodland Springs, part of Lifepoint Behavioral Health, a nationally known healthcare organization with diversified delivery network with facilities from coast to coast, is seeking passionate, patient-centric and goal-oriented team members to join our team. We specialize in compassionate behavioral health services, including crisis stabilization, inpatient care and outpatient treatment for acute mental health and substance use disorders. Our philosophy is built on a psychosocial model of care in order to decrease suicide rates, decrease addiction-related deaths, reverse the decline in life expectancy, and improve productivity in the communities we serve. We offer a collaborative work environment, competitive compensation and flexible scheduling so you can focus on what really matters – providing quality patient care. Join our team in Conroe to build a career that touches lives.

Woodland Springs, part of Lifepoint Behavioral Health, nationally known healthcare organization with diversified delivery network with facilities from coast to coast, seeks passionate, patient-centric, and goal-oriented team members to join our team. We specialize in compassionate behavioral health services, including crisis stabilization, inpatient care, and outpatient treatment for acute mental health and substance use treatment. Our philosophy is built on a psychosocial model of care to decrease suicide rates, decrease addiction-related deaths, reverse the decline in life expectancy, and improve productivity in the communities we serve. We offer a collaborative work environment, competitive compensation, and flexible scheduling so you can focus on what really matters–providing quality patient care. Join our team in Richmond, TX to build a career that touches lives.

Graduate from an accredited program of professional nursing or relevant state licensure required. Previous experience in a psychiatric health care facility, with direct experience working with chemical dependency, dual diagnosis, psychiatric and geriatric patients preferred. Experience in patient assessments, family motivations, treatment planning and communication with external review organizations or comparable entities. Current unencumbered license to practice by the State Board of Nursing. CPR certification and Crisis Prevention Training (CPI) within 30 days of employment and prior to any patient contact. Must be at least 21 years of age.

Will assess the patient and plan care within set time-frames and document findings according to policies. Will oversee and supervise the shift. Demonstrates leadership through duties that may include: delegating tasks such as groups, close observation, meal supervision, etc. Will also oversee staff to ensure nursing policies and procedures are followed and exemplary patient care is consistently delivered by self and all members of the team. Will monitor patient for change of condition and respond accordingly up to and including notification of the physician. RN will follow hospital policy for medication administration. Other duties as assigned.

Urrly

Cardiology Nurse Practitioner (Telehealth – Train Onsite, Then Go Remote)

Posted on:

May 31, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Pennsylvania

Remote cardiology, but with real connection. Train in person. Then work from anywhere. You’ll kick off with 4–6 weeks of in-person training in Bethlehem, PA. It’s how you get to know your cardiologists, build trust, and learn exactly how they practice. That connection? It’s what lets you work remotely at the top of your license—and do it with full confidence from the team. Training travel is fully covered. Whether you fly or drive, we provide a set budget and you decide how to use it. Fly a partner in for the weekend? Go for it. Just stay in budget.

Certified Nurse Practitioner license Active license in PA or NJ (both preferred) 3+ years in cardiology (outpatient preferred) Enrolled with Medicare/Medicaid + valid DEA Strong communication and comfort with tech

Treat and manage lower-acuity cardiac patients via telehealth Partner with cardiologists you trained with in person Monitor, adjust meds, and educate patients on lifestyle changes Keep care moving smoothly with EMRs and remote monitoring tools

UCare

Care Coordinator – MSHO/MSC+ / Active, Unrestricted LSW or RN License required. Travel required throughout designated counties in Minnesota.

Posted on:

May 30, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Minnesota

UCare is an independent, nonprofit health plan providing health care and administrative services to more than 600,000 members throughout Minnesota and parts of western Wisconsin. UCare partners with health care providers, counties, and community organizations to create and deliver Medicare, Medicaid and Individual & Family health plans. The health plan addresses health care disparities and care access issues through a broad array of community initiatives. UCare is the highest ranked health plan in the USA Today 2024 Top Workplaces and has received Top Workplaces honors from the Star Tribune for 15 consecutive years since the rankings began in 2010.

The current hiring base salary range for this role is: $84,436.00/year – $94,990.50/year UCare anticipates paying within the above-references salary range for this position. The actual base salary offer for this position will be determined by a variety of components including but not limited to work experience, education, certifications, location of the role, internal equity, and other relevant factors. LOCATION: Minneapolis, MN (Work from Home) Travel Required to Designated Counties in Minnesota Position Description: As the Care Coordinator – MSHO/MSC+, you will be responsible to coordinate services across the continuum of health care to meet the health and/or social service needs of members in Government plan products as assigned.Coordinate member services with appropriate primary care clinics/providers, care systems, specialists, clinic, county, and UCare personnel to achieve the most appropriate and cost-effective member care to optimize the long-term health of the member.

Education: B.S. in nursing or B.A. in social work or a closely related field. Registered Nurse with a nursing diploma (3-year program) or associate degree in nursing with five or more years' experience also considered. Current and unrestricted Minnesota license as an RN is required or social worker is required. Licensure requirements may depend on assigned product(s). Required Experience: Two year's experience in care coordination/case management across the continuum of health care (hospital, clinic, nursing home, home care etc.) with primary emphasis in working with complex social and medical problems. MnCHOICES certified assessor credential in place or with a plan to receive assessor credential within 3 months of hire date. Preferred Experience: Managed care experience, experience with government programs, particularly Medicare, Medicaid and other State Public Programs. Experience working with multi-cultural populations desired.Bilingual in Hmong, Spanish, Russian, Somali or Vietnamese.

Collaborate with treatment providers, county and community agencies, and contracted and non-contracted providers to identify and coordinate provision of health care services for Government plan product members. Appropriately apply care coordination criteria, protocols and procedures. Understand and accurately interpret and apply relevant contractual requirements, policies, procedures, and regulations for members which care coordination is a provided service. Collaborate with members and/or family members, primary care physicians, clinic staff, providers, and other relevant agencies to assure appropriateness of service that meets member needs and ensures desired outcomes. Complete in-person comprehensive assessment of assigned members.Appropriately utilize interpreter services as needed.Identify and monitor member needs, including needed preventive medical care, and significant changes in condition which may warrant early intervention for medical problems.Develop care plans to meet each member’s individual needs. Incorporate ethnic and culturally appropriate approaches to care planning. Present information on assigned members at assessment conferences and case reviews as appropriate.Enter member information in the clinical documentation system, GuidingCare software.Complete accurate, thorough, and timely required documentation. Meet and maintain all established caseload and performance metrics. Ensure safe transitions when members move from one setting to another (i.e. being discharged from a hospital or skilled nursing facility).Ensure the plan of care is communicated between the sending and receiving settings for both planned and unplanned transitions.Support members and member families through care transitions between various facilities, acute and/or chronic settings, and community-based living situations including home. Use appropriate communication tools per contractual and care model requirements. Monitor and report all quality-of-care issues through the appropriate internal or external systems. Assist with CMS Star Rating initiatives or HEDIS quality initiatives and project improvement planning as appropriate. Attend internal and external meetings, including staff meeting, discharge planning conferences, community meetings. Provide back-up coverage for other care coordinators as assigned. Must have reliable transportation to travel through designated counties in Minnesota. Other projects and duties as assigned.

Optum

LPN Supervisor - Remote

Posted on:

May 30, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

LPN/LVN

State License:

Minnesota

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Supervisor LPN is responsible for coordinating and implementing the HEDIS and STAR’s call center campaigns and works in collaboration with the Director of STARS Call Center to develop strategies for achieving a 5 STAR rating. Directly responsible to manage teams of clinical and nonclinical staff who perform central call initiatives such as performing telephonic outreach to retrieve and/or disseminate appropriate information as relates to member care and CMS quality measures as well as to resolve quality gaps. Coordinates, supervises and is accountable for the daily functions of the patient navigator team. The Supervisor LPN provides support to various corporate interdepartmental teams in the implementation of strategies of the call center for closing care gaps. This role works closely and collaboratively with various functional areas of the healthcare and quality team to achieve the goals and objectives of the Quality Improvement Program. through CAHPS & HOS initiatives, Medication Adherence initiatives, and Part C Gap closures. The Supervisor LPN assists the department with business process and policy development of programs and productivity initiatives. Develops and analyzes monthly reports and a variety of ad hoc reports to support key departmental and corporate initiatives. Schedule: Monday - Friday 8 hour work day between the hours of 7:00 a.m. - 8:00 p.m. CST. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Required Qualifications: Unrestricted Nursing License 3+ years of experience within a healthcare environment including experience within a managed care setting, including 2+ years of supervisory experience 1+ years of experience with data analysis HEDIS/STAR experience Advanced experience using Microsoft office applications, including but not limited to databases, word-processing, spreadsheets, and graphical displays Demonstrated ability to delegate task appropriately to meet established timelines Basic understanding of quality improvement standards such as HEDIS, CAHPS, HOS and CMS Proven capability to work with people at all levels in an organization Proven excellent training and presentation skills with solid communication capabilities and practices, both oral and written Demonstrated effective organizational skills Proven excellent communication, writing, proofreading and grammar skills Proven solid attention to detail and accuracy, excellent Evaluative and Analytical skills Proven solid teamwork, interpersonal, verbal, written, and administrative and customer service skills Proven solid interpersonal skills and the ability to work independently, as well as a member of a team Preferred Qualifications: 2+ years of related experience in a call center or service operation 2+ years of hands on experience with forecasting, capacity planning and scheduling methodologies in a call center environment 2+ years HEDIS & STARs experience Hands on experience with forecasting, capacity planning and scheduling software Auditing experience Proven excellent written and verbal communication skills Proven excellent relationship building skills Proven planning and organizational skills to demonstrate leadership and initiative Physical & Mental Requirements: Ability to lift up to 25 pounds Ability to sit for extended periods of time Ability to use fine motor skills to operate office equipment and/or machinery Ability to receive and comprehend instructions verbally and/or in writing Ability to use logical reasoning for simple and complex problem solving All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Oversees the Patient Navigator Team and the day-to-day operation of the call center campaigns Provides leadership and support in establishing and executing the STARS Call Center Initiatives in alignment with corporate goals Supervises and coordinates the work activities of the team Monitors productivity, call center metrics, documentation and call quality to ensure established standards are met Coach and develop management team to acquire and refine necessary job skills through constructive feedback, ongoing training, and other coaching techniques. Conduct regular performance reviews and one-on-one meetings with direct reports to evaluate performance against KPIs Oversight and analysis of daily, weekly, and monthly operational reports and the development and implementation of action plans to address deficiencies Provide regular communication to Senior Leadership regarding current operational performance and make recommendations for improvements and increasing capacity at scale Partner with Senior Leadership and Human Resources to execute strategic recruiting and employee engagement programs to attract and retain top performers Oversight of the execution of short and long-term performance goals developed by Senior Leadership Team Work with internal teams on strategy and capacity planning Responsible for oversight of call center operational strategies including but not limited to conducting needs assessments, performance reviews, capacity planning, and cost/benefit analyses; identifying and evaluating state-of-the-art technologies; defining user requirements; establishing technical specifications, and production, productivity, quality, and customer service standards Oversight of SOPs and Workflows for the STARS Call Center Team Ability to perform work with minimal supervision Performs all other related duties as assigned

The Judge Group

Clinical Documentation Specialist Nurse (RN or LPN)

Posted on:

May 30, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Pennsylvania

Job Title: Clinical Documentation Integrity RN or LPN (Remote) Job Type: W2 contract to hire/ temp to perm (conversion to full time after 6 months) Location: Remote (U.S. Based) Schedule: Monday to Friday, 8:00 AM–4:30 PM EST (Training start between 8–9 AM EST) Job Summary: We are seeking a highly skilled and coachable Clinical Documentation Integrity (CDI) RN or LPN to join our team. This role focuses on improving the accuracy and quality of clinical documentation through concurrent and retrospective reviews of medical records. The ideal candidate has strong DRG knowledge, is query-proficient, and brings 2–5+ years of recent adult bedside CDI experience.

Minimum Requirements License: Active RN or LPN/LVN licensure (NPs also considered) Certification Required: CCDS (Certified Clinical Documentation Specialist) through ACDIS Verify at: acdis.org Not Accepted: CDIP certification Optional: CRCR (Certified Revenue Cycle Representative) through HFMA Verify at: hfma.org Experience: 2–5+ years of CDI experience in adult bedside settings (5 years preferred) DRG assignment and query development proficiency required Experience with MS-DRG and APR-DRG focused reviews strongly preferred Skills & Abilities: Proficiency in querying and clinical code assignment Solid understanding of healthcare reimbursement models and documentation compliance Exceptional written/verbal communication and interpersonal skills Strong public speaking and training skills Ability to lead cross-functional collaboration and education initiatives Adaptable, highly coachable, and a proactive team contributor Proficient in Microsoft Office Suite and EMR systems Additional Information: A pre-submission assessment mirroring the CCDS exam will be required (provided by R1 upon conditional approval) Candidates must demonstrate a track record of teamwork and adaptability in high-performance environments How to Apply: Submit your resume along with your CCDS certification and licensing details. Qualified candidates will be contacted to complete the required assessment.

Conduct clinical documentation reviews to ensure accurate severity of illness, risk of mortality, and complexity of care. Initiate and formulate provider queries when documentation is unclear or incomplete. Lead education efforts for providers and CDI teams based on audit trends and findings. Evaluate CDI team accuracy and standardize review findings and reporting. Collaborate with HIMS, Coding, and Quality teams for complete documentation and accurate DRG assignment. Maintain expert knowledge in CDI best practices, regulatory compliance, and coding guidelines (MS-DRG, APR-DRG). Participate in special reviews such as mortality, PSI, and other quality-driven documentation assessments.

Theratechnologies Inc.

Nurse Navigator

Posted on:

May 30, 2025

Job Type:

Part-Time

Role Type:

Telehealth

License:

RN

State License:

New Jersey

Theratechnologies is a global specialty biopharmaceutical company headquartered in Montreal, Canada with business units in the US, Canada, and Ireland. Theratechnologies is focused on addressing unmet medical needs by bringing to market specialty therapies for people of greatest need.

Part-Time - Remote (West Coast) Evening Shift 2 PM - 7 PM (Monday - Friday) We are seeking a highly motivated and compassionate Part-Time Nurse Navigator to provide virtual and telephonic support to patients and healthcare providers. This role is instrumental in offering education on specific disease states and product use, ensuring optimal therapy application, and enhancing patient satisfaction for improved health outcomes. The ideal candidate will have a strong clinical background and a passion for patient advocacy, with experience in specialty therapies. Remote – Candidates must be based on the West Coast.

Minimum Qualifications Required Education: Bachelor’s degree in nursing or a related healthcare field. Licensure: Active Registered Nurse (RN) license or Advanced Practice degree (Nurse Practitioner, Physician Assistant, PharmD, or MSN). Technical Skills: Comfortable using virtual communication platforms and electronic documentation systems. Preferred Qualifications: Industry Experience: 3–5 years of experience in the healthcare or pharmaceutical industry, particularly in a patient support or nurse educator role. Therapeutic Area Knowledge: Experience in HIV care or related disease states is highly desirable. Specialty Product Expertise: Experience working with infusion and/or subcutaneous injection therapies.

Engage in telephonic and virtual interactions with patients and healthcare providers to provide support, guidance, and disease-state education in accordance with brand policies and compliance guidelines. Serve as a clinical resource to ensure optimal therapy adherence, addressing patient and provider inquiries related to medication administration, side effects, and best practices. Collaborate with internal teams to stay informed on brand-specific guidelines, ensuring accurate and up-to-date information is shared. Act as a liaison between healthcare professionals, and patients, helping to navigate therapy access challenges. Foster patient empowerment and adherence by providing education on self-administration techniques (if applicable), infusion/subcutaneous injection protocols, and symptom management strategies. Maintain detailed documentation of interactions and follow-up activities in compliance with regulatory and company policies.

SPECTRAFORCE

Safety Review Nurse

Posted on:

May 30, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Illinois

Job Title: Safety Review Nurse 100 % remote Duration: 12 Months Provides timely assessment of reported clinical trial data and participates in applicable safety surveillance activities for assigned studies including review of labs, vital signs, cardiac, medications, medical history, and can communicate with Study Lead any findings. Provide review of safety-related data from clinical trials for content, quality, potential study level trend identification, and adherence to regulatory guidance and protocols utilizing critical thinking skills. Monitoring of safety-related queries to Investigators. Adheres to regulatory guidance, protocols, departmental processes and policies under minimum supervision. Current with knowledge of ICH, FDA, and EMA regulatory guidance’s affecting safety surveillance.

Bachelor's degree with related health science background. RN or clinical pharmacy experience strongly preferred. A minimum of 2 years of clinical practice experience is required and 1-year drug safety experience preferred. Strong critical thinking skills with the ability to apply clinical knowledge to adverse event data collection and data assessment. Ability to present accurate and medically sound safety data, both orally and in writing. Effective communication skills in delivering study-related information. Proficiency in Computers (Windows, Word, Excel).

Responsibilities include medical review, which involves in-house review of Case Report Forms (CRFs) including query resolution and addenda writing, QA of data listings. May manage the activities of regional contract CRAs, and organizes the files and budgets associated with several clinical studies. Provides medical support which may include: Adverse Event Reporting - the investigation and reporting of medical product experiences, in depth investigation of medical adverse events and works with Medical Affairs, Clinical, and Regulatory Affairs in the preparation of documentation on adverse events for the FDA; or Medical Communication which includes writing standard and custom responses to communication requests. In-depth assistance to the medical and lay community by responding to inquiries with medical/scientific information that is more complex and requires more data than is supplied in the package insert or the standard letter database. Off-label information would be disseminated at this level. May provide training internally and at investigator meetings on safety issues, responsible for serious adverse events and CRF completion, writing study summaries, and review protocols, study summary investigator brochures and IND annual updates for safety data verification.

Medasource

Prior Authorization RN

Posted on:

May 30, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

Medasource is a leading consulting and professional services firm serving the healthcare industry, including Life Sciences, RCM/Payers, Technology, and Government. We’ve been recognized by both KLAS and Modern Healthcare for being good to our employees, consultants, clients, and communities. With over 100 clients, more than 2,000 active consultants, and over 30 locations across the U.S., we’re focused on propelling the future of healthcare, one client at a time.

The Prior Authorization RN is responsible for reviewing and processing medical prior authorization requests to ensure services are medically necessary, meet evidence-based guidelines, and align with the health plan’s policies. This RN plays a critical role in supporting cost-effective care while ensuring quality and compliance in alignment with regulatory and accreditation standards.

Active, unrestricted Registered Nurse (RN) license in [Arizona or Compact State]. Minimum of 3 years of RN experience in any clinical setting. 3–5 years of experience in case management, prior authorization, or utilization management (UM). Experience working in primarily outpatient settings, with working knowledge of inpatient care coordination. Utilization Management experience is required. Familiarity with reviewing and applying evidence-based clinical guidelines (this is a pre-service focused role). Proficient in the use of MCG (CareWebQI) and InterQual for clinical reviews. Strong clinical judgment and communication skills. High level of attention to detail and documentation accuracy

Manages health Plan consumer/beneficiaries’ across the health care continuum to achieve optimal clinical, financial, operational, and satisfaction outcomes. Provides pre-service determinations, concurrent review, and case management functions within Medical Management. Ensures quality of service and consistent documentation. Works collaboratively with both internal and external customers in assisting health Plan consumer/beneficiaries’ and providers with issues related to prior authorization, utilization management, and/or case management. Meets internal and external customer service expectations regarding duties and professionalism. Performs transfer of accurate, pertinent patient information to support the pre-service determination(s), the transition of patient care needs through the continuum of care, and performs follow-up calls for advanced care coordination. Documents accurately and timely, all interventions and necessary patient related activities in the correct medical record. Evaluates the medical necessity and appropriateness of care, optimizing health Plan consumer/beneficiaries’ outcomes. Identifies issues that may delay patient services and refers to case management, when indicated to facilitate resolution of these issues, pre-service, concurrently and post-service. Provides ongoing education to internal and external stakeholders that play a critical role in the continuum of care model. Training topics consist of population health management, evidence based practices, and all other topics that impact medical management functions. Identifies and refers requests for services to the appropriate Medical Director and/or other physician clinical peer when guidelines are not clearly met. Conducts call rotation for the health plan, as well as departmental call rotation for holiday. Maintains a thorough understanding of each plan, including the Evidence of Coverage, Summary Plan Description authorization requirements, and all applicable federal, state and commercial criteria, such as CMS, MCG, and Hayes.

University of Miami

Registered Nurse 2 (H) (remote) - UHealth SoLé Mia

Posted on:

May 30, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Florida

The University of Miami UHealth at SoLé Mia opening September 2025, will bring high-quality academic medicine to North Miami, Aventura, and surrounding communities. Our expert team of physicians and staff will represent a wide range of specialties, including NCI–designated Sylvester Comprehensive Cancer Center and Bascom Palmer Eye Institute, the number one eye hospital in the nation. UHealth at SoLé Mia will also deliver the latest in urologic treatments from the renowned Desai Sethi Urology Institute as well as top-notch care from UHealth’s nationally ranked neurology and neurosurgery programs. The University of Miami UHealth – Gastroenterology Satellites at SoLé Mia has an exciting opportunity for a Registered Nurse.

The Registered Nurse 2 (H) delivers patient-family centered care in a culturally competent manner utilizing evidence-based standards of quality, safety, and service while ensuring population-specific patient care, collaborating with physicians and multi-disciplinary professional staffs and providing physical and psychological support for patients and their friends and families. Sign on Bonus $10,000

Education: Bachelor of Science in nursing required Certification and Licensing: Registered Nurse License; Basic Life Support Certification (BLS) Advance Cardia Life Support (ACLS) Certified Gastroenterology Registered Nurse (CGRN) preferred. Experience: Minimum of 2 years relevant experience in medical surgical unit or any procedural based departments. Knowledge, Skills and Attitudes: Knowledge of medical terminology Knowledge of nursing care methods and procedures In-depth knowledge of health and safety guidelines and procedures (i.e. sanitation, decontamination etc.) Excellent patient experience skills Ability to recognize, analyze, and solve a variety of problems Ability to maintain effective interpersonal relationships Ability to communicate effectively in both oral and written form Skill in completing assignments accurately and with attention to detail. Ability to analyze, organize and prioritize work under pressure while meeting deadlines. Ability to process and handle confidential information with discretion. Ability to work evenings, nights, and weekends as necessary. Commitment to the University’s core values. Ability to work independently and/or in a collaborative environment. Good clinical assessment skills, flexibility and basic computer skills. Ability to work under stress, moderate periods of sitting, walking, standing and computer use. Analytical abilities necessary to successfully identify a problem and develop a sound action plan for resolution. Ability to work collaboratively with governing committees, health systems quality committees, business office, clinical staff and physicians. Able to work flexible hours in assuming responsibility and accountability in providing patient care. Ability to educate for staff development and in-service education (e.g., annual mandatory programs and department related education needs). Ability to supervise nursing and ancillary staff and delegates authority as appropriate to qualified staff members. Able to assure compliance with accreditation department, federal or state guidelines (e.g., maintain records, report logs, etc. Good clinical assessment skills, flexibility and basic computer skills.

Assesses assigned patients and evaluates plans to include documentation of nursing care. Reports symptoms and changes in patients’ condition and vital signs. Modifies patient treatment plans as indicated by patients’ responses and conditions, and physician orders. Reviews, evaluates and reports diagnostic tests to assess patient’s condition. Consults with physicians and other healthcare professionals related to assigned patients to assess, plan, implement and evaluate patient care plans. Prepares patients for, and assists with examinations, procedures and treatments. Considers patient age and culture during patient treatments and provides any needed information regarding treatment plan. Nurtures a compassionate environment by providing psychological support. Performs appropriate patient tests and safely administers medications within the scope of practice. Administers and maintains accurate records related to medications and treatments as per regulatory bodies, policies, procedures and physician orders. Communicates plan of care in a timely manner to patient and family, as well as the appropriate team members, ensuring compliance with all regulatory guidelines (i.e. HIPAA). Uses best practices for transition of patient care. Uses available resources to assist in discharge planning. Plans, prioritizes, and adjusts assignments to accomplish goals and render superior patient care; seeks assistance when needed. Adapts to changing work demands and environment. Operates the appropriate medical equipment. Adheres to University and unit-level policies and procedures and safeguards University assets.

CorroHealth

Lead, Provider Risk Adjustment (RN required)

Posted on:

May 30, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Texas

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.

Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member. Lead, Provider Risk Adjustment Coding Services As a member of the CorroHealth team, the Coding Lead utilizes coding knowledge to assist the Director of Coding Services and other members of the Management team in maintaining a high level of client satisfaction through managing the overall quantity and quality of coding production for assigned clients. The candidate will supervise a team of Client Account Coders. Essential Functions Note: The essential duties and primary accountabilities below are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Incumbents may perform all or most of the primary accountabilities listed below. Specific tasks, responsibilities or competencies may be documented in the incumbent’s performance objectives as outlined by the incumbent’s immediate supervisor or manager.

RN or LPN license required National certification through AAPC or AHIMA required, CCDS or CDIP a plus At least 3+ years of previous provider-based risk adjustment coding experience with strong understanding of physician query compliance and composition Previous supervisory experience is preferred Strong computer skills, proficient in Microsoft Office applications including Word and Excel. Ability to navigate in a variety of EMR environments and review hand-written charts Strong verbal and written communication skills are required Ability to prioritize workload, to meet deadlines and to maintain a high level of quality and accuracy Initiative, resourcefulness, and attention to detail Regular, predictable, and punctual attendance is required

Collaborators with global leaders on daily production quantity and quality for each assigned client while maintaining client service level agreement metrics and delivery expectations Review pending accounts and second level quality reviews and for errors or assigns to appropriate staff for remediation and completion Monitors client reports – production, quality, query compliance, and response and resolves issues as necessary Assists in research and resolution of QA disputes and education/trends Tests system and workflow changes related to specific client hospitals Assist assigned Coding Director with independent responsibilities for client reporting and data analysis Recommended staffing modifications and FTEs, assist in overtime planning when necessary Recommend and process salary changes/adjustments/promotions as necessary Responsible for training assistance of new and existing HCC Coding Specialists Participate in and/or lead special projects requiring coding and/or auditing for clients across the organization, as needed Develops and communicates coder schedule and resolves changes to schedule Assist direct reports with accurate application of diagnosis and procedure codes utilizing CMS/HHS HCC models, ICD-10-CM, ICD-10-PCS, CPT®, and HCPCS Provide and/or aid direct reports with interpretation of coding guidelines for accurate code assignment Identify and ensure that direct reports understand the importance of documentation on code assignment and the subsequent reimbursement impact Align personal conduct with and build a team culture that aligns conduct with AHIMA's Standards of Ethical Coding and the Company’s Code of Ethics and Business Conduct Comply with, promote and support direct report’s compliance with all internal policies and procedures Actively participate in Company provided training and education and ensure that direct reports complete mandatory training and education by established deadlines and are able to properly implement and/or practice the principles taught via the Company’s training and education program Ensure individual and direct report compliance with all privacy and security rules and regulations and commit to the protection of all Company confidential information, including but not limited to, Personal Health Information Thoughtfully evaluate risk, participate in the development of risk mitigation activities and engage in correcting deficiencies

CorroHealth

Independent Contractor-Hospital RN (Appeal Writing/Denials Mgmt) (Remote)

Posted on:

May 29, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Texas

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.

This will be a generic IC profile for any clinician that is contracted to work with Corro. Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member. At CorroHealth our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success. Job Description: Status – Independent Contractor (Part-Time/Flexible) (20 hours per week min.) **Must complete and pass a technical and inpt clinical assessment. (link to be sent) ** JOB SUMMARY: As a Denial Management Appeals Clinician, you will have the unique opportunity to evaluate hospitalizations across the country while utilizing your medical knowledge and gaining experience as an expert advisor. You will perform retrospective clinical case reviews and draft appeals that focus on establishing the Medical Necessity of the services performed, both Inpatient and Outpatient.

RN or MD degree with strong clinical knowledge - Active unrestricted clinical license in at least one state within the United States. Minimum of 5 years recent acute-care hospital experience, preferred. Minimum of 2 years Utilization Review / Case Management experience within the last 5 years. Managed care payor experience a plus in either Utilization Review, Case Management or Appeals. Must have excellent attention to detail, written communication skills and be computer proficient. Work will be assigned on an as-needed basis. It will consistent and weekly for the next several months at least. As such, Consultant will receive a queue assignment/ report a) on Tuesday each week with a due date of the end of the business day the following Thursday and b) on Friday each week with due date of the end of the business day the following Monday. Consultant must provide a minimum of 20 hours per week and not exceed 40 hours per week unless approved by manager.

Performs retrospective medical necessity reviews to determine appeal eligibility of clinical disputes/denials. Constructs and documents a succinct and fact-based clinical case to support appeal utilizing appropriate medical necessity criteria and other pertinent clinical facts. Pertinent clinical facts include, but are not limited to, documentation preventing a safe transfer/discharge or documentation of medical necessary services denied for no authorization. Demonstrates ability to critically think, problem solve and make independent decisions supporting the clinical appeal process.

Dane Street

Utilization Management Nurse Reviewer (RN/LPN)

Posted on:

May 29, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Florida

The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately. They review medical records, treatment plans, and patient information to determine the necessity and appropriateness of medical procedures, tests, and treatments. Utilization Management Nurse Reviewers collaborate with healthcare providers, insurance companies, and patients to optimize healthcare delivery, control costs, and maintain quality care. Their responsibilities include assessing medical necessity, coordinating care, conducting utilization reviews, providing recommendations for care plans, and ensuring adherence to regulations and guidelines. This role requires strong clinical knowledge, critical thinking skills, communication abilities, and the ability to make informed decisions regarding patient care pathways. Shifts available: Evening shift (12-8PM EST) and weekends as needed (11-7 PM EST) and weekends as needed

Proficient in both written and spoken communication Capable of maintaining professional communication with physicians and clients Skilled at handling multiple tasks and adjusting swiftly in a dynamic office setting Possesses a keen organizational sense and pays close attention to details Adept at resolving intricate and multifaceted problems Experienced with Microsoft tools such as Word, Excel, PowerPoint, and Outlook Background in medical or clinical practice through education, training, or professional engagement Holds an unrestricted LVN/RN license from an accredited vocational nursing program (for LVNs) or a nursing degree from an accredited college (for RNs) EDUCATION/CREDENTIALS: Licensed Practical/Vocational Nurse with an active and unrestricted license to practice. Licensed RN with an active and unrestricted license to practice. JOB RELEVANT EXPERIENCE: 2 Yrs Minimum Clinical Nursing Experience Is Required. One year of previous experience in Utilization Management is required. JOB RELATED SKILLS/COMPETENCIES: Demonstrate strong abilities in both spoken and written communication, along with effective interpersonal skills. Possess a proficient understanding of computer operations, particularly the Internet, Microsoft Word, Microsoft Access, Microsoft Excel, and Windows. Show the capability to acquire new skills and competencies to address the evolving requirements of systems, software, and hardware. WORKING CONDITIONS/PHYSICAL DEMANDS: Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of sitting and computer work. WORK FROM HOME TECHNICAL REQUIREMENTS: Supply and support their own internet services. Maintaining an uninterrupted internet connection is a requirement of all work from home position.

Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual, or health plan specific guidelines/criteria) Examine and evaluate patient records to verify the quality of patient care and the necessity of provided services Offer clinical expertise and serve as a clinical reference for non-clinical staff members Input and manage essential clinical details within various medical management platforms Keep up-to-date with regulatory prerequisites (such as URAC) and state standards for utilization review Apply clinical reasoning to determine the suitable evidence-based guidelines Foster efficient and high-quality patient care by effectively communicating with management teams, physicians, and the Medical Director Additional Duties: May provide oversight to the work of the team members Continuously improves processes that help to facilitate better turnaround time, peer to peer success rates and lessens returned reports by clients for clarification purposes, ultimately resulting in higher client satisfaction. Responsible for the final approval on cases for release to the client Will act as a liaison and coordinate quality issue reports along with all new reviewer reports with the VP of Clinical Operations

Pyramid Consulting, Inc

HEDIS Abstraction nurse

Posted on:

May 29, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Texas

Immediate need for a talented HEDIS Abstraction nurse. This is a 06+months contract opportunity with long-term potential and is located in Dallas, TX (Remote). Please review the job description below and contact me ASAP if you are interested. Job ID: 25-72555 Pay Range: $33 - $35/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Skills; HEDIS Abstraction EMR Required: 2- or 4-year degree Required: LPN, RN or 5 years abstraction.

Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards Review medical records and abstract data for HEDIS and other measure sets in compliance with standards Track and report on issues and outcomes related to abstractions and over-reads Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required Perform other quality initiatives as necessary

OpenLoop

Telemedicine RN - Contract

Posted on:

May 29, 2025

Job Type:

Contract

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

OpenLoop Health was founded with the vision to deliver healing anywhere. We do so by thoughtfully pairing leading clinicians (like you!) with innovative telehealth companies providing patient care in all 50 states. Our team of Clinician Advocates and full-service support staff are dedicated to helping you land the right virtual care positions aligned to your expertise, passions, and schedule. Consider OpenLoop your all-access pass to rewarding work, great pay, and the flexibility you’ve been looking for.

We are seeking a compassionate and dedicated Registered Nurse (RN) to join our team as a Telemedicine RN. This is an incredible work opportunity in a fast-paced, innovative company that puts the patient at the center. This role is for a clinical care professional who delivers nursing care using telemedicine modalities exclusively, including video, phone, connected devices, and asynchronous messages (chat/email). Registered nurses are members of an interdisciplinary care team working as staff clinicians with OpenLoop. As a, you'll be at the forefront of healthcare delivery, providing vital support to patients over the phone. Your role will involve assessing patient needs, offering medical advice, coordinating care plans, ensuring optimal health outcomes, and providing an outstanding patient experience. If this sounds like a team you want to join - we'd love to connect! This position offers an opportunity to make a meaningful impact on patient satisfaction and quality of care while contributing to the continuous improvement of healthcare services. If you are a dedicated RN with a passion for patient advocacy, excellent communication skills, and love using technology to work in fast-paced environments, , we encourage you to apply for this rewarding position.

Must have an Active and Unencumbered Compact Registered Nursing license, preference for additional licensure This licensure MUST be reflected on a current CV or provided upon application to be considered MUST live in the state in which the Compact was granted to be considered Must have Associate degree in Nursing (A.D.N) from an accredited school of nursing required; Bachelor of Science in Nursing (B.S.N): Registered Nurse (RN) license At least 3+ years of clinical experience in settings such as telemedicine, acute care, or case management Strong interpersonal and communication skills, with the ability to empathize with patients and effectively convey information Above average proficiency in using telecommunication technology and electronic health record (EHR) systems Commitment to providing high-quality patient-centered care. Ability to work independently and as part of a team in a fast-paced environment. Excellent organizational skills and attention to detail, with the ability to manage multiple tasks simultaneously in a fast-paced environment Minimum of 20-hours per week availability required Day, evening, and weekend availability preferred Timely and professional Telemedicine or virtual care experience a plus Fluency in Spanish (both written and spoken) is a plus

Conduct outbound calls to patients who have been discharged from the hospital within a specified time frame. Conduct outbound calls to communicate patient lab results. Receive inbound calls from patients who have clinical questions or concerns. Provide medication administration support, recommendations for managing side effects, and care plan support. Engage with patients in a courteous and empathetic manner, demonstrating sensitivity to their healthcare needs and concerns. Complete detailed documentation of patient care interactions in the ticketing system and electronic medical record. Collaborate with healthcare providers, clinical leaders and other team members to follow up on any issues or discrepancies identified during the survey process. Maintain confidentiality and adhere to HIPAA regulations when handling patient information. Participate in ongoing training and professional development activities to stay updated on survey protocols, healthcare regulations, and best practices. Meet productivity targets and quality standards established by the organization.

Moses/Weitzman Health System

Population Health Nurse

Posted on:

May 29, 2025

Job Type:

Part-Time

Role Type:

Primary Care

License:

RN

State License:

Conneticut

Community Health Center, Inc. (CHC) is one of the country’s most creative and dynamic providers of primary medical, dental, and behavioral health services, and a leader in practice-based research, health professionals training, and use of innovative technologies to advance health and healthcare. CHC is designated as a federally qualified health center and a patient-centered medical home by HRSA, the Joint Commission, and NCQA, respectively. We deliver more than 500,000 patient visits per year from primary care hubs and community clinics across the state of CT, all connected by technology and common standards for quality. We employ several hundred medical, dental, and behavioral health providers who are engaged in practice, teaching, and research. Our Weitzman Institute is devoted to research and practice transformation and is recognized around the country as one of the premier research institutes focused on improving health care and health outcomes for special and vulnerable populations. In addition, the organization has developed three wholly owned subsidiaries from the original pilot developments within the Weitzman Institute: the National Nurse Practitioner Residency and Fellowship Training Consortium (NNPRFTC), the National Institute for Medical Assistant Advancement and ConferMed.

The Population Health Nurse provides high quality comprehensive, professional nursing care to individuals throughout the lifespan. The PHN provides patients with both general and focused health education regarding preventive, chronic and episodic health care issues.

Required Skills and Education: Registered nurse, in good standing. A minimum of Bachelor’s Degree A minimum of 1 year experience working successfully in a healthcare environment Ability to recognize signs of patient health distress and address appropriately Familiarity with medication names; ability to read prescriber’s directions for use Comfortable using a variety of technology resources; ability to concurrently listen while typing quickly and accurately into patient record in a clear and concise manner Possesses sound organizational skills and accuracy at all levels of job Proven excellent communication and customer service skills Preferred Skills: Current Connecticut RN license Bachelor’s Degree in Nursing (BSN) preferred Fluent in both English and Spanish with ability to pass fluency exams 1+ year of experience as a nurse in ambulatory care, preferred. Experienced nurses from other settings with a strong interest in chronic disease management and primary care nursing are encouraged to apply Commitment to care of underserved populations Excellent written and oral communication skills Comfort using motivational interviewing techniques Required Licenses/Certifications: Connecticut Registered Nurse License Physical Requirements/Work Environment Daily and continuous computer use. Daily and frequent telephone use. Alternating of sitting and standing as home-work environment allows Requires manual dexterity to perform administrative tasks, minimal physical activity required Fully Remote and therefore requires a clean/organized space that is free from distractions at home to complete work (see CHC’s Remote Worker Policy for more information) Demonstrates a HIPAA compliant work environment Follows CHC policies around remote work space and connectivity requirements

Outreach to patients to provide health care education during patient visits, by video and by telephone. Follows up on emergency room visits and hospital discharges. Accurately documents all aspects of patient care in the medical chart on a timely basis. Completes medication reconciliation processes Retrieves hospital discharge summaries from the appropriate portal and uploads into patient records, as needed Addresses care gaps related to value based metrics as assigned Other work as delegated by the Population Health Department Director or Supervisor Additional Activities and Responsibilities: Participates in quality improvement projects. Precepts others Participates in on going nursing education activities. Communicates client information to providers and the clinical team accurately. Accurately takes messages, and communicates on the telephone. Communicates effectively with other administrative staff, collaborates with medical providers, nursing staff and members of leadership. Access to clients’ charts and health care information within appropriate parameters. Maintains client confidentiality. Possess desire to collaborate with a team in a positive manner, providing insightful and evidence–based information This Position is available for remote work.

SSM Health

LPN-Virtual Health, Continuum of Care/Weekends Part time

Posted on:

May 29, 2025

Job Type:

Part-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Compact / Multi-State

It's more than a career, it's a calling MO-REMOTE Worker Type: Regular Job Highlights: These roles are for our Remote Patient Monitoring program. We are looking for a nurse who has a genuine interest in virtual health. The patients on this service receive equipment for them to check daily vitals and respond to symptom / risk screening questions on a device. The LPN role for this program does a review of all the patients on the program each day – looking at their daily vitals / survey responses of the patients and calling them if anything is outside of goal to discuss / reinforce education / escalate to the RN or provider as needed. It can be both outgoing and incoming calls – phone or video. Schedule: Friday, Saturday, Sunday $8.50 differential in addition to base wage A comfort with technology is a must for this position. Experience in triage / virtual health is preferred. This position may be a great fit for a nurse who has great direct patient care / bedside experience but is looking to use those skills in a different way and would prefer more of a care management / patient education centered position vs a skills based one. Job Summary: Provides remote care to patients under the direction of a registered nurse or qualified health care provider, functioning within the scope of license.

EDUCATION: Graduate of an accredited school of nursing or education equivalency for licensing EXPERIENCE: One-year licensed practical nurse experience Remote experience preferred but not required PHYSICAL REQUIREMENTS: Constant use of speech to share information through oral communication. Constant standing and walking. Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs. Frequent sitting, reaching and keyboard use/data entry. Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors. Frequent use of smell to detect/recognize odors. Frequent use of hearing to receive oral communication, distinguish body sounds and/or hear alarms, malfunctioning machinery, etc. Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs. Occasional lifting/moving of patients. Occasional bending, stooping, kneeling, squatting, twisting, gripping and repetitive foot/leg and hand/arm movements. Occasional driving. Rare crawling and running. REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS State of Work Location: Illinois Licensed Practical Nurse (LPN) - Illinois Department of Financial and Professional Regulation (IDFPR) State of Work Location: Missouri, Oklahoma, Wisconsin Licensed Practical Nurse (LPN) Nurse Licensure Issued by Compact State

Completes department LPN workflows per department protocols including program referral processing and daily patient metrics review and escalation. Delivers safe and quality care that is in line with provider orders, remote patient monitoring department protocols, and established nursing care standards. Provides documentation that follows the established treatment plan, supports coordination of patient care, meets regulatory requirements, and ensures reimbursement. Communicates with management team, patient care team (including clinical staff and providers), and patient/patient caregiver(s) per department protocols. Uses computer for data collection, documentation, information gathering, and communication. Manages relationships with individuals and departments inside and outside of the ministry structure. Delivers care with customer service and a positive patient care experience at the forefront. Works in constant state of alertness and in a safe manner. Performs other duties as assigned.

Cadence

Nurse Practitioner Supervisor

Posted on:

May 29, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

NP/APP

State License:

Compact / Multi-State

Across the United States, 6 in 10 adults – or 133 million Americans, live with one or more chronic conditions. Chronic disease is today’s leading cause of death and disability in the US and the leading driver of the nation’s $4.1 trillion in annual healthcare costs. Patients who live with chronic conditions require far more touch points than our primary care physicians have time to deliver and the result is countless health emergencies and costly ER visits that could be prevented. Workforce shortages and lack of technologies make it difficult to give patients the attention they need. At Cadence, our mission is to deliver life-changing care to over one million patients living with chronic disease by the end of the decade. We mitigate the impact of chronic disease by using technology and a world-class clinical team to remotely monitor, manage, and support patients at home. Together with our growing network of health system partners, we deliver guideline-directed care to tens of thousands of patients today while producing best-in-class clinical outcomes.

The Cadence Health team seeks a Nurse Practitioner Supervisor to join the team. This individual will dedicate 60% of their time performing the duties as a Nurse Practitioner and 40% of their time leading and supporting other Nurse Practitioners. (This is subject to change based on the needs of the team and the company). You will be responsible for ensuring the delivery of high-quality patient care making sure every healthcare interaction with Cadence is an exceptional experience that prioritizes the well-being of the patient and aligns with the goals of the health system. The schedule for this role: Mon- Fri 9 am-6 pm MT or PT time zone.

5+ years Nurse Practitioner experience treating patients with chronic diseases (T2D, Hypertension, CHF) either in an outpatient or inpatient setting at a high performing medical center. Master’s Degree as a Nurse Practitioner with willingness to expand state licensure as Cadence adds new markets and partners. 5+ years of leading a clinical team NPs, RNs, and/or MAs. Board certification and active license required (ANCC/AANP). Multi-state compact RN licensure. Ability to thrive in an environment founded on trust, autonomy, and direct feedback. Excellent communication skills when leading and managing change initiatives. Analytical mindset with the ability to interpret data, derive actionable insights, and make data-driven decisions. Strong project management skills, with the ability to prioritize tasks and meet deadlines. Proven success in motivating and inspiring a clinical team. Experience coaching and training a team of clinicians. Passion for the patient / customer experience and systematically improving healthcare with digital innovation Prior experience working in a startup environment. Experience working with remote patient monitoring technology is a plus.

Supervise the tracking of patient vital signs, symptoms, and laboratory results in coordination with our Clinical Navigators and Registered Nurses (RNs) Coordinate the patient's treatment regimen and medications, focusing on starting and adjusting guideline-recommended medical therapy (GDMT) for Heart Failure, as well as other relevant guidelines for Type 2 Diabetes (T2D) and Hypertension. Address patient escalations promptly, including abnormal vital signs, symptoms, and laboratory findings identified through Remote Patient Monitoring (RPM). Conduct regular virtual meetings with patients to discuss laboratory results and optimize adherence to GDMT Nurse Practitioner Supervisor responsibilities: Ensure adherence to clinical quality standards and compliance targets by conducting monthly audits, monitoring data for trends, and implementing performance enhancement strategies. Identify areas for quality improvement to enhance patient outcomes and satisfaction, and communicate objectives to the team, monitoring progress towards goals. Provide ongoing guidance, coaching, and mentoring to team members, fostering a collaborative and supportive environment conducive to teamwork and open communication. Assist in communicating policies, procedures, and care pathways, escalating matters to leadership when necessary, and collaborating with Team Leads to ensure adequate coverage. Manage staffing needs, approve PTO and CME, and complete time cards as required for the team. Participate in the recruitment process, interview prospective team members, and assist with onboarding and licensure. Stay updated on healthcare advancements and regulations, integrating them into organizational processes. Demonstrate flexibility to work across time zones to ensure team coverage. Ensuring every healthcare interaction with Cadence is an exceptional experience that prioritizes the well-being of the patient and aligns with the goals of the health system. Support internal growth efforts to help Cadence scale exceptional care delivery to patients with CHF and other chronic conditions including hypertension, Type 2 diabetes, and COPD. Be instrumental in shaping the culture of one of the fastest growing teams at Cadence.

Cadence

Clinical Operations Lead

Posted on:

May 29, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

None Required

State License:

California

Across the United States, 6 in 10 adults – or 133 million Americans, live with one or more chronic conditions. Chronic disease is today’s leading cause of death and disability in the US and the leading driver of the nation’s $4.1 trillion in annual healthcare costs. Patients who live with chronic conditions require far more touch points than our primary care physicians have time to deliver and the result is countless health emergencies and costly ER visits that could be prevented. Workforce shortages and lack of technologies make it difficult to give patients the attention they need. At Cadence, our mission is to deliver life-changing care to over one million patients living with chronic disease by the end of the decade. We mitigate the impact of chronic disease by using technology and a world-class clinical team to remotely monitor, manage, and support patients at home. Together with our growing network of health system partners, we deliver guideline-directed care to tens of thousands of patients today while producing best-in-class clinical outcomes.

Cadence Health is seeking an experienced Clinical Operations Lead to design, lead, and scale a best-in-class Care Management team. This leader will be responsible for driving operational excellence, ensuring clinical impact, and aligning our delivery model with regulatory, patient, and partner expectations.

Inspirational leader with a proven track record of leading high-performing clinical teams. Experience scaling care delivery models, with a balance of strategic and operational thinking. Strong grasp of clinical care delivery, with the ability to turn clinical needs into scalable workflows. Demonstrated ability to rapidly implement and refine programs based on feedback and data. Proven project management and prioritization skills across cross-functional teams. Regularly partners with product and engineering teams to improve systems and tooling. Strong communicator capable of influencing across teams, levels, and disciplines. Comfortable operating in ambiguity and navigating change in fast-paced environments.

Build and lead a high-performing Care Management team, including NPs, RNs, MAs, and clinical support staff. Drive productivity and consistency through clear performance metrics, feedback loops, and ongoing training. Design and refine scalable, standardized workflows that ensure efficient and high-quality care delivery. Ensure all care delivery adheres to evidence-based clinical standards and is tailored to patient needs. Lead initiatives that improve core clinical outcomes. Optimize outreach models and engagement strategies to increase patient impact. Develop and enforce rigorous compliance processes that meet all regulatory and contractual obligations. Foster a culture of accountability and clinical integrity across teams. Drive high levels of satisfaction among patients, providers, and health system partners. Collaborate cross-functionally to ensure operational alignment with strategic goals and partner expectations. Actively engage in feedback loops that improve service and strengthen stakeholder relationships.

Cadence

Care Management RN

Posted on:

May 29, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

Across the United States, 6 in 10 adults – or 133 million Americans, live with one or more chronic conditions. Chronic disease is today’s leading cause of death and disability in the US and the leading driver of the nation’s $4.1 trillion in annual healthcare costs. Patients who live with chronic conditions require far more touch points than our primary care physicians have time to deliver and the result is countless health emergencies and costly ER visits that could be prevented. Workforce shortages and lack of technologies make it difficult to give patients the attention they need. At Cadence, our mission is to deliver life-changing care to over one million patients living with chronic disease by the end of the decade. We mitigate the impact of chronic disease by using technology and a world-class clinical team to remotely monitor, manage, and support patients at home. Together with our growing network of health system partners, we deliver guideline-directed care to tens of thousands of patients today while producing best-in-class clinical outcomes.

The Cadence Health team seeks a Registered Nurse to support patients in our care management programs and help patients better manage their conditions. The schedule for this role is Monday through Friday, 8:00 AM to 5:00 PM PST, MST, or CST.

Multi-state RN Compact State Licensure Associate Degree in Nursing Science 5+ years of clinical experience in a chronic care management program. To ensure that our clinicians have the necessary tools for a successful remote work environment, home office setups must have consistently stable wifi with strong upload and download speeds. A wifi speed test is required before participating in the interview process to verify that these standards are met. Skilled in nursing processes. Excellent clinical acumen. Exceptional written, verbal, and interpersonal communication skills. EMR experience, preferably in Athena and EPIC. Works effectively with minimum supervision. Strong collaboration with cross-functional partners. Ability to support the delivery of health care to patients by performing a variety of activities and procedures that are prescribed by and performed under the direction of the Cadence Nurse Practitioner and Cadence clinical policies and procedures. Patient assessment competency. Technical fluency with the ability to work in multiple platforms and systems, including Notion, Athena, EPIC, Zendesk, and G Suite.

Continuously monitor patient vitals, symptoms, and lab results to proactively identify care gaps and patients requiring clinical intervention. Create and manage personalized care plans to address patients' specific health needs, ensuring alignment with treatment goals and physician recommendations. Address patient concerns and escalations via phone and text, providing timely and empathetic responses. Conduct virtual follow-up appointments to guide patients through program enrollment, update treatment plans, support medication adherence, and achieve lifestyle and health goals. Document clinical interactions thoroughly and prepare detailed care summaries to share with patients’ physicians, ensuring seamless care coordination. Assist in developing workflows and processes to enhance our care management programs, ensuring efficiency, scalability, and patient-centered care. Ensure every patient interaction reflects Cadence’s commitment to delivering exceptional care and aligns with the goals of partnering health systems. Collaborate with the team to scale care delivery for patients with chronic conditions, including CHF, hypertension, and type 2 diabetes, as Cadence grows.

Twig Health

Remote Nurse - Bilingual Spanish / English

Posted on:

May 29, 2025

Job Type:

Contract

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

Twig Health (www.twig.health) is an AI-guided front-desk for patient care. Our nurses communicate with patients mostly via SMS texting (and sometimes phone calls) to coordinate care, verify adherence, answer questions, provide support, and address any issues before they become problems.

We’re seeking registered nurses to join our team for a part-time, contract position. Benefits of working for Twig: 100% remote, telehealth position An opportunity to work with advanced technology such as generative AI (ChatGPT) Collaboration with other nurses and team members Providing concierge-level care to all patients Startup environment with new and exciting opportunities 1099 contract agreement

Located in the US. At least 1 year of Remote work experience. BSN (preferred) or ADN Compact License. Additional license - are an advantage High ability to express yourself in written form Excellent grammar, attention to detail Efficient at writing medical information at a patient level Typing speed > 45 WPM (check yourself on typingtest.com) Tech savvy and excited about technology in healthcare

Collaborate with patients based on their care plans (proactive engagement) and based on incoming patient needs (reactive engagement) Be empathetic, professional, pleasant and responsive when engaging with patients Collaborate with the rest of the patient’s care team Schedule appointments and follow-ups Collaborate with the Twig team to continually improve our level of service

Solace

Healthcare Advocate (Remote 1099)

Posted on:

May 29, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

None Required

State License:

California

Solace is a healthcare advocacy marketplace that connects patients and families to experts who help them understand and take charge of their personal health. By harnessing the power of human connection through technology, Solace is transforming healthcare in the U.S. Healthcare in the U.S. is fundamentally broken. The system is so complex that 88% of U.S. adults do not have the health literacy necessary to navigate the system without help. By helping people work with professional health advocates, Solace serves as an integral, personal support layer for health issues in a way that the health system can’t. Using proprietary technology to match patients with experienced advocates, Solace cuts through the red tape of healthcare and helps individuals and families make informed decisions that result in better outcomes. Solace is a Series B startup founded in 2022 and backed by Inspired Capital, Craft Ventures, Torch Capital, Menlo Ventures and Signalfire. We have a lean, fully-remote U.S. team distributed coast-to-coast.

As an Healthcare Advocate for Solace, you will work with Medicare patients throughout their healthcare journey. In this role, you will navigate patients through difficult and complex health concerns to help them achieve their health and wellness goals while addressing Social Determinants of Health (SDOH). You’ll be an empathetic listening ear and an action-oriented guide who knows what to do to solve patient problems—and actually does it. Please note that this is a 1099 role. You can choose to work part time or full time. The role is remote.

3+ years proven experience in care management, patient advocacy, or healthcare navigation. Deep understanding of Social Determinants of Health and experience working with diverse patient populations. Endless empathy for people, and a strong ability to fight for those who cannot. Strong clinical skills paired with exceptional organizational abilities. You can balance multiple tasks and work under pressure without sacrificing clarity in your communications and documentation. Pride in your technical savvy; you can quickly and fluently learn new systems and software. An extreme bias toward action and execution. A willingness to provide fearless feedback. You care about forging a system that empowers better patients outcomes, and are not shy about sharing your thoughts. This is a remote position. Applicants must be based in the United States.

Learn the Solace systems, tools, technology, partners, and expectations, while also providing your unique expertise in every interaction. Build strong, trusting relationships with Medicare patients, where listening and empathy are the foundation for every interaction. Be able to identify and prioritize Medicare patients’ needs and assist them to maintain a streamlined care continuum. Develop comprehensive patient care plans that holistically address social determinants of health, i.e. food resources, transportation access, and support at home. Build the systems of the future in working with Medicare patients.

Sanford Health

Clinical Informatics Analyst - CI OPS Post Acute

Posted on:

May 28, 2025

Job Type:

Full-Time

Role Type:

Informatics

License:

RN

State License:

Minnesota

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

Facility: Remote MN Location: Remote, MN Address: Shift: 8 Hours - Day Shifts Job Schedule: Full time Weekly Hours: 40.00 Salary Range: $26.00 - $41.50 Department Details Monday thru Friday, limited on call, daytime hours, no nights, weekends or holidays.

Associate’s degree required; Bachelor’s degree preferred. Minimum of two years experience in healthcare setting required. Previous experience in nursing/healthcare management, education, development, and/or healthcare information management preferred. Possess analytical, problem solving, critical thinking, and strong verbal and written communication skills. Electronic Medical Record (EMR) experience preferred. Licensed/registered in a clinical field required. Home Health & Hospice experience required.

The Clinical Informatics Analyst demonstrates a clinical background with special interest and expertise in use of the electronic health record (EHR) and other technology that enhances clinical practice. Acts as a liaison between assigned departments, facilities, providers and Information Technology (IT) staff in order to facilitate optimal use of applications. Experienced EHR user with previous experience providing instruction to others for integration of workflows and processes into daily practice to support safe, efficient, effective patient care and outcomes. Responsible to assist assigned departments, geographical areas or specific functions with utilization of Sanford's electronic medical record (EMR) and associated technology. Research, analyze and make recommendations for application workflow improvements. Create and analyze reports using multiple reporting mechanisms. Perform with a high level of customer service with all support and training requirements. Promote and participate in a team approach. Proficiency in the use of Microsoft Office software required. Comfortable managing change with excellent problem solving skills. Time management and prioritization necessary on a daily basis. Proficient verbal and written communication is essential. A positive attitude and excellent customer service skills are expected. Fosters a work environment of respect, professionalism, accountability and teamwork. Key areas of accountability include individual and classroom training, onsite and remote end-user support, development of supporting clinical workflows, investigation and resolution of application and workflow issues, and participation in committees that promote both the standardization and optimization of clinical informatics changes to Sanford's EMR and other associated technology. May require some periodic day and overnight travel, non-business hour scheduled support or meetings as well as on-call rotation for end-user support.

Sanford Health

Utilization Management Coordinator (Home-Based) - Prior Authorization

Posted on:

May 28, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

Compact / Multi-State

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

Facility: Remote WI Location: Remote, WI Address: Shift: Day Job Schedule: Full time Weekly Hours: 40.00 Salary Range: $21.50 - $28.00

Monitors the utilization of resources, risk management and quality of care for patients in accordance to established guidelines and criteria for designated setting and status. Collection of clinical information necessary to initiate commercial payor authorization. Obtain and maintain appropriate documentation concerning services in accordance to reimbursement agency guidelines. Consult with interdepartmental departments and staff to assure all relevant information regarding patient status and diagnosis are accurately reported. Provide information via multiple sources of technology applications to insurance companies and contracted vendors to assure authorization for patients. May participate in providing assistance in financial aid and/or counseling if applicable. Accurately recognizes coding principle diagnosis and principle procedures including complicating/comorbid diagnoses for accurate diagnosis-related group (DRG) assignment during hospitalization. Monitors patient hospitalization to ensure prospective payment limit is not exceeded without due notice to the attending physician. May also need to notify physician and patient of authorization denials. Inputs collected data into computer system for insurance communication, DRG grouping, data abstraction for monitoring and evaluation, and when applicable, Medicare National and Local Coverage Determinations (NCD/LCD), and Joint Commission (TJC) required functions and credentialing. Assists medical records coding personnel as needed to correctly identify diagnoses and procedures, and obtains physician documentation as needed. Monitors patient hospitalization to ascertain medical necessity and appropriateness. Assists with retrospective review of specified charts as required. Ability to interact on an interpersonal basis with both providers and nursing staff. Demonstrates proficiency with computers, Microsoft applications, and additional designated technology within the department. Will perform multiple administrative duties including accurate record keeping and electronic data management when needed. Ability to work with growth and development needs of pediatric to geriatric populations.

Parkview Health

Telehealth Triage Nurse - RN

Posted on:

May 28, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Here, you’ll find a health system dedicated to meeting your needs throughout your health journey. With 14 hospitals, 50+ clinical specialties, an extensive network of expert providers, and access to advanced technologies typically only found at academic medical centers, Parkview is improving the health of our entire region. We are continually expanding our knowledge, discovering novel ways to care for patients, and connecting our community to the supportive expertise they deserve. We are Parkview. And we are advancing healthcare to be better for you every day.

This position is eligible for a $5,000 sign-on bonus *Once fully trained (6 months to 1 year) option to be remote* Purpose: Triages or manages symptom-based encounters with a patient over the phone or video, utilizing evidence-based triage protocols. Decreases unnecessary visits to physicians, APP’s, and the emergency room and provides information for self-care. Uses excellent communication and information-gathering skills to determine the best course of action for the patient with appropriate disposition. Deals with the entire spectrum, from healthy patients to the acute and chronically ill. Telehealth triage nursing is based on the six-step nursing process: nursing assessment, diagnosis, goal/outcome identification, planning, implementation, and evaluation. Interventions commonly applied by the Triage Nurse are as follows: identifying and clarifying patient needs; conducting health education; promoting patient advocacy and self-efficacy; and assisting the patient to navigate the health care system.

Education: Must be a graduate of a School of Nursing, BSN preferred. Must complete general orientation. Licensure/Certification: Must have a current, active RN license and currently hold a compact license or apply for the Nurse Licensure Compact as a part of the hiring process. Experience: Minimum of five years’ experience as a registered nurse. Previous emergency department or telephone triage experience is desired for this role. Experience in use of computers – hardware and software, and use of an electronic medical record. Other Qualifications: Critical thinking skills. Ability to determine the problem or patient need through conversation with a patient. Superior verbal communication skills are essential. Ability to communicate in a clear, concise, courteous and professional manner, exhibit quality vocal skills through speech rate, volume, enunciation and pronunciation. Strong assessment skills and excellent clinical judgement. Crisis intervention skills. Ability to remain calm in high-stress situations. Teaching ability. Typing and computer ability to keep track of information gathered during the telephone conversation,ability to type 40 wpm with 98% accuracy, document precisely in a concise manner. Demonstrates the ability to work independently and learn applications relevant to the position. Strong organizational skills and attention to detail. Ability to successfully function in a fast paced, service-oriented environment.

Accepts telephone calls from patients with varying levels of acuity and types of medical concerns. Promotes clear and coherent verbal communication following an appropriate line of questioning. Utilizes the electronic medical record to access and review patient records, step through triage protocols to review possible conditions, relatable signs and symptoms, and evidence-based treatments, and facilitate next steps which could include scheduling a clinic appointment. Provides clear health information, assistance with medication refills as needed, thorough patient education, recommendation for use of over-the-counter medications as appropriate, and recommendations for the next steps to take. Evaluates the significance of the patient’s concern, determine if emergency care is needed, if a medical appointment should be made, or if the concern should be reported to the appropriate physician. Works for first call resolution of patient’s concern or need as appropriate. Completes Transitional Care Management telephone encounters for post hospital patients. Functions independently in a fast-paced environment.

Accredo Specialty Pharmacy

Home Infusion Nurse-Accredo- Bowling Green,-Ohio-Per Diem

Posted on:

May 28, 2025

Job Type:

Part-Time

Role Type:

License:

RN

State License:

Ohio

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Take your nursing skills to the next level by helping to improve lives with Accredo, the specialty pharmacy division of Evernorth Health Services. We are looking for dedicated registered nurses like you to administer intravenous medications to patients in their homes. As a Home Infusion Registered Nurse at Accredo, you'll travel to patients' homes to provide critical infusion medications. However, this job is about more than just administering meds; it’s about building relationships with patients and seeing the positive impact of your care. You'll work independently, making decisions that lead to the best outcomes for your patients. You’ll drive growth in your career by challenging yourself to use your nursing skills, confidence, and positive attitude to handle even the toughest situations, with the support from your team. For more than 30 years, Accredo by Evernorth® has delivered dedicated, first-class care and services for patients. We partner closely with prescribers, payers, and specialty manufacturers. Bring your drive and passion for purpose. You’ll get the opportunity to make a lasting impact on the lives of others.

Active RN license in the state where you’ll be working and living 2+ years of RN experience 1+ year of experience in critical care, acute care, or home healthcare Strong skills in IV insertion Valid driver’s license Willingness to travel to patients’ homes within a large geographic region Ability to do multiple patient visits per week (can include days, evenings, and weekends, per business need) Flexibility to work different shifts on short notice and be available for on-call visits as needed If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

Empower Patients: Focus on the overall well-being of your patients. Work with pharmacists and therapeutic resource centers to ensure that patients’ needs are met and to help them achieve their best health. Administer Medications: Take full responsibility for administering IV infusion medications in patients’ homes. Provide follow-up care and manage responses to ensure their well-being. Stay Connected: Be the main point of contact for updates on patient status. Document all interactions, including assessments, treatments, and progress, to keep track of their journey.

Anchor Health, LLC

Clinical Liaison, RN On Call, Music Therapist, Community Outreach

Posted on:

May 28, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

We have multiple opportunities for the right people, those who combine empathy, teamwork, accountability and commitment towards the goal of bringing the highest quality end-of-life care to those who need it.

Atrium

Oncology Nurse Navigators - 155550

Posted on:

May 28, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Our client, a value-based cancer care company, is seeking compassionate Oncology Nurse Navigators to join their team! Salary/Hourly Rate $39.90/hr Position Overview The Oncology Nurse Navigators will provide triage, support, and education to members during their cancer journey via phone, email, and video.

Required Experience/Skills for the Oncology Nurse Navigators: The Oncology Nurse Navigator should possess OCN. Must possess compact licensure. Must have recent oncology navigation or oncology case management experience. Minimum 3 years of nursing experience, including 2 years in direct patient care in outpatient infusion or navigation. Experience in outpatient infusion or navigation. Education Requirements: Bachelor of Science in Nursing is required.

The Oncology Nurse Navigators will establish trusting relationships with members and their care network. Support members throughout their cancer care journey, including screening, survivorship, and end-of-life care. Assist members with care coordination, symptom management, nutritional support, discharge planning, and provider referrals. Assist with urgent clinical escalations and provide clinical consultative support.