OpTech LLC

Telephonic RN Case Manager – Commercial Operations

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

OpTech is a leading Talent Management and Technology Services company with nearly two decades years of successful experience managing large, enterprise-wide solutions for our clients. We provide mission critical services to major commercial clients including well known institutions in financial services, healthcare /insurance , utilities and manufacturing. OpTech has contracts with the Federal Government supporting agencies such as the Department of Homeland Security, Department of Defense, and the Department of Labor. OpTech has been nationally recognized for “Excellence in Staffing”, National “Best and Brightest Companies to Work For”, and “Top 500 Woman Owned Businesses in the United States”. At OpTech we believe that “Talent” matters. We are committed to connecting great companies with great talent to creatively and effectively apply technology to solve important problems.

***REMOTE BUT MUST HAVE A LICENSE FROM ONE OF THESE STATES***: living in a compact state w/ a multi-state license - CO, GA, IN, KY, MS, OH, PA, VA, WA, LA,IA. Pay $37.00- $39.00/hour Remote- M-F 8-5 PM Contract to hire

EDUCATION AND EXPERIENCE: Nursing Diploma or Associates degree in nursing required Bachelor’s degree in nursing strongly preferred 3 years of clinical nursing experience in a clinical, acute/post-acute care, and community setting required 1 year of case management experience in a managed care setting strongly preferred Experience managing patients telephonically and via digital channels (mobile applications and messaging) preferred CERTIFICATES, LICENSES, REGISTRATIONS: Current, active, and unrestricted Michigan Registered Nurse license required Certification in Case Management (CCM) required or to be obtained within 18 months of hire Certification in Chronic Care Professional (CCP) preferred QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. OTHER SKILLS AND ABILITIES: Ability to think critically, be decisive, and problem solve a variety of topics that can impact a member’s outcomes Empathetic, supportive and a good listener Proficient in motivational interviewing skills Demonstrated time management skills Organizational skills with the ability to manage multiple systems/tools, while simultaneously interacting with a member Must have intermediate computer knowledge, typing capability and proficiency in Microsoft programs (Excel, OneNote, Outlook, Teams, Word, etc.). Must embrace teamwork but can also work independently Excellent interpersonal and communication skills both written and verbal

The Case Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person centric care management program to a diverse health plan population with a variety of health and social needs They serve as the single point of contact for members, caregivers, and providers using a variety of communication channels including phone calls, emails, text messages and Our Client’s online messaging platform The Case Manager RN uses the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the member’s health across the care continuum. They work in partnership with the member, providers of care and community resources to develop and implement the plan of care and achieve stated goals. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned: Lead the coordination of a regionally aligned, multidisciplinary team to provide holistic care to meet member needs telephonic and/or digitally The multidisciplinary team is inclusive of Medical and Behavioral Health Social Workers, Registered Dietitians, Pharmacists, Clinical Support Staff and Medical Directors. Use the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the members’ health across the care continuum. Assess the member's health, psychosocial needs, cultural preferences, and support systems Engage the member and/or caregiver to develop an individualized plan of care, address barriers, identify gaps in care, and promotes improved overall health outcomes Arrange resources necessary to meet identified needs (e.g., community resources, mental health services, substance abuse services, financial support services and disease-specific services) Coordinate care delivery and support among member support systems, including providers, community-based agencies, and family Advocate for members and promote self-advocacy Deliver education to include health literacy, self-management skills, medication plans, and nutrition Monitor and evaluate effectiveness of the care management plan, assess adherence to care plan to ensure progress to goals and adjust and reevaluate as necessary Accurately document interactions that support management of the member Prepare the member and/or caregiver for discharge from a facility to home or for transfer to another healthcare facility to support continuity of care Educate the member and/or caregiver about post-transition care and needed follow-up, summarizing what happened during an episode of care Secure durable medical equipment and transportation services and communicate this to the member and/or caregiver and to key individuals at the receiving facility or home care agency Adhere to professional standards as outlined by protocols, rules and guidelines meeting quality and production goals Continue professional development by completing relevant continuing education and maintaining Certified Case Manager (CCM)

C & S Employment Solutions

Registered Nurse (Remote) – CS Employment Solutions

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Missouri

C&S has an immediate opening for full-time, direct hire Remote Registered Nurse in Jefferson City. Must reside more than 45 miles from Jefferson City and be a Missouri resident. Salary/hours for Remote Registered Nurse: $68,000/yr. + benefit package; Monday-Friday 8 a.m.-5 p.m.

current RN license must reside in Missouri must be computer proficient requires excellent written and verbal communication skills previous customer service, utilization review and healthcare experience preferred must reside more than 45 miles from Jefferson City and be a Missouri resident

working with healthcare professionals reviewing requests for medical services and supplies documenting requests

OpTech LLC

Registered Nurse Care Manager

Posted on:

February 4, 2026

Job Type:

Contract

Role Type:

Care Management

License:

RN

State License:

Michigan

OpTech is a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work at OpTech, not only do you get health and dental benefits, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! To view our complete list of openings, pleas e visit our website at www.optechus.com.

QUALIFICATIONS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. OTHER SKILLS AND ABILITIES: Ability to think critically, be decisive, and problem solve a variety of topics that can impact a member’s outcomes Empathetic, supportive and a good listener Proficient in motivational interviewing skills Demonstrated time management skills Organizational skills with the ability to manage multiple systems/tools, while simultaneously interacting with a member Must have intermediate computer knowledge, typing capability and proficiency in Microsoft programs (Excel, OneNote, Outlook, Teams, Word, etc.) Must embrace teamwork but can also work independently Excellent interpersonal and communication skills both written and verbal EDUCATION AND EXPERIENCE: Nursing Diploma or Associates degree in nursing required Bachelor’s degree in nursing strongly preferred 3 years of clinical nursing experience in a clinical, acute/post-acute care, and community setting required 1 year of case management experience in a managed care setting strongly preferred Experience managing patients telephonically and via digital channels (mobile applications and messaging) preferred CERTIFICATES, LICENSES, REGISTRATIONS: Current, active, and unrestricted Michigan Registered Nurse license required Certification in Case Management (CCM) required or to be obtained within 18 months of hire Certification in Chronic Care Professional (CCP) preferred

The Case Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person centric care management program to a diverse health plan population with a variety of health and social needs. They serve as the single point of contact for members, caregivers, and providers using a variety of communication channels including phone calls, emails, text messages and Our Client’s online messaging platform. The Case Manager RN uses the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the member’s health across the care continuum. They work in partnership with the member, providers of care and community resources to develop and implement the plan of care and achieve stated goals. ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned: Lead the coordination of a regionally aligned, multidisciplinary team to provide holistic care to meet member needs telephonic and/or digitally. The multidisciplinary team is inclusive of Medical and Behavioral Health Social Workers, Registered Dietitians, Pharmacists, Clinical Support Staff and Medical Directors. Use the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the members’ health across the care continuum Assess the member’s health, psychosocial needs, cultural preferences, and support systems Engage the member and/or caregiver to develop an individualized plan of care, address barriers, identify gaps in care, and promotes improved overall health outcomes Arrange resources necessary to meet identified needs (e.g., community resources, mental health services, substance abuse services, financial support services and disease-specific services) Coordinate care delivery and support among member support systems, including providers, community-based agencies, and family Advocate for members and promote self-advocacy Deliver education to include health literacy, self-management skills, medication plans, and nutrition Monitor and evaluate effectiveness of the care management plan, assess adherence to care plan to ensure progress to goals and adjust and reevaluate as necessary Accurately document interactions that support management of the member Prepare the member and/or caregiver for discharge from a facility to home or for transfer to another healthcare facility to support continuity of care Educate the member and/or caregiver about post-transition care and needed follow-up, summarizing what happened during an episode of care Secure durable medical equipment and transportation services and communicate this to the member and/or caregiver and to key individuals at the receiving facility or home care agency Adhere to professional standards as outlined by protocols, rules and guidelines meeting quality and production goals Continue professional development by completing relevant continuing education and maintaining Certified Case Manager (CCM)

Lumina Care

Registered Nurse Clinical Manager

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

Lumina Care is focused on unifying, coordinating, and managing care for geriatric patients in nursing facilities and at home. We offer a range of services to improve health outcomes and quality of life for patients, including after-hours telehealth, transitional care, chronic care, remote patient monitoring, behavioral health, and telehealth psychiatry.

Job title: Registered Nurse Clinical Manager Purpose: We are seeking a Registered Nurse (RN) to join our leadership team as a Clinical Manager. Compensation: This role will be full-time, Monday through Friday and will be composed of clinical leadership work, as well as clinical work. This division of time will be fluid based on company needs and initiatives. The salary is $85,000-$90,000 per year (within the range; individual pay is determined by geography, job related skills, experience, licensure, and relevant education or training). We offer a comprehensive and competitive benefits package to support our employees, including: Medical, Dental, and Vision Insurance Paid Time Off (PTO) Paid Holidays and Floating Holidays Flexible Work Arrangements

Credentials: Active and unrestricted RN compact licensure is required. Individual state licensure in IL, NY and or CA are a plus. Willingness to obtain additional state licensure as requested. Bachelor of Science in Nursing is preferred. Qualifications: A minimum of 3 years' experience as a Registered Nurse is required. A minimum of 1 year of experience in a leadership role with direct management of employees is preferred. Previous Long-term care, Chronic Care Management/ Behavior Health experience is preferred. Excellent clinical skills with the ability to develop, review, and communicate a treatment plan with providers in a virtual environment. Highly organized and able to manage multiple projects, people, and deadlines at one time. Excited to become a member of the clinical leadership team to coach and grow team members promoting clinical excellence. Telehealth experience is required Technology proficiency required. Excellent people skills: communicating with patients, families, and members of the healthcare team. Self-directed with the ability to practice autonomously, but functions as a member of the team. Working conditions: A quiet homework space and a functional computer are required for this remote role. Typing is required, as well as using virtual technology to visualize patients during visits. Periods of prolonged sitting or standing can be expected. Travel requirements could occur based on specific state licensure and leadership needs.

Oversees and validates all LPN-developed care plans and SMART goals, ensuring clinical accuracy, regulatory compliance, and alignment with nursing standards of practice for patients in Skilled Nursing Facilities. Identify areas of opportunity to improve care and collaborate more closely with medical providers or behavioral health care team. Acts as the clinical escalation point before provider involvementfor any identified care opportunities during care planning process that require RN-level clinical judgment. Collaborates with Lumina clinical providers to initiate next steps in care plans when appropriate. Reviews daily clinical performance metrics of the team and implements interventions for areas of opportunity. Staff supervision leading and supporting the team by providing coaching, consistent feedback and ensuring adherence to policies and procedures. Collaborates with Lumina Care team to recruit, hire, orient and onboard new clinical team members. Escalates any concerns with care delivery, relationships or any state/regulatory laws/regulations or employment law to the Chronic Care Clinical Manager. Provides coaching and mentorship to LPNs on care-planning best practices, including goal-setting, documentation quality, and patient-centered planning. Identifies learning needs of team and works with Chronic Care Clinical Manager and the Clinical Education team to address. Performs clinical audits through shadowing and documentation audits and provides feedback to team members. If further interventions are needed for performance improvement, partners with the Chronic Care Clinical Manager, the Clinical Education team, and or Human Resources as appropriate. Conducts regular 1:1s with team members and provides feedback to applaud excellent work and implements a plan to address opportunities for improvement. Supervisory Responsibilities: Will have LPN team leads reporting directly to you for supervision, growth and development of the LPN care team. Continues to be innovative in care delivery and works to implement necessary interventions. Accomplishes department objectives by supervising and coaching staff and organizing and monitoring work processes. Nourishes clinical team growth by recruiting, orienting, and training clinicians and developing professional growth opportunities. Ensures quality by monitoring and maintaining clinical standards of care, compliance with health and safety regulations through audits and quality improvement initiatives. Accomplishes team results by coaching and performance managing with assistance from Clinical Education and HR. Develops and implements training in collaboration with the Clinical Education team. Ensures compliance with all federal and state regulatory requirements in collaboration with the Clinical Leadership, Compliance, Legal and HR teams.

Moments Hospice

Workflow RN (3:00pm - 11:30pm)

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Minnesota

Headquartered in Golden valley, Minnesota, Moments Hospice provides hospice services to patients and families throughout Minnesota, Eau Claire and Milwaukee areas of Wisconsin and Central Iowa. Moments hospice involves the support of physicians, registered nurses, social service counselors, certified nursing assistants and volunteers, all following a prescribed plan of care. Our services are available 24 hours a day, seven days a week to any person, regardless of ability to pay. Rather than a place, hospice is a philosophy - a program of care and support wherever patients need us. Our services extend to any location - a private residence, hospital, assisted living facility, or nursing home. Moments Hospice has defined as its mission to affirm life during its final stages by providing compassionate care to patients and their families; by providing access to hospice care for underserved or difficult to serve populations; by wise and efficient use of available resources, and by educating the community in order to provide them with knowledge regarding end-of-life and hospice care around quality of life. Come help us to change the hospice experience, one moment at a time.

Moments Hospice is a leading hospice organization determined to change the hospice experience for patients, families, and team members. Our promise to our patients is "We personalize our care and treat you like family". We are dedicated to making our patients' final days, weeks, and months as comfortable as possible. The promise to treat everyone like family also flows through the daily work environment, where all employees are part of the Moments family. We offer a workplace that employees are proud to be a part of. We are looking for exceptional people to join our exceptional team. People who want to make a difference in the community and in the lives of others. Hours: 3:00pm - 11:30pm Reviews and does all approvals required of an RN. Provides support remotely to field users. Pushes workflow through after business hours. Responds to telephone, fax, email requests for specific task completion. Has good knowledge of HCHB workflow and processes. Ensures that all field users have a timely resolution to requests or issues encountered. Explains to field users workflow process to assist all users in a good understanding of the HCHB process flow. Primary job functions do require problem-solving skills.

Education & Experience: Formal Education: Associate Degree or certification equivalent Experience: 3 years of Hospice License, Registration, and/or Certification Requirement: Yes Education Requirements: Current RN Licensure for all applicable states assigned prior to accepting calls for agencies License Requirements: Current RN Licensure for all applicable states assigned prior to accepting calls for agencies Skill Requirements: Proficient in HCHB preferred

Completes POC tasks timely and efficiently to include and not be limited to data entry of referrals, eligibility, scheduling, quick holds, approval of orrders, and referrals. All tasks should be completed within 30 minutes of request. Escalates appropriate requests to the manager when a resolution is not identified by the user. (Escalation to help desk only to occur after discussing with manager.) Monitors email, fax, and phone system ongoing throughout via blackberry or desktop during assigned hours Prioritizes incoming tasks according to patient needs Meets minimum productivity requirements of 100 tasks per day Participates in department staff meetings and educational sessions. Other duties as assigned by the director.

CareXM

Registered Nurse (RN) – Home Health or Hospice - Remote - Weekends - Sat & Sun 9am to 5:30pm (MST)

Posted on:

February 4, 2026

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

CareXM provides remote care and monitoring services backed by a staff of triage nurses and patient care advocates which serve as an extension of your healthcare business. Our team proactively manages populations of patients in the home environment whether they are transitioning into a home care setting, managing chronic health conditions, or moving towards end-of-life care.

Remote Status: Remote Job Title: Registered Nurse Location: Remote Pay: $26/hour Position Type: Part-Time Training Schedule: The training is four weeks long. You will meet each week, Monday, Wednesday & Friday from 5:00 p.m. to 8:30 p.m. (MST) for two weeks On the third week, you will meet on Thursday + one additional weekday that will be assigned by your Trainer In your fourth week, you will work two weekdays that will be assigned by your Trainer Work Schedule: Saturday: 9:00 a.m. to 5:00 p.m. (MST) Sunday: 9:00 a.m. to 5:00 p.m. (MST) Additional weeknight hours may be picked up as availability is needed States we are currently not entertaining applications from: Alaska, California, Connecticut, DC, Hawaii, Illinois, Massachusetts, Michigan, Minnesota, Nevada, New York, Oregon, Rhode Island, Washington or any US territories (e.g.Puerto Rico). Summary: CareXM is seeking a remote Registered Nurse (RN) to provide after-hours telephone triage care to patients and caregivers of hospice and home health partners. This is a flexible position that offers the opportunity to work from home while making a meaningful difference in the lives of others.

RN license in a compact state (in good standing) 4+ years of clinical nursing experience required. Experience in home health, palliative, med-surg, geriatrics, ICU, ER, and/or hospice care is preferred but not required English fluency is required. Spanish is a plus Proficiency with computers and telecommunications equipment Ability to work independently and as part of a team Ability to work flexible hours, including evenings and weekends Must be able to pass a background check and drug test for pre-employment screening Must be able to meet California RN Required Prerequisites for RN Examination and Endorsements as outlined here: https://www.rn.ca.gov/status.shtml Must have at least 400 work hours in the last two years Personal Computer Requirements: You will use your Personal Computer to work. As each system configuration is unique, our requirement specialist and IT team will confirm your configuration will meet the necessary standards. Internet connection (Satellite broadband and mobile hotspots are NOT permitted) Webcam Windows: 11 or MAC OS: 14 (Sonoma) or newer CPU: 2.5 GHz RAM: 6GB

Provide fast access to quality, compassionate after-hours RN telephone triage care to patients and caregivers of hospice and home health partners Communicate with empathy and understanding, especially when callers are experiencing a difficult situation Assess patient needs and provide appropriate care instructions Coordinate care with other members of the healthcare team Document patient care in the electronic health record (EHR)

CGC Group Inc.

Quality Maternal Health Clinician

Posted on:

February 4, 2026

Job Type:

Contract

Role Type:

Care Management

License:

NP/APP

State License:

New York

Location: Remote Assignment Length: 6 months+ Position Summary: We are seeking a Quality Maternal Health Clinician to support underserved pregnant women within the New York population through a high-touch, concierge-style maternal health program. This role focuses on telephonic outreach, education, care coordination, and ongoing support throughout pregnancy, delivery, and the postpartum period to ensure both mother and baby receive timely, appropriate care. This position plays a critical role in improving maternal and infant health outcomes while helping members navigate healthcare services and close gaps in care.

Education, Licensure & Certification Active New York State license as a: Women’s Health Nurse Practitioner or Nurse Midwife Experience 3–5 years of experience in a managed care, population health, or similar clinical environment Skills & Competencies: Moderate to advanced clinical assessment skills Strong ability to read, interpret, and analyze medical records Excellent written and verbal communication skills Strong organizational and time-management abilities High level of interpersonal skills with a compassionate, patient-centered approach Computer proficiency, including experience with electronic medical records, word processing, spreadsheets, and databases

Conduct proactive telephonic outreach to pregnant and postpartum members to assess needs and provide ongoing clinical support Educate members throughout pregnancy on healthy choices, prenatal care, postpartum recovery, and infant care Coordinate and schedule appointments for maternal and infant care, including: Prenatal and postpartum visits Women’s preventive screenings (including cancer screenings) Pediatric well visits and immunizations Identify and address barriers to care such as transportation, access, or social determinants of health, and connect members to appropriate resources Perform postpartum clinical assessments for newly delivered members to ensure appropriate recovery and follow-up care Schedule follow-up appointments for both mother and baby to ensure adherence to preventive care guidelines Conduct targeted medical record reviews to assess quality of care, identify trends, and support quality improvement initiatives Summarize findings and communicate insights to internal teams to support provider education and care delivery improvements

Emory Healthcare

Utilization Review Specialist Registered Nurse / RN

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Georgia

The Emory Healthcare Network encompasses teams of providers at our locations across Georgia, including Emory University Hospital, Emory University Hospital Midtown, Emory University Orthopaedics & Spine Hospital and the Wesley Woods Center; Emory Saint Joseph's Hospital and Emory Johns Creek Hospital; Emory Clinic; and the Emory Healthcare Network physicians, ranging from primary to specialty care providers. Through our integrated, collaborative care network, we are dedicated to providing the standard of care that our patients expect and deserve. Our researchers are discovering what’s next in medicine, and our physicians and care teams are putting that research to use to improve the health of our community today. From our experts at the Winship Cancer Institute of Emory University, the state’s ONLY National Cancer Institute-designated cancer center, to the specialists at our Orthopaedics & Spine Center and our network of hundreds of primary care physicians, our team is 17,000 strong and committed to the health of our community.

The Utilization Review (UR) Specialist is a Registered Nurse responsible for conducting thorough medical necessity reviews to assist with determining appropriate patient class designation. The UR Specialist will perform timely and comprehensive reviews of the patient chart utilizing InterQual Criteria accurately in conjunction with the UR Department workflows/processes, clinical nursing judgement, and when necessary, discussions with the provider team and/or Medical Director of UR.

Minimum Qualifications: Education - Associate degree in nursing. Experience - Minimum of 5 years of recent acute hospital experience or a minimum of two years of previous utilization review experience. Licensure - Must have a valid, active unencumbered Registered Nurse license approved by the Georgia Licensing Board. Skills - Must meet all quality and productivity expectations and successfully complete yearly competencies. Preferred Qualifications: Education - Bachelor's degree in Nursing strongly preferred. Certification - Case Management certification preferred. Skills - InterQual Level of Care Criteria experience. Previous utilization review experience strongly preferred. PHYSICAL REQUIREMENTS: Occasional to frequent sitting. Close eye work (computers, typing, reading, writing). ENVIRONMENTAL FACTORS: Remote position.

Operational Support: Conducts thorough medical necessity reviews to assist with determining appropriate patient class designation. Performs timely and comprehensive reviews of the patient chart utilizing InterQual Criteria accurately in conjunction with the UR Department workflows/processes, clinical nursing judgement, and when necessary, discussions with the provider team and/or Medical Director of UR. Performs appropriate and accurate initial, admission (episode day one) and concurrent utilization reviews as guided by InterQual Criteria and UR Department workflows on all observation, inpatient, and extended recovery admissions as required based on Emory Healthcare's Utilization Management Plan and the UR Department¿s processes. Ensures that all InterQual reviews are supported with provider team documentation and/or clinical data. When appropriate, the UR Specialist will utilize the UR Department's Severity of Illness/Intensity of Service template to document the medical necessity of the admission or continued stay. While conducting utilization reviews, will identify any Avoidable Delays and accurately document the delay(s) based on the workflow. Follow the UR Department¿s denial workflows as appropriate. 8. Prioritizes work with minimal guidance for optimal reimbursement and to avoid financial risk to both patient and hospital. Compliance: Will identify and complete Medicare Outpatient Observation Notices (MOON), Medicare Change of Status Notice (MCSN), Condition Code 44s and Medicare Hospital Issued Notices of Non-Coverage (HINNs) for Medicare beneficiaries as appropriate. Ensures compliance with all state of Georgia and Federal regulatory requirements as designated in Emory Healthcare's Utilization Management Plan. Maintains all required annual competencies, metrics, and fully participate and engage in department process improvements. Collaboration: Responsible for timely communication to the provider team and interdisciplinary team as it relates to patient class designation and medical necessity of an admission or continued stay on individual patient basis based on UR Department workflows. In a team effort, the UR Specialist will work closely with the UR Department's Case Management Authorization Specialist IP to ensure that authorized days and patient actual LOS are reconciled to ensure appropriate reimbursement for services provided. Responsible for communicating medical necessity denials for in-house patients to the Medical Director of UR, and when designated to the provider team. Serves as a resource to the provider team, Interdisciplinary Care Team, and patient to explain external UR regulations. Provides effective and efficient proactive communication to internal and external customers. Assists in collaborative efforts with the Case Management Department, Revenue Cycle, Physician Advisors, and other required departments. Additional Responsibilities: Ability to multi-task in a fast-paced environment while efficiently handling multiple priorities and ensuring deadlines are met. Performs other duties and tasks as assigned. Travel: Less than 10% of the time may be required. Work Type: This position is a remote position outside traditional office, often from home or another remote setting.

CVS Health

Case Manager, Registered Nurse (Oncology experience required) - Fully Remote

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

This is a remote work from home role anywhere in the US with virtual training. American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members.

Required Qualifications: 5+ years’ experience as a Registered Nurse, including at least 1 year in a hospital setting. A Registered Nurse that holds an active, unrestricted license in their state of residence, and willingness to receive a multi-state/compact privilege and can be licensed in all non-compact states. 1+ years’ experience documenting electronically using a keyboard. 1+ years’ current or previous experience in Oncology. Preferred Qualifications: 1+ years’ Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience as well as experience with transferring patients to lower levels of care. 1+ years' experience in Utilization Review. CCM and/or other URAC recognized accreditation preferred. 1+ years’ experience with MCG, NCCN and/or Lexicomp. Bilingual in Spanish preferred. Bachelors Degree Education Diploma or Associates Degree in Nursing required.

This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients. Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits. 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 utilize information from various sources to address all conditions including co-morbid and multiple diagnoses that impact 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. Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversations. Identifies and escalates member’s needs appropriately following set guidelines and protocols. Need to actively reach out to members to collaborate/guide their care. Perform medical necessity reviews.

RX.ME

Remote Registered Nurse (1200-0000EST)

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

Job Title: Remote-Registered Nurse (1200-0000 EST) (RN) Reports to: Nurse Manager(s) Effective Date: 3/9/2026 The RN staff is responsible for providing care and education to patients while maintaining honesty, integrity, and professionalism, at all times in all working platforms. The RN will be expected to communicate effectively with patients and customers via chat and email communication platforms. The RN is required to work 36-40 hours per week. This includes scheduling the appropriate amount of shifts to work per platform and attending applicable team meetings that are typically on a weekly basis. The RN will report to and work collaboratively with the Lead(s) and Nurse Manager(s). Communication with other members of the medical team and other departments will also be required.

Required Skills/Abilities: Excellent organizational skills and attention to detail. Excellent verbal and written communication skills. Excellent customer service skills. This role requires outstanding customer service abilities as it heavily involves interacting with customers. Excellent time management skills with a proven ability to meet deadlines. Excellent interpersonal skills. Possess exemplary proficiency in computer skills. Average typing speed required for this role is between 60-80 wpm. Ability to utilize critical thinking skills consistently. Ability to prioritize tasks. Ability to remain on-task. Ability to maintain a productive workflow while working remotely and performing repetitive tasks. Proficiency with Google Suite and/or Microsoft Office Suite. Proficiency in reading, writing, and speaking. Schedule: This position is a full-time, remote position that requires the following: 36-40 hours per week 1200-0000 EST Timeframe (may be subject to change due to staffing needs) 16 weekend hours required per biweekly pay period Education and Experience: Registered Nursing License (with compact endorsement) required. Related experience required (preferred min. 2 years of RN). Customer Support experience. Google Suite and/or Microsoft Office Suite experience required. Ability to read, write ,and speak fluently. Possess exemplary proficiency in computer skills. Must obtain Compact License within 6 months of hire date if not already obtained prior to employment. Physical Requirements: This remote position requires prolonged periods of sitting at a desk and working on a computer.

Reviewing medical charts in collaboration with patients and providers. Providing support to patients, including medical education and customer support-based services. Communicating with patients via live chat and email. Providing a distraction-free, private, quiet working environment during any hours worked (regardless of the scheduled platform). The RN will be expected to allow for scheduling flexibility within the time that they are hired for. Maintaining a working knowledge of processes related to daily updates. i.e. staying current with practices specific to different platforms worked. i.e. reviewing internally communicated updates prior to the scheduled shift Ad-hoc projects as volunteers are requested. Attend weekly team meetings as assigned by their direct Lead or NM. Abide by the signed Code of Conduct

Devoted Health

Telehealth Preventative Primary Care Advanced Practice Provider- NP/PA

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce. At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!

Full-time (40 hours/week) · Fully Remote Position​ Schedule options: Standard schedules available; eligibility for 4x10 schedule after successful completion of first 90 days (post onboarding) and performance expectations. About the Role: As a Devoted Preventative Primary Care Provider, you’ll be part of a mission-driven, interdisciplinary clinical team focused on improving the health, dignity, and quality of life of our members. You’ll meet patients in the first step of their primary care journey with Devoted Medical. You’ll conduct 1 hour comprehensive clinical assessments, support chronic condition management, and emphasize preventative and proactive care. You’ll collaborate closely with primary care providers, specialists, pharmacists, nurses, care coordinators, caregivers, and families to deliver coordinated, member-centered care. This role sits at the intersection of preventative care, primary care and complex care management — it is not a traditional primary care panel role, and it’s not a one-time Annual Wellness Visit role. You’ll develop a relationship with your members while working in a supportive, tech-enabled environment designed to optimize clinical time and connection.

Required Skills & Experience: Active Nurse Practitioner (APRN/NP) or Physician Assistant (PA) license. 3+ years of outpatient clinical practice, ideally in primary care, family medicine, internal medicine, or geriatrics. Active and clear NP/PA license in at least one of the following states: AL, AZ, AR, CO, FL, GA, HI, IL, IN, KY, MS, MO, NC, OH, PA, SC, TN, TX (must be willing to obtain additional licenses within the first 90 days — support and reimbursement provided) Active BLS certification at time of hire. Comfort with delivering care via video telehealth and using electronic documentation systems. Preferred Experience: Familiarity with managed care models, including STARS/HEDIS and identification of care gaps. Experience performing comprehensive or preventive care visits with Medicare populations. Experience supporting older adults and/or individuals with complex medical or social needs. You’ll Thrive in This Role If You… Find meaning in caring for older adults and supporting them in living healthier, more independent lives. Lead with empathy, humility, and curiosity. Value feedback, reflection, and personal and professional growth. Enjoy working within a collaborative, supportive, tech-enabled care team environment.

Conduct primarily telehealth video visits, with limited and occasional in-home visits to members in your local area. Perform comprehensive assessments and provide evidence-based care focused on prevention, chronic condition support, medication optimization, and health maintenance. Identify and address care gaps, coordinate with external and internal care team members, and contribute to individualized, whole-person care plans. Utilize integrated technology and AI-enabled workflows to reduce administrative burden and maximize meaningful member interaction time. Communicate with empathy and clarity, fostering trust and confidence with members and caregivers.

Devoted Health

Bilingual Hypertension Specialty Care Nurse Practitioner

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce. At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!

This position is a unique opportunity for an experienced nurse practitioner (APRN) with a compassionate, entrepreneurial approach to deliver exceptional preventive cardiovascular care to members with hypertension and atherosclerotic cardiovascular disease risk. In this role you will be working in a next generation virtual specialty clinic that dramatically expands access to care for America’s most vulnerable seniors. The clinic focuses on optimizing hypertension management and reducing cardiovascular risk for Devoted Health members. You will utilize and help improve our home-grown technology and electronic health information platform to carry out virtual visits. On a day-to-day basis you will work closely with our virtual specialty clinic team members at Devoted Medical including physicians and other APRNs as well as medical assistants, clinical guides (health coaches), clinical pharmacists, and social workers. You will be a key member of our interprofessional team. The Hypertension clinic is one of several of Devoted’s virtual specialty care programs that are designed as “micro centers of excellence” that deliver highly tailored, specialized care to patients with specific chronic conditions.

Desired skills and experience: APRN with 5 or more years working in outpatient clinical practice ideally with experience in management of hypertension, hyperlipidemia and primary and secondary prevention of atherosclerotic cardiovascular disease. Minimum of 2 years of experience concentrated in primary care or a subspecialty with heavy focus on hypertension and lipid management required (e.g., cardiology, nephrology, endocrinology, primary care). Proficiency in using telehealth technology and electronic health records (EHR). Virtual care experience is preferred along with a strong desire to continue practicing clinical nursing and performing virtual visits - you believe in the mission of bringing care to where the patient lives. An understanding of managed care is a plus, including how to appropriately assess STARS/HEDIS measures, code clinical comorbidities, and identify clinical care gaps. Proficiency in English and Spanish preferred for this position. Multi-state licensure is required, along with the ability and willingness to obtain and maintain additional licenses as needed. Devoted currently operates in 29 states and covers all licensing costs. Licensure and Certification: Master's or Doctoral degree in Nursing with a specialization in primary care or cardiovascular care. An active and clear RN and APRN license, as well as APRN certification is required at time of hire and must be maintained while employed at Devoted Medical. Willingness to obtain and maintain multiple state licenses. Active BLS is required at time of hire and must be maintained while employed at Devoted Medical.

Conduct focused and thorough assessments of patients with hypertension through virtual consultations including ordering diagnostics as needed, interpreting labs and imaging data, and developing a treatment plan in collaboration with the specialty care clinic team. Formulate accurate diagnoses and develop individualized treatment plans for patients, including medication management, lifestyle modifications, and monitoring recommendations. Mitigate the risk of cardiovascular disease by proactively initiating and managing statin therapy in persons with diabetes and/or cardiovascular disease Collaborate with an interdisciplinary care team—including primary care providers, specialists, and Devoted team members such as pharmacy, social work, and health coaches—as well as family members and caregivers to coordinate holistic, patient-centered care, ensure continuity, and implement a collaborative care plan. Serve as the clinical advisor and provide clinical escalation support for the speciality clinic staff and other teams during business hours. Participate in regular panel review discussions to offer advice and provide guidance around medical management. Utilize our home grown electronic health information system for visits while also providing feedback on how to improve the interface. Maintain accurate and up-to-date patient medical records, ensuring compliance with relevant legal and ethical guidelines. Participate in quality improvement initiatives and ongoing professional development to stay current on best practices and advancements in hypertension and atherosclerotic cardiovascular disease risk reduction. Adhere to all relevant laws, regulations, and industry standards, including patient privacy and telehealth regulations. Attributes to success: Experienced nurse practitioner with a strong clinical foundation in hypertension management and primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD), including disease processes, evidence-based treatment strategies, medication management, and lifestyle modification. You are influential with patients to promote positive health outcomes and reduce clinical inertia You stay current on the latest clinical practice guidelines and are an expert in your field You are experienced working on an interprofessional team and enjoy team-based care. You have great clinical and non-clinical judgment and provide thorough patient care. You are deeply empathetic and humanistic, and want to go the last mile for your patients. You thrive in a fast-paced, high-energy environment where agility and collaboration are essential, and continuous improvement happens rapidly. You enjoy staying at the forefront of innovation, actively adopting new technologies and taking pride in contributing to improvements that benefit both clinicians and patients. You learn from every experience and are not afraid to fail - that's how you're wired. Finally and most importantly, you have a passion for making healthcare better, solving complex problems, and supporting the delivery of healthcare that we would want for our own family members.

Devoted Health

Hypertension Specialty Care Nurse Practitioner

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce. At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!

This position is a unique opportunity for an experienced nurse practitioner (APRN) with a compassionate, entrepreneurial approach to deliver exceptional preventive cardiovascular care to members with hypertension and atherosclerotic cardiovascular disease risk. In this role you will be working in a next generation virtual specialty clinic that dramatically expands access to care for America’s most vulnerable seniors. The clinic focuses on optimizing hypertension management and reducing cardiovascular risk for Devoted Health members. You will utilize and help improve our home-grown technology and electronic health information platform to carry out virtual visits. On a day-to-day basis you will work closely with our virtual specialty clinic team members at Devoted Medical including physicians and other APRNs as well as medical assistants, clinical guides (health coaches), clinical pharmacists, and social workers. You will be a key member of our interprofessional team. The Hypertension clinic is one of several of Devoted’s virtual specialty care programs that are designed as “micro centers of excellence” that deliver highly tailored, specialized care to patients with specific chronic conditions.

Desired skills and experience: APRN with 5 or more years working in outpatient clinical practice ideally with experience in management of hypertension, hyperlipidemia and primary and secondary prevention of atherosclerotic cardiovascular disease. Minimum of 2 years of experience concentrated in primary care or a subspecialty with heavy focus on hypertension and lipid management required (e.g., cardiology, nephrology, endocrinology, primary care). Proficiency in using telehealth technology and electronic health records (EHR). Virtual care experience is preferred along with a strong desire to continue practicing clinical nursing and performing virtual visits - you believe in the mission of bringing care to where the patient lives. An understanding of managed care is a plus, including how to appropriately assess STARS/HEDIS measures, code clinical comorbidities, and identify clinical care gaps. Multi-state licensure is required, along with the ability and willingness to obtain and maintain additional licenses as needed. Devoted currently operates in 29 states and covers all licensing costs. Licensure and Certification: Master's or Doctoral degree in Nursing with a specialization in primary care or cardiovascular care. An active and clear RN and APRN license, as well as APRN certification is required at time of hire and must be maintained while employed at Devoted Medical Willingness to obtain and maintain multiple state licenses. Active BLS is required at time of hire and must be maintained while employed at Devoted Medical.

Conduct focused and thorough assessments of patients with hypertension through virtual consultations including ordering diagnostics as needed, interpreting labs and imaging data, and developing a treatment plan in collaboration with the specialty care clinic team. Formulate accurate diagnoses and develop individualized treatment plans for patients, including medication management, lifestyle modifications, and monitoring recommendations. Mitigate the risk of cardiovascular disease by proactively initiating and managing statin therapy in persons with diabetes and/or cardiovascular disease Collaborate with an interdisciplinary care team—including primary care providers, specialists, and Devoted team members such as pharmacy, social work, and health coaches—as well as family members and caregivers to coordinate holistic, patient-centered care, ensure continuity, and implement a collaborative care plan. Serve as the clinical advisor and provide clinical escalation support for the speciality clinic staff and other teams during business hours. Participate in regular panel review discussions to offer advice and provide guidance around medical management. Utilize our home grown electronic health information system for visits while also providing feedback on how to improve the interface. Maintain accurate and up-to-date patient medical records, ensuring compliance with relevant legal and ethical guidelines. Participate in quality improvement initiatives and ongoing professional development to stay current on best practices and advancements in hypertension and atherosclerotic cardiovascular disease risk reduction. Adhere to all relevant laws, regulations, and industry standards, including patient privacy and telehealth regulations. Attributes to success: Experienced nurse practitioner with a strong clinical foundation in hypertension management and primary and secondary prevention of atherosclerotic cardiovascular disease (ASCVD), including disease processes, evidence-based treatment strategies, medication management, and lifestyle modification. You are influential with patients to promote positive health outcomes and reduce clinical inertia You stay current on the latest clinical practice guidelines and are an expert in your field You are experienced working on an interprofessional team and enjoy team-based care. You have great clinical and non-clinical judgment and provide thorough patient care. You are deeply empathetic and humanistic, and want to go the last mile for your patients. You thrive in a fast-paced, high-energy environment where agility and collaboration are essential, and continuous improvement happens rapidly. You enjoy staying at the forefront of innovation, actively adopting new technologies and taking pride in contributing to improvements that benefit both clinicians and patients. You learn from every experience and are not afraid to fail - that's how you're wired. Finally and most importantly, you have a passion for making healthcare better, solving complex problems, and supporting the delivery of healthcare that we would want for our own family members.

Devoted Health

Specialty Care Nurse Practitioner Manager

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce. At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!

A bit more about this role: This position is an amazing opportunity for an ambitious nurse practitioner (NP) to take on an impactful leadership role in the Devoted Medical Specialty Department to help develop the clinical excellence of the team. The Specialty Care NP Manager will be responsible for the clinical and operational oversight of the NPs in the Heart Center (CHF and Virtual Cardiology Clinics) and the CKD Clinic while continuing to provide clinical care to patients in either the Heart Center or CKD Clinic. The position will join the Specialty Care management team (Medical Director, Clinic Physicians, Operations Leads, Clinic Managers) and together work to strengthen the programs’ collaborative culture, empower the front line staff to achieve clinical excellence, and surface opportunities to improve patient care. This manager reports to the Medical Director for Specialty Care. Both the Heart Center and the CKD Clinic are Devoted Medical’s newest specialty care clinics focused on delivering high quality, high value, and accessible virtual first heart and kidney care to its members. Responsibilities will include: 50% of your time will be dedicated to providing patient care either in the heart center or the CKD clinic (18 hours per week):

Desired skills and experience: APRN with 5 or more years working in outpatient clinical practice with experience in management of either cardiology or nephrology patients. Experience in a leadership role is preferred. Proficiency in using telehealth technology and electronic health records (EHR). Virtual care experience is preferred along with a strong desire to continue practicing clinical nursing and performing virtual visits - you believe in the mission of bringing care to where the patient lives. An understanding of managed care is a plus, including how to appropriately assess STARS/HEDIS measures, code clinical comorbidities, and identify clinical care gaps. Proficiency in English and Spanish preferred for this position. Multi-state licensure is required in addition to a willingness to obtain, and maintain additional licensure as requested. Licensure and Certification: Master’s or Doctoral degree in Nursing with a specialization in cardiology or nephrology preferred. An active and clear RN and APRN license as well as APRN certification is required at time of hire and must be maintained while employed at Devoted Medical. Active BLS is required at time of hire and must be maintained while employed at Devoted Medical.

Conduct focused and thorough assessments of patients with conditions that impact heart or kidney health through virtual consultations including ordering diagnostics as needed, interpreting labs and imaging data, and developing a treatment plan in collaboration with the clinic team. Formulate accurate diagnoses and develop individualized treatment plans for patients with heart or kidney needs, including medication management, lifestyle modifications, and monitoring recommendations. Work with interdisciplinary teams including lead clinic physicians, social workers, pharmacists, and nurses. 50% of the time will be dedicated to serving as the NP manager of the Devoted Heart Center. Your team will consist of those NPs who work in the Heart Center (CHF and Virtual Cardiology Clinics) as well as the CKD Clinic. These responsibilities include: Provide oversight and accountability for the clinical performance of the NP team, quality chart reviews, coaching and teaching. Lead and maintain a strong team culture, being the standard-bearer for a collaborative, unified, engaged provider group. Serve as the liaison to the Clinic Managers and Medical Director on issues regarding patient care, interdisciplinary coordination, and performance management challenges Lead hiring, interviewing, onboarding and ongoing training of the NP team. Oversee licensure of all direct reports to ensure adequate clinical coverage across all markets in all clinical programs. Participate in all ongoing clinical leadership meetings, including interdisciplinary team meetings, clinical oversight meetings, Specialty Care leadership huddles, etc. Identify areas for improvement and implement strategies to achieve targeted metrics. Manage, empower, inspire, and align the ever-growing team of NPs, to include regular one-on-one meetings with each direct report. Set personalized goals for direct reports and review individual performance. Manage time-off requests and work closely with the Clinic Manager to support adequate NP staffing of the clinical programs at all times. Handle special projects to improve the quality of care delivery. Attributes to Success: You are a servant leader, recognizing that everyone’s success is your success. As a leader you are there to enable your team to be empowered to do the best work possible and trust your guidance and assistance. You are a team player, understanding that to achieve the best results, collaboration across teams is essential. You work well in a matrixed leadership environment. You assume positive intent from everyone on the team and work to create a culture of mutual respect. You enjoy working in a fast-paced, rapid-growth, constantly improving program. You like tackling hard problems and building new solutions. You are agile and flexible, willing to change your opinions on topics as new information arises. You have the fortitude to provide direct, kind and constructive feedback to your reports. You crave feedback for yourself and integrate feedback into your own performance. You are empathetic and able to analyze clinical or operational challenges from multiple perspectives. You are organized and pay close attention to detail. You are eager for improvement and are not afraid to experiment or fail. You are excited by change and willing to try new approaches to patient care. You have a passion for making healthcare better, solving complex problems, and supporting the delivery of healthcare that we would want for our own family members.

Golden Care Solutions

1099 remote position for a Bilingual SPANISH speaking RN/LPN with an active California license.

Posted on:

February 4, 2026

Job Type:

Contract

Role Type:

Care Management

License:

RN

State License:

California

We are dedicated to providing exceptional healthcare services and support with a focus on quality care and compassion. Our mission is to ensure patient satisfaction and well-being through innovative solutions and patient-centered care. GOLDEN CARE SOLUTIONS LLC is committed to building an inclusive work environment where excellence in medical practice thrives.

This is a full-time, 1099 remote position for a Bilingual SPANISH speaking RN/LPN with an active California license. Responsibilities include assessing patient health, providing patient education in multiple languages, and delivering care through Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) services. The role also involves coordinating care with interdisciplinary healthcare teams and maintaining accurate, timely medical documentation.

A valid and current California RN or LPN license and bilingual (SPANISH) proficiency. Experience working remotely in a work-from-home setting, with the ability to function independently A patient-centered approach and enjoyment of ongoing patient engagement are essential to this role. Highly self-directed with strong proficiency in Microsoft Office, particularly Excel Self-motivated with a strong sense of ownership and accountability Proactive and results-driven, with the ability to build and manage a caseload independently Strong clinical skills in patient assessment, care planning, and implementation of nursing interventions Effective communication skills in English and a second language, with the ability to tailor education to diverse patient populations Proficient in electronic health record (EHR) documentation and maintaining accurate, timely patient records Demonstrated ability to manage time efficiently and maintain productivity in a remote environment Knowledge of regulatory compliance and commitment to ethical, high-quality patient care Compassionate, professional, and culturally sensitive approach to patient interactions Preferred: Prior experience in telehealth nursing, CCM/RPM, or remote care delivery Familiarity with telemedicine technologies and remote monitoring platforms

This position requires building and managing your own CCM/RPM caseload, which takes time, consistency, and dedication. It requires a lot of administrative work, working with vendors, practices, and coordination with others. Additional duties include monitoring and updating patient care plans, reviewing CCM/RPM data, offering ongoing support to patients and their families, and ensuring compliance with all regulatory requirements, organizational policies, and best practices. We value nurses who genuinely enjoy building relationships with patients and supporting them over time.

Centene

Clinical Review Nurse - Concurrent Review (NICU)

Posted on:

February 3, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

Florida

As a Fortune 25 healthcare leader, we’re committed to providing high-quality, accessible care to individuals and families, especially in underserved communities. Our innovative approach integrates physical, behavioral and social services to make a real difference in health outcomes. We value collaboration and are dedicated to excellence, creating an environment where our employee contributions can truly shine. Join us in transforming healthcare and enhancing the well-being of communities across the country.

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. **This role is 100% remote. Candidates must reside in the state of Florida and currently have a Florida nursing license. Previous NICU experience is strongly preferred. The work schedule is Monday - Friday, 8am - 5pm Eastern with some flexibility after training has been completed.** Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member.

Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. 2+ years of acute care experience required. Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: LPN - Licensed Practical Nurse - State Licensure required

Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines Reviews member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities Collaborates with care management on referral of members as appropriate Performs other duties as assigned Complies with all policies and standards

CVS Health

Case Manager Registered Nurse

Posted on:

February 3, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

Plan Sponsor business hours : Monday through Friday 7:00am to 6:00pm CST. There are currently no nights, no weekends, and no holidays; however, it is subject to change based on business needs. Can choose your schedule between these hours with either a 30 or 60 min unpaid lunch. The RN Case Manager is responsible for telephonically assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member and to help facilitate the member’s overall wellness.

Must have an active, current and unrestricted RN licensure in the state of residence and be willing to apply for a Compact RN (fees pd by company) 5 years clinical practice experience as an RN Must be able to work Monday through Friday between the hours of 7:00am to 6:00 pm CST. There are currently no nights, no weekends, and no holidays; however, it is subject to change based on business needs. Preferred Qualifications: 6+ months Case Management or Utilization Management experience Case Management Certification Education: Associate Degree required BSN preferred

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. 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 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 plan. Assessments include the member’s level of work capacity and related restrictions/limitations. Using a holistic approach to assess the need for referral to clinical resources for assistance. 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.

Highmark Inc.

Transplant Care Nurse (Remote)

Posted on:

February 3, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

A national blended health organization, Highmark Health and our leading businesses support millions of customers with products, services and solutions closely aligned to our mission of creating remarkable health experiences, freeing people to be their best. Headquartered in Pittsburgh, we're regionally focused in Pennsylvania, Delaware, West Virginia, and eastern and northwestern New York with customers in 50 states and the District of Columbia. We passionately serve individual consumers and fellow businesses alike. And our companies cover a diversified spectrum of essential health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions. Our financial position reflects strength and stability, with our year-end 2020 consolidated revenues totaling $18 billion. And we’re proud to carry forth an important legacy of compassionate care and philanthropy that began more than 170 years ago. This tradition of giving back, reinvesting and ensuring that our communities remain strong and healthy is deeply embedded in our culture, informing our decisions every day.

This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides oversight over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and utilizing data/analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member. The incumbent conducts outreach to members enrolled in case management including but is not limited to: developing a care plan, encouraging behavior changes, identifying and addressing barriers, helping members to coordinate care, and identifying various resources to assist members in achieving their personal health goals. Will work with providers to insure quality and appropriate care is being delivered in a timely manner.

Required: High School/GED Substitutions: None Preferred: Bachelor's Degree in Nursing EXPERIENCE Required: 7 years in any combination of clinical, case/utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience 1 year in a clinical setting Preferred: 5 years in UM/CM/QA/Managed Care 1 year in advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing or dialectical behavior therapy (DBT) 1 year working with the healthcare needs of diverse population and understanding of the importance of cultural competency in addressing targeted populations LICENSES or CERTIFICATIONS Required: Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or WV or DE or NY is required. Other RN license(s), if applicable, must be obtained within the first 6 months of employment. Preferred: Certification in utilization management or a related field Certification in Case Management SKILLS: Written and verbal presentation skills, negotiation skills, and skills in positively influencing others with respect and compassion Broad knowledge of disease processes Working knowledge of pertinent regulatory and compliance guidelines and medical policies Ability to multi task and perform in a fast paced and often intense environment Understanding of healthcare costs and the broader healthcare service delivery system Ability to analyze data, measure outcomes, and develop action plans Be enthusiastic, innovative, and flexible Be a team player who possesses strong analytical and organizational skills Demonstrated ability to prioritize work demands and meet deadlines Excellent computer and software knowledge and skills

Maintain oversight over specified panel of members by performing ongoing assessment of members’ health management needs, identifying the right clinical interventions to address member needs and/or triaging members to appropriate resources for additional support. Implement care management review processes that are consistent with established industry, corporate, state, and federal law standards and are within the care manager’s professional discipline. For assigned case load, create care plans to address members’ identified needs, remove barriers to care, identify resources, and conduct a number of other activities to help improve the health outcomes of members; care plans include both long and short term goals and plan of regular contacts for re-assessment. Ensure all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards. Other duties as assigned.

Highmark Inc.

Care Manager RN - (Remote)

Posted on:

February 3, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

A national blended health organization, Highmark Health and our leading businesses support millions of customers with products, services and solutions closely aligned to our mission of creating remarkable health experiences, freeing people to be their best. Headquartered in Pittsburgh, we're regionally focused in Pennsylvania, Delaware, West Virginia, and eastern and northwestern New York with customers in 50 states and the District of Columbia. We passionately serve individual consumers and fellow businesses alike. And our companies cover a diversified spectrum of essential health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions. Our financial position reflects strength and stability, with our year-end 2020 consolidated revenues totaling $18 billion. And we’re proud to carry forth an important legacy of compassionate care and philanthropy that began more than 170 years ago. This tradition of giving back, reinvesting and ensuring that our communities remain strong and healthy is deeply embedded in our culture, informing our decisions every day.

This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource utilization, identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors and analyzes the delivery of health care services; educates providers and members on a proactive basis; and analyzes qualitative and quantitative data in developing strategies to improve provider performance/satisfaction and member satisfaction. Responds to customer inquiries and offers interventions and/or alternatives.

EDUCATION Required: None Substitutions: None Preferred: Bachelor’s Degree in Nursing EXPERIENCE Required: 3 years of related, progressive clinical experience in the area of specialization Experience in a clinical setting Preferred: Experience in UM/CM/QA/Managed Care LICENSES AND CERTIFICATIONS Required: Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). Additional specific state licensure(s) may be required depending on where clinical care is being provided. Preferred: Certification in utilization management or a related field SKILLS: Working knowledge of pertinent regulatory and compliance guidelines and medical policies Ability to multi task and perform in a fast paced and often intense environment Excellent written and verbal communication skills Ability to analyze data, measure outcomes, and develop action plans Be enthusiastic, innovative, and flexible Be a team player who possesses strong analytical and organizational skills Demonstrated ability to prioritize work demands and meet deadlines Excellent computer and software knowledge and skills Languages (Other than English) None Travel Requirement 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-Based Teaches/trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Does Not Apply Works primarily out-of-the office selling products/services (sales employees) Does Not Apply Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely, Occasionally

Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager’s professional discipline. Function in accordance with applicable state, federal laws and regulatory compliance. Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies. Promote quality and efficiency in the delivery of care management services. Respect the member’s right to privacy, sharing only information relevant to the member’s care and within the framework of applicable laws. Practice within the scope of ethical principles. Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions. Employ collaborative interventions which focus, facilitate, and maximize the member’s health care outcomes. Is familiar with the various care options and provider resources available to the member. Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships. Develop and sustain positive working relationships with internal and external customers. Utilize outcomes data to improve ongoing care management services. Other duties as assigned or requested

TalentLNX

Itemization Review Nurse

Posted on:

February 3, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Texas

We are seeking an Itemization Review Nurse I to support payment integrity efforts through detailed review of hospital itemized bills. This role focuses on validating charge-level accuracy, identifying billing discrepancies, and ensuring services billed are supported by clinical documentation and applicable guidelines. This position is well-suited for Registered Nurses who enjoy analytical work, have strong attention to detail, and are interested in transitioning into non-bedside, audit-focused roles.

Required Qualifications: Active Registered Nurse (RN) license 3 to 5 years of acute care clinical experience Strong attention to detail and analytical thinking skills Ability to interpret medical records and billing documentation Comfortable working independently in a fully remote environment Strong written communication and documentation skills Preferred Qualifications: Prior experience in itemized bill review, payment integrity, or hospital billing Familiarity with UB-04 billing formats Exposure to CPT, HCPCS, and ICD-10 coding concepts Work Environment & Physical Requirements: Fully remote position Prolonged computer use reviewing detailed billing and clinical documentation Ability to focus on repetitive, detail-oriented tasks for extended periods Travel Requirements: Minimal to none

Review hospital itemized bills for accuracy, completeness, and compliance Validate individual charges against medical records and clinical documentation Identify billing discrepancies such as duplicate charges, unbundling, incorrect units, and unsupported services Apply CMS regulations, payer billing guidelines, and internal audit standards Document audit findings clearly and consistently within internal audit systems Meet established quality, productivity, and turnaround time benchmarks Maintain compliance with internal policies and confidentiality requirements

Optum

Call Center Nurse RN – Remote

Posted on:

February 3, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Explore opportunities with Shared Services, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together.

As a Triage Nurse, you’ll be an integral part of the interdisciplinary team and as such is responsible for the excellent delivery of care through triage calls after hours and on holidays. Must be available to work weekends. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Required Qualifications: Current, unrestrictive Registered Nurse licensed in all states of practice 2+ years of RN experience 1+ years of direct patient care in a hospice, home health, or oncology setting Demonstrated ability to work flexible hours and independently Preferred Qualification: Registered Nurse Compact licensure

Receive calls from patients and/or family members and respond appropriately and assess problems focusing on the delivery of high quality, patient-focused, compassionate care Assess patient status and intervene as indicated by the patient’s condition and established protocols Timely and accurate documentation of calls received within the electronic medical records system including the processing of workflow associated with the clinical record Knowledge of basic triage protocols and best practices to guide and address the needs of patients in a crisis situation Coordinating with the agency on-call nurses to deliver high quality nursing care and schedule nursing assessments as required in a timely manner to meet the needs of the patients and families Ensure appropriate education regarding all updates/processes in the electronic medical record, relative state and federal regulations, documentation processes and needs, etc. by attending mandatory educational offerings and in-services Facilitates orientation of new personnel as assigned Exhibits exemplary and timely communication skills when assessing or educating patients/caregivers, performing telephone triage, or collaborating with fellow healthcare professionals Serves as a consistent example of dedication to patient advocacy, customer service, integrity, and superlative nursing pract

Optum

Call Center Nurse RN - Part-Time

Posted on:

February 3, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Wisconsin

Explore opportunities with Optum, in strategic partnership with ProHealth Care. ProHealth Care is proud to be a leader in health care services, serving Waukesha County and the surrounding areas for more than a century. Explore opportunities across the full spectrum of care as you help us improve the well-being of the community with your skills, compassion and innovation. Be part of a collaborative environment that strives for excellence, nurtures respect and ensures high-quality care delivery to our patients. Join us in making an impact as an Optum Team Member supporting Pro Health Care and discover the meaning behind Caring. Connecting. Growing together.

Positions in this function require various nurse licensure and certification based on role and grade level. Licensure includes RN, depending on grade level, with current unrestricted licensure in applicable state. Roles are responsible for providing telephonic clinical assessments utilizing approved medical protocols per policy and recommending an appropriate level of clinical care based on clinical judgment and protocols. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. There are two schedules for this position: Schedule 1: Sunday, 10AM - 2PM CST, Monday, 7AM - 1PM CST, Tuesday, 7AM - 12PM CST, Wednesday 7AM - 12PM CST (20 hours) Schedule 2: Saturday, 10AM - 2PM CST, Monday, 1PM - 7PM CST, Tuesday, 2PM - 7PM CST, Friday, 2PM - 7PM CST (20 hours)

Required Qualifications: Associate's degree in nursing Current, unrestricted RN licensure (include state specific license) RN licensure in the state of Illinois (To be obtained within first 3 months of hire) 3+ years of clinical experience 2+ years of experience with telephonic triage Preferred Qualifications: Bachelor's degree in nursing (BSN) Experience with patient scheduling/coordination All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Analyzes and investigates Provides explanations and interpretations within area of expertise Uses pertinent data and facts to identify and solve a range of problems within area of expertise Investigates non-standard requests and problems, with some assistance from others Works exclusively within a specific knowledge area Prioritizes and organizes own work to meet deadlines Provides explanations and information to others on topics within area of expertise Assess patient's health status and recommend care based on clinical judgment and protocols Identify potential care and/or provider gaps Coach consumers on treatment alternatives Coordinate services and referrals to health programs and community services Assesses and triage immediate health concerns

Optum

Clinical Documentation Improvement Specialist

Posted on:

February 3, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

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 Document Improvement Specialist (CDS) is responsible for providing CDI program oversight and day to day CDI implementation of processes related to the concurrent review of the clinical documentation in the inpatient medical record of Optum clients' patients. The goal of the CDS oversight and practice is to support the CDI manager function by providing staff oversite, serve as an additional resource as well as perform CDI role function. The CDS assess the technical accuracy, specificity, and completeness of provider clinical documentation, and to ensure that the documentation explicitly identifies all clinical findings and conditions present at the time of service. This position collaborates with CDI managers, providers and other healthcare team members to make improvements that result in accurate, comprehensive documentation that reflects completely, the clinical treatment, decisions, and diagnoses for the patient. The CDS utilizes clinical expertise and clinical documentation improvement practices as well as facility specific tools for best practice and compliance with the mission/philosophy, standards, goals and core values of Optum. This position does not have patient care duties, does not have direct patient interactions, and has no role relative to patient care. This position is fully remote with the ability to work Monday - Friday 8 AM - 5 PM PST.

Required Qualifications: Associate Degree in Nursing (or higher) 5+ years of acute care hospital clinical RN experience OR Foreign Medical Graduate with CDI experience 2+ years of experience in clinical documentation improvement 2+ years of experience communicating & working closely with Physicians Intermediate level of proficiency using a PC in a Windows environment, including Microsoft Word, Excel, Power Point and Electronic Medical Records Preferred Qualifications: BSN degree or Foreign Medical Graduate CCDS, CDIP or CCS certification Experience in case management and/or critical care Ability to lead projects with complex responsibilities and timelines Leadership experience All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Provides expert level review of inpatient clinical records within 24-48 hours of admit; identifies gaps in clinical documentation that need clarification for accurate code assignment to ensure the documentation accurately reflects the severity of the patient condition and acuity of care provided Conducts daily follow-up communication with providers regarding existing clarifications to obtain needed documentation specificity Provides expert level leadership for overall improvement in clinical documentation by providing proficient level review and assessment, and effectively articulating recommendations for improvement, and the rational for the recommendations Actively communicates with providers at all levels, to clarify information and to communicate documentation requirements for appropriate diagnoses based on severity of illness and risk of mortality Performs regular rounding with unit-based physicians Provides face-to-face educational opportunities with physicians on a daily basis Provides complete follow-through on all requests for clarification or recommendations for improvement Leads the development and execution of physician education strategies resulting in improved clinical documentation Provides timely feedback to providers regarding clinical documentation opportunities for improvement and successes Ensures effective utilization of the Midas Clinical Documentation Improvement Focus Study, documenting all verbal, written, electronic clarification activity Utilizes only the Optum approved forms, whether paper or electronic Proactively develops a reciprocal relationship with the HIM Coding Professionals Coordinate and conduct regular meetings with HIM Coding Professionals to monitor retrospective query rate and address issues Engages and consultations with Physician Advisor when needed, per the escalation process, to resolve provider issues regarding answering clarifications and participation in the clinical documentation improvement process Actively engages with Care Coordination and the Quality Management teams to continually evaluate and spearhead clinical documentation improvement opportunities

UnitedHealthcare

HSS Care Coordinator, RN - Healthy First Steps - Remote in TX

Posted on:

February 3, 2026

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.

You push yourself to reach higher and go further. Because for you, it’s all about ensuring a positive outcome for patients. In this role, you’ll work in the field and coordinate the long-term care needs for patients in the local community. And at every turn, you’ll have the support of an elite and dynamic team. Join UnitedHealth Group and our family of businesses and you will use your diverse knowledge and experience to make health care work better for our patients. In this Health and Social Services Coordinator role, will be an essential element of an Integrated Care Model by relaying the pertinent information about the member needs and advocating for the best possible care available, and ensuring they have the right services to meet their needs. If you are located in Texas, preferably in the Central Texas Waco area, you will have the flexibility to work remotely* as you take on some tough challenges.

Required Qualifications: Current RN unrestricted license in the State of TX 2+ years of experience working within the community health setting or in a health care role 1+ years of experience working with Maternal and Infant population/Neonatal Intensive Care Unit (NICU) Demonstrated familiarity with Microsoft Office, including Word, Excel, and Outlook Access to reliable transportation and the ability to travel in this ‘assigned region’ 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 Preferred Qualifications: Proven knowledge of the principles of most integrated settings, including federal and State requirements like the federal home and community-based settings regulations Demonstrated ability to create, edit, save and send documents, spreadsheets and emails Reside in the Central Texas Waco area

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, lease 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 Make outbound calls and receive inbound calls to assess members’ current health status Identify gaps or barriers in treatment plans

UnitedHealthcare

Secondary Review Nurse - Remote in Kansas

Posted on:

February 3, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Kansas

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.

As a Secondary Review Nurse, you will be conducting a review of long-term support services (LTSS) for the United Healthcare Community Plan of Kansas population. This nurse will work with the service coordination teams to ensure that the LTSS services align with the state guidelines along with the policies and procedures of the health plan. Additionally, this nurse will track various reporting elements for analysis and trending along with serving as a resource to others. The Secondary Review team consists of nurses and technicians within the plan. Hours are Monday – Friday 8am – 5pm. If you are located within the state of Kansas, you will have the flexibility to work remotely* as you take on some tough challenges.

Required Qualifications: Current, unrestricted RN license in the state of Kansas 2+ years of experience working with the needs of vulnerable populations who have chronic or complex bio-psychosocial needs 1+ years of experience working with people receiving services on one of the homes and community-based waivers in KS 1+ years of Medicaid, Medicare, or Managed Care experience in long-term care, Long Term Services and Supports, home health, hospice, behavioral health, public health or assisted living 1+ years of computer experience, including experience with email, internet research, enter/retrieve data in electronic clinical records, use of online calendars and other software applications Preferred Qualifications: Knowledge of community resources Strong written and verbal communication skills Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action

Review technical metrics/specifications/ measures Evaluate documentation of Functional Assessment, compare to adherence to form instructions. Review and compare to prior assessment for changes. Provide recommendations to SC completing assessment if areas of opportunity exist Follow relevant regulatory guidelines, policies and procedures in reviewing clinical documentation (e.g., HEDIS, Clinical Practice Guidelines, HCC) Review relevant HEDIS specifications to guide chart review Review/ interpret/ summarize medical records/data to address quality of care questions Review provider responses to reports/findings and correlate with medical records Verify necessary documentation is included in medical records Maintain HIPAA requirements for sharing minimum necessary information Based on review of clinical data/documentation, identify potential quality of care issues (e.g., variations from standard practice potentially resulting in adverse outcomes) and potential fraud/waste/abuse Solve moderately complex problems and/or conduct moderately complex analyses Work with minimal guidance; seeks guidance on only the most complex tasks. Translate concepts into practice Provide explanations and information to others on difficult issues Coach, provides feedback, and guide others while acting as a resource for others with less experience

TridentMedical

Remote Nurse Pracitioner

Posted on:

February 3, 2026

Job Type:

Part-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Maine

At Trident Medical, we firmly believe in the power of collaboration and the value of building strong relationships. As we continue to expand and explore new opportunities, we are keen to connect with forward-thinking people like you that share our vision for advancing healthcare. By collaborating with Trident Medical, you will have the opportunity to tap into our extensive resources, expertise, and industry-leading practices. Our organization boasts state-of-the-art medical facilities, a highly skilled workforce, and a strong track record of successful patient outcomes. Through working with Trident Medical, you can gain valuable insights, access new markets, and explore potential areas of collaboration that can mutually benefit both organizations.

We are seeking a highly skilled and adaptable Remote Nurse Practitioner licensed in MAINE to join our healthcare team. This position offers the opportunity to provide comprehensive patient care through telehealth platforms, utilizing extensive clinical expertise across various specialties. The ideal candidate will have experience with diverse medical procedures, EMR systems, and a strong understanding of patient assessment and documentation. This role requires excellent communication skills, critical thinking, and the ability to manage complex cases remotely while maintaining compliance with HIPAA and other healthcare regulations.

Skills: Extensive telehealth experience with proficiency in EMR/EHR systems such as RXNT, Epic Strong knowledge of physiology, anatomy, pharmacology (including psychopharmacology), and clinical procedures such as phlebotomy, venipuncture, oxygen therapy (ventilator management), gastric lavage, spinal tap, and sterile processing techniques. Experience in specialized areas including critical care (ICU), emergency medicine (ER), urgent care settings, dialysis management, hospice & palliative medicine, behavioral health, geriatrics (including Alzheimer’s/dementia care), pediatrics (including neonatal ventilator management), occupational health, internal medicine, family planning, and post-acute care. Ability to perform patient assessments involving vital signs monitoring and physical examinations remotely while ensuring compliance with HIPAA standards. Familiarity with medical documentation requirements for ICD coding (ICD-9/10), CPT coding for procedures like dermal fillers or cardiac catheterization. Competence in managing complex cases involving airway management or tube feeding; experience with medical imaging interpretation is a plus. Excellent communication skills for effective patient education and collaboration within multidisciplinary teams. Knowledge of infection control practices and aseptic techniques applicable in remote or hybrid healthcare environments. This position is ideal for dedicated nursing professionals seeking a flexible remote role that leverages their broad clinical expertise across multiple specialties while providing exceptional patient care through innovative telehealth solutions.

Conduct thorough patient assessments via telehealth consultations, medical history, and symptom evaluation. Manage a wide range of clinical cases including acute pain management, chronic disease follow-up, behavioral health, geriatrics, pediatrics, and post-acute care. Administer injections, IV infusions, catheterizations, and perform basic suturing when necessary. Utilize EMR and EHR systems such as Epic, Cerner, eClinicalWorks, and Athenahealth to document patient encounters accurately and efficiently. Coordinate discharge planning, case management, and utilization review to optimize patient outcomes. Provide health coaching and education tailored to individual patient needs across diverse populations including assisted living residents, hospice patients, and those with developmental disabilities or memory care requirements. Assist in diagnostic evaluations involving laboratory experience, medical imaging interpretation, sonography, and specimen collection/processing. Support infection control protocols and aseptic techniques in virtual settings when applicable. Collaborate with multidisciplinary teams.

WJM Professional Services LLC

Telehealth RN I

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

WJM Professional Services, LLC is a leading healthcare management firm with 20 years of experience providing healthcare personnel, and administrative staffing services to government agencies, including the Defense Health Agency, the United States Air Force, Army, Navy, Coast Guard, National Guard, and the Department of Veterans Affairs.

We are currently recruiting for a Telehealth Registered Nurse I.

Qualifications: Minimum associate’s degree in nursing from an accredited nursing school. Minimum 0-1 year of nursing experience in a clinical or telehealth setting. Must have an active RN license in all 50 states (Enhanced Nursing Licensure Compact). Must be willing to obtain RN license in the non-compact states. Must pass WJM criminal history background check. Resume Requirements: Educational qualifications Career history and relevant experience Certifications, licensure, and credentials Professional references (organization name, contact person, phone number, and address)

Telehealth RNs will provide all eligible MHS beneficiaries with clinical advice based on the Schmitt-Thompson Protocols or equivalent telehealth nursing standards, protocols, or guidelines, coupled with each RN’s professional experience and judgement, to ensure MHS beneficiaries receive high quality nurse triage services. Provide basic telehealth consultations. Assist with remote monitoring of patients under the supervision of more senior staff. Educate patients about routine health management.

Molina Healthcare

IRIS Self-Directed Personal Care (RN) (Milwaukee County, WI)

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Wisconsin

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

IRIS SDPC (RN) (HOME BASED, NO WEEKENDS/NO AFTER HOURS) Home Health Care, Hospice Care, Palliative Care, Long Term Care, Rehab No weekends, No afterhours support, No holidays Job Summary: Are you seeking a unique nursing position that gives you a great work/life balance and lets you support people to live the lives that they choose? Then you’ll want to keep reading about this rewarding work opportunity! We are currently looking for a Registered Nurse licensed in Wisconsin to become our next IRIS Self-Directed Personal Care (SDPC) RN. This is a remote position, where you will partner with people in your community who are enrolled in the Wisconsin IRIS program – a Medicaid long-term care option for older adults and people with disabilities. People in the IRIS program who need personal care services have the choice to enroll in the IRIS Self-Directed Personal Care (IRIS SPDC) option. You can learn more about IRIS SDPC on the Wisconsin Department of Health Services website here, and learn about the IRIS program here. While this role is home-based, you will have regularly scheduled visits with people in their homes and communities. As an IRIS SDPC RN, you’ll provide oversight and guidance to the people enrolled in the IRIS SDPC option. You’ll also build relationships with the people you partner with and ensure that they’re getting the most out of the IRIS Self-Directed Personal Care option through assessment, oversight, training and education. IRIS SDPC RNs are responsible for administering the Wisconsin Personal Care Screening Tool; creating person-centered plans of care; providing personal care oversight to a group of people in IRIS, providing education and training for IRIS participants and care providers, and conducting the required documentation and follow-up. As an IRIS SDPC RN, you’ll play an important role in helping people of various backgrounds and abilities live their lives the way they choose.

Required Qualifications: At least 2 years nursing experience, and at least 1 year of experience serving the target groups of the IRIS program (adults with physical/intellectual disabilities or older adults), or equivalent combination of relevant education and experience. Active and unrestricted Registered Nurse (RN) license in the state of Wisconsin. Associate's degree in nursing. Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements unless otherwise required by law. Database operation/maintenance skills and data entry experience. Teaching and mentoring skills. Analytical and problem-solving skills. Strong organizational and time-management skills, and ability to manage tasks independently. Flexibility in the work environment, and willingness and ability to adapt to changing organizational needs. Strong written and verbal communication skills. Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications: Experience providing care through the Wisconsin Medical Assistance Personal Care program (MPAC). Home care/home health experience.

Provides personal care assessments and oversight to the My Cares Groups by administering the Wisconsin Personal Care Screening Tool and addendums as required Documents assessment as required by individual tool and Department of Health Services policies and by completing oversight visits and calls as required Oversees a My Cares Groups of participants, develops individual plans of care, ensures physician orders for care are obtained and reviews and revises plan of care as needed Submits for Prior Authorization for personal care services Complies with all Department of Health Services policies and SDPC Guidelines, procedures, and practices along with documentation and program regulations Provides personal care training to participants or care providers as requested and provides educational materials as needed Completes collateral contacts with IRIS Consultants and Long-Term Care Functional Screeners and physicians to ensure care needs are met Completes other duties as assigned Overtime work may be required May be required to drive 50% of the time during a given day of member home visits Exposure to members homes which may include navigating stairs, exposure to different environments, and pets

CVS Health

MinuteClinic Virtual Care Nurse Practitioner - Overnight Shift

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Michigan

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

This is a 32 hour/week, fully remote position. The hours for this overnight shift are 8p - 7a, including every other weekend. Qualified candidates must be FNP-certified in at least one of the following states: AL, AR, CO, IA, ID, IN, LA, MI, MS, NE, NV, OK, TN, TX The MinuteClinic Telehealth Nurse Practitioner (Provider) delivers patient care services through a remote technology platform. You will work in collaboration with a dedicated team of professionals as you independently provide holistic, evidenced based care inclusive of accurate assessment, diagnosis, treatment, management of health problems, health counseling, and disposition planning for our patients ranging in age 18 months and above. Encounters are documented utilizing an electronic health record (EHR). MinuteClinic Telehealth providers report directly to the Enterprise Initiative Lead.

WORKING ENVIRONMENT: Dedicated virtual care providers must meet minimum requirements for remote care delivery, including: broadband connectivity, a quiet setting with a neutral background to conduct visits from, and the ability to uphold patient privacy per CVSH guidelines. While performing the duties of the job, the employee is regularly required to interact with customers in a remote manner, site, write, operate the computer and phone, speak intelligibly, and hear patient responses. Specific vision abilities include the ability to view and read a computer screen and other electronic devices. Qualified candidates must hold a current, unrestricted license in one of the following states to meet minimum qualifications for this position: AL, AR, CO, IA, ID, IN, LA, MI, MS, NE, NV, OK, TN, TX. Provider selected for the position must willing and able to obtain additional licensure in requested states. A minimum of high speed/broadband internet connectivity with a download speed of at least 25 download and 3 upload speed. Minimum of two years of medically-relevant experience or equivalent Effective verbal, written, and electronic communication skills Outstanding organizational skills and ability to multi-task Initiative, problem solving ability, adaptability and flexibility Ability to work without direct supervision and practice autonomously Is proficient with information management and technology Capacity to collaborate with professional colleagues as necessary to provide quality care Depending on the market, the ability to be proficient in both speaking and writing in additional languages not limited to but including Spanish may be required Education: Completion of a Master’s Degree level Family Nurse Practitioner program with current National Board Certification and State of Employment license to practice in the Advanced Practice Nurse role required.

Provide holistic, evidenced based care inclusive of accurate assessment, diagnosis, treatment, management of health problems, health counseling, and disposition planning for our patients. This includes education and treatment for pregnancy prevention, STI Prevention and safer sex practices. Evaluate primary care, acute, chronically ill, and transitional care patients, in addition to providing healthcare education and counseling, and disposition planning for our patients ranging in age 18 months and above. Provide patient counseling; inclusive of pregnancy prevention, STI Prevention/safer sex practices, contraceptive care counseling and medication management Educate patients on health maintenance and respond to patient care inquiries Document all patient care within an EHR according to MinuteClinic policies and procedures Provide care and coordination of our patients with internal and external colleagues, including the broader patient centered medical home, ensuring the highest standard of care is provided for all patients. Effectively work within a patient care team, including fellow Providers, Collaborative Physicians, paraprofessionals, Pharmacists and other members of the health care team Work independently , prioritize and solve problems, take initiative, and advocate for their patients and their practice

TECQ Partners

Medical Management Nurse 1

Posted on:

February 2, 2026

Job Type:

Part-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

Texas

Reporting to the Medical Management Director. The title of this role is Medical Management Nurse. The role required a current and unrestricted Registered Nurse (RN) or Licensed Vocational Nurse (LVN) license, with TX licensure required within six (6) months of employment. This is a part time role requiring coverage for each Saturday, Sunday and holidays. Hours of operation are 9AM CST to 3PM CST. Additional coverage to meet department needs may be scheduled as mutually agreed upon. The nurse shall facilitate the timely processing of authorization requests, after verification of eligibility and make certain that clinical information is provided to support a timely review determination. This position requires working knowledge of UM Criteria, including Medicare National Coverage Determinations (NCD) and Local Coverage Determination (LCD) criteria and guidelines, Health Plan criteria, Milliman Care Guidelines (MCG), ICD.9/10, CPT Coding and Medical Terminology.

Experience: Minimum of two (2) years of experience as a nurse, in a hospital, skilled facility, doctor’s office or managed healthcare delivery organization Minimum of one (1) year of experience in UM in a medical group, health plan or other managed care organization Qualifications: Current and unrestricted Registered Nurse or Licensed Vocational Nurse license. Evidence of a valid TX license required six months from hire date. Current knowledge of State and CMS regulations Knowledge of UM principles and standards Excellent verbal and written communication skills. Computer literate and comfortable with electronic documentation systems This position, along with team members within assigned departments and across the organization, fosters an engaging and professional environment committed to respect, inclusivity, continuous improvement, and teamwork. The position works within policies and procedures, related to the department and organization, and supports efforts needed for organizational growth, proposal developments, fiscal management, and monitoring, reporting and analysis, and support compliance with local, state, and federal regulations as well as regulatory, controlling, and licensing agencies.

Following established departmental processes and guidelines, the MM Nurse 1 reviewer reviews authorizations and applies specific medical necessity guidelines for approval of requests. Review on a concurrent basis, ongoing care at the acute, skilled, home care levels to determine appropriateness of continued care at the current level of care Make certain that all referrals are processed in a timely manner and support compliance with appropriate turnaround timeframes Responsible for checking the referral for completeness of supporting clinical information and obtaining missing medical records or clinical information as needed in support of a thorough review and appropriate review outcome. Responsible for meeting accuracy standards for appropriate authorizations of referrals. Utilize and apply medical necessity criteria based on the organization’s established hierarchy When unable to approve the authorization, prepares information to be sent to the UM Medical leader for further review and determination. Support compliance with applicable laws, regulations, procedures, and policies.

BlueCross BlueShield of South Carolina

LPN Medical Reviewer (Myrtle Beach, Remote after 6 months)

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

Compact / Multi-State

Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits or services, and appeals. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. Logistics: PGBA - one of BlueCross BlueShield of South Carolina's subsidiary companies. Government Clearance: This position requires ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.

Required Education: Bachelor's degree - Social Work, OR, Graduate of an Accredited School of Licensed Practical Nursing or Licensed Vocational Nursing. Required Experience: 2 years clinical experience. Required Skills and Abilities: Working knowledge of word processing software. Good judgment skills. Demonstrated customer service and organizational skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Ability to remain in a stationary position and operate a computer. Required Software and Tools: Microsoft Office Required Licenses and Certificates: Active, unrestricted LPN/LVN licensure from the United States and in the state of hired, OR, active compact multistate unrestricted LPN license as defined by the Nurse Licensure Compact (NLC), OR, active, unrestricted LBSW (Licensed Bachelor of Social Work) licensure from the United States and in the state of hire. We Prefer that You have the Following: Preferred Education: Associate Degree- Nursing OR Graduate of an Accredited School of Nursing. Preferred Skills and Abilities: Working knowledge of spreadsheet and database software. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. Preferred Software and Others Tools: Knowledge of Microsoft Excel, Access, or other spreadsheet/database software. Preferred Licenses and Certificates: Active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).

May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes a reasonable charge payment determination. Monitors process's timeliness in accordance with contractor standards. Performs authorization process, ensuring coverage for appropriate medical services within benefit and medical necessity guidelines. Utilizes allocated resources to back up review determination. Reviews interdepartmental requests and medical information in a timely/effective manner in order to complete utilization process. May conduct/perform high dollar forecasting research and formulate overall patient health summaries with future health prognosis and projected medical costs. Performs screenings/assessments and determines risk via telephone. Reviews/determines eligibility, level of benefits, and medical necessity of services and/or reasonableness and necessity of services. Provides education to members and their families/caregivers. Reviews first level appeal and ensures utilization or claim review provides thorough documentation of each determination and basis for each. Conducts research necessary to make thorough/accurate basis for each determination made. Educates internal/external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. in accordance with contractor guidelines. Responds accurately and timely with appropriate documentation to members and providers on all rendered determinations. Participates in quality control activities in support of the corporate and team-based objectives. Participates in all Required Licenses and Certificates.

Network Health, Inc

Weekend RN Coordinator Utilization Management

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

Founded in 1982, Network Health is locally owned by Froedtert ThedaCare Health and is the largest provider-owned Medicare Advantage plan in Wisconsin, serving both employer groups and individuals. We collaborate with our provider-owners to give members access to high-quality coordinated care. When you call us, we don’t bombard you with health insurance jargon. We talk like people, not insurance dictionaries. Being local allows us to focus on our mission of creating healthy and strong Wisconsin communities. We care about making our home a better place to live. In 2026, Network Health Medicare Advantage PPO plans earned a 5 Star Rating for customer service for the fifth consecutive year. For 2026, Network Health earned an overall 4.5 out of 5 Star Rating for its Medicare Advantage Prescription Drug PPO plans from the Centers for Medicare & Medicaid Services (CMS).

The Registered Nurse Care Manager provides case management services that are member-centric and include assessment, planning, facilitation, care coordination, evaluation and advocacy to all members across the healthcare continuum. The Care Manager advocates for options and services to meet an individual’s and family’s comprehensive health needs through communication and coordination of available resources to promote quality, cost-effective outcomes. Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha is required occasionally for the position, including on first day. Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Monday through Friday Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Graduation from accredited school of nursing Bachelor’s degree in Nursing preferred RN licensure in the State of Wisconsin Case Management certification preferred Four years of clinical health care experience as a RN required Previous experience in case management, utilization management, insurance, or managed care preferred Experience with Medicare, Medicaid preferred

Screen candidates for case management and when appropriate completes assessments, care plans with prioritized goals, interventions, and timeframes for re-assessment using evidence-based clinical guidelines. Evaluate and determine member needs based on clinical or behavioral information such as diagnosis, disease progression, procedures and other related therapies Review results from medical or behavioral tests and procedures and updates care plan to reflect progress towards goals; close cases when expected goals/outcomes are achieved Provide information and outreach regarding case or condition management activities to members, caregivers, providers and their administrative staff Evaluate and process member referrals from physicians to other specialty providers Assess, plan, facilitate and advocate for individuals to identify quality, cost effective interventions services and resources to ensure health needs are met Works with members and families on self-management approaches using coaching techniques such as motivational interviewing Educate the individual, his/her family and caretakers about case and condition management, the individual’s health condition(s), medications, provider and community resources and insurance benefits to support quality, cost effective health outcomes. Facilitate the coordination, communication and collaboration of the individual’s care among his/her providers including tertiary, non-plan providers and community resources with the goal of controlling costs and improving quality. Schedule visits with the individual and participates in facility-based care conferences as appropriate to ensure quality care, appropriate use of services, and transition planning. Stay abreast of current best practices and new developments Other duties as assigned

Inova Health System

Registered Nurse (RN) Clinical Documentation Denials Auditor

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Virginia

We are Inova, Northern Virginia’s leading nonprofit healthcare provider. Every day, our 26,000+ team members provide world-class healthcare to the communities we serve. Our people are the reason we're a national leader in healthcare safety, quality and patient experience. And from best-in-class facilities to professional development opportunities, we support them at every step. At Inova, we're constantly striving to be ever better — to shape a more compassionate future for healthcare.

Inova Health is looking for a dedicated Registered Nurse (RN) Clinical Documentation Denials Auditor to join the team. This role will be fully-time remote, Monday-Friday, regular business hours 8:00 AM – 4:30 PM (flexible). Inova is consistently ranked a national healthcare leader in safety, quality and patient experience. We are also proud to be consistently recognized as a top employer in both the D.C. metro area and the nation. Featured Benefits: Committed to Team Member Health: offering medical, dental and vision coverage, and a robust team member wellness program. Retirement: Inova matches the first 5% of eligible contributions – starting on your first day. Tuition and Student Loan Assistance: offering up to $5,250 per year in education assistance and up to $10,000 for student loans. Mental Health Support: offering all Inova team members, their spouses/partners, and their children 25 mental health coaching or therapy sessions, per person, per year, at no cost. Work/Life Balance: offering paid time off, paid parental leave, flexible work schedules, and remote and hybrid career opportunities. Remote Eligibility: This position is eligible for remote work for candidates residing in the following states – VA, MD, DC, DE, FL, GA, NC, OH, PA, SC, TN, TX, WV

Minimum Qualifications: Certification: Certified Coding Specialist / Certified Clinical Documentation Specialist; ACDIS/AHIMA certification, CCDS or CDIP Licensure: Current RN license and eligible to practice in VA Experience: Seven years of recent CDI, DRG validation or coding audit experience in an acute hospital setting with clinician training as RN, BSN, NP, PA or MD; Coding certification CCS and CDI certification CCDS or CDIP Education: Associate Degree in Nursing or Medicine. Preferred Qualifications: Experience: Must have: CDI, DRG, and Coding audit experience. Recent coding experience. Clinical background and coding + denials knowledge. Experience writing denials & appeals. Outpatient and/or inpatient experience. Knowledge to identify clinical indicators (example: sepsis). EPIC experience. Certifications: CCDS Skills: presenting

Evaluates specificity and completeness of physician documentation to ensure optimal coding (e.g. mortality outcomes using APR-DRG, SOI and ROM, appropriate reduction of complications based on PSI and HAC, revenue assurance outcomes based on reimbursement DRG (MS-DRG), documentation of significant chronic conditions affecting resource utilization based on HCC). Summarizes audit findings for individual records along with specific documentation guidelines to improve expected clinical outcomes for an individual physician, physician practice, or specialty. Conducts follow-up audits (i.e. concurrent or post-discharge) with routine feedback until documentation practice comes into line with expected clinical outcomes. Works with Clinical Documentation Improvement (CDI) Director and Lead Auditor on other work related to physician audits and education programs. Demonstrates proficiency with Cobius to access external audit work, record summary results and upload appeal letters. Demonstrates proficiency with Encompass 360 and HDM audit functions to review electronic medical records with advanced functions (i.e. ex, auto-suggest and search) and record detail coding audit results. Showcases proficiency in reviewing records in Epic electronic medical records – which may be the only option for audits of older records. Demonstrates proficiency in writing effective appeal letters that include appropriate coding guidelines and medical references. Identifies trends in external audit findings related to coding quality and physician documentation. Prepares educational communications related to these findings. Evaluates physicians' documentation, diagnostic reports, and clinical findings for validation of diagnoses. Processes the requests for second opinion reviews when clinical validity is not supported or in question. May perform additional duties as assigned.

VIllageCare of New York

RN- Care Manager (Bilingual)

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

New York

VillageCare is a community-based, non-profit organization serving people with chronic care needs, as well as seniors and individuals in need of continuing care and rehabilitation services. VillageCare provides care and services for more than 12,000 unique individuals annually through its residential and community programs. Guided by the people we serve, we provide leadership to improve the health and quality of life of the diverse communities we serve and the quality of care and well-being of the people we serve.

Must reside within the New York Tri-State Area - NY, NJ, or CT. Join our team at Village Care as a Full Time RN- Care Manager! This exciting position offers the opportunity to work remotely, providing care and support to our members in the greater NYC area. As an integral part of our team, you will have the chance to showcase your nursing expertise while managing the care needs of our diverse patient population. With a competitive salary ranging from $95,000 to $105,000, this role provides a rewarding opportunity to make a real difference in the lives of others. Don't miss out on this chance to be part of a dynamic and customer-centric organization that values excellence and integrity. As a team member you'll be able to enjoy benefits such as a generous PTO package, 10 Paid Holidays, Personal and Sick time, Medical/Dental/Vision, HRA/FSA, Education Reimbursement, Retirement Savings 403(b), Life and Disability, Commuter Benefits, Paid Family Leave, and Additional Employee Discounts. Apply now and take the next step in your nursing career! Must reside within the New York Tri-State Area - NY, NJ, or CT.

To excel in the role of Care Manager at Village Care, candidates must possess a valid NYS RN License and a minimum of 3 years of relevant experience in Managed Care, Home Care, or Community settings. An Associate's degree or higher is required for this position. Successful applicants will demonstrate a passionate attitude, exceptional communication skills, and strong problem-solving abilities. Bilingual proficiency is essential, with a particular focus on languages such as Korean, Bengali, Cantonese, Mandarin, Spanish, Russian, or Creole. The ability to effectively navigate and utilize various software and tools relevant to care management is a key requirement for this role.

As a Care Manager at Village Care, you will play a crucial role in all aspects of care management, including care planning, coordination, and health assessments. Monitoring the quality and effectiveness of services, you will track progress towards individual goals and ensure the highest level of care for our patients. Your responsibilities will also involve overseeing transitions for patients, facilitating smooth discharge planning from hospitals or nursing homes. By identifying health, environmental, and psychosocial risks, you will recommend and implement interventions in collaboration with the Interdisciplinary Care team. This position offers a dynamic opportunity to make a significant impact on the well-being of our diverse patient population while working remotely in a customer-centric environment.

NavitasPartners

Registered Nurse – Rural / Remote Care

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Alaska

Registered Nurse – Rural / Remote Care Location - Hoonah, AK Pay Range - $100,000 to $115,000 Yearly Job Summary: The Registered Nurse provides comprehensive nursing care to patients across the lifespan, from infants to geriatric populations, in a rural and remote healthcare setting. This role includes primary care, urgent and emergent after-hours services, and expanded responsibilities typical of remote practice environments. The RN functions independently, utilizing strong clinical judgment, adaptability, and problem-solving skills to ensure safe, high-quality patient care.

Education, Certifications & Licensure: Active, unrestricted Registered Nurse (RN) license in a U.S. state (state licensure eligibility required prior to start). Graduate of an accredited nursing program (BSN, ADN, or Diploma). Basic Life Support (BLS) required. ACLS and PALS required within one year of hire. Completion of employer-provided limited radiology training required. Clinical competency validation within required timeframes. High-risk competency validation within required timeframes. High school diploma or equivalent required. Experience Requirements: Minimum 6 months ambulatory or outpatient nursing experience plus: 1 year of general RN experience following BSN completion, or 2 years of general RN experience. Emergency or critical care nursing experience preferred. Knowledge, Skills & Abilities: Knowledge: Nursing care principles, practices, and procedures. Pharmacology, medication effects, side effects, and complications. Acute, chronic, medical, and psychosocial conditions across the lifespan. Skills: Strong clinical assessment and professional nursing skills. Ability to operate and monitor medical and diagnostic equipment. Effective interpersonal and communication skills. Abilities: Ability to work independently in a rural or remote healthcare environment. Ability to recognize adverse patient conditions and intervene appropriately. Ability to develop and coordinate multidisciplinary outpatient care plans. Ability to prioritize care, multitask, and adapt to expanded clinical roles. Physical Requirements: Ability to stand, walk, sit, bend, stoop, kneel, crouch, and reach as required. Ability to lift and/or move up to 50 lbs. Ability to perform hands-on patient care and operate clinical equipment.

Clinical Care & Patient Management: Provide professional nursing care using the nursing process to meet patients’ physical, emotional, spiritual, and socio-cultural needs. Perform comprehensive patient assessments, develop individualized plans of care in collaboration with providers, and evaluate outcomes. Identify, assess, and respond rapidly to life-threatening and emergent conditions. Administer medications and therapeutic treatments in accordance with provider orders, clinical protocols, and scope of practice. Document assessments, interventions, education, and care coordination activities accurately and timely in electronic health systems. Perform patient triage, including non-routine and urgent care assessments, and direct patients to appropriate levels of care. Extended Scope Responsibilities (Rural Setting): Support moderate-complexity laboratory services, including phlebotomy, specimen handling, quality control, documentation, and shipping. Perform respiratory care functions such as nebulizer treatments, oxygen therapy, pulmonary function testing, peak flow testing, and 12-lead EKGs. Assist with basic radiology functions including image registration, documentation, film handling, and system uploads as required. Participate in case management activities, including care coordination, referral support, and care planning in collaboration with providers. Maintain a clean, safe, and aseptic clinical environment and ensure adequate medical and nursing supplies. Professional Practice & Teamwork: Demonstrate initiative and the ability to work independently during periods of variable patient volume. Communicate effectively with patients, families, providers, and support services to ensure continuity of care. Utilize sound judgment, critical thinking, and decision-making skills in daily clinical operations. Provide guidance and informal leadership to other nursing or clinical support staff as needed. Adhere to safety, infection control, and quality standards at all times.

Parallon

Cardiovascular Data Abstractor II Part Time

Posted on:

February 2, 2026

Job Type:

Part-Time

Role Type:

License:

RN

State License:

Texas

Parallon provides full-service revenue cycle management, or total patient account resolution, for HCA Healthcare. Our services include scheduling, registration, insurance verification, hospital billing, revenue integrity, collections, payment compliance, credentialing, health information management, customer service, payroll and physician billing. We also provide full-service revenue cycle management as well as targeted solutions, such as Medicaid Eligibility, for external clients across the country. Parallon has over 17,000 colleagues, and serves close to 1,000 hospitals and 3,000 physician practices, all making an impact on patients, providers and their communities.

As a work from home Cardiovascular Data Abstractor II, you will be responsible for abstraction of data for complex cardiovascular services.

2+ years of experience in Health Information Management; Coding, Nursing, and/or Health Registry abstraction experience required Completion of a certified coding or nursing program strongly preferred RHIT, RHIA, CCS certification strongly preferred LVN or RN preferred Undergraduate degree in a healthcare related field required. Extensive experience (5 years or more) may be considered in lieu of formal education.

Completes abstraction process for assigned facility(ies), including abstraction of cases into the required system (e.g., COMET, TheraDoc, Digital Innovations, NHSN, etc.). Responsible for reviewing medical records to abstract information according to the standards of various regulatory and accreditation agencies (e.g., CMS, TJC, NHSN, etc.). Performs timely abstraction to ensure compliance with standards. Completes edit checks and makes appropriate changes on a timely basis. Follow standards and CSG/Parallon instructions to abstract all reportable cases. Assist with case follow-up as requested. Attend educational activities as approved by Manager or Director. Maintain clinical knowledge of various abstracted measures. Communicate in a timely manner with manager to achieve measure compliance. Submit data timely through the appropriate reporting system. Resolve errors resulting in the rejection of records from the data entry system.

Centene

DRG Reviewer

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

As a Fortune 25 healthcare leader, we’re committed to providing high-quality, accessible care to individuals and families, especially in underserved communities. Our innovative approach integrates physical, behavioral and social services to make a real difference in health outcomes. We value collaboration and are dedicated to excellence, creating an environment where our employee contributions can truly shine. Join us in transforming healthcare and enhancing the well-being of communities across the country.

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: Responsible for independently conducting comprehensive reviews of MS-DRG and APR-DRG coding and clinical documentation to ensure the accuracy of DRG assignment and reimbursement. Requires advanced expertise in ICD-10-CM/PCS coding and the ability to exercise discretion and professional judgment in assessing complex clinical information, validating diagnosis code assignments, and identifying discrepancies such as coding errors or upcoding. Operates with significant autonomy in supporting DRG validation reviews and appeals, interpreting regulatory requirements, and making authoritative decisions to ensure compliance with all applicable laws, payer contracts, and organizational policies.

Associate's Degree in Health Information Management, Nursing, or related field required 4+ years experience of performing MS-DRG and APR-DRG coding required 2+ years experience of performing DRG reviews for a Payment Integrity vendor or Payer required 2+ years experience of using DRG encoder/grouper experience (TruCode/TruBridge, 3M, Optum Encoder, Webstrat, PSI, or similar) required 1+ years experience of inpatient hospital documentation improvement preferred Licenses/Certifications: RHIT - Registered Health Information Technician required or RHIA - Registered Health Information Administrator required or: CCS-Certified Coding Specialist required or: Certified International Credit Professional (CICP) required or: CCDS Certified Clinical Documentation Specialist required or: RN - Registered Nurse - State Licensure and/or Compact State Licensure Registered Nurse or Higher (in combination with a coding credential) preferred

Independently conducts comprehensive MS-DRG and APR-DRG coding and clinical validation reviews, exercising professional judgment to verify ICD-10-CM/PCS assignments, validate clinical diagnoses, identify discrepancies, and apply inpatient reimbursement rules without direct supervision. Collaborates with the Medical Director on complex cases, providing expert recommendations and influencing review outcomes to ensure clinical accuracy and compliance. Leads the evaluation of complex cases and proactively identifies opportunities to develop medical policy in the absence of established guidelines, demonstrating discretion and authority in decision-making. Applies advanced knowledge of coding guidelines and clinical policies throughout the review process, making autonomous determinations regarding coding accuracy and regulatory compliance. Prepares clear, concise, and well-supported audit findings, referencing authoritative sources such as AHA Coding Clinic and ICD-10 guidelines, approved Centene policies, and adopted clinical guidelines, ensuring recommendations reflect professional expertise. Evaluates claims and medical records for compliance with state and federal regulations, payer contracts, and company policies, exercising independent judgment in interpreting requirements and resolving ambiguities. Consistently meets or exceeds established quality and productivity standards while managing priorities and workflow autonomously. Contributes to strategic initiatives by assisting in the development of audit concepts, identifying new audit opportunities, and selecting claims for review, demonstrating leadership in shaping audit methodologies. Performs other duties as assigned. Complies with all policies and standards.

BRC

Nurse Analyst, Nurse Paralegal, Legal Nurse

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Texas

BRC is a professional services firm specializing in the field of accident analysis and injury causation consulting. BRC has also conducted extensive research in the fields of accident reconstruction and biomechanics, with regular publication in peer-reviewed journals.

For the position we are seeking licensed registered nurses with experience as a Nurse Paralegal or Legal Nurse Consultant reviewing digital medical records and preparing medical chronologies. This person’s main responsibilities include objectively organizing, reviewing, analyzing and managing various medical records and producing a chronological summarization that includes complaints, claimed injuries, medical treatment rendered and identification of records not received/to be requested. Work environment is collegial and challenging with a team that includes not only nurses, but also physicians, engineers, paralegals and other professionals. This position is computer based work with no patient interaction and the training and work is done remotely and includes management of multiple cases.

Associate Degree, Bachelor Degree or Masters Degree in Nursing At least four years of hospital nursing experience, with a minimum of two years in acute care such as ER or ICU. (Experience performing medicolegal chronologies may be substituted for this requirement.) Experience as a Nurse Paralegal or Legal Nurse Consultant Proficient in MS word and Typing

BlueCross BlueShield of South Carolina

Medical Reviewer II

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. Logistics: Palmetto GBA – one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This a full-time remote position. You will work an 8-hour shift scheduled during our normal business hours of 8:00 a.m.-5:00 p.m. Monday - Friday. It may be necessary, given the business need to work occasional overtime. Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). As a Service Contract Act (SCA) employee, you are required to enroll in our health insurance, even if you already have other health insurance. Until your enrollment is complete, you will receive supplemental pay for health coverage. Your coverage begins on the first day of the month following 28 days of full-time employment.

Required Education : Associate's in a job-related field. Degree Equivalency: Graduate of Accredited School of Nursing. Required Work Experience: 2 years clinical experience. Required Skills and Abilities: Working knowledge of word processing software. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service and organizational skills. Demonstrated oral and written communication skills. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Required Software and Tools: Microsoft Office. Required Licenses and Certificates: Active RN licensure in state hired, OR, active compact multistate RN license as defined by the Nurse Licensure Compact (NLC).

Performs medical claim reviews for one or more of the following: claims for medically complex services, services that require preauthorization/predetermination, requests for appeal or reconsideration, referrals for potential fraud and/or abuse, correct coding for claims/operations. Makes reasonable charge payment determinations based on clinical/medical information and established criteria/protocol sets or clinical guidelines. Determines medical necessity and appropriateness and/or reasonableness and necessity for coverage and reimbursement. Monitors process’s timeliness in accordance with contractor standards. Documents medical rationale to justify payment or denial of services and/or supplies. Educates internal/external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. in accordance with contractor guidelines. Participates in quality control activities in support of the corporate and team-based objectives. Provides guidance, direction, and input as needed to LPN team members. Provides education to non-medical staff through discussions, team meetings, classroom participation, and feedback. Assists with special projects and specialty duties/responsibilities as assigned by management.

Blue Cross and Blue Shield of North Carolina

Case Manager

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians. Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all. Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

Dependent on clinical discipline, the Case Manager / Health Coach coordinates appropriate care, resources and/or services of selected member populations. Provides guidance and promotes effective utilization and monitoring of health care resources to drive quality care for our members. Collaborates as needed with varied members of the healthcare team to achieve optimal clinical and/or resource outcomes.

RN with 3 years of clinical and/or case management experience required Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties For some roles, additional specialty certification (i.e. CCM, CDCES) may be required. If so, incumbents must obtain relevant certification within 2 years of employment

Serve as a team member on a multidisciplinary team, coordinating care, resources and/or services for members to achieve optimal clinical and resource outcomes. Utilize applicable clinical skillset and perform comprehensive assessments to determine how to best collaborate with members, family, internal partners and external services/providers on plans for treatment, appropriate intervention and/or discharge planning. Develop a member-centric plan tailored to members’ needs, health status, educational status and level of support needs; identify barriers to meeting goals or plan of care Utilize community resources and funding sources as needed in the development of the plan of care. Perform ongoing monitoring and management of member which may include scheduled follow-up with member, discussion of plan with member, appropriate services/education to address needs, appropriate referrals with supporting documentation, assessment of progress towards goals, modification of plan/goals as needed, with contact frequency appropriate to member acuity. Evaluate and facilitate care provided to members through the continuum of care (physician office, hospital, rehabilitation unit, skilled nursing facility, home care, etc). Educate members and encourage pro-active intervention to limit expense and encourage positive outcomes Effectively document all aspects of the plan from the initial assessment, development of the plan, implementation, monitoring, and evaluating outcome. May outreach directly to members identified as high risk, high cost, or high utilization cases. May review alternative treatment plans for case management candidates and assess available benefits and the need for benefits exception or flex benefit options, where eligible. May evaluate medical necessity and appropriateness of services as defined by department. As needed, develop relevant policies/procedures, education or training for use both internally and externally.

Central Dauphin School District

Substitute Nurse Positions

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Pennsylvania

We are seeking a committed and student-centered Registered Nurse to serve as a School Nurse throughout the district. The primary responsibility of this role is to support student learning by promoting and maintaining the health, safety, and well-being of students and staff. The School Nurse implements health strategies, provides direct care, and ensures compliance with state health mandates and district policies. This position plays a vital role in fostering a safe, healthy, and supportive school environment that enables all students to reach their full potential.

Current Pennsylvania Registered Nurse (RN) license. Valid Pennsylvania driver’s license with reliable transportation to travel between locations. Completion and maintenance of certification in the American Red Cross Standard First Aid Course. Ability to meet all state and district requirements for school health personnel. Strong understanding of health as a holistic state of physical, mental, and social well-being. Skill in managing health emergencies and providing appropriate clinical interventions. Hours: Day to Day Substitute

Promote student and staff health and safety through evidence-based school health practices. Provide direct nursing care, first aid, and emergency response in compliance with the School Health Act. Maintain health records and documentation according to Pennsylvania Department of Health and district requirements. Collaborate with administrators, teachers, and families to support student health needs and learning outcomes. Implement and monitor health plans for students with acute or chronic conditions. Assess and manage communicable disease concerns within the school environment. Participate in health screenings and mandated school health programs. Educate students and staff on wellness, disease prevention, and healthy lifestyle choices. Travel to various school locations as needed to provide health services. Perform additional duties consistent with district policy and assigned by school administration. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

QTC Management, Inc.

Medical Quality Assurance Specialist I

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

LPN/LVN

State License:

Pennsylvania

Leidos QTC Health Services collaborates closely with government and non-government customers to address current and future program needs within the health services domain. We specialize in disability-focused medical examinations, independent medical exams and review services, occupational health services, diagnostic testing, and case management solutions. As innovators, we focus on advancing technologies that improve service delivery, with a particular emphasis on enhancing accessibility for examinees in rural communities. With a proven track record of continuous improvement and steady growth, we now handle over 2 million appointments annually. Visit www.qtcm.com for more information.

Do you crave a career that truly makes an impact in people’s lives? Do you thrive on problem-solving and finding solutions? Join a dedicated, tight-knit team that creates an immediate and meaningful impact every day. Leidos QTC Health Services is seeking a Medical Quality Assurance Specialist on our Veteran Affairs Services team. You will work closely with medical providers and the Veterans Administration to ensure the documentation process is complete and accurate. In this role, you will review documentation sent over from medical providers and ensure the report is complete, concise, clear, and correct and the provider has accurately completed the Disability Benefit Questionnaires for delivery back to the VA.

Preferred Qualifications: Allied medical professional certification, or relevant college, or vocational training in the medical field, i.e. LVN, CNA, Military Corpsman/Medic, EMT, MA, etc. Direct healthcare experience in medical case management or quality assurance to include the review of complex multi-focal medical reports for quality, clarity, thoroughness and insightful medical explanation Experience assisting with medical tests, treatments and procedures Knowledge of military medical examinations or experience working with the VA Understanding of general disability claims, workers compensation, or audits Additional Information: Location: Remote - Must be located in either the Eastern or Central Time Zone Shift: Monday - Friday - 7:30 am - 4:00 pm (Eastern Time Zone) Training: 5-8 months training period that includes coaching, mentorship, and proficiency verification. Upon graduation from training, an 8% pay increase is awarded. Probationary Period: Employment as a Medical QA Specialist will include successful completion of 120-day probationary period during which you will be given objectives to achieve. This timeframe lets you assess your readiness for the position as well as allows Leidos QTC Health Services to determine your ability to successfully perform the job. You will be provided objectives, documentation, training and performance feedback during the 120-day probationary period as part of your assimilation to the role. After successfully completing the 120-day probationary period, you will be removed from the probationary period.

Review and audit exam reports sent over from medical providers Ensure all medical coding is complete and accurate Ensure all tests have been ordered and completed, and present in the medical record Coordinate with medical providers as needed for clarification of reports Work with our in house appointment schedules to request additional appointments for the veteran as necessary

Medcor Inc

Evening Shift Bilingual Spanish/English Telephonic Injury Triage RN - FT

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Illinois

At Medcor, we’re passionate about caring for our advocates as much as you are passionate about caring for your patients! Join our team and receive the support you need to be successful in your practice and to focus on your patients. In addition to a collaborative work environment, we offer great pay and benefits and emphasize your wellness.

Medcor is looking to hire a full-time bilingual Spanish-speaking Registered Nurse for our remote 24/7 Occupational Health triage call center! The hours for this position include 8-hour or 10-hour shifts between 12pm and 2am. For example, shifts could include 2:00pm-12:00am or 4:00pm-2:00am. Job Type: Full-time - 40 hours per week Salary: $30 per hour with additional shift differential pay available for evenings, nights & weekends By joining our nursing team, you will be helping thousands of employers better manage their workplace injuries and improve the quality of healthcare for their employees. Nurses who are successful in this position must be able to talk on the phone for long periods while typing and navigating through various software applications simultaneously. Our nurses must be able to visualize an injury while on the phone and clarify details about the injury while following our propriety algorithms to guide the triage of the injured worker. Training: Training for this role will last 6 weeks, with 3 weeks of classroom instruction and 3 weeks of precepting. These first 6 weeks of training are held Monday through Friday, from 8a-4p CT. The training schedule is non-negotiable, and all training must be successfully completed within the 6-week time frame. Following training, you will transition to your permanent schedule between the hours of 2p and 2a with an every-other-weekend requirement and holiday rotation. Changes to the permanent schedule are not allowed within the first 12 months of employment.

Be bilingual, fluent in both the English and Spanish language Have a valid RN license and current BLS (CPR) certification Be able to handle a high volume of consecutive calls Have strong technological skills as well as a typing speed of at least 30 WPM Work a major U.S. holiday rotation Work every other weekend Have effective written, verbal, and interpersonal communication skills. Ability to read, analyze, and interpret triage tools and information along with care instructions to injured employees and their managers. Be able to talk and/or hear. You are required to sit and use your hands. Specific vision abilities required by this job include close vision for computers and written work with the ability to adjust focus Be able to work on a computer for long periods Have a private space in your home with 4 walls and a door for patient privacy Have access to high-speed internet (no satellite) within your primary residence Be able to receive and apply feedback It's a Plus If You have call center experience You have occupational health experience

Manage a rapid flow of incoming telephone calls from Medcor customers in a call center environment Document each call efficiently and accurately Monitor and track individual as well as call center goals, productivity metrics, and statistics Reflect all shift activities using the phone system and be responsible for personal schedule adherence Provide superior customer service to Medcor’s clients and employees Complete accurate assessment of symptoms and/or concerns utilizing Medcor’s Triage Algorithms Follow HIPAA Compliance Policies

QTC Management, Inc.

Medical Quality Assurance Specialist I

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

LPN/LVN

State License:

Compact / Multi-State

Leidos QTC Health Services collaborates closely with government and non-government customers to address current and future program needs within the health services domain. We specialize in disability-focused medical examinations, independent medical exams and review services, occupational health services, diagnostic testing, and case management solutions. As innovators, we focus on advancing technologies that improve service delivery, with a particular emphasis on enhancing accessibility for examinees in rural communities. With a proven track record of continuous improvement and steady growth, we now handle over 2 million appointments annually. Visit www.qtcm.com for more information.

Do you crave a career that truly makes an impact in people’s lives? Do you thrive on problem-solving and finding solutions? Join a dedicated, tight-knit team that creates an immediate and meaningful impact every day. Leidos QTC Health Services is seeking a Medical Quality Assurance Specialist on our Veteran Affairs Services team. You will work closely with medical providers and the Veterans Administration to ensure the documentation process is complete and accurate. In this role, you will review documentation sent over from medical providers and ensure the report is complete, concise, clear, and correct and the provider has accurately completed the Disability Benefit Questionnaires for delivery back to the VA.

Required Qualifications: High School Diploma or equivalent (GED) Strong knowledge and understanding of anatomy and medical terminology Ability to read and analyze medical reports Aptitude to apply clinical reasoning (diagnostic testing) Ability to write clear questions to submit to the provider Experience working with medical providers (credentialing, medical coding, chart audits, triage, scribe, nursing) Understanding of case management software, electronic medical records and medical databases Must be able to successfully pass National Agency Check with Inquiries (NACI) background investigation Preferred Qualifications: Allied medical professional certification, or relevant college, or vocational training in the medical field, i.e. LVN, CNA, Military Corpsman/Medic, EMT, MA, etc. Direct healthcare experience in medical case management or quality assurance to include the review of complex multi-focal medical reports for quality, clarity, thoroughness and insightful medical explanation Experience assisting with medical tests, treatments and procedures Knowledge of military medical examinations or experience working with the VA Understanding of general disability claims, workers compensation, or audits Additional Information: Location: Remote - Must be located in either the Eastern or Central Time Zone Shift: Monday - Friday - 7:30 am - 4:00 pm (Eastern Time Zone) Training: 5-8 months training period that includes coaching, mentorship, and proficiency verification. Upon graduation from training, an 8% pay increase is awarded. Probationary Period: Employment as a Medical QA Specialist will include successful completion of 120-day probationary period during which you will be given objectives to achieve. This timeframe lets you assess your readiness for the position as well as allows Leidos QTC Health Services to determine your ability to successfully perform the job. You will be provided objectives, documentation, training and performance feedback during the 120-day probationary period as part of your assimilation to the role. After successfully completing the 120-day probationary period, you will be removed from the probationary period.

Review and audit exam reports sent over from medical providers Ensure all medical coding is complete and accurate Ensure all tests have been ordered and completed, and present in the medical record Coordinate with medical providers as needed for clarification of reports Work with our in house appointment schedules to request additional appointments for the veteran as necessary

Pennsylvania Health & Wellness

Care Manager (RN)

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

As a Fortune 25 healthcare leader, we’re committed to providing high-quality, accessible care to individuals and families, especially in underserved communities. Our innovative approach integrates physical, behavioral and social services to make a real difference in health outcomes. We value collaboration and are dedicated to excellence, creating an environment where our employee contributions can truly shine. Join us in transforming healthcare and enhancing the well-being of communities across the country.

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. Remote Role, Monday - Friday 8AM to 5PM EST 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 For YouthCare Illinois plan only: Bachelor’s Degree and IL RN licensure required. Must reside in IL For Sunshine Health (FL) Only: Employees supporting Florida's Children’s Medical Services (CMS) must have a minimum of two years of pediatric experience. May require up to 80% local travel 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 appropriate 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.

Broadway Ventures

Medical Claims Reviewer

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we’re more than a service provider—we’re your trusted partner in innovation.

Broadway Ventures has an opening for a Medical Claims Reviewer. This team handles a variety of claim types including Radiology, Ambulance, Physical Therapy and Surgical. Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. Max Salary: W-2 ($65,000/$31.25) Worksite: This is a Work-from-home position. Logistics: This position is full time (40 hours/week) Monday-Friday, 8:00 am – 4:30 pm This is a work from home position. To work from home, you must have high-speed internet (non-satellite) and a private home office (unshared, lockable office space). Must be able to travel to the Augusta, GA office occasionally (approximately 4 times) throughout the year. Preferred candidate will live in South Carolina or Georgia.

Required Licenses and Certificates: Active, unrestricted RN licensure from the United States and in the state of hire, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC), Required Education: Bachelor’s degree Nursing, Graduate of accredited School of Nursing. Required Experience: five years clinical experience two years utilization/medical review, quality assurance, or home health experience. Required Skills and Abilities: Working knowledge of managed care and various forms of health care delivery systems; strong clinical experience to include home health, rehabilitation, and/or broad medical surgical experience. Knowledge of specific criteria/protocol sets and the use of the same. Working knowledge of word processing software. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service and organizational skills. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Required Software and Tools: Microsoft Office. Education: Bachelor's (Required) Masters (Preferred) Experience: Utilization/Medical Review, Quality Assurance or Home Health: 3 years (Required) Clinical RN: 5 years (Required) License/Certification: RN License (Required) Preferred Job Qualifications: Five years of clinical nursing experience in Home Health, Utilization or Medical Review or Quality Assurance. Masters Degree of Nursing or similar is strongly preferred. Computer proficient to include use of multiple screens and programs simultaneously.

Performs medical claim reviews for one or more of the following: claims for medically complex services, services that require preauthorization/predetermination, requests for appeal or reconsideration, referrals for potential fraud and/or abuse, and correct coding for claims/operations. Makes reasonable charge payment determinations based on clinical/medical information and established criteria/protocol sets or clinical guidelines. Determines medical necessity and appropriateness and/or reasonableness and necessity for coverage and reimbursement. Documents medical rationale to justify payment or denial of services and/or supplies. Educates internal/external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. in accordance with contractor guidelines. Participates in quality control activities in support of the corporate and team-based objectives. Provides guidance, direction, and input as needed to LPN team members. Provides education to non-medical staff through discussions, team meetings, classroom participation and feedback. Assists with special projects and specialty duties/responsibilities as assigned by Management.

Baptist Health System KY & IN

Revenue Cycle Specialist

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Kentucky

Founded in 1924 in Louisville, Kentucky, Baptist Health is a full-spectrum health system dedicated to improving the health of the communities it serves. The Baptist Health family consists of nine hospitals, employed and independent physicians, and more than 400 points of care, including outpatient facilities, physician practices and services, urgent care clinics, outpatient diagnostic and surgery centers, home care, fitness centers, and occupational medicine and physical therapy clinics. Baptist Health’s eight owned hospitals include more than 2,300 licensed beds in Corbin, Elizabethtown, La Grange, Lexington, Louisville, Paducah, Richmond and New Albany, Indiana. Baptist Health also operates the 410-bed Baptist Health Deaconess Madisonville in Madisonville, Kentucky in a joint venture with Deaconess Health System based in Evansville, Indiana. Baptist Health employs more than 23,000 people in Kentucky and surrounding states. Baptist Health is the first health system in the U.S. to have all of its hospitals recognized by the American Nursing Credentialing Center with either a Magnet® or Pathway to Excellence® designation for nursing excellence. Baptist Health’s employed provider network, Baptist Health Medical Group, has nearly 1,500 providers, including more than 750 physicians and more than 740 advanced practice clinicians. Baptist Health’s physician network also includes more than 2,000 independent physicians.

Baptist Health is looking for a Revenue Cycle Specialist to join their team! This is a remote work position that requires residency in KY or IN

Bachelor’s Degree in related field, Practical Nurse License, or Coding Certification with two years healthcare experience required. In lieu of Bachelor’s degree, five years of healthcare experience required including two years in a revenue cycle related area such as registration, patient financial services, or managed care. Requires knowledge of medical terminology; payor reimbursement guidelines (authorization / notification, medical necessity, and timely filing guidelines); payor denial appeal / payment variance resolution processes; and managed care contracts. Individuals working with payor audits must have a keen understanding of all audit response requirements and timelines. Work Experience Education: If you would like to be part of a growing family focused on supporting clinical excellence, teamwork and innovation, we urge you to apply now! Baptist Health is an Equal Employment Opportunity employer.

Research denials from all commercial and governmental payors. Performs payor compliance review on accounts to determine medical necessity of services, pre and post service as well as pre and post billing. Obtains pre-determinations, prior authorizations, and retro authorizations when required by payor. Responds to all account reviews with the best possible efforts to ensure reimbursement, recover outstanding revenue, and prevent future revenue loss while meeting all appropriate payor or government timelines. Recovery efforts include but are not limited to written letter, email, web site, and telephonic communication.

Network Health, Inc

Weekend RN Coordinator Utilization Management

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Wisconsin

Founded in 1982, Network Health is locally owned by Froedtert ThedaCare Health and is the largest provider-owned Medicare Advantage plan in Wisconsin, serving both employer groups and individuals. We collaborate with our provider-owners to give members access to high-quality coordinated care. When you call us, we don’t bombard you with health insurance jargon. We talk like people, not insurance dictionaries. Being local allows us to focus on our mission of creating healthy and strong Wisconsin communities. We care about making our home a better place to live. In 2026, Network Health Medicare Advantage PPO plans earned a 5 Star Rating for customer service for the fifth consecutive year. For 2026, Network Health earned an overall 4.5 out of 5 Star Rating for its Medicare Advantage Prescription Drug PPO plans from the Centers for Medicare & Medicaid Services (CMS).

The RN Coordinator Utilization Management to review submitted authorization requests for medical necessity, appropriateness of care and benefit eligibility. This position reviews applicable guidelines regarding payment and coverage, and makes determinations for authorization/payment. Location: Candidates must reside in the state of Wisconsin for consideration. This position is eligible to work at your home office (reliable internet is required). Travel to the corporate office in Menasha is required occasionally for the position, including on first day. Training is required in person at our Menasha location for the first 6-8 weeks, Monday through Friday 8am - 5pm. Hours: 1.0 FTE, 40 hours per week, 8am - 5pm Saturday and Sunday core hours, weekdays available to make up remaining 40 hours Check out our 2024 Community Report to learn a little more about the difference our employees make in the communities we live and work in. As an employee, you will have the opportunity to work hard and have fun while getting paid to volunteer in your local neighborhood. You too, can be part of the team and making a difference. Apply to this position to learn more about our team.

Bachelor of Science in Nursing, preferred Associate Degree in Nursing, required Current registered nurse licensure in Wisconsin required Minimum of four (4) years clinical health care experience as a Registered Nurse (RN) required Med/Surg experience highly preferred Experience in insurance, managed care, and utilization management preferred

Evaluate and process prior authorization requests/referrals submitted from contracted and non-contracted providers Follow Network Health process, policies, and procedures in authorization review of all membership on a pre-service, concurrent and post-service basis. This process includes verifying eligibility and benefits, as well as documenting all utilization management communication Provide education regarding utilization management activities and processes to members, caregivers, providers, and their administrative staff Participate in Utilization Management auditing (i.e. Utilization Management Inter-reviewer reliability and denial files) Refer all members with complex health problems and needs to Network Health Case Management to reduce medical costs while providing a higher quality of life and an ability to take charge of their diseases. This requires an extensive holistic approach to care management assessment Collaborate with other NH departments to develop interdepartmental operational processes Support Utilization Management department programs and goals through active participation Identify and screen candidates for Case Management intervention and determines appropriate level of care from Utilization Management criteria Complete assessments and plans of care including need for medication regime, treatment plans, practitioner follow-up appointments, knowledge of red flags, disease management, Advance Directives, life planning, and self-management of illness to the best of member ability Evaluate cases for cost savings/quality improvement potential Other duties and responsibilities as assigned

CVS Health

MinuteClinic Virtual Care Provider - PRN

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Tennessee

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.

This is a contract PRN position with an approximate duration of six (6) months. It is an overnight shift from 8p - 7a and provider must commit to a minimum of 9 hours of availability per week, including every third weekend. Qualified candidates must hold a current, unrestricted license in Tennessee and must live within three (3) driving hours to Knoxville or Nashville, TN. If hired, must be willing to obtain additional licensure. The MinuteClinic Telehealth Nurse Practitioner (Provider) delivers patient care services through a remote technology platform. You will work in collaboration with a dedicated team of professionals as you independently provide holistic, evidenced based care inclusive of accurate assessment, diagnosis, treatment, management of health problems, health counseling, and disposition planning for our patients ranging in age 18 months and above. Encounters are documented utilizing an electronic health record (EHR). MinuteClinic Telehealth providers report directly to the Enterprise Initiative Lead.

WORKING ENVIRONMENT: Dedicated virtual care providers must meet minimum requirements for remote care delivery, including: broadband connectivity, a quiet setting with a neutral background to conduct visits from, and the ability to uphold patient privacy per CVSH guidelines. While performing the duties of the job, the employee is regularly required to interact with customers in a remote manner, site, write, operate the computer and phone, speak intelligibly, and hear patient responses. Specific vision abilities include the ability to view and read a computer screen and other electronic devices Required Qualifications: Candidates must be currently licensed in one of the following states to be considered: Tennessee Minimum of two years of medically-relevant experience or equivalent Effective verbal, written, and electronic communication skills Outstanding organizational skills and ability to multi-task Initiative, problem solving ability, adaptability and flexibility Ability to work without direct supervision and practice autonomously Is proficient with information management and technology Capacity to collaborate with professional colleagues as necessary to provide quality care Depending on the market, the ability to be proficient in both speaking and writing in additional languages not limited to but including Spanish may be required Education: Completion of a Master’s Degree level Family Nurse Practitioner program with current National Board Certification and State of Employment license to practice in the Advanced Practice Nurse role required

Provide holistic, evidenced based care inclusive of accurate assessment, diagnosis, treatment, management of health problems, health counseling, and disposition planning for our patients. This includes education and treatment for pregnancy prevention, STI Prevention and safer sex practices. Evaluate primary care, acute, chronically ill, and transitional care patients, in addition to providing healthcare education and counseling, and disposition planning for our patients ranging in age 18 months and above. Provide patient counseling; inclusive of pregnancy prevention, STI Prevention/safer sex practices, contraceptive care counseling and medication management Educate patients on health maintenance and respond to patient care inquiries Document all patient care within an EHR according to MinuteClinic policies and procedures Provide care and coordination of our patients with internal and external colleagues, including the broader patient centered medical home, ensuring the highest standard of care is provided for all patients. Effectively work within a patient care team, including fellow Providers, Collaborative Physicians, paraprofessionals, Pharmacists and other members of the health care team Work independently , prioritize and solve problems, take initiative, and advocate for their patients and their practice

WJM Professional Services LLC

Regional Nurse Supervisor I

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Compact / Multi-State

WJM Professional Services, LLC is a leading healthcare management firm with 20 years of experience providing healthcare personnel, and administrative staffing services to government agencies, including the Defense Health Agency, the United States Air Force, Army, Navy, Coast Guard, National Guard, and the Department of Veterans Affairs.

We are currently recruiting for a Regional Nurse Supervisor I

Minimum associate’s degree in nursing from an accredited nursing school. Minimum of 2-5 years of nursing experience, with at least 1-2 years in a telehealth setting. Must have an active RN license in all 50 states (Enhanced Nursing Licensure Compact). Must be willing to obtain RN license in the non-compact states. Must pass WJM criminal history background check. Resume Requirements: Educational qualifications Career history and relevant experience Certifications, licensure, and credentials Professional references (organization name, contact person, phone number, and address)

Telehealth RNs will provide all eligible MHS beneficiaries with clinical advice based on the Schmitt-Thompson Protocols or equivalent telehealth nursing standards, protocols, or guidelines, coupled with each RN’s professional experience and judgment, to ensure MHS beneficiaries receive high quality nurse triage services. Supervising a small team of telehealth RNs in a limited scope. Managing daily telehealth operations and monitoring team performance. Assisting with scheduling, training, and onboarding new telehealth nurses. Ensuring adherence to policies and quality standards.

Texas Nursing Services

Hospice Registered Nurse (RN) – PRN / Part-Time

Posted on:

February 2, 2026

Job Type:

Part-Time

Role Type:

License:

RN

State License:

Texas

Texas Nursing Services: Your Gateway to Nationwide Healthcare Opportunities! Explore top-notch nursing positions across the US. Join us for rewarding careers in various specialties. Apply today and step into a future of fulfilling healthcare roles!

We are seeking an experienced Hospice Registered Nurse (RN) for a PRN or Part-Time opportunity supporting patients across the Dallas area. This role provides flexible scheduling, per-visit productivity pay, and the opportunity to deliver compassionate, patient-centered end-of-life care in home and community settings.

Required: Active, unencumbered Registered Nurse (RN) license in Texas Minimum 1 year of hospice nursing experience Proficiency with WellSky / Kinnser hospice documentation Valid driver’s license and reliable transportation Strong clinical judgment, communication, and documentation skills Preferred: CHPN certification Hospice admissions or case management experience Comfort working within a per-visit productivity model

Provide skilled hospice nursing care in home and community-based environments Perform comprehensive patient assessments and ongoing clinical evaluations Develop, implement, and update individualized plans of care Accurately document visits, care plans, and clinical notes in WellSky / Kinnser Collaborate with physicians, interdisciplinary team members, patients, and families Educate patients and caregivers on symptom management and end-of-life care Participate in on-call rotation as assigned Ensure compliance with hospice regulations and Medicare Conditions of Participation

Med-Metrix

Clinician, Denial Management - Remote

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

New York

The Clinician, Denials Management will review appeals against medical records to ensure accuracy and thoroughness.

4-year degree in a related field is required Must be a Registered Nurse with clinical experience Experience in medical chart review Hospital nursing experience Ability to learn proprietary databases Proficiency in Microsoft Office Suite Strong interpersonal skills, ability to communicate well at all levels of the organization Strong problem solving and creative skills and the ability to exercise sound judgment and make decisions based on accurate and timely analyses High level of integrity and dependability with a strong sense of urgency and results oriented Excellent written and verbal communication skills required Gracious and welcoming personality for customer service interaction Working Conditions: Must possess a smart-phone or electronic device capable of downloading applications, for multifactor authentication and security purposes. Physical Demands: While performing the duties of this job, the employee is occasionally required to move around the work area; Sit; perform manual tasks; operate tools and other office equipment such as computer, computer peripherals and telephones; extend arms; kneel; talk and hear. Mental Demands: The employee must be able to follow directions, collaborate with others, and handle stress. Work Environment: The noise level in the work environment is usually minimal.

Maintain the integrity of information in each appeal produced Review a high volume of written appeals to ensure information is medically accurate Research payer denials related to referral, pre-authorization, notifications, medical necessity, non-covered services, and billing resulting in denials and delays in payment Make recommendations for workflow revisions to improve efficiency and reduce denials Review payor communications, identifying risk for loss reimbursement related to medical policies and prior authorization requirements; escalates potential issues to clinical stakeholders, managed care contracting, and Revenue Cycle leadership as appropriate Identify opportunities for process improvement and actively participate in process improvement initiatives Other duties as assigned Use, protect and disclose patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards Understand and comply with Information Security and HIPAA policies and procedures at all times Limit viewing of PHI to the absolute minimum as necessary to perform assigned duties

Blue Cross and Blue Shield of North Carolina

Utilization Management Specialist

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

None Required

State License:

North Carolina

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians. Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all. Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives

We’re seeking Utilization Management Specialists to join the Government Pharmacy Utilization Management Operations Team! The Utilization Management Specialist is responsible for the completion of non-clinical reviews and communication to customers to support utilization management reviews and activities. The Utilization Management Specialist may also provide support for administrative functions within the department to support turnaround times. **Shift schedule: 8 AM – 5 PM EST, and includes rotating to cover weekend and holiday shifts**

What You Bring: High school diploma or GED 3+ years of experience in a related field Bonus Points (preferred qualifications) Previous Utilization Management, pharmacy experience strongly preferred Strong customer service and communication skills

Conduct non clinical reviews based on applicable criteria and guidelines on requested services. Communicate decision to provider and/or member, according to department protocols. Document outcome of reviews and demonstrate the ability to interpret and analyze the non-clinical information. Complete verbal or non verbal outreach to providers or members to obtain the medical information for the review. Identify and refer organization determinations that require a clinical review to a nurse or Medical Director. Conduct reviews of authorizations entered to ensure accuracy to avoid impacting claims payment. Support the care management department by completing outreaches to members or providers to meet The Centers for Medicare & Medicaid Services (CMS) requirement for soliciting information or notification standards. Support the administrative support team with the retrieval and attachment of facsimiles to ensure customer requests are forwarded to the respective area for processing. Serve as a subject matter expert for CM&O around the non-clinical review process.

Broadway Ventures

RN Senior Medical Reviewer

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we’re more than a service provider—we’re your trusted partner in innovation.

The RN Senior Medical Reviewer provides advanced medical review expertise and supports oversight of the medical review process, focusing on complex services and quality assurance.

Education: Bachelor of Science in Nursing (BSN) Licensure / Certifications: Current, active, unencumbered Registered Nurse license in the United States Certified Coder credentials required Experience: Minimum of three (3) years of medical record review experience At least three (3) years of current and/or relevant clinical experience Two (2) years of quality assurance experience required Additional Qualifications: Extensive knowledge of the Medicare program Working knowledge of CMS FFS RAC Program requirements and activities

Assist Medical Review Management with monitoring the medical review process Conduct medical record reviews for complex services Evaluate compliance with Medicare coverage, coding, and billing rules Contribute to medical review and proposal deliverables Participate in quality assurance activities to ensure consistency and accuracy

Optum

Call Center Nurse RN - Remote

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Explore opportunities with Shared Services, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together.

As a Triage Nurse, you’ll be an integral part of the interdisciplinary team and as such is responsible for the excellent delivery of care through triage calls after hours and on holidays. Must be available to work weekends. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Required Qualifications: Current, unrestrictive Registered Nurse licensed in all states of practice 2+ years of RN experience 1+ years of direct patient care in a hospice, home health, or oncology setting Demonstrated ability to work flexible hours and independently Preferred Qualification: Registered Nurse Compact licensure

Receive calls from patients and/or family members and respond appropriately and assess problems focusing on the delivery of high quality, patient-focused, compassionate care Assess patient status and intervene as indicated by the patient’s condition and established protocols Timely and accurate documentation of calls received within the electronic medical records system including the processing of workflow associated with the clinical record Knowledge of basic triage protocols and best practices to guide and address the needs of patients in a crisis situation Coordinating with the agency on-call nurses to deliver high quality nursing care and schedule nursing assessments as required in a timely manner to meet the needs of the patients and families Ensure appropriate education regarding all updates/processes in the electronic medical record, relative state and federal regulations, documentation processes and needs, etc. by attending mandatory educational offerings and in-services Facilitates orientation of new personnel as assigned Exhibits exemplary and timely communication skills when assessing or educating patients/caregivers, performing telephone triage, or collaborating with fellow healthcare professionals Serves as a consistent example of dedication to patient advocacy, customer service, integrity, and superlative nursing practice

UnitedHealthcare

RN Health Coordinator - Field Based - West Hawaii

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Hawaii

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.

You push yourself to reach higher and go further. Because for you, it’s all about ensuring a positive outcome for patients. In this role, you’ll work in the field and coordinate the long-term care needs for patients in the local community. And at every turn, you’ll have the support of an elite and dynamic team. Join UnitedHealth Group and our family of businesses and you will use your diverse knowledge and experience to make health care work better for our patients. In this RN Health Coordinator role, you will be an essential element of an Integrated Care Model by relaying the pertinent information about the member needs and advocating for the best possible care available, and ensuring they have the right services to meet their needs. If you are located in West Hawaii (Kailua Kona, South Kona, Ocean View), HI, area you will have the flexibility to work remotely* as you take on some tough challenges. This role also includes travel in the local communities up to 75% of the time.

Required Qualifications: Current, unrestricted RN license in the state of Hawaii 2+ years of clinical experience Intermediate experience working with MS Word, Excel, and Outlook Current access or ability to obtain internet access via a landline Ability to travel in assigned region to visit Medicaid members in their homes and/or other settings, including community centers, hospitals, or providers offices Preferred Qualifications: Bachelor’s degree or higher Experience working directly or collaborating services for long-term care, home health, hospice, public health or assisted living Case management or care coordination experience Experience with arranging community resources Field based work experience Experience with electronic charting Background in managing populations with complex medical or behavioral needs

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, 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 You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Blue Cross and Blue Shield of North Carolina

Utilization Management Specialist

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

None Required

State License:

North Carolina

It's an exciting time to work at Blue Cross and Blue Shield of North Carolina (Blue Cross NC). Health care is changing, and we're leading the way. We offer more than health insurance our customers can count on. We’re committed to better health and better health care − in our communities and beyond. Our employees bring energy and creativity to the workplace, and it shows in our innovative approach to improving the health and well-being of North Carolinians. Blue Cross NC is a fully taxed, not-for-profit company headquartered in Durham, North Carolina. We serve more than 4.3 million members, and we employ more than 5,000 people across the country who are passionate about making health care better for all. Help us lead the charge for better health care by joining our award-winning team. Discover tremendous opportunities with us to do challenging and rewarding work. Opportunities that can lead you to a fulfilling career, work that can help others lead healthier, happier lives.

We’re seeking Utilization Management Specialists to join the Government Pharmacy Utilization Management Operations Team! The Utilization Management Specialist is responsible for the completion of non-clinical reviews and communication to customers to support utilization management reviews and activities. The Utilization Management Specialist may also provide support for administrative functions within the department to support turnaround times. **Shift schedule: 8 AM – 5 PM EST, and includes rotating to cover weekend and holiday shifts**

High school diploma or GED 3+ years of experience in a related field Bonus Points (preferred qualifications) Previous Utilization Management, pharmacy experience strongly preferred Strong customer service and communication skills

Conduct non clinical reviews based on applicable criteria and guidelines on requested services. Communicate decision to provider and/or member, according to department protocols. Document outcome of reviews and demonstrate the ability to interpret and analyze the non-clinical information. Complete verbal or non verbal outreach to providers or members to obtain the medical information for the review. Identify and refer organization determinations that require a clinical review to a nurse or Medical Director. Conduct reviews of authorizations entered to ensure accuracy to avoid impacting claims payment. Support the care management department by completing outreaches to members or providers to meet The Centers for Medicare & Medicaid Services (CMS) requirement for soliciting information or notification standards. Support the administrative support team with the retrieval and attachment of facsimiles to ensure customer requests are forwarded to the respective area for processing. Serve as a subject matter expert for CM&O around the non-clinical review process.

St. Peter's Health Partners

Registered Nurse (RN) Remote Triage Opportunity

Posted on:

February 2, 2026

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

New York

St. Peter’s Health Partners, the region’s largest private-sector employer, with more than 12,500 employees, has more than 145 locations across seven counties. The system has an annual budget of nearly $1.1 billion. St. Peter’s Health Partners was created on October 1, 2011 by the merger of Northeast Health, St. Peter’s Health Care Services, and Seton Health. The merger created the region’s largest and most comprehensive not-for-profit network of high-quality and advanced medical care, primary care, rehabilitation, and senior services. These state-of-the-art services and programs are provided through Albany Memorial and St. Peter’s Hospitals in Albany, NY; Samaritan and St. Mary’s Hospitals in Troy, NY; Sunnyview Rehabilitation Hospital in Schenectady, NY; and The Eddy system of continuing care and The Community Hospice.

RN Triage Opportunity Fully Remote Per Diem Weekly Day hours 7am-11pm 9am-1pm one weekend per month required NYS License Required Local candidates only due to on site training and meetings If you are looking for an RN position doing telephone Triage this could be your opportunity. Here at St. Peter's Health Partner's, we care for more people in more places. Position Highlights: Quality of Life: Where career opportunities and quality of life converge Advancement: Strong orientation program, generous tuition allowance and career development What you will do: The Registered Professional Nurse has the responsibility and accountability to utilize the nursing process to diagnose and treat human responses to actual or potential problems of individuals or groups. The Registered Professional Nurse works within and contributes to an environment where the St. Peter's Healthcare Services mission is actualized, patient outcomes are achieved, and professional practice is realized.

Associates or Bachelor’s degree in Nursing preferred HS Diploma/equivalent required Current unencumbered NYS RN license Basic Life Support certification 6 months previous RN experience Must be able to lift 20 lbs.

Screens calls and schedules appointment accordingly. . Review and update medication list to ensure accurate and complete list in electronic medical record (EMR) available for provider review and submission. Complete referrals and tracks patients' compliance. Review prescriptions electronically and send prescriptions to providers for review and submission. Obtains patient consent for procedures as directed by provider. Performs pre-visit planning and reviews quality metrics. Retrieves telephonic clinical information from patients who call into the office. Monitors task list and completes tasks assigned by provider in a timely manner based on urgency. Educates patients regarding medication, testing procedures and home care techniques. Ensure proper labeling, handling and documentation for patient specimens. Follow up with patient regarding test results based on advice given by provider. Maintains a clean and safe work environment including disinfecting patient care areas and equipment. In conjunction with other nursing colleagues, maintains the medical supply cabinet and drug cabinet. Uses the electronic medical record to communicate effectively. Performs quality assurance duties as assigned. Provides a clinical visit summary (Patient Plan) to patient as requested including educational materials. Participates in daily Patient Care huddles as appropriate. Works cooperatively with all colleagues to ensure quality patient care at all times. Performs other duties as assigned.

Guideway Care

Triage Nurse RN | Weekends

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

At Guideway Care, we are redefining how healthcare organizations engage with patients by delivering high-quality triage and care navigation services that optimize outcomes and elevate the patient experience. Our team is driven by empathy, excellence, and a relentless commitment to service. We’re proud of our legacy—since 2004, we've partnered with providers and health systems across the country to deliver smart, patient-first solutions that improve care delivery and operational performance.

We are seeking an experienced and compassionate Registered Nurse to join our elite team of remote triage professionals. This RN will serve as the front line of clinical support for patients, delivering high-quality assessment, guidance, and care coordination services via telephone and digital communication platforms. This role requires a confident, autonomous nurse with a strong clinical foundation, excellent judgment, and a deep commitment to patient-centered care. You will work remotely in a structured and supportive environment, contributing to improved outcomes and experiences for patients across a variety of primary care and specialty settings. Work Schedule: Friday/Monday - 8 Hour shifts, Saturday/Sunday - 8:00 AM - 8:00 PM CST ** Required Flexible scheduling available - Must be available Saturday and Sunday.

Registered Nurse with Unencumbered e-NCL Licensure. RN Licensure in California and Minnesota is required. Current demonstration of clinical proficiency Excellent written and oral communication skills Excellent critical thinking and problem-solving skills Ability to work within approved procedure and clinical guidelines Electronic Medical Record Experience, i.e EPIC, Cerner, Greenway Ability to use windows-based computer software including ADOBE, MS Word, MS Excel, Fax and others Minimum of 5 years’ experience in working in a variety of direct patient care settings including Emergency Department, Labor and Delivery, Critical Care. Women's Health or Labor and Delivery experience preferred. Minimum of 3 years’ experience in Adult Nursing Oncology experience Strongly preferred. Supervisory Responsibilities: None Travel Requirements: 0% Work Authorization: Sequence Health does not offer Immigration or work visa sponsorship

Receive inbound calls from patients and place outbound calls to patients. Provide clinical assessment based on established protocols and triage patients by phone or through patient portal. Respond to patients’ messages in patient portal, create orders and route to appropriate parties. Provide administrative support for patients’ and providers’ needs in terms of FMLA, ADA, and LTD/STD Communicate with Health Care Provider through approved methods as needed. Any other duties necessary to drive our values, fulfill our mission, and abide by our company values This role requires regular, reliable attendance during scheduled hours, as consistent presence is essential to performing the core duties of the position.

Watchung Pediatrics

Overnight Triage Nurse (Part-Time)

Posted on:

February 2, 2026

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

New Jersey

Watchung Pediatrics is a growing, mission-driven pediatric practice committed to delivering high-quality, accessible, evidence-based care to children and families. Our goal is simple: exceptional care, thoughtful coordination, and an experience that supports families and clinicians alike. We provide comprehensive primary care. We measure success by healthier kids, a great family experience, and a supportive, rewarding workplace for our team.

After-hours Triage Nurse (Part-Time) Schedule: Night shifts, 12:00 AM – 6:00 am Location: Remote Watchung Pediatrics is seeking a compassionate and detail-oriented Part-Time Triage Nurse to support our centralized access and remote care operations. This role is critical to ensuring families receive timely, appropriate guidance when they reach out for help. As a Triage Nurse, you’ll provide pediatric telephone triage, help families navigate next steps in care, and coordinate closely with our clinical and operations teams to ensure continuity and safety. You’ll work closely with practice staff across our offices.

What We’re Looking For: High school diploma or equivalent plus nursing education consistent with licensure Active, unencumbered LPN or RN license BLS certification At least 3 years of pediatric primary care experience Strong communication skills and comfort working with children, families, and care teams Excellent organization and time-management skills Comfort using EHRs and other technology tools Bilingual English/Spanish strongly preferred

Pediatric Telephone Triage: Provide phone-based clinical guidance using established protocols, escalating care appropriately when needed. Care Coordination: Respond to incoming calls and messages, assist with scheduling, collaborate with providers and staff, and support families with clinical questions and education. Documentation: Accurately document all patient interactions in the EHR to support safe, continuous, and compliant care. Clinical Support: Partner with providers to support patient care as needed, including clinical intake, immunizations, point-of-care testing, and medication administration. Compliance & Safety: Follow all internal policies, HIPAA requirements, and applicable state and federal regulations. Other duties as needed in support of patient care and operations.

Vantage Medical Associates

Spanish, Primary Care NP/PA, Immediate Need - NY license Medicare/Medicaid Enrolled

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Primary Care

License:

NP/APP

State License:

New York

We are seeking a dedicated and compassionate Primary Care NP/PA to join our healthcare team. In this role, you will be responsible for providing high-quality care to patients in a primary care setting. You will work collaboratively with physicians and other healthcare professionals to assess, diagnose, and treat various health conditions. Your expertise in triage, medical documentation, and medication administration will be crucial in ensuring optimal patient outcomes.

Qualifications: New York License Medicare/Medicaid Enrolled

Conduct comprehensive patient assessments, including physical examinations and health histories. Administer medications and treatments as prescribed, ensuring accurate documentation in eClinicalWorks. Monitor patient progress and adjust treatment plans as necessary based on clinical findings. Provide education to patients regarding health maintenance, disease prevention, and management of chronic conditions. Maintain thorough medical documentation in compliance with healthcare regulations and standards. Collaborate with interdisciplinary teams to coordinate patient care across various settings, including hospital medicine and nursing homes.

Eden Home Health

Home Health Quality Assurance RN

Posted on:

January 31, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Washington

Eden Health is a 100% employee owned Home Health, Hospice and Home Care services company. Few Healthcare companies can say that. We take pride in what we do, and we believe our employees should share the success of our company in a tangible way. Eden Health is headquartered in Vancouver, Washington and has locations in Washington, California, Nevada, Idaho, Oregon, Montana, Wyoming and Arizona. Eden Health has built our brand on the belief that our people are our greatest asset. We truly value our employees and we’re committed to caring for their whole being, fully supporting their efforts to become the best they can possibly be, both on the job and at home. When you surround yourself with hugely talented, passionate, dedicated, and genuinely kind people, we believe you will succeed in whatever you do. Eden Health is committed to providing a rewarding workplace environment. Eligible team members have the opportunity to enroll in a wide variety of benefit programs in addition to vacation perks and career opportunities.

A Registered Nurse Quality Assurance Coordinator will provide in-home services to our patients. The Quality Assurance Coordinator is a Registered Nurse responsible for supporting the quality activities of Eden Home Health. The Quality Assurance Coordinator is responsible for Electronic Health Record (EHR) workflow tasks, training, and education as needed due to absenteeism and/or increased volumes. This position will perform chart audits that include Medicare, Medicaid, and Private/Commercial insurances to assure Eden Home Health are in compliance with state, federal, and accrediting body regulations

Reports to work on time and as scheduled. Wears identification while on duty. Attends annual review and departmental inservices, as appropriate. Represents the organization in a positive and professional manner. Completes quarterly/annual education requirements. Maintains regulatory requirements, including federal, state, local regulations, and accrediting organization standards. Maintains patient confidentiality. Works at maintaining a good rapport and a cooperative working relationship with physicians, departments, and staff. Attends committee, QAPI, management meetings, and other required meetings as appropriate. Adheres to payroll, billing, and documentation policies and procedures. Guarantees compliance with policies and procedures regarding operations, fire safety, emergency management, grievance and concerns, adverse events, incident reporting and infection prevention and control. Complies with organizational policies regarding ethical business practices. Demonstrates effective time management and organizational skills. Communicates the mission, ethics, and goals of the organization. Able to communicate effectively in English, both verbally and in writing. Able to travel as needed. OASIS knowledge and experience required. Comprehensive knowledge of general nursing theory and practice. EHR documentation experience. Strategic Healthcare Partners (SHP) experience. Basic data management skills required, including but not limited to: Access, Word, Excel, and Power Point. Proficiency monitoring metrics and writing reports based on data presented in various computer systems. Excellent understanding of performance improvement, quality assurance, and utilization management. Critical thinking skills, decisive judgment, and the ability to work with minimal supervision. Must have above average attention to detail to guarantee accuracy. Able to prioritize and multitask efficiently. Registered Nurse, currently licensed in or able to be licensed in all states of Eden Home Health operations. Bachelor’s degree in Nursing from an accredited program by the National League for Nursing preferred. Three years’ Home Health nursing experience. Currently has, or is willing to obtain, OASIS certification

Reads and interprets medical record data for chart audits or abstractions and communicates findings and performance improvement plans to agency leadership. Reviews OASIS and 485’s for consistency, coding recommendations/changes, and Strategic Healthcare Partner (SHP) alerts. Coordinates with clinicians and Clinical Managers in verification, coding approvals, and correction of assessments/notes according to findings on OASIS. Performs chart audits for Eden Home Health locations. Works collaboratively with agency Clinical Manager to identify areas for in-service education programs related to documentation, CoPs, regulations, and ACHC requirements. Provides ongoing remedial training and support to agency staff as necessary. Attends/holds required training sessions, team meetings, and special interest group (SIG) meetings as necessary. Maintains a positive attitude toward change. Provides education and support to clerical and clinical EHR end users. Provides onsite and offsite training for new users as necessary. Acts as a resource in the development and maintenance of training materials for end users. Collaborates with administrative staff to review Quality Assurance and Performance Improvement (QAPI) areas of concern that relate to use of EHR and its content. Maintains and monitors Performance Improvement Plans (PIPs) for the agency. Provides support and education on supplemental resources. Additional tasks as assigned.

Elevance Health

LPN/LVN 100% Virtual, CareBridge

Posted on:

January 31, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

LPN/LVN

State License:

Indiana

CareBridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through home-care and community based services.

Virtual: 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. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Work Shift: Full time (40 hours a week) position. 8am to 5pm local time that will require holidays and weekend rotation. The LPN/LVN is responsible for the examination and treatment of patients under the direction of the physician.

Minimum Requirements: Requires an LPN or LVN and minimum of 2 years of experience as an LPN/LVN; or any combination of education and experience, which would provide an equivalent background. Current LPN/LVN license in the applicable state required. For Carelon Health business unit, satisfactory completion of a Tuberculosis test is a requirement for this position. Preferred Experience, Skills, and Capabilities: Bi-lingual (English/Spanish) preferred. Experience with Telephonic Triage preferred. Acute care experience (e.g., urgent care or ER) preferred.

Reviews patient medical records, interviews patients and records vital signs. Provides nursing interventions and coaching in accordance with the scope of practice and standing orders. Facilitates patient transfers to alternate level of care. Facilitates patient transfers to an alternate level of care as needed. Documents using standard templates. Ability to be on the phone engaging with patients up to 80% of the shift. Ability to work assigned weekends per standard team rotation. Reliable internet and a high level of customer service.

TeamHealth

Oregon OB/GYN Registered Nurse

Posted on:

January 30, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Oregon

TeamHealth was founded in 1979 with a vision of developing the best teams of healthcare professionals. With the relentless pursuit to advance patient care through strong leadership, innovation and teamwork, we're proud to say that over the years we have made great strides towards our goals. The impressive growth of TeamHealth should come as no surprise to hospitals and clinicians aware of our reputation for efficiency and commitment to excellence and collaboration. Originally founded to provide emergency department administrative and staffing services, TeamHealth is one of the nation's largest providers of hospital-based clinical outsourcing in multiple departments, including Anesthesia, Hospital Medicine, in addition to Emergency Medicine. Although we are a national organization, our operating philosophy is essentially the same as when we started. TeamHealth is committed to a patient-centric model of healthcare delivery with hospitals, physician groups and TeamHealth working collaboratively to deliver compassionate, effective, efficient and safe patient care. More than ever before, healthcare executives today face enormous challenges, including financial performance, healthcare reform, government mandates, safety and quality, physician relations, patient satisfaction, personnel shortages and the uninsured. They've turned to TeamHealth for help. Executives know they can benefit from our large pool of resources, infrastructure and best practices while maintaining accountability; clinicians know they can take their career to the next level and do what they do best, focus on patient care. All of this is demonstrated by our 97% average annual client retention rate and 93% physician retention rate.

We are searching for Oregon registered nurses with at least 2 years of OB/GYN experience who are seeking an exciting and rewarding alternative to direct patient care. If you are looking for a way to continue to positively impact patients and use your nursing skills without the wear and tear of working in a hospital you should send your resume today! We promote success through a supportive work environment, provide excellent benefits, and offer competitive pay and paid time off. Part-time and full-time shifts are currently available. Now also recruiting for bilingual nurses who can fluently speak both Spanish and English.

Current Oregon Resident with unencumbered Oregon RN license Computer Skills a MUST 2+ years of OB/GYN Nursing Experience Successful Completion of Background Check, Drug Screen, and References 4-week remote training over Zoom video (100% attendance required) Ability to type a minimum of 25 wpm Excellent organizational and computer skills and ability to multi-task while speaking with patients Excellent listening and comprehension skills to determine key information by patient Professional, courteous telephone voice Dependable, reliable and trustworthy Ability to defuse conversations Ability to handle confidential information; HIPAA compliance is mandatory Flexibility with scheduling Ability to receive feedback on job performance Bilingual Telephone Triage Nurses must be able to converse in Spanish and document in English simultaneously (a Spanish/English proficiency test is required) Must be able to provide a HIPAA-compliant workspace during training and your regular shifts Must be able to pass a pre-employment test plus have a successful background check and reference check*(references are verified) Remote Workstation Requirements Internet A reliable high speed internet connection is required for this position. Please select a cable internet provider. Examples include Xfinity/Comcast, AT&T, Spectrum. Satellite internet and cellular hotspots are not sufficient to adequately connect to our servers. You must hardwire your internet from your modem or Ethernet jack to your work computer. WiFi is not acceptable and disrupts the connection to our servers. The minimum bandwidth speeds must be fast enough for 23 megabits download and 10 megabits upload Test your home internet speeds here Please verify this information with your internet provider Please note these requirements do not include other demands on your internet (e.g. another household member working from home, streaming videos, streaming music, online gaming). It is your responsibility to either limit activities like the ones mentioned above or work with your internet provider to increase your bandwidth so you can work without issues. Workstation Allow enough space to provide room for 2 (two) 27” computer monitors, a computer, a keyboard, a mouse, and a dial pad/phone, which is company provided. Arrange your workstation where you can hardwire to your internet and phone line. Your workstation must be located in a room where there is a door with a lock. HIPAA compliant and protects PHI Prevents disruptions during work hours Physical and Environmental Demands Job performed in a well-lit, modern office setting Occasional lifting (20 pounds or less) Visual and Auditory acuity Manual and finger dexterity Occasional stress Occasional pushing, pulling, carrying, lifting, bending, and reaching Frequent work on a PC/Computer Prolonged telephone work and prolonged sitting

The telephone triage nurse is a registered nurse who helps patients determine the best way to address their medical issues and concerns over the phone: Assess symptoms: Utilizing a physician-written algorithm Provide guidance: Recommend a variety of levels of care (e.g. home care, an office visit, emergency room) Answer questions: Provide and document health education to help patients manage their symptoms when indicated Consult with physicians as needed

Shifamed

Field Clinical Specialist

Posted on:

January 30, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

Akura Medical, a Shifamed Portfolio Company, is focused on a differentiated approach delivering an effective solution to address the major challenges of venous thromboembolism (VTE). Akura recently announced the first-in-human use of its mechanical thrombectomy platform. Each year VTE affects as many as 900,000 Americans, resulting in about 100,000 premature deaths. To learn more about Akura Medical, please visit www.akuramed.com. ABOUT SHIFAMED: Founded in 2009 by serial entrepreneur Amr Salahieh, Shifamed LLC is a privately held medical device innovation hub focused on the development of novel medical products to address clinical needs in the rapidly evolving fields of cardiology and ophthalmology.

We are building our Field Clinical team and currently have remote openings in two of the following regions: Midwest and Southeast. The Field Clinical Specialist is a physician-facing role responsible for representing Akura Medical in the field. In this position, you will provide case support to physicians across assigned territories, primarily during emergency interventional procedures in both pre-market and eventual post-market phases of the Akura Thrombectomy System. You will play a key role in clinical studies, supporting device training, case execution, and ensuring timely and accurate case/site-related reporting. Travel to support other territories may be required based on business needs. Openings (1): Southeast Southeast: Jacksonville, Orlando, Tampa and surrounding area, Atlanta, Nashville

BS/BA or equivalent experience required. Degree in life sciences, biomedical engineering, or medical training (RN, Perfusion, cath lab technician, etc.) preferred, with a strong understanding of the cardiopulmonary anatomy and/or thrombectomy procedures. Training on GCP-ICH guidelines required. 5+ years of related work experience required, medical, (device) industry preferred. Strong clinical orientation, experience with products for use in the target therapy provided by Akura Medical preferred.

Assist in the development and update of the Physicians Training Plan. Provide clinical education support through education of current and potential clinical sites, and procedure coverage with assigned clinical sites. Train investigational product users (Interventional Cardiologists, Interventional Radiologists, Vascular Surgeons), cath lab staff, and ancillary personnel on the set up and use of Akura Medical’s investigational products and provide technical support to physicians during procedures. Collaborate with the clinical monitors, in-house CRA during site selection, qualification and initiation process as well as the scheduling of procedures (ensure good case coverage across clinical sites). Drive subject enrollment during the screening and enrollment phase, working closely with the clinical team. Participate with the clinical monitors during the site initiation and training visits and collect staff, including physician, training records. Work closely with the company’s R&D Engineers to a) relay user input on the field use of Akura’s technologies; b) understand latest product changes and c) identify additional needs for training and/or product development. Learn and then provide updates on the latest product(s), therapy, and technology developments in the industry including competing clinical trials. Actively engage in clinical, procedural, and technical discussions and link data outcomes to key messaging. Report physicians’ experience to the engineers, quality and clinical team after each case support. Responsible for compliance with applicable Corporate and Divisional Policies and procedures including the clinical protocols and procedures. This position requires a strong clinical orientation and ease for public speaking with the ability to influence a variety of clinician personality types. Travel up to 80% with some international travel possible.

VISIUM HEALTHLINK LLC

LPN Nurse Navigator

Posted on:

January 30, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

LPN/LVN

State License:

Kentucky

At Visium HealthLink, we believe exceptional patient care begins with exceptional nurses. We’re looking for experienced, mission‑driven LPNs who are passionate about guiding patients through their healthcare journey—not those simply seeking a flexible remote position. Our patients rely on these calls, and continuity matters. If you’re the kind of nurse who takes pride in meaningful patient relationships, consistent follow‑up, and helping people feel supported and understood, this role is for you.

As a Nurse Navigator, you become the steady, trusted voice for up to 500 patients each month. Your outreach helps patients better manage chronic conditions, understand preventive care, and stay engaged in their health goals. Over 75% of your day is spent speaking directly with patients, offering education, compassion, and clarity. This is not a job where you wait for the phone to ring—you drive the connection.

Required: Active LPN license 2+ years of hands‑on patient care experience A HIPAA‑compliant home office with secure high‑speed internet Experience in patient care coordination or case management Strong clinical judgment and a heart for patient engagement The ability to work reliably Monday–Friday without shifting schedules Preferred: Care coordination or case management certification Experience with diverse patient populations Comfort with various EHR systems and healthcare software

Make up to 20 outbound patient calls daily Conduct assessments within your LPN scope to understand each patient’s unique needs Create and collaborate on personalized care plans Serve as the communication bridge between patients, families, and providers Educate patients on their conditions, treatment options, and preventive care Track progress and adjust care plans as needed Document interactions and work within multiple healthcare systems and tools

Bluebird Kids Health

Triage Nurse - Part Time (Shift: Sat/Mon 7:30a-1p)

Posted on:

January 30, 2026

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Florida

Bluebird Kids Health is a dynamic organization that provides underserved communities with new access to value-based pediatric primary care. We are on a mission to provide exceptional care, so every child can thrive. We offer comprehensive, evidence-based primary and urgent care services to children and their families, with support around-the-clock. Our care model includes robust care coordination, chronic disease management, and other population health supports. Our success is measured by exceptional health outcomes, lower medical costs, an outstanding child and family experience, and a rewarding environment for our clinicians and staff.

Position Description (Shift: Sat/Mon- 7:30a-1pm) Bluebird Kids Health is seeking a dedicated and compassionate Triage Nurse to join our dynamic CARES Center team. The CARES Center serves as our enterprise access and remote care hub, delivering essential resources, education, and support to children and their families. As a Triage Nurse, you will play a critical role in ensuring families have timely access to appropriate care through telephonic triage services. Reporting to the Operations Manager, you will collaborate closely with our Practice Operations team to provide seamless care coordination and clinical support, ensuring exceptional healthcare delivery across our pediatric clinics. Your contributions will directly support our mission to provide exceptional care so every child can thrive.

High school diploma or equivalent and relevant nursing education commensurate with nursing licensure BLS Certification Unencumbered Florida Licensed Practical Nurse (LPN) Minimum 1 year of clinical experience Strong communication and interpersonal skills with the ability to engage effectively with patients, families, and the healthcare team. Excellent organization and time-management skills to handle multiple tasks and priorities efficiently Proficiency in using various technology platforms, including electronic health records (EHR) Bilingual proficiency in English and Spanish is strongly preferred Experience with pediatric populations is strongly preferred

Pediatric Telephone Triage: Provide telephonic triage services, offering clinical guidance or escalation to the appropriate level of care based on established protocols, ensuring timely and accurate access to care. Care Coordination: Respond to inbound inquiries, collaborate with providers, staff, and external care teams to manage patient appointments, provide patient education, and address clinical requests via the clinical inbox. Documentation: Maintain accurate, timely, and comprehensive documentation of all patient interactions in the electronic health record (EHR) system to ensure continuity of care and regulatory compliance. Clinical Support: Work in collaboration with providers to deliver clinical support during patient visits, including medication administration, point-of-care tests, office procedures, immunizations, and clinical intake. Compliance and Safety: Ensure adherence to internal policies, HIPAA regulations, and relevant local, state, and federal healthcare standards to guarantee a safe and compliant healthcare environment. Other Duties as Assigned

Haven Access Works LLC

RN Nurse Advisor

Posted on:

January 30, 2026

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Pennsylvania

Location: Remote / Community-Based (Pennsylvania) Position Type: Part-Time, Contract (Very Limited Hours) Haven Access Works is seeking a Registered Nurse (RN) to provide required nursing oversight for individuals receiving Family Medical Support Assistance (FMSA) services under Pennsylvania Office of Developmental Programs (ODP) waivers. This is a low-hour, oversight-focused role intended for an experienced nurse who is comfortable working independently, reviewing documentation, and supporting families and support assistants in a consultative capacity. Role Overview The RN provides clinical oversight to ensure FMSA services are delivered safely and in accordance with waiver requirements, physician orders, and individual support plans (ISPs). This position does not involve routine direct care.

Active Registered Nurse (RN) license in Pennsylvania Experience working with individuals with intellectual and developmental disabilities preferred Familiarity with delegated nursing tasks and oversight models Strong documentation and communication skills Comfortable working independently with minimal supervision Preferred Experience (Not Required) Experience with ODP waiver services Experience in home and community-based services (HCBS) Prior involvement in nurse oversight, case review, or quality assurance roles Compensation Competitive hourly or per-case compensation, commensurate with experience Contracted position

Provide nursing oversight for individuals enrolled in FMSA services Review and verify physician orders related to delegated nursing tasks Provide guidance and oversight to Support Assistants performing health-related activities Review health-related documentation and compliance with FMSA requirements Participate in meetings with families or team members as needed Communicate clinically relevant changes or concerns to the agency Maintain documentation required by ODP and waiver guidelines Time Commitment: Approximately 1–2 hours per week, depending on census Flexible scheduling Combination of remote review and limited community-based interaction, as needed

InnovAge

Clinical Quality Improvement Advisor

Posted on:

January 30, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Colorado

InnovAge is dedicated to empowering seniors to live independently, allowing them to age in their own homes and communities safely. InnovAge offers an alternative to nursing homes through its Program of All-inclusive Care for the Elderly (PACE), which provides enrolled seniors with customized healthcare and social support at PACE Adult Day Health Centers. These centers are staffed by medical professionals who are committed to creating personalized care plans for each participant. At InnovAge, our team members are our greatest asset and have a significant impact on the lives of our participants every day. When you join InnovAge, you'll work alongside talented, respectful, and passionate colleagues within a patient-centered care model.

*Remote in Colorado The RN Clinical Quality Improvement Advisor ensures standardization of processes, quality in care and compliance in operational and clinical practice at the InnovAge Day Center.

REQUIRED: State Registered Nurses License 3+ years health care experience with an emphasis in geriatrics, 3+ years nursing leadership with a background in quality Current skill with auditing systems, follow-up for corrections and process improvement for healthcare areas. Current knowledge of standards of clinical nursing practice and integration with regulations along with broad knowledge base of health care problems for the frail and elderly. Working knowledge of project management, facilitation of work groups, quality improvement, and team meetings. PREFERRED: Bachelor’s degree in nursing from an accredited college/university Certification as a Gerontological Nurse Lean or Six Sigma

Supports the oversight for the provision of care and delivery of services per PACE regulations and performance goals set by the Quality Improvement Program and Quality Work Plan. Supports the Infection Control Program by tabulating data and investigating issues as needed. Acts in collaboration with the infection preventionist as a resource for infection and infestation control issues. Assists the Director of Quality in developing and maintaining clinical operational policies, procedures and protocols related to quality and compliance. Develops and maintains performance improvement projects based on the needs of the quality department as determined by quarterly quality performance measures and compliance audits while adhering to LEAN methodology standards. Develops and sustains Plan(s) of Correction that results from identified quality improvement initiatives, surveys and/or other regulatory body audits. Develops and implements audits to ensure consistent practice of current policies, procedures and protocols. Prepares for and actively participates in all surveys/monitoring audits and ensures that InnovAge and its affiliates are survey-ready. Supports and implements quality improvement in assigned areas and as needed. Performs pre-operational auditing and promotes smooth transitions from development to implementation. Works to integrate standard clinical practice(s) and documentation compliance throughout InnovAge and its affiliates. Reports on problem areas that fall outside of regulation, community or professional standards, and performs follow-through to see if issues have been addressed. Participates in CMS and State reporting and facilitates work groups within the PACE centers and regional leadership Leads Root Cause Analysis activities to support process improvement activities as well as regulatory reporting. Prepares center-based teams and leadership for monthly and quarterly collaborative calls with state and CMS regulators. Collaborates with compliance team to support clinical quality oversight of community partners, including follow up on incidents and complaints. Facilitates and leads local and regional quality meetings in collaboration with PACE center staff and leadership. . Participates in collaborative care meetings at PACE centers, including fall teams, wound care teams, Participant Council. Leads regional efforts related to participant satisfaction activities at the PACE center. Participates in PCMH education, readiness, and accreditation activities. Delegates quality activities to Quality Improvement Specialists according to Director of Quality. Provides support of quality contracted facilities oversight. Provides coverage for Director of Quality when needed.

Pediatric Associates

Specialist, Healthcare Quality Improvement

Posted on:

January 30, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Florida

Pediatric Associates was founded in Hollywood, FL in 1955. The same clinician-led, evidence-based, medical home passion is a unifying driver for those who join Pediatric Associates Family of Companies. The Pediatric Associates Family of Companies is a growing team of Pediatricians and Pediatric Care Teammates who are excited to be part of the first nationwide Pediatric Primary Care Medical Home. We further our uniqueness by ensuring the clinician voice is leading our medical home innovations.

The Specialist, Healthcare Quality Improvement, is responsible for the healthcare quality improvement activities of the organization. Establishes, administers, and maintains quality studies, quality initiatives and written quality activities as defined by the Board, the organization’s Quality Management and Improvement Plan (including plans, programs, policies, and procedures), accreditation organizations, state and local laws, and governmental organizations.

EDUCATION: Minimum bachelor’s degree required. Registered Nurse certification or proof of MD in progress required. EXPERIENCE: Minimum 3 years of related experience required. 3-5 or more years preferred. LICENSURE / CERFITICATION: Lean or Six Sigma certification required within 3 months of hire. KNOWLEDGE, SKILLS, AND ABILITIES: Strong communication skills Strong clinical, interpersonal, organizational and communication skills Strong English writing skills with excellent spelling, grammar, and punctuation. Ability to manipulate data and create presentations. Expertise in infection prevention practices. Excel, Power Point, Outlook, and Word consistent with basic Microsoft Office certification. Requires strong computer skills and experience with electronic health records. Ability to work independently and as a team player. Detail oriented, ability to multi-task Positive attitude and display exceptional customer service skills. Strong telephonic skills and verbal articulation skills Ability to assess emergency situations and act accordingly. Effective working relationships with patients, parents, guardians, co-workers, and the public. TYPICAL WORKING CONDITIONS: Non-patient facing Potential involvement with patient and/or shadowing office workflow for surveys/outreach Remote; must be U.S. based. Indoor work Operates computer. May be exposed to hazards. Travels to all current and future Florida offices; may travel to locations outside of Florida. OTHER PHYSICAL REQUIREMENTS: Requires physical movement when evaluating offices and acquisitions. Sitting, traveling, walking, crawling, squatting, or kneeling, bending Manual dexterity Reach above shoulder. Lift/carry 20 lbs. or less; push/pull 13-25 lbs. or less. Vision Sense of sound, touch, taste, and smell PERFORMANCE REQUIREMENTS: Adhere to all organizational information security policies and protect all sensitive information including but not limited to ePHI and PHI (Protected Health Information) in accordance with organizational policy, Federal, State, and local regulations.

This list may not include all the duties that may be assigned. Designs, creates, and documents quality initiatives for the organization that meet all requirements as defined by the organization and/or accrediting partner. Collaborates with quality improvement leaders and key stakeholders; provides support to multidisciplinary teams collaborating on quality improvement initiatives. Applies quality improvement and safety tools and methodologies to identify improvement opportunities, such as PDSA, LEAN, six sigma, FMEA, process flow mapping, dashboard utilization. Presents aggregated data findings to committees and stakeholders on a quarterly basis. Provides education, training, and assistance when implementing quality and performance improvement activities throughout the organization. Develops and maintains relationships with key stakeholders such as quality team, safety and infection prevention, centralized services, and ambulatory care offices. Regularly reviews and revises infection prevention policies and procedures, incorporating the latest national standards and recommendations. Conducts site visits; evaluates whether procedures and workflows are being followed per approved guidelines. Provides training on policies, procedures, and practice standards. Acts as primary quality team support for the Patient Care, Quality, and Safety Committee. May prepare agendas, participate in meetings, or present current initiatives and outcomes. Maintains the Quality program, performs yearly evaluation, and communicates changes. Posts completed work projects to SharePoint to communicate activities to the organization. Analyzes studies written utilizing Maintenance of Certification (MOC) requirements; migrates data and documentation into the appropriate template per the accreditation body. May include conducting telephonic and face-to-face meetings to gather data, facts, information, and analysis. Ensures studies meet criteria to be recognized as a component of the Medical Home’s quality improvement program and compliant with the organization’s Quality Management and Improvement Plan.

Aprexis

Clinical Interviewer Bilingual Spanish – CMR and TMRI Completion (RN)

Posted on:

January 30, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Puerto Rico

The Clinical Interviewer – CMR and TMRI Completion (RN) supports Aprexis’ MTM initiatives by conducting Comprehensive Medication Reviews (CMRs) and Targeted Medication Reviews (TMRIs). This role helps patients optimize medication use, identify potential medication-related issues, and improve adherence to prescribed therapies.This role works closely with pharmacists and other clinicians to ensure each patient interaction aligns with CMS MTM program standards, contributes to measurable clinical quality outcomes, and reflects Aprexis’ commitment to compassionate, evidence-based care.

Active and unrestricted Registered Nurse (RN) license in good standing. Minimum 2 years of clinical experience, preferably in ambulatory care, home health, or community health. Strong communication, interviewing, and clinical documentation skills. Familiarity with medication management principles, electronic health records, and patient education. Ability to work independently while maintaining accuracy, professionalism, and patient-centered care. Experience in telehealth or MTM programs preferred. Work Setting: Remote position with flexible scheduling to reach patients across multiple time zones. Collaborative, technology-enabled environment supported by the Aprexis clinical and administrative teams. Performance Metrics: CMR and TMRI completion rate and accuracy Quality and compliance of documentation Patient satisfaction and engagement Collaboration and adherence to Aprexis clinical protocols Employment Contingency: Employment is contingent upon successful completion of professional reference and background checks in accordance with Aprexis’ quality and integrity standards.

Conduct telephonic or virtual CMRs and TMRIs with eligible patients as part of Aprexis’ Medication Therapy Management (MTM) program. Collect and verify accurate medication histories, including prescription, OTC, herbal, and supplement use. Identify and document medication discrepancies, adherence barriers, and potential adverse effects. Educate patients on medication use, chronic disease management, and lifestyle modifications to support therapeutic success. Collaborate with Aprexis pharmacists and healthcare professionals to resolve medication-related problems and implement care plans. Document all patient interactions and clinical findings in accordance with MTM program requirements and Aprexis policies. Ensure timely completion of assigned CMRs and TMRIs, follow-ups, and documentation review. Maintain current knowledge of clinical guidelines, medication safety, and MTM best practices.

Harmonic Health

Remote Contract Nurse Practitioner

Posted on:

January 30, 2026

Job Type:

Contract

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

The U.S. is facing an unseen challenge — millions of patients and families impacted by Alzheimer’s, Parkinson’s, and other neurodegenerative diseases. More than 6.7 million Americans are currently living with Alzheimer’s and related disorders, and that number continues to grow. Harmonic Health (HH) was founded by clinical experts, caregivers, and forward-thinkers to transform the dementia care journey. Our multidisciplinary care model blends telehealth, caregiver education, predictive analytics, and human-centered clinical support to guide patients and families through every stage of dementia with compassion, dignity, and evidence-based care.

Geriatric Nurse Practitioner – Multi-State (100% Remote / Telehealth) Location: United States (Remote – Work From Home) Licensure Requirement: Active NP license in at least 3 of the following states: MA, WA, ND, CA, SC, VA, NH, KS, MS, CO, AR, NV, AZ, LA, MO, NC, OR, UT Organization: Harmonic Health Employment Type: Full-time Harmonic Health is seeking a Geriatric Nurse Practitioner licensed in a minimum of three (3) states from the list above to join our growing fully remote clinical team. This role is central to the Harmonic Health care model and focuses on comprehensive triaging, screening, diagnosing, staging, and longitudinal management of dementia and other neurodegenerative disorders via telehealth. The ideal candidate has experience in geriatrics, dementia care, neurology, or primary care, and is excited to grow specialized expertise through training and certifications supported by Harmonic Health. You must be comfortable working in a fast-paced, mission-driven startup environment with a collaborative, team-based approach to care.

Education & Professional Development: Maintain current knowledge of best practices and emerging research Participate in quality improvement and clinical innovation initiatives Obtain dementia, neurology, or gerontological certifications as appropriate Collaboration: Partner with interdisciplinary team members and external providers Participate in case conferences and clinical reviews Serve as a point of contact for partner clinicians and administrators Qualifications Required: Active Advanced Practice RN license in at least three (3) of the following states: MA, WA, ND, CA, SC, VA, NH, KS, MS, CO, AR, NV, AZ, LA, MO, NC, OR, UT National Advanced Practice Board Certification Eligibility to bill Medicare Master’s or Doctorate degree in Nursing Practice Willingness to obtain gerontological, dementia care, or neurology-related certifications Ability to work full-time in a 100% remote telehealth environment Preferred: 3+ years NP experience in geriatrics, neurology, or primary care Telehealth experience and EMR proficiency Strong communication, organization, and clinical judgment skills Comfort working in a startup environment and contributing to workflow development Interest in clinical leadership, protocol development, or precepting Physical Requirements: Ability to sit for extended periods Frequent use of a computer and telehealth systems Ability to perform standard remote clinical duties

Patient Care: Conduct evidence-based triaging, screening, diagnosis, staging, and ongoing management of dementia and related disorders Prescribe and manage pharmacologic and non-pharmacologic treatment plans Develop and oversee individualized dementia care plans Perform and interpret neuropsychological assessments Conduct advanced medication reconciliation, optimization, and deprescribing Manage neuropsychiatric and behavioral symptoms in collaboration with behavioral health clinicians Serve as a clinical subject matter expert for internal teams and partner practices Patient & Caregiver Education: Provide caregiver education, coaching, and emotional support Facilitate shared decision-making and care planning

TapestryHealth

RPM Weekend RN Team Lead

Posted on:

January 29, 2026

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Conneticut

TapestryHealth, based in Connecticut, is the leader in providing Chronic Care Management, Remote Patient Monitoring, and Primary Care services for Long Term Care and Post Acute facilities. The company leverages a suite of technology to create a 24/7 safety net around each resident, enabling proactive care.

The RN Team Lead of RPM serves as the primary point of contact for inquiries regarding the daily operations of the Notification Center which serves our patient population in the navigation, prevention, and management of their health through our RPM program to help prevent hospitalizations and reduce mortality rates. This role will be responsible for communicating effectively with team members and management to achieve project objectives as well as assisting in the onboarding of new team members and providing the necessary training. The team lead will communicate and collaborate with management on alerts received via remote technological devices leveraging dashboards/reports, assuring integrity and appropriateness of reporting elements, and clinical triaging of the findings per protocols established. The team lead will also assist the Supervisor and Clinical Manager with audits of staff members, assist with delegation of appropriate tasks and assist in the production of the daily assignment. This role is full-time 40 hours weekly and will include weekends.

Active Registered Nurse (RN) License, practicing within the appropriate scope. Minimum 2 years of RN experience, with at least 1 year in a supervisory or leadership capacity. Proficiency in navigating electronic health records. Excellent organizational and prioritization skills with attention to detail. Proficient with Microsoft Office Suite. Experience managing alerts, reviewing data, and utilizing electronic health records (EHRs). ** Work scheduled weekends as assigned. Preferred: Strong verbal/written communication 3 years of RN experience, with at least 2 years in a supervisory or leadership capacity. Background in Remote setting, Emergency, Cardiac, or Critical Care nursing. Proven ability to lead and motivate teams in a remote or hybrid environment. Experience in performance management with a high level of comfort delivering feedback, and ongoing performance management audits. Demonstrated ability to work independently while fostering team collaboration. Strong customer service mindset and professional representation of TapestryHealth.

Serve as initial point of contact for questions and serve as a subject matter expert to the team. Lead the onboarding process for new hires, ensuring a smooth integration into the team. Ensure protocols related to alerts are adhered to as established. Collaborate on refining and maintaining training materials to ensure clarity, accuracy, and consistency. Provide ongoing mentorship and support to foster individual confidence and team success. Partner with the other Team Lead’s to maintain consistent coverage and support when one is out. Identifies medical changes or abnormalities through monitoring for escalation and clinical review per protocol. Communicates with other Team Leads, Supervisor, and Manager regarding quality, system capacity, and resource requirements, facility and/or provider feedback (if applicable). When not onboarding, maintain approximately 50% of a regular assignment to stay actively engaged in daily workflows. Foster a supportive team culture that promotes open communication, mutual respect, and shared success. Adhere to all established policy/protocol of the department and workflow. Works with Tapestry IT and Data Scientists to resolve discrepancies with patient data information. Protects patient information and adheres to the standard of confidentiality. Contributes and participates in continuous quality improvement activities. All other duties as assigned.

HealthSnap

Care Navigator (Remote LPN) - Illinois License Required

Posted on:

January 29, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Compact / Multi-State

HealthSnap (healthsnap.io) empowers patients and their physicians to improve health outcomes using an innovative platform for modern, proactive patient care. We help healthcare organizations easily manage chronic conditions remotely, and deliver personalized patient experiences when it's needed most. Be part of an organization built on teamwork, innovation, mutual respect, and equality for all. We believe in the power of prevention over treatment, after our co-founders experienced how modern healthcare failed their loved ones, they knew there had to be a better way. We believe that every patient deserves to receive the right care, at the right time, and in the right location - regardless of their condition or status. We lead with empathy above all else, and place the patient at the center of everything we do. Working at HealthSnap means being part of a family and a team where if you win, we all win, no matter how big or small the accomplishment. We take ownership - and lead with empathy - and expect each employee to recognize that real patients rely on HealthSnap every day.

We are hiring LPN's with Illinois license to support patients who are enrolled in chronic care management and/or remote patient monitoring programs. This is done in partnership with the patients’ care team which may include primary or specialty physician practices or healthcare systems. Successful candidates will bring experience in educating patients on chronic diseases such as hypertension and diabetes. This is a full-time position that operates Monday through Friday, 9:00 am to 5:30 p.m. Eastern Time, unless otherwise specified. As a Care Navigator, you will be trained in HealthSnap’s remote patient monitoring platform and will be responsible for communicating with enrolled patients in conjunction with the patients’ care team. Care Navigators typically have an assigned group of patients for which the Care Navigator is responsible for assisting throughout the month. Care Navigators also assist with other patients or patient tasks as assigned. Above all else, you will play an essential role in establishing a relationship with assigned patients that allows you to empower them to manage their chronic illnesses and improve their health. ** Illinois Nursing License Required ** ** Additional Compact Nursing License Preferred **

Qualifications: Education: A current, valid, and in good standing Multistate/Compact Nursing License (LPN/LVN) Additional state licenses may be required and will be reimbursed by HealthSnap Experience: 3+ years of experience in primary care practice, cardiology, internal medicine, home care, or chronic care management/remote patient monitoring Skills: Strong communication and interpersonal skills Excellent organizational and time management abilities Proficiency in using electronic health records (EHR) and care management software Ability to work independently and as part of a team Empathy and a patient-centered approach to care Technical Requirements: Reliable internet connection and HIPAA-compliant work area and proficiency with virtual communication tools (e.g., Zoom, Slack)

Patient Support: Complete phone consultations with patients enrolled in care management and/or remote patient monitoring programs providing support and education about their chronic conditions. Education and Empowerment: Educate patients about their health conditions and empower them with lifestyle and behavior strategies to actively manage their chronic conditions. Assist patients to set and reach goals in line with their provider-approved care plans. Documentation: Maintain accurate and up-to-date patient records, ensuring all interactions and care plans are documented per protocol. Problem Solving: Address patient concerns and barriers to care, working to find practical solutions to improve patient adherence and outcomes. Communication: Provide clear, compassionate, and effective communication to patients. Follow approved workflows regarding communicating patient needs to their providers. Continuous Improvement: Participate in training sessions, team meetings, and quality improvement initiatives to enhance the care navigation process and patient experience. Evaluation and Responding: Respond to remotely transmitted patient data such as blood pressure, blood glucose, weight, and pulse oximetry according to approved partner workflows.

HealthSnap

Care Navigator (Remote LPN) - New York License Required

Posted on:

January 29, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Compact / Multi-State

HealthSnap (healthsnap.io) empowers patients and their physicians to improve health outcomes using an innovative platform for modern, proactive patient care. We help healthcare organizations easily manage chronic conditions remotely, and deliver personalized patient experiences when it's needed most. Be part of an organization built on teamwork, innovation, mutual respect, and equality for all. We believe in the power of prevention over treatment, after our co-founders experienced how modern healthcare failed their loved ones, they knew there had to be a better way. We believe that every patient deserves to receive the right care, at the right time, and in the right location - regardless of their condition or status. We lead with empathy above all else, and place the patient at the center of everything we do. Working at HealthSnap means being part of a family and a team where if you win, we all win, no matter how big or small the accomplishment. We take ownership - and lead with empathy - and expect each employee to recognize that real patients rely on HealthSnap every day.

We are hiring LPNs in multiple states to support patients who are enrolled in chronic care management and/or remote patient monitoring programs. This is done in partnership with the patients’ care team which may include primary or specialty physician practices or healthcare systems. Successful candidates will bring experience in educating patients on chronic diseases such as hypertension and diabetes. This is a full-time position that operates Monday through Friday, 9:00 am to 5:30 p.m. Eastern Time, unless otherwise specified. As a Care Navigator, you will be trained in HealthSnap’s remote patient monitoring platform and will be responsible for communicating with enrolled patients in conjunction with the patients’ care team. Care Navigators typically have an assigned group of patients for which the Care Navigator is responsible for assisting throughout the month. Care Navigators also assist with other patients or patient tasks as assigned. Above all else, you will play an essential role in establishing a relationship with assigned patients that allows you to empower them to manage their chronic illnesses and improve their health. **New York Nursing License Required ** Please note: Pay is state-specific. The posted range applies to NY residents; candidates in other states will receive compensation aligned with their state of residence. ** Additional Compact Nursing License Preferred **

Education: A current, valid, and in good standing Multistate/Compact Nursing License (LPN/LVN) Additional state licenses may be required and will be reimbursed by HealthSnap Experience: 3+ years of experience in primary care practice, cardiology, internal medicine, home care, or chronic care management/remote patient monitoring Skills: Strong communication and interpersonal skills Excellent organizational and time management abilities Proficiency in using electronic health records (EHR) and care management software Ability to work independently and as part of a team Empathy and a patient-centered approach to care Technical Requirements: Reliable internet connection and HIPAA-compliant work area and proficiency with virtual communication tools (e.g., Zoom, Slack)

Patient Support: Complete phone consultations with patients enrolled in care management and/or remote patient monitoring programs providing support and education about their chronic conditions. Education and Empowerment: Educate patients about their health conditions and empower them with lifestyle and behavior strategies to actively manage their chronic conditions. Assist patients to set and reach goals in line with their provider-approved care plans. Documentation: Maintain accurate and up-to-date patient records, ensuring all interactions and care plans are documented per protocol. Problem Solving: Address patient concerns and barriers to care, working to find practical solutions to improve patient adherence and outcomes. Communication: Provide clear, compassionate, and effective communication to patients. Follow approved workflows regarding communicating patient needs to their providers. Continuous Improvement: Participate in training sessions, team meetings, and quality improvement initiatives to enhance the care navigation process and patient experience. Evaluation and Responding: Respond to remotely transmitted patient data such as blood pressure, blood glucose, weight, and pulse oximetry according to approved partner workflows.

Broadspire Services, Inc.

Sr Medical Case Manager

Posted on:

January 29, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Texas

Because a claim is more than a number — it’s a person, a child, a friend. It’s anyone who looks to Crawford on their worst days. And by helping to restore their lives, we are helping to restore our community – one claim at a time. At Crawford, employees are empowered to grow, emboldened to act and inspired to innovate. Our industry-leading team pioneers new solutions for the industries and customers we serve. We’re looking for the next generation of leaders to take this journey with us. We hail from more than 70 countries and speak dozens of languages, reflecting the global fabric of the audience we serve. Though our reach is vast, we proudly operate as One Crawford: united in purpose, vision and values. Learn more at www.crawco.com.

Now Hiring: RN Sr Case Manager – San Antonio, TX Region Work from home + local field travel Salary: Competitive & commensurate with experience Quarterly Bonus Opportunities Free CEUs for licenses & certificates License & Certification Reimbursement We’re looking for an RN with a passion for case management to join our team! RN degree required National Certification preferred (CCM, CRC, COHN, CRRC) Workers’ Comp Case Management experience a plus Your Impact: You’ll provide effective case management services in a cost‑effective manner, delivering medical case management consistent with URAC standards, CMSA Standards of Practice, and Broadspire QA Guidelines. You’ll support patients/employees receiving benefits under insurance lines including Workers’ Compensation, Group Health, Liability, Disability, and Care Management. This is your chance to grow your career, earn great rewards, and enjoy true work-life balance.

Bachelor's Degree in a health-related field is preferred. Associates or diploma in nursing also accepted. Three years of Workers' Compensation case management with ability to independently coordinate a diverse caseload ranging in moderate to high complexity. Demonstrated ability to handle complex assignments and ability to work independently is required. Effective oral and written communication skills are required. Thorough understanding of jurisdictional WC statutes. Advanced knowledge to exert positive influence in all areas of case management. Advanced communications and interpersonal skills in order to conduct training, provide mentorship, and assist supervisor in general areas as assigned. Highly skilled at promoting all managed care products and services internally and externally. Active RN home state licensure in good standing without restrictions with the State Board of Nursing. Minimum of 1 nationally recognized Certification from the URAC list of approved certifications. Must be able to travel as required. Individuals who conduct initial clinical review possess an active, professional license or certification: To practice as a health professional in a state or territory of the U.S.; and With a scope of practice that is relevant to the clinical area(s) addressed in the initial clinical review. Must maintain a valid driver's license in state of residence.

May assist supervisor/manager in review of reports, staff development. Reviews case records and reports, collects and analyzes data, evaluates client's medical and vocational status and defines needs and problems in order to provide proactive case management services. Demonstrates ability to meet or surpass administrative requirements, including productivity, time management, quality assessment (QA) standards with a minimum of supervisory intervention. Facilitates a timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician and employer. Coordinates return to work with injured worker/disabled individual, employer and physicians. May recommend and facilitate completion of peer reviews and IME's by obtaining and delivering medical records and diagnostic films notifying patients. Manages cases of various product lines of at least 3-4 areas of service (W/C, Health, STD, LTD, Auto, Liability, TPA, Catastrophic, Life Care Planning). Specifically, the case manager should be experienced in catastrophic cases plus 2-3 additional types listed above. Renders opinions regarding case cost, treatment plan, outcome, and problem areas and makes recommendations to facilitate rehabilitation case management goals to include RTW. May review files for claims adjusters and supervisors. May perform job site evaluations/summaries. Prepares monthly written evaluation reports denoting case activity, progress and recommendations in accordance with state regulations and company standards. May obtain referrals from branch claims office or assist in fielding phone calls for management as needed. Maintains contact and communicates with insurance adjusters to apprise them of case activity, case direction or receive authorization for services. Maintains contact with all parties involved on case, necessary for rehabilitation of the client. May spend approximately 70% of work time traveling to homes, health care providers, job sites, and various offices as required to facilitate return to work and resolution of cases. May meet with employers to review active files. Reviews cases with supervisor monthly to evaluate file and obtain direction. Upholds the Crawford and Company Code of Business Conduct at all times. Demonstrates excellent customer service, and respect for customers, co-workers, and management. Independently approaches problem resolution by appropriate use of research and resources. May perform other related duties as assigned.

Newave Care

Remote Licensed Practical Nurse (LPN)

Posted on:

January 29, 2026

Job Type:

Full-Time

Role Type:

Primary Care

License:

LPN/LVN

State License:

Compact / Multi-State

Newave Care is transforming elder care by combining compassion, advanced technology, and seamless coordination. We deliver high-touch preventive care and chronic disease management to geriatric patients—both in skilled nursing facilities and at home—using AI-powered tools, continuous monitoring, and real-time virtual support.

Job Title: Remote Licensed Practical Nurse (LPN) – Chronic Care Management (CCM) Location: Remote (U.S. Based) Job Type: Full-Time/Part time Reports To: Clinical Operations Manager / CCM Program Director We are hiring a Remote Licensed Practical Nurse (LPN) with Chronic Care Management (CCM) experience to support our expanding patient population. In this remote role, you’ll engage patients telephonically, monitor chronic conditions, update care plans, and help coordinate care. Your work will directly impact outcomes for patients with multiple chronic illnesses.

Active, unrestricted LPN license in the U.S. 2+ years of clinical experience (geriatrics, primary care, or CCM preferred) Prior experience with CMS CCM programs Excellent communication skills (especially by phone) Strong documentation and time-management skills Comfortable with EMRs and remote work environments Nice to Have: Experience with telehealth or remote nursing Bilingual (Spanish/English) preferred Familiarity with Medicare and long-term care populations Passion for preventive, compassionate patient care

Conduct monthly check-ins with assigned CCM patients/caregivers by phone Update and manage care plans as patients’ conditions evolve Document time and care activities in the EMR (PCC experience a plus) Coordinate care: referrals, labs, appointments, follow-ups Educate patients and caregivers on chronic condition management Identify care gaps and escalate concerns to providers Ensure CMS compliance for CCM time tracking and documentation

Tang and Company

Telephonic Nurse

Posted on:

January 29, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

Our story started in 1977, as a single medical clinic in Long Beach, CA. that was to become CareOnSite Medical Services. Since then, we have grown into more than just a medical provider. In 1998, ASAP Drug Solutions was begun as a response to our clients’ drug-testing needs; then came OSCA in 2003, representing our foray into the safety training arena. We have also expanded our presence in the US, with offices in Carson, Martinez and Houston. In 2016, our parent company Tang & Company was established, bringing the three separate businesses in our family – CareOnSite, ASAP and OSCA – under the same umbrella. The move has allowed us to create synergies among the businesses as we integrate our products, services, marketing strategies and corporate infrastructure,

CareOnSite, a division of Tang & Company which provides occupational medical services nationwide, is seeking dedicated and experienced Telephonic Occupational Health Nurses for excellent full-time opportunities. This is a remote position that offers full-time day shift hours with rotating weekends and holidays.

Valid Compact RN license. Excellent verbal communication skills to effectively interact with callers and provide clear instructions. Minimum of 5 years of recent clinical nursing experience in occupational medicine, hospital, clinic, urgent care, or ER/ED settings. Certification as an Occupational Health Nurse is preferred. Telephonic nursing experience is preferred. Must be a resident of a nursing compact state

Answer inbound calls through the telephonic triage line, providing prompt and efficient service. Assess caller's issues by asking relevant and open-ended questions to gather necessary information. Utilize clinical judgment to guide conversations and provide appropriate recommendations for patient care. Consult with Telephonic Provider when necessary to facilitate appropriate patient care. Educate callers on immediate care, advice, and preventive behaviors as appropriate. Handle caller complaints with discretion and independent judgment.

Cotiviti

Clinical Analyst I

Posted on:

January 29, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Utah

Cotiviti is a leading solutions and analytics company that leverages unparalleled clinical and financial datasets to deliver deep insight into the performance of the healthcare system. These insights uncover new opportunities for healthcare organizations to collaborate to improve their financial performance, reduce inefficiency, and improve healthcare quality. We focus on improving the financial and quality performance of our clients. In healthcare, this means taking in billions of clinical and financial data points, analyzing them, and then helping our clients discover ways they can improve efficiency and quality. In addition, we support the retail industry with data management and recovery audit services.

This Coding Validation Analyst I position will perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical knowledge and background to ensure appropriateness for reimbursement and will also respond to provider appeals. This position requires strong organizational skills and the ability to meet strict key performance indicators in a fast-paced work environment. Daily, substantive contact with internal staff. This is a closely monitored productivity-driven role and can be done anywhere in the continental US (this is shift work and hours need to be flexible...this team runs 24 x 7). Shifts include (after training): First, second and third shifts (in Mountain Time) with rotating weekends and holidays.

Active professional license as a Registered Nurse in your current state of residence (BSN preferred). 2 years of professional experience in providing direct patient care. Coding Certification Preferred (Outpatient - CPC, CCS or CCS-P) or required to obtain within 1st year of employment. Required to obtain NY Independent Insurance Adjuster licensure within the first four months. Strong working knowledge of medical procedures, conditions, illnesses, and treatment practices. Has excellent personal computer skills in Microsoft Office Suite (Word, Excel, PowerPoint, Outlook). This position may require after-hours, weekend, or holiday hours to accomplish client objectives. This is an hourly position, and employees will be compensated accordingly. Training for this position lasts approximately 17 weeks and can be completed remotely, time off during the training period would not be preferred. Targeted start date is April 13, 2026; hours during training are 7 AM - 3 PM MT (9 am-5 pm ET) Monday-Friday...after training you will need to be able to work a scheduled shift, that will vary. Shifts include (after training): first, second and third shifts MT with rotating weekends and holidays. Each employee should plan on working rotating weekends and holidays, and that may include early mornings, evenings, nights, weekends, and rotating holidays (everyone is required to be flexible). This group of new hires will have weekends included in their shifts. Mental Requirements: Ability to absorb new information quickly and train in a fast-paced environment and ability to learn, test and pass off new training concepts daily. Ability to work in a high-pressure production environment and make audit decisions efficiently and accurately. Possesses excellent written and verbal communication skills. Ability to think logically and process sequentially with a high level of detailed accuracy and efficiency. Assessing the accuracy, neatness and thoroughness of the work assigned. Physical Requirements and Working Conditions: This position may require after-hours, weekend, or holiday hours to accomplish client objectives. Remaining in a stationary position, often standing or sitting for prolonged periods. Repeating motions that may include the wrists, hands, and/or fingers. Must be able to provide a dedicated, secure work area that is free from distractions, to allow and maintain high levels of productivity. Must be able to provide high-speed internet access/connectivity and office setup and maintenance.

Perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical background to ensure appropriateness for reimbursement and meet required client turnaround time and KPI goals. Respond to provider appeals and meet required client turnaround time and KPI goals. Contribute to product by providing feedback to Management/Development Teams on changes to enhance editing and efficiency. Utilize Coding Validation specific training to Become familiar with claims payment policy and processing – specifically CMS, Medicaid regulations, AAOS, ICD-10, CPT & HCPCS, etc. Complete all responsibilities as outlined in the annual performance review and/or goal setting. Complete all special projects and other duties as assigned. Must be able to perform duties with or without reasonable accommodation. This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.

One Medical

Virtual Family Nurse Practitioner - NY Licensed

Posted on:

January 29, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

New York

One Medical is a primary care solution challenging the industry status quo by making quality care more affordable, accessible and enjoyable. But this isn't your average doctor's office. We're on a mission to transform healthcare, which means improving the experience for everyone involved - from patients and providers to employers and health networks. Our seamless in-office and 24/7 virtual care services, on-site labs, and programs for preventive care, chronic care management, common illnesses and mental health concerns have been delighting people for the past fifteen years. In February 2023 we marked a milestone when One Medical joined Amazon. Together, we look to deliver exceptional health care to more consumers, employers, care team members, and health networks to achieve better health outcomes. As we continue to grow and seek to impact more lives, we're building a diverse, driven and empathetic team, while working hard to cultivate an environment where everyone can thrive.

The One Medical Virtual Medical Team (VMT) is a leading provider of virtual clinical care, providing world-class, convenient, evidence-based virtual medical care to One Medical patients in concert with their primary care providers. Through advanced technology and a team-based approach, we care for patients 24 hours a day, 365 days a year. Our team is united by intellectual curiosity, inclusiveness, and a powerful mission: transforming healthcare and bringing world-class primary care to everyone. Employment type: Full time 40 hours including evenings and weekends This is a full-time virtual role.

Education, licenses, and experiences required for this role: Completed an accredited FNP program with a national certification In the past 5 years, practiced as an Advanced Practitioner for at least: 2 years in an outpatient primary care setting seeing patients of all ages (0+), OR 2 years in an urgent care or emergency medicine setting seeing patients of all ages (0+) Currently licensed in NY with ability to obtain additional state licenses Ability to work weekday and weekend shifts (every Saturday or Sunday required) Current shifts range from (6am-5pm EST, 7am-6pm EST, 8am-7pm EST, 11am-10pm EST, 1pm-12am EST) Excellent clinical and communication skills One Medical providers also demonstrate: A passion for human-centered primary care The ability to successfully communicate with and provide care to individuals of all backgrounds The ability to effectively use technology to deliver high quality care Clinical proficiency in evidence-based primary care The desire to be an integral part of a team dedicated to changing healthcare delivery An openness to feedback and reflection to gain productive insight into strengths and weaknesses The ability to confidently navigate uncertain situations with both patients and colleagues Readiness to adapt personal and interpersonal behavior to meet the needs of our patients

Treating patients via tele-health visits, including telephonic triage calls, video visit appointments, and email follow-ups Continuous learning during weekly Clinical Rounds and through other modalities Ongoing collaboration with both virtual and in-office teammates via daily huddles Utilization of your specific clinical training and opportunities to give exceptional care to patients virtually

1st Call Triage

Pediatric Phone Triage Nurse (RN OREGON LICENSE REQUIRED)

Posted on:

January 29, 2026

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Oregon

Telephone Triage Nurse – Remote Pediatrics (OREGON License Required) Work From Home | Pediatric Medical Office Experience Required Overview: We are hiring a Registered Nurse with pediatric experience to join our remote triage team. This work-from-home role supports busy pediatric clinics by providing clinical phone assessments, symptom-based guidance, and care coordination. You’ll ensure timely and appropriate medical attention for children while working closely with providers and support staff.

Active RN licenses in Oregon (required, not part of compact/multistate license) Minimum 2 years of experience in a pediatric physician office Strong communication, clinical decision-making, and patient education skills EMR proficiency and ability to work independently Triage protocol experience preferred (e.g., Schmitt-Thompson) BSN and remote nursing experience a plus

Conduct telephone assessments and triage pediatric patients using clinical protocols Prioritize care and escalate to physicians as needed Manage prescription refills, referrals, and prior authorizations Educate parents on home care, symptom monitoring, and follow-up instructions Accurately document all patient interactions in the EMR Provide safe, efficient support in a fast-paced virtual environment

Highmark Inc.

Registered Nurse Quality Review Specialist - CIC or CCS

Posted on:

January 29, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

A national blended health organization, Highmark Health and our leading businesses support millions of customers with products, services and solutions closely aligned to our mission of creating remarkable health experiences, freeing people to be their best. Headquartered in Pittsburgh, we're regionally focused in Pennsylvania, Delaware, West Virginia, and eastern and northwestern New York with customers in 50 states and the District of Columbia. We passionately serve individual consumers and fellow businesses alike. And our companies cover a diversified spectrum of essential health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions. Our financial position reflects strength and stability, with our year-end 2020 consolidated revenues totaling $18 billion. And we’re proud to carry forth an important legacy of compassionate care and philanthropy that began more than 170 years ago. This tradition of giving back, reinvesting and ensuring that our communities remain strong and healthy is deeply embedded in our culture, informing our decisions every day

This role involves an indepth review of provider submitted appeals of medical claims, that have been previously been subject to a Payment Integrity finding, to ensure the accuracy and compliance of claim findings. The clinician will prepare and review provider appeal requests, validate accuracy of ICD-10-CM/PCS coding, and ensure proper reimbursement. This role requires strong clinical knowledge, medical coding expertise, and excellent analytical and communication skills.

Required 3 years of experience in Clinical setting 3 years of experience in Medical claim review 3 years of experience with Proficiency in medical coding and healthcare software systems 3 years of experience in Familiarity with payer policies and regulations Preferred 3 years of experience with electronic health systems SKILLS Strong analytical, communication, and problem-solving skills Strong understanding of ICD-10-CM/PCS coding guidelines and medical terminology Ability to work independently and as part of a team EDUCATION Required Associate's degree in Science of Nursing or relevant experience and/or education as determined by the company in lieu of bachelor's degree. ​Preferred Bachelor’s degree in Science of Nursing or relevant experience LICENSES or CERTIFICATIONS Required Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). Certified Inpatient Coder (CIC) or Certified Coding Specialist (CCS) Preferred None Language (Other than English): None Travel Required: Less than 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS Position Type Office-Based or Remote Position Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Review and analyze medical claims for accuracy and compliance with inpatient standards, accuracy of ICD-10-CM/PCS coding, ensuring compliance with current coding guidelines and regulations Prepare comprehensive appeals, including detailed narratives and supporting documentation, to address determinations, and submit determinations to providers in a timely manner. Maintain detailed and organized records of claims, reviews, and appeals. Stay updated with current healthcare regulations and policies Provide expertise and guidance on inpatient claim processed and best practices. Follow up with providers to ensure timely resolution of appeal requests, including providing feedback to providers and coding staff on coding accuracy and documentation requirements. Identify trends in denials and coding issues and collaborate with providers to improve documentation and coding practices. Other duties as assigned or requested.

Highmark Inc.

Care Manager RN - Weekend (FT) Remote

Posted on:

January 29, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

A national blended health organization, Highmark Health and our leading businesses support millions of customers with products, services and solutions closely aligned to our mission of creating remarkable health experiences, freeing people to be their best. Headquartered in Pittsburgh, we're regionally focused in Pennsylvania, Delaware, West Virginia, and eastern and northwestern New York with customers in 50 states and the District of Columbia. We passionately serve individual consumers and fellow businesses alike. And our companies cover a diversified spectrum of essential health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions. Our financial position reflects strength and stability, with our year-end 2020 consolidated revenues totaling $18 billion. And we’re proud to carry forth an important legacy of compassionate care and philanthropy that began more than 170 years ago. This tradition of giving back, reinvesting and ensuring that our communities remain strong and healthy is deeply embedded in our culture, informing our decisions every day.

Weekend Remote RN - 3 days per week plus weekends. This job implements effective utilization management strategies including: review of appropriateness of health care services, application of criteria to ensure appropriate resource utilization, identification of opportunities for referral to a Health Coach/case management, and identification and resolution of quality issues. Monitors and analyzes the delivery of health care services; educates providers and members on a proactive basis; and analyzes qualitative and quantitative data in developing strategies to improve provider performance/satisfaction and member satisfaction. Responds to customer inquiries and offers interventions and/or alternatives.

Required: None Substitutions: None Preferred: Bachelor’s Degree in Nursing EXPERIENCE Required: 3 years of related, progressive clinical experience in the area of specialization Experience in a clinical setting Preferred Experience in UM/CM/QA/Managed Care LICENSES AND CERTIFICATIONS Required: Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). Additional specific state licensure(s) may be required depending on where clinical care is being provided. Preferred: Certification in utilization management or a related field SKILLS: Working knowledge of pertinent regulatory and compliance guidelines and medical policies Ability to multi task and perform in a fast paced and often intense environment Excellent written and verbal communication skills Ability to analyze data, measure outcomes, and develop action plans Be enthusiastic, innovative, and flexible Be a team player who possesses strong analytical and organizational skills Demonstrated ability to prioritize work demands and meet deadlines Excellent computer and software knowledge and skills Languages (Other than English): None Travel Requirement: 0% - 25% PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS: Position Type Office-Based Teaches/trains others regularly Occasionally Travel regularly from the office to various work sites or from site-to-site Does Not Apply Works primarily out-of-the office selling products/services (sales employees) Does Not Apply Physical work site required Yes Lifting: up to 10 pounds Constantly Lifting: 10 to 25 pounds Occasionally Lifting: 25 to 50 pounds Rarely, Occasionally Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.

Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager’s professional discipline. Function in accordance with applicable state, federal laws and regulatory compliance. Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies. Promote quality and efficiency in the delivery of care management services. Respect the member’s right to privacy, sharing only information relevant to the member’s care and within the framework of applicable laws. Practice within the scope of ethical principles. Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions. Employ collaborative interventions which focus, facilitate, and maximize the member’s health care outcomes. Is familiar with the various care options and provider resources available to the member. Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships. Develop and sustain positive working relationships with internal and external customers. Utilize outcomes data to improve ongoing care management services. Other duties as assigned or requested

Healthmap Solutions

RN Care Navigator (100% Remote in PA)

Posted on:

January 29, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Pennsylvania

Healthmap Solutions is the future of specialty health management that focuses on progressive diseases, with a particular expertise in kidney health populations. Healthmap Solutions uses clinical big data resources and high-powered analytics to power complex specialty health management programs. Healthmap Solutions is a diverse, growing company committed to our clients and our employees. We are champions for better health, for those who need us most.

The Registered Nurse, Care Navigator will be responsible for case management specific to kidney health management. The Care Navigator will complete activities for the continuum of care to facilitate and promote high quality, cost-effective outcomes for patients and focus on the whole patient and care delivery coordination. Managing a set caseload of mixed acuity members, reviewing and/or obtaining member data and entry in HealthMap’s Care Management documentation system (Compass), completing member health and social determinants of health screenings, medication reconciliation, creation and maintaining member-centric care plans, updates of identified problems, barriers, interventions, and goals and assistance with ongoing case management. The Care Navigator will collaborate with internal and external (physicians, nurses, and other healthcare personnel) to assure positive patient outcomes and care coordination. Location: We are hiring candidates located in Pennsylvania. This position is 100% remote for Pennsylvania residents.

Requirements: Active, unrestricted RN license required Bachelor's degree required CCM preferred Three (3) years of experience in case management preferred Experience in a dialysis center or transplant center preferred Experience with Medicare and Medicaid preferred Skills: Advocate and energize a culture of collaboration, positivity, and motivation Strategic thinking and planning Deliver effective communication – verbal and written Succeed in a challenging environment with changing priorities

Handle in and outbound calls delivering world-class service to our members Educate kidney health and related co-morbid conditions as well as optimizing renal replacement therapy by educating members on the types of dialysis and transplant options Engage members into HealthMap’s Kidney Health Program Follow up with members based on complexity and cadence by policy Serve as patient advocate for responding and working to resolve concerns or barriers Utilize community resources and programs in care planning Serve as liaison between the patient, the patient’s support network, treating physician, and other ancillary providers as a member of an interdisciplinary care team to coordinate care, resolve nursing problems and assist patients in meeting individualized goals Notify providers of identified patient needs based on policy Comply with HIPAA privacy laws and all other federal, state, and local regulations Comply with company-defined operational policies and procedures Comply with company security policies Accountable for individual metrics and key performance indicators and identified by the organization Navigate technical applications - Excel, OneNote, Outlook, and Word Support after hours and various time zones based on business need Drive patient and families in their own care and to support self-management

Medcor Inc

Bilingual (Spanish) Telephonic Triage RN - 11a-11p CST

Posted on:

January 29, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Medcor provides clinical interventions and management services to help companies reduce their health-care costs and improve health outcomes. Medcor provides its services with staff and systems located on-site in large client locations or telephonically for smaller locations. Business entities can also integrate Medcor’s clinical interventions into their own systems to establish branded clinics. By intervening at the moment an injury occurs, or at the onset of illness, Medcor can determine the severity of each case as well as the best course of action for its immediate treatment. With this approach, unnecessary treatments, claims, and costs are avoided, while required treatments are obtained right away. Medcor's Services include On-site Health & Wellness Clinics, 24/7 Telephonic Injury Triage, Drug Testing & Screening Services, Construction Health & Safety, Mobile Units, Safety Staffing & Training Services (First Aid, CPR, OSHA, HAZWOPER, Blood Borne Pathogens, NIMS, Respirator Use, Fall Protection & Prevention, and many more..

Medcor is looking to hire full-time bilingual Spanish-speaking Registered Nurses for our remote 24/7 Occupational Health triage call center! The hours for this position include 8-hour and 10-hour shifts between 11:00am and 11:00pm CST. For example, shifts could include 11:00am-7:00pm or 12:00pm-10:00pm. The start date for this triage class will be 03/23/2026. Job Type: Full-time - 40 hours per week Salary: $30 per hour with additional shift differential pay available for evenings, nights & weekends By joining our nursing team, you will be helping thousands of employers better manage their workplace injuries and improve the quality of healthcare for their employees. Nurses who are successful in this position must be able to talk on the phone for long periods while typing and navigating through various software applications simultaneously. Our nurses must be able to visualize an injury while on the phone and clarify details about the injury while following our propriety algorithms to guide the triage of the injured worker. Training: Training for this role will last 5-6 weeks, with 2.5 weeks of classroom instruction and 2.5 weeks of precepting. These first 5-6 weeks of training are held Monday through Friday, from 8a-4p CST. The training schedule is non-negotiable, and all training must be successfully completed within a 6-week time frame. Following training, you will transition to your permanent schedule between the hours of 11a and 11p CST with an every-other-weekend requirement and holiday rotation. Changes to the permanent schedule are not allowed within the first 12 months of employment as these are based on our business needs.

Be bilingual, fluent in both the English and Spanish language Have a valid RN license and current BLS (CPR) certification Be able to handle a high volume of consecutive calls Have strong technological skills as well as a typing speed of at least 30 WPM Work a major U.S. holiday rotation Work every other weekend Have effective written, verbal, and interpersonal communication skills. Ability to read, analyze, and interpret triage tools and information along with care instructions to injured employees and their managers. Be able to talk and/or hear. You are required to sit and use your hands. Specific vision abilities required by this job include close vision for computers and written work with the ability to adjust focus Be able to work on a computer for long periods Have a private space in your home with 4 walls and a door for patient privacy Have access to high-speed internet (no satellite) within your primary residence Be able to receive and apply feedback It's a Plus If: You have call center experience You have occupational health experience

Manage a rapid flow of incoming telephone calls from Medcor customers in a call center environment Document each call efficiently and accurately Monitor and track individual as well as call center goals, productivity metrics, and statistics Reflect all shift activities using the phone system and be responsible for personal schedule adherence Provide superior customer service to Medcor’s clients and employees Complete accurate assessment of symptoms and/or concerns utilizing Medcor’s Triage Algorithms Follow HIPAA Compliance Policies

Cambia Health Solutions

Utilization and Care Management Nurse

Posted on:

January 28, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Oregon

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Every day, Cambia’s dedicated team of Nurses are living our mission to make health care easier and lives better. As a member of the Clinical Services team, our Utilization and Care Management Nurses provide utilization and care management (such as prospective concurrent, retrospective review, post-discharge care coordination) to best meet the member’s specific healthcare needs and to promote quality and cost-effective outcomes and appropriate payment for services – all in service of making our members’ health journeys easier. Are you a Nurse who has a passion for healthcare? Are you a Nurse who is ready to take your career to the next level and make a real difference in the lives of our members? Then this role may be the perfect fit.

Qualifications: Associate or Bachelor’s Degree in Nursing or related field 3 years of case management, utilization management, disease management, auditing or retrospective review experience Equivalent combination of education and experience Must have licensure or certification, in a state or territory of the United States, in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice for the discipline (e.g. medical vs. behavioral health) and at least 3 years (or full time equivalent) of direct clinical care. May need to have licensure in all four states served by Cambia: Idaho, Oregon, Utah, Washington. Must have at least one of the following: Bachelor’s degree (or higher) in a health or human services-related field (psychiatric RN or Masters’ degree in Behavioral Health preferred for behavioral health); or Registered nurse (RN) license (must have a current unrestricted RN license for medical care management) Skills and Attributes: Knowledge of health insurance industry trends, technology and contractual arrangements. General computer skills (including use of Microsoft Office, Outlook, internet search). Familiarity with health care documentation systems. Experience with AI tools and technologies to enhance productivity and decision-making in professional settings highly desired Strong verbal, written and interpersonal communication and customer service skills. Ability to interpret policies and procedures and communicate complex topics effectively. Strong organizational and time management skills with the ability to manage workload independently. Ability to think critically and make decisions within individual role and responsibility.

Conducts utilization management reviews (prospective, concurrent, and retrospective) to ensure medical necessity and compliance with policy and standards of care. Participate in care management to identify and coordinate health care needs and gaps for members during the period of discharge from a facility until 30 days post discharge. Applies clinical expertise and evidence-based criteria to make determinations and consults with physician advisors as needed. Collaborates with interdisciplinary teams, case management, and other departments to facilitate transitions of care and resolve issues. Serves as a resource to internal and external customers, providing accurate and timely responses to inquiries. Identifies opportunities for improvement and participates in quality improvement efforts. Maintains accurate and consistent documentation and prioritizes assignments to meet performance standards and corporate goals. Protects confidentiality of sensitive documents and issues while communicating professionally with members, providers, and regulatory organizations.

PeaceHealth

RN Utilization Management Reviewer (Per Diem) - Remote (OR, WA or AK)

Posted on:

January 28, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Washington

PeaceHealth, based in Vancouver, Washington, is a not-for-profit health system offering care to communities in Washington, Oregon, and Alaska. PeaceHealth has approximately 17,000 Caregivers, a multi-specialty medical group practice with more than 1,200 physicians and providers and ten medical centers serving both urban and rural communities throughout the Northwest. At the heart of our Mission, Values, and Vision is our responsibility to our patients, their loved ones and our communities. For over a century, PeaceHealth has been committed to Exceptional Medicine and Compassionate Care. Our founding Sisters, known for their activist and reformist ways, committed to a mission of social justice and healing for all. This vision continues to resonate in all that we do, including the relentless pursuit of continually improving our health care services and care. Today, our heritage and clinical excellence are carried on by Caregivers like you. Are you ready to join our journey? Apply to join our growing team! PeaceHealth is dedicated to EEO and Affirmative Action for all protected groups, including veterans and the disabled.

Join PeaceHealth in advancing compassionate, mission-driven care from wherever you are. PeaceHealth is looking for a skilled and motivated Registered Nurse Utilization Management (UM) Reviewer to join our dedicated team in a Per Diem, Day Shift role. If you enjoy analytical work and are energized by helping ensure patients receive the right care at the right time, this remote opportunity may be the perfect next step in your nursing career. Coverage needed could include weekdays, weekends and holidays. As a Utilization Management Reviewer at PeaceHealth, you will play a key part in supporting safe, high-quality, and efficient patient care across our healthcare system. This position centers on concurrent and retrospective UM reviews, leveraging clinical expertise, payer policy knowledge, and technology tools to guide patient status determinations and promote appropriate utilization of hospital resources. You’ll work fully remote*, with PeaceHealth-provided computer equipment—empowered by a collaborative team, supportive leadership, and a strong organizational commitment to diversity, cultural humility, and caregiver well-being. *Must reside in Washington, Oregon, or Alaska. PeaceHealth will provide the caregiver with necessary computer equipment. It is the responsibility of the caregiver to provide Internet access.

Education Required: Bachelor of Science in Nursing (BSN) Preferred: Master of Science in Nursing (MSN) Experience: 3+ years of acute care hospital experience with strong clinical knowledge In-depth understanding of Medicare/Medicaid UM regulations, RAC, QIO, MAC, and denial/appeals processes Preferred: Prior experience in utilization management or case management Credentials: Active RN license in your state of residence (WA, OR, or AK)

Coordinate accurate patient status identification and documentation Ensure correct admission status and reimbursement through certification and clinical review Gather additional clinical documentation to validate treatment plans and level of care Collaborate closely with physicians, clinicians, and multidisciplinary teams Apply UM criteria using the Xsolis Dragonfly™ platform and PeaceHealth Care Level Score tools Conduct pre-admission status reviews in the ED, patient access areas, and elective settings Communicate with third-party payers regarding medical necessity and discharge progress Support denial and appeal processes; refer cases for physician advisor review when appropriate Participate in UM Committee work, quality initiatives, and performance improvement Identify DRGs with complications/comorbidities and recommend documentation improvements Promote responsible hospital resource utilization, length-of-stay optimization, and care efficiency Perform other duties as needed to support UM and organizational goals

Optum

Inpatient Utilization Management Nurse, RN – Remote in PST or MST

Posted on:

January 28, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

California

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 Utilization Review Nurse, RN is responsible for providing clinically efficient and effective Inpatient utilization management. Reviews inpatient criteria for acute hospital admissions and concurrent review and or prior authorization requests for appropriate care and setting by following evidence based clinical guidelines, medical necessity criteria and health plan guidelines. Reviews and applies hierarchy of criteria to all inpatient admission and preauthorization requests from providers that require a medical necessity determination. Is involved in assuring that the patient receives high-quality cost-effective care. Uses sound clinical judgement and managed care principles in the coordination of care. Prepares any case that does not meet medical necessity guidelines for medical appropriateness of procedure, service or treatment for review with the Medical Director for a decision. The shift is Monday through Friday 8am-5pm in Pacific or Mountain Time Zone. Occasional participation in weekend rotation is required. If you are located in PST or MST, you will have the flexibility to work remotely* as you take on some tough challenges.

Required Qualifications: Current unrestricted Registered Nurse (RN) license in state of residence Ability to obtain Registered Nurse license in the state of California within 90 days of hire 3+ years clinical nursing experience in acute care hospital or LTAC setting 1+ years Utilization Management experience in hospital or insurance setting Experience applying Medicare and/or Medicaid guidelines Experience with Milliman (MCG) or InterQual guidelines Experience researching and preparing clinical information for case review with Physician Leadership for patient treatment and care planning Experience providing accurate and timely documentation of clinical review and supporting rational of decision in care management systems Experience employing analytical skills necessary for quality case management, utilization review, and quality improvement to meet organizational objectives Experience using various computer software applications with an intermediate level of competence, including Microsoft Word and Excel Primary residence in Pacific or Mountain time zone and ability to work required hours in PST or MST Preferred Qualifications: Inpatient Utilization Management experience Utilization Management experience for insurance or managed care organization Prior Authorization experience

Maintains clinical expertise and knowledge of scientific progress in nursing and medical arena and incorporates this information into the clinical review and care coordination processes Performs clinical review for appropriate utilization of medical services by applying appropriate medical necessity criteria guidelines Authorizes healthcare services in compliance with contractual agreements, Health Plan guidelines and appropriate medical necessity criteria Documents clinical reviews in care management system. Provide accurate and timely documentation and supporting rational of decision in care management system Utilizes care management system and resources to track and analyze utilization, variances and trends, patient outcomes and quality indicators Research and prepares clinical information for case review with Physician Leadership for patient treatment and care planning Utilizes knowledge of resources available in the health care system to assist the physician and patient effectively Identifies members who are appropriate for care coordination programs and collaborates with the Medical Management team for care coordination of the member’s needs along the continuum of care Successfully completes the Interrater Reliability Testing to ensure consistency of review and application of criteria Meets timeliness standards for decision, notification, and prior authorization activities Serves as an advocate for all providers and their patients Demonstrates a positive attitude and respect for self and others and responds in a courteous manner to all customers, internal and external Maintains the confidentiality of all company procedures, results, and information about patients, contracts, and all other proprietary information regarding Optum business Performs other duties as required or requested in a positive and helpful manner to enable the department to achieve its goals You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

EmpowerMe Wellness

Nurse Navigator

Posted on:

January 28, 2026

Job Type:

Full-Time

Role Type:

Primary Care

License:

RN

State License:

California

EmpowerMe Wellness is a multi-disciplinary healthcare services organization focused on improving the lives of residents in independent living, assisted living and memory care communities. We provide onsite geriatric primary care services in addition to our physical, occupational, and speech therapy offerings. Our mission is to improve the lives of seniors and the communities they call home.

Remote position Must be willing to work evenings Reports To: Vice President of Medical Services FLSA Status: Non-Exempt Direct Reports: Yes Department: Primary Care Position Summary: As the Nurse Navigator, you are responsible for providing individualized assistance across the care continuum to patients, families, and caregivers to expedite, coordinate care, and address health system barriers. This position assumes the responsibility for the coordination of patient care through interdisciplinary and multidisciplinary collaboration to achieve optimal patient outcomes with a focus on high-risk patients or those with complex care needs (including multidisciplinary care) while building and maintaining community and independent provider relationships to provide expedient and reliable access to quality patient care.

Graduate of an accredited nursing program. Current RN licensure in state of residence. 2 years of relevant patient care experience with 1 year of senior living experience a plus Exceptional communication and interpersonal skills are required along with the heart and passion to work with older adults while providing the best care possible. Ability to work well with others and take direction from management, as well as take initiative- willing to go above and beyond to ensure the needs of the organization are met in accordance with the company’s core values. Must have the ability to remain calm in stressful situations, be flexible, work well with many interruptions, and have exceptional multi-tasking skills. Respect for the principles of patient/resident rights and confidentiality Must exhibit and promote a high level of professionalism, customer service, curiosity, and friendliness in all interactions with employees, residents, and visitors throughout the organization. Computer Skills: Proficiency in Internet browsers (e.g. Explorer, Chrome, Fire Fox), as well as advanced knowledge of Microsoft Office programs: Outlook, Excel, Word and Publisher applications. Experience in working with various EMR and medical billing systems.

Coordinates patient services with physicians and staff to provide quality care in an appropriate and effective manner; provides appropriate counsel and teaching to patients and families; ensures continuity of care and promotes health care maintenance. Bridge gaps in care and assess/troubleshoot care transitions and barriers to care. Promotes and maintains good public relations with patients/families and acts as a liaison between our EmpowerMe team, the communities we serve, and our patients and their families. Coordinates patient care, orders diagnostic tests, conveys findings to care team, coordinates patient appointments and assists with referrals to outside sources. Participates in continued professional development, attending educational programs, in-service, and meetings as needed. Maintain navigation services documentation according to program standards. Obtains consent and all necessary intake paperwork from resident or POA prior to initiation of all integrated services. Performs data entry tasks and maintains patient electronic health record. Documents residents' medical information, including medical history and health insurance information. Assists in schedule management and coordination of services. Comply with HIPAA and PHI guidelines and protect confidentiality at all times. Other clinical and administrative duties as assigned.

CSI Pharmacy

Clinical Outcomes QA Nurse

Posted on:

January 28, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Texas

At CSI Pharmacy (CSI), we are on a mission to provide Specialty Pharmacy services to patients with chronic and rare illnesses in need of complex care. CSI is a rapidly growing national Specialty Pharmacy. Whether you work directly with patients or behind the scenes in support of the business and its employees, you will use your expertise, experience, and skills to support our patients and our mission.

The Clinical Outcomes Quality Assurance Nurse will be responsible for the quality of the Outcomes program’s documentation, implementing clinical best practices, and facilitating the efficient operation of the assigned department by performing a variety of clerical and administrative tasks. Salary Range: $72,000 - $87,000/yr (DOE) Schedule: (Remote) Monday - Friday, 8:30am - 4:30pm CST Travel: (Optional) Occasional travel for training, team get-togethers, conferences, etc. if willing

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Excellent verbal and written communication skills. Excellent interpersonal and customer service skills. Proficient in Microsoft Office or related software. Excellent organizational skills and attention to detail. Ability to work independently. Provide the highest level of professionalism, responsiveness, and communication. Must possess the ability to multi-task and frequently change direction. Education and/or Experience: Associate degree in nursing or Bachelor of Science in nursing RN license, unencumbered Experience in home-infusion of chronic disorders preferred PHYSICAL DEMANDS: 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, climb stairs, 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 20 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus. 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. This job generally operates in a clerical office setting. This role routinely uses standard office equipment such as computers, phones, photocopiers, filing cabinets, and fax machines. While performing the duties of this position, the employee may travel by automobile and be exposed to changing weather conditions. COMMENTS: This description is intended to describe the essential job functions, the general supplemental functions, and the essential requirements for the performance of this job. It is not an exhaustive list of all duties, responsibilities, and requirements of a person so classified. Other functions may be assigned, and management retains the right to add or change the duties at any time.

Reviews/Approves all CSI outcomes forms Works with CSI nurses regarding outcome forms; edits/corrects as needed. Assists in outcomes charting, tracking, reporting, and updates. Communicates and responds to administrative inquiries. Communicates with patients via telecommunications to obtain necessary outcomes forms. Collects and records data obtained via telecommunications, mailed in forms, and electronic health care records system. Tracks and uploads outcomes forms to patient’s scheduled visits. Attends designated meetings or Teams/Zoom calls as needed. Maintains effective working relationships with all members of CSI. Tracks prescriber partners who desire outcomes and/or are involved in research. Sends patient specific outcomes data to pharmacy via Monday.com research board as requested. Monitors outcomes data for trigger points to notify outcomes manager and/or pharmacy. Provides weekly status updates to leadership on Outcomes Management Team goals and accomplishments. Uploads outcomes and research forms into Monday.com research board. Performs other related duties as assigned or requested.

Signature Consulting Services LLC

Utilization Management Nurse RN

Posted on:

January 28, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Kentucky

Signature HealthCARE is a family-based healthcare company offering integrated services across multiple states. Our continuum of care includes skilled nursing, rehabilitation, assisted and memory care, and home-based services supported by innovative technologies like telehealth and Care.ai-enabled solutions. We are committed to advancing person-directed care and quality outcomes. Many of our facilities continue to receive high performance ratings and accreditations. As an award-winning organization recognized over the years by national outlets such as U.S. News & World Report, we take pride in fostering compassionate care environments and being an employer of choice in the healthcare industry.

Collaboration with Managed Care Organizations (MCO) and care providers is vital to ensure care is being delivered in the right setting at the right time.

Registered Nurse (RN) in good standing with required current state license. Associates degree required, but Bachelor’s degree preferred. Basic knowledge of medical necessity criteria such as Milliman Care Guidelines or Interqual. Minimum of three (3) years related case management experience. Minimum of three (3) years of hospital, SNF or Acute Rehab clinical experience Certified in Case Management through ACMA, CCMC or other credentialed agencies, preferred or willing to obtain after one year of employment. Knowledge of Medicare payment methodology and the MDS RUG system. Previous experience with MDS and assessment preferred

Collaborate regularly and maintain open communication with leadership, patients, families, internal care givers, and external Utilization Management Nurses. Coordinate internal and external health care team activities related to resident care, transitions and discharge planning with agencies, and other healthcare organizations. Conduct initial baseline assessment of resident care needs and communicate that effectively to the Managed Care Organization (MCO) ensuring all aspects of care services are communicated accurately. Verify all care needs and the authorization for services and outliers. Communicate/collaborate with the Managed Care Organization (MCO) at required intervals as determined by the MCO Negotiate appropriate levels based on services provided and contractual arrangements with the facility and the MCO. Document all authorizations and continued stay activity in Case Management software to ensure appropriate reporting and billing Prepare all Managed Care documentation to facility accurate billing.

HarmonyCares

Clinical Triage Nurse, RN (Mon, Thurs, Fri, Sat - 9:30 am - 8pm)

Posted on:

January 28, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Michigan

HarmonyCares is a leading national value-based provider of in-home primary care services for people with complex healthcare needs. Headquartered out of Troy, Michigan, HarmonyCares operates home-based primary care practices in 14 states. HarmonyCares employs more than 200+ primary care providers to deliver patient-centered care under an integrated, team-based, physician-driven model. 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.

The Clinical Triage Nurse, RN assists with triage of inbound sick calls from Medical Group patients. The primary responsibility will be to assess patient symptoms, provide appropriate medical advice, determine the level of care required and coordinate care with a care team. The Clinical Triage Nurse, RN also reviews clinical test results, utilizing clinical judgement to summarize results to assist providers in their review process. This position requires strong clinical knowledge, excellent communication skills, and the ability to work remotely, providing critical healthcare guidance to patients in need.

Required Knowledge, Skills and Experience: Graduate of approved or accredited nursing education program as a Registered Nurse Current valid RN license. Must be able to obtain and maintain RN license within all service states within 6 months from hire Satisfactory completion of required nursing continued education requirements Ability to react decisively and quickly in urgent and emergent situations Strong comprehension of medical terminology and pharmaceuticals Demonstrated experience with multi-tasking Strong communication skills (written & spoken) Demonstrated proficiency in using electronic health records (HER) system Ability to communicate effectively with providers, patient care teams, patients, patients’ family members and facility staff Ability to work remotely and independently Knowledge of basic principles, practices, and techniques in primary healthcare Strong organizational skills and attention to detail Conflict resolution skills Preferred Knowledge, Skills and Experience: Familiarity with Medicare and Medicaid insurances and programs 2+ years of experience as an RN Contact center experience Nurse triage experience Experience in Aprima (EHR) Multistate License (MSL) Shift: Monday, Thursday, Friday, Saturday 9:30A-8:00P As part of the hiring process , candidates may be required to complete a background check in the state of Florida. Additional information regarding the background screening can be found at the following link: https://info.flclearinghouse.com.

Prioritizes and responds promptly to each inbound phone call and voicemail received Adheres to daily availability expectations based on schedule Demonstrates exceptional customer service by addressing all inquiries, concerns, and needs with empathy, professionalism, and a solutions-oriented mindset Practices appropriate judgement when classifying whether the inbound interaction requires clinical triage or transfer to another care team member. Utilizes appropriate process when conducting necessary transfers Conducts thorough assessments of patients’ symptoms and medical history over the phone. Utilizes appropriate probing questions and EMR to gather information Uses evidence-based guidelines to make informed decisions about the urgency of patient conditions. Assigns the appropriate triage priority based on available information Utilizes correct judgement to identify when crisis intervention is required. Adheres to outlined protocols for connecting the patient to emergency services Educates patients, caregivers, and others on health maintenance, disease prevention, self-care, medications, and necessary follow-up steps per protocol Performs outbound phone calls to communicate providers orders on behalf of the provider Collaborates with the care team to ensure patient needs are met and follow-ups are appropriately completed Communicates effectively with patients and their families, addressing their concerns and providing emotional support Test Results: Prioritizes and responds promptly to each inbound result received Practices appropriate judgement when classifying the urgency of a result and appropriate clinical information to convey to the provider Analyzes results data, identifying needs, patterns, and variances, and communicating findings to the provider Performs data entry for patient results and quality metrics per defined protocol Maintains clear and compassionate written and verbal communication with care team members Adheres to all company-established policies and procedures Meets required quality standards and productivity expectations Appropriately identifies, acknowledges, escalates, and/pr addresses patient complaints, grievances, and concerns promptly and effectively Collaborates with the care team members to promote quality patient care, satisfaction, and outcomes Participates in projects and quality improvement initiatives as assigned Additional duties as assigned by the Clinical Triage Manager and/or Director as related to clinical performance and outcomes

HarmonyCares

Telephonic RN Nurse Care Manager ( Must live in Wisconsin)

Posted on:

January 28, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Wisconsin

HarmonyCares is a leading national value-based provider of in-home primary care services for people with complex healthcare needs. Headquartered out of Troy, Michigan, HarmonyCares operates home-based primary care practices in 14 states. HarmonyCares employs more than 200+ primary care providers to deliver patient-centered care under an integrated, team-based, physician-driven model. 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.

The Nurse Care Manager is an integral member of the care team and is vital to enhancing the health outcomes of HCMG patients. This position will manage a caseload of high-risk patients where he/she is responsible for managing their care and barriers. These duties will include, but are not limited to Transitional Care Management, Chronic Care Management, Disease Management Education, Medication Education, and the development and management of patient care plans. The Nurse Care Manager will serve as co-chair of the pod alongside the pod leader, focusing on driving and prioritizing patient needs to improve patient outcomes.

Required Knowledge, Skills and Experience: Active Registered Nurse License 2+ years of care management experience in community, health plan or hospital systems Possesses strong clinical skills and proactive thinking Effective communication skills Ability to perform extensive telephone assessment Knowledge of Medicare regulations and home care and hospice standards Experience with small group presentations and teaching/training Exhibits excellent interpersonal skills Exhibits excellent written and oral skills Working knowledge of computer programs (email, Word, Excel, PowerPoint, etc.) Manages time effectively to ensure all duties and documentation requirements are completed in a timely manner Preferred Knowledge, Skills and Experience: Bachelor of Science in nursing or related field May be required to obtain multi-state licensing Strong knowledge of population health, quality measures, care gap closure and value-based care models As part of the hiring process , candidates may be required to complete a background check in the state of Florida. Additional information regarding the background screening can be found at the following link: https://info.flclearinghouse.com.

Coordinates care services with pod leader to ensure that patients have access to a comprehensive set of services tailored to their needs throughout their healthcare journey Works collaboratively within the care team to develop and manage personalized care plans, address care gaps, and engage with other resources to ensure access to care Coordinates the transition of care for patients throughout the continuum to ensure patient needs are met accordingly and to ensure that avoidable hospital admissions do not occur Coordinates and facilitates High Risk Huddles along with ensuring that follow-up actions are completed Prioritizes patients based on the severity and urgency of their conditions to ensure that the most critical cases receive immediate attention Reviews medical records to identify gaps in care and coordinate services with the care team to manage these issues Regularly updates patient care plans Performs thorough nursing assessments via telephone of patients to maximize or improve current health outcomes Provides education to patients and/or their caregivers on disease education, medication, health maintenance, and disease prevention to promote self-management and improve health outcomes Demonstrates strong clinical skills, critical thinking abilities, and effective communication in their interactions with patients, caregivers, providers, fellow care team members, etc. Documents necessary interactions, assessments, updates, etc. in patient’s medical records according to processes and guidelines Serves as liaison between patients, providers, resources, etc. to ensure seamless care delivery Facilitates communication of patient status and plan of care during transitional experiences such as home to hospital, hospital to post-acute care and back to home In this role you may work with. . . Executive Directors Market Leaders Pod Leaders Clinical Social Worker Patient Health Coordinator Population Health Team

VNA of Albany

RN Weekend Supervisor / Evening On-Call

Posted on:

January 28, 2026

Job Type:

Part-Time

Role Type:

Leadership / Management

License:

RN

State License:

New York

Visiting Nurse Association of Albany Inc. (VNA) is a certified home health care agency providing skilled nursing care, rehabilitative services (physical, occupational, speech pathology therapies), and medical social work to individuals in the comfort of their homes. VNA provides services in 11 Capital Region counties: Albany, Columbia, Fulton, Greene, Montgomery, Rensselaer, Saratoga, Schenectady, Schoharie, Warren and Washington. Our mission is to provide health care services to patients in accordance with the highest ethical and professional standards in order to restore, promote, maintain, and support each of our clients’ health and well-being. Founded in 1880 by a small group of public spirited citizens concerned about the lack of home care services in the Albany NY area, VNA Home Health has a long standing history of meeting community home care needs. Incorporated in 1897 as a 501 (c) (3) not-for-profit corporation, VNA Home Health has been a staple in the region as a community based health care provider and an employer. If one-on-one patient care is where your heart is, VNA Home Health has opportunities in a region near you!

RN Supervisor – Weekend (Friday, Saturday and Sunday) VNA of Albany is currently seeking an experienced RN Supervisor to join our team.

EXPERIENCE: Must be a Registered Nurse in NYS with at least two years of acute care experience. A minimum of 4 years of Homecare experience and supervisory experience is required EDUCATION: Must be a graduate of an accredited school of nursing; BSN Degree preferred.

The RN Supervisor will be responsible for direct guidance to staff to render service to individuals and families during weekends and holidays. In addition, this individual will be responsible for Managing assignments of admissions and visits and the acceptance of new referrals on the weekends.

Enjoin

Outpatient Clinical Documentation Specialist (Remote)

Posted on:

January 28, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Tennessee

For more than 35 years, Enjoin has helped healthcare organizations fully and accurately tell the patient story through clinical documentation and coding excellence. A pioneer in CDI programs, Enjoin continues to innovate by aligning physician-led clinical expertise with documentation, coding, and education across the revenue cycle to improve quality, compliance, and patient-centered outcomes.

RN required. CCS, RHIT, RHIA, CCDS-O, CCDS, or CDIP preferred. Pre-Visit and Post-Visit planning review experience required. Query writing experience required. At least 2 years of HCC Risk Adjustment coding/auditing experience for an academic hospital required. Proficiency in CMS-HCC, HHS-HCC, ICD-10 coding guidelines, and familiarity with healthcare regulations and reimbursement requirements required. Knowledge of MA and MSSP Population/Population Health required. Strong knowledge of disease processes and clinical chart review, with prior Clinical Documentation Specialist or CDI program experience preferred. Schedule: This is a remote, full-time, 40 hour per week position. General hours of work are Monday through Friday during regular business hours.

The OP CDS is responsible for reviewing physician clinic medical record documentation for the purpose of analyzing and identifying clinical documentation and/or coding opportunities to accurately capture ICD-10-CM Diagnoses, Hierarchical Condition Categories (HCC) diagnoses, Current Procedural Terminology (CPT) accuracy for procedures (if required per client), Evaluation and Management (E&M), and compliance risks based on the Official Guidelines for Coding and Reporting, and Guidelines for Achieving a Compliant Query Practice-2022 update. The purpose of this position is to ensure clinical documentation is complete, accurate and clinically valid to support all coding outcomes (ICD10, HCC and CPT) for the physician clinic encounter.

BrightStar Care of Naples & Ft. Myers

Care Navigator

Posted on:

January 28, 2026

Job Type:

Part-Time

Role Type:

Case Management

License:

RN

State License:

Illinois

A HIGHER STANDARD OF CARE The care we provide empowers our clients to live well at every stage of life and in every setting, and gives them, their families and their loved ones the support they need to get the most out of life. With BrightStar Care, you can always expect 'A Higher Standard of Care'. Our Professional Care Team, led by a Registered Nurse Director of Nursing, delivers expert, compassionate, and personal care. Our Care Experts are ready to serve 24/7 and only BrightStar Care® combines industry-leading screening, training, and oversight practices. Earned Accreditation & Client Satisfaction are testaments to unmatched care standards validated through Joint Commission Accreditation and Press Ganey Client Satisfaction Surveys It’s more than just our work; helping people is our passion. It’s what makes us truly shine — knowing that we’re making a real difference by bringing more to the lives of others every day. Each BrightStar Care office is individually owned and operated

Dementia Care Navigator The Care Navigator is responsible for developing relationships with client and families who suffer with Dementia . It is part of the Medicare Guide Program.

Must have experience with working with the Dementia population . Should be familiar with local resources in Naples Fort Myers Ability to create execute on the pal of care Ability to help clients through crisis management by providing appropriate resources guidance and educations to families. Ideal Candidate would be a facility DC planner or RN/LPN who has worked in a case management capacity or on a memory care unit. Willing to train !

The care navigator is responsible to conduct a comprehensive assessment and develop and appropriate plan of care connecting the client and family with resources. This position is Part Time hourly and paid as per diem. It is completely a remote position and can be completed on your time schedule. Days, Evenings, weekends.

Artisan Medical Solutions, LLC

Spanish/English Bilingual IVF Nurse Fertility Software Trainer

Posted on:

January 28, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

None Required

State License:

California

We are looking for a skilled and experienced IVF nurse or coordinator to work as a Fertility EMR Trainer and Implementer for our company! You will work with Artisan staff and our clients remotely, and in the practice to help install, implement and support the cloud-based EMR/PMS system, teach processes and workflows and assist their clinical team in the transition to Artisan. We are looking for someone with clinical experience, who is tech-savvy, patient, a self-starter and an excellent teacher. This position will require travel and will provide the ability to work from home.

Bachelor's Degree required Bilingual in English and Spanish 2+ years of Clinical IVF experience required A comprehensive understanding of fertility practice workflows / protocols 1-4 years Relevant work history using or implementing EMR/EHR Software required MUST BE WILLING to travel as needed to perform onsite training (up to 75%)

Assist in the implementation of our fertility EMR/PMS and provide software training and support to fertility practices across the country. Provide guidance in change management, training and ensure client adoption of software. Document all client communications (verbal or written) accurately. Demonstrate the ability to work with various cross-organizational areas Contribute as a positive member of the Implementation and Support Departments by supporting all members of the team in a productive and constructive manner and completing assignments in a timely manner Display an in-depth experience and understanding of IVF laboratory and clinical workflow Exhibit excellent communication skills, both written and spoken, with all levels of management and end users Execute strong organization, time management, analytical and problem solving skills Must work efficiently and successfully on an independent basis All other duties as assigned

Cadence Health

Licensed Practical Nurse, Alert Board | Part-Time Weekends

Posted on:

January 28, 2026

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

Compact / Multi-State

Cadence Health was built around a simple promise: patients always come first. Our technology-enabled remote care model pairs continuous health insights with a highly skilled clinical Care Team, empowering seniors to stay healthier, avoid complications, and live more independent, fulfilling lives, all without the limits of a traditional office visit.

In the U.S., 60% of adults – more than 133 million people – live with at least one chronic condition. These patients need frequent, proactive support to stay healthy, yet our care system isn’t built for that level of attention. With rising clinician shortages, strained infrastructure, and reactive care models, patients too often end up in the ER or the hospital when those outcomes could have been prevented. At Cadence, we’re building a better system. Our mission is to deliver proactive care to one million seniors by 2030. Our technology and clinical care team extend the reach of primary care providers and support patients every day at home. In partnership with leading health systems, Cadence consistently monitors tens of thousands of patients to improve outcomes, reduce costs, and help patients live longer, healthier lives. 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.

Schedule Requirements: This role requires availability Saturday and Sunday Schedules hours are 10:00 AM to 10:00 PM OR 2:00 PM to 11:00 PM Eastern Time Licensed Practical/Vocational Nurse(LPN/LVN) with compact licensure Minimum 5 years of experience as an LPN/LVN Minimum 3 years of experience in a cardiology setting. 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.

PharmD Live

Spanish-Speaking Chronic Care Management LVN/LPN (Tennessee | Remote)

Posted on:

January 28, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Tennessee

Work Model: Remote (Tennessee-based license required) Language Requirement: Spanish-English Bilingual Schedule: Flexible Hours Available Position Summary: PharmD Live is hiring a Spanish-speaking Chronic Care Management LVN/LPN to support diverse patient populations enrolled in long-term care programs. This role focuses on culturally competent engagement, education, and ongoing clinical support delivered virtually.

Active Tennessee LPN or LVN license Fluency in Spanish and English (required) 2+ years of clinical nursing experience Exposure to chronic care, population health, or telehealth preferred Strong communication, documentation, and critical-thinking skills

Provide telephonic and virtual chronic care support in Spanish and English Educate patients on disease management, medication adherence, and preventive care Support RPM and care plan adherence through proactive outreach Identify clinical changes and escalate appropriately within care protocols Assist patients during care transitions and follow-up coordination Collaborate with pharmacists, nurses, and providers across care teams Maintain compliant documentation aligned with CMS and quality benchmarks Build strong patient relationships to improve engagement and outcomes

PharmD Live

Chronic Care Management LPN/LVN – Virtual Care (Nevada

Posted on:

January 28, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Nevada

Location: Remote | Nevada Licensure Required Employment Type: Flexible (PT/FT Options Available) Role Description: PharmD Live is seeking a Chronic Care Management Nurse to deliver longitudinal support to patients with multiple chronic conditions. This role is central to improving care continuity, reducing avoidable utilization, and supporting value-based care initiatives through structured remote engagement.

Active LPN or RN license issued by the State of Nevada Minimum of 2 years nursing experience in ambulatory, chronic, or virtual care Experience with CCM, population health, or care coordination preferred Strong organizational and patient communication skills Comfortable working independently in a remote clinical setting

Conduct routine CCM check-ins and patient assessments via telehealth Reinforce individualized care plans and chronic disease self-management strategies Identify clinical risks and coordinate escalation pathways when needed Track and respond to remote monitoring data in collaboration with clinicians Support transitions of care following hospital or emergency encounters Coordinate with interdisciplinary care teams to ensure consistent follow-up Complete accurate clinical documentation in accordance with CMS requirements Address social, behavioral, and educational barriers impacting adherence