Acentra Health

Sanction Specialist (RN - Remote)

Posted on:

April 22, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Virginia

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

Acentra Health is looking for a RN Sanction Specialist (Remote) to join our growing team. Job Summary: The RN Sanction Specialist plays a pivotal role at Acentra Health, providing essential oversight and direction for all activities associated with the CMS Sanction and EMTALA process. The Specialist will ensure stringent compliance with healthcare regulations and upholds the organization's commitment to maintaining optimal standards of care.

Required Qualifications: Unrestricted, active RN license required. Bachelor of Science Nursing (BSN) or a related field required. 5+ years of clinical experience in either a short-term acute care hospital; Emergency Department and/or Quality Improvement Experience required. Preferred Qualifications: Licensed Health Risk manager (LHRM); Certified Professional in Healthcare Risk Management (CPHRM) or Associate in Risk Management (ARM) preferred. 5 years of previous experience as a claims or risk manager preferred. Experience managing corrective action plans (preferred) Experience communicating with legal entities, CMS and C-suite (preferred)

Facilitate effective communication (verbal/written) between BFCC QIO and healthcare providers involved. Generate comprehensive Initial and Final Sanction Notices in written form. Oversight of provider Corrective Action Plan (CAP); offer technical assistance for CAP development and refinement; scrutinize submitted CAP data. Deliver monthly summaries for COR reports. Prepare written OIG referrals, if required. Conduct communication and education initiatives for providers. Conduct thorough research, identification, and application of relevant standards of care. Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

Optum

LVN Case Manager - Remote PST

Posted on:

April 22, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

LPN/LVN

State License:

California

For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. Optum’s Pacific West region is redefining health care with a focus on health equity, affordability, quality, and convenience. From California to Oregon and Washington, we are focused on helping more than 2.5 million patients live healthier lives and helping the health system work better for everyone. At Optum Pacific West, we care. We care for our team members, our patients, and our communities. Join our culture of caring and make a positive and lasting impact on health care for millions

Under the direction of a Registered Nurse, this position is responsible for ensuring the continuity of care in both the inpatient and outpatient settings utilizing the appropriate resources within the parameters of established contracts and patients’ health plan benefits. Facilitates a continuum of patient care utilizing basic nursing knowledge, experience, and skills to ensure appropriate utilization of resources and patient quality outcomes. Performs care management functions on-site or telephonically as the need arises. Reports findings to the Care Management department Supervisor / Manager / Director in a timely manner. If you’re able to work PST work hours, you’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Required Qualifications: Graduation from an accredited Licensed Vocational Nurse program Current LVN license in California 1+ years of recent clinical experience working as an LVN/LPN Preferred Qualifications: 3+ years of clinical experience working as an LVN/LPN 2+ years of care management, utilization review or discharge planning experience. Experience in an HMO or experience in a Managed Care setting

Consistently exhibits behavior and communication skills demonstrating Optum’s commitment to superior customer service, including quality, care, and concern with every internal and external customer Implements current policies and procedures set by the Care Management department Conducts on-site or telephonic prospective, concurrent and retrospective review of active patient care, including out-of-area and transplant Reviews patients’ clinical records of acute inpatient assignment within 24 hours of notification Reviews patients’ clinical records within 48 hours of SNF admission Reviews patient referrals within the specified care management policy timeframe (Type and Timeline Policy) Coordinates treatment plans and discharge expectations. Discusses DPA and DNR status with the attending physician when applicable Prioritizes patient care needs. Meets with patients, patients’ families, and caregivers as needed to discuss care and treatment plan Acts as patient care liaison and initiates pre-admission discharge planning by screening for patients who are high-risk, fragile or scheduled for procedures that may require caregiver assistance, placement, or home health follow-up Identifies and assists with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, custodial and ambulatory settings. Consults with the physician and other team members to ensure that the care plan is successfully implemented Coordinates provisions for discharge from facilities, including follow-up appointments, home health, social services, transportation, etc., to maintain continuity of care Communicates authorization or denial of services to appropriate parties. Communication may include patient (or agent), attending/referring physician, facility administration, and Optum claims as necessary Attends all assigned Care Management Committee meetings and reports on patient status as defined by the region Demonstrates a thorough understanding of the cost consequences resulting from care management decisions through the utilization of appropriate reports such as Health Plan Eligibility and Benefits, Division of Responsibility (DOR), and Bed Days Ensures appropriate utilization of medical facilities and services within the parameters of the patient’s benefits and/or CMC decisions. This includes appropriate and timely movement of patients through the various levels of care Maintains effective communication with the health plans, physicians, hospitals, extended care facilities, patients and families Provides accurate information to patients and families regarding health plan benefits, community resources, specialty referrals and other related issues Initiates data entry into IS systems of all patients within the parameters of Care Management policies and procedures. Maintains accurate and complete documentation of care rendered, including LOC, CPT code, ICD-9, referral type, date, etc. Follows patients on ambulatory care management programs, including CHF and home health, in order to optimize clinical outcomes Uses, protects, and discloses Optum patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards

Ascendion

Outpatient UM Nurse

Posted on:

April 22, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

California

Ascendion is a full-service digital engineering solutions company. We make and manage software platforms and products that power growth and deliver captivating experiences to consumers and employees. Our engineering, cloud, data, experience design, and talent solution capabilities accelerate transformation and impact for enterprise clients. Headquartered in New Jersey, our workforce of 6,000+ Ascenders delivers solutions from around the globe. Ascendion is built differently to engineer the next. Ascendion | Engineering to elevate life We have a culture built on opportunity, inclusion, and a spirit of partnership. Come, change the world with us: Build the coolest tech for world’s leading brands Solve complex problems – and learn new skills Experience the power of transforming digital engineering for Fortune 500 clients Master your craft with leading training programs and hands-on experience Experience a community of change makers! Join a culture of high-performing innovators with endless ideas and a passion for tech. Our culture is the fabric of our company, and it is what makes us unique and diverse. The way we share ideas, learning, experiences, successes, and joy allows everyone to be their best at Ascendion.

Active and Unrestricted California LVN (Licensed Vocational Nurse) Minimum 2 years of experience in medical management clinical functions. Working knowledge of MCG, InterQual, and NCQA standards Strong nursing background is very helpful – more than one area in nursing EZ-Cap for UM, and Right Fax, and MCG.

Evry Health

REMOTE: Care Coordination RN

Posted on:

April 22, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

We are on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase access and transparency, and feature a personalized, human approach. We strive to ensure members live happier, healthier lives. Evry Health is the major medical division of Globe Life (NYSE:GL). Globe Life has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, Globe Life has earned an A (Excellent) rating or higher from A.M. Best Company.

Evry Health is seeking a tech-savvy Nurse to join our team for Care Coordination. As a Care Coordinator you work with members to improve their wellness and engage with our health plan's benefits. You build good relationships with both our health plan members and our medical providers through phone calls, emails, and texts. This is an exciting role allowing the ability to work with members across the continuum with ~25% utilization review and ~75% care coordination. Our teams are 100% virtual.

Experience and Skills Desired: You have 1-2 years of experience working at a health plan, preferably with a commercial population. You have 3-5 years of nursing experience in a clinical setting assisting with direct patient care, such as a hospital or ambulatory setting. You have working knowledge of medical and insurance industry terminology including basic understanding of health plan benefits, CPT/ICD10, authorizations, and digital health programs. You have an area of interest or experience within cardiology/pulmonology, women’s health, orthopedic surgery/physical medicine, primary care/pediatrics, and oncology. You have experience outreaching and educating members telephonically. You have an innovative and entrepreneurial spirit with a passion to contribute to a much-needed change in our health care system. Bonus: Familiarity with Salesforce/Healthcloud/CareIQ. Bonus: Experience working in a call center. Bonus: Spanish fluency. Telecommuting Requirements: Required to have a dedicated work area established that is separate from other living areas and provides information privacy. Ability to keep all company sensitive documents secure. Must live in the United States. Must live in a location that receives an existing high-speed internet connection/service. Education & License Requirements: Must have a current, unrestricted Texas nursing license or Compact License. Please include your license number(s) and the corresponding state(s) in your resume. Diploma from an accredited school/college of nursing required.

Communicate and provide education to members and providers on insurance plan benefits and digital health solutions. Use negotiation and motivational interviewing techniques to increase engagement. Pro-active and reactive support for members, including outbound phone/email/text outreach. Employ active listening & motivational interviewing skills, and can handle difficult calls tactfully, courteously, professionally and document accordingly that can build patient trust and engagement. Ability to effectively excel in a virtual work environment through active participation in team huddles, Supervisor 1:1s, Instant Messaging, or check-ins, efficiently answering and documenting member/provider calls. Accurately track and document work on a variety of internal software tools and platforms. Consult with supervisors, utilization management team, medical directors, as needed to overcome barriers. Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure. Assist departmental staff with coding, medical records/documentation, pre-certification, reimbursement, and claim denials/appeals. Ability to interact with external facility or providers as needed to gather clinical information to support the medical necessity review process and plan of care.

Alignment Health

Remote Bilingual RN Case Manager, SNP (California RN License Required)

Posted on:

April 22, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

California

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

Alignment Health is seeking a remote bilingual Spanish RN Case Manager to join the case management, special needs program (SNP) team. The Case Manager SNP is responsible for health care management and coordination, within the scope of licensure, for members with complex and chronic care needs. Delivers care to members utilizing the nursing process and effectively interacts with members, care givers, and other interdisciplinary team participants. Assist with closing gaps in care and resolving barriers that prevent members from attaining improved health. Reaches out and connects with members via the telephone. Schedule: Monday - Friday, 8:00 AM - 5:00 PM Pacific Time

Required: Minimum 2 years' clinical experience Minimum 1 year case management experience. Preferred: Health Plan experience preferred Education: Required: Successfully passing Post High School courses to obtain an RN licensure or AS in Nursing. Preferred: BSN or Bachelor's Required: Possess a high level of understanding of community resources, treatment options, home health, funding options and special programs Extensive knowledge of the management of chronic conditions Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors; Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others. Ability to operate PC-based software programs including proficiency in Word, Excel and PowerPoint Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution. Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment. Report Analysis Skills: Comprehend and analyze statistical reports. Licensure Required: Must have and maintain an active, valid, and unrestricted RN license in California (Non-Compact) Immediately upon hire, must be willing to obtain LVN and / or RN licensure in Nevada, (Non-compact), Arizona (Compact), North Carolina (Compact), and Texas (Compact) which will be reimbursed by company. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Coordinates care by serving as a resource for the member, their family, and their physician. Ensures access to appropriate care for members with urgent or immediate needs facilitating referrals/authorizations within the benefit structure as appropriate. Completes comprehensive assessments within their scope of practice that includes assessing the member's current health status, resource utilization, past and present treatment plan, and services. Collaborates with the member, the PCP, and other members of the care team to implement a plan of care. Interfaces with Primary Care Physicians, Hospitalists, Nurse Practitioners, and specialists on the development of care management treatment plans. Provides education and self-management support based on the member’s unique learning style. Assists in problem solving with providers, claims or service issues. Works closely with delegated or contracted providers, groups, or entities to assure effective and efficient care coordination. Maintains confidentiality of all PHI in compliance with state and federal law and Alignment Healthcare Policy. Supervisory responsibilities: N/A

Wellbox Health

LPN/LVN - Care Coordinator (MST/PST)

Posted on:

April 22, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Compact / Multi-State

Wellbox is a rapidly growing healthcare company focused on empowering people to live healthier lives through comprehensive preventative care solutions delivered by an elite team of experienced nurses.

We are currently seeking tech-savvy LPN Patient Care Coordinators to conduct monthly telephonic outreach to chronically ill patients, developing personalized care plans that address their health challenges. Position Type and Expected Hours of Work We are seeking full-time LPN team members who can work 40 hours per week, between the hours of 8 am – 6 pm PST/MST, Monday – Friday.

Active Compact LPN License. Minimum two years of clinical experience; care coordination experience preferred. Proficient with Electronic Medical Records and Microsoft Office. Excellent communication and problem-solving skills. Candidates who reside in Mountain Standard Time (MST) or Pacific Standard Time (PST) are preferred; candidates that reside in Central or Eastern time zones will not be considered for this position.

Manage patients’ healthcare needs via virtual phone conversations. Document visits using technology platforms and EHRs. Develop personalized care plans addressing physical, mental, and preventative health. Coach patients on treatment plans, including nutrition and wellness. Connect patients with resources and prepare them for medical appointments.

Millennium Physician Group

Patient Experience Manager ( Remote - Central & Eastern Time Zones)

Posted on:

April 22, 2025

Job Type:

Full-Time

Role Type:

Primary Care

License:

None Required

State License:

Florida

Millennium Physician Group is one of the largest comprehensive primary care practices with healthcare providers throughout Florida. At Millennium Physician Group, you will find an organization that focuses on family and building a strong network of people to care for the communities we serve. We are always searching for employees who have a strong customer service attitude, fantastic teamwork skills and a willing smile ready to share. Our promise is to provide you with the tools to do your job successfully, as well as providing a team atmosphere that empowers you to seek better ways to deliver care to our patients and their families. We also promise to care for you as an individual, and help you grow in your role with Millennium Physician Group. If you are interested in joining an organization that puts an emphasis on teamwork and family, then Millennium Physician Group is the right choice.

The Patient Experience Manager is responsible for managing the implementation of a patient experience strategy that supports the organization's mission, values, and goals. This role oversees initiatives and projects to nurture and support a patient-centric culture across clinical, support, and administrative functions. The Patient Experience Manager collects, measures, and analyzes patient, family, and staff sentiment data and feedback to identify areas for improvement.

Bachelor's degree in healthcare administration, marketing, business, or a related field. 5+ years of experience in a healthcare setting. Proven experience in patient experiences management, customer service, or a related role. Strong analytical skills with the ability to interpret data and generate actionable insights. Excellent communication and interpersonal skills. Ability to work collaboratively with cross-functional teams. Proficiency in using survey tools and reputation management platforms. Knowledge of patient satisfaction metrics and methodologies. Ability to work independently in a fast-paced, cross-functional environment.

Design, implement, and manage patient surveys to gather feedback on various aspects of the patient experience. Ensure surveys are distributed effectively and responses are collected and analyzed in a timely manner. Use survey data to generate actionable insights and reports for leadership and relevant departments. • Analyze Net Promoter Score (NPS) and Patient Satisfaction (PSAT) data to identify trends, gaps, and opportunities for improvement. Collaborate with cross-functional teams to develop and implement strategies to enhance patient satisfaction and loyalty. Monitor the impact of implemented strategies and adjust as necessary to achieve desired outcomes. Manage the organization's online reputation by monitoring and responding to patient reviews on platforms such as Google. Develop and execute strategies to encourage positive patient reviews and address negative feedback constructively. Track and report on reputation metrics to inform ongoing reputation management efforts. Develop and implement initiatives aimed at improving patient retention and driving organic growth. Collaborate with marketing and clinical teams to create programs that enhance patient engagement and loyalty. Measure the effectiveness of retention and growth initiatives and report on key performance indicators. Develop marketing and educational materials that support patient experience initiatives and promote a patient-centric culture. Ensure materials are aligned with the organization's branding and messaging guidelines. Work with internal and external stakeholders to distribute materials effectively. Demonstrate excellent guest service to internal team members and patients. Perform other related duties as assigned.

ExamWorks

Nurse Planner (28879)

Posted on:

April 22, 2025

Job Type:

Role Type:

Clinical Operations

License:

RN

State License:

Georgia

Are you are RN and passionate about healthcare? Do you want to contribute to a dynamic, values-oriented workplace? If so, you’ll fit right in with the team at ExamWorks Compliance Solutions (ECS). This is a 100% remote , as-needed position with a very flexible schedule! The Nurse Planner works autonomously to develop any and/or all of the following: Life Care Plans, Medical Cost Projections, Limited Medical Cost Projections, Medicare Set-Aside Allocations, Legal Nurse Reviews, Complex Nurse Reviews, Bill Reviews and other reports as needed within their scope of licensing and certification.

Knowledge of the disability and workers' compensation industry including rules and regulations and a full understanding of Medicare rules and regulations. Must be able to adequately operate a general computer, fax, copier, scanner, and telephone. Must have adequate knowledge of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. Ability to demonstrate critical thinking and problem solving skills. Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed. Must be able to work independently, prioritize work activities and use time efficiently. Ability to concentrate and multitask in a fast paced work environment. Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met. Must be able to maintain confidentiality. Must be able to demonstrate and promote a positive team -oriented environment. Must be able to work well under pressure and/or stressful conditions. Must possess the ability to manage change, delays, or unexpected events appropriately. Must be able/willing to work on a flexible schedule when needs arise. Must possess excellent skills in English usage, grammar, punctuation and style. Demonstrates reliability and abides by the company attendance policy. Education And/or Experience: Minimum of an Associates degree or equivalent certification preferred. A minimum of one years workers’ compensation and/or case management experience preferred. A minimum of one year experience in Medicare Set Asides required. Certificates, Licenses, Registrations: Will recognize any of the following: Active unrestricted Nursing license (including but not limited to RN, NP LVN, LPN). Active unrestricted Adjuster license. Certification in Medicare Set Asides and/or certifications in Life Care Planning or Legal Nurse Consulting

Collects, reviews and analyzes health data from medical records and/or other sources as provided. Identify future medical needs utilizing medical standards of care and guidelines, in addition to historical trend of care. Work autonomously and collaborates with all company personnel as needed; including communicating with the accounts and attorneys as needed. Maintain a quality work product evidenced by acceptable quality scores/score cards. Participate in company orientation, management meetings and/or conference calls as required to improve self-knowledge and/or for the improvement of the company. Attend all scheduled conference calls as mandated by management. Maintain any required credentials and adhere to all codes of ethics required by these credentials. Ensures all federal Centers for Medicare and Medicaid Services (CMS) requirements and/or state mandates are adhered to at all times. Provides insight and direction to management on report quality and compliance with all company policies and procedures, client specifications, URAC and CMS guidelines. Promote effective and efficient utilization of company resources. Participate in various educational and or training activities as required. Perform professional duties as assigned by the Manager or upper managem

Wellbox Health

Patient Care Coordinator ( LPN/LVN )

Posted on:

April 22, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

Compact / Multi-State

Wellbox is a rapidly growing healthcare company focused on empowering people to live healthier lives through comprehensive preventative care solutions delivered by an elite team of experienced nurses.

We are currently seeking tech-savvy LPN Patient Care Coordinators to conduct monthly telephonic outreach to chronically ill patients, developing personalized care plans that address their health challenges. Position Type and Expected Hours of Work We are seeking full-time LPN team members who can work 40 hours per week, between the hours of 8 am – 6 pm PST/MST, Monday – Friday.

Active Compact LPN License. Minimum two years of clinical experience; care coordination experience preferred. Proficient with Electronic Medical Records and Microsoft Office. Excellent communication and problem-solving skills. Candidates who reside in Mountain Standard Time (MST) or Pacific Standard Time (PST) are preferred; candidates that reside in Central or Eastern time zones will not be considered for this position.

Manage patients’ healthcare needs via virtual phone conversations. Document visits using technology platforms and EHRs. Develop personalized care plans addressing physical, mental, and preventative health. Coach patients on treatment plans, including nutrition and wellness. Connect patients with resources and prepare them for medical appointments.

Sanford Health

APP - Certified Nurse Practitioner | Virtual Care

Posted on:

April 22, 2025

Job Type:

Full-Time

Role Type:

License:

NP/APP

State License:

South Dakota

Facility: Remote SD (Central Time) Location: Remote, SD Address: Shift: 8 Hours - Day Shifts Job Schedule: Full time Weekly Hours: 40.00 Department Details Joining a growing team supporting preventative care video visits from the provider's home, to members in their homes. These visits take place Monday - Friday 8-5 with 1 night per month of visit support and 1 Saturday morning per month, identified by the NP.

Completion of a master’s, postmaster’s, or doctorate from an nurse practitioner program accredited by the Commission on the Collegiate of Nursing Education or National League for Nursing Accrediting Commission. Licensing prior to August 1, 1995, master's degree in nursing is preferred. Demonstrated current competence and provision of care, treatment, or services for an adequate volume of patients in the past twelve months, or completion of master’s/post-master’s degree program in the past twelve months. Experience must correlate to the privileges requested. Current licensure by the applicable state board of nursing for advanced practice. Current Drug Enforcement Administration (DEA) permit to prescribe controlled substances. Certified Family Nurse Practitioner (NP-C) or (FNP-BC). Obtains and subsequently maintains required department specific competencies and certifications.

The Nurse Practitioner (NP) provides service to patients in designated care settings, including: acute, short and long-term care, by assisting physicians, assessing patients, and treating injuries and ailments. Provides service to patients in acute, short and long term care settings by assisting physicians, assessing patients, and treating injuries and ailments. Obtains a thorough medical history from patient and dependent on patient population and setting will perform an examination and/or assessment to determine patient's needs. With other healthcare professionals, analyze and interpret information collected from patient, medical records, symptoms, physical findings, or diagnostic information, to develop and establish appropriate diagnosis. Acknowledges and demonstrates the importance of care coordination and navigation by rounding on patients when necessary. Works in collaboration with providers and independently to provide care. Formulates a plan for treatment of the patient and prescribes medications based on efficacy, safety, and cost as legally authorized if necessary, in order to aid recovery and manage pain. Maintain complete and detailed records of patients' health care plans and prognoses in a timely manner. Consult with or refer patients to appropriate specialists when conditions exceed the scope of practice or expertise. Provide patients with information needed to promote health, reduce risk factors, or prevent disease or disability. Counsels' patients and family members about self-management on prevention and treatment plan for health issues, tailoring instructions to patients' individual circumstances. May cover hospital consultations, rounding, and assist with patient procedures as needed. Conducts research into area of specialty and uses findings to provide measurable improvements in patient care and clinical outcomes. Incorporates evidence based practice guidelines into care. Maintain current knowledge of state legal regulations for advanced practice provider practices, including reimbursement of services. Keep abreast of regulatory processes and payer systems such as Medicare, Medicaid, managed care, and private sources, as applicable. Demonstrate extensive advanced knowledge of medical principles, practices and techniques.

Niklife Home Care Inc

RNs, LPNs, New grads welcome .

Posted on:

April 22, 2025

Job Type:

Full-Time

Role Type:

Primary Care

License:

RN

State License:

Illinois

This is a full-time remote role for Registered Nurses (RNs), Licensed Practical Nurses (LPNs), and new graduates.

Registered Nursing (RN) and Licensed Practical Nursing (LPN) skills Ability to monitor patient health and administer medications Excellent patient record-keeping and documentation skills Strong communication and coordination skills with healthcare providers Capable of educating patients and families on care plans Familiarity with healthcare regulations and protocols Compassionate, patient, and able to work independently License to practice as an RN or LPN CPR and First Aid certification is a plus Experience in home healthcare is preferred but not required

The role involves providing comprehensive and compassionate care to patients in their homes. Daily tasks include administering medications, monitoring patient health, maintaining accurate patient records, coordinating with healthcare providers, and educating patients and their families about care plans. Ensuring compliance with healthcare regulations and protocols is also a key responsibility.

Gallagher Bassett

Nurse Consultant - Brooklyn

Posted on:

April 21, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

New York

Join our growing team of dedicated professionals at Gallagher Bassett, who guide those in need to the best possible outcomes for their health and wellbeing. You'll be part of a resilient team that works together to redefine the boundaries of excellence. At our organization, we value collaboration and making a positive impact in the lives of our clients and claimants, offering you the opportunity to join a team where your skills and dedication can truly make a difference. GUIDE. GUARD. GO BEYOND. We believe that every candidate brings something special to the table, including you! So, even if you feel that you’re close but not an exact match, we encourage you to apply.

Provides medical management to workers compensation injured employees, performing case management through telephonic and in-person contact with injured workers and medical providers. Coordinates with employers and claims professionals to manage medical care in order to return injured employee to work. This position will cover the Brooklyn / NY area with a travel radius of up to 2 hours.

Nursing or medical degree from an accredited institution with an active Registered Nursing license or medical license within the state of practice or states in which case management is performed. 2-4 years of work experience. Responsible for completing required and applicable training, in order to maintain proficiency and licensing requirements. Able to travel to appointments within approximately a 2 hour radius. Intermediate to advanced computer skills; Microsoft Office, Outlook, etc. Desired: Bachelor's degree preferred. Worker's Compensation experience is preferred. Certification in related field preferred. 1-3 years of clinical experience preferred. Work Traits: Demonstrates adequate knowledge of managed care with emphasis on use of criteria, guidelines and national standards of practice. Advanced written and oral communication skills, along with organizational and leadership skills. Self-directed and proactively manage assigned case files. Demonstrates strong time management skills.

Coordinating medical evaluation and treatment Meeting with physician and injured worker to collaborate on treatment plan and to discuss goals for return to work Keeping employer and referral source updated regarding medical treatment and work status Coordinating ancillary services, e.g. home health, durable medical equipment, and physical therapy. Communicates with employers to determine job requirements and to explore modified or alternate employment. Discusses and evaluates results of treatment plan with physician and injured worker using Evidence Based Guidelines to ensure effective outcome. Documents case management observations, assessment, and plan. Generates reports for referral source to communicate case status and recommendations. Generates ongoing correspondence to referral source, employer, medical providers, injured worker, and other participants involved in the injured worker's treatment plan. May participate in telephonic case conferences. Maintains a minimum caseload of 35 files, and 150 monthly billable hours, with minimum 95% quality compliance.

Family Home Health and Hospice

Triage Hospice Nurse (Weekends)

Posted on:

April 21, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Illinois

Family Home Health Network, is a provider of intermittent Home Health care, Palliative care, Hospice care and Skilled/Custodial private care services throughout the Chicagoland area.

We are seeking a dedicated Hospice Triage Nurse with a strong commitment to quality patient care. To succeed in this role, you must possess excellent clinical nursing and customer service skills. This position starts Friday's at 5pm and lasts until Monday at 8am and is 100% remote but must live in Illinois.

Must possess current Illinois RN licensure Possess a minimum of two (2) years experience (Hospice) Current CPR Home Care Home Base experience a plus Must possess excellent clinical nursing and customer service skills

STRIDE Community Health Center

Triage and Advice Registered Nurse - Remote

Posted on:

April 21, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

At STRIDE Community Health Center, we’re dedicated to more than just providing healthcare—we’re committed to making a lasting impact on the lives of our patients and the communities we serve. As one of Colorado’s largest Federally Qualified Health Centers, we offer comprehensive services—including primary care, dental, pharmacy, behavioral health, health education, and outreach—across our 13 clinics in the Denver Metro area. With over 35 years of serving our community, our growing team is at the heart of this mission. We believe healthcare is about more than treating illness; it's about fostering wellness and addressing the unique needs of every person, ensuring that no one is left behind. If you’re passionate about making a meaningful difference, thrive in a collaborative environment, and are ready for a career that transforms lives—including your own—STRIDE is the place for you.

Under general supervision, the Triage and Advice Registered Nurse (TARN) performs telephone triage and processes medication refill requests in accordance with acceptable nursing standards and organization policies and procedures. This position will primarily work remotely from home; however, training will be held onsite, and continuing education will be held onsite as needed. STRIDE reserves the right to eliminate remote work arrangements and require staff to work at a STRIDE location. Applicants must reside in Colorado. Working Environment and Physical Activities: The work environment characteristics, physical and mental demands described here represent the typical conditions encountered while performing the essential functions of this role on a regular and consistent basis. Physically, the position requires the ability to lift 21–40 lbs (medium weight). The role also involves activities such as talking, hearing, sitting, standing, walking over distance, and climbing stairs. Mentally, the role demands skills in comparing, copying, computing, compiling, analyzing, coordinating, synthesizing, communicating, instructing, and demonstrating strong interpersonal behaviors. Work Schedule: Monday - Friday hours vary between 7:00 am - 5:30 pm MT

What you bring: Values Integrity: Doing the right thing even when no one is watching. Compassion: Meeting patients where they are with empathy. Accountability: Following through on our commitments. Respect: Valuing human dignity. Excellence: Embracing a growth mindset and striving for continuous improvement. Education and Experience: Associate or bachelor’s degree in Registered Nursing from an accredited school or training program. Required: 2 years of full-time experience as a Registered Nurse in a hospital or community health setting. Preferred: Previous home health or ambulatory care nursing experience. Preferred: Previous experience in an Emergency Department. Strongly Preferred: Previous experience performing Triage and Advice Nurse duties. Certificates, Licenses, and Registration: An active, unrestricted Registered Nurse license in the State of Colorado or appropriate compact licensing arrangement. Skills & Expertise: Knowledge of age-appropriate triage and treatment dispositions from newborn to Adult, including OB and through use of language interpretation services. Ability to respond appropriately to emergency situations required. Ability to apply nursing principles, practices and techniques required. Ability to exercise initiative and judgment in selecting proper treatment required. Ability to use computers and computer systems required. Bilingual skills preferred. Computer skills required.

Assesses patient condition/symptoms and gives appropriate clinical direction, education, and recommendation(s) for disposition. Responds to incoming calls in a timely, professional manner and triages (as appropriate) to address and/or support the needs of the caller. Assesses needs using standard evidenced based protocols for triage, offers clinical recommendations, as well as referrals to health care providers, services and community resources using telephone and information system technologies. Utilizes standardized protocols for medication management, prescription refills, and prior authorizations. Schedules appointments. Advises appropriate disposition for guideline selection for patient/caller. Demonstrates the ability to adjust (override) the disposition according to the unique needs/situation of the patient/caller and using appropriate Nursing Judgment. Integrates quality improvement activities into practice. Assists in identifying ways to promote quality care and in collecting data needed to promote process and operational improvements. Maintain patient confidentiality in accordance with Federal and State law and organization policies. Document all patient care delivery in an accurate and timely manner. Meets Key Performance Indicators including quantitative and qualitative expectations for call and medication refills. For example, meeting call and refill volume targets, timely turnaround standards, and successful periodic peer review. Other duties as required.

Headlands ATS

Remote Triage Nurse - Overnight

Posted on:

April 21, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Are you seeking integrity, purpose, and meaning in your work? Do you want to make a difference by improving access to quality addiction medicine services? Join the Headlands Addiction Treatment Services (ATS) provider team. At Headlands ATS, we are an industry leader in addiction and psychiatric services, dedicated to improving patient care in residential and outpatient addiction and mental health programs. Our team consists of compassionate healthcare professionals who are committed to delivering evidence-based care, education, and organizational improvements to historically underserved populations.

As a Remote Triage Nurse at Headlands ATS, you will play a critical role in providing high-quality care to patients dealing with addiction and mental health conditions. Working closely with our dedicated team of healthcare professionals, you will manage nursing requests, triage patient needs, and ensure seamless communication between patients, providers, and programs—all from the comfort of your home. In this role, you will utilize your clinical expertise to: Address and resolve patient care issues using established protocols within your scope of practice. Coordinate and delegate tasks such as admissions and follow-ups to providers, ensuring timely and effective care. Support providers by managing medication orders and refill requests. Serve as a compassionate and responsive point of contact for patients and programs, fostering trust and positive relationships. Schedule and Availability Friday-Sunday, 6:00 AM - 4:00 PM PST (30 hours weekly) Friday-Sunday, 4:00 PM - 2:00 AM PST (30 hours weekly)

Skills and Experience: Exceptional customer service skills and a compassionate bedside manner. Strong multitasking abilities and advanced computer proficiency, including navigating multiple software programs simultaneously. Proven experience in nursing with exceptional organizational and workflow management skills. A strong work ethic, reliability, and commitment to improving the lives of patients dealing with mental health conditions and addiction. A track record of longevity in previous roles, with strong references. A current, active California nursing license in good standing (required). A Nursing Compact License/Multi-State (required). Reside in one of the following states: AZ, CA, CO, FL, IL, IN, KS, MD, MO, NV, NE, NJ, NC, OK, TN, TX, WA, WI.

Managing nursing requests from various treatment programs, per established protocols and within scope of practice. Triage and delegation of admissions to on-call Nurse Practitioner, Physician Assistant and/or Physician providers. Managing common patient care issues that do not require provider involvement, per established protocols. Triage and delegation of patient followup visits with appropriate providers. Assisting providers with medication orders orders and refill requests. Providing friendly, helpful, and responsive, service oriented experience for programs and patients.

Lifespark Group LLC

Population Health: Triage Nurse (RN)

Posted on:

April 21, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Minnesota

Lifespark is a complete senior health company headquartered in St. Louis Park, Minnesota. Since 2004, we’ve been helping seniors stay healthy, navigate their health care options with confidence, and live fuller, more independent lives as they age. That’s where our people come in – from accounting and health technology to front-line nurses, advanced practice professionals, caregivers and everything in between, we are all invested entrepreneurs focused on helping people age magnificently. Our Lifespark culture has created not only an award-winning workplace — earning Star Tribune Top Workplace 11 times, Minneapolis Business Journal Best Places to Work three times, and Top USA #1 in Healthcare — but a place where you have the room to be creative, make a difference, and have a purposeful, direct impact on how people age. Lifespark’s full continuum of services offers a breadth of roles with the support to grow your career. To see the experience we are creating, watch our award-winning video Going South – this is the experience you will help create at Lifespark! Changing the age-old story starts with you – let’s get you hired.

Hourly Wage: $36-$42 an hour, depending on experience Service Area: Remote (home-based, after training) *applicant must be Minnesota-based Schedule: Part-Time, hours are every other Friday 7am-8pm, Saturday 8:30am-5pm, and Sunday 8:30am-5pm The Triage Nurse is primarily responsible for gathering clinical information over the phone and directing healthcare services. The Triage nurse uses Lifespark’s Clinical Guidelines as well as internal process and/or procedure to meet the needs of clients, families and staff within their homes and communities. The Triage LPN must possess and use good clinical judgement, careful listening, critical thinking, triage experience and escalate to appropriate staff members as needed.

Education: Graduate of an accredited school of nursing Current state nursing license Experience: One (1) to two (2) years of recent acute care, triage and/or home health care experience Recent triage experience in clinic, ALF, or SNF Knowledge, Skills and Abilities: Participates in on-call program rotation Participates in weekend coverage as needed Strong phone skills Aging process and related care issues Advanced care planning Person-centered care planning Caregiver and member education Community resources Creativity and ability to solve problems Ability to create trusted relationships with members/families Proficient with technology and relevant applications: Microsoft Office, Smart Phone, Calendaring, Clinical Software platforms (EMR), Wi-Fi, Printers, and Internet Browsing Strong written and oral communication skills Verification of COVID vaccine status or receiving an approved exemption. Key Competencies Teams: skilled at collaboration, works effectively as part of a care team Customer-focus: demonstrates empathy, a desire to serve, and reliability Influencing: confident and comfortable promoting proactive solutions Personal resiliency: emotional/intellectual flexibility, ability to remain calm, stay focused and maintain objectivity in stressful situations Self-directed: demonstrates initiative and works independently Productivity: skills in prioritization, planning, organizing and time management Assessment and Care Planning skills Creativity and Ability to Solve Problems Organization and Detail Orientation Implementation, Follow-through, and Accountability Communication: Oral and Written

Gather pertinent clinical information problem based on conversation with client/patient, family or caregiver Uses clinical judgment, knowledge and experience to direct conversation and guide decision-making to give self-care advice, refer client/patient to provider, make an appointment, instruct client/patient contact emergency assistance, or dispatch appropriate community resource. Provides direct/triage client/patient care as defined in the State Nurse Practice Act. Counsels the client/patient and family in meeting nursing and related needs. Provides health care instructions to the client/patient as appropriate per assessment and plan of care. Provides education when appropriate. Reassures the rapid and effective transmission of client/patient data between all relevant parties. Promotes evidence-based practice. Establishes and maintains strong collaborative arrangements with other health care professionals. Participates in admission avoidance activities dispatching community resources as needed to prevent rehospitalizations. Complete annual mandatory training. Lead by example in establishing rapport with client/patient. Ensure positive/professional communication on team. Customer service resolution; escalate concerns. Prepares clinical notes and updates primary provider when necessary. Communicates with provider regarding the client/patient needs and reports any changes in the client/patient condition; obtains/receives orders as required. Communicates with community health related persons to coordinate the care plan. Extremely skilled at listening and interpreting subtle indications such as tone of voice, hesitations or incomplete responses. Inspires others and encourage them to seek advice and solutions to problems. Challenges others to take an active part in developing knowledge, ideas and work practice. Challenges tradition and accepts joint responsibility for any arising problems and tensions and uses these to inform future practice. Makes effective use of appropriate learning opportunities for themselves and others and applies learning to practice. Honors Client Confidentiality, Rights, Privacy, and Reporting Maltreatment Expectations. Understands and Accepts Clients’ Diagnosis. Understands and accepts emotional needs of client. Accepts unique client symptoms and behaviors. Understanding of Confidentiality & Data Protection Act. Adheres to Emergency Procedure and Response Expectations. Identifies home safety issues and notifies appropriate community resource. Demonstrates proper procedures: handling, lifting, transfers. Escalates employee work injury per protocol. Overview of Process, Types of Reports and Forms Follow-up Required – Escalating Event MOD responsibilities, manage safety concerns for clients and clinicians, escalating when appropriate LPN to work within scope and escalate needs to RN/provider when change in condition or care plan needed.

SCAN Health Plan

Clinical Care Manager

Posted on:

April 21, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

California

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 285,000 members in California, Arizona, Nevada, and Texas. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare

Provides clinical oversight and ensures the efficient handling of member appeals and grievances, maintaining compliance with Medicare regulations and company policies. This role leads a team of clinical and support staff, ensuring high-quality care and member satisfaction.

5+ years’ experience in medical management, change management, and/or leadership. LCSW or RN Clinical License Preferred Strong knowledge of medical group/IPA operations, integrated delivery systems, and health plans. Operational experience in rural and metropolitan markets and the ability to identify performance gaps in these markets and execute relevant solutions. Proven skills with data, analytics and ability to elevate performance through data inquiry, and design programs based on knowledge of trends.

Lead and manage a team of clinical and support staff, providing clinical guidance, training, and performance evaluations. Foster a positive and collaborative work environment that promotes teamwork and continuous improvement. Provide clinical oversight for all appeals and grievances, ensuring medical decisions are based on sound clinical judgment and evidence-based practices. Review and approve clinical documentation and decisions to ensure accuracy and compliance with regulatory standards. Develop and maintain departmental policies and procedures to ensure compliance with Medicare regulations and company standards. Regularly review and update policies to reflect changes in regulations and best practices. Oversee the intake, review, and resolution of member appeals and grievances, ensuring all cases are handled in a timely and accurate manner. Collaborate with interdisciplinary teams to gather necessary clinical information and make informed decisions. Implement and monitor quality assurance processes to ensure all appeals and grievances are handled according to established clinical standards. Conduct regular audits and reviews to identify areas for improvement and implement corrective actions. Maintain open lines of communication with members, healthcare providers, and internal stakeholders. Prepare and present reports on departmental activities, outcomes, and performance metrics to senior management. Ensure all departmental activities comply with Medicare regulations, state laws, and company policies. Stay informed about changes in regulations and industry standards and adjust departmental practices accordingly. Advocate for members to ensure their clinical concerns are addressed and their rights are protected. Provide clear and compassionate communication to members throughout the appeals and grievance process. Develop and deliver training programs to ensure staff are knowledgeable about Medicare regulations, company policies, and best clinical practices. Encourage and support professional development opportunities for team members. Build and maintain strong relationships with healthcare providers, payers, and other stakeholders to facilitate smooth and effective resolution of appeals and grievances. Participate in cross-departmental initiatives to enhance overall member care and satisfaction. All other duties as assigned.

SCAN Health Plan

Sr. Director Network Quality and Clinical Strategy

Posted on:

April 21, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

None Required

State License:

California

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Asvantage plans, serving more than 285,000 members in California, Arizona, Nevada, and Texas. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare

Job Title: Sr. Director Network Quality and Clinical Strategy Location: remote Reports to: CVP, Healthcare Services This role will lead the development and execution of quality improvement and clinical strategy initiatives across our healthcare network. The role will be responsible for enhancing provider performance, improving clinical outcomes, and ensuring compliance with regulatory standards. This role will collaborate closely with network providers, clinical teams, and senior leadership to drive consistent, high-quality care and operational excellence across all network facilities.

Minimum of 7 years of experience in healthcare quality management and clinical strategy, including senior leadership experience Minimum of 5 years of experience leading and developing high-performing teams Proven expertise in developing and implementing network quality improvement programs. Strong understanding of healthcare regulations, accreditation requirements, and clinical best practices. Excellent analytical and problem-solving skills with a data-driven approach. Exceptional communication and interpersonal skills with the ability to engage and influence stakeholders at all levels.

Strategic Leadership: Develop and execute the organization’s network quality and clinical strategy to improve patient outcomes, provider performance, and operational efficiency. Provider Performance: Establish performance benchmarks and quality improvement programs for network providers to enhance care delivery and patient satisfaction. Clinical Strategy: Design and implement clinical care models that align with industry best practices and emerging healthcare trends. Regulatory Compliance: Ensure all network activities comply with state, federal, and accreditation standards (e.g., CMS, NCQA, Joint Commission). Cross-Functional Collaboration: Partner with clinical, operational, and administrative teams to integrate quality and clinical strategy into all aspects of care delivery. Data-Driven Insights: Develop and monitor key performance indicators (KPIs) to track network quality, clinical outcomes, and provider performance. Provider Engagement: Foster strong relationships with network providers and clinical leaders to align on quality improvement goals and best practices. Leadership and Team Development: Build and lead a high-performing team focused on network quality and clinical strategy, providing mentorship and professional development opportunities. Stakeholder Reporting: Present network quality and clinical strategy performance reports to executive leadership and the board of directors, providing strategic recommendations. All other duties as assigned.

SCAN Health Plan

RN Triage- Embrace CareConnect (Remote)

Posted on:

April 21, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

SCAN Group is a not-for-profit organization dedicated to tackling the most pressing issues facing older adults in the United States. SCAN Group is the sole corporate member of SCAN Health Plan, one of the nation’s leading not-for-profit Medicare Advantage plans, serving more than 285,000 members in California, Arizona, Nevada, and Texas. SCAN has been a mission-driven organization dedicated to keeping seniors healthy and independent for more than 40 years and is known throughout the healthcare industry and nationally as a leading expert in senior healthcare. SCAN employees are a group of talented, passionate professionals who are committed to supporting older adults on their aging journey, while also innovating healthcare for seniors everywhere. Employees are provided in-depth training and access to state-of-the-art tools necessary to do their jobs, as well as development and growth opportunities. SCAN takes great pride in recognizing our team members as experts in their fields and rewarding them for their efforts. If you are interested in becoming part of an organization that is innovating senior healthcare

Remote, CA and AZ RN license required Embrace CareConnect is a dedicated team focused on delivering high-quality, senior-centered care through seamless coordination and real-time clinical support. As a CareConnect RN, you will be a frontline clinical resource for Embrace members, providing telephonic and digital triage to ensure timely interventions and effective care coordination. In this remote role, you will assess and respond to clinical concerns from members, caregivers, senior living communities, and POAs/loved ones through phone calls, secure messages, EHR communications, and email. Collaborating with CareConnect Coordinators (CCCs) and Patient Care Coordinators (PCCs), you will work closely with Advanced Practice Clinicians (APCs) and Primary Care Physicians (PCPs) to facilitate timely, appropriate care with a focus on one-touch resolution whenever possible. This role requires agility, strong clinical judgment, critical thinking, and problem-solving skills to navigate complex care situations and ensure members receive the right care at the right time.

Bachelor's Degree in Nursing Active and unencumbered RN license in CA. Active and unencumbered RN license in AZ (or multi-state licensure which includes AZ). Graduate or Advanced Degree or equivalent experience is preferred. 3+ years of clinical nursing experience, preferably in emergency medicine, geriatric home health/hospice, and/or telephonic triage. Experience in managed care, Medicare Advantage, or I-SNP/IE-SNP programs is highly desirable. Strong clinical assessment and critical-thinking skills with the ability to make rapid decisions in a telephonic setting. Proficiency with EMR documentation and care coordination workflows. Familiarity with medical coding, claims processes, and care gap analysis is a plus. Ability to thrive in a fast-paced, startup-like environment, adapting to evolving workflows and technology. Excellent communication and interpersonal skills for engaging with members, caregivers, and clinical teams. Strong problem-solving abilities and a proactive approach to care management. Strong skills in remote team environment. Proficient in MS Office.

As the CareConnect RN, this individual ensures seamless day-to-day operations and strategic alignment with SCAN’s initiatives. Their key responsibilities include: Triage & Clinical Assessment: Handle inbound calls, secure messages, and emails from members, caregivers, and senior living communities, determining the most appropriate next steps for care. Escalation & Care Coordination: Use SBAR methodology to escalate urgent concerns and collaborate with APCs and PCPs for timely clinical interventions. Hospital & SNF Coordination: Work closely with the Embrace Care Management team to coordinate ER visits, hospital admissions, and skilled nursing facility (SNF) transitions when necessary. Collaboration & Member Support: Partner with CCCs and PCCs to ensure seamless member support, proactive follow-ups, and care navigation. Patient & Caregiver Education: Provide guidance on chronic disease management, medication adherence, and preventive care strategies to members and caregivers. Documentation & Communication: Accurately document clinical interactions in the EMR system and coordinate care via HIPAA-compliant messaging tools. Quality Improvement & Best Practices: Contribute to developing clinical protocols, triage workflows, and escalation processes to enhance care delivery. Proactive Risk Management: Identify high-risk members and collaborate with the interdisciplinary care team to implement proactive care strategies. All other duties as assigned.

HERO Crisis Residential Homes LLC

Telehealth Registered Nurse(Virginia Only)

Posted on:

April 21, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

We are seeking a dedicated and compassionate Registered Nurse to join our Crisis healthcare team. The ideal candidate will have experience in various nursing settings, As a Registered Nurse, you will be responsible for providing high-quality patient care, administering medications, and collaborating with healthcare professionals to ensure the best outcomes for our patients. Your expertise in Healthcare will be essential in delivering safe and effective care.

Current Registered Nurse (RN) license in the state of practice. Must be a Virginia-licensed RN Must be able to provide proof and a copy of an active Virginia RN license Experience in crisis , acute care, or urgent care preferred. Familiarity with electronic health record. Ability to work effectively in high-pressure environments. Strong communication skills and the ability to collaborate with a diverse healthcare team. Compassionate demeanor with a commitment to providing exceptional patient-centered care. Willingness to engage in ongoing professional development and training opportunities.

Provide direct patient care, including assessments, planning, implementation, and evaluation of nursing interventions. Administer medications and treatments as prescribed by physicians. Monitor patients' vital signs and report any significant changes to the healthcare team. Collaborate with interdisciplinary teams to develop and implement individualized care plans for patients. Educate patients and their families about health conditions, treatment plans, and self-care strategies. Maintain accurate patient records using electronic health record systems such as Cerner. Provide specialized care for patients in Mental health crisis or those requiring vitals. Support patients in acute care settings or those recovering from mental health crisis

New Perspective Senior Living

Triage Nurse (MN, ND, WI)- Fri5pm-Mon8am

Posted on:

April 20, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Minnesota

Why New Perspective Senior Living? A career with a purpose starts here! This is an exciting time to join New Perspective. We are a growing company serving over 2,000 seniors today with a goal of reaching 10,000 by 2025. Our growth is creating energy, excitement, and the opportunity to make a difference in the lives of others. We have a culture of servant leadership and collaboration that supports each team member’s personal and professional development. At New Perspective you’re not just an employee, you are a valued member of our team.

Work from Home! Every 4th Weekend (Friday 5PM-Monday 8AM) The Triage Nurse works remotely responding to phone calls from team members seeking medical information and/or direction regarding medical attention in conjunction to the resident’s care and/or care plan. Triage nurse complies with federal and state laws and regulations as well as Company’s policies and procedures. The triage nurse leads by example, and champions communication, customer service experience and commitment to the collaborative team model.

Must possess a current license to practice as a Registered Nurse (RN) in the states of Minnesota, North Dakota, and Wisconsin Two years or more clinical experience as an RN Thorough knowledge of practical nursing theory with knowledge of standard practices, rules, and regulations related to nursing Ability to keep accurate records Ability to handle stressful situations Excellent written and oral communication skills Experience working with older adults in an acute or long-term care setting Strong communication and interpersonal skills. Empathy for the challenges experienced by residents, families and team members and the problem-solving skill sets to support them. Strong computer skills and ability to interact with a variety of electronic devices. Ability to communicate effectively verbally and in writing using the English language. Ability to handle multiple tasks simultaneously

Reviews and acknowledges daily triage reports sent by communities Responds to telephone calls from clinical team members, assesses and guides clinical team members on proper response to resident care Ensures that all response/return phone calls are executed timely and appropriately Documents reason, response and outcome for each phone call Provides guidance to team members on triage support procedures Maintains confidentiality of all resident information adhering to HIPAA laws and Company standards. Communicates and interacts with residents, families and team members in a kind, respectful and effective way Promptly communicates triage call information to each community to ensure the nurse can follow up appropriately. Satisfies education needs through learning management system, and other resources

CareBridge Health

CareBridge RN Triage Nurse, 100% Virtual

Posted on:

April 20, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

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.

CareBridge RN Triage Nurse *Seeking candidates that have an active, unrestricted RN Compact license Or Multi-state RN licenses in either of the following states: AZ, FL, IA, IN, KS, MA, NM, OH, PA, TN, TX or VA. Location: This position is primarily a remote role. Work Shift: 4/10 works shifts, 11 am to 9 pm (Central Standard Time) and every two weeks, full weekend shift. The RN Triage Nurse is responsible for triaging acute care needs and issues telephonically. Utilizing department guidelines, completes triage process and applies established criteria to assign members to appropriate care management component. Collaborating with team members and providers to provide appropriate level of care.

Minimum Requirements: Requires an AS in nursing and a minimum of 2 years of acute care clinical experience; or any combination of education and experience, which would provide an equivalent background. Current, unrestricted RN license in the applicable state(s) required. Preferred Skills, Capabilities and Experiences: Current, active, RN Compact license highly preferred. Emergency Room and/or Urgent Care experience highly preferred. Telehealth experience. BS in nursing preferred. Experience with EMR systems. Experience in managing complex care cases for developmental disabilities and chronically ill patients strongly preferred. Ability to understand clinical information and prepare a concise summary following department standards strongly preferred. Basic knowledge of the medical management and care management process and role preferred.

Utilizes the nursing process to meet an individual’s health needs. Learns to develop favorable working partnerships and collaborative relationships with members, healthcare service providers, and internal and external customers to help improve health outcomes for members. Works in collaboration with medical management and care management associates to identify issues, problems, and resource needs and assign to appropriate care management program. Documents appropriate clinical information, decisions, and determinations in a timely, accurate, and concise manner. Monitors inbound calls and tasks by attributed care members. Assigns patients to Nurse Practitioners when necessary.

CareBridge Health

CareBridge Clinical Quality Consultant Nurse Practitioner

Posted on:

April 20, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

NP/APP

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.

CareBridge Clinical Quality Consultant Nurse Practitioner Location: This position is primarily a Remote role. Work Shift: Monday - Friday, 8 am to 5 pm. The Clinical Quality Consultant Nurse Practitioner is responsible for quality documentation, coding and value capture.

Minimum Requirements: Requires an MS in Nursing and minimum of 3 years experience in applying appropriate diagnosis in the Medicare HCC model and/or CMS Risk Adjustment Model; or any combination of education and experience, which would provide an equivalent background. Requires a current, active, valid and unrestricted RN license And NP license in applicable state(s). Preferred Skills, Capabilities and Experiences: AAPC Certified Risk Adjustment Coder preferred Working knowledge of STAR/HEDIS and Risk-adjustment payment model Up-to-date knowledge of latest CMS coding and documentation requirements

Focus on chart reviews by supplying clinical expertise to ensure full accurate and appropriate diagnosis, documentation, coding and care. will review all provider visit medical encounters and apply most appropriate diagnosis codes. Overall accountability for the HCC/Risk Adjustment of goals and workflows to support value capture initiatives and high-quality clinical documentation. Chart reviews for closing HEDIS care opportunities to ensure practice and health plan success. Liaison to coding team. Participate in peer review of medical documentation for completed visit notes and patient profile information in EMR. Reviews and corrects any ICD-10 codes that have been assigned in charts. Provide feedback to the provider for improved documentation to support specific codes. Travels to worksite and other locations as necessary.

CareBridge Health

CareBridge Bilingual Nurse Practitioner, 100% Remote

Posted on:

April 20, 2025

Job Type:

Full-Time

Role Type:

Primary Care

License:

NP/APP

State License:

Compact / Multi-State

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.

CareBridge Nurse Practitioner - Bilingual in Spanish *Sign On Bonus: $5,000 Location: This position is primarily a remote/virtual role. Work Shift: Monday – Friday, 8:00 am to 5:00 pm (CST or EST) and rotating on-call. The Advance Practice Provider, Nurse Practitioner - Bilingual is responsible for collaborating with company physicians, the patient’s other physicians and providers, and their family members to develop complex plans of care in accordance with the patient’s health status and overall goals and values. Provides clinical and non-clinical support to patients.

Minimum Requirements: Requires an MS in Nursing. Requires an active, national NP certification. Requires valid, current, active and unrestricted Family or Adult Nurse Practitioner (NP) license in the states of either Massachusetts, Texas and/or Florida. Requires 2+ years of experience in managing complex care cases. Experience working with Electronic Medical Records (EMR). Bilingual in Spanish or Multi-language skills required. Preferred Skills, Capabilities and Experiences: RN Compact license highly preferred. Possession of DEA registration or eligibility preferred. Experience in managing complex care cases for developmental disabilities and chronically ill patients strongly preferred.

Provides urgent health care via telephone and tele video modalities to patients who receive home and community-based services through state Medicaid programs, dual eligible members and other membership as assigned by our MCO partners. Develops and implements clinical plans of care for adult patients facing chronic and complex conditions (e.g., co-morbid medical and mental health diagnoses, limited personal resources, chronic medical conditions.). Gathers history and physical exam and diagnostics as needed, and then develops and implements treatment plans given the patient’s goals of care and current conditions. Identifies and closes gaps in care. Meets the patient’s and family’s physical and psychosocial needs with support and input from the company’s inter-disciplinary team. Educates patients and families about medication usage, side effects, illness progression, diet and nutrition, medical adherence and crisis anticipation and prevention. Maintains contact with other clinical team members and other medical providers to coordinate optimal care and resources for the patient and his or her family in a timely basis and consistent with state regulations and company health standards and policy. Maintains patient medical records and medical documentation consistent with state regulations and company standards and policy. Participates in continuing education as required by state and certifying body. Prescribes medication as permitted by state prescribing authority.

CareBridge Health

CareBridge Nurse Practitioner, 100% Remote

Posted on:

April 20, 2025

Job Type:

Full-Time

Role Type:

Primary Care

License:

NP/APP

State License:

Compact / Multi-State

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.

CareBridge Nurse Practitioner: Indiana $5,000 Sign On Bonus Location: This position is primarily a Remote role. Work Shift: Monday – Friday, 8:00 am to 5:00 pm CST or EST And rotating on-call. The Advance Practice Provider, Nurse Practitioner is responsible for collaborating with company physicians, the patient’s other physicians and providers, and their family members to develop complex plans of care in accordance with the patient’s health status and overall goals and values. Provides clinical and non-clinical support to patients.

Requires an MS in Nursing. Requires an active, national NP certification. Requires valid, current, active and unrestricted Family or Adult Nurse Practitioner (NP) license in the state of Indiana. Requires valid, current, active, RN Compact license. Requires 2+ years of experience in managing complex care cases. Experience working with Electronic Medical Records (EMR). Preferred Skills, Capabilities and Experiences: Possession of DEA registration or eligibility preferred. Experience in managing complex care cases for developmental disabilities and chronically ill patients strongly preferred.

Provides urgent health care via telephone and tele video modalities to patients who receive home and community-based services through state Medicaid programs, dual eligible members and other membership as assigned by our MCO partners. Develops and implements clinical plans of care for adult patients facing chronic and complex conditions (e.g., co-morbid medical and mental health diagnoses, limited personal resources, chronic medical conditions.). Gathers history and physical exam and diagnostics as needed, and then develops and implements treatment plans given the patient’s goals of care and current conditions. Identifies and closes gaps in care. Meets the patient’s and family’s physical and psychosocial needs with support and input from the company’s inter-disciplinary team. Educates patients and families about medication usage, side effects, illness progression, diet and nutrition, medical adherence and crisis anticipation and prevention. Maintains contact with other clinical team members and other medical providers to coordinate optimal care and resources for the patient and his or her family in a timely basis and consistent with state regulations and company health standards and policy. Maintains patient medical records and medical documentation consistent with state regulations and company standards and policy. Participates in continuing education as required by state and certifying body. Prescribes medication as permitted by state prescribing authority.

Geisinger

Wellness Associate II (work from home Northcentral Pennsylvania resident)

Posted on:

April 20, 2025

Job Type:

Full-Time

Role Type:

License:

None Required

State License:

Pennsylvania

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

Serves community population management initiatives including on site programs, screening services, fitness classes, evidence based program facilitation and program development for the wellness team and partners. Responsible for the development and oversight, as well as implementation of health and wellness programs at the facility as well as surrounding community initiatives.

Position Details: This position will travel throughout the community. Work hours vary including early mornings, occasional weekends, and occasional evenings. Education: Bachelor's Degree-Healthcare Related Degree (Required) Experience: Minimum of 1 year-Related work experience (Required) Skills: Critical Thinking; Interpersonal Communication; Computer Literacy

Service area will include Montour County and surrounding counties. Develops and designs programs in conjunction with their assigned facility ensuring competencies, training requirements, reporting and documentation requirements are being meet. Supports regional teams, operations, new program design and implementation of new products and services. Develops and implements tools to evaluate the effectiveness of the wellness program to manage outcomes. Reports program participation and outcomes quarterly to stakeholders. Prepares and presents educational information consistent with the mission and objectives of the wellness program and the facility. Provides on site screening support and education as needed. Supports team on site with programs, biometric screenings and phlebotomy support as needed and as appropriate, based on skill set and educational background. Represents the facility at various business and community events as needed or coordinates events at the facility. Serves as a wellness resource and oversees member communication and outreach initiatives within the wellness program. Supports regionally based teams and employers throughout our coverage area, as well strategic opportunities as needed. Monitors changes in employee wellness research, new developments and standards. Researches and creates new program to meet the population needs, as appropriate. Supports reporting needs, data management and outcomes. Assists with other policies which have wellness components. Learns new software applications and maintains databases. Coordinates ongoing record keeping and prepares reports as requested. Works closely with internal departments including, but not limited to Health Services, Marketing, IT, Sales and wellness. Responsible for calendar management, promotion of activities in conjunction with marketing and coordination of all onsite activities. Participates on committees, as assigned, to represent and provide expertise related to the Wellness Program. Provides telephonic and on site health coaching for lifestyle management programs, as needed. Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

Geisinger

RN - Performance Improvement Coordinator

Posted on:

April 20, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Pennsylvania

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

Job Summary: As one of the Top 8 Most Innovative Healthcare Systems in Becker’s Hospital Review, we’re working to create a national model for improving health. Today, we’re focused on bringing our region services that improve every facet of life to drive total health, inside and out. Through professional growth, quality improvement, and interdisciplinary collaboration, we’ve built an innovative culture that allows nurses to grow their skillsets, develop their practice, and leverage their years of experience to build a rewarding, lasting career with impact. Join us as a Registered Nurse Performance Improvement Coordinator to strengthen that impact. Job Duties: The RN Performance Improvement Coordinator evaluates the quality of health care rendered by the System for the purpose of meeting regulatory requirements for inpatient and outpatient assigned areas. Will coordinate and ensure action plans and performance improvement projects are performed through practice analysis, audits, education, and the compliance of assigned department, with the standards set by associations of healthcare providers and with applicable laws, rules and regulations. Responsible for coordinating and supporting Regulatory and Performance Improvement activities and identifying ongoing data and information system needs. This opportunity is work from home in the state of Pennsylvania, salaried, and full time. At least (2) years of RN work experience and a BSN are required.

Position Details: Work is typically performed in a clinical environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job. Additional competencies and skills outlined in any department-specific orientation will be considered essential to the performance of the job related to that position. Education: Bachelor's Degree-Nursing (Required) Experience: Minimum of 2 years-Nursing (Required) Certification(s) and License(s) Valid Driver's License - Default Issuing Body; Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania Skills: Working Independently; Communication; Clinical Skills; Computer Literacy; Critical Thinking; Teamwork; Organizing

Demonstrates a comprehensive understanding of the theory and principles of clinical performance improvement. Creates and fosters change in a positive proactive manner. Fosters problem-solving using critical thinking skills. Reviews and monitors occurrences, quality triggers and quality of care concerns observing for problems or patterns related to regulatory standards affecting the quality of care. Educates and orients providers, administration, professional and line staff as needed regarding Regulatory/Performance Improvement requirements. Serves as resource person for Regulatory/Performance Improvement initiatives within assigned areas. Assists with and provides direction to staff in developing measurements for Performance Improvement and evaluation activities. Develops data collection tools, data collection, summarization of data and reporting of findings. Schedules and assists with follow-up on corrective action plans. Prepares and submits monthly Performance Improvement Reports within the regions committee structure as assigned. Maintains appropriate records of all Performance Improvement activities. Assists in the preparation and coordination of all regulatory surveys. Actively participates in all regulatory surveys. Conducts and coordinates the follow-up of survey recommendations and requirements.

IQVIA

Certified Diabetes Educator Manager / Nurse Manager, Virtual Contact Center – West – Remote

Posted on:

April 20, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Texas

IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide. Learn more at https://jobs.iqvia.com

The Nurse Manager will have primary responsibility/accountability for the oversight of a telephonic Certified Diabetes Care and Education Specialist (CDCES) team consisting of clinical educators ensuring the team has the appropriate resources and operational support. The Manager will utilize clinical expertise and leadership skills to manage the team and collaborate with internal cross- functional partners and teams, the team lead when applicable, the program director, and the client team to facilitate successful program operation. The Manager will provide vacancy support if needed for the CDCES team, which would involve telephonic interactions with patients. This role will oversee CDCES’s interacting with patients diagnosed with diabetes and the associated treatment. The Manager will be well versed in the Diabetes and the treatment being supported. Job Duties: The Nurse Manager will have a strong understanding of contact center operations supporting the CDCES team to manage their workload, maintain program metrics, and achieve high customer satisfaction. The Manager will have experience working within multiple virtual platforms including Customer Relationship Management (CRM) systems, telephonic systems, chat platforms, and other web applications. The Manager will have knowledge and experience with data analysis related to contact centers, contact center resource management, call quality and compliance, and adverse event and product complaint reporting. The Manager will have experience within the pharmaceutical industry and will operate within the compliance guardrails outlined within the role. The interactions with the customers are strictly educational based, therefore the educators and/or Manager will not provide medical advice or work clinically within the role.

To be eligible for this position, you must reside in the same country where the job is located. Bachelor degree required Current Healthcare Professional License Current CDCES Certification 3+ years of clinical Diabetes experience 3+ years of clinical educator experience and contact center experience within the healthcare/pharmaceutical industry including supervising/managing a team required Experienced in motivational interviewing and coaching Ability to work within established guardrails in support of the nurse navigator team Effective presentations skills using a virtual platform with the ability to motivate others Leadership skills including strong communication, self-motivation, team building, emotional intelligence, and goal setting Willingness to perform the most complex tasks and manage work utilizing critical thinking, problem solving, and superior time management High level of competency and comfort with technology including: Ability to work independently and trouble shoot issues within a home remote work environment Fully competent in MS Office (Word, Excel, PowerPoint) Customer Relationship Management (CRM) experience required Virtual technology platforms experience required Telephonic platforms experience required Flexibility to work evenings Candidate must have a validated home office environment in which to work Highly Desirable/Strongly Preferred: Previous experience working remotely Bi-lingual Spanish speaking preferred

Use leadership skills to effectively manage a telephonic team Provide program start up and ongoing operational oversight and direction including contact center analysis and resource management Support the development and monitoring of program goals, key performance indicators, and metrics analyzing data to identify performance gaps and promote continued program improvement Develop regular reporting provided to the program director highlighting individual and team performance Provide regular and timely coaching to the CDCES team through one on ones, team interactions, and performance management Encourage professional development of the CDCES team through training, coaching, quality monitoring, and mentoring Support the recruitment, hiring, and training of new nurse navigators Perform interaction monitoring for quality assurance and compliance Complete managerial administrative duties including timekeeping, attendance, expense reporting, and annual reviews Handle interaction escalations when appropriate Act as the subject matter expert for the program supported Work closely with the program director on team dynamics, day to day challenges, program enhancements, and process improvement Perform all duties of the Nurse Navigator as needed Demonstrate flexibility, adaptability, and the ability to prioritize tasks Any additional duties as assigned by program director

Actalent

RN Clinical Documentation Specialist- REMOTE

Posted on:

April 20, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Conneticut

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

Facilitate the improvement of clinical documentation by collaborating with physicians, nursing staff, and other patient caregivers. Perform concurrent and retrospective reviews of medical records to ensure accurate documentation of patient care. Educate healthcare providers on the importance of accurate and complete clinical documentation. Utilize clinical knowledge and expertise to identify opportunities for documentation improvement. Ensure compliance with regulatory requirements and guidelines. Participate in multidisciplinary team meetings to discuss documentation improvement strategies. Provide feedback to healthcare providers on documentation practices and areas for improvement. Maintain up-to-date knowledge of clinical documentation standards and best practices.

Registered Nurse (RN) with a current license. Certified Clinical Documentation Specialist (CCDS) or Certified Documentation Improvement Practitioner (CDIP) certification. Certified Coding Specialist (CCS) certification if holding CCDS 2; if holding CCDS 1, no additional certification needed. Minimum of 3 years of clinical nursing experience. Strong knowledge of clinical documentation standards and regulatory requirements. Excellent communication and interpersonal skills. Ability to work collaboratively with healthcare providers and multidisciplinary teams. Proficiency in electronic health record (EHR) systems. Additional Skills & Qualifications: Excellent communication skills. Strong analytical and problem-solving skills. Experience with EHR, EMR, and Epic systems. Work Environment: Fully remote role. Schedule: Monday-Friday, 9am-5pm with potential for flexibility as long as a 40-hour work week is maintained.

Facilitate the improvement of clinical documentation by collaborating with physicians, nursing staff, and other patient caregivers. Perform concurrent and retrospective reviews of medical records to ensure accurate documentation of patient care. Educate healthcare providers on the importance of accurate and complete clinical documentation. Utilize clinical knowledge and expertise to identify opportunities for documentation improvement. Ensure compliance with regulatory requirements and guidelines. Participate in multidisciplinary team meetings to discuss documentation improvement strategies. Provide feedback to healthcare providers on documentation practices and areas for improvement. Maintain up-to-date knowledge of clinical documentation standards and best practices.

Actalent

Remote PAC Nurse

Posted on:

April 20, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Florida

Actalent is looking for PAC Utilization Review Nurses that will work remote! Qualified candidates must have experience working in the managed care/insurance industry. The PAC Nurse is a telephonic position responsible for recommending discharge plans, assisting with transition of care, and managing the length of stay (LOS) for Long Term Acute Hospital, Skilled Nursing Facility (SNF), and Institutional Rehab Facility (IRF) for assigned and non-assigned post-acute care (PAC) facilities through collaboration. The PAC Nurse will work closely with facility personnel and internal Medical Directors, Market Engagement Directors, and Nurse Managers to develop and maintain timely discharge plans.

Essential Skills: Excellent negotiation, influencing, problem-solving, and decision-making skills. Strong communication (verbal/written), organizational, and interpersonal skills. Ability to work independently, utilizing sound clinical judgment and critical thinking skills under minimal supervision. Commitment to quality and standards. Utilization management experience. Case management experience. Transitional care experience. Acute care experience. Medical record management. Additional Skills & Qualifications: Current and unrestricted LPN or RN license. Associate's Degree or Diploma in Nursing/Practical Nursing. Minimum 2 years of clinical experience in a clinical setting. Post-acute nursing experience (e.g., Inpatient Rehab Facility, Long-Term Acute Care Hospital, Skilled Nursing Facility). 3 years of concurrent review experience and/or discharge planning. 2 years of utilization review/management experience. 1 year of experience within Case Management or Transition-of-care role. Experience in Utilization Management and knowledge of URAC & NCQA standards. Broad knowledge of health care delivery/managed care regulations and evidence-based care guidelines (e.g., MCG/Milliman, Interqual). High-level clinical knowledge, customer service, and problem-solving skills. Ability to effectively interact with all levels of management and a highly diverse clientele. Strong organizational skills. Strong time management skills. Comfortable speaking with providers/offices via phone. Interqual experience. Milliman/MCG experience. Work Environment: Work From Home - Equipment provided. The first 3 weeks are training; candidates must not miss any training days. Training schedule: Monday-Friday 8:00am-4:40pm EST. Schedule post-training: Monday-Friday 11am-7:30pm EST (30-minute lunch break).

Collaborate with the PAC Medical Director to ensure proper medical necessity decisions are being rendered. Partner closely with the PAC Medical Director in care planning and goal setting, reviewing discharge plans and length of stay status to ensure optimal outcomes. Act as a clinical resource for unlicensed Post-Acute Care Coordinators, providing clinical expertise and clarifying referral source directives. Respond to requests from unlicensed staff regarding scripted clinical questions and issues. Serve as the primary contact for assigned post-acute facilities to obtain clinical information and proactively obtain patient status updates. Work alongside the Supervisor and Market Engagement Directors to address potential facility concerns, pushback, or gaps in process. Communicate customer service/provider issues to the supervisor for logging and resolution. Conduct scheduled telephonic touch points with facility point persons to review each member within that facility and confirm appropriateness for continued stay. Authorize continued stay at SNF, IRF, and Home Health care (if delegated) using approved medical care guidelines and collaboration with key facility personnel. Use clinical expertise to review clinical information and criteria to determine if the service/device meets medical necessity for the member. Ensure case review and elevation to complete the determination is rendered within contractual and regulatory turnaround time standards. Participate in performance and operational improvement activities. Contribute to ongoing quality assessment/improvement activities, ensure the collection of data for improvement analysis and prepare reports as requested. Assist the team in implementing and maintaining standardized operational processes to ensure compliance with company policies, legal requirements, and regulatory mandates. Participate in special projects and perform other duties as assigned. Participate in an annual Inter-rater reliability Testing Process. Carry a typical work schedule, with evening and weekend coverage needed at times based on business needs.

ICONMA

Clinical Review Registered Nurse

Posted on:

April 20, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Our Client, a Health Insurance company, is looking for a Clinical Review Registered Nurse for their Remote location.

Subject Matter Expertise Strong knowledge base in health care delivery systems, health insurance, medical care practices and trends, regulatory and accreditation agencies/standards, and provider network management. Strong knowledge of all Plan products and services benefits that effect clinical decision making. Strong knowledge of clinical nursing practice. Computer Skills – Proficient in all Microsoft Office applications; proficient in CPT, HCPCS coding and ICD- 10 diagnosis codes. Proficient in specialized computer applications preferred including SalesForce Health Cloud, Acuity, Microsoft CRM, Onbase(or similar document mgt system), Jira Analytical Skills – Strong analytical skills, including statistical data analysis. Communication Skills – Strong written and oral communication skills Interpersonal Skills – Strong interpersonal skills Organizational Abilities – Strong organizational skills 5 – 7 years of clinical practice required 1- 3 years of insurance related experience desired. Willing to participate in required on-going CEU training. Licensed RN ; BSN desired; Licensed in compact state desired

This position executes utilization management processes to ensure the delivery of medically necessary and appropriate, cost-effective and high-quality care through the performance of clinical reviews. Reviews requests against standardized medical necessity and appropriateness criteria for an initial and a continued service authorization. Identifies questionable cases and refers to superior or a medical director for review.

The Judge Group

Case Manager RN

Posted on:

April 20, 2025

Job Type:

Contract

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

Location: Minneapolis, MN, USA Salary: $38.00 USD Hourly - $40.00 USD Hourly Description: Title: Case Manager RN Hours: 8am to 5pm M-F Job Engagement: Contract Location: remote Pay Rate: $38-$40/hr About The Role We are seeking an experienced Telephonic Case Management RN to provide remote patient support and care coordination. In this role, you will assess patient needs, develop care plans, and offer guidance via phone to help individuals manage their health effectively.

Active Registered Nurse (RN) license in a compact state Associates Degree in Nursing Minimum of two years of clinical experience in case management, telephonic nursing, or related fields Strong knowledge of chronic disease management and healthcare coordination Excellent communication skills and ability to engage with patients remotely Proficiency in electronic health records (EHR) and telehealth platforms

Conduct telephonic assessments to evaluate patient health status and care needs Develop personalized care plans and coordinate appropriate healthcare services Provide education and support to patients regarding chronic disease management, medication adherence, and lifestyle adjustments Collaborate with physicians, specialists, and other healthcare professionals to ensure continuity of care Document patient interactions accurately and ensure compliance with healthcare regulations Assist in care transitions, discharge planning, and follow-up communication Utilize evidence-based practices and clinical guidelines to optimize patient outcomes

Matrix Medical Network

Nurse Practitioner - PRN

Posted on:

April 19, 2025

Job Type:

Part-Time

Role Type:

Primary Care

License:

NP/APP

State License:

Ohio

Matrix Medical Network offers a broad range of clinical services and proven expertise that give primary care providers and the at-risk health plan members we visit with every day the tools and knowledge to better manage their health at home. With deep roots in clinical assessment and care management services, our national network of clinicians break through traditional barriers to care by meeting those members where they are. We help older adults and other at-risk individuals enjoy a better quality of care, experience improved health outcomes, and identify chronic conditions that may otherwise go undiagnosed. Our job opportunities allow you to leverage your expertise and compassion to make a direct impact to the health and well-being of others. Join our team and be rewarded by competitive compensation and flexible scheduling while making a difference in the community!

Geneva, OH 44041 Primary Location: Geneva, OH 44041 Job: Clinical—Nurse Practitioner (NP). Regular Shift. PRN time Job Level: Day Job, 8am, 7pm, Travel, Monday, Friday. No on-call, no evening, no weekend hours unless desired. Job, Clinical, Nursing, Work from Home Opportunity, Regular, Job Type, Standard, Travel, Flexible, Pay, No Call, Hours. During a visit that can last up to one hour, Matrix providers review and observe a member’s current health, medical history, medication adherence, social environment and other risks. This provides unmatched insight into a member’s overall health and well-being that can be difficult to capture during routine office visits. The Matrix Comprehensive Health Assessment helps to improve quality of care and allows us to potentially close multiple care gaps with a single visit. Our Culture: We have a clear vision of where we are going, and we are guided by core values that embody our organization and culture We emphasize innovation and growth, and you will be given the opportunities and tools to develop personally and professionally We encourage and celebrate collaboration We have a deep commitment to positively impact the communities in which we work and make a difference in the lives of those we serve

Master’s Degree OR commensurate experience and satisfactory completion of NP licensure Current RN and NP licensure in state of practice to include prescription authority or the ability to obtain prescriptive authority Board certified by the AANP, ANCC or the AACCN in a Matrix approved specialty Current BLS, ACLS or CPR certification 1 year experience as a Nurse Practitioner preferred, new grads encouraged to apply. Strong computer skills and familiarity with employee health/medical record software Excellent verbal and written communication skills with patient, clients, and colleagues Comfort and flexibility with frequent change Travel Requirements: Travel required to meet patients where they live Ability to travel - Valid state driver license, able to drive a car, proof of adequate automobile insurance coverage for the state of residence

Conduct Adult/Geriatric assessments to include medical history, diagnosis and treatment, health education, physician referrals, case management referrals, follow-up and clear documentation according to Matrix guidelines and protocols Work collaboratively with physicians, case managers, social workers, family members, key caregivers, and ancillary medical personnel as appropriate Collaborate with Primary Care Physician (PCP) on patient education, provide follow-up Provide services in a variety of venues to include: Home Visits, Skilled Facility Visits

Medix™

Prior Authorization Nurse - 241209

Posted on:

April 19, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

California

Medix is hiring for Prior Authorization Nurse for a Health Plan in CA. Must be able to train onsite in Chatsworth, CA. It will be fully remote after training is completed. The schedule is Monday - Friday 8:30a-5p. We are looking for someone that has previous Prior Authorization experience. Training: Chatsworth, CA (3-4 weeks) Job Overview The UM Prior Authorization Nurse is primarily responsible for reviewing referrals for medical services to determine medical necessity and course of action, by using their independent judgement and extensive knowledge of medicine, along with clinical guidelines. The UM Prior Authorization Nurse confers with Nursing Manager, VP of Clinical Policy and/or Medical Director whenever appropriate in utilization management or problem solving.

Current CA State licensure as an Licensed Vocation Nurse (LVN) At least 2 years of experience in a comparable position. Prior authorization or Managed Care experience preferred.

Exercising independent judgement and extensive knowledge of medicine. Independently reviewing and assessing records provided and determining how the patient specifically meets criteria for services being requested. Ensuring all health plans, state and clinical guidelines are enforced in making decisions. Approval Recommendations Developing clinical summary for why a patient specifically meets criteria for services requested. Independently making decision to approve services requested Denial Recommendations Developing clinical summary for why information provided does not show patient meeting criteria for services requested. Making recommendations for Medical Director’s review based on assessment of why information provided does not support patient meeting criteria for services requested

Medasource

Part-Time CDI Nurse

Posted on:

April 19, 2025

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

RN

State License:

Indiana

Position: CDI Nurse Location: 100% Remote Duration: 6 month CTH Start Date: ASAP Job Description: The Clinical Documentation Improvement Specialist uses clinical and coding knowledge for conducting clinically based concurrent and retrospective reviews of inpatient medical records to evaluate the clinical documentation of clinical services by identifying opportunities for improving the quality of medical record documentation, including focused reviews in areas identified by CDI leadership: Mortality reviews, PSI reviews, as well as other identified projects. Facilitates and obtains appropriate physician documentation for any clinical conditions or procedures to support the appropriate severity of illness, expected risk of mortality and complexity of care of the patient. Participates in ongoing documentation improvement initiatives, including formal and informal education plans related to clinical documentation improvement to providers and the CDI team. Assist with onboarding and training new CDI team members.

Minimum Requirements: Any combination of education and experience that would likely provide the required knowledge, skills and abilities as well as possession of any required licenses or certifications is qualifying. Education: Preferred Bachelor's degree in a work-related discipline/field (such as Nursing, Biology, Human Anatomy, Microbiology, Health Sciences or similarly related) from an accredited college or university. Experience: 3-5 years of CDI experience License/Certifications: Currently holds and maintain at least 1 role-related certification (CCDS, or CCS, or CDIP, or CRCR, or CPHQ, or RN; 2 or more preferred).

The essential functions listed are typical examples of work performed by positions in this job classification. They are not designed to contain or be interpreted as a comprehensive inventory of all duties, tasks, and responsibilities. Employees may also perform other duties as assigned. Employees must abide by all Joint Commission Requirements including but not limited to sensitivity to cultural diversity, patient care, patients' rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings. Employees must perform all duties and responsibilities in accordance with hospital programs. Reviews clinical documentation to facilitate the accurate representation of the severity of illness, expected risk of mortality, and complexity of care by improving the quality of the physician's clinical documentation. Communicates review results to department leadership, CDI Specialists and other appropriate staff. Makes recommendations to R1 leadership for corrective action. Conducts focused reviews in areas identified by CDI leadership: Mortality reviews, PSI reviews, as well as other identified projects. Develops and presents CDI specialists and other related departments ongoing education on current documentation trends, CDI practices, focus areas and areas of opportunity identified through the analysis of the clinical and documentation information from a variety of internal and external sources. Lead new CDI specialist orientation. Serves as a subject matter expert and authoritative resource on interpretation and application of CDI practices, coding rules and regulations and conducts risk assessments of potential and detected compliance deficiencies, as well as documentation improvement opportunities. Utilizes Hospital coding code set, policies and procedures, Federal and State coding reimbursement guidelines, and application of the Coding Clinic Guidelines to assign working DRG, reviewing patient records throughout hospitalization that have been identified as focus DRG by regulatory agencies or the facility to ensure the codes are reported at the highest specificity. Initiates physician interaction when ambiguous, missing or conflicting information is in the medical record, through the physician query process and/or participation in rounding with the physicians by requesting additional documentation for correct coding and compliance necessary for accurate reflection of CMI, LOS, and optimal resource utilization. Partners with the HIMS coding staff to ensure accuracy of diagnostic and procedural data and completeness of supporting documentation to determine a working and final DRG, severity of illness, risk of mortality and quality outcomes. Leads provider engagement, relationship establishment and maintenance related to CDI and documentation improvement efforts. Leads and manages ongoing documentation improvement initiatives, including formal and informal education plans related to clinical documentation improvement. Leads and/or participates in department and organization projects related to documentation improvement.

Managed Resources

Clinical Appeals Nurse

Posted on:

April 19, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

Managed Resources is a leading consulting group assisting healthcare organizations nationwide in optimizing its revenue cycle management through review, recovery and educational programs. Please read the below description and apply if you meet the requirements and would like to hear more about this opportunity with Managed Resources!

Our Clinical Appeals Review services consists of reviewing and appealing for reconsideration of medical services that may have been denied, either in part, or in whole, during the initial claims determination phase. Denial of payment may be based on insufficient medical record documentation to support the level of care, billing/coding disputes, utilization review, determination that a treatment is investigational/experimental, and/or that the treatment rendered is not Medically Necessary. Reports to: Assistant Manager of Clinical Appeals Accountabilities: Write quality appeal letters to achieve maximum overturn rate. Ensure workload is completed in an efficient and timely manner.

RN License is required Certification in Case Management, Legal Nurse Consulting, or Coding a plus. Five years of acute hospital experience is mandatory. Possess knowledge and experience with national clinical criteria applied in case management including InterQual and Milliman standards. Working knowledge of billing codes, Revenue Codes, CPT’s, etc. Experience with case management software such as Midas preferred. Experience and knowledge of managed care contracts, account receivables and revenue cycle functions. Working knowledge of provider billing guidelines, payer reimbursement policies, and related industry-based standards. Experience and success in appealing managed care denials and underpayment decisions. Ability to examine financial and clinical data trends and provide recommended action steps to resolve.

The Clinical Appeals Review Nurse will review the case, and determine the potential for a Provider Appeal, on the denied claim. The request for reconsideration will be written in an objective narrative form, utilizing appropriate formatting, English grammar, current nationally accepted criteria, medical literature if applicable, healthcare statutes and clinical judgment. Once completed, the letter will be forwarded to the Clinical Appeals Manager for review and approval and then to the payer source for reconsideration. The Clinical Appeals Review nurse will provide the application of current prudent clinical judgment for the case's purpose. The diagnosis, treatment of an illness, injury, and/or disease of its symptoms, will be in accordance with generally accepted standards of medical practice. The clinical review of the denied stay will be evaluated in terms of type, frequency, extent, site and duration of patient’s illness and/or injury or disease. The clinical review of the case will not be based on convenience factors for the patient, facility, physician, and/or other health care professionals. The Clinical Appeal Review Nurse will receive appropriate documentation which includes previous determination information and complete medical record for review. The review will be written in a narrative, professional manner, with an appropriate review of the clinical facts. The letter will include the medically appropriate reasons for the reconsideration of the denial. Once the review is completed, the Clinical Appeal Review Nurse will forward the reconsideration letter to the corporate office, through a secure website, for review by the Clinical Appeals Manager. Once approved, the letter is mailed with attached medical records to the appropriate entity. The Clinical Appeals Review Nurse will then update the applicable logs for appropriate follow up purposes including payor requested reports.

Akkodis

Grievance and Appeals Nurse

Posted on:

April 19, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

California

Akkodis is hiring a Grievance and Appeals Nurse (LVN) to support our client in the healthcare space! Location: Remote (must be located in California) Employment type: 3 Month contract (potential for extension) Pay Rate: $36 per hour Under general supervision, the Grievance and Appeals Nurse (LVN) is responsible for investigating and processing grievances and appeals in alignment with internal policies, regulatory requirements, and organizational objectives. This role requires strong clinical knowledge within the California LVN scope of practice, as well as the ability to manage case reviews, conduct clinical assessments, and collaborate effectively with both internal and external stakeholders. The ideal candidate is detail-oriented, adaptable, and capable of working independently while contributing as a team player in a fast-paced managed care environment.

Active California LVN license in good standing. Strong clinical skills as defined by California LVN scope of practice. Excellent oral and written communication skills, including the ability to explain complex clinical and regulatory information clearly and professionally. Proven analytical, assessment, and problem-solving abilities. Strong interpersonal skills; able to communicate and build relationships with a diverse range of individuals. Ability to read, interpret, and apply clinical information, guidelines, and regulatory materials. Proficient in Microsoft Word, Excel, and Outlook (including spreadsheets, formulas, tables, and graphs). Demonstrated ability to work both independently and as part of a team. Solid time management, organizational, and prioritization skills; consistently meets deadlines. Ability to handle high volumes of work accurately and efficiently. Strong customer service orientation.

Conduct investigations and clinical reviews of member grievances and appeals, including prospective, concurrent, and retrospective medical records related to denied services. Prepare and distribute case summaries and recommendations for both internal and external medical reviewers. Review and ensure regulatory compliance of member and practitioner Notice of Action (NOA) letters; escalate issues as needed. Generate timely, accurate written correspondence to members, providers, and regulatory entities. Collaborate with internal departments and external partners to ensure the accuracy and timeliness of appeal-related documentation and reports. Investigate and complete clinical reviews of Independent Medical Reviews (IMR) and State Fair Hearings (SFH); prepare and submit health plan responses and participate in SFH proceedings as required. Enter and manage data within multiple databases and systems. Assist in the continuous improvement of processes related to grievance and appeal handling. Maintain confidentiality and handle sensitive information with discretion.

Vaya Health

Innovations Care Manager (Rockingham County, NC)

Posted on:

April 19, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

North Carolina

LOCATION: Remote – must live in or near Rockingham County, North Carolina. The person in this position is required to maintain residency in North Carolina or within 40 miles of the NC border. This position requires travel. GENERAL STATEMENT OF JOB: Innovations Care Manager (Innovations CM) is responsible for providing proactive intervention and coordination of care to eligible Vaya Health members and recipients (“members”) to ensure that these individuals receive appropriate assessment and services. The Innovations CM works with the member and care team to alleviate inappropriate levels of care or care gaps through assessment, multidisciplinary team care planning, linkage and/or coordination of services needed by the member across the MH, SU, intellectual/ developmental disability (“I/DD”), traumatic brain injury (“TBI”) physical health, pharmacy, long-term services and supports (“LTSS”) and unmet health-related resource needs networks. Innovations CMs support and may provide transition planning assistance to state, and community hospitals and residential facilities and track individuals discharged from facility settings to ensure they follow up with aftercare services and receive needed assistance to prevent further hospitalization. This is a mobile position with work done in a variety of locations, including members’ home communities. The Innovations CM also works with other Vaya staff, members, relatives, caregivers/ natural supports, providers, and community stakeholders. As further described below, essential job functions of the Innovations CM include, but may not be limited to: Utilization of and proficiency with Vaya’s Care Management software platform/ administrative health record (“AHR”) Outreach and engagement Compliance with HIPAA requirements, including Authorization for Release of Information (“ROI”) practices Performing Health Risk Assessments (HRA): a comprehensive bio-psycho-social assessment addressing social determinants of health, mental health history and needs, physical health history and needs, activities of daily living, access to resources, and other areas to ensure a whole person approach to care Adherence to Medication List and Continuity of Care processes Participation in interdisciplinary care team meetings, comprehensive care planning, and ongoing care management Transitional Care Management Diversion from institutional placement This position is required to meet NC Residency requirements as defined by the NC Department of Health and Human Services (“NCDHHS” or “Department”). This position is required to live in or near the counties served to effectively deliver in-person contacts with members and their care teams.

Assessment, Care Planning and Interdisciplinary Care Team: Ensures identification, assessment, and appropriate person-centered care planning for members. Links members with appropriate and necessary formal/ informal services and supports across all health domains (i.e., medical, and behavioral health home). Meets with members to conduct the HRA and gather information on their overall health, including behavioral health, developmental, medical, and social needs. Administer the PHQ-9, GAD, CRAFT, ACES, LOCUS/CALOCUS, and other screenings within their scope based on member’s needs. The Innovations CM uses these screenings to provide specific education and self-management strategies as well as linkage to appropriate therapeutic supports. The assessment process includes reviewing and transcribing member’s current medication and entering information into Vaya’s Care Management platform, which triggers the creation of a multisource medication list that is shared back with prescribers to promote integrated care. Supports the care team in development of a person-centered care plan (“Care Plan”) to help define what is important to members for their health and prioritize goals that help them live the life they want in the community of their choice. Ensure the Care Plan includes specific services to address mental health, substance use, medical and social needs as well as personal goals Ensure the Care Plan includes all elements required by NCDHHS Use information collected in the assessment process to learn about member's needs and assist in care planning Ensure members of the care team are involved in the assessment as indicated by the member/LRP and that other available clinical information is reviewed and incorporated into the assessment as necessary Work with members to identify barriers and help resolve dissatisfaction with services or community-based interventions Reviews clinical assessments conducted by providers and partners with Innovations CM, LP and Manager, IDD Care Management, LP or Director, Care Management for clinical consultation as needed to ensure all areas of the member’s needs are addressed. Help members refine and formulate treatment goals, identifying interventions, measurements, and barriers to the goals. Ensures that member/legally responsible person (“LRP”) is/are informed of available services, referral processes, etc. (i.e. Individual/Family Direction for Innovations participants), processes (e.g., requirements for specific service), etc. Provide information to member/LRP regarding their choice in choosing service providers, ensuring objectivity in the process. Works in an integrated care team including, but not limited to, an RN (Registered Nurse) and pharmacist along with the member to address needs and goals in the most effective way ensuring that member/LRP have the opportunity to decide who they want involved. Supports and may facilitate Care Team meetings where member Care Plan is discussed and reviewed. Solicits input from the care team and monitor progress. Ensures that the assessment, care plan and other relevant information is provided to the care team. Reviews assessments conducted by providers and consults with clinical staff as needed to ensure all areas of the member’s needs are addressed. Update Care Plans and Care Management assessment at a minimum of annually or when there is a significant life change for the member. Supports and assists with education and referral to prevention and population health management programs. Participate in multidisciplinary huddles including RN, Pharmacist, M.D. and case staffings to present case to address barriers, identify need for specialized services to meet member needs and receive support and feedback regarding interventions for medical, behavioral health, I/DD, medication, and other needs and provide support to other Care Managers. Risk Management- Proactively ensures that individuals identified as a Special Needs enrollee that have treatment needs or require regular monitoring have a Behavioral Health Clinical Home and a Medical Home. Works with the member/LRP and care team to ensure the development of a Care Management Crisis Plan for the member that is tailored to their needs and desires, which is separate and complementary to the behavioral health provider’s crisis plan. Provides crisis intervention, coordination, and care management if needed while with members in the community. Supports Transitional Care Management responsibilities for members transitioning between levels of care. Coordinates Diversion efforts for members at risk of requiring care in an institutional setting. Consults with care management licensed professionals, care management supervisors, and other colleagues as needed to support effective and appropriate member care. Support Monitoring/Coordination, Documentation and Fiscal Accountability: Serves as a collaborative partner in identifying system barriers through work with community stakeholders. Manages and facilitates Child/Adult High-Risk Team meetings in collaboration with providers, stakeholders and other community supports as appropriate. Participates in cross-functional clinical and non-clinical meetings and other projects as needed/ requested to support the department and organization. Participates in routine multidisciplinary huddles including RN, Pharmacist, M.D. to present complex clinical case presentation and needs, providing support to other CMs (Care Manager) and receiving support and feedback regarding CM interventions for clients’ medical, behavioral health, intellectual /developmental disability, medication, and other needs. Works in partnership with other Vaya departments to identify and address gaps in services/ access to care within Vaya’s catchment. Works with Innovations CM, LP and IDD Manager- LP in participating in other high risk multidisciplinary complex case staffing as needed to include Vaya CMO/ Deputy CMO, Utilization Management, Provider Network, and Care Management leadership to address barriers, identify need for specialized services to meet client needs within or outside the current behavioral health system. Ensures the health and safety of members receiving care management, recognize and report critical incidents, and escalate concerns about health and safety to care management leadership as needed. Ensure that services are monitored (including direct observation of service delivery) in all settings at required frequency and for compliance with standards. Make announced/unannounced monitoring visits, including nights/weekends as applicable. Monitors provision of services to informally measure quality of care delivered by providers and identify potential non-compliance with standards. Supports problem-solving and goal-oriented partnership with member/LRP, providers, and other stakeholders Promotes member satisfaction through ongoing communication and timely follow-up on any concerns/issues. Supports and assists members/families on services and resources by using educational opportunities to present information. Educate members/families on methodology for budget development, total dollar value of the budget and mechanisms available to modify the individual budget. Monitor services to ensure that they are delivered as outlined in individualized service plan and address any deviations in service. Ensure that service orders/doctor’s orders are obtained, as applicable. Verifies member’s continuing eligibility for Medicaid, and proactively responds to a member’s planned movement outside Vaya’s catchment area to ensure changes in their Medicaid County of eligibility are addressed prior to any loss of service. Alerts supervisor and other appropriate Vaya staff if there is a change in member Medicaid eligibility/status. Proactively and timely creates and monitors documentation within the AHR to ensure completeness, accuracy and follow through on care management tasks. Coordinate Medicaid deductibles, as applicable, with the individual/guardian and provider(s). Proactively monitor own documentation to ensure that issues/errors are resolved as quickly as possible. Ensure accurate/timely submission of Service Authorization Requests (SARS) for all Vaya funded services/supports. Works with Innovations CM, LP and Manager, Innovations Care Management, LP to ensure all clinical and non-clinical documentation (e.g. goals, plans, progress notes, etc.) meet all applicable federal, state, and Vaya requirements, including requirements within Vaya’s contracts with NCDHHS. Alert supervisor and other appropriate Vaya staff if there is a change in member Medicaid eligibility/status. Participates in all required Vaya/ Care Management trainings and maintains all required training proficiencies. Other duties as assigned.

Vaya Health

GERO Nurse (Remote - Asheville, NC)

Posted on:

April 19, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

North Carolina

LOCATION: Remote – must live in or near Asheville, North Carolina. Must have the ability to travel as needed. GENERAL STATEMENT OF JOB: This position is a part of the Geriatric and Adult Mental Health Specialty Team (GAMHST) that is an initiative through the NC Division of Mental Health, Developmental Disabilities, and Substance Use Services and is responsible for overseeing operations using the set of Division of MHDDSUS Program Requirements that specifically outline the work of this team. The Geriatric Team Nurse is responsible for working collaboratively with the other members of the team in providing training, consultation, and technical assistance to recipients. Recipients are various community organizations (i.e., senior centers, faith-based organizations, law enforcement and other 1st responders, adult day, department of social services, homeless shelters, and senior meal programs), and staff of nursing homes, adult care homes, family care homes serving adults with mental illness.

KNOWLEDGE, SKILLS, & ABILITIES: Ability to provide instruction and establish and maintain effective working relationships with staff and caregivers as defined above Knowledge of governmental, private organizations and resources in the community and an innate drive to innovate and optimize the use of these. Knowledge of policies which govern the GAMHST program (which are the MHDDSAS Program Requirements) Ability to express ideas clearly/concisely. Ability to drive and sit for extended periods of time (including in rural areas) Represent Vaya in a professional manner. An ability to initiate and build relationships with people in an open, friendly, and accepting manner. Ability to take ownership of projects from planning through execution. Strong attention to detail and superior organizational skills Ability to multitask and prioritize to manage multiple projects on tight timelines. Ability to understand the strategic direction and goals of the department and support appropriate processes to facilitate achievement of business objectives. Well-developed capabilities in problem solving and crafting efficient processes. A result and success-oriented mentality, conveying a sense of urgency and driving issues to closure. Comfort with adapting and adjusting to multiple demands, shifting priorities, ambiguity, and rapid change. Proficiency Microsoft Office proficiency, to include Excel, data analysis, and secondary research. Have an understanding of adult learning styles and the ability to demonstrate these styles in order to provide effective training to a variety of people. Have experience in presenting/teaching/speaking in front of an audience QUALIFICATIONS & EDUCATION REQUIREMENTS: Associate degree in Nursing required and at least 1 year experience working with older adults with mental health and/or substance use disorders. Licensure/Certification Required: An active, unrestricted license to practice as a Registered Nurse in North Carolina by the NC Board of Nursing. License for any candidate must be in “good standing” with their licensing board. PHYSICAL REQUIREMENTS: Close visual acuity to perform activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading. Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive motion of hands, wrists and fingers. Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time. Mental concentration is required in all aspects of work. Ability to drive and sit for extended periods of time (including in rural areas).

Work independently and collaboratively to develop and teach evidence informed presentations about a variety of mental illnesses and how to manage difficult behaviors, as well as, how to navigate the behavioral health system to the above-mentioned agencies. Provide education and linkage to services for caregivers of older adults who are providing care for individuals in the community. Provide training to staff and volunteers on various topics relevant to older adult mental health (i.e., recognizing symptoms of mental illness, behavioral intervention, communication issues); Aid in identifying ongoing training resources for staff and volunteers as needed. Provide case consultation regarding behaviors that may result in the need for more intensive services including and up to hospitalization and facilitate access to those services. Assist staff in assessing behaviors. Provide input and support in the development of intervention (crisis) plans. Model for staff and provide technical assistance with implementation of intervention plans. Assist staff or caregivers with linkage to community providers/resources serving the geriatric population for the purpose of promoting aging in place and improvement of health (i.e., identification of long-term care facilities suited to specific needs). Work collaboratively with other team members on a variety of clinical issues including diagnostic criteria and evidence-based treatment options for individuals with a wide variety of serious and persistent mental illnesses as well as geriatric specific considerations such as dementia and late life depression. Provide marketing to agencies within scope of Program Requirements that are not receiving education or support through the team. Participate in community workgroups to enhance the community’s ability to provide services/care for older adults. Document required elements on Division of MHDDSUS report, in Vaya electronic health record, and other internal processes (i.e., timesheet, travel sheet). Documentation deadlines are specific to each of those above items. Accurate documentation is critical. Participate in meetings with regional team, whole team, department, agency as requested/needed. Attend individual supervision on a regular basis for ongoing employee support. ** Duties are subject to change as updated Program Requirements are distributed from Division of MHDDSUS. Other duties as assigned.

Evolent

Clinical Letter Writer - UM & Specialty Experience is a MUST

Posted on:

April 19, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

Virginia

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture.

Our shared services team offers candidates the opportunity to make a meaningful impact by providing exceptional support to internal and external customers through positive interactions, and timely delivery of high-quality products. Our team values collaboration, continuous learning, and a customer-centric approach, ensuring that every team member contributes to providing better health outcomes. Collaboration Opportunities: Works with the physician reviewer to monitor the adverse determination process and ensure notification timeframes are met Works with internal and external staff to ensure that decisions are made, documented, and communicated clearly

Licensed registered nurse or LVN/LPN (current and unrestricted) Minimum of three years of direct clinical patient care Minimum one year of experience with Utilization Review (UM) in a managed care environment Cardiology and Oncology Healthcare experience/knowledge Excellent written communication skills Experience with clinical decision-making criteria sets (i.e. Milliman, InterQual) Strong interpersonal, oral, and written communication skills. Possess basic Microsoft Office computer skills Knowledge of managed care principles, HMO and Risk Contracting arrangements a plus but not required Technical Requirements: We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

The Clinical Letter Writer is responsible for reviewing adverse determination decisions against criteria and policy, escalating questions to the physician reviewer, and creating letters that meet regulatory and Plain Language requirements. This position requires a person who can synthesize various clinical and administrative requirements, communicate well with the team and clients, and write clearly. Reviews adverse determinations against criteria and medical policies Creates adverse determination notifications that meet all accreditation, State, and Federal criteria Uses Plain Language and good written skills to clearly communicate adverse decisions to both members and providers Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director. Appropriately identifies potential cases for Care Management programs Communicates appropriate information to other staff members as necessary/required. Participates in continuing education initiatives. Collaborates with Claims, Quality Management and Provider Relations Departments as requested. Performs other duties as assigned.

Evolent

Clinical Letter Writer PT Role -UM Experience Essential

Posted on:

April 19, 2025

Job Type:

Part-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

Virginia

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture.

Our shared services team offers candidates the opportunity to make a meaningful impact by providing exceptional support to internal and external customers through positive interactions, and timely delivery of high-quality products. Our team values collaboration, continuous learning, and a customer-centric approach, ensuring that every team member contributes to providing better health outcomes. Collaboration Opportunities: Works with the physician reviewer to monitor the adverse determination process and ensure notification timeframes are met Works with internal and external staff to ensure that decisions are made, documented, and communicated clearly

Licensed registered nurse or LVN/LPN (current and unrestricted) Minimum of three years of direct clinical patient care Minimum one year of experience with Utilization Review (UM) in a managed care environment Cardiology and Oncology Healthcare experience/knowledge Excellent written communication skills Experience with clinical decision-making criteria sets (i.e. Milliman, InterQual) Strong interpersonal, oral, and written communication skills. Possess basic Microsoft Office computer skills Knowledge of managed care principles, HMO and Risk Contracting arrangements a plus but not required Please note this role is an average of 30 hours per week. The schedule includes 8-10 hours on Saturday, Sunday, holidays in addition to 1/2 days on Monday & Friday. Technical Requirements: We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

The Clinical Letter Writer is responsible for reviewing adverse determination decisions against criteria and policy, escalating questions to the physician reviewer, and creating letters that meet regulatory and Plain Language requirements. This position requires a person who can synthesize various clinical and administrative requirements, communicate well with the team and clients, and write clearly. Reviews adverse determinations against criteria and medical policies Creates adverse determination notifications that meet all accreditation, State, and Federal criteria Uses Plain Language and good written skills to clearly communicate adverse decisions to both members and providers Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director. Appropriately identifies potential cases for Care Management programs Communicates appropriate information to other staff members as necessary/required. Participates in continuing education initiatives. Collaborates with Claims, Quality Management and Provider Relations Departments as requested. Performs other duties as assigned.

Evolent

Clinical Reviewer, Nurse

Posted on:

April 19, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

Virginia

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture.

The Nurse Reviewer is responsible for performing precertification and prior approvals. Tasks are performed within the LVN/LPN scope of practice, under Medical Director direction, using independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by expediting the care process through the continuum, working in concert with the health care delivery team to maintain high quality and cost effective care delivery.

The Experience You’ll Need (Required): practical/vocational nurse license (current and unrestricted) High School Diploma or equivalent required UM Experience Minimum of three years of direct clinical patient care Minimum of one year of experience with medical management activities in a managed care environment Finishing Touches (Preferred): Knowledge of managed care principles, HMO and Risk Contracting arrangements. Knowledge of health care resources within the community Experience with clinical decision-making criteria sets (i.e. Milliman, InterQual) Strong interpersonal, oral and written communication skills. Possess basic computer skills Technical Requirements: We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Performs utilization review of outpatient procedures and ancillary services. Fulfills on call requirements for selected clients as scheduled. Determines medical necessity and appropriateness of services using clinical review criteria. Accurately documents all review determinations and contacts providers and members according to established timeframes. Appropriately identifies and refers cases that do not meet established clinical criteria to the Medical Director. Appropriately identifies and refers quality issues to UM Leadership. Appropriately identifies potential cases for Care Management programs Collaborates with physicians and other providers to facilitate provision of services throughout the health care continuum. Performs accurate data entry. Communicates appropriate information to other staff members as necessary/required. Participates in continuing education initiatives. Collaborates with Claims, Quality Management and Provider Relations Departments as requested. Availability on some weekends and holidays may be required Performs other duties as assigned.

Elevate Patient Financial Solutions®

Nurse Auditor

Posted on:

April 18, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Texas

Elevate Patient Financial Solutions has an exciting career opportunity available as a Nurse Auditor. This position will be a remote based role. The Full Time schedule for this role will be 8am-5pm, Monday-Friday. The Nurse Auditor is responsible for performing specialized administrative duties within the billing and reimbursement services department. The Nurse Auditor is responsible for running regular audits, reviewing medical records to justify level of care, and preparing appeal letters when gathered evidence does not support denial of services.

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 abilities. Utilization Review Case Management Preparing and submitting Authorizations Use of InterQual and/or MCG Inpatient Clinical Experience Registered Nurse; or Licensed Vocational Nurse Remote and Hybrid positions require a home internet connection that meets the company’s upload and download speed criteria.

Authorization Denials Prepare a clinical reconsideration/appeal letter to submit to the payer based on the evidence in the patient’s medical records to justify either an acute level of care or skilled level of care (based on results from either MCG or InterQual review). Medical Necessity Denial Reviews Prepare a clinical reconsideration/appeal letter to submit to the payer based on the evidence in the patients’ medical records that supports the necessity for denied services. Other Denial Reviews for Appeal: DRG Downgrades MAC & RAC Audits Payer Utilization Review Audits Experimental Procedures Charge Audits Other duties as assigned.

Actalent

PAC Nurse

Posted on:

April 18, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Florida

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

Actalent is hiring Remote PAC Nurses! Job Description: Actalent is looking for PAC Utilization Review Nurses that will work remote! Qualified candidates must have experience working in the managed care/insurance industry. The PAC Nurse is a telephonic position responsible for recommending discharge plans, assisting with transition of care, and managing the length of stay (LOS) for Long Term Acute Hospital, Skilled Nursing Facility (SNF), and Institutional Rehab Facility (IRF) for assigned and non-assigned post-acute care (PAC) facilities through collaboration. The PAC Nurse will work closely with facility personnel and internal Medical Directors, Market Engagement Directors, and Nurse Managers to develop and maintain timely discharge plans.

Essential Skills: Excellent negotiation, influencing, problem-solving, and decision-making skills. Strong communication (verbal/written), organizational, and interpersonal skills. Ability to work independently, utilizing sound clinical judgment and critical thinking skills under minimal supervision. Commitment to quality and standards. Utilization management experience. Case management experience. Transitional care experience. Acute care experience. Medical record management. Additional Skills & Qualifications: Current and unrestricted LPN or RN license. Associate's Degree or Diploma in Nursing/Practical Nursing. Minimum 2 years of clinical experience in a clinical setting. Post-acute nursing experience (e.g., Inpatient Rehab Facility, Long-Term Acute Care Hospital, Skilled Nursing Facility). 3 years of concurrent review experience and/or discharge planning. 2 years of utilization review/management experience. 1 year of experience within Case Management or Transition-of-care role. Experience in Utilization Management and knowledge of URAC & NCQA standards. Broad knowledge of health care delivery/managed care regulations and evidence-based care guidelines (e.g., MCG/Milliman, Interqual). High-level clinical knowledge, customer service, and problem-solving skills. Ability to effectively interact with all levels of management and a highly diverse clientele. Strong organizational skills. Strong time management skills. Comfortable speaking with providers/offices via phone. Interqual experience. Milliman/MCG experience. Work Environment: Work From Home - Equipment provided. The first 3 weeks are training; candidates must not miss any training days. Training schedule: Monday-Friday 8:00am-4:40pm EST. Schedule post-training: Monday-Friday 11am-7:30pm EST (30-minute lunch break).

Collaborate with the PAC Medical Director to ensure proper medical necessity decisions are being rendered. Partner closely with the PAC Medical Director in care planning and goal setting, reviewing discharge plans and length of stay status to ensure optimal outcomes. Act as a clinical resource for unlicensed Post-Acute Care Coordinators, providing clinical expertise and clarifying referral source directives. Respond to requests from unlicensed staff regarding scripted clinical questions and issues. Serve as the primary contact for assigned post-acute facilities to obtain clinical information and proactively obtain patient status updates. Work alongside the Supervisor and Market Engagement Directors to address potential facility concerns, pushback, or gaps in process. Communicate customer service/provider issues to the supervisor for logging and resolution. Conduct scheduled telephonic touch points with facility point persons to review each member within that facility and confirm appropriateness for continued stay. Authorize continued stay at SNF, IRF, and Home Health care (if delegated) using approved medical care guidelines and collaboration with key facility personnel. Use clinical expertise to review clinical information and criteria to determine if the service/device meets medical necessity for the member. Ensure case review and elevation to complete the determination is rendered within contractual and regulatory turnaround time standards. Participate in performance and operational improvement activities. Contribute to ongoing quality assessment/improvement activities, ensure the collection of data for improvement analysis and prepare reports as requested. Assist the team in implementing and maintaining standardized operational processes to ensure compliance with company policies, legal requirements, and regulatory mandates. Participate in special projects and perform other duties as assigned. Participate in an annual Inter-rater reliability Testing Process. Carry a typical work schedule, with evening and weekend coverage needed at times based on business needs.

Molina Healthcare

Clinical Appeals Nurse (RN)

Posted on:

April 18, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Wisconsin

Residents in CENTRAL Time Zone preferred. Candidates who do not live in Central Time zone must work CENTRAL DAYTIME BUSINESS HOURS. Work Schedule: 4 days a week - 10hrs a day. Schedule will be alternating every 4 weeks Monday-Thursday and Wed - Saturday. Job Summary: Clinical Appeals is responsible for making appropriate and correct clinical decisions for appeals outcomes within compliance standards.

Required Education: Graduate from an Accredited School of Nursing. Bachelor's degree in Nursing preferred. Required Experience: 3-5 years clinical nursing experience, with 1-3 years Managed Care Experience in the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific program experience as needed or equivalent experience (such as specialties in: surgical, Ob/Gyn, home health, pharmacy, etc.). Experience demonstrating knowledge of ICD-9, CPT coding and HCPC. Experience demonstrating knowledge of CMS Guidelines, MCG, InterQual or other medically appropriate clinical guidelines, Medicaid, Medicare, CHIP and Marketplace, applicable State regulatory requirements, including the ability to easily access and interpret these guidelines. Required License, Certification, Association: Active, unrestricted State Registered Nursing (RN) license in good standing. Preferred Education: Bachelor's Degree in Nursing Preferred Experience: 5+ years Clinical Nursing experience, including hospital acute care/medical experience. Preferred License, Certification, Association Any one or more of the following: Active and unrestricted Certified Clinical Coder Certified Medical Audit Specialist Certified Case Manager Certified Professional Healthcare Management Certified Professional in Healthcare Quality other healthcare certification

The Clinical Appeals Nurse (RN) performs clinical/medical reviews of previously denied cases in which a formal appeals request has been made or upon request by another Molina department to reduce the likelihood of a formal appeal being submitted. Independently re-evaluates medical claims and associated records by applying advanced clinical knowledge, knowledge of all relevant and applicable Federal and State regulatory requirements and guidelines, knowledge of Molina policies and procedures, and individual judgment and experience to assess the appropriateness of service provided, length of stay and level of care. Applies appropriate criteria on PAR and Non-PAR (contracted and non-contracted) cases and with Marketplace EOCs (Evidence of Coverage). Reviews medically appropriate clinical guidelines and other appropriate criteria with Chief Medical Officer on denial decisions. Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. Identifies and reports quality of care issues. Prepares and presents cases in conjunction with the Chief Medical Officer for Administrative Law Judge pre-hearings, State Insurance Commission, and Meet and Confers. Represents Molina and presents cases effectively to Judicial Fair Hearing Officer during Fair Hearings as may be required. Serves as a clinical resource for Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. Provides training, leadership and mentoring for less experienced appeal LVN, RN and administrative staff.

Accuhealth is Becoming TelliHealth

Remote Patient Monitoring Nurse

Posted on:

April 18, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

Texas

TelliHealth is a dynamic and innovative Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) company committed to revolutionizing patient care delivery through technology. With a focus on improving patient outcomes and enhancing healthcare efficiency, we leverage cutting-edge solutions to empower healthcare providers and transform the patient experience.

This position is work from home, however, the employee must live in one of the following states: Alabama, Arkansas, Delaware, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, New Hampshire, Missouri, Montana, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming We are looking for a dedicated and compassionate Licensed Practical Nurse to join our team! This position focuses on supporting patients and their families, while also collaborating with the nursing team to provide timely, efficient care and ensure a positive, professional, and supportive patient experience.

Active, unrestricted license LVN, LPN or RN license, required. Graduate of an accredited LVN, LPN or RN program, required. 2 years of clinical experience, required. Minimum upload/download speeds of 35/10 mbps, required. Ability to work from home in a HIPAA compliant environment, required. Proficient using Electronic Medical Records (EMR) or Electronic Health Record (EHR) systems, required. Understanding of clinical workflows, quality assurance processes, and compliance standards. Excellent verbal and written communication skills. Strong organizational skills with attention to detail. Ability to manage multiple priorities simultaneously.

Assist in the continuity of care by monitoring patient data. Facilitate communication with the patients to provider offices. Build relationships with patients for service acceptance, device kitting and fulfillment. Build relationships with partner physicians, ACOs, and hospitals to establish and adhere to continuum of care processes Assist in creation and fulfillment of research and clinical grants for telemonitoring and in the creation/fulfillment of DSRIP initiatives with partner hospitals and communities. Provide behavioral health coaching. Assess the patient’s formal and informal support systems, including caregiver resources and involvement as well as available benefits and/or community resources. Evaluate patient’s progress toward goal achievement, including identification and evaluation of barriers to meeting or complying with care management plan, and systematically reassess for changes in goals and/or health status. Research alternative treatment options Communicate with supervising nurse, primary care physician and members of the comprehensive care team regarding status of patient. Provide education, information, direction and support related to patient care goals. Act as patient advocate and assist with problem solving Address patient care plan barriers. Provide referrals to appropriate community resources. Facilitate access and communication when multiple services are involved. Monitor activities to ensure that services are being delivered and meet the needs of the patient Maintain accurate patient records and patient confidentiality. Measure outcomes and effectiveness of care management including clinical, financial, quality of life and patient/family satisfaction. Facilitate disease prevention and health promotion with patients and families. Troubleshoot problems regarding operational and clinical procedures that may affect patient outcomes. Make 100+ calls per shift to patients with critical readings. Monitor patient vitals and report concerns to the supervisor, as necessary. Train clients on platform and processes. Troubleshoot devices. Other duties as assigned.

Kouper

LPN Care Navigator (Bilingual)

Posted on:

April 18, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

LPN/LVN

State License:

Compact / Multi-State

Kouper Health is leading the charge in transforming transitions of care. Our mission is to bridge the care transition gap and fundamentally improve the patient experience, to help people live longer and better.

Join the Kouper Care Navigator team and empower patients during critical transitions in their healthcare journey. Our team is dedicated to guiding patients smoothly across diverse care settings, ensuring continuity and compassion at every step. We are seeking an experienced bilingual Licensed Practical Nurse (LPN) with at least 2-3 years of direct patient-facing work experience; that thrives in a fast-paced environment, is self-motivated, has impeccable attention to detail, and values the impact they can have on a patient's healthcare experience.

Logistical Requirements: Full Time Availability: Monday - Friday (8:00 am - 5:30 pm CT) Part Time Availability: Monday - Friday (2 - 4 hours per day) Remote work for this position requires you to provide and meet the internet requirements; Fiber or Cable (Broadband/DSL), preferably wired Must have a home office or HIPAA-compliant workspace that is secure with privacy to protect personal health information Qualifications: 2-3 years of clinical patient-facing experience Must be bilingual (Spanish and English) Active LPN license in one of the nurse compact or NLC states Excellent written and verbal communication skills; a stickler for details Positive, uplifting personality with a compassionate and friendly demeanor Fundamental experience with technology; Microsoft Office Suite or related software Natural ability to manage stressful interactions, with a strong concierge approach to potential escalations Enjoy working in a fast-growing, rapidly changing environment Experience with Meditech, Cerner, and Epic and Athena are a plus Preferred Qualificications: Case management, care coordination, or home health experience Bachelor’s in Social Work, Nursing, or related field

Manage patient discharge lists and conduct direct patient outreach to support transitions of care workflows Assist in the care coordination and scheduling across primary care providers, specialty care providers, community resources, etc. Work with cross-functional teams to support software updates Ensure strict adherence to quality compliance and care-time metrics

TekWissen ®

Clinical Review Registered Nurse

Posted on:

April 18, 2025

Job Type:

Contract

Role Type:

Utilization Review

License:

RN

State License:

Vermont

TekWissen is a global workforce management provider headquartered in Ann Arbor, Michigan that offers strategic talent solutions to our clients world-wide. Our client is a health insurance company. It offers different types of health care coverage plans that include individual and family, dental and vision, plans for employers, etc.

Title: Clinical Review Registered Nurse Work Location: Vermont Duration: 1-3 Months Job Type: Contract Work Type: Remote POSITION SUMMARY: This position executes utilization management processes to ensure the delivery of medically necessary and appropriate, cost-effective and high-quality care through the performance of clinical reviews. Reviews requests against standardized medical necessity and appropriateness criteria for an initial and a continued service authorization. Identifies questionable cases and refers to superior or a medical director for review.

COMPETENCIES (KNOWLEDGE, SKILLS, AND ABILITIES): Subject Matter Expertise: Strong knowledge base in health care delivery systems, health insurance, medical care practices and trends, regulatory and accreditation agencies/standards, and provider network management. Strong knowledge of all Plan products and services benefits that effect clinical decision making. Strong knowledge of clinical nursing practice. Computer Skills: Proficient in all Microsoft Office applications; proficient in CPT, HCPCS coding and ICD-10 diagnosis codes. Proficient in specialized computer applications preferred including Salesforce Health Cloud, Acuity, Microsoft CRM, OnBase, Jira Communication Skills: Strong written and oral communication skills Interpersonal Skills: Strong interpersonal skills Organizational Abilities: Strong organizational skills Analytical Skills: Strong analytical skills, including statistical data analysis.

Conduct clinical reviews of all prior approval, post service reviews, customer service and claim requests. Determine adequacy of clinical elements of clinical information submitted. Determine essential elements of clinical information for decision-making and request same as appropriate. Make determinations based on medical policy, evidence-based guidelines, and medical necessity. Communicate directly with requesting providers to obtain additional clinical information as needed in order to make utilization management decisions. Review late and out of network prior approval / referral authorizations for appropriateness and make determination on benefit level based on medical necessity. Provide timely and accurate review for procedure/service appropriateness, reconsideration, and appeals based on Rule 9-03, DRF, and NCQA Standards. Perform monthly audits related to prior approval processes as well as weekly guidelines to confirm medical necessity and appropriateness of reviewed services. Use sound clinical judgment along with appropriate review criteria and practice guidelines to confirm medical necessity and appropriateness of reviewed services. Provide support to Provider Relations and Provider Reimbursement in regard to clinical issues relating to new procedure, coding, pricing and provider communications. Provide appropriate and timely referrals to the medical director. Identify and report any potential quality of care of services issue to the medical director. Perform timely case review information, case entry and updates to case file in the appropriate systems. Participate in medical policy committee including research and development of policies and collaboration with participating provider. Assist in review of health service delivery and utilization and cost data. Determine through clinical review members that would potentially benefit from case management. Initiate referrals to triage to assess these members for effective case management intervention. Determine and interpret member eligibility, coverage and available benefits. Contribute to member and provider satisfaction within program and organization. Assist the claims payer in accurate adjudication of care management approved services as needed.

Hana

Chronic Care Nurse

Posted on:

April 18, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

New York

Hana is an AI-powered voice platform that helps clinics scale chronic care by automating patient check-ins, risk detection, and care coordination between visits. With 60% of adults in the U.S. living with a chronic condition but only 4% receiving reimbursable care, clinics are often overwhelmed and understaffed. Hana acts as a virtual care team, using voice AI to proactively reach out to patients, gather clinical insights, and assist providers with compliance, documentation, and billing.

This is a full-time remote role for a Chronic Care Nurse.

Chronic Care Management and Chronic Care experience Nursing and Disease Management skills Triage experience Excellent communication and organizational skills Ability to work independently and remotely Experience with AI-powered healthcare tools is a plus Registered Nurse (RN) license Experience in chronic disease management or a related field

The Chronic Care Nurse will be responsible for managing chronic care patients, conducting disease management, performing nursing duties, and triaging patient needs. The nurse will also use Hana's AI-powered platform to automate patient check-ins and assist with care coordination between visits.

Molina Healthcare

Care Review Clinician, Prior Auth Nurse

Posted on:

April 18, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

Texas

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.

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

Required Education Any of the following: Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program Required Experience: 1-3 years of hospital or medical clinic experience. Required License, Certification, Association: Active, unrestricted State Registered Nursing (RN), Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) license in good standing Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. Preferred License, Certification, Association Active, unrestricted Utilization Management Certification (CPHM). MULTI STATE / COMPACT LICENSURE WORK SCHEDULE: Sun - Thurs / Tues - Sat with some holidays.

Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines. Analyzes clinical service requests from members or providers against evidence based clinical guidelines. Identifies appropriate benefits and eligibility for requested treatments and/or procedures. Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members. Processes requests within required timelines. Refers appropriate prior authorization requests to Medical Directors. Requests additional information from members or providers in consistent and efficient manner. Makes appropriate referrals to other clinical programs. Collaborates with multidisciplinary teams to promote Molina Care Model Adheres to UM policies and procedures. Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan. Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.

BROADWAY VENTURES, LLC

Remote RN – Medical Claims Reviewer

Posted on:

April 18, 2025

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.

Job Type: Full-time (40 hours/week) Schedule: Monday–Friday, 8:00 AM – 5:00 PM Location: Remote (U.S. – Work from home) Remote Work Requirements: High-speed internet (non-satellite) and a private, lockable home office Equipment: You will be provided with all necessary equipment to perform your job effectively, including but not limited to a desktop computer, dual monitors, a headset, an ethernet cable, and additional accessories as needed. About the Role We are seeking a dedicated Registered Nurse (RN) to join our Medical Review team. This role involves conducting pre- and post-payment medical reviews to ensure compliance with established clinical criteria and guidelines. The ideal candidate will use their clinical expertise to assess medical necessity, appropriateness, and reimbursement eligibility while documenting decisions in accordance with regulatory and organizational requirements.

Licensure: Active, unrestricted RN license in the U.S. and in the state of hire OR Active compact multistate RN license (as defined by the Nurse Licensure Compact). Education: Associate Degree in Nursing OR Graduate of an accredited School of Nursing. Experience: Two years of clinical experience plus at least two years in one of the following: Home Health Utilization/Medical Review Quality Assurance Skills & Competencies: Strong clinical background in managed care, home health, rehabilitation, and/or medical-surgical settings. Ability to interpret and apply medical review criteria and clinical guidelines. Proficiency in Microsoft Office and word processing software. Strong analytical, organizational, and decision-making skills. Ability to work independently while managing priorities effectively. Excellent customer service, communication, and critical thinking skills. Ability to handle confidential information with discretion. Preferred Qualifications: Three years of clinical nursing experience in Home Health, Utilization Review, Medical Review, or Quality Assurance (strongly preferred). Proficiency in using multiple screens and software programs simultaneously.

Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals. Assess payment determinations using clinical information and established guidelines. Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement. Provide clear, well-documented rationales for service approvals or denials. Educate internal and external teams on medical review processes, coverage determinations, and coding requirements. Support quality control activities to meet corporate and team objectives. Provide guidance to LPN team members and support non-clinical staff through training and discussions. Assist with special projects and additional responsibilities as assigned.

Let's Create SUCCESS

Remote Nurse

Posted on:

April 18, 2025

Job Type:

Contract

Role Type:

Leadership / Management

License:

RN

State License:

Texas

At Let’s Create Success, we offer a modern way of working—remotely and independently, with the support of a global community. We’re passionate about helping individuals achieve both personal and professional success. Through a proven system and a focus on leadership and growth, we empower people to take ownership of their careers, create more freedom, and thrive on their own terms.

Remote Nurse| Create More Success with Balance & Flexibility Are you a nurse looking to change up your work schedule, gain more flexibility, and create a new level of success—on your own terms? We’re currently seeking motivated nurses and healthcare professionals to step into a remote role within the personal growth and leadership space. This is an independent contractor position designed for individuals ready to grow professionally while achieving a better work-life balance.

What We’re Looking For: Telephone and Interviewing skills Positive, proactive, and coachable Strong communication and leadership qualities Organised and able to manage time independently A genuine interest in personal development and helping others succeed

This role involves working remotely to support and mentor others through a structured, success-driven system. You'll guide individuals through goal-setting, personal growth, and leadership development—while growing your own skills and professional impact. No cold calling, no pressure selling—our system takes care of the sales process. Key Responsibilities: Conduct brief interviews and guide candidates through the discovery process Lead and mentor a team of like-minded individuals Be present on social media and online platforms to promote and engage Participate in training, personal development, and team collaboration Set and achieve personal and team growth goals

PeaceHealth

LPN Triage Nurse Remote

Posted on:

April 18, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

LPN/LVN

State License:

Washington

PeaceHealth is committed to the overall wellbeing of our caregivers: physical, emotional, financial, social, and spiritual. We offer caregivers a competitive and comprehensive total rewards package. Some of the many benefits included in this package are full medical/dental/vision coverage; 403b retirement plan employer base and matching contributions; paid time off; employer-paid life and disability insurance with additional buyup coverage options; tuition and continuing education reimbursement; wellness benefits, and expanded EAP and mental health program.

PeaceHealth is seeking a LPN Triage Nurse for a Remote, Full Time, 1.00 FTE, Day position. The salary range for this job opening at PeaceHealth is $27.27 – $40.41. The hiring rate is dependent upon several factors, including but not limited to education, training, work experience, terms of any applicable collective bargaining agreement, seniority, etc. Hiring bonus may be available. Under the supervision of an RN, the LPN provides direct nursing care, within the scope of their license, to patients as directed by the physicians and other healthcare providers. Cooperative decision making is expected in the execution of duties.

Graduate from an accredited State Board of Nursing LPN Program Required. Minimum of 1 year Home Health experience as an LPN Licensed Practical Nurse - Registered in Washington Current Basic Life Support certification issued by the American Red Cross or the American Heart Association. Valid driver’s license and proof of auto insurance required.

Implements and evaluates patient care under the supervision of an RN. Participates in the development of a patient-specific care plan. Provides direct patient care including administering medications and treatments as prescribed. Documents patient care in health record according to department standards. Assigns, prioritizes, requests and accepts guidance and assistance from others to assure delivery of care in a safe and timely manner. Ensures own professional effectiveness through continued education and professional development. Assists in transporting of patients, specimens, supplies and equipment and in the maintenance and stocking of supplies and equipment to assure optimal functioning of the department. May triage patient phone calls, counsel patients, provide patient education, take patient histories, administer prescribed medications, change dressings, clean wounds and monitor patient vital signs.

Roze Room Hospice of San Gabriel Valley

Triage RN

Posted on:

April 17, 2025

Job Type:

Role Type:

Triage

License:

RN

State License:

California

Roze Room is a leading provider of Hospice and Palliative Care, celebrating 25 years of service to Southern California communities.

Per Diem Triage RN Computer savvy can work from home. Weeknights 6pm-8am and weekend days/nights.

Graduate of an accredited school of nursing. Current RN License within the State. Certification in Hospice and Palliative Nursing desired and encouraged. Minimum of one-year experience as a professional nurse within the last 3 years. Hospice experience preferred. Must be able to utilize computers and be comfortable with electronic medial records.

We are looking for an experienced triage registered nurse who will provide skilled and palliative care assessments and instructions and who will coordinate services with the hospice team after hours, weekends and holidays. The triage nurse will process incoming calls from families, patients and others and do so from home at least two nights per week. The triage nurse will work cooperatively with physicians and the hospice team of multi-disciplinary professionals to update the plan of care, follow prescribed medical treatments (including pain management and symptom control), and provide education and supportive care to patient and caregivers.

Momentum Life Sciences

Call Center Nurse Case Manager (12-9p EST) (Remote)

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Indiana

**Assigned shift: 12-9p EST** About the Position: The Nurse Case Manager will provide ongoing contact center and virtual support as an integral part of the patient support services provided for patients prescribed an oral therapy for narcolepsy and idiopathic hypersomnia. The Nurse Case Manager will be responsible for utilizing professional nursing skills, ability to foster patient relationships, strong empathy, and clinical experience to provide ongoing personalized high-touch telephonic support to patients . The role will engage with patients and their caregivers to provide clinically relevant individualized education in conjunction with product support. The Nurse Case Manager will leverage their knowledge while combining technical expertise to deliver best-in-class support, customer service, and ongoing education to these unique patients and their caregivers. The Nurse Case Manager will also partner closely with cross-functional stakeholders, including Field Nurse Educators, to ensure continuity of care and escalation as appropriate across teams.

Required Education and/or Experience: Associate’s degree in nursing with patient education experience Experience working for (or contracting with) a pharmaceutical company within a contact center environment, a minimum of 2 years Preferred Education and/ or Experience: Bachelor’s Degree Required License and/or credential(s): Current, unrestricted RN or NP license Required Skills: Background in neurological conditions and/or rare disease Demonstrated ability to collaborate with numerous cross-functional partners/key stakeholders to deliver an optimized patient experience High emotional intelligence and ability to exhibit empathy to meet each patient where they are Strong clinical skills and experience with medication compliance, specialty pharmacy knowledge, and motivational interviewing Desire and ability to create individualized relationships with patients as they progress through their journey Ability to communicate clearly about complex information in a way that resonates with patients Optimistic, upbeat, and enthusiastic in times of challenge and constant change. Ability to deliver outstanding patient experience. Demonstrate experienced competency and ability to independently navigate technology using multiple platforms, computer screens, and other technical components. (Ex: virtual engagement platforms, Telephony Systems, CRM tools, Microsoft Suite) Advanced knowledge of written and verbal communication skills and problem-solving technique Detail-oriented, highly organized, and able to work through ambiguity Able to work independently with minimal supervision, self-motivated Ability to maintain cases and complete calls on time Ability to maintain compliant conversations and documentation in a high-volume role Ability to maintain patient confidentiality by using the headset during all conversations, maintaining a private environment for home office without distraction

Provide telephonic support via inbound and outbound calls, virtual calls, and omnichannel support through email, chat, and text Demonstrate strong empathy and high emotional intelligence to engage patients with complex health conditions effectively, creating an individual relationship-based connection built on trust and rapport Provide instruction and education about treatment/therapy, and connect patients with additional resources when needed while partnering with the Field Nurse Educators, HUB (Certified Pharmacy) and other key stakeholders to ensure the patient feels supported and confident from initiation through any transitions in their therapy journey Collaborate and work cohesively within a POD structure (with VMS Field Nurse Educator team) to identify gaps, barriers, and opportunities to improve process and overall patient experience Communicate complex information effectively and empathetically to patients and their caregivers Accurately complete patient engagements based on provided criteria Identify the root cause for any potential barriers the patients experience in adhering to the therapy through a motivational interviewing model Understand and coach patient initiation and support processes while encouraging patient confidence to help start and stay on therapy Ensure the success of the program through collaborative partnerships with patients, brand, and operational partners Provide your manager constructive patient feedback on the product, patient, and industry insights to enable enhancements. Reporting Adverse Event Product Quality Complaint (AEPQC) reporting per VMS and client policy Ensure all activities are conducted in a manner that complies with all VMS, client, and industry-mandated rules and regulations.

1ST CALL TRIAGE LLC

Telephone Triage Registered Nurse

Posted on:

April 17, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

We are seeking a highly skilled Registered Nurse to join our remote telephone triage team. As a remote triage nurse, you will be responsible for providing exceptional patient care over the phone for busy medicine clinics with both adult and pediatric populations. In addition, you'll assist with medication refills, prior authorizations, referrals, and other patient needs. Your primary goal will be to ensure that patients receive the appropriate medical attention they need in a timely and efficient manner. You will work closely with physicians and other healthcare professionals to provide the best possible quality care to patients.

Minimum Qualifications: Active Registered Nurse license - compact states Minimum of 2 years of experience in a clinical setting Experience caring for both adult and pediatric populations Excellent communication and interpersonal skills Ability to work independently and as part of a team Proficiency in electronic medical records (EMR) Preferred Qualifications: Bachelor's degree in Nursing Experience in remote patient care, telephone triage Experience utilizing standard protocols to guide care advice, Schmitt-Thompson protocols Experience working with diverse patient populations across the lifespan Skills: As a remote triage nurse, you will utilize your exceptional communication and interpersonal skills to provide remote patient care and telephone triage. You will also use your proficiency in electronic medical records (EMR) to maintain accurate and up-to-date patient records. Your ability to work independently and as part of a team will be crucial in collaborating with physicians and other healthcare professionals remotely in a busy face-paced environment. Additionally, your experience in remote patient care and telephone triage will be beneficial in providing the best possible care to our patients. This is a part-time position. You will be expected to work 2-3 days a week 7:30-5:30 pm EST. 24 hours per week

Conduct remote patient assessments and provide telephone triage to patients in need of medical attention Collaborate with physicians and other healthcare professionals Process prescription refills and prior authorizations for medications Maintain accurate and up-to-date patient records Provide patient education and counseling on various health topics Adhere to all relevant healthcare regulations and guidelines

Seva Medical

Remote RN – After hours On-Call Triage Nurse

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Join the gold standard in Geriatric Mobile Primary Care. At Seva Medical, we deliver compassionate, value-based care to seniors in adult family homes, assisted living, and memory care communities—where they feel most at home.

As a Remote RN, you’ll provide after-hours triage and chronic care management (CCM) to patients with complex needs. You’ll play a critical role in reducing ER visits and ensuring seamless, patient-centered care. Shift Options Evenings: 5 PM – 1:30 AM Overnights: 12 AM – 8:30 AM Weekends All Three Shifts Including: 8 AM – 5 PM

Active RN license (unrestricted); Compact license (eNLC) preferred 2+ years of nursing experience (triage, CCM, home health, geriatrics) BLS certification Tech-savvy: EHR, secure messaging, telehealth tools Quiet home office + high-speed internet Evening, weekend, or overnight availability Preferred: 3+ years RN experience Telehealth or long-term care background Familiarity with CMS CCM billing Strong communication & patient education skills

Triage patient calls using protocols and clinical judgment Coordinate care with providers, caregivers, and facilities Manage chronic conditions like CHF, COPD, diabetes, etc. Engage in proactive CCM tasks during non-call hours Document assessments, interventions, and escalations clearly

Elevance Health

LTSS Service Coordinator Assessment RN

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

New York

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

Centers Health Care is a member of the Elevance Health family of companies, serving as a premier network of skilled nursing, rehabilitation, and senior care services. Our goal is to provide eligible members with access to quality healthcare so that they can continue to live healthy and productive lives within their communities. LOCATION: This is a field role for the areas of Jamaica and the Bronx. New York residency is required. HOURS: General business hours, Monday through Friday. TRAVEL: Up to 75% travel is required within your assigned area. The LTSS Svc Coord-RN Clinician is responsible for overall management of member's case within the scope of licensure; provides supervision and direction to non-RN clinicians participating in the member's case in accordance with applicable state law and contract. Develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum. The RN has overall responsibility to develop the care plan for services for the member and ensures the member's access to those services.

Required Qualifications: Requires a high school diploma or equivalent. Requires current, unrestricted RN license issued by the state of New York; and 3 years of experience in working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role; or any combination of education and experience which would provide an equivalent background. Preferred Qualifications: You must be comfortable visiting members and providing care in their homes or in a care facility. You must be computer proficient in Microsoft Office including Word and Excel. Very strong verbal and written communication skills are needed for this position.

Responsible for performing telephonic or face-to-face clinical assessments for the identification, evaluation, coordination, and management of member's needs, including physical health, behavioral health, social services, and long term services and supports. Identifies members for high-risk complications and coordinates care in conjunction with the member and the health care team. Manages members with chronic illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefits. Obtains a thorough and accurate member history to develop an individual care plan. Establishes short- and long-term goals in collaboration with the member, caregivers, family, natural supports, physicians; identifies members that would benefit from an alternative level of care or other waiver programs. May assist with the implementation of member care plans by facilitating authorizations/referrals for utilization of services, as appropriate, within benefits structure or through extra-contractual arrangements, as permissible. Interfaces with Medical Directors, Physician Advisors, and/or Inter-Disciplinary Teams on the development of care management treatment plans. May also assist in problem solving with providers, claims or service issues. May direct or supervise the work of any LPN, LCSW, LMSW, or other licensed professionals than an RN, in coordinating services for the member. Travels to worksite and other locations as necessary.

Actalent

Telehealth Nurse

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Missouri

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

Actively looking to hire multiple Chronic Care Managers (LPNs) to support a client on a remote basis! The max pay for this role is $23.00 an hour! This is a Monday to Friday; no weekends or holidays! Must be comfortable taking a typing test! Great opportunity if you are looking to work from home! Job Description We are looking for a dedicated Chronic Care Manager to provide one-on-one attention via telephone calls to patients with two or more chronic diagnoses. The Chronic Care Manager will collect patient health information to identify risks, provide education, and encourage treatment compliance. The role involves creating patient-specific Care Plans with goals and interventions to monitor and support patient needs as defined by their Primary Care Provider (PCP). The Chronic Care Management (CCM) program aims to promote the highest level of quality care for patients.

Licensed Practical Nurse (LPN) certification. Proficiency in Microsoft Outlook and Excel. Familiarity with documentation in Electronic Medical Records (EMRs). Ability to work self-motivated in a remote environment. Work Environment: This position is 100% remote. Employees must have a high-speed internet connection!

Provide initial risk assessments by gathering clinical elements necessary to determine patient-specific Care Plans. Work with patients to plan and monitor their care as determined by the PCP. Promote compliance with PCP/Specialist office visits. Promote compliance with medication. Act as a patient advocate, liaison, and information resource. Provide chronic care education for chronic/complex conditions as determined.

Molina Healthcare

EPSDT Coordinator (Must Reside in MS, LPN/LVN Required, RN preferred)

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

LPN/LVN

State License:

Mississippi

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.

The EPSDT Coordinator oversees all EPSDT activities for the Health Plan and is responsible for identifying gaps in or barriers to care; assisting Members with scheduling transportation to appointments; reviewing EPSDT and HEDIS data to inform targeted interventions to increase utilization of well-child visits, screenings, exams, and associated services; and improving communication and collaboration among Members, Providers, school health services, CBOs, and other program stakeholders.

REQUIRED EDUCATION: Completion of an accredited Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN) Program OR Bachelor's or Master's Degree (preferably in a social science, psychology, gerontology, public health or social work or related field) REQUIRED EXPERIENCE/KNOWLEDGE, SKILLS & ABILITIES: 1-3 years in case management, disease management, managed care or medical or behavioral health settings. REQUIRED LICENSE, CERTIFICATION, ASSOCIATION: If licensed, license must be active, unrestricted and in good standing. Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation. PREFERRED EXPERIENCE: 3-5 years in case management, disease management, managed care or medical or behavioral health settings. PREFERRED LICENSE, CERTIFICATION, ASSOCIATION: Any of the following: Licensed Clinical Social Worker (LCSW), Advanced Practice Social Worker (APSW), Certified Case Manager (CCM), Certified in Health Education and Promotion (CHEP), Licensed Professional Counselor (LPC/LPCC), Respiratory Therapist, or Licensed Marriage and Family Therapist (LMFT).

Provide education and outreach initiatives to include: Various one-on-one supports such as EPSDT education services, HNAS, and appointment and transportation assistance. Community events such as back-to-school fairs and community baby showers, using them as opportunities to educate communities about the importance of preventive healthcare and how to access EPSDT services. May use MyHealth Mobile stationed near homeless shelters, food banks, community centers, and public social service offices to improve access to preventive services in diverse communities that struggle with disparities in health outcomes. Participate in Molina Days. Promote a healthy lifestyle at events at Provider offices and FQHCs for Members to receive well-child/well-baby exams, vaccinations, and other EPSDT services. The events are also opportunities to educate Members on the importance of healthy eating, physical activity, and preventive care. Provides members with a variety of options for accessing preventive services. The EPSDT Coordinator identifies Members who are out of compliance with the Bright Futures periodicity schedule. Generates lists of Members with open preventive care gaps to prioritize outreach and support quality initiatives for those Members and their PCPs. Maintains dashboards of EPSDT measures, including trends and gaps in services. Oversees design and implementation of campaigns and programs to address gaps at Member, Provider, and system levels related to the EPSDT program.

Groups Recover Together

Population Health Coordinator

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Maine

At Groups, the Population Health Coordinator will play a key role in our organization by supporting the delivery of high-quality care to select high-acuity member populations, as well as members in select transitional periods of their recovery journey. Each population health coordinator will be assigned to one of the following areas of focus and specialization: Medical Focus Pregnant and postpartum members Recently hospitalized members and/or those with complex medical care-coordination needs Members struggling with polysubstance use Members at highest risk of precipitated withdrawal Other special populations Mental Health Focus Members with Serious Mental Illness Members with suicidal or homicidal ideation Members recently admitted to a higher level of care or who may need admission to a higher level of care for a MH diagnosis Members with a recent overdose Other special populations Social Care Focus Members who were recently incarcerated Members experiencing housing insecurity or homelessness Members who have significant gaps in HRSNs (Health Related Social Needs such as food insecurity, financial needs, social support, etc) Members who have case management needs Other special populations Within their area of focus, the Population Health Coordinator supports quality care-delivery and quality improvement via a mixture of: registry review and data management; internal and external interdisciplinary collaboration and care coordination; documentation review and preparation; and direct member-facing care (group and individual). This role will play a key part in pioneering innovative care delivery methods at Groups, with a strong foundation in the Collaborative Care Model. As a result, the person in this role must be flexible, confident in engaging with multiple disciplines across various regions, and comfortable navigating ambiguity. This position requires a passion for leading, supporting, and participating in pilot projects to drive continuous improvement in patient care.

Knowledge, Skills and Abilities: Strong understanding of care coordination and case management Knowledge of health care regulations and HIPAA compliance Excellent communication skills with the ability to effectively manage communications across a large, dispersed team and represent the organization to external audiences Proficient in facilitating clear and efficient communication across telehealth, virtual platforms, telephone, and in-person care settings Willingness to work both in and out of the office depending on need, acquire additional training, willingness to adjust schedule hours to accommodate member care early or in the evening within the usual work week hours Exceptional ability to maintain focus, prioritize tasks effectively, adapt to rapid organizational changes Problem-solving and decision making abilities to navigate complete care situations Capacity to build trust and rapport with diverse patient populations Proficiency with multiple EMR’s, Microsoft Office / Google Suite (spreadsheet proficiency required), and other computer-based documentation tools Excellent organizational and documentation skills Ability to analyze data and outcomes Ability to use discretion and work independently under general supervision Ability to understand and adhere to the Professional Code of Conduct Qualifications & Requirements: Medical Focus only: Registered Nurse (RN) or (Maine Only) Licensed Practical Nurse (LPN) who completes the SAMHSA required training for an X‑DEA license required Bachelor's degree in Nursing preferred At least 5 years experience providing direct patient-care in addiction medicine or other related areas of behavioral health, at high-quality, reputable organizations Mental Health Focus only: Current licensed clinical social worker At least 5 years experience providing direct care or supervision in mental health or integrated behavioral health organizations, serving vulnerable populations Health Related Social Focus only: Current social worker, certified peer, certified community health worker At least 5 years experience providing direct care or supervision in case management, care management, social work, or peer services For all Population Health Coordinators: For remote roles, access to reliable internet and telephone services, specifically 50M download and 10M upload packages or higher as well as a strong WiFi signal from your remote work location Must meet pre-employment requirements and maintain all applicable state and job-related guidelines for background screening. Depending on state-specific requirements, this may include fingerprinting, drug testing, health screening, CPR/Basic First Aid and license/credential verifications

Data and Registry Management/Collaborative Care Model Support Maintain an accurate registry of members enrolled in dedicated special populations or other care pathways Use the registry to assess progress, track outcomes, and prioritize daily tasks for yourself and other members of the care team Facilitate registry reviews with other members of the care team (counselors, medical providers, consulting specialists, etc) Participate in caseload consultation and communicate resulting treatment recommendations to the care team Use the registry to assess the quality of care for the relevant populations and to propose population-level quality improvement initiatives Care Coordination Support the local care teams by performing and documenting internal and external care coordination tasks for the most complex members or scenarios within the area of focus Assist in training staff on how to practice within the Collaborative Care Model (registry review, asynchronous consultations, concise presentations etc) Direct Member Care Support the individual needs of members on an assigned member caseload (i.e. a subset of the members within the area of focus) via telephonic and SMS outreach, and individual telemedicine encounters Perform screenings, structured assessments, brief therapeutic interventions, care coordination with community providers, and other tasks as assigned for select members Provide member education about common co-occurring mental health, physical health, and substance abuse disorders and the available treatment options. In partnership with peer support and care navigation, provide transitional care support to select high acuity members as they begin their recovery journey at Groups, including participation in interdisciplinary meetings, orientation groups, care coordination, and 1:1 member support Facilitate and document treatment plan changes for members with the clinical and medical providers Escalate any urgent/crisis situations to the appropriate clinical and/or medical leadership and support team members through necessary follow up and safety planning activities Pilot Support and Project Management Provide administrative, technical, and leadership support on pilot projects, as delegated by medical, clinical, and operational leaders Duties Specific to Medical Focus: Support medication management as prescribed by medical providers, focusing on treatment adherence monitoring, side effects, and effectiveness of treatment Assist in creating and delivering low barrier, literacy and culturally appropriate educational materials for members, providers and co-prescribers on a variety of addiction and primary care related medical topics Assist in the review of medical data and the preparation of medical documentation to support efficient, top-of-license medical care of medical colleagues Support with medial related coordination of care Duties Specific to Mental Health Focus: Support member referral to a higher level of care or for mental health diagnoses Support a member’s transition from a higher level of care for a mental health diagnosis into the Groups treatment model Assist members with symptom management through direct care, guidance for the care team, or through connection to appropriate external care Support members and care team members through crisis or high risk situations, ensuring appropriate next steps, including safety planning Duties Specific to Social Care Focus: Support regional Recovery Support Specialist (RSS) teams on intensive case management and peer support services for high risk members across special populations Manage escalations related to health-related social needs Facilitate member referrals to higher levels of care from a case management perspective External care coordination with external case management agencies as needed Supporting members directly with very complex social needs

Groups Recover Together

Staff Provider - Indiana (APRN/NP)

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

NP/APP

State License:

Compact / Multi-State

Groups is a leading outpatient provider specializing in substance use disorder (SUD) treatment. We are committed to supporting underserved communities hit hardest by the opioid crisis. Since 2014, our local care teams have guided hundreds of thousands of individuals on their path to recovery, helping them reclaim their purpose and dignity through compassionate, collaborative care. Our evidence-based approach combines medication, group therapy, and personalized support, delivered online and in person by local providers. Founded on the belief that recovery extends beyond the traditional office visit, Groups helps members build a foundation for long-term recovery and the fulfilling lives they want and deserve. Together with our community partners, public agencies, and health plans, we are raising the bar in addiction health care—and we’re just getting started. Groups is changing lives. Join us.

Nurse Practitioner with Active, Unencumbered Indiana APRN License and DEA. Board Certification and CSR Registration in Indiana. Willing and able to become licensed in multiple other states where Groups operates or will operate soon (with support and reimbursement from Groups) Willingness and ability to become credentialed with all government and private health plans with whom Groups Recover Together is in network. Ability to see member in-person at several state locations, if required. At least 1 year of experience managing OUD with buprenorphine, preferably within the Groups Recovery System. At least 1 year experience working in a team-based-care setting with behavioral health providers (therapists, social workers, case managers, etc) At least 2 years experience working with a similar member population, preferably within primary care of behavioral health setting. Adequate internet connectivity to support telemedicine (if working from home) Access to reliable internet and telephone services, specifically 10M download and 5M upload package or higher, as well as a strong WiFi signal from your remote work location. Ability to demonstrate recovery-sensitive behaviors, including choice of language, attitudes and interactions with members and staff. Ability to maintain courteous and professional in all communications (verbal and written) with staff and members. Ability to provide in-person services at our North Vernon location weekly, if required. Physical Requirements & Working Conditions: These physical demands are representative of the physical requirements necessary for an employee to successfully perform the essential functions of the job. Reasonable accommodation can be made to enable people with disabilities; these are made on a case-by-case basis. While performing the responsibilities of the role, the employee is required to talk and hear. The employee is often required to sit and use his or her hands and fingers. The employee is occasionally required to stand, walk, reach with arms and hands, climb or balance, and to stoop, kneel, crouch or crawl. Vision abilities required by this job include close vision. Limitations and Disclaimer: The above job description is meant to describe the general nature and level of work being performed; it is not intended to be construed as an exhaustive list of all responsibilities, duties and skills required for the position.

Adhere to all clinical policies and procedures as outlined in the GRS Manual Intake medical duties Determine each patient’s medical necessity and appropriateness for treatment pursuant to applicable clinical models, policies and procedures, and manuals (e.g., Recovery System Manual) as required by Recover Together. For patients admitted to treatment, prescribe buprenorphine/naloxone and, where appropriate, other approved medications to treat withdrawal symptoms, in a manner consistent with Recover Together’s policies and procedures and Recovery System Manual. Maintain a regular schedule of “intake shifts”, and be available to provide rapid-access telemedicine intakes across multiple geographies, including new markets. Complete all intake documentation thoroughly, efficiently, and accurately. Be accountable for successful initiation of MAT during the early weeks of treatment (weeks 1-4, approximately). As needed, coordinate with community providers to support the successful transition of new members into Groups. Collaborate with other provider colleagues to transition the care of new members into regular maintenance groups. Escalate controversial situations to appropriate medical and/or clinical leadership; Maintenance medical duties Maintain a panel of maintenance members and serve as their dedicated provider at monthly provider groups, per the guidelines of the Groups. Recovery System. Meet with each patient for whom the Physician prescribes buprenorphine at least once every thirty (30) days. This interaction occurs in a group setting, with individual conversations occurring before or after the group as needed. Such meetings may occur via telemedicine, to the extent Physician complies with all applicable federal and state laws, rules, and regulations and any requirements set forth by applicable payers (e.g., Medicare, Medicaid, commercial plans) governing telemedicine. Be available by phone and email to discuss each patient’s medical issues in between monthly visits (e.g., dose changes; prescription troubleshooting, interprofessional communication and collaboration). When indicated and medically necessary, meet with patients for a pre-scheduled individual session to review medical progress. These visits are separate from the individual conversations that occur before and after regular shared medical visits. Such meetings may occur via telemedicine, to the extent Physician complies with all applicable federal and state laws, rules, and regulations and any requirements set forth by applicable payers (e.g., Medicare, Medicaid, commercial plans) governing telemedicine. Medical Records In compliance with HIPAA and other applicable federal or state laws, rules or regulations regarding medical records, maintain patient records in confidence and complete records in a timely fashion and in accordance with policies of the Company. Miscellaneous medical duties Provide regular coverage for “makeup groups” and makeup 1:1 sessions. Provide as needed cross-coverage for colleagues and answers to medical questions when other providers are unavailable. Participate in rotating “on-call” schedule of urgent prescription coverage for unavailable providers. Facilitate access to the State’s prescription drug monitoring database so Groups staff can regularly monitor the Provider’s patients’ access to controlled substances, per Recover Together’s clinical protocols. Administrative duties - approximately 15% per week Completing high quality documentation, specifically all medical encounters accurately and thoroughly on the same business day as the encounter Sign all prescriptions on the same business day that they are generated Manage group and individual sessions in a timely manner so members and office staff stay on schedule Work with the office staff to maintain a clinical schedule that is mutually beneficial to provider and the office; Stay familiar with all Recover Together policies, procedures, reference materials, contracts, etc. Follow up on interprofessional communication Assist with onboarding, training, and support of new providers. Work with the medical leadership team to pilot new initiatives to improve outcomes during early treatment, Assist with other duties as assigned.

MetaPhy Health

Follow-Up Bilingual LPN - Remote! *TN Only*

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Compact / Multi-State

MetaPhy Health is a leading healthcare organization dedicated to providing innovative and personalized medical solutions to enhance patient well-being. At MetaPhy, we partner with physicians to offer the MyCare Program encompassing Medicare's Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) services. Our vision is to enhance patient outcomes by providing every patient with a personal care coordinator to help with health and lifestyle support, assistance with medication management, and assistance with care coordination. We are committed to delivering high-quality patient care through cutting-edge technology and evidence-based practices.

General Information: As a Telehealth Care Coordinator at MetaPhy, you will play a crucial role in delivering patient education, support, and care through our telehealth platform. You will serve as a liaison between providers, clinical staff, and patients, ensuring seamless communication and coordination of comprehensive care plans. Your responsibilities will include utilizing electronic health records (EHR) to document observations, scheduling virtual patient encounters, providing nutritional guidance and education to patients, and prioritizing tasks effectively in a dynamic environment. What We Offer: This position offers a base pay of $22 per hour, with commission opportunities that typically boost earnings to approximately $25 per hour on average. 100% work from home full-time. Flexible schedules Monday - Friday (day shifts). Friday off potential upon meeting weekly performance goals by Thursday. Generous time off annually: 15 days of PTO + 12 paid company holidays + 4 days of unscheduled paid leave. Candidate referral bonus program, $1,000 per referral. Paid maternity leave. Employee Assistance Program, inclusive of counseling sessions. Tuition reimbursement program. Competitive insurance package including medical, dental and vision. Wellness program that includes $$ rewards.

Fluent in English and Spanish Licensed Practical Nurse (LPN) with an active license in TN or compact state. 1-3 years of experience with Microsoft 365, EMR/EHR, Windows operating system, and laptop/desktop professional experience (required). 1-2 years of experience in a healthcare setting (preferred). Interest in Chronic Care Management delivered through telehealth platforms. Legally authorized to work in the United States.

Provide patient education, support, and care via telehealth platform in alignment with physician practices. Deliver patient specific nutritional guidance and education. Coordinate information between providers, clinical staff, and patients to ensure comprehensive care delivery. Manage and update patient-centered care plans in collaboration with healthcare team members. Document clinical observations, updates, and patient education in EHR. Schedule, confirm, and coordinate virtual patient encounters. Demonstrate professionalism, empathy, and effective communication skills with patients and colleagues. Efficiently oversee a caseload of 250-260 patients monthly through the completion of a minimum of 10 patient calls per day. Prioritize tasks efficiently and work effectively in a dynamic environment.

MetaPhy Health

Enrollment Bilingual LPN - Remote! *TN Only*

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Compact / Multi-State

MetaPhy Health is a leading healthcare organization dedicated to providing innovative and personalized medical solutions to enhance patient well-being. At MetaPhy, we partner with physicians to offer the MyCare Program encompassing Medicare's Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) services. Our vision is to enhance patient outcomes by providing every patient with a personal care coordinator to help with health and lifestyle support, assistance with medication management, and assistance with care coordination. We are committed to delivering high-quality patient care through cutting-edge technology and evidence-based practices.

General Information: As a Telehealth Care Coordinator at MetaPhy, you will play a crucial role in delivering patient education, support, and care through our telehealth platform. You will serve as a liaison between providers, clinical staff, and patients, ensuring seamless communication and coordination of comprehensive care plans. Your responsibilities will include utilizing electronic health records (EHR) to document observations, scheduling virtual patient encounters, providing nutritional guidance and education to patients, and prioritizing tasks effectively in a dynamic environment. What We Offer: This position offers a base pay of $24 per hour, with commission opportunities that typically boost earnings to approximately $27 per hour on average. 100% work from home full-time. Flexible schedules Monday - Friday (day shifts). Friday off potential upon meeting weekly performance goals by Thursday. Generous time off annually: 15 days of PTO + 12 paid company holidays + 4 days of unscheduled paid leave. Candidate referral bonus program, $1,000 per referral. Paid maternity leave. Employee Assistance Program, inclusive of counseling sessions. Tuition reimbursement program. Competitive insurance package including medical, dental and vision. Wellness program that includes $$ rewards.

Licensed Practical Nurse (LPN) with an active license in TN or compact state. 1-3 years of experience with Microsoft 365, EMR/EHR, Windows operating system, and laptop/desktop professional experience (required). 1-2 years of experience in a healthcare setting (preferred). Interest in Chronic Care Management delivered through telehealth platforms. Legally authorized to work in the United States. Fluent in English and Spanish

Provide patient education, support, and care via telehealth platform in alignment with physician practices. Educate patients on the health benefits of enrolling into a chronic care program, effectively communicate the expectations of the program, and answer any patient related questions. Coordinate information between providers, clinical staff, and patients to ensure comprehensive care delivery. Manage and update patient-centered care plans in collaboration with healthcare team members. Document clinical observations, updates, and patient education in EHR. Schedule, confirm, and coordinate virtual patient encounters. Demonstrate professionalism, empathy, and effective communication skills with patients and colleagues. Efficiently oversee and enroll 3 patients per day into our chronic care management program. Prioritize tasks efficiently and work effectively in a dynamic environment.

MetaPhy Health

Enrollment LPN - Remote! *TN Only*

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Compact / Multi-State

MetaPhy Health is a leading healthcare organization dedicated to providing innovative and personalized medical solutions to enhance patient well-being. At MetaPhy, we partner with physicians to offer the MyCare Program encompassing Medicare's Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) services. Our vision is to enhance patient outcomes by providing every patient with a personal care coordinator to help with health and lifestyle support, assistance with medication management, and assistance with care coordination. We are committed to delivering high-quality patient care through cutting-edge technology and evidence-based practices.

General Information: As a Telehealth Care Coordinator at MetaPhy, you will play a crucial role in delivering patient education, support, and care through our telehealth platform. You will serve as a liaison between providers, clinical staff, and patients, ensuring seamless communication and coordination of comprehensive care plans. Your responsibilities will include utilizing electronic health records (EHR) to document observations, scheduling virtual patient encounters, providing nutritional guidance and education to patients, and prioritizing tasks effectively in a dynamic environment. What We Offer: This position offers a base pay of $22 per hour, with commission opportunities that typically boost earnings to approximately $25 per hour on average. 100% work from home full-time. Flexible schedules Monday - Friday (day shifts). Friday off potential upon meeting weekly performance goals by Thursday. Generous time off annually: 15 days of PTO + 12 paid company holidays + 4 days of unscheduled paid leave. Candidate referral bonus program, $1,000 per referral. Paid maternity leave. Employee Assistance Program, inclusive of counseling sessions. Tuition reimbursement program. Competitive insurance package including medical, dental and vision. Wellness program that includes $$ rewards.

Licensed Practical Nurse (LPN) with an active license in TN or compact state. 1-3 years of experience with Microsoft 365, EMR/EHR, Windows operating system, and laptop/desktop professional experience (required). 1-2 years of experience in a healthcare setting (preferred). Interest in Chronic Care Management delivered through telehealth platforms. Legally authorized to work in the United States.

Provide patient education, support, and care via telehealth platform in alignment with physician practices. Educate patients on the health benefits of enrolling into a chronic care program, effectively communicate the expectations of the program, and answer any patient related questions. Coordinate information between providers, clinical staff, and patients to ensure comprehensive care delivery. Manage and update patient-centered care plans in collaboration with healthcare team members. Document clinical observations, updates, and patient education in EHR. Schedule, confirm, and coordinate virtual patient encounters. Demonstrate professionalism, empathy, and effective communication skills with patients and colleagues. Efficiently oversee and enroll 3 patients per day into our chronic care management program. Prioritize tasks efficiently and work effectively in a dynamic environment.

MetaPhy Health

Follow-Up LPN- Remote! *Tennessee Only*

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Compact / Multi-State

MetaPhy Health is a leading healthcare organization dedicated to providing innovative and personalized medical solutions to enhance patient well-being. At MetaPhy, we partner with physicians to offer the MyCare Program encompassing Medicare's Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) services. Our vision is to enhance patient outcomes by providing every patient with a personal care coordinator to help with health and lifestyle support, assistance with medication management, and assistance with care coordination. We are committed to delivering high-quality patient care through cutting-edge technology and evidence-based practices.

General Information: As a Telehealth Care Coordinator at MetaPhy, you will play a crucial role in delivering patient education, support, and care through our telehealth platform. You will serve as a liaison between providers, clinical staff, and patients, ensuring seamless communication and coordination of comprehensive care plans. Your responsibilities will include utilizing electronic health records (EHR) to document observations, scheduling virtual patient encounters, providing nutritional guidance and education to patients, and prioritizing tasks effectively in a dynamic environment. What We Offer: As a Telehealth Care Coordinator at MetaPhy, you will play a crucial role in delivering patient education, support, and care through our telehealth platform. You will serve as a liaison between providers, clinical staff, and patients, ensuring seamless communication and coordination of comprehensive care plans. Your responsibilities will include utilizing electronic health records (EHR) to document observations, scheduling virtual patient encounters, providing nutritional guidance and education to patients, and prioritizing tasks effectively in a dynamic environment.

Licensed Practical Nurse (LPN) with an active license in TN or compact state. 1-3 years of experience with Microsoft 365, EMR/EHR, Windows operating system, and laptop/desktop professional experience (required). 1-2 years of experience in a healthcare setting (preferred). Interest in Chronic Care Management delivered through telehealth platforms. Legally authorized to work in the United States.

Provide patient education, support, and care via telehealth platform in alignment with physician practices. Deliver patient specific nutritional guidance and education. Coordinate information between providers, clinical staff, and patients to ensure comprehensive care delivery. Manage and update patient-centered care plans in collaboration with healthcare team members. Document clinical observations, updates, and patient education in EHR. Schedule, confirm, and coordinate virtual patient encounters. Demonstrate professionalism, empathy, and effective communication skills with patients and colleagues. Efficiently oversee a caseload of 250-260 patients monthly through the completion of a minimum of 10 patient calls per day. Prioritize tasks efficiently and work effectively in a dynamic environment

MedWatch, LLC

Disease Manager RN

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Florida

The Disease Manager/Total Lifestyle Coach (TLC)/Complex Condition Manager (CCM) will have direct responsibility for managing an individual caseload using Disease, Complex Condition and Population Health Management constructs. This is a remote work from home position.

Licensure/Certification Requirements: Licensed Practical Nurse / Registered Nurse (current unrestricted, in state of practice) Experience: Minimum of three years of clinical experience including at least two years of chronic Disease Management and patient teaching in any setting preferred. Good keyboarding skills and computer literacy preferably with Microsoft Office applications and with internet. Requirements/Skills: Good organizational skills and time management  Excellent verbal and written communication skills  Ability to handle difficult situations tactfully and diplomatically.   Effective problem solving and decision-making skills.  Strong computer skills with proficiency in MS Office Suite products (Word, Excel, PowerPoint) 

The Disease Manager/Total Lifestyle Coach (TLC) will practice within the scope of his/her licensure. The Disease Manager/TLC operates under the express direction of the Supervising RN. Collect and document patient information to facilitate the patient assessment and formulation of a plan of care. Continuously gather, update and review information to include (but not limited to) collecting medical records, history, assessment information. Guide, coach and encourage the patient in following the plan of care. Instruct the participant regarding both short and long-term goals and offer guidance as to how to meet those goals. Document actions taken and interventions provided throughout the process. Collaborate with providers, payers, and participants to ensure that the participant has access to appropriate resources. Contact the payer to determine benefits and any constraints that may impact the plan of care. Access to member benefit information is available through the Group Screen in MWCMS. All programs and benefit resources are TPA and Group specific. MedWatch does not interpret benefits. The member is referred to their benefit manager at the TPA for any benefit and eligibility questions upon request. Make arrangements for quality care according to the needs of the participant, the physician’s orders and available benefits. Maintain a current up-to-date working knowledge of alternative treatments. If there are no benefits available for recommended alternative treatments, provide to the payer a cost-benefit analysis to demonstrate that extra-contractual services will enhance the participant’s medical condition and will be cost-effective to the benefit plan. Become familiar with community resources or other funding sources that will allow the participant to receive quality care and conserve health benefit dollars. Maintain documentation in the computer system. Complete all aspects of case in the computer. Maintain on-going contact with providers and participants to ensure that the participant’s needs are being met. Take actions upon any awareness of non-medical issues which involve the participant’s safety or welfare and attempts to direct the participant or family to appropriate providers or community resources, or to personally notify appropriate authorities. Consult with the Director of Population Health Management on a regular basis. Keep the director informed regarding any complaints which may occur about Disease Management services or any issues which arise which the Disease Manager is not competent to handle or does not have the expertise to handle. Use good organizational skills to manage time and resources efficiently. Use effective writing style to organize information and thoughts and present them clearly and concisely in writing for prepared reports, correspondence, etc. Use effective teaching strategies during contacts with patients by telephone and in selecting appropriate educational materials. Use effective listening techniques to identify where the patient is in their stages of behavior change and respond appropriately. Seek opportunities for personal growth and development. Remain up-to-date on health and wellness topics as well as current treatment options for chronic medical conditions. Keep abreast of new trends and practices in the field of Disease Management. Maintain a professional attitude and approach at all times using tact, courtesy, self-control, patience, loyalty, and discretion to work harmoniously with others. Maintain the ability to adapt to new situations and changing work responsibilities. Adhere to all department and company policies and procedures. Participate in onsite and offsite employee health fairs as needed. Provide individual or group teaching and/or facilitate support groups focused on a chronic disease topic. Participate in the Quality Management Program by adhering to all company policies and procedures and identifying opportunities for improvement to ensure quality services are rendered to clients and customers. The incumbent may be responsible for duties or responsibilities that are not listed in this job description. Duties and responsibilities may change at any time with or without notice. The salary for this position is $62,000.00 to $74,000.00 annually Work Environment / Physical Demands: This position is in a typical office / home office environment which requires prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment.

MedWatch, LLC

Disease Manager (Chronic Condition Case Manager)

Posted on:

April 16, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Florida

The Disease Manager (Chronic Condition Case Manager) will have direct responsibility for managing an individual caseload using Disease, Complex and Chronic Condition Management and Population Health Management constructs. This individual is expected to accurately service and satisfy customers by responding to customer inquiries, communicate benefit and healthcare questions/answers. This is a remote position.

Education: Minimum of three years of clinical experience including at least two years of chronic disease management and patient teaching in any setting preferred. Licensure/Certification Requirements: Registered Nurse (current unrestricted, in state of practice) Experience: Minimum of three years of clinical experience including at least two years of chronic disease management and patient teaching in any setting preferred. Requirements/Skills: Good keyboarding skills and computer literacy preferably with Microsoft Office applications and with internet. Must be fluent in English. Good organizational skills and time management  Excellent verbal and written communication skills  Ability to handle difficult situations tactfully and diplomatically.   Effective problem solving and decision-making skills.  Strong computer skills with proficiency in MS Office Suite products (Word, Excel, PowerPoint) 

The Disease Manager will practice within the scope of his/her licensure. Individual must speak fluent English with strong reading and writing abilities. Collect and document patient information to facilitate the initial assessment and formulation of an initial plan of care. Continuously gather, update and review information to include (but not limited to) collecting medical records, history, assessment information. Guide, coach and encourage the patient in following the plan of care. Instruct the participant regarding both short and long-term goals and offer guidance as to how to meet those goals. Document actions taken and interventions provided throughout the process. Collaborate with providers, payers, and participants to ensure that the participant has access to appropriate resources. Contact the payer to determine benefits and any constraints that may impact the plan of care. Contact providers and vendors to verify medical necessity of care or products that have been ordered. Make arrangements for quality care according to the needs of the participant, the physician’s orders and available benefits. Maintain a current up-to-date working knowledge of alternative treatments. If there are no benefits available for recommended alternative treatments, provide to the payer a cost-benefit analysis to demonstrate that extra-contractual services will enhance the participant’s medical condition and will be cost-effective to the benefit plan. Become familiar with community resources or other funding sources that will allow the participant to receive quality care and conserve health benefit dollars. Maintain documentation in the computer system. Complete all aspects of case in the computer. For fee-for-service clients: Prepare timely reports to the payer to summarize case actions, the results of those actions, and the continuing disease management plan. Maintain billing as appropriate in computer system. Adhere to standards of production goals. Maintain on-going contact with providers and participants to ensure that the participant’s needs are being met. As needed, negotiate with providers to maximize the medical benefits available to the participant. Make network referrals as appropriate. Take actions upon any awareness of non-medical issues which involve the participant’s safety or welfare and attempts to direct the participant or family to appropriate providers or community resources, or to personally notify appropriate authorities. Consult with the Director of Population Health Management on a regular basis. Keep the director informed regarding any complaints which may occur about disease management services or any issues which arise which the disease manager is not competent to handle or does not have the expertise to handle. Use good organizational skills to manage time and resources efficiently. Use effective writing style to organize information and thoughts and present them clearly and concisely in writing for prepared reports, correspondence, etc. Use effective teaching strategies during contacts with patients by telephone and in selecting appropriate educational materials. Use effective listening techniques to identify where the patient is in their stages of behavior change and respond appropriately. Seek opportunities for personal growth and development. Remain up to date on health and wellness topics as well as current treatment options for chronic medical conditions. Keep abreast of new trends and practices in the field of disease management Always maintain a professional attitude and approach using tact, courtesy, self-control, patience, loyalty, and discretion to work harmoniously with others. Maintain the ability to adapt to new situations and changing work responsibilities. Adhere to all department and company policies and procedures. Participate in onsite and offsite employee health fairs as needed. Provide individual or group teaching and/or facilitate support groups focused on a chronic disease topic. Participate in the Quality Management Program by adhering to all company policies and procedures and identifying opportunities for improvement to ensure quality services are rendered to clients and customers. The incumbent may be responsible for duties or responsibilities that are not listed in this job description. Duties and responsibilities may change at any time with or without notice. The salary for this position is $62,000 to $74,000 annually. Work Environment / Physical Demands: This position is in a typical office / home office environment which requires prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment.

MedWatch, LLC

Case Manager RN

Posted on:

April 16, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Florida

The Case Manager manages an individual caseload using the case management process in order to meet the needs of the MedWatch, LLC customers and consumers. This includes, but is not limited to, authorization of services, review of treatment plans for medical necessity, standards of care, and ongoing communication with all members of the health care team. This is a remote/work-from-home position.

License Requirements: Registered Nurse (current active and unrestricted, in state of current practice and residence, within the United States or its territories.) Education: R.N., a bachelor’s degree in a health-related field preferred. Experience: 7 years of varied clinical experience preferred.

The Registered Nurse Case Manager will practice within the scope of his/her licensure. Review all medical data which can be provided to establish, update and maintain accountability for a case management plan which will incorporate contact with providers, payers, with the patient and with the patient’s primary caregiver. Assess problems and determine goals and actions designed to meet the needs of the patient and document into the case notes. Determine if these goals are long term or short term and how the patient can be expected to meet those goals. Include the action/intervention the case manager will take to work towards achieving those goals. Make contact with the payer office to find out and understand any benefit constraints that will have an impact on the plan of action. Proceed with contacting medical care providers and with equipment vendors to verify medical necessity of care or equipment that has been ordered. Make care arrangements for quality patient care according to the needs of the patient, the physician’s orders and the benefits available. The Case Manager will work in conjunction with the Case Management Assistant to manage case management files, exclusive of Assessment and/or Care Plan activities, and will provide input in the Annual Performance Evaluation of the CM Assistant assigned. The Case Manager will maintain responsibility for the Case Management file. Be aware of any alternative treatment possibilities that may allow the patient to reach wellness goal(s). If there are no benefits available for your recommended alternative treatments, provide to the payer a cost-benefit analysis to demonstrate that extra-contractual services will enhance the patient’s medical condition and will be cost-effective to the benefit plan. Become familiar with community resources and funding sources so that the patient can receive quality health care and conserve health benefit dollars. Many agencies exist which provide assistance to persons in financial need or to provide information to persons with specific medical conditions. Maintain case in computer system documenting case actions for each patient under your case management. Complete all aspects of case in the computer. Prepare timely reports to the payer to detail all case actions, the results of those actions, and the continuing case management plan. Maintain billing as appropriate in computer system. Continue to maintain contact with the providers and with the patient across the continuum of care to be sure that patient needs are being met. On any cases which include a chronic condition keep the file open for periodic contacts to verify the clinical status of the patient and additional medical needs. Negotiate with providers to maximize the medical benefits available to the patient. Make network referral as appropriate. Act upon any awareness of non-medical issues which involve the patient’s safety or welfare. Attempt to direct the patient or family to appropriate providers or community resources, or to personally notify appropriate authorities. Consult with the CM supervisor on a regular basis, and keep the supervisor informed regarding any complaints which may occur about case management services or any issues which arise which the case manager is not competent to handle or does not have the expertise to handle. Adhere to all company policies as stated in the employee handbook. All case managers will possess a URAC-recognized certification in Case Management within 3 years of hire. Participate in the Quality Management Program by adhering to all company policies and procedures and identifying opportunities for improvement to ensure quality services are rendered to clients and customers. This position is eligible for a bonus program. Work Environment / Physical Demands: This position is in a typical home office environment which requires prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment.

MedWatch, LLC

Case Manager Assistant / LPN

Posted on:

April 16, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

LPN/LVN

State License:

Florida

The Case Manager Assistant assists the RN Case Manager in performing necessary functions using the case management process in order to meet the needs of the MedWatch, LLC customers and consumers. This includes, but is not limited to: authorization of services, review of treatment plans for medical necessity, standards of care, and ongoing communication with all members of the health care team. The Case Manager Assistant performs all functions under the direct management and supervision of the RN Case Manager. This is a Remote (work from home) position.

License Requirements: Licensed Practical Nurse or Medical Assistant/Nursing Assistant Certification (current active and unrestricted, in current state of practice and residence, within the United States or its territories) Education, Training and Professional Competencies: Licensed Practical Nursing Education preferred. Basic Computer skills Experience: 5 years of varied clinical experience preferred, or three years in a specialty field.

The Case Manager Assistant will practice within the scope of his/her licensure. The Case Manager Assistant will operate under the direct supervision of the RN Case Manager, and perform case management functions as directed by the CM, excluding Initial Case Assessments and Formulation of the Initial Care Plan. Review all medical data which can be provided to update a case management plan which will incorporate contact with providers, payers, with the patient and with the patient’s primary caregiver. Make contact with the payer office to find out and understand any benefit constraints that will have an impact on the plan of action. Proceed with contacting medical care providers and with equipment vendors to verify medical necessity of care or equipment that has been ordered. Make care arrangements for quality patient care according to the needs of the patient, the physician’s orders and the benefits available. Be aware of any alternative treatment possibilities that may allow the patient to reach wellness goal(s). If there are no benefits available for your recommended alternative treatments, provide to the payer a cost-benefit analysis to demonstrate that extra-contractual services will enhance the patient’s medical condition and will be cost-effective to the benefit plan. Become familiar with community resources and funding sources so that the patient can receive quality health care and conserve health benefit dollars. Many agencies exist which provide assistance to persons in financial need or to provide information to persons with specific medical conditions. Maintain case in computer system documenting case actions for each patient under your Assigned Case Managers caseload, under direction of the Case Manager. Complete all aspects of case in the computer. Prepare timely reports to the payer to detail all case actions, the results of those actions, and the continuing case management plan, which are reviewed by the Case Manager. Maintain billing as appropriate in computer system. Continue to maintain contact with the providers and with the patient across the continuum of care to be sure that patient needs are being met. On any cases which include a chronic condition keep the file open for periodic contacts to verify the clinical status of the patient and additional medical needs. Negotiate with providers to maximize the medical benefits available to the patient. Make network referral as appropriate. Act upon any awareness of non-medical issues which involve the patient’s safety or welfare. Attempt to direct the patient or family to appropriate providers or community resources, or to personally notify appropriate authorities in consultation with the Case Manager. Consult with the Case Manager on a regular basis, and keep the supervisor informed regarding any complaints which may occur about case management services or any issues which arise which the case manager assistant is not competent to handle, or does not have the expertise to handle. Adhere to all company policies as stated in the employee handbook. Participate in the Quality Management Program by adhering to all company policies and procedures and identifying opportunities for improvement to ensure quality services are rendered to clients and customers. Work Environment / Physical Demands: This position is in a typical home office environment which requires prolonged sitting in front of a computer. Requires hand-eye coordination and manual dexterity sufficient to operate standard office equipment including operation of standard computer and phone equipment. The salary range for this position is from $23 to $27 per hour.

Community Health Systems

RN Transfer Coordinator

Posted on:

April 16, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

The Transfer Coordinator - RN is responsible for coordinating patient transfers and admissions into and out of CHS facilities. This role performs initial admission screening using approved clinical criteria, ensuring each transfer aligns with policy and clinical standards. The Transfer Coordinator works closely with the Bed/Capacity Coordinator, hospital departments, and external healthcare providers to facilitate efficient patient flow and address barriers to patient throughput.

Qualifications: Associate Degree in Nursing required Bachelor's Degree in Nursing preferred 1-3 years of clinical nursing experience in an acute care setting required Prior experience in transfer coordination or patient flow in ED or Critical Care preferred Knowledge, Skills And Abilities: Strong clinical assessment and decision-making skills for managing patient transfers. Knowledge of healthcare regulations, including EMTALA and medical necessity guidelines. Excellent communication skills and ability to work effectively with multidisciplinary teams. Strong organizational skills with the ability to prioritize multiple tasks in a dynamic environment. Proficient in using electronic health record systems and standard office software. Ability to provide superior customer service and facilitate positive patient experiences. Licenses and Certifications: RN - Registered Nurse - State Licensure and/or Compact State Licensure in the state of Tennessee required

Coordinates all aspects of patient transfers, admissions, or consultations from referring facilities, ensuring appropriate level of care and transport. Conducts admission screening using approved criteria to verify appropriateness of care level and bed assignments. Collaborates with Bed/Capacity Coordinator to prioritize transfers, bed assignments, and ensure patient information accuracy. Acts as a liaison between physicians, healthcare providers, patients, and families to streamline the admission/transfer process. Maintains and updates the Electronic Health Record (EHR) with accurate patient transfer information and outcomes. Identifies barriers to patient throughput, tracks trends, and recommends actions to improve efficiency and patient flow. Complies with regulatory and CHS policy standards, including EMTALA and quality initiatives, while adapting processes to ensure compliance. Utilizes medical necessity criteria to evaluate admissions, ensuring bed types and patient statuses are appropriate. Builds and maintains collaborative relationships with hospital staff, nursing units, and external healthcare providers to support quality patient care. Performs other duties as assigned. Complies with all policies and standards.

Aveanna Healthcare

Aveanna Healthcare PDN - LVN : Immediate Night Opportunities Available!

Posted on:

April 16, 2025

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

Compact / Multi-State

Join a Company That Puts People First! Licensed Practical / Vocational Nurse – LPN/LVN Night Shifts We Currently Have Patients And Openings In We are one of the largest private duty nursing companies in the nation and growing! At Aveanna, we’re proud to foster a workplace culture that celebrates diversity, encourages connection, and supports our team members every step of the way. Here’s what sets us apart: North Austin Pflugerville Round Rock Georgetown Surrounding Areas Award-Winning Culture Indeed’s Work Wellbeing Top 100 Company in 2024 Best Company for Work-Life Balance, Happiest Employees and Culture and Best CEO in 2024, as ranked by Comparably We consider it both a privilege and an honor when we welcome a new patient into our Aveanna family. Our homecare is always delivered from a place of heartfelt compassion and empathy, and every one of our Licensed Practical / Vocational Nurses (LPN/LVN)s works together to make sure we achieve outstanding clinical outcomes. Aveanna isn’t just a provider of compassionate homecare to children and adults. We are a national leader.

The Licensed Practical Nurse (LPN/LVN) is responsible for providing and documenting skilled nursing care, under the supervision of a Registered Nurse, in accordance with the developed care plan and physicians orders for each individual patient while adhering to confidentiality standards and professional boundaries at all times.

Must have and maintain an active, unencumbered license (LPN/LVN) in the state in which the clinician will practice Compact licenses must be transferred to your state of residence within 90 days Current CPR certification (with hands-on component)- Aveanna can assist in obtaining this requirement after hire, if necessary. TB skin test (current within last 12 months) Six months prior hands-on nursing experience preferred but not required Must have reliable transportation Requirements: Graduate of an accredited school of nursing. Current, unrestricted state license as a Licensed Nurse in the state of practice Current CPR certification Demonstrated proficiency in clinical assessments, documentation and compliance with nursing care and policies and procedures Additional State Specific Requirements: South Carolina – One (1) year of pediatrics experience California – One (1) year of experience required working under current nursing license Louisiana – One (1) year of experience required working as a licensed nurse Continuing Education as required by state Preferences: Six (6) months of recent experience as a Licensed Nurse in a clinical care setting Home health experience Other Skills/Abilities: Attention to detail Time Management Effective problem-solving and conflict resolution Good organization and communication skills Physical Requirements: Must be able to speak, write, read and understand English Must be able to travel Must be able to lift 50 pounds Must be able to sufficiently reposition patients and move equipment without assistance Prolonged walking, standing, bending, kneeling, reaching, twisting Must be able to sit and climb stairs Must have visual and hearing acuity Must have strong sense of smell and touch Must be able to sufficiently reposition patients and move equipment without assistance Must be able to appropriately respond physically and mentally to emergency situations in the home or during transport Environment: Must be able to function in a wide variety of environments which may involve exposure to allergens and other various conditions Possible exposure to blood, bodily fluids and infectious diseases Other Duties: Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Responsible for the delivery and coordination of quality patient care in compliance with physician orders. Continuously observes and assesses patient condition and care needs and reports changes in condition to the supervisor and/or physician as appropriate. Documents all activities, assessments, nursing actions, responses and coordination of care in a timely manner whenever care is delivered. Participate, implement and update the nursing care plan. Takes appropriate nursing action based on assessment and achieves expected outcomes. Recognizes changes in patient needs and responses requiring intervention and implements care to prevent risk or reduce risk. Accepts responsibility for personal and professional accountability by complying with Aveanna policies, state and federal regulations, accrediting bodies and the Nurse Practice Act. Provide care utilizing infection control measures that protect both the staff and the patient according to OSHA standards. Educates the patient and family regarding the disease process, self-care techniques, and prevention strategies, and in meeting the patient’s nursing needs. Maintain knowledge of competencies related to the nursing profession by participating in educational programs, continued education units, internal learning management skills and skill evaluations.

SPECTRAFORCE

RN Managed Care Coordinator (Remote after training)

Posted on:

April 16, 2025

Job Type:

Contract

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

Established in 2004, SPECTRAFORCE is one of the largest and fastest-growing diversity-owned staffing firms in the US. SPECTRAFORCE is built on the concept of “human connection,” defined by our branding tagline NEWJOBPHORIA®, which is the excitement of bringing joy and freedom to the work lifestyle so our people (and clients) can reach their highest potential. Our entire workflow cultivates NEWJOBPHORIA® with candidates and employees throughout their engagement with SPECTRAFORCE. http://www.spectraforce.com

Job Title: Managed Care Coordinator I Location: Columbia, SC 29203 (Onsite training and then remote) Duration: 3 months assignment with possible conversion Pay rate: $30/hr

Active and unrestricted RN license for the state of South Carolina or compact license. Minimum of 2 years of clinical experience.

Evaluate medical eligibility for benefits and clinical criteria, applying clinical expertise and administrative policies. Provide health management program interventions for members managing health, chronic illness, or acute illness. Active case management, assess service needs, develop action plans, and monitor outcomes.

Davies

Triage Nurse Case Manager

Posted on:

April 16, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Alabama

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

Imagine being part of a team that’s not just shaping the future but actively driving it. At Davies North America, we’re at the forefront of innovation and excellence, blending cutting-edge technology with top-tier professional services. As a vital part of the global Davies Group, we help businesses navigate risk, optimize operations, and spearhead transformation in the insurance and regulated sectors. We're on the lookout for a Triage Telephonic Case Manager to join our growing team! As a Triage Telephonic Case Manager, you will be responsible for the management and independent decision making on Workers’ Compensation medical claims at the outset of the claim. You will perform an initial assessment of the injured worker to ensure high quality of care and reduce recovery time to promote an appropriate, prompt return-to-work, according to parameters identified to meet required performance standards.

Skills, knowledge & expertise: Licensed RN with a minimum of three years of clinical experience (medical-surgical, orthopedic, neurological, ICU, industrial, or occupational) Workers’ Compensation and Case Management experience preferred Proficiency with Microsoft Office Suite and various other business software programs Other Skills and Abilities: Proactive, independent, and takes initiative with consistent follow through Superb communication skills, verbal and written, conducted in a timely manner Superior time management skills with capability of working with and meeting deadlines Exceptional capability to multi-task and prioritize with excellent organization and documentation skills in a fast-paced, dynamic work environment High level attention to detail and problem-solving skills Capable of working collaboratively and independently with minimal supervision Exhibit discretion with sensitive and confidential information Ability to adapt to new technologies quickly Customer service orientation, with a track record of resolving client issues efficiently and effectively Proven ability to mentor and train team members, fostering a collaborative and productive work environment

Provide triage case management in a Workers’ Compensation environment at the initial report of the claim while focusing on medical appropriateness of care to the injured worker with cost savings by coordination and utilization of all services, ensuring that as soon as medically feasible, return-to-work status is achieved Utilize keen clinical assessment skills to ascertain all pertinent information from the injured employee to facilitate appropriate care Clinically evaluate the recovery needs of an injured employee after the initial contact assessment Incorporate information obtained from the employer and provider into the initial plan Identify causal relationship issues and document the system notifying all appropriate parties Participate in the daily functioning of a round-the-clock intake call center, ensuring expedient care to the injured employees and being knowledgeable of all functions of the department Facilitate communication between the employee, the employee representative, employer, employer representative, insurer, health care provider, and the medical services organization and when authorized, any qualified rehabilitation consultant Identify barriers to recovery and document for future case planning Develop initial case-management care plan Appropriately document all data received from interviews, contacts and medical records in the computerized system Address the initial return-to-work capability with the injured worker and provider at each medical evaluation and document appropriately in computerized system Identify when initial treatment does not adhere to treatment guidelines and utilization criteria as determined by the state-mandated guidelines, proprietary and nationally published protocols, as well as account requirements, assuring smooth delivery of services to the injured worker Create, edit and/or revise correspondence in the system as necessary Assist with the tracking protocol management for appropriate utilization and delivery of medical services; outcomes will be evidenced by patient satisfaction, appropriate delivery and quality of care and timely recovery per evidence-based criteria and clinical guidelines Manage the file proactively, utilizing all appropriate case management tools Anticipate health needs during case management process and educate patient and family appropriately while encouraging the injured worker to participate in the recovery plan Maintain patient privacy by ensuring that all medical records, case specific information and provider specific information are kept in a confidential manner, in accordance with state and federal laws and regulations Serve as a patient advocate adhering to all legal, ethical and accreditation/regulatory standards Serve on appropriate committees such as the Quality Assurance and others as directed May negotiate fees with providers or channel cases to other vendors as appropriate Perform other duties as requested

Point C

Case Management Nurse

Posted on:

April 16, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

LPN/LVN

State License:

Illinois

Point C is seeking a compassionate and detail-oriented Case Management Nurse to support patients on their journey to better health and well-being. In this role, you’ll serve as a critical liaison between patients, providers, care teams, and community resources—ensuring continuity of care and adherence to treatment plans.

Current standing as a licensed practical nurse (LPN) (required) 5 years of experience in a clinical or community resource setting/care coordination Case Management experience is preferred Highly organized with ability to keep accurate notes and records Evidence of essential leadership, communication, education and counseling skills Proficient computing skills and the ability to learn new systems Exemplary telecommunication skills Maintains high level of professionalism and confidentiality Maintains reliable and punctual attendance

Create and promote adherence to treatment plans, as developed by patients’ healthcare providers Create and maintain accurate, detailed clinical patient reports for clients and carriers Monitor and document adherence to treatment plans, evaluate effectiveness, monitor patient progress in a timely manner Increase continuity of care by managing relationships with tertiary care providers, transitions-in-care, and referrals Increase patients’ ability for self-management and shared decision making Increase comprehension through culturally and linguistically appropriate education Assist with medication reconciliation Connect patients to relevant community resources, with the goal of enhancing patient health and wellbeing. Serve as the contact point, advocate, and informational resource for patients, care team, family/caregiver(s), stop-loss carrier, and community resources Assess a patient’s unmet health and social needs Acknowledges patient’s right on confidentiality issues, always maintains patient confidentiality and follows HIPAA guidelines and regulations

National Care Advisors

Nurse Consultant

Posted on:

April 16, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

NCA is in search of an experienced Field Nurse Case Manager based near the following locations: San Francisco, CA San Jose, CA Modesto, CA Los Angeles, CA Portland, OR Las Vegas, NV Phoenix, AZ

Bachelor of Science in Nursing (BSN) required, CCM or CRRN preferred Minimum of 5 years clinical Nursing experience – experience in field case management or workers’ compensation case management, preferred Experience with third-party benefits – health insurance, Medicaid, Social Security, Developmental Disability services Excellent communication skills – written and verbal Highly motivated self-starter comfortable working in a virtual company/office, with solid time management and organization skills Proficient in using MacOS and a variety of related software applications (including MS Office) Strong ability to quickly learn and adapt to new technologies and tools in a Mac environment Proven ability to collaborate as necessary to accomplish goals and work through conflicts Ability to research and develop solutions to challenges presented by the client Excellent customer service skills Overnight travel required regionally 1-2 times per month and occasional nationwide travel Willingness to meet timely documentation requirements

This position will be responsible for regional case management services responsive to special needs and elder client care and quality of life challenges. This position requires collaboration with the primary family caregivers, attorneys, financial planners and trustees that are also serving the client.

IHA

Call Center Triage Nurse - RN Remote Opportunity

Posted on:

April 16, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Michigan

Contingent weekends only 8a-4p or 4p-12a. Four 8 hr shifts per monthReq #: 16466 Call Center positions offer a $3 shift differential after 5pm and on the weekends! Contingent Schedule: Weekends only 8a-4p or 4p-12a Four - 8 hour shifts per month Holiday rotation is required REMOTE REQUIREMENTS: MUST COMPLETE IN-PERSON TRAINING IN ANN ARBOR, MI MUST BE AVAILABLE FOR IN-PERSON MEETINGS AND TRAINING WHEN NECESSARY MUST HAVE VALID STATE OF MICHIGAN RN LICENSE POSITION DESCRIPTION: Promptly answers incoming IHA patient telephone calls or makes outbound calls and responds to IHA patient health-related questions over the telephone. Follows established and approved Call Center clinical work processes and protocols for addressing and/or directing patient for appropriate care. Works within Clinical Support Staff Scope of Practice document.

MEASURED BY: Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position. ESSENTIAL QUALIFICATIONS: EDUCATION: Bachelor’s degree/graduate of an accredited Registered Nursing 2-year program in combination with prior triage experience. CREDENTIALS/LICENSURE: Valid, unrestricted RN license in the State of Michigan. Valid CPR certification. MINIMUM EXPERIENCE: 1-2 years of clinical experience in a medical or physician office. POSITION REQUIREMENTS (ABILITIES & SKILLS): Ability to demonstrate appropriate use of written clinical protocols. Must have basic knowledge and understanding as to the methods for obtaining patient vital statistics (height, weight, accurate blood pressure, temperature, etc.) and the relevance of this information to the patients’ health history. Proficient/knowledgeable in medical terminology with ability to demonstrate appropriate use of written clinical protocols. Proficiency in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, EPIC, email, e-learning, intranet and computer navigation. Ability to use other software as required while performing the essential functions of the job. Excellent communication skills in both written and verbal forms, including proper phone etiquette. Ability to work collaboratively in a team-oriented environment; displays courteous and friendly demeanor. Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, providers, patients, vendors, family members, outside customers and community groups. Ability to cross-train in other areas of practice in order to achieve smooth flow of all operations. Good organizational and time management skills to effectively juggle multiple priorities, time constraints and ever-changing medical situations. Ability to exercise sound judgement and problem-solving skills. Ability to perform mathematical calculations needed during the course of performing basic job duties, i.e.: calculating proper dosages for immunizations. Knowledge of the compliance aspects of clinical care and patient privacy and best practices in medical office operations. Ability to handle patient and organizational information in a confidential manner. Successful completion of IHA competency-based program within introductory and training period. MINIMUM PHYSICAL EXPECTATIONS: Physical activity that often requires keyboarding, phone work and charting. Physical activity that often requires time working on a computer. Physical activity that sometimes requires lifting up to 20 lbs. Physical activity that often requires, walking, bending, stooping, reaching, climbing, kneeling and/or twisting. Specific vision abilities required include close vision, depth perception, color vision, peripheral vision and the ability to adjust and focus. Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English.

Receives incoming telephone calls and/or makes outbound calls to patients who have left a message with the call center; collects key health data from patient and triages/assesses patient telephone calls with strict adherence to approved Call Center protocols. May provide medical advice for the condition presented over the phone; ensures that advice is within the scope of the role and in accordance with Call Center protocol for the patient’s condition. Identifies emergent medical and/or related patient situations and assists patients by assessing appropriate level of care required. If in question, errs on side of higher level of care if unable to clarify; uses Call Center protocols for emergent medical conditions presented. Understands and adheres to Call Center processes for paging on-call physicians as necessary; May consult with physicians, mid-level providers, and other team members as appropriate to ensure quality patient care is maintained. Appropriately schedules patient appointments; obtains required information and provides necessary documentation. Accurately completes all necessary tasking. Refills medications for 30-day supply per Adult and Pediatric protocols. Orders medications and updates the medication module per Adult and Pediatric protocols. Assists Care Managers in scheduling hospital discharge appointments on weekends and holidays. Receives and processes STAT and critical labs; notifies Provider as per protocol. Refaxes lab and radiology requisitions. Runs PRISM report, makes patient post discharge calls and schedules follow up office visits per protocol. Accurately completes the call center tool. Uses the call log and on-call MD calendar accurately and appropriately. Documents complete and accurate patient records related to calls received, data collected, services rendered, follow-up provided, and/or outcomes as described by the patient or family. Directly enters medication, laboratory, and radiology orders into the electronic medical record per state, local and professional guidelines. Facilitates office quality/performance incentive initiatives. Performs other duties as assigned and works within scope of RN or LPN licensure as outlined on the Clinical Support Staff Scope of Practice document. ORGANIZATIONAL EXPECTATIONS: Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the mission and values of both IHA and Trinity Health. Must be able to work effectively as a member of the clinical care team. Successfully completes IHA’s “The Customer” training and adheres to IHA’s standard of promptly providing a high level of service and respect to internal or external customers. Maintains knowledge of and complies with IHA standards, policies and procedures. Maintains complete knowledge of office services, call center processes and procedures, and in the use of all relevant office equipment, computer and manual systems. Maintains strict patient and employee confidentiality in compliance with IHA and HIPAA guidelines. Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities. Embraces new ideas and respects cultural differences. Uses resources efficiently. If applicable, responsible for ongoing professional development – maintains appropriate licensure and continuing education credentials, participates in available learning opportunities.

IHA

Service Center RN - Behavioral Health REMOTE OPPORTUNITY

Posted on:

April 16, 2025

Job Type:

Part-Time

Role Type:

Behavioral Health

License:

RN

State License:

Michigan

Part Time 24 hoursReq POSITION WILL BE REMOTE AFTER 6 MONTHS OF IN-OFFICE TRAINING IN ANN ARBOR MICHIGAN IS COMPLETED. MUST HAVE CURRENT MICHIGAN RN LICENSE MUST BE ABLE TO COMMUTE TO ANN ARBOR MICHIGAN FOR MEETINGS AND TRAININGS WHEN NEEDED POSITION DESCRIPTION: Provides professional nursing care for patients following established standards and practices, which can include triage (telephone and walk-in visits), and care needs that transpire between office visits. Demonstrates professional clinical leadership and oversight within the scope of the RN role.

MEASURED BY: Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position. ESSENTIAL QUALIFICATIONS: EDUCATION: Graduate of an accredited Registered Nurse program. CREDENTIALS/LICENSURE: Valid, unrestricted RN license in the State of Michigan. Valid CPR certification. MINIMUM EXPERIENCE: 1-2 years of clinical experience in a medical or physician office preferred. Previous nursing experience not required. POSITION REQUIREMENTS (ABILITIES & SKILLS): Demonstrated competency in obtaining accurate patient vital statistics (height, weight, blood pressure, temperature, etc.) and patient health history. Must have basic knowledge and understanding as to the relevance of patient vital statistics to the patients’ health history. Proficient/knowledgeable in medical terminology. Proficiency in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, email, e-learning, intranet and computer navigation. Ability to use other software as required while performing the essential functions of the job. Excellent communication skills in both written and verbal forms, including proper phone etiquette. Ability to work collaboratively in a team-oriented environment; courteous and friendly demeanor. Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, providers, patients, vendors, family members, outside customers and community groups. Ability to cross-train in other areas of practice in order to achieve smooth flow of all operations. Good organizational and time management skills to effectively juggle multiple priorities, time constraints and ever-changing medical situations. Ability to exercise sound judgement and problem-solving skills. Ability to perform mathematical calculations needed during the course of performing basic job duties, i.e.: calculating proper dosages for immunizations. Knowledge of the compliance aspects of clinical care and patient privacy and best practices in medical office operations. Ability to handle patient and organizational information in a confidential manner. Ability to travel to other office/practice sites and meeting and training locations. Successful completion of IHA competency-based program within introductory and training period. MINIMUM PHYSICAL EXPECTATIONS: Physical activity that often requires keyboarding, phone work and charting. Physical activity that often requires time working on a computer. Physical activity that often requires lifting over 50 lbs. Physical activity that sometimes requires handling and lifting patients, transferring patients to gurney using slide board, assisting patients with dressing/undressing, transferring patients to wheelchair using gaitbelt, walking, bending, stooping, reaching, climbing, kneeling and/or twisting. Physical activity that sometimes requires lifting, pushing and/or pulling up to 100 lbs. Specific vision abilities required include close vision, depth perception, color vision, peripheral vision and the ability to adjust and focus. Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English.

The following job functions may not be the responsibility of all RN’s. Some RN’s will be assigned work that has more focused responsibilities (example: prior authorizations or indirect work supporting a provider inbox.) Responsible for efficiently triaging patient needs via telephone and during visits according to IHA's Policies and Protocols. Documents clinical findings in a clear and concise manner according to IHA Policy. Utilizes critical thinking skills within the scope of licensure to appropriately assess patient needs and involves providers as appropriate. Enters orders (medication, laboratory, radiology, referrals) according to provider direction and as per state, local and professional guidelines. Follows clinical and nursing protocols as applicable. Schedules patient appointments as applicable. Encourages patient portal usage and supports where needed. Provides scope-appropriate nursing education during all patient interactions. Consults with providers and other extended care team members (Care Management, Embedded Pharmacy, Behavioral Health and Nutrition) and external case managers as appropriate to effectively ensure quality patient care. Supports physician and advanced practice providers with indirect work according to protocol. This includes and is not limited to test results/orders management. Assesses patients for gaps in care for preventative and disease management needs. Ensures patient medication list is accurate, completes medication reconciliation and processes refill requests per protocol. Works with the entire care team to co-manage indirect patient work according to Standard Work Instructions. Collaborates with insurance, DME, home care and all other care partners to ensure patient needs are met. Reviews patient medical history to identify supporting documentation relevant to ordered services and procedures to assist with or complete prior authorization process. Assists patients with resources for any social influences of health needs. Participates in process improvement projects within the office/department. Serves as a resource to clinical office/department staff within scope of RN role; may direct the work of LPN and Medical Assistant staff as needed and appropriate based on role/scope. May perform clinical support tasks as outlined on the Clinical Support Staff Scope of Practice document. Supports other offices, attends required meetings and training, and participates in committees as requested. Attends weekly patient care meetings and attends daily huddles as applicable. Assumes additional duties as required. ORGANIZATIONAL EXPECTATIONS: Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the IHA CARES mission and core values statement Must be able to work effectively as a member of the clinical care team. Successfully completes IHA’s “The Customer” training and adheres to IHA’s standard of promptly providing a high level of service and respect to internal or external customers. Maintains knowledge of and complies with IHA standards, policies and procedures, including IHA’s Employee Handbook. Maintains complete knowledge of office services and in the use of all relevant office equipment, computer and manual systems. Maintains strict patient and employee confidentiality in compliance with IHA and HIPAA guidelines. Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities. Embraces new ideas and respects cultural differences. Uses resources efficiently. If applicable, responsible for ongoing professional development – maintains appropriate licensure and continuing education credentials, participates in available learning opportunities.

Med-Metrix

QA Auditor: Appeals and Grievances (Remote) - RN or LPN

Posted on:

April 16, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

New York

The QA Auditor performs audit functions across Client Teams to determine operational efficiency, adherence to internal processes and procedures as well as regulatory requirements, and achievement of quality standards. This role requires an in-depth understanding of the denials management process, a clinical background, attention to detail, and the ability to effectively assess the quality of work completed. The QA Auditor will work closely with internal teams to provide feedback, maintain high standards of quality, and ensure compliance with established processes.

Qualifications: State Licensed LPN or RN In-Depth Knowledge of Denials Management: Strong understanding of the denials management process, including common causes of denials and strategies for resolution. Relevant Prior Work Experience: May include medical records review, claims processing, utilization/case management in a clinical practice or managed care organization, Clinical Appeal Writer, etc. Proficiency in Microsoft Office: Advanced knowledge of Microsoft Word, Excel, and Teams for communication, data analysis, and reporting. Adaptability and Learning Ability: Ability to quickly learn and effectively navigate multiple software systems, providing accurate and timely feedback. Attention to Detail: Strong analytical skills with the ability to detect issues, inconsistencies, and areas for improvement in the denials management process. Communication Skills: Excellent written and verbal communication skills, with the ability to present findings clearly and professionally along with the ability to build and maintain positive relationships with cross-functional teams and interact with all levels of management. Organizational Skills: Ability to manage multiple audits simultaneously while maintaining accuracy and efficiency. Preferred Qualifications: Experience working in a healthcare or insurance environment, particularly with claims and denials management. Familiarity with common claims management and denial resolution systems. Experience in quality auditing or process improvement initiatives. Familiarity with MCG and Interqual guidelines and processes. Working Conditions: Ability to travel to other office locations and company events as needed Ability to arrive early or stay late as needed 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.

Audit Denials Management Processes: Conduct regular audits of work performed by appeal writers and automated processes to ensure adherence to internal policies and quality standards in the denials management process. Review and Analyze Denials: Evaluate how denials are handled, ensuring that all necessary steps are followed, documentation is accurate, and appropriate actions are taken. Identify defects and improve departmental performance by supporting quality, operational efficiency and production goals. Provide Feedback and Recommendations: Offer constructive feedback to appeal writers based on audit results, identifying areas for improvement and providing guidance on corrective actions. Provide feedback on automated processes to ensure the highest levels of efficiency in overturning denials. Documentation and Reporting: Maintain accurate records of audit findings and track trends or recurring issues in the denials management process. Prepare reports to share with management and relevant teams. Develops strategies for business performance improvement initiatives. This includes: identifying opportunities for improvement, problem prioritization, and creating performance improvement plans for non-compliant audits and/or reports System Navigation: Utilize and navigate multiple internal systems (e.g., claims processing systems, communication tools) to review audit data and provide feedback. Adapt to new systems as necessary. Collaborate Across Teams: Work closely with appeal writers, managers, and other stakeholders to foster a collaborative approach to quality improvement and process optimization. Additional duties as assigned

Actalent

Remote Pediatric LPN Care Manager

Posted on:

April 16, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Florida

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

Provide day-to-day care management activities, including calling members, completing member assessments, developing care plans, and assisting with member needs. Support the care management team and communicate with supervisors daily.

Essential Skills: Licensed Practical Nurse (LPN) or Registered Nurse (RN) certification. Proficiency in case management. Experience in pediatrics and acute care. Strong computer skills, including proficiency in Microsoft Suite. Ability to effectively communicate and demonstrate time management skills. Ability to create and interpret care and treatment plans. Additional Skills & Qualifications: Experience in managed care. Work Environment: Work hours are Monday through Friday from 8 AM to 5 PM, totaling 40 hours per week. The position is fully remote. A strong Wi-Fi connection, dedicated workspace, and smart device are required.

Call members to assess their needs and provide support. Complete member assessments and develop care plans. Assist members with their needs and coordinate with the care management team. Communicate regularly with supervisors to ensure effective care management.

Availity

Utilization Management Nurse Analyst (Remote)

Posted on:

April 15, 2025

Job Type:

Part-Time

Role Type:

Utilization Review

License:

RN

State License:

Florida

Availity delivers revenue cycle and related business solutions for health care professionals who want to build healthy, thriving organizations. Availity has the powerful tools, actionable insights and expansive network reach that medical businesses need to get an edge in an industry constantly redefined by change. At Availity, we're not just another Healthcare Technology company; we're pioneers reshaping the future of healthcare! With our headquarters in vibrant Jacksonville, FL, and an exciting office in Bangalore, India, along with an exceptional remote workforce across the United States, we're a global team united by a powerful mission. We're on a mission to bring the focus back to what truly matters – patient care. As the leading healthcare engagement platform, we're the heartbeat of an industry that impacts millions. With over 2 million providers connected to health plans, and processing over 13 billion transactions annually, our influence is continually expanding. Join our energetic, dynamic, and forward-thinking team where your ideas are celebrated, innovation is encouraged, and every contribution counts. We're transforming the healthcare landscape, solving communication challenges, and creating connections that empower the nation's premier healthcare ecosystem.

The position of UM Nurse Analyst will report to the Medical Director of Availity’s Auth AI solution. The UM Nursing Analyst is responsible for the interpretation of payer medical policy guidelines and the construction of NLP/AI–enabled decision trees that accurately reflect medical necessity criteria. The role requires in-depth knowledge of utilization management principles, the role and purpose of medical necessity guidelines and prior authorization adjudication practices. This individual will work in a team environment and will be expected to perform highly complex tasks while collaborating with team members with both clinical and engineering/programming backgrounds. The successful candidate will be detail oriented with strong analytic reasoning skills, demonstrate strong communication and organizational skills while remaining open-minded, embracing change and the spirit of innovation. Sponsorship, in any form, is not available for this position. Location: Remote, US Why you want to work on this team: Dynamic, collaborative group working on innovative technologies to disrupt the status quo and solve the problem of prior authorization in healthcare. Opportunity to work directly on cutting edge AI technology and its application to the healthcare industry.

Bachelor’s degree in nursing. At least 3+ years of experience in an outpatient Utilization Management program, either with an insurer or with a healthcare provider OR equivalent clinical experience with familiarity with prior authorization submission practices. Additional experience in fields of billing / coding, claims review or inpatient utilization management, while not necessary, would enhance the application. “Computer smart” – General power user of technology and confident with navigating new technologies and applications. Familiarity and understanding of interpreting medical records to be able to identify how physicians may document conditions and findings. You will set yourself apart: If you have exceptional critical thinking and reasoning skills. If you can synthesize complex, abstract problems, and collaborate effectively with team members with diverse skillsets to create solutions. If you are self-motivated and a quick learner with an ability to multi-task.

Reviewing payer Medical Policy Guidelines to identify pertinent medical necessity criteria related to specific Procedural codes or CPT codes. Use programming language to construct attestation questions that reflect medical necessity criteria. Assign coded medical constructs to attestation trees based on clinical relevance to facilitate automation of responses to the questions. Identify medical terms that should be added to the existing vocabulary of coded medical concepts. Serve as Subject Matter Expert and general medical resource to engineering teams and developers

Frederick National Laboratory for Cancer Research

Clinical Research Nurse III

Posted on:

April 15, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Maryland

The Frederick National Laboratory is operated by Leidos Biomedical Research, Inc. The lab addresses some of the most urgent and intractable problems in the biomedical sciences in cancer and AIDS, drug development and first-in-human clinical trials, applications of nanotechnology in medicine, and rapid response to emerging threats of infectious diseases. Accountability, Compassion, Collaboration, Dedication, Integrity and Versatility; it's the FNL way.

Within Leidos Biomedical Research Inc., the Clinical Monitoring Research Program Directorate (CMRPD) provides strategic, operational, and program/project management support to domestic and international clinical research initiatives sponsored by the National Cancer Institute (NCI), the National Institute of Allergy and Infectious Diseases (NIAID), and various other institutes within the National Institutes of Health (NIH). CMRPD’s services are strategically aligned with the program’s mission to provide comprehensive, dedicated support to assist NIH researchers in providing the highest quality of clinical research that complies with applicable regulations and guidelines, maintains data integrity, and protects human subjects. These clinical trials investigate the prevention, diagnosis, and therapeutic treatment of cancer, influenza, HIV, and other diseases and disorders. CMRPD is providing support to NCI’s Division of Cancer Treatment and Diagnosis (DCTD) Virtual Clinical Trials Office (VCTO) pilot. The pilot aims to determine if participant enrollment to NCI clinical trials, particularly for minority and underserved populations, can be improved by establishing a team of virtual research support staff to provide remote, centralized support to U.S. NCI research sites, including those sites participating in the NCI Community Oncology Research Program (NCORP). The remote support team will supplement and compliment the clinical site staff at NCI research sites to offset clinical-trial specific activities, including subject screening, enrollment, and data entry. A research nurse is required to implement and lead the VRS team in support of this program. The position is 100% remote. Candidates must reside in the U.S.

Possession of a Bachelor’s degree from an accredited college or university according to the Council for Higher Education Accreditation (CHEA) in a related field. Foreign degrees must be evaluated for U.S. equivalency. Possession of a current unencumbered professional license as a Registered Nurse (RN) from any U.S. state. In addition to educational requirements, a minimum of five (5) years of progressively responsible, relevant nursing experience in clinical research, including directly managing multiple concurrent projects and patient data systems, as well as an advanced understanding of clinical trial protocol operations and design. Advanced to expert clinical research nursing experience in adult oncology. Working knowledge and understanding of: Biological principles and scientific methods International Conference on Harmonization/Good Clinical Practices (ICH/GCP) guidelines, clinical research concepts, regulatory, ethics, processes, and clinical protocol implementation Cancer pathophysiology, treatment modalities and side effects Technical proficiency using: Cloud–based clinical trial data management systems (i.e., Medidata Rave) and enrollment tracking systems (e.g., OPEN) Electronic health record systems (e.g., Epic, Cerner, etc.) Microsoft Office products (e.g., Excel, Word) Online/virtual platforms (e.g., Webex, Zoom, MS Teams) Highly effective: Interpersonal and cross-cultural communication skills (written, verbal, non-verbal, and virtual) Organizational skills with the ability to prioritize and manage multiple tasks with a high degree of accuracy and attention to detail Planning, and problem-solving skills Computer skills Ability: Ability to work effectively, both independently and collaboratively, with ability to motivate team members, track progress, and contribute to the team’s performance Identify trends and appropriately escalate findings Demonstrate strong initiative, accountability, and reliability Multidirectional leadership Manage customer relationships Troubleshoot basic IT problems Ability to obtain and maintain a security clearance. PREFERRED QUALIFICATIONS: Candidates with these desired skills will be given preferential consideration: Prior experience with: Study coordination NCTN trials Performing user acceptance trainings Epic, Cerner, OPEN, Medidata Rave, OnCore, Velos eResearch, Complion Professional Certification in Oncology and Clinical Research

Collaboration and Leadership: Serves as the clinical expert for a team of clinical research professionals, providing education to team members on disease processes, treatment modalities, and best practices Coordinates with team leads to perform routine quality control checks, communicates findings, and provides staff education/training to improve team performance Provides coverage for team leads, including leading team and site meetings Works with pilot administrative leadership to coordinate, implement, and monitor pilot expansion Identifies and implements additional opportunities to further minimize the research burden on the clinical site research staff and study participants Works with clinical site staff to coordinate care and provides education on research needs/requirements and VCTO procedures Ability to adapt to evolving requirements and willingness to perform a variety of tasks that may be required to launch and implement the VCTO program Participant Identification, Screening, and Enrollment: Communicates with potential clinical trial participants and referring providers about the screening and enrollment process Facilitates the procurement of outside medical records and materials, and appropriately organize and file those materials Reviews participant materials to appropriately advise local teams on potential participant eligibility for protocols Documents screening and enrollment activities in appropriate databases (e.g., NCI Oncology Patient Enrollment Network, also known at OPEN) Participant Management: Assists with participant retention efforts Reviews medical records to identify con-meds and AEs/unanticipated problems/SAEs Provides medical coding to ensure standardization of terminology and grading Tracks AEs/SAEs through end of event Maintains accurate con-meds and problem lists Assists study sites with follow-up AE/SAE reporting requirements and close-out procedures Data Management: Completes the collection and entry of research participant data and study-related information sourced from the Electronic Health Record (e.g., Epic, Cerner, etc.) into electronic clinical data capturing systems (e.g., eCRFs, Medidata Rave, REDCap) and clinical trial management systems (e.g., OnCore, Florence e-Reg, Velos eResearch, Complion, etc.) timely and accurately to ensure data integrity Tracks and confirms source materials (i.e., images, path) and submit for protocol-defined processing Files and maintains records in accordance with protocol and site-specific guidance Evaluates clinical data for accuracy and completeness while ensuring the safety and confidentiality of clinical trial participant data Collaborates with local site staff and remote VCTO team members to resolve queries to meet protocol requirements in an efficient and effective manner Alerts site study teams to adverse events, abnormal outcomes, or problematic trends, specifically regarding protocol requirements Protocol Coordination: Assists in the preparation of regulatory and protocol-specific documents Edits protocol template documents to add site-specific language and confirms consistency across all protocol documents Helps to ensure proper and timely filing of protocol amendments, annual reports, and other regulatory documents to the IRB and NCI Tracks and manages IRB submissions Enters study coordinators progress notes Assists with study start-up and closure

Wellbox Health

Remote Chronic Care Coordinator - LPN (PST/MST)

Posted on:

April 15, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Compact / Multi-State

Wellbox is a rapidly growing healthcare company focused on empowering people to live healthier lives through comprehensive preventative care solutions delivered by an elite team of experienced nurses. We are currently seeking tech-savvy LPN Patient Care Coordinators to conduct monthly telephonic outreach to chronically ill patients, developing personalized care plans that address their health challenges.

We are seeking full-time LPN team members who can work 40 hours per week, between the hours of 8 am – 6 pm PST/MST, Monday – Friday. Pay Structure Orientation + Training (First two months): $20 hourly. Post-Orientation: $22 hourly, plus bonus incentive. Monthly Bonuses up to $525. Referral Bonuses up to $1000.

Active Compact LPN License. Minimum two years of clinical experience; care coordination experience preferred. Proficient with Electronic Medical Records and Microsoft Office. Excellent communication and problem-solving skills. Candidates who reside in Mountain Standard Time (MST) are preferred; candidates in Pacific or Central time zones will also be considered.

Manage patients’ healthcare needs via virtual phone conversations. Document visits using technology platforms and EHRs. Develop personalized care plans addressing physical, mental, and preventative health. Coach patients on treatment plans, including nutrition and wellness. Connect patients with resources and prepare them for medical appointments.

Red River Pharmacy Services

Part Time LPN

Posted on:

April 15, 2025

Job Type:

Part-Time

Role Type:

License:

LPN/LVN

State License:

Akansas

Red River Pharmacy is seeking a dedicated, skilled, and compassionate Licensed Practical Nurse (LPN) with IV therapy experience to meet our growing patient census. The LPN is responsible for providing care to assigned patients under the supervison of a Registered Nurse (RN) and in accordance with the patient’s plan of care in the home and clinical setting. The ideal candidate is confident with basic IV therapy, patient education, and is willing to travel.

Graduate of an accredited school of nursing and current LPN state license. At least one year of recent nursing experience. Effective interpersonal, time management and organizational skills. Strong communication skills in speaking and writing. Ability to recognize and direct information to the appropriate health care provider. Computer skills that include word processing, and efficient use of the internet and e-mail. Current CPR card, valid driver’s license, reliable transportation, automobile

Demonstrates competency in providing patient care and provides care in accordance with professional standards and state’s nurse practice act. Educates patients and caregivers about IV therapy, medication administration, potential side effects, and signs of complications in the home and clinical setting. Collaborates with other healthcare professionals, including physicians, RNs, and other members of the healthcare team, to ensure continuity of care. Maintains strict infection control practices to prevent complications associated with IV therapy. Thoroughly documents all aspects of patient care, including assessments, medication administration, monitoring, and patient education. Supports patients with professionalism and kindness Represents agency in a positive and professional manner.

UW Medicine

RN Clinical Documentation Second Level Reviewer

Posted on:

April 15, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Washington

UW Medical Center is an acute care academic medical center located in Seattle with two campuses: Montlake and Northwest. As the No. 1 hospital in Seattle and Washington State since 2012 (U.S. News & World Report) and nationally ranked in seven specialties, UW Medical Center prides itself on compassionate patient care as well as its pioneering medical advances. The UW Medical Center-Montlake campus is located on the edge of the beautiful UW campus which includes many amenities available to our staff as well as very convenient public transit options including the Sound Transit’s light rail station across the street. Excellence. Exploration. Education. Become part of our team. Join our mission to make life healthier for everyone in our community.

UW MEDICAL CENTER – MONTLAKE has an outstanding opportunity for a Second Level Review Clinical Documentation Integrity Specialist (RN). WORK SCHEDULE Full-time day shift. The work is fully remote. POSITION HIGHLIGHTS Following established policies, procedures, and professional guidelines, the Second Level Review Clinical Documentation Integrity Specialist (SLR CDIS) provides industry expertise on focused accounts that are set by the direction of CDP leadership to ensure high quality standards are met for risk adjustment, DRG accuracy, SOI and ROM. DEPARTMENT DESCRIPTION The Clinical Documentation Integrity Program (CDIP) performs concurrent review of inpatient medical records to ensure provider documentation accurately reflects patient severity of illness (SOI), acuity of care needs, risk of mortality (ROM) and the quality of treatment provided. Team members also serve on various multidisciplinary committees promoting quality improvement and patient safety initiatives.

Please apply only if you meet the listed requirements below. Current WA RN License or compact RN license Minimum of 6 years of nursing experience to an acute inpatient hospital setting with in-depth knowledge of medical and surgical care. ER or ICU experience preferred. Minimum of 5 years of experience in Clinical Documentation Improvement role. Risk adjustment experience required (Vizient and Elixhauser preferred) Current Certification in CDI (CCDS, CDIP or CCS)

Reviews target DRGs specified by CDP Manager, which is an evolving workflow. This review may focus various elements including, but not limited to, CC/MCC capture rate and/or risk adjustment review and will be clarified by DRG. Ensures that pertinent patient conditions and treatments are documented such that appropriate reimbursement is received for the level of acuity and service rendered to all patients using a DRG based payer (Medicare) methodology. Verifies the accuracy and completeness of clinical information used for measuring and reporting outcomes related to patient care, physician practice and the medical center performance. Participates in various projects and initiatives within the Clinical Documentation Program. Based on findings, department goals and initiatives and industry expectation, the SLR CDIS will participate in the education and evaluation of the CDI team. Collaborate with medical records coding staff, patient financial services (PFS) and compliance for Clinical Validation Denial appeals.

Momentum Life Sciences

Bilingual (Spanish) Virtual Clinical Educator (Remote)

Posted on:

April 15, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Indiana

**This posting is for future opportunities with Momentum Life Sciences** The Bilingual (Spanish) Virtual Clinical Educator is responsible for utilizing professional clinical skills, including the ability to foster patient relationships through empathy and clinical experience, to provide personalized, high-touch support to patients recently prescribed a complex therapy. The role will engage with patients and providers to provide expert, clinically relevant, individualized counsel in conjunction with product support the new therapy regimen. The VCE will manage a series of touch points as the trusted clinical advocate to a specified patient caseload. The touch points will uncover patient barriers and internal motivators, taking patients from product onboarding to therapy initiation to milestone celebrations, motivation, maintenance, and eventual “graduation” from the program. This role will work collaboratively to enhance the patient start experience and support patient compliance and persistence initiatives by building individual relationships with patients. The educator will provide ongoing education and therapy support to the patient, their caregiver, clinical staff, and/or support network.

Registered Nurse with current, unrestricted license Previous telephonic patient support environment experience, including use of an inbound/outbound call system, with seamless warm transfers HCP and/or Patient education experience, including infusion or injection experience required Compassion, high emotional intelligence, and a passion to be a patient educator Strong communication and written skills to a variety of audiences, and experience working with a treatment team Proven adaptability to changing business demands and problem solving in a fast-paced environment Competent and comfortable utilizing technology Experience working for or contracting with pharmaceutical preferred Experience in motivational interviewing and coaching behavior change Ability to work within established guardrails while maintaining personal rapport with the patient Self-starter with proven adaptability to changing business demands and product relevance in a fast-paced environment Ability to actively listen while multi-tasking High level of comfort with technology, including Microsoft Office products, working on dual monitors, CRM, and strong typing skills are required #LI-Remote

Serves as the single point of contact in the treatment process from start to finish Demonstrates empathy and effectively engages patients, creating a personalized relationship-based connection built on trust and rapport Provide disease education, product overview, device training, and side effect management Proactively reaches out to the patient to provide high-touch support to connect the dots for the patient throughout their program journey Create patient empowerment through a series of “wow” engagements along the patient journey Utilize motivational interviewing tools to quickly and accurately anticipate and address patient barriers; personalize patient messaging concisely, within established time parameters, and in a way that resonates Communicate effectively; understand and influence patient initiation and support processes, encourage patient confidence and accountability to help patients start and stay on therapy Ensure success of program through collaborative partnerships with patients, brand, and operations partners Use intuition and clinical expertise to offer patients appropriate responses to their questions; discern the most beneficial information for the patients; accurately assess patients using provided guidelines outlined in approved messaging Ensure the patient is aware of all the patient services available to them and assisting to connect them to the right resource Connect the patient to local support groups, advocacy groups, and other external resources Provide health coaching throughout the journey to support adherence and compliance to medication Provide assistance and guidance through access and affordability journey Provide HCP feedback to keep them aware of the patient’s participation in the support program Provide education to the care team and proactively reaching out after the clinical decision has been made to start a new patient on regimen Triage and follow-up with Specialty Pharmacy to support patient getting product and knowing where product is in process Provide continuous updates, guidance, and triaging when needed and most importantly ensuring that the patient is driving towards the right health outcomes. Ensure all activities are conducted in a manner that is compliant with all Momentum, client, and industry mandated rules and regulations

Momentum Life Sciences

Full Time Virtual Clinical Educator (11-8p EST) (Remote)

Posted on:

April 15, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Indiana

**This role will be covering the the hours of 11-8p EST, Monday through Friday** The Virtual Clinical Educator is responsible for utilizing professional clinical skills, including the ability to foster patient relationships through empathy and clinical experience, to provide personalized, high-touch support to patients recently prescribed a complex therapy. The role will engage with patients and providers to provide expert, clinically relevant, individualized counsel in conjunction with product support the new therapy regimen. The VCE will manage a series of touch points as the trusted clinical advocate to a specified patient caseload. The touch points will uncover patient barriers and internal motivators, taking patients from product onboarding to therapy initiation to milestone celebrations, motivation, maintenance, and eventual “graduation” from the program. This role will work collaboratively to enhance the patient start experience and support patient compliance and persistence initiatives by building individual relationships with patients. The educator will provide ongoing education and therapy support to the patient, their caregiver, clinical staff, and/or support network.

Registered Nurse with current, unrestricted license Previous telephonic patient support environment experience, including use of an inbound/outbound call system, with seamless warm transfers HCP and/or Patient education experience, including infusion or injection experience required Compassion, high emotional intelligence, and a passion to be a patient educator Strong communication and written skills to a variety of audiences, and experience working with a treatment team Proven adaptability to changing business demands and problem solving in a fast-paced environment Competent and comfortable utilizing technology Experience working for or contracting with pharmaceutical preferred Experience in motivational interviewing and coaching behavior change Ability to work within established guardrails while maintaining personal rapport with the patient Self-starter with proven adaptability to changing business demands and product relevance in a fast-paced environment Ability to actively listen while multi-tasking High level of comfort with technology, including Microsoft Office products, working on dual monitors, CRM, and strong typing skills are required #LI-Remote

Serves as the single point of contact in the treatment process from start to finish Demonstrates empathy and effectively engages patients, creating a personalized relationship-based connection built on trust and rapport Provide disease education, product overview, device training, and side effect management Proactively reaches out to the patient to provide high-touch support to connect the dots for the patient throughout their program journey Create patient empowerment through a series of “wow” engagements along the patient journey Utilize motivational interviewing tools to quickly and accurately anticipate and address patient barriers; personalize patient messaging concisely, within established time parameters, and in a way that resonates Communicate effectively; understand and influence patient initiation and support processes, encourage patient confidence and accountability to help patients start and stay on therapy Ensure success of program through collaborative partnerships with patients, brand, and operations partners Use intuition and clinical expertise to offer patients appropriate responses to their questions; discern the most beneficial information for the patients; accurately assess patients using provided guidelines outlined in approved messaging Ensure the patient is aware of all the patient services available to them and assisting to connect them to the right resource Connect the patient to local support groups, advocacy groups, and other external resources Provide health coaching throughout the journey to support adherence and compliance to medication Provide assistance and guidance through access and affordability journey Provide HCP feedback to keep them aware of the patient’s participation in the support program Provide education to the care team and proactively reaching out after the clinical decision has been made to start a new patient on regimen Triage and follow-up with Specialty Pharmacy to support patient getting product and knowing where product is in process Provide continuous updates, guidance, and triaging when needed and most importantly ensuring that the patient is driving towards the right health outcomes. Ensure all activities are conducted in a manner that is compliant with all Momentum Life Sciences, client, and industry mandated rules and regulations

Momentum Life Sciences

Call Center Nurse Case Manager (Remote)

Posted on:

April 15, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Indiana

**Assigned shift: 12-9p EST** The Nurse Case Manager will provide ongoing contact center and virtual support as an integral part of the patient support services provided for patients prescribed an oral therapy for narcolepsy and idiopathic hypersomnia. The Nurse Case Manager will be responsible for utilizing professional nursing skills, ability to foster patient relationships, strong empathy, and clinical experience to provide ongoing personalized high-touch telephonic support to patients . The role will engage with patients and their caregivers to provide clinically relevant individualized education in conjunction with product support. The Nurse Case Manager will leverage their knowledge while combining technical expertise to deliver best-in-class support, customer service, and ongoing education to these unique patients and their caregivers. The Nurse Case Manager will also partner closely with cross-functional stakeholders, including Field Nurse Educators, to ensure continuity of care and escalation as appropriate across teams

Required Education and/or Experience: Associate’s degree in nursing with patient education experience Experience working for (or contracting with) a pharmaceutical company within a contact center environment, a minimum of 2 years Preferred Education and/ or Experience: Bachelor’s Degree Required License and/or credential(s): Current, unrestricted RN or NP license Required Skills: Background in neurological conditions and/or rare disease Demonstrated ability to collaborate with numerous cross-functional partners/key stakeholders to deliver an optimized patient experience High emotional intelligence and ability to exhibit empathy to meet each patient where they are Strong clinical skills and experience with medication compliance, specialty pharmacy knowledge, and motivational interviewing Desire and ability to create individualized relationships with patients as they progress through their journey Ability to communicate clearly about complex information in a way that resonates with patients Optimistic, upbeat, and enthusiastic in times of challenge and constant change. Ability to deliver outstanding patient experience. Demonstrate experienced competency and ability to independently navigate technology using multiple platforms, computer screens, and other technical components. (Ex: virtual engagement platforms, Telephony Systems, CRM tools, Microsoft Suite) Advanced knowledge of written and verbal communication skills and problem-solving technique Detail-oriented, highly organized, and able to work through ambiguity Able to work independently with minimal supervision, self-motivated Ability to maintain cases and complete calls on time Ability to maintain compliant conversations and documentation in a high-volume role Ability to maintain patient confidentiality by using the headset during all conversations, maintaining a private environment for home office without distraction

Provide telephonic support via inbound and outbound calls, virtual calls, and omnichannel support through email, chat, and text Demonstrate strong empathy and high emotional intelligence to engage patients with complex health conditions effectively, creating an individual relationship-based connection built on trust and rapport Provide instruction and education about treatment/therapy, and connect patients with additional resources when needed while partnering with the Field Nurse Educators, HUB (Certified Pharmacy) and other key stakeholders to ensure the patient feels supported and confident from initiation through any transitions in their therapy journey Collaborate and work cohesively within a POD structure (with VMS Field Nurse Educator team) to identify gaps, barriers, and opportunities to improve process and overall patient experience Communicate complex information effectively and empathetically to patients and their caregivers Accurately complete patient engagements based on provided criteria Identify the root cause for any potential barriers the patients experience in adhering to the therapy through a motivational interviewing model Understand and coach patient initiation and support processes while encouraging patient confidence to help start and stay on therapy Ensure the success of the program through collaborative partnerships with patients, brand, and operational partners Provide your manager constructive patient feedback on the product, patient, and industry insights to enable enhancements. Reporting Adverse Event Product Quality Complaint (AEPQC) reporting per VMS and client policy Ensure all activities are conducted in a manner that complies with all VMS, client, and industry-mandated rules and regulations.

Athletico

Occ Health RN Telephone Triage - Full-Time - Day Shift (Remote)

Posted on:

April 15, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Athletico’s Greater Purpose is to empower people, inspire hope and transform lives. We accomplish this by providing exceptional, progressive, and cost-effective fitness, performance and rehabilitative services through personalized care that emphasizes education and prevention of future injury. This is accomplished through building on our Core Values of one team, understanding our business, recognition, people-focused, accountability, continuous innovation and trust and integrity, which are the foundation for our unique culture.

Pivot Onsite Innovations is now hiring an experienced and passionate Remote Triage Registered Nurse (RN) for our healthcare clinic located at our client's manufacturing plants. This is your opportunity to step out of a traditional nurse setting and make your impact on employee health, wellness and safety! Great schedule: Monday - Friday 6AM to 2PM. Position Summary: The Remote Occupational Health Nurse is responsible for utilizing evidence-based guidelines to employ best practices that require early intervention and setting of realistic expectations for recovery and return to work.

Education: Associate’s Degree in Nursing required, BSN preferred Work Experience: Min 2 years in occupational health preferred Telephonic case management experience preferred Certification/Licensure: Current Compact RN License required Maintain Enhanced Nurse Licensure Compact (eNLC) and reside in a compact state Adhere to the requirements and time frames of licensure in all other states Knowledge and Technical Skills: Strong clinical knowledge in Occupational Health Nursing Positive telephone interaction skills including ability to ask open-ended questions to identify problems and focus conversation for goal directed and time limited conversation Ability to effectively interact with HR, safety staff, local medical providers and other designated personnel for proper initiation and follow-up of possible work-related injuries and illnesses Excellent written and oral communication skills and computer skills Competence with Windows operating system environment, Adobe Professional, Microsoft Office Suite (Outlook, Word, Excel and PowerPoint) and learn other software as needed Language Skills: Ability to read, write and speak English proficiently Bi-lingual (Spanish speaking) beneficial Physical Demands: Ability to fulfill office activities including but not limited to remain stationary for extended periods of time (i.e., while working at a desk), stand/stoop/kneel/crough/stretch, bending and stretching, communicate with others (verbal and written), and use fine motor skills including fine hand manipulation and keyboarding. Working under stress and use of computer/phone required Ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus. Work Environment: Fully remote position Mainly indoor, office environment conditions Environment must be free from background noise and distraction, noise level is acceptable, temperature is controlled. A home set-up; must meet all Company IT, privacy and safety requirements

Provide initial injury intake, follow up and case closures in accordance with Policy Procedures Provide initial contact with injured worker, employer, provider and other appropriate stakeholders Obtain history of injury (mechanism and setting) and current job functions Assesses functional status and provide recommendations for first aid, self-care, or medical treatment according to treatment protocols Assess and collect data regarding risk factors for delayed recovery, and generate creative solutions to minimize or eliminate obstacles which prevent, or delay return to work Provide appropriate stakeholders with updates regarding the nature and mechanism of injury as well as suggested level of care Serve as an advocate for the injured/ill worker Counsel’s employees on reduction of risks associated with occupational and environmental hazards, and provides appropriate care plans as needed Request medical records as needed Direct care to preferred providers and negotiates as necessary Ensure appropriate use of medical facilities, early and appropriate referrals, and quality of care at controlled or reduced cost Identify excessive, ineffective or inefficient delivery of health care services and redirect care as needed Perform additional duties and assumes additional responsibilities as identified by supervisor

Athletico

Occ Health RN Telephone Triage - Full-Time - Afternoon Shift (Remote)

Posted on:

April 15, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Athletico’s Greater Purpose is to empower people, inspire hope and transform lives. We accomplish this by providing exceptional, progressive, and cost-effective fitness, performance and rehabilitative services through personalized care that emphasizes education and prevention of future injury. This is accomplished through building on our Core Values of one team, understanding our business, recognition, people-focused, accountability, continuous innovation and trust and integrity, which are the foundation for our unique culture.

Pivot Onsite Innovations is now hiring an experienced and passionate Remote Triage Registered Nurse (RN) for our on-site healthcare clinic located at our client's manufacturing plants. This is your opportunity to step out of a traditional nurse setting and make your impact on employee health, wellness and safety! Must be able to afternoons: Monday - Friday 2PM to 10PM! Position Summary: The Remote Occupational Health Nurse is responsible for utilizing evidence-based guidelines to employ best practices that require early intervention and setting of realistic expectations for recovery and return to work.

Education: Associate’s Degree in Nursing required, BSN preferred Work Experience: Min 2 years in occupational health preferred Telephonic case management experience preferred Certification/Licensure: Current Compact RN License required Maintain Enhanced Nurse Licensure Compact (eNLC) and reside in a compact state Adhere to the requirements and time frames of licensure in all other states Knowledge and Technical Skills: Strong clinical knowledge in Occupational Health Nursing Positive telephone interaction skills including ability to ask open-ended questions to identify problems and focus conversation for goal directed and time limited conversation Ability to effectively interact with HR, safety staff, local medical providers and other designated personnel for proper initiation and follow-up of possible work-related injuries and illnesses Excellent written and oral communication skills and computer skills Competence with Windows operating system environment, Adobe Professional, Microsoft Office Suite (Outlook, Word, Excel and PowerPoint) and learn other software as needed Language Skills: Ability to read, write and speak English proficiently Bi-lingual (Spanish speaking) beneficial Physical Demands: Ability to fulfill office activities including but not limited to remain stationary for extended periods of time (i.e., while working at a desk), stand/stoop/kneel/crough/stretch, bending and stretching, communicate with others (verbal and written), and use fine motor skills including fine hand manipulation and keyboarding. Working under stress and use of computer/phone required Ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus. Work Environment: Fully remote position Mainly indoor, office environment conditions Environment must be free from background noise and distraction, noise level is acceptable, temperature is controlled. A home set-up; must meet all Company IT, privacy and safety requirements

Provide initial injury intake, follow up and case closures in accordance with Policy Procedures Provide initial contact with injured worker, employer, provider and other appropriate stakeholders Obtain history of injury (mechanism and setting) and current job functions Assesses functional status and provide recommendations for first aid, self-care, or medical treatment according to treatment protocols Assess and collect data regarding risk factors for delayed recovery, and generate creative solutions to minimize or eliminate obstacles which prevent, or delay return to work Provide appropriate stakeholders with updates regarding the nature and mechanism of injury as well as suggested level of care Serve as an advocate for the injured/ill worker Counsel’s employees on reduction of risks associated with occupational and environmental hazards, and provides appropriate care plans as needed Request medical records as needed Direct care to preferred providers and negotiates as necessary Ensure appropriate use of medical facilities, early and appropriate referrals, and quality of care at controlled or reduced cost Identify excessive, ineffective or inefficient delivery of health care services and redirect care as needed Perform additional duties and assumes additional responsibilities as identified by supervisor

Athletico

Occ Health RN Telephone Triage - Full-Time - Overnights (Remote)

Posted on:

April 15, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Athletico’s Greater Purpose is to empower people, inspire hope and transform lives. We accomplish this by providing exceptional, progressive, and cost-effective fitness, performance and rehabilitative services through personalized care that emphasizes education and prevention of future injury. This is accomplished through building on our Core Values of one team, understanding our business, recognition, people-focused, accountability, continuous innovation and trust and integrity, which are the foundation for our unique culture.

Pivot Onsite Innovations is now hiring an experienced and passionate Remote Triage Registered Nurse (RN) for our on-site healthcare clinic located at our client's manufacturing plants, supporting telephonically. This is your opportunity to step out of a traditional nurse setting and make your impact on employee health, wellness and safety! Must be able to work overnights: Monday - Friday 10PM to 6AM! Position Summary: The Remote Occupational Health Nurse is responsible for utilizing evidence-based guidelines to employ best practices that require early intervention and setting of realistic expectations for recovery and return to work.

Education: Associate’s Degree in Nursing required, BSN preferred Work Experience: Min 2 years in occupational health preferred Telephonic case management experience preferred Certification/Licensure: Current Compact RN License required Maintain Enhanced Nurse Licensure Compact (eNLC) and reside in a compact state Adhere to the requirements and time frames of licensure in all other states Knowledge and Technical Skills: Strong clinical knowledge in Occupational Health Nursing Positive telephone interaction skills including ability to ask open-ended questions to identify problems and focus conversation for goal directed and time limited conversation Ability to effectively interact with HR, safety staff, local medical providers and other designated personnel for proper initiation and follow-up of possible work-related injuries and illnesses Excellent written and oral communication skills and computer skills Competence with Windows operating system environment, Adobe Professional, Microsoft Office Suite (Outlook, Word, Excel and PowerPoint) and learn other software as needed Language Skills: Ability to read, write and speak English proficiently Bi-lingual (Spanish speaking) beneficial Physical Demands: Ability to fulfill office activities including but not limited to remain stationary for extended periods of time (i.e., while working at a desk), stand/stoop/kneel/crough/stretch, bending and stretching, communicate with others (verbal and written), and use fine motor skills including fine hand manipulation and keyboarding. Working under stress and use of computer/phone required Ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus. Work Environment: Fully remote position Mainly indoor, office environment conditions Environment must be free from background noise and distraction, noise level is acceptable, temperature is controlled. A home set-up; must meet all Company IT, privacy and safety requirements

Provide initial injury intake, follow up and case closures in accordance with Policy Procedures Provide initial contact with injured worker, employer, provider and other appropriate stakeholders Obtain history of injury (mechanism and setting) and current job functions Assesses functional status and provide recommendations for first aid, self-care, or medical treatment according to treatment protocols Assess and collect data regarding risk factors for delayed recovery, and generate creative solutions to minimize or eliminate obstacles which prevent, or delay return to work Provide appropriate stakeholders with updates regarding the nature and mechanism of injury as well as suggested level of care Serve as an advocate for the injured/ill worker Counsel’s employees on reduction of risks associated with occupational and environmental hazards, and provides appropriate care plans as needed Request medical records as needed Direct care to preferred providers and negotiates as necessary Ensure appropriate use of medical facilities, early and appropriate referrals, and quality of care at controlled or reduced cost Identify excessive, ineffective or inefficient delivery of health care services and redirect care as needed Perform additional duties and assumes additional responsibilities as identified by supervisor

Athletico

Occ Health RN Telephone Triage - Part Time (Weekends) - Day Shift (Remote)

Posted on:

April 15, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Athletico’s Greater Purpose is to empower people, inspire hope and transform lives. We accomplish this by providing exceptional, progressive, and cost-effective fitness, performance and rehabilitative services through personalized care that emphasizes education and prevention of future injury. This is accomplished through building on our Core Values of one team, understanding our business, recognition, people-focused, accountability, continuous innovation and trust and integrity, which are the foundation for our unique culture.

Pivot Onsite Innovations is now hiring an experienced and passionate part-time Remote Triage Registered Nurse (RN) for our on-site healthcare clinic located at our client's manufacturing plants, supporting telephonically. This is your opportunity to step out of a traditional nurse setting and make your impact on employee health, wellness and safety! Must be able to work every weekend remotely: Saturday and Sunday 6A-6P! Position Summary: The Remote Occupational Health Nurse is responsible for utilizing evidence-based guidelines to employ best practices that require early intervention and setting of realistic expectations for recovery and return to work.

Education: Associate’s Degree in Nursing required, BSN preferred Work Experience: Min 2 years in occupational health preferred Telephonic case management experience preferred Certification/Licensure: Current Compact RN License required Maintain Enhanced Nurse Licensure Compact (eNLC) and reside in a compact state Adhere to the requirements and time frames of licensure in all other states Knowledge and Technical Skills: Strong clinical knowledge in Occupational Health Nursing Positive telephone interaction skills including ability to ask open-ended questions to identify problems and focus conversation for goal directed and time limited conversation Ability to effectively interact with HR, safety staff, local medical providers and other designated personnel for proper initiation and follow-up of possible work-related injuries and illnesses Excellent written and oral communication skills and computer skills Competence with Windows operating system environment, Adobe Professional, Microsoft Office Suite (Outlook, Word, Excel and PowerPoint) and learn other software as needed Language Skills: Ability to read, write and speak English proficiently Bi-lingual (Spanish speaking) beneficial Physical Demands: Ability to fulfill office activities including but not limited to remain stationary for extended periods of time (i.e., while working at a desk), stand/stoop/kneel/crough/stretch, bending and stretching, communicate with others (verbal and written), and use fine motor skills including fine hand manipulation and keyboarding. Working under stress and use of computer/phone required Ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus. Work Environment: Fully remote position Mainly indoor, office environment conditions Environment must be free from background noise and distraction, noise level is acceptable, temperature is controlled. A home set-up; must meet all Company IT, privacy and safety requirements

Provide initial injury intake, follow up and case closures in accordance with Policy Procedures Provide initial contact with injured worker, employer, provider and other appropriate stakeholders Obtain history of injury (mechanism and setting) and current job functions Assesses functional status and provide recommendations for first aid, self-care, or medical treatment according to treatment protocols Assess and collect data regarding risk factors for delayed recovery, and generate creative solutions to minimize or eliminate obstacles which prevent, or delay return to work Provide appropriate stakeholders with updates regarding the nature and mechanism of injury as well as suggested level of care Serve as an advocate for the injured/ill worker Counsel’s employees on reduction of risks associated with occupational and environmental hazards, and provides appropriate care plans as needed Request medical records as needed Direct care to preferred providers and negotiates as necessary Ensure appropriate use of medical facilities, early and appropriate referrals, and quality of care at controlled or reduced cost Identify excessive, ineffective or inefficient delivery of health care services and redirect care as needed Perform additional duties and assumes additional responsibilities as identified by supervisor

Athletico

Occ Health RN Telephone Triage - Part Time (Weekends) - Overnights (Remote)

Posted on:

April 15, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Athletico’s Greater Purpose is to empower people, inspire hope and transform lives. We accomplish this by providing exceptional, progressive, and cost-effective fitness, performance and rehabilitative services through personalized care that emphasizes education and prevention of future injury. This is accomplished through building on our Core Values of one team, understanding our business, recognition, people-focused, accountability, continuous innovation and trust and integrity, which are the foundation for our unique culture.

Pivot Onsite Innovations is now hiring an experienced and passionate part-time Remote Triage Registered Nurse (RN) for our on-site healthcare clinic located at our client's manufacturing plants, supporting telephonically. This is your opportunity to step out of a traditional nurse setting and make your impact on employee health, wellness and safety! Must be able to work weekend overnights consistently: Saturday and Sunday 6P-6A! Position Summary: The Remote Occupational Health Nurse is responsible for utilizing evidence-based guidelines to employ best practices that require early intervention and setting of realistic expectations for recovery and return to work.

Education: Associate’s Degree in Nursing required, BSN preferred Work Experience: Min 2 years in occupational health preferred Telephonic case management experience preferred Certification/Licensure: Current Compact RN License required Maintain Enhanced Nurse Licensure Compact (eNLC) and reside in a compact state Adhere to the requirements and time frames of licensure in all other states Knowledge and Technical Skills: Strong clinical knowledge in Occupational Health Nursing Positive telephone interaction skills including ability to ask open-ended questions to identify problems and focus conversation for goal directed and time limited conversation Ability to effectively interact with HR, safety staff, local medical providers and other designated personnel for proper initiation and follow-up of possible work-related injuries and illnesses Excellent written and oral communication skills and computer skills Competence with Windows operating system environment, Adobe Professional, Microsoft Office Suite (Outlook, Word, Excel and PowerPoint) and learn other software as needed Language Skills: Ability to read, write and speak English proficiently Bi-lingual (Spanish speaking) beneficial Physical Demands: Ability to fulfill office activities including but not limited to remain stationary for extended periods of time (i.e., while working at a desk), stand/stoop/kneel/crough/stretch, bending and stretching, communicate with others (verbal and written), and use fine motor skills including fine hand manipulation and keyboarding. Working under stress and use of computer/phone required Ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus. Work Environment: Fully remote position Mainly indoor, office environment conditions Environment must be free from background noise and distraction, noise level is acceptable, temperature is controlled. A home set-up; must meet all Company IT, privacy and safety requirements

Provide initial injury intake, follow up and case closures in accordance with Policy Procedures Provide initial contact with injured worker, employer, provider and other appropriate stakeholders Obtain history of injury (mechanism and setting) and current job functions Assesses functional status and provide recommendations for first aid, self-care, or medical treatment according to treatment protocols Assess and collect data regarding risk factors for delayed recovery, and generate creative solutions to minimize or eliminate obstacles which prevent, or delay return to work Provide appropriate stakeholders with updates regarding the nature and mechanism of injury as well as suggested level of care Serve as an advocate for the injured/ill worker Counsel’s employees on reduction of risks associated with occupational and environmental hazards, and provides appropriate care plans as needed Request medical records as needed Direct care to preferred providers and negotiates as necessary Ensure appropriate use of medical facilities, early and appropriate referrals, and quality of care at controlled or reduced cost Identify excessive, ineffective or inefficient delivery of health care services and redirect care as needed Perform additional duties and assumes additional responsibilities as identified by supervisor

Amcord Care Inc.

Nursing Facility Service Coordinator - Kutztown area - Remote

Posted on:

April 15, 2025

Job Type:

Full-Time

Role Type:

License:

None Required

State License:

Pennsylvania

The Nursing Facility Service Coordinator will be responsible for identifying, coordinating, and facilitating all necessary support and services for residents of nursing facilities. This role requires an individual with excellent communication and interpersonal skills, the ability to manage multiple tasks and priorities, and a strong understanding of nursing facility operations.

Must have a Bachelor’s degree in social work, psychology, or other related fields with practicum experience, or in lieu of a Bachelor’s degree have at least three (3) or more years’ experience in a social service or healthcare related setting. Excellent communication and interpersonal skills. Ability to work collaboratively with staff, program participants, and community organizations. Strong organizational and problem-solving skills. *Must be willing and able to travel regularly through these areas and surrounding counties* Pottsville, PA 17901 Bethlehem, PA 18017 Allentown, PA 18103-18104 Shenandoah, PA 17976 Easton, PA 18042 Reading, PA 19611

Manage an active caseload which involves monitoring and evaluating options and services to meet an individual's health needs. Develop and modify care plans at least annually or on an as needed basis in collaboration with the resident, their family, and facility staff. Ensure that nursing facility residents receive appropriate healthcare services and that their medical needs are being met. Notify the member of their right to choose any willing and qualified provider to provide a service on the members service plan. Serve as a liaison between nursing facility residents, their families, and healthcare providers. Coordinate and participate in interdisciplinary care conferences with nursing facility staff and healthcare providers as needed. Ensure compliance with all legal and regulatory requirements related to nursing facility services. Required to complete forty (40) hours orientation training and ongoing twenty (20) hour annual training. Responsible for following Amcord Care Inc. policies and procedures for document maintenance, confidentiality or records and employees' rights. Willingness and ability to work in the field while also having the ability to work independently with integrity in a virtual setting.

The Cigna Group

RN Utilization Management Clinical Reviewer Senior Analyst - Work from Home, Anywhere, USA

Posted on:

April 15, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Conneticut

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

Provides advanced professional input to complex Nurse Case Management assignments/projects. Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan. Handles more complex, high acuity cases, and/or account sensitive cases involving largest reserves. Utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services in order to facilitate appropriate healthcare outcomes for members. Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained. Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services. May review initial liability disability claims to determine extent and impact of insured's medical condition, medical restrictions and limitations and expected duration. Performs leadership role on team when implementing new tools or case management programs/initiatives. Manages own caseload and coordinates all assigned cases. Supports and provides direction to more junior professionals. Works autonomously, only requiring “expert” level technical support from others. Exercises judgment in the evaluation, selection, and adaptation of both standard and complex techniques and procedures. Utilizes in-depth professional knowledge and acumen to develop models and procedures, and monitor trends, within Nurse Case Management. RN and current unrestricted nursing license required.

Minimum requirements: Active unrestricted Registered Nurse (RN) license in state or territory of the United States. Preferred requirements: Bachelors degree a plus 3 years clinical experience in inpatient or managed care setting Demonstrated ability to anticipate, plan, coordinate and organize. Knowledge of community, state and federal resources. Possession of a valid driver’s license, proof of insurance, good driving record and reliable transportation. Strong skills in teamwork, negotiation, conflict management, problem solving, and effective decision making. Experience in medical management and case management in a managed care setting or hospital is highly desirable. Ability to assess complex issues, recommend changes and resolve problems. Strong computer knowledge and abilities. Knowledge of managed care products and strategies. Ability to work within changing business environment and balance business needs with patient advocacy. Experience managing multiple projects in a fast paced matrix driven environment. Effective at negotiation, teamwork and cooperative relations with diverse internal and external stakeholders. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.

Position Scope: Manages/Coordinates an active caseload of inpatient case management cases for Cigna. Uses clinical knowledge to assess inpatient admission level of care, treatment plan and goals, identified gasps or risk for readmission or complications and any barriers to discharge. Establishes patient centric goals and interventions to meet the member’s needs while inpatient and post inpatient stay. Interfaces with facility, member, family, and other healthcare team members as well as internal matrix partners. Balances business needs with patient advocacy. Builds solid working relationships with internal staff, matrix partners, key functional areas, customers, and providers. Summary description of position: Plans, implements and evaluates appropriate health care services in conjunction with the physician treatment plan. Handles more complex, high acuity cases and /or account sensitive cases. Performs prospective, concurrent and retrospective reviews for inpatient acute care, rehabilitation, referrals and select outpatient services including DME (durable medical equipment). Ensures that inpatient case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained. Excellent time management, organization and negotiation skills. Strong research and analytical skills. Ability to assess complex issues, recommend changes and resolve problems. Knowledge of managed care preferred. Works independently, receiving direction from manager or team leader for new or unprecedented situations. Manages own caseload and coordinates all assigned cases. Acts as a resource to others. Utilizes Cigna's approved guidelines and tools to rigorously assess the clinical status of the member, the level of care and the services the member is receiving as clinically appropriate covered services. Anticipates care needs along the continuum of inpatient and outpatient services and facilitates coordination across the network of providers, participants and caregivers to assure timely discharge/transfer to an alternate level of care. Consults with manager and medical director to resolve any issues related to delay of services or barriers to discharge in a timely manner. Major responsibilities and desired results: Develops and defines a structured working relationship with key partners in inpatient facilities to support regular, effective communication and exchange of information in order to manage the member’s needs in compliance with all Federal/State/Facility contract and internal Cigna requirements. Retrieves active daily census each morning and prioritizes cases for impact. Access the approved Cigna guidelines for inpatient review and directs communication with the facility to elicit clinical information and facilitate discharge planning. Identified all cases appropriate for inpatient case management interventions, initiates and discusses options for discharge planning with the facility, provider, vendor, member and/or family and documents interactions and outcomes related to those actions. Identify and build effective relationships with a network of community, government, and knowledge resources. Maintain information on those resources and share with peers as appropriate. Act as liaison and patient advocate between account, participant, family, physician(s) and facilities/agencies. Take appropriate action to ensure participant and practitioner satisfaction within benefit constraints. Develop a participant centered plan for short term and long term objectives, including time frames for follow up. Utilize available internal and community resources in development of plan. Involve all appropriate parties (member, physician, providers, employers, etc) to determine case results/outcomes. Provide information and resources as appropriate to empower participants to take an active role in care, treatment and cost decisions. Implement, coordinate, monitor and evaluate the plan on a systematic, ongoing, appropriate basis. Negotiate price and quality care levels, intensity and durations of services. Document findings and continue to anticipate needs, determine benefit coverage status and communicate proactively to participant and members of treatment team. Identifies new referrals for complex and specialty CM programs and coordinates transition to appropriate CM when necessary. Identifies and elevates potential quality of care issues to Cigna's Quality representatives for follow up determination. Works to identify gaps in care and resolution of those identified and prevention of future gaps in care. May be required to participate in customer and auditor visits. Participates in special projects as deemed necessary. Other duties as required and related to this role.

Solace

Case Manager - Healthcare Advocate (Remote 1099)

Posted on:

April 15, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

None Required

State License:

California

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

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

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

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

Solace

RN Healthcare Advocate (Remote 1099)

Posted on:

April 15, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

California

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

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

RN license in good standing. Deep understanding of Social Determinants of Health and experience working with diverse patient populations. Endless empathy for people, and a strong ability to fight for those who cannot. Strong clinical skills paired with exceptional organizational abilities. You can balance multiple tasks and work under pressure without sacrificing clarity in your communications and documentation. Pride in your technical savvy; you can quickly and fluently learn new systems and software. An extreme bias toward action and execution. A willingness to provide fearless feedback. You care about forging a system that empowers better patients outcomes, and are not shy about sharing your thoughts.

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

Wellbox Health

Virtual Nurse Coordinator: LPN

Posted on:

April 15, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Compact / Multi-State

Wellbox is a rapidly growing healthcare company focused on empowering people to live healthier lives through comprehensive preventative care solutions delivered by an elite team of experienced nurses. We are currently seeking tech-savvy LPN Patient Care Coordinators to conduct monthly telephonic outreach to chronically ill patients, developing personalized care plans that address their health challenges.

Position Type And Expected Hours Of Work We are seeking full-time LPN team members who can work 40 hours per week, between the hours of 8 am – 6 pm in the patient’s time zone, Monday – Friday. Pay Structure Orientation + Training (First two months): $20 hourly. Post-Orientation: $22 hourly, plus bonus incentive. Monthly Bonuses up to $525 monthly. Referral Bonuses up to $1000.

Active Compact LPN License. Minimum two years of clinical experience; care coordination experience preferred. Proficient with Electronic Medical Records and Microsoft Office. Excellent communication and problem-solving skills.

Manage patients’ healthcare needs via virtual phone conversations. Document visits using technology platforms and EHRs. Develop personalized care plans addressing physical, mental, and preventative health. Coach patients on treatment plans, including nutrition and wellness. Connect patients with resources and prepare them for medical appointments.

NaphCare, Inc.

PRN Utilization Managment Registered Nurse

Posted on:

April 14, 2025

Job Type:

Role Type:

Utilization Review

License:

RN

State License:

Alabama

NaphCare is a family owned, medical technology company that has been delivering high quality healthcare to correctional facilities across the nation for over 30 years. Come join our team of over 4000 employees and growing! NaphCare pays well, offers outstanding benefits, and has an incredibly engaged corporate support team to make sure you have what you need to be truly excellent at what you do. NaphCare partners with correctional facilities to provide proactive, patient-focused healthcare. We recognize that we serve a unique and diverse patient population, and our onsite teams take pride in bringing excellence in care to a population in great need. Be part of a world-class team of professionals who are revolutionizing correctional healthcare as you use our cutting-edge resources, including our award-winning electronic operating system NaphCare has a partnership with NetCE that provides CEU/CME for our staff. NetCE uses a rigorous peer review process to ensure that all activities and content are up-to-date. This service streamlines continuing education for all NaphCare Employees to meet state specific requirements for maintaining licensing. With NaphCare, you'll play a critical role in our continuing mission to be the leading provider of quality healthcare in the correctional industry. If you want a career that will make a difference, choose the company that is different. We support your growth and internal promotion. Once hired, we encourage our employees to continue to seek opportunities for advancement and leadership.

NaphCare is hiring experienced PRN-Utilization Management Registered Nurse just like you at the Corporate Headquarters located in Birmingham, Alabama.

A current and unrestricted RN license in Alabama A minimum of 3 years’ experience in an acute care setting and 2 years’ experience in utilization review and/or case management Valid cpr card Excellent communication and interpersonal skills attention to detail and decision-making skills are essential BSN or ADN required. Some travel required.

Develop, implement, and administer the quality assurance and utilization review processes Monitor and report on the quality of all facets of the medical care provided to patients Perform utilization and concurrent review of patient cases Conduct detailed clinical chart assessments Gather clinical information to assess and expedite care needs Determine need, if any, for intervention, and discussing with physicians Reviews requests from providers regarding medical necessity of requested services for patients Reviews and audits patients' medical records as indicated to determine medical necessity Utilizes nationally recognized criteria to determine medical necessity of requested services Refers provider requests to Medical Director or designee when medical necessity of requested services does not meet recognized criteria

Tuesday Health

Complex Care Navigator (RN)

Posted on:

April 14, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Ohio

Tuesday Health launched in 2023 to deliver compassionate, supportive care for patients and caregivers navigating serious illness. We believe that each patient's journey is unique. As such, we deliver member-directed, whole-person care to seriously ill patients in our program, using leading edge supportive care models, including appropriate transitions to hospice when the time is right. This results in drastically improved quality of life for members and their caregivers, and a meaningful reduction in unproductive medical spend. Our overall mission is to transform serious illness and end of life care; our team believes deeply in this mission and puts our members first in all that we do.

Location: Canton, OH This is a full-time position, traveling within the community. Monday-Friday with hours of 8:00am-5:00pm Tuesday Health is looking for a creative and experienced Registered Nurse to join our team as a Complex Care Navigator. You will work alongside other members of the Tuesday Health clinical teams, providing a multi-disciplinary approach to care for our members with serious illness and ensuring the delivery of high-quality supportive care services to our patients and their families. The RN will conduct home visits and work remotely on occasion.

Active and unrestricted Registered Nurse license in the State of Ohio without any board action Experience in clinical/medical setting preferred Experience in a multi- disciplinary care model working across network providers, health plan care management support, and employed clinicians Strong communication and organization skills Ability to multitask and work under pressure without sacrificing a positive member experience Ability to know when to escalate and potentially act professionally in an emergent situation Strong technical skills to navigate different documentation systems and tools; as well as ability to learn new systems as the company grows and evolves Strong written skills Ability to drive during daytime, nighttime, or inclement weather Valid driver's license with safe driving record State minimum automobile insurance coverage Comfort with change and ambiguity; you understand that rapid changes to the business, strategy, organization, and priorities will come with rapid evolution of our business

Administer multiple assessments and screening tools within the clinical model at different times throughout the care timeline Interpret responses to assessments and screening tools and support prioritization of need based on responses Be accountable for care plan development within the multidisciplinary care team Lead in internal and joint rounds to ensure the member experience is optimal and coordinated Learn the Tuesday Health electronic systems, tools, technology, to deliver a coordinated approach to ensure the members have a unique experience Build a strong, trusting relationship with every member, where listening and empathy are the foundation of every interaction Serve as the quarterback of the multidisciplinary team transforming care for members with serious illness