CVS Health

Case Manager RN

Posted on:

February 7, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Pennsylvania

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

The Case Manager RN position is 100% remote and employees can live in any state. Normal Working Hours: Monday through Friday 8:30am - 5:00pm in respective time zone. There is a late shift requirement until 9PM on a rotational basis approximately 2-3 times per quarter. Weekends are not required. Holidays are covered on a volunteer basis. There is no travel expected with this position. This Case Manager RN position is part of Aetna’s Commercial Care Management division and is part of the dedicated team supporting the membership of plan sponsor UPS. The RN Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.

Required Qualifications: Must have an active and unrestricted RN license in the state that you reside. Multiple State RN licensure is welcomed but not required. If chosen must be willing and able to obtain multiple state RN licensure after hire (expenses paid for by company) 2+ years of clinical experience as an RN All clinical experience will be considered, such as Emergency Department, Home Health, Hospice, Operating Room, ICU, NICU, Telemetry, Medical / Surgical, Orthopedics, Long Term Care, and Infusion nursing. Preferred Qualifications: 2+ years’ experience with Telephonic Case Management 1+ years’ experience with all types of Microsoft Office including PowerPoint, Excel, and Word Strong telephonic communication skills Certified Case Manager (CCM) certification BSN Education: Associates Degree in Nursing

Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. Through the use of clinical tools and information/data review, conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Reviews prior claims to address potential impact on current case management and eligibility. Assessments include the member’s level of work capacity and related restrictions/limitations. Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality. Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Trinity Health

Registered Nurse (RN) Remote Triage Opportunity - NYS License Required

Posted on:

February 7, 2026

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

New York

Trinity Health is one of the largest not-for-profit, Catholic health care systems in the nation. It is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians caring for diverse communities across 25 states. Nationally recognized for care and experience, the Trinity Health system includes 88 hospitals, 131 continuing care locations, the second largest PACE program in the country, 125 urgent care locations and many other health and well-being services. Based in Livonia, Michigan, its annual operating revenue is $20.2 billion with $1.2 billion returned to its communities in the form of charity care and other community benefit programs.

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

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

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

CVS Health

Case Manager Registered Nurse - Remote CST

Posted on:

February 7, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

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

Required Schedule Monday-Friday 8-5pm CST with flexibility needed to meet business needs.

Active and good standing RN Compact License Minimum 3+ years clinical practical experience required with preference for the following backgrounds: diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac with Medicare members. Discharge Planning experience Minimum 2+ years case management, discharge planning and/or home health care coordination experience Preferred Qualifications: Excellent analytical and problem-solving skills Effective communications, organizational, and interpersonal skills. Ability to work independently (may require working from home). Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications. Efficient and Effective computer skills including navigating multiple systems and keyboarding Willing and able to obtain multi state RN licenses if needed, company will reimburse expense Bilingual preferred Education: Associates degree minimum required BSN preferred Certified Case Manager is preferred. Additional national professional certification (CRC, CDMS, CRRN, COHN, or CCM) is preferred, but not required

Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies. Potential for minimal travel as business needs arise.

The Cigna Group

UM Clinical Reviewer Senior Analyst

Posted on:

February 7, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

Cigna Healthcare, a division of The Cigna Group, is an advocate for better health through every stage of life. We guide our customers through the health care system, empowering them with the information and insight they need to make the best choices for improving their health and vitality. Join us in driving growth and improving lives.

The UM Clinical Reviewer Senior Analyst promotes quality and cost-effective medical services through clinical review, applying Cigna clinical policies, national guidelines, and decision-support tools to determine authorizations. The role ensures timely completion of reviews to meet regulatory and contractual requirements while representing Cigna professionally.

Registered Nurse (RN) with multistate license in good standing. BSN preferred; Minimum 3 years RN experience in managed care, UM, or prior authorization. Strong analytical, communication, and decision-making skills. Proficiency with Windows, Word, care management platforms, and documentation systems. Ability to manage multiple tasks, meet deadlines, and adapt to a fast-paced environment. Competencies: Clinical Judgment & Decision Making Regulatory & Policy Compliance Communication & Collaboration Customer-focused Service Delivery Time & Workload Management 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.

Conduct utilization management reviews for medical necessity, appropriateness, and benefit coverage. Apply Cigna medical policies, MCG, ASAM, URAC standards, and clinical judgment. Identify cases requiring physician review and coordinate with Medical Directors. Initiate Case Management referrals as appropriate. Maintain compliance with HIPAA, regulatory rules, and internal quality standards. Participate in team meetings, quality audits, training, and workflow improvements. Support departmental initiatives, documentation accuracy, and performance metrics.

Southern Illinois Healthcare

Admissions Coordinator, Post-Acute Care (NE)

Posted on:

February 7, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Illinois

Southern Illinois Healthcare is a not-for-profit integrated health system with over 3,000 employees. It is comprised of over twenty facilities, including three inpatient hospitals, two clinics, two physician office buildings, an urgent care and dedicated centers that include neuro, cancer, heart, sleep and rehabilitation.

Responsible for coordinating pre-screening referrals, patient admission process, and PPS to the Acute Rehabilitation Center.

Education: Associates Degree in Nursing Licenses and Certification: Current Illinois Registered Nurse License BLS preferred Experience and Skills: Technical Experience: 5 years

Coordinates the Acute Rehabilitation admission, referral and PPS systems. Assists with coverage during staff shortages. Assists with staff training.

Unitek Learning

Remote Nursing Course Lead Instructor - BSN

Posted on:

February 7, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

California

Unitek Learning Education Group Corp. (“Unitek Learning”) is a leader in healthcare‐focused workforce development. With over 30 years of experience, Unitek Learning provides customized education programs that bridge the gap between academic preparation and real-world clinical needs. Drawing on its deep roots in nursing education, Unitek Learning helps hospitals and health systems build sustainable talent pipelines by embedding faculty and curriculum directly into hospital settings through its “School in a Box” and integrated workforce solutions. In partnership with hundreds of clinical sites, we upskill incumbent staff, train new clinicians, and enable hospitals to better recruit, retain, and advance nursing talent.

Registered Nurse with current and unencumbered Registered Nurse licensure or eligible in all states where Workforce Development programs are established. Registered Nurse with current and unencumbered licensure in California. Eligible for approval by CA BRN as Instructor for Medical-Surgical, OB, Pediatrics, Mental Health, Community Health, or Geriatrics. Master's Degree in Nursing required; Terminal Degree in Nursing (DNP, EdD, PhD) preferred. Able to meet the faculty requirements set by California's Board of Registered Nursing. Experience which demonstrates: Current knowledge of nursing practice; ability to mentor students; effective communication skills, both verbal and written. Previous pre-licensure nursing online teaching experience required utilizing a Learning Management System (LMS). A documented background in educational methodology consistent with teaching assignments including but not limited to: education theory and practice, current concepts related to subjects taught current clinical practice experience distance education techniques and delivery Working knowledge of Microsoft Office Suite Products, especially Outlook, Word, PowerPoint, and other MS office products as needed.

Provide online course facilitation for the pre-licensure Workforce Development Programs. Instruct students utilizing existing curriculum for assigned classes. Make continuous efforts to improve the quality of instruction by using different and innovative methodologies and/or teaching techniques. Assist with reviewing and revising syllabi and instructional guidelines. Regularly evaluate students to measure their progress in achieving curriculum and course objectives and inform them in a timely manner of their progress. Assist with strategic planning and assessment of instructional initiatives to ensure quality of program. Maintain student records of attendance, grades, and assist with program data collection. Utilize the Learning Management System (LMS) as the tool to deliver course content while maintaining relevance and currency. Provide access to students for ongoing communication through scheduling of office hours, electronic communication, and other appropriate methods. Participate in professional development; maintain CE hours to ensure renewed licensure and stay current with college updates. Commitment to teaching and working with a multicultural and multigenerational student body. Serve as subject matter expert (SME) for university and accreditation requirements/reporting. Serve on curriculum and evaluation committee. Other duties as assigned by the Assistant Dean, Workforce Development. Faculty are responsible for exam analysis and reviews for all exams within assigned course. Faculty teaching in courses with unit/final exams are responsible for conducting weekly recorded synchronous sessions for students via distance modality (Zoom, MS Teams, WebEx, etc.). Faculty must hold a minimum of four (4) office hours weekly.

Ankura

Health Care | Life Sciences, Senior Associate - Registered Nurse / Certified Coder

Posted on:

February 7, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

New York

Ankura Consulting Group, LLC is an independent global expert services and advisory firm that delivers services and end-to-end solutions to help clients at critical inflection points related to change, risk, disputes, finance, performance, distress, and transformation. The Ankura team consists of more than 1,500 professionals in more than 30 offices globally who are leaders in their respective fields and areas of expertise. Collaborative lateral thinking, hard-earned experience, expertise, and multidisciplinary capabilities drive results and Ankura is unrivaled in its ability to assist clients to Protect, Create, and Recover Value.

Ankura’s Health Care Disputes, Compliance and Investigations practice advises outside counsel and their clients on a wide variety of legal and regulatory matters. Our practitioners provide expert witness testimony on commercial disputes involving payers and providers, as well as in matters involving False Claims Act, Anti-kickback, Stark, and FDA disputes and investigations. We work with Chief Compliance Officers to build and mature their compliance programs, conduct program effectiveness reviews, and risk assessments, and perform compliance audits. We assist in-house and outside counsel during internal and externally driven investigations through the evaluation of medical records, the determination of medical necessity and appropriate medical coding, and the computation of financial impacts that may lead to repayments. We also provide investigative assistance in matters involving research misconduct, human subjects’ protection, and financial fraud related to research. Our practice is often called upon to advise investors on operational and compliance matters during due diligence. We serve as the Independent Review Organization for many clients and our work product is routinely presented to the Office of Inspector General of HHS and the US Department of Justice. We also work on provider / payor litigation matters where our team members serve as experts. Our clients include academic medical centers, health systems, physician practice groups, post- and sub-acute providers, health plans, pharmacies, and pharmacy benefit management companies, as well as pharmaceutical and medical device manufacturers. We will consider candidates in most major US markets.

Registered Nurse with active license, unrestricted license. Bachelor of Science in Nursing from an accredited college/university Substantial clinical experience with demonstrated ability to interpret clinical documentation and medical necessity Certified Professional Coder (CPC) with coding experience across inpatient, outpatient, and professional services Familiar with the revenue cycle process and facility and professional claims Demonstrates excellent communication skills, both written and oral Experience managing small projects and teams Familiar with accessing and identifying clinical documentation in electronic medical record systems Proficient in Excel, Word, and PowerPoint and able to draft reports and presentations and present findings Ability to problem solve, multi-task, and prioritize assignments Understands the importance of privileged and confidential communication Willingness to travel when needed Must be legally authorized to work in the United States without the need for employer sponsorship, now or at any time in the future.

Demonstrates proficiency in medical coding, billing, clinical documentation, and regulatory standards Works with Project Managers to analyze and understand client concerns and develop project work plans as requested Understands health care compliance concepts, issues, and how to research and access regulatory guidelines and reference materials Conducts independent review of medical records – EMR (electronic medical records) or paper documentation Drafts clear and concise analyses of medical record review and coding findings Ensures successful completion of high-quality project deliverables as assigned and within the desired timeframe Works collaboratively with Ankura team members focusing on building and maintaining internal and external client and counsel relationships Proven writing and presentation skills and has a keen sense of attention to detail Communicates findings of concern with the team and Project Manager as they are identified Utilizes creative and critical thinking problem-solving techniques

Professional Credit Service

Clinical Documentation Integrity Specialist

Posted on:

February 7, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Oregon

PROFESSIONAL is the Pacific Northwest’s leading accounts receivable management firm, specializing in early-out and recovery services for healthcare providers and government agencies nationwide. At Professional we do things a little differently, which is what sets us apart from our competitors. We seek to humanize account management by providing consumers with compassionate financial care and cutting-edge technologies that help them make the best decisions for their financial health and by doing so enhance consumer-client relationships.

The CDI Specialist is responsible for providing expert Clinical Documentation Improvement services to assigned clients. This role involves conducting comprehensive reviews of clinical documentation, collaborating with healthcare providers, and ensuring compliance with applicable standards and regulations. The CDI Specialist will also provide education and training to healthcare staff to promote accurate and complete clinical documentation. This is a PRN/Part-Time fully remote position.

CCDS, CDIP, RHIA, RHIT or other relevant credential from AAPC and/or AHIMA A minimum of 3 years’ CDI experience; within a client facing role preferred Maintain confidentiality and remain compliant by effectively handling protected health information (PHI) Exceptional oral and written communication skills with the ability to communicate effectively with physicians and other clinical disciplines Energetic, confident, self-starter with the ability to work independently and thrive in the dynamic environment of a growing company Detail oriented, with strong time management and planning skills to effectively meet deadlines Proficient in Microsoft Office, including Excel Strong technological skills with the ability to quickly and efficiently learn new systems, potentially working in more than one system at the same time

Conduct detailed reviews of clinical documentation to ensure accuracy, completeness, and compliance. Identify opportunities for documentation improvement and communicate these to healthcare providers. Ensure documentation practices comply with federal, state, and organizational regulations and standards. Stay current with changes in clinical documentation regulations, guidelines, and industry best practices. Provide education and training to physicians, nurses, and other healthcare staff on best practices for clinical documentation. Collaborate with healthcare providers, coding staff, and other stakeholders to facilitate accurate and complete documentation. Analyze clinical documentation data to identify trends, areas for improvement, and track the progress of CDI initiatives. Prepare and present detailed reports on documentation performance, highlighting successes and areas needing attention.

Blue Cross and Blue Shield of North Carolina

Episodic Care Manager - Medicare Advantage

Posted on:

February 7, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Compact / Multi-State

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

The Episodic Care Manager is responsible for performing clinical reviews to assess, facilitate, and coordinate the delivery of health care services for members based on medical necessity and contractual benefits. Effectively coordinate with providers, members, and internal staff to support the delivery of high quality and cost-effective care across the health care system.

RN with 3 years of clinical experience or LPN with 5 years of clinical experience Must have and maintain a valid and applicable clinical license (NC or compact multi-state licensure) to perform described job duties

Clinical Evaluation and Review: Receive assigned cases for varied member services (i.e. inpatient, outpatient, DME) Review and evaluate cases for medical necessity against medical policy, benefits and/or care guidelines and regulations. Complete work in accordance with timeliness, production, clinical quality/accuracy and compliance standards Provide notifications to member and/or provider, according to regulatory requirements. Assess appropriateness for secondary case review by the Medical Director (MD) for denials and coordinate as needed. May coordinate peer-to-peer review upon provider request when members’ health conditions do not meet guidelines Collaboration and Documentation Communicate and collaborate effectively with internal and external clinical/non-clinical staff (including MDs) to coordinate work Appropriately and fully document outcome of reviews and demonstrate the ability to interpret and analyze clinical information Utilize detailed clinical knowledge to summarize clinical review against the criteria/guidelines to provide necessary information for MDs

Main Line Health

Documentation Quality & Appeal Spec

Posted on:

February 7, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

None Required

State License:

Compact / Multi-State

Main Line Health (MLH) is a not-for-profit health system serving portions of Philadelphia and its western suburbs. At its core are four of the region’s respected acute care hospitals—Lankenau Medical Center, Bryn Mawr Hospital, Paoli Hospital and Riddle Hospital—as well as one of the nation’s premier facilities for rehabilitative medicine, Bryn Mawr Rehabilitation Hospital; Mirmont Treatment Center and Main Line Health HomeCare & Hospice. MLH also consists of multi-specialty physician networks, Lankenau Institute for Medical Research- non-profit biomedical research organization. It also comprises five outpatient health centers located in Broomall, Collegeville, Concordville, Exton and Newtown Square. At Main Line Health we recognize that people are the most important asset we have so we believe in fostering a work environment of collaboration, participation and respect. A cornerstone of that belief is a commitment to attracting talented, dedicated people from a broad cross-section of backgrounds, experiences and walks of life—all working together for the common purpose of providing superior care.

**Remote Position** Make an Impact! Shift: Monday - Friday; day shift Develop and Grow Your Career! Invest in furthering your education through seeking certifications or advanced degrees by taking advantage of our Tuition Reimbursement! This position is eligible for up to $6,000 per year based upon your Full or Part Time status. Get Involved! Get involved by attending educational coding sessions and maintaining clinical (RN) CEUs when applicable. Join the Team! Like our patients, the Main Line Health Family encompasses a wide range of backgrounds and abilities. Just as each of our patients requires a personalized care plan, each of our employees, physicians, and volunteers, bring distinctive talents to Main Line Health. Regardless of our unique design, we all share a purpose: providing superior service and care. Position-Specific Benefits include: You are eligible for up to 240 hours of paid time off per year based on your Full or Part Time status. We also offer a number of employee discounts to various activities, services, and vendors... And employee parking is always free!

Experience: Minimum one year experience as a CDI Reviewer in an acute care setting. Minimum of five years of clinical experience in an acute care setting. Working knowledge of DRGs and clinical conditions impacting quality outcomes is required. Education: Bachelor’s Degree required. Strong clinical training required. Licensures/Certifications: CCDS or CDIP certification preferred. CCS or concurrent enrollment in AHIMA-approved coding program within 90 days of hire. RN is preferred.

Are you an experienced CDI reviewer looking to join a premier healthcare provider? If so, come be a part of Main Line Health as a Documentation Quality and Appeals Specialist where you will use your extensive knowledge of clinical documentation requirements and ICD-10 guidelines to perform record review to ensure complete and accurate documentation for continuing care which reflects the appropriate Severity of Illness (SOI) and Risk of Mortality (ROM) as well as any potential Patient Safety Indicators (PSIs). Use your critical skills to understand legal and compliance issues and how they pertain to clinical documentation, and present information to clinical and end users.

Heritage Health Network

Registered Nurse Care Manager (RNCM)

Posted on:

February 7, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

California

This is a remote position. We are seeking a Registered Nurse Care Manager (RNCM) to provide clinical oversight for a team of non clinical Lead Care Managers. In this fully remote role, you will review member charts in the electronic medical record (EMR) system, assess care plans, and collaborate with Lead Care Managers to ensure members receive comprehensive, high-quality clinical care. Most hours can be completed at your convenience. However, one hour per week will be required to participate in case reviews with the ECM team.

Licensure: Active Registered Nurse (RN) license in California. Experience: Minimum 2 years of nursing experience, with at least 1 year in care management, case management, or leadership. Experience working with vulnerable populations and individuals with complex medical and social needs. Familiarity with Enhanced Care Management (ECM) or similar care coordination programs is preferred. Skills & Knowledge: Strong clinical assessment and care planning skills. Knowledge of Medi-Cal, Medicare, and care management best practices. Excellent communication and teamwork abilities. Proficiency in electronic medical records (EMR) systems.

Clinical Oversight & Quality Assurance: Review member charts in the EMR system to assess care plans, medical history, and treatment adherence. Ensure the quality and appropriateness of care coordination for members in the ECM program. Provide clinical guidance to non-clinical Lead Care Managers, helping them navigate complex cases. Identify gaps in care and recommend interventions to improve health outcomes. Care Coordination & Collaboration: Work closely with a multidisciplinary team that includes: Lead Care Managers Behavioral Health Care Managers Community Health Workers Partner with healthcare providers and community organizations to facilitate referrals and-access to care. Participate in weekly team case reviews to discuss high-risk members and ensure best practices in care management. Support care transitions by coordinating with hospitals and providers to optimize discharge planning. Regulatory Compliance & Documentation: Ensure compliance with Medi-Cal ECM guidelines and other healthcare regulations. Maintain accurate documentation in the electronic health record (EHR) system. Provide clinical input for monthly reports required by health plans and regulatory bodies.

Ascension

Registered Nurse Transfer Center

Posted on:

February 7, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Florida

Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 99,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you’ll find an inclusive and supportive environment where your contributions truly matter.

Your future role at a glance: Department: Bed Management Schedule: PRN; as needed; (1) Major and (1) Minor Holiday required Location: St. Augustine, FL Salary: $37.77 - $53.32 Must be within 1 hour of St. Augustine How you'll make an impact in this role: Coordinate and facilitate patient admissions and transfers to other facilities within the market, other markets, and other healthcare facilities according to patient acuity, bed availability, and required services.

Licensure / Certification / Registration: Registered Nurse obtained prior to hire date or job transfer date required. BLS Provider preferred. American Heart Association or American Red Cross accepted. Education: Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire. What additional requirements you'll need: At least 1 year of telemetry experience

Collaborate with the nursing staff and multidisciplinary team members to place patients in appropriate levels of care to achieve desired outcomes. Coordinate as liaison between physician requestors for consultants and specialty consultants. Assist in the care management process including pre-registration and insurance verification. Stay informed of patient changes and communicates the impact to admitting physicians. Review medical reports from referring hospitals or physician offices and relays information to the receiving nursing unit as needed. Develop and maintain relationships with referral sources and admission decision makers. Maintain standards for documentation and communications with physician/service referrals for legal, medical, statistical, and process improvement purposes.

CVS Health

Utilization Management Nurse Consultant

Posted on:

February 7, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Montana

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

As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. You would be responsible for ensuring the member is receiving the appropriate care at the appropriate time and at the appropriate location, while adhering to federal and state regulated turn-around times. This includes reviewing written clinical records.

Required Qualifications: Must be an RN with active, current and unrestricted RN state licensure in state of residence 3+ years of clinical experience as an RN (all clinical areas considered: Home Health, Med/Surg, Telemetry, ICU, NICU, Long term care, orthopedics, and more) 1+ years’ experience with Microsoft Office Suite (PowerPoint, Word, Excel, Outlook) Must be willing to work Monday through Friday 8:00am-4:30pm. Shift times may vary occasionally per the need of the department and business needs. Must be willing and able to work weekend and/or holiday shift requirement per the needs of the team and business needs. Preferred Qualifications: 1+ years’ experience Utilization Review experience 1+ years’ experience Managed Care Strong telephonic communication skills Experience with computers toggling between screens while using a keyboard and speaking to customers. Ability to exercise independent and sound judgment, strong decision-making skills, and well-developed interpersonal skills Ability to manage multiple priorities, effective organizational and time management skills ] Ability to use a computer station and sit for extended periods of time Education: Associates Degree required BSN preferred

Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization, facilitates safe and efficient discharge planning and works closely with facilities and providers to meet the complex needs of the member. Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation along the continuum of care Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.

CVS Health

Case Manager Registered Nurse

Posted on:

February 7, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

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

This is a remote RN Case Manager. Prefer candidates with a COMPACT RN license or NY RN License.

Required Qualifications: Must have an active current and unrestricted RN licensure in the state of residence Must be willing to obtain multiple state RN licensure after hire (expenses paid for by company) 2+ years of clinical experience as an RN - All clinical experience will be considered, such as Emergency Department, Home Health, Hospice, Operating Room, ICU, NICU, Telemetry, Medical / Surgical, Orthopedics, Long Term Care, and Infusion nursing. Must be willing and able to work Monday through Friday 8:30 am to 5:00 pm in the time zone of residence with occasional evening, weekend, and holiday shifts per the needs of the team. Preferred Qualifications: Certified Case Manager (CCM) certification 3+ years’ experience with Microsoft Office Suite Case Management in an integrated model Discharge Planning experience Managed care experience Prefer EST or CST candidates Education: Bachelor's in Science and Nursing Required

Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. Through the use of clinical tools and information/data review, conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. Assessments take into account information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Reviews prior claims to address potential impact on current case management and eligibility. Assessments include the member’s level of work capacity and related restrictions/limitations. Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality. Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Classet

Remote Care Coordinator - LPN

Posted on:

February 5, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Illinois

Chronic Care Staffing is Hiring a Remote Care Coordinator - LPN!: Employment Type: Full-Time Location: Remote (Work from Anywhere) Pay Range: $21 – $24/hour Schedule: Monday–Friday, No Weekend Work About the Role: Chronic Care Staffing is seeking a Remote Care Coordinator (LPN) to join our growing team of healthcare professionals dedicated to improving patient outcomes. This role is ideal for experienced and compassionate LPNs who thrive in a remote, patient-centered care environment. As a Care Coordinator, you’ll engage directly with patients managing chronic conditions, helping them stay on track with their care plans and ensuring strong communication between patients and providers. Your work will directly impact health outcomes, patient satisfaction, and care continuity.

Active, unencumbered LPN/LVN license BLS certification High proficiency in EHR systems Experience in a clinical or CCM setting Strong communication, problem-solving, and clinical reasoning skills Proficiency in Google Suite Ability to work independently in a HIPAA-compliant home office (locked door, two monitors, high-speed internet) Excellent verbal and written communication abilities Nice to Have: Prior experience in care coordination, chronic care management, or remote patient monitoring Familiarity with community resource navigation Experience in patient/family education on chronic conditions Knowledge of quality measures, CMS compliance, or reporting Strong team-player mindset in a remote work environment Home Office Requirements HIPAA-compliant workspace (distraction-free, private area) Reliable high-speed internet connection Dual-monitor setup (provided or approved by CCS)

Conduct monthly Chronic Care Management (CCM) calls and verbal enrollments. Perform Health Risk Assessments, Transitional Care Management, and Remote Patient Monitoring services. Educate patients and families on chronic conditions, medications, and treatment goals. Collaborate with healthcare providers and staff to ensure effective communication and care coordination. Encourage adherence to care plans and support patient self-management. Document all communications and interventions accurately in EHR systems. Comply with HIPAA, CMS, and company quality standards. Maintain productivity and call volume expectations while demonstrating empathy and professionalism.

AMN Healthcare

REMOTE - RN Case Manager

Posted on:

February 5, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

California

At AMN Healthcare, we strive to be recognized as the most trusted, innovative, and influential force in helping healthcare organizations provide quality patient care that continually evolves to make healthcare more human, more effective, and more achievable. Facility Location Situated in the San Francisco Bay Area, Walnut Creek is a picture-perfect California town known for its ample wide open spaces. Although the majority of the city is developed and offers everything from an orchestra to countless restaurants and side-walk cafes, there is a lot of area that remains undeveloped in effort to preserve the region’s natural beauty.

POSITION SUMMARY RN Case Manager REMOTE POSITION DUTIES DCP in an acute care setting MINIMUM REQUIRED QUALIFICATIONS CA RN license in hand PREFERRED QUALIFICATIONS Kaiser exp (not req) + Prefer ED/ICU/PCC or Transfer Center Experience LENGTH OF ASSIGNMENT 13 weeks SHIFT / HOURS PER WEEK 8:30am - 5:00pm (likely every other weekend) SYSTEMS EPIC START DATE 2/16/26

Lumina Care

Care Manager (LPN/RN)

Posted on:

February 5, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

New York

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

We are seeking a dedicated and experienced Care Manager (LPN/RN) to join our team. This remote role involves creating comprehensive care plans for patients in long-term care settings, conducting monthly chart reviews, and addressing care gaps.

Qualifications: Licensure: Licensed Practical Nurse (LPN) or Registered Nurse (RN) with current and valid certification. Experience: Minimum of one year of experience in long-term care settings. Skills: Strong organizational and communication skills, proficiency in remote care management tools, and the ability to work independently. Preferred Qualifications: Experience with telemedicine platforms and remote care coordination. Familiarity with electronic health record (EHR) systems. Strong problem-solving skills and the ability to handle complex care scenarios. Requirements: A laptop (Chromebooks are not compatible with our required tools and systems). An external monitor for efficient multitasking and productivity. Reliable internet connection. A quiet and dedicated workspace.

Conducting monthly chart reviews to assess patient care and identify any gaps in their treatment plans. Updating patient information to ensure accurate and up-to-date records. Developing, reviewing, and revising care plans tailored to each patient’s unique needs and health goals. Identifying and addressing care gaps to improve health outcomes and enhance the quality of life for patients. Maintaining compliance with all healthcare regulations and company policies while delivering exceptional service to our patients.

KYYBA, Inc

Registered Nurse Case Manager

Posted on:

February 5, 2026

Job Type:

Contract

Role Type:

Case Management

License:

RN

State License:

Michigan

Kyyba, Inc. is a global workforce management and technology solutions firm headquartered in Farmington Hills, Michigan with multiple locations across the globe. Our expertise is in connecting the right people with the right opportunities. We deliver high-quality solutions and top-notch recruiting services, enabling businesses to effectively respond to organizational changes and technological advances. Kyyba offers IT, Engineering, Professional, customized project solutions and Business Consulting Services. Industry areas include but are not limited to Automotive, Education, Financial Services, Public Services, Aerospace & Defense, Insurance, Transportation, Technology, Government, Healthcare & Medical, Manufacturing, and Oil & Energy.

Job Title: RN Case Manager Location: 100% Remote Duration: 12+ months License Required: Active & unrestricted Michigan RN license The Case Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person centric care management program to a diverse health plan population with a variety of health and social needs. They serve as the single point of contact for members, caregivers, and providers using a variety of communication channels including phone calls, emails, text messages and the client's online messaging platform. The Case Manager RN uses the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the member's health across the care continuum. They work in partnership with the member, providers of care and community resources to develop and implement the plan of care and achieve stated goals.

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

Lead the coordination of a regionally aligned, multidisciplinary team to provide holistic care to meet member needs telephonic and/or digitally. The multidisciplinary team is inclusive of Medical and Behavioral Health Social Workers, Registered Dietitians, Pharmacists, Clinical Support Staff and Medical Directors. Use the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the members' health across the care continuum. Assess the member's health, psychosocial needs, cultural preferences, and support systems. Engage the member and/or caregiver to develop an individualized plan of care, address barriers, identify gaps in care, and promotes improved overall health outcomes. Arrange resources necessary to meet identified needs (e.g., community resources, mental health services, substance abuse services, financial support services and disease-specific services). Coordinate care delivery and support among member support systems, including providers, community-based agencies, and family. Advocate for members and promote self-advocacy. Deliver education to include health literacy, self-management skills, medication plans, and nutrition. Monitor and evaluate effectiveness of the care management plan, assess adherence to care plan to ensure progress to goals and adjust and reevaluate as necessary. Accurately document interactions that support management of the member. Prepare the member and/or caregiver for discharge from a facility to home or for transfer to another healthcare facility to support continuity of care. Educate the member and/or caregiver about post-transition care and needed follow-up, summarizing what happened during an episode of care. Secure durable medical equipment and transportation services and communicate this to the member and/or caregiver and to key individuals at the receiving facility or home care agency. Adhere to professional standards as outlined by protocols, rules and guidelines meeting quality and production goals. Continue professional development by completing relevant continuing education and maintaining Certified Case Manager (CCM).

Houston Methodist

Clinical Documentation Specialist RN (Remote)

Posted on:

February 5, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Washington

Houston Methodist is one of the nation’s leading health systems and academic medical centers. The health system consists of eight hospitals: Houston Methodist Hospital, its flagship academic hospital in the Texas Medical Center, seven community hospitals and one long-term acute care hospital throughout the Greater Houston metropolitan area. Houston Methodist also includes a research institute; a comprehensive residency program; international patient services; freestanding comprehensive care clinics, emergency care and imaging centers; and outpatient facilities. Come lead with us!

The candidate for this role must live in these states: TX, LA, WA, FL or GA. At Houston Methodist, the Clinical Documentation Specialist is responsible for improving the overall quality and completeness of clinical documentation. This position analyzes medical records for DRG's, complications, and comorbidities; identifies trends; and notes observations and recommendations for documentation improvement. This role also facilitates modifications to clinical documentation through extensive interaction with physicians, nursing staff, other patient care givers, and medical records coding staff to ensure that appropriate reimbursement is received for the level of service rendered to all patients. Additional duties include supporting the accuracy and completeness of the clinical information used for measuring and reporting physician and hospital outcomes and educating all members of the patient care team on an ongoing basis.

EDUCATION: Medical School graduate where Western Medicine is practiced EXPERIENCE: One year of clinical experience preferred LICENSES AND CERTIFICATIONS Required Preferred: CCDS - Clinical Documentation Specialists (ACDIS) or CDIP - Certified Documentation Integrity Practitioner (AHIMA) or CCS - Certified Coding Specialist (AHIMA) SKILLS AND ABILITIES: Demonstrates the skills and competencies necessary to safely perform the assigned job, determined through on-going skills, competency assessments, and performance evaluations Sufficient proficiency in speaking, reading, and writing the English language necessary to perform the essential functions of this job, especially with regard to activities impacting patient or employee safety or security Ability to effectively communicate with patients, physicians, family members and co-workers in a manner consistent with a customer service focus and application of positive language principles Demonstrates knowledge of DRG payor issues, appropriate DRG assignment alternatives, clinical documentation requirements, and referral policies and procedures Demonstrates accountability and professional development Requires excellent observation skills, analytical thinking, problem solving, plus good verbal and written communication Regular significant contacts with other personnel throughout the institution (including but not limited to – physicians and their staff, mid-level providers, mid-level staff, coders, Case Managers). Contacts may be in person, by telephone, or through correspondence. Requires assertiveness while being even tempered, with a pleasing personality and the ability to communicate easily with others. SUPPLEMENTAL REQUIREMENTS WORK ATTIRE Uniform: No Scrubs: No Business professional: Yes Other (department approved): No ON-CALL* Note that employees may be required to be on-call during emergencies (ie. Disaster, Severe Weather Events, etc) regardless of selection below. On Call* No TRAVEL** **Travel specifications may vary by department** May require travel within the Houston Metropolitan area No May require travel outside Houston Metropolitan area No

PEOPLE ESSENTIAL FUNCTIONS: Improves the overall quality, completeness and accuracy of clinical documentation by performing open record reviews using clinical documentation guidelines. Supports the accuracy and completeness of clinical information used for measuring and reporting physician and medical outcomes. SERVICE ESSENTIAL FUNCTIONS: Seeks additional information regarding clinical condition from appropriate clinical personnel and follows up as necessary. Tracks responses and trends completion of DRG/Documentation worksheets as pertinent to scope of department. Conducts follow-up reviews of clinical documentation to ensure points of clarification have been recorded in the patient’s chart. QUALITY/SAFETY ESSENTIAL FUNCTIONS: Demonstrates knowledge of DRG payor issues, optimization strategies, clinical documentation requirements and referral policies and procedures. Requests clarification and/or correction from physicians for unclear diagnoses, complications, procedures, and clinical information. Helps identify appropriate ICD10 codes for diagnoses or procedures related to projects or studies being conducted as needed. FINANCE ESSENTIAL FUNCTIONS: Promotes clarification to clinical documentation to ensure that appropriate reimbursement is received for the level of service rendered to all patients. Identifies diagnoses and procedures performed and comorbidities and complications. Impacts discharges by updating the DRG worksheet to reflect any changes in status, procedures/treatments, conferring with physician to finalize diagnosis as necessary. GROWTH/INNOVATION ESSENTIAL FUNCTIONS Educates all internal customers on clinical documentation opportunities, coding, and reimbursement issues, as well as performance improvement methodologies

Integrated Resources - Hosted Jobs

Medical Management Specialist I

Posted on:

February 5, 2026

Job Type:

Contract

Role Type:

Case Management

License:

RN

State License:

New Mexico

Founded in 1996, Integrated Resources Inc. (IRI), an American staffing company, has been leading the industry for two decades. With best-in-class selection process we connect ambitious candidates with companies nationwide. For companies seeking specialized staffing and talent acquisition, IRI is the one-stop solution.

Job Title: Medical Management Specialist I Job Location: NM (Remote + Field Visit) Job Duration: 11-12 Months+ contract (possibility of extension) Remote near Bernalillo and Sandoval- Travel throughout Albuquerque and Rio Rancho

Registered Nurse (RN), with 3 years direct clinical care to the consumer in a clinical setting or Licensed Professional Counselor (LPC), or Licensed Master Social Worker (LMSW), which includes 2 years of clinical practice to obtain their LPC or LMSW license. Current, valid, unrestricted license in the state of operations (or reciprocity). For compact licensee changing permanent residence to state of operations, you must obtain active, unrestricted RN licensure in the state of operations within 90 days of hire. Plus 3 years wellness or managed care experience presenting clinical issues with members/physicians. Knowledge of the health and wellness marketplace and employer trends. Verbal and written communication skills including discussing medical needs with members and interfacing with internal staff/management and external vendors and community resources. Analytical experience including medical data analysis. Current driver's license, transportation, and applicable insurance. Ability and willingness to travel within assigned territory. PC proficiency to include Word, Excel, and PowerPoint, database experience and Web based applications. Preferred Job Qualifications: 3 years clinical experience. Patient education experience. Condition Management experience. Bilingual in English and Spanish. Transition of Care experience. Experience in managing complex or catastrophic cases. Certification in Case Management, Training, Project Management or nationally recognized health care certification.

Responsible for conducting medical management and health education programs for customers on government health care programs. Other responsibilities include gathering, analysing, and providing data for regulatory reports. This position will represent the company to members.

C2Q Health Solutions

RN CARE MANAGER - COMPLEX CARE & HIGH UTILIZER MANAGEMENT

Posted on:

February 5, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

New York

The RN Care Manager – Complex Care & High Utilizer Management is responsible for the comprehensive management of participants who exhibit high utilization of outpatient services, are at high risk for readmission, hospitalization, or ED visits, or present with complex behavioral health needs and chronic conditions such as COPD, Heart Failure, and Diabetes. This role provides advanced clinical oversight, risk stratification, and proactive outreach to ensure participants receive timely, coordinated, and appropriate care. The RN Care Manager – Complex Care & High Utilizer Management collaborates closely with medical providers, behavioral health specialists, and operational leaders to develop and implement strategies that reduce avoidable utilization, strengthen chronic disease management, and enhance participant experience. The RN Care Manager – Complex Care & High Utilizer Management also ensures that referrals—particularly those related to high-risk and complex participants—are clinically appropriate, timely, and aligned with evidence-based interventions for chronic disease care pathways.

Education: BSN required Current Registered Nurse (RN) license in New York State Certification in Case Management (CCM) or equivalent, preferred Experience: 3+ years of clinical experience in chronic disease management, care coordination, or case management Experience working with high‑risk, medically complex, or high‑utilizing populations Strong assessment, communication, and interdisciplinary collaboration skills Experience in PACE, MLTC, Managed Care, or high‑risk care management preferred Prior experience with behavioral health integration or complex psychosocial case management preferred Physical Requirements: Individuals must be able to sustain certain physical requirements essential to the job. This includes, but is not limited to: Standing – Duration of up to 6 hours a day. Sitting/Stationary Positions – Sedentary position in duration of up to 6-8 hours a day for consecutive hours/periods. Lifting/Push/Pull – Up to 50 pounds of equipment, baggage, supplies, and other items used in the scope of the job using OSHA guidelines, etc. Bending/Squatting – Have to be able to safely bend or squat to perform the essential functions under the scope of the job. Stairs/Steps/Walking/Climbing – Must be able to safely maneuver stairs, climb up/down, and walk to access work areas. Agility/Fine Motor Skills - Must demonstrate agility and fine motor skills to operate and activate equipment, devices, instruments, and tools to complete essential job functions (ie. typing, use of supplies, equipment, etc.) Sight/Visual Requirements – Must be able to visually read documentation, papers, orders, signs, etc., and type/write documentation, etc. with accuracy. Audio Hearing and Motor Skills (Language) Requirements – Must be able to listen attentively and document information from patients, community members, co-workers, clients, providers, etc., and intake information through audio processing with accuracy. In addition, they must be able to speak comfortably and clearly with language motor skills for customers to understand the individual. Cognitive Ability – Must be able to demonstrate good decision-making, reasonableness, cognitive ability, rational processing, and analysis to satisfy essential functions of the job.

Chronic Disease Management: Deliver ongoing care, support, and health education to participants with chronic illnesses including COPD, Diabetes, Heart Failure, cardiovascular disease, and degenerative neurological or musculoskeletal disorders. Facilitate and enable engagement with the CL provider and IDT Design and lead the implementation of care pathways and clinical protocols to streamline the management of the most common chronic illnesses. Develop and implement individualized chronic disease action plans to prevent avoidable ED visits, hospital readmissions, and disease exacerbations in collaboration with TOC and IDT. Conduct clinical reviews using evidence-based criteria to ensure appropriateness of care for chronic disease–related needs. High Utilizer Oversight (Outpatient, Inpatient & ED): Lead clinical management of participants identified as high utilizers of outpatient care or at elevated risk for hospital or ED use. Perform risk stratification emphasizing chronic disease burden and complex behavioral health conditions such as COPD, CHF, Diabetes, and psychiatric comorbidities. Monitor utilization patterns and proactively engage participants to reduce unnecessary, repetitive, or avoidable service use Collaborate with behavioral health staff to address psychosocial, psychiatric, or adherence related barriers that contribute to high utilization. Referral & Utilization Review: Oversee the referral process for high-risk and complex participants to ensure clinical appropriateness and timeliness. Collect and evaluate clinical documentation supporting medical necessity for specialty services, chronic disease care, and behavioral health interventions. Prioritize urgent referrals and coordinate follow-through for participants at highest medical risk. Support participants in navigating the healthcare system and reinforce chronic-condition self-management practices. Respond to participant concerns related to care access, delays, or coordination and resolve barriers in real time. Care Coordination & Communication: Work closely with CenterLight physicians, behavioral health teams, and external providers to ensure cohesive, risk reducing care coordination Maintain current knowledge of CenterLight's provider network, including behavioral health and chronic disease specialties such as COPD, CHF, and Diabetes care. Communicate care trends, system changes, and clinical insights to the CMO and IDT. Serve as the Clinical Programs’ subject matter expert, coordinating with TOC, Social Work Care Managers, Clinical Review Specialists, and the IDT for high-risk or complex cases. Partner with TOC on safe discharge planning and transitions to reduce readmissions. Quality & Performance Improvement: Conduct prospective, concurrent, and retrospective clinical reviews related to chronic disease and complex care management. Apply evidence-based guidelines to determine medical necessity for participants with frequent ED visits, behavioral health complexity, or chronic disease complications. Participate in quality improvement initiatives, including inter‑rater reliability testing. Support HR‑HI provider panel updates and contribute clinical insights to enhance risk reduction and chronic disease control. Perform other duties as assigned.

CIRCADIAN HEALTH INC

Registered Nurse Care Manager - Diabetes

Posted on:

February 5, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

New York

This innovative, technology-forward virtual medical practice that specializes in remote patient monitoring and chronic care management is currently hiring due to rapid growth. Our expert clinical team utilizes the latest digital technology to deliver personalized care to patients in a virtual care setting that allows easy, everyday patient access to the care team. Our streamlined integration of care is partnered with the local primary team and together, this fuels a powerful approach to achieving optimal patient outcomes. If you join our team, you will maximize your current and potential skills, and then discover the dual reward of professional and patient satisfaction.

The Diabetes RN will provide specialty level endocrine/diabetes care to a defined panel of patients using advanced Remote Patient Monitoring (RPM) technology while working collaboratively with a dynamic team of clinical experts. The care team is composed of Registered Nurse Care managers (RNs), CDCES/RNs, Nurse Practitioners (NPs), and patient coordinators, all of whom will work simultaneously to move patients to their targeted health goals under the direction of a Lead Endocrinologist. Applying clinical expertise and knowledge of diabetes management, the RN/LPN will deliver remote education and care management to patients with individualized care plans set forth by the Nurse Practitioner and Endocrinologist. The RN/LPN will provide independent patient monitoring, outreach, education and titration of medications using approved protocols with the support of physicians and NPs.

5 years experience in diabetes care management required Current and unrestricted RN/LPN License in New York required, with willingness to endorse to additional states as required such as California, Arizona, Minnesota, Nevada, and Hawaii Bilingual (Spanish/English) required, additional language skills helpful BSN Degree with CDCES certification preferred Knowledge of diabetes technology including Dexcom sensors, Libre sensors/flash readers, diabetes smartphone apps, insulin calculators Knowledge and experience with ordering various insulins and other anti-diabetes therapies Passion for improving patient outcomes long term

Identify gaps in diabetes knowledge to address and work to fully equip the patient with skill sets needed for self care. Provide full DSMT (Diabetes Self Management Training) to patients remotely by using digital tools and virtual interactive platforms over a series of visits. Support and educate patients on the use of diabetes technology: including proprietary blood glucose meters, commercial continuous glucose monitors and diabetes smartphone apps. Using integrated remote patient data, the RN/LPN will assist in medication adjustment using validated titration protocols with support from the medical provider when needed. Independent judgment will be used to identify the need for modification of the current treatment plan based on glucose trends. The RN/LPN will then work with the medical provider to explore other interventions or escalate therapy as needed. Identify SDOH (Social Determinants of Health) and apply problem solving skills to ensure optimal outcome by coordinating referrals to community resource programs, such as rehabilitation, financial assistance, behavioral health and other social services when needed. Serve as a resource to answer any clinical diabetes questions from the team and provide ongoing collaborative diabetes education to both internal and external health care team members.

Myriad Genetics Inc.

Medical Information Nurse Liaison I

Posted on:

February 5, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Utah

At Myriad Genetics, we’re passionate about our mission of advancing health and wellbeing for all through genetic insights. Our mission is underpinned by our values: collaborative, innovative, inclusive, caring, and committed guide everything we do. We inspire a dynamic and diverse culture, where career development is prioritized, and all teammates have equal opportunity to grow and make a difference in patients’ lives.

The primary responsibility of the Medical Information Nurse Liaison I is to optimize sample submission, perform clinical case review, and provide support to internal and external clients. With a primary focus in pathology and genomic testing, this position is responsible for liaising between healthcare providers, Myriad Customer Service, and other Myriad medical teams.

Qualifications: Nursing degree from an accredited college. RN, BSN required. Experience in pathology, histopathology, genetics, genomics needed. 5+ years post-graduate clinical experience. Advanced training and/or experience in clinical cancer care desired. Valid RN license in state of residence. Requires excellent leadership, written and verbal communication, interpersonal skills, problem solving, decision making and critical thinking. Professional and detail oriented with the ability to work independently and be a contributing team member. Willing and able to travel <5%, primarily for team meetings. Physical Requirements: Lifting Requirements – sedentary to light work or exerting 10 to 20 pounds of force frequently. Physical Requirements – stationary positioning, moving, operating, ascending/descending, communicating, and observing. Use of equipment and tools necessary to perform essential job functions. OSHA category III – normal routine involves no exposure to blood, body fluid, or tissue and as part of the employment, will not be called upon to perform or assist in emergency care or first aid.

Client Support: Interacts with healthcare providers to provide product information, improve sample acquisition, confirm clinical information and discuss laboratory procedure. Assists in the creation, editing, and review of written material for internal and external communications. Clinical Knowledge: Maintains current clinical knowledge for MGL products supported by the Medical Information Nurse Liaison team. Maintains CE requirements for relevant certifications/licenses. Internal Support: Provides medical case review to ensure proper processing, appropriate test selection, and test result accuracy. Provides clinical support to interdepartmental teams and projects. Provides a clinical voice to support product and corporate initiatives. Administrative: Manages time and expenses. Accurately documents client interactions and assesses the need for communication with other Medical Services team members and/or MSL and AE in specific geographic regions. Keeps up to date on all SOP tasks and maintains a high level of understanding of internal processes and protocols. Accesses and updates all relevant databases in an appropriate and effective manner. Leadership: Active member of Medical Services community through best practice sharing, participation in meetings and coaching programs.

Optum

Per Diem Utilization Management Nurse RN - Remote

Posted on:

February 5, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Minnesota

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

The Utilization Management Nurse will accurately and efficiently review and extract pertinent case details from patient medical records; and craft strongly defensible appeal letters per process instructions and the department’s/company’s guidance. The nurse will complete their case within the time expectations while providing high quality reviews. The Utilization Management Nurse will perform their job functions, adhering to both Optum and OPAS policies and procedures, which include but are not limited to the following. Schedule: Per Diem as needed, flexible start times with the ability to support evening, weekend and holiday shifts. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Required Qualifications: Unrestricted Registered Nurse License in your state of residence 3+ years of bedside nursing experience in ED/telemetry/ICU/CCU Advanced level of experience with Microsoft applications and software, internet navigation and utilization Ability to type 45 wpm Preferred Qualifications: Proven working knowledge of Word Proven effective communication skills Proven excellent typing skills with a minimum of 45/min speed Proven solid, effective verbal and written communication skills

Follows directive of composing appeal letters to include appropriate data extraction, construction of well-written appeals letters with proper grammar, utilization of appeal tools including pre-constructed templates, inclusion of appropriate medical literature references, and use of national criteria guidelines. Adheres to company policies and procedures as well as policies, procedures, and laws Understands and complies with HIPAA confidentiality requirements Support and promote OPAS, Optum, and the enterprise goals and mission Build relationships across Optum, OPAS, OGA and our clients Collaborate with peers to assure continuity of communication and execution of deliverables as needed Adheres to quality and productivity expectations Participate in and contribute to meetings as appropriate Maintains organization on the team and ensures everyone conducts themselves professionally Remains up to date with all learning modules, competencies, and state required licenses Performs other related duties, tasks, and processes as required by leadership Ability to establish priorities, be self-motivated, work independently, and follow instructions with supervision and structure Positive attitude and the ability to function as a collaborative team member You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Cohere Health

RN Reviewer

Posted on:

February 5, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Massachusetts

The RN Reviewer position is a crucial role in our organization — in this role you are responsible for performing a full range of activities that will positively impact the organization and contribute to guiding the strategic operations for the company. As an RN Reviewer, you will perform prospective review (prior authorization) admission, concurrent, and retrospective reviews according to established criteria and protocols to determine the medical appropriateness of the clinical requests from providers. You will work closely with Medical Directors and other Cohere Health staff to ensure appropriate cost-effective care by applying your clinical knowledge and critical thinking skills to assess the medical necessity of inpatient admissions, outpatient services and procedures, and provider out of network requests. You will be required to review Commercial, Medicare, and Medicaid lines of business. You will need to be an agile and comprehensive thinker and planner and be able to work in an environment that is in flux. This position offers the ability to make a substantive mark in simplifying the way healthcare is delivered and contributes to an up and coming company with exponential growth opportunity. Important to know about this role: This is a 100% remote role, and requires robust internet speeds (above 50 megabytes/second), including the ability to utilize zoom meeting software and to stream video The department is staffed seven days per week, 8am-8pm EST and shifts will be assigned based on need This is a full time, 40 hour per week opportunity

What you'll need: Strong communication and collaboration skills across remote teams Customer-focused mindset and ability to stay calm under pressure Adaptability in a fast-moving, startup environment Solid understanding of utilization and case management programs Organized, detail-oriented, and comfortable managing multiple priorities Knowledge of NCQA/CMS standards; proficiency with MCG (CareWebQI a plus) Must Haves: Active, unencumbered RN license (state of residence) 3+ years of clinical experience Utilization Management experience Experience in acute or post-acute settings Comfortable using Mac and Google Workspace Strong communication skills and continuous improvement mindset Preferred: HEDIS abstraction, Legal RN, or Utilization Review background Bachelor’s degree in Nursing, Business, or related field

Review medical necessity for inpatient, concurrent, prior auth, and retrospective cases to ensure appropriate, high-quality care Collaborate with Medical Directors and providers to align on clinical decisions Document reviews accurately and meet production/quality goals Apply MCG, Cohere, and coverage guidelines to ensure compliance and consistency Partner across teams (Operations, Product, Quality, Health Plans) to improve processes and outcomes Identify opportunities for care management or quality improvement programs Support accreditation, regulatory, and quality initiatives

Optum

Telephonic Case Manager RN Transplant Medicine - Remote

Posted on:

February 5, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

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

We’re making a solid connection between exceptional patient care and outstanding career opportunities. The result is a culture of performance that’s driving the health care industry forward. As a Telephone Case Manager RN with UnitedHealth Group, you’ll support a diverse member population with education, advocacy and connections to the resources they need to feel better and get well. Instead of seeing a handful of patients each day, your work may affect millions for years to come. Ready for a new path? Apply today! The Telephonic Case Manager RN Transplant will identify, coordinate, and provide appropriate levels of care. The Telephonic Case Manager RN Transplant is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes case management, coordination of care, and medical management consulting. This is a full-time, Monday – Friday, 8am-5pm position in your time zone. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Required Qualifications: Current, unrestricted Compact RN license in the state of residence 3+ years of experience in a hospital, acute care or direct care setting Proficiency in Microsoft Office Tools and Systems (Outlook, Word, Excel, Teams) Have access to high-speed internet (DSL or Cable) Dedicated work area established that is separated from other living areas and provides information privacy Preferred Qualifications: New York single state license or willing to obtain within 90 days of employment BSN Certified Case Manager (CCM) 3+ years of experience within the transplant setting Case management experience Experience or exposure to discharge planning Experience in a telephonic role Background in managed care Bilingual in English and Spanish

Make outbound calls and receive inbound calls to assess members current health status Identify gaps or barriers in treatment plans Provide patient education to assist with self-management Make referrals to outside sources Provide a complete continuum of quality care through close communication with members via in-person or on-phone interaction Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels This is high volume, customer service environment. You’ll need to be efficient, productive and thorough dealing with our members over the phone. Solid computer and software navigation skills are critical. You should also be solidly patient-focused and adaptable to changes. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Happy Health

Sleep Medicine Nurse Practitioner

Posted on:

February 5, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Texas

Happy Health is an Austin-based biotech company with $60M in venture financing and a mission to reinvent healthcare through at-home diagnostics and remote patient monitoring. Happy Health is revolutionizing sleep medicine delivery through our comprehensive telehealth platform. We've eliminated the traditional barriers to sleep care – no more waiting months for appointments or spending uncomfortable nights in sleep labs. Our patients receive FDA-cleared home sleep testing via Happy Ring, connect with board-certified sleep specialists, and when required, begin evidence-based treatment within just 5 days. Happy Ring represents the future of sleep diagnostics: an FDA-cleared medical device integrating advanced biometric sensors with AI-powered analysis to deliver clinical-grade accuracy in the home environment. For sleep medicine practitioners, this means you'll have access to high-quality diagnostic data that empowers you to make confident clinical decisions for your patients.

Join a team of sleep medicine specialists dedicated to expanding access to expert care across the country. As a Remote Sleep Medicine Nurse Practitioner, you'll deliver comprehensive, evidence-based care for the full spectrum of sleep disorders. Location: Remote (work from anywhere in the U.S.) Schedule: Flexible but consistent hours designed around patient availability and your lifestyle Compensation: $76/hour (1099), with a full-time (W2) opportunity for qualified individuals

Current, unrestricted Nurse Practitioner license with APRN certification Minimum 3 years of comprehensive sleep medicine clinical experience or supervised sleep medicine practice Understanding of sleep disorder classification (ICSD-3), diagnostic criteria, and differential diagnosis Proficiency in communicating sleep testing data and understanding therapy compliance reports Must maintain residence in the United States Training in sleep medicine (ANCC Sleep Health NP certification, AASM RPSGT/RST, or equivalent specialized training), preferred Multiple state licenses to practice as an APRN, preferred Technical Competency: Prior telehealth experience strongly preferred Comfortable with EHR systems, remote monitoring platforms, and sleep technology interfaces Quick to adapt to new clinical tools and digital workflows

Clinical Practice: Perform comprehensive sleep medicine evaluations including detailed sleep histories, assessment of comorbid conditions, and medication review Develop individualized, evidence-based treatment plans incorporating CPAP/BiPAP therapy, oral appliances, CBTi, etc. as clinically appropriate Provide expert patient education on sleep hygiene and lifestyle modifications specific to their sleep issues Collaborative Care: Work alongside board-certified sleep physicians and clinical researchers Consult on complex cases and participate in clinical discussions, case conferences, and continuing education programming Patient Care: Conduct follow-up visits to assess treatment adherence, efficacy, and side effects Assess and adjust PAP therapy, OAT, medications, CBTi, and modify treatment plans based on objective data and patient-reported outcomes Monitor for treatment-emergent issues and evolving sleep pathologies Integrate endotype and phenotype-based precision medicine approaches to therapeutic decision making Professional Excellence: Leverage our integrated EHR to maintain meticulous clinical documentation that exceeds current practice standards Engage in quality improvement initiatives, evidence-based protocol development, and patient-reported outcomes measurements Stay current with sleep medicine literature and clinical guidelines

Brilliant Care

Bilingual (Spanish and English) Nurse Care Coordinator, Full-time

Posted on:

February 5, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

New York

Brilliant Care is a very innovative, fast-growing, mission-driven population health management company that assists with value based care initiatives. Our objective is simple: improve health outcomes and reduce total cost of care. We proactively identify at-risk hypertensive, diabetic and CHF patients and provide them with personalized access to a nurse care manager who works as an extension to the provider. Using high-touch care coordination and advanced remote technologies, we improve patient compliance and medication adherence while reducing unnecessary ER and hospital visits. Essentially, we help improve outcomes substantially, without heavy lift or any out-of-pocket costs for healthcare organizations.

This position will assist healthcare providers and practices to successfully manage their care management and remote patient monitoring program and provide remote patient monitoring services to patients who are enrolled in the program. Must have a passion for educating patient on how to manage their chronic conditions, be self-driven to meet required monthly goals, and have ability to maintain flexibility in a constantly changing environment.

Education & Experience: LPN or RN Min 3-year work experience working in practice or healthcare setting. Must be fluent in both Spanish and English Location: Work from home - Ideal candidates should reside in the Central Time Zone

Patient Enrollment: Enroll patients in Remote Patient Monitoring (RPM). Possess the skill to verbally train and educate patients on how to use devices Data Collection: Monitor daily capture of patient physiologic data from devices Conduct coaching call to remind patients to capture daily data Follow-up with non-compliant patients Care Management: Act as primary contact for patients to build rapport and maintain patient satisfaction, improvement in health status, and compliance with program Analyze collected data and triage out of range readings in a timely manner Escalate cases which require provider attention Provide health coaching to high-risk diabetic, hypertensive, and congestive heart failure patients Document assessment data, education provided, and lifestyle interventions planned in patient charts Capture detailed and concise notes of all patient interactions Act as a resource to patients and providers in enabling access to the provider and presenting information to the provider for medical decision-making Provider & practice management: Understand physician and practice challenges or objections which come in their way of enrolling patients in RPM Professionally address provider expressed challenges and workflow related issues to ensure program success Possess ability to change workflow and processes as requested by provider or practice Communicate with provider of patient needs and institute care changes per provider instructions

Zenith Grace Home Care

Supervisor Registered Nurse (RN) – Part-Time

Posted on:

February 5, 2026

Job Type:

Part-Time

Role Type:

Leadership / Management

License:

RN

State License:

New Jersey

Zenith Grace Home Care is seeking an experienced and dependable Part-Time Supervisor Registered Nurse (RN) to provide clinical oversight and regulatory supervision for our non-medical home care agency in New Jersey. This role is primarily supervisory and compliance-focused and does not involve routine hands-on bedside nursing care. The Supervisor RN supports quality assurance by conducting required client assessments, developing and reviewing plans of care, supervising caregivers, and ensuring compliance with New Jersey Division of Consumer Affairs home care regulations. The ideal candidate is organized, detail-oriented, and comfortable working independently while collaborating with agency leadership. This position is well-suited for an RN seeking flexible, part-time work, such as a hospital RN, school nurse, case manager, or nurse with regulatory or home care experience. The Supervisor RN plays a key role in maintaining care standards, supporting caregivers, and ensuring the agency operates with integrity, professionalism, and compassion.

Skills: Strong knowledge of New Jersey home care regulations or ability to quickly learn and apply regulatory requirements Excellent clinical assessment and care planning skills Ability to provide clinical supervision and guidance to caregivers and CHHAs High level of attention to detail with accurate documentation and record-keeping Strong organizational and time-management skills in a part-time, independent role Effective written and verbal communication skills Ability to work independently with minimal supervision Professional judgment and problem-solving skills related to client care concerns Experience with or comfort using electronic documentation systems Ability to collaborate with administrative leadership in a compliance-focused environment Reliable transportation and willingness to travel locally for assessments when needed

Conduct initial, annual, and change-of-condition client assessments in accordance with New Jersey home care regulations Develop, review, and update Plans of Care to ensure client safety, appropriateness of services, and regulatory compliance Provide clinical supervision and oversight to caregivers and Certified Home Health Aides (CHHAs) Participate in caregiver orientation, training, and competency evaluations as required Serve as a clinical resource for caregivers and administrative staff regarding client care concerns Review and follow up on incident reports, complaints, and adverse events, and assist with corrective action plans when needed Ensure services are delivered in compliance with NJ Division of Consumer Affairs – Health Care Service Firm requirements Collaborate with agency leadership to support quality assurance and performance improvement initiatives Maintain accurate and timely clinical documentation in accordance with agency policies and state regulations Be available for on-call consultation related to clinical oversight as required

Grand Capital Management inc

Clinical Nurse Specialist (CNS) – Telehealth (Remote) | Medicare-Enrolled

Posted on:

February 5, 2026

Job Type:

Contract

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

We are seeking a qualified and compassionate Nurse Practitioner (NP) or Clinical Nurse Specialist (CNS) who is Medicare-enrolled to provide remote clinical services to Medicare beneficiaries. The clinician will conduct comprehensive telehealth evaluations, provide preventive care counseling, and ensure accurate clinical documentation.

Required Qualifications: Active NP or CNS license in [STATE] National certification (AANP, ANCC, or CNS certification) Active Medicare enrollment (required) NPI number DEA registration (preferred) Experience in primary care, internal medicine, family medicine, or geriatrics Comfortable with telehealth platforms and EMR systems Reliable internet and private workspace Preferred Qualifications: Telehealth experience Multi-state licensure Experience with Medicare population

Conduct telehealth clinical encounters with Medicare patients Perform health assessments and medical history reviews Provide preventive care counseling and patient education Develop and document individualized care plans Maintain timely and accurate documentation in EMR Collaborate with physician leadership as applicable Follow all clinical and regulatory compliance standards

Optum

RN Call Assist Overnight Everett, WA

Posted on:

February 5, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

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

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

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

Utilizes clinical expertise and approved protocols to provide health advice to consumers with clinical questions and makes referrals for health services as appropriate via telephone Be able to document calls in applicable system in a timely manner and exhibits a willingness to master new work routines and methods Documents all inquiries according to department standards for legal/statistical purposes Excellent written and verbal communication skills Be able to problem solve issues independently as well as work with teams collaboratively situations require assessment, decision-making within the framework of established protocols, excellent listening and communication skills, knowledge of computers, critical thinking skills and the nursing process Speaks with a pleasant, professional phone voice and provides superior customer service to internal and external customers Ensures performance standards are met and accepts constructive feedback You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Curana Health

Care Manager, LPN

Posted on:

February 5, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Texas

At Curana Health, we’re on a mission to radically improve the health, happiness, and dignity of older adults—and we’re looking for passionate people to help us do it. As a national leader in value-based care, we offer senior living communities and skilled nursing facilities a wide range of solutions (including on-site primary care services, Accountable Care Organizations, and Medicare Advantage Special Needs Plans) proven to enhance health outcomes, streamline operations, and create new financial opportunities. Founded in 2021, we’ve grown quickly—now serving 200,000+ seniors in 1,500+ communities across 32 states. Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds, all working together to deliver high-quality, proactive solutions for senior living operators and those they care for. If you’re looking to make a meaningful impact on the senior healthcare landscape, you’re in the right place—and we look forward to working with you. For more information about our company, visit CuranaHealth.com.

The Care Manager supports Curana Health providers by managing patient scheduling, coordinating with long‑term care facilities, and ensuring clinical documentation accuracy within the EHR. This role follows CMS guidelines, maintains census accuracy, and prepares encounter information to support efficient, high‑quality patient care. The Care Coordinator works closely with providers, facility staff, and the interdisciplinary team to ensure timely, organized, and compliant care delivery.

Qualifications: Active, unrestricted LPN license; RN is also acceptable. Ability to function effectively in a remote environment with minimal supervision. Strong organizational skills and ability to prioritize tasks in a fast‑paced setting. Experience navigating electronic health records; GEHRIMED experience preferred but not required. Excellent written and verbal communication skills. Ability to collaborate successfully with providers, facility staff, and interdisciplinary team members. Preferred: Experience in long‑term care, assisted living, or post‑acute settings. Prior scheduling or care coordination experience. Familiarity with CMS regulations related to long‑term care or value‑based care programs.

Patient & Provider Support: Schedule patients for Curana providers in accordance with CMS guidelines and internal scheduling protocols. Communicate with long-term care facilities to identify new or additional residents needing evaluation. Maintain an accurate and up‑to‑date census in GEHRIMED, ensuring patients are added, removed, and categorized appropriately. Prepare provider encounters by entering and/or updating required clinical information including: Medication lists Vital signs Laboratory results Medical history and relevant past encounters Ensure encounters are complete and ready for provider review prior to the visit. Monitor incoming facility communication and escalate urgent needs to the appropriate provider. Support smooth provider workflows through proactive organization and timely updates. Facility & Communication Support: Serve as the primary liaison between Curana providers and facility staff to coordinate scheduling, access, and patient needs. Communicate clearly and professionally with facility nursing staff regarding patient status or updates required to complete the visit workflow. Ensure residents needing follow-up or additional attention are appropriately documented and scheduled. Maintain collaborative communication to support high-quality, efficient patient care. Administrative Responsibilities: Follow all CMS, company, and documentation guidelines to ensure compliant scheduling and recordkeeping. Support quality initiatives by ensuring documentation accuracy and completion prior to submission. Assist with operational needs related to provider schedules, census changes, and EHR documentation. Other duties as assigned.

Providence

Care Manager LPN LVN - Case and Disease Government Program *Remote*

Posted on:

February 5, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Oregon

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

Care Manager LPN LVN Remote Candidates residing in Oregon are encouraged to apply. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Health Plan Partners and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Certificate/Diploma from a state approved practical nursing program (should go under education level) Major - Nursing Associate's Degree Healthcare or healthcare related field Upon hire: Oregon Licensed Practical Nurse Upon request: Additional state licensure as assigned Upon request: Driving may be necessary as part of this role. Caregivers are required to comply with all state laws and requirements for driving. Caregivers will be expected to provide proof of driver's license and auto insurance upon request. 5 years of clinical nursing experience 2 years of experience working with physicians in the collaboration and management of patient care Preferred Qualifications: Bachelor's Degree in Health education or healthcare related field Experience in Care Management and/or Care Navigation in a healthcare setting. Experience with Health Insurance, CMS, OHA and other governing healthcare entities

The purpose of this position is to provide care coordination services to Providence Health Plans (PHP) members. Care coordination services include: disease management programs, including educating, motivating and empowering members to manage their disease. Case management including: triage and referral, transition of care planning, end of life care planning, and other support to advocate for and assist the member in the achievement of optimal health, access to care, and appropriately utilizing resources. These services are offered to members and their families who have acute and complex health care needs; members with chronic conditions at risk for poor health outcomes and members who are terminal and nearing end of life.

OpTech LLC

Clinical Case Manager, RN – Commercial Health

Posted on:

February 5, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Michigan

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

***REMOTE BUT MUST HAVE A LICENSE IN MICHIGAN*** Pay $37.00- $39.00/hour Remote- M-F 8-5 PM Contract to hire

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

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

OpTech LLC

Telephonic RN Case Manager – Commercial Operations

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

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

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

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

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

C & S Employment Solutions

Registered Nurse (Remote) – CS Employment Solutions

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Missouri

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

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

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

OpTech LLC

Registered Nurse Care Manager

Posted on:

February 4, 2026

Job Type:

Contract

Role Type:

Care Management

License:

RN

State License:

Michigan

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

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

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

Lumina Care

Registered Nurse Clinical Manager

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

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

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

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

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

Moments Hospice

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

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Minnesota

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

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

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

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

CareXM

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

Posted on:

February 4, 2026

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

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

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

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

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

CGC Group Inc.

Quality Maternal Health Clinician

Posted on:

February 4, 2026

Job Type:

Contract

Role Type:

Care Management

License:

NP/APP

State License:

New York

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

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

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

Emory Healthcare

Utilization Review Specialist Registered Nurse / RN

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Georgia

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

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

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

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

CVS Health

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

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

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

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

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

This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients. Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. Assessments utilize information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversations. Identifies and escalates member’s needs appropriately following set guidelines and protocols. Need to actively reach out to members to collaborate/guide their care. Perform medical necessity reviews.

RX.ME

Remote Registered Nurse (1200-0000EST)

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

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

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

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

Devoted Health

Telehealth Preventative Primary Care Advanced Practice Provider- NP/PA

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

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

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

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

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

Devoted Health

Bilingual Hypertension Specialty Care Nurse Practitioner

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

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

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

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

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

Devoted Health

Hypertension Specialty Care Nurse Practitioner

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

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

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

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

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

Devoted Health

Specialty Care Nurse Practitioner Manager

Posted on:

February 4, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

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

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

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

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

Golden Care Solutions

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

Posted on:

February 4, 2026

Job Type:

Contract

Role Type:

Care Management

License:

RN

State License:

California

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

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

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

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

Centene

Clinical Review Nurse - Concurrent Review (NICU)

Posted on:

February 3, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

Florida

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

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

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

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

CVS Health

Case Manager Registered Nurse

Posted on:

February 3, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

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

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

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

Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. Through the use of clinical tools and information/data review, conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to programs and plans. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. Assessments consider information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Reviews prior claims to address potential impact on current case management plan. Assessments include the member’s level of work capacity and related restrictions/limitations. Using a holistic approach to assess the need for referral to clinical resources for assistance. Consults with supervisor and others in overcoming barriers in meeting goals and objectives; presents cases at case conferences for multidisciplinary focus to benefit overall claim management. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

Highmark Inc.

Transplant Care Nurse (Remote)

Posted on:

February 3, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

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

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

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

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

Highmark Inc.

Care Manager RN - (Remote)

Posted on:

February 3, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

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

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

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

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

TalentLNX

Itemization Review Nurse

Posted on:

February 3, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Texas

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

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

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

Optum

Call Center Nurse RN – Remote

Posted on:

February 3, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

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

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

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

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

Optum

Call Center Nurse RN - Part-Time

Posted on:

February 3, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Wisconsin

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

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

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

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

Optum

Clinical Documentation Improvement Specialist

Posted on:

February 3, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

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

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

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

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

UnitedHealthcare

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

Posted on:

February 3, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Texas

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

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

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

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team Make outbound calls and receive inbound calls to assess members’ current health status Identify gaps or barriers in treatment plans

UnitedHealthcare

Secondary Review Nurse - Remote in Kansas

Posted on:

February 3, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Kansas

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

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

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

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

TridentMedical

Remote Nurse Pracitioner

Posted on:

February 3, 2026

Job Type:

Part-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Maine

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

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

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

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

WJM Professional Services LLC

Telehealth RN I

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

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

We are currently recruiting for a Telehealth Registered Nurse I.

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

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

Molina Healthcare

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

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Wisconsin

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

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

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

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

CVS Health

MinuteClinic Virtual Care Nurse Practitioner - Overnight Shift

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Michigan

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

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

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

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

TECQ Partners

Medical Management Nurse 1

Posted on:

February 2, 2026

Job Type:

Part-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

Texas

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

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

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

BlueCross BlueShield of South Carolina

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

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

Compact / Multi-State

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

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

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

Network Health, Inc

Weekend RN Coordinator Utilization Management

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

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

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

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

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

Inova Health System

Registered Nurse (RN) Clinical Documentation Denials Auditor

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Virginia

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

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

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

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

VIllageCare of New York

RN- Care Manager (Bilingual)

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

New York

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

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

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

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

NavitasPartners

Registered Nurse – Rural / Remote Care

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Alaska

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

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

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

Parallon

Cardiovascular Data Abstractor II Part Time

Posted on:

February 2, 2026

Job Type:

Part-Time

Role Type:

License:

RN

State License:

Texas

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

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

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

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

Centene

DRG Reviewer

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

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

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Responsible for independently conducting comprehensive reviews of MS-DRG and APR-DRG coding and clinical documentation to ensure the accuracy of DRG assignment and reimbursement. Requires advanced expertise in ICD-10-CM/PCS coding and the ability to exercise discretion and professional judgment in assessing complex clinical information, validating diagnosis code assignments, and identifying discrepancies such as coding errors or upcoding. Operates with significant autonomy in supporting DRG validation reviews and appeals, interpreting regulatory requirements, and making authoritative decisions to ensure compliance with all applicable laws, payer contracts, and organizational policies.

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

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

BRC

Nurse Analyst, Nurse Paralegal, Legal Nurse

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Texas

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

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

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

BlueCross BlueShield of South Carolina

Medical Reviewer II

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

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

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

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

Blue Cross and Blue Shield of North Carolina

Case Manager

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

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

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

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

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

Central Dauphin School District

Substitute Nurse Positions

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Pennsylvania

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

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

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

QTC Management, Inc.

Medical Quality Assurance Specialist I

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

LPN/LVN

State License:

Pennsylvania

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

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

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

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

Medcor Inc

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

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Illinois

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

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

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

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

QTC Management, Inc.

Medical Quality Assurance Specialist I

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

LPN/LVN

State License:

Compact / Multi-State

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

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

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

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

Pennsylvania Health & Wellness

Care Manager (RN)

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

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

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Remote Role, Monday - Friday 8AM to 5PM EST Position Purpose: Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plans and education for members and their families.

Education/Experience: Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 2 – 4 years of related experience. License/Certification: RN - Registered Nurse - State Licensure and/or Compact State Licensure required For YouthCare Illinois plan only: Bachelor’s Degree and IL RN licensure required. Must reside in IL For Sunshine Health (FL) Only: Employees supporting Florida's Children’s Medical Services (CMS) must have a minimum of two years of pediatric experience. May require up to 80% local travel required

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

Broadway Ventures

Medical Claims Reviewer

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

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

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

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

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

Baptist Health System KY & IN

Revenue Cycle Specialist

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Kentucky

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

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

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

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

Network Health, Inc

Weekend RN Coordinator Utilization Management

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Wisconsin

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

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

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

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

CVS Health

MinuteClinic Virtual Care Provider - PRN

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Tennessee

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

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

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

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

WJM Professional Services LLC

Regional Nurse Supervisor I

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Compact / Multi-State

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

We are currently recruiting for a Regional Nurse Supervisor I

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

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

Texas Nursing Services

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

Posted on:

February 2, 2026

Job Type:

Part-Time

Role Type:

License:

RN

State License:

Texas

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

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

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

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

Med-Metrix

Clinician, Denial Management - Remote

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

New York

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

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

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

Blue Cross and Blue Shield of North Carolina

Utilization Management Specialist

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

None Required

State License:

North Carolina

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

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

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

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

Broadway Ventures

RN Senior Medical Reviewer

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

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

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

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

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

Optum

Call Center Nurse RN - Remote

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

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

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

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

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

UnitedHealthcare

RN Health Coordinator - Field Based - West Hawaii

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Hawaii

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

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

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

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, least restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Blue Cross and Blue Shield of North Carolina

Utilization Management Specialist

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

None Required

State License:

North Carolina

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

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

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

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

St. Peter's Health Partners

Registered Nurse (RN) Remote Triage Opportunity

Posted on:

February 2, 2026

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

New York

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

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

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

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

Guideway Care

Triage Nurse RN | Weekends

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

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

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

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

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

Watchung Pediatrics

Overnight Triage Nurse (Part-Time)

Posted on:

February 2, 2026

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

New Jersey

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

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

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

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

Vantage Medical Associates

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

Posted on:

February 2, 2026

Job Type:

Full-Time

Role Type:

Primary Care

License:

NP/APP

State License:

New York

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

Qualifications: New York License Medicare/Medicaid Enrolled

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

Eden Home Health

Home Health Quality Assurance RN

Posted on:

January 31, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Washington

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

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

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

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

Elevance Health

LPN/LVN 100% Virtual, CareBridge

Posted on:

January 31, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

LPN/LVN

State License:

Indiana

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

Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Work Shift: Full time (40 hours a week) position. 8am to 5pm local time that will require holidays and weekend rotation. The LPN/LVN is responsible for the examination and treatment of patients under the direction of the physician.

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

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

TeamHealth

Oregon OB/GYN Registered Nurse

Posted on:

January 30, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Oregon

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

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

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

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

Shifamed

Field Clinical Specialist

Posted on:

January 30, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

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

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

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

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

VISIUM HEALTHLINK LLC

LPN Nurse Navigator

Posted on:

January 30, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

LPN/LVN

State License:

Kentucky

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

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

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

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