Stealth Ventures at Redesign Health

Wound Specialist - Virtual Wound Care (REMOTE)

Posted on:

September 21, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

The Wound Care Nurse provides quality, cost-effective management of a caseload of patients via telehealth and remote encounters for patients across multiple states who have complex wound care needs. Upon referral from StealthCo partner physicians, the wound care nurse provides comprehensive patient care (treating the whole patient). Leveraging our tech stack, they can assess, formulate, and execute plans of care, using image-based remote patient monitoring to regularly adjust care plans, triage, and coordinate care for accelerated healing. You will provide expert consultation, coordination of services and education for patients, families and the healthcare team to achieve optimal patient care.The major clinical focus of this position is providing wrap-around services and management of the treatment journey virtually. You will report to and work with the Chief Medical Officer. (Note: this position has the opportunity to become full-time.)

Background: Nursing Degree Minimum four (4) years of wocn or NP experience Minimum two (2) years of wound care experience. License, Certification, Registration: This job requires licensure and credentials in Colorado, with the capability to be licensed and credentialed in multiple states in the future (Support to be provided) National Provider Identifier/ WOCN certification Misc. Skills Current evidence-based knowledge of wound nursing practice. Experience with wound assessments, Experience working with multiple technology platforms Knowledge/experience with all kinds debridement including sharp wound debridement. Ability to complete concise, thorough clinical documentation of patient assessments and care. Working knowledge of quality management and resource utilization methodologies. Thorough knowledge of universal infection control Presents in-service training Strong verbal and communication skills. Problem-solving, organizational and time management skills. Ability to work in interdisciplinary team as a consultant and direct care provider. Able to provide continuous patient education in alliance with WOCN standards Demonstration of customer-focused service skills. Ability to proficiently operate personal computer, technology platforms, virtual conferencing, and remote image support

Wound Care: Collaborates with partner physicians, coordinates referrals, DME, and prescriptions to drive positive outcomes. Assesses, examines, counsels, and determines a plan of care for prevention and healing of wounds. Determines and orders appropriate topical products, compression therapy, sharp debridement, referrals to specialty providers, labs and x-rays and protocols based on established evidence-based guidelines and algorithms Organizes and forms the plan of care for patients and rehabilitation through assessment, examination, teaching, counseling and recommending treatment and product use. Leverages image-based remote patient monitoring to continually inform treatment and care management. Wound Education and Consultation: Consults with contracted home health agencies, primary care clinicians, wound care clinics, and partner physicians regarding appropriate clinical wound care and utilization for home care and outpatient services. Informs treatment protocols and patient engagement plans Consults with DME, Materials Management regarding optimum use of supplies and equipment Quality Management/Utilization: Participates in quality management/improvement activities including occurrence reporting, focused studies, process and outcome measurement and continuous quality improvement projects. Performs other duties as assigned.

Atlantic Health Strategies

Remote Behavioral Health SUD Registered Nurse (CT Licensed) Pathfinder Recovery

Posted on:

September 21, 2025

Job Type:

Part-Time

Role Type:

Behavioral Health

License:

RN

State License:

Conneticut

At Pathfinder Recovery, we’re redefining addiction treatment by blending evidence-based therapy with cutting-edge technology. If you’re a licensed therapist ready to make a meaningful impact - and you’re excited about using tools like AI-powered medical records and bioinformatics to enhance care - we want to hear from you.

We’re seeking a dedicated Nurse to provide virtual, patient-centered care for individuals in our addiction and mental health programs. You’ll have the flexibility of remote work, the support of an experienced clinical team, and access to technology that streamlines documentation and improves continuity of care - so you can focus on delivering compassionate treatment. Why Join Pathfinder Recovery Remote, part-time role with flexible scheduling. Hourly compensation of $30–$55 per hour, with opportunities for growth. Work closely with a collaborative team of physicians, therapists, and medical staff. Access to innovative telehealth tools and real-time monitoring technology. Direct involvement in advancing accessibility and excellence in addiction and mental health care. Ongoing training and professional development in telehealth and evidence-based treatment. If you want to combine your nursing expertise with the most advanced tools in behavioral health - and be part of a team committed to transforming lives - apply today

Active LPN, RN, or higher licensure in Connecticut. Associate’s or Bachelor’s Degree in Nursing, or equivalent education qualifying for licensure. At least 1 year of nursing experience. Knowledge of substance use and mental health treatment preferred. Strong critical thinking, active listening, and communication skills. Familiarity with HIPAA, confidentiality standards, and electronic medical record systems. CPR/First Aid certification and crisis intervention training.

Conduct virtual assessments by observing, monitoring, and documenting patient health, behaviors, symptoms, and self-reported vitals. Coordinate with physicians, behavioral health specialists, and interdisciplinary teams to implement individualized treatment and recovery plans. Provide education and guidance on safe use of prescribed treatments and medications, including medication-assisted treatments (MAT) such as Vivitrol and Naltrexone. Maintain accurate and timely electronic health records (EHR) in compliance with HIPAA and organizational standards. Educate patients on health maintenance, medication compliance, relapse prevention, and mental health self-care strategies via telehealth platforms. Support patient access by assisting with telehealth platforms and promoting digital literacy. Participate in ongoing professional development, including training in telehealth best practices and substance use disorder treatment.

Evergreen Nephrology

Nurse Care Manager

Posted on:

September 21, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. We believe patients living with kidney disease deserve the best care. We are committed to improving patient outcomes and improving quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants. We help nephrologists focus on the right patients at the right time across the full care spectrum. We do this by providing them with the best-in-class interdisciplinary clinical resources, analytical insight and tools, and services to patients. We listen to the needs of our patients, our employees, and our client partners, continually working to push beyond the status quo in which the care system manages patients today.

You are devoted, compassionate, and enjoy being on the front lines of healthcare, changing the lives of patients by supporting them and the team by focusing on customers. You’re excited about being part of a team that is building a healthcare delivery model that ensures the highest possible quality of life and best outcomes for those in our care. You believe people living with kidney disease deserve the best person-centered, holistic, comprehensive care and want to influence the healthcare system to drive towards that. You thrive in innovative and evolving environments with high rates of change. As a Nurse Care Manager with Evergreen Nephrology, you are responsible for managing an assigned patient panel and addressing each patient’s specialized needs based on their individual conditions, healthcare needs, goals, and wishes. You will collaborate with a team of physicians, Advanced Practice Providers (APPs), and Interdisciplinary Team (IDT) members. Nurse Care Managers at Evergreen often focus on patients targeted for specific programs such as Chronic Complex Care Management, Compassionate Care Management, Post Acute Care, Transitions of Care, and CKD Management. While our Nurse Care Manager positions are fully remote, this specific position will support patients in the Central Time Zone and must be able to work 8:30a - 5p CST.

Associate degree in nursing Current RN License is required, Compact License preferred Care management experience required Certified Case Manager preferred Intermediate skills with MS Office Suite of products including Outlook and Teams Able to work effectively in a primarily remote environment: Home internet must support a minimum download speed of 25 Mbps and upload speed of 10 Mbps. Cable, Fiber, or DSL connections hardwired to the internet device are recommended Evergreen will provide remote employees with telephony applications and equipment to meet the business requirements for their role Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Managing the overall care management of patient panel by leveraging experience, expertise, and knowledge in both the nursing field and value-based care operations. Establishing trusting and empathetic relationships with patients and families to provide clinical and emotional support and foster collaboration throughout their care journey. Serving as an advocate and community liaison for patients to ensure proper and timely resources and support while navigating the health care system and maintaining compliance with the primary care team’s/nephrologist’s treatment plan. Performing assessments and identifying the needs, including social determinants of health, of panel patients and caregivers based on values, care goals, and individual preferences, and translating these into patient-centric actionable care plans through comprehensive evaluations. Coordinating the interdisciplinary approach to achieving continuity of care and reducing fragmentation, focusing on kidney disease progression management, utilization management, and provider coordination through active care plan management. Monitoring and evaluating the effectiveness of care management plans regularly, modifying interventions as necessary. Following evidence-based care management guidelines and established workflow protocols to deliver high quality, efficient, patient-centered care that aligns with Evergreen’s goals, quality metrics, and regulatory and payer requirements. Collaborating with physician partners, community providers, APPs, and other clinical disciplines to create, implement, and manage integrated care plans. Identifying cost-effective measures for patients that support value-based care goals of improving patient outcomes and quality while effectively managing resource utilization. Facilitating patient and caregiver education on treatment options and empowering patients to make informed decisions about their care. Supporting seamless transitions of care as patients move between care settings, proactively addressing potential barriers and collaborating with IDTs. Actively participating in clinical huddles, and patient care conferences for patients under your care management as needed. Engaging in continuous, organizational process improvement to identify opportunities for improvement and execute action plans to optimize care management workflows, patient engagement processes, customer/patient care efforts, and other protocols. Preparing reports and other deliverables to communicate program changes or developments to appropriate stakeholders. Collecting data to prepare and deliver reports alongside program leaders on program success, patient outcomes, and patient/caregiver satisfaction. Other duties consistent with this role, as assigned.

Centerwell

Care Manager- Telephonic Nurse - Part Time Evenings & Weekends

Posted on:

September 21, 2025

Job Type:

Part-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

Clinical call center. High volume. Fast paced. This is a part time position, scheduled 20 hours per week. The shift is Monday-Wednesday, and Friday from 5:30pm-8:30pm EST as well as Sunday from 3pm-11:30pm EST. Must be available to work every other holiday. The Clinical Care Coordinator helps to ensure optimal continuity of care for patients transitioning into and out of our services. They are responsible for being highly knowledgeable regarding post-acute levels of care, and an expert regarding CenterWell Home Health services including home health, hospice, and palliative care. The Clinical Care Coordinator is expected to communicate with the CenterWell Home Health clinical team and help facilitate timely patient follow-up for patients in need of (additional) services when appropriate. The Clinical Care Coordinator is under the general supervision of the Manager of Care Coordination and under established performance criteria. This is a work-from-home telephonic nurse position

Required Qualifications: Licensed Registered Nurse (RN) with compact state licensure in state of residence with no disciplinary action 3 - 5 years of clinical acute care experience Comprehensive knowledge of Microsoft Office applications including Word, Excel, Outlook, Teams and One Note Must be passionate about contributing to an organization focused on continuously improving consumer experiences High speed internet (no hotspot, DSL or satellite) Preferred Qualifications: Experience with case management, discharge planning and patient education for adult acute care Managed care experience Home Health Care experience Telephonic triage experience Bachelor's degree HCHB experience preferred

Act as CenterWell Home Health representative in supporting patients who have been discharged from service or for those who may need post-acute services. Able to navigate healthcare options; care services post-acute offerings, Medicare coverage, billing issues, as well as accessing healthcare resources. Utilize a variety of tools and methods to quickly provide patient options and education including but not limited to sites of service, specialty offerings, post-acute care, and other related questions. Appropriately handle a variety of customer issues including location lookup, directions, and complaints. Makes clinical level of care determination based on discussion, medical records, and any other pertinent clinical data. Matches these needs to a service site location or, if not available, look up and provide alternative services. Act as customer advocate throughout the referral process to ensure timely response and to maximize referral to admission conversion rate. Follow-up and track referral and admission outcomes. Maintains awareness and orientation to department performance objectives, meets standards, and assures patient satisfaction goals are met. Assists in the admissions process by acting as an ambassador for patients who meet the admissions requirements. Focus on placing the right patient to the right care setting at the right time Adheres to and participates in Company’s mandatory training which includes but is not limited to HIPAA privacy program/practices, Business Ethics and Compliance programs/practices, and Company policies and procedures. Reviews and adheres to all Company policies and procedures. Provide education regarding Home Health, Hospice, and Palliative Care Services. Assist with clinical eligibility review for alternate services Participates in special projects and performs other duties as assigned.

United Biosource Corporation

Registered Nurse (Call Center)

Posted on:

September 21, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

Provides telephonic professional nursing services in support of client funded contracts. This includes telephonic patient support and resource, referral source, data collector and nurse educator to patients, consumers, and healthcare professionals.

Minimum- associate degree and professional nursing license Registered Nurse License in good standing in the state in which you work and/or cross-licensed in other states Telephonic nursing roles are required to have a Compact State License in eligible states; additionally, employee must be willing to obtain Compact State license at such time as their state elects to adopt Compact legislation Telephonic nursing roles are required to have a California State License and the employee must be willing to obtain additional Single State Licenses upon request. 2-5 years’ experience Basic database and office navigation skills Ability to maintain a high level of customer interaction/service skills while talking with patients, prescribers and/or specialty pharmacies via phone; ability to multitask in both PC/Phone related tasks and maintain adherence to approved scripted materials. Ability to interpret information shared by the patient to determine next steps as the individual case may warrant.

Adheres to principles as stipulated by program specific contractual agreements and company practices which may include Patient Support: Make outbound phone calls to patients who have opted into a patient program, make additional calls as directed and be available to support these patients by phone at all other times. Receive inbound phone calls from patients, healthcare professionals and consumers and provide a professional resource for inquiries. Resource: Answer patient, consumer and healthcare professional questions and suggest appropriate resources patients. Referral Source: Make appropriate referrals for additional training, support groups, program materials, or literature, and to recommend that the patients contact personal physicians for additional information, directions, and care. Collect Data: Assemble accurate, timely, clear data and complete summary of follow up phone calls, patient inquiries, and outcomes Educator: Complete patient teaching in relation to the use of products 75 % Participates in program specific customer meetings and training sessions. 10 % Participates in program specific orientation meetings and demonstrates clinical competency on electronic/written tests. 5 % Performs special projects and performs other duties as it pertains to specific contract performance 10 %

MPF Federal

PART-TIME Remote Nurse (RN - Call Center)

Posted on:

September 20, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Ready to Bring Your Acute Care Skills Home? Join Our Remote RN Team Supporting Our Military Communities! Are you a seasoned ER or Med-Surg nurse looking for a meaningful, mission-driven role that lets you care for others without the scrubs and long drives to the hospital? MPF Federal is hiring PART TIME Remote Telehealth Triage Nurses (RNs) to join our 24/7 Nurse Advice Line—supporting veterans and their families—all from the comfort of your home. This isn’t just a job; it’s your chance to use your clinical expertise, empathy, and critical thinking skills to guide patients through their toughest moments—all while achieving better work-life balance. Pay & Perks: $35.00/hr base rate Evening, night, and weekend differentials may apply 100% Remote – Work From Home Most schedules include Saturday and Sunday and do not rotate 4 hour Shifts Available (Share Your Schedule Preference!) SM==RFY 1600-2000 (4pm - 8pm) 4hr =MTWRF= 1730-2130 (5:30pm - 9:30pm) 4hr SM==RFY 1500-1900 (3pm - 7pm) 4hr =MTWRF= 1630-2030 (4:30pm - 8:30pm) 4hr SMTWR== 1500-1900 (3pm - 7pm) 4hr =MTWRF= 1600-2000 (4pm - 8pm) 4hr =MTWRF= 1500-1900 (3pm - 7pm) 4hr SM==RFY 0630-1030 (6:30am - 10:30am) 4hr =MTWRF= 0630-1030 (6:30am - 10:30am) 4hr =MTWRF= 0600-1000 (6am - 10am) 4hr SMT==Y= 0700-1100 (7am - 11am) 4hr R - Thursday; Y - Saturday; = means day off Training: Approximately 6 Weeks Paid Training | Monday–Friday, 8:00 AM – 4:30 PM Start Date: October 27, 2025

You’re a Great Fit If You Have: 5+ Years of Recent Hands-On Acute Care RN Experience ER or Med-Surg strongly preferred Current Compact RN License in good standing from the state you are physically in BSN Degree from an accredited American university Confidence with phone-based care and multi-screen computer systems Strong clinical judgment, emotional intelligence, and documentation skills A mission-first mindset and passion for serving military-connected communities Bonus Points If You Also Have: Experience with behavioral health, mother-baby, and/or peds Past work in telehealth, triage, or call center nursing Familiarity with military healthcare systems or VA patients Tech & Work Environment: Must have a hard-wired Ethernet internet connection (Wi-Fi only, satellite, or radio internet is not acceptable) Quiet, distraction-free home office space with a door for HIPAA compliance Metrics-driven environment – you’ll need to meet quality, handle time, and documentation goals Federal Requirements: Must be a U.S. Citizen Ability to pass a Public Trust Background Check & Drug Screening per federal guidelines Must be willing and able to obtain licenses in all 50 states (we support you here!)

Triage Symptoms: Assess callers using evidence-based protocols Deliver Immediate Care Advice: Recommend next steps, from self-care to urgent care, calmly and confidently Offer Health Education: Counsel patients on medications, test results, and chronic condition management Crisis Triage: Handle behavioral health, emergency, and complex calls with empathy and grace Document Interactions: Accurately chart calls in our EHR and follow compliance protocols Team Collaboration: Work closely with a supportive leadership team and fellow remote RNs If you're an experienced nurse with a calm voice, a critical mind, and a heart for service—this is your moment to make a real difference.

MPF Federal

Call Center Nurse (RN-BSN) - Remote - October 2025

Posted on:

September 20, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Ready to Bring Your Acute Care Skills Home? Join Our Remote RN Team Supporting Our Military Communities! Are you a seasoned ER or Med-Surg nurse looking for a meaningful, mission-driven role that lets you care for others without the scrubs and long drives to the hospital? MPF Federal is hiring Remote Telehealth Triage Nurses (RNs) to join our 24/7 Nurse Advice Line—supporting veterans and their families—all from the comfort of your home. This isn’t just a job; it’s your chance to use your clinical expertise, empathy, and critical thinking skills to guide patients through their toughest moments—all while achieving better work-life balance. Pay & Perks $35.00/hr base rate Evening, night, and weekend differentials may apply 100% Remote – Work From Home Most schedules include Saturday and Sunday and do not rotate Shifts Available (Share Your Schedule Preference!) Day Shifts Evening Shifts Night Shifts Training Approximately 6 Weeks Paid Training | Monday–Friday, 8:00 AM – 4:30 PM Start Date: October 27, 2025

You’re a Great Fit If You Have: 5+ Years of Recent Hands-On Acute Care RN Experience ER or Med-Surg strongly preferred Current Compact RN License in good standing from the state you are physically in BSN Degree from an accredited American university Confidence with phone-based care and multi-screen computer systems Strong clinical judgment, emotional intelligence, and documentation skills A mission-first mindset and passion for serving military-connected communities Bonus Points If You Also Have: Experience with behavioral health, mother-baby, and/or peds Past work in telehealth, triage, or call center nursing Familiarity with military healthcare systems or VA patients Tech & Work Environment: Must have a hard-wired Ethernet internet connection (Wi-Fi only, satellite, or radio internet is not acceptable) Quiet, distraction-free home office space with a door for HIPAA compliance Metrics-driven environment – you’ll need to meet quality, handle time, and documentation goals Federal Requirements: Must be a U.S. Citizen Ability to pass a Public Trust Background Check & Drug Screening per federal guidelines Must be willing and able to obtain licenses in all 50 states (we support you here!)

Triage Symptoms: Assess callers using evidence-based protocols Deliver Immediate Care Advice: Recommend next steps, from self-care to urgent care, calmly and confidently Offer Health Education: Counsel patients on medications, test results, and chronic condition management Crisis Triage: Handle behavioral health, emergency, and complex calls with empathy and grace Document Interactions: Accurately chart calls in our EHR and follow compliance protocols Team Collaboration: Work closely with a supportive leadership team and fellow remote RNs If you're an experienced nurse with a calm voice, a critical mind, and a heart for service—this is your moment to make a real difference.

UnitedHealthcare

Clinical Appeals RN - Fully Remote (4 or 5 work days/week) Weekends required

Posted on:

September 20, 2025

Job Type:

Part-Time

Role Type:

Utilization Review

License:

RN

State License:

California

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.

The Clinical Appeals RN is responsible for providing expertise in clinical appeals and grievances (analyzing, reviewing, and evaluating appeals and grievances), and acting as a Clinical Interface Liaison (clinical problem solver with facilities, providers, carriers, resolution of issues concerning members, benefits, program definition and clarification). You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. This role will work weekends, usually every other week or every week if working a 4 day work week. 5 day work week schedules are also availilbe.

Required Qualifications: Active, unrestricted RN license in state of residence 2+ years of clinical experience as an RN, including in an acute, inpatient hospital setting Proficiency in Microsoft Office, Word, Outlook, and Internet applications Available for 5 day work weeks including weekdays and weekends, 8:00- 4:30 in their time zone and some weekend work will be needed Preferred Qualifications: Bachelor of Science in Nursing 1+ years of experience using MCG and/or Medicare criteria 1+ years of Utilization Management, pre-authorization, concurrent review or appeals experience Appeals experience Proven excellent communication, interpersonal, problem-solving, and analytical skills

Review medical records and verify if the requested service meets criteria Review pre-service appeals for clinical eligibility for coverage as prescribed by the Plan benefits Review and interpret Plan language Coordinate reviews with the Medical Director Utilize clinical guidelines and criteria Accurately documenting determinations Adherence to all confidentiality regulations and agreements Hours M-F 8a-5p with alternating Saturdays Comfortable working mandatory overtime

Rula

Registered Nurse (Remote)

Posted on:

September 20, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

California

We believe that mental health is just as important as physical health. We recognize that mental health issues can be complex and multifaceted, and we are dedicated to treating the whole person, not just the symptoms. We aim to create a world where mental health is no longer stigmatized or marginalized, but rather is embraced as an integral part of one's overall well-being. We believe that by providing quality care that is both evidence-based and compassionate, we can empower individuals to take charge of their mental health and achieve their full potential. We are passionate about making a positive impact on the lives of those struggling with mental health issues and we strive to be a force for positive change in the field of mental healthcare.

Join our dynamic and fully remote Psych Clinical team at Rula, where you will play a pivotal role in providing accessible, comprehensive, and personalized mental health care for a diverse range of patients. As a remote psychiatric RN, you will play a pivotal role in supporting nearly 60 providers (PMHNPs + MDs) by triaging and providing crucial clinical support to patients in between their telehealth appointments. By assessing medication concerns, addressing safety issues, managing refills, and processing standing orders, the psychiatric RN ensures a seamless patient experience while our providers engage in direct patient care. Collaborating closely with our Virtual Assistants and Support agents, you will oversee prior authorizations and paperwork requests.

Required Qualifications: 2+ years of recent experience in a psychiatric/mental health setting Graduate of an accredited nursing school with a completed BSN Current RN licensure with an active CA license Familiarity with psychiatric medications and DSM-5 diagnoses; demonstrated expertise in patient education and crisis management Experience utilizing technology for mental health services Strong EHR and technological literacy Exceptional prioritization skills for assessing, triaging, and addressing patient requests Strong verbal and written communication skills with a focus on clear, concise, and accurate clinical documentation Experience supporting a diverse range of providers and their patients within an interdisciplinary team Ability to work M-F from 9 am to 5 pm PST Ability and willingness to cover during the 4th of July holiday week and the last week of the year on a rotational basis Preferred Qualifications: While having the preferred qualifications enhances your candidacy, having all of them is not mandatory. We encourage all interested applicants to apply, even those who may not meet every preferred requirement. Experience in a telehealth environment Strong operational knowledge with a focus on developing and implementing compliant workflows, policies, and procedures 2+ years of staff supervisory experience, OR 2+ years of experience leading/managing a healthcare team Ability to thrive in an autonomous, self-driven, and highly collaborative role within a fast-paced, innovative, high-growth company

This role is an opportunity to work at the forefront of telehealth, leveraging your organizational and tech-savvy skills to ensure effective communication between all team members and patients while fostering a collaborative culture. Your impact will extend beyond direct patient care, as you contribute to creating evidence-based protocols, policies, and workflows that elevate the standard of care we provide. If you're passionate about delivering safe, patient-centered psychiatric care in a fast-paced and innovative environment, join us on our mission to make quality psychiatric care accessible to all. Your journey at Rula begins with transforming lives, one virtual connection at a time.

RX.ME

Registered Nurse (Remote) (0600-1800 EST)

Posted on:

September 20, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Compact / Multi-State

Job Title: Remote-Registered Nurse (0600-1800 EST) (RN) Reports to: Nurse Manager(s) Effective Date: 10/20/2025 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 in chat and email communication platforms. The RN is required to work 36-40 hours per week. This includes scheduling the appropriate number 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. Schedule: This position is a full-time, remote position that requires the following: 36-40 hours per week 0600-1800 EST Timeframe (may be subject to change due to staffing needs) 16 weekend hours required per biweekly pay period

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. 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. 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 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

Acentra Health

Clinical Reviewer-RN (Remote)

Posted on:

September 20, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

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

Acentra Health is looking for a Clinical Reviewer - RN (Remote U.S.) to join our growing team. Job Summary: Review medical records against criteria, contract requirements, and regulatory standards. Employ critical thinking to determine medical appropriateness while meeting production goals and QA standards. Ensure day-to-day processes align with NCQA, URAC, CMS, and other regulatory benchmarks, ensuring precision and compliance in medical record reviews. Work Hours: * Monday through Friday, 9:00 AM until 5:30 PM Eastern Standard Time *

Required Qualifications/Experience: Active, unrestricted Registered Nurse (RN) License in any state, or an RN compact state License. Completion of an Associate’s, Bachelor's or higher degree in Nursing 2+ years of clinical experience in an acute OR med-surgical environment.. Knowledge of medical records, medical terminology, and disease process organization. Skilled in reviewing, interpreting, and abstracting data from medical records Strong clinical assessment and critical thinking skills Excellent verbal and written communication skills. Must be proficient in Microsoft Office and internet/web navigation. Preferred Qualifications/Experience: Knowledge of current National Committee for Quality Assurance (NCQA) standards. Knowledge of Utilization Review Accreditation Commission (URAC) standards. Knowledge of Independent Review Organization (IRO) Knowledge of Medicare (CMS) guidelines. Experience with Medical Appeals. Ability to work in a team environment. Flexibility and strong organizational skills.

Review and interpret patient records, comparing them against criteria to determine medical necessity and appropriateness of care; assess if the medical record documentation supports the need for services. Initiate a referral to the physician consultant and process physician consultant decisions, ensuring the reason for denial is described in sufficient detail in correspondence. Abstract review-related data/information accurately and promptly using the appropriate means on an appropriate review tool. Ensure accurate and timely submission of all administrative and review-related documents to the company. Perform ongoing reassessment of the review process to identify improvement and/or change opportunities. Foster positive and professional relationships and liaise with internal and external customers to ensure effective working relationships and team building, facilitating the review process. Be responsible for attending training and scheduled meetings and maintaining and using current/updated information for review. Maintain medical records confidentiality by properly using computer passwords, maintaining secured files, and adhering to HIPAA policies. Utilize proper telephone etiquette and judicious use of other verbal and written communications, following company policies, procedures, and guidelines. Actively cross-train to perform duties of other contracts within the company network to provide a flexible workforce to meet client/consumer needs. Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules.

HeiTech Services

Telehealth Registered Nurse- REMOTE December 2025

Posted on:

September 20, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

HeiTech Services is seeking Full-time Registered Nurses to staff a Nurse Advice Line call center 24x7/365 (primarily inbound). The Full-Time Registered Nurse is responsible for providing telehealth clinical assessment, health education, and utilization management services to a variety of beneficiaries. MUST HAVE a Current, Active, Compact License issued by the state of residence and be in good standing with the Board of Registered Nurses. This is a remote, work from home position. Registered Nurses provide telephone triage and health advice to callers across North America remotely, from the comfort of their own home office. In addition to triage calls, we receive questions requesting information on medical conditions, medications, diagnostic tests, etc. All calls are documented electronically, and all telephone encounters are recorded. Work Schedule While there are different shifts available, ALL of them require working at least one weekend day. PLEASE NOTE: the work schedule will begin with 4-6 weeks of paid training, scheduled Monday through Friday, 8:00AM to 4:30PM Central Time, starting September 15th. Candidates must be available to attend all days of training.

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

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

Sorelle Medical Group

Registered Nurse

Posted on:

September 20, 2025

Job Type:

Contract

Role Type:

Primary Care

License:

LPN/LVN

State License:

Compact / Multi-State

Veteran Disability Documentation Specialist Position Type: Part-time | Remote Non-benefitted, 1099 Job Summary: We are seeking a highly skilled and detail-oriented RN to join our team as a medical scribe and Veteran Disability Documentation Specialist. This role is responsible for collecting patient data telephonically, accurately scribing provider-patient encounters, and drafting clinical documentation including DBQs (Disability Benefits Questionnaires) and medical nexus letters. The ideal candidate will be experienced in obtaining thorough patient histories, have strong medical writing skills, and possess a deep understanding of the VA disability process.

Prior experience in medical scribing, health information management, or clinical documentation Familiarity with virtual health platforms and electronic health record (EHR) systems Strong knowledge of VA disability benefits, DBQ completion, and nexus letter standards Excellent written communication skills and attention to detail Ability to manage sensitive patient data with discretion and professionalism Comfortable working independently in a remote environment Licensed Practical Nurse with clinical training preferred (e.g., primary care, urgent care, internal medicine, nursing, health sciences) Preferred Qualifications: Military or Veterans Affairs background (personal or professional) Prior experience supporting providers in disability or compensation & pension exams Experience with medical terminology and case-based documentation

Conduct virtual patient intakes, including comprehensive medical, surgical, and social histories Accurately document provider assessments, plans, and recommendations during telephonic consultations Prepare medical documentation such as SOAP notes, patient summaries, and clinical letters on behalf of the provider Complete DBQs and assist in drafting nexus letters for VA disability claims with attention to legal and clinical standards Ensure all medical writing is clinically sound, grammatically correct, and aligned with regulatory and compliance guidelines Maintain confidentiality and handle patient records in compliance with HIPAA standards Collaborate with clinical staff to ensure timely and accurate documentation

Pinnacle Home Care Inc.

RN Nurse Triage Concierge

Posted on:

September 20, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Florida

Are you looking to make a difference in patients’ lives with a company that values your expertise? Join us in our mission of delivering compassionate healthcare where it matters most – at home. Pinnacle Home Care, Florida’s largest Medicare-certified home health provider, has been delivering high-quality, patient-centered care for over two decades, and we’re looking for a Care Center Concierge to join our award-winning team. Schedule: Four 10-hour shifts 8:00AM to 6:30PM Eastern Time -EITHER- Wednesday, Thursday, Friday and Saturday -OR- Sunday, Monday, Tuesday and Wednesday.

Registered Nurse or Licensed Practical Nurse with IV Certification. Health Care experience, preferably Home Health Care experience (minimum 1 year). Medical triage experience. Strong organizational and time management skills with the ability to effectively prioritize and complete tasks with attention to detail while managing multiple responsibilities. Strong written and verbal communication skills with the ability to address concerns in a courteous and timely manner. Commitment to providing compassionate and patient-centered care. Strong knowledge of relevant computer systems and proficient computer literacy skills. Ability to maintain confidentiality and adhere to HIPAA regulations.

Answer incoming and/or make outgoing calls to/from stakeholders, referral sources, and new patients to provide exceptional patient care and customer service in a fast-paced, high-volume call center environment. Demonstrate the ability to prioritize and multitask, operate multiple web-based systems simultaneously, access and comprehend information to determine next steps, and perform data entry with high accuracy. Be able to easily accept and adapt to changes in procedures, programs, and/or role functions based on the needs of the company. Compliance with HIPAA in all interactions. Create, update, and access confidential client data in the company's Electronic Medical Records with a high level of confidentiality and accuracy. Communicate effectively with both internal and external customers. Maintain internal department spreadsheet logs and/or reports. Utilizes appropriate supervisors and leaders to discuss, enhance, and resolve issues.

Pomelo Care

Menopause & OB Provider (FL, GA, or TX License)

Posted on:

September 19, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

NP/APP

State License:

Compact / Multi-State

Pomelo Care is a multi-disciplinary team of clinicians, engineers and problem solvers who are passionate about improving care for moms and babies. We are transforming outcomes for pregnant people and babies with evidence-based pregnancy and newborn care at scale. Our technology-driven care platform enables us to engage patients early, conduct individualized risk assessments for poor pregnancy outcomes, and deliver coordinated, personalized virtual care throughout pregnancy, NICU stays, and the first postpartum year. We measure ourselves by reductions in preterm births, NICU admissions, c-sections and maternal mortality; we improve outcomes and reduce healthcare spend.

Your North Star: Deliver direct patient care and clinical oversight that optimizes outcomes for individuals navigating pregnancy and postpartum or perimenopause and menopause, through a population-based, evidence-based approach.

Must be licensed as an APP in FL, GA, or TX and hold an active compact RN license Extensive obstetric experience, that includes delivering care in the in-patient labor and delivery setting (minimum 4 years experience), including treating high-risk patients Delivering ambulatory care to menopause patients, including prescribing and managing HRT Passionate about comprehensive women’s health, including pregnancy,perimenopause and menopause, with a strong desire to support patients through all stages of midlife care Experience using data to drive patient engagement, activation, and clinical outcomes Experience working with an interdisciplinary successful teams, with track record of outstanding collaboration and teamwork A sense of urgency to improve outcomes coupled with exceptional organization and attention to detail Growth mindset with the ability to approach process change and ambiguous situations with enthusiasm, creativity, and accountability Facility using multiple tech platforms, with an eagerness for advising about platform improvements and adapting to new systems Eager to thrive in a fast-paced, metric-driven environment Phenomenal interpersonal and communication skills Education and training: CNM/WHNP with significant experience in obstetrics and menopause treatment Bonus points for: 3+ years of menopause care experience 3+ years of high risk pregnancy care experience Menopause society certified Telehealth and/or remote monitoring experience Experience managing high-risk patients in outpatient or home-based settings

Be accountable for improving clinical outcomes for patients, by overseeing their medical care Care for complex patient cases, develop care plans, and support other members of the clinical team in providing them with evidence-based care Participate in continuous quality improvement efforts to improve our ability to provide the highest quality care to patients Participate and review of evidence-based medical protocols and algorithms related to pregnancy and menopause care Actively participate in on-call schedules including overnight and on weekends

WEP Clinical

Lead Mobile Research Nurse (Texas)

Posted on:

September 19, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Are you looking for an exciting and fulfilling new position? Join our dynamic team at WEP Clinical, where your contributions will play a key role in driving impactful solutions and improving outcomes for clients and patients. We encourage innovation and collaboration, challenging our team to bring forward ideas that make a real difference. Be part of a mission-driven organization dedicated to advancing clinical research and transforming lives.

Location: Ideally based in Texas The Lead Mobile Research Nurse performs the delivery of care to participants and provides regional support to per-diem Mobile Research Nurses. The Lead Mobile Research Nurse ensures the professional delivery of patient care in compliance with all national/local regulations, Good Clinical Practice, and Standard Operating Procedures. The Ideal Candidate: Adaptable Problem-solver Collaborative Clinically skilled

Nursing degree from an accredited organization Active RN licensure in home state and eligibility for Compact Licensure or additional state licensure Minimum of 4+ years of clinical experience; 2+ years of research experience preferred Basic Life Support (BLS) Certification Active driver’s license and access to a reliable vehicle Ability to work from a home-based position and travel up to 80% for study participant visits, regional nurse oversight, and project team meetings Physical ability to perform nursing tasks and lift equipment up to 15 lbs Proficient in using technology for assessments and documentation (e.g., care equipment, laptops, communication devices, tablets) Excellent verbal and written communication skills in English Flexibility to work nights and weekends as needed

Provide DCT nursing services to qualified study participants at home within the assigned region Ensure compliance with study protocols through thorough review and documentation at each visit Administer investigational medications/products and assess patients for side effects, reporting findings to the Principal Investigator Perform medical tests, including vital signs, specimen collection, and electrocardiograms; process and ship specimens per protocol Adhere to clinical research policies and ensure ethical conduct and protection of vulnerable populations Maintain compliance with SOPs, GCP principles, and applicable regulations Support the delivery of study-specific nurse training as needed Participate in Site Initiation Visits for assigned studies Apply clinical research and nursing expertise to develop solutions to complex challenges Collaborate with and support per diem DCT research nurses through education and resource support

Pomelo Care

Overnight Triage RN

Posted on:

September 19, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Pomelo Care is a multi-disciplinary team of clinicians, engineers and problem solvers who are passionate about improving care for moms and babies. We are transforming outcomes for pregnant people and babies with evidence-based pregnancy and newborn care at scale. Our technology-driven care platform enables us to engage patients early, conduct individualized risk assessments for poor pregnancy outcomes, and deliver coordinated, personalized virtual care throughout pregnancy, NICU stays, and the first postpartum year. We measure ourselves by reductions in preterm births, NICU admissions, c-sections and maternal mortality; we improve outcomes and reduce healthcare spend.

SHIFT SCHEDULE: This position involves working three 12-hour overnight shifts per week (9:00 PM to 9:00 AM EST). Over a six-week period, you would work six weekend shifts total, which averages to about one weekend shift per week, though the exact schedule may vary. Additionally, there is a rotating holiday commitment, alternating between summer and winter holidays. Your North Star: Provide and facilitate amazing patient-centered clinical care to our patients.

REQUIRED: Registered Nurse, current unrestricted multi-state (compact) license (residence in a nursing compact state required) Have 4+ years experience in a hospital and/or healthcare practice, serving maternal-child health populations (minimum 3 years in labor and delivery) Flexible and agile thinker who embraces change Are internet-connected, able to work remotely via video, phone and text Willing to travel occasionally (infrequent) Willing to work nights, weekends and holidays Understand the prevalence of birth inequity and role that structural racism plays in maternal morbidity and mortality Experience providing care in Spanish Professionally engaged Ability to commit to the working hours: Three 12-hour overnight shifts per week (9:00 PM to 9:00 AM EST). Over a six-week period, you would work six weekend shifts total, which averages to about one weekend shift per week, though the exact schedule may vary. Additionally, there is a rotating holiday commitment, alternating between summer and winter holidays. Bonus points if you have any of the following: Experience working with perinatal patients who have had complicated pregnancy-related conditions such as diabetes, hypertension, perinatal loss, etc. Experience providing virtual care

Reporting to the Head of Nursing Programs, your key responsibilities will include: Ongoing clinical and psychosocial assessment of new patients, providing reassurance and building rapport Identifying and addressing barriers to care that have been identified by patients and/or the care team. Reducing care gaps (missed appointments, medication management, etc.) by frequent and personalized engagements with patient Assessing the need for and educating patients on the equipment they will use to monitor their health remotely Timely response to abnormal diagnostic results (labs, radiology, etc.) Assessment of urgent concerns and proactively triaging patients to support appropriate utilization of emergency services Timely documentation of all care/interactions and escalating to appropriate multidisciplinary teams, as needed Supporting the development of programs and product by providing user feedback

Pager Health

Nurse Navigator - Remote

Posted on:

September 19, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Pager Health is a connected health platform company that enables healthcare enterprises to deliver high-engagement, intelligent health experiences for their patients, members and teams through integrated technology, AI and concierge services. Our solutions help people get the right care at the right time in the right place and stay healthy, while simultaneously reducing system friction and fragmentation, powering engagement, and orchestrating the enterprise. Pager Health partners with leading payers, providers and employers representing more than 28 million individuals across the United States and Latin America. We believe that healthcare should work for everyone. We believe that it’s too important to be as cumbersome and difficult as it is. And we believe that there is a better way to deliver a simplified, more meaningful healthcare experience for all – one that we’re determined to enable.

This position is for a full-time, remote Registered Nurse who is willing to think creatively and utilize their clinical skills in the field of Telehealth! We are seeking motivated Registered Nurses with 2+ years of clinical hospital experience to work in Pager Health's Command Center. An active compact unencumbered RN license is required for this position. This position entails working the overnight shift from 10:45pm-11:15am EST, 3 days per week, including alternating weekends and some holidays. The core objective of the Triage RN, Nurse Navigator is to use technology to build trust and triage patients to the right care at the right time while providing an exceptional virtual care experience through empathic communication.

2+ years of clinical hospital experience; within the ICU or ER highly preferred An active compact unencumbered RN license Minimum of Associates Degree in Nursing (ADN) Bilingual and able to communicate in both English and Spanish is a major plus Ability to give and receive actionable feedback Passionate about patient care and triage Enjoy helping others Ability to use critical thinking when presented with new and challenging situations Relish solving problems, seeking out answers, and trying new things Kind, empathetic and possess a strong social perceptiveness Positive, energetic, and fun! Outstanding multitasking skills Enthusiasm and savviness for new technology Mastery of oral and written language along with strong typing skills Ability to assess and communicate with patients via a text-based platform Flexible and fast learner, comfortable in a fast-paced and changing environment Eager to challenge the status quo of traditional healthcare Detail oriented and an organized self-starter with outstanding interpersonal skills

Provide exceptional customer service and virtual care by communicating with patients via live messaging, video, phone, and/or email Document within EMR Follow and apply clinically validated triage protocols Ensure the highest quality customer service for patients and providers Complete basic nursing responsibilities, outpatient testing, medications, etc… Troubleshoot technology with patients Work to ensure a seamless patient call center experience Coordinate lab orders, prescription orders, radiology tests, and any aspect of patient care Work on projects that will optimize operational efficiency and improve the patient’s telemedicine experience Assist in identifying technology needs that improve patient experience Additional projects as assigned

Staff4Me

Telehealth Nurse

Posted on:

September 19, 2025

Job Type:

Part-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

The Telehealth Nurse provides medical advice and support to patients over the phone or via video conferencing. The Telehealth Nurse assesses patients, forms diagnoses, develops care plans, and provides direct patient care, including medication management. The Telehealth Nurse also provides patient education, referral services, and follow-up care. The Telehealth Nurse must be knowledgeable in the use of telemedicine technologies and understand the complexities of providing healthcare in remote settings. The Telehealth Nurse must have excellent communication and interpersonal skills, as well as strong critical thinking and problem-solving abilities.

Telehealth Nurse Skills: Ability to assess patient needs remotely Excellent communication, problem-solving and interpersonal skills Knowledge of medical terminology and approved protocols Proficient with electronic medical records and home monitoring systems Ability to provide patient and family education Telehealth Nurse Requirements: Registered Nurse license Experience with telehealth systems Understanding of clinical protocols Ability to work with a diverse range of patients Strong communication and problem solving skills Must have an active Nursing Compact License or for specific states such as New York, Illinois, etc. Personal Traits: Excellent communication skills Ability to think critically and problem-solve Team-player attitude A passion for helping others Knowledge of healthcare regulations Ability to manage time efficiently

Provide telehealth nursing services to patients via phone, video, and other digital media Answer patient inquiries, provide health education and advice, and assess patient needs Refer patients to appropriate health professionals and follow up on health care services Develop and implement patient care plans Document patient care services in medical records and reports Stay up-to-date on changes in the health care industry and relevant regulations and protocols

XSOLIS, INC

Utilization Management Nurse

Posted on:

September 19, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

Tennessee

Xsolis is an AI-driven technology company with a human-centered approach, fostering collaboration between healthcare providers and payers through real-time transparency, objective data for increased accuracy and alignment of medical necessity decisions, and more efficient outcomes. Dragonfly®, its AI-driven proprietary platform, is the first and only solution to use real-time predictive analytics to continuously assign an objective medical necessity score and assess the anticipated level of care for every patient, enabling more efficiency across the healthcare system. Xsolis is headquartered in Franklin, Tennessee.

This position will have well-developed knowledge and skills in areas of utilization management (UM), medical necessity, and patient status determination. This individual is responsible for performing a variety of concurrent and retrospective UM-related reviews and functions. This individual maintains current and accurate knowledge regarding commercial and government payers and Joint Commission regulations/guidelines/criteria related to UM. The UM Nurse effectively and efficiently manages a diverse workload in a fast-paced, rapidly changing regulatory environment.

Education: Minimum Licensed Practical Nurse, A.A.S. in Nursing, or BSN  Experience: Minimum 3-5 years of experience in an acute care hospital setting or equivalent health care experience in utilization management and case management  Knowledge of Medicare rules and regulatory standards   Excellent interpersonal communication, problem-solving, and conflict resolution skills.   Computer skills in word processing, database management, and spreadsheet desirable.   Knowledge in areas of: Medicare and Medicaid UM regulations, Medicare Inpatient Only List, RAC, QIO, MAC, and Denial Management. Working Environment and Travel Requirements: Work is typically in a normal office administrative environment involving minimal exposure to physical risks. Position requires little to moderate physical activity. Mostly sedentary work exerting up to 10 pounds of force occasionally or a negligible amount of force to lift, carry, push, pull, or otherwise move objects. Work involves sitting most of the time, but may involve walking or standing for brief periods of time. No significant stooping is usually required.

The essential functions include, but are not limited to the following: Coordinate and facilitate correct identification of patient status.  Facilitates optimal reimbursement through accurate certification and denial processes, including complete chart documentation ensuring that the appropriate admission status is ordered.   Coordinate and integrate UM functions.  Conducts concurrent and retrospective reviews based on Xsolis AI capabilities with usage of Client approved Care Level Score decision matrixes.   Refers cases for secondary review when appropriate.   Supports the medical necessity denial and appeal process.  Collaborate with all members of the healthcare team, both internal and external.  Refers and consults with the multidisciplinary team to promote appropriate communication in the absence of definitive documentation and/or review criteria to support hospital stay.  Communicate with third party payers regarding patient clinical progress.  Assists the UM team in educating providers on trends found in medical necessity statuses, authorization, and communication from third-party payers.  Participate in clinical performance improvement activities to achieve set goals.  Demonstrate positive and professional written, verbal, and nonverbal communication skills.  Apply advanced critical thinking and conflict resolution skills using creative approaches.  The responsibilities listed are a general overview of the position and additional duties may be assigned.  Supervisory Responsibilities: This role does not have any direct reports and is a single contributor role. 

Atlantic Health Strategies

Remote Behavioral Health SUD Registered Nurse (VT Licensed) Pathfinder Recovery

Posted on:

September 19, 2025

Job Type:

Part-Time

Role Type:

Behavioral Health

License:

RN

State License:

Vermont

At Pathfinder Recovery, we’re redefining addiction treatment by blending evidence-based therapy with cutting-edge technology. If you’re a licensed therapist ready to make a meaningful impact - and you’re excited about using tools like AI-powered medical records and bioinformatics to enhance care - we want to hear from you.

We’re seeking a dedicated Nurse to provide virtual, patient-centered care for individuals in our addiction and mental health programs. You’ll have the flexibility of remote work, the support of an experienced clinical team, and access to technology that streamlines documentation and improves continuity of care - so you can focus on delivering compassionate treatment.

Active LPN, RN, or higher licensure in Vermont. Associate’s or Bachelor’s Degree in Nursing, or equivalent education qualifying for licensure. At least 1 year of nursing experience. Knowledge of substance use and mental health treatment preferred. Strong critical thinking, active listening, and communication skills. Familiarity with HIPAA, confidentiality standards, and electronic medical record systems. CPR/First Aid certification and crisis intervention training.

Conduct virtual assessments by observing, monitoring, and documenting patient health, behaviors, symptoms, and self-reported vitals. Coordinate with physicians, behavioral health specialists, and interdisciplinary teams to implement individualized treatment and recovery plans. Provide education and guidance on safe use of prescribed treatments and medications, including medication-assisted treatments (MAT) such as Vivitrol and Naltrexone. Maintain accurate and timely electronic health records (EHR) in compliance with HIPAA and organizational standards. Educate patients on health maintenance, medication compliance, relapse prevention, and mental health self-care strategies via telehealth platforms. Support patient access by assisting with telehealth platforms and promoting digital literacy. Participate in ongoing professional development, including training in telehealth best practices and substance use disorder treatment.

Creed Infotech

Registered Nurse

Posted on:

September 19, 2025

Job Type:

Contract

Role Type:

Utilization Review

License:

RN

State License:

Florida

Creed InfoTech is a tech savvy company providing different kinds of KPO, BPO, Business Consulting and IT consulting services for all kinds of businesses. Irrespective of the type of business, our consultants provide the great assistance to help you climb the peak effortlessly. Our expert’s team will most certainly provide ideas, suggestions and solutions to your business problems so that you spend less time on the problems and instead concentrate on the productive side of your business.

Registered Nurse-Review Analyst Work Location: Detroit, MI, 48243 Duration: 8 Months Job Type: Temporary Assignment Work Type: Remote Dept: MA Inpatient Precertifi Pay Rate - $30-34/hr. On W2 Engagement Description: “Requested criteria: 2 years acute care experience with an unrestricted Registered Nurse license, ICU/ER preferred or for post-acute care positions SNF/Rehab/LTACH (Should not just be 2 years in a specialized field,) InterQual/MCG or other utilization review experience, advanced computer skills, 40+ WPM typing”

Top 3 Required Skills/Experience – 2 years acute care – ICU / ER / MED SURGE 40+ WPM TYPING COMPUTER SKILLS Required Skills/Experience – The rest of the required skills/experience. Include: INTERQUAL / MCG OR UTILIZATION REVIEW EXPERIENCE MICROSOFT OFFICE EXPERIENCE EXPERIENCE WITH MULTIPLE MONITORS / SCREEN USAGE TIME MANAGEMENT Preferred Skills/Experience – Optional but preferred skills/experience. Include: ABILITY TO WORK INDEPENDENTLY IN REMOTE ENVIRONMENT Education/Certifications – Include: ASSOCIATES OR BACHELORS IN NURSING ACTIVE UNRESTRICTED REGISTERED NURSE LICENSE

SAN JOAQUIN COUNTY HEALTH COMMISSION

Pediatric Nurse, Lead

Posted on:

September 19, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

California

Our Vision: Continuously improve the health of our community. Our Mission: We provide healthcare value and advance wellness through community partnerships.

The expected pay range is based on many factors such as geography, experience, education, and the market. The range is subject to change. We are currently hiring a Pediatric Nurse, Lead to join our team! This position is remote eligible; Candidates must reside in California.

Required: Produces work that is accurate and complete. Produces the appropriate amount of work. Actively learns through experimentation when tackling new problems, using both successes and failures to learn. Rebounds from setbacks and adversity when facing difficult situations. Knows the most effective and efficient process to get things done, with a focus on continuous improvement. Self-motivated with effective critical thinking skills. Strong oral and written communication skills. Strong customer service skills. Time management and organizational skills. Uses time effectively and efficiently. Values time. Concentrates his/her efforts on the more important priorities. Can attend to a broader range of activities. Meets deadlines. Strong ethics and high level of personal and professional integrity. Computer literate and highly proficient in using MS office programs. Interpersonal skills - interacts effectively with individuals both inside and outside of HPSJ; relates openly and comfortably with diverse groups of people. Strong ethics and high level of personal and professional integrity. Ability to direct clearly and in an organized pattern Ability to promote learning and self-empowerment in associates. Computer literate and highly proficient in using MS office program What You Have: Education and Experience Required Associate degree in nursing. Preferred: Baccalaureate Degree in Nursing. Minimum two years acute clinical experience; two years experiencing in utilization management in health plan, medical group or IPA setting is preferred. Utilization Management experience with MCG Criteria. Licenses, Certifications Required: Current and valid, unrestricted California state RN nursing license. Valid Driver Licenses with no driving restrictions. Preferred: Current Certified Case Manager (CCM) Preferred.

Responsible for achieving overall clinical performance goals through day-to-day direction of the designated clinical care team, coordinating operational processes, monitoring performance to achieve consistent process standards and metrics through quality assessments, training, and improvement tactics, and in compliance with regulatory and NCAA accreditation standards. In a partnership with the Inpatient Supervisor, leads the Pediatric team and provides day to day oversight of team functions to meet all regulatory guidelines and company initiatives for CCS and pediatric cases. Works in collaboration with the supervisor to identify and implement consistent work processes to achieve compliance standards and continuous operational readiness in accordance with NCQA accreditation and State regulations. Monitors daily workflow including incoming referrals, case load and acuity management to meet production standards and to achieve compliance standards according to regulatory guidelines and company initiatives for CCS and Pediatric cases. Independently oversees and advises the correct application of methodology and outcomes monitoring and reporting for members eligible for the CCS program. Provides subject matter expertise to staff. Utilizes clinical knowledge to apply evidence- based practice guidelines and criteria. Conducts and records both focused and standard QI audits in collaboration with Supervisor. Provides feedback for team members and the management team. Tracks and trends performance, identifies root causes, and reports and recommends improvement opportunities to management, based on audit results. Coaches, trains, and conducts follow up for team performance improvement. Collaboration with the Superior to identify, design and deliver training modules to promote improved performance and/or implement new regulatory guidelines pertinent to pediatric programs. Carries caseload, as assigned by the Supervisor; and provides coverage as needed. Acts as subject matter expert and participated in the training of new clinical personnel. Maintains the Unit’s Training Manual and Desktop Procedures (Job Aids) Regular and consistent attendance.

Innovaccer Analytics

3401-UM Nurse Reviewer

Posted on:

September 18, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

California

Innovaccer is a leading healthcare technology company. We’re pioneering the Data Activation Platform that’s helping Big Data and the Healthcare industry realize the promise of value-based care.

We are looking for a Utilization Management (UM) Nurse Reviewer to bring clinical expertise into our AI-powered prior authorization workflows. This role is responsible for ensuring that our AI- powered prior authorization workflow reflects evidence-based and payer-specific guidelines. The ideal candidate will have broad experience across multiple specialties and payer policies, with strong utilization management and prior authorization expertise. This role blends clinical judgment with hands-on review of AI outputs to improve accuracy and alignment with payer criteria.

What You Need: Registered Nurse (RN) with an active license. 5+ years of experience in utilization management, prior authorization or medical policy review. Broad exposure across multiple specialties (e.g., radiology, oncology, surgery, cardiology). Strong understanding of payer policies, medical necessity criteria, and authorization workflows. Working knowledge of ICD-10, CPT, and HCPCS coding. Comfort with technology platforms; interest in AI or decision support systems. Strong analytical and critical thinking skills with attention to detail. Clear communication skills to bridge clinical and technical teams. Preferred Skills: Certification in medical coding (e.g., CPC, CCS, CCA, or equivalent). Prior experience reviewing or implementing payer medical policies. Familiarity with health informatics or evidence-based guideline development Experience working with AI, automation tools, or clinical decision support systems. Ability to work in a fast-paced, innovative environment and contribute to process improvement.

Apply clinical judgment to ensure outputs align with payer requirements, evidence-based guidelines, and coding standards. Monitor payer updates and guideline changes; ensure payer knowledge base remains current. Collaborate with product, engineering, and AI teams to translate clinical and utilization review requirements into actionable design. Test, validate, and refine AI-powered workflows to improve completeness, reduce denials, and ensure usability. Provide feedback loops to enhance knowledge base structure, clinical decision support, and automation quality. Stay current on payer requirements, clinical guidelines, regulatory standards, and coding updates relevant to utilization management.

Orpyx Medical Technologies

Remote Nurse, Spanish Speaking

Posted on:

September 18, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Orpyx is a health technology company that is committed to extending healthspan for people living with diabetes through personalized remote care. Our flagship product, the Orpyx Sensory Insole System, is transforming diabetes care by helping prevent diabetic foot ulcers, a major complication of diabetes that can lead to amputation.  Our dedicated remote patient monitoring team, comprised of credentialed providers and nurses, utilizes advanced data science methodologies to provide personalized support and triaged clinical escalation.  With our whole-person approach, Orpyx empowers people to take control of their health, prevent debilitating complications and extend their healthspan. We are an ISO 13485 company committed to providing quality medical solutions that consistently meet customer needs and regulatory requirements.

We are seeking a remote, Spanish-speaking nurse based in the USA who holds a valid nursing license (LVN or RN) in any US State, however, a valid Nurse Licensure Compact is preferable. This is a fantastic opportunity for someone looking to work from the comfort of their home. Join us at the cutting edge of medical device technology and remote healthcare

Located in the USA and possess legal authorization to work in the United States Fluent in both English and Spanish (written and spoken) is required LPN or RN with verified credentials and licensure in any US State LPN or RN verified credentials and valid Nurse Licensure Compact (NLC) is an asset Must be considered “qualified clinical staff” by the CPT codebook Minimum 3 years of licensed clinical staff professional service with patient management experience (remote or in person) Ability to analyze data and formulate clear clinical feedback based on this information Proven record of professional and effective customer communication skills is essential Demonstrated ability to establish rapport, build relationships, and diffuse conflict situations effectively Familiar with technological troubleshooting and able to understand how multiple smartphone platforms operate Proficiency with Microsoft Office suite is required; experience with Atlassian and/or Zendesk suites an asset Familiarity with quality management systems (ISO 13485) and HIPAA/PIPEDA standards considered an asset Demonstrated excellent attention to detail, decision-making, problem solving, and critical thinking skills Proven self-motivation and ability to deliver under pressure Ability to thrive in a rapidly growing, fast-paced, high-tech start-up environment Excellent written and verbal communication skills Fluency in foreign language(s) considered an asset

The Patient Care Coordinator (Remote Nurse – Spanish Speaking) will provide remote patient monitoring services. This role will analyze patient data in a secure dashboard and provide clinical feedback based on this information. This role will be responsible for liaising with healthcare providers and patients to ensure that supplementary healthcare information from the monitoring platform is used to optimize the patient’s care. Reporting to the Director of Nursing and working as part of a cross-functional team plays a vital role in delivering seamless and engaging patient and provider experiences to our patients. This includes: Monitoring and analyzing physiological data as supplemental support to the healthcare providers patient care plan Liaising between patient and provider to help with patient compliance to their remote monitoring care plan Making proactive outbound calls to provide clinical support and education Maintaining accurate records and documenting monitoring actions and discussions in a cloud-based dashboard Ensuring clear and consistent communication with healthcare providers and patients Addressing incoming calls requiring clinical guidance Liaising as a key stakeholder with other departments (Sales, Marketing, Customer Care, Development etc.) to optimize the overall patient and provider experience Collaborating on customer procedures, policies, and standards Assisting Clinical & Regulatory Affairs with remote patient monitoring-related tasks Performing duties in a manner that is consistent with and committed to upholding the requirements of the quality management system

Orpyx Medical Technologies

Remote Nurse with Nurse Licensure Compact (NLC)

Posted on:

September 18, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Orpyx is a health technology company that is committed to extending healthspan for people living with diabetes through personalized remote care. Our flagship product, the Orpyx Sensory Insole System, is transforming diabetes care by helping prevent diabetic foot ulcers, a major complication of diabetes that can lead to amputation.  Our dedicated remote patient monitoring team, comprised of credentialed providers and nurses, utilizes advanced data science methodologies to provide personalized support and triaged clinical escalation.  With our whole-person approach, Orpyx empowers people to take control of their health, prevent debilitating complications and extend their healthspan. We are an ISO 13485 company committed to providing quality medical solutions that consistently meet customer needs and regulatory requirements.

We are seeking a Remote Nurse (LPN or RN) based in the USA who holds a valid Nurse Licensure Compact (NLC). This is a fantastic opportunity for someone looking to work from the comfort of their home. Join us at the cutting edge of medical device technology and remote healthcare delivery.

Located in the USA and possess legal authorization to work in the United States LPN or RN verified credentials and valid Nurse Licensure Compact (NLC) Additional verified LPN or RN credentials and licensure in any US State outside the Nurse Licensure Compact (NLC) is an asset Fluent in English (written and spoken) is required Must be considered “qualified clinical staff” by the CPT codebook Minimum 3 years of licensed clinical staff professional service with patient management experience (remote or in person) Ability to analyze data and formulate clear clinical feedback based on this information Proven record of professional and effective customer communication skills is essential Demonstrated ability to establish rapport, build relationships, and diffuse conflict situations effectively Familiar with technological troubleshooting and able to understand how multiple smartphone platforms operate Proficiency with Microsoft Office suite is required; experience with Atlassian and/or Zendesk suites an asset Familiarity with quality management systems (ISO 13485) and HIPAA/PIPEDA standards considered an asset Demonstrated excellent attention to detail, decision-making, problem solving, and critical thinking skills Proven self-motivation and ability to deliver under pressure Ability to thrive in a rapidly growing, fast-paced, high-tech start-up environment Excellent written and verbal communication skills Fluency in foreign language(s) considered an asset

The Patient Care Coordinator (Remote Nurse) will provide remote patient monitoring services. This role will analyze patient data in a secure dashboard and provide clinical feedback based on this information. This role will be responsible for liaising with healthcare providers and patients to ensure that supplementary healthcare information from the monitoring platform is used to optimize the patient’s care. Reporting to the Director of Nursing and working as part of a cross-functional team plays a vital role in delivering seamless and engaging patient and provider experiences to our patients. This includes: Monitoring and analyzing physiological data as supplemental support to the healthcare providers patient care plan Liaising between patient and provider to help with patient compliance to their remote monitoring care plan Making proactive outbound calls to provide clinical support and education Maintaining accurate records and documenting monitoring actions and discussions in a cloud-based dashboard Ensuring clear and consistent communication with healthcare providers and patients Addressing incoming calls requiring clinical guidance Liaising as a key stakeholder with other departments (Sales, Marketing, Customer Care, Development etc.) to optimize the overall patient and provider experience Collaborating on customer procedures, policies, and standards Assisting Clinical & Regulatory Affairs with remote patient monitoring-related tasks Performing duties in a manner that is consistent with and committed to upholding the requirements of the quality management system

American Data Network

NSQIP-Adult SCR (Remote, Full-time, or Part-time)

Posted on:

September 18, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Akansas

Why ADN? Join the American Data Network family and become an integral part of a dynamic and purpose-driven organization. At ADN, we're not just a company; we're a community of passionate professionals dedicated to making a difference in healthcare. Embark on a journey where your work goes beyond a job description – it becomes a meaningful contribution to the improvement of patient care. We foster a culture of integrity, excellence, continuous learning, collaboration, and a genuine commitment to making a positive impact. If you're ready to be part of a trusted advisor in healthcare data services and shape the future of quality and patient safety, come build your career with us at American Data Network. Make every day count, and make a difference with ADN.

Performs primary data abstraction duties for NSQIP-Adult and ensures high levels of abstraction accuracy for assigned accounts via validation activities. Demonstrates strong communication, documentation, organizing, and planning skills to ensure strong leadership of multiple accounts concurrently.

Experience abstracting NSQIP-Adult measures within the last 2 years is required. Must have current SCR. Familiar with medical records, billing/documentation practices, Microsoft Office, and standard healthcare quality concepts Ability to work independently. Relies on experience and judgment to plan/accomplish goals. Maintains a strict level of confidentiality in all aspects of work. Demonstrates a high standard of accuracy and attention to detail. Excellent interpersonal and communication skills. Remote position. BSN, LPN, or RN preferred. CPHQ preferred.

Collects and abstracts data from patient medical records, especially those related to surgical procedures. This includes information on diagnoses, treatments, procedures, and outcomes. Ensures the accuracy and completeness of the abstracted data. This involves cross-referencing information from multiple sources within a patient's medical record. Adheres to specific clinical data abstraction guidelines and standards, such as those set by the American College of Surgeons. Enters the abstracted data into a database or registry, often using specialized software. This includes maintaining and updating the data as necessary. Participates in quality assurance processes to ensure data integrity. This involves regular audits of the data or the abstraction process. Remains informed about developments in patient care and data management to ensure ongoing competency in the role.

Ilumed Llc

RN Care Coach

Posted on:

September 17, 2025

Job Type:

Full-Time

Role Type:

Coaching

License:

RN

State License:

Compact / Multi-State

The RN Care Coach is an integral part of the ilumed clinical team, providing a comprehensive, patient-centered approach to Chronic Disease Management programs. This role focuses on coordinating patient care and ensuring efficient resource utilization for beneficiaries by assessing, planning, implementing, coordinating, monitoring, and evaluating available care options. The ultimate goal is to empower beneficiaries to achieve optimal health outcomes, enhance their quality of medical care, and drive improved clinical outcomes. Through comprehensive assessment, strategic care planning, proactive coordination, continuous monitoring, and evidence-based evaluation, the RN Care Coach works to reduce barriers to care, educate on disease management awareness, enhance the quality of medical outcomes, and improve key performance indicators related to patient engagement, intervention effectiveness, and enhance overall quality performance metrics within the organization. The RN Care Coach is responsible for monitoring patient progress, ensuring the effective implementation and execution of care plans, and leveraging data-driven insights to refine intervention strategies. Through ongoing assessment, evaluation of trends in care effectiveness, and proactive problem-solving, this role plays a critical part in enhancing care delivery, optimizing healthcare resource allocation, and decreasing preventable hospital readmissions.

Knowledge, Skills and Competencies: Adaptability & Flexibility – Ability to thrive in a fast-paced, evolving environment. Technical Proficiency – Strong working knowledge of MS Suite of services as well as EMR familiarity. Project & Time Management – Capable of managing multiple projects and priorities efficiently. Critical Thinking & Problem-Solving – Strong analytical skills to address complex care scenarios. Excellent Communication – Highly effective in both verbal and written communication; strong organizational skills. Education and Experience: Active RN license in good standing. (Possess a Compact Nurse License/Ability to successfully obtain a Compact Nurse License required). 2–4 years of experience in case management, home health, or other similar healthcare roles. Experience working with Medicare and Medicare Advantage plans is preferred. Physical Requirements: Prolonged periods of sitting at a desk and working on a computer. Flexibility to work outside regular business hours as needed to meet organizational goals. Ability to travel up to 10%

Provide telephonic care guidance and support to beneficiaries, families, and caregivers, ensuring proper education, care coordination, and support per the established plan of care. Collaborate within Care Management programs, working with physicians and providers to develop fully integrated care plans that address beneficiary needs. Utilize Motivational Interviewing and solution-focused communication to effectively engage beneficiaries. Meet departmental KPIs for calls per day and caseload, ensuring efficiency and effectiveness in care management. Demonstrate strong critical thinking in decision-making and problem-solving processes. Adapt to patient-centric needs, tailoring care strategies to individual beneficiary circumstances. Time management proficiency, balancing multiple priorities to meet performance goals. Identify Social Determinants of Health (SDOH) needs and connect beneficiaries with community resources for essential services. Maintain privacy, confidentiality, safety, and advocacy, ensuring adherence to ethical, legal, and accreditation/regulatory standards. Participate in professional development activities, staying current on industry best practices, case management procedures, and licensure requirements. Perform all duties within the scope of licensure. Performs additional duties as assigned. Travel on company business as requested.

Healthcare Management Administrators

Medical Claims Review Nurse II

Posted on:

September 17, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

Washington

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service. We are proud to say that for four years, HMA has been chosen as a ‘Washington’s Best Workplaces’ by our Staff and PSBJ™. Our vision, ‘Proving What’s Possible in Healthcare™,’ and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results.

What we are looking for: We are always searching for unique people to diversify our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven. What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: https://www.accesshma.com/ How YOU will make a Difference: The Medical Claims Review Nurse provides monitoring of member utilization and claim patterns using clinical nursing knowledge and coding expertise to oversee the accuracy of claims for medically necessary care provided to our members. This work promotes the integrity of claim payment to support fiscal responsibility of payments. This nurse also works in conjunction with the Appeals team providing clinical expertise and performs high-level writing skills.

Current Baccalaureate prepared (Preferred) Active RN clinical license 3-5+ years of clinical nursing experience Current Certified Professional Coder certificate (preferred) Experience in the application of common coding and billing standards including the American Medical Association CPT (Current Procedural Terminology), the Centers for Medicare and Medicaid Services National Correct Coding Initiative, Optum Coding resource manuals, the UB04 Billing Manual coding guidelines and the National Uniform Billing Committee Knowledge of Utilization Review processes Knowledge of the medical plan appeal process (preferred) Strong experience in clinical practice with diverse diagnoses Problem solving and critical thinking skills Excellent verbal and written communication skills Proficiency with Microsoft Office applications (Outlook, Word, DOSS) Ability to be self-motivated and self-directed Enjoys the pace and rhythm of a deadline-oriented environment with strong prioritization skills Behavioral health experience (Preferred)

Analyzes claims against clinical documentation using coding and clinical expertise Clinical support of the Hospital Bill Review process Retrospective utilization management case review Extrapolates and summarizes medical information for medical directors and other external entities Ensures that reviews and appeals are resolved timely to meet regulatory timeframes Generates written correspondence to providers, members, brokers and clients

Vigilance Health

Care Manager - Registered Nurse (RN) - Louisiana RN License Required

Posted on:

September 17, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Louisiana

Vigilance Health Inc. is an innovative, progressive health care organization that assists provider organizations in transforming the way they deliver care in preparation for healthcare payment reform. Vigilance Health staff are experts in healthcare management, health care I.T., meaningful use, enabling clinical and administrative interoperability, and solving complex cross-organizational process and technology challenges. Everything we do is focused on changing the experience of the provider and patient. Our mission at Vigilance is to empower patients to take a more proactive role in their own health outcomes and to enable the providers to thrive in the new healthcare environment. Vigilance health employs the optimal mix of Care Teams and health information technology. Vigilance Health is now hiring health care professionals to fill Care Coordination Teams providing Chronic Care Management services in a way that maximizes the benefit to patients while having minimal disruption on routine provider operations.

Job Title: Registered Nurse (RN) – Louisiana RN License Required Location: Louisiana (Remote) Employment Type: Full-Time Department: Care Management Reports To: Clinical Operations Manager Position Overview Vigilance Health is seeking a compassionate, organized, and driven Registered Nurse (RN) licensed in Louisiana to join our growing team of healthcare professionals committed to improving health outcomes through proactive, team-based care. This RN will work within our care management and population health programs, delivering high-quality, patient-centered services to chronically ill and high-risk patient populations across multiple clinical partners. This is an excellent opportunity for a nurse who is passionate about health coaching, education, care coordination, and working at the intersection of clinical excellence and community-based care.

Key Performance Indicators (KPIs): Daily/weekly patient outreach goals met (e.g., number of successful calls, care plan completions). Documentation accuracy and timeliness (e.g., care plans completed within 48 hours). Patient satisfaction and engagement rates. Reduction in care gaps or improved outcomes (e.g., BP control, A1C management). Effective collaboration with interdisciplinary teams. Qualifications: Current and unrestricted RN license in the state of Louisiana. Minimum of 2 years of nursing experience (care management, community health, FQHC, or primary care experience preferred). Strong clinical judgment and communication skills. Bilingual (English/Spanish or English/Creole) a plus but not required. Proficient with EHR systems and comfortable navigating remote care platforms. Able to work independently in a remote or hybrid environment with minimal supervision.

Perform outreach and engagement with assigned patients to support chronic care, behavioral health integration, and preventive health goals. Provide education, coaching, and motivational interviewing to support self-management of chronic conditions (e.g., diabetes, hypertension, heart failure). Collaborate with providers, care managers, behavioral health specialists, and community-based resources to address social determinants of health. Document patient interactions accurately and timely using our care management software and EHR platforms (e.g., eCW, Athena, Epic). Develop, update, and monitor patient-centered care plans aligned with CMS and FQHC guidelines. Ensure timely follow-up after hospitalizations, ED visits, or transitions of care. Adhere to applicable Louisiana nursing scope of practice, HIPAA guidelines, and internal protocols. Participate in team huddles, quality assurance reviews, and clinical audits.

ISLAND PEER REVIEW CORP

Nursing Facility Resolution Reviewer (RN req'd)

Posted on:

September 17, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

New York

Based in Albany, in this role you will be primarily responsible for the day-to-day case management of nursing facility quality of care complaints working at the direction of the New York State Department of Health (DOH). As a Nursing Facility Resolution Reviewer, you will interface with the resident and/or resident’s representative throughout the complaint resolution process including assisting with alternative dispute resolution; communication with the nursing facility; case processing including preparation of correspondence and assistance with mediation; medical record review and related activities to assure compliance with timelines and confidentiality regulations. You will also participate in other activities, including other resident protection activities, as directed. Potential opportunity to telecommute will be considered.

Strong interpersonal skills are desirable to facilitate positive customer satisfaction in situations that are adverse or in controversy. Ability to work independently with minimal supervision, as well as in a team environment. Excellent written and verbal skills with the ability to communicate professionally with co-workers, supervisors, providers, medical and administrative personnel, and residents/patients. Strong computer skills with working knowledge of Microsoft Office products and the ability to learn new programs. Ability to translate collected information into a clear, concise, legal, and defensible document. If approved to work remotely, must have secure internet that meets the speed required to perform all work duties, must have workspace that provides privacy for all work-related calls, and must be able to secure all work-related items when not in use. The ability to obtain Surveyor Minimum Qualifications Test (SMQT) certification within 12 months of employment, required. Must have a valid driver’s license & the ability to travel, required. EDUCATION & EXPERIENCE: NYS Licensed, Registered Nurse, required. A minimum of two (2) years of experience in performing utilization review, claims adjudication, medical review, fraud investigation, surveillance, or monitoring activities, OR three (3) years of clinical or administrative experience, OR a bachelor’s degree in nursing and two (2) years of clinical or administrative experience. SMQT certification, preferred.

ISLAND PEER REVIEW CORP

Complaint Intake and Triage Nurse Reviewer (RN req’d)

Posted on:

September 17, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

New York

Based in Albany, NY, working at the direction of the New York State Department of Health (NYSDOH) Nursing Home Centralized Complaint Intake Unit (NH CCIU) you will function as a Complaint Intake and Triage Nurse Reviewer performing clinical reviews and triage complaints and incident reports for possible noncompliance, received via telephone, electronic or postal mail, or other forums. Perform reviews irrespective of the submission method, triage complaints by severity consistent with federal triage guidelines, perform data entry, and identify the appropriate actions consistent with federal triage protocols. Potential opportunity to telecommute will be considered. Albany Region - Become SMQT Certified! ** $3,000 Sign-on Bonus**

Strong interpersonal. Excellent communication (verbal & written) skills. Ability to work independently with minimal supervision. Ability to relate effectively to providers, physicians, senior medical and administrative personnel and resident/patients. Basic computer skills, including working knowledge of all Microsoft Office products. Ability to travel as needed, required. Ability to work weekends and holiday on-call, as needed, on a rotating basis, required. Must have a valid driver's license & the ability to travel to on-site facilities review assignments. EDUCATION & EXPERIENCE: New York State Registered Professional Nurse (RN). Two (2) years’ experience performing utilization review, medical review, fraud investigations, surveillance or monitoring activities at the facility level. Three (3) years of clinical experience in a medical facility, preferably a nursing home. Surveyor Minimum Qualifications Test (SMQT) certification, preferred. If not certified, within 12 months of employment, must obtain the online SMQT certification.

Vitasigns LLC

Remote Nurse- Bilingual English/Farsi

Posted on:

September 16, 2025

Job Type:

Contract

Role Type:

License:

RN

State License:

California

Vitasigns is a leading healthcare provider committed to delivering exceptional patient care through innovative remote monitoring solutions. We are dedicated to leveraging technology to improve patient outcomes and enhance the quality of care provided. As we expand our remote patient monitoring services, we are seeking a dedicated Remote Patient Monitoring Nurse to join our team.

As a Remote Patient Monitoring Nurse, you will play a crucial role in monitoring and managing patients' health remotely using advanced healthcare technology. You will be responsible for assessing patients' health status, analyzing data collected through remote monitoring devices, and working with Lead Registered Nurses to provide timely interventions and support to patients as needed. This position requires a strong clinical background, excellent communication skills, and the ability to work independently in a remote setting. Benefits: Flexible remote work arrangements. Meaningful work that makes a difference in patients' lives.

Registered Nurse, BSN with active licensure in California. Minimum of 5 years in acute setting. Preferably, ER or ICU Experience in remote patient monitoring, telehealth, or telemedicine is preferred but not required. Strong assessment and critical thinking skills, with the ability to analyze complex health data and make informed clinical judgments. The ability to conduct telephone or video calls and document encounters in the health record system Excellent communication and interpersonal skills, with the ability to effectively engage with patients, caregivers, and healthcare professionals remotely. Proficiency in using electronic health records (EHR) and other healthcare technology platforms. Ability to work independently and manage time effectively in a remote setting. Participate in a multidisciplinary team to develop, execute, monitor, and adjust comprehensive and coordinated care plans that include shared goals with measurable outcomes Commitment to providing patient-centered care and promoting positive health outcomes. Requirements: Minimum 15 hours week commitment Personal computer or laptop Typing proficiency: 60 words per min Bilingual: English/Farsi This is a 1099 independent contractor position

Conduct initial assessments of patients enrolled in remote monitoring programs to establish baseline health status. Monitor patients' vital signs, symptoms, and health data transmitted through remote monitoring devices. Analyze and interpret data collected from remote monitoring devices to identify trends, abnormalities, and potential health risks. Collaborate with patients, caregivers, and healthcare providers to develop and implement personalized care plans based on remote monitoring data. Provide timely interventions and clinical support to patients, including medication management, lifestyle modifications, and health education. Document patient interactions, assessments, and interventions accurately and comprehensively in electronic health records (EHR) or other designated systems. Maintain regular communication with patients to provide ongoing support, answer questions, and address concerns related to remote monitoring. Coordinate with other members of the healthcare team, including physicians, specialists, and care coordinators, to ensure continuity of care and optimal patient outcomes. Stay informed about advances in remote monitoring technology, best practices in telehealth, and relevant healthcare regulations and guidelines.

Chartspan Medical Technologies Inc

Clinical Resource Nurse

Posted on:

September 16, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

5% of Americans over the age of 65 live with multiple chronic conditions that require ongoing medical attention. Yet preventative care programs remain highly underutilized: forcing older Americans to spend more time sick or in the hospital and less time with their loved ones. We offer full-service care management programs for healthcare organizations across the country. Our services help practices and health systems improve patient outcomes, reduce costs, and enhance their quality scores. Our team is: Passionate about remote, preventative care Comfortable using technology to reach patients across the country Invested in working with older patients to improve their health We regularly hire new team members to provide remote clinical care and to help enroll patients in care management.

The ChartSpan Clinical Resource Nurse plays a vital role in Chartspans clinical operations serving as a key resource for clinical expertise, staff education, and patient care coordination.

Education and Licensure: Registered Nurse (RN) with an active, COMPACT, unencumbered license in good standing. Bachelor of Science in Nursing (BSN) required; Master’s degree in Nursing, Education, or related field preferred. Certification in a specialty nursing area (e.g., CCRN, CEN, or CMSRN) is a plus. Current Basic Life Support (BLS) Experience: Minimum of 3–5 years of clinical nursing experience in an acute or outpatient care setting. At least 1–2 years in a leadership, educator, or mentor role within a healthcare environment. Experience in triage, care coordination, or working with clinical protocols (e.g., Schmitt-Thompson) is preferred. Skills and Competencies: Advanced clinical judgment and decision-making skills in complex patient care scenarios. Proven ability to educate and coach nurses and interdisciplinary teams effectively. Strong understanding of evidence-based practices and ability to translate them into clinical policies and workflows. Familiarity with quality improvement processes and data-driven decision-making. Ability to work independently and take initiative while also excelling in collaborative, team-based environments. Proficient in clinical documentation systems and electronic health records (EHR). Strong interpersonal, verbal, and written communication skills. Comfort with coaching, feedback, and leading meetings with supervisors or clinical teams. Competence in problem-solving under pressure, including critical patient care situations or equipment troubleshooting. Knowledge Requirements: Knowledge of HIPAA regulations, accreditation standards, and healthcare compliance. Experience supporting nursing licensure tracking and triage call audits. Familiarity with patient education tools, such as Healthwise, and care planning resources. Comfortable stepping into a Charge Nurse or team lead role as needed.

Clinical Expertise and Patient Care: Serve as a resource for complex patient care situations, providing advanced clinical knowledge and guidance to clinical and non-clinical staff. Assist in assessing, planning, implementing, and evaluating patient care protocols to ensure it meets the highest standards across the clinical departments. Support clinical staff in decision-making and problem-solving related to patient care. Provide direct patient care when necessary, particularly in cases requiring advanced expertise. Staff Education and Training: Develop and deliver ongoing education programs for nursing and non-nursing staff, ensuring they are updated on clinical best practices, new protocols, and procedures. Provide one-on-one coaching or mentorship to nurses/health coaches, especially new hires or those needing additional support. Organize and lead up-trainings Meet with supervisors to discuss coachings Update Healthwise and CRS data Quality Improvement and Best Practices: Participate in or lead quality improvement initiatives aimed at enhancing patient care, safety, and clinical outcomes. Monitor compliance with clinical guidelines, policies, and procedures, ensuring that all staff adhere to established standards of care. Collaborate with other teams to develop and implement best practices in patient care. Clinical Policy Development and Implementation: Contribute to the development of clinical protocols, policies, and procedures to ensure they reflect current evidence-based practices. Assist with the implementation of new clinical policies and ensure all staff are properly trained and compliant. Mentorship and Leadership: Act as a mentor or role model for clinical staff, fostering professional growth and development. Help to manage clinical workflows, prioritization of care, and efficient use of resources. Facilitate communication between nursing staff and other departments to enhance collaboration and patient outcomes. Troubleshooting and Problem-Solving: Serve as a point of contact for nursing staff when clinical issues or challenges arise, offering support and solutions in real time. Assist with clinical problem-solving, such as interpreting lab results, managing critical situations, or troubleshooting medical equipment. Regulatory Compliance and Accreditation: Lead HIPAA policies and protocols implementation Maintain triage team licensure tracking Support staff in understanding and complying with relevant regulations, providing guidance and corrective actions as needed. Documentation and Record-Keeping: Monitor and ensure accurate and timely documentation of patient care activities in compliance with organizational standards. Support clinical staff in maintaining thorough, up-to-date patient records and ensure compliance with documentation protocols. Assist in conducting regular audits of triage calls to ensure quality and adherence to Schmitt-Thompson protocols. Patient Education: Assist in developing patient education materials for internal use and create materials alongside the marketing department. Develop and maintain care plan library Support for the Nurse Escalation Team: Step into the Charge Nurse role to manage daily operations as needed, ensuring high-quality patient care and efficient team performance. Assist with triage of critical situations and provide direct patient care as necessary.

Chartspan Medical Technologies Inc

Bilingual Triage Support RN

Posted on:

September 16, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

5% of Americans over the age of 65 live with multiple chronic conditions that require ongoing medical attention. Yet preventative care programs remain highly underutilized: forcing older Americans to spend more time sick or in the hospital and less time with their loved ones. We offer full-service care management programs for healthcare organizations across the country. Our services help practices and health systems improve patient outcomes, reduce costs, and enhance their quality scores. Our team is: Passionate about remote, preventative care Comfortable using technology to reach patients across the country Invested in working with older patients to improve their health We regularly hire new team members to provide remote clinical care and to help enroll patients in care management.

Possess a current COMPACT license as an RN Ability to work Monday - Friday 3:30 pm- 12:30 am EST Willing to obtain multi-state licenses of ChartSpan footprint Familiar with chronic care conditions and the medications used to treat chronic conditions such as HTN, CHF, COPD, DM, etc. Excellence in following clinical triage protocols and procedures, and documenting accordingly in patient charts Recognize acute onset of symptoms that might require immediate attention Demonstrate sound knowledge, critical thinking skills and appropriate decision-making skills Demonstrate sensitivity and empathy with patients Demonstrate excellent verbal and written communication skills Possesses excellent computer skills with the ability to multitask including navigating and documenting in an EMR while communicating with the patient and using a telephonic platform Willing to work an on-call rotating schedule as needed Must be Bilingual (Spanish) with fluency in medical terminology. Successfully pass a background check

Triage Services Provides skillful, non-face-to-face telephone triage, care and planning to Medicare patients who have 2 or more chronic conditions Follow accepted evidenced-based guidelines and protocols and document encounters appropriately in patient charts Collaborate with physicians and healthcare team to optimize care Triage Leads Download notes from Triage Vendor, add to patient charts in CCM, and follow-up with patients/providers Be on-call during assigned Triage Lead shifts during the month to answer questions as needed Nurse Urgent Queue Educates and coaches to find creative ways to assist patients in reaching their health goals Review and complete Nurse Urgent To-Do’s, with a goal to keep the queue below 50 Communicate with patients and providers to assist in answering questions, coordinating care and services. (examples: schedule appointments, contacting service providers, sending notifications to healthcare providers, calling the patient back to follow up on their recent urgent or emergent medical issue, etc.) Attend meetings as required of the position Other duties as assigned

Chartspan Medical Technologies Inc

Part Time Triage Support RN

Posted on:

September 16, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

5% of Americans over the age of 65 live with multiple chronic conditions that require ongoing medical attention. Yet preventative care programs remain highly underutilized: forcing older Americans to spend more time sick or in the hospital and less time with their loved ones. We offer full-service care management programs for healthcare organizations across the country. Our services help practices and health systems improve patient outcomes, reduce costs, and enhance their quality scores. Our team is: Passionate about remote, preventative care Comfortable using technology to reach patients across the country Invested in working with older patients to improve their health We regularly hire new team members to provide remote clinical care and to help enroll patients in care management.

Possess a current COMPACT license as an RN Ability to work Monday - Friday 5:00 pm 9:00 pm EST Willing to work an on-call rotating schedule as needed Willing to obtain multi-state licenses of ChartSpan footprint Familiar with chronic care conditions and the medications used to treat chronic conditions such as HTN, CHF, COPD, DM, etc. Excellence in following clinical triage protocols and procedures, and documenting accordingly in patient charts Recognize acute onset of symptoms that might require immediate attention Demonstrate sound knowledge, critical thinking skills and appropriate decision-making skills Demonstrate sensitivity and empathy with patients Demonstrate excellent verbal and written communication skills Possesses excellent computer skills with the ability to multitask including navigating and documenting in an EMR while communicating with the patient and using a telephonic platform Successfully pass a background check

Triage Services Provides skillful, non-face-to-face telephone triage, care and planning to Medicare patients who have 2 or more chronic conditions Follow accepted evidenced-based guidelines and protocols and document encounters appropriately in patient charts Collaborate with physicians and healthcare team to optimize care Triage Leads Download notes from Triage Vendor, add to patient charts in CCM, and follow-up with patients/providers Be on-call during assigned Triage Lead shifts during the month to answer questions as needed Nurse Urgent Queue Educates and coaches to find creative ways to assist patients in reaching their health goals Review and complete Nurse Urgent To-Do’s, with a goal to keep the queue below 50 Communicate with patients and providers to assist in answering questions, coordinating care and services. (examples: schedule appointments, contacting service providers, sending notifications to healthcare providers, calling the patient back to follow up on their recent urgent or emergent medical issue, etc.) Attend meetings as required of the position Other duties as assigned

Call 4 Health, Inc.

Registered Nurse (RN) Saturdays and Sundays Only – 8,10,12 Hours Shifts - Compact + NY/IL License Required

Posted on:

September 16, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Call 4 Health is a leading medical call center with a genuine understanding of the patient’s perspective. Delivering compassionate commitment with quality medical solutions to our clients since 1997, Call 4 Health has a keen understanding of what it is like to face trauma and has developed a sound system to seamlessly balance professionalism with compassion. Our call representatives understand the difficulties in facing traumas and coping with treatments as well as the emotional and financial strains those challenges present. Our altruistic approach places patients and their families first. Compassion is more than just a word at Call 4 Health, it is what drives us. Customer service excellence is not something we just “talk about” it. We deliver it every day. Call 4 Health uses state-of-the-art technological initiatives to process up to 2,500 calls simultaneously. Each call is received with compassionate commitment using our Interactive Voice Response (IVR) system which can be tailored to your specific requirements through an assigned account manager. Our call representatives continually create innovative solutions in today’s fast-paced digital world. Call 4 Health is always ready with real solutions consistent with the needs of both the client and the patient. Our staff takes pride in their community commitment as one of the leading Disaster Relief Call Centers during hurricanes or other local emergencies.

The Registered Nurse (RN) will play a crucial role as a physician extender within the healthcare team, operating in a remote capacity. In this role, the RN will support providers by efficiently managing Electronic Health Records (EHR), addressing patient inquiries, and delivering clinical guidance to ensure optimal patient care. This position involves responding to calls for a multi-state nurse triage telephone service, managing inbound and outbound patient calls, triaging patient needs, conducting follow-ups, and facilitating effective communication among healthcare professionals and patients, ultimately enhancing patient outcomes and team effectiveness.

Bachelor’s or Associate’s Degree in Nursing. Minimum of 2-4 years of full-time clinical experience as a Registered Nurse, preferably in areas such as ER/Urgent Care, Adult, Pediatric, OB/GYN, Orthopedic, Ambulatory Care, Home Health, or ICU. Previous telephone triage experience using electronic triage systems and at least two Bachelor’s or Associate’s Degree in Nursing. Minimum of 2-4 years of full-time clinical experience as a Registered Nurse, preferably in areas such as ER/Urgent Care, Adult, Pediatric, OB/GYN, Orthopedic, Ambulatory Care, Home Health, or ICU. Previous telephone triage experience using electronic triage systems and at least two Qualifications & Skills: We are committed to providing our employees with the support they need. At Call 4 Health, we offer eligible employees an attractive benefit package that includes medical, wellbeing, dental and vision benefits along with some unique benefits including: Teamwork: Demonstrated ability to collaborate effectively with peers, cross-functional teams, and leadership. Leadership: Proactive in stepping up to lead, when necessary, capable of motivating colleagues, and sharing knowledge for the enhancement of team performance. Customer Service: Exceptional empathy, patience, and active listening skills to understand and address patient needs effectively. Quality: Strong attention to detail in charting, utilizing correct grammar, spelling, and medical terminology to ensure complete and accurate patient documentation. Organization and Time Management: Highly organized, capable of handling and documenting at least four calls per hour during peak times Physical Requirements: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The employee must be able to sit for extended periods, talk, and engage in active listening without visual contact with patients. Occasional standing and the use of hands for operating office equipment are required, with infrequent stooping, kneeling, or crouching. Ability to hear in normal range and wear a headset/ earpiece Good visual acuity to read computer screens, scripts, forms etc. Able to work remotely at home in a private HIPAA compliant workspace Able to house company equipment needed to perform job Broadband Internet Access Participation (via telephone or video) in staff meetings Work Environment: Able to thrive in a fast-paced environment. Demonstrated capability to maintain professional relationships with diverse personalities. Must be flexible and adaptable to change, managing stress effectively. May require occasional overtime or adjusted start times. Schedule: Saturdays and Sundays Only – 8,10,12 Hours Shifts Licenses: Compact + NY/IL License Required Education Required: Bachelors or better in Nursing Licenses & Certifications Required: Registered Nurse License Skills Required: Problem solving Clinical Expertise Phone Triage Electronic Health Records (EHR) Technology Behaviors Preferred Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well Dedicated: Devoted to a task or purpose with loyalty or integrity

Track and respond to calls for a multi-state nurse triage telephone service, receiving inbound calls from patients and placing outbound calls, while utilizing Schmitt-Thompson telephone triage protocols to document patient interactions effectively within clients’ EHR and/or a Call 4 Health platform. Provide clinical assessment based on established protocols and triage patients by phone or through patient portal. Provide administrative support and perform clinical tasks such as medication prescription refills per established protocols, notifying providers of critical results, and coordinating follow-up care post-discharge or post-operative. Facilitate referrals and collaborate on addressing prior authorization requests that require clinical consultation, while also assisting with requests from other agencies such as hospitals, nursing homes, funeral homes, and Departments of Labor or Motor Vehicles. Participate in Remote Patient Monitoring (RPM) initiatives by tracking patients' vital signs and delivering education on managing chronic diseases such as diabetes, hypertension, and COPD. Screen and qualify patients for clinical trials. Perform follow-ups and patient education. Carry out additional responsibilities as needed to assist the healthcare team and enhance the delivery of patient care.

Trinity Health

HOSPICE Triage RN -Full-Time

Posted on:

September 16, 2025

Job Type:

Full-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.

Full-Time Triage RN - Day Shifts The Community Hospice has a wonderful opportunity for an RN to work as part of our Hospice Care Team triaging symptom management calls for patients and families in the homecare and NH setting. Hours will vary and includes an every other weekend rotation. This is a remote position** but requires employee to live LOCALLY for training and in the event that working in the office is needed.** Here at St. Peter's Health Partner's, we care for more people in more places. Organization Highlights: Quality of Life: Where career opportunities and quality of life converge Advancement: Strong orientation program, generous tuition allowance and career development Work/Life: Positions and shifts to accommodate all schedules

A current license to practice as a Registered Nurse in the State of New York Associates Degree in Nursing, BSN preferred 1-2 years recent experience as an RN required. Homecare RN experience is strongly preferred Previous hospice experience preferred but NOT required. Ability to actively listen and respond appropriately to patients/families as well as to support patient/families through times of crisis.

You will respond to symptom management needs and coordinate with our team to provide end of life support to patients and families.

TRILLIUM HEALTH RESOURCES

LTSS Triage Supervisor

Posted on:

September 16, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

North Carolina

Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. We manage services for individuals with serious mental health needs, substance use disorders, traumatic brain injuries, and intellectual/development (IDD) disabilities. Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives. Why Work for Us? Trillium believes that empowering others begins with supporting our team. We offer our employees: A collaborative, mission-driven work environment Competitive benefits and work-from-home options for most positions Opportunities for professional growth in a diverse inclusive culture Every day, our work changes lives – from children thriving through early intervention and school-based therapies, to adults with severe mental illness living independently and contributing to their communities. If you are looking for a unique opportunity to make a tangible impact on the lives of others, apply today!

Trillium Health Resources has a career opening for a Long Term Services and Support (LTSS) Supervisor to join our team! The LTSS Supervisor oversees a skilled, integrated team of professionals who provide localized support within a managed care environment for members living with intellectual/developmental disabilities or traumatic brain injury. This position assist members who are eligible for Long Term Services Supports and who are eligible for 1915 (I) services. The employee contributes to the LTSS care Management process by performing telephonic, face to face contacts with members based on their unique needs, including behavioral health, social services and long term services and support.

Required: Bachelor’s degree or licensure as an RN, and five (5) years of experience providing care management, case management, or care coordination to complex individuals with I/DD or TBI; or Master’s degree in a human services field or licensure as an RN, and three (3) years of experience providing care management, case management, or care coordination to complex individuals with I/DD or TBI. No license or certification, unless if qualifying as a Registered Nurse. A valid active driver’s license is required to be maintained for this position Must reside within North Carolina. Must be able to travel within catchment as required. Preferred: •Prefer experience working with members with Intellectual Developmental Disabilities, Traumatic Brain Injuries (TBI), Severe Mental Illness (SI), or Severe Emotional Disturbances, (SED).

Provide oversight and planning for staff supported in this program. Provide direct supervision and oversight for a localized, multi-disciplinary team supporting child members living with mental health, substance use, and intellectual/developmental disabilities. Ensure staff utilize workflows as required to complete comprehensive care management assessment and care plans for members as care needs change. Establish a team based, person-centered approach to coordination of care to be implemented by all team members that effectively manages a member’s physical health, behavioral health, and social determinant of health needs using established workflows and processes effectively and efficiently. Monitor staff to ensure integration of care through the establishment of a multi-disciplinary team (e.g. member, caretaker/legal guardian, PCP, behavioral health provider, specialists, nutritionists, pharmacy, etc.) to meet the member’s needs.

TRILLIUM HEALTH RESOURCES

Complex Transitional Care Nurse - Southern/South Central Region

Posted on:

September 16, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

North Carolina

Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. We manage services for individuals with serious mental health needs, substance use disorders, traumatic brain injuries, and intellectual/development (IDD) disabilities. Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives. Why Work for Us? Trillium believes that empowering others begins with supporting our team. We offer our employees: A collaborative, mission-driven work environment Competitive benefits and work-from-home options for most positions Opportunities for professional growth in a diverse inclusive culture Every day, our work changes lives – from children thriving through early intervention and school-based therapies, to adults with severe mental illness living independently and contributing to their communities. If you are looking for a unique opportunity to make a tangible impact on the lives of others, apply today!

Trillium Health Resources has a career opening for a Complex Transitional Care Nurse. The core responsibility of the Complex Transitional Care Nurse is to develop personalized care planning strategies. This involves a thorough assessment of the patient’s unique situation, taking into account their medical history, social circumstances, and individual needs. The care plans are meticulously crafted with foundation in national evidence-based and informed standards, ensuring the delivery of whole person care. This evidence-based approach is crucial for achieving optimal patient outcomes and promoting long-term well-being.

Required: Fully licensed by the North Carolina State Board of Nursing as an RN. Minimum of one (1) year experience as a Registered Nurse. Must reside in North Carolina within Trillium’s Southern or South Central Regions. Counties included are: Bladen, Brunswick, Carteret, Columbus, Craven, Duplin, Hoke, Jones, Lee, Lenoir, Moore, New Hanover, Onslow, Pender, Robeson, Sampson, and Wayne. Must have a valid driver’s license. Must be able to a Trillium office location and within catchment as required. Preferred: Experience working with BH/MH/SU/IDD population. Knowledge of QM, UM procedures as well as experience in using data analytics for population health management. Experience assessing and coordinating care for members in adult care homes, family care homes, home residence, or other settings.

Coordinate care for assigned individuals. Collaborate with internal staff to facilitate integrated care. Monitor the care plan, service delivery, and health and safety of assigned members. Complete assessments as needed. Perform clinical functions of discharge/transition planning and diversion. Provide education about all available services and natural and community supports, treatment options, diagnosis, etc.

Merakey

LumiLink Registered Nurse Weekend Remote

Posted on:

September 16, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Merakey is a non-profit provider of developmental, behavioral health, and education services. More than 8,000 employees provide support to nearly 40,000 individuals and families throughout 12 states across the country each year.

**Weekend Position **Temporary position Description Remote weekend position Saturday and Sunday 7am-7pm - $30.01/hr plus $3.00 Shift Differential for weekend hours.

Current RN Compact License Preferred IDD group home experience Cell Center experience Candidate resides in Ohio, Delaware, Virginia or Pennsylvania Minimum of 1-2 years clinical experience in acute or ambulatory care setting Additional RN licenses as determined by Lumicare

The LumiLink Registered Nurse is responsible for professionally answering LumiLink calls for health-related concerns for all contracted providers. This position is responsible for the following: Triaging needs Clinical decision making Monitoring remote patient support system when applicable and advising the customer or their support team on actions to take for vital sign or compliance alerts Symptom-based problems, injuries, or general health questions by utilizing clinical software and guideline information

Accomplish Health Services, LL

Obesity Medicine Nurse Practitioner

Posted on:

September 16, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Delaware

Accomplish Health is a telehealth obesity medicine practice providing science based, stigma free personalized care. By first treating the underlying metabolic conditions including insulin resistance, type 2 diabetes, and obesity we help people to build sustainable, healthy habits while maximizing the affordability and accessibility of the care each person needs. Accomplish Health is a data-centric, objective focused, collaborative, and iterative culture where feedback and open communication are encouraged. We’re building experiences and creating clinical tools that help healthcare professionals personalize the experience for each patient. Our clinical model leverages pharmacotherapy, nutrition therapy, health coaching, and connected devices in a virtual care environment.

WHAT TO EXPECT AT ACCOMPLISH HEALTH: We are a remote-first, progressive, and technology focused workplace We are a mission-driven organization made up of veteran entrepreneurs and healthcare professionals passionate about treating obesity and related metabolic conditions. We care about the well being and growth of our patients, employees, and community. We are an equal opportunity employer that values diversity at our company. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status We are backed by top venture capitalists and entrepreneurs who have invested in or founded billion dollar startups

BACKGROUND AND EXPERIENCE: The ideal candidate will be a board certified Nurse Practitioner with at least 2-3 years of experience in bariatric medicine, endocrinology, primary care and/or related fields Certification in obesity medicine a plus Must have experience with using anti-obesity pharmacotherapy Active, unrestricted license to practice medicine in at least one state with additional state licenses a plus. Demonstrated excellent written/verbal communication skills. Competency in the genetic, biologic, environmental, social, and behavioral factors that contribute to obesity and a thorough understanding of the treatment of obesity. Competence with non-surgical therapeutic interventions including diet, physical activity, behavioral change, and pharmacotherapy, and in providing peri- and post-surgical care of endoscopic, metabolic and bariatric surgery patients ADDITIONAL DETAILS: Market-based compensation commensurate with experience. Malpractice coverage will be provided Flexibility to deliver care at your convenience Quality initiatives that guide the highest standards of evidence-based, compassionate care IDEAL QUALITIES: A non-stigmatizing, empathetic demeanor and virtual “bedside” manner. Excellent at collaborating and forming respectful relationships with colleagues regardless of function or level of seniority. Enthusiasm for innovation in healthcare and leveraging software to improve patient outcomes. Creative and flexible, but always puts the patient first You will need superior communication skills and excellent technical abilities. You must be comfortable interacting with patients over telehealth communication.

Consistently provide confidential high quality, stigma free, person-centric clinical care and a superior user experience. Review patient intake and provide the initial patient interaction, assess and diagnose relevant disorders, and provide care plan, including the discussion of the scientific principles of obesity, the prescription of appropriate weight loss therapy based on Accomplish Health’s scientifically-based clinical protocols. Review and manage daily tasks, patient communications, lab results. Oversee patient progress including remote physiological monitoring data. Experience working in a team of healthcare professionals (including dieticians and health coaches) and collaborating with them to ensure positive, effective patient experiences with our organization. Record complete, timely and legible medical records, providing appropriate encounter-related billing services. Utilize and support a detailed software enabled clinical model leveraging pharmacotherapy, nutrition therapy, health coaching and remote physiological monitoring to support patients with obesity and other metabolic conditions to achieve their weight loss and wellness goals. This role is full-time.

Accomplish Health Services, LL

Obesity Medicine Triage Nurse

Posted on:

September 15, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Oregon

Accomplish Health is a rapidly-growing, venture-backed leader providing telemedicine obesity care. We are redefining remote medical weight management and medical bariatrics through evidence-based stigma-free care, managed by obesity specialized clinicians and dietitians. Our mission is to provide people living with obesity with access to the high-quality evidence-based treatment they deserve. Our comprehensive clinical model leverages pharmacotherapy (prescription drugs), nutrition therapy, health coaching, and connected devices (i.e. scales, blood pressure cuffs), which has generated best-in-class clinical outcomes for our patients (12-month Weight Loss of 22% vs. industry norm of 5-16%) and in turn extraordinarily high patient satisfaction (NPS of ~90, Satisfaction Levels of >95%). By providing care in a completely virtual environment, we can provide enhanced access for patients in even the most remote locations, while providing clinical opportunities to medical professionals across the country. We partner with health systems and bariatric practices across the US, to provide our obesity care services to their patients in need, either through direct referral partnerships or joint ventures, with strong traction to date. More about Accomplish Health: We are a remote-first progressive and technology focused workplace. We are a mission-driven organization made up of veteran entrepreneurs and healthcare professionals passionate about treating obesity and other metabolic conditions. We are a data-centric, objective focused, collaborative, and iterative culture where feedback and open communication are encouraged. Our investors are top venture capitalists and entrepreneurs who have backed or founded unicorns like Zocdoc, Grove, Ginkgo Bioworks, Sweetgreen, Udemy, Clover Health, ASAPP and Moat. We care about the well being and growth of our patients, employees, and communities.

BSN plus a minimum of 3 years of recent related experience as a Registered Nurse. Experience in obesity medicine and/or bariatrics a plus. Either an active license in a compact state OR an active unrestricted eNLC. Strong communication, clinical assessment, and computer skills required. Demonstrated excellent written/verbal communication skills. Competency in the genetic, biological, environmental, social, and behavioral factors that contribute to obesity and a thorough understanding of the treatment of obesity. Candidates should have strong computer skills and excellent phone skills to work with providers, patients, and administrators

Deliver prompt and insightful triage (via phone or messaging) to aid patients in making informed healthcare decisions, applying critical thinking and clinical assessment skills alongside established protocols to ensure accurate patient care. Communicate proactively with providers and care team members to ensure seamless coordination and timely resolution of patient needs. Consistently provide confidential, high-quality, stigma-free, person-centered care and a superior patient experience. Record complete, timely, and legible medical documentation, ensuring appropriate encounter-related billing services. Utilize and support a detailed, software-enabled clinical model that leverages pharmacotherapy, nutrition therapy, health coaching, and remote physiological monitoring to help patients with obesity and other metabolic conditions achieve their weight loss and wellness goals.

Specialty Orthopedic Group

LPN Phone Nurse

Posted on:

September 15, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

LPN/LVN

State License:

Mississippi

Specialty Orthopedic Group of Mississippi, PLLC was founded in 2015 by Dr. Tyler Marks and Dr. Rowland Roberson with the vision of providing highly specialized orthopedic care across North Mississippi. Our group is composed of fellowship-trained orthopedic surgeons who practice exclusively within their area of subspecialty training—ensuring patients receive expert care tailored to their unique needs.

Specialty Orthopedic Group is currently seeking a Licensed Practical Nurse (LPN) Phone Nurse to join our team. This position will be Monday–Friday, full time. Training will be completed at our Tupelo, MS clinic, after which the position will transition to remote work for Mississippi residents. Please do not call in to Specialty Orthopedic Group regarding this position. The LPN Phone Nurse is responsible for patient triage, managing the nurse phone line, assisting with patient scheduling, and collaborating with providers and clinic staff. This position provides support within the scope of practice, ensures accurate and timely documentation in the EMR, and promotes continuity of patient care. The LPN Phone Nurse must be proficient with computer systems, have excellent phone etiquette, and demonstrate strong organizational and communication skills.

Active LPN license in Mississippi (required). 1 year of nursing experience preferred; orthopedic or phone triage experience a plus. Strong computer proficiency; prior EMR experience. Cooperative work attitude toward co-employees, management, patients, visitors, and physicians. Ability to promote a favorable clinic image with physicians, patients, insurance companies, and the general public.

Answer and return patient calls promptly, documenting all communication in the EMR (ModMed). Perform brief evaluations of patient situations to assess urgency and direct next steps within scope of practice. Assist with patient scheduling, medication questions, and general patient education as appropriate. Collaborate with providers, nurses, and staff to ensure continuity of patient care. Record and maintain accurate documentation of patient and physician communications. Prioritize multiple patient needs, ensuring timely responses and follow-up. Serve as a resource for clinic staff regarding patient care concerns within LPN scope of practice. Perform other duties as assigned.

Vital Health Solutions

Nurse Practitioner

Posted on:

September 15, 2025

Job Type:

Full-Time

Role Type:

Primary Care

License:

NP/APP

State License:

Florida

This is a full-time remote role for a Nurse Practitioner at Vital Health Solutions. The Nurse Practitioner will be responsible for providing patient care, diagnosing and treating acute and chronic illnesses, collaborating with healthcare professionals, and promoting health education among patients.

Patient Care, Diagnosis, and Treatment skills Collaboration with Healthcare Professionals Health Education skills Strong interpersonal and communication skills Advanced Practice Registered Nurse (APRN) certification Master's degree in Nursing State licensure as a Nurse Practitioner Experience in a clinical setting is a plus

The Judge Group

Quality Audit Nurse

Posted on:

September 15, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Our client is currently seeking a Remote Quality Auditor Nurse! This is a contract role, running through January 2026 Candidates must live in NJ, PA, NY, CT, or MD Mon-Fri business hours Equipment provided!

Candidates must live in NJ, PA, NY, CT, or MD Familiarity with electronic health records (EHR) and audit tools. Strong analytical, communication, and documentation skills. Experience with HEDIS, NCQA standards, and CMS regulations Registered Nurse (RN) Active NJ or Compact RN license

Audit Clinical Documentation: Review medical records and documentation to ensure accuracy, completeness, and compliance with regulatory standards. HEDIS & CMS Compliance: Conduct audits aligned with HEDIS measures and CMS-CAPs (Corrective Action Plans) to evaluate adherence to Medicare and Medicaid requirements. Data Analysis & Reporting: Analyze audit results, identify error trends, and prepare reports for internal teams and leadership. Process Improvement: Recommend changes to workflows or documentation practices to improve quality and compliance. Collaboration: Work closely with clinical teams, quality improvement staff, and business unit directors to ensure audit findings are addressed and improvements are implemented.

Molina Healthcare

RN Clinical Learning Facilitator based in Detroit MI

Posted on:

September 15, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

Michigan

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.

Delivers training programs for clinical staff across the enterprise to orient employees to Molina's clinical methodology, policies, processes, and systems. Ensures all Molina clinical team members are positioned to improve quality, control medical costs, and ensure compliance with state and federal regulations and guidelines. Leads and manages classes, adapting to trainee skill level, specific backgrounds, changing priorities, and operating environments as needed. Training includes clinical new employee orientation, implementations, partnerships on clinical initiatives, technical/system initiatives, and optimization efforts. For this position we are seeking a candidate with an active unrestricted RN MI licensure and must reside in the state of MI. This position will support our MMP (Medicaid Medicare Population). The Clinical Learning Facilitator will be responsible for creating training material/presentation decks and conducting classroom training in person/virtually. We are looking for a candidate with a background in healthcare training. Candidates with MMP and Behavioral Health experience are highly preferred. Excellent MS Word, Excel and PowerPoint skills are needed to be successful in this position. Home office with high-speed internet connection and a private work area are required. Preferred location: Detroit, MI Remote position with light travel to the Detroit location Schedule: Monday through Friday 8:30AM to 5:00PM

REQUIRED QUALIFICATIONS: Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandate. At least 2 years in case, disease or utilization management; managed care; or medical/behavioral health settings. One year of training delivery experience, including adult learning concepts. Experience working independently and handling multiple projects simultaneously. Knowledge of applicable state and federal regulations/requirements. Experience using virtual delivery tools (e.g., Zoom, MS Teams). Strong communication and presentation skills. Proficiency in MS Word, Excel, PowerPoint. PREFERRED QUALIFICATIONS: Active, unrestricted State RN or Clinical Social Worker/Counseling License. Certified Case Manager (CCM), Utilization Management Certification (CPHM), Certified Professional in Health Care Quality, or other related certification.

Prepares the learning environment for classroom setup, systems setup, course materials, media, and online learning. Educates regarding proper clinical judgment and approaches to decision making. Provides best practices for working as a member of an interdisciplinary clinical team. Educates integrated care teams on effective collaboration to improve member quality of life and to control costs. Trains healthcare services staff on professional standards of documentation. Reeducates staff via group facilitation and/or individual coaching when performance gaps are identified. Monitors learner engagement, attendance, and participation during training sessions, providing timely feedback to leadership on issues that arise during training sessions. Participates in committees and/or workgroups as a liaison between the training team and workgroup to ensure alignment and influence best practices. Supports training efforts for enterprise growth and new clinical programs or systems. Reinforces key behaviors through post-training support, coaching, and calibration.

UnitedHealthcare

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

Posted on:

September 15, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Texas

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

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, 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 experience working with Maternal and Infant population/Neonatal Intensive Care Unit (NICU) Familiarity with Microsoft Office, including Word, Excel, and Outlook 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 Wiling or ability to travel up to 10% throughout the state of Texas as business needs change Preferred Qualifications: 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 within commutable distance of assigned duties Dallas/Ft Worth, Northeast Texas, West Texas, Central Texas

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

CenterWell Pharmacy

Telephonic Nurse 2 (Care Manager) Bilingual English/Spanish

Posted on:

September 15, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Arizona

CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.

We are seeking a dedicated and compassionate Registered Nurse with a Bachelor of Science in Nursing (BSN) to join our team as a Care Manager, Telephonic Nurse 2. In this pivotal role, you will play a crucial part in our Patient Management Program, focusing on individuals with specialized and complex health conditions, including autoimmune disorders, pulmonary diseases, neuromuscular disorders, infectious diseases, cancer(s), and other rare ailments. This position has a set schedule that is provided daily with inbound and outbound tasks to perform. This position is for 9-5:30pm EST M-F, there will be two late nights a month with the hours of 11:30-8pm EST, and a Friday night late night requirement on a rotation of 11:30-8pm. Overtime is required on an as needed basis. There is a Holiday rotation that will be worked. Workable holidays for the pharmacy include Martin Luther King Day, Memorial Day, Juneteenth, 4th of July, Labor Day, The day after Thanksgiving, and New Years Day.

Use your skills to make an impact: Bachelors of Science in Nursing 3 - 5 years of clinical acute care experience Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action Must live in OH, KY, FL, AZ, TX. Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook Managed care experience Must be passionate about contributing to an organization focused on continuously improving consumer experiences Bilingual English/Spanish Preferred Qualifications: Experience with care management, and patient education for adult acute care Managed care experience Auto dialer experience

As a Care Manager, Telephonic Nurse your primary responsibility will be to assess and evaluate the conditions of our members, with a particular emphasis on medication therapy, through telephonic interactions to ensure they achieve and maintain optimal wellness.. Additionally, you will develop and implement comprehensive care plans, monitor patient progress through regular assessments, and utilize advanced telecommunication systems to provide medication education. The ideal candidate will demonstrate strong clinical expertise, exceptional communication skills, and the ability to work independently while adhering to established protocols and guidelines. This position offers the opportunity to make a significant impact on the lives of patients with serious and rare health conditions within a supportive and professional environment.

Cadence

Care Management Registered Nurse, RN Compact License Required

Posted on:

September 15, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

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

The Cadence Health team seeks a Registered Nurse to support patients in our care management programs and help patients better manage their conditions. The schedule for this position is Monday to Friday 8am-5pm Eastern or Central.

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

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

Insight Global

Telehealth Registered Nurse

Posted on:

September 15, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

Insight Global is an international professional services and staffing company specializing in delivering talent and technical solutions to Fortune 1000 companies across the IT, Non-IT, Healthcare, and Engineering industries. Fueled by staffing and talent experts, Evergreen, our professional services brand, brings technical advisors and culture consultants to help customers tackle their biggest challenges. With over 70 locations across North America, Europe, and Asia, and global staffing capabilities in 50+ countries, our teams of tech-enabled recruiters are dedicated to finding the right talent and technical solutions to help our customers thrive. At our core, we are dedicated to empowering people to do great things. That’s why we’re passionate about developing our people personally, professionally, and financially so they can be the light to the world around them. To find out more, visit www.insightglobal.com

A leading healthcare client is seeking Remote Registered Nurses to support a new program focused on reviewing health risk assessments and supporting HEDIS gap closure . In this role, you will conduct inbound and outbound calls to assess patients, gather health history, and provide guidance based on physician-approved triage protocols. You will use your clinical judgment to help patients navigate the next steps in their care. This is a remote position offering the opportunity to make a meaningful impact in a healthcare program focused on patient care and well-being. Your key responsibilities include taking inbound and making outbound calls. You’ll complete a brief history intake and record any symptoms. You will provide guidance using a physician-approved triage protocol, advising patients on whether to follow up with their provider, seek same-day care, or go to the emergency department. You’ll utilize strong clinical judgment to ensure patients take appropriate next steps in their care. You’ll offer concise, supportive patient education during calls and accurately document all phone call details using Athena encounter templates and text macros.

Minimum of 2+ years’ experience working as a Registered Nurse including experience in telehealth or phone-based patient care. Active Registered Nurse (RN) License (Compact Preferred) Electronic Medical Record (EMR) experience Experience with handling high volume of medical phone calls. Tech savvy, ability to quickly learn new technology platforms and tools including Slack and Google Suite. Strong clinical judgment and the ability to work independently in assessing patient needs. Excellent communication skills with the ability to provide clear and focused patient education. Proven ability to manage and prioritize patient cases based on urgency while working effectively with diverse populations. Plusses: Bilingual in Spanish Experience within in Women’s Wellness, Dialysis, Oncology highly preferred. Athena EMR experience preferred, this is the EMR used for this role. Preferred Zendesk VoIP, computer-based calling software used in this role. HEDIS or Risk Based Assessment knowledge

Medix™

REMOTE Utilization Management Nurse (Inpatient)

Posted on:

September 15, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

Medix provides workforce solutions to clients and creates opportunity for talent in the Healthcare, Life Sciences, Engineering and Technology fields. Through our core purpose of positively impacting lives, we have earned our reputation as an industry leader by providing unsurpassed customer service and top quality professionals to our clients.

Inpatient Utilization Management Nurse (Concurrent Review) Location: Remote (U.S. Based, Working PST Hours) Position Overview We are seeking an experienced Inpatient Utilization Management (UM) Nurse to perform concurrent review for initial inpatient admissions. This role focuses exclusively on Medicare members and requires strong knowledge of MCG criteria and Medicare/Medicare Advantage processes. The ideal candidate has inpatient UM experience, excellent clinical judgment, and the ability to clearly document, communicate, and advocate in a fast-paced environment. This is a temporary, remote role with the potential to convert to a permanent position after approximately 16 weeks.

Required Qualifications: Active CA RN or LVN license (compact or additional state licenses—TX, NC, NV, AZ—are a plus). 2+ years inpatient UM/concurrent review experience (minimum required). Strong knowledge of Medicare/Medicare Advantage utilization management processes. Proficiency with MCG criteria. Experience writing denial letters. Comfortable with case presentation and physician interaction. Excellent communication, critical thinking, and organizational skills. Schedule & Work Environment: Hours: Monday–Friday, 8:00 AM – 5:00 PM PST (or 8:30 AM – 5:00 PM with 30-min lunch).

Conduct concurrent reviews for inpatient admissions using MCG clinical criteria. Apply sound clinical judgment to synthesize medical records and determine medical necessity. Draft clear and original denial letters (high OBS scrutiny expected). Present cases during weekly rounds with Medical Director, including catastrophic cases (≥10-day LOS or flagged diagnoses). Collaborate with physicians, case managers, and internal teams; escalate when necessary. Maintain accurate, timely documentation in compliance with internal quality standards. Navigate manual workflows (fax reliance at some facilities, limited EMR access).

Blue Cross and Blue Shield of Minnesota

RN Case Manager - Self Insured TOC

Posted on:

September 15, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Minnesota

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.

The Case Manager is a critical component of BCBSMN Care Management team as the primary clinician providing condition and case management services to members. The position exists to support member needs across the continuum of care by leveraging member partnership, case and disease management processes, skill sets and tools.

Required Skills and Experience: Registered Nurse licensure in the state of Minnesota with no restrictions. 3 years relevant direct clinical care experience. All relevant experience including work, education, transferable skills, and military experience will be considered. CCM Certification or ability to obtain within 3 years of starting in the position. Excellent communication skills. Excellent conceptual thinking skills. Excellent relationship management skills. Excellent organizational skills. Computer application proficiency. Flexibility to work varied hours. High school diploma (or equivalency) and legal authorization to work in the U.S. Preferred Skills and Experience: 1+ years of managed care experience; e.g. case management/health coach, utilization management and/or auditing experience. Outstanding telephonic skills.

Receives referral and/or reaches–out to member and leverages clinical knowledge, motivational interviewing and behavioral modification techniques. Conducts comprehensive clinical assessments; gathers, analyzes, synthesizes and prioritizes member needs and opportunities. Collaborates and communicates with member, family, or designated representative on a plan of care that produces positive clinical results and promotes high-quality effective outcomes. Identifies relevant BCBSMN and community resources and facilitates warm program and network referrals. Monitors and evaluates plan of care over time. Ensures member data is documented according to BCBSMN application protocol and regulatory standards. Maintains outstanding level of service at all points of customer contact. Understands broad–based goals of assigned market segment(s) including clinical and service availability. Collaborates and coordinates with team members to facilitate day to day functions and enhance the overall operation of the department. Engage providers telephonically in reviewing and understanding treatment plans, including alignment with benefits and medical reimbursement policies to facilitate optimal treatment plans, care coordination, and transition of care between settings.

Tia

Virtual Care Nurse Practitioner or Physician Assistant (New York Licensed)

Posted on:

September 15, 2025

Job Type:

Full-Time

Role Type:

License:

NP/APP

State License:

New York

Virtual Care Nurse Practitioner/Physician Assistant (New York licensed) at Tia Tia is a full-stack women's healthcare business that builds products, tools and clinical services virtually and in person to help every woman be her own patient advocate and get meaningfully better healthcare. We’re putting the soul back in medicine, one patient and one provider at a time through a care philosophy that is reimagined to listen to and empower women to actively take control of their healthcare. The care philosophy that supports our patients is also built to support clinicians who are the heart and soul of the care Tia is able to provide. In order to do that - we need YOU! Read More About Tia’s Products: https://asktia.com/article/what-is-product-at-tia Services: https://asktia.com/ Care principles: https://www.asktia.com/care-philosophy/

We’re looking for a Full-Time Nurse Practitioner or Physician’s Assistant (active NY NP and RN license) passionate about women’s health for Tia’s Virtual Care Team. As a Virtual Medical Provider, you will be an integral part of the care delivery system. You will see patients virtually and deliver comprehensive and integrative care spanning across gynecology and primary care services: from virtual establishment of care visits, to birth control and flu/cold consults to weight management and dermatology focused visits. In addition to synchronous telemedicine visits you will be responsible for answering patient questions via chat and managing your inbox for lab review, patient follow-ups and case consultations. Nurse Practitioners and Physician Assistants are integral to the formation and iteration of our technology development and care model. In addition to your clinical role, you’ll have an opportunity to shape the Tia care model and improve our technology tools. You’ll collaborate with our product & engineering teams to share insights and feedback. Schedule is set with some flexibility. We offer 10 hr or 8 hr virtual days. Start times are 7a-9a for early shifts and or 10a-12p for later shifts. Expectation is that you take one-two evening shifts per week and working Wednesday and Friday is required.

Skills And Assets You’ll Bring To Tia You’re a board certified Nurse Practitioner or Physician Assistant, with active and unrestricted licenses in the state of New York and able to provide primary care and support of all aspects of women’s health with compassion and empathy. Must have at least 2 years of post graduate clinical experience You have experience and a passion for delivering high quality integrated care via telemedicine and are highly tech savvy. While experience as a direct digital care provider in the past is not a must - it is highly desired! Deep clinical expertise in providing primary care and women’s health experience (at least 2 years of post-graduate clinical experience) including: STD screens, UTI & Vaginal infections consults, Pelvic Pain, Vaginal Bleeding, Birth Control counseling, annual exams and urgent care concerns (coughs, sore throat, abdominal pain, basic dermatological conditions) with an ability to take this brick and mortar experience and translate it to virtual delivery. Exceptional written and verbal communication skills. Demonstrated excellence in Interpreting and act on clinical labs + ultrasound results Willingness to work evenings + weekends as needed by schedule Authorized to work in the US and willingness to be credentialed through major health systems and payers Other “nice To Have” Skills As an organization that seeks to create an environment for all women to feel safe, heard, recognized and avowed in their health, bodies and lives, we are consistently seeking providers with backgrounds that are meaningfully different from those already forming our team. You bring a diverse background, a range of care experiences in different communities or various modalities. Formal professional training in the following areas is highly valued: care delivery for women who have experienced trauma and care delivery for LGBTQ identified folks Experience or formal training weaving integrative medicine practices into your care plan development. Benefits Remote role Talented and collaborative team who will support and collaborate with you Competitive salary with quarterly bonus program in place for clinicians Paid time off, paid sick leave, paid learning time off Comprehensive benefits package effective day one, including medical, dental & vision Medical malpractice coverage Reimbursed for state licenses, board certification, and BLS certification. DEA will be reimbursed where it is required for practice. Complimentary subscriptions to educational tools such as UptoDate along with extensive internal educational resources and monthly clinical training opportunities Access to AI documentation software drastically reducing administrative burden of clinical documentation Per New York Pay Transparency Laws (as of November 1, 2022), please see below for the compensation range for a ( NP/PA- NY Williamsburg): $115,000 - $140,000

You’re motivated to elevate women’s care by bringing a shared-decision making approach to women’s health. You believe that each woman knows her body best, though she may need help interpreting what the signs mean. Your mission as a woman’s healthcare provider is to help your patients understand those signs and develop robust, multi-faceted treatment plans to reach health goals. You are flexible and excited to work in a dynamic start-up environment You’re facile with technology, comfortable and experienced providing high quality care digitally via telemedicine and interested in the process of developing new technology to support the highest quality clinical care.. You’re data driven and consistently incorporate new and evolving research into your day-to-day practice You’re a high functioning multi-tasker who has an incredible ability to stay calm and focused under pressure You are a tolerant and inclusive thinker. You believe in sex-positive, no judgment and radically inclusive healthcare for every person, and espouse these values in your everyday life.

Superior HealthPlan

Senior LTSS Service Care Manager (RN)

Posted on:

September 15, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. RN Care Manager – works from home and conduct case management member visits near Laredo, TX, Botines, TX, Webb, TX, or Callaghan, TX NOTE: Company equipment and mileage reimbursement is provided Schedule: Monday - Friday: 8 am - 5 pm (CST); no evenings or weekends Position Purpose: Performs care management duties to assess and coordinate all aspects of medical and supporting services across the continuum of care for complex/high acuity populations with primary medical/physical health needs to promote quality, cost effective care. Develops a personalized care plan / service plan for long-term care members, addresses issues, and educates members and their families/caregivers on services and benefit options available to receive appropriate high-quality care.

Education/Experience: Requires Graduate from an Accredited School of Nursing or a Bachelor's degree and 4–6 years of related experience Bachelor's degree in Nursing preferred License/Certification: Registered Nurse - State Licensure and/or Compact State Licensure is required Preferred Experience: Clinical RN nursing experience with direct patient care, case management, and/or care coordination of medical services Direct experience in Critical Care, Multi-Specialty ICU (MSICU), Med/Surg, ER, Oncology, Neuro, PACU, CICU, Surgery, Step Down Unit, Telemetry, Float Pool, or Nursing Rehab Assisted Living Facilities (ALF) Skilled Nursing Facilities (SNF) Long Term Care Home Health or Hospice Case Management or Service Coordination Managed Care – managing Medicaid or Medicare members

Evaluates the service needs of the most complex or high risk/high acuity members and recommends a plan for the best outcome Develops and continuously assesses ongoing long-term care plans / service plans and collaborates with care management team to identify providers, specialists, and/or community resources needed to address member's needs Coordinates and manages 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 Monitors care plans / service plans and/or 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 / needs Monitors member status for complications and clinical symptoms or other status changes, including assessment needs for potential entry into a higher level of care and/or waiver eligibility, as applicable Reviews member data to identify trends and improve operating performance and quality care in accordance with state and federal regulations Reviews referrals information and intake assessments to develop appropriate care plans / service plans Collaborates with healthcare providers as appropriate to facilitate member services and/or treatments and determine a revised care plan for member if needed Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and clinical guidelines Provides and/or facilitates education to long-term care members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits Acts as liaison and member advocate between the member/family, physician, and facilities/agencies Educates on and coordinates community resources. Provides coordination of service authorization to members and care managers for various services based on service assessment and plans (e.g., meals, employment, housing, foster care, transportation, activities for daily living) May perform home and/or other site visits (e.g., once a month or more), such as to assess member needs and collaborate with resources, as required Partners with leadership team to improve and enhance quality of care and service delivery for long-term care members in a cost-effective manner May precept clinical new hires by fostering and building core skills, coaching and facilitating their growth, and guiding through the onboarding process to upskill readiness May provide guidance and support to clinical new hires/preceptees in navigating within a Managed Care Organization (MCO) and provides coaching and shadowing opportunities to bridge gap between classroom training and field practice May engage and assist New Hire/Preceptee during onboarding journey including responsibility for completing competency check points ensuring readiness for Service Coordination success Engages in a collaborative and ongoing process with People Leaders and cross functional teams to measure and monitor readiness Performs other duties as assigned Complies with all policies and standards

Health Care Service Corporation

Primary Nurse CA Specialty (Oncology Certification Required)

Posted on:

September 15, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development.

This position’s primary focus is the management of members with specialty (ONCOLOGY) diagnoses. This position will be responsible for performing all functions of case management (CM) and is a primary source of contact for members, health care personnel and all other entities involved in managing specialty care. The primary nurse case administrator performs care coordination; identifies alternate treatment programs; consults with physicians, providers, members, and other resources to evaluate options and services required to meet an individual’s health needs; promotes quality and cost- effective outcomes; and serves as liaison to physicians and members. Provide education/local resource information and encourage member (self) education functioning in a clinical care advisory role, the primary nurse case administrator assesses members for case management, introduces members to our website tools, educates members regarding their specific condition, and facilitates the coordination of care for identified members.

JOB REQUIREMENTS: Registered Nurse (RN) with current, valid, unrestricted license in state of operations 4 years clinical practice experience of direct clinical care, to include 3 years of recent Specialty (ONCOLOGY) clinical experience Knowledge of specialty diagnosis drugs, adjunct therapies and treatment protocols including side effects and complications Current certification in one of the following: OCN/ONS/ONCC PC proficiency to include Word, Excel, and database experience Clear and concise verbal and written communication skills Knowledge of UM/CM/DM activities and standardized criteria set Familiarity of ancillary services including HHC, SNF, Hospice, etc Verbal and written communication skills; analytical skills; sound clinical judgment Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. Knowledge of drugs and treatment protocols including side effects and complications Knowledge of diets relating to assist members Knowledge of Problem Solving, Healthy Coping and establishing SMART goals. Current Certified Specialists must maintain their certification PREFERRED JOB REQUIREMENTS: RN Compact License required ONCOLOGY CERTIFICATION REQUIRED CCM certification PREFERRED Experience in managing complex or catastrophic health cases Inpatient and Outpatient experience preferred. 1-year experience in Care Management in a health insurance/managed care setting Knowledge of medical management policies and procedures 1-year education experience in Specialty area This position is Telecommute (Remote) role: Must reside within 250 miles of the office or anywhere within the posted state. #LI-Remote

Vis-À-Vis Health

Nurse Practitioner (Telehealth)

Posted on:

September 15, 2025

Job Type:

Part-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

Vis-À-Vis Health is a Brooklyn-based healthcare provider specializing in proactive care. We offer a range of comprehensive healthcare services, with a focus on delivering high-quality preventive care to patients in the comfort of their own homes and care facilities.

Must have 3 or more active NP licenses in the following states: PA, NY, NJ, FL, CT, MA, NH, NM, VT, TX, WV Position Summary The Nurse Practitioner (NP) will work in collaboration with the clinical interdisciplinary team to coordinate and support the participant’s functional, clinical, and psychosocial needs. This role requires the provider to conduct telehealth visits done via video to provide quality care of transitional care management (TCM) and chronic care management (CCM) for geriatric patients through remote patient monitoring (RPM).

Must hold current and valid registration and license as a Registered Professional Nurse and Nurse Practitioner in the state or practice. Minimum of three years in clinical nursing practice in home care, skilled nursing facility or hospital. More than 3500 hours of experience as a Nurse Practitioner, NPI# and ability to bill both Medicare and Medicaid system with no restrictions. Should have excellent computer skills working in electronic documentation in and HER platform. Excellent computer skills with experience in Microsoft Office programs required. Experience with technology-based programs and platforms, including electronic medical records and customer relationship management systems preferred. Excellent customer service skills required, with the ability to mediate and resolve conflict and complaints. Excellent interpersonal skills, with the ability to develop positive working relationships. Must be aligned with company goals, mission, vision, and values. Strong working knowledge of industry rules and regulations. Must be able to think critically and propose solutions to operational issues. Strong organizational and time management skills, with the ability to manage multiple projects and changing priorities. Excellent written and verbal communication skills required. Bilingual in English/Spanish preferred. Payment is on the RVU model.

Conduct virtual/remote video visits with patients Reviews patient’s past medical history and formulates a comprehensive and complete diagnostic list of current and past medical conditions using clinical knowledge and judgement and the findings of his/her assessment. The NP is responsible for ensuring that all such complete, accurate and specific diagnosis codes will be documented in the resident’s medical record. Reviews Participant’s current symptoms, exacerbation of problems that were previously controlled and identify active diagnoses and chronic problems or conditions to be used for active medical management and treatment. Prescribe medications and provide comprehensive insight into medication management Collaborate with case managers to fill labs, diagnostics, DME, and other recommendations Reviews change in condition reports and schedules follow up visits as needed. Completes and submits daily billing log, includes CPT codes and ICD 10 codes for resident care visits. Participates in Interdisciplinary team meetings as needed. Complies with all HIPAA regulations and maintains security of Protected Health Information. Contributes to team effort by accomplishing related results as needed. Other reasonable duties as assigned by supervisor.

TeleMed2U

Virtual Nurse Practitioner - OR License - Cardiology

Posted on:

September 14, 2025

Job Type:

Part-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Oregon

At TeleMed2U, we believe that time is the most valuable resource in healthcare— whether it is time to diagnosis, time to treatment, or time to better health. That is why, since our founding in 2011, we have been dedicated to increasing access to care across 20 medical and behavioral health specialties nationwide. By breaking down traditional barriers to specialty care, TeleMed2U has become a leading technology-enabled healthcare services company, delivering high-quality, convenient, and easy-to-access virtual healthcare solutions. Our integrated approach to chronic disease management empowers both patients and providers, improving health outcomes through seamless care coordination. With a focus on patient-centered innovation, provider collaboration, and data-driven care delivery, TeleMed2U is redefining specialty care—making it faster, simpler, and more accessible for all.

Sigma Tactical Wellness and TeleMed2U company is seeking a Part-Time Nurse Practitioner to become a part of our team! You will focus on providing high quality patient care as part of a healthcare team. Our patients are first responders/law enforcement enrolled in a cardiac wellness program. All care is provided remotely, with no travel required. Dates can be scheduled in advance for clinicians looking for extra income or flexible work days. This is contract work. Additional opportunities available for applicants licensed in additional states, and/ or willing to obtain a license. Benefits/Compensation: Fully Remote/Virtual Opportunity Part-Time Contractor Opportunity Competitive Hourly Rates

Active Oregon Nurse Practitioner License a MUST Previous experience in cardiology preferred or experience in acute care with EKG interpretation Ability to build rapport with patients Ability to thrive in a fast-paced environment Excellent verbal communication skills Strong leadership qualities Comfortable working remotely with Telehealth Experience Minimum 1-3 years Experience

Review lab results, cardio-metabolic testing, stress testing and other modalities Provide a detailed H&P Consult with supervising Cardiologist as needed Facilitate referrals to other healthcare professionals Communicate with collaborating physician or specialist regarding patient care Consult with patient regarding outcomes, wellness and prevention

Thyme Care

Palliative Care Nurse Practitioner

Posted on:

September 14, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

NP/APP

State License:

New York

Imagine building a better healthcare journey for patients with cancer, where individuals and their loved ones feel seen, supported, and heard by their care team – both in and out of the clinic. Where fast access to high-quality care is the norm, not the exception. Where patients have access to a care navigator to guide them through their diagnosis and trusted support all along the way. At Thyme Care, we share a passion for transforming the cancer care experience – not just for patients but also for their caregivers and loved ones, as well as those delivering and paying for their care. Today, Thyme Care is known predominantly as a cancer care navigation company enabling value-based cancer care; in the next few years, we will become a nationally recognized technology-driven and provider-centric care delivery model, reshaping the landscape of cancer care access, delivery, and experience. Our commitment runs deep—we're not satisfied with the status quo but determined to redefine it. To make this happen, we’re building a diverse team of problem solvers and critical thinkers to drive innovation and shape the future of healthcare. If you share our vision and want to be part of something truly meaningful, we want to hear from you. Together, we can revolutionize cancer care and make a difference that lasts a lifetime.

As a Thyme Care Palliative Care Nurse Practitioner, you will be a critical member of the clinical team caring for our members with serious illness. You will have three primary responsibilities: First, you will see members for specialty palliative care outpatient appointments via video visits as part of an interdisciplinary team consisting of our Community Health Workers, Oncology Nurses, Social Worker, and Palliative Medicine Physician. As one of the first Nurse Practitioners to join the palliative care team, you will be an important part of bringing our model to scale. Second, you will be responsible for the oversight and direction of interdisciplinary case conferences for our members with advanced serious illness, in which individualized care plans for our members are created and monitored by our team of Community Health Workers and Oncology Nurses. You will provide clinical oversight to the case management team and direct clinical care, as needed. Third, you will provide education about palliative care to our team of Community Health Workers and Oncology Nurses. In particular, you will focus your teaching efforts on the outpatient management of cancer-related symptoms, serious illness communication skills, and advance care planning. In addition, you will be integral to the development and implementation of our advance care planning program. This role reports into our Senior Medical Director and can be remote or hybrid based in our New York City or Nashville offices. All patient interactions will be virtual via telephone, video, text, or our proprietary virtual care platform.

People-first. Thyme Care’s mission and members matter to you, deeply. Experience. You have at least 3 years of nurse practitioner (NP) experience with at least 2 years in palliative care, preferably caring for patients in the outpatient oncology setting. You are an advanced certified hospice and palliative nurse practitioner (ACHPN). You have an unrestricted nurse practitioner license and a willingness to obtain additional state licenses, as needed. ​​It would be exceptional if you have worked at a startup or tech-forward company. Organized. You’re skilled in juggling multiple tasks and working under pressure without sacrificing organization in your communications and documentation. Effective listener and communicator. You are winsome and articulate, but you always start with listening and you hear what may not be voiced, because you listen so intently to others. You build rapport and great working relationships with members and colleagues. Comfort with ambiguity. Start-ups are fast-paced environments, and you understand that rapid changes to the business, strategy, organization, and priorities are par for the course… and part of the adventure. A desire to learn how to use new technologies. We are a technology company focused on interacting with folks during the season where they need it most. Experience with video chatting, Google Suite, Slack, electronic health records or comfort using and learning new technology is important. Identify priorities and take action. You know how to identify and prioritize a member's needs, and do what it takes to ensure that urgent and important needs are addressed immediately.

Complete training and are up to speed on Thyme Care’s systems, tools, technology, partners, and clinical expectations. Complete virtual palliative care outpatient visits for our members with the highest degree of clinical rigor. You will work fluidly with our in-house care team and providers to ensure any identified needs are met in follow-up to patient visits. Be adept at leading interdisciplinary case conferences for members with advanced serious illness, guiding our team of community health workers and oncology nurse navigators in the creation of evidence-based, member-centered care plans that focus on interventions that improve member outcomes. Become the go-to person for our oncology nurse navigators and community health workers when they are working with a member who has advanced serious illness. Be comfortable with and correctly follow policies and procedures, escalation pathways, communications best practices, and documentation standards. Your ability to effectively engage and support our members is reflected in our metrics and quality standards.

Shield Health

Care Manager – Work From Home

Posted on:

September 14, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Tennessee

Shield Health provides care management services - Chronic Care Management (CCM) and Principal Care Management (PCM) - for Medicare patients. We’re a tight-knit team that values transparency, flexibility, and delivering genuinely personal care. If you enjoy talking to your grandma on the phone, helping her stay on top of her meds, and making her feel heard and supported - this job will feel familiar.

Patients often fall through the cracks between office visits - missing meds, skipping follow-ups, or waiting too long to speak up. That’s where Shield Health comes in. We assign each patient a dedicated nurse who checks in monthly, manages medications, answers questions, and keeps care on track. It’s an extra layer of support that keeps patients healthier, longer. We’re hiring licensed RNs, LPNs, or LVNs who love meaningful phone conversations and want the flexibility of remote work.

Active RN, LPN, or LVN license Experience in nursing or other medical settings Strong verbal communication and empathy Comfortable with basic tech tools (EMR, phone platforms, data entry) Quiet, reliable remote workspace Self-starter who’s organized and goal-oriented

Make ~50 outbound calls per day to patients Educate patients and caregivers about our care management programs Enroll patients by gathering health history, current medications, and concerns Build trust and explain the value of ongoing nurse support Use our platform to manage outreach, documentation, and follow-up tasks

Clearlink Partners

Care Management RN (MA License)

Posted on:

September 14, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Massachusetts

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

Expected Hours of Work: Friday 8 am – 5 pm; with ability to adjust to Client schedules as needed Travel: May be required, as needed by Client Direct Reports: None Salary Range: $60,000 - $90,000

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

Specific: Manage expenses, facilitate access and improve quality of life for persons with long-term chronic conditions and/ or high risk, high cost disease states (Disease and/ or Chronic Condition Management) Work with patients in distinct populations and sub-populations to promote global outcomes, optimize health, manage care and control costs (Population Health) Assist with empowering the member to manage and improve their health, wellness, safety, adaptation, and self-care through effective care coordination, case management Educate member/caregivers about treatment options, community resources, insurance benefits, etc Engage member to complete health and psychosocial assessment, taking into account the cultural and linguistic needs of each member Assess, develop, implement, document, coordinate, monitor, manage, evaluate and update comprehensive individualized care plans (ICP) designed to provide evidence based care to meet member needs Employ ongoing assessment and documentation to evaluate member response to and progress on the ICP Identify and manage barriers to achievement of care plan goals Identify and implement effective interventions based on clinical standards and best practices Collaborate with members of an inter-disciplinary care team (ICT) to identify member needs and opportunities that would benefit from care coordination to achieve goals and maximize member outcomes Act as a liaison to collaborate with facility based case managers, provider and care transition/ discharge planners to plan for post-discharge care needs or facilitate transition to an appropriate level of care in a timely and cost-effective manner Coordinate with community-based case managers, service providers and community resource agencies to ensure coordination and avoid duplication of services Appropriately terminate care coordination services based upon established case closure guidelines Provide clinical oversight and direction to unlicensed team members as appropriate General: Perform daily work with a focus on the core principles of managed care: patient education, wellness and prevention programs, early screening and intervention, continuity of care Work proactively to expedite the care process Identify priorities and necessary processes to triage and deliver work Empower members to manage and improve their health, wellness, safety, adaptation, and self-care Assess and interpret member needs and identify appropriate, cost-effective solutions Identify and remediate gaps or delays in care/ service Advocate for treatment plans that are appropriate and cost-effective Work with low-income/ vulnerable populations to ensure access to care and address unmet needs Gather and evaluate clinical information to assess and expedite referrals within the healthcare system including consideration of alternate levels of care and service Facilitate timely and appropriate care and effective discharge planning Work collaboratively across the health care spectrum to improve quality of care Leverage experience/ expertise to observe performance and suggest improvement initiatives Ensure understanding of industry standard competencies and performance metrics to optimize decisions and clinical outcomes Ensure individual and team performance meets or exceeds the performance competencies and metrics Contribute actively and effectively to team discussions Share knowledge and expertise, willingly and collaborativel Provide outstanding customer service, internally and externally Follow and maintain compliance with regulatory agency requirements

CVS Health

Transition of Care, Licensed Vocational Nurse (California Licensed)

Posted on:

September 13, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

California

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

Help us elevate our member care to a whole new level! Join our Aetna Team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members, who are enrolled in Care Management and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs. Join us in this exciting opportunity as we grow and expand our Care Management Programs to change lives in new markets across the country.

REQUIRED QUALIFICATIONS: 2 years Nursing experience Licensed Vocational Nurse in the state of California Demonstrated knowledge and experience using Microsoft Office (Word, Outlook, Teams, and Excel) PREFERRED SKILLS: 3 years nursing experience Self-motivated, energetic, detail-oriented, highly organized, tech-savvy Licensed Practical Nurses Discharge planning Advanced proficiency in Microsoft Word, Excel, and Outlook Associate's Degree and/or Bachelor's Degree EDUCATION: High School Diploma or equivalent GED, Licensed Vocational Nurse

The Transition of Care Coach is responsible for care coordination of our members who are experiencing a significant change in health status which has resulted in the necessity of an emergency department visit, inpatient, skilled nursing, or rehabilitative stay. Under the direction of a Registered/Licensed RN, the TOC Coach ensures the member experiences a seamless transition to their next care setting and facilitates post-discharge goal attainment by: Complete post-discharge questionnaire, which may be market specific. Ensures the member has filled/received their medication(s) and has an understanding on how to take their ordered medications. Benefit education Monitor members in low CM level for alerts or changes in condition to be transitioned back to RN. Complete post discharge call and required assessments (RAP), medication reconciliation (if within scope of practice), fall assessment if fall risk identified. Complete inpatient confinement calls and monitoring for discharge Management of warm transfers form concierge and engagement hub Provides clinical assistance to determine appropriate services and supports due to member’s health needs (including but not limited to: Coordination with PCP and Specialty providers, Condition Management information and education, Medication management, Community Resources and supports) Evaluation of health and social indicators Identifies and engages barriers to achieving optimal member health. Uses discretion to apply strategies to reduce member risk. Facilitates overall care coordination with the care team to ensure member achieves optimal wellness within the confines of the member’s condition(s) and abilities to self-manage. Coordinates post-discharge meal delivery, assists with securing DME, and helps to ensure timely physician follow-up. Understands Payer/Plan benefits, policies, procedures, and can articulate them effectively to providers, members, and other key personnel. Our TOC Coaches are frontline advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and eligibility status. Focus assessments and/or questionnaires are designed to use a holistic approach to identify the need for a referral to clinical resistance in functionality. Additional responsibilities to include but not limited to the following: Responsible for completing outreach cadence calls and post-discharge questionnaires within required compliance driven timelines.- Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department Utilization and 30-day hospital readmissions. Follows members identified as inpatient in hospitals (whether planned or unplanned admission) and then throughout the subsequent care continuum until member can return to prior level of functioning in the community. Facilitates Interdisciplinary Care Team Meetings with Social Services, Care Management, PCP and other key players to discuss service needs and support safe transitions.

Monogram Health

Remote Pulmonary Nurse Practitioner

Posted on:

September 13, 2025

Job Type:

Full-Time

Role Type:

License:

NP/APP

State License:

Tennessee

Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders. Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home.

The Monogram Pulmonary Nurse Practitioner or Physician Assistant will be responsible for the delivery of personalized compassionate medical care to patients primarily with COPD and other pulmonary conditions. The Pulmonary APP will be responsible for caring for patients, maintaining accurate and current patient records and scheduling, and administering follow-up appointments to patients as required. The successful candidate will work as a team with our physician specialists, field-based nurses, community health workers, and physicians and assist in delivering premium care to every patient. Primary duties include patient health assessment, creating strategies to improve or manage a patient health for pulmonary conditions, and introduce habits for health promotion. He/she may also conduct physical exams, order tests, prescribe medications, and serve as a coordinator with the patient's primary healthcare provider and their specialists.

Active and unrestricted Registered Nurse and Nurse Practitioner license or Physician Assistant License Up to 10% travel required Board certified by ANCC or AANP. Current and unrestricted DEA certificate. Ability to work without direct supervision and practice autonomously. Must be proficient with medical instruments and equipment required by the work. Knowledge of computer-based data management programs and information systems, as well as medical records and point-of-interview technology. Ability to communicate effectively, in verbal and written form, with retail and medical partners at various levels, patients, family members, physicians and representatives of the community. Sound understanding of all federal and state regulations including HIPAA and OSHA. Minimum of 2 years of experience as an NP working in an inpatient or outpatient pulmonology setting, required (please no new graduates). Strong background in patient assessment, diagnosis, treatment, and management of pulmonology diseases. Excellent communication skills, works well in a team environment, and is adaptable.

Work with COPD patients to ensure medication compliance, monitoring dietary and lifestyle changes, regular follow ups and care coordination. Deliver evidence-based, timely care in a manner that reduces avoidable hospitalizations, maximizes quality of life, and puts patient health and satisfaction first. Work collaboratively with the Pulmonologist and staff to provide high quality, patient centered care. Work closely with pulmonology team, other specialist teams, and clinical care teams. Conducts assessments on patients both in the patients' home and in the virtual environment. Counsels and educates patients and families about benefits and programs available to help them live healthier lives. Documents items such as: appropriate chief complaint, all applicable diagnosis, past medical, family, and social history, review of systems, examinations, medications, allergies, assessment, and plan. Completes all documentation and paperwork in a timely manner. Maintains quality of care standards as defined by the practice. This position will not be office-based but will be remote in state in which employed and will need to attend periodic training/meetings outside of that state. Prescribe medications, order tests, and collaborate with patient’s Monogram pulmonologist and physician. Perform effectively, as reflected by improved patient quality outcomes, which will be measured and reported daily. Assists patients with enrolling to access educational videos. Participates in the integrated care team meetings. Knowledge of disease diagnosis and prevention. Make assessment of patient's health status. Develop treatment plan. Implement a plan consistent with appropriate plan of care. Follow-up and evaluate patient's status. Other duties as assigned.

OneHome

SNF Utilization Management RN - Compact Rqd

Posted on:

September 13, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients’ homes. OneHome’s patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family.

The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Required Qualifications: ​Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action. MUST have Compact License Greater than one year of clinical experience in a RN role in acute care setting with preference for specialty areas such as critical care, emergency room, trauma units, etc. Comprehensive knowledge of Microsoft Word, Outlook and Excel Ability to work independently under general instructions and with a team Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualification: Education: BSN or Bachelor's degree in a related field Three or more years of clinical experience in an acute care setting with preference for specialty areas such as critical care, emergency room, trauma units, etc. Experience as an MDS Coordinator or discharge planner in an acute care setting Previous experience in utilization management/utilization review for a health plan or acute care setting Compact license PLUS a single state RN Licensure in any of the following non-compact states: California, Hawaii, Nevada, Oregon Health Plan experience Previous Medicare/Medicaid Experience a plus Call center or triage experience Bilingual is a plus Additional Information: Scheduled Weekly Hours: 40 Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Work-At-Home Requirements Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance is 25mbs download x 10mbs upload is required. Check your internet speed at www.speedtest.net A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Humana

RN, Care Manager, Telephonic Nurse

Posted on:

September 13, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Illinois

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

Humana Gold Plus Integrated is seeking a RN, Care Manager, Telephonic Nurse 2 who will assess and evaluate member’s needs with emphasis on discharge planning on preventing rehospitalization, monitoring, and managing chronic conditions effectively, in a telephonic environment. This position supports members in addressing their health care needs by helping them access appropriate services, skills, and support needed to achieve optimal health and life functioning independence in the community. The RN, Care Manager, Telephonic Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Required Qualifications: Applicants are required to live in the state of Illinois. An active, unrestricted Registered Nurse (RN) license in the state of Illinois. Three (3) or more years of clinical experience as a RN with demonstrated expertise in educating patients/members on the management of chronic health conditions. Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook. Intermediate to advanced computer skills and experience with Microsoft Word, Outlook, and Excel. Knowledge of community health and social service agencies and additional community resources. Exceptional oral and written communication. Preferred Qualifications: Bachelor's degree in nursing (BSN). Case Management Certification (CCM). Managed Care experience. Certified Diabetes Educator. Certified Asthma Educator. Additional Information: Workstyle: This is remote position. Travel: Occasionally to onsite team engagement meetings in Humana’s Schaumburg, IL office. Work Schedule: Monday - Friday; 8:00 AM - 5:00 PM Central Standard Time (CST). Language Assessment Statement: Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. WAH Internet Statement: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Strengthens care management activities and supports improving members well-being, reducing unnecessary healthcare costs and enhancing healthcare delivery. Assesses, monitors, and evaluates members’ chronic condition as well as provide and document meaningful interventions and outcomes. Provides episodic care coordination focusing on education and support to enhance lifestyle modifications and self-management techniques. Collaborate with Care Coordinators and other identified care team members as needed along with utilization management (UM) staff, physicians and providers as necessary and arrange services necessary to address the member’s condition and current needs. May contribute to interdisciplinary care planning and meetings. Meet requirements for contractual and regulatory compliance. Makes decisions regarding your own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Follows established guidelines/procedures. Other duties as required.

LanceSoft, Inc.

Clinical Review Nurse

Posted on:

September 13, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Virginia

Established in 2000, LanceSoft is a pioneer in delivering top-notch Global Workforce Solutions and IT Services to a diverse clientele. As a Certified MBE and Woman-Owned organization, we pride ourselves on fostering global cross-cultural connections that advance both the careers of our employees and the success of our clients' businesses. At LanceSoft, our mission is clear: to leverage our global network to seamlessly connect businesses with the right talent and individuals with the right opportunities, all without bias. We believe in providing Global Workforce Solutions with a personalized, human touch. Our comprehensive range of services spans various domains, encompassing temporary and permanent staffing, Statement of Work (SOW) arrangements, payrolling, Recruitment Process Outsourcing (RPO), application design and development, program/project management, and engineering solutions. Currently, our team of over 5,000 professionals caters to 110+ enterprise clients worldwide, including Fortune companies. Our client base represents a diverse spectrum of industries, including Banking & Financial Services, Semiconductor/VLSI, Technology, Healthcare & Life Sciences, Government, Telecom & Media, Retail & Distribution, Oil & Gas, and Energy & Utilities. Headquartered in Herndon, VA, LanceSoft operates 32+ regional offices across the North America, Europe, Asia, and Australia. We also have nine delivery centers strategically located in India in Bangalore, Indore, Noida, Baroda, Hyderabad, Bhubaneshwar, Dehradun, Goa, and Aligarh to further enhance our client service capabilities.

Title: Clinical Review Nurse Duration: 3+ months Schedule: After training & onboarding (about 6 weeks) the schedule 2 temps will be Sunday-Thursday and 2 will be Tuesday-Saturday 8am to 5pm PST Pay Rate: $43.06/hr. On W2 (All Inclusive) Location: 100% Remote Must be located: AZ, FL, GA, ID, IA, KY, MI, NE, NY, OH, TX, UT, WA, WI, NV. General Information Job Description: Must align with Client Healthcare competencies. Able to complete and maintain a daily productivity rate of 15 authorizations a day for concurrent review or 20 authorizations a day for prior authorization. Highly organized. Strong clinical assessment skills. Excellent attention to detail, critical thinking, and effective communication skills in this fast-paced, multidisciplinary setting. Ensures appropriate care delivery, meeting compliance standards, and facilitating collaboration between healthcare providers. Unrestricted Registered Nurse licensure within Nevada upon hire or within 90 days of starting. Summary: Works with the Utilization Management team, primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Client Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures, providing prior authorizations and/or concurrent review. Assesses services for Client Members to ensure optimum outcomes, cost effectiveness, and compliance with all state and federal regulations and guidelines.

Will require dual monitors & a docking station. After training & onboarding (about 6 weeks), the schedule: 2 temps will be Sunday–Thursday 2 temps will be Tuesday–Saturday, 8am to 5pm PST Knowledge / Skills / Abilities: Demonstrated ability to communicate, problem solve, and work effectively with people. Excellent organizational skills with the ability to manage multiple priorities. Work independently and handle multiple projects simultaneously. Knowledge of applicable state and federal regulations. In-depth knowledge of Interqual and other references for length of stay and medical necessity determinations. Experience with NCQA. Ability to take initiative and see tasks to completion. Computer literate (Microsoft Office Products). Excellent verbal and written communication skills. Ability to abide by Client’s policies. Ability to maintain attendance to support required quality and quantity of work. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers, and customers. Required Education: Completion of an accredited Registered Nursing program. (A combination of experience and education will be considered in lieu of Registered Nursing degree). Required Experience: Minimum 0–2 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management. Required Licensure / Certification: Active, unrestricted State Nursing RN license in good standing.

Provides concurrent review and prior authorizations (as needed) according to Client policy for Client members as part of the Utilization Management team. Identifies appropriate benefits, eligibility, and expected length of stay for members requesting treatments and/or procedures. Participates in interdepartmental integration and collaboration to enhance the continuity of care for Client members, including Behavioral Health and Long Term Care. Maintains department productivity and quality measures. Attends regular staff meetings. Assists with mentoring of new team members. Completes assigned work plan objectives and projects on a timely basis. Maintains professional relationships with provider community and internal and external customers. Conducts self in a professional manner at all times. Maintains cooperative and effective workplace relationships and adheres to company Code of Conduct. Consults with and refers cases to Client medical directors regularly, as necessary. Complies with required workplace safety standards.

Devoted Health

Emergency Medicine/Acute Care Nurse Practitioner

Posted on:

September 13, 2025

Job Type:

Full-Time

Role Type:

Primary Care

License:

NP/APP

State License:

Massachusetts

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 role is fully remote and must be located within one of the contiguous 50 states. You must be able and willing to work 4-10 hour shifts per week, including one weekend shift per month, with working hours from 11am-9pm EST. A bit about this role: This position is an amazing opportunity for a caring Nurse Practitioner (APRN) to help build and staff our growing telehealth medical group called Devoted Medical. Your primary focus will be delivering world class acute care to our members with emergent/critical illness. The Care OnDemand Nurse Practitioner will diagnose complex medical conditions, order and interpret diagnostic tests, and work with patients, families, and Care OnDemand team to establish care plans. One of Devoted Medical’s missions is to bring care to where our members live meaning your visits will be virtual telehealth care. On a day-to-day basis you will work closely with co-clinicians at Devoted Medical including physicians and APRNs as well as medical assistants, documentation experts, practice administrators, and our close social work and clinical nurse partners at Devoted Health Plan.

Required skills and experience: At least three years or more working as an APRN. Role licensure and certification in good standing is required and the ability to get licensed in requested states within 90 days of hire date. You will be required to get licensed in additional states as needed. RN and APRN licenses are active and in good standing. Active BLS certification. Must be willing to work four-10 hour shifts per week, including one weekend shift per month, with working hours from 11am-9pm EST. Desired skills and experience: Bilingual in Spanish/English a plus. Experience in primary care, internal medicine, urgent care, emergency room, and/or geriatrics. Experience performing visits over telehealth video platforms. Experience in managing acute/chronic disease exacerbations including CHF exacerbations, diabetic emergencies, COPD exacerbations and hypertensive emergencies. A strong desire to continue practicing acute care - you believe in the mission of bringing care to where the patient lives.

Performing Care OnDemand (acute care) visits including evaluating and diagnosing acute illnesses, ordering/interpreting diagnostic testing, establishing care plans including prescribing appropriate medications, and assessment for quality of care (STARS/HEDIS) interventions as well as social and home health/DME needs. Work closely with the member’s care team including their PCP, specialists, and other Devoted team members including pharmacy, clinical nursing, and social work as well as interfacing with family members and caregivers in order to coordinate care for the member and deliver a collaborative care plan. Utilize our home grown electronic health information system for visits while also providing feedback on how to improve the interface. In certain geographies, there will be a weekend on-call component to support our clinical nurses who triage calls from our members during the weekend. As our healthcare environment and service needs continue to evolve, this role may expand to include additional responsibilities such as supporting new clinical/organizational programs/initiatives and integrating innovative virtual care practices. We seek candidates who are adaptable, eager to learn, and comfortable working in a fast-paced, dynamic setting where change is constant. Flexibility in scope of practice and willingness to embrace new challenges are essential for success and professional growth in this role.

OneHome

Utilization Management Nurse - Home Solutions - Compact RN Required

Posted on:

September 13, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

OneHome coordinates a full range of post-acute care ranging from home health, infusion therapy and durable medical equipment services at patients’ homes. OneHome’s patient focused model creates one integrated point of accountability that coordinates with physicians, hospitals and health plans serving more than one million health plan members nationwide. OneHome was acquired by Humana in 2021 to advance value-based care. Our culture is inclusive, diverse, and above all, caring. It is important to us that our employees are engaged, supported and fairly treated. We offer a comprehensive benefits package to ensure the health and financial well-being of you and your family.

Full-Time, Remote Telephonic opportunity The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

The Utilization Management Nurse 2 helps to ensure fully coordinated care at home for our members. Success in this role requires the following: Must be passionate about contributing to an organization focused on continuously improving consumer experiences. Excellent organizational and time management skills Solid analytical skills to understand and interpret clinical information to make recommendations to improve patient outcomes. Technical savvy and ability to navigate multiple systems and screens while working cases. Collaboration skills to effectively interact with multiple parties both internal and external. An understanding of department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Ability to make decisions regarding your own work methods, occasionally in ambiguous situations, and with minimal direction receiving guidance where needed. Ability to follow established guidelines, processes, and procedures. Required Qualifications: Minimum of Associate Degree in nursing Licensed Registered Nurse (RN) in a compact state with no disciplinary action. Must have valid compact license or reside in a compact state and be eligible to upgrade to compact licensure. Three (3) or more years of progressive and varying clinical experience that includes direct patient care to geriatric population Effective telephonic and virtual communication skills• Comprehensive knowledge of Microsoft Word, Outlook and Excel Ability to work independently under general instructions and within a team. Preferred Qualifications: Bachelor’s degree Two (2) or more years of home health experience and/or utilization management experience Experience in a managed care setting Health Plan experience CGX experience Work-At-Home Requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance is 25mbs download x 10mbs upload is required. Check your internet speed at www.speedtest.net• A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information

As a Utilization Management RN working on the OneHome/Home Solutions UM Team, you will have the opportunity to use your clinical knowledge, communication skills, and independent critical thinking skills to ensure value-based care for members who desire to heal at home. In this role you will coordinate and communicate with providers, members, or other parties to facilitate optimal member care and treatment.

Mercy Health

Conduit Registered Nurse Triage Specialist

Posted on:

September 13, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Everyone who works with Mercy Health is united under one purpose: to help our patients be well in mind, body and spirit. This drive, along with our history of faith, is a powerful combination. It gives us a shared calling to work toward every day. Join our exceptional team and help us continue to provide the highest quality of health care possible to our communities.

​​The RN Triage Specialist provides telephonic triage to assist callers to determine the most appropriate level of care needed for the current situation expressed or assessed, following workflows and utilizing protocols/resources to provide supportive service to patients and customers. The RN Triage Specialist will maintain a performance standard that prioritizes safety, quality and experience and coincides with the organization's mission and identified key strategic or performance initiates. 3 Opportunities Available! Full time and Part time - ALL Shifts

Licensing/Certification: RN license required in applicable state(s). ​​Multistate/Compact RN Licensure​  preferred Education: ​​ADN or Diploma​  Nursing  required ​​BSN​  preferred: Work Experience 1 year of acute care nursing experience required. Triage experience preferred. Training EPIC Electronic Health Record (preferred) Working Conditions - Periods of high stress and fluctuating workloads may occur. General office environment. May have periods of constant interruptions. Required to car travel to off-site locations, occasionally in adverse weather conditions. Prolonged periods of working alone. Other:  Remote/ At Home work Environment Opportunity may be provided. This is dependent upon business needs and capability. Will require a signed agreement. Minimum internet speed of primary and secondary work locations is: download speed of 100Mpbs; upload speed of 20Mbps. Reference policy: Conduit Health Partners Work from Home.​ 

Provides telephonic triage or requested support and / or virtual monitoring. Offers subsequent recommendations, education or care advice using decision making tools, clinical judgement, and defined workflows. Participates in care coordination, by partnering with customers to reduce readmissions, enhance chronic disease management, manage health risk and injury reporting. Schedules provider appointments and facilitates provider communication. ​​Ensures accurate, timely documentation in the EMR (Electronic Medical Record) according to best practice, guidelines, or workflows. Participates in virtual monitoring and subsequent reporting and escalation to support services identified by customer. Provides additional support to Conduit Health Partners business functions as identified to ensure all patient needs are being met and continuity of Conduit Health Partners business operations is maintained.  Participates in process improvement, professional development, peer development and peer review This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation and appropriate within the scope of practice for the registered nurse.

TimeDoc Health

Remote Care Coordinator CMA/RMA, LPN, or RN ( PST/MST)

Posted on:

September 13, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Utah

Founded in 2015, TimeDoc Health is a leader in Virtual Care Management (VCM) for healthcare providers - one of the largest new markets in healthcare. We enable providers to deliver truly continuous, comprehensive care by helping them establish care management programs for patients with chronic and behavioral health conditions. Our solution combines a care management SaaS platform, remote patient monitoring devices, and digital care management services to provide the personal touch often missing in healthcare. Are you ready to have a huge impact on thousands of patients' lives? Apply now to get started!

You are a clinical professional with a track record of delivering high-quality patient care. You possess strong active listening and critical thinking skills that enable you to understand and respond with exactly what patients and providers need. You are an incredible communicator, collaborator, and succeed in delivering patient and provider value. You know exactly what it takes to deliver our solutions. You are passionate about delivering patient-centered care, and you like your work to make a difference. You thrive in a dynamic, fast-paced, team-oriented, and remote environment. The Role (In a Nutshell): As a care coordinator, you will work with chronically ill patients to provide comprehensive care coordination while uncovering and addressing barriers to care through innovative, holistic interventions. This role requires you to think creatively to help patients find resources that address their specific barriers, educate them about their conditions, and coordinate treatment plans with physician offices as needed This role requires a patient-focused individual who possesses a compassionate nature, general knowledge of healthcare practices, and is able to work virtually to deliver high-quality patient care coordination services. You must be comfortable handling a high call volume and meeting standard productivity goals as outlined by your leader.

Requirements: At least 1 year experience as a CMA/RMA, LPN, or RN, with an active accreditation/professional license required. Exceptional verbal and writing skills in English, including accurate spelling and grammar. Technology experience - preferably with multiple EMR/EHR systems, and familiarity with Microsoft Office, Google Suite products. Highly professional on the phone, with the ability to maintain a compassionate and engaging tone. Exceptional verbal skills - able to explain our services with confidence, speak clearly, confidently, and have a friendly phone demeanor. Highly self-motivated, organized, and able to work independently. Experience serving a geriatric population is a plus. Case management or care coordination experience is a plus. General Working Conditions: Able to work a 40-hour schedule (Monday through Friday). Must have a private home office that allows you to speak privately and maintain confidentiality with patients (no distractions or interruptions). Must have a second monitor, fast and reliable internet (50mbps or more). We will provide you with a company laptop and all necessary software to perform the role.

Conducting monthly CCM phone calls with patients, practices, pharmacies, etc. to ensure that your patients are getting what they need between office visits. Expect to spend 7-8 hours on the phone daily. Creating and/or revising personalized care plans for each patient you call, in coordination with the practices and providers you support. Identifying social determinants of health, gaps in care, and eligibility for assistance or other referral services for each of your patients. Collaborating with office staff, other community programs, and resources to address all of these effectively. Empowering patients to take charge of their own wellness and goals in the context of their care plan. Making approximately 30-50 phone calls daily to yield the 15 patient interactions necessary to complete 20 minutes of CCM service for the month. Maintaining your patients' privacy, confidentiality, and safety, and adhering to ethical, legal, and accreditation/regulatory standards at all times.

Insight Global

Telehealth Nurse

Posted on:

September 13, 2025

Job Type:

Contract

Role Type:

Telehealth

License:

RN

State License:

Georgia

Insight Global is an international professional services and staffing company specializing in delivering talent and technical solutions to Fortune 1000 companies across the IT, Non-IT, Healthcare, and Engineering industries. Fueled by staffing and talent experts, Evergreen, our professional services brand, brings technical advisors and culture consultants to help customers tackle their biggest challenges. With over 70 locations across North America, Europe, and Asia, and global staffing capabilities in 50+ countries, our teams of tech-enabled recruiters are dedicated to finding the right talent and technical solutions to help our customers thrive. At our core, we are dedicated to empowering people to do great things. That’s why we’re passionate about developing our people personally, professionally, and financially so they can be the light to the world around them. To find out more, visit www.insightglobal.com

We are seeking a dedicated and compassionate Telehealth Nurse to join our healthcare team. The ideal candidate will possess a strong commitment to providing exceptional patient care and will be well-versed in nursing practices, medical documentation, and patient management. This role requires a thorough understanding of anatomy and physiology, as well as adherence to HIPAA regulations to ensure the privacy and confidentiality of patient information. Shifts: Monday-Friday 8:00 am-4:30 pm EST 11:30 am-8:00 pm EST **This is currently a contract going through the end of December with possibilities to extend!**

Minimum of 2+ years’ experience working as a Registered Nurse including experience in telehealth or phone-based patient care Active Registered Nurse (RN) license Electronic Medical Record (EMR) experience Experience with handling high volume of medical phone calls Tech savvy, ability to quickly learn new technology platforms and tools including Slack and Google Suite Strong clinical judgment and the ability to work independently in assessing patient needs. Excellent communication skills with the ability to provide clear and focused patient education. Proven ability to manage and prioritize patient cases based on urgency while working effectively with diverse populations. Nice to have: Experience working with Athena EMR and Salesforce (or similar platforms) for documentation Bilingual in Spanish Women's health environment

Cadence

PRN Registered Nurse Coordinator

Posted on:

September 12, 2025

Job Type:

Full-Time

Role Type:

Primary Care

License:

RN

State License:

Compact / Multi-State

Cadence Health was built around a simple promise: patients always come first. Our technology-enabled remote care model pairs continuous health insights with a highly skilled clinical Care Team, empowering seniors to stay healthier, avoid complications, and live more independent, fulfilling lives, all without the limits of a traditional office visit. Your expertise is the heart of our system. Nurse practitioners, registered nurses, medical assistants, patient-success coordinators, and other frontline clinicians are the face and beating heart of Cadence. You’ll bring warmth, clinical precision, and the empathy that turns a virtual touchpoint into a human connection. Every chat, phone call, and care plan you deliver shapes how patients experience “what healthcare should be.” A modern toolkit to practice top-of-license care We’ve replaced reactive visits with real-time data, intelligent workflows, and seamless collaboration tools. That means you can spend less time on busywork and more time practicing at the top of your license, coaching patients, spotting risks early, and coordinating with physicians to keep care proactive and personal. Thriving in a fast-moving, mission-driven culture. Change excites us. Innovation fuels us. If you’re energized by technology, eager to re-imagine care delivery, and motivated to improve outcomes for both patients and the providers who serve them, you’ll feel at home here. We invest in continuous learning, clinical mentorship, and transparent growth paths so you can advance your skills while making a measurable impact every day. Join us in redefining healthy aging. If you’re passionate about compassionate care and ready to transform how seniors across the country manage chronic conditions, recover after hospitalization, and age with confidence, let’s talk. Together, we’ll build a future where exceptional care is consistent, connected, and just a call away.

In the U.S., 60% of adults – more than 133 million people – live with at least one chronic condition. These patients need frequent, proactive support to stay healthy, yet our care system isn’t built for that level of attention. With rising clinician shortages, strained infrastructure, and reactive care models, patients too often end up in the ER or the hospital when those outcomes could have been prevented. At Cadence, we’re building a better system. Our mission is to deliver proactive care to one million seniors by 2030. Our technology and clinical care team extend the reach of primary care providers and support patients every day at home. In partnership with leading health systems, Cadence consistently monitors tens of thousands of patients to improve outcomes, reduce costs, and help patients live longer, healthier lives. The Cadence Health team seeks a PRN Registered Nurse that will be responsible for appropriately monitoring and triaging patients based on vitals and alerts; supporting the management of patient treatment plans and medications in collaboration with Cadence NPs and the patient's Physician. The role of PRN staff is to provide relief when regularly scheduled staff take time off for scheduled vacation, sick leave, or CME. This will cover shifts during the day, nights, weekends, and holidays. SCHEDULE REQUIREMENTS: Minimum of 4 shifts a month (if needed), with priority for nights/weekends if offered. 2 holiday requirements per year. 2 nights per quarter or 1 weekend per quarter if offered.

RN compact multi-state license, at least 1 additional state license either in CA, MI, IL, or AK, and a willingness to expand state licensure if needed as Cadence adds new markets. 3+ years of experience treating patients with chronic conditions including CHF, Hypertension, and/ or Diabetes patients either in an outpatient or inpatient setting. Passion for the patient/customer experience and systematically improving healthcare with digital innovation. Independent thinker/operator (comfortable working in a less structured environment).

Respond to inbound patient clinical questions and escalations by phone (and/or text message). Follow standardized triage protocols for incoming calls and escalate appropriately (e.g. Schmitt - Thompson clinical telephonic triage guidelines). This can range from directing the patient to their clinic after-hours call line for non-urgent needs to sending the patient to the ER and/or dialing 911 for emergencies. Support clinical documentation for the patients’ Cadence care team (NP, RN, and Patient Success); including documenting patient case notes in the Cadence platform and logging tickets/follow-up tasks in ZenDesk (dedicated ZenDesk training provided). Follow up with patients with abnormal readings to gather more information on their clinical status and triage appropriately. Monitor patient vitals, symptoms, and labs to identify patients in need of clinical interventions and appropriate escalation. Clinical documentation on alert resolution/follow-ups in the Cadence platform. Additional administrative support as needed: Follow up with patients who need rescheduling, reach out to patients who have had lapses in taking their vitals, and other administrative work. Ensure every healthcare interaction with Cadence is an exceptional experience that prioritizes the well-being of the patient and aligns with the goals of our health system partners.

Actalent

Clinical Review Nurse - Concurrent Review REMOTE

Posted on:

September 12, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

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

The Clinical Review Nurse will perform concurrent reviews to assess the member's overall health, evaluate the type of care being delivered, and determine medical necessity. This role also involves contributing to discharge planning according to established care policies and guidelines. The position requires assisting in evaluating inpatient services to validate the necessity and setting of care. The nurse will be responsible for generating denial letters for concurrent reviews, but no member or provider outreach is required.

Work Environment: This is a 100% remote position The schedule is Tuesday to Saturday, 10 AM to 7 PM PST. Training will be conducted Monday to Friday, 6 AM to 3 PM PST, for a two-week course with no time off and mandatory camera use. The assignment duration is undetermined, with the possibility of extension or conversion to a full-time position. Holidays may be worked as needed with prior notice. MUST HAVE: Active RN License Required - TX or Compact License. 2-4 years of related experience with a minimum of 2 years in acute care. Strong time management and attention to detail. Ability to work independently and manage time effectively. Flexibility to adapt to volume shifts in specific areas. Clinical knowledge and ability to determine member's overall health and treatment needs. Knowledge of Medicare and Medicaid regulations preferred. Understanding of utilization management processes preferred. Proficient in clinical review, case management, and concurrent review.

Conduct concurrent reviews to determine the member's overall health. Review the type of care being delivered and assess medical necessity. Contribute to discharge planning according to care policies and guidelines. Assist in evaluating inpatient services to validate the necessity and setting of care. Generate denial letters for concurrent reviews. Work with software tools such as TruCare Classic, Excel, Outlook, Word, and OneNote.

Stormont Vail Health

Ambulatory Registered Nurse (Remote Triage) - Internal Medicine - FT - Day

Posted on:

September 12, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Kansas

Position Status: Full time Shift: First Shift (Days - Less than 12 hours per shift) (United States of America) Hours Per Week 40 Job Information Exemption Status: Non-Exempt A Brief Overview Provides professional nursing care for clinic patients following established standard and practices. The delivery of professional nursing care at Stormont Vail Health is guided by Jean Watson's Theory of Human Caring and the theory of Shared governance, both of which are congruent with the mission, vision, and values of the organization.

Education Qualifications: Bachelor's of Science in Nursing (BSN) Preferred Experience Qualifications: 1 year Nursing experience. Preferred Skills And Abilities Skill in applying and modifying the principles, methods and techniques of professional nursing to provide on-going patient care. (Required proficiency) Skill in establishing and maintaining effective working relationships with patients, medical staff and the public. (Required proficiency) Ability to maintain quality control standards. (Required proficiency) Ability to react calmly and effectively in emergency situations. (Required proficiency) Licenses and Certifications: Registered Nurse - KSBN Required Required for All Jobs: Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health Performs other duties as assigned Patient Facing Options Position is Not Patient Facing Remote Work Guidelines: Workspace is a quiet and distraction-free allowing the ability to comply with all security and privacy standards. Stable access to electricity and a minimum of 25mb upload and internet speed. Dedicate full attention to the job duties and communication with others during working hours. Adhere to break and attendance schedules agreed upon with supervisor. Abide by Stormont Vail’s Remote Worker Policy and will review and acknowledge the Remote Work Agreement annually.

Triage of all incoming phone calls by evaluating the physical and psychosocial health status of patients. Follows nursing protocols and guidelines for answering and directing calls. Record and reports patient’s condition and reaction to drugs and treatments to interdisciplinary team. Provide instruction to patients/family regarding treatment. Maintains and reviews patient records, charts, and other pertinent information. Oversee appointment bookings and ensure preferences are given to patients in emergency situations. Arranges for patient testing and admissions. Refill prescribed medications per standing orders. Clarify medication orders and refills to pharmacies as directed by providers. Perform medication prior authorizations as needed by providing needed clinical information to insurance. Maintain timely flow of patient to include scheduling of follow up appointments if needed. Working of in-basket medication refill requests for providers. Provide education to patient and family on medications, treatments and procedures. Record and report patient’s condition and reaction to drugs and treatments to interdisciplinary team, reviewing patient records and other pertinent information. Ensure patients receive appointments that align with triage disposition and that maintain timely flow of patients. Coordinate patient testing, referrals, and admissions Work collaboratively with on-site staff to provider coordinated patient care

Berkley Medical Management Solutions (a Berkley Company)

Workers Compensation - Telephonic Nurse Case Manager, California (Remote)

Posted on:

September 12, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

California

Berkley Medical Management Solutions (BMMS) provides a different kind of managed-care service for W.R. Berkley Corporation. We believe focusing on an injured worker’s successful and speedy return to work is good for people and good for Berkley’s insurance operating units. BMMS was first started in 2014 by reimagining the relationship between medical need and technology to deliver the best outcome for injured workers and Berkley’s operating units. Our goal was clear: combine solid clinical practices, proven return-to-work strategies and robust software into one system for seamless management of workers’ compensation cases. To get it right, we started with a flexible technology platform that allowed for impressive customization without sacrificing the ability for expansion and continued innovation. We deploy integrated systems to give W.R. Berkley Companies recommendations and professional services for managing each individual case in an efficient and appropriate manner. The power of our technology takes medical bill-review services and clinical advisory services to a new level. Our unique marriage of technology, software platforms, data analytics and professional services ensures we provide Berkley’s operating units with reliable results, and reduced time and expenses associated with case management.

As a Telephonic Nurse Case Manager, you will assess, plan, coordinate, monitor, evaluate and implement options and services to facilitate timely medical care and return to work outcomes of injured workers.

Minimum 2 years of experience in workers compensation insurance and medical case management preferred Minimum of 4 years medical/surgical clinical experience required Exhibit strong communication skills, professionalism, flexibility and adaptability Possess working knowledge of medical and vocational resources available to the Workers’ Compensation industry Demonstrate evidence of self-motivation and the ability to perform case management duties independently Demonstrate evidence of computer and technology skills Oral and written fluency in both Spanish and English a plus Education: Graduate of an accredited school of nursing and possess a current RN license. CA RN License RN compact license preferred, CCM preferred, Bachelor of Nursing preferred

Coordinate and implement medical case management to facilitate case closure Timely and comprehensive communication with with employers, adjusters and the injured workers. Assess appropriate utilization of medical treatment and services available through contact with physicians and other specialist to ensure cost effective quality care Review and analyze medical records and assess data to ensure appropriate case management process occurs while providing recommendations to achieve case progress and movement to closure Responsible for assigned caseloads, which may vary in numbers, territory and/or by state jurisdiction Acquire and maintain nursing licensure for all jurisdictions as business needs require Coordinate services to include home services, durable medical equipment, IMEs, admissions, discharges, and vocational services when appropriate and evaluate cost effectiveness and quality of services Document activities and case progress using appropriate methods and tools following best practices for quality improvement Reviewing job analysis/job description with all providers to coordinate and implement disability case management. This includes coordinating job analysis with employer to facilitate return to work. Engage and participate in special projects as assigned by case management leadership team Occasionally attend on site meetings and professional programs Foster a teamwork environment Maintaining and updating evidence based medical guidelines (such as Official Disability Guidelines, MD Guidelines and all required state regulated guidelines) in reference to the injured worker treatment plan and work status. Obtain and maintain applicable state certifications and/or licensures in the state where job duties are performed. Obtain case management professional certification (CCM) within 2 years of hire

CVS Health

Appeals Nurse Consultant

Posted on:

September 12, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Conneticut

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

Required Qualifications: Must have active and unrestricted RN licensure in state of residence 3+ years of clinical experience Excellent verbal and written communication skills. Strong organizational skills Preferred Qualifications: Appeals Experience Utilization Review Medicare Experience Education: Associate's Degree in Nursing required Bachelor's Degree preferred

The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare Part C appeals from both members and providers. This role is considered a production role and remains as part of the Nurse Appeal Consultant job code. Primary duties may include, but are not limited to: requesting clinical, research, extrapolating pertinent clinical, applying appropriate Medicare Guidelines, navigating through multiple computer system applications in a fast paced department. Must work independently as well as in a team environment while working remotely. The Medicare Clinical Appeals Team C Member/Non-Par Team operates 7 days per week, 365 days per year. This position requires some weekends and holidays on a scheduled rotation.

AdventHealth

Indeed Nursing Virtual Hiring Event AdventHealth Orlando

Posted on:

September 12, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Compact / Multi-State

Joining AdventHealth is about being part of something bigger. Its about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

AdventHealth Virtual Interview day October 8th, 2025 9am to 1pm Please join us for our upcoming RN virtual interview day with AdventHealth Orlando All the potential benefits and perks you need for you and your family: Benefits from Day One Paid Days Off from Day One Debt-free Education (Certifications and Degrees without out-of-pocket tuition expense) only for eligible roles Nursing Clinical Ladder Program eligible roles only Schedule: Full Time, Part Time, PRN Shift : Day Shift and Night Shift positions available 12 hours EVENT LOCATION : VIRTUAL INDEED We are hiring for the following departments ICU (all) PCU (all) M/S (all) NICU/PICU Surgical RN The positions we are hiring for are - Registered Nurse - Assistant Nurse Manager - Senior Nurse Manager

The expertise and experiences you'll need to succeed: Graduate of a school of nursing Current valid State of Florida or multistate license as a Registered Nurse Basic Life Support (BLS) Certification Advanced Life Support Certifications (ACLS, PALS, NRP) per specialty/unit requirements EKG Preferred Qualifications: Bachelor's degree in Nursing Professional Certification

Insight Global

Remote Clinical Documentation Specialist

Posted on:

September 12, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Georgia

Remote – must sit AK, CA, MT, OR, TX, or WA The Clinical Documentation Specialist (CDS) is responsible for supporting and facilitating the overall quality of medical record documentation by improving the completeness, accuracy, and reliability of clinical documentation. A key success factor of this process is educating providers through the query process and independently supporting them with education and feedback to accurately reflect the patient's true clinical picture within the medical record. In partnering with the coding team, the CDS will be an expert with ICD-10, NS-DRG and APR-DRG assignment. The CDS's primary responsibility will be to obtain appropriate clinical documentation through extensive review of provider, nursing, ancillary, and other patient caregivers' documentation, to ensure that appropriate documentation and reimbursement is received for the level of services rendered to patients. The CDS exercises their judgment and discretion to ensure the clinical information utilized in analyzing and reporting outcomes is complete and accurate. On an ongoing basis, the CDS is responsible for supporting the direction and focus of education for providers and the coding staff within their assigned scope of work. The CDS must exercise independent judgment, critical thinking, ability to work independently while interpreting and following CMS guidelines, organizational policies, and procedures.

Must Have: ASN, BSN preferred 5 years of experience as an RN in an acute care setting within the last 5 years OR 2-3 years of Clinical Documentation Integrity experience in an acute care setting Registered Nurse License required upon hire Plusses: 5 years of hospital experience in ICU, ED, or Med-Surg 1 year of MS-DRG and APR-DRG assignment experience and/or understanding and experience/understanding of the fundamentals of establishing a DRG 1 year of ICD-10 experience and/or understanding

The Clinical Documentation Specialist conducts thorough reviews of medical records to ensure accurate, complete, and compliant documentation that reflects the patient’s clinical status. They collaborate closely with providers, offering education and feedback through the query process, and partner with coding teams to support accurate ICD-10 and DRG assignment. The CDS also leads documentation improvement initiatives, builds dashboards, and reports, and independently manages provider education and performance insights to enhance clinical and financial outcomes.

US Tech Solutions

Licensed Vocational Nurse - LPN

Posted on:

September 12, 2025

Job Type:

Contract

Role Type:

Utilization Review

License:

LPN/LVN

State License:

New Jersey

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com.

The UM Nurse Associate I is responsible for reviewing and completing criteria-based prior authorizations in compliance with company policies and procedures. This role provides after-hours nurse availability for urgent prior authorization requests, supports the PA team and member services, and refers cases requiring clinical review to the Pharmacist or MD team.

Experience: 1–3 years of related work experience (healthcare or call center preferred). Prior experience with utilization management or prior authorization processes preferred. Licensure: Active, unrestricted LPN/LVN license (screenshot of license must be included at the top of the resume). Education: High School Diploma or GED (required).

Answer inbound nurse queue calls promptly, including escalated calls. Serve as the final decision-maker for all prior authorization approvals. Refer cases not meeting clinical criteria to secondary review for final decision by a pharmacist. Work distributed case volumes and client exceptions. Maintain accurate, timely documentation of calls and clinical information obtained. Ensure proper processing, review, and maintenance of all PA paperwork. Participate in ongoing training and development sessions. Maintain and update desk reference materials. Train and mentor PA team representatives as needed. Execute other assignments as directed by the PA supervisor or manager.

Impresiv Health

Utilization Management RN (Part-Time)

Posted on:

September 12, 2025

Job Type:

Part-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges. Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it. That’s Impresiv!

Schedule: part-time hours, every Saturday and Sunday 10 hour shifts OR Friday, Saturday, and Sunday 6 hour shifts Description: We are seeking a detail-oriented and collaborative Utilization Management RN to join a high-performing team. The ideal candidate brings strong clinical judgment and experience with concurrent and preservice review. This role offers the opportunity to contribute to process improvements and support the successful transition to Zyter/TruCare, a new utilization management platform.

Active, unrestricted Registered Nurse (RN) license (compact or Maine preferred). Minimum of 3 years of UM experience, including inpatient concurrent and preservice review. Familiarity with MCG or InterQual criteria and UM protocols. Experience with Zyter/TruCare preferred; Essette experience a plus. Strong attention to detail, time management, and collaboration skills in a remote work setting.

Conduct concurrent, preservice, and occasional post-service reviews for medical necessity and coverage using MCG or InterQual. Evaluate services across inpatient, outpatient, SNF, and pharmacy (e.g., specialty infusion). Ensure timely documentation and compliance with state-specific turnaround time (TAT) standards. Accurately document determinations in Zyter/TruCare and contribute to ongoing workflow refinement. Work closely with medical directors, care managers, and other team members to coordinate care.

Educated Solutions Corp

RN Review Analyst

Posted on:

September 12, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Michigan

Educated Solutions Corp. (ESC) is a recruitment firm, offering contract for hire and direct placement services, specializing in placing individuals in careers that match their experience, education and compensation levels. If you are an employer looking for recruiting assistance or a job seeker looking to apply for new opportunities ESC is for you. We take a different approach than many of our competitors as we work closely with job seekers to rework resumes, provide interview coaching and preparation and find jobs that meet career goals and monetary desires. Our services for job seekers are completely free of charge. Employers can expect personalized service at affordable prices. We provide both Direct Placement and Contract services in all industries. Our virtual office model, promotes the lowest overhead possible, enabling us to beat our competitors in the pricing game. As our staffing professionals are experts in recruiting, we are able to locate and qualify professionals in any skill set, price range and location. Our Operating Principles and business reputation demonstrates our willingness to work within our clients'​ budgets, while providing thoroughly screened, well-prepared talent. ESC is a Certified Woman-Owned Business Enterprise (WBE)

ESC has an exciting opportunity for an RN Review Analyst to work fully remotely and perform prospective, concurrent, and retrospective review of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity, appropriate length of stay, intensity of service and level of care, including appeal requests initiated by providers, facilities and members. The Review Analyst may establish care plans and coordinate care through the health care continuum including member outreach assessments.

Required Experience: Bachelor’s degree in nursing, allied health, business, or related field preferred. Two (2) to four (4) years of clinical experience which may include acute patient care, discharge planning, case management, and utilization review, etc. Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes. One (1) year health insurance plan experience or managed care environment preferred. Registered Nurse with current unrestricted Michigan Registered Nurse license required. Additional Requirements: InterQual / MCG or Utilization Review experience Microsoft Office experience Experience with multiple monitors / screen usage Time Management: Preferred Skills/Experience Ability to work independently in remote environment Education/Certifications: Associates or Bachelors in Nursing Active unrestricted Registered Nurse License

NPHire

Work-From-Home NP – Telehealth/Flexible Consults | Flat-Fee + Bonus Incentives

Posted on:

September 12, 2025

Job Type:

Contract

Role Type:

Telehealth

License:

NP/APP

State License:

Texas

Want to build your telehealth career in wellness-focused care with full flexibility? 🌟 An innovative wellness group is seeking Nurse Practitioners to provide non-prescriptive, CBD-focused consultations through a remote telehealth platform. This role is perfect for providers who are passionate about patient education, holistic care, and lifestyle medicine.

Active NP license in Texas (FNP preferred) Strong communication and patient education skills Interest in holistic wellness and CBD care Telehealth experience a plus (not required) New graduates welcome 🎓

Conduct remote wellness consultations with patients exploring CBD options Educate clients on safety, best practices, and product selection Provide guidance tailored to lifestyle and health goals Document visits and support patients through personalized care plans

Humata Health

Utilization Management RN - Payer Operations

Posted on:

September 12, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Florida

Solving Prior Authorization on Both Sides of the Fax Machine: Humata is revolutionizing Prior Authorization and Utilization Management with cutting-edge AI and automation. Our commitment is to deliver a seamless, efficient, and automated workflow for healthcare providers and payers. At Humata, we transcend traditional automation, addressing the complexities of prior authorizations with a powerful blend of AI, automation, and unparalleled payer connectivity. This transformative approach revolutionizes the entire end-to-end experience, setting a new standard for the prior authorization and utilization management process. Humata's mission for providers and payers is to make 90% of PA touchless, enable processing to be completed in <2 minutes when human intervention is required, and bring complete transparency for patients throughout the process.

Humata Health Inc. is seeking a Clinical Nurse to join our team and work at the intersection of healthcare and AI technology. In this role, you will collaborate with clients composed of health plan utilization review nurses and internal teams to ensure that our AI systems accurately support medical necessity decisions and prior authorization reviews. A key part of the workflow involves digitizing medical policies so that AI can interpret and apply them consistently — but the larger mission is to leverage clinical expertise to make prior authorization faster, smarter, and more reliable. This position also requires project management skills to coordinate policy digitization efforts, track progress across multiple health plans, and manage timelines and deliverables with cross-functional teams. Location: Remote, US or Hybrid - Orlando, Florida, US

Registered Nurse (RN) with an active license. 3+ years of experience in utilization management, prior authorization, case management, or related clinical roles. Strong understanding of payer policies, medical necessity criteria, and the prior authorization process. Working knowledge of medical coding systems (ICD-10, CPT, HCPCS). Comfort working with technology platforms; interest or experience in AI, clinical decision support, or health tech is a plus. Demonstrated project management skills — ability to organize complex workflows, manage deliverables, and ensure accountability across teams. Excellent critical thinking and problem-solving skills. Strong communication and collaboration abilities across clinical and technical teams. Preferred Skills: Certification in medical coding (e.g., CPC, CCS, CCA, or equivalent). Experience reviewing or implementing medical policies in a payer or managed care setting. Familiarity with health informatics, evidence-based guideline development, or digital clinical tools. Background in leading cross-functional projects or initiatives (formal project management certification is a plus). Experience working with AI, automation tools, or clinical decision support systems. Ability to work in a fast-paced, innovative environment and contribute to process improvement.

Partner with health plan utilization review nurses to validate and improve AI-driven prior authorization workflows. Review and structure medical policies to enable AI-powered automation of utilization review decisions. Apply clinical judgment to ensure that AI outputs align with evidence-based guidelines, payer standards, and medical coding practices. Participate in product review cycles by providing feedback on usability, accuracy, and workflow alignment. Guide product teams by translating clinical and utilization review needs into actionable product requirements. Collaborate with product and engineering teams to refine how clinical decision points are represented in AI models. Test, validate, and continuously improve AI-enabled review tools for accuracy and fairness. Provide feedback to enhance both policy digitization workflows and AI-driven decision support. Manage small-scale projects, including organizing digitization initiatives, tracking timelines, coordinating stakeholders, and reporting on progress. Stay current on payer requirements, clinical guidelines, regulatory standards, and coding updates relevant to utilization management.

Western Governors University

Family Nurse Practitioner

Posted on:

September 12, 2025

Job Type:

Part-Time

Role Type:

Primary Care

License:

NP/APP

State License:

Utah

WGU, www.wgu.edu, is an online university for the 21st century. We are driven by a mission to expand access to higher education through online, competency-based degree programs. Since its establishment in 1997, WGU has grown into a national university, serving more than 120,000 students from all 50 states. The university continues to open doors for adult learners who need flexibility to achieve their education and career goals. WGU’s innovative competency-based academic approach makes it possible, allowing individuals to fit their education into their lives, not the other way around. WGU was founded by the governors of 19 U.S. states. WGU is also supported by over 20 major corporations and foundations who believe in WGU’s commitment to producing highly competent graduates.

Western Governors University is looking for individuals to participate in an upcoming Beta testing project for our Master of Science in Nursing – Family Nurse Practitioner program. Beta testing is the final stage of development for our assessments. It is an opportunity for us to see how well our items will perform before we deliver them to our students. Our Psychometric team collects the data after the project is complete, for analysis. From there they can determine an appropriate cut score for the assessment. Project Information: Beta must be fully completed within one week during December–January (exact dates TBD) You must complete all the items. Approximately 11 hours to complete. You can stop and start test as needed during the testing period. Compensation is $715 for completing ALL items (no pay for partial completion). A W9 and Workday account with WGU must be completed to be compensated.

Graduate of accredited NP program Doctorate preferred but MSN is accepted At least 1 year experience as an NP Current unencumbered license as an NP Must live in the United States.

Partnership HealthPlan of California

Grievance and Appeals Nurse Specialist

Posted on:

September 12, 2025

Job Type:

Contract

Role Type:

License:

RN

State License:

California

Part of a multidisciplinary team, responsible for clinical oversight of assigned grievance and appeal cases. Utilizes clinical judgement in the assessment, solution, and/or guidance of cases to ensure members receive high quality healthcare services. Working closely with PHC Medical Directors, oversees assessments for medically necessary determinations, quality of care concerns, allegations of abuse, fraudulent acts or wasteful activity. Provides clinical leadership to Grievance & Appeals Case Analysts to ensure clinical solution followed on casework. Ensures casework complies with DHCS guidelines, NCQA standards, and PHC best practices. Works independently, prioritizes case deliverables, remains customer-focused and stays current on changes in the healthcare system that may trigger member dissatisfaction.

Education and Experience: Bachelor’s degree in Nursing, 3-5 years’ experience to include at least one year of case management experience and one (1) year in an acute care setting; or equivalent combination of education and experience. CCM desired. Knowledge of PHC Grievance & Appeals processes. General knowledge of managed care with emphasis in UM or CM preferred. Special Skills, Licenses and Certifications: Current California Registered Nurse license. Critical thinker. Organized. Thorough knowledge of utilization and case management programs an related criteria and protocols. Experience in managed care business practices and ability to access data information using computer systems. Ability to work within an interdisciplinary structure and function independently in a fast-paced environment while managing multiple Priorities And Meeting Deadlines. Strong Organizational Skills Required. Effective telephone and computer data entry skills required. Valid California driver’s license and proof of current automobile insurance compliant with PHC policy are required to operate a vehicle and travel for company business. Performance Based Competencies Excellent written and verbal communication skills with ability to read and interpret benefit contract specifications are required. Ability to apply clinical judgment to complex medical situations and make quick decisions in a fast-paced environment. Works well under pressure and maintains a professional composure when interacting with all stakeholders, including members. Work Environment And Physical Demands Daily use of telephone and computer for most of the day. Standard cubicle workstation or telecommute eligible. When required, ability to move, carry or lift objects weighing up to 25 lbs. All HealthPlan employees are expected to: Provide the highest possible level of service to clients; Promote teamwork and cooperative effort among employees; Maintain safe practices; and Abide by the HealthPlan’s policies and procedures, as they may from time to time be

Assesses all cases to determine if members have any emergent or immediate medical needs. Identifies potential quality of care, fraud, waste, and abuse issues. Takes appropriate actions. Executes independent clinical judgement in assessing members concern, care and treatment. Evaluates and solves for any deviations in the standard of care, regulations, policy and procedures relevant to assigned cases. Conducts comprehensive clinical assessments as they relate to a member’s physical, psychosocial, environmental, safety, developmental, cultural and linguistic needs. Takes appropriate actions. In coordination with the Grievance & Appeal Case Analyst, may contact members as it directly relates to their immediate clinical concerns. May refer to Care Coordination for continued/ongoing case management. Assesses and formally classifies disputed benefits according to NCQA pre-service and post-service classifications. Provides guidance to determine if/which medical records are needed to thoroughly evaluate the substance of on grievance and appeal cases. Evaluates all received medical records and writes clinical summary of observations in preparation of MD Director’s review. Medical records average 30-500 pages per case. Works closely with Grievance & Appeal Case Analyst, ensuring clinical content of resolution letters reflect clinical accuracy and medical terms are written in layman language Responsible for end-to-end investigation of exempt grievances. Works closely with PHC Medical Directors to identify and address concerns related to quality of care, HIPAA violations, fraud, waste, or abuse activity. Documents all casework activity thoroughly, accurately, timely, and ethically. Manages assigned cases so they are completed within DHCS timeframes, according to G&A Desktop procedures, and/or as directed by management. Serves as a clinical resource to the Grievance & Appeals team Identifies systematic or recurring issues that create barriers to high quality healthcare and reports them to leadership. Can work in a team environment Effective communicator in all modes of communication (e.g., written, verbal) May serve as a backup to absent Grievance & Appeals Nurse Specialists Attends meetings as needed including but not limited to Clinical Case Forum meetings, Department Meetings, and Division Meetings Maintains a Registered Nurse licensure in good standing Other duties as assigned.

Banyan Treatment Centers

Telehealth Nurse Practitioner (PMHNP or FNP)

Posted on:

September 12, 2025

Job Type:

Part-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Texas

Exciting Opportunity with Banyan Treatment Centers – Telehealth Nurse Practitioner (PMHNP or FNP) Banyan Treatment Centers is seeking a reliable and experienced Nurse Practitioner (PMHNP preferred, FNP accepted) to join our Telehealth Medication Maintenance team. This role is ideal for Nurse Practitioners who bring strong clinical judgment in psychiatric and substance use treatment, thrive in independent and organized practice, are tech-savvy and adaptable to virtual care workflows, and are passionate about expanding access to behavioral healthcare Position Details: Reports to: Medical Director Schedule: Per-diem Patient Load: 20+ patients per day Consult Duration: 10–15 minutes per patient Location: Remote (location agnostic); Must hold active CA, CO, AK, IL, PA, MA, and/orTX ARNP license

Required Qualifications: Active and unrestricted ARNP license in the state of CA, CO, AK, IL, PA, MA, and/or TX Certification as a PMHNP (preferred) or FNP Minimum of 1 year experience as an FNP or PMHNP Ability to manage a fast-paced telehealth caseload Private, secure work environment with high-speed internet Preferred Qualifications: Licensed in two or more of the following states: CA, CO, AK, IL, PA, MA, TX Experience with behavioral health, addiction medicine, or telehealth Familiarity with KIPU and telemedicine platforms

Conduct brief, structured telehealth follow-ups for patients on medication-assisted treatment plans. Assess progress, adjust medications, and ensure continuity of care. Accurately document all patient encounters and follow established treatment protocols. Collaborate with a multidisciplinary team to support holistic patient recovery. Maintain compliance with all clinical and regulatory guidelines.

IMCS Group

UM Review Nurse -Inpatient

Posted on:

September 12, 2025

Job Type:

Contract

Role Type:

Utilization Review

License:

RN

State License:

Ohio

IMCS Group is an IT, Healthcare, and Professional Staffing Company that helps Enterprises optimize the business value of their Staffing investments and enables them to achieve world-class business performance. IMCS Group supports strategic and operational aspects of IT implementations to help businesses implement growth strategies and leverage technology to achieve competitive advantage. In addition, IMCS provides hospitals and medical facilities with high-quality clinical professionals with the highest standards and compliance to provide the best medical care. At IMCS Group, quality and efficiency are of paramount importance. Our consistent growth, many successful customer engagements, and high customer retention are the hallmarks of our success. In addition, our passion for taking complex business processes and simplifying them by applying the right technology has been the key to our success. At all times, IMCS ensures the highest standards of quality in providing resources, time, and material to design, implement, and support to keep organizations operating efficiently.

**Only Local Candidate from Ohio will be accept** Job Title: Clinical Review Nurse - Concurrent Review Duration: 6 months Contract Desired Start Date/End Date: 10/21/2025 - 4/21/2026 Location: Remote- Ohio Shift Type: Monday through Friday, 8 AM - 5 PM, no weekends, holidays or overtime. Payrate: 40-42 $ /hr

Must Have: Inpatient Hospital experience UM Concurrent Review Ability to work in a remote environment Nice to haves: Experience in Microsoft teams, outlook, and excel. Education/Certification: Required: Associates Preferred: Bachelors Licensure: Required: Ohio LPN Preferred: RN

The purpose of this team is to review inpatient hospital requests for inpatient level of care. We work in coordination with care management on discharge planning. 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. 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 There are a lot of unique situations and cases to learn about. We have weekly rounds for our inpatient admissions that stay over 10 days at the hospital to focus on discharge planning and needs with our Case Management team. Performance indicators: 1.2 reviews per hour minimum.

Sentara Health

Integrated Nurse Case Manager/Integrated Nurse Case Manager/RN/Maternity/OBGYN

Posted on:

September 12, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

In addition to providing excellent quality care, we are committed to helping prevent illness and empowering individuals to manage their health. Sentara invests in technology, focuses on the future, and provides hundreds of millions of dollars in community benefits and uncompensated patient care. Our success is the result of a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth.

Sentara Health Plans is hiring an Integrated Nurse Case Manager/RN/Maternity/OBGYN for Lynchburg and the surrounding areas! This is a full-time, work-from-home position that requires travel to conduct face-to-face home visits for low and high risk pregnant population in Lynchburg and the surrounding areas! Status: Full-time, permanent position (40 hours) Standard working hours: 8am to 5pm EST, M-F Location: Applicants must be reside in Lynchburg and the surrounding areas!

Education: Associate or Bachelors Degree in Nursing REQUIRED Certification/Licensure: Registered Nurse (RN) License (Compact or Virginia) REQUIRED Experience: 3 years experience in Nursing REQUIRED Case Management experience preferred Managed Care or Health Plan experience preferred Experience working with low and high risk pregnant population/Maternity/OB/L&D/Mother Baby/Postpartum experience preferred Strong knowledge of physical, psychological, socio-cultural, and cognitive patient needs. Excellent communication skills, both oral and written, as well as strong problem-solving and analytical

Responsible for case management services within the scope of licensure; develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum Performs telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical and behavioral health, social services and long-term services Identifies members for high-risk complications and coordinates care in conjunction with the member and health care team Manages chronic illnesses, co-morbidities, and/or disabilities ensuring cost effective and efficient utilization of health benefits; conducts gap in care management for quality programs Assists with the implementation of member care plans by facilitating authorizations/referrals within benefits structure or extra-contractual arrangements, as permissible Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on care management treatment plans Presents cases at case conferences for multidisciplinary focus. Ensures compliance with regulatory, accrediting and company policies and procedures May assist in problem solving with provider, claims or service issues.

CVS Health

Case Manager – Registered Nurse – Field – Southwest Michigan

Posted on:

September 12, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Michigan

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. Our Mission Our Field Case Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for 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.

Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members' health care and social determinant needs. Join us in this exciting opportunity as we grow and expand dually eligible members to change lives in new markets across the country. Help us elevate our patient care to a whole new level!

Remote Work Expectations: This a remote role with 25-50% travel required, candidates must have a dedicated workspace free of interruptions. Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted. Required Qualifications: 3+ years clinical practical experience as an Registered Nurse (RN) Candidate must have active and unrestricted Michigan Registered Nurse (RN) licensure Candidate must be willing and able to travel up to 25%- 50% of the time in Barry, Van Buren, Kalamazoo, Calhoun, Branch, St Joseph, Cass, and Berrien Counties (Reliable transportation required - Mileage is reimbursed per our company expense reimbursement policy) Ability to work independently Effective computer skills including navigating multiple systems and keyboarding Demonstrates proficiency with standard corporate software applications, including Microsoft Word, Excel, Outlook, and PowerPoint Preferred Qualifications: 2+ years of experience in case management, discharge planning and/or home health care coordination experience Behavioral health experience Bilingual in Spanish or Arabic Certified Case Manager Additional national professional certification (CRC, CDMS, CRRN, COHN) Excellent analytical and problem-solving skills Effective communications, organizational, and interpersonal skills Educational: Associate's Degree in Nursing (REQUIRED) Bachelor's Degree in Nursing (PREFERRED)

Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member's overall wellness. Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits. Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning. Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality. Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members. Collaborates with supervisor and other key stakeholders in the member's healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences. 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 conversation.

Spakinect

*Part-Time* Aesthetic Telehealth Nurse Practitioner

Posted on:

September 12, 2025

Job Type:

Part-Time

Role Type:

Telehealth

License:

NP/APP

State License:

California

Not only will you experience significant cost savings, but our process infrastructure and tools guarantee an efficient and thorough good faith evaluation. We understand every client has different needs and expectations, and Spakinect works hard to meet or exceed them all. With our virtual GFE service currently offered across the country, it's never been easier to receive quality service and patient care at the click of a button. With Spakinect, Never Turn a Patient Away™!

This is a remote position. *This role is for a remote PART-TIME position with an anticipated start date as early as October 13th, 2025* Are you an Aesthetic Nurse Practitioner seeking a new and exciting growth opportunity in a remote environment? Spakinect is a successful and growing business in the Aesthetic Telehealth arena. With hundreds of clients located in Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Virginia, Washington, Washington D.C., Wisconsin, and Wyoming, we have grown to a point where it would truly benefit the company to bring on another part-time Aesthetic Nurse Practitioner. We are looking for a provider with multiple state licensures and candidates must have weekday and weekend availability between the hours of 10am-6pm PST. The part-time role requires a minimum of 12 hours of availability weekly and a weekend requirement of a minimum of 2 Saturdays/month. Any additional weekly availability is a plus! To be considered for this opening, you must be licensed at MINIMUM in California and Texas. Applicants may be considered if CA and TX licenses are in application status in addition to having previous aesthetic experience. The starting base rate for this position is $62/hour, however candidates with additional desirable licensure may be eligible to receive a higher starting rate. What you will do at Spakinect: The Aesthetic Telehealth Provider conducts live, interactive Good Faith Evaluations (GFEs) for medical spas and clinics with patients seeking aesthetic treatments throughout the United States from the comfort of their home office. This fast-paced and dynamic position requires excellent communication skills, efficiency, adaptability, independent clinical decision making, and the ability to provide impeccable customer service. The Aesthetic Telehealth Provider maintains a positive, figure-it-out attitude, and is proficient with technology. Spakinect medical providers embrace teamwork and seek collaboration with their colleagues to deliver safe, evidenced-based, high-quality care.

Education and/or Experience Master's degree from an accredited college/university or equivalent with related experience in the aesthetic industry. Aesthetic Industry Experience In-depth knowledge of aesthetic medicine and treatments offered by industry. Knowledge of legal regulations and best practices in healthcare. Up to date with ever-changing standards in telehealth and aesthetic administration. Licensing: Minimum licensure requirements for hire are active licenses in California and Texas. Preferred licensure for hire are active medical licenses in good-standing in additional states of operation. Aesthetic Telehealth Provider candidates must be willing and able to acquire additional licensure in requested states of operation. Availability: Must have weekday and weekend availability between the hours of 10am-6pm PST. Must be able to provide a minimum of 12 hours of weekly availability and be willing to work a minimum of 2 Saturday shifts per month. Additional weekly availability is a plus!

Deliver thorough, efficient, and exceptional healthcare by reviewing health histories, screening for any contraindications to treatment, and providing treatment plan recommendations for desired aesthetic treatments. Displays superior customer service by addressing client and patient care concerns, answering clinical questions, and providing medical guidance as necessary. Demonstrates behavior that is kind, compassionate, polite, friendly, and respectful towards patients, clients, and co-workers. Effectively communicates with office staff regarding any administrative issues that arise in a timely manner; demonstrates accountability. Documents electronically using an Electronic Health Record (EHR) system to submit completed GFEs in real-time. Exhibits the ability to troubleshoot basic technical problems to resolve any potential issues, reaches out appropriately for further assistance when needed. Adheres to company guidelines and policies, completes all required training, attends continuing education opportunities for growth and development. Improves productivity and efficiency by developing and implementing standards and processes. Fosters and embraces best care practices. Demonstrates Spakinect’s company core values and mission. Performs other duties as assigned.

Humana

Utilization Management Nurse Lead

Posted on:

September 12, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Michigan

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

The Utilization Management Nurse Lead uses clinical knowledge, communication skills, and independent critical thinking skills to interpret criteria, policies, and procedures that provide the best and most appropriate treatment, care, or services for Enrollees. The Utilization Management Nurse Lead coordinates and communicates with Providers, Enrollees, or other parties to facilitate optimal care and help drive quality outcomes for Humana's dual eligible members.

Required Qualifications: Must reside in or be willing to relocate to the state of Michigan. An active, unrestricted registered nurse (RN) license in the state of Michigan. Bachelor’s degree in nursing, health services, healthcare administration, business administration or a related field. Minimum five (5) years of clinical experience in utilization management. Minimum two (2) years of direct or indirect leadership experience. Knowledge of Medicare regulatory requirements and National Committee for Quality Assurance (NCQA) standards. Comprehensive knowledge of Microsoft Office applications including PowerPoint, Word, Excel, and Outlook. Preferred Qualifications: Master’s degree nursing, health services, healthcare administration, business administration or a related field. Knowledge of Medicaid regulatory requirements. Experience with contracting, audit, risk management, or compliance. Additional Information Workstyle: This is a remote position. Travel: Up to 25% travel to Michigan Department of Health and Human Services (MDHSS), locations across Michigan, including participation in team engagement meetings and conferences both within and outside the state. Direct Reports: Up to 5 associates. WAH Internet Statement To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Serves as a liaison between Humana utilization management (UM) operations and the State of Michigan regarding prior authorization reviews, prepayment retrospective reviews, and any additional utilization management functions. Coordinates with Humana’s Clinical Leadership teams to ensure utilization reviews comply with Centers for Medicare & Medicaid Services (CMS) regulations as well as Michigan Dual Special Needs Plan (DSNP) Contract terms. Works in conjunction with the Quality Improvement Director to develop quantifiable metrics that can track and evaluate the results of the targeted interventions designed to reduce health disparities and address health inequities. Manages Michigan state reporting and collaborate with the UM operations teams to aggregate and analyze data and reporting metrics. Provides quality oversight to support the supervision and daily guidance of prior authorization associates ensuring outcomes that meet or exceed Humana and the Michigan Department of Health and Human Services (MDHHS) standards. Works in conjunction with Humana’s Medicare UM Committees to ensure adoption and consistent application of appropriate medical necessity criteria. Participates in oversight of the programs to ensure that Enrollees are accessing and utilizing services in an appropriate manner in accordance with all applicable rule and regulations. In conjunction with Humana’s UM monitoring and oversight processes, monitors, analyzes, Michigan DSNP specific outcomes and initiates action to implement appropriate interventions based on utilization data, including but not limited to: identifying and correcting over- or under-utilization of services; addressing issues with timeliness standards; ensuring appropriate Notice of Action is followed; appropriate collaboration with Medical Directors to ensure reason for denial, reduction, or termination is specific and clear. Ensures development and implementation of departmental policies and procedures in accordance with contract changes or updates. Provides oversight to ensure Humana maintains compliance with MDHHS, National Committee for Quality Assurance (NCQA), Department of Health and Human Services (DHHS), CMS guidelines and contractual requirements.

Aptive Resources

Registered Nurse Risk Manager

Posted on:

September 11, 2025

Job Type:

Full-Time

Role Type:

License:

None Required

State License:

Virginia

Aptive partners with federal agencies to achieve their missions through improved performance, streamlined operations and enhanced service delivery. Based in Alexandria, Virginia, we support more than a dozen agencies including Veterans Affairs, Transportation, Defense, Homeland Security and the National Science Foundation. ​ We specialize in applying technology, creativity and human-centered services to optimize mission delivery and improve experiences for millions of people who count on government services every day. ​ Founded: 2012 Employees: 300+ nationwide

Aptive is seeking a registered nurse risk manager. IHSC's mission is to provide medical care to maintain the health of individuals in the custody of ICE through an integrated health care delivery system, based on nationally recognized correctional, detention and residential health care standards. The Agency is committed to providing healthcare services to protect the nation's health, reduce global disease and provide medical support for the law enforcement mission of the safe apprehension, enforcement and removal of detained individuals involved in immigration proceedings. IHSC is committed to ensuring a system of care that is ethical, responsible, and accountable through rigorous surveillance and monitoring activities. The ICE Health Services Corps (IHSC) exists within the organizational structure of the United States Immigration and Customs Enforcement (ICE), Enforcement and Removal Operations (ERO) under the supervision of the Department of Homeland Security (DHS). The United States Public Health Service (USPHS) Commissioned Corps Officers, civil service staff and contractors comprise the healthcare professionals working together to provide quality healthcare services. IHSC serves as the medical experts for ICE for detainee health care.

Minimum Qualification: Bachelor's degree in Nursing or related field Minimum five years of professional experience as a licensed registered nurse/in health administration Certification in Healthcare Quality or Risk Management or able to obtain certification within one year of employment. Ability to navigate in an electronic work environment including electronic health records, web based training and communications. Knowledge of, and moderate proficiency in, common Microsoft Office programs, specifically Microsoft Word, Excel, Outlook and SharePoint. Knowledge of regulations (HIPAA/Privacy Act) regarding the confidentiality of patient medical records and information as well as Personally Identifiable Information (PII). Ability to interact well and collaborate with all levels of personnel and management in IHSC,ERO, ICE and DHS offices, and with federal GS employees, Commissioned Corps officers and contractors. Required to walk unaided at a normal pace for up to 10 minutes and maintain balance. Must be able to lift, push, or carry 30 pounds.Must perform the duties in a stressful and often austere environment without physical limitations. Desired Qualifications: Advanced degree from a recognized accredited institution Verbal and written proficiency in Spanish Experience in a detention/correctional or residential healthcare setting

Enforce risk management program initiatives, and enact the changes in clinical practice,policy and procedures to preserve the agency’s assets, reputation and quality of care. Provide policy guidance, consultation and review of sentinel events. Develop, review and revise policies and guides related to risk management annually, or as necessary to reduce mitigating risks to the agency. Monitoring and training on the incident reporting electronic tool. Participate in the development of risk management activities, e.g. root cause analysis (RCA) of incidents that occurred in the facilities and provide proactive risk reduction strategies. Collect data, monitor trends and report results to the Compliance and Risk Management Program Manager and/or Chief, Medical Quality Management. Ensure established standards of care are monitored in ICE facilities as well as in contract detention facilities and jails throughout the United States. Maintain accountability and monitoring of risk management activities and assist in identifying areas for improvement.

CommonSpirit Health

Utilization Review RN

Posted on:

September 11, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Washington

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings.

This will be a remote position. Responsible for the review of medical records for appropriate admission status and continued hospitalization. Works in collaboration with the attending physician, consultants, second level physician reviewer and the Care Coordination staff utilizing evidence-based guidelines and critical thinking. Collaborates with the Concurrent Denial RNs to determine the root cause of denials and implement denial prevention strategies. Collaborates with Patient Access to establish and verify the correct payer source for patient stays and documents the interactions. Obtains inpatient authorization or provides clinical guidance to Payer Communications staff to support communication with the insurance providers to obtain admission and continued stay authorizations as required within the market.

Required: Graduate of an accredited school of nursing Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience. Preferred: Bachelors Degree in Nursing (BSN) or related healthcare field. At least five (5) years of nursing experience. Required Licensure and Certifications: Required: ● Current licensure as a Registered Nurse in the state of Washington. Preferred ● Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred BLS required within 3 months of hiring if located within hospital

Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on established criteria and critical thinking. Reviews include admission, concurrent and post discharge for appropriate status determination. Ensures compliance with principles of utilization review, hospital policies and external regulatory agencies, Peer Review Organization (PRO), Joint Commission, and payer defined criteria for eligibility. Reviews the records for the presence of accurate patient status orders and addresses deficiencies with providers. Ensures timely communication and follow up with physicians, payers, Care Coordinators and other stakeholders regarding review outcomes. Collaborates with facility RN Care Coordinators to ensure progression of care. Engages the second level physician reviewer, internal or external, as indicated to support the appropriate status. Communicates the need for proper notifications and education in alignment with status changes. Engages with Denials RN/Revenue cycle vendor to discuss opportunities for denials prevention. Coordinates Peer to Peer between hospital provider and insurance provider, when appropriate. Establishes and documents a working DRG on each assigned patient at the time of initial review as directed. Demonstrates behavior that aligns with the Mission and Core Values of the Organization. Responsible for completing required education within established timeframes. Adheres to all hospital policies, standards of practice and Federal or State regulations pertaining to their practice. Participates regularly in performance improvement teams and programs as necessary. Demonstrates behavior that aligns with the Mission and Core Values of the Organization. Responsible for completing required education within established timeframes. Adheres to all hospital policies, standards of practice and Federal or State regulations pertaining to their practice.

NPHire

Work-From-Home Nurse Practitioner (Acute Care | New Grads Welcome | High $)

Posted on:

September 11, 2025

Job Type:

Contract

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

A respected telehealth group is expanding its nationwide team of Nurse Practitioners to meet rising patient demand. This role is ideal for NPs who want flexibility, independence, and opportunities to practice across multiple states.

Active, unrestricted NP license (multi-state licenses preferred) FNP or ANP certification required New graduates welcome 🎉 Strong assessment skills & independent decision-making Telehealth experience a plus (not required)

Provide telehealth care via real-time video and asynchronous platforms Focus on acute care needs (ear infections, sinus infections, urgent visits) Serve patients nationwide with a growing digital-first practice

Sentara Health

Clinical Documentation Specialist RN

Posted on:

September 11, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

The Sentara CDI Team is expanding! This summer we will implement Aware CDI by Iodine. We are seeking to expand our team with a Clinical Documentation Specialist RN, with 3 years+ CDI experience. Iodine experience is a plus! The Clinical Documentation Improvement Specialist (CDS) is a highly knowledgeable RN who is responsible for concurrent review of provider in-patient medical record documentation. Reviews include reviewing records, with identified opportunities. Remote Eligible candidates must be residents of the following approved states: Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Nebraska, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, Wyoming

Education: RN Associate Level Degree or Bachelors of Nursing Degree RN- Diploma Certification/Licensure: RN Nursing License Compact or Multi-state RN License Experience: Five (5) years Acute Care experience in Medical Surgical or ICU Prefer recent CDI experience, 3+ years Microsoft Office Strong Communication Skills

Responsible for facilitation of modifications to clinical documentation through concurrent interaction with providers, and other members of the healthcare team, to ensure that appropriate clinical severity of illness and risk of mortality is captured for the level of service rendered. The CDS is responsible for communicating to providers to ensure timely and accurate documentation and then utilizing specific software, to code the documentation utilizing ICD-10 codes. Additionally, the CDS provides education and training as needed with the medical staff. The CDS utilizes coding and clinical expertise to identify opportunities and ensure the accuracy and completeness of clinical documentation in the medical record used for measuring and reporting physician/provider hospital outcome.

Spakinect

*Part-Time* Aesthetic Telehealth Nurse Practitioner

Posted on:

September 11, 2025

Job Type:

Part-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

Not only will you experience significant cost savings, but our process infrastructure and tools guarantee an efficient and thorough good faith evaluation. We understand every client has different needs and expectations, and Spakinect works hard to meet or exceed them all. With our virtual GFE service currently offered across the country, it's never been easier to receive quality service and patient care at the click of a button.

This is a remote position. *This role is for a remote PART-TIME position with an anticipated start date as early as October 13th, 2025* Are you an Aesthetic Nurse Practitioner seeking a new and exciting growth opportunity in a remote environment? Spakinect is a successful and growing business in the Aesthetic Telehealth arena. With hundreds of clients located in Arizona, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Kansas, Kentucky, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Tennessee, Texas, Utah, Virginia, Washington, Washington D.C., Wisconsin, and Wyoming, we have grown to a point where it would truly benefit the company to bring on another part-time Aesthetic Nurse Practitioner. We are looking for a provider with multiple state licensures and candidates must have weekday and weekend availability between the hours of 10am-6pm PST. The part-time role requires a minimum of 12 hours of availability weekly and a weekend requirement of a minimum of 2 Saturdays/month. Any additional weekly availability is a plus! To be considered for this opening, you must be licensed at MINIMUM in California and Texas. Applicants may be considered if CA and TX licenses are in application status in addition to having previous aesthetic experience. The starting base rate for this position is $62/hour, however candidates with additional desirable licensure may be eligible to receive a higher starting rate.

Education and/or Experience: Master's degree from an accredited college/university or equivalent with related experience in the aesthetic industry. Aesthetic Industry Experience: In-depth knowledge of aesthetic medicine and treatments offered by industry. Knowledge of legal regulations and best practices in healthcare. Up to date with ever-changing standards in telehealth and aesthetic administration. Licensing: Minimum licensure requirements for hire are active licenses in California and Texas. Preferred licensure for hire are active medical licenses in good-standing in additional states of operation. Aesthetic Telehealth Provider candidates must be willing and able to acquire additional licensure in requested states of operation. Availability: Must have weekday and weekend availability between the hours of 10am-6pm PST. Must be able to provide a minimum of 12 hours of weekly availability and be willing to work a minimum of 2 Saturday shifts per month. Additional weekly availability is a plus!

The Aesthetic Telehealth Provider conducts live, interactive Good Faith Evaluations (GFEs) for medical spas and clinics with patients seeking aesthetic treatments throughout the United States from the comfort of their home office. This fast-paced and dynamic position requires excellent communication skills, efficiency, adaptability, independent clinical decision making, and the ability to provide impeccable customer service. The Aesthetic Telehealth Provider maintains a positive, figure-it-out attitude, and is proficient with technology. Spakinect medical providers embrace teamwork and seek collaboration with their colleagues to deliver safe, evidenced-based, high-quality care. Essential Duties and Responsibilities Deliver thorough, efficient, and exceptional healthcare by reviewing health histories, screening for any contraindications to treatment, and providing treatment plan recommendations for desired aesthetic treatments. Displays superior customer service by addressing client and patient care concerns, answering clinical questions, and providing medical guidance as necessary. Demonstrates behavior that is kind, compassionate, polite, friendly, and respectful towards patients, clients, and co-workers. Effectively communicates with office staff regarding any administrative issues that arise in a timely manner; demonstrates accountability. Documents electronically using an Electronic Health Record (EHR) system to submit completed GFEs in real-time. Exhibits the ability to troubleshoot basic technical problems to resolve any potential issues, reaches out appropriately for further assistance when needed. Adheres to company guidelines and policies, completes all required training, attends continuing education opportunities for growth and development. Improves productivity and efficiency by developing and implementing standards and processes. Fosters and embraces best care practices. Demonstrates Spakinect’s company core values and mission. Performs other duties as assigned.

21st Century Home Health Services

Readmission Prevention Coordinator (Registered Nurse)

Posted on:

September 11, 2025

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

At 21st Century Home Health Services (21HHS), we treat every patient with the same empathy, compassion, and understanding we would show our own family. With more than 600 employees, we are the largest home health agency in San Francisco and the fastest-growing in the Bay Area. Today, we care for more than 4,000 patients across San Francisco, San Mateo, Santa Clara, Santa Cruz, Alameda, Contra Costa, Solano, Napa, Yolo, Placer, El Dorado, and Sacramento counties—and we are actively expanding into Marin and Sonoma counties. Our clinicians are dedicated not only to the patients they serve, but also to one another. The results speak for themselves: hospital readmission rates at 21HHS consistently remain under 10%, compared to an industry average of over 15%. We’ve also set a new benchmark for employee satisfaction in home health. Recognized as a 2024 Top Workplace, 21HHS fosters an environment of support, growth, and recognition through open communication and professional development opportunities.

As our Readmission Prevention Coordinator (Registered Nurse), you’ll be at the heart of our mission to Educate, Enhance, Empower. Think of yourself as both detective and coach—you’ll dig into data, spot trends, and uncover the “why” behind hospital readmissions. Then, you’ll turn those insights into smart, practical strategies that keep our patients healthier and out of the hospital. Your work will include tracking patterns, brainstorming new approaches to care, and teaming up with clinicians to deliver recommendations that are grounded in evidence but easy to act on. You’ll also have the chance to reimagine care protocols, helping us improve outcomes, elevate patient experiences, and celebrate every win against readmission. This is a remote opportunity— all candidates must reside within California and have a valid CA RN license.

Bachelor’s degree in Nursing (Master’s degree preferred). Valid and current CA nursing license. Minimum of 3 years of clinical experience, with at least 1 year in a home health or similar setting. Demonstrated experience in analyzing patient care trends and providing data-driven care recommendations. Strong analytical and problem-solving skills with the ability to interpret complex datasets. Excellent communication and collaboration skills for working with multidisciplinary teams. Commitment to improving patient outcomes through proactive data analysis and protocol improvements.

Collect and analyze patient data, including readmission statistics, to identify trends, patterns, and risk factors. Categorize and record common themes based on data from patient care records, helpline interactions, and clinical outcomes. Develop and propose data-driven alternatives to existing care protocols to address identified risks and prevent readmissions. Suggest adjustments and interventions to care teams that align with findings from data analysis and patient trends. Work closely with nursing, physical therapy (PT), occupational therapy (OT), speech therapy (ST), home health aides (HHA), social workers (SW), and other healthcare professionals to gather insights from their care experiences. Provide feedback to clinical staff based on data analysis to help refine patient care strategies. Collaborate with clinical and educational leaders to ensure that training programs are aligned with current data findings on disease management, medication adherence, and patient care practices. Suggest improvements to training and education materials based on observed trends and gaps in care protocols. Continuously monitor and evaluate the effectiveness of readmission prevention initiatives, identifying areas where care improvements can be made. Use data visualization tools such as Pareto charts to clearly communicate common causes of readmissions and suggest targeted interventions. Assist in developing new protocols or refining existing ones based on data analysis, focusing on addressing common causes of readmission. Ensure that protocol changes are well-documented and communicated to the relevant teams to enhance care outcomes. Ensure that all actions and data collection processes comply with federal, state, and local regulations regarding home healthcare and patient privacy. Prepare and submit detailed reports on readmission rates, preventive measures, and care improvements to senior management and external partners, such as Kaiser, within 24 hours of discharge when required.

Cohere Health

Weekend RN Supervisor, Clinical Operations

Posted on:

September 11, 2025

Job Type:

Part-Time

Role Type:

Leadership / Management

License:

RN

State License:

Massachusetts

Cohere Health is a fast-growing clinical intelligence company that’s improving lives at scale by promoting the best patient-specific care options, using cutting-edge AI combined with deep clinical expertise. In only four years our solutions have been adopted by health plans covering over 15 million lives, while our revenues and company size have quadrupled. That growth combined with capital raises totaling $106M positions us extremely well for continued success. Our awards include: 2023 and 2024 BuiltIn Best Place to Work; Top 5 LinkedIn™ Startup; TripleTree iAward; multiple KLAS Research Points of Light awards, along with recognition on Fierce Healthcare's Fierce 15 and CB Insights' Digital Health 150 lists. The Coherenauts, as we call ourselves, who succeed here are empathetic teammates who are candid, kind, caring, and embody our core values and principals. We believe that diverse, inclusive teams make the most impactful work. Cohere is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone. We can’t wait to learn more about you and meet you at Cohere Health!

Cohere’s Service Operations team is responsible for ensuring that our healthcare partners are supported throughout their lifecycle of using the platform. The RN Supervisor, Clinical Operations position is a crucial role in our organization. In this role, you are responsible for coaching, mentoring, evaluating and developing the RN Reviewer team. The RN Supervisor will use established operational tools to ensure all RN staff are meeting or exceeding performance metrics and quality standards established by the leadership team. As an RN Supervisor, you will work closely with the leadership team at Cohere and report to the Director/Manager of Clinical Operations. You will be responsible for providing daily operational guidance to the RN Reviewers to allow them to meet or exceed operational objectives and metrics. You will leverage both your creative skills and communication skills to promote a high performing clinical team. The RN Supervisor will be highly organized in order to plan daily operational activities and provide oversight of the RN Reviewer team. You will use your professionalism, personality, and communication skills to inspire the team to meet or exceed all performance standards. At a growing organization, this is a position that offers the ability to make a substantive mark on the company and its partners with exponential growth opportunities.

Registered Nurse with an active and unencumbered license to practice 2-3 years of supervisory/management experience Knowledge of NCQA/CMS requirements Experience using MCG, CMS NCDs/LCDs, clinical criteria guidelines Prior Authorization or Utilization Management experience Excellent computer skills and familiarity with a Mac. Experience supervising and training in a remote work environment.

Oversee the weekend RN Reviewer team Establish a plan for the day and communicate to all staff daily Manage the daily timeliness report and ensure all cases meet expected turnaround times Monitor the nurse productivity reports daily and provide feedback to the nurses, managing performance to ensure consistency Lead weekly team meetings Capture process efficiency ideas from the team and work with the appropriate stakeholders to recommend and lead changes needed to improve nurse efficiency. Meet individually with all direct reports on bi-weekly cadence to develop solid work relationships with each team member and to share any performance feedback, positive and constructive. Working with the RN Reviewer Leads, track hourly nurse productivity, keeping the Director/Manager informed on productivity results as needed. Train and Develop new RNs who join the team. Oversee daily newsletter publication May be asked to help with other projects as needed. Weekly schedule will include Saturday and Sunday

Cohere Health

RN Supervisor, Clinical Operations

Posted on:

September 11, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Massachusetts

Cohere Health is a fast-growing clinical intelligence company that’s improving lives at scale by promoting the best patient-specific care options, using cutting-edge AI combined with deep clinical expertise. In only four years our solutions have been adopted by health plans covering over 15 million lives, while our revenues and company size have quadrupled. That growth combined with capital raises totaling $106M positions us extremely well for continued success. Our awards include: 2023 and 2024 BuiltIn Best Place to Work; Top 5 LinkedIn™ Startup; TripleTree iAward; multiple KLAS Research Points of Light awards, along with recognition on Fierce Healthcare's Fierce 15 and CB Insights' Digital Health 150 lists. The Coherenauts, as we call ourselves, who succeed here are empathetic teammates who are candid, kind, caring, and embody our core values and principals. We believe that diverse, inclusive teams make the most impactful work. Cohere is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone.

Cohere’s Service Operations team is responsible for ensuring that our healthcare partners are supported throughout their lifecycle of using the platform. The RN Supervisor, Clinical Operations position is a crucial role in our organization. In this role, you are responsible for coaching, mentoring, evaluating and developing the RN Reviewer team. The RN Supervisor will use established operational tools to ensure all RN staff are meeting or exceeding performance metrics and quality standards established by the leadership team. As an RN Supervisor, you will work closely with the leadership team at Cohere and report to the Director/Manager of Clinical Operations. You will be responsible for providing daily operational guidance to the RN Reviewers to allow them to meet or exceed operational objectives and metrics. You will leverage both your creative skills and communication skills to promote a high performing clinical team. The RN Supervisor will be highly organized in order to plan daily operational activities and provide oversight of the RN Reviewer team. You will use your professionalism, personality, and communication skills to inspire the team to meet or exceed all performance standards. At a growing organization, this is a position that offers the ability to make a substantive mark on the company and its partners with exponential growth opportunities.

Registered Nurse with an active and unencumbered license to practice 2-3 years of supervisory/management experience Knowledge of NCQA/CMS requirements Experience using MCG, CMS NCDs/LCDs, clinical criteria guidelines Prior Authorization or Utilization Management experience Excellent computer skills and familiarity with a Mac Experience supervising and training in a remote work environment The ability to cover evening shifts (up to 8pm EST)

Oversee the RN Reviewer team including one RN Team Lead Establish a plan for the day and communicate to all staff daily Manage the daily timeliness report and ensure all cases meet expected turnaround times Monitor the nurse productivity reports daily and provide feedback to the nurses, managing performance to ensure consistency Lead weekly team meetings Capture process efficiency ideas from the team and work with the appropriate stakeholders to recommend and lead changes needed to improve nurse efficiency Meet individually with all direct reports on bi-weekly cadence to develop solid work relationships with each team member and to share any performance feedback, positive and constructive Working with the RN Reviewer Leads, track hourly nurse productivity, keeping the Director/Manager informed on productivity results as needed Train and Develop new RNs who join the team Oversee daily newsletter publication May be asked to help with other projects as needed

Progyny, Inc.

Contact Center Manager - RN License

Posted on:

September 11, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

New York

Progyny (Nasdaq: PGNY) is a global leader in women’s health and family building solutions, trusted by the nation’s leading employers, health plans and benefit purchasers. We envision a world where everyone can realize dreams of family and ideal health. Our outcomes prove that comprehensive, inclusive and intentionally designed solutions simultaneously benefit employers, patients and physicians. Our benefits solution empowers patients with concierge support, coaching, education, and digital tools; provides access to a premier network of fertility and women's health specialists who use the latest science and technologies; drives optimal clinical outcomes; and reduces healthcare costs.  Our mission is to empower healthier, supported journeys through transformative fertility, family building and women’s health benefits.  Headquartered in New York City, Progyny has been recognized for its leadership and growth as a TIME100 Most Influential Company, CNBC Disruptor 50, Modern Healthcare's Best Places to Work in Healthcare, Forbes' Best Employers, Financial Times Fastest Growing Companies, Inc. 5000, Inc. Power Partners, and Crain's Fast 50 for NYC. For more information, visit www.progyny.com.

Progyny is looking for a Contact Center Manager who will be responsible for managing multiple supervisors, ensuring the achievement of service-level targets, operational efficiency, inventory management and overall customer satisfaction. This role involves planning, team development, and performance management.

5+ years of contact center experience, including 3+ years in a leadership role. Must hold a valid RN license, with Fertility or Labor and Delivery experience preferred Proven track record of improving customer service performance and efficiency Excellent communication and leadership skills Proven problem-solving and analytical skills Strong understanding of contact center technology, analytics, and metrics

Manage the day-to-day operations of the contact center, ensuring that all member impacting processes and procedures are optimized. This individual will be leading both Clinical and non-clinical team members Develop and implement strategies to improve productivity, member satisfaction, and operational efficiency Communicate a clear and consistent message regarding departmental goals and company policies to produce desired results Support training and development initiatives for all contact center agents Analyze contact center data and generate reports for senior management on performance metrics Work closely with other departments to enhance cross-functional processes and resolve customer-related issues Drive continuous improvement initiatives within the contact center Attend and serve as a liaison in Member Services impacting meetings and cross-functional collaborations