Thyme Care

Compliance Nurse

Posted on:

April 24, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Tennessee

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.

The Quality Assurance Nurse (QA) plays a vital role in upholding Thyme Care’s high-quality standards by conducting quality audits that evaluate nurse-member interactions (via telephone, text, and e-mail) against established quality standards, to ensure compliance, and support remediation plans as needed. This position reports to the Manager of Education and Enablement, and involves conducting quarterly call audits and documentation reviews, in addition to providing coaching and feedback sessions to each nurse team member. A summary of findings and audit scores are then provided to clinical leadership to confirm compliance, performance, and address any gaps affecting service delivery. Quarterly audits are conducted on all nurse team members with a focus on adherence to regulatory requirements, comprehensive assessments, effective goal setting, and member support in driving outcomes to meet established goals. Audit frequency is increased to weekly for new hires and nurse team members not meeting established quality scores. The Quality Assurance (QA) Nurse will also serve as a resource for clinical expertise, collaborate with clinical leadership and cross-functional teams to enhance services offerings, and support the implementation of best practices in oncology case management, care navigation, and population health. Although the primary focus of this role is auditing and coaching, this role will also provide support to the Education and Enablement Nurse team with developing and delivering training programs, advanced training, and ongoing education sessions as directed, to meet business needs. Our dedicated Care Team oncology nurses serve as advocates, navigators, and coordinators for individuals diagnosed with cancer, guiding them through the continuum of care. They conduct telephonic clinical assessments, assist members in managing symptoms, and provide continuous support from initial diagnosis through treatment and transitions of care.

Education: Bachelor of Science in Nursing (BSN) required; master’s degree in nursing or related field preferred. Licensure: Current RN license active, unrestricted, and in good standing. Experience: Minimum of 5 years of clinical nursing experience, with at least 2 years in a training or quality auditing role, or equivalent experience. Previous experience in Oncology as a Nurse Navigator, Case Manager, Disease Management. Skills: Proven track record of functioning in roles that focused on assuring high-quality care, strong leadership, communication, and organizational skills. Proficiency in auditing, providing feedback and coaching to nurses and/or other clinical team members, and developing or contributing to clinical onboarding and training programs Within your first three months, you will: Have completed training and are on the path to becoming an expert on our Thyme Care systems, tools, technology, partners, and expectations Know our Care Team policies and procedures, escalation pathways, communications best practices, and documentation standards backwards and forwards, and actively share ideas on how to improve them Have built strong, trusting relationships with Care Team nurses, where listening and empathy are the foundation for every interaction both with our members and with each other. Partner with QTE team and Nurse Team Leads to develop and deliver clinical onboarding and general training. Audit nurse-member interactions (via telephone recordings, text, email, etc.) against our quality standards to ensure they are consistently met, and support remediation plans as appropriate. Continually raise the bar in clinical quality and improve the standard of care through coaching and objective, effective feedback delivery. Identify and surface quality trends and training gaps, to enhance training and coaching delivery, in addition to reference materials of the Care Delivery team. Contribute to quality improvement initiatives and regulatory, quality, and experimental audits, as needed. Constantly be on the lookout to improve the effectiveness and quality of our work with our members. WHAT LEADS TO SUCCESS: People-first. Thyme Care’s mission and members matter to you, deeply. A BSN. You must have Bachelors of Science Degree in Nursing and an unrestricted Registered Nurse (RN) license and willingness to obtain additional state licenses, as needed. Experience. You have at least 5 years of nursing experience with 3 years of oncology nursing and/or case management. Additionally, you have experience with clinical education and regulatory/quality audits. An eye for quality. You are passionate about upholding and raising the bar in delivering high quality care and challenging the team to adhere to and improve the standard of care, to beat their best and never lose sight of the goal. 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 colleagues and articulate feedback effectively and objectively. 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 learning new technology is important.

Conducting routine and ongoing audits of telephonic nurse interactions with members, in addition to supporting documentation, to ensure accuracy, compliance, and value-added interactions that drive positive health outcomes. Create individualized feedback and coaching plans for new hires and nursing team members, based on audit findings. Conduct 1:1 feedback and coaching sessions with nurse team members to provide feedback, identify risks, training opportunities, and ensure adherence to operational policies and procedures. Support the creation and maintenance of clinical training materials, job aids, and other educational resources. Evaluate new hire training effectiveness, and provide PIP support, through audits of telephonic nurse interactions with members, in addition to supporting documentation, to ensure accuracy, compliance, and value-added interactions that drive positive health outcomes. Conduct/Support new hire training sessions as needed Conduct new hire ramp-up auditing and feedback sessions

Thyme Care

After-Hours Virtual Care Nurse Practitioner

Posted on:

April 24, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

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 an After Hours Virtual Care Nurse Practitioner, you will deliver care using Thyme Care’s platform, phone, or synchronous audio & video during nights and weekends. You’ll have the opportunity to support members with off-hours, time-sensitive needs by clinically assessing the urgency and severity of symptoms and directing the appropriate care through direct management, a recommendation for a next-day appointment, or a referral for an emergent in-person evaluation. This is a remote, part-time role. Compensation will include a $1000 weekly retainer plus $100 per hour for every hour in which a call begins.

You must possess the following required education and qualifications: F-NP/AG-NP, APRN-MSN, or D-NP degree from an accredited nursing school On-call availability to support during non-business hours, including weekdays from 8 PM to 8 AM ET, and all day on weekend days (Friday from 8 PM through Monday at 8 AM). (All times Eastern) Unrestricted compact RN and APN license to practice medicine in a majority of the following states: Alabama, Arizona, Arkansas, California, Colorado, District of Columbia, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Michigan, Mississippi, Missouri, Nevada, New Jersey, New Mexico, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia, Washington, Wisconsin 3+ years experience in oncology or emergency medicine/urgent care, with virtual care experience Spanish fluency is a plus but not required WHAT LEADS TO SUCCESS: People-first. Thyme Care’s mission and members matter deeply to you. Experience. You have at least 3 years of oncology or emergency medicine/urgent care experience, including interacting with patients with complex medical, behavioral health, and social needs. You have an unrestricted medical license and graduated from an accredited medical school. 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 when they need it most. Experience with video chatting, Google Suite, Slack, electronic health records, or comfort in 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 immediately address urgent and important needs.

Answering inbound clinical calls or texts, assessing clinical status, and triaging to the appropriate level of care Managing clinical care telephonically or via synchronous audio & video during non-business hours - arranged in 7 on/7 off shifts Using our Thyme Care & EHR (Elation) platforms to document appropriately, place orders, and schedule follow-up tasks Providing member-centered, trauma-informed, evidence-based medical care in alignment with Thyme Care Medical Group guidelines, practices, and policies Collaboration with Thyme Care RNs, non-clinical staff, and physicians

Thyme Care

Remote Oncology Nurse Navigator (2:30 - 11 PM EST Shift)

Posted on:

April 24, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

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 our members 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.

Thyme Care Inc., the management company to Thyme Care Medical PLLC, is the employing entity with your duties to be performed for Thyme Care Medical PLLC, a medical practice, and its patients. As a Thyme Care Oncology Nurse Navigator, you'll be a vital clinical resource for our members and their care network, offering triage, support, and education during their cancer journey via phone, email, and video communication. Under the guidance of our Nurse Team Lead, you'll conduct comprehensive clinical assessments, oversee member health, and facilitate end-of-life care discussions. Your main objective will involve actively engaging with members, addressing clinical issues, and efficiently managing any escalations that arise. The shift for this position is 2:30 - 11 PM EST (11:30 - 8 PM PST).

Member-Centric Approach: You prioritize the member experience and demonstrate a deep commitment to Thyme Care's mission. Action-Oriented: You proactively identify and prioritize initiatives, taking prompt action to address urgent needs. Organizational Skills: You excel at multitasking and thrive in fast-paced environments while maintaining meticulous organization in communications and documentation. Communication Skills: You are an effective listener and communicator, skilled at building rapport and fostering strong working relationships with members and colleagues. Adaptability: You are comfortable with change and ambiguity and have a proven track record of success in dynamic environments. Qualifications: A Bachelor of Science Degree in Nursing and a compact unrestricted registered nurse (RN) license are required. Compact + single state licensure in Alaska, New York, Illinois, Michigan, and/or California licensure is preferred. Additionally, you have at least 5 years of nursing experience, including 3 years in solid tumor oncology nursing. Certifications: Oncology-related certifications such as Oncology Certified Nurse (OCN), Advanced Oncology Certified Nurse (AOCN), Advanced Oncology Certified Nurse Specialist (AOCNS), or Certified Case Manager (CCM) are required or obtained within 2 years of hire.

Familiarize yourself with Thyme Care systems, tools, technology, and partners, conducting a minimum of 20 member calls per day. Collaborate closely with Nurse leaders and Medical Directors to ensure alignment with clinical protocols and best practices. Establish trusting relationships with members and their care network, prioritizing empathy and active listening in every interaction. Adhere to Care Team policies, procedures, and documentation standards, contributing to efficient operations and maintaining quality standards. Support members throughout the oncology care continuum, from screening to survivorship or end-of-life care, coordinating care and providing clinical support as needed. Identify and address member needs promptly, offering assistance with care coordination, symptom management, nutritional support, discharge planning, and provider referrals. Participate in case conferences to monitor member progress, provide updates, and collaborate on targeted support plans with the healthcare team. Foster strong partnerships with payers and providers to optimize care delivery and minimize readmissions. Collaborate with non-clinical Care Team members to address social determinants of health needs, such as food resources and transportation access. Be available for urgent clinical escalations and provide clinical consult support as required Performs other projects and duties as assigned and as related to department business needs and objectives.

Optum

RN Call Assist - Remote in WA State

Posted on:

April 24, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Washington

For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

Position in this function is under general supervision, the Staff RN/Consulting Nurse is responsible for providing telephone triage assessment to Primary Care patients by using state of the art telecommunications, information technology and approved protocols; to clients ensuring the efficient use of medical and nursing, facilities and equipment and to provide excellent customer service.

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

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

Virta Health

Continuity Clinician - Nurse Practitioner

Posted on:

April 24, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

NP/APP

State License:

Compact / Multi-State

Virta Health is on a mission to transform diabetes care and reverse the type 2 diabetes epidemic. Current treatment approaches aren’t working—over half of US adults have either type 2 diabetes or prediabetes. Virta is changing this by helping people reverse type 2 diabetes through innovations in technology, personalized nutrition, and virtual care delivery reinvented from the ground up. We have raised over $350 million from top-tier investors, and partner with the largest health plans, employers, and government organizations to help their employees and members restore their health and live diabetes-free. Join us on our mission to reverse diabetes and Obesity in 1 Billion people.

Virta is looking for dynamic and dedicated clinicians to join our core clinical team. Our clinicians offer a real solution to patients with diabetes, pre-diabetes, and weight management, one that dramatically improves health and decreases the need for medications. Our clinical systems have been built from the ground up by our clinician team, allowing us to keep patient care front and center with streamlined documentation and no “accountable clicking.” While our continuous remote care allows for flexibility, you are responsible for providing safe and timely care during office hours. We provide occurrence malpractice insurance.

Provide highest quality patient-centered care. Manage your panel of patients through continuous remote care. In this, you will collaborate with our team of expert health coaches and be supported by the rest of our clinicians, including our endocrinology team. Be proactive in ensuring adequate follow up of patients and their concerns. Share after-hours coverage with our team. All Virta care is delivered remotely, so there is no such thing as an “in-house” call. Our team rotates weeks of calls such that you would cover about 1 in 8 weeks Actively participate in the development of new technology and protocols to improve patient care and outcomes.

Unrestricted medical license Multiple state licenses are helpful, but only the willingness & ability to get additional licenses are required. Board certified in a relevant specialty (Internal Medicine, Family Medicine, and Endocrinology are preferred) 2 yrs experience and competence in diabetes management Outstanding bedside manner & patient service orientation Excellent organizational skills Deep interest in the science behind Virta, and commitment to Virta’s nutritional approach to diabetes reversal Telemedicine experience preferred

Virta Health

Nurse Coach

Posted on:

April 24, 2025

Job Type:

Full-Time

Role Type:

Coaching

License:

RN

State License:

Compact / Multi-State

Virta is an online specialty medical clinic that reverses type 2 diabetes and obesity safely and sustainably. Our innovations in the application of nutritional biochemistry, data science, and digital tools--combined with our clinical expertise--are shifting the metabolic health treatment paradigm from management to reversal. Virta has developed a novel, team-based care model that delivers the Virta treatment exclusively through a telemedicine platform, with no brick-and-mortar clinics. We’ve been reversing diabetes for the last seven years, we see patients in all 50 states, and we are expanding our reach to patients with pre-diabetes and obesity. To achieve that mission, Virta is hiring RNs experienced with weightloss/GLP1's to join our team. We are hiring for fully virtual, full time roles with set hours, although some shifts will include early morning, evening, and weekend hours.

Virta launched Responsible Prescribing for patients to assist them with their weight loss goals leveraging Virta’s well established approach to obesity reversal as well as GLP-1 agonist medications. We are looking for RNs who live in a nursing compact state to help our physicians and nurse practitioners with this service. The role requires experience with diabetes and obesity care and an innovator’s spirit, as this program is new, and we need problem solvers who are willing to help Virta build this program from the ground up. Some experience working in a non-traditional healthcare setting such as a health tech company or other innovative environment is essential to success in this role.

Minimum of two years experience working with diabetes or weight loss patients in a clinical setting Interest and knowledge of weight loss, diabetes care, diabetes education, diabetes prevention, and low carbohydrate nutrition. Training and experience with health coaching or motivational interviewing. Active RN license with at least three years of clinical experience working with patients with type 2 diabetes. CDE/CDCES licensure preferred but not required. At least one year of experience working with patients who are taking GLP-1 agonists. Active RN license in, and resident of, a Nursing Licensure Compact state. Associate or Bachelor's RN Nursing degree from an accredited school or university. Eligible to be licensed in every U.S. state. Interest and aptitude for working with a growth stage, tech-enabled healthcare organization. Occasional (2-3x/yr) travel to team and company events. An outstanding bedside manner: Patients trust you and feel supported and empowered by your presence on the phone/video and your communication. Team player: You work well with others, put your team first, and contribute toward the betterment of the Virta clinical team.

Manage the prescriptions of a panel of patients seeking to reverse their obesity in collaboration with the patient’s Virta medical provider. Educate patients about Virta and Virta’s treatment and help them prepare for their nutritional and behavioral journey with Virta, setting them up for clinical success. Use motivational interviewing techniques to help patients progress in their weight management journey. Supporting patients on their obesity reversal journey, whether it involves nutritional change, medication or both, but with a firm understanding and commitment to Virta’s nutrition-first approach to weight loss. Collaborate closely with our clinical and technology teams to help us build out this new service line. We are committed to providing our patients with an evidence-based, highly-effective clinical program. Embrace a MVP (minimal viable product) approach to clinical program development. As time allows, provide clinical support for our team of providers (MDs and NPs). Responsibilities include panel management, triage calls with patients, medication entry, and diabetes education regarding medication administration, sliding scale insulin, carb counting, etc Commitment to providing care of the highest quality that delivers an exceptional experience for the patient As time allows, conduct 20-minute clinical intake visits with prospective patients via video and/or phone. Intakes include verifying and documenting a clinical history, verifying medications, answering basic questions about Virta treatment, and identifying and flagging concerning history or labs for provider review.

Gentiva

Remote Clinical Care Coordinator - RN or LPN

Posted on:

April 24, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

We are looking for a Remote C linical Care Coordinator to join our team. This position will directly report to the Director Contact Centerand is responsible for being highly knowledgeable regarding post-acute levels of care, and an expert regarding Gentiva services including home health, hospice, and palliative care. The shift is Friday 3:30pm-12am, Sat & Sun 8pm-8:30am and Wednesday 10am-6:30pm. This is a work from home position. To support operational needs and business hours, candidates should reside in these states: Alabama, Florida, Georgia, Indiana, Kansas, Michigan, Missouri, North Carolina, Pennsylvania, South Carolina, Tennessee, Texas or Virginia.

Associate degree required. Bachelor's degree preferred Registered Nurse or LPN with professional licensure in a compact state preferred. May be required to obtain licensure in additional states as dictated by business needs. Minimum of 3 years’ post-acute experience. Home Care and hospice experience preferred Nursing background working across multiple areas of post-acute care. INTERNET REQUIREMENT: High-speed Internet connection (minimum 10 Mb/s download speed and minimum 2 Mb/s upload speed, recommended 5 Mb/s upload). Satellite based internet services are not acceptable. Excellent analytical and problem-solving skills. Ability to learn and master information related to locations and services of client. Outstanding computer skills. Good time management skills Good working knowledge of home health, hospice and palliative care services Ability to communicate effectively with empathy over the phone and while interacting with others; excellent interpersonal skills. RN, LPN, Remote RN, Remote Nursing, Remote Nurse

Makes clinical level of care determination based on discussion, medical records, and any other pertinent clinical data. 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. Able to navigate healthcare options, care services post-acute offerings, Medicare coverage, billing issues, as well as accessing healthcare resources.

argenx

Nurse Case Manager, Northern Indiana

Posted on:

April 24, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Indiana

Join us as we transform immunology and deliver medicines that help autoimmune patients get their lives back. argenx is preparing for multi-dimensional expansion to reach more patients through a rich pipeline of differentiated assets, led by VYVGART, our first-in-class neonatal Fc receptor blocker approved for the treatment of gMG, and with the potential to treat patients across dozens of severe autoimmune diseases. We are building a new kind of biotech company, one that maintains its roots as a science-based start-up and pushes our commitment to innovate across all corners of our business. We strive to inspire and grow our company, our partnerships, our science, and our people, because when we do, we deliver more for patients.

The Nurse Case Manager (NCM) is the single point of contact for patients and their caregivers. They are aligned regionally and are responsible for educating patients, caregivers and families affected by generalized Myasthenia Gravis (gMG) and CIDP about the disease and argenx’s products and support services. The NCM may provide resources to help patients better manage their disease and coordinate their treatment. The NCM is responsible for participating in one-on-one communications with patients and their caregivers. Desired Location: Northern, Indiana (Time zone EST)

Skills and Competencies: Demonstrated effective presentation skills; ability to motivate others; excellent interpersonal (written and verbal) skills – with demonstrated effectiveness to work cross-functional and independently Demonstrated ability to develop, follow and execute plans in an independent environment Demonstrated ability to effectively build positive relationships both internally & externally Demonstrated ability to be adaptable to changing work environments and responsibilities Must be able to thrive in team environment and willing to contribute at all levels with flexibility and a positive attitude Fully competent in MS Office (Word, Excel, PowerPoint) Flexibility to work weekends and evenings, as needed Participate in and complete required pharmacovigilance training Comply with all relevant industry laws and argenx’s policies Travel requirements less than 50% of the time Education, Experience and Qualifications: Current RN License in good standing Bachelor’s degree Preferred 5 + yrs.’ clinical experience in healthcare to include hospital, home health, pharmaceutical or biotech 2-5+years of case management 2+ plus years’ experience in pharmaceutical/ biotech industry a plus Reimbursement experience a plus Bilingual or multilingual a plus

Provide direct educational training and support to patients and caregivers about gMG and CIDP and prescribed argenx products Will manage patient cases across regions as coverage and volume requires. Communicate insurance coverage updates and findings to the patient and/or caregiver Review and educate the patients and/or caregivers on financial assistance programs that they may be eligible for. Coordinate logistical support for patient to receive therapy and manage their disease Collaborate with argenx Field Access Specialist, Field Liaisons, and Field Reimbursement Manager teams to troubleshoot and resolve reimbursement-related issues Engage with patients and provider case coordinators to ensure appropriate support is being given on an individualized basis Provide patient-focused education to empower patients to advocate on their behalf Develop relationships and manage multiple and complex challenges that patient and caregivers are facing Ensure compliance with relevant industry laws and argenx’s policies Aligned regional travel will be required for patient education to support patient programs Must be an excellent communicator and problem-solver Demonstrated time management skills; planning and prioritization skills; ability to multi-task and maintain prioritization of key projects and deadlines

argenx

Nurse Case Manager - Florida

Posted on:

April 24, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Florida

Join us as we transform immunology and deliver medicines that help autoimmune patients get their lives back. argenx is preparing for multi-dimensional expansion to reach more patients through a rich pipeline of differentiated assets, led by VYVGART, our first-in-class neonatal Fc receptor blocker approved for the treatment of gMG, and with the potential to treat patients across dozens of severe autoimmune diseases. We are building a new kind of biotech company, one that maintains its roots as a science-based start-up and pushes our commitment to innovate across all corners of our business. We strive to inspire and grow our company, our partnerships, our science, and our people, because when we do, we deliver more for patients.

The Nurse Case Manager (NCM) is the single point of contact for patients and their caregivers. They are aligned regionally and are responsible for educating patients, caregivers and families affected by generalized Myasthenia Gravis (gMG) and CIDP about the disease and argenx’s products and support services. The NCM may provide resources to help patients better manage their disease and coordinate their treatment. The NCM is responsible for participating in one-on-one communications with patients and their caregivers. Desired Location: West Palm Beach, FL (Time zone EST)

Skills And Competencies: Demonstrated effective presentation skills; ability to motivate others; excellent interpersonal (written and verbal) skills – with demonstrated effectiveness to work cross-functional and independently Demonstrated ability to develop, follow and execute plans in an independent environment Demonstrated ability to effectively build positive relationships both internally & externally Demonstrated ability to be adaptable to changing work environments and responsibilities Must be able to thrive in team environment and willing to contribute at all levels with flexibility and a positive attitude Fully competent in MS Office (Word, Excel, PowerPoint) Flexibility to work weekends and evenings, as needed Participate in and complete required pharmacovigilance training Comply with all relevant industry laws and argenx’s policies Travel requirements less than 50% of the time Education, Experience And Qualifications: Current RN License in good standing Bachelor’s degree Preferred 5 + yrs.’ clinical experience in healthcare to include hospital, home health, pharmaceutical or biotech 2-5+years of case management 2+ plus years’ experience in pharmaceutical/ biotech industry a plus Reimbursement experience a plus Bilingual or multilingual a plus

Provide direct educational training and support to patients and caregivers about gMG and CIDP and prescribed argenx products Will manage patient cases across regions as coverage and volume requires. Communicate insurance coverage updates and findings to the patient and/or caregiver Review and educate the patients and/or caregivers on financial assistance programs that they may be eligible for. Coordinate logistical support for patient to receive therapy and manage their disease Collaborate with argenx Field Access Specialist, Field Liaisons, and Field Reimbursement Manager teams to troubleshoot and resolve reimbursement-related issues Engage with patients and provider case coordinators to ensure appropriate support is being given on an individualized basis Provide patient-focused education to empower patients to advocate on their behalf Develop relationships and manage multiple and complex challenges that patient and caregivers are facing Ensure compliance with relevant industry laws and argenx’s policies Aligned regional travel will be required for patient education to support patient programs Must be an excellent communicator and problem-solver Demonstrated time management skills; planning and prioritization skills; ability to multi-task and maintain prioritization of key projects and deadlines

CenterWell Pharmacy

LPN Rx Clinical Program Professional

Posted on:

April 24, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

Compact / Multi-State

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.

The LPN (Licensed Practical Nurse) RX Clinical Program Professional 1 integrates programs developed to improve overall health outcomes with a focus on prescription drugs. The RX Clinical Program Professional 1 work assignments are often straightforward and of moderate complexity. Must be able to work an 8-hour shift, Monday-Friday, anytime between the business operating hours of 8 A.M. EST to 8 P.M. ET. There is also one rotating shift from 11:30 A.M.- 8 P.M. EST every other week. Due to business needs, overtime may be required. In periods of business required overtime, each associate is expected to work the minimum required hours. If these hours are not worked, it will result in a full occurrence to be held in line with the Attendance Policy.

Active LPN (Licensed Practical Nurse) license in the state of residence Minimum of 1 year LPN experience Strong data entry skills Ability to solve problems and encourage others in collaborative problem solving Self-directed, but also able to work well in a group A positive, proactive attitude, energetic, highly motivated and a self-starter Work ethic that is focused, accurate and highly productive Preferred Qualifications: Mail Order Pharmacy experience 1 year or more years of experience as an LPN in a specialty pharmacy setting LPN Compact license

The LPN RX Clinical Program Professional 1 oversees medication therapy, strategy on comprehensive medication reviews, and prescription drug optimization in cases where patients are taking multiple medications. Drives health awareness with patients through Rx Education and targeted quarterly campaigns. Places outbound calls and receives inbound calls to confirm patients are taking drugs, ensures delivery of medications and provides counseling. Understands own work area professional concepts/standards, regulations, strategies, performance goals and operating standards. Makes decisions regarding own work approach/priorities and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.

argenx

Nurse Case Manager - Bluegrass

Posted on:

April 24, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Virginia

Join us as we transform immunology and deliver medicines that help autoimmune patients get their lives back. argenx is preparing for multi-dimensional expansion to reach more patients through a rich pipeline of differentiated assets, led by VYVGART, our first-in-class neonatal Fc receptor blocker approved for the treatment of gMG, and with the potential to treat patients across dozens of severe autoimmune diseases. We are building a new kind of biotech company, one that maintains its roots as a science-based start-up and pushes our commitment to innovate across all corners of our business. We strive to inspire and grow our company, our partnerships, our science, and our people, because when we do, we deliver more for patients.

The Nurse Case Manager (NCM) is the single point of contact for patients and their caregivers. They are aligned regionally and are responsible for educating patients, caregivers and families affected by generalized Myasthenia Gravis (gMG) about the disease and argenx’s products and support services. The NCM may provide resources to help patients better manage their disease and coordinate their treatment. The NCM is responsible for participating in one-on-one communications with patients and their caregivers. Desired Location: Bluegrass- EST time zone preferred

Skills and Competencies: Demonstrated effective presentation skills; ability to motivate others; excellent interpersonal (written and verbal) skills – with demonstrated effectiveness to work cross-functional and independently Demonstrated ability to develop, follow and execute plans in an independent environment Demonstrated ability to effectively build positive relationships both internally & externally Demonstrated ability to be adaptable to changing work environments and responsibilities Must be able to thrive in team environment and willing to contribute at all levels with flexibility and a positive attitude Fully competent in MS Office (Word, Excel, PowerPoint) Flexibility to work weekends and evenings, as needed Participate in and complete required pharmacovigilance training Comply with all relevant industry laws and argenx’s policies Travel requirements less than 50% of the time Education, Experience and Qualifications: Current RN License in good standing Bachelor’s degree Preferred 5 + yrs.’ clinical experience in healthcare to include hospital, home health, pharmaceutical or biotech 2-5+years of case management 2+ plus years’ experience in pharmaceutical/ biotech industry a plus Reimbursement experience a plus Bilingual or multilingual a plus #LI-REMOTE

Provide direct educational training and support to patients and caregivers about gMG and prescribed argenx products Will manage patient cases across regions as coverage and volume requires. Communicate insurance coverage updates and findings to the patient and/or caregiver Review and educate the patients and/or caregivers on financial assistance programs that they may be eligible for. Coordinate logistical support for patient to receive therapy and manage their disease Collaborate with argenx Patient Access Specialist, Case Coordinator, and Field Reimbursement Manager teams to troubleshoot and resolve reimbursement-related issues Engage with patients and provider case coordinators to ensure appropriate support is being given on an individualized basis Provide patient-focused education to empower patients to advocate on their behalf Develop relationships and manage multiple and complex challenges that patient and caregivers are facing Ensure compliance with relevant industry laws and argenx’s policies Aligned regional travel will be required for patient education to support patient programs Must be an excellent communicator and problem-solver Demonstrated time management skills; planning and prioritization skills; ability to multi-task and maintain prioritization of key projects and deadlines

Humana

Utilization Management Registered Nurse

Posted on:

April 24, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

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 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.

Active enhanced Registered Nurse, (eNLC) license (RN) with no disciplinary action. Ability to obtain multiple state registered nurse license Minimum three, (3), years of Medical Surgery, Heart, Lung, maternity/obstetrics, or Critical Care Nursing experience required Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting Intermediate to advanced knowledge of Microsoft Word, Outlook and Excel, systems and platforms Ability to work independently under general instructions and with a team Preferred Qualifications: Bachelor's degree Previous experience in utilization management Health Plan experience Previous Medicare/Medicaid Experience a plus Bilingual is a plus Workstyle: Remote work at home Location: US Schedule: Monday through Friday 8:00 AM to 5:00 PM Eastern, with ability to work over-time, weekends as needed to support business needs. Travel: Less than 5%

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. Must be passionate about contributing to an organization focused on continuously improving consumer experiences

Davies

Telephonic Nurse Case Manager

Posted on:

April 24, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Florida

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

Imagine being part of a team that’s not just shaping the future but actively driving it. At Davies North America, we’re at the forefront of innovation and excellence, blending cutting-edge technology with top-tier professional services. As a vital part of the global Davies Group, we help businesses navigate risk, optimize operations, and spearhead transformation in the insurance and regulated sectors. We're on the lookout for a Telephonic Nurse Case Manager to join our growing team! As a Telephonic Nurse Case Manager, you will be responsible for monitoring, evaluating and coordinating the delivery of high quality, timely, cost-effective medical treatment and other health services under Workers’ Compensation law. You will also perform ongoing assessments of the injured employee’s recovery to ensure high quality of care, reduce recovery time and minimize the effects of injury.

RN with 3-5 years clinical experience (medical-surgical, orthopedic, neurological, ICCU, industrial or occupational) Case Management experience and at least 1 year Workers’ Compensation experience is required Field Case or Catastrophic Case Management and Utilization Review experience preferred Must possess one of the following certifications: CCRN, CCM, COHN, COHN‐S if managing a WC/MCO claim Proof of current State Licensure and eligible for endorsement in all other states Bilingual; fluent English/Spanish preferred Ability to demonstrate strong focus on cost containment to manage cases in most cost-effective way while still ensuring quality medical care Maintain knowledge of current trends, standards and law changes appropriate to the law at the date of injury Must be self-directed and able to work independently Ability to effectively operate a personal computer and related claims and business software

Provide specialized telephonic case-management in a Workers’ Compensation environment Focus on medical appropriateness of care to injured worker with cost savings by coordination and utilization of all services, ensuring that as soon as medically feasible, return-to-work status is achieved Demonstrate experience in the handling of Workers’ Compensation claims according to applicable statutes and rules Facilitate communication between the employee, the employee representative, employer, employer representative, insurer, health care provider, the medical services organization and, when authorized, any qualified rehabilitation consultant, to achieve the goals as identified for that case upon review of the file Clinically evaluate the medical needs of an injured employee after the initial file assessment and incorporate a case management plan to provide quality care in a cost-effective manner Identify barriers to recovery and formulate an action plan to overcome these barriers Provide ongoing assessment of health and medical records Monitor vendor performance, ensuring quality service Develop case-management care plan, track and modify appropriately Appropriately document all data received from contacts and medical records in the computerized system Address the return-to-work capabilities; investigate opportunities for return to work if appropriate; document appropriately in computerized system Manage the file adhering to treatment guidelines and utilization criteria as determined by the state-mandated guidelines pursuant to the specific date of injury, proprietary and nationally published protocols, as well as account requirements, assuring smooth delivery of services to injured workers or third-party claimants Create, edit and/or revise correspondence Evaluate treatment plans and document outcomes, track protocol management for appropriate utilization and delivery of medical services; outcomes will be evidenced by patient satisfaction, appropriate delivery and quality of care and timely recovery per evidenced-based criteria and clinical guidelines, per law for that date of injury Manage the file pro-actively, utilizing all appropriate case management tools Develop alternative treatment plans when necessary Demonstrate the ability to accommodate changes on the case management process for delivery of a more refined, efficient and cost-effective system If applicable, identify the need for Utilization Review procedures to claims, such as triggers that might indicate a potential barrier to recovery; UR tools include physician advisor review, prospective review, concurrent review and retrospective review of bills and reports; communicate the findings determined in utilizing these tools and document appropriately Anticipate health needs during case management process and educate patient and family appropriately; encourage the injured worker to participate in the recovery plan Maintain patient privacy by ensuring that all medical records, case-specific information, and provider-specific information are kept in a confidential manner, in accordance with state and federal laws and regulations Serve as a patient advocate adhering to all legal, ethical, and accreditation/regulatory standards Negotiate fees with providers or channel cases to other vendors as appropriate, with a focus on cost containment, ensuring compliance with applicable statute/rule relevant to the specific date of injury May provide leadership of lower graded staff in the department Perform other duties as needed.

The Joint Commission

International Nurse Surveyor

Posted on:

April 24, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Illinois

Surveys international health care organizations as assigned. Applies systems analysis skills and inductive reasoning skills to determine a health care organization’s degree of compliance with applicable standards and functionality of care delivery systems. Engages health care organization staff in interactive dialogues on standards-based issues in health care in order to assess compliance and to identify opportunities for improving compliance. Prepares exit reports that clearly link individual measurable deficiencies with potential systems vulnerabilities and related organization risk points. Effectively communicates this information to health care organization leadership in a constructive and collegial style. Participates in other Joint Commission International activities as assigned.

Seeking candidates for full-time/part time status (IC - Independent Contractor, .14 FTE, .5 FTE, .75 FTE) Seeking candidates preferrably located in the United States. Will also consider candidates living overseas.

Education : Accepted qualifications for surveyors with a clinical background include: Bachelor of Science in Nursing (BScN, BSN), Masters preferred Certification/Licensure (at Time Of Hire And Throughout Employment): Current professional licensure/registration in related disciplines is required (when required by law) at time of hire. Certification requirement: You must hold a CPHQ certification (Certified Professional in Healthcare Quality) through National Association for Healthcare Quality (NAHQ) at time of hire or attain within one year of hire. Applicants must have no history of disciplinary action(s) relative to current or previous professional license, provided such adverse action did not result solely from an individual’s health status. General Knowledge And Experience: Five years of recent experience, including 3 years of direct clinical experience in the appropriate health care setting(s), and 2 years of senior management experience. Recent experience as a consultant to health care organizations may be considered. Contemporary knowledge of and experience in health care operations, clinical practice, use of performance improvement methods to assess organizational performance, and current research and trends relative to health care practices. Knowledge of Joint Commission International standards and direct involvement with a minimum of two Joint Commission domestic or international surveys. Experience in an international health care setting is preferred. Specialized Knowledge And Experience: Surveyors must have knowledge or experience in various components of a hospital and health care system (i.e., medical staff, quality improvement, medical records, infection control, etc.). Additional experience in other health care settings is preferred. Hospital Administrators with the designation of FACHE (Fellow, American College of Healthcare Executives) are preferred. Clinical Care Program Certification program surveyors must have a minimum of 5 years experience of progressive clinical leadership and current knowledge or experience in the implementation of clinical practice guidelines, development and implementation of clinical pathways and in the identification and use of performance measures to improve clinical outcomes. Experience in chronic disease management is desirable. Critical Thinking Skills: Ability to research, collect, organize, interpret and communicate a large volume of information from multiple sources (i.e., documentation, observation, interviews) to assess the degree of compliance with Joint Commission International standards. Ability to differentiate and assess the adequacy of alternative/innovative approaches to standards compliance, consistent with survey policy and protocols. Ability to analyze and synthesize observations to identify survey findings and educational opportunities. Ability to connect observations and interviews into a comprehensive analysis of the organization’s care delivery systems. Interpersonal Skills: Multi-cultural awareness and sensitivity Respectful of all internal and external customers. Open to inquiry and exchange. Responsive to verbal and nonverbal communication cues. Problem Solving Skills: Independent decision-making skills to direct and effectively manage the survey process. Ability to objectively assess organization performance. Ability to openly discuss and resolve conflicts/controversy. Ability to seek assistance when appropriate to make decisions, resolve conflicts and/or achieve consensus. Interviewing Skills: Ability to elicit information through sensitive, appropriate use of open-ended questions and active listening. Ability to further explore observations and received information through effective use of follow-up questioning. Teamwork Skills: Behavior consistent with Joint Commission International values (i.e., Quality, Respect, Integrity, Courtesy, Teamwork, Recognition, Improvement, Empowerment and Responsiveness). Dependability, including delivering on commitments, assuming appropriate share of all work, being prepared, and adhering to schedules. Candor, including sharing one’s own views, encouraging others to share their views, and being willing to offer and receive constructive feedback. Professionalism, including appearance and demeanor. Organizational Skills: Independently organize work into a smooth flow and to be flexible as necessitated by unique circumstances. Demonstrate effective time management skills. Coordinate activities involving other people. Written And Verbal Communication Skills: Ability to make presentations and produce written materials which are accurate, clear, concise, complete, well organized, understandable by others, and can be accurately translated into the client’s native language if needed. Ability to use a computer or similar technology. Fluent in speaking and business writing in English is required, fluent in another language is preferred Physical Abilities: Must be able to lift/move/carry 25-50 pounds (i.e. luggage or supplies), sit and stand or remain in a stationary position for long periods of time, and walk or move lengthy distances in a variety of settings. Must be capable of extensive travel 100% of work time including but not limited to, flying for extended periods of time (i.e. over 10 hours of continuous flight in coach class), manage moving and sleeping across various time zones, positioning self on small airplanes and in small airports, and into all countries that Joint Commission International does business. Work and healthcare environments may include, but not limited it, exposure to dust, allergens, pollution, infectious diseases, hazardous materials, and noise. Must be able to observe and participate in work activities in real-time and without slowing or otherwise interrupting the progress. Work activities include operating a laptop or tablet as well as frequently communicating with large and small groups in person, via phone, or webinar. Must repetitively ascend/descend multiple flights of steps and ladders, stooping, squatting, adequately inspect and observe all medical facilities, equipment, and procedures. Availability: Must be willing and able to travel to all countries where Joint Commission International accredits. Participation in up to one week of corporate orientation and education upon hire. Completion of up to three surveys with a preceptor in order to facilitate understanding of the Joint Commission International standards and their interpretation, survey process, survey technology, presentation techniques, general policies and procedures, and organization structure. Ongoing participation in continuing education activities, including those sponsored by Joint Commission International, (i.e., Invitational Training Conference, regional meetings, other face-to-face meetings, teleconferences, self-directed learning activities, distance learning programs, and special conferences). Must be able to meet one of the following availability requirements depending upon employment status: Full time (0.75 FTE) – available 52 weeks/year (vacation, personal, and holiday time) Part time (0.5 FTE) – 2 to 3 consecutive calendar weeks per month Intermittent – one calendar week per month (available 6-8 consecutive days at a time) Independent Contractor – six calendar weeks per year (available 6-8 consecutive days at a time) Obtain and maintain a current passport. Ability to obtain visas when applicable. For frequent US travelers, a second passport may be advisable to ensure that one passport is always available for use (if permitted by laws of the country in which the passport is held). Weekend travel will be required.

Conducts a thorough evaluation of international organizations that meet accreditation/ certification eligibility criteria on-site or remotely. Reviews and evaluates pre-survey information and conducts all pre-survey activities. Using organization-specific information, selects patient records based upon an evaluation of the client application. Using patient experiences as guides and discussion tools: Conducts analysis of care delivery systems Evaluates patient care environments to assess health care organizations’ operations and standards compliance Interviews staff and patients to determine health care organizations’ level of compliance with standards In response to patient-centered evaluation activities, analyzes documents, such as policies, procedures, meeting minutes, clinical standards, protocols, patient records, employee records, committee reports, etc. to assess the level of compliance with Joint Commission International standards, implementation of policies, evidence of performance improvement and quality and safety of care. Using established survey process: Participates in and/or conducts all required on-site and/or remote activities Documents all observations in a complete and accurate manner utilizing survey technology Participates in on-site/off-site findings integration discussions Provides adequate documentation to guide health care organization improvement activities Provides comprehensive rationale for each documented finding Links each observation to potential system-level vulnerabilities found in the measurable elements and opportunities for organizational improvements in patient care and safety Reports survey findings in a complete, accurate, and timely manner Follows JCI Scoring Guidelines to determine a measurable element score based on evaluation of the evidence Prepares an exit report for the organization Interprets and explains the intent of standards to the organization’s personnel in a constructive, sensitive, and professional manner. Seeks assistance from central office when appropriate. Through interactive evaluation sessions, consults with organization leaders on high profile issues in health care. Offers relevant consultation where improvement is needed. Communicates organization-specific information to central office as needed. Maintains current knowledge of Joint Commission International standards, policies, and procedures. Maintains current knowledge in professional field of expertise. Demonstrates appropriate knowledge of local and regional laws, cultural beliefs, and practices pertinent to the survey. Complies with requirements for utilization of all JCIA applications for documenting findings, submitting availability, and completing expense reports, team evaluation tool, etc. Participates in evaluating the performance of the survey team after each survey by completing the Team Evaluation Tool, including preceptees in training, as requested. Follows clients' safety policies when on site, including following requested safety measures (e.g., wearing appropriate protective clothing or equipment) provided that such policies are not in conflict with Joint Commission International Accreditation policies. Participates in all required JCI staff development activities. May perform other duties as assigned, including, but not limited to: Participate in special projects Assist in developing, writing, and testing standards, scoring guidelines and the survey process, and provide recommendations for improvement Assists the central office in responding to standards interpretation questions from the field Assists the central office in analysis of organization intra-cycle monitoring reports, evidence of standards compliance reports and complaints Serves on JCI Accreditation committees Serves as team leader when assigned to a team Serves as faculty for surveyor education and/or field education programs Receives training and conducts surveys across programs and settings onsite and/or remotely Serves as preceptor for surveyors in training If assigned the team leader role, responsibilities and duties also include the following as defined in the “JCI Accreditation Team Leader Role and Responsibilities” document. Also refer to the “Team Leader Job Description”. Contacts the organization to clarify any questions from the review of the application Develops an organization-specific agenda from the standard agenda template based on the information provided in the survey applications Maintains communications with the organization’s survey coordinator. Responds to special requests regarding the survey agenda and revises the agenda, as needed, prior to the start of the survey. Communicates any modified agenda information to the organization and each team member in a timely manner Coordinates travel, security/safety, and hotel accommodations for the team Coordinates Preliminary Survey Activities. Coordinates Survey Activities during the Survey Coordinates and finalizes the exit report Completes all required post-survey activities Serves as preceptor for surveyors Serves as mentor for on-going surveyor development

ilumed

RN Care Coach -Chronic Care (Remote)

Posted on:

April 24, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

Are you a compassionate and experienced Registered Nurse with a passion for supporting patients with chronic conditions? If so, we’d love for you to join our mission-driven team at ilumed as an RN Care Coach for Chronic Care. Bilingual in English and Spanish highly required In this role, you’ll make a real impact by guiding patients and families through their health journeys, ensuring care is accessible, coordinated, and centered around their unique needs. Job Summary As an RN Care Coach, you’ll serve as a key advocate and partner for our members, delivering holistic, telephonic support as part of our Case Management and Disease Management programs.

Active RN license in your state of residence (multi-state compact license preferred) 2–4+ years of experience in managed care or case management Case Management Certification (CCM) preferred Strong communication and organizational skills Proficiency in Excel, Word, Outlook, and other Microsoft 365 tools Ability to multitask and adapt in a fast-paced, evolving environment Preferred Skills & Qualifications: Bilingual in English and Spanish highly required – many of the patients we serve are Spanish-speaking, and this skill significantly enhances the level of care and connection we provide Experience with motivational interviewing techniques A patient-first, solution-oriented mindset Knowledge, Skills and Competencies: Demonstrated ability to adapt and be flexible in an environment that moves at a rapid pace, where change is common and frequent. Solid working knowledge of Excel with proficient skills in MS Word, PowerPoint, and Outlook Ability to manage multiple projects and conflicting priorities. Excellent time management skills. Strong Problem solving and critical thinking skills. Excellent communication skills; verbal and written, and organizational skills Education and Experience: Active RN license in state of employment with a multi-state compact license for States served. Case Management Certification (CCM), preferred 2-4 plus years managed care experience Physical Requirements: Prolonged periods of sitting at a desk and working on a computer Additional Information: Must abide by all HIPAA, Confidentiality & Privacy Laws Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job

Provide telephonic care coaching and education to members and their caregivers Partner with providers to build and maintain integrated care plans Support patients with chronic conditions through care coordination and empowerment Use motivational interviewing and solution-based communication Identify Social Determinants of Health needs and connect patients to appropriate resources Maintain thorough documentation and adhere to HIPAA and regulatory standards Stay current on case management best practices

HarmonyCares

Clinical Triage Nurse, RN

Posted on:

April 24, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Michigan

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

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

Graduate of approved or accredited nursing education program as a Registered Nurse Current valid RN license. Must be able to obtain and maintain RN license within all service states within 6 months from hire Satisfactory completion of required nursing continued education requirements Ability to react decisively and quickly in urgent and emergent situations Strong comprehension of medical terminology and pharmaceuticals Demonstrated experience with multi-tasking Strong communication skills (written & spoken) Demonstrated proficiency in using electronic health records (HER) system Ability to communicate effectively with providers, patient care teams, patients, patients’ family members and facility staff Ability to work remotely and independently Knowledge of basic principles, practices, and techniques in primary healthcare Strong organizational skills and attention to detail Conflict resolution skills Preferred Knowledge, Skills and Experience: Familiarity with Medicare and Medicaid insurances and programs 2 years of experience as an RN Contact center experience Nurse triage experience Experience in Aprima (EHR) Multistate License (MSL)

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

AF - Group

Nurse Case Manager

Posted on:

April 23, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Michigan

The Nurse Case Manager (NCM) is responsible for applying medical knowledge in reviewing workers’ compensation claims to assess, evaluate, plan, implement and oversee the treatment appropriateness for occupational injuries based upon evidence based guidelines. The NCM utilizes clinical knowledge to evaluate the medical and disability needs of an injured worker against relevant policies, facilitate coordination of the patient’s medical treatment and timely return to work. The NCM engages the claimant and physician(s) in providing proactive medical and disability management, working collaboratively with claim handlers in providing focused claim resolution and return to work driven outcomes. The case management process requires a focus on customer service, skills, knowledge of setting appropriate goals and measuring outcomes to effectively ensure optimal outcomes.

EMPLOYMENT QUALIFICATIONS: Registered Nurse license active and unrestricted required. Bachelor’s degree in Nursing (BSN) preferred. Continuous learning required, as defined by the Company’s learning philosophy. Case management certification or progress toward certification is highly preferred and encouraged. EXPERIENCE: Three years active patient or clinical care experience as a Registered Nurse required. Three years workers’ compensation case management, occupational health, rehabilitation or insurance experience preferred. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: Knowledge of clinical care and jurisdictional requirements. Demonstrates the ability to be organized and efficient in prioritizing and managing assignments with minimal oversight and direction. Strong time management skills. Excellent oral and written communication, customer service, written report preparation, human relations and decision making skills are required. Demonstrates use of critical thinking, attention to detail, sound clinical judgment and assessment skills for decision making. Proficient with computer and Microsoft Windows Suite. Demonstrates courteous, professional demeanor and team spirit and the ability to work in a collaborative, effective manner. WORKING CONDITIONS: Work is performed in an office/remote setting with no unusual hazards. Minimal travel.

The nurse case manager must be able to demonstrate and be accountable for the standards of practice policies and procedures, quality assurance and the goals of the organization. Also, manage treatment of claimants through the workers’ compensation system based on the individual’s diagnosis and state workers’ compensation regulations. Obtains and reviews patient clinical status and history to determine casual nature of patient’s symptoms as related to reported work injuries. Applies knowledge of age-specific, cultural diversity, psycho/social and developmental issues during the interview process, documentation and intervention with the claimant, their family or significant other. Determines the medical necessity/reasonableness of proposed and ongoing treatment as well as inpatient or outpatient hospitalization for each lost-time case. Formulates all internal and external correspondence necessary to research and resolve case disputes and case inquiries, contacting providers and involving claims handlers as required. Communicates final decision and subsequent ramifications to claim handlers. Presents, discusses and finalizes alternative care and return to work programs with permanency ratings assigned to lost-time cases by medical providers, reinsuring the level of injury and ratings assigned are accurate and consistent with workers’ compensation, state, industry and division rating standards and policies, in conjunction with the claim handler. As it relates to California: Adhere to California Nurse Practice Act, Case Management Code of Professional Conduct and Employee Code of Ethical Conduct

CardioOne

Remote Patient Monitoring Licensed Practical Nurse (LPN)\

Posted on:

April 23, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Colorado

CardioOne partners with independent cardiologists to provide innovative solutions that improve patient outcomes and reduce costs. Our platform helps our physician partners thrive in today’s fee-for-service environment and prepare for success in value-based care. In February 2024, we partnered with WindRose Health Investors as well as top physician services and payor executives to grow our team and invest in our next phase of growth. CardioOne offers a magnificent work environment, good working conditions, and competitive pay. We offer medical, dental, vision, and a 401k plan with a match to benefit eligible employees. We offer PTO (Personal Time Off) and sick time to full-time employees. We take pride in creating a culture of employee engagement that translates into an exemplary patient experience. Join us in our mission to positively impact US cardiology. CardioDiagnostics is a Healthcare Technology Company whose innovative work was recognized by President Barack Obama. The company developed the World’s 1st Cloud-Based, Hardware-Agnostic, HIPAA-Compliant Cardiac Monitoring Solution, accessible from any internet-connected device. CardioDiagnostics also offers a Remote Patient Monitoring (RPM) solution that allows patients to record their vital signs and automatically send them to their Healthcare Providers, by pairing monitoring device(s) with our CardioConnect mobile App.

CardioDiagnostics is currently recruiting a Licensed Practical Nurse (LPN) to provide high-quality patient care services. In this role, the successful candidate will be responsible for monitoring patients remotely and ensuring that their health and well-being are optimized. The Remote Patient Monitoring LPN will work closely with our healthcare team to provide patients with the best possible care and support.

Licensed Practical Nurse (LPN) with a valid nursing license in the state of practice. Experience working in a healthcare setting, preferably in remote patient monitoring or telehealth and comfortable using technology to communicate with patients and healthcare providers. Excellent communication and interpersonal skills. Ability to work independently and as part of a team. Strong ethics and values Strong critical thinking and problem-solving skills. Additional Information: Full-time and part-time roles available starting at $20/hour. Work Location: Remote

Use technology to remotely monitor patients' health and provide necessary interventions based on patient data. Monitor patient vital signs, including blood pressure, blood glucose, oxygen saturation, body weight and temperature. Engage with patients by phone, text, or video-call: Remind patients to record their vitals; Respond to alerts related to patient symptoms or physiological data; Respond to patients for minor technical troubleshooting and provide ongoing chronic care management. Collaborate with healthcare providers to develop and implement the best possible care and support. Educate patients on how to use remote monitoring technology and provide guidance on healthy lifestyle habits. Assist with managing patients, ensure patient compliance, and generate reports for getting the practice reimbursed on time.

Vesta Healthcare

REMOTE Full Time Russian Bilingual NY Licensed Nurse Practitioner (NP)

Posted on:

April 23, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

NP/APP

State License:

New York

Vesta Healthcare is a specialized medical group focused today on aging adults with long-term home care needs. We help these individuals live happier, healthier lives by partnering with their aides and caregivers, as a key part of the care team. We use a combination of virtual care, home-based and mobile technologies, data integrations and partnerships with home care agencies to make the home an integrated setting of care with patients, and their Caregivers at the center. Vesta is the Roman name for the goddess of home, hearth and family. She is the caregiver. Often unseen yet greatly revered, she puts others' needs ahead of her own, keeping the hearth warm so the home and family can function. We see Caregivers and recognize the power and potential they embody. More than just assistance, Caregivers are eyes, ears and hands in the home. Caregivers play the role of Doctor, Nurse, Pharmacist, EMT and more, but without support or guidance. That is where Vesta Healthcare comes in. Our program provides Caregivers with a personalized clinical team in their pocket. Our team links Caregivers to the people they care for and the other providers involved in their care. It’s an insurance covered benefit, so it’s available to most adults with Caregivers free of charge to them.

We seek team members who are passionate about making home the best place it can be for people with home care needs and see the important role Caregivers play. Our team members are collaborative data-driven optimists who always focus on doing what’s best for patients and their caregivers. We see ourselves as being here to improve the quality of life for caregivers and care recipients, allowing them to focus on the important things (like going to the mall with their grandkids).

Certified and licensed as a Nurse Practitioner in good standing in the state of New York (required) Master’s or doctoral degree from an accredited institution for nurse practitioners (required) Medicare participation and ability to have the company bill for services on your behalf (required) Certification from ANCC (or equivalent) as an Adult, Family, Geriatric, and/or Acute Nurse practitioner (required) 1+ years of Nurse Practitioner Experience (required), qualified for independent practice in your licensed jurisdiction (preferred) 1+ years of telephonic triage or equivalent experience (required) 2+ years of clinical experience working with complex adult populations (required) Ability to practice independently with little clinical support (required) Comfort using technology like Google Suite, multiple EMRs, Slack (required) The ability to work remotely and has a private area with a computer in their home/workspace (required) Experience working in home care and/or family medicine, geriatrics (preferred) Experience working within a clinical team environment Strong organizational skills, including the ability to prioritize Passionate about our mission to improve people’s lives Comfortable in a dynamic and always evolving startup environment

Conduct video visits for chronic care management and remote patient monitoring to create an appropriate care plan for the member Conduct care coordination and recommend/identify cost effective research based treatment and intervention Utilize strong clinical skills in physical assessment and chronic disease management for at risk adults and apply member specific Care Management and individualized care planning Be comfortable with advanced care planning discussions with caregivers and members Serve as a consulting resource on care management practice as needed Attend meetings, training sessions and participates on committees as needed Possess a strong knowledge of clinical procedures, standards and quality control checks Possess a strong knowledge of medical conditions, interventions and treatment Provide members, caregivers and facility education Monitor the quality of member’s care and updates plan of care

Vesta Healthcare

REMOTE Full Time Bengali Bilingual Nurse Practitioner (NP)

Posted on:

April 23, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

NP/APP

State License:

New York

Vesta Healthcare is a specialized medical group focused today on aging adults with long-term home care needs. We help these individuals live happier, healthier lives by partnering with their aides and caregivers, as a key part of the care team. We use a combination of virtual care, home-based and mobile technologies, data integrations and partnerships with home care agencies to make the home an integrated setting of care with patients, and their Caregivers at the center. Vesta is the Roman name for the goddess of home, hearth and family. She is the caregiver. Often unseen yet greatly revered, she puts others' needs ahead of her own, keeping the hearth warm so the home and family can function. We see Caregivers and recognize the power and potential they embody. More than just assistance, Caregivers are eyes, ears and hands in the home. Caregivers play the role of Doctor, Nurse, Pharmacist, EMT and more, but without support or guidance. That is where Vesta Healthcare comes in. Our program provides Caregivers with a personalized clinical team in their pocket. Our team links Caregivers to the people they care for and the other providers involved in their care. It’s an insurance covered benefit, so it’s available to most adults with Caregivers free of charge to them.

We seek team members who are passionate about making home the best place it can be for people with home care needs and see the important role Caregivers play. Our team members are collaborative data-driven optimists who always focus on doing what’s best for patients and their caregivers. We see ourselves as being here to improve the quality of life for caregivers and care recipients, allowing them to focus on the important things (like going to the mall with their grandkids).

Certified and licensed as a Nurse Practitioner in good standing (required) Fully fluent (reading, writing, speaking) in English and Bengali or Shuddho Bangla (required) Master’s or doctoral degree from an accredited institution for nurse practitioners (required) Medicare participation and ability to have the company bill for services on your behalf (required) Certification from ANCC (or equivalent) as an Adult, Family, Geriatric, and/or Acute Nurse practitioner (required) 1+ years of Nurse Practitioner Experience (required), qualified for independent practice in your licensed jurisdiction (preferred) 1+ years of telephonic triage or equivalent experience (required) 2+ years of clinical experience working with complex adult populations (required) Ability to practice independently with little clinical support (required) Comfort using technology like Google Suite, multiple EMRs, Slack (required) The ability to work remotely and has a private area with a computer in their home/workspace (required) Experience working in home care and/or family medicine, geriatrics (preferred) Experience working within a clinical team environment Strong organizational skills, including the ability to prioritize Passionate about our mission to improve people’s lives Comfortable in a dynamic and always evolving startup environment

Conduct video visits for chronic care management and remote patient monitoring to create an appropriate care plan for the member Conduct care coordination and recommend/identify cost effective research based treatment and intervention Utilize strong clinical skills in physical assessment and chronic disease management for at risk adults and apply member specific Care Management and individualized care planning Be comfortable with advanced care planning discussions with caregivers and members Serve as a consulting resource on care management practice as needed Attend meetings, training sessions and participates on committees as needed Possess a strong knowledge of clinical procedures, standards and quality control checks Possess a strong knowledge of medical conditions, interventions and treatment Provide members, caregivers and facility education Monitor the quality of member’s care and updates plan of care

Vesta Healthcare

Spanish Bilingual Health Coach (Remote)

Posted on:

April 23, 2025

Job Type:

Full-Time

Role Type:

Coaching

License:

None Required

State License:

New York

Vesta Healthcare is a specialized medical group dedicated to enhancing the lives of individuals with long-term home care needs. By collaborating closely with caregivers and leveraging innovative technology, Vesta transforms the home into a comprehensive care setting. Named after the Roman Goddess of home, hearth, and family, Vesta Healthcare offers caregivers, patients, and family members personalized support and guidance through a dedicated clinical team, ensuring that care recipients receive the highest quality care in the comfort of their own homes.

A Health Coach who is passionate about working closely with members and caregivers to support them on their journey to manage their chronic conditions and acute exacerbations. This Health Coach is excited by working as part of a team to build relationships and coach individuals toward improved health outcomes.

Experience speaking with members about chronic disease management (required) Experience educating the geriatric population on lifestyle goals (required) Passionate about working with and adjusting coaching techniques for underserved populations (required) Chronic care management (CCM) experience (preferred) Health Coaching Certification or Bachelors in Health and Wellness (required) At least 1 year of recent health coaching experience (required) Bilingual in English AND Spanish (required) Motivational interviewing training/experience Customer-centric focus with ability to build relationships and gain trust quickly Proven administrative abilities, with strong computer and software application skills Meeting and maintaining high quality standards while achieving individual and team targets Meeting and maintaining daily/weekly and monthly individual performance goals Demonstrate flexibility and work collaboratively with other disciplines to ensure the holistic needs of the members are met. The ability to work independently and is organized, tech-savvy, and highly motivated to meet company goals

Work with individuals to help them improve their health and manage their chronic medical conditions Follow up with your members to provide ongoing support and ensure their success in meeting their health goals Empower members to become an active participant in their own health outcomes Assist member in overcoming barriers to better health Utilize biometric values and motivational interviewing techniques to collaborate with members to drive to improve clinical and health outcomes Update and maintain members' care team profiles, documenting any changes in health conditions or events to ensure accurate and coordinated care.

Vesta Healthcare

Mandarin Bilingual Health Coach (Remote)

Posted on:

April 23, 2025

Job Type:

Full-Time

Role Type:

Coaching

License:

None Required

State License:

New York

Vesta Healthcare is a specialized medical group dedicated to enhancing the lives of individuals with long-term home care needs. By collaborating closely with caregivers and leveraging innovative technology, Vesta transforms the home into a comprehensive care setting. Named after the Roman Goddess of home, hearth, and family, Vesta Healthcare offers caregivers, patients, and family members personalized support and guidance through a dedicated clinical team, ensuring that care recipients receive the highest quality care in the comfort of their own homes.

A Health Coach who is passionate about working closely with members and caregivers to support them on their journey to manage their chronic conditions and acute exacerbations. This Health Coach is excited by working as part of a team to build relationships and coach individuals toward improved health outcomes.

Experience speaking with members about chronic disease management (required) Experience educating the geriatric population on lifestyle goals (required) Passionate about working with and adjusting coaching techniques for underserved populations (required) Chronic care management (CCM) experience (preferred) Health Coaching Certification or Bachelors in Health and Wellness (required) At least 1 year of recent health coaching experience (required) Bilingual in English AND Mandarin (required) Motivational interviewing training/experience Customer-centric focus with ability to build relationships and gain trust quickly Proven administrative abilities, with strong computer and software application skills Meeting and maintaining high quality standards while achieving individual and team targets Meeting and maintaining daily/weekly and monthly individual performance goals Demonstrate flexibility and work collaboratively with other disciplines to ensure the holistic needs of the members are met. The ability to work independently and is organized, tech-savvy, and highly motivated to meet company goals

Work with individuals to help them improve their health and manage their chronic medical conditions Follow up with your members to provide ongoing support and ensure their success in meeting their health goals Empower members to become an active participant in their own health outcomes Assist member in overcoming barriers to better health Utilize biometric values and motivational interviewing techniques to collaborate with members to drive to improve clinical and health outcomes Update and maintain members' care team profiles, documenting any changes in health conditions or events to ensure accurate and coordinated care.

Vesta Healthcare

Health Coach (Remote)

Posted on:

April 23, 2025

Job Type:

Full-Time

Role Type:

Coaching

License:

None Required

State License:

New York

Vesta Healthcare is a specialized medical group dedicated to enhancing the lives of individuals with long-term home care needs. By collaborating closely with caregivers and leveraging innovative technology, Vesta transforms the home into a comprehensive care setting. Named after the Roman Goddess of home, hearth, and family, Vesta Healthcare offers caregivers, patients, and family members personalized support and guidance through a dedicated clinical team, ensuring that care recipients receive the highest quality care in the comfort of their own homes.

A Health Coach who is passionate about working closely with members and caregivers to support them on their journey to manage their chronic conditions and acute exacerbations. This Health Coach is excited by working as part of a team to build relationships and coach individuals toward improved health outcomes.

Experience speaking with members about chronic disease management (required) Experience educating the geriatric population on lifestyle goals (required) Passionate about working with and adjusting coaching techniques for underserved populations (required) Chronic care management (CCM) experience (preferred) Health Coaching Certification or Bachelors in Health and Wellness (required) At least 1 year of recent health coaching experience (required) Bilingual in English AND Spanish OR Mandarin (preferred) Motivational interviewing training/experience Customer-centric focus with ability to build relationships and gain trust quickly Proven administrative abilities, with strong computer and software application skills Meeting and maintaining high quality standards while achieving individual and team targets Meeting and maintaining daily/weekly and monthly individual performance goals Demonstrate flexibility and work collaboratively with other disciplines to ensure the holistic needs of the members are met. The ability to work independently and is organized, tech-savvy, and highly motivated to meet company goals

Work with individuals to help them improve their health and manage their chronic medical conditions Follow up with your members to provide ongoing support and ensure their success in meeting their health goals Empower members to become an active participant in their own health outcomes Assist member in overcoming barriers to better health Utilize biometric values and motivational interviewing techniques to collaborate with members to drive to improve clinical and health outcomes Update and maintain members' care team profiles, documenting any changes in health conditions or events to ensure accurate and coordinated care.

Vesta Healthcare

Spanish Bilingual Triage Registered Nurse (Remote)

Posted on:

April 23, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Vesta Healthcare is a specialized medical group dedicated to enhancing the lives of individuals with long-term home care needs. By collaborating closely with caregivers and leveraging innovative technology, Vesta transforms the home into a comprehensive care setting. Named after the Roman Goddess of home, hearth, and family, Vesta Healthcare offers caregivers, patients, and family members personalized support and guidance through a dedicated clinical team, ensuring that care recipients receive the highest quality care in the comfort of their own homes.

The ability to commit to a full-time opportunity working 8, 10, or 12 hour shifts during the daytime on weekdays and commit to four weekend shifts per month (required) Has a Compact AND New York nursing license (required) Is bilingual and fluent in both English AND Spanish (required) Graduated from an accredited nursing program (required) At least 2 years of nursing experience providing care to adult and geriatric patient populations (required) Confidence with clinical skills in performance of telephonic triage/assessment (required) The ability to work remotely and has a private area in their home/workspace (required) A genuine, compassionate desire to serve others and help those in need High speed home WiFi/data connection to support company provided IT equipment

Plan and conduct intervention opportunity evaluations, respond to urgent alerts and remote patient monitoring alerts as needed to help drive high quality care at a lower cost Have the ability and skill to recognize clinical scenarios that require escalation to the internal team nurse practitioner Work directly with the member, via various forms of communication, texting, virtual visits, and telephone, to develop and achieve patient centered chronic care management goals Develop and update care plans for members while keeping a close eye on caregiver and/or family support Apply clinical experience and judgment to the utilization management/care management activities Be responsible for day to day work with patients related to interventions needed for quality outcomes to reduce avoidable admissions, readmissions and ED utilization. Collaborate with engagement and product teams to promote quality outcomes, optimize service experience, and promote effective use of resources for complex or elevated medical issues

Guideway Care

Triage LPN [Full-Time]

Posted on:

April 23, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

LPN/LVN

State License:

Compact / Multi-State

At Sequence Health, we are passionate about improving the patient healthcare journey through innovative, high-touch care navigation and triage services. Since 2004, we’ve partnered with healthcare organizations nationwide to deliver measurable results through operational efficiency, patient engagement, and clinical support. Our culture is grounded in integrity, excellence, and compassion. We pride ourselves on attracting professionals who are detail-oriented, proactive, and driven by a shared mission to positively impact patients and their families.

We are seeking a dedicated and compassionate Licensed Practical Nurse (LPN) to join our nationally recognized triage team. This remote position offers the opportunity to deliver impactful, protocol-based support to patients while working in a collaborative, virtual care environment. As a Triage LPN, you will perform focused clinical assessments within your scope, provide non-emergent care guidance, and facilitate timely communication between patients and providers. You’ll play an essential role in care coordination—helping patients navigate next steps, follow-up needs, and provider communications with empathy and precision.

Required Qualifications: Active, unencumbered LPN license in a compact licensure state. Minimum of 5 years of LPN experience, preferably in primary care, community health, care coordination, or ambulatory settings. Previous telephone triage or remote patient interaction experience strongly preferred. Excellent verbal and written communication skills, with a professional and empathetic tone. High level of comfort using technology, including EMRs (e.g., Epic, Cerner, Greenway) and Microsoft Office tools. Strong attention to detail, time management, and critical thinking within the LPN scope of care. Remote Work Requirements: A dedicated, HIPAA-compliant home workspace free from distractions. Ability to securely house company-provided equipment. High-speed internet access (minimum: download speed of 24 Mbps / upload speed of 4 Mbps). Must be located within the United States; no visa sponsorship available. Physical Requirements: Ability to sit for extended periods during call coverage. Adequate hearing and vision to use a computer, telephone, and other digital tools effectively. Comfortable wearing a headset for prolonged periods.

Conduct telephonic and secure message-based interactions with patients to gather clinical information and assess health concerns using approved protocols. Triage patient needs within the LPN scope of practice and escalate to a Registered Nurse or provider when clinical judgment or higher-level assessment is required. Educate patients on self-care, appointment scheduling, and follow-up instructions as directed by care pathways or provider guidance. Accurately document interactions and actions in the electronic medical record (EMR) in a timely and professional manner. Facilitate provider communication and assist with routing clinical questions, refills, and documentation needs (FMLA, ADA, STD/LTD). Contribute to quality outcomes and service excellence by collaborating across care teams and aligning with clinical best practices. Maintain compliance with HIPAA and company confidentiality standards while working in a remote setting. Any other duties nessessary to drive our values, fulfill our mission, and abide by our company values.

By the Bay Health

Hospice Triage RN - Remote

Posted on:

April 23, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

California

By The Bay Health, a non-profit established in 1975, set the standard for hospice in the U.S. by emphasizing the role of the patient in making important medical decisions. Our spectrum of home-based services now includes Skilled Home Health Care, Palliative Care, Adult Hospice Care and Pediatric Care. Our team approach strives to address practical, social, emotional and spiritual aspects of care, with the goal to maximize quality of life for our patients, caregivers and families.

This full-time position offers competitive pay, generous benefits and a supportive work environment. We are seeking the Triage RN will receive phone calls from hospice patients and families. They will assess the needs of the patient and family and coordinate the needed care and/or scheduling home visits as needed. Schedule: Monday - Friday; 8:30am - 5:00pm Location: Remote By the Bay Health follows all CDPH vaccine requirements for healthcare personnel.

Education/Experience: Bachelor’s degree in nursing from an accredited nursing program Minimum of three (3) years of experience as a professional nurse within the last five (5) years At least one (1) year of hospice or palliative care experience Experience working effectively with an interdisciplinary group Certificates, Licenses, Registrations: Current license as a registered professional nurse in the State of California CHPN certification

Receives phone calls from hospice patients and families Assesses the needs of the patients and families to coordinate needed care over the phone and scheduling visits as needed Managing patients’ pain and symptoms pursuant to physicians’ orders; obtaining changes in orders as need and updating the patient’s plan of care and medication list accordingly Assessing the patient and family’s needs for home visits, contacting the appropriate clinicians to schedule the visit, and notifying the patient and family of expected visit times

IntellaTriage

Remote Hospice Triage RN- PT 2 shift 3:30p-9:30p + rotating Sat & Sun 3:

Posted on:

April 23, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

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

We invite you to join our growing team! IntellaTriage Nurses enjoy the benefits of working from home, providing care, without the stress and expense of commuting each day! MUST have or be willing to obtain a Compact RN license MUST live in/work from a Compact US state Experience with end-of-life care is required Must have high speed internet Must be tech savvy, enjoy a fast-paced environment, and have keyboard competence Part-time nurses only work 6 days out of a 14-day pay period Part- time schedule: Work a minimum 2 evening shift weekly 3:30p-9:30p CST (shift times are set/ week day flexes) Work every other weekend, both Saturday and Sunday 3:30p-12a CST

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

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

CorsoCare

Nurse Triage - PRN (7a-7p Weekend Shifts)

Posted on:

April 23, 2025

Job Type:

Role Type:

Triage

License:

LPN/LVN

State License:

Compact / Multi-State

Nurse On Call Line - PRN (7a-7p Weekend Shifts) Department: WELLNESS - STAFF Location: START YOUR APPLICATION CorsoCare Staffing Agency Nurse on Call (LPN or RN) REMOTE OPPORTUNITY - WORK FROM HOME. MUST be in EST or CST time zones Position Summary: The CorsoCare Nurse On Call is responsible for the overall direction and clinical support for questions in the phone queue, providing assessments and evaluations according to the urgency and need, review of chart audits and coordinating orders. They are responsible for delivering a 1440 experience, optimizing efficiency and prioritizing urgency of tasks. CorsoCare Nurse On Call Line reports to the Staffing Agency Director.

Compact Licensed Practical Nurse (LPN) or Registered Nurse (RN) required. Leadership experience preferred. Proven ability to complete assessments, evals and chart audits. Ability to work successfully through complex issues; problem solve. Proven organizational and communication skills. Basic computer skills and ability to learn in house systems (e.g. YARDI, Point Click Care) Proven high performer. Accountability for CorsoCare Nurse On Call Line: Understanding and leading to our 1440 care standards: advanced knowledge of policy and procedures and scope of care. Supports team and community with professional integrity and with commitment to upholding our 1440 culture and pillars. Clear Communication: Ability to communicate efficiently and effectively with community leadership team. Community Leader Partnership: Leading relationships with fellow community leaders and external partners by meeting and following through on action items. Manage Assessments Process: Conduct assessments to 1440 standards. Maintains appropriate records for new and existing residents. Provide information to community leadership team within 2 hours of assessment/eval. Phone Line: Assist with questions or assessments of QMA’s. Med Lists: Maintaining all appropriate records of med lists. Communicate with community leaders for medication efficiency, reduce PRN meds, reviewed missed med reports and provide updates by end of shift. General Working Conditions: This position entails standing for long periods of time. While performing the duties of this job, the employee is required to communicate effectively with others, sit, stand, walk and use hands to handle keyboard, telephone, paper, files, and other equipment and objects. The employee must be able to read, write, and speak fluent English. The employee is occasionally required to reach with hands and arms and push/pull equipment frequently. The employee is expected to possess good organization skills, with the ability to work under pressure and meet deadlines. The employee must be compassionate and empathetic. The employee will occasionally lift and/or move up to 50 pounds. The employee may frequently bend, reach, grasp, and climb. The employee may need to squat and kneel. The work environment requires appropriate interaction with others. The noise level in the work environment is moderate. Occasional travel to different locations may be required.

Own the relationships with your community leadership team and market wellness throughout the community by increasing visibility, credibility, and trust. Perform admission and ongoing evaluations of residents as needed, upon return from hospital or skilled environment, or change of condition (initiate care conference). Use this information to set care services within the community to meet resident needs. Develops and maintains positive relationships with residents and their families. Assists in maintaining and updating all required resident orders, med lists or point click care. Organizes, implements, and evaluates training for all new hires and existing staff. Communication of all emergency policies and provision of updated information to staff. Coordinates deliveries/pick-ups of medical equipment. Available to work a flexible schedule including on call, weekends, and holidays when necessary. Regional partnership for quality assurance. Continued process improvement. Perform other duties as necessary. Skills for Success: Applying knowledge of our business and competition to advance organization. Managing complex situations Building strong resident relationships, 1440 Care Standards. Consistently achieves results, even under tough circumstances. Planning, scheduling, and prioritizing to meet community needs Building strong teams and applying a diverse skill set to achieve goals Managing conflict resourcefully while minimizing drama. Sharing our vision and strategy to motivate others to action. Relating openly and comfortably with diverse groups of people. Understanding our organizational structure and navigates through policies, regulations, functional, community and home office team relationships. Communicating clearly and frequently. Stepping up to address difficult issues, saying what needs to be said. Being open to try new things and learns from successes and failures. Making good and timely decisions that keep the organization moving forward. Understanding budget and goals to make better business decisions. Holding self and others accountable to finishing tasks and duties. Taking on new challenges with a sense of urgency. Being flexible and approachable. Rebounding quickly from setbacks. Gaining the confidence and trust and others.

Superior HealthPlan

RN, Senior LTSS Service Care Manager - Remote

Posted on:

April 23, 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. 100% Remote Telephonic RN Case Mgt- Must reside in Texas Required Training and Work Schedule: Monday - Friday 8:00am to 5:00pm (CST)

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: RN - Registered Nurse - State Licensure and/or Compact State Licensure required NP - Nurse Practitioner - Current State's Nurse Licensure required For Superior: Resource Utilization Group (RUG) certification must be obtained within 90 days of hire required Preferred Experience: Clinical Registered Nurses with experience in Acute Care settings – Critical Care, ICU, Military, ER, Urgent Care, Surgery, Trauma, LTC, SNF, Triage Nursing, Telehealth RN, Internal Medicine, Oncology, Neuro, Ortho, PACU, Cardiac, Veterans Hospitals, Public Health, Nursing Rehab Direct RN experience working in clinical nursing phone queue environment to assess and manage member needs via clinical phone queue Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care for complex medical conditions Strong computer skills and experience working within multiple CMS databases Must be able to navigate between multiple screens, Microsoft Office applications and utilize multiple avenues of communication (e.g. phone queue, MS Teams, email, video conferencing) - 90% of the role responsibilities. Strong clinical assessment and critical thinking skills required to communicate with clinical staff, members, and providers

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. 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

Mass General Brigham

Nurse Practitioner/Physician Assistant, After Hours Call Program

Posted on:

April 23, 2025

Job Type:

Part-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Massachusetts

Mass General Brigham relies on a wide range of professionals, including doctors, nurses, business people, tech experts, researchers, and systems analysts to advance our mission. As a not-for-profit, we support patient care, research, teaching, and community service, striving to provide exceptional care. We believe that high-performing teams drive groundbreaking medical discoveries and invite all applicants to join us and experience what it means to be part of Mass General Brigham. The Mass General Brigham Medical Group is a system-led operating entity formed by Mass General Brigham to deliver high quality, low cost, innovative community-based ambulatory care. This work stems from Mass General Brigham’s unified system strategy to bring health care closer to patients while lowering total health care costs. The Medical Group provides a wide range of offerings, including primary care, specialty care, behavioral and mental health, and urgent care, both digitally as well as at physical locations in Massachusetts, New Hampshire, and Maine. The group also offers outpatient surgery and endoscopy, imaging, cardiac testing, and infusion. We share the commitment to delivering a coordinated and comprehensive experience across all locations, ensuring the appropriate level of care is available to every patient across our care delivery sites.

Our After Hours Call Program aims to provide virtual visits, telephonic support, and clinical guidance to our patients when our primary care practices aren’t open (evenings, nights, weekends, and holidays). If you are a Nurse Practitioner or Physician Assistant looking for an opportunity to work from the comfort of your own home, we are seeking experienced, autonomous APPs to field calls and conduct virtual visits within a clinically appropriate scope. All of our clinical staff members have access to Schmitt-Thompson triage guidelines/protocols, as well as comprehensive patient information via our fully integrated EMR system, Epic. We support the following Mass General Brigham entities: North Shore Physicians Group Mass General Physicians Organization Newton Wellesley Medical Group Mass General Brigham Community Physicians Pentucket Medical Associates Cooley Dickinson Medical Group Harbor Medical Associates Wentworth Health Partners Due to the remote nature of the role, we ensure that our employees receive required technology and training to be proficient and independently productive in all job responsibilities regardless of work location. Employees are responsible for designating a workspace within the remote work location that is private, safe, ergonomic, and free from distractions for all hours worked. At this time, we are looking for per diem weekend coverage with a commitment of 16 hours per month. The shifts are 8 hours in duration between the hours of 8:00am-6:00pm on Saturdays and Sundays. Our per diem APPs are also required to work a minimum of 20 holiday hours per year. Bring your skills to this innovative program and join us in driving medicine forward!

Performs other duties as assigned Complies with all policies and standards Does this position require Patient Care (indirect/direct)? Yes Education: Master's Degree Nursing required Can this role accept experience in lieu of a degree? No Licenses and Credentials: Class D Passenger Vehicle Driver's License [State License] - Generic - HR Only preferred Registered Nurse [RN - State License] - Generic - HR Only preferred Basic Life Support [BLS Certification] - Data Conversion - Various Issuers preferred Nurse Practitioner [NP] / Advanced Practice Registered Nurse [APRN] [State License] - Generic - HR Only preferred Nurse Practitioner [NP] / Advanced Practice Registered Nurse [APRN] [State License] - Generic - HR Only preferred Experience: 3 years of licensed nurse practitioner experience required Knowledge, Skills and Abilities: Skilled in taking medical histories to assess medical condition and interpret findings. Ability to maintain quality control standards. Ability to react calmly and effectively in emergency situations. Ability to interpret, adapt and apply guidelines and procedures. Ability to communicate clearly and establish/maintain effective working relationships with patients, medical staff and the public. Ability to triage patients of all ages Experience with Epic EMR

The Nurse Practitioner (NP) is a licensed provider. The NP is responsible for the assessment and management of various populations of patients, medical and/or surgical, including diagnostic and therapeutic interventions, development of appropriate plans of care and ongoing evaluation. May also perform additional duties, such as precepting a small group of learners. Essential Functions: Provides direct care, counseling, and teaching to a designated patient population in the ambulatory, inpatient, operative, and/or procedural setting. Performs complete histories and physical examinations. Orders, interprets, and evaluates appropriate laboratory and diagnostic tests. Develops appropriate plans of care and follow-up based on the outcomes of diagnostic, laboratory, and physical examination findings. Orders medications and writes prescriptions according to organizational and regulatory policies and procedures. Consistently provides high quality and timely documentation including admission and progress notes, procedure notes, operative notes and discharge summaries. Performs bedside procedures as are appropriate to the patient population.

Pella Regional Health

TRIAGE NURSE

Posted on:

April 23, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Iowa

Pella Regional Health Center is a private, non-profit provider of health care accredited by The Joint Commission. Since opening in 1960, Pella Regional has grown from a facility to care for the acutely ill to a system that includes the hospital, outpatient services and medical clinics. The hospital is operated as a Critical Access Hospital, staffing 25 acute-care beds. Pella Regional Health Center offers a wide range of quality health care services for every member of your family—through every phase of life. From newborns to seniors, we can accommodate your health care needs. Not only do we offer the latest in modern technology and medical procedures, we’re focused on providing compassionate care to our patients, residents and their families. We have clinics in six communities (Bussey, Sully, Knoxville, Pella, Ottumwa, Prairie City) and outpatient services like Hospice of Pella and Home Health Care that extend well beyond the walls of the hospital.

Graduate of an accredited RN program. Current RN license in the state of Iowa. 3 years of clinical experience in acute or ambulatory care setting preferred. Acute care and/or Home Health nursing for cardiac or diabetic patients – or prior phone triage, ER triage, MD office triage, combined Adult/Pediatric experience preferred. Superior nursing process skills and patient service drive. Current American Heart Association (AHA) Heart Code BLS required. New employees certify within three (3) months after hire date. Positive, enthusiastic, helpful, fun-seeking personality. Organized, able to set priorities and work effectively under pressure with minimum supervision. Works well as a team member. Must have or quickly develop an ability to think, converse, and type simultaneously while utilizing excellent telephone communication skills and customer focused interpersonal relationship skills. Basic PC skills and comfort with Windows Operating Systems. Membership in a professional organization or certification in a specialty is highly desired.

This position is primarily responsible in taking live calls for clinic patients; to provide over the phone assessment, and triage through an active listening and questioning process; documenting in real-time all patient phone encounters and providing home care instruction based on established protocol, scheduling appointments or referring to the providers for direction as appropriate. This position maintains responsibility for the patient medical record and documentation.

Acentra Health

Sanction Specialist (RN - Remote)

Posted on:

April 22, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Virginia

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

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

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

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

Optum

LVN Case Manager - Remote PST

Posted on:

April 22, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

LPN/LVN

State License:

California

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

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

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

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

Ascendion

Outpatient UM Nurse

Posted on:

April 22, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

California

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

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

Evry Health

REMOTE: Care Coordination RN

Posted on:

April 22, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

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

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

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

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

Alignment Health

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

Posted on:

April 22, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

California

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

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

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

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

Wellbox Health

LPN/LVN - Care Coordinator (MST/PST)

Posted on:

April 22, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Compact / Multi-State

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

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

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

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

Millennium Physician Group

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

Posted on:

April 22, 2025

Job Type:

Full-Time

Role Type:

Primary Care

License:

None Required

State License:

Florida

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

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

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

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

ExamWorks

Nurse Planner (28879)

Posted on:

April 22, 2025

Job Type:

Role Type:

Clinical Operations

License:

RN

State License:

Georgia

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

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

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

Wellbox Health

Patient Care Coordinator ( LPN/LVN )

Posted on:

April 22, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

Compact / Multi-State

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

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

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

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

Sanford Health

APP - Certified Nurse Practitioner | Virtual Care

Posted on:

April 22, 2025

Job Type:

Full-Time

Role Type:

License:

NP/APP

State License:

South Dakota

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

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

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

Niklife Home Care Inc

RNs, LPNs, New grads welcome .

Posted on:

April 22, 2025

Job Type:

Full-Time

Role Type:

Primary Care

License:

RN

State License:

Illinois

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

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

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

Gallagher Bassett

Nurse Consultant - Brooklyn

Posted on:

April 21, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

New York

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

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

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

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

Family Home Health and Hospice

Triage Hospice Nurse (Weekends)

Posted on:

April 21, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Illinois

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

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

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

STRIDE Community Health Center

Triage and Advice Registered Nurse - Remote

Posted on:

April 21, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

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

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

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

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

Headlands ATS

Remote Triage Nurse - Overnight

Posted on:

April 21, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

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

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

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

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

Lifespark Group LLC

Population Health: Triage Nurse (RN)

Posted on:

April 21, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Minnesota

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

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

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

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

SCAN Health Plan

Clinical Care Manager

Posted on:

April 21, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

California

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

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

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

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

SCAN Health Plan

Sr. Director Network Quality and Clinical Strategy

Posted on:

April 21, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

None Required

State License:

California

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

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

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

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

SCAN Health Plan

RN Triage- Embrace CareConnect (Remote)

Posted on:

April 21, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

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

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

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

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

HERO Crisis Residential Homes LLC

Telehealth Registered Nurse(Virginia Only)

Posted on:

April 21, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

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

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

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

New Perspective Senior Living

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

Posted on:

April 20, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Minnesota

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

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

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

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

CareBridge Health

CareBridge RN Triage Nurse, 100% Virtual

Posted on:

April 20, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

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

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

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

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

CareBridge Health

CareBridge Clinical Quality Consultant Nurse Practitioner

Posted on:

April 20, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

NP/APP

State License:

Indiana

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

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

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

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

CareBridge Health

CareBridge Bilingual Nurse Practitioner, 100% Remote

Posted on:

April 20, 2025

Job Type:

Full-Time

Role Type:

Primary Care

License:

NP/APP

State License:

Compact / Multi-State

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

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

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

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

CareBridge Health

CareBridge Nurse Practitioner, 100% Remote

Posted on:

April 20, 2025

Job Type:

Full-Time

Role Type:

Primary Care

License:

NP/APP

State License:

Compact / Multi-State

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

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

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

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

Geisinger

Wellness Associate II (work from home Northcentral Pennsylvania resident)

Posted on:

April 20, 2025

Job Type:

Full-Time

Role Type:

License:

None Required

State License:

Pennsylvania

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

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

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

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

Geisinger

RN - Performance Improvement Coordinator

Posted on:

April 20, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Pennsylvania

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

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

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

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

IQVIA

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

Posted on:

April 20, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Texas

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

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

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

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

Actalent

RN Clinical Documentation Specialist- REMOTE

Posted on:

April 20, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Conneticut

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

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

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

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

Actalent

Remote PAC Nurse

Posted on:

April 20, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Florida

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

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

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

ICONMA

Clinical Review Registered Nurse

Posted on:

April 20, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

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

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

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

The Judge Group

Case Manager RN

Posted on:

April 20, 2025

Job Type:

Contract

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

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

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

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

Matrix Medical Network

Nurse Practitioner - PRN

Posted on:

April 19, 2025

Job Type:

Part-Time

Role Type:

Primary Care

License:

NP/APP

State License:

Ohio

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

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

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

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

Medix™

Prior Authorization Nurse - 241209

Posted on:

April 19, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

California

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

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

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

Medasource

Part-Time CDI Nurse

Posted on:

April 19, 2025

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

RN

State License:

Indiana

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

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

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

Managed Resources

Clinical Appeals Nurse

Posted on:

April 19, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

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

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

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

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

Akkodis

Grievance and Appeals Nurse

Posted on:

April 19, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

California

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

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

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

Vaya Health

Innovations Care Manager (Rockingham County, NC)

Posted on:

April 19, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

North Carolina

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

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

Vaya Health

GERO Nurse (Remote - Asheville, NC)

Posted on:

April 19, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

North Carolina

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

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

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

Evolent

Clinical Letter Writer - UM & Specialty Experience is a MUST

Posted on:

April 19, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

Virginia

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

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

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

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

Evolent

Clinical Letter Writer PT Role -UM Experience Essential

Posted on:

April 19, 2025

Job Type:

Part-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

Virginia

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

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

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

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

Evolent

Clinical Reviewer, Nurse

Posted on:

April 19, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

Virginia

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

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

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

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

Elevate Patient Financial Solutions®

Nurse Auditor

Posted on:

April 18, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Texas

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

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities. Utilization Review Case Management Preparing and submitting Authorizations Use of InterQual and/or MCG Inpatient Clinical Experience Registered Nurse; or Licensed Vocational Nurse Remote and Hybrid positions require a home internet connection that meets the company’s upload and download speed criteria.

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

Actalent

PAC Nurse

Posted on:

April 18, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Florida

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

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

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

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

Molina Healthcare

Clinical Appeals Nurse (RN)

Posted on:

April 18, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Wisconsin

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

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

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

Accuhealth is Becoming TelliHealth

Remote Patient Monitoring Nurse

Posted on:

April 18, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

Texas

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

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

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

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

Kouper

LPN Care Navigator (Bilingual)

Posted on:

April 18, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

LPN/LVN

State License:

Compact / Multi-State

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

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

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

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

TekWissen ®

Clinical Review Registered Nurse

Posted on:

April 18, 2025

Job Type:

Contract

Role Type:

Utilization Review

License:

RN

State License:

Vermont

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

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

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

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

Hana

Chronic Care Nurse

Posted on:

April 18, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

New York

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

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

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

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

Molina Healthcare

Care Review Clinician, Prior Auth Nurse

Posted on:

April 18, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

Texas

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

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

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

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

BROADWAY VENTURES, LLC

Remote RN – Medical Claims Reviewer

Posted on:

April 18, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

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

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

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

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

Let's Create SUCCESS

Remote Nurse

Posted on:

April 18, 2025

Job Type:

Contract

Role Type:

Leadership / Management

License:

RN

State License:

Texas

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

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

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

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

PeaceHealth

LPN Triage Nurse Remote

Posted on:

April 18, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

LPN/LVN

State License:

Washington

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

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

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

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

Roze Room Hospice of San Gabriel Valley

Triage RN

Posted on:

April 17, 2025

Job Type:

Role Type:

Triage

License:

RN

State License:

California

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

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

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

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

Momentum Life Sciences

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

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Indiana

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

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

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

1ST CALL TRIAGE LLC

Telephone Triage Registered Nurse

Posted on:

April 17, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

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

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

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

Seva Medical

Remote RN – After hours On-Call Triage Nurse

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

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

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

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

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

Elevance Health

LTSS Service Coordinator Assessment RN

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

New York

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

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

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

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

Actalent

Telehealth Nurse

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Missouri

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

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

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

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

Molina Healthcare

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

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

LPN/LVN

State License:

Mississippi

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

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

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

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

Groups Recover Together

Population Health Coordinator

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Maine

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

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

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

Groups Recover Together

Staff Provider - Indiana (APRN/NP)

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

NP/APP

State License:

Compact / Multi-State

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

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

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

MetaPhy Health

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

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Compact / Multi-State

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

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

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

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

MetaPhy Health

Enrollment Bilingual LPN - Remote! *TN Only*

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Compact / Multi-State

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

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

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

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

MetaPhy Health

Enrollment LPN - Remote! *TN Only*

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Compact / Multi-State

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

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

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

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

MetaPhy Health

Follow-Up LPN- Remote! *Tennessee Only*

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Compact / Multi-State

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

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

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

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

MedWatch, LLC

Disease Manager RN

Posted on:

April 17, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Florida

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

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

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

MedWatch, LLC

Disease Manager (Chronic Condition Case Manager)

Posted on:

April 16, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Florida

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

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

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

MedWatch, LLC

Case Manager RN

Posted on:

April 16, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Florida

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

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

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