Banner Health

Registered Nurse RN Triage Northern Colorado

Posted on:

December 11, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

At Banner Medical Group, you'll have the opportunity to perform a critical role in the community where you practice. Banner Medical Group provides both primary and specialty care throughout the communities in which Banner Health operates. We do this in a variety of settings - from smaller group practices like our Banner Health Clinics in Colorado and Wyoming, to large multi-specialty Banner Health Centers in the metropolitan Phoenix area. We currently have more than 1,000 physicians and more than 3,500 total employees in our group and are seeking others to enhance our ability to deliver our nonprofit mission of providing excellent patient care.

A rewarding career that fits your life. Those who have joined the Banner mission come from all walks of life, united by the common goal: Make health care easier, so life can be better. If changing health care for the better sounds like something you want to be part of, apply today. Located just 45 minutes north of Denver, Northern Colorado offers trendy restaurants, a thriving retail sector, and endless cultural amenities. Between wildflower-filled meadows and spectacular views of the Rocky Mountains, you will find adventures by horse, mountain bike and boat plus, endless hiking trails and world class skiing. We currently have a part-time opening for a Triage RN, working remote/hybrid! This position will support Northern Colorado clinics by taking incoming calls from patients, answering questions and triaging the call/patient appropriately. The preferred candidate for this role will have a strong RN background in various roles. Location: Must be located in Northern Colorado to support on-site requirements, when needed. Will primarily work remote. Must have reliable internet (NO WIFI, Ethernet Connection only) and a quiet work area/home office. Shift: Monday/Thursday/Friday, 8am - 4:30pm POSITION SUMMARY: This position manages incoming member/patient calls to evaluate call purpose and acuity utilizing established protocols and nursing assessment. Recommends appropriate care disposition and follows up as necessary to promote positive outcomes for member/patient. This position also utilizes protocols to assess the situation and provides treatment recommendations, options and ultimate care resolution. This includes reviewing caller’s relevant health care information, as well as documenting the purpose, information and resultant disposition of the call. This position may provide education to the public or other health professionals and participate in continuous quality improvement projects. May also facilitate appropriate referrals to physicians, services, and facilities, and/or directs individuals to other departments or services that may meet the needs and treatment recommendations.

Must possess knowledge as normally obtained through the completion of a Bachelor's degree in nursing or related field. Must possess a current, valid RN license in state of practice, temporary RN license in state of practice, or compact RN licensure for current state of practice. Current BLS certification is required for state of practice. BLS certification is not required for remote workers or for team members working in the Insurance Division. Additional certification or continuing education may be required based on area of practice. Requires a proficiency level typically achieved with five years clinical experience. Requires excellent organizational skills and clinical knowledge regarding specialty care services, as well as care coordination of services, legal and financial aspects of diagnostic services and health services in specialty area. Must possess ability to make autonomous decisions utilizing excellent clinical judgment. Must possess highly effective interpersonal and communication skills. Must understand the principles of quality customer service. Requires effective communication and writing skills, good time management skills and knowledge of word processing and database software applications. Requires the ability to teach both clinical and non-clinical personnel regarding care and diagnostics services. Also requires a good understanding of process improvement. PREFERRED QUALIFICATIONS: Bachelor’s in nursing and/or recent telephone triage experience strongly preferred. Previous emergency nursing, pediatric nursing, maternal/child health, ambulatory, home health or critical care experience preferred. Bilingual ability a plus. Additional related education and/or experience preferred.

Evaluates member/patient call and needs following established protocols. Utilizes databases and best practice evidence available, as well as clinical judgment to determine purpose of the call. This also includes assessing the member’s status to provide appropriate direction toward resolution whether triaged to another source or treatment recommended. Utilizes multiple databases and electronic health systems (EHR) to research member history to provide appropriate coordinated care. Determines the acuity of situation/needs and triage callers to the appropriate level of care or call resolution. Effectively accesses symptom-based guidelines, as well as documents all calls for medical/legal purposes using appropriate tools. Documents assessment, planning, implementation and evaluation in a timely manner to ensure compliance with established policies and procedures. Documentation reflects objective/subjective data, nursing interventions and patients response and disposition plan. Actively participates in quality assurance and improvement processes to deliver excellent customer service to callers. Considers the patient/member’s physical, cultural, psychosocial, and spiritual and age specific needs when planning care or direction toward treatment or call resolution. Monitors member needs and proactively connects members with the appropriate services or contacts other departments or locations to assist with coordination of care of the patient. Provides direction and supervision to licensed and non-licensed personnel in the activities necessary to provide quality care and services. Customers are external community callers and healthcare providers as well as internal employees and physicians. Interacts with all levels of staff in a variety of departments, physicians, patients, families and external contacts, such as employees of other health care institutions, community providers and agencies, concerning the health care of the patient. Interacts with other health care providers in numerous settings in order to report and ask for or clarify information. Synthesizes and prioritizes data from multiple sources to provide support for the human response of the patient and family to changes in health status.

VDart BPM

Clinical Nurse Specialist

Posted on:

December 11, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

We extend assistance in improving business processes that empowers the organization's overall growth. Our ultimate goal is to improve corporate performance through a systematic approach.

Title: Clinical Nurse Specialist Mode : Remote Pay Rate : $37/hr on W2 REQUIRED: ACTIVE RN LICENSE (multi-state preferred)

Active RN license (multi-state preferred) OR Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC), CPC, CSS, RHIT, or equivalent credential. Minimum 3–5 years of experience in clinical coding and DRG validation. Strong knowledge of CMS guidelines, payer policies, and therapy benefit structures. Experience with reconsiderations, appeals, and code editing (CPC experience preferred). Medicaid experience strongly preferred. Ability to teach systems and code editor tools; prior coding experience required. Preferred Skills: Familiarity with state-specific coding policies and written guidelines. Knowledge of all service types and payer structures. Strong analytical and organizational skills

Perform clinical coding and DRG validation for various service types. Review claims for accuracy and severity of stay based on appropriate diagnosis codes. Apply CMS guidelines, state policies, and payer requirements in coding processes. Support appeals and reconsiderations, including Medicaid-related cases. Collaborate with vendors and internal teams on coding and editing systems. Ensure compliance with coding certifications and payer policies.

CorVel Corporation

Case Management Manager RN

Posted on:

December 11, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

North Carolina

CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

The Manager of Case Management is responsible for the total operation of their designated departments and/or offices, which may include the following functions: operations, financial performance (profit and loss), customer service, sales management, and human resources. This is a remote role.

KNOWLEDGE & SKILLS: Clear written and verbal communication skills with the ability to communicate complex ideas across multiple platforms Ability to remain poised in stressful situations and communicate diplomatically Ability to skillfully manage multiple, complex projects and competing priorities while working under pressure to meet deadlines and maintaining strong customer service orientation Ability to work independently, while remaining available to others Computer proficiency and technical aptitude with the ability to utilize Microsoft Office including Excel spreadsheets Must have technical knowledge of applicable laws, policies, and procedures in defined territory Strong interpersonal, time management and analytical skills Great attention to detail and focus on results EDUCATION & EXPERIENCE: Graduate of accredited school of nursing with a diploma/Associates degree (Bachelor of Science degree or Bachelor of Science in Nursing preferred) Current RN licensure in state of operation 3 or more years of recent clinical experience, preferably in rehabilitation National certification (CRC, CIRS, CCRN, CVE, CCM, etc.), CCM preferred 3+ years of demonstrated experience in management or supervision

Responsible for financial operations, including but not limited to: productivity, profitability, expenses, budgeting, billing, collections and day-to-day operations Responsible for new business development, including marketing and sales activities Responsible for quality of service provided Responsible for human resources matters May perform daily, weekly, monthly reviews of various reports, invoices, logs and expenses Payment of bills may be delegated to a clerical person, with final approval by manager May be required to oversee case management clinical activities (dependent on whether or not unit manager is an RN) May perform case management responsibilities Additional duties as assigned

P3 Health Partners

National Supervisor, Nurse Practitioner Call Center

Posted on:

December 10, 2025

Job Type:

Part-Time

Role Type:

Leadership / Management

License:

NP/APP

State License:

Oregon

People. Passion. Purpose. P3 Health Partners is a population health management group founded and led by fellow physicians who want to shift the industry’s focus from managing illness to cultivating wellness. We are health plan agnostic and work with most plans in our markets. As the conduit between you and the health plan, we want to make a difference where it counts - with your patients, their families, and the communities where we live. The mission of P3 is simple. We want to help providers and their patients embrace a new kind of care. A kind of care that gives patients the tools and resources they need to manage their long-term health and wellness.

Are you a compassionate mission-driven Nurse Practitioner looking to make a meaningful impact on the lives of complex medical patients? As the Manager of P3 Health Partners National Call Center, you’ll bring hope and healing to patients with complex medical needs. In this full-time role, you’ll be a vital member of an interdisciplinary team, transforming lives and empowering primary care physicians to deliver exceptional care to those who need it most. The goal of the Call Center is to provide afterhours telephonic or televideo care to P3 Health Partner patients across all P3 markets. The hours of operation are 5pm-8am, 7 days per week including holidays. The hours of operation and goals can be subject to change. The scope of practice for the call center includes providing care for non-life or limb threatening urgent or non-urgent concerns or triaging to an appropriate level of care. Patient and caregiver education combined with support and follow-up phone calls enhance your outcomes. The above actions, combined with preventive and timely patient care by the comprehensive care teams, afford emergency department and hospital admission avoidance which is a known factor in decreasing complications while maintaining a higher quality of life in this subset of patients. Additional accountabilities for the manager of the call center encompasses, but is not limited to, developing call center operations to include choice of operational/software systems, work flow and objective KPI dashboard development, educational development, role based handbooks, operational playbooks, hiring manager for team members, on-going education, quality of care reviews, response to call center complaints, accountability for call center KPIs and strategy, communication strategy with primary care providers/P3 IDT comprehensive care teams, work schedules, and people management. The manager of the call center will collaborate closely with market and regional leadership teams. This role has a dyad relationship with the Pacific Rim Clinical Medical Director who is accountable for overall quality of care. Some participation in the clinical call schedule is required.

Active and unencumbered nurse practitioner licenses in all states where P3 Health Partners is located Current DEA license in all states where P3 is located Experience in call center design and workflows Minimum of 5-years of call center experience preferred Minimum of 5 years of leadership experience preferred Experience in geriatric acute care Flexible and innovative driven personality Travel within the market as needed to fulfill goals or as requested Qualifications Licenses & Certifications Required: APRN-Cert Nurse Pract

In addition to the above accountabilities, you will oversee the day-to-day functions of the call center. Lead the National Call Center as a cohesive unit. Serve as a positive and collaborative leader and team member. Uphold high standards of clinical excellence within the call center. Effectively manage KPIs. Perform random and targeted case reviews ensuring integrity of patient care. Perform evaluations and provide treatment using sound clinical judgment. Identify care gaps and communicate recommended interventions to the member’s primary care provider and to the complex care team. People management team members. Triage and manage non-life or limb threatening conditions. Collaborate with interdisciplinary teams using data-driven clinical tools to support coordinated, value-based care. Collaborate with the Regional Clinical Medical Director or designee when assistance in clinical decision making is identified. Communicate opportunities to advance the clinical model. Educate P3 team members when necessary. Educate patients, their families and caretakers on health maintenance, chronic disease management, medications, and preventive care. Confidently use technology and evidence-based medicine to guide care planning and decision-making. Ensure patient privacy and adherence to all HIPAA regulations and standards for handling PHI. Participate in quality improvement initiatives, documentation audits, and other activities that support clinical excellence and operational efficiency. Maintain compliance with required trainings, timely chart closures, chart queries, meeting attendance, email responses and other requirements. Serve as a positive and collaborative leader and team member. Maintain a license and DEA certificate in good standing. Role model the P3 Health Partners core values.

Turing

Remote Nurse Practitioner - 50884

Posted on:

December 10, 2025

Job Type:

Contract

Role Type:

Primary Care

License:

NP/APP

State License:

California

Based in San Francisco, California, Turing is the world’s leading research accelerator for frontier AI labs and a trusted partner for global enterprises deploying advanced AI systems. Turing supports customers in two ways: first, by accelerating frontier research with high-quality data, advanced training pipelines, plus top AI researchers who specialize in coding, reasoning, STEM, multilinguality, multimodality, and agents; and second, by applying that expertise to help enterprises transform AI from proof of concept into proprietary intelligence with systems that perform reliably, deliver measurable impact, and drive lasting results on the P&L.

Turing is looking for candidates who have solid experience in advanced clinical practice, diagnosis, and patient management, particularly at the level expected for licensed Nurse Practitioners working in hospital, outpatient, or specialty care settings. Role Overview: In this role, you will be working on projects to help fine-tune large language models using your advanced clinical expertise and patient care experience. No prior AI experience is required. These projects will help you learn how to leverage AI to advance your field by improving clinical reasoning, diagnostic support, and patient communication.

Requirements: Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) degree. 4+ years of experience as a Nurse Practitioner in a clinical, hospital, or specialty care setting. Active NP certification and license in the U.S. (or equivalent jurisdiction). Strong English communication skills and the ability to explain complex clinical reasoning clearly and precisely. Perks of Freelancing with Turing & Offer Details: Strong compensation (exact amount varies by project). Work in a fully remote environment. Engagement type: Contractor assignment/freelancer, potentially full-time. Duration of projects: approximately 1 month (with possibility for extension). What Turing is NOT seeking from your expertise: Confidential or proprietary information from any employer, university, etc. Trade secrets or internal company or university data. Specific client information or case details. Any information that would violate NDAs, employment agreements or other confidentiality obligations.

Design and solve real-world clinical and diagnostic scenarios to test AI reasoning and accuracy. Write clear, structured explanations covering diagnosis, treatment planning, patient education, and evidence-based care. Collaborate with AI researchers to enhance models’ understanding of medical terminology, documentation, and clinical judgment. Evaluate AI-generated content for accuracy, safety, and adherence to professional clinical standards.

Aditi Consulting

Nurse RN

Posted on:

December 10, 2025

Job Type:

Contract

Role Type:

License:

RN

State License:

California

We’re the AI-powered engineering expertise behind some of the world’s most innovative companies. As their strategic digital engineering partner, we transform ambitious visions into market-leading realities across Fortune 500 enterprises and emerging leaders alike. Our intelligent solutions unlock real value at every stage of our clients’ innovations that not only elevate them to industry leadership but also create lasting value for the customers they serve and the communities they impact. With over three decades of engineering excellence across 70+ Fortune 500 enterprises and emerging companies. We design, build, and operate impactful solutions that unlock real value at every stage of our clients’ digital transformation with speed at scale. Our cross-industry expertise enables us to thoughtfully transfer best practices while delivering extraordinary experiences throughout the entire transformation journey, fostering the lasting relationships that drive sustained success.

The main function of the nurse is to provide and coordinate patient care, educate patients and the public about various health conditions, and provide advice and emotional support to patients. This person is responsible for providing simple medical care and treatment to patients.

Skills: Verbal communication skills, attention to detail, and problem-solving skills. Verbal and written communication skills, attention to detail, and problem-solving skills. Basic ability to work independently and manage one’s time. Basic knowledge of the information and techniques needed to diagnose and treat human injuries and diseases. Basic ability to analyze data and accurately document and record results. Understands the Nurse Practice Act and legal consequences of nursing action. Education/Experience: Associate’s degree in nursing required. Bachelor’s degree preferred. Nursing license required. 5-7 years’ experience required

Collect information from patients to be admitted regarding medical records, medical insurance details, and other pretreatment formalities. Record health details of patient vital signs such as height, weight, temperature, blood pressure, etc. Help patients prepare for medical examinations and take samples from patients. Take care of sanitary requirements of patients such as bathing, dressing, and other similar tasks. Observe patients, charting and reporting changes in patients’ conditions, and taking any necessary action. Assemble and use equipment such as catheters, tracheotomy tubes, oxygen suppliers, etc. Collect samples such as blood, urine, etc. and perform routine laboratory tests on samples. Give direct patient care and individual patient needs as directed by the patient care plan. Administer prescription medications and injections to patients under specific policies and procedures.

Nuvance Health

Clinical Denials Prevention & Appeals Specialist RN

Posted on:

December 10, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

New York

Nuvance Health is a system of award-winning nonprofit hospitals and outpatient healthcare services throughout the Hudson Valley and western Connecticut, including: Danbury Hospital and its New Milford campus, Norwalk Hospital and Sharon Hospital in Connecticut; Northern Dutchess Hospital, Putnam Hospital and Vassar Brothers Medical Center in New York. Nuvance Health offers the latest prevention, diagnostic, medical, surgical and rehabilitation services, including through the Cancer, Heart & Vascular and Neuroscience Institutes; and primary and specialty care services through Nuvance Health Medical Practices. Nuvance Health also provides convenient healthcare through home care, urgent care and telehealth visits.

FULL TIME DAY SHIFTS- VARIABLE HOURS / WEEKEND ROTATIONS REQUIRED Hybrid/Remote Summary: The purpose of the Denial Prevention Nurse is to ensure that all patient admissions are appropriately status within the first 12-24 hours and that ongoing communication (electronic and telephonic) with payers ensures timely approval of all hospital days, preventing delays in reimbursement. This role plays a critical part in preventing payment denials by providing timely and accurate clinical information to all payers, while ensuring compliance with CMS requirements, guidelines, and standardized published criteria to support the medical necessity of patient admission and continued hospital stays. This role will require specialized system skills, best practice application of investigating payer practices, successfully challenging payers as they prevent obstacles and deny claims and escalating any egregious payer behaviors to internal leadership for assistance in resolution.

Education Skills Experience: Bachelor’s Degree (BSN) is highly preferred. Minimum of Associate’s Degree in Nursing required when accompanied by strong demonstrated competencies and significant experience. Minimum of 5 years experience in acute care Nursing Proficiency in Milliman and InterQual Guidelines required Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting required, minimum of 4 years experience required for Associate’s Degreed individuals. PREFER: Master’s Degree in related field Required: Current RN License in Connecticut and New York InterQual/MCG proficiency testing completed (preferred); required within 1 year of hire. As certification becomes available, requirement will be revisited. Knowledge of regulatory requirements for CMS Have the positive attitude and aptitude to adapt to the continuing change in payer behaviors Recognizes that education is the responsibility of the individual as well as the organization Seeks external knowledge on payers (such as free email services as Becker’s) Must have analytical abilities to assist in obtaining solutions to problems Self-starter and highly motivated Must be able to work independently in a fast-paced environment, manage workload and prioritize work Must be able to manage multiple competing priorities and maintain calm professional demeanor during peak demand Must possess a high degree of prioritization skills Exceptional interpersonal skills to effectively communicate with the physicians, payers, and other members of the interdisciplinary care team Current working knowledge of utilization management, performance improvement and managed care reimbursement.

Review all inpatient admission and observation cases using InterQual, or Milliman Care Guidelines or CMS 2 Midnight Rule (depending on payer) within 12-24 hours of admission, seven days a week for assigned shifts. Complete an initial screening review within the first few hours of decision to admit from ED and communicate with appropriate Provider if initial status is to be re-considered. Identify incomplete clinical reviews in work queues and complete them within two hours whenever possible. If clinical information is not available by the time the lack of a review may result in a denial, escalate to the appropriate Provider/VPMA. Identify and complete clinical reviews required for submission to specific payers. Validate admission orders for all new admits/observations/outpatients daily. Ensure that the patient status order documented in the chart aligns with the MCG and/or InterQual criteria, or the CMS Two- Midnight Rule, to support the appropriate status and level of care. Prioritize review of all outpatient observation and outpatient bedded cases at least every 8 hours for conversion to inpatient status or discharge opportunities. Participate in daily Observation Huddles. Conduct concurrent reviews for all payers daily for the first three days of admission, then every 2-3 days, or more frequently if criteria are waning. Submit concurrent reviews to payers to ensure authorization of all days for per diem and percentage of charge reimbursement payers. If concurrent inpatient case does not meet medical necessity review criteria during the first level review, discuss with the attending MD to obtain additional clinical information and documentation to support inpatient level of care. If the case still does not meet, send to the Physician Advisor (PA) for a second level review. Forward cases that require secondary physician review to appropriate resource (e.g., Physician Advisor). Resolve any discrepancy at the time of review. If unable to resolve, escalate to the PA and Utilization Review (UR) Leadership. Coordinate with the care team in changing patient status, as needed. � Notify the care team when patient does not meet medical necessity per InterQual or MCG guidelines or 2 MN Rule and escalate appropriately. Document and proactively communicate relevant clinical information to payers for authorizations for treatments, procedures, and Length of Stay � submit clinical information as required by payers. Ensure completion and delivery of required patient notices (by onsite team member). These include but are not limited to: HINNs, Condition Code 44, MOON, Connecticut notice of conversion, etc. Tracking and trending all appeals and communicating on a daily/regular basis with the Denials Management team. Assists with informing Managed Care contracting team with necessary contractual language to protect organization financial position specific to inpatient medical necessity requirements. Employs creative solutions with team members and leadership to prevent denials. Performs other duties as assigned.

Sedgwick

RN Pharmacy

Posted on:

December 10, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve. Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies Certified as a Great Place to Work® Fortune Best Workplaces in Financial Services & Insurance

PRIMARY PURPOSE OF THE ROLE: To utilize evidence-based tools to evaluate the prescribed medications to ensure patient safety and quality standards are in alignment with best practice standards. ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment a are driven to deliver great work. Apply your RN clinical knowledge and experience to provide pharmacy utilization management services to ensure safety, enhance recovery and reduce time out of work. Work in the best of both worlds - a rewarding career making an impact on the health and well-being of others in a remote work environment. Enjoy flexibility and autonomy in your daily work and your career path while advocating for the most effective and efficient medical treatment for injured employees in a non-traditional setting. Enable our Caring Counts® mission supporting injured employees from some of the world’s best brands and organizations. Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service. Celebrate your career achievements and each other through professional development opportunities, continuing education credits, team building initiatives and more. Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.

EDUCATION AND LICENSING: Active unrestricted RN license in a state or territory of the United States required. Compact licensure preferred. Bachelor's degree in nursing (BSN) from an accredited college or university or equivalent work experience preferred. Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly preferred. Two (2) years of direct clinical experience as an RN is required. TAKING CARE OF YOU BY: Seeks innovative customer solutions Seeks ongoing learning as a professional and a person Thrives when solving challenging problems Seeks clear role expectations Metrics/policies/processes are helpful Seeks to contribute to a larger purpose Thrives when everyone is working towards same vision/goals Strong team and customer service orientation

Performs clinical assessments via information in pharmacy reports and medical files; assesses patient situation which may include psychosocial needs. Evaluates patient drug usage to ensure alignment with evidence-based treatment guidelines. Collaborate effectively with physicians, claims examiners, clients, vendors, supervisors and other parties as needed. Acts as a resource in consulting with the client, nursing staff and claims examiners regarding pharmacy issues. Performs prospective and retrospective drug utilization management reviews. Maintains patient privacy and confidentiality, promotes safety and advocacy and adheres to ethical, legal, accreditation and regulatory standards. We offer a diverse and comprehensive benefits including medical, dental vision, 401K, PTO and more beginning your first day.

The MedElite Group

LPN CoCM Care Coordinator (Remote)

Posted on:

December 10, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Georgia

Infinite Medical P.C. is a nationwide network of advanced practice providers and specialty clinicians committed to delivering high-quality, proactive care directly to residents in skilled nursing and long-term care facilities. Our partnership with MedElite Healthcare Management Group empowers us to focus on what matters most: providing compassionate, personalized care that meets the unique needs of each resident. Together, we champion continuous innovation and collaboration in our shared mission to redefine senior care across the country.

We are seeking a dedicated LPN CoCM Behavioral Health Care Manager to join our team. In this role, you will be responsible for reviewing patient charts and communicating with the Clinical department and providers about any irregularities as part of chronic care management.

LPN degree/ certificate required. Experience in long-term care preferred. Experience in behavioral health preferred.

Provide assessment and care management services, including: Administration of validated rating scales. Initiation of behavioral health care planning concerning behavioral or psychiatric health problems. Revision and modification of care plans for patients not progressing or whose status changes. Brief psychosocial interventions as needed. Engage in ongoing collaboration with the billing practitioner. Maintain the registry/tracking sheets. Consult with the psychiatric consultant. Maintain a continuous relationship with patients. Foster collaborative, integrated relationships with the rest of the care team. Conduct interdisciplinary care plan meetings to review patient beneficiaries.

CenterWell Pharmacy

Care Manager, Nurse 2

Posted on:

December 10, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Florida

About CenterWell Pharmacy: 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 Care Manager, Telephonic Nurse 2 , in a telephonic environment, assesses and evaluates members' needs and requirements to achieve and/or maintain optimal wellness state by guiding members/families toward and facilitate interaction with resources appropriate for the care and wellbeing of members. The Care Manager, Telephonic Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Use Your Skills To Make An Impact This position is a call center based environment. There is a set schedule that is provided daily with inbound and outbound tasks to perform. This position is for 10am-6:30pm EST three days a week M-F, and two days a week hours of 11:30am-8pm EST. There will be a Friday late night requirement on a rotation of 11:30am-8pm. There will be a Saturday rotation hours of 8:30am-12:30pm EST. Overtime is required on an as needed basis. There is a Holiday rotation that will be worked. Workable holidays for the pharmacy include Martin Luther King Day, Memorial Day, Juneteenth, 4th of July, Labor Day, The day after Thanksgiving, and New Years Day.

Must have Completed Bachelor's Degree in Nursing 3 - 5 years of clinical acute care experience Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action Must live in OH, KY, FL, AZ, TX. Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications: Experience with case management, discharge planning and patient education for adult acute care Knowledge of Milliman or Interqual Managed care experience Certified Case Manager (CCM)

The Care Manager, Telephonic Nurse 2 employs a variety of strategies, approaches and techniques to manage a member's physical, environmental and psycho-social health issues. Identifies and resolves barriers that hinder effective care. Ensures patient is progressing towards desired outcomes by continuously monitoring patient care through assessments and/or evaluations. May create member care plans. 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.

Tenavi Staffing

RN Care Manager (Contract)

Posted on:

December 10, 2025

Job Type:

Contract

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

Tenavi Staffing delivers execution-ready talent with speed, flexibility, and strategic precision — helping businesses thrive through change. Tenavi Staffing is a women-owned, modern staffing firm built on Tenacity, Navigation, and Vision. We deliver high-quality, cost-effective talent solutions for organizations that need to move fast and build smart.

The RN Care Manager is responsible for coordinating patient care, providing education, triaging condition changes, and escalating issues to the appropriate treating provider. This fully remote role serves as the primary contact for incoming patients and communicates clinical concerns while managing patient resources and services in a telehealth environment.

Experience: Minimum of 2 years of clinical experience in an acute care setting. Graduation from an accredited registered nursing program. Ability to obtain multi-state licensure and maintain associated continuing education. At least 6 months of experience in telephonic triage and patient education. Skills: Exceptional critical thinking skills Excellent verbal and written communication skills Ability to document according to general standards and follow care protocols Proficiency in using multiple technology systems to deliver patient care High proficiency in telephonic assessment, following decision support tool guidelines, and independent triage, including escalation to treating providers. Effective communication with team members regarding patient concerns and care plans. Ability to develop care plans that can be executed by multiple levels of skilled staff. Competence in creating patient centered clinical care plans customized to patient education levels and social determinants Ability to follow and initiate standing orders as appropriate. Ability to understand and troubleshoot telehealth and remote monitoring technology. Preferred Qualifications: Multi-state RN license Texas, New York, Hawaii or Connecticut nursing license Bilingual in English and Spanish (preferred) Over 2 years of experience in cardiac care Ability to obtain endorsements from other states as needed

Manages a caseload of patients, serving as an escalation point for changes in condition or higher-level care needs. Supports non-licensed staff in carrying out ongoing care management tasks. Understands condition management, associated assessments, and signs of worsening conditions. Reaches out to patients based on incoming monitoring alerts indicating a need for action. Assess physiological data and preemptively acts on concerning information. Presents patient concerns to MD/NP/PA in a standard and professional format. Follows protocols and documents any necessary deviations when necessary. Assess patient concerns and escalate to appropriate resources (e.g., device management, condition change, resource procurement). Assist with coverage in other programs as deemed necessary by Team Leads/Project Managers for urgent staffing situations. Perform other related duties as assigned.

Tenavi Staffing

Licensed Practical Nurse

Posted on:

December 10, 2025

Job Type:

Contract

Role Type:

Telehealth

License:

LPN/LVN

State License:

Texas

Tenavi Staffing delivers execution-ready talent with speed, flexibility, and strategic precision — helping businesses thrive through change. Tenavi Staffing is a women-owned, modern staffing firm built on Tenacity, Navigation, and Vision. We deliver high-quality, cost-effective talent solutions for organizations that need to move fast and build smart.

Our Client is seeking a Licensed Professional Nurse (LPN) to provide telehealth services. This fully remote position works with clinical staff to provide patient education, monitor patient conditions, and ensure condition changes are reported to the appropriate treating provider. This role works directly with patients in a telehealth environment and communicates clinical concerns to providers.

Active state LPN license (or multi-state license) is preferred. 3+ years of clinical experience as a Licensed Practical Nurse. Experience with cardiac care and heart failure is preferred

Engage patients in individualized, one-on-one sessions to reinforce care plans Deliver patient-centered nursing support Gather and update clinical information such as health history, medications, vital signs from home devices, and patient-reported symptoms during virtual visits. Guide patients in applying their care plans by offering practical strategies for healthier routines, such as diet adjustments, activity tracking, and stress management Track patient progress through scheduled follow-ups and review of monitoring data, ensuring timely communication of concerns or changes to the clinical team Provide clear education on medication schedules, recognition of early warning signs, and preventive care practices, empowering patients to manage their conditions confidently

MagnaCare

Utilization Review Nurse, Complex Care

Posted on:

December 10, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

North Carolina

At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all of your unique abilities. Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions. Come be a part of the Brightest Ideas in Healthcare™.

Current licensed Registered Nurse (RN) with state licensure. Must retain active licensure throughout employment. Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint) Must be able to work independently. Adaptive to a high pace and changing environment. Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review. Working knowledge of URAC and NCQA. 3+ years’ experience in a UM team within managed care setting. 5+ years experience in clinical nurse setting preferred. TPA Experience preferred.

Perform prospective, concurrent, and retrospective utilization reviews and first level determination approvals for members using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures. Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments. Ensure discharge (DC) planning at levels of care appropriate for the members needs and acuity and determine post-acute needs of member including levels of care, durable medical equipment, and post service needs to ensure quality and cost-appropriate DC planning. Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed. Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards and identify potential quality of care issues, service or treatment delays and intervenes or as clinically appropriate. Triages and prioritizes cases and other assigned duties to meet required turnaround times. Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations. Communications determinations to providers and/or members in compliance with regulatory and accreditation requirements. Experience with Complex Medical case reviews including but not limited to: Oncology, Clinical Trials, High Cost Medical Pharmacy and Transplants. Act as a resource for complex case discussions for all staff.

MagnaCare

Medical Utilization Management Nurse

Posted on:

December 10, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

New York

At Brighton Health Plan Solutions (BHPS), we’re creating something new and different in health care, and we’d love for you to be part of it. Based in New York City, BHPS is a rapidly growing, entrepreneurial health care enablement company bringing tangible innovation to the health care delivery system. Our team is committed to transforming how health care is accessed and delivered. We believe that cost, quality, and population health are optimized when people have long term relationships with their health care providers – and that’s why we’re creating new products that today do not exist anywhere in the New York/New Jersey market. With a growing labor business under the well-known MagnaCare brand, the launch of Create - a new marketplace of health systems focused on self-insured commercial health plan sponsors, and a successful Casualty business, we’re fiercely committed to positively impacting our partners.

BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely.

Current Licensed Practical Nurse (LPN) or Registered Nurse (RN) with state licensure. Must retain active and unrestricted licensure throughout employment. Weekend availability Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint) Must be able to work independently. Must be detail oriented and have strong organizational and time management skills. Adaptive to a high pace and changing environment- flexibility in assignment. Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review. Proficient in MCG and CMS criteria sets Experience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or elective surgical cases preferred. Working knowledge of URAC and NCQA. 2+ years’ experience in a UM team within managed care setting. 3+ years’ experience in clinical nurse setting preferred. TPA Experience preferred. *General Knowledge of HIPAA Confidentiality Laws

Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures. Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments. Collaborates with healthcare partners to ensure timely review of services and care. Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed. Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate. Triages and prioritizes cases and other assigned duties to meet required turnaround times. Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations. Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements. Duties as assigned.

MagnaCare

Behavioral Health Utilization Management Nurse

Posted on:

December 10, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

New York

At Brighton Health Plan Solutions (BHPS), we’re creating something new and different in health care, and we’d love for you to be part of it. Based in New York City, BHPS is a rapidly growing, entrepreneurial health care enablement company bringing tangible innovation to the health care delivery system. Our team is committed to transforming how health care is accessed and delivered. We believe that cost, quality, and population health are optimized when people have long term relationships with their health care providers – and that’s why we’re creating new products that today do not exist anywhere in the New York/New Jersey market. With a growing labor business under the well-known MagnaCare brand, the launch of Create - a new marketplace of health systems focused on self-insured commercial health plan sponsors, and a successful Casualty business, we’re fiercely committed to positively impacting our partners.

BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely.

Current Licensed Practical Nurse (LPN) or Registered Nurse (RN) with state licensure. Must retain active and unrestricted licensure throughout employment. Weekend availability Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint) Must be able to work independently. Must be detail oriented and have strong organizational and time management skills. Adaptive to a high pace and changing environment- flexibility in assignment. Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review. Proficient in MCG and CMS criteria sets Experience with both inpatient and outpatient reviews for Behavioral Health (examples: TMS, ECT, ABA, Psychotherapy, IOP, PHP, IP Stays, RTC), DME, Genetic Testing, Clinical Trials, Oncology, and/or elective surgical cases preferred. Working knowledge of URAC and NCQA. 2+ years’ experience in a UM team within managed care setting. 3+ years’ experience in clinical nurse setting preferred. TPA Experience preferred. *General Knowledge of HIPAA Confidentiality Laws

Performs behavioral health clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures. Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments. Collaborates with healthcare partners to ensure timely review of services and care. Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed. Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate. Triages and prioritizes cases and other assigned duties to meet required turnaround times. Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations. Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements. Duties as assigned.

TALENT Software Services

Nurse RN 3

Posted on:

December 10, 2025

Job Type:

Contract

Role Type:

Triage

License:

RN

State License:

California

TALENT Software Services is a Service Disabled Veteran-Owned Small Business (SDVOSB) providing the best IT Consulting and Professional Services nationwide for over 35 years. We are one of the most trusted partners for delivery of Project, Data Management, Application, and Infrastructure Services, TALENT staffs technologies including Java, .NET, Project Management, Analytics, Architecture, and more.

Required Skills (top 3 non-negotiables): Computer skills Good communication skills Valid CA Nursing License Preferred Skills (nice To Have) Utilization review experience preferred BSN preferred Desired Skills and Experience: RNNURSEUTILIZATION REVIEWREVIEW CASES

Triage and review cases as needed, working on prior authorisation cases following medical policy utilizing resources as needed

Merakey

LumiLink Registered Nurse Remote Weekend

Posted on:

December 9, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

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

Position Type Part-Time Shift Weekends Work Schedule Saturday and Sunday 7am-7pm Remote Double Shift Weekend position - $30.01/hr plus $3.00 Shift Differential for weekend hours. The LumiLink Registered Nurse is responsible for professionally answering LumiLink calls for health-related concerns for all contracted providers.

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

Triaging needs Clinical decision making Monitoring remote patient support system when applicable and advising the customer or their support team on actions to take for vital sign or compliance alerts Symptom-based problems, injuries, or general health questions by utilizing clinical software and guideline information

Reqroute, Inc

Fully Remote Registered Nurse

Posted on:

December 9, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Reqroute is a Staffing and Recruitment Marketing firm based in the heart of Silicon Valley in California. We enable our clients to concentrate on their core business while we look after their recruitment and staffing needs. We are a young, vibrant and dynamic organization that offers a wide range of services for the entire employment cycle. Reqroute leverages social media networks to build a Social Media Recruiting Strategy (SMRS) for your organization to help you reach the passive candidate pool and also provide services in marketing your jobs across various job search engines to further reach out to a larger target audience. We differentiate ourselves by our strong value system, commitment to our clients, strategic approach, unique search processes, accountability for our actions, tireless efforts and a strong candidate experience in finding out-performers. We uphold our values in everything we do. ReqRoute strives to develop sustainable relationships based on mutual trust, responsiveness and accountability. While we continue to expand the infrastructure and resources available to our clients, we remain nimble in our approach to customer service and the management of our relationships.

Job Title: Fully Remote Registered Nurse Employment Type: W2 contract Pay Range: $30 – $34.50/hour Location: Remote

Active RN License (Multi-state/Compact license preferred) Strong proficiency with CMS Tools (e.g., FISS, HETS, MAC portals, Medicare/Medicaid guidelines) Experience handling clinical coding–related appeals, denials, and documentation clarification Role Summary: The Clinical Nurse Specialist will support clinical documentation, coding accuracy, and appeals management for cardiothoracic and cardiovascular service lines. This role combines clinical expertise with advanced coding knowledge to ensure compliance, optimize reimbursement, and support quality and performance initiatives.

Perform detailed clinical documentation and code review for CTS/CVS cases Apply CCS expertise to ensure accuracy of ICD-10-CM, CPT, and HCPCS coding Utilize CMS tools to validate coverage, check claim status, and interpret payer policies Prepare, submit, and track clinical appeals and denials, providing strong clinical justification Collaborate with physicians, nurses, CDI teams, and revenue cycle staff for documentation clarity Ensure regulatory compliance with CMS, Joint Commission, and hospital guidelines Provide clinical insight during coding audits and quality improvement processes Maintain confidentiality and adhere to HIPAA regulations

Sutter Health

Advice Nurse, Mental Health Work From Home

Posted on:

December 9, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

California

Sutter Health is a not-for-profit, people-centered healthcare system providing comprehensive care throughout California. Sutter Health is committed to innovative, high-quality patient care and community partnerships, and innovative, high-quality patient care. Today, Sutter Health is pursuing a bold new plan to reach more people and make excellent healthcare more connected and accessible. The health system’s 57,000+ staff and clinicians and 12,000+ affiliated physicians currently serve more than 3 million patients with a focus on expanding opportunities to serve patients, people and communities better. Sutter Health provides exceptional, affordable care through its hospitals, medical groups, ambulatory surgery centers, urgent care clinics, telehealth, home health and hospice services. Dedicated to transforming healthcare, at Sutter Health, getting better never stops. Learn more about how Sutter Health is transforming healthcare at sutterhealth.org and vitals.sutterhealth.org.

The Virtual Mental Health Intake RN is a Registered Nurse who provides competent and thorough intake services by conducting initial screening of psychiatric and medical needs of all incoming referrals for psychiatric and chemical dependency admissions. Utilizes virtual assessment skills through phone triage and patient assessments including triaging patients in acute crisis and disposition to correct level of care.

DISCLAIMER: You must be a resident of one of the following states to be eligible for consideration for this position: Utah, Idaho, Arizona, and Montana. EDUCATION: Graduate of an accredited school of nursing CERTIFICATION & LICENSURE: RN-Registered Nurse of California (must be able to acquire prior to starting) RN-Registered Nurse in State of Residence PREFERRED EXPERIENCE AS TYPICALLY ACQUIRED IN: 1 year of mental health 2 years of practical nursing in a hospital, clinic, urgent care, or emergency room/department. SKILLS AND KNOWLEDGE: Professional knowledge of clinical nursing protocols, regulations and institutional standards of care and risk management with an emphasis in the areas of disease processes, emergencies, health sciences and pharmacology. Advanced clinical knowledge of medical diagnoses, procedures, protocols, treatments, and terminology, including a working knowledge of state and federal regulations and guidelines. Solid analytical and project management skills, including the ability to analyze problems, situations, practices, and procedures, reach practical conclusions, recognize alternatives, provide solutions, and institute effective changes. Communication, interpersonal, and interviewing skills, including the ability to build rapport and explain medical lab results or sensitive information clearly and professionally to diverse audiences (patients, staff, and doctors). Proficient computer skills, including Microsoft Office Suite and experience working electronic medical/health records. Work independently, as well as part of a multidisciplinary team, while demonstrating exceptional attention to detail and organizational skills. Manage multiple priorities/projects simultaneously, sometimes with rapidly changing priorities, while maintaining event/project schedules. Recognize unsafe or emergency situations and respond appropriately and professionally. Ensure the privacy of each patient’s protected health information (phi). Analyze possible solutions using precedents, existing departmental guidelines and policies, experience and good judgment to identify and solve standard problems. Build collaborative relationships with peers, physicians, nurses, administrators, and public to provide the highest quality of patient care.

Provides competent and thorough mental status assessment when an involuntary hold evaluation is required. Triages to the most appropriate level of care, according to severity of illness and determines patient placement at the appropriate level. Provides illness advice and self-care intervention, identifying resources, consulting and referring. Uses the nursing process, input from physicians, and Sutter Health's approved telephone nursing guidelines and protocols to maintain highly efficient operations, to provide quality care, and to ensure positive patient outcomes.

Personify Health

Case Manager Nurse - Part Time

Posted on:

December 9, 2025

Job Type:

Part-Time

Role Type:

Case Management

License:

RN

State License:

Rhode Island

Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.

We are seeking a Part Time Case Manager Nurse, RN to join our team on a part-time basis, working up to 29 hours per week. In this role, you will provide telephonic case management between providers, patients and caregivers to help ensure cost-effective, high-quality healthcare for health insurance plan participants. This position offers flexibility and is ideal for candidates looking for reduced hours while making an impact within the team. Evening and weekend availability may be required.

Graduation from an accredited RN program and possession of a current California RN license. Minimum of five (5) years medical/surgical or acute care experience, including two years’ experience in case management, or an equivalent combination of education and experience. Prefer case management experience, emergency room, critical care background or some other area of clinical care that is pertinent to case management. Knowledge of medical claims and ICD-10, CPT, HCPCS coding. Ability to critically evaluate claims data and determine treatment plan; discharge planning experience.

Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs. Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health and identify for participation in appropriate programs. Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short- and long-term goals. Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner; report measurable outcomes that record effectiveness of interventions. Initiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of care. Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs; provide patient/family with emotional support and guidance. Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis. Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports. Establish and maintain working relationships with healthcare providers, client/group, and patients to provide emotional support, guidance and information. Evaluate and make referrals for wellness programs. Maintain complete and detailed documentation of case managed patients in Eldorado and UM Web; maintain site specific files ensuring confidentiality; prepare reports and updates at 30-day intervals for high-risk cases and 90 days interval for low risk cases ensuring confidentiality according to Company policy and HIPAA Perform Utilization Review for assigned members. Serve as mentors to LVNs and provide guidance on complicated cases as it relates to clinical issues.

Personify Health

Utilization Review Nurse- LVN

Posted on:

December 9, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

Rhode Island

Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.

Under the supervision of a registered nurse the Utilization Review Nurse will provide professional assessment and review for the medical necessity of treatment requests and plans. This position offers flexibility and is ideal for candidates looking for reduced hours while making an impact within the team. Evening and weekend availability will be required.

The clinical foundation: Current LVN license in the United States or U.S. territory. 1+ years of clinical experience required. The professional competencies: Knowledge of medical claims and ICD-10, CPT, HCPCS coding. Proficiency in software applications including, but not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint and Outlook Excellent verbal and written communication skills Ability to speak clearly and convey complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others.

Provide first level review for all outpatient and ancillary pre-certification requests for medical appropriateness; all inpatient hospital stays including mental health, substance abuse, skilled nursing and rehabilitation for medical necessity; and all post claim or post service reviews. Ensure proper referral to medical director for denial authorizations through independent review organizations (IRO). Work with hospital staff to prepare patients for discharge and ensure a smooth transition to the next level of care. Refer requests that fall outside of established guidelines to advance review or senior care consultants. Process appeals for non-certification of services; complete non-certification letters when appropriate. Review plan document for benefit determinations; attempt to redirect providers and patients to PPO providers. Identify and refer potential cases to case management, wellness, chronic disease and Nurturing Together program. Complete documentation for all reviews in Eldorado/Episodes; maintain confidentiality. Utilize MCG guidelines, medical policies, Medscape, and NCCN. Ability to meet productivity, quality, and turnaround times daily.

Personify Health

Case Manager Nurse - LPN/LVN

Posted on:

December 9, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

LPN/LVN

State License:

Rhode Island

Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.

Case Manager Nurse LVN/LPN will provide telephonic case management between providers, patients and caregivers to help ensure cost-effective, high-quality healthcare for health insurance plan participants. . This position offers flexibility and is ideal for candidates looking for reduced hours while making an impact within the team. Evening and weekend availability may be required.

Graduation from an accredited LVN/LPN program and a current LVN/LPN license Prior experience in case management, coordinating wellness programs, or an equivalent combination of education and experience. Experience in medical, surgical, and/or acute care setting Strong understanding of how to manage cases and coordinate health programs Clear communication style and strong collaboration skills Computer proficiency and working knowledge of Microsoft Office Suite and Microsoft Outlook required. Knowledge of medical claims and ICD-10, CPT, HCPCS coding preferred. Knowledge of utilization management/quality management case philosophies and reporting requirements; quality improvement methodologies preferred. Ability to critically evaluate claims data and provide accurate patient assessment; ability to establish nursing treatment plans. Excellent interpersonal and communication skills; strong customer orientation; good time management skills; highly organized.

Manage cases on a short- and long-term basis over the phone Perform basic questionnaires and assessments to determine a patient’s diagnosis, treatments, barriers to care, and healthcare needs Works with RN Case Manager to create and implement individualized plans Educate patients on treatment and services options, navigating their health plan, benefits utilization, coordinating referrals, etc. Initiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of care Monitor interventions, evaluate the effectiveness of the treatment plan, report measurable outcomes Establish working relationships with healthcare providers, client/group, and patients to provide emotional support, guidance, and information Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health and identify for participation in appropriate programs Be able to meet productivity, quality, and turnaround time requirements on a daily, weekly, and monthly basis

North Memorial Health

Nurse, Care Access Triage

Posted on:

December 9, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Minnesota

At North Memorial Health, you’re part of an inclusive health team that is rooted in our values: Advocate Courageously, Rally Together, Respect Uniqueness and Create Impact. Empathy and care are at the heart of North’s culture which is designed to actively support each team member’s wellbeing and growth. Our strength lies in our diversity, and we embrace the unique contributions and experiences of each person. Together, we empower patients to achieve their best health. Our health system encompasses two hospital locations in Robbinsdale and Maple Grove as well as a network of 23 clinics which includes 13 primary clinics, 6 specialty clinics, 4 urgent care/urgency centers and emergency care offerings covering five counties. Our Robbinsdale Hospital, established in 1954, is a 385-bed facility recognized as the top Level 1 Trauma center for 25 years, as well as serving as a Level II pediatric trauma center. Our Maple Grove Hospital was established in 2009, is a 134-bed facility recognized as a top hospital in the state for Women and Children Care, with a Level III NICU, and is the largest Family Birth Center in the state (~5,000 deliveries per year and over 60,000 babies delivered). Both have been named to the 2022 Fortune/Merative 100 Top Hospitals® list, 2023 Women’s Choice Award Best Hospitals list. Benefits the North Way! As North Memorial Health is a non-profit organization you are eligible for the Public Student Loan Forgiveness program. Most part-time and all full-time positions are eligible for benefits. Health & Welfare Benefit Packages 401k Retirement Match or Pension Plan, based on workgroup eligibility Generous Paid Time Off (PTO) Plans Adoption Reimbursement up to $3000 per child Child Care Discount Program with New Horizon 10% off weekly childcare tuition Education/Tuition Reimbursement 24/7 Fitness Center Access for all benefit eligible team members Commitment to Diversity, Equity & Inclusion At North Memorial Health we recognize that the strength of our team lies in our diversity and make every effort to embrace the unique contributions and experiences of each person on our team. We strive to ensure that everyone feels like they are a valuable part of our community, with initiatives that reinforce our belief in diversity, equity, and inclusivity, to promote a workforce that enables authenticity, as we want to be our best when providing effective services to our patients. We acknowledge and celebrate the unique traditions, backgrounds, languages, beliefs, and customs of our community, and want everyone to feel welcome. Through our DE&I initiatives we hope to dispel myths, assumptions, and acts of implicit bias.

The Care Access Nurse Line Nurse uses the nursing process in coordinating all aspects of care for patients. The Nurse applies telephonic communication with and/or regarding an established patient or non-North Memorial established patient in which the Nurse utilzes medically approved nursing protocols to determine urgency of the customer's needs, and appropriate level of care; clinical judgement; and clinical care coordination.The Nurse works towards providing clinical support and coordination to all North Memorial Health Programs. The Nurse maximizes the customer's health outcomes by utilizing standard protocols in triaging, coordinating, and communicating patient care needs. The Nurse executes the Standards of Nursing Practice including: assessment; nursing diagnosis; outcome identification; planning, implementation; and evaluation.The Nurse will provide education, advice, and facilitate communication between patients and North Memorial Health providers, clinics, and departments. At all times, the Nurse helps to foster a team-based, supportive, and collaborative care and work environment, including documenting within the electronic medical record. The scope of practice includes the care of neonates, infants, pediatrics young adults, and older adults throughout the life cycle.

Education: Graduate from an accredited school of Nursing Experience: 3+ years of nursing experience in a hospital, acute care or clinic setting required. Experience with EPIC Electronic Health Record preferred. Knowledge, Skills and Abilities: Typing test minimum 40+ WPM required. Skilled in Microsoft Word, Excel, and Outlook email or similar email software High speed internet required (unable to support satellite internet) Ability to provide telephone nursing assessment of the actual or potential health needs of an individual and provide nursing care such as teaching, counseling, case finding and referral to other health resources and evaluates these actions. Ability to react calmly and effectively in emergency situations. Knowledge of drugs and their indication, contraindications, dosing, side effects and proper administration. Knowledge of nursing theory and practice. Knowledge of patient evaluation and triage procedures. Ability to listen, observe, assess, and record symptoms, reactions, and progress. Ability to balance, prioritize work in a rapidly changing environment. Works well independently in addition to being skilled in interdisciplinary collaboration. Demonstrates effective written and oral communication. Licensure/Certification: Current licensure as RN in State of Minnesota

The Nurse applies telephonic communication with and/or regarding an established patient or non-North Memorial established patient in which the Nurse utilzes medically approved nursing protocols to determine urgency of the customer's needs, and appropriate level of care; clinical judgement; and clinical care coordination. The Nurse works towards providing clinical support and coordination to all North Memorial Health Programs. The Nurse maximizes the customer's health outcomes by utilizing standard protocols in triaging, coordinating, and communicating patient care needs. The Nurse executes the Standards of Nursing Practice including: assessment; nursing diagnosis; outcome identification; planning, implementation; and evaluation. The Nurse will provide education, advice, and facilitate communication between patients and North Memorial Health providers, clinics, and departments. At all times, the Nurse helps to foster a team-based, supportive, and collaborative care and work environment, including documenting within the electronic medical record. The scope of practice includes the care of neonates, infants, pediatrics young adults, and older adults throughout the life cycle.

Fresh Clinics

Telehealth Nurse Practitioner – Aesthetics & Wellness

Posted on:

December 9, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Texas

At Fresh Clinics, we’re not just supporting healthcare professionals—we’re revolutionising the medical aesthetics industry. Our industry leading "clinic in a box" model equips nurse-entrepreneurs and business owners to build, scale, and thrive with confidence. Backed by world-class technology, unrivalled medical compliance support, and a thriving community of healthcare professionals, we’re empowering clinics to deliver exceptional care whilst achieving their business dreams. As one of Australia’s fastest-growing tech companies and a proud top-ten finalist in Deloitte’s Tech Fast 50 three years in a row, we’re scaling fast, making waves, and redefining a global industry. At Fresh, our culture is as bold as our mission. We “work smart, hustle hard, stay humble, and lead with kindness.” If you’re looking for a workplace that celebrates innovation, drives real-world impact, and champions your growth—welcome home.

At Fresh Clinics, patient safety and provider support go hand in hand. As a Telehealth Nurse Practitioner, you’ll be the trusted clinical voice ensuring every patient receives a thoughtful, compliant, and professional assessment before treatment begins. You will play a dual role: conducting telehealth consultations (Good Faith Exams) for aesthetic procedures, and serving as a clinical resource for providers, patients, and medical directors with questions about treatment, safety, and complication management. This is a remote, full-time position (40 hours/week), ideally based in Eastern or Central time zones to align with service coverage.

Active Nurse Practitioner license, with multi-state licensure strongly preferred. Family Nurse Practitioner (FNP), Adult-Gerontology Primary Care NP, or Women’s Health NP training/background. DEA licensure and prescriptive authority. Hands-on experience in aesthetics, dermatology, or plastic surgery. Familiarity with complication management and ability to provide first-line guidance. Strong communicator who balances professionalism with warmth. Proficiency with EMR systems and telehealth platforms. Bonus Points If You Bring: Bilingual (Spanish/English) communication skills. Experience in HRT, GLP-1s, peptides, or sexual wellness protocols. Background in SOP development, clinical coaching, or quality assurance.

Champion Patient Safety: Conduct timely and thorough telehealth consultations (Good Faith Exams) for aesthetic patients. Provide clear, compassionate communication about medical history, treatment eligibility, and safety considerations. Accurately document each exam to meet state and regulatory requirements. Act as first-line support for complication management related to aesthetic procedures, escalating cases to medical directors as needed. Answer general clinical questions from providers and medical directors, particularly those newer to aesthetics. Participate in Fresh’s Clinical Advisory Board (CAB), bringing forward insights from patient and provider interactions. Support Medspa Partners & Clinical Excellence: Act as a trusted clinical resource for medspa partners, offering guidance on protocols, patient eligibility, and complication management. Collaborate with providers and medical directors to create safe, consistent, and compliant patient experiences. Partner with the Director of Clinical Excellence to review and refine SOPs, and support onboarding of new providers. Provide clinical perspective to improve processes and training across Fresh Clinics. Stay Sharp & Current: Complete training on all aesthetic and wellness procedures supported by Fresh Clinics. Stay up to date with industry best practices, compliance regulations, and evolving state laws. Apply expertise in aesthetic procedures, hormone replacement therapy (HRT), sexual wellness, GLP-1s, peptides, and wellness care. Read and interpret labs to guide safe patient care. Continuously refine telehealth and assessment skills to deliver the best possible patient experience.

Fresh Clinics

Nurse Practitioner – Clinical GFE Support (Part-Time, Contractor)

Posted on:

December 9, 2025

Job Type:

Part-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Georgia

At Fresh Clinics, we’re not just supporting healthcare professionals—we’re revolutionising the medical aesthetics industry. Our industry leading "clinic in a box" model equips nurse-entrepreneurs and business owners to build, scale, and thrive with confidence. Backed by world-class technology, unrivalled medical compliance support, and a thriving community of healthcare professionals, we’re empowering clinics to deliver exceptional care whilst achieving their business dreams. As one of Australia’s fastest-growing tech companies and a proud top-ten finalist in Deloitte’s Tech Fast 50 three years in a row, we’re scaling fast, making waves, and redefining a global industry. At Fresh, our culture is as bold as our mission. We “work smart, hustle hard, stay humble, and lead with kindness.” If you’re looking for a workplace that celebrates innovation, drives real-world impact, and champions your growth—welcome home.

The Clinical GFE Support – Nurse Practitioner is a part-time, contractor position responsible for conducting Good Faith Exams (GFEs) for Fresh Clinics' medspa clients. The NP will be available during designated shifts each week, responding to and conducting GFEs for patients via telemedicine or other approved platforms. This role requires an NP who can efficiently provide concise, thorough, and professional patient assessments while maintaining compliance with state regulations. The NP must demonstrate strong clinical judgment, effective communication, and a professional demeanor when working with patients and medspa providers. Candidates must be licensed in the state where they will provide services and be willing to complete training on all procedures supported by Fresh Clinics to ensure consistent, high-quality patient evaluations. How We Work: Remote, part-time contractor position with scheduled shifts each week. NP must be available during their assigned shifts to answer calls and perform GFEs as needed. Reports to the Medical Director/Clinical Manager and collaborates with Fresh Clinics’ support team.

Prior experience in aesthetic medicine, dermatology, or telehealth patient assessments. Familiarity with Good Faith Exams and regulatory requirements for medspa settings. Comfort using telemedicine platforms and electronic medical records (EMR) systems. Active Nurse Practitioner (NP) license in the state of practice. Experience conducting patient assessments (telemedicine experience preferred). Ability to communicate effectively and professionally with both patients and medspa providers. Strong understanding of state regulations and compliance requirements related to GFEs and aesthetic medicine. Willingness to complete training on aesthetic procedures supported by Fresh Clinics. Ability to work independently and efficiently while managing multiple patient interactions during scheduled shifts.

Good Faith Exams & Patient Assessments: Conduct timely and thorough GFEs for medspa patients in accordance with state regulations and Fresh Clinics protocols. Utilize telehealth and other approved platforms to perform assessments and document findings. Ensure all required documentation is accurate, complete, and compliant with legal and regulatory standards. Provide clear, professional communication when discussing medical history, treatment eligibility, and patient safety considerations. Clinical Support & Professionalism: Maintain a professional and knowledgeable presence when interacting with medspa providers and patients. Offer guidance and education to medspa clients as needed regarding patient eligibility and safety protocols. Act as a trusted clinical resource for Fresh Clinics’ medspa clients, providing concise and effective medical evaluations. Demonstrate proficiency in all procedures supported by Fresh Clinics, ensuring informed and standardized patient assessments. Compliance & Training: Ensure adherence to all state-specific laws and regulations regarding GFEs and the NP’s scope of practice. Participate in training programs to maintain proficiency in aesthetic medicine assessments. Stay informed on industry best practices, compliance requirements, and evolving regulations related to Good Faith Exams and aesthetic medicine.

Fresh Clinics

Nurse Practitioner – Clinical GFE Support (Part-Time, Contractor)

Posted on:

December 9, 2025

Job Type:

Role Type:

License:

NP/APP

State License:

Washington

At Fresh Clinics, we’re not just supporting healthcare professionals—we’re revolutionising the medical aesthetics industry. Our industry leading "clinic in a box" model equips nurse-entrepreneurs and business owners to build, scale, and thrive with confidence. Backed by world-class technology, unrivalled medical compliance support, and a thriving community of healthcare professionals, we’re empowering clinics to deliver exceptional care whilst achieving their business dreams. As one of Australia’s fastest-growing tech companies and a proud top-ten finalist in Deloitte’s Tech Fast 50 three years in a row, we’re scaling fast, making waves, and redefining a global industry. At Fresh, our culture is as bold as our mission. We “work smart, hustle hard, stay humble, and lead with kindness.” If you’re looking for a workplace that celebrates innovation, drives real-world impact, and champions your growth—welcome home.

The Bilingual Nurse Practitioner – Clinical GFE Support role is a part-time, contractor position responsible for conducting Good Faith Exams (GFEs) for Fresh Clinics' medspa clients. The NP will be available during designated shifts each week, responding to and conducting GFEs for patients via telemedicine or other approved platforms. This role requires an NP who can efficiently provide concise, thorough, and professional patient assessments while maintaining compliance with state regulations. The NP must demonstrate strong clinical judgment, effective communication, and a professional demeanor when working with patients and medspa providers. Candidates must be licensed in the state where they will provide services and be willing to complete training on all procedures supported by Fresh Clinics to ensure consistent, high-quality patient evaluations. How We Work: Remote, part-time contractor position with scheduled shifts each week. NP must be available during their assigned shifts to answer calls and perform GFEs as needed. Reports to the Medical Director/Clinical Manager and collaborates with Fresh Clinics’ support team.

Bilingual in English and Spanish – this is a must for the role! Prior experience in aesthetic medicine, dermatology, or telehealth patient assessments. Familiarity with Good Faith Exams and regulatory requirements for medspa settings. Comfort using telemedicine platforms and electronic medical records (EMR) systems. Active Nurse Practitioner (NP) license in the state of practice. Experience conducting patient assessments (telemedicine experience preferred). Ability to communicate effectively and professionally with both patients and medspa providers. Strong understanding of state regulations and compliance requirements related to GFEs and aesthetic medicine. Willingness to complete training on aesthetic procedures supported by Fresh Clinics. Ability to work independently and efficiently while managing multiple patient interactions during scheduled shifts.

Good Faith Exams & Patient Assessments: Conduct timely and thorough GFEs for medspa patients in accordance with state regulations and Fresh Clinics protocols. Utilize telehealth and other approved platforms to perform assessments and document findings. Ensure all required documentation is accurate, complete, and compliant with legal and regulatory standards. Provide clear, professional communication when discussing medical history, treatment eligibility, and patient safety considerations. Clinical Support & Professionalism: Maintain a professional and knowledgeable presence when interacting with medspa providers and patients. Offer guidance and education to medspa clients as needed regarding patient eligibility and safety protocols. Act as a trusted clinical resource for Fresh Clinics’ medspa clients, providing concise and effective medical evaluations. Demonstrate proficiency in all procedures supported by Fresh Clinics, ensuring informed and standardized patient assessments. Compliance & Training: Ensure adherence to all state-specific laws and regulations regarding GFEs and the NP’s scope of practice. Participate in training programs to maintain proficiency in aesthetic medicine assessments. Stay informed on industry best practices, compliance requirements, and evolving regulations related to Good Faith Exams and aesthetic medicine.

Oracle

Senior Solution Architect, Nursing - Build, Millennium

Posted on:

December 9, 2025

Job Type:

Full-Time

Role Type:

Informatics

License:

RN

State License:

Texas

As a world leader in cloud solutions, Oracle uses tomorrow’s technology to tackle today’s challenges. We’ve partnered with industry-leaders in almost every sector—and continue to thrive after 40+ years of change by operating with integrity. We know that true innovation starts when everyone is empowered to contribute. That’s why we’re committed to growing an inclusive workforce that promotes opportunities for all. Oracle careers open the door to global opportunities where work-life balance flourishes. We offer competitive benefits based on parity and consistency and support our people with flexible medical, life insurance, and retirement options. We also encourage employees to give back to their communities through our volunteer programs.

You will be a member of a team dedicated to supporting a single, prominent client in the midwestern United States, known for the excellent care they provide to primarily underprivileged populations. The work you do will directly contribute to the client's success, both in supporting their clinicians with workflows that are efficient and pertinent, and in enabling safe, high quality patient care. The team is made up of employees in both India and the United States, and is divided into two parts: a group of analysts providing support for operationally required changes and enhancements to clinical applications, and a a group of analysts leading projects that will standardize and modernize the workflows of nurses and providers. You will be part of the second group, working with the client to localize new build and workflows. Position Overview: We are seeking a highly experienced Nursing analyst to collaborate directly with clients at a prominent academic medical center in the Midwest. This remote role will act as the primary subject matter expert and point person for multiple optimization initiatives for existing nursing applications built on the Oracle Health Millennium platform. These include, but are not limited to, multiple Essential Clinical Dataset (ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding, and various nurse chart review and documentation optimizations. The ideal candidate will leverage their significant experience in both mapping clinical workflows and performing hands on build to assess current state and plan future state needs, communicate effectively with both their teammates and client stakeholders, independently research and ask insightful questions to understand objectives, and accurately configure Millennium in order to attain the desired outcomes, high client satisfaction, and alignment with model and best practices.

Required qualifications: Current nursing license, with at least two years of experience in bedside care. Bachelor's degree in Nursing, Informatics, or a related field. 5+ years of experience in Oracle Health Millennium (formerly Cerner Millennium), with a focus on nursing support and/or implementations in healthcare settings. Hands-on experience with Millennium build, including, but not limited to, the Clinical Leader Organizer, Care Compass, IView, PowerForms, and MPages. Proven track record of working directly with clients in large academic or hospital environments on nursing and clinical application initiatives. Strong analytical skills with the ability to translate complex clinical needs into technical solutions on the Millennium platform. Excellent communication and interpersonal skills for remote collaboration, including virtual presentations and stakeholder management. Experience with healthcare regulations and governing bodies (e.g., HIPAA, CMS, The Joint Commission) and project management tools/methodologies (e.g., Agile, Waterfall). Ability to work independently in a remote setting, managing priorities across multiple initiatives. Willingness to travel occasionally if needed for on-site client engagements (though primarily remote). Preferred qualifications: Experience with implementing or supporting Multi-disciplinary Rounding. Experience with data analysis tools (e.g., LightsOn, Cerner Advance) for evaluating system configuration and adoption, and the ability to use these metrics to measure project success. Certification in Oracle Health (Cerner) Millennium or related EHR consulting credentials. Familiarity with academic medical center challenges, such as research integrations or multi-specialty workflows. Certain US customer or client-facing roles may be required to comply with applicable requirements, such as immunization and occupational health mandates. Range and benefit information provided in this posting are specific to the stated locations only US: Hiring Range in USD from $41.83 to $85.63 per hour; from: $87,000 to $178,100 per annum. May be eligible for equity. Oracle maintains broad salary ranges for its roles in order to account for variations in knowledge, skills, experience, market conditions and locations, as well as reflect Oracle’s differing products, industries and lines of business. Candidates are typically placed into the range based on the preceding factors as well as internal peer equity. The role will generally accept applications for at least three calendar days from the posting date or as long as the job remains posted.

Engage directly with clinical stakeholders, including nursing teams, physicians, and hospital leadership, to localize optimizations in installed Oracle Health Millennium applications. Lead assessments of current nursing (and related) workflows, configurations, and integrations, leading the discussion when appropriate, to recommend and implement enhancements that drive operational efficiency and patient care improvements. Manage the nursing needs for multiple concurrent optimization projects, from requirements analysis and solution design to testing, deployment, and post-implementation support. Provide expert guidance on Millennium platform customizations, including Care Compass, Clinical Leader Organizer, MPages, IView, PowerForms, and so on. Collaborate with cross-functional teams, including IT staff and end-users, to ensure seamless adoption of optimizations while minimizing disruptions. Develop training materials, conduct virtual sessions, and offer ongoing consultation to support user proficiency and system utilization. Monitor project outcomes, track key metrics, and report progress to clients and internal leadership. Stay current with relevant Oracle Health Millennium updates, industry trends, and regulatory changes to inform proactive optimization strategies.

Twin Health

Virtual Treatment Nurse- Bilingual (English/Spanish)

Posted on:

December 8, 2025

Job Type:

Full-Time

Role Type:

Primary Care

License:

RN

State License:

California

At Twin Health, we empower people to improve and prevent chronic metabolic diseases, like type 2 diabetes and obesity, with a new standard of care. Twin Health is the only company applying AI Digital Twin technology exclusively toward metabolic health. We start by building a dynamic model of each person’s metabolism — drawing on thousands of data points from CGMs, smartwatches, and meal logs — that maps their personal path to better health. Guided by a dedicated clinical care team, our members have lowered their A1C below the diabetes range, achieved lasting weight loss, and reduced or even eliminated medications, all while living healthier, happier lives. Working here: Our team at Twin Health is passionate, talented, and united by a shared purpose: to improve the metabolic health and happiness of our members. We believe in empowering every Twin to make a meaningful impact for our members, our clients, and each other, while enjoying a supportive, collaborative work environment. Twin has been recognized not only for our innovation but also for our culture, including: Innovator of the Year by the Employer Health Innovation Roundtable (EHIR), selected to CB Insights’ Digital Health 150, and named one of Newsweek’s Top Most Loved Workplace® . With more than $100 million raised in recent funding, including a $53 million Series E round in 2025 led by Maj Invest, and a $50 million investment in 2023 led by Temasek, Twin is scaling rapidly across the U.S. and globally. Backed by leading venture firms like ICONIQ Growth, Sequoia, Sofina, Temasek, and Peak XV, we are building the most impactful digital health company in the world. Join us as we reinvent the standard of care in metabolic health.

Opportunity: Join us in one of our most critical member care management roles, inspiring behavior change and motivating members to adopt new behaviors and improve their health. As an RN at Twin you make a difference in people's lives every day by providing clinical guidance, support, education, and encouragement to empower your members seeking to prevent and reverse chronic metabolic diseases and improve their overall health. This job is a great fit for you if you have expertise with building rapport with members, are highly motivated, energetic, and focused on enhancing the quality of healthcare. You have demonstrated the ability to work collaboratively with an interdisciplinary care team in the adoption of new technologies to coordinate care, engage in shared decision making, and achieve successful clinical outcomes. You are comfortable leveraging data in observing trends and developing corrective action plans to facilitate the transformation of member lives. Join Us: This is an exciting role for a Registered Nurse with a diverse healthcare systems background. Join us to use your finely-tuned skills in assessing physical and psychological-social needs. You will support a dynamic care team in identifying member goals, health priorities and learning opportunities. This will include utilizing motivational interviewing techniques and designing interventions with members to build engagement and improved health outcomes. Other skill set considerations include ability to work efficiently and with competing priorities, comfort with technology and data, as well as employing knowledge of care management principles. This role will report to a nurse manager and work within a team pod structure. A successful candidate for this role will be curious, collaborative and adaptable to member journey and team needs. You will be excited to jump into a day that may look a bit different than the day before, while making improvements along the way and building upon your highly-valued skill set. The schedule for this position is: Tuesday-Saturday, 9am-5pm CST (7am-3pm PST, 8am-4pm MST, 10am-6pm EST)

Currently active and unencumbered RN license within the state in which patient care is occurring Minimum 4 years of nursing experience in various healthcare systems such as hospitals, Federally Qualified Health Care centers, ambulatory care environments (primary care, internal medicine, family practice, surgical/multi-specialty), health payor systems (case management), etc. Experience preferred in one or more of the following areas: Case/care management, value-based care, population health, care coordination or transition care management Required, BSN or MSN from accredited school of nursing Preferably skilled in motivational interviewing and driving behavior change Comfort and enthusiasm for adopting the latest technologies and integrating data and technical outputs in patient care Demonstrated ability to manage large caseloads and effectively work in a fast paced environment Proficient with simultaneously navigating the internet and multi-tasking with multiple electronic documentation systems and business tools (Google, Slack, etc.) Comfort with ambiguity and change Experience in a high-growth, or other quickly changing environment Professional telephone and video skills Self-motivated and results-focused Client service excellence Quick learner who integrates new knowledge Organized and detail-oriented Ability to handle competing demands with diplomacy and enthusiasm Ability to work collaboratively with clinical infrastructure and hierarchies Excellent time management and ability to prioritize work assignments Passion for Twin’s purpose to transform lives by empowering people to reverse, prevent and improve chronic metabolic diseases Bilingual, fluent in Spanish required

Delivers remote clinical monitoring and member education via software, video conferencing, and the Twin Health electronic medical record Promotes member self-care management by utilizing clinical judgment, data analysis and critical thinking skills Evaluates member progress toward goal achievement, including identification and evaluation of barriers to meeting or maintaining plan of care and/or health status Prioritizes and manages individual members along the Twin journey by monitoring health condition reversal trends, conducting lab reviews, supporting medication management Collaborates closely with team colleagues including nurses, health coaches, providers, and operations teams to drive a seamless experience for members Engages the nursing philosophy to capture a holistic picture of the member’s clinical status from Intake to ongoing care management Gives appropriate health guidance by utilizing clinical knowledge, training and protocols Leverages the nursing processes to triage member alerts and inquiries Strictly adheres to Standard Operating Procedures for member management and escalations Provides timely responses and feedback to colleagues regarding member care Conducts detailed monitoring to support medication reconciliation and adherence Collaborate with members and pharmacies to identify solutions to defray costs for members and reduce gaps in coverage Organizes accurate records and maintains confidentiality according to federal law and Twin policies Generates and analyzes reports as needed for management, identifying trends, anomalies and areas of concerns Contributes to the development and improvement of clinical care that enhances cost effectiveness while ensuring quality care Participates in on-going education and performance improvement activities Additional duties as assigned

Twin Health

Virtual Treatment Nurse- Part Time Weekends

Posted on:

December 8, 2025

Job Type:

Part-Time

Role Type:

Telehealth

License:

RN

State License:

California

At Twin Health, we empower people to improve and prevent chronic metabolic diseases, like type 2 diabetes and obesity, with a new standard of care. Twin Health is the only company applying AI Digital Twin technology exclusively toward metabolic health. We start by building a dynamic model of each person’s metabolism — drawing on thousands of data points from CGMs, smartwatches, and meal logs — that maps their personal path to better health. Guided by a dedicated clinical care team, our members have lowered their A1C below the diabetes range, achieved lasting weight loss, and reduced or even eliminated medications, all while living healthier, happier lives. Working here Our team at Twin Health is passionate, talented, and united by a shared purpose: to improve the metabolic health and happiness of our members. We believe in empowering every Twin to make a meaningful impact for our members, our clients, and each other, while enjoying a supportive, collaborative work environment. Twin has been recognized not only for our innovation but also for our culture, including: Innovator of the Year by the Employer Health Innovation Roundtable (EHIR), selected to CB Insights’ Digital Health 150, and named one of Newsweek’s Top Most Loved Workplace® . With more than $100 million raised in recent funding, including a $53 million Series E round in 2025 led by Maj Invest, and a $50 million investment in 2023 led by Temasek, Twin is scaling rapidly across the U.S. and globally. Backed by leading venture firms like ICONIQ Growth, Sequoia, Sofina, Temasek, and Peak XV, we are building the most impactful digital health company in the world. Join us as we reinvent the standard of care in metabolic health.

Opportunity: Join us in one of our most critical member care management roles, inspiring behavior change and motivating members to adopt new behaviors and improve their health. As an RN at Twin you make a difference in people's lives every day by providing clinical guidance, support, education, and encouragement to empower your members seeking to prevent and reverse chronic metabolic diseases and improve their overall health. This job is a great fit for you if you have expertise with building rapport with members, are highly motivated, energetic, and focused on enhancing the quality of healthcare. You have demonstrated the ability to work collaboratively with an interdisciplinary care team in the adoption of new technologies to coordinate care, engage in shared decision making, and achieve successful clinical outcomes. You are comfortable leveraging data in observing trends and developing corrective action plans to facilitate the transformation of member lives. Join Us: This is an exciting role for a Registered Nurse with a diverse healthcare systems background. Join us to use your finely-tuned skills in assessing physical and psychological-social needs. You will support a dynamic care team in identifying member goals, health priorities and learning opportunities. This will include utilizing motivational interviewing techniques and designing interventions with members to build engagement and improved health outcomes. Other skill set considerations include ability to work efficiently and with competing priorities, comfort with technology and data, as well as employing knowledge of care management principles. This role will report to a nurse manager and work within a team pod structure. A successful candidate for this role will be curious, collaborative and adaptable to member journey and team needs. You will be excited to jump into a day that may look a bit different than the day before, while making improvements along the way and building upon your highly-valued skill set. This is a part time weekend role with the following schedule options: Saturday - Sunday, 8 hour day shift Saturday - Sunday, 10 hour day shift Saturday - Sunday, 12 hour day shift

Currently active and unencumbered RN license within the state in which patient care is occurring Minimum 4 years of nursing experience in various healthcare systems such as hospitals, Federally Qualified Health Care centers, ambulatory care environments (primary care, internal medicine, family practice, surgical/multi-specialty), health payor systems (case management), etc. Experience preferred in one or more of the following areas: Case/care management, value-based care, population health, care coordination or transition care management Required, BSN or MSN from accredited school of nursing Preferably skilled in motivational interviewing and driving behavior change Comfort and enthusiasm for adopting the latest technologies and integrating data and technical outputs in patient care Demonstrated ability to manage large caseloads and effectively work in a fast paced environment Proficient with simultaneously navigating the internet and multi-tasking with multiple electronic documentation systems and business tools (Google, Slack, etc.) Comfort with ambiguity and change Experience in a high-growth, or other quickly changing environment Professional telephone and video skills Self-motivated and results-focused Client service excellence Quick learner who integrates new knowledge Organized and detail-oriented Ability to handle competing demands with diplomacy and enthusiasm Ability to work collaboratively with clinical infrastructure and hierarchies Excellent time management and ability to prioritize work assignments Passion for Twin’s purpose to transform lives by empowering people to reverse, prevent and improve chronic metabolic diseases Bilingual, fluent in Spanish preferred

Delivers remote clinical monitoring and member education via software, video conferencing, and the Twin Health electronic medical record Promotes member self-care management by utilizing clinical judgment, data analysis and critical thinking skills Evaluates member progress toward goal achievement, including identification and evaluation of barriers to meeting or maintaining plan of care and/or health status Prioritizes and manages individual members along the Twin journey by monitoring health condition reversal trends, conducting lab reviews, supporting medication management Collaborates closely with team colleagues including nurses, health coaches, providers, and operations teams to drive a seamless experience for members Engages the nursing philosophy to capture a holistic picture of the member’s clinical status from Intake to ongoing care management Gives appropriate health guidance by utilizing clinical knowledge, training and protocols Leverages the nursing processes to triage member alerts and inquiries Strictly adheres to Standard Operating Procedures for member management and escalations Provides timely responses and feedback to colleagues regarding member care Conducts detailed monitoring to support medication reconciliation and adherence Collaborate with members and pharmacies to identify solutions to defray costs for members and reduce gaps in coverage Organizes accurate records and maintains confidentiality according to federal law and Twin policies Generates and analyzes reports as needed for management, identifying trends, anomalies and areas of concerns Contributes to the development and improvement of clinical care that enhances cost effectiveness while ensuring quality care Participates in on-going education and performance improvement activities Additional duties as assigned

LanceSoft, Inc.

Behavioral Health UM Clinician (RN, LMHC, LMFT, OR LCSW): 100% Remote

Posted on:

December 8, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

Florida

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

Position Type: Full time Job Tittle: Healthcare - Care Review Clinician I Location: 100% Remote Offered Rate: $43.06/hr. On W2 (all inclusive) Job Description: MUST RESIDE IN FLORIDA HOWEVER THIS IS FULLY REMOTE PREFERRENCE IS FOR A LMHC, LMFT, OR LCSW, HOWEVER RN WITH BEHAVIROAL HEALTH OUTPATIENT EXPERIENCE WILL BE CONSIDERED Summary: Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Molina Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Molina Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.

At least 2 years of behavioral health experience including outpatient community behavioral health services to include: Psychosocial Rehabilitation, Day Treatment, Partial Hospitalization Program, Intensive Outpatient Program, Mental Health Targeted Case Management, Residential Treatment. Master’s level clinician with active and unrestricted license in state of Florida (LMHC, LMFT, LCSW) 1+ Managed care experience Experience utilizing MCG Florida Agency for Healthcare Administration (AHCA) BH coverage policies knowledge Must be available to work 40-hour work week Monday- Friday 8:00-5:00pm EST , potential for overtime with an expectation to cover weekend, if necessary to meet business needs. 2 years of direct care experience in an outpatient behavioral health setting Experience with Utilization Management or Prior Authorization Recent behavioral health experience in psychiatric facility, or community behavioral health center Knowledge or community health and social service agencies Knowledge/Skills/Abilities: Demonstrated ability to communicate, problem solve, and work effectively with people. Excellent organizational skill with the ability to manage multiple priorities. Work independently and handle multiple projects simultaneously. Knowledge of applicable state, and federal regulations. In depth knowledge of Interqual and other references for length of stay and medical necessity determinations. Experience with NCQA. Ability to take initiative and see tasks to completion. Computer Literate (Microsoft Office Products). Excellent verbal and written communication skills. Ability to abide by Molina’s policies. Ability to maintain attendance to support required quality and quantity of work. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). Skilled at establishing and maintaining positive and effective work relationships with coworkers, clients, members, providers and customers. Required Education: Completion of an accredited Registered Nursing program. (a combination of experience and education will be considered in lieu of Registered Nursing degree). Required Experience: Minimum 0-2 years of clinical practice. Preferably hospital nursing, utilization management, and/or case management.

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

Elevance Health

RN Delegated Care Management Monitor (DSS Regions 1/2)

Posted on:

December 8, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

North Carolina

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.

We are partnering with North Carolina DHHS to operationalize a statewide Medicaid Plan designed to support Medicaid-enrolled infants, children, youth, young adults, and families served by the child welfare system so that they receive seamless, integrated, and coordinated health care. Within the Children and Families Specialty Plan (CFSP), and regardless of where a member lives, they will have access to the same basic benefits and services, including Physical health, Behavioral health, Pharmacy, Intellectual/Developmental Disabilities (I/DD) services, long term services and supports, Unmet health-related resource needs, and Integrated care management. We envision a North Carolina where all children and families thrive in safe, stable, and nurturing homes. NC RESIDENCY IS REQUIRED! $3,500 SIGN ON BONUS LOCATION: This position supports DSS Regions 1 and 2. You must live in one of these regions. HOURS: General business hours, Monday through Friday. TRAVEL: Travel within these regions may be required. When you are not in the field, you will work virtually from your home. This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on engagement. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. The Delegated Care Management Monitor (Special Programs Case Manager II) is responsible for overseeing and monitoring healthcare services to insure quality, compliance, and cost-effectiveness. Coordinate care across providers and settings to improve outcomes and lower costs.

For the State of North Carolina, in accordance with federal/state law, scope of practice regulations or contract, the requirements are: Requires a degree in nursing and minimum of 5 years of clinical experience; or any combination of education and experience which would provide an equivalent background. Requires an active, current and valid license as an RN to practice as a health professional within the scope of licensure in the state of North Carolina. Experience conducting audits and generating compliance reports within a healthcare setting to ensure adherence to regulatory and contractual standards is required. Preferred Qualifications: Experience working with Children, Youth, and Families who are being served by Local Departments of Social Services through Foster Care and Adoptive Assistance programs is very strongly preferred. Service delivery coordination, discharge planning or behavioral health experience in a managed care setting preferred. Experience with oversight and monitoring of delegated care management services is strongly preferred. Case management certification is preferred.

Review daily reports and performance data to ensure compliance and identify areas for improvement. Manage and control healthcare costs for the designated population through integrated case management. Review member care plans and ensure they are appropriate, high quality, and cost-effective. Coordinate care between delegated care management and internal resources, including social determinants of health, to meet the member's needs and provide patient education. Escalate member crises, or quality of care concerns, as needed. Build relationships with the designated population and their families, addressing cultural and linguistic needs, and coaching the delegated entity to improve overall outcomes. Maintain knowledge of the "system of care" philosophy, which involves a coordinated network of community-based services and supports. May conduct pre-assessment, annual, and ad-hoc audits to evaluate policies, procedures, and documentation.

TRIUNE Health Group

Nurse Case Manager - Michigan

Posted on:

December 8, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Michigan

TRIUNE Health Group is a nationally recognized managed healthcare company with over 35 years of experience. As a mission-driven, second-generation family-owned business, we are dedicated to improving lives by reducing the impact of injuries, enhancing health and wellness, and lowering healthcare and workers' compensation costs. At TRIUNE, we believe that every team member is essential to our success. We foster a supportive and collaborative environment where employees are valued, empowered, and provided with the tools they need to thrive—both professionally and personally. Why Join TRIUNE Health Group as a Nurse Case Manager? Be part of a well-established, family-owned company that prioritizes people over profits. Experience our culture of People Helping People, where every team member is treated with dignity and respect. Enjoy the stability, support, and resources needed to succeed while maintaining a healthy work-life balance. Perks & Benefits: Generous Time Off: 20 days of vacation plus 8.5 paid holidays Retirement Savings: 401(k) match to help you plan for the future Comprehensive Insurance: Medical, dental, and vision coverage Disability Coverage: Short-Term (STD) and Long-Term Disability (LTD) insurance Employee Support: Employee Assistance and Referral Program Work-from-Home Essentials: Home office equipment, including a laptop and desktop monitor Travel Perks: Mileage and travel reimbursement

Summary of Position: The Nurse Case Manager coordinates resources and creates flexible, cost-effective options for catastrophically or chronically ill or injured individuals to facilitate quality, individualized, holistic treatment goals, including timely return to work when appropriate.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Skills and Abilities: Proven leadership skills. Excellent verbal and written communication skills, including the ability to interact effectively with patients, customers, and fellow employees via phone, email, in-person, and formal presentations. Methodical in accomplishing job-related goals. Strong analytical and organizational skills, including the ability to multitask with attention to detail. In-depth knowledge of multi-software packages, notably Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) and the Internet. Maintain a friendly, professional attitude at all times. Exercise initiative and be solution-oriented, while keeping management up-to-date on current situations or opportunities. Dependability and adaptability. Education and Experience: Graduate of an accredited school of nursing. Current RN licensure in the state of operation. Fluency in English (speaking, reading, and writing). Three or more years of recent clinical experience, preferably in trauma, psychology, emergency, orthopedics, rehabilitation, occupational health, and neurology. CCM preferred. Certificates, Licenses, Registrations: While not mandatory, individuals with one or a combination of the following certifications are preferred: COHN, COHN-S, and CDMS. IV. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The base salary range/hourly rate listed is dependent on job-related, non-discriminatory factors such as experience, education, and skills. This position is also eligible for incentive compensation awards. You may be eligible for the following competitive benefits: medical, dental, vision, life, accident & disability, short and long-term disability, paid holidays, paid time off and 401 (k). bination of the following certifications is preferred: COHN, COHN-S, CCM, and CDMS.

Provide medical case management to individuals through coordination with the patient, physicians, other health care providers, the employer, and the referral source. Utilize the steps of Case Management to provide assessment, planning, implementation, evaluation, and outcome of an individual’s progress. Evaluate individual treatment plans for appropriateness, medical necessity, and cost-effectiveness. Facilitate care, such as negotiating and coordinating the delivery of durable medical equipment and home health services, ensuring clear communication. Assess rehabilitation facilities for appropriateness of care, facilitate transportation, and coordinate architectural assessments of patients’ homes when required. Communicate medical information clearly and compassionately to patients and families. Stay current with medical terminology and the federal and state laws related to health care, Workers’ Compensation, ADA, HIPAA, FMLA, STD, LTD, SSDI, and SSA. Utilize technology (computer, cell phone, fax, and scanning machine) to prepare organized, timely reports while complying with safety rules and regulations in conjunction with HIPAA. Research medical and community resources for individuals with catastrophic or chronic diagnoses, such as but not limited to AIDS, cancer, spinal cord injuries, diabetes, head injuries, back injuries, hand injuries, and burns, ensuring accessibility for individuals. Possess a valid driver’s license with the ability to travel 90% of the time. Perform other duties as assigned.

Molina Healthcare

RN Transition of Care Coach remote based in WA state

Posted on:

December 8, 2025

Job Type:

Full-Time

Role Type:

Coaching

License:

RN

State License:

Washington

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 RN Transition of Care Coach provides support for care transition activities. Facilitates transitional care processes and coordination for member discharge from hospital admission to all other settings. Strives to ensure that best possible services are available to members at time of hospital discharge, and focuses on goal to reduce member readmissions. Contributes to overarching strategy to provide quality and cost-effective member care. This position will be supporting our Washington State Medicare plan. We are seeking a candidate with a WA RN licensure and previous Case Management experience. The candidate should have proficient knowledge of MS Suite, organized and analytical thinking. Experience with care coordination and discharge planning highly preferred.. Further details to be discussed during our interview process. Remote position based in Washington State Work schedule Monday through Friday 8:30 AM to 5:00 PM PST. WA RN licensure required.

At least 2 years experience in health care, with at least 1 year of experience in hospital discharge planning, care management or behavioral health setting, or equivalent combination of relevant education and experience. Registered Nurse (RN). License must be active and unrestricted in state of practice. Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. Knowledge of or experience using the Care Transitions Intervention (CTI) or similar model. Background in discharge planning and/or home health. Demonstrated knowledge of community resources. Proactive and detail-oriented. Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. Ability to work independently, with minimal supervision and demonstrate self-motivation. Responsive in all forms of communication, and ability to remain calm in high-pressure situations. Ability to develop and maintain professional relationships. Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. Excellent problem-solving, and critical-thinking skills. Excellent verbal and written communication skills. Microsoft Office suite/other applicable software program(s) proficiency. Preferred Qualifications: Transitions of care sub-specialty certification and/or Certified Case Manager (CCM). Hospital discharge planning or home health experience.

Follows member throughout a 30 day program that starts at hospital admission and continues oversight through transitions from acute setting to all other settings, including nursing facility placement/private home, with the goal of reduced readmissions. Ensures safe and appropriate transitions by collaborating with the hospital discharge planner, as well as collaborating with hospitalists, outpatient providers, facility staff, and family/support network. Ensures member transitions to setting with adequate caregiving and functional support, as well as medical and medication oversight support. Works with participating ancillary providers, public agencies or other service providers to make sure necessary services and equipment are in place for safe transition. Conducts face-to-face visits of all members while in the hospital and, home visits high-risk members post-discharge as needed. Coordinates care and reassesses member needs using the Coleman Care Transition model post-discharge. Educates and supports member focusing on seven primary areas (Transition of Care Pillars): medication management, use of personal health record, follow-up care, signs and symptoms of worsening condition, nutrition, functional needs and or home and community-based services, and advance directives. Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. Assesses for barriers to care, provides care coordination and assistance to member to address concerns. Facilitates interdisciplinary care team meetings (ICT) and collaboration. Provides consultation, recommendations and education as appropriate to non-behavioral health care managers. 40-50% local travel may be required (based upon state/contractual requirements).

East x West Med

HRT Nurse Practitioner NY or NJ

Posted on:

December 8, 2025

Job Type:

Part-Time

Role Type:

Primary Care

License:

NP/APP

State License:

New Jersey

We are a growing boutique virtual practice focused on personalized hormone optimization, metabolic health, and longevity. Our mission is to help patients feel their best at every stage of life through evidence-based, integrative care. We offer a supportive, collaborative environment where clinical excellence and patient experience are top priorities.

**MUST ALREADY HAVE STRONG WOMENS HRT EXPERIENCE AND LICENSED IN AT LEAST NJ AND/OR NY TO APPLY. YOUR RESUME WILL NOT BE REVIEWED IF YOU DO NOT MEET THESE TWO REQUIREMENTS** Part-Time(with flexibility to go full-time) Nurse Practitioner – Virtual Hormone & Longevity Practice Compensation: Competitive cost-sharing approach, based on experience and licensure, no limit to income! Location: Remote (Must be licensed in at least NJ and/or NY) Schedule: Part-time (Flexible hours but at least a 10 hr/week commitment. Preferred availability for more) Position Overview: We are seeking a contract Nurse Practitioner (NP) with a strong background in hormone and metabolic health to join our virtual care team. You will be responsible for conducting both synchronous (video) and asynchronous consultations and follow-ups, managing patient messages, and developing personalized treatment plans.

Active NP licensure in New Jersey (NJ) or New York (NY) REQUIRED Preference given to candidates with additional licenses in independent practice states Minimum of 2 years of clinical experience in HRT REQUIRED Strong knowledge of GLP-1 therapies PREFERRED Comfortable with telehealth platforms and asynchronous care delivery Excellent communication skills, attention to detail, and a patient-centered approach

Conduct comprehensive hormone and metabolic assessments via telehealth Complete asynchronous chart reviews and follow-ups as needed Prescribe and manage hormone replacement therapy (HRT), GLP-1s, and naturopathic supplements Respond promptly to patient questions and concerns through a secure messaging platform Collaborate with the care team to ensure continuity and quality of care Maintain accurate and thorough documentation in the EHR Stay up-to-date with emerging research and best practices in hormone and longevity medicine

Pulse Clinical Alliance

RN - Oncology Abstractor

Posted on:

December 8, 2025

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

RN

State License:

Florida

To our caregivers and internal corporate employees we have one mission; To empower you to make the most out of every opportunity so that you and your family can live better. We challenge the status quo and relentlessly search for new ways to achieve better outcomes for caregivers and clients alike.

The Clinical Data Abstractor will be responsible for performing high-quality medical record abstraction for all abstraction needs across cancer, women’s health and rare diseases. The Clinical Data Abstractor is also responsible for providing regular reporting on all patients and data abstracted.

Registered Nurse, Advanced Practice Nurse, Physician’s Assistant. Bachelor’s degree minimum. 2+ years of clinical data abstraction, with a focus on Oncology, Gynecological Oncology/Women’s Health, and Rare Diseases experience preferred (may be supplemented by a minimum of 5+ years of Oncology direct patient care, clinical trials, and data management experience.) Currently licensed to practice within the United States. KNOWLEDGE, SKILLS, AND ABILITIES: Must be a clinical expert in the following clinical and therapeutic areas: Oncology, Gynecological Oncology/Women’s Health, and Rare Diseases experience preferred Ability to work independently, with little to no direction, and as part of a team Strong organizational and communication skills Strong research and clinical skills In-depth attention to detail and a fast learner Experience working with startup companies and respond to shifting priorities and changes Ability to interact with various levels of staff in a remote environment. Possess a high level of initiative and self-motivation Strong computer skills, including proficiency in spreadsheet applications, word processing, Google Workspace, project management software, etc. Experience working with multiple monitors Strong familiarity with data abstraction tools, EDCs, and registries and working with system change requests, and providing design input in the design of such databases. Medical terminology experience Experience with multiple electronic medical record systems such as Allscripts, OncoEMR, Cerner, Epic, NextGen, Meditech, Cerner, etc. Experience working with paper, handwritten, and electronic forms of records/unstructured data and various file formats such as pdfs, RTFs, jpegs, etc. Job Types: Full-time, Part-time, Contract Pay: $35.00 - $45.00 per hour Expected hours: 20 – 40 per week Medical Specialty: Oncology Experience: Oncology: 2 years (Required) License/Certification: RN License (Required) Work Location: Remote

Responsible for performing abstraction for ad hoc and ongoing internal and external data and abstraction requests for cancer, women’s health or rare diseases information. Abstraction responsibilities include manually reading, reviewing, and abstracting clinical data from medical records. Maintain minimum quality and productivity standards as established by the CDA team. Participating in quality reviews on records abstracted by abstraction peers, tracking records quality reviewed and through the entire abstraction life-cycle. Maintain confidential, accurate, and detailed records and reports. Identify clinical data gaps within existing patient medical records across the entire clinical database. Attend cross-team meetings and provide relevant reporting to cross-teams and directly to the first line supervisor or manager. Other duties as assigned.

CVS Health

Family Nurse Practitioner

Posted on:

December 8, 2025

Job Type:

Contract

Role Type:

Primary Care

License:

NP/APP

State License:

North Carolina

CVS Health is the leading health solutions company, delivering care like no one else can. We reach more people and improve the health of communities across America through our local presence, digital channels and over 300,000 dedicated colleagues. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by simplifying health care one person, one family and one community at a time.

Job Title: Family Nurse Practitioner Virtual Care MC Duration: 6+ Months Contract (Potential for extension) Location: Remote (Work from Home) Pay Rate:$74.84/ HR on W2 Shift Hours: FT (every other weekend and holiday rotation) or PRN (requirements listed in description above) Start Date - 12/08/2025 Schedule: FULL TIME or PRN – list preference at top of resume. Manager will be hiring four full time NPs and eight PRN NPs Must have a minimum of four of the below licenses ACTIVE: NC, SC, GA, VA, PA, NY, NJ All MC positions are safety sensitive Description: The MinuteClinic Telehealth Nurse Practitioner or Physician Assistant (Provider) delivers patient care services through a remote technology platform. You will work in collaboration with a dedicated team of professionals as you independently provide holistic, evidenced based care inclusive of accurate assessment, diagnosis, treatment, management of health problems, health counseling, and disposition planning for our patients ranging in age 18 months and above. Encounters are documented utilizing an electronic health record (EHR). MinuteClinic Telehealth providers report directly to the Enterprise Initiative Lead.

PRN Shift Requirements: One 8 hour shift per week (up to 40 hours if desired/volume permits) Two weekends (Sat & Sun) per 6 week cycle One on call day (or additional pick up) per 6 week cycle One major holiday One minor holiday Shift times are between 6am-11pm - can be flexible based on half/partial shifts Full time requirements: 8 or 10 hour shift 4 days a week every other weekend multiple shift times available 1 minor holiday 2 major holidays *All MC NP submissions must include the completed candidate questionnaire: Do you hold an NP license that is active and in good standing, within the state - where you are applying for the position? NP License # and current valid dates NPI # BLS expire date - AHA # How much experience do you have in a primary care setting? What Electronic Medical Systems (EMS) have you used in the past? Do you have any upcoming planned time off? Are you actively working with a CVS recruiter on a permanent role? Are you open to occasional travel beyond that distance for float work (if necessary)? Availability for interview: Availability to start a new position if offered: Education: Completion of a Master’s Degree level Family Nurse Practitioner program with current National Board Certification and State of Employment license to practice in the Advanced Practice Nurse role required

Patient-Centered Quality and Safety: Evaluate primary care, acute, chronically ill, and transitional care patients, in addition to providing healthcare education and counseling, and disposition planning for our patients ranging in age 18 months and above Provide patient counseling; inclusive of pregnancy prevention, STI Prevention/safer sex practices, contraceptive care counseling and medication management Educate patients on health maintenance and respond to patient care inquiries Document all patient care within an EHR according to MinuteClinic policies and procedures Provide care and coordination of our patients with internal and external colleagues, including the broader patient centered medical home, ensuring the highest standard of care is provided for all patients and at all times Effectively work within a patient care team, including fellow Providers, Collaborative Physicians, para-professionals, Pharmacists and other members of the health care team Customer Service Excellence: Deliver excellent customer service Seek to increase patient engagement and satisfaction through integration of feedback from patients, management, and professional colleagues Focuses consistently on the patient to create a warm and welcoming environment Tailor communication style to effectively influence quality outcomes and patient needs Collaborate with pharmacy and front store colleagues to provide a complete patient experience Maintain patient confidentiality in accordance with PHI and HIPAA standards Healthcare Environment Management: Resolve conflict using appropriate management techniques Cultivate and maintain positive relationships among practice employees, CVS Health colleagues and external partners Reprioritizes continually throughout the day to fulfill patient and business needs Support the overall patient experience, by effectively managing clinical and non-clinical duties as well as patient expectations Quickly adopt new service offerings and patient care models Adhere to the core values of CVS Health MinuteClinic in all communications and interactions Assist with hiring, development, and evaluation of Practice employees Complete necessary tasks for clinic operations, including but not limited to taking inventory, following up on lab results, receiving incoming phone calls, ordering supplies and maintaining clinic cleanliness Business Acumen: Remain accountable to managing business needs including, but not limited to, budget, payroll, inventory, billing insurance, and payment collection Own the success of your practice through implementation of the clinic level business plan designed to meet identified business goals Assure complete and accurate payment for services through comprehensive documentation in the patient chart, verification of payment method (insurance, cash or combination) for each visit, and collection of payment as directed by the EMR Complete revenue cycle managements tasks including collecting payment at time of service for all visits and preparing nightly deposits. Autonomy: Work independently , prioritize and solve problems, take initiative, and advocate for their patients and their practice Actively participate in professional development thru professional groups, committees within the organization and/or additional external experiences Maintain self awareness and professionalism of individual actions and how they impact the clinic, practice, and healthcare industry Continuing education, including what is required to maintain employment at Minute Clinic, is the responsibility of the provider. Experience: Nurse Practitioner Questionnaire must be included on resume. Minimum of two years of medically-relevant experience Basic Life Support (BLS) certification A minimum of high speed/broadband internet connectivity with a download speed of at least 25 download and 3 upload speed. Speed test not required on resume, but please ensure candidate is aware of this requirement. Must hold an unrestricted license and have the ability to obtain multi state/ compact privileges and licensure in noncompact states as required by the business. Effective verbal, written, and electronic communication skills Outstanding organizational skills and ability to multi-task Initiative, problem solving ability, adaptability and flexibility Ability to work without direct supervision and practice autonomously Is proficient with information management and technology Capacity to collaborate with professional colleagues as necessary to provide quality care.

Medix™

Clinical Review RN - 247995

Posted on:

December 8, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

New York

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

Job Title: Clinical Review RN (Independent Dispute Resolution) Experience: Open to various clinical backgrounds/experience. Must have 2+ years of clinical experience post graduation, must has critical thinking and problem solving skills. ***Must have BSN and NYS RN license*** Location: Will start out as remote for ~6-8 months until there is enough office space and then will be asked to work in the office full time M-F. Office is in Jericho, NY. Hours of Operation: M-F 7a-5:30p *flexible start between 7am-9am (40hrs/wk) Start date: ASAP Pay: $50-53/hr DOE Volume: Will do appeals work under the IDR team handling on average 10 cases a day. These will be a mix between simple and complex cases. They will be reviewing documentation, codes, and more for out of Network bills and cost and making determinations on how to move forward based on the evidence. This individual will complete the full spectrum of activities related to State and Federal Independent Dispute Resolution (IDR) case determinations. They will conduct clinical level review, Prior Authorization, and disputed benefits review, supporting Medical Review Analysts, and Physician Consultants to ensure an appropriate and accurate process.

QUALIFICATIONS: Knowledge and experience with electronic medical records. Ability to oversee, problem solve, and work collaboratively with peers, medical, analytical, and administrative support staff. Excellent written and verbal skills. Ability to work independently with little supervision. Ability and desire to be flexible, innovative, and creative. EDUCATION AND EXPERIENCE: Licensed, Registered Nurse, required in New York Baccalaureate degree in Nursing Minimum of two years’ experience in a clinical setting, required.

Conduct reviews up to and including the appeal level. This includes chart screen, compiling regulatory guidance, researching insurer requirements, complete electronic worksheets and preparing final determinations. Act as a resource for the administrative and clinical staff in training, problem solving, and clarifying determinations. Will provide technical assistance and conduct/participate in staff huddles. Training and mentoring new RNs as the project expands. Claims assessment and adjudication. Participate in collaborative training. Other activities as may be deemed necessary.

Vis-À-Vis Health

Remote After Hours/Weekend Acute Care Nurse Practitioner

Posted on:

December 8, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

NP/APP

State License:

Massachusetts

Vis-À-Vis Health is a comprehensive care solution, providing physician services in the community as well as in Skilled Nursing Facilities. Vis-À-Vis Health provides convenient access to high-quality medical care to patients within the house call setting in a compassionate, complete, comprehensive, and cost-effective manner. We are focused on creating a revolutionary patient-centric healthcare model that leverages technology to generate positive healthcare outcomes and savings with the help of our medical teams.

Must hold a valid and active NP license in at least four of the following states: Illinois, New York, Massachusetts, New Hampshire This position is remote for: 15 hour shifts - 5pm-8am weekday overnights 12 hour shifts - 8am-8pm weekend daylight 12 hour shifts - 8pm - 8am and weekend overnights Job Description: Vis A Vis Health is seeking a dedicated Remote After Hours/Weekend Acute Care Nurse Practitioner to provide medical support for patients in skilled nursing facilities (SNFs). This role involves remotely triaging urgent patient concerns, conducting medical assessments via telehealth, and coordinating care with nursing staff to ensure timely and appropriate medical interventions. The ideal candidate is a dedicated and compassionate provider with strong clinical decision-making skills and the ability to work independently in a remote setting.

Required Skills/Abilities: Telehealth and/or geriatric/SNF experience preferred Minimum of 3 years of experience as a Nurse Practitioner, preferably in telehealth, skilled nursing facilities (SNFs), urgent care, or emergency medicine. More than 3500 hours of experience as a Nurse Practitioner, NPI# and ability to bill both Medicare and Medicaid system with no restrictions. Knowledge of electronic medical record (EMR) systems and ability to document patient encounters in real time. Should have excellent computer skills (MS word, excel, outlook etc.) Excellent communication & interpersonal skills Highly Organized, Professional & Motivated. Strong problem-solving skills with ability to multitask & prioritize Education and Experience: Master’s or Doctorate degree in Nursing (MSN/DNP) from an accredited institution. Board certification through ANCC or AANP. Experience in telehealth or virtual care settings is preferred.

Triage and respond to inbound calls from nursing staff regarding patient concerns. Conduct real-time telehealth medical assessments via our telehealth platform. Evaluate patients’ current symptoms, identify acute issues, and provide appropriate medical interventions. Order and interpret diagnostic tests as needed. Prescribe non-controlled and controlled medications in accordance with state and federal regulations. Provide clinical guidance to nursing staff on managing urgent medical conditions. Conduct care coordination and recommend research-based treatment interventions. Review patient medical histories and update comprehensive diagnostic lists to ensure accurate documentation. Assess and monitor changes in patient conditions and recommend necessary follow-up care. Completes and submits daily billing log, includes CPT codes. Comply with all HIPAA regulations and maintain the confidentiality of patient information. Complete and submit accurate and timely documentation, including updates to patient care plans. Participate in quality improvement initiatives and attend required training sessions or meetings. Other reasonable duties as assigned by the supervisor.

Blue Cross Blue Shield of Massachusetts

Senior RN Peer Review Specialist

Posted on:

December 7, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Massachusetts

Blue Cross Blue Shield of Massachusetts is a community-focused, tax-paying, not-for-profit health plan headquartered in Boston. We have been a market leader for over 80 years, and are consistently ranked among the nation's best health plans. Our daily efforts are dedicated to effectively serving our 3 million members, and consistently offering security, stability, and peace of mind to both our members and associates. As an employer, we are committed to investing in your development and providing the necessary resources to enable your success. We are dedicated to creating an inclusive and rewarding workplace that promotes excellence and provides opportunities for employees to forge their unique career path. We take pride in our diverse, community-centric, wellness-focused culture and believe every member of our team deserves to enjoy a positive work-life balance. Blue Cross Blue Shield of Massachusetts is an Independent Licensee of the Blue Cross and Blue Shield Association. Blue Cross Blue Shield of Massachusetts complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation or gender identity.

The Role: The Peer Review Specialist is responsible for monitoring the quality of the credentialed practitioner/ organizational provider networks ensuring our members receive the highest quality of care possible. The Team: As an integral part of the Credentialing & Peer Review (CPR) Team, the Peer Review Specialist works closely with CPR’s Director and Clinical Lead, Operations Lead, Senior Credentialing Manager/ Compliance Consultant, Risk Specialist, Exception Review Specialists and Project Manager. This position is eligible for our Resident, Mobile, and eWorker personas.

Current, valid, and unrestricted Massachusetts RN licensure. BSN with seven (7) years nursing experience in the delivery system Proven competency with quality assurance reviews and strong medical record review background. Strict adherence to state and federal regulation, accreditation standards and guidelines, and Blue Cross confidentiality mandates regarding all CPR information, documentation, oral and written communication. Demonstrated analytical and organizational expertise and ability to prioritize multiple tasks in demanding environment with aggressive deadlines. Purposeful, meticulous learner with a personal commitment to high quality performance through integrity, accountability, compassion, and teamwork. Initiative-taking to identify opportunities for improvement. Excellent written and oral communication skills include demonstrating ability to interact with providers on sensitive issues. Expertise in Microsoft Access, Adobe, Excel, Outlook, Power Point, Word as well as Blue Cross business systems, e.g., Cactus, CAQH, CMS, HURN, SalesForce, SharePoint, STARS and Verysis (CVO). Minimum Education Requirements: High school degree or equivalent required unless otherwise noted above Location: Boston, Hingham Time Type: Full time

Identify, investigate, evaluate, and develop cases with suspected quality of care concerns. Initiate data entry and maintain timely and accurate information on all cases in CPR’s case management system (Access database) used for on-going monitoring, reporting and comparative data analysis (track and trend). Assume responsibility for strategic planning, screening, research development, writing, and presenting cases for internal and external review. Proactively anticipate issues/concerns and address them in accordance with Credentials & Peer Review Committee (CPRC) policies. Possess ability to interpret member benefit information per the BCBSMA subscriber certificates and apply to the investigation of member grievances. Manage the fair hearing process for cases that involve adverse action decisions made by the CPRC which include Prepare, finalize, and send all written notifications to the practitioner/organizational provider and their legal counsel, as appropriate, after obtaining BCBSMA legal counsel approval. Prepare documentation reviewed by CPRC to make its decision to terminate a practitioner’s participating agreement or to make a recommendation for termination of an organizational provider’s participating agreement for reasons related to quality of care, unprofessional conduct, or fraudulent activity. Determine which internal and external CPRC members will participate in the hearing panel. Identify, evaluate, recruit, and initiate a consulting agreement for peer review consultants in accordance with BCBSMA principles of fair and equitable review. Work collaboratively with the CPR Project Manager to schedule and confirm date/time/location of hearing and dissemination of documentation to the hearing panel. Seek CPRC Chair, CPR Director, and BCBSMA Legal Counsel approval on appropriate language for reporting to the National Practitioner Data Bank (NPDB) and/or Massachusetts licensing boards, as required by state and federal regulations, National Committee for Quality Assurance (NCQA) accreditation standards, and CPRC policies. Collaborate with the following internal business units, but are not limited to: CPRC/S membership Healthcare Contracting and Management Team Legal Department: Medical Directors Member Appeals Grievance Programs (Commercial, Medicare Advantage, and InterPlan Program) Physician Review Units Prepare documentation in response to regulatory inquiries (e.g., subpoena, regulatory filings, CMS audits, NPDB challenges, etc.). Conduct independent and joint educational visits with practitioners and organizational providers. Identify, monitor, and evaluate skilled nursing (SNF) deficiencies found on the Commonwealth of Massachusetts Department of Public Health (MA DPH) surveys and ensure appropriate interventions when identifying substandard care. Determine the SNF’s current participation status with BCBSMA. Review participating agreements for language regarding the SNF’s participation in the quality program. Conduct internet research for information on the current local standards of care regarding the deficiencies identified by the MA DPH for the deficient services. Review all available documentation regarding MA DPH Public Health Survey Results, including corrective action plans, to determine overall performance as compared to the statewide average score in comparison to other facilities in the same area and the effectiveness of complaint investigation. Ensure appropriate interventions when identifying substandard care. Participates in all other projects, as necessary.

K Health

Weekend Advanced Practice Provider (APP), NJ-100% Remote

Posted on:

December 7, 2025

Job Type:

Full-Time

Role Type:

Primary Care

License:

NP/APP

State License:

New Jersey

Founded in 2016, K Health's mission is to deliver accessible, high-quality healthcare at scale. As a leading clinical AI company in primary care, K Health has developed a suite of clinical AI agents that enhance provider efficiency and improve patient outcomes. K Health's virtual primary care platform is enhanced by an AI copilot to complete the initial patient intake, summarizing relevant history from the EMR, and generating “the perfect note” to reduce the time providers spend on basic data collection and non-clinical tasks. Unlike other virtual medicine companies, K Health delivers comprehensive, longitudinal primary care in a virtual setting, enabling our clinicians to be true primary care providers without sacrificing scope of practice or continuity of care. As a venture-backed startup trusted with nearly $400 million in funding and a $900 million valuation as of July 2024, K Health is well-positioned for sustained future growth. We are expanding our partnerships with major health systems (Cedars-Sinai, Hackensack Meridian Health, Hartford HealthCare), enhancing accessibility and quality of care by pairing people with technology. Our providers are credentialed at these renowned academic health systems and adhere to their clinical guidelines, ensuring patient-first, evidence-based care. Fully integrated into Epic, our AI platform enables K Health to operate as an extension of existing healthcare systems, benefiting from a built-in network of specialists and social services to seamlessly serve patients within those communities. Our unique care delivery model enables our providers to deliver the same high-quality, accessible care to a mixed-payer population, including those with commercial insurance, Medicare, and Medicaid. Join us in our mission to deliver smarter, simpler healthcare of the future - today!

Join K Health as we partner with the nation's top-rated hospital systems to close care gaps by launching completely Virtual Comprehensive Care Clinics. We are seeking a full-time, board-certified Family Nurse Practitioner or Physician Assistant who will deliver fully remote text and video-based acute care, encompassing preventive care, sick visits, and chronic condition management. The ideal candidate must be licensed in NJ. You will be responsible for maintaining a strong rapport with your patients, representing K Health and our clinical partners, while providing world-class remote care. You are comfortable practicing the full spectrum of comprehensive care, including pediatrics and mental health. Work from the comfort of your home and deliver care to those who need it the most, backed by K Health's cutting-edge clinical-grade AI Platform. Our virtual clinics are fully supported 24/7 by a dedicated team of Care Concierge, Clinical Operations, and technical support staff, which greatly reduces your administrative burden.

3+ years of clinical practice experience as a Nurse Practitioner or Physician Assistant in a Family Practice setting Licensed in NJ Board-Certified Family Nurse Practitioner or Physician Assistant Must-Have min 1 year of experience using Epic EMR Must be currently enrolled, or eligible for enrollment, as a Medicare provider Primary care experience and behavioral health experience, ability to treat both acute and chronic care conditions Should be tech-savvy, proactive, organized, detail-oriented, and have telemedicine experience Clean background and medical malpractice history Willing to work weekend hours, 36 hours per week (7a-7p Sat & Sun +1 Weekday)

Provide video-based, comprehensive clinical care that encompasses Acute Care, including pediatrics and mental health Work regular weekend day shifts (7a-7p Sat & Sun +1 Weekday) Support physicians with Epic inbox management (labs, imaging, patient questions, etc.) Educate patients on appropriate treatments and care plans for their health needs Prescribe medication and refills as appropriate Drive high-quality care with a focus on patient outcomes Elevate remote care; provide compassionate and meaningful care Think on your feet to devise creative solutions to problems that arise or escalate as appropriate Collaborate with Care Team Members Perform against challenging goals with a best-in-class team

K Health

Weekend Hartford Healthcare HHC 24/7-Advanced Practice Provider (APP), CT-100% Remote

Posted on:

December 7, 2025

Job Type:

Full-Time

Role Type:

Primary Care

License:

NP/APP

State License:

New York

Founded in 2016, K Health's mission is to deliver accessible, high-quality healthcare at scale. As a leading clinical AI company in primary care, K Health has developed a suite of clinical AI agents that enhance provider efficiency and improve patient outcomes. K Health's virtual primary care platform is enhanced by an AI copilot to complete the initial patient intake, summarizing relevant history from the EMR, and generating “the perfect note” to reduce the time providers spend on basic data collection and non-clinical tasks. Unlike other virtual medicine companies, K Health delivers comprehensive, longitudinal primary care in a virtual setting, enabling our clinicians to be true primary care providers without sacrificing scope of practice or continuity of care. As a venture-backed startup trusted with nearly $400 million in funding and a $900 million valuation as of July 2024, K Health is well-positioned for sustained future growth. We are expanding our partnerships with major health systems (Cedars-Sinai, Hackensack Meridian Health, Hartford HealthCare), enhancing accessibility and quality of care by pairing people with technology. Our providers are credentialed at these renowned academic health systems and adhere to their clinical guidelines, ensuring patient-first, evidence-based care. Fully integrated into Epic, our AI platform enables K Health to operate as an extension of existing healthcare systems, benefiting from a built-in network of specialists and social services to seamlessly serve patients within those communities. Our unique care delivery model enables our providers to deliver the same high-quality, accessible care to a mixed-payer population, including those with commercial insurance, Medicare, and Medicaid. Join us in our mission to deliver smarter, simpler healthcare of the future - today!

Work where every moment matters Every day, over 30,000 Hartford HealthCare (HHC) colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut’s most comprehensive healthcare network. About the role: HHC 24/7 is at the forefront of transforming how medicine is delivered, and we’re looking for visionary full-time advanced practice providers (APPs) ready to help build the next era of primary care. As a remote APP, you will be part of a groundbreaking care model that integrates advanced AI from K Health to deliver smarter, faster, and more personalized care, connected within Hartford HealthCare. This powerful technology synthesizes rich patient data and medical history, giving you actionable clinical insights in real time. Supported by a dedicated 24/7 care team, you’ll experience a practice environment where technology and teamwork remove administrative barriers — freeing you to focus on delivering transformative, patient-centered care. Join us to shape what’s next in medicine. Board certified Family Nurse Practitioner or Physician Assistants with Connecticut license required (IMLC strongly preferred).

4+ years of clinical practice experience as a Nurse Practitioner or Physician Assistant in a Primary Care setting Licensed in CT Board-Certified Family Nurse Practitioner or Physician Assistant Must-Have min 1 year of experience using Epic EMR Brick-and-mortar primary care experience and behavioral health experience, ability to treat both acute and chronic care conditions Must be currently enrolled, or eligible for enrollment, as a Medicare provider Should be tech-savvy, proactive, organized, detail-oriented, and have telemedicine experience. Clean background and medical malpractice history Willing to commit to 40 hours per week, including 36 clinical hours: 12 hours on Saturday, 12 hours on Sunday, and 12 hours on one weekday

Provide video-based, comprehensive primary care care Educate patients on appropriate treatments and care plans for their health needs Manage patient follow-ups for chronic care programs Prescribe and refill medication as appropriate Drive high-quality care with a focus on patient outcomes Elevate remote care by providing compassionate and meaningful patient encounters Critical thinking to devise creative solutions to problems that arise or escalate as appropriate Collaborate with Care Team Members Perform against challenging goals with a best-in-class team Under established guidelines and in collaboration and/or supervision with the practice physician(s), Nurse Practitioners and Physician Assistants perform routine physical examinations, and formulate medical, educational, and psychosocial plans to treat patients. In consultation with the physician(s) and care team members, Nurse Practitioners and Physician Assistants develop plans for further evaluation of health needs, e.g., referral to other health team members or specialists. Nurse Practitioners or Physician Assistants provide appropriate treatment for problems within the scope of the provider’s practice as designated by protocols and identifies problems outside of their scope of practice and refers appropriately to physician.

UASI

Clinical Appeals Review Nurse

Posted on:

December 7, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Ohio

Since 1984, UASI has been one of the largest independent healthcare revenue cycle consulting firms in the United States. UASI is a nationally-recognized leader in the Health Information Management field, weaving technology, expertise, & flexible problem solving together to create effective strategies for each healthcare client. UASI offers services and employment opportunities in Remote Coding, Coding Compliance Review, Education and Training, Clinical Documentation Improvement, HIM and Coding Interim Management, and Revenue Integrity. Our client base includes top-ranked hospitals for academics, research, quality, and patient care. Through this broad client base, remote-employment opportunities, and multiple service offerings, we engineer individual career paths and encourage balance for each employee. As medical coding and regulatory compliance demands continue to increase for every healthcare organization, UASI works within the core values on which our company was founded and offers the newest solutions for producing low-cost, high-quality records.

United Audit Systems, Inc. (UASI), a rapidly growing healthcare consulting firm seeks to expand its professional team of employees by adding experienced Clinical Appeals Review Nurse to our team. The ideal candidate will have a combination of clinical experience in a hospital acute care setting and experience providing reviews of the hospital billing and charging policies.

RN Certification CCDS or CDIS Certification preferred Experience with DRG Denials Epic experience preferred InterQual and Medical Necessity experience Ability to read and comprehend itemized billing statement, patient medical record and other laboratory reports Ability to analyze medical information and determine appropriate billing procedures Ability to effectively communicate with others Analytical thinking process

DRG Denials Perform a variety of audit services including charge audit, compliance audit, medical necessity, denials and other requests as needed. Audits may be performed on a concurrent or retrospective basis Review and analyze the client inpatient and/or outpatient itemized billing statement and the patient medical record and related documentation to identify items that were not billed correctly. Document findings on appropriate form and submit findings to client management staff daily so new billing forms can be generated in hospitals billing systems. Adhere to the National Health Care Billing Audit Guidelines, UASI Code of Conduct and Compliance Program, and the client third party audit policy while performing all duties. Attend meetings with members of client-hospital finance, medical records, and ancillary departments. Educate Client-Hospital personnel on validation and documentation of charges if requested by client contract relationship. Navigate hospitals medical record system and understand where to locate the financial information in relation to the patient payor billing information

Evidence In Motion (EIM)

Chief Nursing and Clinical Education Officer

Posted on:

December 7, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Texas

Evidence In Motion (EIM) is a health care learning solutions company dedicated to reimagining education that transforms every community. We offer specialty certifications, post-professional programs and continuing education courses. EIM also partners with leading higher education institutions to provide accelerated graduate programs in health care. EIM is reimagining health care education through hybrid learning, which integrates evidence-based practice, top faculty from across the country, and a leading curriculum that combines online learning and collaboration with intensive hands-on lab experiences. We believe that our reimagined health care education model increases access, reduces student debt and improves outcomes.

The Chief Nursing & Clinical Education Officer is a senior academic and operational executive responsible for shaping, delivering, and scaling EIM-supported hybrid nursing programs and the national clinical education strategy. This role oversees clinical site procurement and student placement across multiple healthcare disciplines while serving as the organization’s chief nursing authority. The leader drives academic and operational excellence, innovation in learning models, accreditation and regulatory compliance, and strategic healthcare partnership growth. This executive plays a pivotal role in advancing clinical workforce readiness and student success through high-quality hybrid education, accreditation excellence (CCNE and state BON), and robust clinical collaborations. The role works closely with EIM executive leadership, university partners, academic and clinical faculty, and health system partners to strengthen program quality, clinical capacity, and learner outcomes. This is a remote position

Required : 10+ years of progressive leadership in nursing education and clinical practice. Experience in leadership roles within CCNE- or ACEN-accredited programs (Program Director, Associate Dean, CNO, or equivalent). Demonstrated success in clinical education operations, site development, or placement strategy. Doctoral degree in nursing, healthcare, or education (PhD, EdD, DNP). Current, unrestricted U.S. RN license. Experience leading CCNE accreditation and state board of nursing approval processes. Proven ability to build strategic partnerships and lead cross-functional teams at scale. Preferred : Experience launching or scaling hybrid or accelerated nursing programs. Multi-state regulatory and clinical site development experience. Experience in high-growth or innovation-oriented higher-education environments. Exceptional executive communication, relationship-building, and change-leadership capabilities. Position is remote with travel required as needed Apply for this job online Email this job to a friend Share on your newsfeed

Strategic Leadership : Set and execute the vision for clinical education and nursing program excellence across EIM-supported programs. Serve as EIM’s senior nursing leader and regulatory authority, representing the organization with academic, accreditation, and clinical bodies (AACN, CCNE, BONs). Build and oversee scalable systems for clinical site development, student placement, preceptor engagement, and data-driven performance management. Lead strategic planning, budgeting, resource allocation, and technology enablement to support growth and operational performance. Stay ahead of workforce and regulatory trends, guiding innovation in curriculum, accelerated learning models, market positioning, and student experience. Academic & Program Leadership : Lead development and continuous improvement of hybrid, evidence-based nursing curricula aligned with accreditation and regulatory standards. Advise university partners on program design, launch, execution, assessment, and ongoing improvement. Lead accreditation and regulatory strategy, including CCNE submissions, BON approvals, and external reviews. Clinical Operations & Partnerships : Oversee national clinical placement strategy and expansion across healthcare disciplines. Build and strengthen strategic relationships with health systems and clinical partners. Collaborate with leadership to expand and operationalize EIM’s fee-for-service clinical placement offering and student-to-specialist pathways. Faculty Development & Support : Support recruitment, development, and retention of nursing faculty, clinical educators, and preceptors. Establish faculty workload models, onboarding frameworks, and development programs to support hybrid, clinical, and simulation-based instruction. Cross-Functional Collaboration : Partner across EIM functions — partner services, curriculum, marketing, enrollment, and technology — to ensure alignment with regulatory, academic, and operational standards. Collaborate with data and technology teams to build reporting systems, dashboards, and metrics supporting compliance and continuous improvement. Other duties as assigned

MD Anderson Cancer Center

Nurse Defense Auditor

Posted on:

December 7, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Texas

The University of Texas MD Anderson Cancer Center is one of the world's most respected centers devoted exclusively to cancer patient care, research, education and prevention. MD Anderson provides cancer care at several convenient locations throughout the Greater Houston Area and collaborates with community hospitals and health systems nationwide through MD Anderson Cancer Network®. U.S. News & World Report's "Best Hospitals"​ survey has ranked MD Anderson the nation's top hospital for cancer care. Every year since the survey began in 1990, MD Anderson has been named one of the top two cancer hospitals. The recognition reflects the passion of our 21,000 extraordinary employees and 1,000 volunteers for providing exceptional care to our patients and their families, and for realizing our mission to #EndCancer.

As a Nurse Defense Auditor in our Hospital Billing & Collections department, your expertise ensures accurate reimbursement and supports patient access to life-saving care. This role combines clinical knowledge, insurance expertise, and critical thinking to resolve complex denials and audits-making a direct impact on patient outcomes and organizational success. MD Anderson offers our employees: Paid Medical Benefits for employees and eligible dependents Generous Paid Time Off (PTO) for work-life balance Retirement Plans with employer contributions Career Development Opportunities and tuition assistance Additional perks such as wellness programs, employee discounts, and more The primary purpose of the Nurse Defense Audit Coordinator position within the Hospital Billing & Collections department is to utilize clinical expertise, insurance knowledge, business acumen, and strong communication skills to analyze patient accounts and invoices for retrospective approval of denied services and potential continued access needs. This role also includes conducting retrospective reviews and audits of patient accounts to complete Defense Audits. Ideal Candidate: A Registered Nurse (RN) with experience in appeals and nurse defense auditing.

EDUCATION Required: Graduation from an accredited school of nursing. Preferred: Bachelor's Degree Nursing. WORK EXPERIENCE Required: 5 years Experience in clinical nursing and 1 year Experience in utilization review. May substitute preferred degree for two years of the five clinical nursing experience. Preferred: Nurse Defense Audit experience, experience with insurance appeals, prior case management or business office experience. Work Schedule: This position is remote. Prefer Houston/local area. LICENSES AND CERTIFICATIONS Required: RN - Registered Nurse - State Licensure State of Texas Professional Nursing License (RN). Upon Hire and Required: BLS - Basic Life Support Upon Hire or Required: CPR - Cardiac Pulmonary Resuscitation Upon Hire Preferred: CM - Case Management Upon Hire Preferred: ACLS - Advanced Cardiac Life Support Certification as required by patient care area. Upon Hire Preferred: PALS - Pediatric Advanced Life Support Certification as required by patient care area. Upon Hire

Analyze invoices and accounts in the patient accounting system to prepare for appeals of third-party payer denials. Utilize Explanation of Benefits (EOB) and Remittance Advices to verify denials and identify possible avenues of appeal. Contact third-party payers, insurance medical directors, case management, and utilization review to request reconsideration and/or appeal of claims requiring clinical intervention, ensuring comprehensive data is provided to justify appeals. Evaluate and audit medical records to support Defense Audits, confirming services were provided and billed accurately. Review for overcharges and missing charges, and discuss findings with outside auditors. Collaborate with Case Management and providers to ensure all medical necessity documentation is captured. Coordinate appeal or audit processes and maintain appropriate follow-up on appealed/audited claims. Update and document patient accounting system accurately and efficiently, including insurance, demographics, notations, and service codes. Communicate with leadership regarding issues impacting future care needs and contract performance. Demonstrate thorough knowledge of third-party payer claim requirements, UB04, HCFA1500, EOBs, and appeal timelines. Maintain understanding of insurance guidelines for medical necessity review, including M&R and InterQual, and working knowledge of ICD-10 and CPT codes. Stay current on oncology clinical processes and outcomes, including clinical trials and related resources. Perform related business office responsibilities with minimal supervision, demonstrating innovation, good judgment, and adherence to ethical and legal billing procedures. Follow hospital and department policies and maintain confidentiality in all matters. Actively contribute to a team approach, offering positive suggestions and ideas for improved revenue recovery and team success.

L.A. Care Health Plan

Registered Nurse (RN) Manager, Appeals and Grievances General Operations (Clinical)

Posted on:

December 7, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

California

Established in 1997, L.A. Care Health Plan is an independent public agency created by the state of California to provide health coverage to low-income Los Angeles County residents. We are the nation’s largest publicly operated health plan. Serving more than 2 million members, we make sure our members get the right care at the right place at the right time. Mission: L.A. Care’s mission is to provide access to quality health care for Los Angeles County's vulnerable and low-income communities and residents and to support the safety net required to achieve that purpose.

The Manager, Appeals & Grievances (A&G) & General Operations (Clinical) is responsible for the daily oversight of clinical appeals and grievances functions within the Appeals & Grievances Department to ensure clinical grievances, complaints, appeals and complex issues are investigated and resolved using regulatory guidance across all lines of business. Provides direct supervision to the A&G clinical team and the unit that supports them in order to assure operational effectiveness which includes the implementation and adherence to L.A. Care's Policies & Procedures that meet Centers for Medicare and Medicaid Services (CMS), the California Department of Health Care Services (DHCS), the California Department of Managed Health Care (DMHC), the Managed Risk Medical Insurance Board (MRMIB), National Committee for Quality Assurance (NCQA) and other rules/ regulations/ standards. The Manager is responsible for establishing and monitoring processes to oversee and coordinate the identification, documentation, reporting, investigation and resolution of all member appeals and grievances in a timely and culturally-appropriate manner. Coordinates, tracks, and resolves internal and external appeal and grievance complaints for L.A. Care Plan Partners, including identifying opportunities for improvement. This position will be a role model for integrity and will establish and maintain effective professional work relationships, working collaboratively with all levels of management and business owners to help guide the discipline of planning, organizing, securing, managing, leading, and controlling resources to achieve specific goals. Manages all aspects of running an efficient team, including hiring, supervising, coaching, training, disciplining, and motivating direct-reports.

Education Required: Bachelor's Degree in Nursing Education Preferred Experience Required: 6 years of clinical acute care experience with at least 3 years of experience with health care grievance and/or appeals issues, preferably in a managed care or Medicaid Health Plan environment and/or public services or public benefits programs. At least 3 years of management level operations leadership experience. Experience working with firm deadlines, regulators, detail oriented with the ability to interpret and apply regulations Experience building relationships with organizations and business partners. Equivalency: Completion of the L.A. Care Management Certificate Training Program may substitute for the supervisory/management experience requirement. Preferred: Managed care experience. Skills Required: Excellent analytical, problem solving, planning and implementation skills. Demonstrated strong writing and communication skills. Demonstrates excellent leadership, communication, and negotiation skills with the ability to interact and influence all levels of the organization including executive management and key decision -makers. Demonstrates professional judgement, and critical thinking, to promote the delivery of quality, cost-effective care. Time management and priority setting skills. Excellent understanding of NCQA, DMHC, DOI, DHCS, and CMS regulatory requirements. Knowledge of Coordination of Care, Medicare and Medi-Cal regulations, prior authorization, level of care and length of stay criteria sets. Able to work effectively with various internal departments/service areas, L.A. Care's plan partners, participating provider groups, and other external agencies. Able to operate PC-based software programs including proficiency in Word, Excel and PowerPoint presentations. Excellent verbal, written communication and presentation skills. Licenses/Certifications Required Registered Nurse (RN) - Active, current and unrestricted California License Licenses/Certifications Preferred Required Training Physical Requirements Light Additional Information This position requires work after hours, on weekends, holidays, a hybrid remote schedule, occasional flexibility in hours/shift in critical situations and work on-call. This position requires handling various caseloads and flexibility to adapt to changing priorities which may include but not limited to redistributed work assignments, team projects, and other priorities as assigned

Manage and oversee the handling of clinical grievances and appeals, for L.A. Care and Plan Partner members. Establishes and oversees processes and all relevant member correspondence for accuracy, clarity, and cultural appropriateness and sensitivity. Review and monitor procedures for identifying quality of care issues and work collaboratively with cross-functional departments to appropriately address and resolve member grievances. Serve as the Key Contact for State Fair Hearings, internal and external audits, DMHC and DHCS inquiries. Review and monitor procedures for identifying quality of care issues and work collaboratively with cross-functional departments to appropriately address and resolve member and provider grievances. Responsible for timely daily operations in the A&G Clinical Services Unit and other general operations units. Ensures timely appeal and grievance reporting to regulatory agencies, internal Regulatory Affairs and Compliance Department, internal Quality Oversight Committee, etc. Collaborates with cross-functional departments to ensure the use of appropriate appeal and grievance issue codes, timely resolution, and refers to community partners as appropriate. Lead, participate and provide representation of the A&G Team at Internal and External meetings/workgroups and acts as the point person for A&G Programs especially the Clinical Programs. Develop and execute on strategic opportunities to improve the overall appeals & grievance process. Create a best in clinical appeals process that is efficient and effective in managing member appeals. Work cross functionally and collaboratively within Appeals and Grievances with key internal partners to build a high functioning, results oriented environment and organization. Duties Continued: Partner with internal and external stakeholders to build and maintain collaborative relationships and partnerships. Identify areas of connection to leverage and create added value for L.A. Care. Provide input into the development of automation to guide the team to process efficiencies for all lines of business while maintaining compliance and manageable workloads for staff. Responsible for maintaining and updating on an annual basis, or as necessary, appeal and grievance policies and procedures, member correspondence, etc., consistent with regulatory changes. Develop and maintain inventory reports for the appeals process ensuring appropriate productivity, compliance, and inventory management. Identify and implement continuous business process improvement recommendations to leverage organizational added value to the Appeals and Grievances Department. Develop and implement short and long-term strategies to improve team results, reducing administrative expenses. Manage staff, including, but not limited to: monitoring of day to day activities of staff, monitoring of staff performance, mentoring, training, and cross-training of staff, handling of questions or issues, etc. raised by staff, encourage staff to provide recommendations for relevant process and systems enhancements, among others. Supervision of the Clinical Services unit and general operations within Appeals and Grievances. Maintain a team of top talent, providing a culture of teamwork and collaboration. Perform other duties as assigned

Thyme Care

Oncology Triage Nurse (11:30AM - 8:00PM EST)

Posted on:

December 6, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Tennessee

We exist to create a more connected, compassionate, and confident experience for people with cancer and those who care for them. We make it easier to get answers, access high-quality care quickly, and feel supported throughout treatment and beyond. Today, Thyme Care is a market-leading value-based oncology care enabler, partnering with national and regional health plans, providers, and employers to deliver better outcomes and lower costs for thousands of people across the country. Our model combines high-touch human support with powerful technology and AI to bring together everyone involved in a person’s cancer journey: caregivers, oncologists, health plans, and employers. As a tech-native organization, we believe technology should strengthen the human connection at the center of care. Through data science, automation, and AI, we simplify complexity, improve collaboration, and help care teams focus on what matters most: supporting people through cancer. Looking ahead, our vision is bold: to become a household name in cancer care, where every person diagnosed asks for Thyme Care by name. If you’re inspired to make cancer care more human and to help reimagine what’s possible, we’d love to meet you. Together, we can build a future where every person with cancer feels truly cared for, in every moment that matters.

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 11:30AM - 8:00PM EST.

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. 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.

Thyme Care

Nurse Manager, Population Health

Posted on:

December 6, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Tennessee

We exist to create a more connected, compassionate, and confident experience for people with cancer and those who care for them. We make it easier to get answers, access high-quality care quickly, and feel supported throughout treatment and beyond. Today, Thyme Care is a market-leading value-based oncology care enabler, partnering with national and regional health plans, providers, and employers to deliver better outcomes and lower costs for thousands of people across the country. Our model combines high-touch human support with powerful technology and AI to bring together everyone involved in a person’s cancer journey: caregivers, oncologists, health plans, and employers. As a tech-native organization, we believe technology should strengthen the human connection at the center of care. Through data science, automation, and AI, we simplify complexity, improve collaboration, and help care teams focus on what matters most: supporting people through cancer. Looking ahead, our vision is bold: to become a household name in cancer care, where every person diagnosed asks for Thyme Care by name. If you’re inspired to make cancer care more human and to help reimagine what’s possible, we’d love to meet you. Together, we can build a future where every person with cancer feels truly cared for, in every moment that matters.

As an Oncology Nurse Manager, you will lead multiple Nurse Team Leads and their nursing teams, ensuring they are equipped to deliver the highest standards of clinical care and to do so with efficiency. Reporting to the Senior Oncology Nurse Manager, you will serve as a leader who drives performance and productivity while fostering a culture of compassion, trust, and growth. In this role, you will coach and mentor Nurse Team Leads — especially those new to leadership — helping them grow into confident, capable people managers. Your guidance will focus on equipping them with the skills to enhance team productivity and efficiency through effective people management, including setting goals, providing constructive feedback, fostering accountability, and addressing performance challenges. You will also design and implement overarching people management strategies that enhance team performance and productivity, creating the framework that becomes the cornerstone for scaling the nursing team. Additionally, you will support the reinforcement of NCQA-compliant workflows and documentation, helping ensure that quality standards and compliance practices are consistently embedded and sustained across teams.

People-first. Thyme Care’s mission and members matter to you deeply. You must have a Bachelor of Science Degree in Nursing, an unrestricted Registered Nurse (RN) license, and a willingness to obtain additional state licenses, as needed. Nursing Experience. You have at least 8 years of nursing experience, including 2 years as a nurse leader in a remote oncology navigation and/or remote oncology case management environment. You are certified as an Oncology Certified Nurse (OCN), Advanced Oncology Certified Nurse (AOCN), Advanced Oncology Certified Nurse Specialist (AOCNS), or Certified Case Manager (CCM). Prior startup experience is preferred. Coaching and Leadership Experience. You have proven leadership experience with a strong track record of coaching, mentorship, and holding teams accountable to drive results. Additionally, you have demonstrated success in building leaders, particularly through coaching and mentoring emerging leaders in core skills of people management. Scaling Performance and Productivity. You bring hands-on experience designing and implementing structured performance management strategies that improve productivity, efficiency, and engagement across multiple roles and teams in a remote environment. You have applied data-driven approaches in prior roles, using performance metrics and outcomes to measure success, diagnose issues, and lead sustainable improvements. You also have experience aligning leadership development and team performance strategies with organizational goals to deliver measurable impact.You understand how to align team goals with broader population health strategies — including risk stratification, care gap closure, and quality improvement — and can use data to drive this work forward. Comfort with change and ambiguity. You have experience leading teams through organizational change and growth, including restructuring, scaling, or process redesign, while maintaining engagement, morale, and performance. You demonstrate flexibility and resilience by adapting to shifting priorities, unclear situations, or rapidly changing environments, and you know how to guide your teams through ambiguity with steadiness, transparent communication, and a focus on outcomes. Grit. You’re never afraid to get your hands dirty, but you can also take a step back and connect the company’s strategy to your team’s performance and execution. You’re always determined to persevere through any challenges or barriers you encounter. A desire to learn how to use new technologies. We are a technology-driven 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 a willingness to learn new technology is essential. Identify priorities and take action. You know how to identify and prioritize your team’s needs and take the necessary steps to address urgent and essential issues immediately. Bias to action. You’re a self-starter and don’t need anyone to tell you when to do something. You’re always solving problems and going the extra mile for others.

Directly manage Nurse Team Leads, providing coaching, mentorship, and structured performance management strategies to help them become strong and effective leaders. Enable Nurse Team Leads to improve team performance, productivity, and efficiency through people management practices, including clear goal-setting, regular feedback, accountability systems, and engagement strategies. Set and monitor performance metrics across multiple teams, using data to identify trends, address barriers, and implement targeted improvement plans. Serve as an escalation point for complex member and caregiver cases, modeling sound clinical judgment while supporting team confidence. Build strong communication loops across leadership and frontline nurses, ensuring insights from staff and members shape organizational decisions. Champion the adoption and consistency of NCQA-compliant workflows and documentation, ensuring quality standards and compliance practices are understood, integrated, and sustained across teams. Anticipate staffing and leadership needs, support succession planning, and foster career growth pathways for Nurse Team Leads and their teams. Represent nursing leadership in cross-functional forums, advocating for strategies that advance both quality of care and workforce productivity.

Thyme Care

Palliative Care Nurse Practitioner (Compact + IL-Licensed)

Posted on:

December 6, 2025

Job Type:

Full-Time

Role Type:

License:

NP/APP

State License:

Compact / Multi-State

We exist to create a more connected, compassionate, and confident experience for people with cancer and those who care for them. We make it easier to get answers, access high-quality care quickly, and feel supported throughout treatment and beyond. Today, Thyme Care is a market-leading value-based oncology care enabler, partnering with national and regional health plans, providers, and employers to deliver better outcomes and lower costs for thousands of people across the country. Our model combines high-touch human support with powerful technology and AI to bring together everyone involved in a person’s cancer journey: caregivers, oncologists, health plans, and employers. As a tech-native organization, we believe technology should strengthen the human connection at the center of care. Through data science, automation, and AI, we simplify complexity, improve collaboration, and help care teams focus on what matters most: supporting people through cancer. Looking ahead, our vision is bold: to become a household name in cancer care, where every person diagnosed asks for Thyme Care by name. If you’re inspired to make cancer care more human and to help reimagine what’s possible, we’d love to meet you. Together, we can build a future where every person with cancer feels truly cared for, in every moment that matters.

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

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

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

CVS Health

Utilization Management Clinical Nurse Consultant (Must be licensed in Arizona)

Posted on:

December 6, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

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

The Utilization Management Clinical Nurse Consultant utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program.

Required Qualifications: 3+ years of experience in acute hospital clinical practice. Must have active and unrestricted RN (Registered Nurse) Licensure in the state of Arizona, or Compact RN licensure. Ability to work Monday-Friday from 8:30am-5:00pm, Arizona Time Zone. Preferred Qualifications: Previous experience with utilization management. Previous clinical experience in Emergency Department, ICU (Intensive Care Unit), Telemetry, and/or Medical/Surgical. Ability to collaborate with various internal departments. Strong communication skills. Strong organizational and time management skills. Education: Associate’s degree in Nursing.

Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care, and medical necessity criteria for appropriate utilization of services. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. Gathers clinical information and applies the appropriate medical necessity criteria/guideline, policy, procedure, and clinical judgment to render coverage determination/recommendation/discharge planning along the continuum of care. Utilizes clinical experience and skills in a collaborative process to evaluate and facilitate appropriate healthcare services/benefits for members. Coordinates and communicates with providers and other parties to facilitate optimal care/treatment. Identifies members who may benefit from care management programs or other post-discharge programs and facilitates referrals. Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization.

Robert Half

RN Medical Coder

Posted on:

December 6, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

California

We are looking for an experienced RN Medical Coder with a strong background in coding and reimbursement methodologies to join our team. This long-term contract role offers the opportunity to work remotely and contribute to the development of coding for benefit plans within the healthcare insurance industry. As part of this position, you will collaborate with certified coders and business analysts to ensure accuracy and compliance in coding practices.

Minimum of 3 years of experience in coding and reimbursement methodologies, including ICD-10 and HCPCS coding. CPC certification is required. Active and unrestricted Registered Nurse (RN) license. Proficiency in Microsoft Word, Excel, Access, and PowerPoint. Excellent verbal and written communication skills. Prior experience in managed care is preferred. Strong ability to review, audit, and adjust coding practices. Familiarity with healthcare insurance processes and benefit plan coding.

Analyze and identify appropriate codes for language used in benefit plans. Review and validate coding decisions made by peers to ensure accuracy. Facilitate discussions to align on coding documentation and standards. Assess audit results and implement necessary adjustments to maintain compliance. Actively participate in project meetings to provide insights and updates. Collaborate with team members, including certified coders and business analysts, to achieve project goals. Ensure coding practices align with industry standards and regulatory requirements. Contribute to the creation of coding documentation for benefit plans. Utilize Microsoft Office tools to support project tasks and communication. Stay updated on healthcare coding methodologies and best practices.