Munson Healthcare

MHC Call Center Triage Nurse (Must reside in Michigan)

Posted on:

May 17, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Michigan

Why work as a Call Center Triage Nurse at Munson Healthcare? Be part of a team that nurtures a culture of caring every day. Our nurses work in positive, supportive and compassionate environments built on our organizational values. We employ more than 1,000 nurses who practice in nearly every acute-care specialty. Our nurses are respected clinical experts and valued partners in care. They are recognized as mentors, educators and strong health care advocates. Professional nursing practice is emphasized, and nurses participate in clinical decision-making and improve the quality of their work life. Our dynamic work environment includes many opportunities for growth and development. Why Choose Munson Healthcare: Balance – Get out on the water, in the woods, on the trails or around town. Opportunity – Be a part of northern Michigan’s leading healthcare team with opportunities for personal and professional growth throughout the healthcare system. Flexibility – A career that can change as your life changes. Teamwork – Our people make Munson Healthcare a great place to work!

CALL CENTER TRIAGE RN - REMOTE Must reside in the State of Michigan and have a current and active Michigan Nursing License Full Time / 40 Hours / Day Shift Find more than your next job. Find your community. We’re northern Michigan’s largest healthcare system and we are deeply rooted in the communities we serve. That means that our patients are often our family, friends and neighbors – and it’s special to be able to care for them. And as one of the top healthcare systems to work for in Michigan by Forbes (American’s Best Employers by State 2022), we’re committed to your ongoing growth and development. After work, you’ll find things to do in every season – beaches, outdoor recreation, unique restaurants, world-class wineries, arts and entertainment.

What is Required for this role: Graduate of a recognized accredited school of nursing. Currently licensed as a Registered Nurse in good standing in the State of Michigan. Must reside in the State of Michigan Preferred qualifications: BSN Preferred and Certification in the specialty area of practice is encouraged. Excellent analytical, communication, facilitation, and computer software skills are required. Care management experience Patient Triage experience Ambulatory/Clinic-based Patient Care experience

Munson Healthcare

PRN Remote MHC Call Center Triage Nurse

Posted on:

May 16, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Michigan

We’re northern Michigan’s largest healthcare system and we are deeply rooted in the communities we serve. That means that our patients are often our family, friends and neighbors – and it’s special to be able to care for them. And as one of the top healthcare systems to work for in Michigan by Forbes (American’s Best Employers by State 2022), we’re committed to your ongoing growth and development. After work, you’ll find things to do in every season – beaches, outdoor recreation, unique restaurants, world-class wineries, arts and entertainment.

CALL CENTER TRIAGE RN - REMOTE Must reside in the State of Michigan and have a current and active Michigan Nursing License PRN POSITION / 0-40 Hours weekly (Full time summer coverage needed) / Day Shift Why work as a Call Center Triage Nurse at Munson Healthcare? Be part of a team that nurtures a culture of caring every day. Our nurses work in positive, supportive and compassionate environments built on our organizational values. We employ more than 1,000 nurses who practice in nearly every acute-care specialty. Our nurses are respected clinical experts and valued partners in care. They are recognized as mentors, educators and strong health care advocates. Professional nursing practice is emphasized, and nurses participate in clinical decision-making and improve the quality of their work life. Our dynamic work environment includes many opportunities for growth and development.

Graduate of a recognized accredited school of nursing. Currently licensed as a Registered Nurse in good standing in the State of Michigan. Must reside in the State of Michigan Preferred qualifications: BSN Preferred and Certification in the specialty area of practice is encouraged. Excellent analytical, communication, facilitation, and computer software skills are required. Care management experience Patient Triage experience Ambulatory/Clinic-based Patient Care experience

BayCare

RN Phone Triage

Posted on:

May 16, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Florida

At BayCare, we are proud to be one of the largest employers in the Tampa Bay area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians. With the support of more than 30,000 team members, we promote a forward-thinking philosophy that’s built on a foundation of trust, dignity, respect, responsibility, and clinical excellence.

BayCare is currently in search of our newest RN Phone Triage who is passionate about providing outstanding customer service to our community. BayCare’s top priority is the health and well-being of our communities as Tampa Bay's leading multi-specialty group with more than 600 providers practicing 45 specialties in over 175 outpatient locations throughout the Tampa Bay and west central Florida regions. Status: Full Time Shift Hours: 8:00 AM – 5:00 PM (Hours May Vary) Shift Days: Monday thru Friday Location: Remote Weekend Work: None On Call: No

Required Technical in Nursing; OR Associate’s in nursing; Preferred: Bachelors in Nursing Required - RN (Registered Nurse) Required 3 years of experience in primary care, pediatrics, or emergency room Highly preferred pediatrics experience

Triages patients over the phone providing basic medical advice and direction within the appropriate scope of practice. Accurately and completely documents patient interaction within the patient record the EMR. Triages for multiple practices and providers during normal business hours. This position will be remote. During periods of low call volume will be asked to perform other duties such as prescription refills and medication questions. Perform other duties as assigned.

Millennium Physician Group

ACO Triage Nurse (North Fort Myers) Remote

Posted on:

May 16, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Florida

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

ACO Triage Nurse Full Time: 3 -day 12 hr. shifts (Monday-Friday 8am-5pm) + rotating weekends North Fort Myers - Remote Position Millennium Physician Group is currently looking for a professional, compassionate, knowledgeable and licensed individual to fill the position of Triage Nurse. H/She must be a Licensed Registered Nurse who will utilize best practices to provide effective triage processes and principles that provide for the safety and wellbeing of the patient. If you have RN Triage experience in a larger-sized medical practice, we encourage you to apply for this position.

Registered Nurse licensed in FL License must always be kept current 5+ Years of clinical experience with 1+ year(s) of case management experience preferred ER Triage experience is preferred. Telephonic Triage experience preferred

Participate in the After-Hours On-Call Team rotation Answer all incoming calls immediately and give correct advice Provide Post-Acute Care Outreach Assist Hospitalist's Patient Outreach Facilitate Prescription Refills Assist RN Care Management Teams with patient assessments and/or monthly follow-up calls, when needed Monitor Patients enrolled in the Patient Monitoring Program

Maxim Healthcare Services

RN Case Manager - Home Health - REMOTE residing in Columbia, MO

Posted on:

May 16, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Missouri

Maxim Healthcare Services has been making a difference in the lives of our patients, caregivers, employees and communities for more than 30 years. We offer private duty nursing, skilled nursing, physical rehabilitation, companion care, respite care and behavioral care for individuals with chronic and acute illnesses and disabilities. Our commitment to quality customer service, compassionate patient care, and filling critical healthcare needs makes us a trusted partner wherever care is needed.

Maxim Healthcare Services is hiring for a Case Manager to oversee the clinical care of homecare clients - REMOTE - residing in Columbia, MO! Why This Role? Balanced Responsibilities Work-Life Balance Autonomy & Flexibility Long-Term Impact Company Culture Educational Opportunities What We Offer: Competitive Salary: $70,000 - $80,000 with an additional annual bonus potential of $5,000, paid out quarterly Weekly Paychecks Comprehensive Benefits Retirement Savings Recognition Programs Expense Reimbursement

Active RN license required (for states where office and patients are located) A minimum of one year of RN experience is preferred Supervisory experience is an advantage Strong communication, organization, and time management skills Proficiency in Microsoft Office and general computer literacy Must be a team player with excellent customer service skills

Oversee the clinical care of homecare clients from admission through discharge Manage care delivery and personnel, ensuring high-quality clinical services Orient and evaluate homecare caregivers, ensuring their skills and competencies Foster caregiver development through education, training, and ongoing support Perform both in-office and field duties, including patient home visits

Maxim Healthcare Services

RN Case Manager - Home Health - $5,000 Sign On Bonus - REMOTE residing around Wellsburg, IA/Waterloo, IA!

Posted on:

May 16, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Iowa

Maxim Healthcare Services has been making a difference in the lives of our patients, caregivers, employees and communities for more than 30 years. We offer private duty nursing, skilled nursing, physical rehabilitation, companion care, respite care and behavioral care for individuals with chronic and acute illnesses and disabilities. Our commitment to quality customer service, compassionate patient care, and filling critical healthcare needs makes us a trusted partner wherever care is needed.

Maxim Healthcare Services is hiring for a Case Manager to oversee the clinical care of homecare clients - REMOTE - residing around Wellsburg, IA/Waterloo, IA! Why This Role? Balanced Responsibilities Work-Life Balance Autonomy & Flexibility Long-Term Impact Company Culture Educational Opportunities What We Offer: Competitive Salary: $70,000 - $75,000 with an additional annual bonus potential of $5,000, paid out quarterly $5,000 Sign-On Bonus! Only new hires are eligible to receive a sign on bonus for joining the Maxim Healthcare Services team Weekly Paychecks Comprehensive Benefits Retirement Savings Recognition Programs Expense Reimbursement

Active RN license required (for states where office and patients are located) A minimum of one year of RN experience is preferred Supervisory experience is an advantage Strong communication, organization, and time management skills Proficiency in Microsoft Office and general computer literacy Must be a team player with excellent customer service skills

Oversee the clinical care of homecare clients from admission through discharge Manage care delivery and personnel, ensuring high-quality clinical services Orient and evaluate homecare caregivers, ensuring their skills and competencies Foster caregiver development through education, training, and ongoing support Perform both in-office and field duties, including patient home visits

HarmonyCares

Telephonic RN Nurse Care Manager- Remote in Newark, NJ

Posted on:

May 16, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

New Jersey

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

The Nurse Care Manager is an integral member of the care team and is vital to enhancing the health outcomes of HCMG patients. This position will manage a caseload of high-risk patients where he/she is responsible for managing their care and barriers. These duties will include, but are not limited to Transitional Care Management, Chronic Care Management, Disease Management Education, Medication Education, and the development and management of patient care plans. The Nurse Care Manager will serve as co-chair of the pod alongside the pod leader, focusing on driving and prioritizing patient needs to improve patient outcomes.

Required Knowledge, Skills and Experience: Active Registered Nurse License 2+ years of care management experience in community, health plan or hospital systems Possesses strong clinical skills and proactive thinking Effective communication skills Ability to perform extensive telephone assessment Knowledge of Medicare regulations and home care and hospice standards Experience with small group presentations and teaching/training Exhibits excellent interpersonal skills Exhibits excellent written and oral skills Working knowledge of computer programs (email, Word, Excel, PowerPoint, etc.) Manages time effectively to ensure all duties and documentation requirements are completed in a timely manner Preferred Knowledge, Skills and Experience: Bachelor of Science in nursing or related field May be required to obtain multi-state licensing Strong knowledge of population health, quality measures, care gap closure and value-based care models

Coordinates care services with pod leader to ensure that patients have access to a comprehensive set of services tailored to their needs throughout their healthcare journey Works collaboratively within the care team to develop and manage personalized care plans, address care gaps, and engage with other resources to ensure access to care Coordinates the transition of care for patients throughout the continuum to ensure patient needs are met accordingly and to ensure that avoidable hospital admissions do not occur Coordinates and facilitates High Risk Huddles along with ensuring that follow-up actions are completed Prioritizes patients based on the severity and urgency of their conditions to ensure that the most critical cases receive immediate attention Reviews medical records to identify gaps in care and coordinate services with the care team to manage these issues Regularly updates patient care plans Performs thorough nursing assessments via telephone of patients to maximize or improve current health outcomes Provides education to patients and/or their caregivers on disease education, medication, health maintenance, and disease prevention to promote self-management and improve health outcomes Demonstrates strong clinical skills, critical thinking abilities, and effective communication in their interactions with patients, caregivers, providers, fellow care team members, etc. Documents necessary interactions, assessments, updates, etc. in patient’s medical records according to processes and guidelines Serves as liaison between patients, providers, resources, etc. to ensure seamless care delivery Facilitates communication of patient status and plan of care during transitional experiences such as home to hospital, hospital to post-acute care and back to home In this role you may work with: Executive Directors Market Leaders Pod Leaders Clinical Social Worker Patient Health Coordinator Population Health Team

Akkodis

Clinical Claims Nurse (Healthcare Provider)

Posted on:

May 16, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Florida

This role supports individuals such as patients, beneficiaries, and healthcare providers by reviewing submitted documentation to evaluate the validity of appeals or disputes. It involves delivering a fair and unbiased second-level decision based on an in-depth analysis of facts, supporting documentation, applicable laws, and relevant guidelines. Pay Range: $30-$36.25/hr. The rate may be negotiable based on experience, education, geographic location, and other factors.

Education: Associate’s degree or higher in a healthcare-related field from an accredited institution. LPN or RN License Experience: Minimum of three (3) years’ experience in medical appeals, dispute resolution, clinical review, or a related healthcare environment. Background in Nursing, Physical Therapy, Occupational Therapy, or Respiratory Therapy is required. Candidates holding a Juris Doctorate or a Master’s in a healthcare-related discipline may substitute this requirement. Proven ability to compose or assess appeals and payment-related determinations. Preferred experience with patient-provider or independent dispute resolution processes. Possession of a coding certification is a plus.

Analyze medical records and case files to produce clear, objective reconsideration or dispute resolution summaries that justify the final determination. Exercise independent judgment to make evidence-based decisions in alignment with legal statutes, established regulations, policies, and clinical standards. Address and respond thoroughly to all issues presented by patients, beneficiaries, authorized representatives, or healthcare providers involved in the appeal or dispute. Render impartial conclusions supported by current evidence, policy, and regulatory frameworks. Conduct detailed research utilizing online resources such as federal regulations, medical standards, policy manuals, and clinical literature to support accurate, well-informed decisions. Stay informed of developments in healthcare practices, legal regulations, and organizational policies to ensure decisions remain compliant and current.

CarePlus Health Plans

Telephonic Care Manager, Behavioral Health

Posted on:

May 16, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

South Carolina

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

Are you a transitioning military service member or a Military Spouse looking for an internship that supports the goal to put health first? The Telephonic Care Manager Behavioral Health, Registered Nurse, RN, Intern will assess and evaluate 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 Behavioral Health Care Manager’s work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The DOD SkillBridge Internship Program provides an opportunity for transitioning military service members to gain civilian work experience with an employer for a period between 90 and 180 days upon approval.

Required Qualifications: Must be a transitioning service member eligible to participate in SkillBridge or military spouse eligible to participate in the military spouse fellowship Must meet one (1) of the following: Unrestricted active licensed Registered Nurse (RN) in a state that participates in the enhanced, (eNLC) licensure without restrictions or disciplinary action. Master's degree clinician in the field of social work, nursing, rehabilitation, psychology or related health and human services and independent licensure in South Carolina without disciplinary action For example: LISW or LPC Must meet all of the following: Minimum Two (2) years clinical nursing experience in acute care, emergency room, ICU, skilled or rehabilitation setting. Proficient using MS Office including Word, Excel, PowerPoint, and Teams in a Windows based environment and an ability to quickly learn new systems and ability to troubleshoot and resolve basic technical difficulties in a remote environment. Ability to work independently under general instructions and with a team. Familiar with working with serious mental illness specialty population and behavioral health members, using MI and positive techniques 1 year Care Coordination Preferred Qualifications: BSN preferred Clinical acute care experience in a behavioral health setting Possess an interest in working in the managed care industry Previous Medicare/Medicaid experience a plus. Experience with case management, discharge planning and patient education for adult acute care Managed care experience Certified Case Manager (CCM) Additional Requirements / Adherence Workstyle: Remote Work at Home Preferred Location: South Carolina Alternate Locations: Humana Healthy Horizon Medicaid State Locations: Louisiana, Wisconsin, Indiana, Oklahoma, Virginia, Florida, or Kentucky, Texas, Ohio Work Schedule: Weekdays 8:00 AM to 5:00 PM Eastern Time Travel: None Work at Home Guidance To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested, Satellite, cellular and microwave connection can be used only if approved by leadership Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

The Behavioral Health Care Manager, Telephonic 2 Intern will utilize Humana’s Medicaid training and engage formerly acquired skillsets to participate in 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. Is passionate about contributing to an organization focused on continuously improving consumer experiences

CarePlus Health Plans

Manager, Care Management Behavioral Health

Posted on:

May 16, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Virginia

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

The Manager, Care Management Behavioral Health (BH) leads teams of nurses and behavior health professionals responsible for care management. The Manager, Care Management Behavioral Health works within specific guidelines and procedures; applies advanced technical knowledge to solve moderately complex problems; receives assignments in the form of objectives and determines approach, resources, schedules, and goals. Additional Information: This is a remote position in Virginia. May need to go into Humana office located in Glen Allen, VA.

Required Qualifications: Must reside in the Commonwealth of Virginia or within a 20-mile radius from Virginia in a bordering state/district (Washington DC, MD, WV, KY, TN & NC). Licensed Mental Health Professional (LMHP) license in the Commonwealth of Virginia (LCSW, LPC, LCP) or Active Registered Nurse (RN) license 3+ years of professional experience in Care Management, specifically in the delivery of care for the behavioral health needs of adult and/or adolescent members in Medicaid and/or Medicare 2+ years of management or supervisory experience. Proficiency in analyzing and interpreting data trends. Progressive business consulting and/or operational leadership experience. Comprehensive knowledge of all Microsoft Office applications, including Word, Excel, and PowerPoint. 25% travel anticipated to Humana Health Horizons office in Glen Allen, VA for collaboration and face-to-face meetings as well as field interactions with Providers, members, and their families. Travel needs could exceed 25%, as business needs required. Preferred Qualifications: Previous experience working in a managed care field. Knowledge of NCQA requirements for complex case management Previous experience in a field based or a homecare-based role. Work at Home Criteria: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Oversees the assessment and evaluation of members' behavioral health needs and requirements to achieve and/or maintain an optimal wellness state. Manages the BH care management and care coordination team, as well as peer support liaisons, providing support to low, moderate, and high risks members, including those experiencing serious mental illness and serious emotional disturbances, guiding and facilitating connection to resources appropriate for the care and well-being of members. Provides leadership in the design and implementation of policies, processes, and procedures to ensure compliance with regulatory requirements by the Virginia Department of Medical Assistance Services (DMAS), the Center for Medicare and Medicaid Services (CMS), and the National Committee on Quality Assurance (NCQA). Collects and analyzes performance reports on care management and care coordination functions to monitor adherence with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership. Collaborates with internal departments, providers, and community partners to support delivery of high-quality behavioral health care management and care coordination, including implementing innovative strategies to address unaddressed mental health and behavioral needs and create tools for recovery and resiliency. Influences and assists corporate leadership in strategic planning to improve effectiveness of care and the behavioral health services for maternal, adult, adolescent populations, and justice-involved members. Ability to work independently under general instructions and with a team. Collaborates with utilization management to coordinate seamless transitions for Members across crisis service continuum and those receiving DMAS mental health services. Provides ongoing coaching and feedback to enhance contribution, competency, and performance.

CarePlus Health Plans

RN Utilization Management

Posted on:

May 16, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Florida

About CarePlus Health Plans: CarePlus Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. CarePlus strives to help people with Medicare, or both Medicare and Medicaid, achieve their best possible health and wellness through plans with benefits and services they care about. As a wholly owned subsidiary of Humana, CarePlus currently serves Medicare beneficiaries throughout 21 Florida counties.

The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Hours for this position are Mon-Fri, 8am-5pm EST.

Required Qualifications: Active Registered Nurse (RN) license in FL with no disciplinary action. Previous experience in utilization management Minimum 2 years of clinical experience in an acute care, skilled or rehabilitation setting focused on the adult population Comprehensive knowledge of Microsoft Word, Outlook and Excel Ability to work independently under general instructions and with a team Preferred Qualifications: BSN or Bachelor's degree in a related field Medicare/Medicaid health plan experience MCG experience Bilingual is a plus Certified Case Manager (CCM) Work-At-Home Requirements: To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested Satellite, cellular are NOT allowed for this position Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

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

NeueHealth

UM Prior Authorization Nurse, LVN/LPN

Posted on:

May 16, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

California

We are transforming healthcare to be value-driven, creating a seamless, consumer-centric care experience that maximizes value for all. We believe that all health consumers are entitled to high quality, coordinated healthcare. We uniquely align the interests of health consumers, providers, and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.

The Utilization Management (UM) Prior Authorization (PA) Nurse is a full-time role with NeueHealth, dedicated to promoting quality and cost-effective outcomes for the designated population. Working in collaboration with Medical Directors and the clinical team, the PA Nurse ensures members receive the appropriate benefit coverage for services requiring prior authorization. Responsibilities include reviewing prior authorizations for treatments, medications, procedures, and diagnostic tests to confirm alignment with contract requirements, coverage policies, and evidence-based medical necessity criteria. The PA Nurse also collects and analyzes utilization data and monitors the quality and appropriate use of services. This role demands clinical expertise, keen attention to detail, and strong communication skills to effectively engage with healthcare providers, patients, and health plans.

EDUCATION AND PROFESSIONAL EXPERIENCE: Associate’s degree in Nursing, preferred Minimum 2 years of experience in medical management clinical functions. Working knowledge of MCG, InterQual, and NCQA standards LICENSURES AND CERTIFICATIONS: Active and Unrestricted License as an LVN or LPN for the State of California Certification Managed Care Nursing (CMCN) preferred PROFESSIONAL COMPETENCIES: Strong analytical and critical thinking skills. Proficiency in medical terminology and pharmacology. Effective written and verbal communication skills. Ability to work independently and collaboratively in a fast-paced environment. Adaptable and self-motivated. Experience with EMR systems and prior authorization platforms. Proficient in Microsoft Office Suite (Word, Excel, Outlook).

Authorization and Review: Evaluate and process prior authorization requests based on clinical guidelines such as Medicare, Medicaid/Medi-Cal criteria, InterQual, MCG, or health plan-specific guidelines. Assess medical necessity and appropriateness of requested services using clinical expertise. Verify patient eligibility, benefits, and coverage details. Collaboration and Communication: Act as a liaison between healthcare providers, patients, and health plans to facilitate the authorization process. Communicate authorization decisions to providers and patients promptly. Provide detailed explanations for denials or alternative solutions and collaborate with Medical Directors on adverse determinations. Ensure compliance with regulatory requirements regarding adverse determination notices, including readability standards and appeal information. Documentation and Compliance: Accurately document all authorization activities in electronic medical records (EMR) or authorization systems. Maintain compliance with federal, state, and health plan regulations. Stay updated on policy and clinical criteria changes. Quality Improvement: Identify trends or recurring issues in authorization denials and recommend process improvements. Participate in team meetings, training sessions, and audits to ensure high-quality performance.

NeueHealth

UM Prior Authorization Nurse, RN (Work from Home)

Posted on:

May 15, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

California

We are transforming healthcare to be value-driven, creating a seamless, consumer-centric care experience that maximizes value for all. We believe that all health consumers are entitled to high quality, coordinated healthcare. We uniquely align the interests of health consumers, providers, and payors to make high-quality healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid.

The Utilization Management (UM) Prior Authorization (PA) Nurse is a full-time role with NeueHealth, dedicated to promoting quality and cost-effective outcomes for the designated population. Working in collaboration with Medical Directors and the clinical team, the PA Nurse ensures members receive the appropriate benefit coverage for services requiring prior authorization. Responsibilities include reviewing prior authorizations for treatments, medications, procedures, and diagnostic tests to confirm alignment with contract requirements, coverage policies, and evidence-based medical necessity criteria. The PA Nurse also collects and analyzes utilization data and monitors the quality and appropriate use of services. This role demands clinical expertise, keen attention to detail, and strong communication skills to effectively engage with healthcare providers, patients, and health plans. The PA Nurse adheres to all standard operating procedures and organizational policies and consistently meets or exceeds established performance benchmarks.

Education: Active California license as a Registered Nurse (RN) Bachelor of Science in Nursing (BSN) preferred but not required. Certification Managed Care Nursing (CMCN) preferred. Experience: Minimum 2 years of clinical nursing experience, preferably in utilization management, case management, or prior authorizations. Familiarity with insurance authorization processes, medical billing, and coding (e.g., ICD-10, CPT codes). Working knowledge of MCG, InterQual, and NCQA standards. Skills: Strong analytical and critical thinking skills to assess medical necessity. Proficient in medical terminology and pharmacology. Effective written and verbal communication skills. Ability to work independently and collaboratively in a fast-paced environment. Highly adaptable to change and self-motivated. Technology: Experience with EMR systems and prior authorization platforms. Proficient in Microsoft Office Suite (Word, Excel, Outlook).

Authorization and Review: Evaluate and process prior authorization requests for medical procedures, medications, and services based on clinical guidelines such as: Medicare criteria, Medicaid/Medi-Cal criteria, InterQual, MCG, or Health Plan specific guidelines. Utilize clinical knowledge to assess medical necessity and appropriateness of requested services. o Verify patient eligibility, benefits, and coverage details. Collaboration and Communication: Serve as a liaison between healthcare providers, patients, and health plans to facilitate the authorization process. Communicate authorization decisions to the requesting provider and/or patient in a timely manner. Provide detailed explanations of denials or alternative solutions when authorization is not granted. Collaborate with the Medical Directors as needed to ensure all information is considered prior to an adverse determination. When an adverse determination is rendered, collaborate with the Medical Director to ensure integrity of determination notices based on the quality standards for adverse determinations. Comply with federal, state, and health plan specific requirements related to member communication of adverse determinations to include preferred language, mandated readability standard, correct medical criteria is referenced and the appropriate appeal information is provided. Documentation and Compliance: Accurately document all authorization-related activities in the electronic medical record (EMR) or authorization management system. Ensure compliance with federal, state, and health plan specific regulations and guidelines. Maintain knowledge of evolving policy and clinical criteria. Quality Improvement: Identify trends or recurring issues in authorization denials and recommend process improvements. Participate in team meetings, training sessions, and audits to ensure high-quality performance.

All Hours Home Healthcare

Infusion Nurse

Posted on:

May 15, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Massachusetts

All Hours Home Healthcare was founded by highly qualified medical professionals with over 30 years of experience in various healthcare settings. The company specializes in skilled IV Home Infusion Nursing, Medication Management, and providing caregivers for loved ones who need assistance while staying at home.

Nursing and Home Infusion skills Experience in Direct Patient Care and Critical Care Medicine Knowledge of medication management Strong communication and interpersonal skills Ability to work independently and remotely Current nursing license and certification in infusion therapy Experience in home healthcare or infusion therapy is a plus Bachelor's degree in Nursing or related field

This is a full-time remote role for an Infusion Nurse at All Hours Home Healthcare. The Infusion Nurse will be responsible for providing direct patient care in home infusion settings and critical care medicine. The role involves administering medications, monitoring patients, and ensuring optimal care delivery.

Hey Jane

Clinical Support Team Manager

Posted on:

May 15, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

None Required

State License:

New York

Unless otherwise noted, all positions are fully remote with work permitted from the following states: CA, CO, CT, DC, DE, HI, IL, MA, MD, NJ, NM, NY, OR, VT, and WA. We are living through a pivotal moment for reproductive and sexual health—and Hey Jane is uniquely positioned to help. From day one, we've been committed to providing safe, discreet medication abortion treatment and have helped more than 80,000 people get the care they need. Today, we offer a range of reproductive and sexual health care services from the comfort and convenience of your phone. Our in-house clinical care team, composed of board certified doctors, advanced practice clinicians, nurses, and patient care advocates, is just a text message away. We’re committed to helping our patients get safe, discreet, judgment-free virtual health care, from a team that truly cares.

The Clinical Support Team Manager will oversee the Patient Care Advocate (PCA) team, ensuring high-quality, compassionate, and efficient support for our patients. This role is responsible for team management, training, quality assurance, workflow optimization, and overall team performance. The ideal candidate will have experience in reproductive healthcare, leadership, and telehealth operations, with a strong commitment to patient-centered, trauma-informed care.

3+ years of experience in healthcare leadership, team management, or care coordination Strong leadership and interpersonal skills, with experience managing remote teams Commitment to reproductive justice, racial equity, and trauma-informed care Excellent verbal and written communication skills, with an emphasis on patient-centered communication High proficiency in technology, including web-based applications and telehealth platforms Strong problem-solving, time-management, and decision-making skills The ability to work in a fast-paced, evolving environment with a high level of adaptability Experience in quality assurance, training, and workflow optimization It'd be a bonus if you also have: Bilingual proficiency in Spanish and English Experience in reproductive health, abortion care, or patient advocacy Experience in telehealth operations or managing a virtual care team Background in customer service or patient experience improvement in healthcare Experience with telephone triage and crisis intervention Familiarity with insurance navigation for reproductive health services Prior experience working in a startup or high-growth healthcare environment

Lead and manage the Patient Care Advocate team, including scheduling, performance management, and professional development Ensure timely, compassionate, and efficient patient support, including text-based communications, triaging, and referrals Monitor and evaluate team performance through quality assurance reviews, coaching, and feedback Collaborate with clinicians and the clinical operations team to streamline patient workflows and ensure effective communication Identify and implement improvements to enhance the patient experience and advocate for team needs Develop and maintain standard operating procedures (SOPs) for patient interactions, triaging, and escalations Support hiring, onboarding, and training of new PCAs, ensuring competency in telehealth, trauma-informed care, and reproductive justice principles Monitor patient satisfaction and address concerns proactively Ensure compliance with HIPAA and other relevant regulations for patient privacy and care Utilize data and key performance indicators (KPIs) to assess team effectiveness and identify areas for improvement Act as an escalation point for complex patient situations requiring additional support Maintain a culture of empathy, inclusion, and patient advocacy within the team

Hey Jane

Clinic Team Manager

Posted on:

May 15, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

New York

Unless otherwise noted, all positions are fully remote with work permitted from the following states: CA, CO, CT, DC, DE, HI, IL, MA, MD, NJ, NM, NY, OR, VT, and WA. We are living through a pivotal moment for reproductive and sexual health—and Hey Jane is uniquely positioned to help. From day one, we've been committed to providing safe, discreet medication abortion treatment and have helped more than 80,000 people get the care they need. Today, we offer a range of reproductive and sexual health care services from the comfort and convenience of your phone. Our in-house clinical care team, composed of board certified doctors, advanced practice clinicians, nurses, and patient care advocates, is just a text message away. We’re committed to helping our patients get safe, discreet, judgment-free virtual health care, from a team that truly cares.

The Clinic Team Manager will be responsible for streamlining clinical processes, ensuring operational goals are met, and driving efficiency improvements within Hey Jane’s clinical team. This individual will collaborate closely with clinical leadership to enhance productivity, improve patient experience, and maintain compliance and quality standards. The ideal candidate has experience in healthcare operations, is data-driven, and thrives in a fast-paced, mission-driven environment.

5+ years of clinical experience as an RN, NP, PA-C, CNM, or in a related healthcare leadership role 2+ years of experience managing clinical teams, preferably in telehealth, reproductive healthcare, or a startup environment Strong leadership and coaching skills, with the ability to foster a high-performing team Experience optimizing workflows and improving operational efficiency in a clinical setting Excellent communication and interpersonal skills, with a patient-first mindset Knowledge of healthcare compliance, regulatory requirements, and quality assurance Ability to analyze clinical data and translate insights into actionable improvements Comfortable working in a fast-paced, mission-driven startup environment It'd be a bonus if you also have... Experience in abortion or reproductive health care Prior startup or telehealth experience Experience in clinical telephone triage or remote care delivery Deep understanding of trauma-informed care principles Proficiency in Spanish

Directly manage and support telehealth Nurses and Advance Practice Clinicians, ensuring high performance, job satisfaction, and professional growth Lead team meetings, provide regular feedback, and conduct performance evaluations Monitor and manage key performance indicators (KPIs) such as treatment turnaround time, patient satisfaction (NPS), and provider response time Foster a collaborative, mission-driven culture that prioritizes patient-centered care Ensure team is appropriately licensed to meet business and patient needs Oversee scheduling, staffing, and workload distribution to optimize patient care and team efficiency Identify operational challenges and work cross-functionally to implement solutions that enhance efficiency and patient outcomes, driving timely and effective communication between clinical teams and other departments Implement process improvements that enhance patient care, provider efficiency, and clinical workflows Maintain compliance with HIPAA, OSHA, FDA, and other regulatory requirements to ensure patient safety and confidentiality Collaborate with the Medical Director and Product team to identify and implement tech-enabled solutions that improve clinical operations Onboard new clinical team members and provide ongoing training on Hey Jane’s protocols, technology, and best practices Create a professional development framework for team growth and career progression

Hey Jane

Telehealth Nurse

Posted on:

May 15, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

We are living through a pivotal moment for reproductive and sexual health—and Hey Jane is uniquely positioned to help. From day one, we've been committed to providing safe, discreet medication abortion treatment—and have helped more than 80,000 people get the care they need. Today, we offer a range of reproductive and sexual health care services from the comfort and convenience of your phone. Our in-house clinical care team, composed of board certified doctors, advanced practice clinicians, nurses, and patient care advocates, is just a text message away. We’re committed to helping our patients get safe, discreet, judgment-free virtual health care, from a team that truly cares.

Unless otherwise noted, all positions are fully remote with work permitted from the following states: CA, CO, CT, DC, DE, HI, IL, MA, MD, NJ, NM, NY, OR, VT, and WA. We are looking for Registered Nurses with a passion for reproductive justice and trauma informed care who are eager to be at the forefront of a new model of care delivery that leverages telemedicine to challenge the status quo in healthcare. In this position, you will provide direct education, counseling, and clinical care to patients undergoing medication abortion treatment. This remote nursing position provides triage and nursing assessment by responding to electronic portal messages from patients with clinical questions and concerns. Registered nurses will provide patient-specific nursing care and advice in a compassionate, caring, culturally and ethnically sensitive manner. We are currently hiring for full time RNs. Working hours: 40 hours per week working 4-10 hour shifts Compensation: $90,000-$93,000/yr plus equity, generous PTO, and health benefits

BSN prepared RN from an accredited nursing education program 2+ clinical nursing experience Active state licensure (RN) and licensed in one or more of the following states: CA, CO, IL, NJ, NY, WA, VA RN experience in either direct abortion care/L&D/Outpatient OBGYN or Fertility. Excellent decision-making skills and verbal and written communication skills Great organizational and time management skills Demonstrated experience in working with diverse groups, including diversity in race, ethnicity, economic status, and educational background Skilled at using online tools and technology to deliver care and communicate with patients Comfort in counseling on sensitive health issues, such as abortion and birth control Commitment to reproductive justice, and ability to provide judgment-free abortion care Demonstrated understanding of regulatory requirements and organizational policies relating to patient information and consultation services Eager to engage in constant process improvement to help refine tools and operations for improved care delivery 1+ years providing abortion care Bonus points Bilingual in Spanish Startup experience Experience in clinical telephone triage Competency in providing trauma-informed care 1+ year of telehealth experience Compact RN license

Triage and assess patient complaints, providing education, interventions, and referrals as appropriate Completing nursing assessments Provide care education to patients through text or over the phone Taking occasional after hours on-call (compensated) Collaboration with providers and other departments Adhere to compliance guidelines throughout processes (OSHA, FDA, HIPAA) Review medical intakes and determine patient eligibility for treatment.

River Valley Child Development Services, Inc.

Child Care Nurse Health Consultant | MountainHeart North

Posted on:

May 15, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

West Virginia

Title: Child Care Nurse Health Consultant | MountainHeart North Program: WVECTCR Worksite: Remote Home Office (located within or close to the service region) Reports to: Project Manager FLSA Status: Exempt Classification: Full-time Position Summary: Provide technical assistance and develop and conduct professional development trainings on specialized health, safety, caring for children with special health needs, and nutrition topics.

Knowledge, Skills & Abilities: Abide by all applicable Federal, State, and local laws, rules, regulations, and policies related to the program and relevant grants. Excellent verbal and written communication skills. Utilize technology to enter, retrieve, and process information and communicate electronically. Excellent interpersonal, negotiation, problem solving, and conflict resolution skills. Excellent organizational skills and attention to detail. Excellent time management skills with a proven ability to meet deadlines. Remain aware of emerging trends and best practices for health, safety, and nutrition as it relates to childcare settings. Act with integrity, professionalism, and confidentiality. Work collaboratively. Education Required: Associate’s degree from an accredited college or university in nursing. Experience Preferred: Two (2) years of teaching and training experience. Employment Conditions: Successfully clearing the background check process, which may include: criminal background check, education verification, references, drug testing, motor vehicle records, sex offender registry, Child Protective Services check, and federal grants debarred list. WV RN license, current and unrestricted. Valid driver’s license and reliable transportation. Able to travel extensively; requires the need for flexible scheduling, including occasional evening, weekend, and/or overnight hours. Adhere to the National Association for the Education of Young Children (NAEYC) Code of Ethics. Maintain STARS career pathway enrollment and STARS Specialty Professional Development Provider. Business casual apparel. Environmental Conditions: Indoors in a normal office environment with little exposure to temperature changes at least fifty percent (50%) of the time. Prolonged sitting at a desk viewing a computer screen and keyboard typing. Frequent face-to-face, electronic, and virtual interactions with internal and external customers. Frequently work at a fast pace with unscheduled interruptions. Public contact position. This position may be eligible to work remotely up to two days per week following a successful 90-day review. Physical Demands: Mobility within the office including movement from floor to floor. Access information using a computer. Must be able to lift 25 pounds at times.

Essential Functions: Develop and conduct face-to-face and online professional development sessions on health and safety topics as they relate to the state childcare licensing requirements and national health and safety standards based on the educational needs of childcare providers. Provide consultation to childcare providers and families on health, safety, caring for children with special health needs, and nutrition topics based on research and best practice. Develop and disseminate informational materials to childcare providers on a variety of health, safety, and nutrition related topics. Traverse various terrain to access visitation sites. Remain stationary up to 50% of the time. Marginal Functions: Establish contacts, build relationships and collaborate with stakeholders. Work collaboratively as a member of the comprehensive Child Care Nurse Health Consultant team. Maintain social media account for Child Care Nurse Health Consultants. Ensure all Child Care Nurse Health Consultant information is current and up-to-date on WVECTCR website. Compile and submit reports within established timelines. Respond to any inquiries within a timely manner. Participate in all required committees, conferences, meetings and training relevant to the program and/or agency. Participate in ongoing monitoring and continuous improvement activities. Any other duties as assigned.

Pyramid Consulting, Inc

Clinical Review Nurse – Concurrent Review

Posted on:

May 15, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Texas

Immediate need for a talented Clinical Review Nurse – Concurrent Review. This is a 06+months contract to hire opportunity with long-term potential and is located in TX(Remote). Please review the job description below and contact me ASAP if you are interested.

Key Skills; Concurrent Review Multitasking, fast learner, positive, and be computer savvy. 2+ Years as RN Requires Graduate from an Accredited School of Nursing or bachelor’s degree in nursing and 2 – 4 years of related experience. Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: RN- Registered Nurse - State Licensure required. Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care. Graduate from an Accredited School of Nursing or bachelor’s degree in nursing Preferred: 2 – 4 years of related experience Licensure Required: Texas RN Preferred: Multitasking, fast learner, positive, and be computer savvy. Flexible, Ambetter knowledge Disqualifiers: Less than 2 years of nursing experience, no LPNs

Shift Time & Working Days: Mon-Fri 8ap-5pm CST Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member. Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care. Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member. Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered. Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines. Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings. Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members. Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines. Reviews member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities. Collaborates with care management on referral of members as appropriate. Performs other duties as assigned. Complies with all policies and standards. Will have task queue to work from. Will work closely with team lead and team members to meet daily deadlines. Will be reviewing cases for medical necessity all day. Will work from home with multiple monitors and needs to be able to multitask. Once off training, they will need to work one Saturday every other month. Performance indicators: Quality work and meet productivity expectations

Cottage Health

Utilization Review Nurse

Posted on:

May 15, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

California

Cottage Health is a leading acute care hospital system, located on the central coast of California, widely known for our superior patient care, innovation, medical research and education. Our health system operates primarily in Santa Barbara, Ca, since 1888, and consists of three acute care hospitals, a Rehabilitation Hospital, multiple clinics and a multi-site Urgent Care system. Our mission is to serve the central coast communities with excellence, integrity, and compassion. Every day we touch thousands of lives in many different ways, resolute in our mission to put patients first. We take pride in helping our patients get back to living their lives - in the places they love.

Cottage Health seeks a Utilization Review Nurse for their CH Clinical Denials and Appeals department responsible for utilization review, utilization management, and quality assurance activities for assigned services/areas/patients within the Cottage Health System and will champion, engage, manage and monitor proactive communications and interventions by and between relevant stakeholders with regard to utilization review management. Utilization review activities will result in quality outcomes, optimal care/cost management of services and/or procedures, a high level of customer satisfaction, and contribution to an overall value-oriented experience of stakeholders and persons served in a manner compliant with The Joint Commission, HIPAA and Title 9 Regulations (DHCS).

All job qualifications listed indicate the minimum level necessary to perform this job proficiently. Education Minimum: Minimum education to allow candidate to achieve California RN license. Preferred: Bachelor's Degree in Nursing (BSN). Certifications, Licenses, Registrations Minimum: Current California Registered Nurse license in good standing. Preferred: Certification in Case Management. Technical Requirements Minimum: Ability to use an electronic medical records system and other clinical systems, such as AllSCRIPS, CPOE, and/or SUNRISE. Years of Related Work Experience Minimum: Minimum of two years direct patient care RN experience in an acute care setting. Other direct patient care RN experience may be considered. Preferred: 3 years of experience as a Utilization Review Nurse in an acute care setting.

The Utilization Review Nurse will work collaboratively and proactively with the medical staff, nursing staff, and other disciplines to support and achieve the goals of the collaborative care process. Additional responsibilities include: maintain a working knowledge of regulations and provider contracts governing coverage of inpatient services (i.e., Medicare, Medi-Cal, Contracted Medical Groups); maintain and model interpersonal skills and productive relationships that allow for and support effective interaction with a wide variety of stakeholders; consistently demonstrate professionalism and compassion with regard to human dignity, preserving and protecting client autonomy and rights and with respect for patient/family values and beliefs.

Highmark

Complex Case Manager RN - Pediatrics (Remote)

Posted on:

May 15, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Pennsylvania

This job has primary ownership and oversight over a specified panel of members that range in health status/severity and clinical needs. The incumbent assesses health management needs of the assigned member panel and utilizing data/analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member. The incumbent will be supported by a multi-disciplinary team and will use clinical judgment to refer members to appropriate multi-disciplinary resources. In addition to identifying the appropriate clinical interventions and referrals, the incumbent will manage an active case load of members in his/her panel that are enrolled in case management. The incumbent conducts outreach to members enrolled in case management including but is not limited to: developing a care plan, encouraging behavior changes, identifying and addressing barriers, helping members to coordinate care, and identifying various resources to assist members in achieving their personal health goals. The incumbent monitors, improves and maintains quality outcomes (clinical, financial and functional) for the specified panel of members.

Required: High School Diploma/GED Substitutions: None Preferred: Bachelor's Degree in Nursing EXPERIENCE: Required 7 years of any combination of clinical, case management and/or disease/condition management experience, provider operations and / or health insurance experience Preferred: Pediatric Experience Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing or dialectical behavior therapy (DBT) Experience working with the healthcare needs of diverse populations Understanding of the importance of cultural competency in addressing targeted populations LICENSES AND CERTIFICATIONS: Required RN license in PA or WV or DE or NY is required. Other RN license(s), if applicable, must be obtained within the first 6 months of employment. Preferred Certification in Case Management SKILLS: Written and verbal presentation skills, negotiation skills, and skills in positively influencing others with respect and compassion Broad knowledge of disease processes Understanding of healthcare costs and the broader healthcare service delivery system Proficiency in MS Excel and strong analytic skills with ability to interpret, evaluate and act on clinical and financial data, including analysis of statistical data Excellent interpersonal/ consensus building skills as well as the ability to work with a variety of internal and external colleagues from all levels of an organization Ability to work in a high performing team environment that requires flexibility Demonstrated ability to handle multiple priorities in a fast paced environment. Excellent organizational, time management and project management skills Self-directed; self-starter, ability to work successfully with indirect supervision and moderate autonomy

Maintain oversight over specified panel of members by performing ongoing assessment of members’ health management needs, identifying the right clinical interventions to address member needs and/or triaging members to appropriate resources for additional support. For assigned case load, create care plans to address members’ identified needs, remove barriers to care, identify resources, and conduct a number of other activities to help improve the health outcomes of members; care plans include both long and short term goals and plan of regular contacts for re-assessment. Ensure targeted percentage of patient goal achievement (i.e., realization of member care plan), and other patient outcomes, as applicable, are achieved. Ensure all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards. Maintain current knowledge and adheres to applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management including those published by CMSA and/or ACMA, as required by the organization. Other duties as assigned or requested.

Capital Markets Placement

Registered Nurse - Ambulatory Gastroenterology - Remote opportunity available after training (Hiring

Posted on:

May 15, 2025

Job Type:

Role Type:

License:

RN

State License:

Vermont

On-call: Not required Incentives: Per diem differential - $2.00/hour Remote opportunity after completion of training.

Appropriate experience in specific clinical area. Varies by unit. Greater than one year of experience.

Provides professional nursing care to patients in varying state of health and illness by assessment, planning, implementation, and evaluation of the nursing plan of care. The Staff Nurse II functions as an essential member of nursing and multidisciplinary teams, providing direct patient care, instruction, and preparation for continuing care during and following care transitions. May take charge as operational need allows.

Harris Teeter

NON-COMPACT STATE - PT Remote CCM/RTM Care Management Nurse (MN)

Posted on:

May 14, 2025

Job Type:

Part-Time

Role Type:

Care Management

License:

RN

State License:

North Dakota

Esrun Health, a division of Harris Computer, is on a mission to redefine remote care. Our program offers a customized model of remote care services that blends Chronic Care Management (CCM), Remote Therapeutic Monitoring (RTM), Remote Physiologic Monitoring (RPM), Behavioral Health Integration (BHI), and/or Transitional Care Management (TCM) for each client based on their specific practice needs. As a Harris healthcare business, we are able to maintain a people-focused, small company experience with the financial security of a large organization.

Join our mission to help transform healthcare delivery from reactive, episodic care to proactively managed patient care that prevents live-changing problems before they happen for patients with two or more chronic conditions. We believe every patient with chronic disease deserves consistent check-ins, follow-up, and support. The position of the Nurse Chronic Care Coordinator, Remote will perform telephonic encounters with patients on behalf of our partners each month and develops detailed care plans within our care plan templates in the electronic health record. This begins as an Independent 1099 Contractor position but offers the potential to reach full-time W2 employment (with employee benefits). Esrun Health is seeking Nurses to work part-time from their home office while complying with HIPAA privacy laws. You will set your own hours and will not be held to a daily work hour schedule. You will be contracted to work a minimum of 20hrs/wk. Esrun Health wants its team members to have the flexibility to balance their work-life with their home life. Part-time team members will typically need to dedicate an average of 20-30 hours per week to care for their assigned patients. This unique business model allows you to choose what days and what hours of the day you dedicate to care for your patients. The Care Coordinator will be assigned a patient panel based on skill and efficiency level and is expected to carry a patient panel of a minimum of 100 patients per calendar month. Care Coordinators will be expected to complete encounters on 90 percent of the patients they are assigned. Esrun Health utilizes a productivity-based pay structure and pays $10.00 per completed patient encounter up to 99 encounters/month, $10.25/encounter from 100-149 encounters/month, $12/encounter from 150-199 encounters/month, $14/encounter from 200-249 encounters/month, and $16/encounter for >250 encounters/month. Payment tier increases require 2 months consistency to achieve. A patient encounter will take a minimum of 20 minutes (time is cumulative including chart review, call times/attempts/texts, care plan development, care coordination, and documentation time).

Graduate from an accredited School of Nursing. (LPN, LVN, RN, BSN, etc.) Current license to practice as an RN/ LVN/LPN with no disciplinary actions noted A minimum of two (2) years of clinical experience in a Med/Surg, Case Management, and/or home health care. Hands-on experience with Electronic Medical Records as well as an understanding of Windows desktop and applications (Microsoft Office 365, Teams, Excel, etc.), also while being in a HIPAA compliant area in home to conduct Chronic Care Management duties. Ability to exercise initiative, judgment, organization, time-management, problem-solving, and decision-making skills. Skilled in using various computer programs (If you don’t love computers, you won’t love this position!) High Speed Internet and Desktop or Laptop computer (Has to be operation system of Windows 10 or higher or Mac) NO Chromebooks and no iPad. Excellent verbal, written and listening skills are a must. What Will Make You Stand Out: Quickly recognize condition-related warning signs. Organized, thorough documentation skills. Self-directed. Ability to prioritize responsibilities. Demonstrated time management skills. Clear diction. Applies exemplary phone etiquette to every call. Committed to excellence in patient care and customer service.

The role of the Care Coordinator is to abide by the plan of care and orders of the practice. Ability to provide prevention and intervention for multiple disease conditions through motivational coaching. Develops a positive interaction with patients on behalf of our practices. Improve revenue by creating billable CCM episodes, increasing visits for management of chronic conditions. Develops detailed care plans for both the doctors and patients. The care plans exist for prevention and intervention purposes. Understand health care goals associated with chronic disease management provided by the practice. Attend regularly scheduled meetings (i.e., Bi-Monthly Staff Meetings, monthly one on one's, etc.). These “mandatory” meetings will be important to define the current scope of work.

Syneos Health

Research Nurse-Chattanooga, TN

Posted on:

May 14, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Tennessee

Illingworth Research Group provides a range of patient focused clinical services to the pharmaceutical, healthcare, biotechnology and medical device industries. These include mobile research nursing, patient concierge, medical photography and clinical research services. Illingworth are experts with experience across all study phases and in a diverse range of therapeutic areas. Illingworth Research Group is a global organization operating in over 45 countries, bringing clinical research directly into the home of the patient, to improve the experience of patients involved in clinical trials and the quality of their lives.

Are you a Registered Nurse who would like to be involved in working in a variety of research projects for ground-breaking patient treatments? We are looking for motivated and enthusiastic nurses who combine high quality clinical skills with a compassionate, engaging personality and a dedication to ensure exceptional patient outcomes.

Experienced Registered Nurse (Adult or Pediatric) Experience and knowledge of working in clinical research trials with ICH-GCP (Good Clinical Practice) Certification - (Training can be provided) Attention to detail and highly organized Ability to prioritize and manage multiple tasks Excellent verbal and written communication skills in English and the ability to complete detailed data Ability to work with initiative independently and as part of a wider team Good IT (Information Technology) skills and a working knowledge of computer software Trained in Handling and Transport of Hazardous Substances (preferable- training can be provided) Our studies require a variety of Clinical skills (some desirable and not all essential, depending on project requirements). Phlebotomy skills (Venipuncture) and handling, processing of blood. Sub cutaneous injections ECGs, observations and taking specimen collections. Cannulation and administration of Intravenous Therapies Experience working with central venous access PLEASE NOTE This role will require you to travel, a driving license and access to a vehicle is essential.

Tasks, duties, and responsibilities as listed in this job description are not exhaustive. The Company, at its sole discretion and with no prior notice, may assign other tasks, duties, and job responsibilities. Equivalent experience, skills, and/or education will also be considered so qualifications of incumbents may differ from those listed in the Job Description. The Company, at its sole discretion, will determine what constitutes as equivalent to the qualifications described above. Further, nothing contained herein should be construed to create an employment contract. Occasionally, required skills/experiences for jobs are expressed in brief terms. Any language contained herein is intended to fully comply with all obligations imposed by the legislation of each country in which it operates, including the implementation of the EU Equality Directive, in relation to the recruitment and employment of its employees. The Company is committed to compliance with the Americans with Disabilities Act, including the provision of reasonable accommodations, when appropriate, to assist employees or applicants to perform the essential functions of the job.

BAYADA Home Health Care

Home Health RN Clinical Support Specialist- REMOTE

Posted on:

May 14, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

North Carolina

BAYADA Home Health Care is seeking a remote Clinical Support Specialist (RN required) for our Home Health Senior Care team. The ideal candidate will be a Registered Nurse in North Carolina. Do you want to be part of providing care with the highest professional, ethical, and safety standards? Do you want to use your skills to make a difference in people’s lives? We’re BAYADA Home Health Care—a leading home health care company—and we believe that our clients and their families deserve home health care delivered with compassion, excellence, and reliability. Your important work will help ensure that our clients come first and that our BAYADA caregivers have the support they need to be successful. In this growing and dynamic environment, we offer exciting career paths for nurses like you.

Registered Nurse (RN) with 2 or more years of experience as an RN in North Carolina. Experience using Oasis and Homecare Homebase is required.

Review Oasis and Homecare Homebase 485 documentation Applies knowledge and experience with implementation of standardized QI surveys and mentoring, orienting and educating Clinical Managers/Leaders. Serves as a general clinical resource to expand into mentoring, identifying and recommending changes in agency policies and practices, and assisting in development and/or implementation of new policies, procedures, programs and services.

UnitedHealth Group

RN Call Us First – Remote

Posted on:

May 14, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Washington

Optum WA, (formerly The Everett Clinic) is seeking a RN Call Us First to join our team in Everett, WA. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone. At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

Positions in this function is under general supervision, the Staff RN/Consulting Nurse is responsible for providing telephone triage assessment to Primary Care patients by using state of the art telecommunications, information technology and approved protocols; to clients ensuring the efficient use of medical and nursing, facilities and equipment and to provide excellent customer service. You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. during PST time zone business hours as you take on some tough challenges.

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

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

UnitedHealth Group

Utilization Management Nurse - Remote in PST

Posted on:

May 14, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Washington

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

The Utilization Management Nurse will conduct reviews of requested healthcare services and determine medical appropriateness of inpatient services following evaluation of medical guidelines and benefit determination in accordance with Utilization Management policies and procedures. This position collaborates with medical directors, facility case management and utilization management, and stakeholders to provide the level of care necessary to meet the members’ needs. The UM Nurse provides planning and care coordination to facilitate transition plans to the appropriate level of care across the care continuum. If you are located in PST, you will have the flexibility to work remotely* as you take on some tough challenges. Must be able to work 8am-5pm PST.

Graduation from an accredited school of nursing Active, unrestricted Registered Nurse license in State of Hire 2+ years of experience in Utilization Review for Insurance or Community Based facility 2+ years of clinical nursing experience

Communicates directly with providers/designees when appropriate to gather all clinical information to determine the medical necessity of requested healthcare services Performs utilization and concurrent reviews of all inpatient stays using evidence-based criteria, approves bed days, identifies and evaluates delays in care, initiates discharge planning, arranges alternative care settings when medically appropriate Manages and follows relevant time frame standards for conducting and communicating utilization review determinations Works closely with relevant medical entities to assure members are transitioned to appropriate levels of care and all supporting resources are available either through the healthcare benefits or other supporting entity Prepares for oversight audits by the health plans and responds to appeal requests Monitors and evaluates medical services and community-based resources to meet the individual member’s health needs at time of care transitions Follow up with ancillary contracted entities if services or resources have not been made available to the member to assure that medical needs are being met Makes appropriate care management referrals through triage process during care transition to case management staff Reviews written requests for clinical services for medical appropriateness Interfaces with referring practitioners or staff, to facilitate care alternatives within specified time restrictions Facilitates understanding in the areas of case management, quality management, utilization management, member education and preventive health guidelines to promote health plan expectations and refers members for appropriate services Responds to questions from medical offices and hospitals about the necessary steps of the medical referral authorization process Manages utilization review authorizations, both verbal and written to assure high continuity of care for all managed care members in the program and consistency of gathering specific information within the department to comply with policies and procedures Review and respond to all reconsideration and appeal requests within timeframes outlined by the health plan Works closely with the CMO to obtain timely medical decisions on pended referrals and requests for medical services from health plans and providers

Prime Physicians

Remote / IHS / Nurse Case Manager Consulting

Posted on:

May 14, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

New Mexico

Prime Physicians is a physician-led, The Joint Commission (TJC) Accredited, ISO 9001 certified and CMMI Level 3 appraised organization. Our commitment extends beyond traditional consulting and management services, offering comprehensive solutions to hospitals, health systems, and federal government agencies. At the heart of our operations is the ultimate goal to deliver high-quality patient care. Driven by a mission to catalyze healthcare transformation and innovation, we offer an array of services designed to redefine the healthcare landscape. From program and project management to strategic planning, we enhance operational efficiency and streamline business processes. With Prime Physicians, the future of patient care is in skilled and dedicated hands, leading the way towards a more efficient, effective, and compassionate healthcare system.

Job Title: Nurse Case Manager (Consulting) Location: Remote (with required travel to New Mexico) Start Date: June Shifts: 40 hours / Week Duration: 6 Months

Active RN license in any U.S. state (required) Minimum 10 years of experience in nursing consulting, case management, or related field Proven background in consultation and technical assistance Strong presentation, communication, and problem-solving skills Willingness and ability to travel to healthcare facilities in New Mexico Must be authorized to work in the U.S.

Provide expert-level consultation and technical assistance on nurse case management processes Conduct initial on-site assessments at three hospital locations in New Mexico Analyze current workflows, identify gaps, and develop improvement strategies Prepare comprehensive evaluation reports and present findings to stakeholders Make follow-up visits to present final recommendations and assist with implementation Collaborate with multidisciplinary teams and leadership to ensure sustainable improvements

Conifer Health Solutions

Utilization Management RN Nurse - Remote

Posted on:

May 14, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Texas

We know it takes a special person to be a nurse, and we are committed to providing our nurses with an enriching and rewarding environment. We provide the resources, tools and support our employees need to serve our patients and customers in the best way possible — so we can provide the right care, in the right place, at the right time, and do so with compassion.

The purpose of the Utilization Management Nurse is to ensure quality of patient care, effective utilization of available health services, review of admissions for medical necessity and necessity of continued stay in the inpatient setting. Ensures members have a safe discharge plan in place prior to discharge from the inpatient setting.

KNOWLEDGE, SKILLS, ABILITIES: 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 accommodation may be made to enable individuals with disabilities to perform the essential functions. Two (2) years managed care experience in UM/CM Department, preferred Knowledge of CMS, State Regulations, URAC and NCQA guidelines preferred ICD-9 and CPT coding experience a plus Experienced computer skills with Microsoft Word, Microsoft Outlook, Excel and experience working in a health plan medical management documentation system a plus Experience in EZ-CAP preferred Medical Terminology preferred Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE: Include minimum education, technical training, and/or experience preferred to perform the job. Minimum Education: RN Preferred Education: BA or BS in Nursing Minimum Experience: 3 to 5 years of acute care experience 2 Years Health Plan Utilization Review or equivalent Preferred Experience: 5 years Health Plan Utilization Review 5 years Acute Care experience with 1 year ICU / ER REQUIRED CERTIFICATIONS/LICENSURE: Include minimum certification required to perform the job. Licensure must be current and unrestricted in the appropriate jurisdiction 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 accommodation may be made to enable individuals with disabilities to perform the essential functions. Must be able to work in sitting position, use computer and answer telephone Ability to travel Includes ability to walk through hospital-based departments across broad campus settings, including Emergency Department environments WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Office Work Environment TRAVEL: Approximately 5% travel may be required

Responsible for providing timely referral determination by accurate: Usage of the Milliman Care Guidelines Identification of referrals to the medical director for review Appropriate letter language and coding (denials, deferrals, modifications) Appropriate selection of the preferred and contracted providers Proper identification of eligibility and health plan benefits Proper coding to trigger the record to be routed to a different work queue or to trigger the proper determination notice to be sent out Responsible for maintaining compliance in turnaround time requirements as mandated by the TAT Standards Responsible for working closely with supervisor/lead to address issues and delays that can cause failure to meet or maintain compliance. Meets or exceeds production and quality metrics. Work directly with the provider(s) and health plan Medical Director to facilitate quality service to the member and provider. Identifies Clinical Program opportunities and refers members to the appropriate healthcare program (e.g. case management, engagement team, and disease management). Attend all mandatory meetings and training. Maintains and keeps in total confidence all files, documents and records that pertain to the business operations. Collaborates, educates and consults with Customer Service/Claims Operations, Sales and Marketing and Health Care Services to ensure consistent work processes and procedural application of clinical criteria. All other job related duties as it relates to the job function or as delegated by the management team.

Brighton Health Plan Solutions

Nurse Case Manager ,Workers Compensation

Posted on:

May 14, 2025

Job Type:

Part-Time

Role Type:

Case Management

License:

RN

State License:

New York

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 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™. Company Mission: Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners. Company Vision: Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.

Brighton Health Plan Solutions (BHPS) provides Utilization Review/Medical and Case Management services for Group Health and Workers’ Compensation and other Casualty clients. The Workers’ Compensation Nurse Case Reviewer collaborates with medical care providers, employers, employees, and at times, attorneys to support the appropriate return to work, the provision of necessary medical services, and the evaluation of coverage under the Plan. The Nurse Case Manager reports to the Casualty Department Manager. This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities, and activities may change, or new ones may be assigned at any time with or without notice.

Currently licensed Registered Nurse in the state of NY, or the ability to obtain. Maintain current licensure(s) and specialty certifications that are relevant to this position; CCM is encouraged. Minimum 1 year experience in worker’s compensation case management. Bachelor’s degree preferred. Minimum of 4 years’ experience in a clinical environment required. Strong skills in medical assessment/medical record review. Excellent customer service skills. Ability to define and solve problems, collect data, establish facts and make effective decisions a must. Must be detail oriented and have strong organizational and time management skills, and the ability to work independently. Ability to work proficiently on a computer (PC) with working knowledge of Microsoft Office, especially Word, Excel Teams, and Outlook.

Collaborates with workers' compensation patients, employers, providers, and claims adjusters to coordinate medical and disability services for timely return to work. Provides case management, utilization review, continued stay reviews, and based on clinical judgment and state WCB Medical Treatment Guidelines. Knowledgeable and compliant with New York State Workers’ Compensation Law, Medical Treatment Guidelines, ERISA, HIPAA confidentiality requirements, and NY Formulary Review process. Proven ability to anticipate claimant's treatment or recovery milestones. Provides Case Management services, including assessing barriers to recovery and determining treatment alternatives. Facilitates and expedites discharge planning as needed. Produces accurate electronic records of individual cases. Ensures timely, cost-effective medical care for injured workers' recovery. Answers provider calls and assists with Casualty Department workload as necessary. Adheres to established quality assurance standards and MagnaCare policies and procedures.

Amergis

RN Case Manager Role (REMOTE) APPLY TODAY!

Posted on:

May 14, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Louisiana

Amergis, formerly known as Maxim Healthcare Staffing, has served our clients and communities by connecting people to the work that matters since 1988. We provide meaningful opportunities to our extensive network of healthcare and school-based professionals, ready to work in any hospital, government facility, or school. Through partnership and innovation, Amergis creates unmatched staffing experiences to deliver the best workforce solutions.

Current RN licensure in state practicing At least one year of Case Management experience preferred Current CPR if applicable TB questionnaire, PPD or chest x-ray if applicable Current Health certificate (per contract or stateregulation) Must meet all federal, state and local requirements Must be at least 18 years of age

The RN Case Manager is responsible for coordinatingcontinuum of care activities for assigned patients and ensuring optimumutilization of resources, service delivery, and compliance with medical regime.

UnitedHealth Group

RN Case Manager - Seattle - Field Remote

Posted on:

May 14, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Washington

Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs – helping patients access and navigate care anytime and anywhere. As a team member of our Optum At Home product, together with an interdisciplinary care team we help patients navigate the health care system, and connect them to key support services. This preventive care can help patients stay well at home. We’re connecting care to create a seamless health journey for patients across care settings. Join us to start Caring. Connecting. Growing together.

Under minimal supervision, responsible for ensuring the continuity of care in the outpatient setting utilizing the appropriate resources within the parameters of established contracts and patients’ health plan benefits. Facilitates continuum of patients’ care utilizing advanced nursing knowledge, experience and skills to ensure appropriate utilization of resources and patient quality outcomes. Performs care management functions on-site and telephonically as the need arises. Works in conjunction with the care team and PCP as care team leader to develop a patient centered plan of care.

Required Qualifications: Graduation from an accredited school of nursing Basic Life Support for Healthcare providers (AHA) or CPR/AED for the Professional Rescuer (American Red Cross) Washington State Registered Nurse license. 3+ years of experience in a clinical setting Washington State driver’s license and vehicle for work-related travel Travel 70% within the King County Service area Preferred Qualifications: Bachelor of Science in Nursing, BSN Telehealth certification 3+ years of experience working in acute care 1+ years of care management, utilization review or discharge planning experience HMO experience

Prioritizes patient care needs upon initial visit and addresses emerging issues Meets with patients, patients’ family and caregivers as needed to discuss care and treatment plan Identifies and assists with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, custodial and ambulatory settings Consults with physician and other team members to ensure that care plan is successfully implemented Coordinates treatment plans with the care team and triages interventions appropriate to the skill set of the team members. Uses protocols and pathways in line with established disease management and care management programs in order to optimize clinical outcomes and minimize unnecessary institutional care Monitors and coaches patients using techniques of motivational interviewing and behavioral change to maximize self-management Oversees provisions for discharge from facilities including follow-up appointments, home health, social services, transportation, etc. in order to maintain continuity of care Works in coordination with the care team and demonstrates accountability with patient management and outcome Discusses Durable Power of Attorney (DPOA) and advanced directive status with patient and PCP when applicable Maintains effective communication with the physicians, hospitalists, extended care facilities, patients and families Provides accurate information to patients and families regarding resources available to them through health plan benefits, community resources, and referrals Participates actively in Monthly Care Management Department meetings and daily huddles Documents pertinent patient information and Care Management Plan in Electronic Health Record Coordinates care with central departments on assigned patient caseload, including, inpatient, long term care facilities, adult family homes, and home health agencies Demonstrates a thorough understanding of the cost consequences resulting from Care Management decisions through utilization reports and systems such as Health Plan Benefits, CM dashboards and reports Maintains concise and accurate documentation that supports effective and efficient management of care plans to decrease Emergency and hospital readmissions

Medix™

UM/Chart Reviewer RN (Remote) - 242149

Posted on:

May 14, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

Utilization Management (UM)/Chart Reviewer RN, IP & Concurrent - REMOTE Pay Rate: $40.00-$42.00 per hour Location: Remote, equipment provided Start Date: 05-26-2025 Hours: M-F, can start as early as 6am EST. ~30 hours per week, no more than 40 Employment Type: Temporary contract, expected to last throughout the summer (~Aug/Sept). This could be extended but will not turn into an opportunity to convert FTE with the company. Our organization is the largest External Quality Review Organization (EQRO) in the nation and provides quality review services for states that operate Medicaid managed care programs and fee-for-service programs. As an EQRO, we evaluate managed care organizations (MCOs), prepaid inpatient health plans (PIHPs), prepaid ambulatory health plans (PAHPs), and primary care case management (PCCM) programs. Our quality review services affect more than 44 million Medicaid recipients, or approximately 49 percent of the nation's Medicaid population.

Registered Nurse License - State of AZ and/or Compact *Including AZ 2+ Years of UM/Chart Review Experience for IP & Concurrent Stays WITH a FFS/MCO 2+ Years of Hospital Clinical Experience in Acute Care (ER, ICU, etc)

This project will be supporting one of our clients who is requiring IP/Concurrent chart reviews. Training will be provided, however it is important that candidates come with prior review and clinical experience so they can grasp the knowledge quickly. Evaluate and process prior authorization requests for medical procedures and medications. Collaborate with healthcare providers to gather necessary documentation. Conduct clinical assessments based on established guidelines.

UnitedHealth Group

Senior Utilization Management Nurse - Remote with travel in Boston

Posted on:

May 14, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Massachusetts

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

We serve the Commonwealth of Massachusetts in partnering with onsite audits and projects. We have collaborative team scheduling and there is an occasional opportunity for remote work based on business needs. For the role there will be no weekends, no holidays, and no on-call work. If you are located in Massachusetts, you will have the flexibility to work remotely* as you take on some tough challenges.

Required Qualifications: Undergraduate degree or 4+ years of equivalent nursing experience Current unrestricted RN nurse license in Massachusetts MDS certification OR ability to obtain and provide proof prior to start date Experience working within medical insurance and/or healthcare industries Experience analyzing inventory, researching, identifying, and resolving issues Experience with defining and managing processes within a team Proficient in Microsoft Office Proficient written and verbal skills Ability to travel within geographic territory 75% of the time and assist when needed throughout the state of Massachusetts for audits. (Audits will be conducted onsite) Preferred Qualifications: Recent long-term care MMQ, MDS, staff development or management experience (in long-term care) Experience trouble shooting issues for users within teams, IT and or business partners Proven knowledge of Medicaid and Medicare benefit products including applicable state regulations Demonstrated knowledge of applicable area of specialization Demonstrated knowledge of Massachusetts DPH guidelines Demonstrated knowledge of computer functionality, navigation, and software applications

Audit entire medical record for accuracy of the coding on the MDS/ MMQ to support payment to the nursing facility Discuss Patient Care specifics with peers or providers in overall patient care and benefits Communicate clinical findings and present rationale for decisions to medical professionals and members at the appropriate level for understanding Review the entire medical record for accuracy, and appropriate clinical treatment Communicate findings of audits to client, and community as needed Education of findings with community, identifying plans for correction Comply with HIPAA guidelines related to Personal Health Information (PHI) when communicating with others Leverage experience and understanding of disease pathology to review chart/clinical information, ask appropriate questions, and identify appropriate course of care in a given situation Perform medical chart review that includes a review of current and prior patient conditions, documents, and evaluations, and relevant social and economic situations to identify patients’ needs Research and identify information needed to review assessment for accuracy, respond to questions, or make recommendations Apply knowledge of pharmacology and clinical treatment protocol to determine appropriateness of care Work collaboratively with peers/team members and other levels or segments within Optum, UHC, or UBH (e.g. Case Managers, Field Care Advocates) to identify appropriate course of action (e.g. Appropriate care, follow up course of action, make referral) Required to travel within geographic territory 75% of the time and assist when needed throughout the state of Massachusetts for audits. (Audits will be conducted onsite)

Insight Global

Telephonic Triage Nurse

Posted on:

May 14, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Must Have Requirements: Active, unrestricted Compact RN license issued in the state you reside in 3+ years of licensed experience in a triaging environment Call Center, Telehealth/Remote, or Telephonic Triage experience Highly organized, self-directed worker with an ability to function in a high-volume environment Proficient level of experience with Microsoft Office applications and strong technical aptitude Bonus Requirements: 3+ years of licensed RN experience in behavioral/mental health, maternity/obstetrics or pediatrics Previous experience working with the military population or Tricare beneficiaries

UnitedHealth Group

Utilization Management RN Optum West - Remote - MST or PST Hours

Posted on:

May 14, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

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

Put your skills and talents to work in an effort that is seriously shaping the way health care services are delivered. As a Utilization Management Nurse at UnitedHealth Group, you will make sure our health services are administered efficiently and effectively. You'll assess and interpret member needs and identify solutions that will help our members live healthier lives. This is an inspiring job at a truly inspired organization. Ready to make an impact? Must be available to work on the weekend, Saturday and Sunday as part of a 5 day work week schedule. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Must work PST or MST schedule

Required Qualifications: Compact RN License 3+ years of Managed Care and/or Clinical experience Proven basic computer skills with MS Outlook, Word and Excel Preferred Qualifications: Prior-authorization experience Multi-Specialty experience Utilization Management experience Case Management experience Experience in a skilled nursing facility or inpatient rehabilitation facility Multiple EMR experience including Epic, Cerner, TMC, Meditech or Care Advance Knowledge of Milliman Criteria All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Positions in this function require unrestricted compact RN licensure Function is responsible for utilization management which includes Prior Authorization Review of skilled nursing facility, acute inpatient rehabilitation and long-term acute care hospital Determines medical appropriateness of level of care following evaluation of medical guidelines and benefit determination Generally, work is self-directed and not prescribed Works with less structured, more complex issues Identify solutions to non-standard requests and problems Translate concepts into practice Act as a resource for others; provide explanations and information on difficult issues

HireGenics

Patient Trainer/Medical Device Education- PR/RN - ***MUST reside within 25 miles of hiring location ***

Posted on:

May 14, 2025

Job Type:

Part-Time

Role Type:

License:

RN

State License:

Oklahoma

This is not a traditional RN role. This role is focused on training patients on how to use a medical device. ***MUST reside within 25 miles of hiring location (see available locations below)*** Schedule: Patient Trainers receive weekly assignment requests from the medical device company. They are allowed to accept or deny the request. Typically, they are allowed to take between 0-5 patients per week. This position allows for flexible scheduling. Example training session: 1 hour travel, 1 hour of training, 1 hour travel back, 30 minutes administrative time Assignments fluctuate- no guaranteed set number of assignments per week or per month Assignments are auto assigned depending on trainer’s roundtrip mileage on file Requested amount of assignments per week is not available, when trainer is Active, workload is expected to be completed Pay Range: $35.00-$45.00 per hour. Patient Trainers are paid their hourly rate to travel to and from the patient’s home. Additionally, they are paid the federal mileage reimbursement amount for travel. This job position does not offer any benefits. Locations Available: There is 1 opening per location. Muskogee, OK Job Description: A reputable medical device company is hiring part-time Patient Trainers throughout the USA. Currently, one patient trainer is needed in each of the cities listed above. Patient Trainers go into patients’ homes and train them on how to use INR (international normalized ratio, blood test) monitoring machines. Scheduling is very flexible and can be done anytime during the week. A typical training session takes about 1 hour. There is roughly 30 minutes of administrative paperwork to complete after each training session. The international normalized ratio (INR) blood test tells you how long it takes for your blood to clot. It is used to test clotting times in people taking warfarin (a medicine used to treat and prevent blood clots). Your doctor will use your INR result to work out what dose of warfarin you should take.

Work Environment: This is a remote position, requiring Patient Trainers to travel with their own reliable transportation. A typical travel radius is 50 miles from the listed work city. This varies depending on the location of patients. All supplies are provided to the trainer by the medical device company. The patient will have the INR machine and additional equipment already with them for the training. Masks are NOT required for this role but recommended. Preferred Qualifications: Home Health/In home care experience Anticoagulation/ Cardiology experience Medical Device training/ experience If employed, has availability to train 0-5 customers per week in addition to primary employment (1 hour/ training) Availability to return phone calls, check systems and schedule trainings on a weekly basis Requirements: Registered Nurse (RN) license Pass a Background Check and Drug Test Must be a resident of the hiring state or a neighboring state Access to reliable transportation COVID Vaccination or approved COVID Declination Form Techy Savvy Availability to train weekdays and weekends Must live within 25 miles of a hiring location (hiring locations listed above)

Remotely set up training appointment directly with the customer/caregiver Travel to the customers home setting within the general geographic location of the Trainer's home Provide personalized Face-2-Face® training Explain reporting options and provide company resources Communicate and present themselves in a professional manner Accurately document and submit customer training records Maintain communications with the client by cell phone, email and internet access

Trillium Health Resources

Behavioral Health Crisis Line Clinician Bilingual

Posted on:

May 13, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

North Carolina

Trillium Health Resources is a local governmental agency (LME/MCO) in North Carolina that manages serious mental health, substance use, and intellectual/developmental disability services. Serving in 46 counties, we help individuals, and their families strengthen well-being and build foundations for a healthy life. Join our team as we empower others to live their best lives by providing access to quality healthcare. We offer a challenging, engaging work environment where staff take home more than a paycheck. Every day, we see the results of our dedication – in the smiles of children on our accessible playgrounds and in the pride on the face of an adult cooking a meal for the first time. Working at Trillium Health Resources is more than just a job; it is an opportunity to make a direct impact on the communities we serve. At Trillium, we know that empowering others begins with supporting and developing our team. That’s why we offer competitive benefits and work-from-home flexibility so that our employees thrive outside of the office. We’re also committed to building a diverse, inclusive culture where all employees have the potential to grow professionally and personally.

Pay Plan Title: Clinician Working Title: Behavioral Health Crisis Line Clinician/Bilingual FLSA Status: Exempt Posting Salary Range: $62,712 - $77,564 Office Location: Remote in North Carolina Trillium is seeking a bilingual clinician for the Behavioral Health Crisis line, who will be able to assist Spanish and English-speaking callers. As a vital member of the Call Center team, this clinician plays a pivotal role in transforming lives by providing immediate support to individuals and families seeking mental health, substance use, and developmental disability services. Serving as the first point of contact, this position ensures that each call leads to the right care through expert screening, triage, and referral (STR) processes. In this dynamic position, the clinician not only assesses, and triages calls but also takes charge in crisis and emergency situations, offering critical guidance in moments of need. The clinician empowers non-clinical staff with essential knowledge, offering education and support.

Education: Master’s in human services (BA with full license accepted) Experience: Minimum of one (1) year post graduate experience with adult mental health, developmental disabilities, or substance abuse population. Fluent or conversational Spanish speaking ability required. Preferred Experience: Prefer experience with psychiatric trauma and crisis. License/Certification: Valid NC license as a LCSW, LPA, LCAS, LCMHC, or RN license is required. Must have a valid driver’s license Must reside in North Carolina to be considered for remote status. Deadline for application: This position will remain open until it is filled To be considered for employment, all candidates are required to submit an application through ADP and upload a current resume. Your resume must provide your level of education and detailed work experience, including: Employer Name Dates of service (month & year) Average number of hours worked per week Essential duties of the job as related to the position you’re applying for Education Degree type Date degree was awarded Institution Licensure/certification, if applicable

Provide assistance to non-licensed call center staff to perform clinical triage, take the lead in emergency or crisis calls or to provide guidance and support to non-licensed staff when needed or requested. Interview callers to determine nature of call, intensity of need and appointment timeframes. Provide crisis de-escalation techniques when working with an individual in crisis and link that individual to a crisis provide. Process grievances and complaints. Collect, enter, track and monitor data.

Trillium Health Resources

Complex Transitional Care Nurse

Posted on:

May 13, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

North Carolina

Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) that manages serious mental health, substance use, traumatic brain injury, and intellectual/developmental disability services in North Carolina. Serving in 46 counties, we help individuals and their families strengthen well-being and build foundations for a healthy life. Join our team as we empower others to live their best lives by providing access to quality healthcare. We offer a challenging, engaging work environment where staff take home more than a paycheck. Every day, we see the results of our dedication – in the smiles of children on our accessible playgrounds and in the pride on the face of an adult cooking a meal for the first time. Working at Trillium Health Resources is more than just a job; it is an opportunity to make a direct impact on the communities we serve. At Trillium, we know that empowering others begins with supporting and developing our team. That’s why we offer competitive benefits and work-from-home flexibility so that our employees thrive outside of the office. We’re also committed to building a diverse, inclusive culture where all employees have the potential to grow professionally and personally.

Salary Range: $62,712.00 To $77,564.00 Annually Pay Plan Title: RN Working Title: Complex Transitional Care Nurse Cost Center: 92/Community Transition Position Number: 80983 FLSA Status: Exempt Posting Salary Range: $62,712 - $77,564 Office Location: Remote within Trillium’s South Central Region of our Catchment Area, which includes the North Carolina Counties: Carteret, Carven, Duplin, Jones, Lenoir, Onslow, Pender, Sampson, and Wayne. Trillium Health Resources has a career opening for a Complex Transitional Care Nurse! The core responsibility of the Complex Transitional Care Nurse is to develop personalized care planning strategies. This involves a thorough assessment of the patient's unique situation, taking into account their medical history, social circumstances, and individual needs. The care plans are meticulously crafted with foundations in national evidence based and informed standards, ensuring the delivery of whole person care. This evidence based approach is crucial for achieving optimal patient outcomes and promoting long-term well-being. Apply today to join this indispensable modern healthcare team!

Education/Experience: A minimum of three (3) years’ experience as a Registered Nurse is required. Preferred Experience: Experience working with BH/MH/SU/IDD population. Knowledge of QM, UM procedures as well as experience in using data analytics for population health management preferred. Experience assessing and coordinating care for members in adult care homes, family care homes, home residence or other settings. License/Certification: Fully licensed by the North Carolina State Board of Nursing as an RN required. Must have a valid driver’s license Location: Must reside in NC to be considered for remote status. Must be able to travel to a Trillium office location and within catchment as required. Remote within Trillium’s South Central Region of our Catchment Area, which includes the North Carolina Counties: Carteret, Carven, Duplin, Jones, Lenoir, Onslow, Pender, Sampson, and Wayne. To be considered for employment, all candidates are required to submit an application through ADP and upload a current resume. Your resume must provide your level of education and detailed work experience, including: Employer Name Dates of service (month & year) Average number of hours worked per week Essential duties of the job as related to the position you’re applying for Education Degree type Date degree was awarded Institution Licensure/certification, if applicable

Coordinate care for assigned individuals who may have identified needs with behavioral health, physical health, co-occurring, co-morbid or multi-morbid conditions. Collaborate with Internal Staff across discipline/teams (Care Coordinators, Clinicians, OT, COTA, Housing Specialists, Peers, etc.) to facilitate integrated care. Monitor the Care Plan (physical, behavioral health and social determinant concerns), service delivery and health and safety of the member. Perform clinical functions of discharge/transition planning and diversion including, clinical interviewing; obtaining and reviewing clinical records; identifying potential treatment needs; assessing barriers to treatment and recommending solutions; and assessing general health needs and recommending referrals. Complete Complex Transitional Care Nursing Assessment and other assessments as needed, to identify and link members to appropriate services/supports. Coordinate and participate in Integrated Care Teams. Review medical history and assessments. Provide education about all available services and natural and community supports, treatment options, diagnosis, etc. Coordinate linkage to needed psychological and physical health providers for evaluation and service implementation. Ensure the coordination of care with each individual’s primary care physician and/or other identified specialty physician.

Privia Health

MDPCP RN Care Coordinator

Posted on:

May 13, 2025

Job Type:

Full-Time

Role Type:

Primary Care

License:

RN

State License:

Maryland

Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.

The Maryland Primary Care Program (MDPCP) Care Coordinator will work closely with Primary Care providers in the state of Maryland to identify, screen, track, monitor, and coordinate the care of patients with multiple chronic conditions to develop and deliver Comprehensive Collaborative Care to patients. Our Care Coordinators seek to develop, implement, and deliver extensive care coordination within our medical group and affiliated partners in a patient centered manner. They interact and collaborate with interdisciplinary care teams, population health teams, networked facility partners, physicians, and others involved in meeting the patient’s needs This role demands unwavering professionalism, exceptional clinical skills, and a commitment to maintaining the highest standards of patient care.

2+ years of population health or care coordination experience RN or LPN clinical certification and/or experience required Active unrestricted license in MD or able to obtain (if needed) Strong computer and EHR skills and expertise Preferred experience with Medicare aged patients in a value-based program Preferred experience educating and engaging patients Experience working in an outpatient medical office Ability to travel to and from care centers to meet with patients and providers Must comply with all HIPAA rules and regulations

Collaborate with assigned local teams to meet Maryland Primary Care Program performance metrics Own the execution and performance toward defined performance metrics Collaborate effectively with integrated care team to support care coordination for patients Review patient non-compliance reports and conduct telephonic and/or in person outreach to ensure timely disease specific and wellness visits Independently conduct Annual Wellness Visits as needed Provide Transitional Care Management including, but not limited to, post in-patient and/or emergency department discharge follow up Deliver thorough and clear education to patients on a wide range of health care concerns. Collaborate with providers to review high-risk patients, develop a plan of care, and administer Care Plan to patients As needed, meet patients in the office or community for face-to-face visits Provide education and assistance with patient self-management goals Identify and coordinate referrals to community resources, home care, and disease management programs within Privia Preferred Network Operate independently within defined practice(s) and patient population to achieve agreed upon goals Attendance and participation in regular care team meetings to discuss patient care Perform other duties as assigned

Privia Health

Senior Value Based Care Manager

Posted on:

May 13, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

None Required

State License:

Washington

Privia Health™ is a national physician platform transforming the healthcare delivery experience. We provide tailored solutions for physicians and providers, creating value and securing their future. Through high-performance physician groups, accountable care organizations, and population health management programs, Privia works in partnership with health plans, health systems, and employers to better align reimbursements to quality and outcomes.

This full-time position can be remote in Washington or California. This role will also have some travel to care centers in both Washington and California. The Sr. VBC Manager is responsible for developing and operationalizing value-based care programs and initiatives that contribute meaningfully and measurably to the overall success of Privia’s value-based care strategy. They are focused on strategic initiatives geared toward success in new and existing Privia Health markets. This role relies heavily on listening to the customer, consolidating needs and goals, and gaining stakeholder alignment, and thus requires a leader comfortable with significant transparency. The Sr. VBC Manager will also play a significant role in owning a critical domain, attribution, in our company’s value-based care strategy.

Bachelor’s degree in Healthcare Administration, Public Health, Business Administration, or a related field preferred (Master’s a plus) Minimum of 4 years of experience in healthcare, preferably in value-based care for MSSP, MA, Medicaid and Commercial Care center workflow knowledge and understanding EMR experience required; Athena and Epic preferred Advanced knowledge of value-based care concepts and processes Excellent one-on-one and group communication and presentation skills, with a strong emphasis on emotional intelligence Highly organized with a proven ability to manage multiple priorities and projects Familiarity with project management tools such as Monday.com or similar platforms Microsoft Excel advanced knowledge, pivot tables, VLOOKUP, and data analysis Presentation development tools experience like Google Slides or Microsoft PowerPoint Comfort navigating ambiguity and adapting to a rapidly growing work environment Self-starter with the ability to work autonomously while maintaining a collaborative mindset Additional Information: All your information will be kept confidential according to EEO guidelines. Technical Requirements (for remote workers only, not applicable for onsite/in office work): In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Act as a subject matter expert to influence strategy and goal setting by developing insights around patient attribution and its implications in each of our value-based care contracts. Demonstrate a strong balance of both data-savvy and organizational insight to design tools to influence and inform multi-market actions toward various attributed member cohorts. Collaborate with stakeholders to enhance provider and practice-facing tools that provide curated data and actions to end-users. Gather requirements and feedback to ensure the application meets the evolving needs of medical practices. Act as a liaison between market teams and reporting teams. Manage a set of highly complex and diverse needs. Consolidate and prioritize needs and initiatives. Utilize judgment to balance competing priorities and drive collaborative solutions. Demonstrate advanced knowledge of value-based care and provider and care team workflows to develop processes to onboard and educate new providers in various markets, ensuring they understand value-based care principles and tools. Foster an engaging learning environment, employing emotional intelligence to facilitate provider receptiveness and growth. Utilize project management tools (e.g., Monday.com) to track progress on initiatives and ensure timely execution. Organize and manage multiple projects simultaneously, adapting to changing priorities as needed. Other duties as assigned

Jaybird Senior Living

Virtual Triage Nurse - Sat. and Sun. 7 am to 7 pm

Posted on:

May 13, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Iowa

There are jobs – and then there are careers. At Jaybird Senior Living, we offer team members the chance to do the kind of work that is meaningful and makes a difference every day. We are looking for people who live our mission of demonstrating exemplary red carpet service in all we do. The opportunity to grow, challenge yourself, and learn new skills is at your fingertips and we are always interested in talented individuals who desire to bring this innovative thinking to life in our communities. Does this sound like you? Then, we invite you to join us.

RN/LPN in good standing Have or obtain a Minnesota nursing license Expert knowledge of state-specific assisted living program requirements (IA, MN, WI)

Provides on-call relief for property nurses by acting as a virtual triage resource for community caregivers and floor nurses Equips callers with clinical advice and directs proper action based on regulation and care plan details Recognizes emergent situations and swiftly provides instruction for care staff to contact emergency services, if appropriate Assists care staff with reviewing symptoms and incidents to identify appropriate courses of action Analyze resident conditions and use clinical knowledge to ensure callers understand next steps and expectations

Acuity International

Medical Review Nurse (USACE)

Posted on:

May 13, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Florida

Our vision aims to empower our clients by actively leveraging our broad range of services. With our global presence, we have career opportunities all across the world which can lead to a unique, exciting and fulfilling career path. Pick your path today! To see what career opportunities we have available, explore below to find your next career!

Under general supervision of the Program Manager (PM) and reporting to the PM, the Medical Review Nurse (MRN) is responsible for the initial chart review and chart case management for medical exam/screening programs to verify that all medical information and exam components are accurate. The RN works directly with Physicians and Examinees to ensure all medical information is gathered and performs medical Quality Assurance on all charts in various process stages leading to a final determination.

Qualifications: 5-7 years of relevant experience. Fully unencumbered nursing license required. Proficiency with computer and common office equipment, as well as with MS Office products. Must be able to multitask, be flexible, be organized, and have excellent oral and written communication skills as well as exceptional attention to detail. Preferred Qualifications: COHN-S and/or CAOHC certifications Bachelor’s Degree with 5 years of relevant experience Flexibility and availability to travel and assist to support medical mobile events as either site lead and/or RN Physical Requirements and Work Conditions: Work is normally performed in a typical interior/office work environment. Work involves sitting and standing for prolonged periods of time. May require bending and lifting up to 15 lbs. Constant use of computer and common office equipment required. Acuity International is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration without regard to race, color, sex, national origin, age, protected veteran status, or disability status.

Performs medical review of incoming charts to determine if additional medical information is needed. Collaborates with Physician(s) and other internal nursing staff members for chart review. Performs medical Quality Assurance (QA) on all charts in various process stages. Interfaces with Client’s Medical Department as well as the on-site provider. Contacts Examinee via telephone or email to clarify information necessary to complete the chart. Develops a very good understanding of the specific contract’s guidelines and addendums as required. Masters the various software programs specific to the functioning of the exam program. Implements and follows up on requests for further evaluation from the Examinee when required. Works closely with other departments to provide accurate and quality outcomes. Thoroughly cognizant of metrics and organizes workload to meet them. Consistently learns and applies codified state and federal regulations specific to particular contract(s). Serve as backup to other nurses for daily duties and assists with follow-up calls to facilities and Examinees as needed as well as other duties as assigned. Opportunity to travel and assist on medical mobile events as either a site lead and/or RN as work or personal schedule permit. May participate in interdepartmental project groups or task forces to integrate activities, communicate issues, obtain approvals, resolve problems, and maintain a specific level of knowledge pertaining to new developments, new task efforts, contract awards, and new policy requirements. Supports marketing and sales objectives and efforts as requested. Performs duties in a safe manner. Follows the corporate safety policy. Participates and supports safety meetings, training, and goals. Ensures safe operating conditions within an area of responsibility. Encourages co-workers to work safely. Identifies “close calls” and/or safety concerns to supervisory personnel. Maintains a clean and orderly work area. Assists in the active implementation of company initiatives to ensure compliance with OSHA VPP, ISO, JCAHO, AAAHC, and other mandated regulations/standards. May serve on the OSHA VPP, Safety, and Wellness Committees.

Highmark

Complex Case Manager RN - Remote

Posted on:

May 13, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Pennsylvania

This job has primary ownership and oversight over a specified panel of members that range in health status/severity and clinical needs. The incumbent assesses health management needs of the assigned member panel and utilizing data/analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member. The incumbent will be supported by a multi-disciplinary team and will use clinical judgment to refer members to appropriate multi-disciplinary resources. In addition to identifying the appropriate clinical interventions and referrals, the incumbent will manage an active case load of members in his/her panel that are enrolled in case management. The incumbent conducts outreach to members enrolled in case management including but is not limited to: developing a care plan, encouraging behavior changes, identifying and addressing barriers, helping members to coordinate care, and identifying various resources to assist members in achieving their personal health goals. The incumbent monitors, improves and maintains quality outcomes (clinical, financial and functional) for the specified panel of members.

Required: High School Diploma/GED Substitutions: None Preferred: Bachelor's Degree in Nursing EXPERIENCE Required: 7 years of any combination of clinical, case management and/or disease/condition management experience, provider operations and / or health insurance experience Preferred: Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing or dialectical behavior therapy (DBT) Experience working with the healthcare needs of diverse populations Understanding of the importance of cultural competency in addressing targeted populations LICENSES AND CERTIFICATIONS Required: RN license in PA or WV or DE or NY is required. Other RN license(s), if applicable, must be obtained within the first 6 months of employment. Preferred: Certification in Case Management SKILLS: Written and verbal presentation skills, negotiation skills, and skills in positively influencing others with respect and compassion Broad knowledge of disease processes Understanding of healthcare costs and the broader healthcare service delivery system Proficiency in MS Excel and strong analytic skills with ability to interpret, evaluate and act on clinical and financial data, including analysis of statistical data Excellent interpersonal/ consensus building skills as well as the ability to work with a variety of internal and external colleagues from all levels of an organization Ability to work in a high performing team environment that requires flexibility Demonstrated ability to handle multiple priorities in a fast paced environment. Excellent organizational, time management and project management skills Self-directed; self-starter, ability to work successfully with indirect supervision and moderate autonomy

Maintain oversight over specified panel of members by performing ongoing assessment of members’ health management needs, identifying the right clinical interventions to address member needs and/or triaging members to appropriate resources for additional support. For assigned case load, create care plans to address members’ identified needs, remove barriers to care, identify resources, and conduct a number of other activities to help improve the health outcomes of members; care plans include both long and short term goals and plan of regular contacts for re-assessment. Ensure targeted percentage of patient goal achievement (i.e., realization of member care plan), and other patient outcomes, as applicable, are achieved. Ensure all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards. Maintain current knowledge and adheres to applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management including those published by CMSA and/or ACMA, as required by the organization. Other duties as assigned or requested.

Humana

Utilization Management Behavioral Health RN, CCR

Posted on:

May 13, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

Compact / Multi-State

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

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

Required Qualifications: Licensed Registered Nurse (RN) in an enhanced compact, (eNLC) with no disciplinary action. Minimum one, (1) year of experience in Behavioral Health Nursing (inpatient outpatient, psych, substance use) Varied physical health clinical experience preferably in an acute care, obstetrics, skilled or rehabilitation clinical setting Comprehensive knowledge of Microsoft Word, Outlook and Excel Ability to work independently under general instructions and with a team Preferred Qualifications Education: BSN or Bachelor's degree in a related field 3 years of experience in Behavioral Health Nursing experience (inpatient outpatient, psych, substance use) 1 year of Medical Surgery, Heart, Lung or Critical Care Nursing experience Previous experience in utilization management with ASAM knowledge Health Plan experience Previous Medicare/Medicaid Experience a plus Bilingual is a plus Workstyle: Remote work at home Location: Must reside in a state that participate in the enhanced nurse licensure, (ENLC) Schedule: Monday through Friday 8:00 AM to 5:00 PM Eastern Time

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

The Judge Group

CDI DRG Auditor Nurse

Posted on:

May 13, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Pennsylvania

Start Date: 06/02/2025 Positions available: 4 Training hours must be Eastern time between 8AM – 4PM. Work hours: 8 hours straight between 6 AM and 6 PM EST. Job Type: W2 contract to hire/ temp to perm (conversion to full time after 6 months) Job Summary: We are actively hiring experienced Clinical and Coding Auditors to support inpatient medical claims audits with a focus on DRG/APR-DRG validation and clinical chart review. This role requires a unique blend of clinical nursing and coding expertise, emphasizing accuracy, compliance, and quality in audit execution. Training begins May 5th. Schedule: Training Schedule: Monday–Friday, 8:00 AM–4:00 PM EST Regular Work Hours: Flexible start time between 8:00 AM–10:30 AM EST (Must complete a full shift ending no later than 6:00 PM EST)

Licensure (One required): RN or LPN/LVN (active, unrestricted U.S. license) Education (One required): Associate or Bachelor’s Degree in Nursing or Health Information Management Certifications (One required and must remain active): RHIA, RHIT, CPC, COC, CCS, CIC, CDIP, or CCDS Experience (Required): 2+ years of ICD-9/10-CM, MS-DRG, APR-DRG experience Extensive knowledge of: Provider billing practices Medical claims systems Payer reimbursement policies Official coding guidelines, CMS regulations, and Coding Clinic updates Experience with chart review, DRG validation, and auditing from both a clinical and coding perspective Technical Skills: Proficiency in Microsoft Word, Excel, Access, Teams, and web-based audit tools Strong verbal and written communication Ability to manage audits independently and efficiently

Audit Inpatient Claims: Review clinical documentation for accurate coding, appropriateness of treatment setting, and correct DRG/APR-DRG assignment. Utilize Coding & Audit Tools: Work with systems to perform high-volume, high-accuracy audits and generate audit letters. Analyze Data & Apply Standards: Leverage knowledge of ICD-10, coding guidelines, and industry standards for auditing and documentation. Ensure Productivity & Accuracy: Consistently meet or exceed internal productivity and quality benchmarks. Identify Opportunities for Improvement: Propose new claim types, recovery opportunities, or process enhancements.

Humana

RN Case Manager - Viroqua, WI

Posted on:

May 13, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Wisconsin

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

The Field Care Manager Nurse 2 assesses and evaluates member's 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 Field Care Manager Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Required Qualifications: Registered Nurse with 2 years of experience of in home case/care management Experience working with the adult population Knowledge of community health and social service agencies and additional community resources Ability to travel to member's residence within 30 to 40 miles Exceptional communication and interpersonal skills with the ability to quickly build rapport Ability to work with minimal supervision within the role and scope Ability to use a variety of electronic information applications/software programs including electronic medical records Intermediate to Advanced computer skills and experience with Microsoft Word, Outlook, and Excel Excellent keyboard and web navigation skills Ability to work a full-time (40 hours minimum) flexible work schedule Must have a separate room with a locked door that can be used as a home office to ensure continuous privacy while you work Valid driver's license, car insurance, and access to an automobile Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications: BSN 3-5 years of in home assessment and care coordination experience Experience with health promotion, coaching and wellness Previous managed care experience Bilingual — English, Spanish Certification in Case Management Motivational Interviewing Certification and/or knowledge Additional Information: Workstyle: This is a field position where employees perform their core duties at non-company locations, such as providing services at business partner facilities or prospects' and members' homes. Work Location: Viroqua, Wisconsin and surrounding area. Travel: up to 40% throughout Viroqua, WI and surrounding area. Typical Work Days/Hours: Monday through Friday, 8:00 am – 4:30 pm CST. WAH Internet Statement: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Driving: This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits. TB: This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

The Field Care Manager 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.

Humana

RN Case Manager - Sparta, WI

Posted on:

May 13, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Wisconsin

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

The Field Care Manager Nurse 2 assesses and evaluates member's 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 Field Care Manager Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Registered Nurse with 2 years of experience of in home case/care management Experience working with the adult population Knowledge of community health and social service agencies and additional community resources Ability to travel to member's residence within 30 to 40 miles Exceptional communication and interpersonal skills with the ability to quickly build rapport Ability to work with minimal supervision within the role and scope Ability to use a variety of electronic information applications/software programs including electronic medical records Intermediate to Advanced computer skills and experience with Microsoft Word, Outlook, and Excel Excellent keyboard and web navigation skills Ability to work a full-time (40 hours minimum) flexible work schedule This role is a part of Humana's Driver Safety program and therefore requires and individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100,000/300,000/100,00 limits. Must have a separate room with a locked door that can be used as a home office to ensure continuous privacy while you work Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana At Home systems if 5Mx1M This role is considered patient facing and is part of Humana At Home's Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB. Valid driver's license, car insurance, and access to an automobile Associates working in the State of Florida will need ACHA Level II Background clearance Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications: BSN 3-5 years of in home assessment and care coordination experience Experience with health promotion, coaching and wellness Previous managed care experience Bilingual — English, Spanish Certification in Case Management Motivational Interviewing Certification and/or knowledge Additional Information: Workstyle: This is a field position where employees perform their core duties at non-company locations, such as providing services at business partner facilities or prospects' and members' homes. Work Location: Sparta, WI and surrounding areas. Travel: up to 40% throughout Sparta, WI and surrounding areas. Typical Work Days/Hours: Monday – Friday, 8:00 am – 4:30 pm CST Limited Geography Remote - This is a remote position but located within a specific geography. WAH Internet Statement: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Driving: This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits. TB: This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

The Field Care Manager 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.

IntellaTriage

Bilingual Hospice Triage RN PT 2 shifts 3:30p-12a Sat & Sun 3:30p-12a (REMOTE)

Posted on:

May 13, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

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

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

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

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

HarmonyCares

Nurse Practitioner - PRN (Akron, Barberton and Fairlawn)

Posted on:

May 12, 2025

Job Type:

Part-Time

Role Type:

Primary Care

License:

NP/APP

State License:

Ohio

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

The Nurse Practitioner delivers annual risk assessment in a residential setting or telehealth, within the scope of practice for a Nurse Practitioner, as delegated by the Collaborative Physician.

Required Knowledge, Skills, and Experience: Active/unrestricted medical license. Active CPR Certification Board eligible or board certified in family medicine. Outstanding EHR skills Preferred Knowledge, Skills and Experience: Geriatric training/experience Skill in teamwork and maintaining effective working relationships with patients, medical staff, and the public Conditions of this role to be aware of: Adaptability to differing weather conditions and patients’ home/residential environments Full range of body motion including handling/lifting patients. Manual and finger dexterity, eye-hand coordination, normal visual acuity, normal hearing, standing, bending, walking and stair climbing Regular lifting/carrying items weighing up to 50 pounds Ability to ride in automobile or van up to 150 miles daily in urban and/or rural settings. Ability to drive, if necessary

Conduct comprehensive in-home health risk assessments to identify all active and chronic disease conditions, as well as determine all physical, mental, and social needs present at the time of the visit Takes history, examines, determines diagnoses. Provides written documentation of patient visit, per NCQA standards Takes patient vital signs, as necessary. Places case management referrals and communicates with PCP as necessary. Communicates with patients, caregivers, agency nurses, other providers and vendors as necessary to assure proper diagnosis. Performs all clinical duties while observing OSHA Universal Precautions Maintains patient confidentiality Attends required meetings and in-services and participates in committees, as requested Participates in professional development activities and maintains professional licenses and affiliations