Performant Healthcare, Inc.

Medical Review Training Specialist - RN, Coding Certification Required

Posted on:

September 11, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Florida

At Performant, we’re focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Through this important work we accomplish our mission: To offer innovative payment accuracy solutions that allow our clients to focus on what matter most – quality of care and healthier lives for all. If you are seeking an employer who values People, Innovation, Integrity, Fun, and fostering an Ownership Culture – then Performant is the place for you!

The Medical Review Training Specialist - RN (Coding) partners with applicable operational business leaders, including functions such as compliance, appeals, and quality, and is responsible for the development, delivery, and continuous improvement of operational training program and tools for the line of business that contributes to increasing staff capability and its overall success. This position requires strong subject matter expertise, experience developing and delivering training content via a variety of methods and tools effective for remote workforce, excellent interpersonal and communication skills, and demonstrated ability to have meaningful impact on operational workforce capability through training programs and tools.

Knowledge, Skills and Abilities Needed: Strong operational subject matter expertise clinical nursing practices. Must have exposure and experience with health care technology (Electronic Medical Records, Coding software and Practice Management Information Systems). Knowledge of laws, regulations, or policies impacting the Healthcare industry and understanding of Managed Care requirements under the Medicare/Medicaid and other third-party payor programs. Demonstrated ability to take complex ideas and large amounts of information and distill to key learning concepts and principals appropriate for audience intended learning and development. Ability to rapidly comprehend and teach new information. Demonstrated strength facilitating/presenting information to various audiences in a professional manner with high success in knowledge transfer and skill enhancement. Ability to implement concepts of adult learning principles, instructional design, needs assessment and performance measurement and evaluation. Demonstrated Project/program management skills. Good research and problem-solving skills. Demonstrated technical competence to quickly learn and leverage various applications and tools. Intermediate to advanced skills in Word, Excel, PowerPoint, and curriculum development tools. Experience developing and delivering learning materials through a Learning Management System (LMS) highly desired. Demonstrated ability to develop high quality training plans, courses, and content, with effective delivery and assessment methods. Must have ability to work with sensitive information and maintain confidentiality. Builds credibility and trust. Mind-set of continuous improvement and adapts quickly to change. Excellent written and verbal communication, and interpersonal skills. Ability to effectively interact with all levels internal and external to the organization. Demonstrates ability to apply good judgment. Can work independently as well as effectively collaborate within a team and cross-functionally. Self-motivated and ability to drive results given direction in the form of objectives. Demonstrates good judgement in decision making. Possess excellent analytical skills and strong attention to detail. Efficient organization and effective time management. Ability to obtain and maintain client required clearances as well as pass company regular background and/or drug screening. Completion of Teleworker Agreement upon hire, and adherence to the Agreement (and related policies and procedures) including, but not limited to: able to navigate computer and phone systems as a user to work remote independently using on-line resources, must have high-speed internet connectivity, appropriate workspace able to be compliant with HIPAA, safety & ergonomics, confidentiality, and dedicated work focus without distractions during work hours. Required and Preferred Qualifications: Associate degree in relevant field, or equivalent (additional 4 years of directly applicable experience), Bachelor’s degree preferred. Active Registered Nursing license AHIMA/AAPC Coding Certification required. Prior experience in similar role or function with responsibility for developing and delivering effective knowledge and skill development programs is required; delivery of remote learning is highly preferred.

Employ a variety of methods to maintain current in-depth knowledge, requirements, and subject matter expertise for business segment (legal, regulatory, compliance, and client requirements) in a dynamic environment. Develop structured training program and material for policies & procedures and comprehensive review guidelines for audit, operations support, and other audit-related staff, with a specific emphasis on clinical nurse review. Maintaining the calendar of assigned training and ensuring that training is scheduled and delivered based upon internally developed timelines, legal, and contractual requirements, as applicable. Plan, coordinate, deliver, track, monitor, and report new hire training, as well as ongoing training as required for periodic refreshers, performance improvement, new or modified operating procedures, workflows, tools, requirements, etc. Employ a variety of methods to gather information and input to assess training gaps and programs effectiveness such as 360-degree feedback (from trainees, management, and applicable stakeholders), operational performance and QA results, appeals and other metrics at individual and group level, as well as from audit performance, QA results, Appeal metrics and other inputs. Provide instruction and direction to employees on proper usage of on-line training tools, and provides follow-up to ensure staff completion of required assigned training in a timely manner, leveraging support from employee’s management and/or HR if required. Apply outcomes of program assessment and needs inputs toward continuous improvement and further development of training program scope, courses, materials, and tools. Utilize effective adult learning training pedagogy to maximize successful knowledge transfer and skill building, as well as tools and methods for efficiency in training records management effectively in remote/virtual classroom, as well as in-office training. Conduct effective training 1:1 and various group size settings. Serve as a subject matter expert regarding official clinical guidelines, audit system functionality and audit workflows and files. Knowledge of payer reimbursement methodologies is a plus. Provide training on Audit guidelines, to ensure compliance with client requirements and in conformance with proper clinical nursing practices. Deliver concept-based training which may include reviewing operative reports and other documentation to properly code services using current CPT, HCPCS and ICD 10 CM/PCS codes. Proactively monitor changes to coding/clinical methodologies, official guidelines, regulatory standards, and update training material for delivery to auditors using relevant training methods. Support Medical Review management in documenting workflows and process improvement plans as needed. Provide consultative input to the development of business requirements for audit platform and reporting enhancements to prepare for User Acceptance testing and development of relevant training materials; deliver training on new client implementation, new audit programs, new audit products and/or new audit concepts. Conduct User Acceptance Testing on new workflow platform and/or reporting enhancements, ensuring correct functionality, documenting all changes and incorporating changes into training materials and training plans as required. Leads by example. Must be able to meet requirements for and perform work assignments in accordance with Company policies and expectations on a home remote basis (and must meet Performant remote-worker requirements). Basic office equipment required to perform remote work is provided by the company. Other duties as required and assigned by management to meet overall business needs.

Performant Healthcare, Inc.

Medical Review Nurse II - Commerical Home Health

Posted on:

September 11, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Florida

At Performant, we’re focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Through this important work we accomplish our mission: To offer innovative payment accuracy solutions that allow our clients to focus on what matter most – quality of care and healthier lives for all. If you are seeking an employer who values People, Innovation, Integrity, Fun, and fostering an Ownership Culture – then Performant is the place for you!

The Medical Review Nurse II - Commercial Home Health primarily performs medical claims audit reviews. As a MR Nurse, you will join a team of experienced medical auditors and coders performing retrospective and prepayment audits on claims for Government and Commercial Payers. You will work remotely in a fast paced and dynamic environment and be part of a multi-location team.

Knowledge, Skills and Abilities Needed: Experience with utilization management systems or clinical decision-making tools such as Medical Coverage Guidelines (MCG) or InterQual. Experience with and deep knowledge of ICD-9, ICD-10, CPT-4 or HCPCS coding. Knowledge of insurance programs program, particularly the coverage and payment rules. Ability to maintain high quality work while meeting strict deadlines. Excellent written and verbal communication skills. Ability to manage multiple tasks including desk audits and claims review. Must be able to independently use standard office computer technology (e.g. email telephone, copier, etc.) and have experience using a case management system/tools to review and document findings. Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload Effectively work independently and as a team, in a remote setting. Required and Preferred Qualifications: Active unrestricted RN license in good standing, is required. Must not be currently sanctioned or excluded from the Medicare program by the OIG. Minimum of five (5) years diversified nursing experience providing direct care in an inpatient or outpatient setting. One (1) or more years' experience performing medical records review. One (1) or more years' experience in health care claims that demonstrates expertise in, ICD-9/ICD-10 coding, HCPS/CPT coding, DRG and medical billing experience for an Insurance Company or hospital required. Strong preference for experience performing utilization review for an insurance company, Tricare, MAC, or organizations performing similar functions.

Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules. Document all findings referencing the appropriate policies and rules. Generate letters articulating audit findings. Supporting your findings during the appeals process if requested. Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse. Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits. Keep abreast of medical practice, changes in technology, and regulatory issues that may affect our clients. Work with the team to minimize the number of appeals; Suggest ideas that may improve audit workflows; Assist with QA functions and training team members. Participate in establishing edit parameters, new issue packets and development of Medical Review Guidelines. Interface with and support the Medical Director and cross train in all clinical departments/areas. Other duties as required to meet business needs.

Zipliens

Nurse Claims Analyst

Posted on:

September 11, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

North Carolina

Zipliens is a leading lien resolution company that specializes in streamlining the lien process for personal injury law firms. We are looking for proactive, results-driven individuals to join our dynamic team.

Zipliens is seeking a Nurse Claims Analyst to provide clinical expertise that strengthens the accuracy and reliability of our Mass Tort lien resolution process. Health plans often submit reimbursement claims that include extensive medical itemizations, and it is critical that only treatment directly related to the underlying litigation is considered. The Nurse Claims Analyst will leverage clinical judgment and familiarity with medical coding (ICD/CPT) to support this process, ensuring reviews are accurate, consistent, and defensible. As a clinical Subject Matter Expert (SME), the Nurse Claims Analyst will support the development of clear review protocols, provide guidance on complex or disputed claims, and contribute to process improvements that uphold the highest standards of quality and fairness.

3+ years of experience in medical record review, claims auditing, or medical billing and coding. 1+ years of experience in itemized bill review (or equivalent claims review experience). Active, unrestricted RN license in good standing within the United States is required. Strong understanding of payer policies and medical coding systems such as CPT, ICD-9/10, and HCPCS. Proficiency in Excel (e.g., formulas, pivot tables, data analysis) to efficiently manage and evaluate large claim datasets. Excellent written communication skills, including the ability to write clear, concise, and fact-based rationales in support of determinations. Ability to evaluate medical information and apply clinical judgment to make defensible determinations on claim appropriateness.

Conduct high-volume QA reviews of claimant-level medical records (up to 1,000 per week), using clinical judgment and knowledge of medical coding to determine relatedness to the underlying litigation. Help create and establish medical claim audit protocols to enable consistent and defensible determinations. Use Excel/Google Sheets to efficiently manage and analyze large datasets, creating workflows that streamline reviews and reduce the need for one-off line-by-line analysis. Document review findings and rationales clearly and accurately for use by internal teams and clients. Identify trends or recurring issues in claim reviews and recommend updates to processes or protocols to improve consistency and accuracy. Support knowledge sharing by documenting review standards and providing clinical guidance to internal team members and vendors. Adapt review approach across multiple claim types to meet evolving client and project needs. Ensure reviews and determinations meet accuracy, quality, and productivity standards that support reliable client outcomes. Contribute subject matter expertise to reports, analysis, and special projects that strengthen review protocols and client deliverables.

AmTrust Financial Services, Inc.

Telephonic Nurse Case Manager

Posted on:

September 11, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Texas

AmTrust Financial Services, a fast growing commercial insurance company, has a need for a Telephonic Medical Case Manager, RN. PRIMARY PURPOSE: To provide comprehensive quality telephonic case management to proactively drive a medically appropriate return to work through engagement with the injured employee, provider and employer. Our nurses will be empathetic informative medical resources for our injured employees and they will partner with our adjusters to develop a personalized holistic approach for each claim. These responsibilities may include utilization review, pharmacy oversight and care coordination.

Education & Licensing: Active unrestricted RN license in Dallas is required. Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work experience preferred. Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly preferred. Ability to acquire, and maintain, appropriate Professional Certifications and Licenses to comply with respective state laws may be required Preferred for license(s) to be obtained within three - six months of starting the job. Written and verbal fluency in Spanish and English preferred Experience: Five (5) years of related experience or equivalent combination of education and experience required to include two (2) years of direct clinical care OR two (2) years of case management/utilization management required. Skills & Knowledge: Knowledge of workers' compensation laws and regulations Knowledge of case management practice Knowledge of the nature and extent of injuries, periods of disability, and treatment needed Knowledge of URAC standards, ODG, Utilization review, state workers compensation guidelines Knowledge of pharmaceuticals to treat pain, pain management process, drug rehabilitation Knowledge of behavioral health Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Leadership/management/motivational skills Analytic and interpretive skills Strong organizational skills Excellent interpersonal and negotiation skills Ability to work in a team environment Ability to meet or exceed Performance Competencies WORK ENVIRONMENT: When applicable and appropriate, consideration will be given to reasonable accommodations. Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines Physical: Computer keyboarding Auditory/Visual: Hearing, vision and talking

Uses clinical/nursing skills to determine whether all aspects of a patient’s care, at every level, are medically necessary and appropriately delivered. Perform Utilization Review activities prospectively, concurrently or retrospectively in accordance with the appropriate jurisdictional guidelines. Sends letters as needed to prescribing physician(s) and refers to physician advisor as necessary Responsible for accurate comprehensive documentation of case management activities in case management system. Uses clinical/nursing skills to help coordinate the individual’s treatment program while maximizing quality and cost-effectiveness of care including direction of care to preferred provider networks where applicable. Addresses need for job description and appropriately discusses with employer, injured employee and/or provider. Works with employers on modifications to job duties based on medical limitations and the employee’s functional assessment. Responsible for helping to ensure injured employees receive appropriate level and intensity of care through use of medical and disability duration guidelines, directly related to the compensable injury and/or assist adjusters in managing medical treatment to drive resolution. Communicates effectively with claims adjuster, client, vendor, supervisor and other parties as needed to coordinate appropriate medical care and return to work. Performs clinical assessment via information in medical/pharmacy reports and case files; assesses client's situation to include psychosocial needs, cultural implications and support systems in place Objectively and critically assesses all information related to the current treatment plan to identify barriers, clarify or determine realistic goals and objectives, and seek potential alternatives. Partners with the adjuster to develop medical resolution strategies to achieve maximal medical improvement or the appropriate outcome Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim. Engage specialty resources as needed to achieve optimal resolution (behavioral health program, physician advisor, peer reviews, medical director). Partner with adjuster to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves Maintains client's privacy and confidentiality; promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards. May assist in training/orientation of new staff as requested Other duties may be assigned. Supports the organization's quality program(s).

Way2Class

NGN NCLEX Nursing SME

Posted on:

September 11, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Wyoming

Why Join Us: Flexible remote work. Opportunity to contribute to high-impact nursing education projects. Collaborative environment with global education partners.

Job Title: Nursing Subject Matter Expert (SME) – NGN NCLEX Location: Remote (US-based preferred) Type: Contract/Freelance About the Role: We are seeking highly qualified Nursing Subject Matter Experts (SMEs) with expertise in the Next Generation NCLEX (NGN) to support academic content development and fact-checking projects. The ideal candidate will bring strong clinical knowledge, MSN-level teaching experience, and proven familiarity with NGN NCLEX standards.

Master of Science in Nursing (MSN) required. Minimum 3 years of teaching experience at the MSN level (academic or clinical). Strong expertise with Next Generation NCLEX (NGN) exam format, question design, and competency requirements. Current RN license (active, unrestricted) preferred. Excellent written communication and attention to detail. Preferred Qualifications: Prior experience as an SME for educational publishers, testing bodies, or e-learning projects. Familiarity with U.S. nursing curriculum standards and accreditation guidelines.

Review, fact-check, and validate nursing education content aligned with NGN NCLEX guidelines. Contribute subject matter expertise to assessment development and instructional materials. Ensure accuracy, relevance, and alignment of content with current nursing practice and educational standards. Collaborate with instructional designers, project managers, and editorial teams. Provide feedback and recommendations to strengthen nursing curriculum content.

Peraton

Nurse Reviewer

Posted on:

September 10, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Virginia

Peraton is a next-generation national security company that drives missions of consequence spanning the globe and extending to the farthest reaches of the galaxy. As the world’s leading mission capability integrator and transformative enterprise IT provider, we deliver trusted, highly differentiated solutions and technologies to protect our nation and allies. Peraton operates at the critical nexus between traditional and nontraditional threats across all domains: land, sea, space, air, and cyberspace. The company serves as a valued partner to essential government agencies and supports every branch of the U.S. armed forces. Each day, our employees do the can’t be done by solving the most daunting challenges facing our customers. Visit peraton.com to learn how we’re keeping people around the world safe and secure.

Performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse in Medicare and Medicaid programs. About The Role SafeGuard Services (SGS), a subsidiary of Peraton, performs data analysis, investigation, and medical review to detect, prevent, deter, reduce, and make referrals to recover fraud, waste, and abuse. We are looking to add a Nurse Reviewer to our SGS team of talented professionals.

4 years with AS/AA; 2 years with BS/BA; 6 years with no degree At least 2 years of experience in the medical field as a Registered Nurse or other clinician, and/or experience in review of medical claims for coverage and medical necessity. Current nursing license. Strong investigative skills Strong communication and organization skills Strong PC knowledge and skills U.S. citizenship required The most competitive candidates will have: Experience in reviewing claims for technical requirements, performing medical review, and/or developing fraud cases Have a strong Medicare Part A, Home Health and Hospice review background Have a CPC (Certified Professional Coder) certificate. Knowledge of CMS Shared Systems is a plus Essential Functions: This position may require the incumbent to appear in court to testify about work findings. Ability to compose correspondence, reports, and referral summary letters. Ability to communicate effectively, internally and externally Ability to handle confidential material. Ability to report work activity on a timely basis. Ability to work independently and as a member of a team to deliver high quality work Ability to attend meetings, training, and conferences, overnight travel required

The Nurse Reviewer position requires the individual to conduct medical record reviews and to apply sound clinical judgment to claim payment decisions. Responsibilities may include additional research on medical claims data and other sources of information to identify problems, review sophisticated data model output, and utilize a variety of tools to detect situations of potential fraud and to support the ongoing fraud investigations and requests for information. The incumbent will use a variety of tools to identify and develop cases for future administrative action, including referral to law enforcement, education, over payment recovery. Will work with external agencies to develop cases and corrective actions as well as respond to requests for data and support. Ability to present issues of concern, citing regulatory violations, alleging schemes or scams to defraud the Government Research regulations and cite violations. Conduct self-directed research to uncover problems in Medicare payments made to institutional and non-institutional providers. Make claim payment decisions based on clinical knowledge Telework available from the continuous United States.

Telligen

Temporary Intake Assessor - LPN

Posted on:

September 10, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

LPN/LVN

State License:

Colorado

Telligen is one of the most respected population health management organizations in the country. We work with state and federal government programs, as well as employers and health plans offering clinical, analytical, and technical expertise. Health has changed a lot through our 50-year history, but what has remained constant is that we care deeply about who we serve and what we do. Our success is built on our ability to adapt, respond to client needs, and offer innovative solutions. Our business is our people and we’re looking for talented individuals who not only believe in our mission but who are ready to take ownership and make a difference in the lives of people, in the world of health. Learn more about who we are and what we do at www.telligen.com/about-us

This position provides front line intake clinical screening to members who need skilled nurse assessment services. The incumbent is accountable for performing and documenting all member outreach activities, which may include assessing urgency of assessment referrals, determining members acuity level, current health status, and determining the type of assessment most applicable for members based on their health care needs at the time of referral. In addition, the position is responsible for assisting with scheduling and conducting express assessments as needed under the supervision of a Registered Nurse (RN). Express assessments are performed virtually. Persons being assessed reside in the community or in facilities. Assessor Reviewers also may complete review decisions regarding services needed to be successful in the community.

Two or four-year nursing degree and/or equivalent training and/or experience 1-2 years of clinical experience required Minimum of two years of experience in working with persons with disabilities. Case management experience preferred. Current and valid LPN/RN licensure in Colorado. Contracts requires a Licensed Practical Nurse with a current and unrestricted state license, or psychology / social work degree. The License must be current and unrestricted in the contract State. LPN’s shall perform services within the scope of licensure and nursing practice. Bilingual English/Spanish a plus. Able to work weekend, holidays and after hours. Able to work a flexible schedule based on business needs.

Performs virtual assessments of persons with disabilities. Contracts may require collaboration with health care providers and ancillary service providers to create or validate the appropriate treatment plan. Documents assessment results for the individual member status or negotiates service plan as needed. Provides ongoing education. May communicate with all health care providers to ensure appropriateness of care. Performs miscellaneous duties as assigned.

Datavant

CDQI Nurse Specialist - Part Time - Remote

Posted on:

September 10, 2025

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

RN

State License:

Arizona

Datavant is a data platform company and the world’s leader in health data exchange. Our vision is that every healthcare decision is powered by the right data, at the right time, in the right format. Our platform is powered by the largest, most diverse health data network in the U.S., enabling data to be secure, accessible and usable to inform better health decisions. Datavant is trusted by the world’s leading life sciences companies, government agencies, and those who deliver and pay for care. By joining Datavant today, you’re stepping onto a high-performing, values-driven team. Together, we’re rising to the challenge of tackling some of healthcare’s most complex problems with technology-forward solutions. Datavanters bring a diversity of professional, educational and life experiences to realize our bold vision for healthcare.

As a Clinical Documentation Quality Improvement (CDQI) Specialist, you will play a pivotal role in elevating the impact of our medical record documentation. You will conduct daily evaluations and engage in direct communication with providers to enhance documentation clarity, completeness, and overall medical record quality. By ensuring accurate and comprehensive physician documentation, you will be at the forefront of influencing the precision of code assignment, making a tangible difference in the accuracy of healthcare data. Join us in this critical role where your efforts will have a direct and meaningful impact on the quality and effectiveness of patient care.

3+ years of CDI experience 3+ years of clinical experience in an academic medical center Registered Nurse license, Bachelor's degree in Nursing CCDS or CDIP certification required Must pass a CDI skills competency assessment Must be able to accommodate a min of 15 hours per week

Conduct timely, accurate, and complete documentation reviews for selected inpatient records, addressing inadequate or conflicting documentation. Collaborate with physicians and caregivers to ensure appropriate reimbursement and clinical severity for DRG-based payer patients. Demonstrate understanding of complications, co-morbidities, severity of illness, risk of mortality, case mix index, secondary diagnoses, and procedure impact on DRG. Improve coding specificity by educating physicians and caregivers on the importance of clear documentation throughout a patient's stay. Follow AHA guidelines and coding clinics for accurate coding and required documentation to ensure compliance. Query physicians regarding missing, unclear, or conflicting health record documentation to obtain necessary details. Maintain daily production logs for evaluation, tracking cases reviewed, queries placed/responded, etc. Perform follow-up reviews to confirm recorded points of clarification in the patient's medical record. Ensure confidentiality of all files, documents, and records. Meet or exceed production and quality metrics.

WellSky

Utilization Review Clinician - RN - Remote

Posted on:

September 10, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Kansas

WellSky is where independent thinking and collaboration come together to create an authentic culture. We thrive on innovation, inclusiveness, and cohesive perspectives. At WellSky you can make a difference. WellSky provides equal employment opportunities to all people without regard to race, color, national origin, ancestry, citizenship, age, religion, gender, sex, sexual orientation, gender identity, gender expression, marital status, pregnancy, physical or mental disability, protected medical condition, genetic information, military service, veteran status, or any other status or characteristic protected by law. WellSky is proud to be a drug-free workplace. Applicants for U.S.-based positions with WellSky must be legally authorized to work in the United States. Verification of employment eligibility will be required at the time of hire. Certain client-facing positions may be required to comply with applicable requirements, such as immunizations and occupational health mandates. Here are some of the exciting benefits full-time teammates are eligible to receive at WellSky: Excellent medical, dental, and vision benefits Mental health benefits through TelaDoc Prescription drug coverage Generous paid time off, plus 13 paid holidays Paid parental leave 100% vested 401(K) retirement plans Educational assistance up to $2500 per year

The Utilization Review Clinician is responsible for reviewing medical records to determine medical necessity. This role includes conducting patient evaluations, managing admissions and informational visits, and ensuring post-discharge visits occur within the required timeframe, with assessments completed to help prevent acute care readmissions. The Utilization Review Clinician also reviews requests for post-acute services in a timely manner, using established clinical guidelines and coverage limitations to assess appropriateness. They build relationships with physicians, healthcare providers, and internal/external clients to support improved health outcomes. Applying clinical expertise, they coordinate care with facilities and providers, follow standard operating procedures and organizational policies, and consult with peer reviewers, Medical Directors, or delegated clinical reviewers to ensure care is medically appropriate, high-quality, and cost-effective throughout the medical management process. The ideal candidate will possess working knowledge and aptitude of the Microsoft suite of applications (e.g., Office, Excel) as well as clinical decision support tools and operational software.

Required Qualifications: Bachelor's Degree or equivalent work experience 4-6 years of clinical nursing or therapy experience Active RN license Preferred Qualifications: 1-2 years' experience in utilization review, case management and/or managed care regulations Experience with MCG Guidelines, InterQual or other clinical decision support tools, especially in utilization management and prior authorization processes Located in the state of Michigan Job Expectations: Able to pass federal and state required background checks and drug screen Willing to travel up to 30% based on business needs. Willing to work additional or irregular hours as needed. Must work in accordance with applicable security policies and procedures to safeguard company and client information. Must be able to sit and view a computer screen for extended periods of time.

Conduct prior authorization reviews and/or continued stay reviews for post-acute care services by applying clinical guidelines and escalating cases to medical directors as needed. Approve services in compliance with health plan guidelines, contractual agreements, and medical necessity criteria. Collaborate with case managers, physicians, and medical directors to ensure appropriate levels of care and seamless care transitions. Participate in team meetings, educational activities, and interrater reliability testing to maintain review consistency and professional growth. Ensure compliance with federal, state, and accreditation standards, and identify opportunities to enhance communication or processes. Support all payer programs and initiatives related to the post-acute space. Make benefit determinations about appropriate levels of care using clinical guidelines. Coordinate benefits and transitions between various areas of care. Utilize knowledge of resources available in the healthcare system to assist physicians and patients effectively. Perform other job duties as assigned.

Jaybird Senior Living

Remote Triage Nurse, Weekend Hours Full-Time

Posted on:

September 10, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Minnesota

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. Together we are better.

Why You Should Apply: Competitive pay Great benefits including medical, dental, vision, life and more Excellent growth and advancement opportunities 401k with 5% Match Generous Paid Time Off (PTO) program Rotating shifts (12 hour weekday shifts, 24 hour weekend shifts)

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

Diana Health

Remote Triage Nurse (Full-Time)New

Posted on:

September 10, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

LPN/LVN

State License:

Tennessee

Diana Health is a network of modern women’s health practices working in partnership with hospitals to reimagine the maternity and women’s healthcare experience. We are restructuring the traditional approach to care to create an experience that is good for patients and good for providers. We do that by combining a tech-enabled, wellness-focused care program that women love with a clinical system that helps us drive continuous quality improvement and ensure work-life balance for our care team. We work with clients across all life stages to empower and support them to live happier, healthier, more fulfilling lives. With strong collaborative care teams; passionate administrators and a significant investment in operational support, Diana Health providers are well-supported to bring their very best to the work they love. We are an interdisciplinary team joined together by our shared commitment to transform women’s health. Come join us!

We are looking for a full-time LPN passionate about all aspects of women’s health to provide direct patient care as part of an interdisciplinary care team and to serve as the first line of communication with patients in our clinical phone and messaging triage during office hours. The ideal candidate thrives in a busy practice, loves women’s health and building relationships with patients, is an excellent problem-solver and communicator, and is able to multi-task easily. Bilingual skills preferred with a preference for Spanish language, open to other languages.

Current certification as a Tennessee Licensed Practical Nurse 2+ years of experience in an outpatient preferred Excellent communication, interpersonal, and organizational skills Strong computer skills and familiarity with EMRs Lactation certification (IBCLC, CLC, CLE) preferred, but not required Bilingual, Spanish skills preferred

Patient Care: Act as the first line of call in clinical communications for patients, within guidelines/protocols Administer injections and medications Provide direct clinical care as needed for minor check in visits or lab draws Provide supporting paperwork and education for patients Support clinic visits as appropriate and per training when needed Administrative: Support the everyday flow of clinic acting as back up support for MA Maintaining logs Cleaning of rooms as needed and sterilization of instruments Obtaining and transcribing patient medical records Additional workflow items as the need arises

Insight Global

Licensed Practical Nurse

Posted on:

September 10, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Compact / Multi-State

They partner with primary care providers and provide remote patient monitoring to Medicare populations, specifically those with chronic illnesses (ex. Type2 diabetes, hypertension etc.).

Hiring a remote LPN/LVN full time for a chornic care management organization! Schedule: Direct Hire, Mon-Friday 8-5 PST (no weekends) 40 hours per week Day to Day: This role acts as a health coach for chronic care management under the discretion of an MD. The LPN/LVN will be responsible for calling 20 patients per day, with each call lasting around 20 minutes. You must be comfortable conversing with patients over the phone to gather key information (such as how is your breathing today, what is your blood pressure today) and document detailed charts.

This role requires a multistate LPN license and a California LVN license (*must not reside in California).

Provide one-on-one coaching and support to patients managing chronic conditions, including but not limited to type 2 diabetes, hypertension, and cardiovascular disease. Conduct comprehensive assessments of patients' health status, lifestyle behaviors, nutritional habits, and readiness to change. Help patients execute on their personalized care plans and goals, focusing on behavior modification, nutrition, physical activity, and self-management strategies. Monitor patients' progress, adherence to treatment plans, and health outcomes through regular check-ins and remote monitoring tools. Educate patients on disease management, medication adherence, symptom recognition, and prevention strategies.

Columbia Southern University

Part Time Nursing

Posted on:

September 10, 2025

Job Type:

Part-Time

Role Type:

Coaching

License:

RN

State License:

Compact / Multi-State

At Columbia Southern University, we truly believe in offering students flexible, affordable online degree programs with exceptional service. By giving our students the tools they need to succeed, we provide them with an opportunity to take charge of their education in a way that no other university offers.

Job Title: Part-Time Faculty Nursing Department: College of Nursing within the College of Nursing and Health Sciences Reports to: Academic Program Director and Lead Faculty FLSA: Exempt Hours: As necessary to meet teaching guidelines Location: This is an off-campus remote position that requires checking classes and attending to students in the evening and on weekends. Job Summary Part-time faculty provide teaching and instruction to Columbia Southern University students and collaborates with other faculty to promote an engaging learning environment. In addition to the teaching responsibility, part-time faculty serve as subject matter experts within their assigned discipline.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Knowledge, Skills, & Abilities Knowledge English Language - Knowledge of the structure and content of the English language including the meaning and spelling of words, rules of composition, and grammar. Academic Processes - Knowledge of university guidelines, course descriptions, and academic terminology. Clerical - Knowledge of office administrative procedures including word processing, managing files and records, typing, and other office procedures. Computer - Knowledge of basic computer processes including word processing, web browsing, and Microsoft Office including Basic Microsoft Excel. Mathematics - Knowledge of basic mathematics. Skills Critical Thinking - Uses logic and reasoning to look at different types of information in order to make conclusions and work through problems. Reading Comprehension - Understanding written sentences and paragraphs in work related documents. Research - Locates key facts and information in order to learn more about different types of information. Interpersonal Skills - Communicates and interacts with people effectively while being aware of social perceptions. Time Management - Manages one’s own time to accomplish assigned tasks. Attention to Detail - Thoroughness and accuracy when accomplishing a task ensuring all aspects are reviewed. Abilities Written Comprehension - The ability to read and understand information and ideas presented in writing. Written Expression - The ability to communicate information and ideas in writing so others will understand. Oral Comprehension - The ability to listen to and understand information and ideas presented through spoken words and sentences. Oral Expression - The ability to communicate information and ideas in speaking so others will understand. Selective Attention (Vigilance) - The ability to concentrate on a task over a period of time without being distracted. Education and/or Experience Faculty Teaching Undergraduate should (Course Numbers 1000 – 3000) Possess a minimum of a master's degree in nursing from an accredited program/college/university and ... Possess an active, unencumbered multistate licensure and... Possess experience teaching in the online environment at the college/university level Possess certification (preferred) Experience with Blackboard learning management system (preferred) *If a faculty does not meet the above credentialing requirements, an alternative justification requires approval from the College Dean and Provost. Faculty Teaching Graduate Courses should (Course Numbers ≥ 4000) Possess a terminal degree in nursing or related field from an accredited program/college/university and… Possess an active, unencumbered multistate licensure and... Possess experience teaching in the online environment at the college/university level Possess certification (preferred) Experience with Blackboard learning management system (preferred) *If a faculty does not meet the above credentialing requirements, an alternative justification requires approval from the College Dean and Provost. Equipment Required Instructors are required to provide their own equipment. This includes: Computer, camera, telephone, and a printer with a scanner. Microsoft Word, Excel, Outlook, Blackboard, and internal database software Secure and reliable internet access with sufficient speed/bandwidth to perform job responsibilities is required. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Supervisory Responsibilities This job has no supervisory responsibilities.

Teaches undergraduate and/or graduate courses within the qualified discipline, to include the following: Records and posts a welcome video and transcript. Communicates with students to encourage engagement and course completion. Conducts weekly outreach to students struggling in the course. Participates in the classroom a minimum of four separate days during the week. Responds to student email inquiries in a timely manner (48 hours) utilizing the university’s assigned email account. Facilitates discussion boards. Reviews student submissions and provides relevant, substantive, and value-added feedback in a timely manner through the Blackboard Learning Management System. Feedback should explain point deduction/loss per the rubric. Hosts a minimum of two live lectures on camera, each lasting at least one hour, throughout the course. Live lectures must be scheduled within the following times during units II and VI: Monday – Friday: Between 5 pm – 9 pm CST Saturday or Sunday: Between 9 am – 9 pm CST Serves as course content expert to assist with curriculum maintenance and review individual courses for rigor and currency. Resolves academic integrity concerns, grade inflation, and grade challenges in a timely manner. Participates in faculty development opportunities and annual university mandatory trainings. Other responsibilities and projects as assigned by the Academic Program Director and lead faculty. May have the opportunity to serve as a Course Writer for an additional stipend.

Ovation Healthcare

Clinical Informatics - Interoperability Coodinator

Posted on:

September 10, 2025

Job Type:

Full-Time

Role Type:

Informatics

License:

None Required

State License:

Compact / Multi-State

At Ovation Healthcare, we’ve been making local healthcare better for more than 40 years. Our mission is to strengthen independent community healthcare. We provide independent hospitals and health systems with the support, guidance and tech-enabled shared services needed to remain strong and viable. With a strong sense of purpose and commitment to operating excellence, we help rural healthcare providers fulfill their missions. The Ovation Healthcare difference is the extraordinary combination of operations experience and consulting guidance that fulfills our mission of creating a sustainable future for healthcare organizations. Ovation Healthcare's vision is to be a dynamic, integrated professional services company delivering innovative and executable solutions through experience and thought leadership, while valuing trust, respect, and customer focused behavior.

We’re looking for talented, motivated professionals with a desire to help independent hospitals thrive. Working with Ovation Healthcare you will have the opportunity to collaborate with highly skilled subject matter specialists and operations executives, in a collegial atmosphere of professionalism and teamwork. Ovation Healthcare's corporate headquarters is located in Brentwood, TN. For more information, visit https://ovationhc.com.

Education Requirements: Bachelor’s degree in health informatics, Nursing, Healthcare Administration, Public Health, Information Technology or related field. Certification Requirements Preferred certifications may include: Epic Certifications, especially in Care Everywhere or Interconnect (API Integration) Experience Requirements: 2–5 years of experience in health IT, clinical informatics, or regulatory compliance roles, with a focus on interoperability or health information exchange (HIE). Experience working with CMS Promoting Interoperability (formerly Meaningful Use) programs, TEFCA, or other public health data reporting requirements is strongly preferred. Demonstrated experience in project coordination or leadership, cross-functional team collaboration, and regulatory reporting. Familiarity with federal and state health IT regulations, such as CMS MIPS, ONC Cures Act, and HIE frameworks. Strong background in data validation, audit readiness, and compliance documentation. Working Conditions and Physical Requirements: Reliable high-speed internet connection is required for all remote/hybrid positions. Must have access to stable Wi-Fi with sufficient bandwidth to support video conferencing, cloud-based tools, and other online work-related activities. A HIPAA-compliant work environment is required, including a secure workspace free from unauthorized access or interruptions, no use of public Wi-Fi unless connected through a secure company-provided VPN, and compliance with all applicable HIPAA privacy and security regulations. #LI-Remote

The Interoperability Coordinator is responsible for leading system-wide efforts to ensure compliance with federal and state interoperability mandates. This role involves high-level coordination and communication across key departments such as Clinical Informatics, IT, Regulatory, and Operations to support enterprise-wide health information exchange strategies. Key responsibilities include chairing the Promoting Interoperability (PI) Steering Committee, maintaining detailed project implementation plans, and facilitating organizational assessments such as the SAFER Guides. The role collaborates closely with stakeholders to ensure that interoperability initiatives are executed effectively, meet compliance requirements, and align with broader organizational priorities. The Coordinator is also accountable for developing and maintaining performance metrics, validating data for regulatory submissions, and preparing supporting documentation for CMS and state audits. Additional responsibilities include driving process improvement initiatives, monitoring regulatory changes at both the state and federal levels, and participating in external workgroups to remain current with national health IT trends. This position requires strong technical knowledge, keen attention to detail, and the ability to interpret complex regulatory requirements and translate them into actionable, operational strategies. These skills are critical to ensuring the organization remains compliant while advancing its long-term interoperability and health information exchange goals.

Accredo Specialty Pharmacy

RN Telephonic Nurse - Accredo - Work from Home, Anywhere, USA (Compact Nursing License Required)

Posted on:

September 10, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.

Full time work from home – you MUST reside in a compact state. Start Date: Monday, October 20, 2025 Shift for this role: 10:30 am to 7:00 pm CST Monday – Friday Please note, the first 6 weeks of training will be varied and may start between 8am-11:30am EST depending on the week. The primary responsibility of this role is to provide telephonic education to patients and caregivers following Clinical Protocols and working within the nursing scope of practice and guidelines. This opportunity allows you to improve the health and well-being of others, while giving them a sense of security

Minimum Qualifications Registered Nurse (RN) compact license required MUST reside in a compact state 2 years or more of relevant experience with an RN License: Requirements The RN must have an active unencumbered license in the state that they reside and should have completed the NCLEX or a recognized state board exam. The RN will be required to apply for or have a compact license as well as the ability, with no restrictions, to apply for additional single state licenses Maintaining all nursing licenses required for this role is a condition of employment, and the failure or inability to do so will result in termination of employment. Must have taken Microbiology in order to obtain California licensure Knowledge and experience in the areas of Neurology / Multiple sclerosis, Rheumatology, Dermatology, Pulmonology, Gastroenterology, Infectious Disease, Asthma, Oncology, or Pediatrics. Proficient in using microsoft applications Minimum Internet speed: 5MBPS upload/2 MBPS download - Cable broadband or Fiber Optic. Excellent phone etiquette

Take ownership of patient experience via telephone: Provide telephonic education that includes (but not limited to) disease and drug specific education to both patients and caregivers. Follow clinical protocols and work within the nursing scope of practice and guidelines while assessing and documenting clinical data and intervention. Be a coach to empower your patients to be at their best. Focus on the overall well-being of your patients. Work with the patient’s treating physician to inform them of any new symptoms and health-related matters with an entire network of nurses that you can lean on. At Accredo, you are a part of an eco-system that will support you and advocate for you. Grow alongside your peers in a patient-centered environment. Aid our clinical departments with new hire training and mentoring as well as conduct peer-to-peer quality documentation checks to provide feedback to management.

NMDP

Nurse Coordinator, Donor Medical Operations

Posted on:

September 10, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Minnesota

This role is responsible for providing comprehensive medical support to NMDP network and staff for all aspects of donor evaluation and management, donor and recipient adverse events, and investigations of quality incidents involving medical issues. The role serves as a liaison between the network and other NMDP departments to ensure proper quality procedures related to cellular products and to minimize organizational risk associated with quality incidents and adverse events. This position requires work hours between 8 am - 5 pm Central Time, Monday-Friday, with occasional flexibility to work after hours. Please consider this requirement before applying to the opportunity.

Knowledge of: Common medical diseases and disease management. General health assessment. Collection and analysis of pertinent data and/or clinical findings. Health care confidentiality standards. Basic computer applications. Ability To Effectively summarize and communicate complex medical information. Evaluate health issues from various sources. Solve complex problems making timely and sound decisions. Demonstrate critical thinking skills. Exercise independent judgment utilizing appropriate resources. Handle multiple issues with flexibility and appropriate prioritization. Exhibit strong customer service skills. Show proficiency in computer software such as Microsoft Office programs. Education And/or Experience Minimum Education: RN required; BSN preferred. Five years’ experience as a nurse in medicine or a medicine subspecialty area unless BMT-specific, then two years. Two years of experience in a position that involved quality assurance strongly preferred. Clinical knowledge of health conditions and related treatments. Other Requirements: Requires some flexibility in work hours to meet business needs. Occasional travel to Worldwide Headquarters in Minneapolis – 1-2x/year (if remote) PREFERRED QUALIFICATIONS: (Additional qualifications that may make a person even more effective in the role, but are not required for consideration) Foreign language skills desirable. Certification for Hematopoietic Transplant Coordinator (CHTC). Stem cell transplantation and HLA typing. Donor health issues related to stem cell donation. Basic clinical research.

General: Uses medical knowledge to assess complex clinical situations. Determines appropriate actions based on clinical judgment and/or in consultation with NMDP physician or designee. Communicates professionally and succinctly with involved stakeholders in a manner that is understandable at stakeholders’ medical knowledge level. Utilizes GTP and cGMP regulations in daily practice. Maintains confidentiality as outlined in NMDP policy and procedures. Serves as an advocate for volunteer stem cell donors. One or more of the following specialty areas may be assigned: Donor Medical Assessment Serves as primary NMDP resource for addressing suitability and/or eligibility, to include non-medical factors. Performs initial nurse review of medical clearance information. Assists NMDP operated donor center and network staff in medical assessment of donors related to research protocol participation. Performs donor notification of positive IDM test results. Donor And Recipient Adverse Events Monitors an NMDP stem cell donor during and after an adverse event. Investigate and monitor a NMDP recipient qualifying adverse event. Prepares data and presents summaries of donor and recipient adverse events for review to appropriate outside agencies as needed. Quality Assurance Prepares data and presents summaries of donor and recipient adverse events for review to appropriate outside agencies as needed. Performs root cause analysis and investigation of events identified in the Quality Incident system or through FormsNet, as applicable. Collaborates with Case Management staff and Network members regarding incident recognition, protocol deviations, documentation, follow-up, and other quality assurance issues. Acts as liaison with NMDP Quality in identifying and reporting trends related to quality assurance. Risk Management Acts as liaison with NMDP Quality in identifying and reporting trends related to quality assurance. Communicate with key NMDP stakeholders when a serious event is identified as a potential risk management concern. Mitigates risk by active participation in problem solving and appropriate interventions during an event as well as effective communication post-event. Consults with Legal as needed. Donor Advocacy Mitigates risk by active participation in problem solving and appropriate interventions during an event as well as effective communication post-event. Ensures awareness and education regarding maintenance of donor confidentiality. Coordinates medical care of donors with long-term complications. Assists with the procurement of financial assistance for donors who experience financial difficulties due to post-donation complications. Serves as a resource regarding essential information, comprehension, and voluntariness to ensure informed consent. Acts as liaison to donor insurance carrier and Third-Party Administrator (TPA) for disability and medical claims. Other duties as assigned.

Inizio Engage

Remote RN- Medical Information Specialist II

Posted on:

September 10, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Pennsylvania

Inizio Engage is a strategic, commercial, and creative engagement partner that specializes in healthcare. Our passionate, global workforce augments local expertise and diverse mix of skills with data, science, and technology to deliver bespoke engagement solutions that help clients reimagine how they engage with their patients, payers, people and providers to improve treatment outcomes. Our mission is to partner with our clients, improving lives by helping healthcare professionals and patients get the medicines, knowledge and support they need.  We believe in our values: We empower everyone/We rise to the challenge/We work as one/We ask what if/We do the right thing, and we will ask you how your personal values align to them. To learn more about Inizio Engage, visit us at:  https://inizio.health/

Inizio Engage has a long-standing partnership with a leading Biotechnology company across Commercial, Patient Solutions and Medical Affairs businesses. A frontline specialist responsible for delivering virtual or telephonic support to identified clients engaging customers, patients, and/or healthcare professionals, in a robust clinical dialogue. The specialist serves as a primary resource to provide drug/medical device product information. This is your opportunity to join Inizio Engage and represent a top biotechnology company!

Current US healthcare professional license: RN Excellent verbal, written and listening communication skills Competency with a computer keyboard and mouse Ability to join frequent meetings and calls without disruption or disconnecting Competency with Call Center Telephone Technology Pleasant telephone manner Ability to work both independently and within a group setting Results oriented, excellent organizational skills and ability to work cross-functionally At least one year of experience in healthcare or pharmaceuticals is strongly preferred Provides value and demonstrates Leadership (individual program leadership to determine specifics)

Completely and accurately document all Medical Information Requests, Adverse Events and Product Quality Complaints in compliance with Inizio, Client and Federal guidelines and regulations Conduct study compliance calls to volunteers enrolled in clinical/medical research trials Enroll participants in educational seminars Provide patient support to patients enrolled in Patient Support Programs Collect demographic data and disposition for product, sample and literature fulfillment Maintain excellent quality and productivity standards for all client programs; adhere to program scripts and guidelines Accurately collect information required by individual programs and correctly capture in specific program databases Exhibit effective communication and tele-management skills Converse with callers in an empathetic manner and facilitate the callers in their ability to understand medical terminology, as needed Display flexibility within department to maximize utilization, including performing administrative and non-telecommunication duties as needed Adhere to all company policies and Standard Operating Procedures Possess effective organizational skills, including working on multiple projects simultaneously Must safeguard patient privacy and confidentiality by following the guidelines set forth in the Privacy and Security Rules of the Health Insurance Portability and Accountability Act (HIPAA) Update and submit resume upon requests for audits Other duties as assigned

FreedomCare

Home Health Registered Nurse

Posted on:

September 9, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Oregon

FreedomCare is a healthcare company that has been dedicated to revolutionizing the home care industry since 2016. We support our patients by ensuring they have the power to choose a caregiver who will care for them in the comfort of their own homes. Our mission spans coast to coast, supporting patients across the U.S. We pride ourselves on our values which drive the level of care that we deliver to our patients: Here For You (An attitude of service, empathy, and availability) Own It (Drive and ownership) Do the Right Thing (High integrity) Be Positive (Great attitude and a can-do positive approach to challenges)

This is a remote role with required fieldwork and the possibility of an occasional commute to our Portland, OR office. CANDIDATES MUST RESIDE IN OREGON. Department & Position Overview: Personal Care Services is a caregiving arrangement in which a patient has a principal caregiver who provides daily support based on the patient's daily care needs. The goal of this service is to provide necessary care while fostering and emphasizing the patient’s independence in the patient’s home that will provide them with a range of care options as their needs evolve. The service is designed to provide options for alternative long-term care to people who meet nursing facility-level care needs while preserving the dignity, self-respect, and privacy of the patient.    Structured Family Caregiving is a caregiving arrangement in which a patient lives with a principal caregiver who provides daily support based on the patient's daily care needs. The goal of this service is to provide necessary care while fostering and emphasizing the patient’s independence in a home environment that will provide them with a range of care options as their needs evolve. The service is designed to provide options for alternative long-term care to persons who meet nursing facility-level care needs while preserving the dignity, self-respect, and privacy of the patient.  The Registered Nurse will be a vital part of administrating and ensuring the efficient delivery of services, oversight of the Personal Care Attendants (PCA) and compliance with regulatory requirements.  We are seeking an individual with a nursing background with elders or adults with disabilities, as well as experience managing PCAs.

Education and Experience: Valid and active RN License from the Oregon Board of Nursing 2 years of recent work experience in direct care of elders or adults with disabilities Previous experience in a management role Qualifications: Strong communication and interpersonal skills  Problem-solving and decision-making abilities  Organizational and multitasking skills  Comfortable wearing multiple hats; helping where needed  Excellent communication, critical thinking, and organizational skills  Self-motivated  Able to thrive in a fast-paced start-up environment 

Ensure compliance with all contractual guidelines and federal and state regulations governing Medicaid and the Personal Care Services program Ensure efficient day-to-day PCA operations by analyzing, monitoring, and optimizing workflows, processes, and procedures. Identify areas for improvement and implement solutions to enhance productivity  Providing oversight to PCS/SFC caregivers in conjunction with the Care Manager Conducting initial home visits to define the PCA’s tasks and develop activity plans Performing regular evaluations every 60 days to monitor the PCA’s performance, consumer satisfaction, and adherence to the activity plan​ Respects client and employee rights and privacy, ensures the security of protected information, practices in an ethical manner and is compliant to the agency’s compliance program and privacy policy Build a positive work environment and culture consistent with FreedomCare core values: Here for You, Be Positive, Own It, Do the Right Thing 

Bluestone Physician Services

Dementia Care Navigator, RN

Posted on:

September 9, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Minnesota

Bluestone Physician Services delivers great outcomes by bringing exceptional care to patients living with complex, chronic conditions and disabilities. Our unique, robust model of care goes beyond primary care services — our multidisciplinary care teams collaborate with patients, their families and other healthcare providers to deliver care that is preventative, proactive and tailored to their unique needs. Using an evidence-based approach focused on quality care management and data-driven medical decisions, Bluestone care teams collaborate to manage patients’ chronic conditions, address social determinants of health, manage transitions to and from inpatient settings, provide behavioral health support and more. Under our model of care, Bluestone patients experienced 21% fewer ER visits, 36% fewer hospitalizations and 41% fewer hospital readmissions compared to patients with similar conditions and complexities over the same time period. Our care teams travel directly to patients who reside in Assisted Living, Memory Care and Group Home communities throughout Minnesota, Wisconsin and Florida and are supported by clinical operations and administrative colleagues who work remotely or at our corporate offices in Stillwater, Minnesota, and Tampa, Florida. Our success is only possible through the hard work of our employees who bring our core values of Dedication, Excellence, Collaboration and Caring to life every day. Bluestone has been named to the Star Tribune's Top Workplace list for the 13th year in a row! Bluestone also achieved Top Workplace USA 2021-2025! In 2022, Bluestone Accountable Care Organization (ACO) was the best performing ACO in the country as measured by the overall savings per Medicare beneficiary.

As a GUIDE Model Dementia Care Navigator, you will assist in delivering the 9 core elements outlined in the CMMI GUIDE Model of care delivery. You will build strong, collaborative relationships with internal teams as well as external partners to ensure patients and caregivers receive appropriate and high quality care. Assessment, care planning, coordination of care and resources, and transitional care management are foundational to the position. The Care Navigator position allows for great work-life balance, with approximately 20% remote and 80% of the time allowing you to directly impact patients, team members and community partners. Schedule: Full time position, day shift hours, no evenings, weekends or holidays. Hours are 8am to 5pm Monday thru Thursday & 8am to 3pm on Fridays. Location: This position entails a mix of remote work, as well as about 80% direct patient care mainly throughout Plymouth, Maple Grove, Blaine areas Salary Range: $65,000 - $80,000, Position is eligible for a $1,000 Sign-on Bonus, Salary will be commensurate with experience

Education/Certification/Experience: Registered Nurse or Licensed Social Worker 3-5 years of experience in case/care management or care coordination Experience working directly with the Dementia population required Formal training in Dementia from a credible organization (i.e. Certification as a Dementia Practitioner) is highly sought Valid driver’s license required Knowledge/Skills/Abilities: Ability to work independently Strong customer service, relationship building, and communication skills Strong technical skills and experience with EHRs preferred Demonstrated compatibility with Bluestone’s purpose, focus and values Ability to travel throughout the market area as needed Demonstrated ability to read, write, speak, and understand the English language

Conducting comprehensive assessments that include clinical, behavioral, psychosocial, and advance care planning domains Reviewing current health needs, identifying goals, and developing individualized care plans Helping connect members with resources and services Completing required documentation Collaborating with primary care teams to ensure high quality team-based care Use utilization management tools to facilitate appropriate transitional care management Collaborate with hospitals, rehabs, and SNFs to manage patient’s inpatient stay and desired discharge plan Communicate effectively with internal and external stakeholders in order to promote Bluestone’s core values Help reduce unnecessary visits to the emergency departments as to acute settings with the goal of reducing utilization and unnecessary costs Work to increase coordination of care for a vastly complex geriatric population Be proficient in community resources Proactively engage with providers to identify high risk patients

Vitability Health

Remote Chronic Care Manager (RN) Vitability Health

Posted on:

September 9, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

Vitability Health of New Jersey is dedicated to providing high-quality, patient-centered care to individuals with chronic health conditions. Our mission is to enhance the well-being of our patients through comprehensive, personalized care management.

We are seeking a highly skilled and compassionate Chronic Care Manager (RN) to join our team. The ideal candidate will have a strong background in chronic care management and patient monitoring. This role requires excellent communication and organizational skills, as well as the ability to delegate tasks effectively to care coordinators. This position offers the flexibility to work remotely.

Registered Nurse (RN) license in the state of New Jersey or a Compact RN License. Experience in chronic care management is required. Acute care experience is required. Strong leadership and delegation skills. Excellent communication and interpersonal skills. Proficiency in using electronic health records (EHR) and telehealth platforms. Ability to work independently and as part of a multidisciplinary team. Compassionate and patient-centered approach to care.

Provide chronic care management services to patients with chronic conditions. Develop and implement individualized care plans in collaboration with patients, their families, and healthcare providers. Monitor patient progress, assess their needs, and make necessary adjustments to care plans. Educate patients and their families on disease management, medication adherence, and lifestyle modifications. Utilize telehealth technology to conduct regular follow-ups and remote monitoring. Delegate tasks to care coordinators and oversee their performance to ensure the highest quality of care. Maintain accurate and up-to-date patient records in accordance with HIPAA regulations. Collaborate with interdisciplinary teams to coordinate care and ensure continuity. Perform comprehensive health assessments to identify patient needs and establish care goals. Facilitate medication reconciliation and ensure patients understand their medication regimens. Coordinate and schedule appointments, tests, and procedures to ensure timely and efficient care. Assist patients with accessing community resources and support services. Develop and implement strategies to reduce hospital readmissions and emergency room visits. Provide support and counseling to patients and their families regarding disease processes and care plans. Track and report on quality metrics and patient outcomes to ensure program effectiveness. Stay current with best practices and advancements in care management.

Blue Cross and Blue Shield of North Carolina

Episodic Care Manager

Posted on:

September 9, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

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

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

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

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

Ethire LLC

Nurse Case Manager ($35/Hr) (Remote)

Posted on:

September 9, 2025

Job Type:

Contract

Role Type:

Case Management

License:

RN

State License:

Ohio

Our Care Managers are frontline advocates for members who cannot advocate for themselves. They are responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.

Minimum 3-5 years clinical practical experience Minimum 2-3 years CM, discharge planning and/or home health care coordination experience Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually Bilingual desired Excellent analytical and problem-solving skills Effective communications, organizational, and interpersonal skills. Ability to work independently Effective computer skills including navigating multiple systems and keyboarding Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications

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

Thyme Care

Nurse Practitioner, Comprehensive Health Assessment

Posted on:

September 9, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Compact / Multi-State

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

As the Comprehensive Health Assessment Nurse Practitioner, you will be a critical clinical team member caring for our members. You will conduct the first clinical interaction with our members in this role. Using a telemedicine platform, this interaction will be a thorough, whole-person, comprehensive history and exam. You will evaluate risk scores and assess gaps in care. You will develop comprehensive care plans to address clinical and non-clinical needs and barriers. You will prioritize our members’ goals and create concrete plans for our Oncology Nurse Navigators and Community Health Workers to reach these goals. To achieve this, you will review available medical records, collaborate with external providers, provide clinical insights to our care team, and adhere to best documentation practices to deliver high-quality care for our members. In addition to your primary responsibilities, you may be asked to participate in some holiday, night, and weekend emergency coverage as needed. This role reports to our Nurse Practitioner Team Lead and can be remote or hybrid-based in our Nashville or New York City offices. All patient interactions will be virtual via telephone, video, text, or our proprietary virtual care platform.

People-first. Thyme Care’s mission and members matter to you deeply. Experience. You have at least 3 years of NP experience, including 2 years in adult oncology and at least 1 year of experience in telehealth. Experience completing health risk assessments is a plus! ​It would be exceptional if you have worked at a startup or tech-forward company. Licensure. You hold a compact RN license, an unrestricted Advanced Practice license, and are willing to obtain additional state licenses. Organized. You’re skilled in juggling multiple tasks and working under pressure without sacrificing organization in your communications and documentation. Effective listener and communicator. You are winsome and articulate, but you always start by listening and hearing what may not be voiced because you listen intently to others. You build rapport and excellent working relationships with members and colleagues. Comfort with ambiguity. Start-ups are fast-paced environments, and you understand that rapid changes to the business, strategy, organization, and priorities are par for the course… and part of the adventure. A desire to learn how to use new technologies. We are a technology company focused on interacting with folks during the season when they need it most. Experience with video chatting, Google Suite, Slack, electronic health records, or comfort in using and learning new technology is vital. Identify priorities and take action. You know how to identify and prioritize a member's needs, and take the necessary steps to address urgent needs immediately.

Complete training and be up to speed on Thyme Care’s systems, tools, technology, partners, and clinical expectations. Be adept at developing evidence-based, member-centered care plans that will guide our Community Health Workers and Oncology Nurse Navigators in effectively prioritizing our members' needs and goals. Complete whole-person history and physical assessments for our members with the highest clinical rigor. You’re working fluidly with our in-house care team and providers to ensure any identified needs are met in follow-up to patient visits. Become the go-to person for our Oncology Nurse Navigators and Community Health workers when working with members who have complex and intersecting needs. Be comfortable following policies, procedures, escalation pathways, communications best practices, and documentation standards.

INTERLINK COE Networks & Programs

Nationwide Work from Home Oncology Nurse Expert

Posted on:

September 9, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Compact / Multi-State

INTERLINK Health Services was founded in 1995 and is headquartered in Hillsboro, Oregon. INTERLINK is well known as the leader in outcome-based managed care, providing access to the nation’s finest centers for cancer, bone marrow, and solid organ transplant services. INTERLINK is a stable and growing company, focused on the delivery and continued development of outcome-based cost containment products to meet the expanding healthcare market. The CancerCARE Program is INTERLINK’s most desired program and is projected to grow rapidly over the next 2-3 years. Additionally, new program launches are occurring that will be market leading in nature.

CancerCARE is searching for an Oncology RN with managed care, insurance based case management experience. We are seeking a full-time Oncology Nurse Expert whose oncology expertise and training can help guide patients to make informed decisions and provide supportive care throughout the cancer continuum. Applicants will be working with a multidisciplinary team including Chief Medical Officer, VP of CancerCARE Quality Programs, and Oncology Nurse Experts. The Oncology Nurse Expert will serve as an advocate for high-risk cancer patients and review to ensure treatment is evidence-based. reach out to them on a regular basis, educating them and receiving updates on their current phase in their treatment plan. He/She will review NCCN guidelines and work collaboratively with both the Member and his/her providers to ensure evidence-based care is being provided. If a case warrants it, you will coordinate either onsite or remote access to a Center of Excellence (COE) facility. You will transition Members to a lower level of care once stable on maintenence therapy or treatment is complete. The CancerCARE program is considered the next-generation style of cancer management which involves specially drafted benefit language, extensive use of NCCN Guidelines® and custom-built Center of Excellence (COE) networks. You will have extensive support provided by both Medical Directors and other nurses. This position comes with an opportunity for professional growth.

RN with active license (Compact state license preferred) Effective verbal and written communication required Excellent organizational and time management skills required Minimum of 3-5 years of case management experience within a Managed Care Setting (HHC, Hospice and Inpatient Case Management not counted) Case Management Certification required (must be willing to sit for exam as soon as eligible) Extensive Oncology Experience desired Oncology Certification (OCN) preferred, but required to sit for exam as soon as eligible Compassionate teamwork, experience in multi-tasking and working in groups Experience in working with managed care, TPA, or medical stop-loss and reinsurance industry is ideal

Provide exceptional care and coordination for patients with cancer Perform and ensure comprehensive assessments of the Member’s health and psychological needs to develop a collaborative care plan with the Member and his/her medical team Individualize Members’ care using a Member-centric, collaborative, comprehensive, and holistic approach to facilitate Member engagement and provide education and empower them to be an active participant in their treatment decisions Promote the use of evidence-based care through extensive use of NCCN Guidelines®, Clinical Trials.gov, McKesson Clear Value Plus, and the use of our COE networks Discuss COE access options with the Member as appropriate Advocate for Members dependent on their needs Documents all activities in electronic medical record (EMR) Perform all duties efficiently while keeping cost containment and Member-centric quality care a priority Prepares reports in a timely manner, per policy by collecting, analyzing, and summarizing activities and interventions along with treatments based on NCCN, CVP, and our COE networks.

myLaurel

Care Manager, RN (Emergency Department Exp Required)

Posted on:

September 9, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

We are dedicated to creating care models that meet the needs of providers and payers already supporting high-risk populations. We deliver services that have an outsized impact in eliminating preventable acute care utilization, radically improving patient & caregiver experiences, and decreasing medical costs.

We’re Hiring: Remote RN Care Managers (Anywhere in the U.S.) myLaurel is reimagining acute care — bringing hospital-level treatment home. 🏥➡️🏡 We’re looking for Registered Nurse Care Managers to join our virtual care team. This is a fully remote role with flexible scheduling (full or part time).

Active RN license in NY or LA (multistate encouraged) 3+ years hospital experience – Emergency Department Exp REQUIRED BSN required Tech-savvy, compassionate, and patient-first

Block Institute

Residential Registered Nurse

Posted on:

September 8, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

New York

Established in 1962, Block Institute is a Brooklyn-based non-profit organization dedicated to supporting children and adults with Intellectual and Developmental Disabilities. Committed to our mission-driven approach, we believe in building meaningful relationships, embracing challenges as opportunities, and inspiring and being inspired every day. If you are passionate about supporting individuals with disabilities and possess the qualifications and dedication for this role, we encourage you to apply.

Summary: The ARS Registered Nurse must provide comprehensive nursing evaluations for all individuals, determining the most beneficial interventions with expected outcomes. These outcomes will directly affect each individual's unique capacity and ability to participate as actively as possible in daily life, and to equally enjoy an enhanced quality of life. Essential Employees: All Block Institute Employees have been deemed Essential Employees by New York State. As such, that means that if there are requirements for Essential Employees to show up to work during announced emergencies or times of crisis, all Block employees are among those mandated to do so. (Subject to any other Executive Order to the contrary.) The scope of an Essential Employees’ tasks during an emergency situation will vary from situation to situation, may include, but not be limited to: physically showing up to a designated work site as instructed, even if other businesses are closed; completion of all work where possible online, including documentation of services, evaluations, billing, etc.; attendance at Microsoft Team Meetings (or other online communication platforms) as invited; and completion of any assignments or training modules as instructed, and working remotely where possible. Description: The ARS Registered Nurse must provide comprehensive nursing evaluations for all individuals, determining the most beneficial interventions with expected outcomes. These outcomes will directly affect each individual's unique capacity and ability to participate as actively as possible in daily life, and to equally enjoy an enhanced quality of life.

Current Registered Nurse Licensure in NYS Bachelor's Degree One (1) year of clinical experience in a hospital or adult care medical facility Experience with developmentally disabled / mentally challenged adults

Use discretion and independent judgment involving the comparison and evaluation of possible courses of conduct. These judgments may affect business operations or have a significant financial impact. Assess, identify and evaluate all of the health care needs for the individuals living in this setting. Follow or establish consistent tracking systems to ensure observation, monitoring, reporting and evaluation of all individuals' medical concerns. Ensure necessary appointments are properly scheduled and completed and follow-up information is obtained. Act as a liaison between the residence and medical facilities when problems or questions arise. Provide on-site medical service and direction to staff and individuals within the residence. Supervise the AMAP staff regarding the proper completion of medical duties. Prepare individuals for specialized treatments, tests or procedures in accordance with the agency's policies and informed consent. Ensure all medical books are kept in proper condition at all times.

Monogram Health Inc

Monogram Health First Remote RN - Bilingual

Posted on:

September 8, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

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

This is a pipeline position for future hiring needs. While we are not actively hiring for this role at the moment, we anticipate opportunities in the near future and encourage interested candidates to apply. By submitting your application, you’ll be considered for upcoming openings. The MH FIRST RN is pivotal in providing critical support to field teams facing urgent and complex patient concerns. The Registered Nurse has expertise that will ensure patients receive the care, resources, and support they need, especially during high-stress situations and environmental crises.

Maintain a current and valid compact RN license, allowing you to practice across state lines. Minimum of 3 years of clinical nursing experience, with a preference for emergency care, critical care, or triage backgrounds. Bilingual (Spanish/English) preferred Availability to adjust shift flexibly in response to peak coverage or staffing needs. Demonstrate the ability to communicate calmly and confidently during high-stress situations. Build strong relationships with team members and patients through effective rapport-building. Exhibit meticulous attention to detail and outstanding organizational skills. Show unwavering dedication to patient safety and delivering high-quality care. ER/ED/ICU/Floor Experience preferred.

Utilize licensing and crisis management skills to assess and address urgent needs. Utilize proficiency in documentation and technology to streamline member care. Offer valuable support and guidance to patients and their families in critical situations. Primary point of contact for patients, Monogram field staff, and care center personnel needing immediate support. Provide seamless transitions by providing comprehensive handoffs to incoming staff. Conduct chart auditing during non-peak call volumes. Emergency/disaster outreach as events occur. Availability to adjust shift flexibly in response to peak coverage or staffing needs.

Blue Cross Blue Shield of Michigan

Care Manager RN - Compact License

Posted on:

September 7, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

Make your career making a difference. We’re united in our social mission as a non-profit mutual to make a meaningful and lasting impact to Michigan citizens and communities. Our employees have a uniquely personal connection to our mission. Our members are our neighbors, friends and family. We come to work each day knowing that those we work with share our commitment to serve our communities. Our commitment to members wouldn’t be possible without the hard work, management style, and teamwork of our employees. When you join Blue Cross you are joining one of the best, brightest and most diverse companies to work for in Michigan. Join us and transform the future of health care in Michigan.

This opportunity is available for individuals that reside in the following areas with a compact license: Colorado, Georgia, Indiana, Kentucky, Massachusetts, Minnesota, Mississippi, Ohio, Pennsylvania, Virginia, Washington, Louisiana, and Iowa. The Care Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person centric care management program to a diverse health plan population with a variety of health and social needs. They serve as the single point of contact for members, caregivers, and providers using a variety of communication channels including phone calls, emails, text messages and the BCBSM online messaging platform. The Care Manager RN uses the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the member’s health across the care continuum. They work in partnership with the member, providers of care and community resources to develop and implement the plan of care and achieve stated goals. Fully remote telephonic position. This position requires outbound calls to members to engage them into the program with continuous telephonic outbound calls for ongoing care plan goals. Members may also request to interact via our digital app, instead of telephonically. As a care manager you will need to use motivational interviewing skills to engage members into the free program. Currently Care Managers are calling members that do not know they have been identified for the program and we are looking at opportunities for other team members to make these outreaches in the future. Note: All specialties are needed including Pediatrics, also working hours up to 8pm EST may be expected. This position is fully remote. To work remote your internet speed must be 25mbps or higher, please check with your Internet provider to confirm that you have enough speed.

Licenses and Certifications • RN - Registered Nurse - Multi-State-Licensure, RN - M ust reside and be licensed in the same state that is part of the Nurse Compact Department Preference Must have exemplary computer skills and be able to utilize multiple systems when interacting with members/providers – Strongly Preferred QUALIFICATIONS: Nursing Diploma or associate degree in nursing required. Bachelor’s degree in nursing strongly preferred. 3 years of clinical nursing experience in a clinical, acute/post-acute care, and community setting required. 1 year of case management experience in a managed care setting strongly preferred. Experience managing patients telephonically and via digital channels (mobile applications and messaging) preferred. Certification in Case Management (CCM) required or to be obtained within 18 months of hire Certification in Chronic Care Professional (CCP) preferred Ability to think critically, be decisive, and problem solve a variety of topics that can impact a member’s outcomes. Must have intermediate computer knowledge, typing capability and proficiency in Microsoft programs (Excel, OneNote, Outlook, Teams, Word, etc.).

Lead the coordination of a regionally aligned, multidisciplinary team to provide holistic care to meet member needs telephonic and/or digitally. The multidisciplinary team is inclusive of Medical and Behavioral Health Social Workers, Registered Dietitians, Pharmacists, Clinical Support Staff and Medical Directors. Monitor and evaluate effectiveness of the care management plan, assess adherence to care plan to ensure progress to goals and adjust and reevaluate as necessary. Accurately document interactions that support management of the member. Prepare the member and/or caregiver for discharge from a facility to home or for transfer to another healthcare facility to support continuity of care. Educate the member and/or caregiver about post-transition care and needed follow-up, summarizing what happened during an episode of care. Secure durable medical equipment and transportation services and communicate this to the member and/or caregiver and to key individuals at the receiving facility or home care agency. Adhere to professional standards as outlined by protocols, rules and guidelines meeting quality and production goals Continue professional development by completing relevant continuing education and maintaining Certified Case Manager (CCM).

Valenz

Utilization Management Nurse

Posted on:

September 7, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Arizona

Vālenz® Health is the platform to simplify healthcare – the destination for employers, payers, providers and members to reduce costs, improve quality, and elevate the healthcare experience. The Valenz mindset and culture of innovation combine to create a distinctly different approach to an inefficient, uninspired health system. With fully integrated solutions, Valenz engages early and often to execute across the entire patient journey – from care navigation and management to payment integrity, plan performance and provider verification. With a 99% client retention rate, we elevate expectations to a new level of efficiency, effectiveness and transparency where smarter, better, faster healthcare is possible.

As a Utilization Management Nurse, you will play a vital role in delivering comprehensive, patient-centered care by assessing individual needs, developing personalized care plans, and fostering collaboration among healthcare providers. Using your clinical knowledge, you will guide patients through the healthcare system, support adherence to treatment plans, and advocate for high-quality outcomes through education, emotional support, and clear communication. You will also contribute to wellness promotion, effective use of resources, and compliance with both regulatory and organizational standards. Where You’ll Work: This is a fully remote position, and we’ll provide all the necessary equipment! Work Environment: You’ll need a quiet workspace that is free from distractions. Technology: Reliable internet connection—if you can use streaming services, you’re good to go! Security: Adherence to company security protocols, including the use of VPNs, secure passwords, and company-approved devices/software. Location: You must be US based, in a location where you can work effectively and comply with company policies such as HIPAA.

What You’ll Bring to the Team: Three (3) or more years of clinical nursing experience. One (1) or more years of UM experience. Active, Unrestricted RN License in your state of residence. Ability to work in a fast-paced, detailed, deadline-driven environment. Ability to maintain strict confidentiality and handle sensitive information with discretion. Experience working independently with strong problem solving and organization skills. Strong aptitude for relationship building with a highly effective communication style. A plus if you have: Utilization Management or Case Management Certification.

Conduct timely reviews of UM activities, including prospective, concurrent, and retrospective reviews and apply to summary plan documents or other resources related to the request. Collaborate with appropriate parties to apply the correct UM criteria within the appropriate timelines. Promote quality care and cost-effective outcomes that enhance the physical, psychosocial, and vacation health of plan participants. Ensure compliance with regulatory standards and guidelines related to UM activities, such as those set forth by CMS, URAC, and other regulatory agencies. Identify and report cases of potential overutilization, underutilization, or improper utilization of healthcare services. Identify potential catastrophic, high-risk, and disease management cases and refer cases to the appropriate team. Communicate UM decisions and recommendations to healthcare providers and plan participants. Maintain accurate and complete records of UM activities and ensure confidentiality of sensitive information. Participate in ongoing UM education and training to stay up-to-date with industry developments. Maintain a high level of confidentiality in accordance with HIPAA. Maintain an active role in assuring continuity of care for all inpatients through early discharge planning. Identify and communicate to the Quality Improvement Coordinator potential quality of care and patient safety issues. Perform other duties as assigned.

Legacy Health LLC

Clinical Appeals Registered Nurse - Fully Remote

Posted on:

September 7, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Texas

A Clinical Appeals Registered Nurse (RN) is responsible for reviewing and analyzing clinical cases to determine the appropriateness of healthcare services provided to patients. They work with insurance companies, healthcare providers, and patients to resolve denied or disputed claims by evaluating clinical documentation and making evidence-based

Registered Nurse (RN) licensure with clinical experience in a healthcare setting. Strong understanding of medical terminology, clinical documentation, and healthcare insurance processes. Experience with case management, utilization review, or medical auditing is preferred. Excellent communication, critical thinking, and problem-solving skills. Ability to interpret medical records, clinical guidelines, and insurance policies effectively. This role requires attention to detail, strong organizational skills, and a commitment to advocating for appropriate patient care while ensuring compliance with health insurance regulations.

Review denied insurance claims and clinical documentation to assess the validity of the denial. Work closely with healthcare providers and insurance companies to gather additional information or documentation needed for appeal. Ensure compliance with clinical guidelines, regulatory standards, and payer policies. Communicate effectively with patients, healthcare providers, and insurance representatives regarding the appeal process. Prepare and submit formal written appeals, including necessary clinical evidence to support the appeal. Analyze trends in claim denials and provide feedback to the healthcare provider or organization to improve future outcomes. Stay updated on industry regulations, payer policies, and clinical best practices to ensure accuracy in appeal submissions.

Hicuity Health

Advanced Care at Home RN- DAY Full Time- OR license required

Posted on:

September 7, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

Hicuity Health is the leader in delivering expert telemedicine care in support of patients and bedside care teams in acute and critical care environments. Since our founding in 2006, Hicuity Health has pioneered provider-to-provider telemedicine, fueling success with clinical and technical innovation.

Join our team as a Work from Home – Remote – Hospital Care at Home (Advanced Care at Home) RN. As the leading high acuity telemedicine provider in the United States, we are seeking a highly motivated and talented individual to join our team of high performing Clinical Support professionals as a Hospital Care at Home (ACAH) RN.

Must have an active, unencumbered Oregon state license. RN Compact (multi-state) license in addition to an Oregon preferred. Three (3) years RN experience. Med/Surg or Nursing experience in the inpatient hospitalized setting required. Clinical knowledge. Able to promote patient safety and a positive patient experience. Flexible and comfortable with a changing and dynamic work environment and schedule across all shifts and days. Team player who also works well independently. Participates in ongoing learning and continuing education to care for a variety of patient populations. Collaborate, advocate and mentor others with a professional, non-condescending manner. Model collaborative, respectful team relationships with colleagues and customers; lead by example. This job may be performed remotely from anywhere in the United States, except that this job may not be filled or performed in Washington, California, New York, Illinois, or Colorado.

In this role, you will be responsible for providing high-quality patient care to various patient populations within the framework of the Advanced Care at Home program and includes the following key elements: You Will: Utilize monitoring, assessment, planning, intervention and critical thinking skills to care for acute care patient populations in the home Navigate patients and families across the continuum of the program’s phases of care Monitor and responding to biometric data per program protocols Conduct home and audio/visual patient care visits as directed by the care team and/or protocol Ensure all interventions in the patient’s care plan are implemented efficiently with a patient centered approach Leverage the resources and expertise of the team and our supplier partners to implement collaborative workflows, standards, policies, protocols, guidelines and documentation systems to support safe, reliable, high-quality, evidence-based care with clinical protocols as the foundation Adhere to the clinical protocols and be willing to obtain the necessary training to provide care within the context of the providing evidence-based care Promote professional practice and a culture of safety; willingness to engage in process improvement efforts Obtain certifications as required by Hicuity Health

Arizona College of Nursing

Remote Asynchronous Didactic Nursing Adjunct Faculty

Posted on:

September 7, 2025

Job Type:

Part-Time

Role Type:

Coaching

License:

None Required

State License:

Virginia

Arizona College of Nursing is a rapidly growing, nursing school that transforms people’s lives by preparing them for careers in nursing and improving communities through the care its graduates provide. As a leading nurse educator, Arizona College of Nursing offers students the opportunity to earn a bachelor’s in nursing in 3 years or less with qualified transfer credits. Our quality nursing curriculum prepares students for an in-demand career to help communities overcome the chronic, well-known, and increasing nursing shortage. Through the execution of a targeted growth strategy, the college plans to meet the growing demand for nurses by launching campuses in markets where bachelor’s prepared nurses are needed. Putting students first, we are dedicated to providing students with an exceptional education in growing healthcare fields; teaching them relevant, required skills for today and the future. Our culture is positive, supportive, and collaborative. As a team, we continually embrace our core values: Passion: We love helping others succeed. Excellence: We strive to be the best. Adaptability: We learn, in part by trying new ideas. Accountability: We own our results. Integrity: We do the right thing.

We are seeking remote, asynchronous didactic adjunct faculty to teach a variety of courses for our Chesapeake, VA BSN campus, including: Ethics Leadership Evidence-Based Practice Doctorate degree strongly preferred. Experience teaching online, along with proficiency in Canvas, required. A valid VA RN license and/or a compact RN license is required.

Faculty shall provide evidence of education and experience necessary to indicate that they are competent to teach a given course and develop and evaluate student admission, progression, retention, and graduation policies within the framework of the controlling institution. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements below are representative of the knowledge, skill, and/or ability required. Graduate degree in Nursing required; if the graduate degree is not in nursing must have a Bachelor’s degree in nursing and a graduate degree in a related nursing discipline from an accredited program recognized by the U.S. Secretary of Education or the Council for Higher Education Accreditation (CHEA)*. Doctorate degree preferred. A minimum of three (3) years’ work experience as a professional registered nurse providing direct patient care. Previous experience teaching in a registered nursing program at a college or university is preferred. Holds a current unencumbered state professional registered nurse license or enhance compact nurse licensure relevant to the state of teaching location. Experience teaching online, along with proficiency in Canvas, required. Certified Nurse Educator certification and national certification in area of nursing specialty is preferred. Maintains professional competence/expertise in teaching through activities such as nursing practice, continuing education programs, conferences, workshops, seminars, academic courses, research projects and professional writing. * Subject to state BON/BRN/HEB regulation(s) where the campus/student is located.

What You'll Do: Nursing Adjunct Faculty provide instruction that facilitates students’ achievement of course objectives while demonstrating Arizona College of Nursing’s values of Passion, Adaptability, Accountability, Integrity, and Excellence. Core Nursing: Develops, implements, teaches, and evaluates the philosophy and objectives of the nursing education program. Designs, implements, teaches, evaluates, and revises the curriculum. Documents actions taken in faculty and committee meetings using a systematic plan of evaluation for total program review Leads simulation learning experiences in the Nursing Lab. Didactic: Responsible for teaching and evaluating students in the classroom. Designs an effective learner environment that facilitates student learning to address contemporary issues in nursing. Supports students’ progression in academics and socialization into the role of nursing. Utilizes an array of assessment tools to evaluate student learning. Actively participates in systematic plan for curriculum design, program evaluation and program revision. Works with Course Lead Faculty to develop student success plans and remediate “at risk” students. Performs other related duties as requested by the dean. Clinical: Facilitates the nursing students’ application of theory to clinical practice. Attends healthcare facility/agency-based orientation. Demonstrates and maintains knowledge of overall program, program outcomes and assigned course objectives. Communicates effectively utilizing professional techniques with clinical agency representatives, staff, faculty, and students. Identifies and immediately communicates problem areas/clinical areas of concern to Course Lead Faculty and recommends changes and solutions as appropriate. Provides daily and as needed communication with Course Lead Faculty concerning student progress including successes and identified needs, clinical issues, suggestions, and/or professional learning needs. Grades associated clinical papers and provides students with timely and clear feedback. Maintains all records on student performance, i.e., Student Success Plan, Progressive Disciplinary Plan, and Mid-term and final clinical evaluations. Completes clinical site evaluations. Adheres to/enforces the policies and procedures of Arizona College of Nursing and the assigned clinical facility Attends course faculty meetings during planning week to assure all clinical rotations are in alignment with the didactic course. In addition to responsibilities for teaching didactic and or clinical classes: Plans, teaches, and evaluates classroom, clinical, skills labs and other learning experiences in conjunction with other team members. Connects students to College resources for their success. Participates in the academic advisement and counseling of students as necessary. Consistently demonstrates and coaches students on soft skills: Leadership and ethics Communication and critical thinking Teamwork and collaboration Responsibility and dependability Attends campus-based orientation and faculty meetings when applicable. Provides input to developing, evaluating, and revising program policies as applicable. Protects student privacy through completing required FERPA training and upholding FERPA guidelines. Other Duties as Assigned

Enlyte

Utilization Reviewer 2

Posted on:

September 7, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Pennsylvania

At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth.

This is a full-time remote position that can be located anywhere in the U.S. PA RN license is required We are seeking a qualified Utilization Reviewer who can work remotely from home. The ideal candidate performs utilization review on workers’ compensation related prospective, concurrent, and retrospective treatment referrals. The ideal candidate will play a crucial role in assessing and ensuring the appropriateness of medical treatment plans, contributing to effective claims management and optimal patient outcomes.

Minimum Education: Bachelor's degree. Required Skills and Experience: Registered Nurse (RN) with a valid license in the state of Pennsylvania is required. Minimum of 2 years of clinical experience; or an advanced degree without experience. Knowledge of medical terminology, treatment modalities, and healthcare guidelines. Analytical and critical thinking skills for effective decision-making. Strong communication and interpersonal skills to liaise with diverse stakeholders. Ability to work independently and collaboratively within a team environment. Detail-oriented with strong organizational skills to manage multiple cases efficiently. Familiarity with relevant software and tools used in healthcare. Desired Skills and Experience: Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity. Prior experience in the workers' compensations field.

Uses solid clinical judgment to ensure treatment approved is medically necessary. Forwards treatment requests for physician reviewer that cannot be approved as medically necessary based on application of solid clinical judgment. Collaborates with healthcare providers, claims adjusters, and other stakeholders to gather relevant information for comprehensive assessments. Evaluates medical documentation to ensure compliance with industry standards and regulatory requirements. Communicates findings clearly and concisely through written reports and verbal discussions. Stays up-to-date on industry regulations, medical advancements, and best practices to enhance the quality of reviews. Participates in team meetings and contributes to the continuous improvement of utilization review processes.

Vinfen

Clinical Care Manager RN

Posted on:

September 7, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Massachusetts

Established in 1977, Vinfen is a nonprofit, health and human services organization and a leading provider of community-based services to individuals with mental health conditions, intellectual and developmental disabilities, brain injuries, and behavioral health challenges. Our services and advocacy promote the recovery, resiliency, habilitation, and self-determination of the people we serve. Vinfen's 3,500 dedicated employees are experienced, highly-trained professionals who provide a full range of supportive living, health, educational, and clinical services in over 550 sites throughout Massachusetts and Connecticut. For more information about Vinfen, please visit www.vinfen.org/careers.

This position is remote. Candidates must live within 100 miles of Boston, MA to attend necessary trainings/meetings. The Clinical Care Manager (CCM) RN provides intensive care coordination and clinical care management for MassHealth Members with complex medical and behavioral health needs who are enrolled in an Accountable Care Organization (ACO) or Managed Care Organization (MCO) plan. The CCM collaborates with their respective Community Partner team and the clinical staff of each Enrollee’s ACO/MCO’s plan to minimize duplicative efforts, promote integrated care, ensure quality and continuity of care, and support the values of person-centered planning, Community First and SAMHSA Recovery Principles. The CCM is at the helm of organizing and coordinating resources and services in response to the Enrollee’s healthcare needs across multiple settings, and inclusive of both LTSS and Social Determinants of Health (SDH) needs. This role drives outreach and engagement, assessment and care planning, care transitions, health and wellness coaching, as well as community and social services connections in partnership with Enrollees and their care teams.

Registered Nurse (RN) license required. Minimum of 5 years clinical and case management experience preferred. Effective skills in managing, teaching, negotiating, and collaborating with multidisciplinary teams and enrollee/family focus. Experience working with people with psychiatric disability, co-occurring disorders preferred. Preference given to bi-lingual/bi-cultural applicants and applicants with lived experience of psychiatric conditions.

Provides outreach to and engages with enrollees referred for CP program as assigned by Team Leader or Director. Conducts comprehensive assessment of enrollees including the medical, psychiatric and social issues of enrollees served. Reviews/approves medical components of comprehensive assessment for Care Team enrollees. Organizes and facilitates the effective functioning of the Interdisciplinary Care Team (ICT), including coordinating meetings, facilitating communication, and documentation. Reviews, analyzes, and tracks incident reports to identify patterns, trends, and potential risks to enrollee safety: collaborate with interdisciplinary teams to investigate adverse events, develop corrective actions, and implement quality improvement strategies in alignment with risk management protocols and organizational policy Monitors the enrollee’s health status and needs and provides nursing and medical care coordination, including revising health related treatment goals and plans in collaboration with the enrollee and the team. Coordinates the development, implementation, monitoring, and review/approval of enrollee care plans. Collaborates closely with PCP and other Providers including, but not limited to community resources, and assures appropriate referrals based on level of care needed to optimize outcomes and minimize risk. Performs other related duties, as assigned.

Hicuity Health

Advanced Care at Home- DAY Full Time

Posted on:

September 7, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Who We Are Hicuity Health is the leader in delivering expert telemedicine care in support of patients and bedside care teams in acute and critical care environments. Since our founding in 2006, Hicuity Health has pioneered provider-to-provider telemedicine, fueling success with clinical and technical innovation. What We're Solving Hicuity Health leverages telemedicine to address clinical needs and staffing shortages for a diverse range of clients and care venues nationwide, including health systems, hospitals, post-acute care facilities, and at-home acute care environments. Our Mission For nearly two decades, Hicuity Health has delivered “Care Innovated” to its clients and patients. Across a range of services, Hicuity offers clinical, technical, and operational expertise that improves patient care and supports healthcare facilities nationwide.

Join our team as a Work from Home – Remote – Hospital Care at Home FT RN (day shift). As the leading high acuity telemedicine provider in the United States, we are seeking a highly motivated and talented individual to join our team of high performing Clinical Support professionals as a Hospital Care at Home RN. In this role, you will be responsible for providing high-quality patient care to various patient populations within the framework of Hicuity Health’s vision, mission, and values and includes the following key elements:

RN Compact (multi-state) license. Three (3) years RN experience. Med/Surg or Nursing experience in the inpatient hospitalized setting required. Clinical knowledge. Able to promote patient safety and a positive patient experience. Flexible and comfortable with a changing and dynamic work environment and schedule across all shifts and days. Team player who also works well independently. Participates in ongoing learning and continuing education to care for a variety of patient populations. Collaborate, advocate and mentor others with a professional, non-condescending manner. Model collaborative, respectful team relationships with colleagues and customers; lead by example. Shift is from 7a- 7p PST. This job may be performed remotely from anywhere in the United States, except that this job may not be filled or performed in Washington, California, New York, Illinois, Montana, or Colorado.

Utilizing monitoring, assessment, planning, intervention, and critical thinking skills to care for acute care patient populations in the home. Navigating patients and families across the continuum of the Hicuity Health phases of care. Monitoring and responding to biometric data per Hicuity Health protocols. Conducting home and audio/visual patient care visits as directed by the care team and/or protocol. Ensuring all interventions in the patient’s care plan are implemented efficiently with a patient centered approach. Leveraging the resources and expertise of the Hicuity Health team and our supplier partners to implement collaborative workflows, standards, policies, protocols, guidelines, and documentation systems to support safe, reliable, high-quality, evidence-based care with clinical protocols as the foundation. Adhering to the clinical protocols and willing to obtain the necessary training to provide care within the context of the providing evidence-based care. Promoting professional practice and a culture of safety; willingness to engage in process improvement efforts. Obtaining certifications as required by Hicuity Health

Guideway Care

Triage Nurse RN (Telehealth) | Weekend Overnights

Posted on:

September 7, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

California

Sequence Health is a mission-driven organization committed to improving patient care and providing superior patient activation solutions to healthcare organizations. We pride ourselves on building an inclusive culture and hiring team members who are motivated by purpose, impact, growth, and innovation.

We are seeking an experienced and compassionate Registered Nurse to join our elite team of remote triage professionals. This RN will serve as the front line of clinical support for patients, delivering high-quality assessment, guidance, and care coordination services via telephone and digital communication platforms. This role requires a confident, autonomous nurse with a strong clinical foundation, excellent judgment, and a deep commitment to patient-centered care. You will work remotely in a structured and supportive environment, contributing to improved outcomes and experiences for patients across a variety of primary care and specialty settings. Work Schedule: Friday/Saturday/Sunday - 7:00 PM - 8:00 AM

Registered Nurse with Unencumbered e-NCL Licensure. RN Licensure in California is required Current demonstration of clinical proficiency Excellent written and oral communication skills Excellent critical thinking and problem-solving skills Ability to work within approved procedure and clinical guidelines Electronic Medical Record Experience, i.e EPIC, Cerner, Greenway Ability to use windows-based computer software including ADOBE, MS Word, MS Excel, Fax and others Minimum of 5 years’ experience in working in a variety of direct patient care settings including Emergency Department, Labor and Delivery, Critical Care. Women's Health or Labor and Delivery experience preferred. Minimum of 3 years’ experience in Adult Nursing

Receive inbound calls from patients and place outbound calls to patients. Provide clinical assessment based on established protocols and triage patients by phone or through patient portal. Respond to patients’ messages in patient portal, create orders and route to appropriate parties. Provide administrative support for patients’ and providers’ needs in terms of FMLA, ADA, and LTD/STD Communicate with Health Care Provider through approved methods as needed. Any other duties necessary to drive our values, fulfill our mission, and abide by our company values

MISSION PRE-BORN INC

Telehealth Nurse Manager

Posted on:

September 7, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

None Required

State License:

Indiana

Location: Remote  Reports To: Sr. Director of Virtual Care Systems (VCS)  FLSA Status: Exempt  Type: Full-Time  Position Summary The Telehealth Nurse Manager is responsible for the operational oversight and continuous improvement of the organization’s virtual care programs. This role ensures the delivery of high-quality, accessible, and patient-centered virtual care services across all platforms and specialties. The Telehealth Nurse Manager will collaborate with clinical, technical, and administrative teams to expand virtual care offerings, optimize workflows, and ensure regulatory compliance.

Education: Bachelor’s degree in nursing required. Master’s degree (MPH, MHA, MBA, or MSN) strongly preferred. Experience: Minimum 7 years of experience in healthcare leadership, with at least 3 years in telehealth or digital health. Proven track record of managing virtual care programs or digital transformation projects. Experience working with clinical teams, IT, and regulatory bodies. Skills & Competencies: Strong leadership and project management skills. Deep understanding of telehealth regulations, reimbursement, and technology. Excellent communication, collaboration, and problem-solving abilities. Data-driven mindset with experience in analytics and performance improvement. Preferred Certifications: Certified Telehealth Coordinator (CTC) or similar credential. Lean Six Sigma or PMP certification.

Strategic Leadership: Develop and execute process standardization aligned with organizational goals. Conduct needs and skill assessments to support program level operations. Identify opportunities for innovation and expansion in virtual care delivery. Monitor industry trends and emerging technologies to maintain a competitive edge. Program Management Oversee day-to-day operations of clinical services, ensuring efficiency and quality. Lead cross-functional teams to implement new care initiatives. Establish and track KPIs to measure program performance and clinical outcomes. Clinical Integration: Collaborated with clinical leaders to integrate virtual services into care pathways. Ensure clinical protocols and standards are upheld. Supports clinical training and engagement in best practices. Technology & Infrastructure: Partner with IT to ensure platform reliability, security, and optimal user experience. Evaluate and optimize software platforms and tools. Ensure interoperability with EHR and other digital health systems. Compliance & Quality: Ensure adherence to federal, state, and payer regulations related to telehealth. Maintain documentation and reporting for audits and accreditation. Lead quality improvement initiatives to enhance patient safety and satisfaction. Develops and maintains evidence-based based standard operating polices and procedures. Financial Oversight: Develop and manage budgets for telehealth programs. Analyze ROI and cost-effectiveness of virtual care services. Support billing & reimbursement optimization and payer engagement.

Knowtion Health

Nurse Specialist II, Audit

Posted on:

September 6, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Florida

In a world where the balance of power has favored the payers and the rules of determining coverage and the processing of claims has grown complex, someone had to find a way to give providers and patients more control over their destiny to get denied and complex claims resolved. That’s why we’re here, in your corner. We’ve got the people, the expertise and the technology to resolve claims faster and continuously optimize your A/R. Your patients don’t know how to wrangle their claims or coordinate benefits. Aging A/R is piling up and you need to get as much of it as possible. But most claims are either too complex to figure out or too small to chase down, even though there are enough of them to give a much-needed boost to your bottom line.

Are you seeking an exciting opportunity to join a passionate, growing, and dynamic team of professionals who support patients? The Nurse Specialist II works with attorneys and claims representatives by reviewing and appealing claims when appropriate to overturn clinical validation and coding denials from Medicare, Medicaid, and other third-party payers. What’s Attractive to the Right Candidate? Knowtion Health is a growing firm in a growing industry. Our status as a leader in this industry means that we have the resources to invest in the business and to innovate. Our business is intensely competitive and is constantly evolving. We quickly identify new challenges and develop solutions, so you won’t simply be doing what was done last year. Our new employees are frequently pleased and surprised by how quickly we make decisions and adapt to market conditions. Knowtion Health culture is inviting and competitive, embracing challenge and celebrating accomplishment; dedicated colleagues striving to provide quality results that have lasting impact.

Current and valid RN License Minimum of two years of experience in an acute care hospital required Minimum of five years of experience in clinical medical record audits or coding preferred Experience using InterQual and Milliman healthcare criteria preferred Experience reviewing CMS LCD/NCD criteria preferred Knowledge of CMS and payer reimbursement guidelines preferred Knowledge of DRG, ICD-10, CPT and HCPCS codes preferred Comfort with productivity standards

Reviews medical record documentation to verify clinical indicators and coding issues as related to DRG Validation Audits, Emergency Department Downgrade Audits, Inpatient Level of Care Audits, and Charge Outlier Audits, etc. Creates detailed appeal letters for denials from payer to support payment of patient claims Manages Inventory and Follow up on accounts as appropriate Reviews InterQual/Milliman, coding guidelines and/or payer medical policies related to denied procedures or services and includes criteria in appeals letter as appropriate Provides feedback to supervisor regarding issues identified for ongoing training to peers and non-clinical staff members Identifies root causes and trends to share with clients and staff Works with peers in collaboration of clinical writing situations

Lakeland Care Incorporated

RN Care Manager - Shawano (Work From Home Flexible)

Posted on:

September 6, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Wisconsin

Lakeland Care was one of the first Managed Care Organizations to provide the Family Care Program in the state of Wisconsin more than 19 years ago. Family Care helps eligible elders and adults with disabilities live independently at home or in their community. Lakeland Care members partner with our care teams and local providers to get the supports and services they need to achieve their goals. Lakeland Care supports members in 22 counties in Northeast and North Central Wisconsin.

The RN Care Manager (RN CM), as part of an interdisciplinary team (IDT) with a Care Manager, serves Lakeland Care's (LCI) members, the frail elderly, adults with physical disabilities, and adults with intellectual/developmental disabilities. The RN Care Manager does not provide hands-on care; it provides care management and service coordination to LCI members. The RN care manager arranges for provision of services and supports based on a comprehensive assessment of the member's identified outcomes and needs. The IDT monitors the provision of services based on the member-centered plan per LCI policy and procedures, and Department of Health Services (DHS) contract requirements. Position requires traveling in the field/community visiting members.

Current License to practice as a Registered Nurse in the State of Wisconsin. Bachelor’s degree in nursing strongly preferred. Two (2) or more years of skilled nursing experience preferred, ideally in gerontology/disabilities and/or home care. Ability to access members’ homes which are not required to comply with the ADA regulations. Ability to lift up to 25lbs. Current driver’s license, acceptable driving record and proof of adequate insurance.

Coordinate and participate in home visits and care conferences involving the member, their supports, and providers. Coordinate acute and primary care services, care transitions, and related follow-up care. Conduct in-person comprehensive, strengths-based assessment of the member's outcomes, needs and risks; perform reassessment as condition changes. Develop, coordinate, monitor and evaluate the members’ outcome-based member-centered plans, considering cost and effectiveness in authorizing services and choosing providers. Implement risk mitigation strategies to promote the member’s health, safety and independence while respecting the member’s rights to appeal and grieve. Maintain member records as required by DHS contract and LCI policy. Build and maintain an effective and collaborative working relationship with Care Manager partner and various departments/stakeholders. Participate in team meetings and on-going trainings to stay abreast of policies, procedures, and state/federal regulations. Maintain the confidentiality of member information and protected health information (PHI) in accordance with HIPAA and state/federal regulations. Provide nursing care in accordance with the Nurse Practice Act.

NeueHealth

UM Prior Authorization Nurse, RN

Posted on:

September 6, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

California

NeueHealth is a value-driven healthcare company grounded in the belief that all health consumers are entitled to high-quality, coordinated care. By uniquely aligning the interests of health consumers, providers, and payors, we help to make healthcare accessible and affordable to all populations across the ACA Marketplace, Medicare, and Medicaid. NeueHealth delivers clinical care to health consumers through our owned clinics – Centrum Health and Premier Medical – as well as unique partnerships with affiliated providers across the country. We also enable providers to succeed in performance-based arrangements through a suite of technology and services scaled centrally and deployed locally. Through our value-driven, consumer-centric approach, we are committed to transforming healthcare and creating a better care experience for all.

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. 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.

bServed

Utilization Management Nurse - Nights/Weekends

Posted on:

September 6, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

At bServed UM, we’re transforming the way healthcare organizations manage utilization. Our mission is to improve patient outcomes while helping hospitals and providers reduce costs. We specialize in lowering denial rates, optimizing length of stay, and supporting Case Management teams across hospitals, IPAs, and insurance companies.

We're Hiring: Utilization Management Nurse REMOTE Job Type: Full-Time Department: Utilization Management We are seeking a dedicated Utilization Management Nurse to join our growing team. You’ll play a key role in reviewing the medical necessity and appropriateness of care using clinical guidelines and collaborating with providers and payers to ensure efficient, effective patient care.

Active LVN/RN license (State-specific or Compact) 2+ years clinical nursing experience (med-surg, acute, etc.) 2+ years in Utilization Review or Case Management experience required InterQual experience required Excellent communication, organization, and critical thinking Bonus Points: BSN preferred CCM or UR certification Experience with Medicare, Medicaid, or commercial payers

Conduct prospective, concurrent, and retrospective reviews Apply InterQual criteria to support UM decisions Collaborate with providers and payers on authorizations and discharges Document and justify clinical decisions in compliance with regulations Support appeals, monitor high-cost cases, and promote cost-effective care

Digital Axis, LLC

Telehealth Nurse (Registered Nurse – Remote, Federal Contract Support)

Posted on:

September 6, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

Telehealth Nurse (Registered Nurse – Remote, Federal Contract Support) Location: Remote (U.S. Based) Contract Type: Federal Government Support Contract Clearance: Public Trust (may be required) Position Type: Full-Time, 1,700 hours/year Nurse Licensure Compact (NLC) or licensed in Wyoming About the Role We are seeking a dedicated Telehealth Nurse (RN) to support a federal healthcare program under contract. The nurse will provide remote clinical support using telehealth platforms, coordinate patient care, and ensure compliance with program standards. This role is mission-critical to ensuring timely, high-quality healthcare delivery to underserved and rural communities.

Registered Nurse (RN) license – active and in good standing (multi-state/compact license preferred). Minimum 2 years of clinical nursing experience, with at least 1 year in telehealth, ambulatory care, or primary care preferred. Strong communication skills for remote patient interactions. Proficiency with telehealth platforms and EHR systems. Familiarity with federal healthcare programs (e.g., IHS, VA, or CMS) preferred. Must be a U.S. citizen or authorized to work on a federal contract. Ability to work independently in a remote, secure environment.

Deliver telehealth services using approved Electronic Health Record (EHR) and telehealth platforms (e.g., eClinicalWorks TeleVisits, athenaTelehealth). Conduct remote patient assessments, collect health histories, and monitor ongoing health concerns. Support physicians and providers in virtual care delivery by documenting encounters, following up on care plans, and managing referrals. Coordinate care between patients, providers, and case managers to ensure continuity. Monitor and respond to patient inquiries through secure telehealth portals. Maintain compliance with HIPAA, federal regulations, and contract-specific requirements. Participate in training and maintain certifications as required by contract. Provide input to improve telehealth workflows and patient satisfaction.

Children's Medical Group Austin, PLLC

Triage Pediatric Nurse

Posted on:

September 6, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Texas

Maintain current license and up-to-date CE activities.Job description CMG is seeking a bright and driven Register Nurse to join its team. The ideal candidate is expected to be proficient in clinical back office duties and not limited to front office activities for a medical office.

Education : High school diploma or equivalent. Registered Nurse who is currently licensed to practice, in good standing by the state of Texas. Strong organizational skills with the ability to multi-task. Be able to plan ahead and think on your feet. Positive attitude and willing to adapt to fast paced environment Maintain current license and up-to-date CE activities.

Accurately and completely reports patient status, point of testing, provider orders, contact with patients. Fluent in administrating immunization for ages 0-18 Provide safe and accurate medical advice Perform lab tests: throat culture, rapid strep screen, rapid flu, COVID, RSV, monospot, finger stick glucose, urinalysis, stool studies, newborn screen, and heel stick for bilirubin Perform procedures: bladder catheterization, vision screen, hearing screen, and CPR support if needed. Patient appointment scheduling All other duties and responsibilities as assigned.

AccordCare & Family of Companies

On-Call Registered Nurse

Posted on:

September 6, 2025

Job Type:

Part-Time

Role Type:

License:

RN

State License:

Georgia

At AccordCare our mission is simple—but powerful: to help our clients live their best possible lives, safely and comfortably in the place they call home. We believe home is where healing happens best—and our nurses are at the heart of making that possible.

We are seeking an On-Call Registered Nurse (RN) who is compassionate, reliable, and skilled to be a lifeline for our clients and caregivers after hours. This role is key in helping prevent unnecessary hospitalizations or facility placements and supporting our clients in staying home—where they belong. This is a 100% remote that can be based anywhere in Georgia or Florida. Schedule: Monday to Friday: 5:00 PM – 9:00 AM (overnight on-call) Saturday & Sunday: 24-hour on-call coverage Please note, these are the only hours we are seeking for this role.

A current and valid Registered Nurse (RN) license in Florida, Georgia and/or New York. Ability to obtain a RN license in Florida, Georgia, and New York At least 2 years of nursing experience, preferably in home care or a community-based setting Excellent clinical judgment, communication skills, and the ability to work independently Tech-savviness—especially with virtual care tools and EMRs A deep belief in our mission and a commitment to client-centered care

As an On-Call RN, you’ll be the trusted clinical voice after-hours—ensuring that clients get timely, expert care even when the office is closed. Your responsibilities will include: Taking clinical calls from caregivers, clients, and families and offering expert support and direction. Starting incident reports and escalating concerns appropriately to protect client safety and ensure quality of care. Conducting virtual Start of Care (SOC) nurse visits to begin services quickly and smoothly. Managing new client intakes with care, accuracy, and a warm, reassuring presence. Providing detailed clinical reports to care teams to ensure continuity and quality of service.

Netsmart Technologies

Utilization Review RN, Full-Time - Multiple Shifts Available, Including FT Weekends

Posted on:

September 6, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Kansas

Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart’s sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart’s third party screening provider.

Responsible for utilization review work for emergency admissions and continued stay reviews.

Required: Current and unrestricted RN license At least 3 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing At least 2 years utilization management experience in acute admission and concurrent reviews Intermediate level experience with InterQual and/or MCG criteria within the last two years Proficiency in medical record review in an electronic medical record (EMR) Experience in Microsoft Suite including Office and basic Excel Ability to thrive in a fast-paced, dynamic environment and adapt to frequent changing business needs Passing score(s) on job-related pre-employment assessment(s) Preferred: At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing At least 3 years utilization management experience within the hospital setting Bachelor's of Science in Nursing (BSN) Case Management Certifications such as Certified Case Manager (CCM), Accredited Case Manager (ACM), Certified Managed Care Nurse (CMCN), Case Management, Board Certified (CMGT-BC) Expectations: Comfortable with remote work arrangements and virtual collaboration tools Physical demands include extended periods of sitting, computer use, and telephone communication Shifts Requirements & Needs: Working between the hours of 9am EST and 9pm EST either for 8-hour, 10-hour or 12-hours shifts. All Full-Time required to work 4 Holidays per year All Full-time required to work every other weekend of 4 weekend shifts per month. Additional Shifts Available: Weekend FT Available - (3, 12 hours shifts, one shift worked during a weekday) Work schedules and shift assignments are subject to change based on evolving client needs and operational demands. While we strive to provide consistent scheduling, associates may be required to adjust their availability or work different shifts. Flexibility and adaptability are essential for success in this role.

Review and evaluate electronic medical records of emergency department admissions and screen for medical necessity using InterQual or MCG criteria Apply evidence-based clinical guidelines and criteria to assess and ensure proper utilization of healthcare resources Participate in telephonic discussions with emergency department physicians relative to documentation and admission status Enter clinical review information into system for transmission to insurance companies for authorization Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources

MedReview

DRG Clinical Validation Nurse

Posted on:

September 5, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

New York

At MedReview, our mission is to bring accuracy, accountability, and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews. We are seeking a registered nurse with experience in clinical validation to work within our coding department. Candidate should be highly motivated, with strong clinical and coding background. This individual must have excellent communication skills and an analytical mindset to achieve and maintain high-level performance in a fast-paced environment. This is a fulltime position (40 hours per week) Monday – Friday. You’ll enjoy the flexibility to telecommute from anywhere within the United States. Training will be conducted virtually from your home.

Minimum of two years’ experience in clinical validation in a payment integrity setting required May consider nurses with inpatient claims auditing experience or case management experience. Unrestricted Registered Nurse with active RN licensure required CCS (Certified Coding Specialist) or CIC (Certified Inpatient Coder) certification preferred CCDS or CDIP Certification preferred Knowledge of ICD-10 coding Basic Knowledge of DRG validation and coding Ability to use Windows PC with the ability to utilize multiple applications at the same time Remote Work Requirements: High speed internet (100 Mbps per person recommended) with secured WIFI. A dedicated workspace with minimal interruptions to protect PHI and HIPAA information. Must be able to sit and use a computer keyboard for extended periods of time.

Perform clinical validation by ensuring diagnosis codes billed by the provider are supported within the medical record Must be able to interpret clinical guidelines/criteria and apply to clinical review Solid understanding of anatomy and physiology, diagnostic and surgical procedures developed from specialized training and extensive experience with ICD-10-PCS code assignments Demonstrates the ability to accurately interpret the medical record Writes clear, accurate and concise rationales in support of findings Maintains and manages case reviews with a high emphasis on quality Demonstrates the ability to work in a high – volume production environment Knowledge of health insurance business, industry terminology, and regulatory guidelines

Boulder Care

Registered Nurse (Telehealth)(SUD)

Posted on:

September 5, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Texas

Boulder Care is an award-winning digital clinic for addiction medicine, recognized for both innovation and high quality of patient care. Founded in 2017 by CEO Stephanie Strong, our mission is to improve the lives of people with substance use disorders through compassionate, evidence-based care. We provide Boulder patients with a fully virtual, multidisciplinary care team—including medical providers, behavioral health clinicians, and peer recovery specialists—who deliver personalized treatment, including medication-assisted treatment (MAT) and ongoing support. Our approach is grounded in clinical excellence, patient-centered care, and a commitment to reducing barriers to recovery. Boulder partners with leading health plans, employers, and community organizations to ensure that our services are accessible and covered for the people who need them most. Named by Fortune as one of the Best Workplaces in Healthcare, Boulder fosters a culture of kindness, respect, and meaningful work that delivers outstanding patient outcomes and moves the addiction medicine industry forward.

Boulder Care is looking for Registered Nurses who are aligned with Harm Reduction principles and have experience supporting patients receiving buprenorphine-based treatment for opioid use disorder in an outpatient setting. This is a 100% remote, full-time, W2 position. We are looking for RNs who: Have an active, unrestricted RN license in your state of residency Have a minimum of 2 years of specialized nursing experience in outpatient substance use disorder (SUD) treatment. Are interested in full-time work (40 hours a week) with a Monday-Friday schedule: 12pm - 8pm EST (9am- 5pm Pacific Time) 11am - 7pm EST (8am - 4pm Pacific Time) 1pm - 9pm EST (10am - 6pm Pacific Time) About the role This position is 100% remote The Registered Nurse works directly with patients to deliver medication-assisted recovery for substance use disorder (SUD) and empowers patients in their recovery journeys in coordination with the Care Team (primarily Nurse Practitioners, Medical Assistants and Peer Recovery Specialists) Our team delivers compassionate and empathetic telephonic, text-based, and video-based (telehealth) patient engagement and monitoring Boulder Care recognizes the value that lived experience can provide to our organization, community, and patients. Applicants with lived experience and/or training as a peer recovery specialist are encouraged to apply

Bachelor’s Degree in Nursing, preferred Preference given to candidates with 2+ years specialized nursing experience in outpatient substance use disorder treatment Embrace a harm reduction philosophical approach to care Compassion, empathy, and deep dedication to patient care Excellent written and verbal communication Extraordinary customer service skills, computer skills and record keeping Ability to handle multiple tasks simultaneously and prioritize based on severity of need, while working independently with minimal supervision Ability to achieve specified outcomes in collaboration with all members of the leadership team Demonstrates quality in clinical performance as evidenced by creativity in problem solving and interdisciplinary communications Ability to work collaboratively with medical staff including Clinicians, Care Advocates , Peers, Case Managers and colleagues in all aspects of care provision Experience in office-based nursing preferred Knowledge of Hepatitis C, HIV preferred Membership in a relevant professional nursing organization (e.g. International Nurses Society on Addiction) or specialty certification (e.g. CARN) preferred A dedicated, private workspace with a lockable door and high-speed internet to maintain a secure, distraction-free environment, ensuring compliance with HIPAA and confidentiality standards Due to privacy protocols, we are unable to employ individuals who are or have previously been patients at Boulder Care

Essential Functions - Patient Care (50%) Provide compassionate, empathetic telephonic, text based & video-based (Telehealth) patient engagement and monitoring, assisted by clinical decision support tools Provide support to patients within the Boulder application to ensure successful engagement and initiation of treatment Educate patients about addiction, medications, and available support services; answer questions regarding treatment and program protocols, and provide guidance to patients and providers within scope of practice Provide opioid overdose prevention, education, and reversal, safer consumption education, and safer sex education and testing Access Prescription Drug Monitoring Program information, facilitate patient adherence monitoring protocols, for each assigned patient Assess progress, patient functioning, and stage in recovery; in collaboration with other care team members and the patient, develop and update treatment care plans for each individual Assess and advocate for acute withdrawal management Assess for pain and collaborate findings with Clinician Provide Buprenorphine initiation education and follow up Maintain effective, proactive, and superior follow-up communication with patients, providers and care team Maintain an accurate and updated medical record of individual patient progress during all clinical interactions Identify and provide crisis intervention, within scope of practice If applicable: facilitate placement for adjunctive or higher level of care; maintain contact with these placements to provide continuity of care and to streamline transitions of care Obtain and review drug testing results and recommend further testing as appropriate, guided by clinical decision support tools Essential Functions - Care Coordination (30%) Coordinate with multidisciplinary care teams via telehealth to guide treatment planning and delivery including the following functions; Collaborate with pharmacies to facilitate medication refills and support patients with medication-related concerns Collaborate with outside providers and community care agencies to maintain accurate and timely data exchanges between all organizations and individuals involved in patient care Assist with the management of patient appointments with other care team members and referrals outside of Boulder Report patient change in status (e.g. high risk for returning to use) and potential support services to prescribing clinicians in a timely manner Provide patient updates and outcomes reports to the prescribing provider in alignment with Boulder Care goals Essential Functions - Administrative (20%) Meetings (department, company-wide, ECHO, meetings with your manager) Maintain HIPAA and 42 CFR Part 2 compliance and all levels of required patient confidentiality Manage and maintain individual schedule of assigned patients Chart prep

Boulder Care

Nurse Practitioner – Addiction Medicine | October Start Dates

Posted on:

September 5, 2025

Job Type:

Full-Time

Role Type:

License:

NP/APP

State License:

Kansas

Boulder Care is an award-winning digital clinic for addiction medicine, recognized for both innovation and high quality of patient care. Founded in 2017 by CEO Stephanie Strong, our mission is to improve the lives of people with substance use disorders through compassionate, evidence-based care. We provide Boulder patients with a fully virtual, multidisciplinary care team—including medical providers, behavioral health clinicians, and peer recovery specialists—who deliver personalized treatment, including medication-assisted treatment (MAT) and ongoing support. Our approach is grounded in clinical excellence, patient-centered care, and a commitment to reducing barriers to recovery. Boulder partners with leading health plans, employers, and community organizations to ensure that our services are accessible and covered for the people who need them most. Named by Fortune as one of the Best Workplaces in Healthcare, Boulder fosters a culture of kindness, respect, and meaningful work that delivers outstanding patient outcomes and moves the addiction medicine industry forward.

Boulder Care is looking for Nurse Practitioners who are aligned with Harm Reduction principles and have experience prescribing buprenorphine-based medications for opioid use disorder in an outpatient setting, and can start on or before November 3rd. This is a fully remote, full-time, W2 position. If you are interested in part-time opportunities, please visit our careers page to view current openings. Can start on or before November 3rd (candidates with longer notice requirements are welcome to apply but we are prioritizing candidates with expedited timelines) Reside in one of the following states: AZ, CO, FL, ID, KS, MD, NM, NC, OH, OR, WA, and WY Have an active Nurse Practitioner license in your state of residence (Note: we are currently unable to hire PA-Cs or CNSs) Have at least 1 year of experience in an independent, outpatient setting where you regularly prescribed buprenorphine-based medications — including initiating care, not just continuing existing prescriptions — as a core part of your daily practice. Are interested in Full-time work: 30-40 hours/week, with shifts ending at 6pm Eastern Time or Pacific Time depending on your location (see below for details) About the Role This position is 100% remote. The Nurse Practitioner works directly with patients to deliver medication-assisted recovery for Substance Use Disorder (SUD) and empowers patients in their recovery journeys in coordination with the Care Team (primarily Care Advocates and Peer Recovery Specialists). Our clinicians deliver compassionate and empathetic telephonic, text-based, and video-based (telehealth) patient engagement and monitoring. Boulder Care recognizes the value that lived experience can provide to our organization, community, and patients. Applicants with lived experience and/or training as a peer recovery specialist are encouraged to apply. Our clinicians receive structured support to ensure success from day one - we provide a comprehensive onboarding and training experience covering clinical protocols, technology, and workflows. Schedule Expectations (Full-time) Monday–Friday only (no weekends) 30–40 hours/week with flexible shift structures: 3x10s, 4x8s, 4x10s, or 5x8s Typical 8 hour shifts are: 10am to 6pm Eastern Time for candidates who reside in: FL, KS, MD, NC, or OH 10am to 6pm Pacific Time for candidates who reside in: AZ, CO, ID, NM, OR, WA, or WY

Minimum 1+ year of addiction treatment experience 3 or more years of clinical experience as an NP or RN preferred Degree from an accredited school of nursing and a graduate-level nurse practitioner program Demonstrated experience managing SUDs in a chronic care model through medication assisted recovery paired with social needs management Specific experience transitioning individuals from illicit opioids to buprenorphine Proficiency in EMRs and video conferencing platforms (Google Suite or similar highly preferred) Ability to gain approval for multiple state licenses and insurance company contracts (no significant legal or credentialing barriers/sanctions) Ability to work independently and as part of a team; outstanding communication and collaboration Ability to quickly learn and adapt to new technologies and workflows Exceptional time management and organizational skills Dedicated, private workspace with a lockable door and high-speed internet to ensure HIPAA compliance Cannot have previously been a patient at Boulder Care

Patient Facing (80%) Average patient volume is around 17 patients per 8-hour day, though this can vary over time as schedules and team needs evolve Evaluate, diagnose, treat, and manage ongoing care for individuals with complex SUDs and related comorbidities Understand, embrace, and incorporate harm reduction practices into all patient care Help elicit patients’ own goals for their recovery and support them over time through therapeutic alliance and shared decision-making Educate patients on Boulder’s model of care, SUDs, related comorbidities, recovery strategies, and safer use where appropriate Coordinate with Medical Directors/Clinical Leadership to develop and oversee treatment plans, adjusting them as needed Provide patient care coverage during scheduled shifts, including some nonstandard hours (evenings/weekends) based on team needs and candidate availability Use technology effectively to facilitate a safe and rewarding patient experience Interpret and share lab/clinical results with patients without judgment to help them meet their goals and stay safe Enable care coordination, connecting patients to clinical and social resources inside and outside of Boulder Administrative (20%) Participate in Department and Company-wide meetings (ECHO, All Hands, Pod meetings, Care Team, etc.) Deliver proactive, clear, and constructive feedback and collaborate with Boulder’s Technology and Operations teams to troubleshoot as we continuously build out our digital treatment platforms Completes thorough chart notes within 24-hours of patient visit Regularly monitor relevant channels for updates, team communication, and patient care collaboration Understands and follows Boulder’s policies and procedures

Boulder Care

Registered Nurse (Telehealth)

Posted on:

September 5, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Oregon

Boulder Care is an award-winning digital clinic for addiction medicine, recognized for both innovation and high quality of patient care. Founded in 2017 by CEO Stephanie Strong, our mission is to improve the lives of people with substance use disorders through compassionate, evidence-based care. We provide Boulder patients with a fully virtual, multidisciplinary care team—including medical providers, behavioral health clinicians, and peer recovery specialists—who deliver personalized treatment, including medication-assisted treatment (MAT) and ongoing support. Our approach is grounded in clinical excellence, patient-centered care, and a commitment to reducing barriers to recovery. Boulder partners with leading health plans, employers, and community organizations to ensure that our services are accessible and covered for the people who need them most. Named by Fortune as one of the Best Workplaces in Healthcare, Boulder fosters a culture of kindness, respect, and meaningful work that delivers outstanding patient outcomes and moves the addiction medicine industry forward.

Boulder Care is looking for Registered Nurses who are aligned with Harm Reduction principles and have experience supporting patients receiving buprenorphine-based treatment for opioid use disorder in an outpatient setting. This is a 100% remote, full-time, W2 position. We are looking for RNs who: Have an active, unrestricted RN license in your state of residency Have a minimum of 2 years of specialized nursing experience in outpatient substance use disorder treatment. Are interested in full-time work (40 hours a week) with a Monday-Friday schedule: 12pm - 8pm EST (9am- 5pm Pacific Time) 11am - 7pm EST (8am - 4pm Pacific Time) 1pm - 9pm EST (10am - 6pm Pacific Time) If this sounds like you, please continue applying. About the role This position is 100% remote The Registered Nurse works directly with patients to deliver medication-assisted recovery for substance use disorder (SUD) and empowers patients in their recovery journeys in coordination with the Care Team (primarily Nurse Practitioners, Medical Assistants and Peer Recovery Specialists) Our team delivers compassionate and empathetic telephonic, text-based, and video-based (telehealth) patient engagement and monitoring Boulder Care recognizes the value that lived experience can provide to our organization, community, and patients. Applicants with lived experience and/or training as a peer recovery specialist are encouraged to apply

Bachelor’s Degree in Nursing, preferred Preference given to candidates with 2+ years specialized nursing experience in outpatient substance use disorder treatment Embrace a harm reduction philosophical approach to care Compassion, empathy, and deep dedication to patient care Excellent written and verbal communication Extraordinary customer service skills, computer skills and record keeping Ability to handle multiple tasks simultaneously and prioritize based on severity of need, while working independently with minimal supervision Ability to achieve specified outcomes in collaboration with all members of the leadership team Demonstrates quality in clinical performance as evidenced by creativity in problem solving and interdisciplinary communications Ability to work collaboratively with medical staff including Clinicians, Care Advocates , Peers, Case Managers and colleagues in all aspects of care provision Experience in office-based nursing preferred Knowledge of Hepatitis C, HIV preferred Membership in a relevant professional nursing organization (e.g. International Nurses Society on Addiction) or specialty certification (e.g. CARN) preferred A dedicated, private workspace with a lockable door and high-speed internet to maintain a secure, distraction-free environment, ensuring compliance with HIPAA and confidentiality standards Due to privacy protocols, we are unable to employ individuals who are or have previously been patients at Boulder Care

Essential Functions - Care Coordination (30%) Coordinate with multidisciplinary care teams via telehealth to guide treatment planning and delivery including the following functions; Collaborate with pharmacies to facilitate medication refills and support patients with medication-related concerns Collaborate with outside providers and community care agencies to maintain accurate and timely data exchanges between all organizations and individuals involved in patient care Assist with the management of patient appointments with other care team members and referrals outside of Boulder Report patient change in status (e.g. high risk for returning to use) and potential support services to prescribing clinicians in a timely manner Provide patient updates and outcomes reports to the prescribing provider in alignment with Boulder Care goals Essential Functions - Administrative (20%) Meetings (department, company-wide, ECHO, meetings with your manager) Maintain HIPAA and 42 CFR Part 2 compliance and all levels of required patient confidentiality Manage and maintain individual schedule of assigned patients Chart prep

MedCost LLC

Nurse Case Manager (Medical/Surgical)

Posted on:

September 5, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

North Carolina

Under the direction of the Case Management Supervisor, the Nurse Case Manager is responsible for providing telephonic case management services to MedCost customers. This position will work with the health care provider staff, via telephone, fax, and e-mail, in the coordination of care for members ranging from low acuity to catastrophic as they move through the care continuum. The Nurse Case Manager shall practice solely within the scope of a licensed registered nurse and individual competency and education for this position. The role requires experience providing direct patient care.

Required: College degree in nursing, either ADN, BSN, or MSN Registered Nurse with a current, unrestricted North Carolina nursing license A minimum of 3 years direct care experience in varied health care settings Preferred: Prior case management, utilization review or disease management experience Skills, Knowledge, and Abilities Excellent oral and written communication skills Exceptional customer service, and interpersonal skills Effective problem-solving and influencing skills Self- motivated with strong organizational and multi-tasking skills Proficient keyboarding skills Knowledge of computer programs such as Excel and Microsoft Word and Outlook Proficiency in navigating the Internet and multi-tasking with multiple electronic documentation systems simultaneously. Ability to work independently, handle multiple assignments and prioritize workload

Confirm eligibility and policy provisions. Obtain consent for case management services and communicates case management objectives to the patient and their primary caregiver/support system and determine patient and family desires. Gather clinical information to assess and initiate discharge planning from hospital admittance to discharge. Collaborate and communicate with the member's health care team to coordinate the care needs for the member. Review available resources of all providers to determine the means of providing the highest quality care in the most effective setting. Obtain an estimate of the patient's current costs from the provider or other sources and compare to those of the alternative means of providing the necessary care. Provide ongoing education to members regarding their health care needs, available benefits and services. Identify barriers to optimal care and outcomes or clinical concerns and communicate with member and providers to formulate action plan to address Work to facilitate member compliance with their care/treatment plan and to ensure continuity of care. Maintain detailed records of all care coordination activities and interventions in the member's health plan clinical record. Notify appropriate persons in writing or by telephone of any potentially high dollar claim and the projected continued costs. Monitor alternative services for effectiveness, continued medical necessity and coverage. Advise all concerned parties when coverage may no longer be available due to cessation of medical necessity or benefit exhaustion. Facilitate patient referrals to community-based funding resources. Evaluate the effectiveness of the case management process.