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As a leading healthcare education organization, Unitek Learning’s family of schools helps thousands of students launch and accelerate their careers every year. As a rapidly growing and highly successful company, Unitek is also a great place to pursue a rewarding and challenging career. We offer a competitive salary, generous benefits, unlimited growth potential, and a collegiate work environment.
Registered Nurse with current and unencumbered Registered Nurse licensure or eligible in all states where Workforce Development programs are established. Registered Nurse with current and unencumbered licensure in California. Eligible for approval by CA BRN as Instructor for Medical-Surgical, OB, Pediatrics, Mental Health, Community Health, or Geriatrics. Master's Degree in Nursing required; Terminal Degree in Nursing (DNP, EdD, PhD) preferred. Able to meet the faculty requirements set by California's Board of Registered Nursing. Experience which demonstrates: Current knowledge of nursing practice; ability to mentor students; effective communication skills, both verbal and written. Previous pre-licensure nursing online teaching experience required utilizing a Learning Management System (LMS). A documented background in educational methodology consistent with teaching assignments including but not limited to: education theory and practice, current concepts related to subjects taught current clinical practice experience distance education techniques and delivery Working knowledge of Microsoft Office Suite Products, especially Outlook, Word, PowerPoint, and other MS office products as needed.
Provide online course facilitation for the pre-licensure programs. Instruct students utilizing existing curriculum for assigned classes. Make continuous efforts to improve the quality of instruction by using different and innovative methodologies and/or teaching techniques. Assist with reviewing and revising syllabi and instructional guidelines. Regularly evaluate students to measure their progress in achieving curriculum and course objectives and inform them in a timely manner of their progress. Assist with strategic planning and assessment of instructional initiatives to ensure quality of program. Maintain student records of attendance, grades, and assist with program data collection. Utilize the Learning Management System (LMS) as the tool to deliver course content while maintaining relevance and currency. Provide access to students for ongoing communication through scheduling of office hours, electronic communication, and other appropriate methods. Participate in professional development; maintain CE hours to ensure renewed licensure and stay current with college updates. Commitment to teaching and working with a multicultural and multigenerational student body. Serve as subject matter expert (SME) for university and accreditation requirements/reporting. Serve on curriculum and evaluation committee. Other duties as assigned by the Assistant Dean, Workforce Development. Faculty are responsible for exam analysis and reviews for all exams within assigned course. Faculty teaching in courses with unit/final exams are responsible for conducting weekly recorded synchronous sessions for students via distance modality (Zoom, MS Teams, WebEx, etc.). Faculty must hold a minimum of four (4) office hours weekly.
Choose a supplier that delivers reliable, personalized service for catheter, incontinence, and bowel management supplies. At Comfort Medical, we believe patients deserve more than products; they deserve both practical assistance and emotional support to navigate their conditions successfully. Living with a chronic condition entails more than just managing day-to-day tasks; it’s about conquering everyday challenges to lead the life they aspire to.
The Clinical Nurse Reviewer plays a crucial role in Comfort Medical by evaluating and assessing medical records, progress notes, and healthcare Certificates of Medical Necessity (also known as CMN’s or Prescriptions) to ensure compliance with industry standards, federal and state regulations, and quality of care. This position requires a strong understanding of medical terminology, healthcare protocols, and attention to detail to maintain the highest standards of patient care and safety.
Basic Qualifications: College Degree in healthcare, nursing, or related fields. Minimum of 2 years’ experience working as a clinical nurse reviewer or in utilization management. Must have active LPN or RN Certification in the state in which they reside (must maintain certification). Ability to work collaboratively and independently and stay on task. Strong background knowledge in healthcare regulatory, government policy, and contracted payer policy. Excellent medical terminology skills. Excellent written and verbal communication skills. Preferred Qualifications: 5+ years’ DME industry experience (urological/ostomy) EHR system experience Certified Professional in Healthcare Quality (CPHQ)
Review and analyze patient medical records, ensuring accuracy, completeness, and compliance with relevant regulations and guidelines. Collaborate with healthcare professionals, including physicians, nurses and appropriate staff, to ensure receipt of proper documentation. Responsible for understanding and adhering to all Medicare Local and National Coverage Determinations (LCD’s and NCD’s), policy articles, government rules and regulations, and contracted payor policies pertaining to services and products provided. Will work closely with the department Manager and external resources to accurately interpret and explain policy documentation requirements to all company stakeholders. Responsible for navigating between multiple computer-based systems to accurately review audits/appeals as assigned Will identify and communicate deficiencies/discrepancies in documentation while complying with company policies & procedures. Ensure audit/appeal packets are assembled and submitted correctly according to department policies and procedures within the defined timeframe. Effectively communicates with Comfort Medical internal stakeholders clinical need qualifications and regulatory requirements. Serve as a clinical resource for non-medical staff. Support training and education on clinical need qualifications, justification, and regulatory requirements when knowledge gaps are identified for internal associates. Participate in peer review processes to assess the quality of care provided by other clinicians, offering constructive feedback and recommendations for improvement. Analyze and provide feedback to Comfort Medical stakeholders with respect to trends in clinical patient care and identify opportunities for quality improvement. Responsible for keeping Manager informed of deficient audits/appeals, patterns, errors, or other systematic problems identified. Responsible for understanding and adhering to all company and department policies, procedures, and process documents. Comfort Medical employees are required to conduct business to the highest ethical and professional standards; comply with applicable laws and regulations, the MedTech Code of Conduct, and company policies. Responsible for additional duties assigned by the department’s management.
At Enhabit, we are expanding what’s possible for patient care in the home. As a national leader in home health and hospice, we provide extraordinary care that patients and their families can count on. And our talented, compassionate care teams make it all possible. They bring their clinical expertise and commitment to work every day, knowing that they play a critical part in each patient’s healthcare journey. We’re committed to making sure our team feels at home within Enhabit. Our supportive culture consistently ranks us as a best place to work in the communities we serve. We uphold acceptance and inclusivity as key workplace values, raising the bar on our diversity, equity, inclusion and belonging efforts so everyone can feel safe and welcome at work. As a team, we strive to give every patient the healthcare journey they decide on and deserve — bringing ourselves and our industry toward a better way to care.
Manages the after-hours on-call administrative operations for assigned branches. This position is 100% remote for overnight, weekends, and holidays. Ensures that patient care and services are delivered appropriately and timely during after-hours and holiday coverage. Impacts patient, family and referral source satisfaction directly. The ideal candidate will be proficient with Homecare Homebase (HCHB), both PointCare and back office / R2 application.
Must be a registered nurse (RN). Must have two years of full-time experience in hospice nursing. Proficiency with Homecare Homebase, both R2 and PointCare is required. Must have 5 years of full-time experience as a RN. Must have one year of full-time experience in a supervisory hospice RN position.. Must be able to work assigned shift and all company holidays.
Triage hospice calls appropriately during assigned shift and all company holidays. Provide an environment which fosters continuous quality assessment performance improvement (QAPI); maintain high standards of patient care, integrity and cost effectiveness. Provide a focused effort to reduce unnecessary hospitalizations and emergency department (ED) trips during after-hours and holidays. Receive, review and enter patient referral information appropriately. Work with local branch to schedule patient admission during the weekend or holiday ensuring a same day admission philosophy. Enter on-call coordination note in patient electronic record for all triaged calls. Promote effective performance and delivery of after-hours hospice; guide clinicians appropriately. Assist in the orientation of new triage nurses. Contact local leadership appropriately for follow-up on time sensitive issues.
At Enhabit, we are expanding what’s possible for patient care in the home. As a national leader in home health and hospice, we provide extraordinary care that patients and their families can count on. And our talented, compassionate care teams make it all possible. They bring their clinical expertise and commitment to work every day, knowing that they play a critical part in each patient’s healthcare journey. We’re committed to making sure our team feels at home within Enhabit. Our supportive culture consistently ranks us as a best place to work in the communities we serve. We uphold acceptance and inclusivity as key workplace values, raising the bar on our diversity, equity, inclusion and belonging efforts so everyone can feel safe and welcome at work. As a team, we strive to give every patient the healthcare journey they decide on and deserve — bringing ourselves and our industry toward a better way to care.
Manages the after-hours on-call administrative operations for assigned branches. This position is 100% remote for overnight, weekends, and holidays. Ensures that patient care and services are delivered appropriately and timely during after-hours and holiday coverage. Impacts patient, family and referral source satisfaction directly. The ideal candidate will be proficient with Homecare Homebase (HCHB), both PointCare and back office / R2 application. This position will work 12 hours on Saturday and 12 hours on Sunday
Qualifications: Must be a registered nurse (RN). Must have two years of full-time experience in hospice nursing. Proficiency with Homecare Homebase, both R2 and PointCare is required. Must have 5 years of full-time experience as a RN. Must have one year of full-time experience in a supervisory hospice RN position.. Must be able to work assigned shift and all company holidays.
Triage hospice calls appropriately during assigned shift and all company holidays. Provide an environment which fosters continuous quality assessment performance improvement (QAPI); maintain high standards of patient care, integrity and cost effectiveness. Provide a focused effort to reduce unnecessary hospitalizations and emergency department (ED) trips during after-hours and holidays. Receive, review and enter patient referral information appropriately. Work with local branch to schedule patient admission during the weekend or holiday ensuring a same day admission philosophy. Enter on-call coordination note in patient electronic record for all triaged calls. Promote effective performance and delivery of after-hours hospice; guide clinicians appropriately. Assist in the orientation of new triage nurses. Contact local leadership appropriately for follow-up on time sensitive issues.
Headquartered in Newtown Square, Pennsylvania, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. Our services include integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services.
The Clinical Appeals Reviewer is responsible for processing appeals and ensuring all milestones are met in compliance with regulatory requirements. This role involves outreach to appellants or their representatives, obtaining and reviewing medical records, packaging pertinent information into a case for determination, interacting directly with providers to obtain additional clinical information, and with members or their advocates to understand the full intent of the appeal.
Associate's Degree in Nursing (ASN) required 3 or more years of experience in a related clinical setting and working with diagnosis procedure codes Coding experience preferred Working knowledge of InterQual criteria Proficiency in a Windows 10 environment and utilizing MS Office, including Word, Excel, and Outlook Proficiency in utilizing Electronic Medical Records (EMRs) Familiarity with the appeals process, preferably within a managed care organization Licensure: Current and unrestricted Registered Nurse (RN) licensure or compact state licensure Skills & Abilities: Strong verbal and written communication, critical thinking, presentation, and the ability to manage and complete multiple high-priority tasks within designated timeframes.
Process appeals, ensuring compliance with all regulatory milestones Review medical records to identify Hospital-Acquired Conditions (HAC), ensure proper documentation, billing code compliance, and prevent reimbursement errors Outreach to appellants or their representatives to obtain and review medical records Package pertinent information into a case for determination Interact with providers to obtain additional clinical information Engage with members or their advocates to understand the full intent of the appeal Provide clinical expertise and determine medical necessity for case classifications when necessary Perform front-line regulatory/compliance functions in the evaluation of appeals Review appeal cases and ensure the Medical Director makes timely decisions Review final determinations and create decision letters containing required information as regulatory entities dictate Present cases to committees when necessary Utilize InterQual criteria and apply them to appeals reviews Stay current with the department and AmeriHealth Caritas policies and procedures Familiarize yourself with and comply with federal, state, and local regulations, such as the National Committee Quality Assurance (NCQA) standards related to appeal and grievance operations
Your career starts now. We are looking for the next generation of healthcare leaders. At AmeriHealth Caritas, we are passionate about helping people get care, stay well, and build healthy communities. As one of the nation's leaders in healthcare solutions, we offer our associates the opportunity to impact the lives of millions of people through our national footprint of products, services, and award-winning programs. AmeriHealth Caritas is seeking talented, passionate individuals to join our team. Together, we can build healthier communities. We want to connect with you if you're going to make a difference. Headquartered in Newtown Square, AmeriHealth Caritas is a mission-driven organization with over 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral health services, and other administrative services. Discover more about us at www.amerihealthcaritas.com.
Under the direction of the Long Term Services and Supports (LTSS) Supervisor, the LTSS Reviewer is responsible for completing care and service needs reviews. Using evidence-based LTSS needs assessment knowledge and health care/social services licensure experience, the Reviewer reviews the Service Coordinator and Participant requests for inpatient and outpatient services, working closely with Service Coordinators to collect all information necessary to perform a thorough needs review. It is at the Reviewer’s discretion to request additional information and clarification. The Reviewer will use their professional judgment to evaluate the request to ensure that appropriate services are approved, recognize care and service coordination opportunities, and refer those cases as needed. The Reviewer will apply medical health benefit policy and medical management guidelines to authorize services and appropriately identify and refer requests to the Medical Director when guidelines are unmet. The Reviewer will maintain current knowledge and understanding of the laws, regulations, and policies that pertain to the organizational unit’s business and use clinical judgment in their application.
Education/Experience: Bachelor’s Degree preferred Professional licensure in health care or social services-related field preferred. Registered Nurse is preferred. Three or more years of experience in a related clinical or social services setting Expertise and experience in addressing the needs of the Long Term Services and Support population.
Receives requests for authorization of Long Term Services and Supports available and as defined in the Community HealthChoices Program. Authorization request examples include but are not limited to Personal Assistance Services (PAS), home care (skilled) services, Adult Day services, home-delivered meals, Durable Medical Equipment, and Environmental Modifications. Documents date that the request was received, nature of the request, utilization determination (and events leading up to the determination). Verifies and documents Participant eligibility for services. Communicates and interacts in real time via “live” encounters with providers and appropriate others to facilitate and coordinate the Utilization Management process(es) activities. Utilize technology and resources (systems, telephones, etc.) to support work activities appropriately. Voice mail as an adjunct to the daily work activities versus primary reliance for giving and receiving information from Service Coordinators. Accessing and applying Medical Guidelines for decision-making before Medical Director/Physician Advisor referral. Applies submitted information to the Plan Community HealthChoices (CHC) authorization process (utilizing medical guidelines, Process Standards, Policies and Procedures, and Standard Operating Procedures). Authorizes services by medical and health benefits guidelines. Coordinates with the referral source if insufficient information is unavailable to complete the authorization process. Advises the referral source and requests specific information necessary to complete the process. Documents the request and follows the Plan CHC process for requesting additional information. Refers cases to the Plan Medical Director for medical necessity review when medical information provided does not support the nurse review process for giving approval of services requested. Documents case activities for Utilization determinations and discharge planning enterprise platform systems in real-time (as events occur). Completes the detail line as indicated. Provide verbal denial notification to the requesting Service Coordinator and Participant per policy. Generates denial letters promptly. Adheres to Process Standards, Standard Operating Procedures, and Policies and Procedures as defined by specific UM roles (Prior Authorization, Concurrent Review) Submits appropriate documentation/clinical information in enterprise platform systems, record keeping, and documentation requirements. Recognizes opportunities for referrals to the Service Coordination team and refers accordingly. Participates in quality reviews and interrater reliability processes and achieves performance results at or above thresholds established by management. Maintains awareness and complies with Plan CHC authorization timeliness standards based on DHS/NCQA requirements.
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Required Qualifications: Nursing degree (RN) A minimum of 2–3 years of professional experience as a licensed Registered Nurse (RN), or equivalent clinical experience Strong analytical skills to assess medical claims
This role requires the nurse to exercise clinical judgment and perform the following duties: Review and interpret clinical documentation obtained from medical records or systems. Apply clinical decision-making to utilize appropriate clinical criteria and policies for post-service claims Coordinate clinical resolutions independently, with clinician/MD support as required Act as a resource for customer service and claims processing teams Train new staff and provide cross-training to existing team members Identify trends and provide feedback to leadership if discrepancies or potential fraudulent activities are identified Remain current with applicable laws, regulations, and internal workflows to ensure full compliance with organizational and state-specific requirements
Here at Baylor Scott & White Health we promote the well-being of all individuals, families, and communities. Baylor Scott and White is the largest not-for-profit healthcare system in Texas that empowers you to live well. Our Core Values are: We serve faithfully by doing what's right with a joyful heart. We never settle by constantly striving for better. We are in it together by supporting one another and those we serve. We make an impact by taking initiative and delivering exceptional experience. Benefits Our benefits are designed to help you live well no matter where you are on your journey. For full details on coverage and eligibility, visit the Baylor Scott & White Benefits Hub to explore our offerings, which may include: Immediate eligibility for health and welfare benefits 401(k) savings plan with dollar-for-dollar match up to 5% Tuition Reimbursement PTO accrual beginning Day 1 Note: Benefits may vary based upon position type and/or level.
You, as a Registered Nurse in the Denial Resource Center at Baylor Scott & White Health, manage denials and appeals. Your job is to handle claim denials from all insurance companies, addressing various reasons. SALARY: The pay range for this position is $40.35 (entry-level qualifications) - $62.52 (highly experienced) The specific rate will depend upon the successful candidate’s specific qualifications and prior experience
Key Success Factors: Awareness and knowledge of nursing procedures and patient care standards. Excellent ability in problem-solving and critical thinking. Highly capable of clear communication, both spoken and written. Capability to engage meaningfully with varied groups of people. Ability to carefully observe patients' condition changes and communicate effectively with nursing staff and providers. Belonging Statement We believe that all people should feel welcomed, valued and supported. Qualifications: Associate degree. A minimum of (2) two years of relevant work experience is preferred. Applicants should be registered nurses. Clinical Experience: Five (5) or more years of clinical experience preferred with a strong ability to analyze medical records and support medical necessity.
You receive rejected healthcare claims from financial office or provider. You appeal until resolution following guidelines. Reviewing medical records is important. Verify care levels, admissions, and hospitalizations. Evaluate stay duration and discharge planning. You will contribute to improving processes and protocols by identifying opportunities for enhancement and earnestly participating in their implementation. By closely examining denial trends, you will categorize them based on impacts like diagnosis, type and procedural variations amongst others. You will record denial data and appeal findings in an electronic system. The system helps study denial trends and assess appeal outcomes.
At 24-MAG, we support emerging AI and consulting platforms by sourcing and connecting qualified professionals with remote, contract-based opportunities. Our work focuses on identifying strong talent, guiding candidates through modern application pipelines, and promoting verified roles in AI evaluation, consulting, project management, and tech-enabled work. We collaborate with platforms and companies that operate in the intersection of AI, digital transformation, and expert-driven problem solving. Our aim is to make high-quality opportunities more accessible while helping organisations tap into skilled global talent.
We are sharing a specialised part-time consulting opportunity for experienced Nurses to join an expert network supporting advanced AI research initiatives. This is an open application talent network designed to connect nursing professionals with leading AI labs and companies seeking clinical expertise. Once approved, experts may be invited to participate in projects that help train and evaluate AI systems designed to understand patient care workflows, clinical decision-making, and healthcare documentation
Strong candidates may have experience in: Patient care and clinical monitoring Medication administration and treatment protocols Clinical documentation and patient records Hospital, clinical, or healthcare system nursing roles Candidates should also demonstrate: Strong communication and clinical reasoning skills Practical understanding of healthcare workflows Ability to work independently in remote environments
Experts in this network may contribute to: Evaluating AI systems that simulate clinical workflows and nursing care scenarios Creating tasks based on real-world patient care and clinical situations Designing evaluation frameworks for clinical documentation and care planning Reviewing AI-generated responses related to patient monitoring, medication administration, and care coordination Providing domain expertise to improve AI reasoning in nursing and healthcare settings
At Curana Health, we’re on a mission to radically improve the health, happiness, and dignity of older adults—and we’re looking for passionate people to help us do it. As a national leader in value-based care, we offer senior living communities and skilled nursing facilities a wide range of solutions (including on-site primary care services, Accountable Care Organizations, and Medicare Advantage Special Needs Plans) proven to enhance health outcomes, streamline operations, and create new financial opportunities. Founded in 2021, we’ve grown quickly—now serving 200,000+ seniors in 1,500+ communities across 32 states. Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds, all working together to deliver high-quality, proactive solutions for senior living operators and those they care for. If you’re looking to make a meaningful impact on the senior healthcare landscape, you’re in the right place—and we look forward to working with you. For more information about our company, visit CuranaHealth.com.
Summary: The Care Manager delivers telephonic care management for Curana patients enrolled in a Value-Based Care Program such as but is not limited to Advanced Primary Care Management (APCM) or Chronic Care Management (CCM). These patients often have complex, emerging health risks, or recent care transitions. Working with Curana Providers and the interdisciplinary team, the Care Manager supports quality, cost-effective care.
Qualifications: Exhibits knowledge of pathophysiology and accepted treatment protocols for common health diagnoses (i.e., diabetes, chronic heart failure, chronic obstructive pulmonary disease). Ability to analyze patient records to identify gaps in care and report to the provider. Ability to work in a remote environment that is free of distractions. Proficient computer skills and ability to adapt to various technology platforms. Excellent written communication skills. Demonstrated experience in the usage of clinical data to guide decision making. Must have the ability to function independently and as a member of the interdisciplinary care team. Required Education and Experience: Must hold an active, unrestricted compact LPN license. Ability to obtain additional state licenses, as needed 2+ years of experience in nursing is required. Care settings may include inpatient, outpatient, or skilled nursing facilities. Preferred Education and Experience: Case Management experience CCM certification (strongly preferred) Experience working with Electronic Health Records Travel Requirements: 100% remote position requires a reliable high-speed internet connection.
Patient and Caregiver Support: Review electronic health records (EHR) to identify gaps in care for patients residing in a Long-term Care Nursing Facility. Review and approve initial and ongoing health questionnaires completed by a member of the care management team. Serve as a health coach to educate patients and/or caregivers about their disease process. Develop patient-centered care plans. Educate patients and their durable medical power of attorney (DPOA) on the benefits of APCM or CCM. Provider Support: Support quality gap closure through clinical discovery. Schedule Provider visits for at-risk patients Coordinate with the Transitional Care Manager to schedule patient visits and inform the TCM nurse if a patient is discharged to acute or SNF. Ensure orders, referrals, and prior authorizations are facilitated by the virtual care support team. Escalate abnormal diagnostic test results to Curana providers. Communication Support: Communicate patient health updates to the Curana providers. Communicate treatment plans and health updates to the patient’s caregiver in an effective and caring manner. Primary liaison between the provider and administrative support team. Other duties as assigned
At Curana Health, we’re on a mission to radically improve the health, happiness, and dignity of older adults—and we’re looking for passionate people to help us do it. As a national leader in value-based care, we offer senior living communities and skilled nursing facilities a wide range of solutions (including on-site primary care services, Accountable Care Organizations, and Medicare Advantage Special Needs Plans) proven to enhance health outcomes, streamline operations, and create new financial opportunities. Founded in 2021, we’ve grown quickly—now serving 200,000+ seniors in 1,500+ communities across 32 states. Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds, all working together to deliver high-quality, proactive solutions for senior living operators and those they care for. If you’re looking to make a meaningful impact on the senior healthcare landscape, you’re in the right place—and we look forward to working with you. For more information about our company, visit CuranaHealth.com.
Summary The Care Manager delivers telephonic care management for Curana patients enrolled in a Value-Based Care Program such as but is not limited to Advanced Primary Care Management (APCM) or Chronic Care Management (CCM). These patients often have complex, emerging health risks, or recent care transitions. Working with Curana Providers and the interdisciplinary team, the Care Manager supports quality, cost-effective care.
Qualifications: Exhibits knowledge of pathophysiology and accepted treatment protocols for common health diagnoses (i.e., diabetes, chronic heart failure, chronic obstructive pulmonary disease). Ability to analyze patient records to identify gaps in care and report to the provider. Ability to work in a remote environment that is free of distractions. Proficient computer skills and ability to adapt to various technology platforms. Excellent written communication skills. Demonstrated experience in the usage of clinical data to guide decision making. Must have the ability to function independently and as a member of the interdisciplinary care team. Required Education and Experience: Must hold an active, unrestricted compact LPN license. Ability to obtain additional state licenses, as needed 2+ years of experience in nursing is required. Care settings may include inpatient, outpatient, or skilled nursing facilities. Preferred Education and Experience: Case Management experience CCM certification (strongly preferred) Experience working with Electronic Health Records Travel Requirements: 100% remote position requires a reliable high-speed internet connection.
Patient and Caregiver Support: Review electronic health records (EHR) to identify gaps in care for patients residing in a Long-term Care Nursing Facility. Review and approve initial and ongoing health questionnaires completed by a member of the care management team. Serve as a health coach to educate patients and/or caregivers about their disease process. Develop patient-centered care plans. Educate patients and their durable medical power of attorney (DPOA) on the benefits of APCM or CCM. Provider Support: Support quality gap closure through clinical discovery. Schedule Provider visits for at-risk patients Coordinate with the Transitional Care Manager to schedule patient visits and inform the TCM nurse if a patient is discharged to acute or SNF. Ensure orders, referrals, and prior authorizations are facilitated by the virtual care support team. Escalate abnormal diagnostic test results to Curana providers. Communication Support: Communicate patient health updates to the Curana providers. Communicate treatment plans and health updates to the patient’s caregiver in an effective and caring manner. Primary liaison between the provider and administrative support team. Other duties as assigned
At Curana Health, we’re on a mission to radically improve the health, happiness, and dignity of older adults—and we’re looking for passionate people to help us do it. As a national leader in value-based care, we offer senior living communities and skilled nursing facilities a wide range of solutions (including on-site primary care services, Accountable Care Organizations, and Medicare Advantage Special Needs Plans) proven to enhance health outcomes, streamline operations, and create new financial opportunities. Founded in 2021, we’ve grown quickly—now serving 200,000+ seniors in 1,500+ communities across 32 states. Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds, all working together to deliver high-quality, proactive solutions for senior living operators and those they care for. If you’re looking to make a meaningful impact on the senior healthcare landscape, you’re in the right place—and we look forward to working with you. For more information about our company, visit CuranaHealth.com.
The Care Ally, Case Manager is a key member of the interdisciplinary care team (ICT). They use a collaborative process of assessment, planning, implementing, coordinating, monitoring, and evaluating options and services required to meet the members health and social needs. They act as a liaison between our Members, their Responsible Parties and/or Power of Attorneys (RP/POAs), Advance Plan Provider/PCP, and key Align Senior Care stakeholders. The Care Ally, Case Manager reports to the Supervisor of Case Management.
Education & Experience: One (1) year of clinical practice experience in at least one of the following areas: case management, home health, critical care, medical/surgical, discharge planning, concurrent review, or obstetric/neonatal care. Proficiency using basic computer skills in Microsoft Office such as Word, Excel, and Outlook, including the ability to navigate multiple systems and keyboarding. Case management certification preferred. Professional Certification Or Licenses Registered nurse license, active and unencumbered state license in the state where job duties are performed is required. BSN preferred OR Active Licensed Social Worker (LSW). Bachelor's degree in social work (BSW) required
Executes on strategies and goals set by the Align Senior Care Board of Directors, the Senior Leadership Team, and Executive Director for managing and improving overall Member experience. Contacts Plan members to conduct a comprehensive health assessment of the individual, develop a plan of care, and participate in the facilities interdisciplinary care team meeting. Serves as health coach to educate the member, the family and/or caregiver, about disease status and treatment, plan benefits, community resources, and resource options Collaborates with members of the interdisciplinary care team and medical director(s) to facilitate appropriate treatment for members Routinely follows up with member as scheduled to assess progress towards goals Communicates with the member and/or caregiver to assist with the development of health goals and identify interventions to achieve these goals Provide patient-centered intervention, such as making and verifying appointments, performing medication and care compliance initiatives. Acts as front-line support with Members and their RP/POAs to ensure the needs of the Member are met. Serves as a connection point among Members, their Communities, their Care Team, and Align Senior Care internal departments. Regularly engages Align Senior Care Members and RP/POAs in-person or by phone to provide education and assistance with utilizing Align Senior Care benefits. Including but not limited to. checking on upcoming specialist appointments, connecting members to supplemental benefits and providers, identifying immediate Member needs, and answering any questions the Member or RP/POA may have. Communicates Member health updates from Care Team to RP/POAs. Coordinates with the Care Team for non-urgent health or clinical questions. Works directly with internal departments to solve Member Grievances, Utilization Management, and Billing related issues. Updates Member and RP/POA contact information such as changes of address, email, or phone numbers. Actively supports Account Manager in identifying and securing contracts with "preferred" Providers. Assists Members, RP/POAs, and Partner Communities with locating in-network providers and scheduling/facilitation of appointments. Assists with (on request of member or APP) coordination of home health and therapy visits, ordering of Durable Medical Equipment, and utilization of supplemental benefits for Members. Monitors and, if needed, facilitates care team meetings with facility team, member, responsible partie(s) and the APP/clinical team. Ensures documentation of care team meetings and transmits to Plan. Monitors care plan updates, facilitates APP and PCP input into care plan, and distributes care plan as needed to care team members. Monitors midnight reports/community census to help identify member transitions to hospital or other care levels.
Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges. Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.
Join a collaborative and purpose-driven Inpatient Care Management team dedicated to improving the healthcare experience for physicians and their patients. This role supports hospitalized members through utilization review, care coordination, and discharge planning to ensure patients receive care at the appropriate level and at the right time. The Inpatient Care Manager works closely with physicians, care teams, and Medical Directors to assess, coordinate, and implement care plans across the continuum of care. This position focuses on optimizing patient experience, outcomes, and cost while supporting members during periods when they are most vulnerable. You will build strong relationships with Health Management Operations, Health Value Teams, and provider partners to support the management and coordination of care for hospitalized members at risk.
You Will Be Successful If: You demonstrate strong clinical judgment and critical thinking in utilization review and care coordination. You are committed to patient-centered care and improving patient and provider experience. You communicate effectively with internal teams and external healthcare partners. You build collaborative relationships with physicians and providers to support shared goals and values. You approach challenges with a solutions-oriented mindset and strong problem-solving skills. What You Will Bring: Current unrestricted California RN license required. Minimum of 3 to 5 years of recent acute care, hospital, or related clinical experience. Working knowledge of utilization management standards and medical necessity criteria. Ability to organize, extract, and analyze clinical data from medical records using nationally recognized evidence-based treatment standards. Strong written and verbal communication skills to support patient advocacy, accurate documentation, and care coordination. Ability to develop collaborative relationships with providers and care teams. Bachelor of Science in Nursing preferred. Proficiency with computer systems including EMR and Microsoft Office Suite. Experience with managed care concepts and practices preferred.
Conduct initial and concurrent utilization reviews for hospitalized members using evidence-based criteria and clinical expertise. Coordinate discharge planning and care transitions to ensure appropriate admissions, level of care, and timely discharges. Monitor and evaluate severity of illness, intensity of services, and patient response to treatment. Make recommendations for continued stay, transition to lower levels of care, or tertiary care when appropriate. Collaborate with physicians, care teams, and Medical Directors to support appropriate care coordination. Coordinate member transitions and referrals across the continuum of care. Apply clinical knowledge, critical thinking, and strong decision-making skills to support patient care and care management goals.
Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges. Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.
The Care Manager, LVN supports coordinated member care across the continuum by partnering with internal teams, providers, hospitals, IPAs, and community agencies. This role works under department leadership and collaborates closely with RN Care Managers to ensure members receive appropriate, high-quality care aligned with a mission-driven, patient-centered approach.
You Will Be Successful If: You are passionate about member-centered care and improving health outcomes You thrive in a collaborative, team-based care management environment You demonstrate strong communication and coordination skills across multiple stakeholders You are detail-oriented and able to manage multiple cases effectively You are committed to quality metrics and regulatory standards in managed care What You Will Bring: Active, unrestricted California LVN license High school diploma or GED Minimum three years of care management experience in a healthcare setting At least one year of clinical experience in acute care, skilled nursing, home health, or clinic setting preferred Managed care or HMO experience preferred Valid California driver’s license Ability to meet physical requirements including occasional lifting up to 25 pounds and routine movement such as standing, walking, and reaching
Coordinate care for members by collaborating with providers, medical groups, hospitals, and community resources Support care plan implementation alongside RN Care Managers and interdisciplinary teams Serve as a liaison between members, caregivers, and healthcare entities Ensure continuity of care and appropriate utilization of services Act as a resource for internal and external stakeholders regarding care management processes Contribute to quality improvement initiatives aligned with HEDIS, CAHPS, and NCQA standards
Impresiv Health is a healthcare consulting partner specializing in clinical & operations management, enterprise project management, professional services, and software consulting services. We help our clients increase operational efficiency by delivering innovative solutions to solve their most complex business challenges. Our approach is and has always been simple. First, think and act like the customers who need us, and most importantly, deliver what larger organizations cannot do – provide tangible results that add immediate value, at a rate that cannot be beaten. Your success matters, and we know it.
Work Hours: Candidates must be available to work Pacific Standard Time hours. Description: The Medical Claim Review Nurse provides a variety of services with respect to medical care review, cost containment, claims review, appeals and grievances, and analytical reporting. As part of our Claims Team, the MCR Nurse employs best practices and principles to ensure high-quality and cost-effective assurance standards.
You Will Be Successful If: Excellent communication skills, both verbal and in writing, are critical. Knowledge of principles, practices, and current trends in nursing as well as best practices in quality assurance. Knowledge and application of state and federal laws, statutes, and regulations; excellent analytical skills; ability to work as part of a team and be self-directed; and intermediate knowledge of Word and Excel. Communication qualifications include demonstrated verbal and written communication skills and the ability to present information effectively, tailor presentations to a wide variety of audiences (including executive management), and present complex concepts and recommendations clearly for management decision-making purposes. Ability to comprehend, interpret, and apply Business Rules Management System (BRMS) policies; ability to continually adjust in a dynamic environment; and ability to work as a member of a team. What You Will Bring: 2 years of acute clinical experience Active RN License One year of case management or utilization review experience
Conducts retrospective case reviews for appropriateness/quality of treatment and bills accordingly, as well as medical Provides statistical case reviews and generates utilization reports Examine DRG pre-certification, certification of admissions, and continued stay. Act as a liaison between the Medical and Claims departments regarding medical review issues. Communicate with other departments and personnel to facilitate proper adjudication of claims. Review medical information from various facilities for medical necessity. Maintain medical standards for all clients. Communication with hospitals, physicians, and subscribers regarding certification of hospital admissions and outpatient services. Meets with the Management team about current processes and implementing new processes Develops relationships with physicians, healthcare service providers, and internal and external customers to help improve health outcomes for members. May access and consult with peer clinical reviewers, Medical Directors, and/or delegated clinical reviewers to help ensure medically appropriate, quality, cost-effective care throughout the medical management process. Educates the member about plan benefits and contracted physicians, facilities, and healthcare providers. Refers treatment plans/plan of care to peer clinical reviewers in accordance with established criteria/guidelines and does not issue medical necessity non-certifications. Maintains compliance with regulation changes affecting utilization management. Reviews patients’ records and evaluates patient progress. Documents review information in a computer. Communicates results to the appropriate parties and enters the appropriate billing information for services. Responds to complaints per UR guidelines. Records and reports all information within the scope of authority Performs analytical reporting from a variety of reports, client charts, and other documents, and participates in developing strategies for medical cost containment, maintaining quality of care, and client satisfaction. Develop recommendations for appropriate solutions. Validate and perform quality assurance. Create or revise analytical approaches to reflect current priorities and circumstances. Develop, analyze, and implement project plans. Mobilize project teams. Exercise discretion, tact, and judgment when working with internal and/or external departments Develop plans or proposals that include cost/benefit analysis, policy, and financial, operational, and organizational implications.
Myers and Stauffer LC is a certified public accounting and health and human services consulting firm, specializing in audit, accounting, data management and consulting services to government-sponsored health care programs (primarily state Medicaid agencies, and the federal Center for Medicare & Medicaid Services). We have 45+ years of experience assisting our government clients with complex health care reimbursement and provider compliance issues, operate 21 offices and have over 900 associates nationwide. At Myers and Stauffer, you will have a career that is rewarding while also supporting our state and federal government health and human service clients that focus on those in need. We are committed to providing our employees with professional growth and development opportunities, a diverse, dynamic, challenging work environment, and a strong and visionary leadership team. Our firm takes pride in the welcoming and collaborative culture we have throughout our offices. We are always willing to discuss potential flexibility that an employee may need to better suit their work-life wellbeing.
Bachelor’s degree in Nursing or other related health care field required (Associate’s Degree from accredited nursing school with related experience may be substituted in lieu of a bachelor’s degree) Must be a licensed Registered Nurse (RN) Minimum 3 years of long term care experience required; 5 years preferred MDS experience preferred Experience and knowledge of State and Federal healthcare regulations in long term care Knowledge of Medicaid reimbursement and coverage policies desired Proficient use of applicable software programs, including Microsoft Windows, Word, Excel Strong verbal and written communication skills Ability to manage multiple deadlines and prioritize assignments Ability to work in a team environment Well organized with a high degree of accuracy and attention to detail Must be able to travel based on client and business needs (up to 20% Travel) Minimum Qualifications: High school diploma or GED
Review resident medical records for accuracy, completeness and consistency with professional standards Participate in remote and on-site field examinations of Medicaid providers to review clinical documentation Successfully interact with providers in a professional manner, developing rapport and enhancing business relationships Maintain security of and confidentiality of all Protected Health Information (PHI) Additional responsibilities as assigned
Medasource is a leading consulting and professional services firm supporting organizations across the healthcare ecosystem – including Life Sciences, RCM/Payers, Technology, Government and Nursing & Allied Health. Recognized for our commitment to our employees, consultants, and the communities we serve, we deliver solutions that drive meaningful progress across healthcare. With a nationwide footprint of 33 offices and 1,900+ active consultant placements across 120+ clients who are actively engaging Medasource talent, we continue to expand our impact as we advance the future of healthcare, one client at a time.
Job Title: CDI Nurse Length: 6 month Contract-to-hire Location: Remote Position Summary The Clinical Documentation Special Projects Team Member supports strategic initiatives to improve the quality, accuracy, and compliance of clinical documentation across the organization. This role partners with physicians, CDI teams, coding, and IT to identify documentation gaps, implement process improvements, and enhance overall documentation integrity. Responsibilities include conducting detailed chart reviews, supporting project-based CDI initiatives, and analyzing data to measure performance and guide ongoing improvements. This individual will also provide support during high-volume periods, contribute to education and training efforts, and assist in developing workflows and documentation best practices.
Education (one of the following): RN (BSN, ADN, or diploma) Physician Assistant (PA) RHIT or RHIA (CAHIIM-accredited program) Experience RN/PA: 3+ years in an acute care setting 5+ years CDI experience preferred RHIT/RHIA: 3+ years inpatient coding experience 5+ years CDI experience preferred 6+ years CDI or relevant experience may be considered in lieu of the above Certifications (Required) CCDS or CDIP RN/PA licensure as applicable (state-specific requirements apply) RHIT/RHIA candidates must also hold CCS certification Core Knowledge & Skills Strong knowledge of ICD-10-CM, MS-DRG, APR-DRG methodologies Deep understanding of disease processes, clinical documentation standards, and coding guidelines Experience with CDI query processes and physician engagement Proficiency in EHR systems (Epic preferred), Microsoft Office, and reporting tools Ability to analyze data, identify trends, and drive process improvement Strong communication, collaboration, and education skills Ability to work independently in a fast-paced, remote environment Work Environment: Remote position High-volume, fast-paced setting Extended periods working at a computer
Conduct comprehensive reviews of clinical documentation to identify gaps and improvement opportunities Analyze trends and report on project outcomes, KPIs, and performance metrics Collaborate cross-functionally with providers, coding, CDI leadership, and IT teams Support documentation improvement initiatives and workflow optimization Provide case review support during high-demand periods or special projects Assist with provider and staff education related to documentation, query processes, and compliance Contribute to development of documentation and coding-related policies and procedures Participate in audits, reporting, and continuous improvement initiatives
Cardinal Health is a distributor of pharmaceuticals and specialty products; a supplier of home-health and direct-to-patient products and services; an operator of nuclear pharmacies and manufacturing facilities; a provider of performance and data solutions; and a global manufacturer and distributor of medical and laboratory products. Our company’s customer-centric focus drives continuous improvement and leads to innovative solutions that improve people’s lives every day.
Clinical Operations is responsible for providing clinical specialties support and expertise in the areas of information and consulting, research and patient care to internal business units and external customers. Individualized Care provides care that is planned to meet the particular needs of an individual patient. Job Summary: The Virtual Injection Training Nurse, Individualized Care promotes high-quality patient care and treatment through patient education. With a focus on the products and treatments of a small number of pharmaceutical clients, the Nurse receives inbound calls from patients and schedules outbound calls for patients who have begun treatment with one or more of the client’s products. The Nurse educates patients on their treatments and disease states, refers patients to a variety of additional services, and reports adverse events in accordance with FDA and client requirements. The Nurse also schedules and conducts virtual injection training via Microsoft Teams with enrolled patients and/or caregivers.
Qualifications: Registered Nurse that has no license restrictions required 5 years Medical/Surgical/Other Hospital Unit experience-hospital or clinical preferred Previous pharmaceutical experience preferred Experience with Microsoft Office products Superior communication skills to include verbal and written Must have excellent computer skills and utilize technology for webinars Must be able to work collaboratively; team focused and flexible. Excellent organizational skills What is expected of you and others at this level Apply working knowledge in the application of concepts, principles and technical capabilities to perform varied tasks Work on projects of moderate scope and complexity Identifies possible solutions to a variety of technical problems and takes action to resolve Apply judgment within defined parameters Receive general guidance and may receive more detailed instruction on new projects Work reviewed for sound reasoning and accuracy TRAINING AND WORK SCHEDULES: Your new hire training will take place 8:00am-5:00pm CST, mandatory attendance is required. This position is full-time (40 hours/week) The hours for this position are 11:30am-8:00pm CST. REMOTE DETAILS: You will work remotely, full-time. It will require a dedicated, quiet, private, distraction free environment with access to high-speed internet. We will provide you with the computer, technology and equipment needed to successfully perform your job. You will be responsible for providing high-speed internet. Internet requirements include the following: Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location. Dial-up, satellite, WIFI, Cellular connections are NOT acceptable. Download speed of 15Mbps (megabyte per second) Upload speed of 5Mbps (megabyte per second) Ping Rate Maximum of 30ms (milliseconds) Hardwired to the router Surge protector with Network Line Protection for CAH issued equipment
Educate patients during outbound and inbound calls with patients on the treatments that they are receiving as well as their disease states. Counsel patients on standard treatment information, disease symptoms, potential treatment side effects, and what they should expect during visits to patient care facilities. During initial calls, answers patients’ initial questions regarding their treatment programs and establishes rapport for future conversations. Work closely with consumers, healthcare providers (HCPs), and Sonexus Health reimbursement team. Refers patients to additional services in order to improve their treatment experiences, based on lists of referral organizations approved by each client. Assists patients in accessing services such as alternate funding and support groups by providing information to patients. In accordance with FDA regulations and client requirements, records adverse events for treatments and answers patient questions regarding the events. Completes documentation using the client-preferred reporting system and submits it to the client’s Drug Safety department. Provide identification, intake, documentation and submission of all reported Product Complaints, per the manufacturer guidelines using the client-preferred reporting system and submits it to the client’s Drug Safety department. Effectively manages both scheduled outbound calls and inbound call queue. Meets regularly with Supervisor, Individualized Care and/or Senior Nurse, Individualized Care to discuss feedback from call monitoring and quality reviews of adverse event documentation. Discusses progress on productivity and quality goals including number of calls completed, call quality, document quality, and time requirements. Upon the client’s introduction of new treatments or indications, participates in trainings in order to gain an understanding of the treatments. Responsible for maintaining HIPAA guidelines. Responsible for adhering to program guidelines for appropriate escalation of calls/correspondence to Manager of Clinical Operations. Must adhere to strict guidelines regarding the protection of proprietary educational materials and product information that may be printed or available via email, websites, or other electronic means, provided by the manufacturer.
At ClinNEXUS - we are changing lives through our mission of "Navigating Complexity, Empowering Lives" and growing fast! We're pioneering a transformation in the American healthcare system through proactive community engagement at the grassroots level. Our goal is to forge social connections, enhance clinical outcomes, and lower healthcare expenses for our patients. How we do this is by being proactive via individualized patient assessments, which ensures we are fully equipped to address every patient and their unique needs. To learn more about our innovative solutions and how we're simplifying healthcare, visit our website at https://clinnexus.com
In partnership with health plans and clinical providers, the ClinNEXUS Enhanced Care Management (ECM) Registered Nurse works to build relationships with people experiencing homelessness and/or multiple chronic health conditions. The ECM Registered Nurse will be responsible for review of patient care plans, addressing the patient’s medical and behavioral health needs, with such review focused on identifying appropriate clinical services to be provided to individuals by third-party providers. The ECM Registered Nurse will not be responsible for providing clinical services directly to an individual. In addition, the ECM Registered Nurse provides advocacy, and assists with connection to health services, housing, and other social services. The ECM Registered Nurse employs health coaching techniques to foster patient engagement, patient education, coaching, and access to and care navigation of systems to improve health outcomes. The ECM Registered Nurse will primarily interact with individuals via remote teleconferencing technologies and may also interact in-person. The ECM Registered Nurse demonstrates deep cultural competency, leans into patients’ diverse beliefs, values, and social norms, and ensures care is provided in a culturally and linguistically appropriate manner to meet the needs of all patients served.
Valid Registered Nurse (RN) license in California. CPR certification (American Heart Association or Red Cross). Knowledge of medical terminology and medications. Ability to work independently with minimal supervision. Excellent verbal and written communication (in English), negotiation, and relationship-building skills. Self-driven, motivated and highly empathetic. Resilience to deal with various situations. High level of empathy and ability to engage with people with various backgrounds. A technical aptitude with strong analytical, critical thinking, and reporting abilities. Ability to effectively interact and build collaborative relationships with community agencies, members, and clinical personnel. Valid California driver’s license, reliable personal transportation, proof of insurance, and a driving record in good standing. Proficiency in utilizing electronic health records and related software, as well as computer, technology platforms including documentation systems, data reporting tools, and virtual communication platforms (e.g., Google Workplace Suite, HealthCloud for SalesForce, Smartsheet) to conduct administrative duties, keep track of health records, research, and professional networking. Meet and maintain credentialing requirements with contracted healthcare partners, including background screening, drug testing, FACIS (Fraud and Abuse Control Information System) checks, ID or licensure verification, and ability to produce applicable vaccination or immunization records or declinations, in order to access partner systems or facilities. Working Conditions/Physical Requirements: Ability to work remotely, with reliable internet access. Frequent use of computers, phones, video conference tools and related office equipment. Requires high manual dexterity and prolonged, extensive standing, sitting, walking, and lifting. Adequate hearing and clear speech for in-person or telephone communication. Speak clearly to communicate information to members and staff. Vision suitable for reading various documents, including memos, screens, and forms. Ability to reach above the shoulder level to work. Ability to bend, squat and sit, stand, stoop, crouch, reach, kneel, twist/turn, etc. Regular independent travel for home visits and community-based meetings. Occasionally subjected to irregular hours. May be exposed to infections and contagious diseases Nice to haves: Bachelor of Science in Nursing. Knowledge of the local community where providing service and residency in the service-area. Experience working in care management. Strong verbal and written ability in English and Spanish, Hmong or Punjabi preferred.
Showcase exemplary communication, and organizational prowess to cultivate a vibrant and positive work atmosphere. Assist the Enhanced Care Management (ECM) team regarding members’ physical and medical needs. Participate in the review of and support of member-centered care plans for enrollees. Assist in identifying health care resources that focus on general health conditions, treatments, and interventions specific to each individual's health needs and consistent with standards of care. Monitor individualized care plans and support members to comprehend care plans and instructions, motivating them to actively engage in their health journey. Diligently monitor services to ensure adherence to care plan goals. Actively consult with Care Managers to review medical visit summaries, discharge papers, prepare for upcoming appointments, or review appointment outcomes to help ensure enrollees are being positioned to receive appropriate clinical and social services from third-parties with whom ClinNEXUS works. Assist Care Managers to implement health and preventive care education for acute health conditions, chronic disease management, and medication monitoring techniques. Engage vulnerable populations as part of a multidisciplinary outreach team, including home visits, accompaniment to appointments, outreach to hospitals, homeless shelters and other settings, as needed. Help address Social Determinants of Health and enhance connections to community-based organizations. Work with the ECM team to be aware of and understand hospital admission/ discharge plans with the behavioral health clinician, PCP, pertinent specialists, and other organizations with the goal of preventing readmissions, if possible. Coordinate medication review and reconciliation following transitions in care. Assist the ECM team to implement prevention and engagement activities. Engage in quality improvement efforts for ECM team operations. Assess the needs of patients with the ECM team, identifying social determinants of health and recommending appropriate follow-up and community connections. Coordinate identification of needed member care activities by third parties, through implementation of home visits and offering culturally sensitive support for effective medical care and behavioral change within the team. Assist members in accessing resources, including appointment scheduling and navigating program applications. Foster positive relationships with team members, patients, providers, and community representatives to enhance teamwork and service excellence. Provide exceptional service to all stakeholders, ensuring culturally and appropriate care, attending meetings as necessary, and upholding established policies and procedures. Other duties and projects as assigned.
Medasource is a leading consulting and professional services firm supporting organizations across the healthcare ecosystem – including Life Sciences, RCM/Payers, Technology, Government and Nursing & Allied Health. Recognized for our commitment to our employees, consultants, and the communities we serve, we deliver solutions that drive meaningful progress across healthcare. With a nationwide footprint of 33 offices and 1,900+ active consultant placements across 120+ clients who are actively engaging Medasource talent, we continue to expand our impact as we advance the future of healthcare, one client at a time.
The Clinical Documentation Improvement (CDI) Nurse is responsible for ensuring the accuracy, completeness, and integrity of patient medical records. This role partners closely with physicians, coding teams, and clinical staff to improve documentation quality, support accurate code assignment, and ensure the medical record reflects the true severity of illness and level of care delivered. The CDI Nurse plays a critical role in optimizing reimbursement, supporting regulatory compliance, and enhancing quality reporting initiatives.
Qualifications: Active Registered Nurse (RN) license required 2+ years of acute care clinical experience (ICU, Med-Surg, or Emergency Department preferred) Prior CDI experience preferred but not required Strong understanding of clinical disease processes and medical terminology Knowledge of coding guidelines, including ICD-10-CM and DRG methodologies preferred Experience working with electronic health records (EHRs) Strong analytical, communication, and critical thinking skills Preferred Certifications: CCDS (Certified Clinical Documentation Specialist) CDIP (Certified Documentation Improvement Practitioner) Work Environment: Remote or onsite opportunities available depending on client needs Standard business hours with flexibility based on provider availability Compensation: Hourly Pay: $46–$52/hour Conversion Salary: Approximately $100,000 annually upon full-time hire Opportunity for contract-to-hire placement with long-term growth potential
Review inpatient medical records to assess documentation accuracy, completeness, and clinical specificity Identify documentation gaps, inconsistencies, and opportunities for clarification Issue compliant queries to providers to obtain additional specificity regarding diagnoses and procedures Ensure documentation supports appropriate assignment of ICD-10-CM/PCS codes and Diagnosis Related Groups (DRGs) Collaborate with coding teams to validate clinical documentation and resolve discrepancies Monitor and impact key performance indicators such as Case Mix Index (CMI), severity of illness (SOI), and risk of mortality (ROM) Educate providers and clinical staff on documentation best practices and regulatory requirements Maintain compliance with organizational policies, CMS guidelines, and industry standards
PHI Health is the leading air ambulance provider in the United States. With an unmatched safety record and the best aviation, medical and communication specialists in the field, we set the standard in the air medical industry. We transport more than 22,000 patients each year from our more than 80 bases across the country, all while offering services and outreach education to local communities and leading healthcare systems. Our mission is simple: move communities to health while maintaining the highest standard of safety, period.
Are you ready to elevate your career to new heights? PHI Health is looking for dynamic, driven individuals to join our team. We are committed to providing top-tier emergency medical services with unmatched speed and efficiency, saving lives when every second counts. By supporting our mission from the ground, you will play a crucial role in orchestrating the seamless operations that keep our advanced fleet soaring and our patients safe. With PHI Health you’ll collaborate with the best minds in the industry, driving initiatives that enhance our services and expand our reach to those who need it most. If you're passionate about making a difference and thrive on challenges, PHI Health offers an extraordinary opportunity to impact lives and develop your professional career in a meaningful way. Job Summary: Performing under the direct supervision of the Manager, National Clinical Educational Standards and indirectly to the designated Director, this position is responsible for the coordination and delivery of clinical education programs for internal personnel, as well as general support of community outreach educational programs.
Requires at least 1 and preferably 3 years flight experience and current licensure (RN or EMT-P or RRT) Bachelor's degree preferred Current specialty certification preferred (CFRN, FP-C, RRT), otherwise must complete within 24 months of hire Certified instructor in ITLS, ACLS, BLS, PALS, NRP strongly preferred Must possess good writing, speaking, and interpersonal communication skills Leadership skills and ability to relate to clinical (EMS) staff are essential Must be computer literate with above average software proficiency Must be able to pass a pre-placement drug test and background screen This position is designated Safety Sensitive for purposes of Arizona Medical Marijuana Act Schedule/Location: 5&2 Must reside in Arizona up to 75% travel required
Responsible for ensuring the coordination and delivery of required educational programs for both new hires and existing personnel Maintains active involvement in program wide EMS activities Performs audits and verifies employee educational requirement completion and documentation (travel required) Assists management with interviews and evaluations of potential New Hires Works Closely with Program Medical Director(s) and CQI Committee for involvement in case review sessions and ad hoc presentations as needed Maintains requirements for active flight status and may periodically function as primary fight crew member and/or third-party observer if applicable
PHI Health is the leading air ambulance provider in the United States. With an unmatched safety record and the best aviation, medical and communication specialists in the field, we set the standard in the air medical industry. We transport more than 22,000 patients each year from our more than 80 bases across the country, all while offering services and outreach education to local communities and leading healthcare systems. Our mission is simple: move communities to health while maintaining the highest standard of safety, period.
We are on the lookout for passionate Flight Nurses to join our elite crew! If you 've ever dreamt of making a real impact and being part of a life-saving mission, now is your chance! We are looking for talented nurses to join our team of dedicated professionals. Join us in saving lives! As a Flight Clinician with PHI Health, you'll be at the forefront of critical care, providing rapid response and advanced medical assistance to those in need. We need heroes like you to ensure swift and effective medical transport, especially in emergencies. Job Summary: Under the direction and supervision of the Base Medical Supervisor or the Manager of Business Operations as applicable, this position is responsible for providing safe, comprehensive care to critically ill and/or injured patients of all ages. Care is provided in the pre-hospital setting and during inter-facility transports by understanding and applying the specialized principles and techniques of flight nursing or if dual certified flight paramedic practice, emergency procedures and diagnostics.
Must have an active RN Compact license Must be able to obtain RN California license Minimum of three years (five years preferred) of current critical care/emergency experience. Current BLS, ACLS, PALS, and TNATC, TNCC, ITLS, or PHTLS. NRP preferred. Instructor certifications preferred. CFRN within twenty-four months of hire. Flight or transport experience preferred. Must successfully complete the PHI Air Medical Group education/orientation program. Effective human relations skills required for interfacing with all levels of personnel and external customers. Must meet and maintain clinical personnel weight restriction limit for flight according to policy. Must possess basic computer skills for e-mail, electronic charting, etc. Must maintain body weight below 235 lbs Must be able to pass pre-placement physical exam including functional capacity exam (strength and flexibility assessment, lift up to 100 pounds) and drug screening Schedule/Location: 7&7 or 15&13 Various Locations as needed
Performs a wide range of specialized functions and complex assessments, diagnoses, therapies and emergency treatment of patients transported by rotor-wing and/or fixed wing and/or ground. Documents appropriate and accurate information for assessment and treatment during stabilization and transport. Documents accurate and complete billing information of patient transports. Maintains and facilitates effective and timely communication between management, internal and external customers. Participates in activities to support PR and marketing efforts. Maintains knowledge base for flight nursing role by attending mandatory meetings, chart reviews, equipment reviews, skill labs, clinical rotations, and continuing education sessions related to the care and transport of critically ill and/or injured patients. Completes all annual recurrent competency requirements. Maintains an active RN license and all certifications required by policy. Clinically functions under the direction of the program's Medical Director through medical protocols and procedures and online medical guidance. For clinical matters, reports directly to the program's Manager of Clinical Services and indirectly to the National Director of Clinical Standards.
Join us in shaping the future of emergency nursing! We are dedicated to our mission of advancing excellence and innovation through research, education, resources, advocacy, and collaboration. Our vision is a world where every emergency nurse is empowered and supported to deliver the highest quality patient care. If you're passionate about making a difference, growing professionally, and being part of a dynamic, supportive team, we invite you to join us in this exciting journey of care and progress.
This position offers a hybrid work arrangement for local candidates or the option to work fully remotely for those based outside of the Chicago area. GENERAL SUMMARY: The Nursing Content Specialist is responsible for the content of educational products to ensure clinical accuracy, relevance to emergency nursing practice, and consistency among ENA educational offerings. This role focuses on creating education content for and requires consistent pulse and knowledge of current environment, literature and evidence. There will be a high level of collaboration with colleagues across various divisions.
Required: RN, BSN required. Registered nurse; minimum of 7-10 years of recent experience working as an emergency nurse and/or nurse educator TNCC Course Director status, Faculty preferred Writing experience to support evidence-based practice Desired: Highly desired master’s degree in nursing with a relevant clinical focus Specialty nursing certification Nurse Professional Development Board Certification ENPC Course Director or Faculty status Clinical or research publication experience Note: Along with your application please submit a writing sample that demonstrates mastery of academic writing and/or curriculum development related to emergency nursing with the appropriate supporting references. KNOWLEDGE, SKILLS, AND ABILITIES: Excellent writing skills, with the ability to translate complex emergency nursing concepts into clear, concise, and testable exam content. Exceptional collaborative communication and interpersonal skills Team oriented and able to work independently Effective organizational, analytical, and critical thinking skills Ability to exercise a high level of discretion, creativity, and independent judgment Ability to assimilate and role model the association’s collaborative culture Ability to prioritize multiple and varied tasks within established deadlines and tight timelines Computer proficiency in Microsoft Office Strong attention to detail with a commitment to quality Ability to interface with staff and external relationships in a timely, professional manner with excellent customer service abilities PHYSICAL DEMANDS: Nature of work requires an ability to operate standard business office equipment. Requires ability to communicate verbally and in writing in an exchange of information; collect, compile and prepare work documents; set-up and maintain work files, participate in meetings. Use of the computer, with repetitive motion, is approximately 80% of the time. WORKING CONDITIONS: Majority of work is performed in a general office environment. Periodic travel will be required.
Ensures that educational product content is clinically accurate, evidence-based, and consistent with current practice and other ENA educational offerings, including understanding specific practice needs/gaps and understanding current evidence. Accountable for the specific program educational content at all different stages of development, from product concept to content development, exam item writing, product delivery, product evaluation, and revision. Responsible as the nurse planner for educational design process in accordance with American Nurses Credentialing Center (ANCC) criteria for accredited education as nurse planner by demonstrating ongoing education to ensure awareness and capability to deliver on ANCC criteria. Reviews and develops educational products based on the educational needs assessment, professional gap identification, stakeholder feedback, market research, and related market information. Serves as a staff liaison to committees and work groups responsible for the development or revision of educational products. Source and manage SMEs to ensure quality content development, providing support through content reviews, revisions and at times, re-writes. Collaborates with key stakeholders across ENA departments including digital learning, program specialist, product management, content specialist peers, course management, marketing and communication as products are considered for development and revision. Contributes to the workplace culture that is consistent with the association’s culture statement and emphasizes the mission, vision, and values of the organization. Displays a high level of accountability, taking responsibility for individual actions and the impact on the organization. Views oneself as a reflection of the organization by following through on commitments and accepting ownership. Performs additional related duties as required or assigned.
This position is posted by Jobgether on behalf of a partner company. We are currently looking for a Team Lead, Registered Nurse, Expert Medical Opinion in United States. This role offers a unique opportunity to lead a dynamic telehealth nursing team while directly impacting the quality of patient care. You will balance clinical responsibilities with operational oversight, guiding nurses in delivering member-centric care and ensuring adherence to standards and protocols. The position emphasizes mentorship, coaching, and cross-functional collaboration, allowing you to influence both team performance and organizational processes. You will manage workflows, monitor quality metrics, and provide support for new initiatives while fostering a positive and professional work environment. This is a chance to combine clinical expertise, leadership, and strategic thinking to enhance healthcare delivery across a remote care platform.
Candidates should have: BSN or RN with a bachelor’s degree and a minimum of 5 years of clinical experience, or AAS/ADN with 7+ years of clinical experience. At least 1 year of telephonic nursing experience and a current/valid RN license. Proven experience leading a nursing team, with strong organizational and multitasking skills. Proficiency with EMR systems and other professional technology platforms. Excellent communication and interpersonal skills, with empathy and adaptability in a fast-paced healthcare environment. Commitment to continuing education and professional development. Preferred: 2-3 years of direct patient care or case management, Certified Case Manager (CCM) certification or willingness to obtain within a year, and experience with utilization management, triage, managed care, or discharge planning. RN license with compact licensure is a plus.
As the Team Lead, Registered Nurse, you will: Provide first-line support and guidance to telehealth nursing staff, serving as a culture and change champion. Manage a caseload while delivering high-quality, member-centric care. Identify gaps and barriers in care or processes and partner with leadership to implement solutions. Act as a subject matter expert for interdisciplinary teams and cross-functional stakeholders. Onboard, coach, and mentor new team members to ensure adherence to standards and operational excellence. Utilize metrics and data to inform daily activities, guide decision-making, and drive performance improvements. Communicate effectively with internal and external stakeholders, ensuring alignment and collaboration.
Cardinal Health Sonexus™ Access and Patient Support helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain on the therapy they need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in-class solutions—driving brand and patient markers of success. We’re continuously integrating advanced and emerging technologies to streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas, Texas, empowering manufacturers to rethink the reach and impact of their products. Together, we can get life-changing therapies to patients who need them—faster.
Clinical Operations is responsible for providing clinical specialties support and expertise in the areas of advice and consulting, research and patient care to internal business units and external customers. Individualized Care provides care that is planned to meet the particular needs of an individual patient. Job Summary: The Nurse, Individualized Care promotes high-quality patient care and treatment through patient education. The Nurse Care Manager (NCM) will play a critical role in supporting identified cohorts of oncology patients across their continuum of care. This role coordinates comprehensive care, proactively monitors patient progress, and delivers continuous, personalized support between provider visits within a virtual environment. Focusing on management of side effects where applicable and improving the quality of care for cancer patients, the NCM drives patient engagement in their health and wellness through remote care planning and management. Utilizing telehealth platforms, the NCM may also facilitate transitions from acute care to home, ensuring continuity of care and optimal resource utilization through close collaboration with the interdisciplinary oncology team.
Qualifications: Registered Nurse with a current, unrestricted Florida or multistate Compact license 5 years’ experience-hospital or clinical, involving patients with complex chronic disease states preferred Care Management experience is strongly preferred Oncology patient experience a plus Strong working knowledge and basic medical management of chronic disease states Experience with Microsoft Office products Basic computer skills including previous work with an electronic health record (EHR) and Excel spreadsheets Superior communication skills to include verbal and written Must be able to work collaboratively; team focused Excellent organizational skills Bilingual skills a plus All U.S. residents are eligible to apply to this position. You will work remotely, full-time. It will require a dedicated, quiet, private, distraction free environment with access to high-speed internet. We will provide you with the computer, technology and equipment needed to successfully perform your job. You will be responsible for providing high-speed internet. Internet requirements include the following: Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location. Dial-up, satellite, WIFI, Cellular connections are NOT acceptable. Download speed of 15Mbps (megabyte per second) Upload speed of 5Mbps (megabyte per second) Ping Rate Maximum of 30ms (milliseconds) Hardwired to the router Surge protector with Network Line Protection for CAH issued equipment
Collaborate with health care staff responsible for patient care to develop, implement, monitor and evaluate appropriate clinical care or other services to meet the needs of patients and coordinate all activities related to care management. Ensure that areas of responsibility are operating in compliance, including documentation and records with all federal, state, and regulatory agencies. Document all encounters and activities in the designated system accurately and in a timely manner Participate in interdisciplinary case conferences and team huddles to ensure coordinated care as needed With the oncology care team and internal care management team, identify patients to be case managed, assess patient’s care requirements, modify or coordinate modification of patient care and intervene, as necessary Participate in the development and review of clinical pathway trends and share with appropriate service and management teams Assist in quality improvement activities by identifying trends, barriers, and opportunities to improve program outcomes Attend meetings, seminars, and conferences as appropriate Principal and Chronic Care Management Telephonically manage patient care, through the following methods: Review of the patient’s medical, functional, and psychosocial needs Medication reconciliation with review for adherence Reinforce disease self-management education and symptom management Communicate provider instructions and advice, and provide patient education materials Referral to and coordination with community service organizations and make and/or specialist appointments and schedule other tests, treatments or procedures as needed Facilitating patient follow-up visits with acute or chronic needs Documents all concerns and follow-up and escalates to the onsite Clinical Team, or oncology provider when appropriate Provide coaching and health promotion to encourage self-management and adherence to care plans Collaborate with onsite clinical staff to order supplies for patients as needed (e.g., blood pressure machines, remote patient monitoring medical supplies) Track and report on member progress, escalating complex cases to provider, the onsite clinical team or program leadership as needed Transitional Care Management: Attempt outreach to TCM members on the caseload via phone call as needed to support onsite TCM programs. Assist with discharge planning: assess needs; help coordinate medication reconciliation; schedule TCM (Post -Acute) face-to- face visit with provider Triage patient needs and identify necessary plan of action within such as scheduling an appointment, triaging for a provider or directing the patient to the ER, etc. as needed. Bridge gaps between the onsite clinical team and the community, and ensuring patients fully understand their discharge instructions and follow-up care Meets regularly with management team to discuss feedback from call monitoring and quality reviews. Discusses progress on productivity and quality goals. Responsible for maintaining HIPAA guidelines
Compensation: $85,000 – $92,000 Hourly Equivalent: ~$41–$44/hr Location: Remote Schedule: Must work AZ hours (typically 1st shift) CLIENT NOTES / EXPECTATIONS Client anticipates multiple hires (approx. 5 roles) Requesting top 7 qualified candidates for initial interview slate Candidates must meet required AND preferred qualifications Speed is critical ? need strong pipeline immediately Target to present candidates early next week Internal recruiter support will be assigned on client side PRIORITY DEADLINE Submit Top 7 Candidates By EOD Monday (12/30/26) APPROVED WORK STATES (RECRUITING GUIDELINES) AK, AR, AZ, CO, DC, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NC, ND, NE, NM, NV, OK, OR, SC, SD, TN, TX, UT, VA, WA, WI, WY Only source candidates in these states
Required Qualifications (must Have): Active, unrestricted license: RN OR LCSW Minimum 3+ years clinical experience (med/surg and/or behavioral health) Strong clinical documentation + writing ability U.S. Citizenship required Must be eligible for DoD background clearance Preferred Qualifications (highly Desired): Clinical Quality / Utilization Review / Case Review experience Experience with federal or government healthcare programs InterQual or similar clinical criteria tools Data analysis / reporting exposure Bachelor’s degree in Nursing or healthcare-related field IDEAL CANDIDATE PROFILE: Clinical reviewer / utilization review nurse Experience with health plans or large healthcare systems Strong analytical + writing skills
Review medical records for quality, safety, and utilization issues Identify Potential Quality Issues (PQIs) Write detailed case summaries + recommendations Support peer review + quality improvement initiatives Collaborate with Medical Directors Analyze trends and recommend improvements Ensure compliance with regulatory and program standards
Horizon Blue Cross Blue Shield of New Jersey empowers our members to achieve their best health. For over 90 years, we have been New Jersey’s health solutions leader driving innovations that improve health care quality, affordability, and member experience. Our members are our neighbors, our friends, and our families. It is this understanding that drives us to better serve and care for the 3.5 million people who place their trust in us. We pride ourselves on our best-in-class employees and strive to maintain an innovative and inclusive environment that allows them to thrive. When our employees bring their best and succeed, the Company succeeds.
This position is responsible for performing RN duties for the Primary Nurse population using established guidelines to ensure appropriate level of care, as well as, planning for the transition to the continuum of care and developing a member centric plan of care. Primary Nurses will outreach to high risk members and will work to engage members in preventative care opportunities & screenings when possible. This position will perform duties and types of care management as assigned by management. Serves as a mentor/trainer to new RN's and other staff as needed. Positions involving ASO accounts may require some travel for on-site availability.
What You Bring: High School Diploma/GED required. Bachelor degree preferred or relevant experience in lieu of degree. Requires a minimum of two (2) years clinical experience. Experience with both acute and chronic conditions preferred. Requires a minimum of three (3) years' experience in the health care delivery system/industry. Experience with health care payer experience strongly preferred. Additional Licensing, Certifications, Registrations Active Unrestricted RN License Required; NJ License required and/or Compact License. Requires a valid Driver's License and Insurance. Knowledge: Requires proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, and PowerPoint) and Microsoft Outlook. Prefers knowledge in the use of intranet and internet applications. Requires working knowledge of case/care/disease management principles. Requires working knowledge of operations of utilization, case and/or disease management processes. Requires working knowledge of principles of utilization management. Requires basic knowledge of health care contracts and benefit eligibility requirements. Requires knowledge of hospital structures and payment systems. Prefers understanding of fiscal accountability and its impact on the utilization of resources, proceeding to self-care outcomes. Skills And Abilities Bi-lingual proficiency preferred. Adaptability/Flexibility. Analytical. Compassion. Information/Knowledge Sharing. Interpersonal & Client Relationship. Sound decision making. Active listening. Organization Planning/Priority Setting. Problem Solving/Critical Thinking. Team Player. Time Management. Written/Oral Communications. Travel Travel primarily within State of NJ may be required. Occasional travel in the tri-state area may also be required.
Assesses member's clinical need against established guidelines and/or standards to ensure that the services provided are medically appropriate to member's needs and aligned with the benefit structure. Facilitates response to gaps in care and identified high risk members to appropriate settings of care for annual wellness visits including collaboration with treating provider. Evaluates the necessity, appropriateness and efficiency of medical services and procedures provided for both acute and chronic health care needs. Develops, coordinates and assists in implementation of individualized plan of care for members and identification of barriers towards Self-Management and optimal wellness. Coordinates with members, family, physician, hospital and other external customers with respect to the appropriateness of care from diagnosis to outcome. Coordinates the delivery of high quality, cost-effective care supported by clinical practice guidelines established by the plan addressing the entire continuum of care including transitional care. Monitors member's medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness. Advocates for the member/family among various sites to coordinate resource utilization and evaluation of services provided. Encourages member participation and compliance in the case/disease management program efforts. Documents accurately and comprehensively based on the standards of practice and current organization policies. Interacts and communicates with multidisciplinary teams either telephonically and/or in person striving for continuity and efficiency as the member is managed along the continuum of care. Evaluates care by problem solving, analyzing variances and participating in the quality improvement program to enhance member outcomes. Serves as mentor/trainer to new RN's and other staff as needed Presents clinical cases during audits conducted by external review organizations. Performs other duties as assigned by management.
Maximus partners with the State of Tennessee to conduct Preadmission Screening and Resident Review (PASRR)—a federally mandated process designed to determine whether a nursing facility is the appropriate level of care; identify individuals with mental illness, intellectual disabilities, or developmental disabilities and help connect individuals with the services and supports they need.
Maximus is hiring a Clinical Reviewer, RN or LPN to support our PASRR program for the State of Tennessee. In this role, you will review clinical documentation and requests submitted by individuals and/or providers to determine appropriate level of care and prior authorization needs. You will also review Level I PASRR screenings, evaluate completed assessments, and determine when a Level II comprehensive PASRR evaluation is required. This position plays a key role in ensuring accurate, timely, and compliant clinical determinations for individuals applying to or residing in Medicaid‑certified nursing homes.
Minimum Requirements: Education and licensure requirements are based on program contract requirements and are outlined in job posting High School Degree or equivalent required Minimum 2 years of clinical experience required An active unrestricted Registered Nurse (RN) or Licensed Practical Nurse (LPN) license valid in Tennessee state or a compact nursing license with Tennessee privileges. Minimum of two (2) years of clinical experience in a Registered Nurse (RN) or Licensed Practical Nurse (LPN) position. Proficiency in Microsoft Office Suite (Word, Outlook, Excel), Adobe Strong clinical assessment, critical thinking, documentation skills, and the ability to apply clinical judgment accurately in a fast‑paced environment. Strong written and verbal communication skills. Preferred Requirements: Experience navigating and documenting clinical reviews within utilization management or authorization database platforms (e.g., Legacy AMI or similar systems) Proficiency with electronic medical records and clinical documentation systems Prior utilization review, care management, or clinical review experience Candidates who reside in Tennessee state Home Office Requirements Maximus provides company-issued computer equipment Reliable high-speed internet service Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity Minimum 5 Mpbs upload speeds Private and secure workspace
Review requests for services including admission, discharges and continued stays for adherence to clinical criteria, state and federal policy, and related requirements. Issue approvals, denials or recommendations based on contract requirements. Identify need for additional clinical documentation or consultation. Complete documentation of activities within contract systems. Communicate with providers, individuals and their designees, or state workers as required. Performs other related duties as assigned.
Built around a mission to improve the lives of nurses and patients, IntellaTriage has been providing after-hours nurse triage for hospice and home health providers since 2008. Utilizing best-in-class technology, IntellaTriage provides round-the-clock direct access to licensed, registered nurses using client-customized protocols for patient-centered, compassionate care. We are growing rapidly and excited to support our clients’ nursing staff in the field by leveraging our remote team of nurses to manage after-hours care delivery. Our triage nurses become an extension of our clients’ care team, and they trust us to support them and their patients during their non-core hours.
We are seeking a compassionate registered nurse (RN) to join our growing team! In this role, you will provide critical after-hours support, triaging hospice patients and family needs over the phone wit professionalism and empathy. You will help ensure timely interventions and coordination of care for patients receiving hospice services.
Active multistate Registered Nurse (RN) license Hospice, palliative, or end-of-life care is strongly preferred Must be comfortable with technology and electronic medical records (EMR) utilized for documentation of calls Ability and comfort with typing documentation and notes in a fast-paced environment Must be able to handle stress and multitask when receiving calls (minimum of 5 calls per hour on weekdays, and up to 8 per hour on weekends) Strong communication and critical thinking skills Ability to work independently in a remote environment This is a remote position that requires consistent attendance, active communication, and reliable internet connectivity during all scheduled shifts to support timely patient care coordination
Provide telephone triage for hospice patients and families Assess patient conditions and determine appropriate next steps Collaborate with on-call teams to coordinate care and resources Accurately document all communications and interventions Maintain a calm and professional demeanor while handling urgent calls.
CircleLink is a digital healthcare company that improves health for the chronically ill by engaging patients through personal phone calls and/or mobile technology, helping to solve the ~$600 billion problem of preventable chronic complications. Our patient engagement software and services enable physicians to monitor and manage their patients’ chronic conditions between office visits without investing in additional staff or technology.
CircleLink Health® is a company of passionate clinicians, technologists and business people tackling the $600B problem of preventable chronic condition complications. Our mission is to accelerate the shift to preventative care (from status quo reactive care) through our world-class preventative care platform. As a Care Coach you will work remotely for 20-25 hours per week with a team to manage patients with chronic conditions enrolled in Medicare’s Chronic Care Management program.
Required Skills and Abilities: Fluent in English. Meet communication skills, must be self-directed, able to work independently with little supervision while meeting performance metrics for case completion Strong passion for nursing of Medicare patients Strong communication: all messages and emails from staff must be acknowledged and responded to within 24–48 hours. Your caseload will consist of at least 40 patients but could be more. Excellent organizational and time management skills. Strong critical thinking and problem-solving skills. Commitment to work 20-25 hours, 3 days a week. Availability to make calls between 9-6 pm, EST. LPN needs a STRONG internet-connected computer. CLHealth does NOT provide computers. Required Education And Experience: Current, unrestricted Compact LPN license--please visit www.nursys.com to find your license # and state Proficiency with electronic health records and web-based applications At least 5+ years' experience as a Licensed Practical Nurse Preferred Education And Experience, But Not Required Case Management or Chronic Disease Management experience Case Management Certification Certified Diabetes Educator Transitional Care Management experience Experience with Motivational Interviewing or other behavior change communication techniques
Educating patients on self-management skills and goal setting. Chronic conditions include: Diabetes, CHF, COPD/Asthma, Hypertension, CAD, Ischemic Heart Disease, Anxiety, Depression, etc. Implement and improve the Plan of Care by updating medications, appointments due, record biometrics, vital signs, and care coaching provided. Utilize Motivational Interviewing or other behavior change techniques to coach and assist the patient with self-management. Conduct Transitional Care Management activities to high risk patients discharged from the hospital and the ER to reduce unnecessary readmissions, including medication reconciliation, medication adherence, identify red flags, address barriers, encourage follow-up care, how and when to seek appropriate level of care. Reduce care gaps by encouraging or assisting with preventive care, and chronic care management, i.e. annual well visits, follow up visits, medication management, pre-visit labs, diagnostic tests due, preventive cancer screens. Connect the patient with community resources as needed, including transportation, personal care needs, homemaker or chore services, social services, etc.
Mercy, one of the 15 largest U.S. health systems and named the top large system in the U.S. for excellent patient experience by NRC Health, serves millions annually with nationally recognized care and one of the nation’s largest and highest performing Accountable Care Organizations in quality and cost. Mercy is a highly integrated, multi-state health care system including 55 acute care and specialty (heart, children’s, orthopedic and rehab) hospitals, convenient and urgent care locations, imaging centers and pharmacies. Mercy has over 1,000 physician practice locations and outpatient facilities, more than 5,000 physicians and advanced practitioners and more than 50,000 caregivers serving patients and families across Arkansas, Illinois, Kansas, Missouri and Oklahoma. Mercy also has clinics, outpatient services and outreach ministries in Arkansas, Louisiana, Mississippi and Texas. In fiscal year 2025 alone, Mercy provided more than half a billion dollars of free care and other community benefits, including traditional charity care and unreimbursed Medicaid.
Basic knowledge of Microsoft Excel and Word programs. Excellent phone etiquette required. Must have excellent communication skills and guest relations expertise. Must be able to multi-task in a fast paced dynamic environment while maintaining attention to detail. Critical thinking and problem solving skills. Professional verbal and written communication skills with the ability to work in triage software and electronic medical record. EDUCATION AND/OR EXPERIENCE: Basic typing and computer skills. High School diploma or equivalent Medical Assistant or college degree preferred Previous healthcare, customer service or call center experience preferred. Basic knowledge of medical terminology preferred, but not required CERTIFICATES, LICENSES, REGISTRATIONS: BLS required. PHYSICAL DEMANDS: While performing the duties of this job, the co-worker is regularly required to stand; walk, sit; use hands and fingers, handle or feel; reach with hands and arms; talk and hear. The co-worker is required to stoop, kneel, crouch, or crawl. The co-worker must occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include color vision, and ability to adjust focus. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Performs as a navigator in the virtual ICU/sepsis/stroke programs within Mercy Virtual and in accordance with all applicable Federal, State, and Mercy rules, regulations, policies and procedures. Facilitates the experience at Mercy Virtual by providing coordinated personal, professional and compassionate service to the sites and patients that we serve. Navigator will perform a wide variety of duties to provide clerical, call center, data collection and clinical support. Activities include admitting/discharging patients, census reconciliation, phone call triage, data collection and documentation, data entry, continuous patient observation via camera and collaboration with the bedside staff as needed. Assists in unit operational support tasks, works cooperatively with others as part of the team and recognizes the importance of group goals. Supports all aspects of the delivery of vICU care to a diverse population of patients across multiple ICUs at various hospitals across multiple states. Performs duties and responsibilities in a manner consistent with Mercys mission, values, and Mercy Virtual Service Standards.
Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives. Learn even more about the work that drives us at personifyhealth.com.
As a Case Manager RN, you will provide telephonic case management between providers, patients and caregivers to help ensure cost-effective, high-quality healthcare for health insurance plan participants. May be required to work evening and/or weekend shifts
Education and Experience: Graduation from an accredited Registered Nursing (RN) program. Possession of a current California RN license; a multi-state license will also be required. Minimum of five (5) years medical/surgical or acute care experience, including two years’ experience in case management, or an equivalent combination of education and experience. Prior case management experience, emergency room, critical care background or other relevant clinical care experience pertinent to case management. Required Knowledge, Skills, and Abilities: Knowledge of medical claims and ICD-10, CPT, HCPCS coding. Ability to critically evaluate claims data and determine treatment plan, discharge planning experience. Ability to work independently making decisions and problem solving Knowledge of community resources and alternate funding programs. Computer proficiency or working knowledge of Microsoft Office Suite. Excellent interpersonal, communication and negotiation skills. Strong customer orientation. Good time management skills and highly organized. Work Environment: At Personify Health we value and celebrate diversity, and we are committed to creating an inclusive environment for all employees. We believe in creating teams made up of individuals with various backgrounds, experiences, and perspectives. Why? Because diversity inspires innovation, collaboration, and challenges us to produce better solutions. But more than this, diversity is our strength, and a catalyst in our ability to change lives for the good. Physical Requirements: Must be able to remain in a stationary position 50% of the time. The person in this job needs to occasionally move about inside the office to access office machinery, filing cabinets and meeting facilities. Constantly operates a computer and other office productivity machinery, such as copy machine, computer printer, calculator, etc. Frequently positions self to maintain files in file cabinets. Frequently moves boxes or equipment weighing up to 25 pounds. Must communicate information and ideas so others understand. Must be able to exchange accurate information in these situations. Must be able to observe details at close range.
Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs. Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health and identify for participation in appropriate programs. Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short- and long-term goals. Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner; report measurable outcomes that record effectiveness of interventions. Initiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of care. Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs; provide patient/family with emotional support and guidance. Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis. Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports. Establish and maintain working relationships with healthcare providers, client/group, and patients to provide emotional support, guidance and information. Evaluate and make referrals for wellness programs. Maintain complete and detailed documentation of case managed patients in Eldorado and UM Web; maintain site specific files ensuring confidentiality; prepare reports and updates at 30-day intervals for high-risk cases and 90 days interval for low-risk cases ensuring confidentiality according to Company policy and HIPAA Perform Utilization Review for assigned members. Serve as mentors to LVNs and provide guidance on complicated cases as it relates to clinical issues.
Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives. Learn even more about the work that drives us at personifyhealth.com.
The Payment Integrity - Clinical LPN supports the clinical and administrative coordination of Single Case Agreements for out-of-network services. This role partners closely with Care Management, Payment Integrity, Cost Containment, and Provider Relations to ensure SCA requests are complete, clinically supported, timely, and compliant with internal policies and client plan requirements. The LPN serves as a key point of contact for gathering documentation, tracking SCA status, and facilitating communication between internal teams and external providers.
Required Qualifications: Active, unrestricted Licensed Practical Nurse (LPN) license in the applicable state(s). 2+ years of clinical or healthcare administrative experience (e.g., care management, utilization management, prior authorization, or medical management support). Working knowledge of healthcare benefits, out-of-network services, and medical terminology. Strong organizational skills with the ability to manage multiple cases simultaneously in a fast-paced environment. Preferred Qualifications: Experience supporting Single Case Agreements, Letters of Agreement (LOAs), or out-of-network negotiations. Experience working with care management or payment integrity teams. Familiarity with case management systems, Smartsheet, or similar tracking tools. Remote work experience in a health plan, TPA, or managed care organization. Key Competencies: Attention to detail and documentation accuracy Professional communication and provider engagement Time management and prioritization Collaboration across clinical and non-clinical teams Understanding of medical necessity and benefit interpretation Working Conditions: Primarily remote, sedentary work Frequent computer and phone use Standard business hours with occasional time-sensitive requests
What You'll Actually Do: Receive, review, and track Single Case Agreement (SCA) requests for completeness and accuracy, ensuring required clinical and demographic information is obtained prior to submission. Support Care Managers and Payment Integrity teams by gathering clinical documentation that substantiates medical necessity for out-of-network services. Enter, update, and maintain SCA requests in designated systems (e.g., Smartsheet, case management platforms), ensuring accurate status tracking and documentation. Clinical & Administrative Support: Review member eligibility, benefits, and plan provisions related to out-of-network services and Single Case Agreements. Assist in identifying appropriate scenarios for SCA consideration, including continuity of care, lack of in-network availability, or specialized services. Collaborate with internal clinical staff (RNs, Care Managers, Medical Directors) to escalate cases requiring clinical review or urgent handling. Provider & Internal Communication: Serve as a liaison between providers, internal clinical teams, and Payment Integrity regarding SCA documentation requirements and next steps. Communicate professionally with provider offices to obtain missing information, clarify services requested, and support timely SCA processing. Document all communications and actions in accordance with internal SOPs and compliance standards. Compliance & Quality: Adhere to established Single Case Agreement policies, workflows, and turnaround time expectations. Ensure all SCA activity aligns with regulatory, contractual, and client-specific requirements. Participate in quality audits, process improvement initiatives, and training related to SCA workflows.
Clarest Path (a division of Clarest Health) is a software company that supports health insurance companies by providing software solutions and outsourced services. We license software to help manage medical programs, particularly the Medication Therapy Management (MTM) Program required by CMS for Medicare Part D. We also offer outsourced MTM services, utilizing our team of pharmacists, clinicians, and support staff to conduct Comprehensive Medication Reviews (CMRs) for our clients' members. These reviews are crucial for maintaining high star ratings in Medicare Part D programs.
The LPN Clinical Interviewer conducts telephonic medication interviews and supports Medication Therapy Management activities to improve medication adherence, safety, and member understanding. This role operates in a structured, high-volume environment with defined productivity and quality metrics. Clinical Interviewers plays a critical part in improving medication safety and health outcomes for underserved and complex populations. Success in this role requires sound clinical judgment, clear member communication, strong documentation discipline, and the ability to work efficiently in a fast-paced, metrics-driven environment. Location: Remote (Full Time) Salary: $25.00 per hour Schedule: Flexible scheduling is available during standard business hours, Monday through Saturday, 9:00 AM–7:00 PM EST.
Qualifications: Graduation from an accredited LPN/LVN program with an active license in good standing. Experience in a healthcare and/or telephonic outreach environment. Comfort operating in a high-volume, metrics-driven setting with simultaneous documentation requirements. Experience navigating electronic documentation systems and Microsoft Office tools. Exposure to MTM, Transition of Care, or Medicare/Medicaid programs is a plus, but not required Skills + Abilities: Integrity: handles PHI appropriately, raises compliance or patient safety concerns promptly, and follows through on commitments. Learning Agility: stays current on medications, program requirements, and systems; applies coaching and QA feedback quickly. Adaptability: reprioritizes calmly during operational changes while maintaining documentation quality and member experience. Listening: asks clarifying questions, confirms understanding, and accurately captures member-reported medication use and barriers. Clarity: explains medication instructions and education in plain language and documents findings in an organized, auditable way. Discipline: follows clinical workflows, scripts, and documentation standards consistently with minimal rework. Accountability: owns outcomes for documentation accuracy, timely escalation, and follow-up actions. Patient Outcomes & Safety: prioritizes medication safety and appropriate escalation over speed during high-volume periods.
Member Medication Interviews and Clinical Data Collection: Conduct telephonic medication interviews with members, including CMR/TMR-related data collection as applicable, following program specifications and clinical workflows. Verify member identity and obtain consent prior to discussing medication-related information. Collect, review, and reconcile complete medication lists, including prescription, OTC, herbal, and supplement use. Assess adherence, medication effectiveness, side effects, affordability, and barriers to proper use. Identify potential medication-related problems (for example, duplications, contraindications, adverse effects, and possible interactions) and document findings clearly. Education, Support, and Escalation: Provide evidence-based medication education in clear, understandable language within scope of practice. Reinforce proper medication administration, dosing schedules, storage guidance, and adherence strategies. Escalate urgent, complex, or out-of-scope concerns to a pharmacist, provider, or designated clinical resource per established protocols. Collaborate with pharmacists, care coordinators, and operational teams to ensure appropriate follow-up and continuity. Documentation, Quality, and Compliance: Document member interactions, assessments, and outcomes in designated systems in real time or within required timeframes. Ensure documentation meets clinical, regulatory, and audit standards (including CMS and health plan requirements where applicable). Follow established scripts, decision-tree logic, and escalation pathways to support consistency and compliance. Meet defined productivity, quality, and documentation accuracy expectations. Participate in quality assurance reviews, audits, coaching, and corrective action processes as required. Operational Effectiveness: Use multiple systems simultaneously (for example, MTM platform, call systems, email, and documentation tools) while maintaining accuracy and service quality. Manage multiple interactions and documentation tasks efficiently, including tracking outreach attempts and follow-up actions. Maintain current knowledge of commonly used medications and program updates. Perform other duties as assigned. The ability to adhere to Clarest’s Code of Conduct, follow Clarest Compliance policies and procedures, and report any suspected violations of any federal or state laws to either their direct supervisor, Human Resources or the Compliance Officer
At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.
The Clinical Documentation Improvement (CDI) Auditor Educator will facilitate improvement system-wide in the overall quality, completeness, and accuracy of the medical record documentation through extensive audit investigation, education and data analysis. The incumbent will be responsible for identification of patterns, trends, and opportunities for the entire CDI team, at all acute care facilities, to improve accuracy and outcomes. This position will also be responsible for assisting with large retrospective audits, at the request of hospital clients system-wide, and for educating physicians, if needed. Reports to the CDI Quality/Education Manager. The CDI Auditor reports to the Director as an individual contributor and provides recommendations on clinical documentation quality improvement and education programs. Job Description MEMORIAL HERMANN CANNOT HIRE REMOTE WORKERS IN THE FOLLOWING STATES: Arizona, California, Connecticut, Maryland, Massachusetts, Missouri, New Jersey, New York, Utah, Ohio, Pennsylvania, Washington, Alabama, Mississippi, Illinois, Oregon, Arkansas or Iowa
Education: Bachelor's of Nursing, required; Master’s Degree in Nursing or Management preferred Licenses/Certifications: Current State of Texas license or temporary/compact license to practice professional nursing One of the following is required: Certified Clinical Documentation Specialist (CCDS) from the Association of Clinical Documentation Improvement Specialists Certified Clinical Documentation Integrity Professional (CDIP) from the American Health Information Management Association (AHIMA) Certified Coding Specialist (CCS) from the American Health Information Management Association (AHIMA) Experience / Knowledge / Skills: Three (3) years of Clinical Documentation Integrity (CDI) experience required Approved AHIMA ICD-10-CM/PCS Trainer preferred Previous CDIS auditing and education experience and/or CDIS supervisory/management background preferred Strong computer proficiency including working knowledge of MS Office- Word, Excel and Outlook and 3M Coding and Reimbursement software; experience with Epic EMR preferred Excellent communication, analytical and problem solving skills are essential Strong organizational skills and must be detail oriented Highly analytical with strong risk assessment, impact analysis and problem solving skills Highly self-motivated, yet demonstrate ability to be a team player and take direction Flexible and able to multi-task and prioritize work load on a daily basis, performing concurrent chart reviews as needed
Audits case reviews and queries of Clinical Documentation Specialists (CDIS) to ensure quality and compliance, using audit tools developed. Tracks, trends, and reports audit findings for each Clinical Documentation Specialist (CDIS), Hospital Region, and System-wide to Director/management team. Identifies knowledge gaps and provides clear explanations and interpretations on missing, unclear, conflicting, or non-compliant information captured by the CDIS. Researches, investigates and remains up to date on both clinical and coding guidelines in quarterly Coding Clinics as they relate to physician documentation improvement needed, in an ICD-10 coding environment. Assists in overall quality, timeliness and completeness of the quality health record to ensure appropriate data, provider communication, and quality outcomes. Serves as a resource for appropriate clinical documentation. Develops presentation material and provides training and education to physicians and CDIS staff as needed in an effort to strengthen documentation practices and ensure accurate coding that reflects the severity of illness (SOI) and risk of mortality (ROM) of patients they serve. Responsible for using audit tools to conduct clinical quality audits Develops and updates policies and procedures around the CDIS audit function; and refines audit tools as needed in collaboration with Director/management team. Collaborates with leadership to conduct focused post-discharge documentation and coding audits as requested by hospital clients system-wide. Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service. Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff. Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues. Other duties as assigned.
We are seeking a dynamic and compassionate Telehealth Nurse Practitioner to join our innovative healthcare team. In this role, you will deliver high-quality, patient-centered care through virtual platforms, ensuring accessible and efficient healthcare services across diverse populations. Your expertise will support acute and chronic condition management, health education, and preventive care, all while utilizing advanced electronic health record (EHR) systems. This position offers an exciting opportunity to make a meaningful impact by providing expert clinical care remotely, fostering healthier communities through technology-driven solutions.
Current Nurse Practitioner license with valid state certification to practice independently in a telehealth setting. Proven experience in telehealth environments with familiarity in telemedicine best practices. Strong clinical skills across multiple specialties such as internal medicine, emergency medicine, geriatrics, pediatrics, or behavioral health. Proficiency in EMR/EHR systems including Epic, Cerner or Athenahealth; experience with medical documentation standards is essential. Knowledge of CPT coding (Current Procedural Terminology), ICD-10 coding (International Classification of Diseases), and utilization management processes. Experience with complex procedures such as suturing, spinal taps, or sonography is advantageous but not mandatory. Critical care experience or ICU background enhances ability to manage acute cases effectively remotely. Familiarity with HIPAA regulations to ensure patient privacy and data security at all times. Ability to perform detailed patient assessments involving physiology knowledge and diagnostic evaluation techniques. Skills in triage protocols for urgent care scenarios and working with diverse populations including children, seniors in memory or assisted living care settings. Additional qualifications that strengthen candidacy include hospital experience (Level I trauma centers), nursing home or hospice care expertise, infectious disease management knowledge, or experience working within post-acute care environments. Join us to be part of a forward-thinking healthcare organization committed to transforming patient access through innovative telehealth solutions!
Conduct comprehensive virtual patient assessments, including vital signs, medical history review, and symptom evaluation using telehealth platforms. Manage a wide range of clinical conditions such as acute pain, infectious diseases, geriatrics, pediatrics, behavioral health issues, and chronic illnesses like diabetes or hypertension. Administer medications and injections via telehealth protocols, including IV infusions and dermal fillers when appropriate. Perform procedures such as suturing, catheterization, phlebotomy, and basic life support in accordance with clinical guidelines. Utilize EMR (Electronic Medical Records) systems like Epic or eClinicalWorks to document patient encounters accurately and efficiently. Collaborate with multidisciplinary teams on discharge planning, case management, and utilization review to optimize patient outcomes. Provide health coaching and education tailored to individual needs, including medication management, nutrition guidance, and disease prevention strategies.
The Over Night Nurse Supervisor provides leadership and clinical oversight to nursing staff during overnight shifts, ensuring patient care quality, safety, and compliance—while working remotely. This role often supports multiple facilities and telehealth teams
Qualifications: Active Registered Nurse (RN) license (state-specific or compact license preferred) 3–5+ years of clinical nursing experience Prior supervisory or charge nurse experience preferred Strong knowledge of clinical protocols and emergency procedures Experience with telehealth or remote patient monitoring (preferred) Skills & Competencies: Strong leadership and decision-making skills Excellent communication (especially verbal for remote coordination) Critical thinking under pressure Tech proficiency (EMR systems, telehealth tools) Ability to work independently overnight Strong understanding of Detoxification protocols Knowledge of CIWA/COWS Strong assessment skills for admissions and triaging of patients Work Schedule: Overnight hours May include weekends and holidays On-call responsibilities are common
Supervise and support nursing staff (RNs, LPNs, BHTs) during night shifts Act as the on-call clinical decision-maker for escalations or emergencies Monitor patient care quality and ensure adherence to protocols and regulations Provide real-time guidance via phone/video systems Chart audits, review of documentation, QA Communicate with physicians, administrators, and on-site teams as needed Ensure compliance with HIPAA and healthcare regulations Participate in handoff reports between day and night team Remote-Specific Duties: Use telehealth platforms and KIPU EMR systems to monitor patient status Conduct virtual rounds or check-ins with staff Support multiple locations simultaneously Troubleshoot clinical or operational issues remotely
Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living God's love by inspiring health, wholeness and hope.
Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect. Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work. Job Location Details: Remote position but must live near Glendale, CA, Roseville, CA or Portland, OR Job Summary: Plays a critical role in ensuring that patients receive high-quality care while efficiently utilizing medical resources. Reviews patient medical records, assessing the appropriateness and necessity of proposed treatments, and collaborating with healthcare providers and insurance companies to ensure a seamless care experience and the practicing of financial stewardship and denial prevention. Focuses on maximizing patient outcomes and optimizing resource allocation. Utilizes exceptional clinical knowledge, excellent communication skills, and the ability to thrive in a fast-paced and ever-changing healthcare environment.
Education and Work Experience: Associate’s Degree in nursing or equivalent combination of education/related experience: Required Bachelor's Degree in Nursing (BSN): Preferred Five years' acute hospital experience required with preferred experience in critical care areas: Required Two years' utilization review experience using the Optum/Inter Qual product within the last 12 months: Required Licenses/Certifications: Registered Nurse (RN) licensure in the state of practice: Required Organizational Requirements: Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Completes clinical reviews of acute medical patients using the Optum/Inter Qual tool to determine if the patient is in the right acute setting, receiving the right acute services, during the appropriate length of stay. Participates in annual Optum/Inter Qual training required. Takes the required annual Optum/Inter Qual Interrater Reliability (IRR) test with a minimum passing score as defined in the yearly departmental goals. Meets weekly productivity metrics within 90 days of completing orientation and maintains on a weekly basis as defined in the yearly departmental goals. Meets quality audit metrics within 90 days of completing orientation and maintained on the audit cadence set within the department as defined in the yearly departmental goals. Completes all required departmental education assigned with timeliness and accuracy. Follows all departmental workflows in communication variances to the on-site care management teams when appropriate. Reviews and analyzes medical records to assess the necessity and appropriateness of treatments and interventions. Collaborates with healthcare professionals to develop and implement comprehensive patient care plans. Facilitates communication between the patient, healthcare team, insurance providers, and other stakeholders to ensure a coordinated and efficient care process. Stays up to date with the latest healthcare regulations, insurance guidelines, and evidence-based practices to ensure the delivery of optimal healthcare services. Performs other job-related duties as assigned.
EmblemHealth is a leading health care organization whose companies provide insurance plans and primary and specialty care. As one of the nation’s largest not-for-profit health insurers, we serve communities across New York State. EmblemHealth started back in the 1930s, at the height of the Great Depression. Out of hard times, the idea of health insurance was born: a system that would protect everyday people from financial misfortune if they had an accident or illness. Two companies from those early days of health insurance, Group Health Incorporated (GHI) and Health Insurance Plan of Greater New York (HIP), would later merge and become EmblemHealth. And after 80 years, our mission is still the same: to create healthier futures for our customers and communities.
Perform clinical reviews within the Medical Management Operations Concurrent Review utilization management department. Ensure accurate administration of benefits, execution of clinical policy and timely access to appropriate levels of care.
Associate’s degree or bachelor’s degree in nursing Valid RN License without restriction May require a CME accreditation in specific specialties Certification in utilization or care management preferred 4 – 6+ years of Nursing experience Case and/or utilization management/care coordination and managed care experience Strong communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience Organizing and prioritizing skills, and strong attention to detail Trained in the use of Motivational Interviewing techniques Experience working in physician practice and/or with electronic medical records Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) Proficiency with the use of mobile technology (Smartphone, wireless laptop, etc.)
Under the direction of the leader, is responsible for the execution of efficient departmental processes designed to manage inpatient utilization within the benefit plan. Act as the clinical coordinator collaborating with members and facilities to evaluate member needs within the inpatient setting. Establish and maintain active working relationships with assigned facility care managers/utilization management departments to facilitate appropriate clinical reviews and patient care. Enter and maintain documentation in the TPH platform meeting defined timeframes and performance standards. Communicate authorization decisions and important benefit information to providers and members in accordance with applicable federal and state regulations, and NCQA and business standards. Review and investigate member and provider requests to determine appropriate utilization of benefits and/or claim adjudication. Research evidence-based guidelines, medical protocols, provider networks, and on-line resources in making coverage determinations and recommendations. Prepare and present clinical case summaries in routine inpatient rounds. Maintain an understanding of utilization management, program objectives and design, implementation, management, monitoring, and reporting. Identify quality, cost and efficiency trends and provide solution recommendations to Supervisor/Manager. Actively participate on assigned committees. Perform other related projects and duties as assigned.
Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.
Facility: Remote WI Location: Remote, WI Address: Shift: 8 Hours - Day Shifts Job Schedule: Full time Weekly Hours: 40.00 Salary Range: $29.00 - $46.50
Depending on area of focus, education, experience and licensure differs. Bachelor's degree in nursing required. Graduate from a nationally accredited nursing program preferred, including, but not limited to, Commission on Collegiate Nursing Education (CCNE). Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA) is strongly preferred. OR Master's degree in counseling, social work, marriage and family therapy or psychology required. Graduate from a nationally accredited behavioral health program. Accreditation from (CACREP) Council for Accreditation of Counseling and Related Educational programs. Accreditation from (COAMFTE) Commission on Accreditation for Marriage and Family Therapy Education, or (CSWE) Council of Social Worker Education. Nursing: Will consider applicant with significant background in case management, transplant services and/or other utilization review experience. Minimum of three years nursing experience is required. Behavioral Health: Will consider applicant with significant background in case management or specialized clinical experience. Minimum of five years behavioral health experience is required. Must have knowledge of Diagnostic and Statistical Manual of Mental Disorders (DSM) V, and American Society of Addiction Medicine (ASAM) criteria. Nursing: Currently licensed with the applicable state nursing board and/or possess multistate licensure privileges as required by position. Current Commission for Case Manager Certification (CCMC) is preferred or is to be obtained within two years of employment. Behavioral Health: Currently licensed with the applicable behavioral health board or appropriate regulatory board and/or possess multistate licensure privileges as required by position.
The case manager provides case management and care coordination for designated Health Plan members. Develops a care plan that includes managing and directing members to appropriate resources, services and programs. Evaluates for comprehensive coordination of care and health services to manage members across the continuum, creates action plans for members and helps them track toward program graduation. Collaborates with the integrated team and partners in order to provide a seamless exchange of information between providers, members and caregivers with the ultimate outcome to improve quality, reduce costs and enhance the member experience. Conducts member assessments, identifies gaps and interventions, and coordinates ongoing care with physician and integrated team. Coordinate with facilities to assist with discharge planning, aftercare follow-up appointments and transition of care as appropriate. Coordinates and manages medical/behavioral health needs of members across the continuum of care. May perform authorizations for services as indicated for specialty case management. Provides educational resources to member based on medical and behavioral health needs. Serve as a consult on cases for their clinical expertise when they are not the lead case manager. Supports a successful self-management of their long-term health status. Uses internal and external resources to provide quality and cost-efficiency care. Utilizes motivational techniques to promote member engagement. Possesses strong clinical knowledge and skills. Collaborates with team members both internally and externally to ensure care is coordinated and appropriate based on evidence based medicine. Must be self-motivated with the ability to work independently, a problem solver and fiscally responsible. Ability to work independently or as a member of a team. Ability to multitask and work with little direction. Works primarily day hours. Works primarily telephonically in an office environment and onsite as needed. Travel may be required as necessary.
Baptist Health Brookwood Hospital is a 595-bed comprehensive healthcare facility known for providing a wide range of medical services and specialized care to the Homewood community and beyond. Our dedicated team of physicians, nurses, clinicians and medical professionals are committed to delivering quality and compassionate care. Accredited by The Joint Commission, Baptist Health Brookwood Hospital is recognized for excellence in stroke care, cardiovascular services, rehabilitation, bariatrics, surgical care including minimally invasive procedures and is one of the largest providers of psychiatry care in the state. We have earned Primary Stroke Center certification from The Joint Commission and Get with the Guidelines® Gold Plus Achievement in Stroke from the American Heart Association.
Baptist Health Brookwood Hospital is looking for a Registered Nurse to work Full-time (three 12 hour shifts per week) Baylor at night, 7pm - 7am in our Medical ICU (MICU). The RN administers patient care in an inpatient/observation setting where an acute care patient receives active treatment for an injury, episode of illness, a medical condition, or post intervention with assessment.
Education/Training: Graduate of an approved school of nursing. Meets all mandatory, developmental, and performance competency requirements for Baptist Health unit/department. Licensure/Certification: Maintains current State of Alabama RN license or valid eNLC multistate RN license Maintains current BLS/Healthcare Provider certification. ACLS, NRP, PALS, and TNCC are required for certain areas. NRP is required for the Neonatal Intensive Care Unit (NICU). Experience: 1 year experience required unless approved by AVP level or above; New Graduate RNs may be considered.
Assesses patient’s needs and develops/revises an individualized plan of care based on patient needs and responses. Evaluates the patient’s progress toward attaining expected outcomes. Respects diversity by building respectful relationships with all team members and customers. Functions as a patient and family advocate. Demonstrates knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit/ department. Serves as a preceptor, charge nurse, unit educator, and/ or nurse clinician. Communicates and collaborates with medical staff and interdisciplinary team to effectively plan and manage the unit/department. Serves as a role model for staff and supports the hospital and nursing department’s goals and strategies. Demonstrates knowledge of the principles of growth and development over the life span, assesses the data reflective of the patient’s status, and interprets the necessary information needed to identify each patient’s requirements relative to his or her age- specific needs. Coordinates the care and delegates as appropriate to other team members on a defined group of patients. Documents patient care in a knowledgeable, skillful, and consistent manner meeting all required and regulatory standards. This includes but is not limited to patient assessment, education, medication administration, treatments, and patient safety. Demonstrates competency in nursing skills and use of patient care/unit equipment as defined by unit/department-specific requisite skills. Prioritizes patient care in an ongoing manner in accordance with Evidence-Based Practice Standards of Care. Practices effective problem identification and resolution. Delegates tasks and duties to healthcare team members in accordance with the patient’s needs and the team member’s capabilities and qualifications. Communicates appropriate information regarding patient condition or unit concerns to other health care team members. Demonstrates caring practices by providing a compassionate and therapeutic environment for patients and their families. Demonstrates awareness of legal issues and patients’ rights. Collaborates with the education department and nursing leadership team to effectively transition and support new team members and/or students. Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA, and other federal, state, and local standards. Maintains compliance with all Orlando Health policies and procedures. The professional nurse contributes to the knowledge and skills of others, and the continuous improvement of the quality of healthcare practice and organizational outcomes. Participates and may lead unit level and/or organizational level committees of nursing practice and performance improvement. Participates in department and organizational peer review, mentoring, and coaching regarding professional practice or role performance. Practices efficient use of supplies and maintains a clean, safe, and organized work area. Attends staff development in-services, department meetings, and/or nursing committee meetings. Partners with the nursing leadership team to identify professional development needs. Assumes responsibility for one’s own professional development and continuing education.
Do you have the career opportunities as a Revenue Integrity Clinical Review Analyst RN you want with your current employer? We have an exciting opportunity for you to join Parallon which is part of the nation's leading provider of healthcare services, HCA Healthcare. This Work from Home position requires that you live and will perform the duties of the position; within 60 miles of an HCA Healthcare Hospital (Our hospitals are located in the following states: FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, VA). Job Summary and Qualifications The Revenue Integrity Clinical Review Analyst RN is responsible for determining the appropriateness of patient charges by reviewing the medical record, facility protocol, corporate standards and other applicable documentation. Provides charge review results and develops and coordinates educational in-services for facility staff related to charging/billing issues. Reviews for documentation and charging opportunities. Serves as a liaison between facilities Administration, Shared Services Center, and ancillary department directors regarding charging issues, clinical documentation issues and revenue opportunities.
Registered Nurse Degree required. Minimum 1 year directly related Healthcare experience required. Knowledge of CPT/HCPCS codes or experience in charging or performing charging validation reviews preferred.
Consistently monitors charging practices across all facilities to include charge reviews, remedial training and education. Provide education and training to Facility Departments on the Charge Reconciliation reporting. Performs oversight and trending of reporting on a monthly basis. Works directly with Facility Departments by providing education to support HCA charging practices and regulatory requirements. Work directly with Facility Department Directors when standing up new service lines and/or procedures to develop chargemaster and charging practices utilizing approved standardization guidelines. Monitors charging practices upon implementation to provide specific guidance related to charging activity and provide support with education. Serves as a liaison to facilitate clinical department education on appropriate charging of CPT codes, Revenue Codes, and communicating with Ancillary Departments to resolve issues. Coordinates updates (activate, inactivate, modification) with Ancillary Departments as necessary. Reviews Regulatory and Compliance Communications, applicable CMS transmittals, and Local Coverage Decisions (LCD). Assess impact to Revenue Integrity procedures and implement changes as needed. Works on Charge Optimization projects when time permits and supports the Corporate RI team when necessary on special projects, charge reviews and patient audits.
EmblemHealth is a leading health care organization whose companies provide insurance plans and primary and specialty care. As one of the nation’s largest not-for-profit health insurers, we serve communities across New York State. EmblemHealth started back in the 1930s, at the height of the Great Depression. Out of hard times, the idea of health insurance was born: a system that would protect everyday people from financial misfortune if they had an accident or illness. Two companies from those early days of health insurance, Group Health Incorporated (GHI) and Health Insurance Plan of Greater New York (HIP), would later merge and become EmblemHealth. And after 80 years, our mission is still the same: to create healthier futures for our customers and communities
Perform clinical reviews within the Medical Management Operations Concurrent Review utilization management department. Ensure accurate administration of benefits, execution of clinical policy and timely access to appropriate levels of care.
Associate’s degree or bachelor’s degree in nursing Valid RN License without restriction May require a CME accreditation in specific specialties Certification in utilization or care management preferred 4 – 6+ years of Nursing experience Case and/or utilization management/care coordination and managed care experience Strong communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience Organizing and prioritizing skills, and strong attention to detail Trained in the use of Motivational Interviewing techniques Experience working in physician practice and/or with electronic medical records Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) Proficiency with the use of mobile technology (Smartphone, wireless laptop, etc.)
Under the direction of the leader, is responsible for the execution of efficient departmental processes designed to manage inpatient utilization within the benefit plan. Act as the clinical coordinator collaborating with members and facilities to evaluate member needs within the inpatient setting. Establish and maintain active working relationships with assigned facility care managers/utilization management departments to facilitate appropriate clinical reviews and patient care. Enter and maintain documentation in the TPH platform meeting defined timeframes and performance standards. Communicate authorization decisions and important benefit information to providers and members in accordance with applicable federal and state regulations, and NCQA and business standards. Review and investigate member and provider requests to determine appropriate utilization of benefits and/or claim adjudication. Research evidence-based guidelines, medical protocols, provider networks, and on-line resources in making coverage determinations and recommendations. Prepare and present clinical case summaries in routine inpatient rounds. Maintain an understanding of utilization management, program objectives and design, implementation, management, monitoring, and reporting. Identify quality, cost and efficiency trends and provide solution recommendations to Supervisor/Manager. Actively participate on assigned committees. Perform other related projects and duties as assigned.
EmblemHealth is a leading health care organization whose companies provide insurance plans and primary and specialty care. As one of the nation’s largest not-for-profit health insurers, we serve communities across New York State. EmblemHealth started back in the 1930s, at the height of the Great Depression. Out of hard times, the idea of health insurance was born: a system that would protect everyday people from financial misfortune if they had an accident or illness. Two companies from those early days of health insurance, Group Health Incorporated (GHI) and Health Insurance Plan of Greater New York (HIP), would later merge and become EmblemHealth. And after 80 years, our mission is still the same: to create healthier futures for our customers and communities
Support the department’s quality of care and cost containment. Provide utilization management as needed to ensure coordination of health care delivery. Conduct medical appropriateness evaluations of acute care hospital admissions, post-acute care requests, and selected outpatient procedures. Facilitate the achievement of quality clinical outcomes by integrated and collaborative interventions with multiple disciplines, Pre/Post Service. Ensure that members are receiving the appropriate level of care in the appropriate setting for the appropriate length of time within the established guidelines and benefit sets; Pre-service, Concurrent Review, Post-acute and Care Management. Work with interdisciplinary team to utilize the SNP members' Plan of care to achieve improved health outcomes. Provide services per the NYCE contract.
Associate Degree in Nursing; Bachelor’s preferred RN with an active, unrestricted nursing license (Concurrent Review, Medical Management, etc.) LPN with an active, unrestricted nursing license (Prior Authorization, Discharge Planning, Retrospective Review) MCG Certification prefe4 – 6+ years of clinical experience Managed care experience Post-acute facility experience Care management experience Ability to work weekends and holidays on a rotating schedule Excellent communications skills (verbal, written, presentation, interpersonal) Effectively able to screen and stratify members who are appropriate for care management services Ability to: manage a caseload of members in need of care management; and apply the care management process as outlined by the CMSA standards and EH’s policies Ability to make appropriate referrals to internal and external programs that meet the member’s needs Ability to create and execute care management care plans and document per EH’s policies and procedures Ability to speak professionally with all necessary parties associated with the member’s care plan
Utilize MCG, CMS Guidelines, medical and administrative policies to evaluate medical necessity. Identify members at risk and refers for Care management and/or disease management as needed. Assess and evaluate member’s needs, coordinate care utilizing approved criteria(s). (Include member and family discussion as necessary). Maintain utilization time frames are met according to regulatory guidelines (i.e., initial determination decisions, adverse determination notification to providers and members). Provide appropriate case review; ensure timely notification and correspondence to facilities, members and providers. Utilize the member’s contract to determine coverage eligibility. Work with providers and take action in problem solving while exhibiting judgment and a realistic understanding of the issues. Prepare and present clinical detail to the Medical Director for final case determination in accordance with regulation and department policy. Ensure cost effectiveness and identified opportunities to reduce cost are captured (i.e. reinsurance reporting). Refer to Medical Director any questionable quality issues or inappropriate hospitalizations for immediate intervention and/or refer cases that do not meet established criteria for approval of selected procedure or service. Regular attendance is an essential function of the job. Perform other duties as assigned or required.
Join Newport Healthcare: Transform Lives Through Meaningful Work! Are you ready to embark on a rewarding career in psychiatric healthcare? At Newport Healthcare, we are passionate about delivering exceptional mental health services to individuals in need. Our comprehensive approach covers the entire spectrum of care, creating a wealth of diverse roles for those who aspire to make a real impact. We believe in nurturing talent and fostering professional growth in a supportive environment. Here, you won’t just find a job—you’ll discover a fulfilling career path in the mental health field. If you're eager to contribute to a mission-driven organization and help change lives for the better, we invite you to join our dedicated team at Newport Healthcare. Together, we can make a profound difference in the lives of those we serve!
The Remote Overnight Registered Nurse (RN) provides clinical consultation and oversight for all California-based programs during overnight hours. This role serves as a key clinical resource to support patient safety, regulatory compliance, and nursing best practices. The Overnight RN functions as a centralized clinical consultant, offering guidance to on-site staff, overseeing chart audits, and supporting statewide nursing operations remotely.
Education, Experience, License Requirements: Active California RN license in good standing. Minimum of 3-5 years of clinical nursing experience. Experience in behavioral health, residential treatment, adolescent care, or similar settings preferred. Strong knowledge of California nursing regulations and documentation standards. Comfort providing clinical guidance remotely and independently. Excellent critical thinking, communication, and documentation skills. Proficiency with electronic health records (EHR). Prior experience in nursing leadership or charge nurse roles preferred. Experience with chart auditing or compliance review, quality improvement or risk management preferred. Multi-site or centralized nursing support experience preferred. Demonstrate sound clinical judgment and decision-making. Ability to provide clear, calm communication in high-stakes situations. Ability to work independently during overnight hours. Strong organizational and follow-up skills.
Serve as the on-call overnight RN for all California programs, providing real-time clinical guidance to on-site nursing and program staff. Support assessment and decision-making related to changes in patient condition, medication-related questions, escalation of care and provider notification, and incident response and documentation guidance. Assist staff in determining when to escalate concerns to providers, leadership, or emergency services. Document consults and trends as appropriate. Conduct routine and targeted chart audits for California programs to ensure compliance with state regulations and licensing requirements, accuracy and completeness of nursing documentation, and adherence to Newport clinical standards and policies. Identify documentation gaps, trends, and risk areas, provide written feedback and recommendations to nursing leadership and support corrective action planning as assigned. Quality & Risk Support: Assist with preparation for audits, licensing visits, or correction action follow-ups, and support quality improvement initiatives related to nursing practice. Nursing Operations Support: serve as a clinical resource for policy interpretation and application and assist with competency tracking and skills validation documentation. Communication & Handoffs: provide overnight-to-day shift clinical handoff summaries to nursing leadership when needed, communicate urgent follow-ups or unresolved clinical concerns to appropriate leaders or nursing staff, and maintain clear documentation of consults. Data & Reporting: track overnight consult volume, themes, and outcomes; assist with development of reports related to overnight nursing utilization, documentation compliance and clinical risk trends in California programs. Perform other duties as assigned.
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development.
This is a Telecommute (Remote) role: Must reside within 250 miles of the office or anywhere within the posted state. #LI-TELECOMMUTE #LI-SG1 Compensation: $61,500.00 - $136,100.00 Exact compensation may vary based on skills, experience, and location
Registered Nurse (RN) with current, valid, unrestricted license to practice in state of operations. 3 years clinical practice experience. Experience utilizing various software packages. Verbal and written communication skills. Analytical skills. Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. Incumbents with other clinical licenses are not required to obtain multi-state licenses. Preferred Job Qualifications: Familiarity with UM/CM activities and standardized criteria set. Knowledge of ancillary services including HHC, SNF, Hospice, etc. Telecommute: This is a Telecommute (Remote) role: Must reside within 250 miles of the office or anywhere within the posted state.
This position is responsible for performing concurrent review in accordance with approved departmental guidelines; performing discharge planning and identifying alternate treatment programs; conducting episodic case management, consulting and collaborating with providers, members, and other resources as appropriate; assessing, planning, and implementing options and services required to meet an individuals health needs within the scope of their benefit plan.
Discover the job, the career, the purpose you were meant for. The supportive and inclusive team where you can thrive. The place where growth meets balance – and opportunities meet flexibility. Find it all at Carle Health. Based in Urbana, IL, Carle Health is a healthcare system with nearly 16,600 team members in its eight hospitals, physician groups and a variety of healthcare businesses. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. The system includes Methodist College and Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Health Alliance™. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.
$5,000 sign-on bonus and $5,000 relocation (for greater than 100 miles) or $2,500 relocation (for greater than 50 miles) for nurses with 1 or more years experience - External Applicants Only ***Position requires 6 months of in-office training prior to being remote. The office is located in Champaign, IL*** The Patient Services Nurse coordinates the patient intake and triage process for Primary Care Departments ensuring appropriate level of care and advice is provided.
Certifications: Licensed Registered Professional Nurse (RN) - Indiana (IN) within 1 year - Indiana Professional Licensing Agency (IPLA); Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR), Education: College Diploma Nursing, Work Experience: None
Assists patients via phone to determine the urgency of care needed, referring to or scheduling appointments with providers, and giving health information and advice to callers. Evaluates, assesses, and documents patients' questions or concerns. Coordinates with Primary Care Center physicians and nursing staff in order to meet the needs of the patient.Insures documentation of care is complete and accurate. Provides general health information using approved references including, but not limited to, providing individual and group health and wellness education. Supports maintenance and completeness of patient's electronic medical record, including medication reconciliation. Triage calls from patients regarding emergent matters ndash; provide education and disposition per provider approved protocols. Assist primary care office with old telephone encounters and return calls regarding patient lab and diagnostic results. Provide assistance to primary care offices with in-basket messages, prescription requests, and other concerns as requested, including providing normal result notification to patients from primary care provider. Provides assistance to Medication Renewal Center, as needed. Review medication requests from patients and medication responses from provider. Disseminate education to patient as written by provider. Cross train and provide float support to all Patient Contact Center Clinical teams as call volumes, in-baskets, patient care, and other business needs dictate Support Patient Contact Center Virtual physician and nurse in-baskets
This Work from Home position requires that you live and will perform the duties of the position; within 60 miles of an HCA Healthcare Hospital (Our hospitals are located in the following states: FL, GA, ID, KS, KY, MO, NV, NH, NC, SC, TN, TX, UT, VA). Shift Schedule: various 4 day - 10 hour shifts available, which will all include Saturdays Are you passionate about the patient experience? At HCA Healthcare, we are committed to caring for patients with purpose and integrity. We care like family! Jump-start your career as a Telephone Triage Registered Nurse today with Parallon As a Registered Nurse, you will be responsible for delivering high-quality, patient-centered care in line with the requirements of the department and the standards of practice for the relevant state and specialty. Collaborating with medical providers and the care team, you will provide personalized, comprehensive, and compassionate care, following established nursing models such as "Assess, Perform, Teach, and Manage." You will also act as an advocate for patients, families, and caregivers, embodying the organization's vision, mission, and values to ensure an outstanding patient experience and positive clinical outcomes.
Associate Degree in Nursing or RN Diploma -Required Bachelor's Degree in Nursing– Preferred 3+ years of experience in bedside nursing required Telehealth experience helpful, not required Med Surg, ED, or ICU experience is highly preferred BLS Certification Required (RN) Registered Nurse, or (RN) Registered Nurse, or (RN) Registered Nurse, or Registered Nurse Diploma must be obtained within 6 months of employment start date
Provide nurse advice and triage services to consumers calling with clinical questions Provide appropriate compassionate advice to callers using evidence based clinical decision tools to help callers make personal health decisions. Make cross referrals as indicated. Facilitate referrals and event registration through internal transfer mechanisms. Utilizes nursing skill and along with approved protocols to provide telephone nurse triage and/or health advice to consumers with clinical questions or symptoms. Facilitates referrals for health services as appropriate via telephone and performs all components of call processing Ensures performance standards are met and accepts constructive feedback Speaks with a pleasant, professional phone voice and provides superior customer service to create an exceptional patient experience. Documents caller information and outcomes in a relational database system in accurately and as prescribed by current standards and policies Maintains confidentiality, HIPAA and PHI compliance Communicates appropriately and clearly with departmental management, co-workers and callers and exhibits willingness to master new work routines and methods Provides homecare, advice and/or education to callers that respects the cultural, spiritual, intellectual/educational, and psychosocial differences of individuals and preserves caller’s autonomy, dignity and rights. Maintains and contributes to a collaborative professional and ethical work environment. Actively participates in team meetings and engages in the processes of the contact center
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The RN Senior Clinical Analyst is responsible for reviewing large claim notices to identify potential risks, setting up and monitoring claimants in POWER, and notifying relevant stakeholders as risk levels change. The role also involves educating internal and external customers about clinical trends, researching disease states using reputable resources, and assessing opportunities for cost containment. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Required Qualifications: Registered Nurse (RN) with a current, unrestricted RN license in the state of residence 5+ years of clinical experience 2+ years of experience working in an ER, ICU or Critical Care environment 2+ years of experience working in an insurance or managed care company, or working with a third-party administrator 1+ years of hands-on Excel experience Required Qualifications: Employer Stop Loss experience Computer proficiency, specifically solid typing skills and Internet research skills, must have a clear understanding of Microsoft Word and Excel Demonstrated ability to multitask and remain organized
Review and assess large claim notices for potential risks. (approx. 25%) Set-up potential large dollar claimants in POWER for ongoing risk assessment and allocation of reserves Continue to follow these claimants on a monthly or bi-weekly basis depending on the severity and change in treatment Know when to set these claimants up based on clinical and cost knowledge Complete review of LCNs within 48 business hours of receipt Notify underwriter and claims auditor of potential risk when first notice received and again as risk changes Educate non-medical internal and external customers regarding clinical trends, treatments, possible outcomes Research medical conditions and disease states for appropriate treatment for specific conditions Utilize reputable clinical resources for research as needed such as NCCN, CDC, Predict Dx Assess all claimants for potential cost containment opportunities. (approx. 20%) Collaborate with TPA, case manager, claims auditor, underwriter, vendor to discuss and place appropriate cost containment measures Maintain timely diary follow-up of all claimants open in POWER. (10%) Index all documentation received Co-manage complex medical cases with Transplant/Dialysis coordinator Provide clinical claim file review for claims auditor as needed. (5%) Perform appropriate research for each clinical claim file review request Provide discussion/answer questions for claims auditor as needed Perform experimental/investigational file reviews for Claims Review PYCS to assist claim auditor in setting appropriate reserves based on known or anticipated cost Reviewed all documents indexed into the package for each cost estimator request. (approx. 40% but during busy season-end of August to December approx. 75%) Perform appropriate research for each cost estimator request Identify all actual and potential risks for each cost estimator request Document clinical summary and estimate cost of care for each individual identified as at risk Provide re-review of additional information for updated cost estimates as needed Complete requests for cost estimates on new business within 24 business hours of receipt and on renewal business within 48 business hours of receipt Provide discussion/answer questions for underwriter as needed Complete Hot Claims reports as needed. This is used to track large claims and any cost containment strategies put in place Attend monthly Account Management/Sales calls
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The Disease Management Coordinator collaborates with patients and primary care providers to ensure patients receive quality, efficient, and cost-effective healthcare services. Coordinates, monitors, and evaluates all options and services to optimize a patient’s health status.
MINIMUM QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: Associate’s Degree in Nursing AND Seven (7)years clinical experience in a healthcare setting OR Bachelor’s Degree in Nursing AND Five (5) years clinical experience in a healthcare setting. Current Registered Nurse license issued by the state in which services will be provided or current multi-state Registered Nurse license through the enhanced Nurse Licensure Compact (eNLC). State criminal background check and Federal (if applicable), as required for regulated areas. Obtain certification in Basic Life Support within 30 days of hire date. PREFERRED QUALIFICATIONS: EDUCATION, CERTIFICATION, AND/OR LICENSURE: Bachelor’s Degree in Nursing. EXPERIENCE: Prior care coordination experience. PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. WORKING 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. Office and clinical settings SKILLS AND ABILITIES: Possesses excellent interpersonal communication and negotiation skills in interactions with patients, families, physicians, and health care team colleagues Ability to work with people of all social, economic, and cultural backgrounds and be flexible, open minded, and adaptable to change Capable of independent judgment and action regarding psychosocial needs of patients.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned. Ambulatory Utilization Management, Financial Management and Quality Screening for assigned patients. Identifies the targeted population and risk stratifies all patients to prioritize needs and direct interventions. Communicates and collaborates with inpatient and outpatient case management to implement the discharge plan and coordinate a safe transition to the next level of care. Works in collaboration with physicians/providers, patients, and their families to ensure safe and efficient transitions of care. Works collaboratively with patients to design an individualized plan of care that ensures coordination of services by the healthcare team. Collaborates with available social services for appropriate resource and financial management which may include, but is not limited to financial assistance coordination/referrals, entitlement program coordination/referrals, patient benefit coordination, assessment for appropriate usage of Health Care Resources/clinical cost efficiency. Coordinates/facilitates patient progression throughout the continuum, Transitional Planning, Advocacy and Education: Clinical performance improvement, outcome management and quality activities. Uses data to drive decisions and plan/implement performance improvement strategies for assigned patients, including fiscal, clinical and patient satisfaction data Implements clinical interventions based on risk stratification and evidence-based clinical guideline adherence and promotes best practice by initiating/adjusting therapies as directed by the practitioner and providing appropriate follow-up monitoring as needed. Coordinates appropriate laboratory and diagnostic testing. Continuously evaluates laboratory results, diagnostic tests, utilization patterns and other metrics to monitor quality and efficiency results for assigned population Participates in development, implementation, evaluation and revision of clinical pathways and other tools. Educates the multidisciplinary team and physicians about clinical pathways/protocols and managed care principles Works with leadership to design, implement, and evaluate a centralized care model that optimizes value. Works with leadership to continuously evaluate process, identify problems, and propose process improvement strategies Monitors clinical and financial indicators on an ongoing basis and takes action to achieve continuous improvement in both areas.
EnableComp provides Specialty Revenue Cycle Management solutions for healthcare organizations, leveraging over 24 years of industry-leading expertise and its unified E360 RCM™ intelligent automation platform to improve financial sustainability for hospitals, health systems, and ambulatory surgery centers (ASCs) nationwide. Powered by proprietary algorithms, iterative intelligence from 10M+ processed claims, and expert human-in-the-loop integration, EnableComp provides solutions across the revenue lifecycle for Veterans Administration, Workers’ Compensation, Motor Vehicle Accidents, and Out-of-State Medicaid claims as well as denials for all payer classes. By partnering with clients to supercharge the reimbursement process, EnableComp removes the burden of payment from patients and provider organizations while enabling accelerated cash, higher and more accurate yield, clean AR management, reduced denials, and data-rich performance management. EnableComp is a multi-year recipient the Top Workplaces award and was recognized as Black Book's #1 Specialty Revenue Cycle Management Solution provider in 2024 and is among the top one percent of companies to make the Inc. 5000 list of the fastest-growing private companies in the United States for the last eleven years.
The Clinical Nurse Auditor is responsible for performing comprehensive clinical audits to ensure medical necessity, regulatory compliance, and payer guideline adherence across a broad portfolio of high-complexity claims. This role applies expert clinical judgment to evaluate medical services, admission status, level of care, and coverage determinations for claims involving non-standard benefits, jurisdictional variances, and specialized regulatory frameworks. The Clinical Nurse Auditor partners with internal and external stakeholders to identify trends, mitigate risk, and support accurate reimbursement through accurate documentation and well-supported clinical appeals.
Active RN license with ADN or BSN required. Compact State licensure preferred. Minimum of 2 years’ experience in: Medical Necessity Reviews Admission/Length of Stay LCD/NCD interpretation and application DRG validation and downgrade reviews Line-item reviews 3-5 years’ acute care hospital experience in one of more of the following: ICU/Trauma Surgery Orthopedics Neurosurgery Strong knowledge of payer policies, CMS guidelines, and nationally recognized medical review standards. Elevated level of analytical ability and attention to detail Excellent written and verbal communication skills Prerequisites General computer skills (including use of Microsoft Office, specifically Excel and Outlook, internet search). Strong verbal, written and interpersonal communication skills. Ability to think critically and make decisions within individual role and responsibility. Strong organizational and time management skills with the ability to manage workload independently. Demonstrated competency in claim review and experience in using billing and claims forms (UB, CMS, and HCFA). Proven knowledge of trauma/medical/surgical procedures, clinical treatment patterns and healthcare practices and trends Strong clinical assessment and critical thinking skills. Familiarity with health care documentation systems. Ability to interpret policies and procedures and communicate complex topics to others. Ability to communicate audit outcomes and clinical appeal strategies with other staff within the company who are both medically and non-medically oriented. Special Considerations Professional Coding Credentials: AAPC and/or AHIMA certification (e.g., CPC, CCS, RHIA, RHIT) reflecting advanced understanding of coding standards and regulatory requirements is a plus Technology Proficiency: Demonstrated familiarity with EMR/EHR systems and the ability to efficiently navigate electronic medical records across multiple platforms Audience-Adaptive Communication: Ability to clearly articulate audit outcomes, clinical rationale, and recommendations to both medically trained professionals and non-clinical audiences, ensuring understanding, alignment, and actionable next steps
Review, analyze, and resolve high-complexity claims and denials requiring advanced clinical judgment, payer-specific interpretation, and regulatory expertise. Determine appropriate admission type, level of care, length of stay, care setting, and coverage based on clinical documentation and payer-specific rules. Apply appropriate medical review guidelines, policies, and regulatory standards (CMS, InterQual, MCG, LCD/NCD, and payer-specific policies). Perform line-item reviews to validate accuracy, compliance, and reimbursement integrity. Review DRG assignments and downgrades and identify opportunities for support, correction, or appeal. Document clear, concise opinions, conclusions, and recommendations supported by clinical evidence. Compose high-quality clinical appeals with supporting documentation from nationally recognized sources (e.g., CMS, peer-reviewed literature, InterQual/MCG, specialty society guidance, etc.). Identify trends, risks, and educational opportunities across audit findings. Communicate results and insights to internal leadership and external partners in a professional and actionable manner. Support continuous improvement efforts through data-driven recommendations and collaboration with operational teams. Provide guidance and clinical insight to support alignment, knowledge-sharing, and quality outcomes across global operations. Collaborate with domestic and international teams to ensure consistency in medical review standards, audit methodology, and best practices. Communicate audit findings, clinical rationale, and recommendations clearly and professional across a globally distributed workforce.
Axiom Medical Consulting, LLC was founded in 1999 in The Woodlands, TX and has established itself as an industry leader in providing comprehensive occupational health services for the total life cycle of the employee health journey. Axiom Medical empowers organizations large and small to strategically address workplace health challenges across the spectrum, from mental behavioral health and infectious disease control, to OSHA mandated medical programs and workplace injury case management. Axiom Medical has positively impacted over 1,000,000 lives by supporting employees in the workplace and extending medical expertise during the COVID-19 pandemic by managing over 140,000 COVID cases and ten million CheckIn2Work attestations
The Intake Nurse Case Manager (“NCM”) is an integral member of Axiom’s Nursing Department (“Nursing”). The NCM is primarily responsible for performing telephonic medical case management for work-related and non-work-related injuries and illnesses. The NCM will be accountable for providing first aid recommendations to injured employees, keeping detailed records on employee injuries and communications in Axiom’s database, and properly communicating any pertinent/necessary information with Axiom’s clients. It is the responsibility of the NCM to maintain their home state RN/BSN license and obtain/maintain additional licenses as requested by management. This role is expected to uphold Axiom’s dedication to providing the highest quality of service, care, and expertise. Additionally, the NCM will have other duties and responsibilities as determined from time to time by the Nurse Case Manager Team Manager.
Qualifications: The successful candidate should have an active RN or BSN license in good standing plus a minimum of 5 years demonstrated experience with a focus on ER, acute injury, triage management or related fields. Previous nurse case management or telephonic case management is preferred. Physical Requirements: Regularly required to, stand, sit; talk, hear, and use hands and fingers to operate a computer and telephone keyboard reach, Specific vision abilities required by this job include close vision requirements due to computer work, Light to moderate lifting is required, Ability to uphold the stress of traveling, This is a remote position. Regular, predictable attendance is required.
The essential functions of the NCM are to: Perform and document telephonic medical case management according to Axiom's Best Practice Guidelines and Nursing Directives. Uphold Axiom’s dedication to maintaining excellent client service and relationships by providing the highest quality of service, care, and expertise. Educate injured workers, safety representatives, and supervisors on Axiom’s style of case management, as needed Transfer cases to the Outcome Team according to Axiom procedures Adhere to current OSHA Guidelines and Case Management Procedures Adhere to current state specific Worker's Compensation Guidelines Participate in departmental meetings and in-services
Texas Connect, Inc. (TCI) is a Management Services Organization (MSO). As an MSO, we are dedicated to providing business and administrative services for healthcare providers, such as medical practices and hospital systems, allowing them to focus on patient care. TCI handles crucial backend functions, such as Information Technology, Billing, and Medical Coding. This allows our client healthcare organizations to delegate these and other essential, but non-medical tasks to TCI to improve operational efficiency. https://www.texasconnectinc.com
This position is open to Texas residents ONLY. We're hiring for 3 shifts, 7am, 7md, 7pm.
SPECIFIC SKILLS NEEDED: Excellent verbal and written communication skills Ability to follow chain of command Knowledge of hospital operations especially from an ER, ICU, nursing unit, environmental services and financial perspective. Knowledge of EMTALA regulations Advanced ability to multi-task and maintain focus Proactive, can-do approach and desire to build positive working relationships through collaborative problem-solving Self-motivated and results oriented. Must be able to demonstrate sound decision making, flexibility and prioritization skills. Strong organizational skills Basic computer skills; Outlook, Word, and Excel EDUCATION/EXPERIENCE/TRAINING Required: Maintain an active California RN Minimum of two (2) years of acute hospital nursing experience or similar field Preferred: CCM or ACM (Certified Case Manager, Accredited Case Manager) Minimum of one (1) year acute hospital nursing experience in Critical Care or Emergency Department Previous experience in case management, access management or utilization management Knowledge of payer requirements
The Emergency Prospective Review (EPR) RN has the responsibility to conduct a review of all patients requiring hospital admission from the emergency room at all facilities after stabilizing care has been initiated for medical necessity and appropriateness. Also, the EPR-RN is responsible for reviewing all interfacility transfer request from non-PIH facility in accordance to transfer policies, Health and Safety Codes, and applicable laws (COBRA/EMTALA). The EPR-RN performs, and supervises the EPRN-LVN, in utilization review with a prominent level of expertise by using approved criteria that demonstrates medical necessity to achieve appropriate authorization and reimbursement for services for the appropriate level of care and status (Inpatient, Observation, or Outpatient). EPR-RN Communicates medical necessity criteria effectively to outside insurance providers to obtain appropriate authorization for services up front or engages in disagreement of care in accordance with Health and Safety Codes. Additionally, EPR-RN collaborates closely with patient’s insurance and various payors to coordinate and assist with reparation/transfer of out-of-network patients from PIH facility to the patient’s contracted facility including coordination of post-emergency discharge needs, as necessary. EPR-RN is also responsible for the repatriation of all PHP risk patients from non-PIH facilities to any one of the PIH facilities in an expeditious manner. EPR-RN conducts emergency physician-to-emergency physician discussions of members and provides authorization for post-stabilization care of PHP members presenting at a non-PIH facility and is required to assist in making other appropriate arrangements to promote/enhance continuity of care. Similarly, EPR -RN is responsible for the issuance of post stabilization care (PSC) denial to facilities and providers who fail to meet requirements in accordance with Health and Safety Codes. Lastly, the EPR-RN Works collaboratively with House Supervisor or designee in ensuring timely bed assignment and placement of patient admissions or transfers from PIH ED or outside facility. The position serves as a liaison between patients, families, providers, payors, and PIH Health leadership to optimize resource utilization and patient outcomes. This position is considered hybrid with remote and in-office assignment.
Texas Connect, Inc. (TCI) is a Management Services Organization (MSO). As an MSO, we are dedicated to providing business and administrative services for healthcare providers, such as medical practices and hospital systems, allowing them to focus on patient care. TCI handles crucial backend functions, such as Information Technology, Billing, and Medical Coding. This allows our client healthcare organizations to delegate these and other essential, but non-medical tasks to TCI to improve operational efficiency. https://www.texasconnectinc.com
There are 3 open positions for this role.
SPECIFIC SKILLS NEEDED: Excellent verbal and written communication skills Ability to follow chain of command Highly developed ability to multi-task and maintain focus Proactive, can-do approach and desire to build positive working relationships through collaborativeproblem-solving Self-motivated and results oriented. Must be able to demonstrate sound decision making, flexibility and prioritization skills with minimal supervision. Strong organizational skills Basic computer skills: Word, Excel, PowerPoint, Outlook. Able to utilize multiple electronic systems. Type 50 WPM Ability to apply appropriate UM criteria EDUCATION/EXPERIENCE/TRAINING Required: Current licensure as a LVN in the state of California. A minimum of 2 years of case management experience. Knowledge of payer requirements. Preferred: Certified Case Manager or Accredited Case Manager Experience with Milliman Care Guidelines (MCG) A minimum of 2 years of bedside nursing experience in an acute care setting
The Utilization Management (UM) LVN performs utilization review activities, including, but not limited to, precertification, ensures appropriate level of care and status (Inpatient, Outpatient, and Observation) throughout admission and performs concurrent reviews/retrospective reviews according to guidelines. In addition, the UM LVN delegates to UM RN initial reviews and determines the medical necessity of requests by performing first level reviews. The UM LVN ensures a process that is efficient for providing care, ensuring timely and appropriate levels of care for the incoming patients. UM LVN is responsible for preparing cases for Physician Advisor for 2nd level review. This position will be hybrid with remote and in-office assignment.
Texas Connect, Inc. (TCI) is a Management Services Organization (MSO). As an MSO, we are dedicated to providing business and administrative services for healthcare providers, such as medical practices and hospital systems, allowing them to focus on patient care. TCI handles crucial backend functions, such as Information Technology, Billing, and Medical Coding. This allows our client healthcare organizations to delegate these and other essential, but non-medical tasks to TCI to improve operational efficiency. https://www.texasconnectinc.com
There are 6 open positions for this role. The Utilization Management (UM) RN performs utilization review activities, including, but not limited to, precertification, ensures appropriate level of care and status (Inpatient, Outpatient, and Observation) throughout admission and performs initial reviews, concurrent reviews, and retrospective reviews according to guidelines. Determines the medical necessity of requests by performing first level reviews. The UM nurse ensures a process that is efficient for providing care, ensuring timely and appropriate levels of care for the incoming patients. UM RN is responsible for preparing cases for Physician Advisor for 2nd level review. UM RN delegates accordingly to LVN and works in conjunction with a multi-disciplinary team to manage the care of patients in an ethical and fiduciary responsible manner. This position is hybrid with remote and in-office assignment.
SPECIFIC SKILLS NEEDED: Knowledge of payer requirements Excellent verbal and written communication skills Ability to follow chain of command Highly developed ability to multi-task and maintain focus Proactive, can-do approach and desire to build positive working relationships through collaborative problem-solving Self-motivated and results oriented. Must be able to demonstrate sound decision making, flexibility and prioritization skills with minimal supervision. Strong organizational skills Basic computer skills: Word, Excel, PowerPoint, Outlook. Able to utilize multiple electronic systems. Type 50 WPM Ability to apply appropriate UM criteria EDUCATION/EXPERIENCE/TRAINING Required: Current licensure as an RN in the state of California. A minimum of 2 years of bedside nursing experience in an acute care setting. A minimum of 2 years of case management experience. Preferred: Certified Case Manager or Accredited Case Manager BSN Experience with Milliman Care Guidelines (MCG)
Texas Connect, Inc. (TCI) is a Management Services Organization (MSO). As an MSO, we are dedicated to providing business and administrative services for healthcare providers, such as medical practices and hospital systems, allowing them to focus on patient care. TCI handles crucial backend functions, such as Information Technology, Billing, and Medical Coding. This allows our client healthcare organizations to delegate these and other essential, but non-medical tasks to TCI to improve operational efficiency. https://www.texasconnectinc.com
We have 8 openings. This position supports denials, appeals and compliance activities within the Care Management Department, including patient chart review, writing appeal letters and various audits supporting the Department and hospital in meeting regulatory requirements associated with Care Management.
SPECIFIC SKILLS NEEDED: Excellent verbal, written, and organizational skills required Ability to follow chain of command Knowledge of medical terminology and current third party payor reimbursement methodologies Selfmotivated and results oriented. Must be able to demonstrate sound decision making and prioritization skills, utilizes the approved process to resolve biophysical, psychological, educational and environmental needs of patient/significant others when administering or explaining care. EDUCATION/EXPERIENCE/TRAINING Required: Maintain an active California LVN license Minimum of 2 years acute hospital experience Proficiency with mainframe and personal computers Preferred: Maintain an active California RN license. Managed care and case management experience
CorVel is a national provider of industry leading risk management solutions to employers, third party administrators, insurance companies and government agencies. We have over 30 years of experience and are publicly traded (NASDAQ: CRVL). Annual revenues exceeded $429 million in 2013. We specialize in applying advanced communication and information technology to improve healthcare management. Nationwide, our associates work side by side with our customers to deliver innovative, tailored solutions to manage risk and keep our customers ahead of their costs.
The Telephonic Case Manager coordinates resources and develops cost-effective, personalized care plans for ill or injured individuals. The goal is to support quality treatment and, when appropriate, a timely return to work. This role uses clinical expertise to assess the appropriateness of current treatment plans based on the patient’s medical and physical condition. The Case Manager communicates directly with treating physicians to evaluate and recommend alternative care options when needed. They also explain medical conditions and treatment plans to patients, family members, and adjusters, while supporting the objectives of the Case Management department and of CorVel. This is a remote role.
KNOWLEDGE & SKILLS: Ability to make independent medical decisions and recommendations to all parties Effective multi-tasking skills in a high-volume, fast-paced, team-oriented environment Ability to interface with claims staff, attorneys, physicians and their representatives, and advisors/clients and coworkers Excellent written and verbal communication skills Ability to meet designated deadlines Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets Strong interpersonal, time management, and organizational skills Ability to work both independently and within a team environment EDUCATION & EXPERIENCE: Bachelor’s degree required, BSN preferred Graduate of accredited school of nursing Current RN Licensure in state of operation 3 or more years of recent clinical experience, preferably in rehabilitation URAC recognized Case Management certification (ACM, CCM, CDMS, CMAC, CMC, CRC, CRRN, COHN, COHN-S, RN-BC) required to be obtained within 3 years of hire if no nationally recognized certification is present at time of hire Strong clinical background in orthopedics, neurology, or rehabilitation preferred Strong cost containment background, such as utilization review or managed care helpful Certification as a CIRS or CCM preferred
Provide medical case management to individuals through coordination with the patient, the physician, other health care providers, the employer, and the referral source Provide assessment, planning, implementation, and evaluation of patient's progress Evaluate patient's treatment plan for appropriateness, medical necessity, and cost effectiveness Utilize medical and nursing knowledge to discuss the current treatment plan/alternate treatment plans with the physician Make medical recommendations of available treatment plans to the payer Implement care such as negotiating and coordinating the delivery of durable medical equipment and nursing services Devise cost-effective strategies for medical care Required to prepare organized reports within a specified timeframe Minimum Productivity Standard is 95% per month Additional duties as assigned
Light the Way Home Care is a faith-based, family-centered startup in Florida providing compassionate non-medical homemaker and companion services to seniors and families in need. At Light the Way, we are committed to serving with compassion, dignity, and integrity while building a supportive environment for both our clients and team.
We are seeking a Registered Nurse (RN) for a flexible per diem/PRN supervisory role to support agency compliance as we grow. This position is ideal for an RN seeking supplemental income with minimal time commitment.
Responsibilities are primarily administrative and compliance-based, with a largely remote and flexible schedule. This is a per diem/PRN-style role with a flat monthly stipend, reflecting the limited scope and minimal hours required.
The Nurse Advocate serves as the Trust’s clinical liaison to members, dependents, providers, and vendors. The role ensures members receive timely, appropriate, and high‑quality care while supporting the Trust’s cost‑management strategies, plan design, and fiduciary obligations. This position blends clinical judgment, care navigation, education, and data‑driven outreach to improve outcomes and reduce avoidable spend in a self‑funded environment.
Registered Nurse (RN) with an active, unrestricted license. Minimum 3–5 years of clinical experience in acute care, case management, care coordination, or a related field. Experience working with self‑funded plans, TPAs, or employer‑sponsored benefits. Strong understanding of medical terminology, evidence‑based care, and care management principles. Excellent communication, empathy, and problem‑solving skills. Ability to work independently while collaborating with multiple stakeholders. Preferred Qualifications: Experience with firefighter, public safety, or high‑risk occupational populations. Background in utilization management, population health, or chronic disease programs. Familiarity with PBM programs, specialty drug management, and high‑cost claim mitigation. Certification in Case Management (CCM), Care Coordination (CCCTM), or similar credential. Core Competencies: Clinical judgment grounded in evidence‑based practice. Member‑first mindset with strong advocacy skills. Data‑informed decision‑making to identify risk and drive interventions. Cross‑functional collaboration with TPAs, providers, and vendors. Clear communication with members, trustees, and operational partners. Confidentiality and compliance with HIPAA and fiduciary standards.
Member Advocacy & Care Navigation: Provide one‑on‑one clinical guidance to members and families regarding diagnoses, treatment options, specialist referrals, and care pathways. Assist members in navigating complex medical situations, including chronic conditions, cancer care, high‑cost procedures, and post‑hospital transitions. Coordinate with providers to ensure continuity of care, timely follow‑up, and adherence to evidence‑based guidelines. Support members in understanding plan benefits, coverage rules, and available Trust‑sponsored programs. Clinical Case Management & Cost Stewardship: Identify high‑risk, high‑cost, or rising‑risk members through data reports, and vendor analytics. Conduct proactive outreach to support early intervention, reduce avoidable ER visits, and improve chronic disease management. Collaborate with the TPA’s medical management team to review complex cases, prior authorizations, and utilization trends. Recommend care pathways, centers of excellence, or alternative treatment options aligned with quality and cost‑effectiveness. Provider & Vendor Coordination: Serve as the Trust’s clinical point of contact with TPAs, PBMs, wellness vendors, behavioral health partners, and specialty networks. Participate in case rounds, utilization review discussions, and appeals/denials processes. Support integration of clinical programs such as telehealth, mental health services, wellness initiatives, and disease‑specific programs. Member Education & Outreach: Develop and deliver educational materials, workshops, and communications on preventive care, chronic disease management, and health literacy. Provide targeted outreach to improve compliance with screenings, vaccinations, and Trust‑sponsored wellness programs. Support member engagement strategies that improve outcomes and reduce long‑term plan costs. Compliance, Reporting & Quality Improvement: Maintain accurate, confidential case notes and documentation consistent with HIPAA and Trust policies. Track and report key metrics such as case outcomes, member engagement, cost avoidance, and program utilization. Identify trends and recommend improvements to plan design, vendor programs, or clinical processes. Participate in annual plan evaluation, renewal discussions, and strategic planning with Trust leadership.
Taking care of our customers, our communities and each other. That’s the Travelers Promise. By honoring this commitment, we have maintained our reputation as one of the best property casualty insurers in the industry for over 170 years. Join us to discover a culture that is rooted in innovation and thrives on collaboration. Imagine loving what you do and where you do it. Compensation Overview The annual base salary range provided for this position is a nationwide market range and represents a broad range of salaries for this role across the country. The actual salary for this position will be determined by a number of factors, including the scope, complexity and location of the role; the skills, education, training, credentials and experience of the candidate; and other conditions of employment. As part of our comprehensive compensation and benefits program, employees are also eligible for performance-based cash incentive awards.
Under moderate supervision, provide office based telephonic and/or in-person medical case management supporting Concierge locations with emphasis on early intervention, return to work planning, coordination of quality medical care on claims involving disability and medical treatment as well as in-house medical reviews as applicable to claim handling laws and regulations. Responsible for helping to ensure injured parties receive appropriate treatment directly related to the compensable injury or assist claim handlers in managing medical treatment to an appropriate resolution.
RN or LVN Disability case management experience. Prior clinical experience. Familiarity with URAC standards. Analytical Thinking: Identifies current or future problems or opportunities; analyzes, synthesizes and compares information to understand issues; identifies cause/effect relationships; and explores alternative solutions that support sound decision-making. Communication: Expresses, summarizes and records thoughts clearly and concisely orally and in writing by applying proper content, format, sentence structure, grammar, language and terminology. Ability to effectively present file resolution to internal and/or external stakeholders. Negotiation: Intermediate ability to understand alternatives, influence stakeholders and reach a fair agreement through discussion and compromise. General Insurance Contract Knowledge: Ability to understand policies and contracts, as they apply to policy conditions. Principles of Investigation: Intermediate investigative skills. Follows a logical sequence of inquiry with a goal of securing information about the work accident, resulting injury, anticipated treatment, job duties and any material factors that may impact recovery and return to work. Value Determination: Basic ability to determine liability and assigns a dollar value based on damages claimed and estimates, sets and readjusts reserves. Legal Knowledge: Basic knowledge, understanding and application of state, federal and regulatory laws and statutes, rules of evidence, chain of custody, trial preparation and discovery, court proceedings, and other rules and regulations applicable to the insurance industry. Medical knowledge: Thorough knowledge of the nature and extent of injuries, periods of disability, and treatment needed. WC Technical: intermediate ability to demonstrate understanding of WC Products and ability to apply available resources and technology to manage treatment plans and assist with claim resolution. Demonstrate a clear understanding and ability to work within jurisdictional parameters within their assigned state. Customer Service: Advanced ability to build and maintain productive relationships with our insureds and deliver results with optimal outcomes. Teamwork: Advanced ability to work together in situations when actions are interdependent and a team is mutually responsible to produce a result. Planning & Organizing: Advanced ability to establish a plan/course of action and contingencies for self or others to meet current or future goals. Certified Case Manager (CCM), Certified Disability Management Specialist (CDMS), Clinical Research Counselor (CRC), or Certified Rehab Registered Nurse (CRRN). What is a Must Have? Registered Nurse; Licensed Practical Nurse or Licensed Vocational Nurse.
Meet with injured employees face to face following office visits at a provider's medical facility to assist with the claim process and ensure compliance with their medical treatment plan. Contact customer, medical provider and injured parties on claims involving medical treatment and /or disability to coordinate appropriate medical care and return to work. Develop strategies to facilitate an injured employee's return to work and achieve maximum medical improvement. Evaluate and update treatment and return to work plans within established protocols throughout the life of the claim. Coordinate with medical providers to ensure the injured employee is actively participating in a viable treatment plan. Evaluate medical treatment requests to ensure that they are reasonable and necessary based upon jurisdictional guidelines. Engage specialty resources as needed to achieve optimal resolution (Dial-a-doc, physician advisor, peer reviews, MCU). Partner with Claim Professional to provide medical information and disability status necessary to create an overall strategy to achieve an optimal outcome. Utilize internal Claim Platform Systems to manage all claim activities on a timely basis. Utilize Preferred Provider Network per jurisdictional guidelines. Partner with Claim Professional to provide input on medical treatment and recovery time to assist in evaluating appropriate claim reserves. Submit accurate billing documentation on all activities as outlined in established guidelines. Customer Engagement. Participate in Telephonic and/or onsite File Reviews. Respond to inquiries - oral and written. Keep injured worker apprised of claim status. In order to perform the essential functions of this job, acquisition and maintenance of Insurance License(s) and/or certifications may be required to comply with state and Travelers requirements. Generally, License(s) are required to be obtained within three months. Perform other duties as assigned.
We are seeking a compassionate, organized, and experienced Registered Nurse (RN) to join our care team as a Clinical Care Manager. This role combines patient-centered care with remote monitoring and chronic care management (RPM/CCM) and includes supervisory responsibility over a team of CMAs (Certified Medical Assistants / Medication Aides) and LPNs and RNs. The ideal candidate will ensure high-quality patient care, streamline care coordination, and lead a clinical support team to deliver efficient and safe patient services. Location: Remote (FL, GA, NJ, NY, OH, TX)
Active, unrestricted Registered Nurse (RN) license. Knowoledge or remote care space and virtual care Preferred: BSN degree from an accredited institution Minimum of 2–5 years of clinical nursing experience; prior exposure to case management, chronic care, telehealth, home-health.
Lead a team of clinical personnel to provide the highest quality patient care Monitor and review biometric and physiologic data (e.g. blood pressure, glucose, weight, heart rate, oxygen saturation, etc.) transmitted via RPM devices from patients’ homes. Perform clinical assessments (telephonic or virtual) based on RPM data, identify alarming signals or concerning trends, and escalate care or intervene as appropriate and coach others on how to do this. Provide patient education and coaching — explain device usage, help patients understand their health data, reinforce treatment plans, and encourage adherence. Document all data, assessments, interventions, and communications accurately in electronic health records (EHR) or care-management software; ensure compliance with clinical and billing documentation requirements. Team Supervision & Leadership (CMAs & LPNs): Supervise and oversee the daily work of CMAs and LPNs assigned under your direction — assign shifts and duties to ensure adequate coverage and balanced workload. Provide orientation, training, and ongoing education for CMAs/LPNs regarding care protocols, safety standards, documentation procedures, and scope-of-practice guidelines Mentor and coach the team — offer clinical guidance, support decision-making, answer questions, and promote professional development of support staff. Evaluate performance of team members, provide feedback, conduct performance reviews, and implement corrective actions or improvement plans when necessary. Ensure that tasks assigned to CMAs/LPNs are within their legal scope of practice and follow appropriate delegation rules under RN supervision. Monitor quality and consistency of care delivered — perform periodic audits, review documentation, and conduct rounds (in-person or virtual) to ensure safety and adherence to standards. Manage staffing and scheduling — maintain adequate staffing levels per shift, adjust assignments based on patient acuity, leave or peak times, and ensure coverage for all necessary care services. Serve as a liaison between the nursing/support staff and other healthcare professionals (physicians, specialists, therapists, social workers), ensuring proper communication, smooth handoffs, and coordination of care across disciplines. Care Coordination, Quality Assurance & Program Management: Oversee the overall care delivery process for patients under RPM/CCM and the clinical support team — ensuring care quality, patient safety, and regulatory compliance. Participate in developing, implementing, and maintaining protocols, policies, and standard operating procedures (SOPs) for care delivery, remote monitoring, documentation, and care coordination. Track clinical outcomes, readmissions, hospitalizations, patient satisfaction, and other relevant metrics; analyze trends and recommend quality improvement initiatives. Facilitate patient and family education — teach about chronic disease management, self-care, medication adherence, use of RPM devices, lifestyle modifications, and health literacy. All other assigned duties.
Cadence Health was built around a simple promise: patients always come first. Our technology-enabled remote care model pairs continuous health insights with a highly skilled clinical Care Team, empowering seniors to stay healthier, avoid complications, and live more independent, fulfilling lives, all without the limits of a traditional office visit.
In the U.S., 60% of adults – more than 133 million people – live with at least one chronic condition. These patients need frequent, proactive support to stay healthy, yet our care system isn't built for that level of attention. With rising clinician shortages, strained infrastructure, and reactive care models, patients too often end up in the ER or the hospital when those outcomes could have been prevented. At Cadence, we're building a better system. Our mission is to deliver proactive care to one million seniors by 2030. Our technology and clinical care team extend the reach of primary care providers and support patients every day at home. In partnership with leading health systems, Cadence consistently monitors tens of thousands of patients to improve outcomes, reduce costs, and help patients live longer, healthier lives. The Cadence Health team seeks a Registered Nurse that will be responsible for appropriately monitoring and triaging patients based on vitals and alerts; supporting the management of patient treatment plans and medications in collaboration with Cadence NPs and the patient's Physician. A core part of this role includes fielding inbound patient calls and managing patient alerts after normal core business hours. Available Schedules: Sunday, Monday, Tuesday, and every other Wednesday, 7:00 PM to 7:00 AM ET
4+ years experience treating CHF, hypertension, and Diabetes patients either in an outpatient or inpatient setting. Compact multi-state licensure (RN compact). Experience working in a CHF bridge clinic environment. Experience working with remote patient monitoring technology. Passion for the patient/ customer experience and systematically improving healthcare with digital innovation. Independent thinker/ operator. Ability to monitor patient vitals, symptoms and labs to identify patients in need of clinical interventions. Ability to follow up with patients with abnormal readings to gather more information on their clinical status and triage appropriately. Ability to lead virtual follow-ups with patients to support program enrollment, treatment plan changes, medication adherence and achievement of lifestyle goals.
Follow standardized triage protocols for incoming calls and escalate appropriately (e.g. Schmitt - Thompson clinical telephonic triage guidelines). This can range from directing the patient to their clinic after-hours call line for non-urgent needs to sending the patient to the ER and/or dialing 911 for emergencies. Follow up with patients with abnormal readings to gather more information on their clinical status and triage appropriately. Monitor patient vitals, symptoms, and labs to identify patients in need of clinical interventions and appropriate escalation. Additional administrative support as needed: Follow up with patients who need rescheduling, reach out to patients who have had lapses in taking their vitals and other administrative work. Respond to inbound patient clinical questions and escalations by phone (and/or text message). Support clinical documentation for the patients' Cadence care team (NP, RN, and Patient Success); including documenting patient case notes in the Cadence platform and logging tickets/follow-up tasks in ZenDesk. Ensure every healthcare interaction with Cadence is an exceptional experience that prioritizes the well-being of the patient and aligns with the goals of our health system partners.
Are you a skilled, compassionate nurse looking for flexible work in clinical research? As a Clinical Research Nurse – Home Visits (PRN), you’ll provide high-quality nursing care directly in patients’ homes while supporting important research studies. This role is ideal for nurses who value flexibility, independence, enjoy local travel, and want to supplement their income with meaningful work. Key Points to Know: • You’ll use your own vehicle to visit patients in their homes, typically within 1–2 hours of your location. • Shifts are PRN / per diem, meaning you’ll work only when projects are available in your area; project frequency may vary. • Orientation, training, and project-specific instructions are provided before each assignment. • You will be compensated for all time spent on training, travel, and patient visits, including documentation. Position: Clinical Research Nurse – Home Visits (PRN) Job Type: Contract, PRN, Per Diem Hourly Rate: $60/hr onsite and $50/hr travel time Work Location: Scranton, Pennsylvania; Drive up to 1–2 hours to patient homes in your area (travel time compensated!) Job Description: As a Clinical Research Nurse – Home Visits (PRN), you will play a crucial role in ensuring the successful execution of research studies in patient homes. You will be responsible for administering investigational medications/products, conducting patient assessments, collecting vital information, and adhering to study protocols with utmost accuracy and ethics. Your expertise and caring nature will help us maintain compliance with each study's protocol and safeguard the well-being of study patients.
Relevant Nurse Licensure CH-GCP Certificate Graduate from an accredited BSN or Associate Degree in Nursing or Nursing Diploma program Minimum 2 years’ post qualification acute care experience Clinical Research experience preferred BLS certification required Experience and knowledge of working in clinical research trials with ICH-GCP (Good Clinical Practice) Certification - (training can be provided) Good basic IT skills, utilizing mobile devices and Microsoft systems Trained in Handling and Transport of Hazardous Substances (training can be provided) A flexible schedule is essential Unencumbered driver’s license, reliable car
Deliver competent, high-quality nursing care to study patients in their homes. Accountable for the competent and confident delivery of high-quality clinical care to patients/participants. Ensure compliance with each study’s protocol by providing thorough review and documentation at each subject study visit. Administer investigational medications/products as needed; Perform patient assessments to determine presence of side effects; notify Principal Investigator of findings/issues. Perform medical tests as outlined in protocol, including, but not limited to: vital signs, specimen collection, electrocardiograms; Process specimens and ship specimens per protocol. Provide patient education and medical information to study patients to ensure understanding of proper medication dosage, administration, and disease treatment. Responsible for adherence to clinical research policies to ensure ethical conduct and protect vulnerable populations. Communicate effectively, promoting open and trusting relationships.
Are you a skilled, compassionate nurse looking for flexible work in clinical research? As a Clinical Research Nurse – Home Visits (PRN), you’ll provide high-quality nursing care directly in patients’ homes while supporting important research studies. This role is ideal for nurses who value flexibility, independence, enjoy local travel, and want to supplement their income with meaningful work. Key Points to Know: • You’ll use your own vehicle to visit patients in their homes, typically within 1–2 hours of your location. • Shifts are PRN / per diem, meaning you’ll work only when projects are available in your area; project frequency may vary. • Orientation, training, and project-specific instructions are provided before each assignment. • You will be compensated for all time spent on training, travel, and patient visits, including documentation. Position: Clinical Research Nurse – Home Visits (PRN) Job Type: Contract, PRN, Per Diem Hourly Rate: $55/hr onsite and $50/hr travel time Work Location: Richmond, Virginia; Drive up to 1–2 hours to patient homes in your area (travel time compensated!) Job Description: As a Clinical Research Nurse – Home Visits (PRN), you will play a crucial role in ensuring the successful execution of research studies in patient homes. You will be responsible for administering investigational medications/products, conducting patient assessments, collecting vital information, and adhering to study protocols with utmost accuracy and ethics. Your expertise and caring nature will help us maintain compliance with each study's protocol and safeguard the well-being of study patients.
Relevant Nurse Licensure CH-GCP Certificate Graduate from an accredited BSN or Associate Degree in Nursing or Nursing Diploma program Minimum 2 years’ post qualification acute care experience Clinical Research experience preferred BLS certification required Experience and knowledge of working in clinical research trials with ICH-GCP (Good Clinical Practice) Certification - (training can be provided) Good basic IT skills, utilizing mobile devices and Microsoft systems Trained in Handling and Transport of Hazardous Substances (training can be provided) A flexible schedule is essential Unencumbered driver’s license, reliable car
Deliver competent, high-quality nursing care to study patients in their homes. Accountable for the competent and confident delivery of high-quality clinical care to patients/participants. Ensure compliance with each study’s protocol by providing thorough review and documentation at each subject study visit. Administer investigational medications/products as needed; Perform patient assessments to determine presence of side effects; notify Principal Investigator of findings/issues. Perform medical tests as outlined in protocol, including, but not limited to: vital signs, specimen collection, electrocardiograms; Process specimens and ship specimens per protocol. Provide patient education and medical information to study patients to ensure understanding of proper medication dosage, administration, and disease treatment. Responsible for adherence to clinical research policies to ensure ethical conduct and protect vulnerable populations. Communicate effectively, promoting open and trusting relationships.
Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits. The Registered Nurse (RN), a member of Advocate Health Nursing Professional Governance community, provides high- quality, patient-centered care through evidence-based practice, clinical expertise, and compassionate care delivery in an acute care setting. The RN collaborates with interdisciplinary teams, advocates for patient needs, and upholds professional practice standards to promote optimal health outcomes.
Department: 39733 Enterprise Corporate - Care Transitions Status: Part time Benefits Eligible: Yes Hours Per Week: 20 Schedule Details/Additional Information: Preferred qualifications: 3+ years RN: experience in case management, triage, with prior telephonic/remote experience. This is a weekend position, hours of operation 8am to 8:30pm with a potential to include holidays. This is a remote work from home position. Must have high speed internet. Must live within 1 hour of Mint Hill, NC Primary Care office. Pay Range $38.20 - $57.30 Job Description: Must live within 1 hour of Mint Hill, NC Primary Care Office to be considered for this remote opportunity.
Licensure, Registration, and/or Certification Required: Registered Nurse license issued by the state in which the team member practices. Education Required: Bachelor's Degree in Nursing or related field. Experience Required: Typically requires 5 years of experience in clinical nursing or 1-2 years of care management experience. Knowledge, Skills & Abilities Required: Applicable certification is encouraged. Must be self-directed with the ability to work well independently and within a team environment while recognizing and meeting the individual needs of external and internal partners/customers. Ability to demonstrate excellent oral, written and interpersonal skills. Ability to demonstrate critical thinking, problem solving and excellent organizational skills. Ability to work productively and effectively in a complex environment that includes multiple changing priorities. Demonstrated ability to work well with physicians and other healthcare professionals in a direct and positive manner. Proficient computer/Microsoft-suite skills and previous Epic EMR experience. Ability to handle multiple responsibilities. Physical Requirements and Working Conditions: Position may require travel between clinic sites so there may be exposure to road and weather conditions. Manual dexterity required for operation computer and calculator. Visual acuity required to facilitate review of written documents/computer screens, medical records, and to record information accurately. Clear oral communications and hearing acuity required for receiving instructions and converse on standard telephone. Functional speech and hearing to allow for effective communication of instructions and conversation over the telephone. Exposed to normal office environment; including usual hazards related to operating electrical equipment. Operates all equipment necessary to perform the job.
Facilitates communications among patient/family, multidisciplinary team, medical management team, community resources and other disciplines to anticipate, identify, evaluate, and act to resolve any potential barriers and constraints to delivery of care in a timely manner. Understands and interprets multiple contracts and contractual obligations in order to enable the care management team to achieve maximum clinical and financial outcomes. Collaborates with the patient/family and inter-professional team including the primary care team, hospital care team, post acute care managers, and other care partners to provide a model of care that ensures the delivery of quality, efficient, and cost-effective healthcare services. May work embedded within a provider office or telephonically working with a care team. Uses evidenced-based approaches to increase patient and family activation and engagement in their own care. As appropriate to the population, partners with patient and family to develop SMART (specific, measurable, attainable, relevant, time-bound) goals. Assists in the development, procurement, and adoption of patient self-management educational resources. Identifies potential barriers to learning and/or to the optimal delivery of care. Reports abnormal findings to the responsible provider/care team, and collaborates to develop a plan. Independently manages CM caseload according to department expectations. Ensures timely completion of tasks and documentation related to MCO, regulatory and contractual requirements. Partners with identified at-risk patients throughout the diagnosis, treatment and follow-up in order to deliver continuity of care. Anticipates the needs of the patient, recognizes and responds to changes in a patient’s status and determines priorities of patient care based on essential patient needs. Coordinates patient information and communication between and among the patient/family, the referring/accepting facilities and physicians, community caregivers (as applicable) and other members of ACM to ensure smooth transitions of care. Coordinates referrals to other internal AAH departments and/or external community resources as necessary. Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards.
Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits. The Registered Nurse (RN), a member of Advocate Health Nursing Professional Governance community, provides high- quality, patient-centered care through evidence-based practice, clinical expertise, and compassionate care delivery in an acute care setting. The RN collaborates with interdisciplinary teams, advocates for patient needs, and upholds professional practice standards to promote optimal health outcomes.
Department: 12707 Enterprise Corporate - Patient Access & Care Team: NC/GA Nursing Status: Part time Benefits Eligible: Yes Hours Per Week: 24 Schedule Details/Additional Information: Weekender, every Saturday and Sunday 8a-8p, at least 5 years RN experience required, BSN required Pay Range $38.20 - $57.30
Minimum Job Requirements Education: Graduate of a Board of Nursing approved nursing education program. Certification / Registration / License: Basic Life Support (BLS). Additional education, training, certifications, or experience may be required based on specialty. Active, unrestricted registered nurse (RN) multi-state compact and/or single-state license with privileges to practice in the state(s) where the RN is providing client nursing services Note: Licensed nurses practicing via telehealth/telenursing/virtual modalities are required to be licensed or hold the privilege to practice in the state(s) where the client(s) is/are located. Licensed nurses are responsible and accountable for knowing, understanding, and practicing in compliance with the laws, rules, regulations, and standards of practice of the state(s) where the client(s) is/are located. Experience: Typically requires 1 year of experience in clinical nursing. Knowledge / Skills / Abilities: Strong clinical judgment and critical thinking. Time management, prioritization and problem-solving skills. Excellent communication and interpersonal skills. Ability to work in a fast-paced, dynamic environment. Proficiency in operating computer functions (e.g., E-mail, electronic records, digital platforms etc.) clinical, aviation, maintenance, communications, and administrative departments. Physical Requirements and Working Conditions: Must be able to sit, stand, walk, lift, squat, bend, reach above shoulders, and twist frequently throughout the workday. Must be able to lift and support the weight of 35 pounds in handling patients, medical equipment, and supplies. Must be able to: push/pull with 30 lbs. of force and perform a sliding transfer of 150 lbs. with a second person present. Must have functional speech, vision, hearing, and touch with ability to use fine hand manipulation skills for IV insertion and other procedures/functions. Maneuver foot pedals on carts or machines. Perform physical safety interventions such as patient restraint and verbal de-escalation, if needed. May be exposed to chemical and hazardous waste as well as blood and body fluids and communicable disease. Therefore, protective clothing and equipment must be worn as necessary. Must be able to respond quickly to changes in patient and/or unit conditions. Physical Abilities Testing may be required. Additional department specific physical requirements may be identified for unique responsibilities within the department by the nurse leader. Preferred Job Requirements Education: Bachelor of Science degree in Nursing (BSN)
Engages in unit councils, professional governance, and quality initiatives to improve care processes and apply evidence-based practices. Utilizes the nursing process to assess, plan, diagnose, implement, and evaluate nursing care, engaging patients and families through the continuum of care. Monitors patient conditions, adjusts care plans, mobilizes resources, and collaborates with the care team to influence care outcomes. Upholds and promotes a culture of safety. Continuously evaluates patient, team, and unit outcomes, taking action as needed. May administer medications, treatments, and therapies safely and according to clinical protocols and procedures. Demonstrates effective communication, feedback, and conflict resolution, fostering team collaboration and appropriate delegation. Pursues professional development, completes required education, and maintains certifications. Adhere to the ANA Code of Ethics and practices ethical decision-making, respects interdisciplinary roles, and contributes to integrated, unbiased patient care. Appropriate delegation to other Registered Nurses, Licensed Practical Nurses, and unlicensed assistive personnel (i.e., nurse aides, credentialed medical assistants, etc.). Maintains accurate, timely EHR documentation. May be required to float to other units, departments, care areas, or facilities within the designated service area to meet patient care needs. Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. We believe patients living with kidney disease deserve the best care. We are committed to improving patient outcomes and improving quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants. We help nephrologists focus on the right patients at the right time across the full care spectrum. We do this by providing them with the best-in-class interdisciplinary clinical resources, analytical insight and tools, and services to patients. We listen to the needs of our patients, our employees, and our client partners, continually working to push beyond the status quo in which the care system manages patients today.
You are devoted, compassionate, and enjoy being on the front lines of healthcare, changing the lives of patients by supporting them and the team by focusing on customers. You’re excited about being part of a team that is building a healthcare delivery model that ensures the highest possible quality of life and best outcomes for those in our care. You believe people living with kidney disease deserve the best person-centered, holistic, comprehensive care and want to influence the healthcare system to drive towards that. You thrive in innovative and evolving environments with high rates of change. Your Role: As a Licensed Practical Nurse (LPN) with Evergreen Nephrology, you are responsible for conducting monthly clinical check-ins, identifying and addressing clinical concerns, reinforcing care plans, escalating issues appropriately, and ensuring clinical documentation accuracy across both the EHR and partner technology platform. This position requires clinical judgment, licensed expertise, and the ability to support patients between office visits while collaborating closely with Evergreen’s providers, care teams, and leadership. LPNs are essential to delivering a safe, compliant, clinically credible Connected Care Program. The program uses SMS as the first-line channel for patient engagement, with phone outreach used when appropriate. While this position is fully remote, you must be able to work from 8:30am – 5pm in the Eastern time zone.
Required Qualifications: Active LPN or Licensed Vocational Nurse (LVN) license Minimum 1–2 years of clinical experience in: Ambulatory care Population health Care coordination Case management Strong clinical assessment, communication, and documentation skills. Comfortable working in two systems (EHR + CCM platform) simultaneously. Ability to manage a structured, metric-driven workflow with reliability. Intermediate skills with MS Office Suite of products including Outlook and Teams Able to work effectively in a primarily remote environment: Home internet must support a minimum download speed of 25 Mbps and upload speed of 10 Mbps. Cable, Fiber, or DSL connections hardwired to the internet device are recommended Evergreen will provide remote employees with telephony applications and equipment to meet the business requirements for their role Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Preferred Qualifications: Experience in chronic disease management Prior work in virtual care, remote nursing, or telehealth programs. Familiarity with CCM regulatory requirements. Strong patient education and motivational interviewing skills.
Some responsibilities may vary based on specific patient programs, but this role's primary duties include the following: Patient Engagement & Outreach Perform monthly CCM touchpoints for assigned patient panels. Build strong, ongoing relationships with patients and caregivers through regular outreach. Review patient chart data (diagnoses, kidney disease history, medications, labs, imaging, treatment cycles) before calls. Explain CCM participation and reinforce program benefits. Clinical Assessments & Judgment Conduct structured symptom assessments (pain, fatigue, neuropathy, SOB, nausea, etc.). Evaluate changes in condition using licensed clinical judgment. Assess medication adherence issues, side effects, or confusion about regimen. Identify clinical red flags requiring escalation (e.g., worsening symptoms, new SOB, uncontrolled pain, concerning vitals). Escalation, Coordination & Provider Communication Escalate urgent issues based on defined triage pathways (same-business-day or immediate). Collaborate with the provider team on symptom changes, new concerns, or medication-related issues. Route EHR messages with clinically relevant documentation. Assist in coordinating care: scheduling follow-up, arranging labs, ensuring nephrology appointments are kept, and reducing missed care. Care Plan Reinforcement & Patient Education Reinforce provider-developed CKD and chronic disease care plans. Provide clinical explanation of symptom management instructions (within LPN scope). Support adherence to medications, lifestyle changes, and follow-up instructions. Identify social, behavioral, or access barriers and determine appropriate interventions or referrals. Documentation, EHR Updates & Compliance Document all patient interactions clearly in both the EHR and CCM patient management platform. Track and log qualifying CCM time accurately for billing compliance. Ensure documentation meets regulatory, internal QA, and partner expectations. Maintain high call quality and adherence to scripting and workflow pathways. Quality, Performance & Continuous Improvement Maintain or exceed: ≥80% monthly engagement ≥90% billable conversion High QA/documentation accuracy scores Participate in peer reviews, QA audits, coaching sessions, and continuous education. Identify recurring patient needs and communicate trends to the Program Manager. Other duties consistent with this role, as assigned.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. We believe patients living with kidney disease deserve the best care. We are committed to improving patient outcomes and improving quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants. We help nephrologists focus on the right patients at the right time across the full care spectrum. We do this by providing them with the best-in-class interdisciplinary clinical resources, analytical insight and tools, and services to patients. We listen to the needs of our patients, our employees, and our client partners, continually working to push beyond the status quo in which the care system manages patients today.
You are devoted, compassionate, and enjoy being on the front lines of healthcare, changing the lives of patients by supporting them and the team by focusing on customers. You’re excited about being part of a team that is building a healthcare delivery model that ensures the highest possible quality of life and best outcomes for those in our care. You believe people living with kidney disease deserve the best person-centered, holistic, comprehensive care and want to influence the healthcare system to drive towards that. You thrive in innovative and evolving environments with high rates of change. Your Role: As the Program Manager of Chronic and Complex Patient Management (CCPM) and Transitions of Care (TOC) with Evergreen Nephrology, you will lead a team focused on delivering longitudinal, patient-centered care for individuals with complex and chronic conditions, including kidney disease, diabetes, heart failure, and other comorbidities. In this role, you will provide collaborative, supportive leadership and oversee the day-to-day operations of the care management team, ensuring consistent execution of proactive care strategies that improve patient outcomes. You will leverage your clinical and operational expertise to guide the management of high-risk populations, ensure adherence to established care pathways, and reduce complications, avoidable hospital admissions, and overall healthcare utilization. You will be accountable for CCPM and TOC program performance, driving results against key performance indicators (KPIs) and quality metrics. Additionally, you will support ongoing team development through coaching, training, and performance management to ensure delivery of high-quality, efficient, and patient-centered care aligned with Evergreen’s standards.
Bachelor’s degree in healthcare or nursing (BSN required) Active state nursing license in good standing 3+ years of longitudinal clinical nursing care management experience required 2+ years of experience in a clinical nursing managerial or leadership role Experience in longitudinal care management Strong business acumen of value-based healthcare operations in disease management and population health programs Understanding of Business Continuity and how to build resiliency into business processes / systems Ability to develop talent, know when to delegate, innovate and iterate with your team, leveraging their strengths Exceptional relationship-building, communication, and change management skills, with the ability to influence effectively and establish trust and credibility quickly with internal and external partners Strong leadership presence which inspires others and instills confidence in peers, external partners, board members, and team members Execution-focused and hands-on, with the ability to effectively balance strategic priorities and detailed, day-to-day operational work (“in the weeds”). Able to motivate staff; influence people and outcomes, you promote team building Demonstrated ability to work effectively independently and as part of a team, in collaborative settings Commitment to maintaining highest level of confidentiality Organizational skills, operational rigor, resilience, and commitment to the business Intermediate skills with MS Office Suite of products including Outlook and Teams Able to work effectively in a primarily remote environment: Home internet must support a minimum download speed of 25 Mbps and upload speed of 10 Mbps. Cable, Fiber, or DSL connections hardwired to the internet device are recommended Evergreen will provide remote employees with telephony applications and equipment to meet the business requirements for their role Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Preferred Qualifications: Master's Degree in Nursing or Healthcare Administration or related field Experience with quality improvement using data to track and improve program performance Previous experience working within a managed care environment especially with experience in administrative/management capacity Experience in leading the clinical function of a Value Based Care organization
Oversee day-to-day operations for the CCPM and TOC care management teams, ensuring efficient workflows, standardized processes, and consistent achievement of program goals. Ensure delivery of high-quality longitudinal chronic/complex care management and best-in-class transitions of care, including adherence to clinical pathways, protocols, and documentation standards. Continuously evaluate and improve the performance of CCPM and TOC programs and team members, consistent with Evergreen’s performance management philosophy. Develop and implement collaborative strategies to improve program performance and patient outcomes (e.g., chronic disease control, complication prevention, and reduced readmissions) while ensuring patient and provider partner satisfaction. Support newly hired CCPM/TOC team members through orientation and onboarding; provide ongoing training, coaching, and development for established team members. Perform regular call and documentation (chart) audits to support performance management and identify opportunities for continuous improvement. Prepare performance reports, dashboards (as applicable), and meeting materials for CCPM and TOC programs for internal and external audiences. Oversee TOC workflows that support timely post-discharge outreach, medication reconciliation support, follow-up appointment coordination, and issue escalation to reduce avoidable readmissions. Develop and foster relationships with key stakeholders (e.g., IDT members, market leaders, and other program leaders) to drive outcomes through collaboration and cross-program partnership across CCPM and TOC. Build and maintain effective communication strategies between Evergreen and market stakeholders to foster strong relationships that support improved patient outcomes, in collaboration with market leaders. Be a Culture Champion by cultivating a culture of high performance, transparency, trust, and collaboration. Other duties consistent with this role, as assigned.
Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. We believe patients living with kidney disease deserve the best care. We are committed to improving patient outcomes and improving quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants. We help nephrologists focus on the right patients at the right time across the full care spectrum. We do this by providing them with the best-in-class interdisciplinary clinical resources, analytical insight and tools, and services to patients. We listen to the needs of our patients, our employees, and our client partners, continually working to push beyond the status quo in which the care system manages patients today.
You are devoted, compassionate, and enjoy being on the front lines of healthcare, changing the lives of patients by supporting them and the team by focusing on customers. You’re excited about being part of a team that is building a healthcare delivery model that ensures the highest possible quality of life and best outcomes for those in our care. You believe people living with kidney disease deserve the best person-centered, holistic, comprehensive care and want to influence the healthcare system to drive towards that. You thrive in innovative and evolving environments with high rates of change. Your Role: As a Licensed Practical Nurse (LPN) with Evergreen Nephrology, you are responsible for conducting monthly clinical check-ins, identifying and addressing clinical concerns, reinforcing care plans, escalating issues appropriately, and ensuring clinical documentation accuracy across both the EHR and partner technology platform. This position requires clinical judgment, licensed expertise, and the ability to support patients between office visits while collaborating closely with Evergreen’s providers, care teams, and leadership. LPNs are essential to delivering a safe, compliant, clinically credible Connected Care Program. The program uses SMS as the first-line channel for patient engagement, with phone outreach used when appropriate. While this position is fully remote, you must be able to work from 8:30am – 5pm in the Eastern time zone.
Active LPN or Licensed Vocational Nurse (LVN) license Minimum 1–2 years of clinical experience in: Ambulatory care Population health Care coordination Case management Strong clinical assessment, communication, and documentation skills. Comfortable working in two systems (EHR + CCM platform) simultaneously. Ability to manage a structured, metric-driven workflow with reliability. Intermediate skills with MS Office Suite of products including Outlook and Teams Able to work effectively in a primarily remote environment: Home internet must support a minimum download speed of 25 Mbps and upload speed of 10 Mbps. Cable, Fiber, or DSL connections hardwired to the internet device are recommended Evergreen will provide remote employees with telephony applications and equipment to meet the business requirements for their role Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Preferred Qualifications: Experience in chronic disease management Prior work in virtual care, remote nursing, or telehealth programs. Familiarity with CCM regulatory requirements. Strong patient education and motivational interviewing skills.
Patient Engagement & Outreach Perform monthly CCM touchpoints for assigned patient panels. Build strong, ongoing relationships with patients and caregivers through regular outreach. Review patient chart data (diagnoses, kidney disease history, medications, labs, imaging, treatment cycles) before calls. Explain CCM participation and reinforce program benefits. Clinical Assessments & Judgment Conduct structured symptom assessments (pain, fatigue, neuropathy, SOB, nausea, etc.). Evaluate changes in condition using licensed clinical judgment. Assess medication adherence issues, side effects, or confusion about regimen. Identify clinical red flags requiring escalation (e.g., worsening symptoms, new SOB, uncontrolled pain, concerning vitals). Escalation, Coordination & Provider Communication Escalate urgent issues based on defined triage pathways (same-business-day or immediate). Collaborate with the provider team on symptom changes, new concerns, or medication-related issues. Route EHR messages with clinically relevant documentation. Assist in coordinating care: scheduling follow-up, arranging labs, ensuring nephrology appointments are kept, and reducing missed care. Care Plan Reinforcement & Patient Education Reinforce provider-developed CKD and chronic disease care plans. Provide clinical explanation of symptom management instructions (within LPN scope). Support adherence to medications, lifestyle changes, and follow-up instructions. Identify social, behavioral, or access barriers and determine appropriate interventions or referrals. Documentation, EHR Updates & Compliance Document all patient interactions clearly in both the EHR and CCM patient management platform. Track and log qualifying CCM time accurately for billing compliance. Ensure documentation meets regulatory, internal QA, and partner expectations. Maintain high call quality and adherence to scripting and workflow pathways. Quality, Performance & Continuous Improvement Maintain or exceed: ≥80% monthly engagement ≥90% billable conversion High QA/documentation accuracy scores Participate in peer reviews, QA audits, coaching sessions, and continuous education. Identify recurring patient needs and communicate trends to the Program Manager. Other duties consistent with this role, as assigned.
Yoh delivers expertise, methodology, and momentum to keep work moving forward. From strategy to execution, we deliver bold ideas and big results through consulting, staffing, and enterprise solutions. Nearly a century after our founding, Yoh remains STEM-centered, collaborative, and committed to client success. Yoh is a proud member of the Day & Zimmermann family of companies.
Registered Nurse Complex Case Manager needed for a full-time, 6 month, remote temp contract opportunity with Yoh’s well-known client based out of Alameda, CA. * Although this is remote - you MUST have experience with CM within California.* Provide case management services for health plan members with highly complex medical and psychiatric conditions. Work closely with a team comprised of the Complex Case Manager, a Medical Social Worker, and a Health Navigator to collaborate with key departments at the health plan, including Utilization Management and Pharmacy. Externally, team will work closely with community partners to make referrals for care and resources and to best manage members across the care spectrum. The goal of the Complex Case Management program is to improve members' quality of life and assure cost-effective outcomes by utilization all available and appropriate resources.
Active/unrestricted Registered Nurse (RN) license in state of California Minimum (3) years' experience in clinical case management Certified Case Manager (CCM) preferred Knowledge of Medi-Cal and Medicare regulations a plus Demonstrate ability to critically think, problem solve, and make independent decisions supporting the case management process Must be able to consistently work Monday-Friday 8:00am to 5:00pm Required: Bachelor's Degree in Nursing (BSN) or Master's Degree in Nursing (MSN) Computer savvy (including EMR and Microsoft Office products) Demonstrate effective oral and written communication skills (communicate effectively with employees, providers, and operational leaders) Three years of clinical experience in an acute care setting (desired) Excellent organizational and time-management skills
Assessment, planning, facilitation and advocacy through collaboration with the member and other health care resources involved in the member's care Work closely with licensed and unlicensed staff to co-manage the care of complex cases telephonically through regular contact with members, caretakers, healthcare professionals and others involved in the member’s care The nurse will be responsible for triage and all aspects of the nursing process, including assessing, diagnosing, planning, implementing, and evaluating care Develop multi-disciplinary care plans with the input of the member and PCP to address identified member problems using evidence-based goals and interventions Participate in the ongoing process of identifying the health plan’s members who are most at-risk of poor health outcomes and in need of care management services Communicate with providers, members, and community resources as necessary, to support the planning, implementation and evaluation of care management programs Complete other duties and special projects as assigned
RN Case Manager – Compact License required Duration: Long-term contract with opportunity to convert to FTE Location(s): Remote (Compact States) Pay Rate: $35-40/hour 100% remote - Compact/multi-state nursing license required. RN must reside in the state for which they are licensed. Must have diverse case management experience; hospice, hospital, home care, medical (acute care, ER, ICU, Med surg, etc.). Case management experience Must have multi state compact license ROLE SUMMARY: 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 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.
EDUCATION AND EXPERIENCE: Nursing Diploma or Associate’s 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. CERTIFICATES, LICENSES, REGISTRATIONS: Current, active, and unrestricted Registered Nurse license required (Compact License) Certification in Case Management (CCM) required or to be obtained within 18 months of hire Certification in Chronic Care Professional (CCP) preferred
Lead the coordination of a regionally aligned, multidisciplinary team to provide holistic care to meet member needs telephonic and/or digitally. Use the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the members’ health across the care continuum. Assess the member's health, psychosocial needs, cultural preferences, and support systems. Engage the member and/or caregiver to develop an individualized plan of care, address barriers, identify gaps in care, and promotes improved overall health outcomes. Arrange resources necessary to meet identified needs (e.g., community resources, mental health services, substance abuse services, financial support services and disease-specific services). Coordinate care delivery and support among member support systems, including providers, community-based agencies, and family. Advocate for members and promote self-advocacy. Deliver education to include health literacy, self-management skills, medication plans, and nutrition. 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.
Job Title: LVN Case Manager (Utilization Review) Location: Remote Schedule: Monday – Friday, 8:00 AM – 5:00 PM Pay Rate: $33 – $45 per hour Job Type: Temporary Assignment Overview: We are seeking an experienced LVN Case Manager to support care coordination and utilization review for patients admitted to hospitals and Skilled Nursing Facilities (SNFs). This role works closely with an interdisciplinary care team to manage patient care across the continuum, ensure appropriate level of care, and facilitate safe and timely discharges. The position is fully remote and requires strong inpatient utilization review and care coordination experience.
Graduate of an accredited LVN nursing program. Active California Licensed Vocational Nurse (LVN) license. BLS certification (American Heart Association or American Red Cross). Minimum 3 years of clinical experience in public health, acute care, case management, or home health. At least 2 years of managed care case management experience with a focus on inpatient utilization review and/or ambulatory care. Experience working within a multidisciplinary care team. Bilingual English/Spanish preferred. Experience working with geriatric or medically complex populations preferred. Skills & Knowledge: Strong knowledge of utilization review, case management processes, and discharge planning. Understanding of managed care regulations, health plan requirements, and community resources. Excellent communication, critical thinking, and problem-solving skills. Ability to prioritize, multitask, and manage cases efficiently in a fast-paced environment. Proficiency with computer systems and medical documentation. Work Environment: Fully remote position supporting hospital and SNF care coordination. Works as part of a collaborative care team including RN Case Managers, social workers, and care coordinators. Ideal Candidate: A self-sufficient LVN with strong inpatient utilization review and care coordination experience who can quickly integrate into the team with minimal training.
Conduct daily concurrent and retro utilization reviews for hospitalized and SNF patients using evidence-based criteria (e.g., InterQual). Coordinate care and discharge planning to ensure appropriate level of care and prevent avoidable readmissions. Collaborate with hospitalists, Regional Medical Directors, social workers, ambulatory case management, and hospital nursing staff. Review and process pre-certifications, prior authorizations, and referral authorizations within required turnaround times. Identify California Children’s Services (CCS) cases, manage patient transfers, and support ambulatory case management enrollment when appropriate. Coordinate support services such as home health, durable medical equipment (DME), and follow-up PCP appointments. Conduct telephonic outreach to patients, providers, and caregivers to support care transitions. Participate in interdisciplinary rounds, discharge planning discussions, and care coordination meetings.
Paradigm is an accountable specialty care management organization focused on improving the lives of people with complex injuries and diagnoses. The company has been a pioneer in value-based care since 1991 and has an exceptional track record of generating the very best outcomes for patients, payers, and providers. Deep clinical expertise is the foundation for every part of Paradigm’s business: risk-based clinical solutions, case management, specialty networks, home health, shared decision support, and payment integrity programs. We’re proud to be recognized—again! For the fourth year in a row, we’ve been certified by Great Place to Work®, and for the third consecutive year, we’ve earned a spot on Fortune's Best Workplaces in Health Care™ list. These honors reflect our unwavering commitment to fostering a positive, inclusive, and employee-centric culture where people thrive. The Surprising Truth About Case Management - Paradigm Watch this short video for a brief introduction to role of a nurse case manager at Paradigm.
We are seeking a part-time Triage Nurse. A Triage Nurse takes calls from injured workers, assesses their current medical status, applies appropriate triage protocols, and directs the injured worker to seek the appropriate level of care. The Triage Nurse follows specific account guidelines to complete the triage process. The Triage Nurse works with the injured person, the claim’s examiner, employers, and medical providers. Schedule: Minimum one evening shift per week Minimum every fourth weekend Availability to pick up additional shifts (day, evening, night) as determined by business needs Shift differentials are included
Current, unencumbered compact RN license required Bilingual (Spanish speaking) a plus Professional licenses or certifications required to meet qualifications for this position must be current, unrestricted and allow for practice within a state or territory of the United States.
In this role, you will support Remote Therapeutic Monitoring (RTM) and Chronic Care Management (CCM) programs by connecting with patients from the comfort of your home. You will assist with patient follow-ups, care coordination, and documentation while working alongside supervising healthcare providers.
Active LPN license in Louisiana or Mississippi (Required) 1–2 years of clinical experience Telehealth experience preferred Strong communication and patient engagement skills Reliable internet connection and quiet work-from-home environment Preferred Experience Experience with Chronic Care Management (CCM), RTM, or Remote Patient Monitoring (RPM) is a plus. Schedule: Can be flexible, you will work on a number of patients over the course of the month
Conduct outbound and inbound patient calls Document patient interactions in EHR systems Support Remote Therapeutic Monitoring (RTM) programs Follow up with patients regarding treatment plans and care instructions Maintain HIPAA compliance Coordinate with supervising providers and care teams
Utilization Management Nurse Reviewer (LPN) (Part-time up to 24 hours a week) (remote/Work from home position for FL residents only) Currently seeking a (PART-TIME) FL licensed LPN for Utilization Management/ Review for a great opportunity working remotely (FROM HOME) at a dynamic healthcare organization based in Miami, FL area. The ideal candidate will possess 3 years of experience managing the treatment plan and utilization for members receiving Home Health Care / Infusion Services. JOB SUMMARY: Manages the treatment plan and utilization for all members receiving Home Health Care / Infusion Services and Durable medical equipment and supplies. Conducts the review process for those requests that appear not to be medically necessary; facilitates, coordinates and evaluates the ongoing care of a specific caseload of patients to collaborate with physicians, the patient and the family to assure cost-effective, high quality, appropriate home care for the patient during the entire episode of illness and for post discharge services and to monitor and evaluate patient outcomes, including self-management.
PHYSICAL REQUIREMENTS: The physical activities of this position involve fingering, grasping, talking, hearing, repetitive motions that may include the wrists, hands and/or fingers, sedentary work. The physical demands of this position involve sedentary work constantly remaining in a stationary position, sitting for prolonged periods of time. It may include exerting up to 10 pounds of force occasionally to lift, carry, push, pull or otherwise move objects, including the human body. Constantly communicating with others to express or exchange information by means of the spoken word and/or in writing. The visual acuity requirements of this position involve (including color, depth perception, and field of vision) to have close visual acuity to perform an activity such as: preparing and/or analyzing data and figures; constantly viewing a computer terminal and/or extensive reading. Working Conditions of this position involve constant typical office or administrative work. No adverse environmental conditions expected. MINIMUM QUALIFICATIONS: LPN license required (active and clear) 3 years of Home Health Managed Care experience. Medicare/Medicaid Managed Care experience Experience with InterQual (IQ), Milliman Care Guidelines (MCG) or other criteria used to determine medical necessity. preferred. Possess excellent customer service skills. Bilingual (English/Spanish) preferred. Effective verbal and written communication skills. Proficient in MS Outlook, MSWord and Internet Explorer. WAH (Work at Home) Requirements - Must have reliable high-speed internet. Minimum standard speed for optimal performance of 10 x 1 (10mbs download x 1mbs upload) required. Must have a separate private workspace / desk area designated for home office to ensure absolute and continuous privacy while at work.
Duties of the Home Health Case Manager include but are not limited to: Receive updated orders and medical information from all referral sources, i.e. Hospitals, Physician’s offices, Skilled Nursing Facilities, Rehabilitation Centers, Health Plans, PHOs, CM Departments, Home Health Agencies and others. Perform clinical review, to ensure that pre-established medical necessity/appropriateness criteria are met. Refer reviews that do not meet coverage criteria to Medical Director and/or Health Plan. Review and evaluates home health admission for clinical appropriateness of the continued care. Identifies and engages patients in appropriate care. Develop coordinated, collaborative care plans with all involved providers. Perform reviews telephonically using the member’s medical records, discussion with the member’s physician and/or discussion with Home health agency staff. Facilitate timely discharges and transfers based on individual needs and care requirements Educate patients to help them understand their health choices and assist them in making informed decisions about their health care. Serve as information resource and liaison to patients, health care professionals, facilities, health plan representatives, care givers, agencies and family members. Monitor cost-effective use of resources. Monitor health care service delivery and utilization according to the plan of care Provide authorizations and notifications in a timely manner. Maintain/update active patient list Document and resolve first line patient treatment plan. Prepare concise clinically based rationales that support clinical criteria such as: CMS, Medicaid, Health Plan Benefits, and InterQual Maintain a working knowledge of, and adheres to applicable federal/state regulations including but not limited to, laws related to patient confidentiality, release of information, and HIPAA Input the pertinent information and authorization into the appropriate software Maintain files. Participate in department meetings and in-services
Puzzle Healthcare is hiring a District Clinical Supervisor! Must reside in Atlanta, GA. Position Summary: The District Clinical Supervisor oversees and supports the day-to-day operations of clinical team members to ensure high-quality patient care. This role coordinates clinical activities, evaluates performance, ensures compliance with practice standards, and provides direct patient care as needed. The Clinical Supervisor serves as a key liaison between the clinical team, facility leadership, and supervising physicians.
Master's degree in Nursing and current certification as a Nurse Practitioner (NP) from an accredited program. Active, unrestricted NP license in the relevant state(s) of employment, with prescriptive authority. Minimum of 2-3 years of experience in PM&R, geriatrics, post-acute care, or a related field; experience in nursing facilities strongly preferred. Strong clinical skills in assessing and managing barriers to recovery, including rehabilitation, pain, and chronic conditions. Excellent communication and time-management abilities to handle brief, efficient patient encounters. Proficiency with EHR systems and remote documentation. Ability to work independently with a high level of autonomy and consistency.
Clinical Team Leadership & Oversight: Coordinate and supervise the activities of clinical team members providing patient care under the direction of a physician or provider for the diagnosis, treatment, and prevention of disease. Monitor daily performance of clinical team members to ensure duties are completed accurately, efficiently, and on time; intervene or provide support as needed. Supervise assigned staff, including assigning and reviewing work schedules, training team members in proper work methods, and implementing corrective or disciplinary actions when necessary. Evaluate team member performance and conduct verbal and written performance evaluations as required. Provide program oversight for assigned areas, monitor clinical outcomes, identify improvement opportunities, and implement process enhancements. Direct Patient Care: Serve as a back-up clinician for providers as needed to support staffing needs due to vacations, illness, or other absences. Function as a healthcare provider for patients undergoing rehabilitation in Skilled Nursing Facilities (SNFs). Coordinate patient care with the facility Director of Nursing, nursing staff, unit managers, and supervising physicians to ensure alignment across the care continuum. Operational & Administrative Responsibilities: Participate in Puzzle leadership meetings and provider staff meetings, offering input and updates on clinical operations. Ensure encounter thresholds are met in alignment with practice goals and productivity expectations. Maintain HIPAA-compliant use of all computer systems, records, and electronic communications. Perform other duties as assigned.
Join our dynamic healthcare team as a Nurse Practitioner, where your expertise will directly impact patient outcomes and elevate the standard of care. This role offers an exciting opportunity to work across diverse clinical settings, utilizing advanced skills in patient assessment, diagnosis, and treatment. You will collaborate with multidisciplinary teams to deliver comprehensive, compassionate care while leveraging cutting-edge electronic health record (EHR) systems and clinical protocols. If you’re passionate about making a difference in patients’ lives and thrive in a fast-paced environment, this position is your next great challenge!
Valid Nurse Practitioner license with current state certification; experience in acute care or hospital medicine strongly preferred. Demonstrated proficiency with EMR/EHR systems such as Epic or Cerner; familiarity with Athenahealth is a plus. Critical care experience including ICU or Level I/II trauma center exposure; hospital or emergency room experience highly desirable. Skills in advanced procedures such as IV insertion, phlebotomy, venipuncture, sterile processing techniques, and airway management. Knowledge of medical terminology, physiology, anatomy, CPT coding, ICD coding (ICD-10/ICD-9), and documentation standards aligned with NCQA standards. Experience working in diverse settings including nursing homes, assisted living facilities, hospice & palliative medicine environments or outpatient clinics. Ability to handle complex cases involving infectious disease care, occupational health issues like Workers' Compensation law compliance, or post-acute care scenarios. Strong communication skills for triage assessments and patient education; ability to work effectively within multidisciplinary teams. Embark on a rewarding career where your expertise fuels better health outcomes! We are committed to supporting your professional growth through ongoing training opportunities in areas such as esthetic laser treatments, gastroscopy procedures like gastric lavage or spinal taps, and advanced pain management techniques. Join us to make a meaningful difference every day!
Conduct thorough patient assessments, including vital signs, physical examinations, and medical histories to determine appropriate care plans. Diagnose acute and chronic conditions across various specialties such as emergency medicine, geriatrics, pediatrics, and behavioral health. Administer medications, injections, IV infusions, dermal fillers, botulinum toxin treatments, and perform suturing with precision and sterile technique. Manage complex cases involving pain management, wound care, catheterization, tube feeding, ventilator management, and spinal taps. Utilize EMR (Electronic Medical Records) systems like Epic or eClinicalWorks for documentation, coding (ICD-10/ICD-9), CPT procedures, and compliance with HIPAA regulations. Coordinate with specialists for diagnostic evaluations including sonography and laboratory testing; interpret results for informed decision-making. Provide telehealth consultations and participate in clinical research studies to advance evidence-based practices. Support discharge planning, case management, utilization review, and working with individuals with disabilities or developmental disabilities.
CareBridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through home-care and community based services.
Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Work Shift: Monday through Friday, 8AM to 5PM local time. No weekends or holidays. The Clinical Quality Consultant is responsible for quality documentation, coding and value capture.
Minimum Requirements: Requires an MS in Nursing and minimum of 3 years experience in applying appropriate diagnosis in the Medicare HCC model and/or CMS Risk Adjustment Model; or any combination of education and experience, which would provide an equivalent background. Requires a current, active, valid and unrestricted RN license and NP license in applicable state(s). Multi-state licensure is required if this individual is providing services in multiple states. For Carelon Health, satisfactory completion of a Tuberculosis test is a requirement for this position. Preferred Skill, Capabilities & Experiences: Prefer AAPC Certified Risk Adjustment Coder.
Focus on chart reviews by supplying clinical expertise to ensure full accurate and appropriate diagnosis, documentation, coding and care. Will review all provider visit medical encounters and apply most appropriate diagnosis codes. Overall accountability for the HCC/Risk Adjustment of goals and workflows to support value capture initiatives and high-quality clinical documentation. Liaison to coding team. Chart reviews for closing HEDIS care opportunities to ensure practice and health plan success. Participate in peer review of medical documentation for completed visit notes and patient profile information in EMR. Reviews and corrects any ICD-10 codes that have been assigned in charts. Provide feedback to the provider for improved documentation to support specific codes.
The Registered Nurse (RN) Disease Manager is responsible for coordinating care and managing the health outcomes of patients with chronic or complex health conditions. This role involves assessing, monitoring, educating, and supporting patients in managing their diseases to improve overall health and quality of life while reducing unnecessary hospitalizations and emergency care.
Education: Bachelor’s Degree in Nursing (BSN) or an Associate's Degree in Nursing (ADN) with appropriate certifications. Licensure: Current Registered Nurse (RN) license in the state of employment. Experience: 3-5 years of clinical nursing experience, preferably in disease management, case management, or a related field. Certifications: Certification in Disease Management (CDM), Case Management (CCM), or other relevant certifications preferred. Skills: Strong communication, problem-solving, and critical thinking skills. Ability to work independently and as part of a team. Proficiency with electronic health records (EHR) and other healthcare technology.
Patient Assessment: Conduct comprehensive assessments of patients’ physical, emotional, and psychosocial needs related to their chronic conditions. Care Coordination: Work closely with interdisciplinary teams, including physicians, case managers, social workers, and other healthcare professionals, to develop and implement individualized care plans for patients. Disease Education: Provide education to patients and their families regarding their diagnoses, treatment plans, and self-management techniques to improve disease outcomes. Case Management: Monitor patient progress and adjust care plans as necessary. Ensure that patients are following their prescribed treatment and managing their conditions effectively. Data Management and Reporting: Track patient outcomes and document interactions accurately. Utilize health information technology to document care, track patient progress, and report to appropriate stakeholders. Advocacy: Advocate for the patient’s needs, including obtaining necessary resources or services that will improve their health outcomes. Prevention and Health Promotion: Promote preventive care, including vaccinations, screenings, and lifestyle modifications to reduce the impact of chronic conditions. Collaboration with Providers: Maintain communication with healthcare providers to ensure continuity of care, timely follow-ups, and updates on patient status.
CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).
The Care Advocate Nurse oversees initiatives surrounding assessing the severity of the injured workers’ reported injury(ies), reviews medical data in CareMC, validates and secures medical information, assesses and evaluates prescribed treatment of work related injury. The Care Advocate Nurse functions as a nurse consultant, supporting the goals of the Claims Management department and of CorVel. This is a remote role.
KNOWLEDGE & SKILLS: Fundamental concepts, practices and procedures of early intervention in the field of Workers’ Compensation (WC) Excellent verbal and written communication skills Ability to skillfully manage multiple, complex projects and competing priorities concurrently while working under pressure to meet production standards deadlines and maintaining strong customer service orientation Computer proficiency and technical aptitude with the ability to utilize Microsoft Office including Outlook, Word, and Excel spreadsheets Strong interpersonal skills Great attention to detail, and results focused Ability to work independently and as part of a team EDUCATION/EXPERIENCE: Minimum of 2 years' clinical nursing experience Graduate of an approved accredited school of nursing Current unencumbered RN Licensure in state of residency and practicing state(s) must be maintained throughout employment with CorVel
Initiates and receives telephonic contact with reported injured worker, employer and medical providers to obtain treatment plan, secures medical documentation, and assesses if injured worker has returned to work Responsible for detailed documentation within the claim system focusing on medical condition, treatment plan and return to work status Directs callers to appropriate medical and/or claim resources Identifies and communicates urgent situations related to treatment or patient condition directly to the claim team Functions as nurse consultant to the claim team Assesses appropriate medical follow-up and makes necessary recommendations to the claim team, working closely with team to assist in identifying potential red flags from the injury that may require further follow-up or additional services Adheres to the Care Advocate Nurse production standards and Account special handling guidelines Additional duties as assigned
Amaze Health is revolutionizing the healthcare landscape by empowering patients to take control of their healthcare journeys. Our mission is to simplify access to high-quality medical care while enhancing the patient experience. As a Nurse, you will be at the forefront of this mission, providing critical support and assessment to our patients in a timely and effective manner.
We are seeking an experienced Registered Nurse (RN) or Licensed Practice Nurse (LPN) with 5+ years of clinical experience in Family Medicine or Internal Medicine to support a growing weight management and metabolic health program. This role focuses on medical weight loss, GLP‑1 therapy management, and nutrition-focused patient education, working closely with providers to deliver evidence-based, patient-centered care. The ideal candidate is clinically strong, highly organized, comfortable with chronic disease management, and passionate about helping patients achieve sustainable weight loss and improved overall health. This is a fully remote position and requires strong assessment skills and the ability to collaborate closely with care teams.
Active, unrestricted compact Registered Nurse (RN) or Licensed Practical Nurse (LPN) license 5+ years of clinical experience in Family Medicine, Internal Medicine, or Primary Care Experience supporting patients with chronic disease management, including obesity, diabetes, or metabolic conditions Familiarity with medical weight loss programs and evidence-based obesity treatment Experience with or strong working knowledge of GLP‑1 medications (e.g., semaglutide, tirzepatide, liraglutide), including patient education and monitoring and utilization of compounding pharmacies Background in nutrition counseling, wellness, and preventive care Excellent patient education, communication, and motivational coaching skills Comfort coordinating care, reviewing labs, and supporting medication management Strong organizational skills and ability to thrive in a fast-paced, patient-centered environment Certification or training in wellness, health coaching, or nutrition is a plus but not required
Clinical Care & Weight Management: Support patients in medical weight loss programs, including GLP-1 medications. Conduct assessments, monitor progress, and follow-ups for weight management and chronic conditions. Educate on medication use, side effects, and lifestyle integration. Assist in care planning for obesity, diabetes, and related conditions. Coordinate patient care across providers, pharmacies, and care teams.. GLP-1 & Medication Support: Provide support for GLP-1 medications (e.g., semaglutide, tirzepatide). Triage patient inquiries about weight loss medications and monitor clinical indicators. Ensure safe medication use and advocate for evidence-based practices. Nutrition & Lifestyle Education: Deliver nutrition and lifestyle counseling based on provider recommendations. Encourage behavior change in diet and physical activity for long-term success. Collaborate with providers and other health professionals as needed.
Make an Impact Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. We manage services for individuals with serious mental health needs, substance use disorders, traumatic brain injuries, and intellectual/development (IDD) disabilities. Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives.
Pay Plan Title: RN Working Title: Complex Transitional Care Nurse Position Number: 91208, 81282 FLSA Status: Exempt Posting Salary Range: $ 66,240 - $ 88,595 Office Location: Remote within Trillium’s Mid State Region (See requirements section for included counties) Trillium Health Resources has a career opening for a Complex Transitional Care Nurse to join our team! The Complex Transitional Care Nurse is responsible for providing Complex Care Coordination targeting those with chronic, unresolved or complex physical, behavioral health and social determinant needs. This includes providing care planning with foundations in national evidence based and informed standards to do whole person care. The Complex Transitional Care Nurse completes required documentation/paperwork/tasks in a software platform according to timelines.
Required: Fully licensed by the North Carolina State Board of Nursing as a Registered Nurse (RN) with a minimum of one (1) year experience as a Registered Nurse. Must have a valid driver’s license. Must reside within Trillium’s Mid State Region, which includes the following counties: Anson, Guilford, Montgomery, Randolph, and Richmond. Must be able to travel within catchment as required. Preferred: Experience working with BH/MH/SU/IDD population. Knowledge of QM, UM procedures as well as experience in using data analytics for population health management. Experience assessing and coordinating care for members in adult care homes, family care homes, home residence or other settings.
Complex care coordination to assigned individuals who may have identified needs with mental health, physical health, co-occurring, co-morbid or multi-morbid conditions. Collaborate with Internal Staff across discipline/teams (Care Coordinators, Clinicians, OT, COTA, Housing Specialists, Peers, etc.) to facilitate integrated care. Monitor the Care Plan (physical, behavioral health and social determinant concerns), service delivery and health and safety of the members. Perform clinical functions of discharge/transition planning and diversion including clinical interviewing; obtaining and reviewing clinical records; identifying potential treatment needs; assessing barriers to treatment and recommending solutions; and assessing general health needs and recommending referrals. Provide education about all available services and natural and community supports, treatment options, diagnosis, etc.
At Medcor, we’re passionate about caring for our advocates as much as you are passionate about caring for your patients! Join our team and receive the support you need to be successful in your practice and to focus on your patients. In addition to a collaborative work environment, we offer great pay and benefits and emphasize your wellness. Here’s why people love working for Medcor: Stability! We’ve been around since 1984. Potential for retention and performance incentives Opportunities galore! Medcor has a lot more to offer than just this job. There are opportunities to move vertically, horizontally, and geographically. Annually, 20% of our openings are filled by internal employees. The fact is, opportunity exists here! Training! We believe in it and we’ll train and support you to be the best you can be. We feel we offer more training than most other companies. We have an open-door policy. Do you have something to say? Speak your mind! We encourage it and we look forward to how you can help our organization.
Medcor is looking to hire full-time bilingual Spanish-speaking Registered Nurses for our remote 24/7 Occupational Health triage call center! The hours for this position include 8 to 10 hour shifts between 7:00am to 7:00pm CST. For example, shifts could include 7:00am-5:00pm or 11:00am-07:00pm. The start date for this triage class will be 04/27/2026. Job Type: Full-time - 40 hours per week Salary: $30 per hour with additional shift differential pay available for evenings, nights & weekends By joining our nursing team, you will be helping thousands of employers better manage their workplace injuries and improve the quality of healthcare for their employees. Nurses who are successful in this position must be able to talk on the phone for long periods while typing and navigating through various software applications simultaneously. Our nurses must be able to visualize an injury while on the phone and clarify details about the injury while following our propriety algorithms to guide the triage of the injured worker. Training: Training for this role will last 5-6 weeks, with 2.5 weeks of classroom instruction and 2.5 weeks of precepting. These first 5-6 weeks of training are held Monday through Friday, from 8a-4p CST. The training schedule is non-negotiable, and all training must be successfully completed within a 6-week time frame. Following training, you will transition to your permanent schedule between the hours of 7a and 7p CST with an every-other-weekend requirement and holiday rotation. Changes to the permanent schedule are not allowed within the first 12 months of employment as these are based on our business needs.
Be bilingual, fluent in both the English and Spanish language Have a valid RN license and current BLS (CPR) certification Be able to handle a high volume of consecutive calls Have strong technological skills as well as a typing speed of at least 30 WPM Work a major U.S. holiday rotation Work every other weekend Have effective written, verbal, and interpersonal communication skills. Ability to read, analyze, and interpret triage tools and information along with care instructions to injured employees and their managers. Be able to talk and/or hear. You are required to sit and use your hands. Specific vision abilities required by this job include close vision for computers and written work with the ability to adjust focus Be able to work on a computer for long periods Have a private space in your home with 4 walls and a door for patient privacy Have access to high-speed internet (no satellite) within your primary residence Be able to receive and apply feedback It's a Plus If: You have call center experience You have occupational health experience
Manage a rapid flow of incoming telephone calls from Medcor customers in a call center environment Document each call efficiently and accurately Monitor and track individual as well as call center goals, productivity metrics, and statistics Reflect all shift activities using the phone system and be responsible for personal schedule adherence Provide superior customer service to Medcor’s clients and employees Complete accurate assessment of symptoms and/or concerns utilizing Medcor’s Triage Algorithms Follow HIPAA Compliance Policies
Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better. All the benefits and perks you need for you and your family: Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance Paid Time Off from Day One 403-B Retirement Plan 4 Weeks 100% Paid Parental Leave Career Development Whole Person Well-being Resources Mental Health Resources and Support Pet Benefits
Schedule: Full time Shift: Day (United States of America) Address: 2600 WESTHALL LN City: MAITLAND State: Florida Postal Code: 32751 Job Description: AHMG Urology Clinical Contact Center 2600 Westhall Lane, Maitland, FL 32751 Monday - Friday 8am - 5pm
Knowledge, Skills, and Abilities: Organizational and multi-tasking skills Knowledge of nursing care methods and procedures Ability to work as a Team player within a unit Effective verbal and oral communication and problem-solving skills EKG (based on patient ; see document EKG and Advanced Life Support Requirements) Must be fluent in English (read, verbal and written skills) Basic computer skills – must be able to navigate Microsoft windows based programs Must be able to use a high level of abstract reasoning to assess patient, evaluate interventions, and revise plan of care according to patient outcomes Education: Associate's of Nursing [Required] Bachelor's of Nursing [Preferred] Field of Study: N/A Work Experience: 1+ acute care hospital setting [Preferred] Additional Information: Additional Licensure or certification requirements may apply depending on the specific unit or state in which this position is located. Please consult the relevant credential grid for detailed information regarding these requirements Licenses and Certifications: Registered Nurse (RN) [Required] Basic Life Support - CPR Cert (BLS) [Required] Physical Requirements: (Please click the link below to view work requirements) Physical Requirements – https://tinyurl.com/49cf4xnf
Conduct comprehensive assessments to evaluate the physiological, psychological, developmental, sociocultural, spiritual, and lifestyle factors of patients. Develop and implement individualized care plans based on patient needs and standards of care, regularly evaluating and revising these plans as necessary. Administer medications and treatments accurately and safely, following physician orders and hospital protocols, and monitor for adverse reactions. Educate patients and families about health conditions, treatments, medications, and self-care strategies to promote understanding and compliance. Collaborate with medical staff and ancillary departments to coordinate and optimize patient care, ensuring effective communication and teamwork.
At Genworth, we empower families to navigate the aging journey with confidence. We are compassionate, experienced allies for those navigating care with guidance, products, and services that meet families where they are. Further, we are the spouses, children, siblings, friends, and neighbors of those that need care—and we bring those experiences with us to work in serving our millions of policyholders each day. We apply that same compassion and empathy as we work with each other and our local communities. Genworth values all perspectives, characteristics, and experiences so that employees can bring their full, authentic selves to work to help each other and our company succeed. We celebrate our diversity and understand that being intentional about inclusion is the only way to create a sense of belonging for all associates. We also invest in the vitality of our local communities through grants from the Genworth Foundation, event sponsorships, and employee volunteerism. Our four values guide our strategy, our decisions, and our interactions: Make it human. We care about the people that make up our customers, colleagues, and communities. Make it about others. We do what's best for our customers and collaborate to drive progress. Make it happen. We work with intention toward a common purpose and forge ways forward together. Make it better. We create fulfilling purpose-driven careers by learning from the world and each other.
POSITION TITLE: Claims Clinical Specialist POSITION LOCATION: This position is available to Virginia residents as Richmond or Lynchburg, VA Hybrid in-office applicants or remote applicants residing in states/locations under Eastern or Central Standard Time: Alabama, Arkansas, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Virginia, Washington DC, Vermont, West Virginia or Wisconsin. YOUR ROLE: As an Operations team member, you will play a crucial role in delivering world class customer service and capabilities to our policyholders – now and in the future. The In-House Certification Specialist is an excellent opportunity for a Registered Nurse or Licensed Social Worker. You will be responsible for improving our in-house certification functions by providing updates to the plan of care, in-house certifications, completing telephonic assessments, and monitoring claimants with multiple health conditions. This position will promote the provision of evidence-based, short-term case management services to long-term care insurance policyholders.
Active Licensed Social Worker or Registered Nurse At least two years-experience working in a role that required an understanding of single and cumulative medical conditions (particularly those common in the aging process), including their effect on physical/cognitive function, as well as their prognosis and rehabilitative potential. Able to understand and interpret MDS, Plan of Care, Physician Records and Occupational/Physical Therapist records and understand disease progression and recovery expectations. Demonstrated experience in making sound business decisions using risk management and quality protocols. Able to manage and prioritize work queues and multiple job responsibilities. You will be expected to have consistent, reliable, and predictable attendance to support the needs of the business. Ability to understand and interpret insurance contracts and Long-Term Care benefits. Good working knowledge of systems applications (e.g., WORD, EXCEL, PowerPoint, etc.).
You will be responsible for communicating with medical personnel at Long Term Care Facilities by conducting telephonic assessments for claimants to develop the plan of care and provide tax qualified certifications as required by the policy. You will be responsible for obtaining information about the medical status and care needs of the insured to best understand the disease progression, ADL/IADL loss and cognitive status. You will be responsible for making decisions about the care need expectations and benefit eligibility of the insured as it aligns with specific policy requirements and the HIPAA regulations related to Tax Qualification Certification. You will be responsible for identifying, requesting, and analyzing pertinent medical records required to best understand the disease progression, ADL/IADL loss and potential for recovery. You will be responsible for working within a structured environment with established Standard Operating Procedures to ensure consistency of claims practices. You will identify process improvement opportunities, provide feedback on processes and case management model as well as be a critical team member in enhancing the team’s performance and results. You will be responsible for communication, teamwork and collaboration, and partnering with other teams or departments to achieve common goals and support continuous improvement initiatives.
Orlando Health proudly embraces and honors the individuality of our team members. By sharing different ideas and perspectives and working together as a team, we are better able to relate to, care for and authentically serve our patients and families who make up the collective populations in our community. So, no matter who you are, what you believe or how you express yourself, you are welcome here. ORLANDO HEALTH - BENEFITS & PERKS: Competitive Pay Evening, nights, and weekend shift differentials offered for qualifying positions. All Inclusive Benefits (start day one) Student loan repayment, tuition reimbursement, FREE college education programs, retirement savings, paid paternity leave, fertility benefits, back up elder and childcare, pet insurance, PTO/Holidays, and more for full time and part time employees. Forbes Recognizes Orlando Health as a Best-In-State Employer Forbes has named Orlando Health as one of America's Best-In-State Employers for 2021. Orlando Health is the top healthcare organization in the Metro Orlando area to make the prestigious list. "We are proud to be named once again as a best place to work," said Karen Frenier, VP (HR). "This achievement reflects our positive culture and efforts to ensure that all team members feel respected, supported and valued. Employee-centric Orlando Health has been selected as one of the “Best Places to Work in Healthcare” by Modern Healthcare.
The Remote Patient Monitoring (RPM) RN delivers expert virtual nursing care across a population of patients with complex, chronic, or transitional health needs. This role integrates advanced clinical judgment, care coordination, and digital health tools to proactively manage patient conditions, reduce avoidable utilization, and improve outcomes. The position includes flexible work arrangement, supporting a virtual-first care delivery model.
Education/Training: For Team Members hired into this job prior to January 1, 2020: Graduate of an approved school of nursing. Bachelor of Science in Nursing degree (BSN). Based on area of assignment, specialty courses and specialty experience may be required. Must meet unit-specific performance competencies. Licensure/Certification: Maintains current RN license in the State of Florida. Maintains Multistate Nursing License and is obtained within first 90 days of hire. Ambulatory Care Nursing Certification (AMB-BC) completion required within 36 months of hire. Maintains current BLS/Healthcare Provider certification. Experience: Three (3) years of clinical experience in area of specialty or five (5) years of clinical experience when covering multiple specialties/service lines. Bilingual skills not required but are preferred.
Welcomes newly enrolled patients into Remote Patient Monitoring (RPM) or continuous care programs; reviews program benefits, expectations, and how remote care supports chronic disease management and prevention. Educates patients and caregivers on the use, purpose, and frequency of in-home monitoring devices; assists with troubleshooting and escalates technical issues to ensure uninterrupted data transmission. Creates a personalized, patient-centered care plan during initial onboarding and updates it regularly via phone or video based on biometric trends, self-reported symptoms, and patient goals. Conducts comprehensive nursing assessments to identify clinical needs, gaps in care, or social determinants impacting health; coordinates appropriate resources or referrals to address barriers. Provides condition-specific education and motivational coaching to promote self-management, improve adherence, and prevent disease progression—focusing on chronic conditions such as CHF, COPD, hypertension, and diabetes. Acts as the patient’s primary clinical contact for non-emergent needs, including medication refills, symptom concerns, appointment scheduling, and care navigation across the health system. Monitors in-home device readings in real time during normal business hours; follows established protocols to document trends, assesses symptoms, and escalates concerning data to the appropriate provider or team. Performs proactive outreach to review biometric data, assess symptom control, and delivers monthly care plan updates; adjust care pathways based on ongoing risk evaluation and patient response. Applies care management principles to coordinate across levels of care—helping patients transition between acute, ambulatory, and post-acute services while reducing avoidable utilization and supporting timely follow-up. Collaborates cross-functionally with virtual team members, in-office staff, primary and specialty providers, case managers, and population health teams to align care delivery and ensure continuity. Anticipates patient needs by reviewing utilization history and care gaps (e.g., overdue screenings, specialty referrals, or medication reconciliation); partners with clinical teams to close those gaps. Builds and sustains meaningful patient relationships to foster trust, engagement, and accountability in long-term health improvement. Participates in innovation pilots, Epic workflow testing, and quality improvement initiatives that advance the design and scalability of virtual care models. Documents all patient interactions, interventions, assessments, and care plan updates accurately and in a timely manner within the electronic health record. Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state, and local standards. Maintains compliance with all Orlando Health policies and procedures. Performs all other duties as assigned. Other Related Functions Troubleshoots device or connectivity issues to ensure uninterrupted biometric data transmission; escalate unresolved technical issues appropriately. Screens and processes incoming RPM referrals for program eligibility and appropriateness based on diagnosis, risk factors, and provider orders, ensuring timely documentation, patient onboarding, and device setup Participates in performance improvement projects, chart audits, and clinical reporting for quality assurance and process optimization. Cross-trained to support TeleCare triage, including after-hours nurse advice, Schmitt-Thompson-based dispositioning, and urgent symptom management. Maintains clinical and technical competence in remote monitoring equipment, documentation systems, and virtual communication platforms. Performs all other duties as assigned.
The Patient Coordinator (RN) serves as the primary point of contact for patients participating in value-based care programs beginning at the onset of a care episode and continuing through recovery. This person will provide proactive clinical support, education, and care coordination, designed to improve patient outcomes while reducing unnecessary utilization and hospital readmissions. This role is responsible for engaging patients as early as possible in their healthcare journey – often immediately following diagnosis, hospital admission, or referral into the care management program. – to ensure patients understand their care plan, access the right resources, and receive appropriate support throughout the episode of care. The Patient Coordinator builds trusted relationship with patients and caregivers, proactively identifying clinical or social barriers that could lead to complications, avoidable emergency visits, or hospital readmissions. Through continuous engagement, education, and clinical assessment, the coordinator helps guide patients through the healthcare system, ensuring timely follow-up care and adherence to treatment plans. Because this role requires overnight patient engagement and triage support candidate must hold an active Registered Nurse (RN) license and demonstrate strong clinical assessment skills.
Qualifications: Associate’s or Bachelor’s degree in Nursing (BSN preferred) An active nursing license in good standing is REQUIRED for this role 3+ years of clinical nursing experience preferred Experience in care management, case management, population health, or telehealth. Experience working with high-risk patient populations Familiarity with value-based care models (ACO, Medicare Advantage, bundled payment, or risk contracts preferred) Strong clinical triage and patient assessment skills Exceptional patient communication and empathy Ability to establish trust quickly with patients and caregivers Strong care coordination and organizational skills Comfort working with remote care technologies and EMR systems is a must Ability to remain calm and decisive in overnight clinical situations.
Early Episode Engagement: Initiate patient outreach at the beginning of the care episode, including hospital admission, discharge planning, referral into our value-based care program, or identification as a high-risk patient. Introduce the Patient Coordinator program and establish a trusted relationship with patients and caregivers from the outset of care. Ensure patients understand their diagnosis, care plan, medications, and next steps. Identify potential barriers to recovery early, including transportation, medication access, social determinants of health, or caregiver support needs. Patient Coordination and Ongoing Support: Serve as primary clinical contact for patients throughout their episode of care, providing guidance and support from initial engagement through recovery and program graduation. Respond to patient concerns or symptoms that arise outside of normal provider office hours. Provide clinical triage and guidance, including: Self-care instructions Urgent care referral Escalation to on-call physicians or clinical teams Offer reassurance and coaching to patients experiencing symptoms or uncertainly overnight Conduct proactive outreach calls to monitor patient progress and ensure adherence to care plans. Provide coaching, education, and support to patients and families navigating complex healthcare systems. Act as a consistent point of contact to help patients avoid unnecessary emergency department visits or hospital readmissions. Conduct structured post-discharge follow-up and monitoring to identify early signs of complications. Ensure patients complete timely follow-up appointments with primary care providers and specialists Address medication adherence issues Escalate clinical concerns to physicians or care teams when early warning signs are identified Document all patient interactions, risk factors, and interventions within the care management platform Coordinate closely with physicians, discharge planners, case managers, and other healthcare providers to ensure continuity of care. Facilitate access to services such as home health, rehabilitation, transportation, and durable medical equipment. Connect patients with community resources and support services when needed.
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
Location: Fully Remote (Must be licensed in California) Schedule: Monday–Friday, 8:00 AM – 5:00 PM PT Language: Bilingual candidates strongly preferred (Spanish and Vietnamese) Join the Team That’s Redefining Healthcare! Are you a compassionate Registered Nurse with a passion for improving the lives of seniors and complex care patients? Join Alignment Health as a Telephonic RN Case Manager for our Special Needs Plan (SNP) members — all from the comfort of your home! This is a fully remote, phone-based position where you'll play a vital role in helping members navigate their care journeys, close gaps in care, and overcome barriers to better health. (HIPAA compliant work space)
Must-Haves: Active, unrestricted RN license in California (Non-Compact) Minimum 2 years of clinical nursing experience At least 1 year of case management experience Proficiency with Microsoft Office (Word, Excel, Outlook) Nice-to-Haves: Bilingual (Spanish, Korean, Mandarin, etc.) Previous health plan or IPA experience Bachelor's Degree in Nursing (BSN) Licensure Requirement Upon Hire: Active, unrestricted RN license in California (Non-Compact) Must be willing to obtain RN licensure in Nevada, Arizona, North Carolina, and Texas (company reimburses costs) Work Environment: Fully remote — work from anywhere in the U.S., but must work Pacific Time hours All communication is conducted via phone, email and Teams. Company-provided equipment and IT support included
Provide telephonic case management to medically complex and chronically ill members Conduct comprehensive health assessments and create individualized care plans Coordinate care with internal and external partners, including physicians and specialists Educate members and caregivers on disease management and preventive care Monitor member progress and advocate for timely, appropriate interventions Identify and help resolve service or access issues impacting care quality
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
Alignment Health is seeking an inpatient review nurse to join the remote utilization management team. As an inpatient review nurse, you will assist patients through the continuum of care in collaboration with the patient’s primary care physician, facility case manager, discharge planner and employing contracted ancillary service providers and community resources as needed. Assures that services are provided at the most appropriate, cost effective level of care needed to meet the patient’s medical needs while maintaining safety and quality. Schedule: Monday - Friday, 8:00 AM - 5:00 PM Pacific Time (Required)
Experience Required: Minimum 3 years of general case management skills. Minimum of two years of experience utilizing Milliman Care Guidelines to justify Inpatient versus Observation Length of stay: including review of diagnosis and length of stay. Two consecutive years related experience in a managed care setting as an inpatient case manager Preferred: Experience with a Senior population. Education Required: Successful completion of an accredited Licensed Vocational Nursing Program Preferred: Associates or Bachelors Degree Specialized Skills Required: Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others. Excellent critical thinking skills related to nursing utilization review Knowledge of Medicare Managed Care Plans Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors; Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution. Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment. Report Analysis Skills: Comprehend and analyze statistical reports. Preferred: Knowledge and experience in complex/catastrophic case management preferred Licensure Required: Must have and maintain an active, valid, and unrestricted LVN or RN license in California (Non-Compact) Immediately upon hire, must be willing to obtain LVN and / or RN licensure in Nevada, (Non-compact), Arizona (Compact), North Carolina (Compact), and Texas (Compact) which will be reimbursed by company. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, hand, or feel and talk or hear. The employee is frequently required to reach with hands and arms The employee is occasionally required to climb or balance and stoop, or kneel The employee must occasionally lift and/or move up to 20 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.
Performs reviews of inpatients with complex medical and social problems. Generates referrals to contracted ancillary service providers and community agencies with the agreement of the patient’s primary care physician. Performs follow-up reviews and evaluations of patients in the ambulatory care or lower level of care setting. Reviews inpatient admissions timely and identifies appropriate level of care and continued stay based on acceptable evidence-based guidelines used by AHC. Effectively communicates with patients, their families and or support systems, and collaborates with physicians and ancillary service providers to coordinate care activities. Identifies Members who may need complex or chronic case management post discharge and warm handoff to appropriate staff for ambulatory follow up, as necessary. Communicates and collaborates with IPA/MG as necessary for effective management of Members. Assigns and provides daily oversight of the activities and tasks of the CCIP Coordinator. Records communications in EZ-Cap and/or case management database. Arranges and participates in multi-disciplinary patient care conferences or rounds. Monitors, documents, and reports pertinent clinical criteria as established per UM policy and procedure. Monitors for any over utilization or underutilization activities. Generates referrals as appropriate to the QM department. Enters data as necessary for the generation of reports related to case management. Reports the progress of all open cases to the Medical Director, Director of Healthcare Services and Manager of Utilization Management. Performs other duties as assigned.
Grace At Home is a provider-led, community-based health and care partner dedicated to improving the health and well-being of those who need care the most, with a deep commitment to high-needs, urban and rural communities. Our local physicians, nurses, and caregivers work together to serve people and the communities they live in, beyond just treating symptoms. We remove barriers by delivering personalized care as close to home as possible, often in-home, because we know a deep understanding of our patient’s race, culture, and environment is critical to delivering improved health outcomes. By empowering patients, providers, and caregivers with the support they need, we strive to make health and care a reality—not a burden—every single day. Join us in creating a better way to care.
The Transitions of Care (TOC) Nurse provides timely, telephonic clinical outreach to family members following acute care, skilled nursing, or facility-based discharges to support safe and effective transitions across care settings. This role focuses on reducing avoidable readmissions, closing quality care gaps, and improving patient outcomes through assessment, education, care coordination, and escalation as needed. The TOC Nurse serves as a critical clinical touchpoint during high-risk transition periods and collaborates closely with interdisciplinary teams to ensure continuity of care. This role supports value-based care objectives by improving utilization outcomes and quality performance.
Qualifications Licensure: Active Registered Nurse (RN) license in good standing required; ability and willingness to obtain multi-state licensure as needed. Nurse Licensure Compact (NLC) license preferred. Education: Bachelor of Science in Nursing (BSN) required. Experience: Clinical nursing experience required; experience in care management, transitions of care, case management, or population health preferred. Experience providing telephonic or remote patient support preferred. Familiarity with post-acute care settings, discharge planning, or care coordination strongly preferred. Skills: Strong clinical assessment and critical thinking skills. Excellent communication and patient education abilities. Ability to manage multiple patients and priorities in a remote environment. Proficiency with EHRs, care management systems, and documentation tools. Comfort working independently while collaborating with interdisciplinary teams. The working environment and physical requirements of the job include: Work is performed indoors in a setting with air conditioning and artificial light. Travel to and work in offices or other environments is required. In this position you will need to communicate with customers, vendors, management, and other co-workers in person and over devices, sometimes with people who are agitated. Regular use of the telephone and e-mail for communication is essential. Sitting for extended periods is common. Must be able to receive ordinary information and to prepare or inspect documents. Lifting of up to 10 lbs. occasionally may be required. Good manual dexterity for the use of common office equipment such as computer terminals, calculator, copiers, and FAX machines. Good reasoning ability is important. Able to understand and utilize management reports, memos, and other documents to conduct business.
Transitions of Care Outreach & Clinical Support: Conduct timely post-discharge telephonic outreach in accordance with established TOC workflows and timelines. Perform comprehensive clinical assessments to identify post-discharge risks, unmet needs, and barriers to recovery. Complete medication reconciliation, reinforce discharge instructions, and assess understanding of care plans. Educate family members on symptom monitoring, red flags, follow-up care, and self-management strategies. Coordinate follow-up appointments with primary care providers, specialists, and ancillary services as appropriate. Care Coordination & Escalation: Identify and escalate clinical concerns, care gaps, or social barriers to appropriate care team members. Collaborate with primary care practices, care managers, pharmacists, social workers, and other partners to ensure continuity of care. Facilitate referrals to community-based resources or internal programs to address identified needs. Document and communicate actionable information to support timely intervention and risk mitigation. Quality & Value-Based Care Support: Support closure of quality gaps related to transitions of care, medication adherence, and follow-up. Contribute to reduction of hospital readmissions, emergency department utilization, and total cost of care. Adhere to evidence-based TOC models and organizational protocols aligned with value-based care programs, including ACO and MSSP requirements. Participate in quality improvement initiatives and feedback loops to enhance TOC effectiveness. Documentation & Reporting: Accurately document all outreach, assessments, interventions, and outcomes in designated EHRs or care management platforms. Ensure timely, complete, and compliant documentation to support reporting, audits, and performance monitoring. Communicate key findings and trends to leadership and interdisciplinary teams as required. Professional Practice: Maintain active RN licensure and adhere to professional nursing standards and scope of practice. Participate in onboarding, training, and ongoing education related to transitions of care and value-based care models. Support a culture of patient-centered, high-quality, and accountable care delivery.
ProgenyHealth is a leading provider of care management solutions for premature and medically complex newborns positively impacting maternal and infant health outcomes across America. Our program builds a network of support for an uninterrupted continuum of care from prenatal health, through any resultant NICU stay, and all the way to one full year of life. Our team of neonatologists, pediatricians, and NICU nurses provide continuity of care in collaboration with providers from hospital to caregivers at home and throughout the first year of life. We help overcome systemic barriers to support healthier pregnancies and healthier starts to life for all moms and babies, one family at a time.
The Case Manager is a Registered Nurse in a telephonic managed care setting combining strong clinical knowledge and critical thinking to facilitate a care plan that will ensure quality medical care for the member population serviced by ProgenyHealth. The Case Manager for Maternity program will focus on empowering the member to support optimal wellness while advocating for necessary medical services.
Registered Nurse (RN) with a current, unrestricted compact license is required. College degree is preferred. Scheduled hours will be in central, mountain or pacific time zone. Three or more years of experience in a Case Management role is required. Previous experience in a maternity management program preferred. Three or more years of clinical experience in OB/L&D or related area is required. CCM certification required within the timeframe specified by company policy. Experience with data entry into a database or EHR required. Must be computer literate. Excellent communication skills and organizational ability are required. Must be self-motivated and willing to learn multiple tasks. Must be well organized and able to prioritize tasks. Must demonstrate accuracy in spelling and documentation. Demonstrated strength in working independently as well as collaboratively within a team. Must have excellent interpersonal skills, telephone etiquette, and maintain positive communication at all times. Must have commitment to excellence in customer service.
Assesses the physical, functional, psychological, environmental, educational, and financial needs of members referred to the Case Management program. Completes needs assessments for all members in CM and develops care plans individualized to the needs of each member as per ProgenyHealth policies and procedures. Assigns risk stratification based on complexity of medical and social needs and determines ongoing frequency of calls to continually assess plan of care. Monitors the care plan to ensure effective, appropriate provision of services and adequacy of benefits. Interfaces with providers to assist with care coordination activities, which can include appointments, transportation, DME, etc. Provides education to members regarding condition, treatment plan, benefits, services, and how to access needed care. Monitors ongoing progress towards goal achievement and reassess changes in health status throughout continuum of care. Provides referrals to appropriate community resources; facilitates access and communication when multiple services are involved; monitors activities to ensure that services are actually being delivered and meeting the needs of the member. Participates in interdisciplinary and client rounds with pertinent health care team members to identify, clarify, and/or prevent risk, quality, or plan of care variances.
Medlogix, LLC delivers innovative medical claims solutions through a seamless collaboration of our Medlogix® technology, our highly skilled staff, access to our premier health care provider networks, and our commitment to keeping our clients’ needs as our top priority. Medlogix has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is lower expenses and increased productivity for the auto insurance and workers’ compensation insurance carriers; third party administrators (TPAs); and government entities we serve.
The role of Precertification Nurse is to perform Pre-Certification determining the medical necessity of requested services for New Jersey Auto No-Fault injuries. Knowledge: New Jersey Auto PIP / No-Fault - Preferred InterQual/Review Manager/CERME CPT and ICD-9/ICD-10 diagnosis coding Medical management related to auto claims – Preferred Microsoft Office Suite programs Structure and content of the English language including the meaning and spelling of words, rules of composition and grammar
Skills: Strong interpersonal skills, communication and presentation Ability to use logic and reasoning to identify appropriate alternative course of care based on individual clinical outcomes Ability to work independently Ability to provide instruction and direction to support staff Will be required to have the ability to educate patients and the provider community regarding the Pre-Certification process and its governing laws Must be detail oriented and able to multi-task Must be able to type 45-50 words per minute Experience: 3 Years Med-Surg – Required Utilization Review – Preferred Ortho/Rehab – Preferred Job Type: Full Time; home based Required Education: Graduate of an accredited school of nursing Required License or certification: Active Nursing License in good standing – LPN/RN
Trinity Health is one of the largest not-for-profit, Catholic health care systems in the nation. It is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians caring for diverse communities across 25 states. Nationally recognized for care and experience, the Trinity Health system includes 88 hospitals, 131 continuing care locations, the second largest PACE program in the country, 125 urgent care locations and many other health and well-being services. Based in Livonia, Michigan, its annual operating revenue is $20.2 billion with $1.2 billion returned to its communities in the form of charity care and other community benefit programs.
RN – Internal Medicine Office FULLY REMOTE If you are looking for an RN II position in an Internal Medicine Office, this could be your opportunity. Here at St. Peter's Health Partner's, we care for more people in more places. Position Highlights: Quality of Life: Where career opportunities and quality of life converge Advancement: Strong orientation program, generous tuition allowance and career development Work/Life: Monday – Friday What you will do: The Registered Professional Nurse has the responsibility and accountability to utilize the nursing process to diagnose and treat human responses to actual or potential problems of individuals or groups. The Registered Professional Nurse works within and contributes to an environment where the St. Peter's Healthcare Services mission is actualized, patient outcomes are achieved, and professional practice is realized.
What you will need: Associates or Bachelor’s degree in Nursing preferred HS Diploma/equivalent required Current unencumbered NYS RN license Basic Life Support certification 6 months previous RN experience Must be able to lift 20 lbs.
Brings patient to exam room, takes appropriate vital signs and documents in electronic medical record. Review and update medication list to ensure accurate and complete list in electronic medical record (EMR) available for provider review and submission. Complete referrals and tracks patients' compliance. Review prescriptions electronically and send prescriptions to providers for review and submission. Obtains patient consent for procedures as directed by provider. Performs pre-visit planning and reviews quality metrics. Retrieves telephonic clinical information from patients who call into the office. Monitors task list and completes tasks assigned by provider in a timely manner based on urgency. Educates patients regarding medication, testing procedures and home care techniques. Ensure proper labeling, handling and documentation for patient specimens. Follow up with patient regarding test results based on advice given by provider. Maintains a clean and safe work environment including disinfecting patient care areas and equipment. In conjunction with other nursing colleagues, maintains the medical supply cabinet and drug cabinet. Uses the electronic medical record to communicate effectively. Performs quality assurance duties as assigned. Provides a clinical visit summary (Patient Plan) to patient as requested including educational materials. Participates in daily Patient Care huddles as appropriate. Works cooperatively with all colleagues to ensure quality patient care at all times. Performs other duties as assigned.
Are you a caring person who enjoys helping people? AnswerPro is seeking a Telephone Triage Registered Nurse to join our family! Your duties would include fielding incoming Nurse Triage calls.
Oregon License *Required Bilingual a plus Can-Do Attitude Maintain accurate patient records Previous experience in triage nursing or other medical fields Familiarity with medical software and equipment Ability to build rapport with patients Strong problem solving and critical thinking skills Ability to thrive in a fast-paced environment Knowledge of Triage Logic software Hours Available: Varies - Must be able to work weekends
Administer nursing care to ill, injured, or disabled patients Monitor and report changes in patient symptoms or behavior Communicate patient care with established protocols Educate patients about health maintenance and disease prevention Maintain accurate patient medical records Provide advice and emotional support to patients and their family members
Welcome! We’re excited you’re considering an opportunity with us! To apply to this position and be considered, click the Apply button located above this message and complete the application in full. Below, you’ll find other important information about this position. Responsible for triaging incoming patient referrals, assessing needs, giving appropriate clinical dispositions and facilitating referrals to WVU Medicine primary care and specialty care providers. This position will educate the patient when appropriate regarding immediate care advice and preventive behaviors. Accompanies patients to appointments and coordinates travel, accommodations, and itinerary.
EDUCATION, CERTIFICATION, AND/OR LICENSURE: Current unencumbered licensure with the WV Board of Registered Professional Nurses, or appropriate state board where services will be provided, as a registered professional nurse OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC). EXPERIENCE: Three (3) years of registered nursing experience. PREFERRED QUALIFICATIONS : EDUCATION, CERTIFICATION, AND/OR LICENSURE: Bachelors of Science in Nursing Degree (BSN). Obtain certification in Basic Life Support within 30 days of hire date. EXPERIENCE: Care coordination experience. Outpatient/clinic experience. PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Frequent walking, standing, stooping, kneeling, reaching, pushing, pulling, lifting, grasping are necessary body movements utilized in performing duties through the work shift. Ability to sit for extended periods of time. WORKING 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. Standard office environment. Multiple different clinic offices and ancillary testing departments. SKILLS AND ABILITIES: Ability to handle and maintain confidential information. Ability to work in a fast paced and rapidly changing environment. Excellent oral and written communication skills as well as strong organizational and motivational skills. Additional Job Description: primarily working 7a-7p with rotation of weekends and an occasional rotation to 7p-7a.
CORE DUTIES AND RESPONSIBILITIES: The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned. Assess and facilitate coordination of multidisciplinary care across the care continuum. Provide communication, advocacy, and education in a culturally competent manner. Clinically triages new patient referrals efficiently, to ensure timely access to care. Collaborate with multidisciplinary care team and expedite sequence of patient's workup, active treatment, survivorship, and/or end of life care. May facilitate referrals within clinics by scheduling and coordinating clinic appointments, e-visits or telehealth visits with a provider. Provide communication and reinforcement of clinical information and serve as a conduit between patient and providers/clinicians to address needs of patients. Assess health literacy and educational needs of patient. Provide clinical education about diagnosis, treatment, side effects, and post- treatment care. Assess and document patient's needs, goals, and preferences and work to ensure such are integrated into treatment and care delivery. Bridge gaps in care and assesses/troubleshoots care transitions and barriers to care. Documents all conversations with patients to maintain a comprehensive medical record. Provides communication with referring providers and primary care providers. Provides direction/guidance to Patient Navigators. Participates in all service line team meetings.
We’re seeking licensed nurses interested in educating families about health and life insurance from home. This is a non-clinical, 1099 contractor role with flexible part-time or full-time hours. You’ll have the opportunity to use your nursing knowledge and compassion to support families—no bedside care, no quotas, no pressure. Successful candidates must be willing to obtain a life insurance license in their resident state (if not already licensed) and complete a background check. Position Highlights: Fully remote with a flexible schedule 1099 commission-based income with high earning potential Non-clinical, supportive role—no bedside nursing Comprehensive training, mentorship, and ongoing support provided Ideal for nurses seeking a flexible part-time, full-time, or career transition opportunity What’s in It for You: Work from home on your schedule No prior insurance experience required—just your nursing knowledge and willingness to learn Residual income potential based on your effort Step-by-step guidance to help you feel confident and supported
Doxy.me (doc-see-me) is a telemedicine company committed to making telemedicine simple, free, and accessible worldwide. Telehealth.org is part of doxy.me. While doxy.me delivers secure, reliable telehealth technology, Telehealth.org provides the knowledge, training, and resources healthcare providers need to stay compliant, improve care quality, and build sustainable programs — no matter what technology they use. Together, we go beyond technology to help clinicians and organizations succeed with telehealth. Our shared mission is simple: to connect the world to the future of telehealth. We are seeking experienced clinicians to serve on the Clinical Advisory Board for Doxy.me and Telehealth.org. This board will provide real-world clinical insight to help guide product development, telehealth strategy, and educational initiatives across both organizations. This is a paid independent contractor advisory role designed to complement an active clinical career, requiring an average commitment of approximately four hours per month.
Clinical Advisory Board Member – Doxy.me & Telehealth.org United States (Independent Contractor) Who you are: You are an actively practicing healthcare professional who brings thoughtful perspectives on how telehealth technology can better support clinicians and patients. You are comfortable sharing constructive feedback, participating in strategic conversations, and helping bridge the gap between healthcare delivery and digital health innovation.
Licensed healthcare professionals currently practicing in the United States (part-time or full-time), or licensed professionals who are in administrative roles but not currently practicing. Meaningful experience delivering or overseeing telehealth services. Clinical experience in one of the following areas is essential: Behavioral health (e.g., psychologists, social workers) Primary care or internal medicine Psychiatry or neurology Nursing (registered nurses or nurse practitioners) A thoughtful perspective on how technology affects clinical workflows and patient care. Willingness to share candid feedback and contribute constructively to strategic discussions. Comfort collaborating with clinicians and technology teams in a professional advisory setting.
Participate in quarterly virtual advisory board meetings to discuss product direction, clinical workflows, and emerging telehealth needs. Provide practical clinical insight that helps inform product development and feature improvements within the doxy.me platform. Identify friction points in telehealth workflows and recommend opportunities to improve usability, efficiency, and patient experience. Offer perspective on emerging trends and challenges in telehealth delivery across healthcare settings. Participate in occasional product feedback sessions, surveys, or targeted testing of new features. Provide consistent guidance on Telehealth.org educational initiatives, including webinars, courses, and continuing education offerings. Occasionally participate in webinars, discussions, or other professional engagements that support clinician education and telehealth advancement.
NavistaCare is a company specializing in the clinical and administrative management of all Post-Acute Long-Term Care (PALTC) services. Program lines include medical management, mental health, dementia care and palliative care, population health and care management, on-site dialysis, wound care, Program of All-Inclusive Care for the Elderly (PACE), home health, hospice and personal care, referral management, and quality and data analytics.
We are seeking a Telemedicine Provider to join our long-term care team in an after-hours schedule working 7 days on / 7 days off supporting skilled nursing facilities in Arkansas. This role combines clinical expertise with the convenience of telehealth to improve access, reduce unnecessary hospitalizations, and enhance continuity of care for our nursing home patients. WORK ENVIRONMENT: Telemedicine-based care for Arkansas long-term care residents. Work from home; 7 days on / 7 days off; After-hours coverage with Typical shifts: 11:30 PM – 8:00 AM, 11:00PM - 07:00AM.
Schedule & Compensation: Flexible scheduling (daytime, evening, or weekend coverage available). Competitive compensation based on experience and productivity. Malpractice coverage and training provided. QUALIFICATIONS AND EDUCATION REQUIREMENTS DEGREE REQUIRED: BS-PAS/MPAS/DMSc/MSN-NP/DNP EXPERIENCE LEVEL: 2 years. Long-term care experience highly desirable BOARD CERTIFICATION: AANP/ANCC/PA-C EXPERIENCE LEVEL: 2 years of PALTC care experience is highly desirable. Our ideal candidate will possess a strong knowledge of chronic disease management, post-acute care, and geriatric syndromes; be comfortable using telehealth technology and electronic documentation systems; have excellent communication and interpersonal skills; and be able to work collaboratively with interdisciplinary teams.
Patient Care: Diagnose and treat acute and chronic illnesses, prescribe medications, and order/interpret diagnostic tests. Conduct virtual rounds with on-site nursing staff. Document all encounters accurately in the electronic medical record (EMR). Self-directed Practice: Independently assess and treat patients within the provider’s scope of practice, following facility protocols and regulations. Make clinical decisions regarding patient care in the absence of immediate supervision. Compliance & Documentation: Ensure compliance with all federal and state regulations, including OTLC, HIPAA, and OSHA guidelines. Maintain accurate, detailed, and timely medical records. Remain current with continuing education and maintain all licensure and certifications required for practice. Self-directed Work Capability: Ability to work independently, managing patient care without direct supervision. Strong clinical decision-making skills and the ability to act decisively in urgent or emergency situations. Demonstrated ability to receive constructive criticism positively. Interpersonal and Communication Skills: Excellent verbal and written communication skills to effectively interact with facility leadership, staff, patients, and families. Ability to build and maintain strong working relationships with an interdisciplinary team. Strong leadership skills to serve as a medical authority within the facility while fostering collaboration. Technology Proficiency: Experience with EHR systems and electronic documentation processes. Competency in telemedicine tools and virtual care platforms. Physical Requirements: Ability to stand, walk, and move for extended periods. Capability to respond to patient needs quickly, especially in emergency scenarios.
Trio Health Partners embodies the fundamental philosophy of prioritizing the three pillars crucial to exceptional patient care: facility, family, and provider. As a multi-specialty clinical service provider, we are dedicated to improving clinical outcomes and preventing re-hospitalizations for patients in skilled nursing and long-term care facilities. Through our full-time clinicians dedicated to your facility, Providers are seamlessly integrated into their respective disciplinary teams, working collaboratively and fully aligned towards a shared vision and common goals.
Nurse Practitioner (NP) — Transitional Care Management (TCM) Provider (Remote) Position Overview: We are seeking a licensed Nurse Practitioner (NP) to provide Transitional Care Management (TCM) services for patients discharged from our partner skilled nursing facilities. This role focuses exclusively on conducting post-discharge patient visits via telehealth (video or phone) to support continuity of care, improve outcomes, and reduce readmissions.
Required Qualifications: Active and unrestricted Nurse Practitioner license Experience reviewing and synthesizing clinical information from hospital and post-acute care settings Strong clinical judgment and patient care skills Excellent communication and patient engagement abilities Highly tech-savvy and comfortable using digital health platforms Ability to manage schedules independently and maintain productivity Comfortable working exclusively in a remote, telehealth-based environment Preferred Qualifications (Optional): Prior experience with Transitional Care Management (TCM) services Experience in skilled nursing, post-acute care, or care coordination Telehealth or virtual care delivery experience
Conduct Transitional Care Management (TCM) visits for patients following discharge from skilled nursing facilities Perform patient encounters via video or phone (fully remote role) Review and synthesize clinical data from hospital and post-acute care stays Assess patient status, address clinical needs, and provide appropriate care guidance Document visits accurately and efficiently within the designated platform Communicate clearly with patients, caregivers, and care teams Manage and maintain a full patient schedule based on availability Navigate clinical situations appropriately and escalate when necessary Utilize technology platforms to deliver care and manage workflows Deliver high-quality patient care exclusively in a virtual environment Visit Structure & Work Environment Visits typically last up to 20 minutes per patient Flexible patient volume based on provider schedule and availability 100% remote — no field work, bedside care, or in-person clinical responsibilities Fully technology-enabled care delivery model
We’re hiring Remote Pulmonary Telemedicine Providers to join our skilled nursing facility (SNF) care team. You’ll conduct daily virtual rounds in collaboration with on-site Respiratory Therapists, helping manage patients with chronic and acute pulmonary issues — all from the comfort of your home. This role is perfect for providers seeking work-life balance, a consistent schedule, and a rewarding clinical impact without the demands of full-day shifts.
Schedule & Work Environment Monday–Friday, flexibility to start anywhere between 7:30am-2pm. 4–6 hours per day from start to finish, depending on provider efficiency Remote/Work-from-Home Most providers finish their day by early to mid-afternoon Physician support available 24/7/365 for clinical backup and complex case guidance Ideal Candidate: Active NP or PA license in New Jersey & New York. Experience in pulmonary, ICU, emergency medicine, or urgent care Proficiency in Athena EMR Comfortable using Microsoft Excel for clinical tracking/logs Strong communication and decision-making skills in a remote setting We are recruiting up to 20 providers in a staggered rollout as we expand our SNF telemedicine program across these states. Apply early to secure your role in this high-impact, flexible-care model.
Conduct remote daily pulmonary rounds for SNF patients Collaborate with Respiratory Therapists and facility staff to guide care Manage a wide range of pulmonary conditions in the post-acute setting Document encounters in Athena EMR Coordinate labs, imaging, and medication changes as needed Enjoy 24/7/365 access to physician backup for escalations, second opinions, and support
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