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Reliable Home Health Care Providers offers a variety of personalized and affordable home care services to provide elderly individuals, and/or those with disabilities or those recuperating with the special care and companionship care services they require tailored to their specific needs. We offer highly skilled caregivers, companions and certified nursing assistants on a convenient, flexible hourly, full time, or 24-hour live-in basis.
We are seeking a highly skilled and experienced QA Nurse to join our team of healthcare professionals. As a QA Nurse for Home Health, you will be responsible for ensuring that our patients receive the highest quality of care possible. You will work closely with our team of nurses and other healthcare professionals to ensure that all patient care is delivered in accordance with established standards and guidelines.
Active nursing license in the state of IL Minimum of 1 year of experience in home health nursing Strong knowledge of quality assurance and improvement processes Excellent communication and interpersonal skills Ability to work independently and as part of a team Strong attention to detail and organizational skills
Conduct regular quality assurance audits of patient care plans and documentation Complete record review according to agency-defined parameters and timeframes Identify areas for improvement and develop action plans to address deficiencies Collaborate with the nursing team to ensure that all patient care is delivered in accordance with established standards and guidelines Provide education and training to nursing staff on quality assurance and improvement processes Participate in interdisciplinary team meetings to discuss patient care and identify opportunities for improvement Maintain accurate and complete records of all quality assurance activities Fully understand current Medicare guidelines and COP's If you are a dedicated and compassionate nurse with a passion for quality patient care, we encourage you to apply for this exciting opportunity.
Crawford Thomas Recruiting is a nationwide recruiting and staffing firm recognized for exceeding client expectations regarding time to fill, value and quality of candidates. Our mission is to connect industry-leading companies of all sizes with experienced, vetted professionals. Our success has included the focus areas of management, sales, finance, technology, engineering, healthcare, legal and more. Crawford Thomas Recruiting is proud to service clients ranging from startups to members of the Inc. 5000 and Fortune 500.
Our client is seeking an experienced Registered Nurse (RN) to oversee its care delivery team and ensure high-quality execution of Principal Care Management (PCM) and Chronic Care Management (CCM) programs. The RN will supervise LPNs, review and sign off on care plans, maintain clinical quality standards, and ensure compliance with Medicare guidelines. This is a fully remote role.
Active, unrestricted NLC RN license, or licensed in Florida, Texas, or Colorado 2+ years of experience in chronic disease management, neurology, or care coordination. Experience supervising or mentoring clinical staff (LPNs, MAs, etc.). Excellent communication and leadership skills with a focus on patient-centered care. Proficient with EMRs and digital health tools. Detail-oriented, organized, and committed to quality assurance and compliance. Preferred: Experience with Medicare PCM/CCM documentation, neurodegenerative conditions (Alzheimer’s, Parkinson’s, dementia), telehealth care models, and prior involvement in clinical quality improvement.
Supervise and support Licensed Practical Nurses (LPNs) in care coordination, patient engagement, and documentation. Review, approve, and sign off on care plans and clinical documentation. Conduct quality assurance reviews to ensure accuracy, timeliness, and compliance with Medicare PCM/CCM standards. Serve as a clinical liaison between our client and their partner neurologists, escalating concerns as needed. Provide mentorship, training, and feedback to nursing staff to promote professional growth. Participate in workflow optimization and quality improvement initiatives. Engage patients and caregivers to assess care quality and address clinical needs. Maintain detailed, compliant time-based activity logs for CPT billing. Uphold our client’s standards of compassionate, proactive care delivery.
AvonRisk is a leading third-party administrator (TPA) and managed care solutions provider, backed by Aquiline Capital Partners. Formed through the combination of established TPA and managed care businesses, AvonRisk is building a platform designed to elevate what clients expect from claims and risk partners. We’re focused on creating a new kind of company—entrepreneurial at its core, collaborative in its model, and committed to bringing people, data, and technology together to deliver better outcomes across workers’ compensation, liability, and managed care. At AvonRisk, we see opportunity in change and strength in partnership. Our goal is to bring together like-minded teams across the country to build a modern, national platform that remains grounded in local expertise, service, and accountability.
The primary responsibility of the utilization review nurse is to review medical records to determine the medical necessity of a request for medical services. Previous work experience might include occupational medicine, orthopedics, and general medicine. An understanding of the workers’ compensation system is essential. Review and decisions are based upon evidence based guidelines including MTUS, ACOEM, ODG, MCG, and others. Using this information the UR Nurse is able to identify if requested medical services are within the guidelines for that specific injury and clinical history. The UR Nurse works closely with the Medical Director, and may also consult with an assigned Nurse Case Manager during the course of decision making. Additional training is provided. Work hours are Monday-Friday, usual business hours.
Requirements: May be required to direct ancillary non-licensed personnel Competency: To perform the job successfully, an individual should demonstrate the following competencies: Must be self-motivated with the ability to multi task and adapt to changing work priorities Must have strong organizational skills with attention to details Must have strong time management skills Must be able to work with a variety of clients and providers Must be able to follow directions Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience: Minimum of 3 years clinical experience California Worker’s Compensation, Managed Care experience/Utilization Review experience desired Needs to be familiar with California Worker’s Compensation regulations, medical terminology Completion is IEA CA10 is required within one year of employment
Will receive and review referrals for treatment for medical appropriateness of treatment plan based on accepted evidence based guidelines and best practices. Will identify the medical diagnosis and treatment plan; validate diagnosis and corresponding algorithms of care. Will review treatment protocols and make recommendation using local, regional, and national recognized evidence base guidelines such as MTUS, ACOEM, MCG, ODG, state specific treatment guidelines, as well as documentation provided by the PTP. Will evaluate for over-utilization of treatment requests inconsistent with evidence based guidelines and when possible, negotiate with provider to amend or withdraw the treatment request when appropriate. Will refer potential non-certification cases to peer clinical reviewers. Arrange peer to peer contact with peer reviewer as needed and as requested by the requesting treating provider. Will direct and maximize the utilization of PPO/MPN networks. Pre-authorization of all appropriate inpatient and outpatient procedures. Will communicate with the claims examiner, providers, attorneys and any other auxiliary provider regarding UR determination in the prescribed given time frame set by each state, followed in written with in 24 hours. Will summarize medical records and all pertinent information presented with recommendation to Physician Advisor and/or prepare questions on complex cases for peer or third party review Identify the need for medical case management and make recommendation for referral through supervisor Will work closely with the client, claims handler, nurse case manager and supervisor, and take directions when needed. Responsible for conducting ongoing availability, monitoring oversight of non-clinical staff activities and task assigned. Assist in the notification process for the non-certification issued by the physician reviewer
AvonRisk is a leading third-party administrator (TPA) and managed care solutions provider, backed by Aquiline Capital Partners. Formed through the combination of established TPA and managed care businesses, AvonRisk is building a platform designed to elevate what clients expect from claims and risk partners. We’re focused on creating a new kind of company—entrepreneurial at its core, collaborative in its model, and committed to bringing people, data, and technology together to deliver better outcomes across workers’ compensation, liability, and managed care. At AvonRisk, we see opportunity in change and strength in partnership. Our goal is to bring together like-minded teams across the country to build a modern, national platform that remains grounded in local expertise, service, and accountability.
The primary responsibility of the utilization review nurse is to review medical records to determine the medical necessity of a request for medical services. Previous work experience might include occupational medicine, orthopedics, and general medicine. An understanding of the workers’ compensation system is essential. Review and decisions are based upon evidence based guidelines including MTUS, ACOEM, ODG, MCG, and others. Using this information the UR Nurse is able to identify if requested medical services are within the guidelines for that specific injury and clinical history. The UR Nurse works closely with the Medical Director, and may also consult with an assigned Nurse Case Manager during the course of decision making. Additional training is provided. Work hours are Monday-Friday, usual business hours.
Requirements: May be required to direct ancillary non-licensed personnel Competency: To perform the job successfully, an individual should demonstrate the following competencies: Must be self-motivated with the ability to multi task and adapt to changing work priorities Must have strong organizational skills with attention to details Must have strong time management skills Must be able to work with a variety of clients and providers Must be able to follow directions Qualification Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education and/or Experience: Minimum of 3 years clinical experience California Worker’s Compensation, Managed Care experience/Utilization Review experience desired Needs to be familiar with California Worker’s Compensation regulations, medical terminology Completion is IEA CA10 is required within one year of employment
Will receive and review referrals for treatment for medical appropriateness of treatment plan based on accepted evidence based guidelines and best practices. Will identify the medical diagnosis and treatment plan; validate diagnosis and corresponding algorithms of care. Will review treatment protocols and make recommendation using local, regional, and national recognized evidence base guidelines such as MTUS, ACOEM, MCG, ODG, state specific treatment guidelines, as well as documentation provided by the PTP. Will evaluate for over-utilization of treatment requests inconsistent with evidence based guidelines and when possible, negotiate with provider to amend or withdraw the treatment request when appropriate. Will refer potential non-certification cases to peer clinical reviewers. Arrange peer to peer contact with peer reviewer as needed and as requested by the requesting treating provider. Will direct and maximize the utilization of PPO/MPN networks. Pre-authorization of all appropriate inpatient and outpatient procedures. Will communicate with the claims examiner, providers, attorneys and any other auxiliary provider regarding UR determination in the prescribed given time frame set by each state, followed in written with in 24 hours. Will summarize medical records and all pertinent information presented with recommendation to Physician Advisor and/or prepare questions on complex cases for peer or third party review Identify the need for medical case management and make recommendation for referral through supervisor Will work closely with the client, claims handler, nurse case manager and supervisor, and take directions when needed. Responsible for conducting ongoing availability, monitoring oversight of non-clinical staff activities and task assigned. Assist in the notification process for the non-certification issued by the physician reviewer
Quest Diagnostics (NYSE: DGX) empowers people to take action to improve health outcomes. Derived from the world's largest database of clinical lab results, our diagnostic insights reveal new avenues to identify and treat disease, inspire healthy behaviors and improve health care management. Quest annually serves one in three adult Americans and half the physicians and hospitals in the United States, and our 47,000 employees understand that, in the right hands and with the right context, our diagnostic insights can inspire actions that transform lives.
The primary responsibility of the Health Screener is to provide coverage in the field ensuring that health screenings are completed accurately and on time. Maintain a safe and professional environment for clients and employees; perform with confidence all aspects of a health screening, including specimen collection and processing duties following established practices and procedures.
Preferred Work Experience: At least 1 year of healthcare experience in a professional setting preferred. Physical And Mental Requirements Lift light to moderately heavy objects. The normal performance of duties may require lifting and carrying objects. Objects in the weight range of 1 to 15 pounds are lifted and carried frequently; objects in the weight range of 16 to 40 pounds may be lifted and carried occasionally. Objects exceeding 41 pounds are not to be lifted or carried without assistance Requires use of phone and PC Fine dexterity with hands/steadiness Handling stress & emotions Concentrating on tasks Making decisions Adjusting to change Examining/observing details Sitting or standing for long periods at a time Position requires travel Knowledge Must be knowledgeable of required regulations and comply with them Skills: Proficient with finger sticks and manual blood pressure. Ability to understand and perform complex procedures and techniques and work with complex instrumentation (Cholestech and/ or Cardio Check experience preferred). Skills required for proper specimen and reagent handling, labeling, processing, preparation, transportation, and storage necessary. Excellent customer service internally and externally Possess good written and verbal communication skills Ability to read, understand and follow detailed procedures Basic computer skills necessary including access to internet / email Strong communication skills both written and verbal Proficient in Microsoft Office Suite, specifically Word, Outlook, and Excel Education: Some College Courses Formal medical education including current appropriate medical certification (RN, BSN, NP) (Required) Licenses and Certifications: Meet state licensure requirements, if applicable. (Required) Work Requirements: Travel Required
Perform biometric screening at client sites including finger stick blood collection, BMI, Blood Pressure and other health screening services based on service package Performs basic waived testing technical procedures on blood samples and completes required quality control. Provide exceptional customer service at all health screenings. Maintains accurate, complete, and legible records. Participates in training/retraining and continuing education programs as necessary. Complies with all designated safety policies and procedures in the work area, including the use of applicable protective equipment when necessary to prevent exposure to potentially infectious agents. Understands and complies with applicable federal, state and local laws. Adheres to quality assurance procedures and good manufacturing practices. Maintain all HIPAA and OSHA standards while on events. Performs other related duties as necessary.
We’re moving people forward by providing transformative technology services, digitally enabled customer experiences, and clinical health services that change lives. Our employees share an authentic desire to make vital services available to the public and support the missions of our customers.
Maximus is seeking a Clinical Reviewer (LPN) supporting the Colorado HMA (Health Maintenance Activities) Review Program. This role requires completion of desk based clinical reviews to determine appropriateness of recommended services, supports program goals and service level agreements (SLAs). The reviewer must participate in all required trainings and meetings, in addition to other tasks as required by their supervisor. Position is contingent upon contract award** Work Schedule: This position is scheduled Monday through Friday from 8:00 a.m. to 5:00 p.m. Mountain Time with some weekend coverage required based on business needs.
Minimum Requirements: Current Licensed Practical Nurse (LPN) license valid in the state of practice is required High School Degree or equivalent required Minimum 2 years of clinical experience required Associate degree in Nursing An active LPN license in the state of Colorado or a compact license is required Minimum 2 years of experience working with people with complex disabilities, including pediatric and geriatric populations Familiarity with Home and Community Based Services waivers (HCBS) Proficiency in Microsoft Office applications Preferred Requirements: Prior experience conducting document-based reviews Excellent written and communication skills Previous experience working remotely Prior experience conducting document-based reviews 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.
2070 Health is India's first healthcare-focused venture studio - an innovation platform that builds transformative healthcare companies in India and USA from scratch, by identifying disruptive opportunities in whitespace. We are deeply involved in idea generation, day-to-day operations, and strategic decisions of every company we build. Portfolio companies include Everbright Health, Reveal Healthtech, Elevate Now, Nivaan Care, BabyMD, and Everhope Oncology.
This role is part of a new company we are actively incubating in the US care navigation space. This is a chance to be on the ground floor of something being built from scratch. As a Patient Navigator (RN), you'll work directly with patients facing serious, complex illnesses - cancer, congestive heart failure, COPD, chronic kidney disease, dementia, helping them understand their diagnosis, navigate treatment decisions and coordinate care across specialists. You'll work under the general supervision of a billing practitioner, and your work will be reimbursed through Medicare's Principal Illness Navigation (PIN) codes (G0023/G0024). Translation: this is a sustainable, reimbursable model that pays for exactly the kind of clinical coordination patients with serious illnesses desperately need.
Active RN license (multi-state compact preferred) 3+ years of clinical nursing experience, with strong preference for oncology, cardiology, pulmonary, nephrology, or other serious illness specialties Deep clinical knowledge of disease-specific care—treatment pathways, medication management, side effects, escalation protocols Care coordination experience - you've navigated complex patients across multiple providers and know how to keep things from falling through the cracks Comfort with documentation - you're organized, detail-oriented, and understand that good documentation = sustainable programs Experience with Medicare patients or managed care populations
Build trusting relationships with patients and families facing serious, life-altering diagnoses Conduct comprehensive assessments to understand the patient's clinical status, treatment goals, and barriers to care Educate patients on their disease, treatment options, side effects, warning signs, and when to escalate concerns Prepare patients for appointments with specialists - what questions to ask, what to expect, how to advocate for themselves Facilitate informed decision-making about treatment options, clinical trials, palliative care, and advance care planning Track treatment adherence, identify gaps in care, and intervene before problems escalate Provide emotional support and help patients cope with the psychological burden of serious illness Coordinate across the care team - oncologists, cardiologists, PCPs, specialists, pharmacies, home health, social workers Schedule appointments, manage referrals, and ensure smooth care transitions (hospital to home, specialist to PCP) Monitor treatment plans and medication regimens, flagging issues to the billing practitioner Document your navigation activities with precision (time spent, activities performed, clinical assessments) so we can bill Medicare and sustain the program This role is remote-first.
Healthmap Solutions is the future of specialty health management that focuses on progressive diseases, with a particular expertise in kidney health populations. Healthmap Solutions uses clinical big data resources and high-powered analytics to power complex specialty health management programs. Healthmap Solutions is a diverse, growing company committed to our clients and our employees. We are champions for better health, for those who need us most.
The Registered Nurse, Care Navigator will be responsible for case management specific to kidney health management. The Care Navigator will complete activities for the continuum of care to facilitate and promote high quality, cost-effective outcomes for patients and focus on the whole patient and care delivery coordination. Managing a set caseload of mixed acuity members, reviewing and/or obtaining member data and entry in HealthMap’s Care Management documentation system (Compass), completing member health and social determinants of health screenings, medication reconciliation, creation and maintaining member-centric care plans, updates of identified problems, barriers, interventions, and goals and assistance with ongoing case management. The Care Navigator will collaborate with internal and external (physicians, nurses, and other healthcare personnel) to assure positive patient outcomes and care coordination. Location: This position is 100% remote for candidates that have an active RN license in IL.
Active, unrestricted RN license required Bachelor's degree required CCM preferred Three (3) years of experience in case management preferred Experience in a dialysis center or transplant center preferred Experience with Medicare and Medicaid preferred Skills: Advocate and energize a culture of collaboration, positivity, and motivation Strategic thinking and planning Deliver effective communication – verbal and written Succeed in a challenging environment with changing priorities
Handle in and outbound calls delivering world-class service to our members Educate kidney health and related co-morbid conditions as well as optimizing renal replacement therapy by educating members on the types of dialysis and transplant options Engage members into HealthMap’s Kidney Health Program Follow up with members based on complexity and cadence by policy Serve as patient advocate for responding and working to resolve concerns or barriers Utilize community resources and programs in care planning Serve as liaison between the patient, the patient’s support network, treating physician, and other ancillary providers as a member of an interdisciplinary care team to coordinate care, resolve nursing problems and assist patients in meeting individualized goals Notify providers of identified patient needs based on policy Comply with HIPAA privacy laws and all other federal, state, and local regulations Comply with company-defined operational policies and procedures Comply with company security policies Accountable for individual metrics and key performance indicators and identified by the organization Navigate technical applications - Excel, OneNote, Outlook, and Word Support after hours and various time zones based on business need Drive patient and families in their own care and to support self-management
At Enlyte, we combine innovative technology, clinical expertise, and human compassion to help people recover after workplace injuries or auto accidents. We support their journey back to health and wellness through our industry-leading solutions and services. Whether you're supporting a Fortune 500 client or a local business, developing cutting-edge technology, or providing clinical services you'll work alongside dedicated professionals who share your commitment to excellence and make a meaningful impact. Join us in fueling our mission to protect dreams and restore lives, while building your career in an environment that values collaboration, innovation, and personal growth. Be part of a team that makes a real difference.
This is a full-time (32 hours per week), fully remote overnight position with a Friday, Saturday, Sunday, Monday schedule, 7:30PM - 4:00AM CST. Qualified candidates must be located in a Compact state and hold a Compact RN License in the state in which you reside. Bilingual Spanish/English Language Skills Are Preferred. The Worker’s Compensation Telephone Triage Clinician position provides inbound telephone triage services remotely to injured workers while following the individual state Worker Compensation rules and regulations. Uses clinical expertise and communication skills to triage, consult, and provide recommendations for emergent and non-emergent situations. Focuses on conveying compassion and ensuring service excellence is centered on the injured worker. This is a remote position and the successful candidate must have a safe and HIPAA compliant home office with high speed internet connection, verified by speed test.
Unencumbered RN License in state of residence required, compact state strongly preferred Minimum of three years’ recent RN experience in one of the following adult clinical areas: Telephone Triage, ER, Urgent Care, Medical Surgical Unit, Occupational Medicine Bilingual in Spanish Preferred Ability to obtain other state licenses as required with fees reimbursed Ability to function independently and learn in a virtual work environment Experience using Microsoft Office Suite 24 hour work week, schedules and shifts available dependent on the needs of the business, and schedules may include working every Saturday OR every Sunday
Make safe decisions for appropriate care using critical thinking skills Use departmental evidence-based protocols to triage patients Build and maintain solid interdependent relationships within the team Maintain up-to-date knowledge and skill in professional, clinical, and system areas Demonstrate effective written and verbal communication skills
Prenuvo is the world's most advanced and comprehensive whole-body proactive health scan in under 1 hour, offering potentially life-saving insights (1 out of 20 patients) — with no contrast and zero radiation.
The Registered Nurse Navigator is a hybrid clinical and operational role that blends patient-facing communication with cross-functional collaboration. You'll provide high-touch support to patients undergoing imaging procedures, while working alongside internal teams to continuously improve how care is delivered. In this role, the Registered Nurse Navigator will function independently to conduct comprehensive nursing assessments of a patient's intention and understanding of Prenuvo services, to provide evidence-based guidance that prioritizes safety and satisfaction. The Flex Nurse Navigator will be responsible for inbound triage of patient questions and pre-scan counseling in addition to medical history review as it pertains to Prenuvo imaging and add on services. The ideal candidate will present with strong collaboration and communication skills while being able to function autonomously during flex hours to help manage a high volume patient load and clinical requests. The Nurse Navigator will work collectively with the Preventative Medicine Team to deliver timely, high-quality patient care through telephone triage, EMR management, and clinical support across multiple states. This role is fully remote. Candidates must be located in the US within registered Prenuvo locations and be able to work one of the following shifts: 6:30 AM – 2:30 PM EST or 10:30 AM – 6:30 PM PST, with schedules available Monday–Friday or Thursday–Monday. Flexibility to work any of these shifts is considered an asset. Help reshape the world through proactive healthcare while working with cutting-edge technology and high performing teams with deep expertise - join us to make a difference in people's lives!
Active compact state RN license Located in Pacific or Eastern Time Zone and available to work full-time flex hours either Monday - Friday or Thursday - Monday Minimum 3 years of clinical experience, preferably in ambulatory care, radiology, oncology, or concierge settings Minimum 2 years of remote nursing experience in addition to the 3 years of clinical experience Certifications in radiology-related and/or oncology-related nursing Strong background in patient communication, education, and relationship-building over the phone and video Experience working cross-functionally within healthcare or digital health teams Ability to thrive in a fast-paced, startup environment—comfortable with ambiguity, pivots, and iterative work Clear, professional written and verbal communication skills Confidence using clinical software, telehealth platforms, and productivity tools Demonstrated systems thinking and eagerness to contribute to continuous improvement A warm, calm presence and a commitment to patient-centered care Passion for Prenuvo's mission and excitement to build something new
Inbound Call Triage and Patient Navigation Conduct thorough and real-time chart review of patients who are returning calls from our nurse navigator team Support patients in understanding what to expect, how to prepare, and what their next steps may be Provide counseling as it relates to patient specific concern and answer patient questions with clarity and empathy Complete medication requests per standing order protocol Screen patient for appropriateness and safety for add on services Follow up with patients to promote comprehensive care coordination before, during, and after their journey Internal Collaboration & Influence Contribute to internal process improvements by sharing insights and identifying workflow gaps Participate in quality improvement initiatives, knowledge sharing, and feedback loops Collaborate with nursing and non-clinical team members via communication platforms to ensure closed-looped patient care Clinical Documentation & Coordination Maintain accurate and timely documentation of all patient interactions Ensure compliance with privacy standards and clinical protocols Coordinate with other members of the medical group to ensure seamless patient care
Optum Home & Community Care, part of the Optum family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and social needs – helping patients access and navigate care anytime and anywhere. As a team member of our Optum HouseCalls team, together in an interdisciplinary care environment, we help patients navigate the health care system and connect them to key support services. This preventive care can help patients stay well at home. We’re connecting care to create a seamless health journey for patients across settings. Join us to start Caring. Connecting. Growing together.
The Telehealth Urgent Care program is a comprehensive integrated care delivery program. The National On Call advanced practice clinician (APC) is responsible for providing telephonic/telehealth care and direction to patients, caregivers and facility staff providing 24/7 coverage including holidays. In this remote role you will provide virtual care for patients in various settings. This excellent opportunity affords a collaborative role bringing enormous satisfaction in the care and comfort of our patients. In this role you will have the ability to achieve work life balance. Optum is transforming care delivery with innovative and personal care. As one of the largest employers of APCs, Optum offers unparalleled career development opportunities. Scheduling: This is a Part time, work from home position requiring various shift coverage with a mix of weekday, weeknights, weekend, and holiday coverage. While shift times can vary, we provide coverage to members 24/7 including all company recognized holidays Flexibility and the ability to adapt are a must as you will cross cover multiple markets and teams Availability and Coverage expectations for this role Weekday shifts between 8a-5pm Weeknight shifts between 5pm and 8am Every other weekend coverage between 8-12 hour shifts covering both day and night shifts is required based on business needs Expectations that you are working or have approved PTO for 26 weekends/year. Each FT/PT employee is eligible to have off up to 6 weekend shifts a year for PTO Unapproved time away/Unpaid Time Off will result in need to add additional weekend shift to your schedule based on business needs Holidays are required for all APCs and on a rotation basis Holiday scheduling is completed at the beginning of the year for advanced planning
Required Qualifications: Active and unrestricted license in the state which you reside, and ability to obtain in other required locations Ability to gain a collaborative practice agreement, if applicable in your state APCs working in jurisdictions that authorize APCs to practice autonomously or without formal supervision must have obtained approval to practice autonomously or without formal supervision from their licensing board, if applicable. New hires who are eligible and have not applied prior to hire date, must apply to practice autonomously or without supervision within 1 month of hire. If not eligible to practice autonomously or without formal supervision at hire, the APC must begin working towards meeting the requirement within 1 month of hire, if applicable, and apply for approval to practice autonomously or without formal supervision within 3 months of becoming eligible Education: NP: Graduate of an accredited Master of Science Nursing or Doctor of Nursing Practice program Active Nurse Practitioner certification through a national board: NP: Board certified through the American Academy of Nurse Practitioners or the American Nurses Credentialing Center, with certification in one of the following: Family Nurse Practitioner Adult Nurse Practitioner Gerontology Nurse Practitioner Adult-Gerontology Acute Care Nurse Practitioner Current, active DEA licensure/prescriptive authority or ability to obtain post-hire, per state regulations (unless prohibited in state of practice) Ability to work scheduled shifts in accordance with scheduling policies Proficient computer skills including the ability to document medical information with written and electronic medical records Preferred Qualifications: 3+ years of clinical experience as an APC Experience in meeting the medical needs of patients with complex behavioral, social and/or functional needs Experience working in a nursing home, or with seniors in an acute care facility Understanding of Geriatrics, Chronic Illness, and acute disease management Understanding of Advanced Illness and end of life discussions Ability to develop and maintain positive customer relationships Adaptability to change
Available on provided telephonic platform, both taking and placing calls to coordinate and manage care for members between care givers, facilities, hospitals, primary care providers and the Optum field colleagues Available to use video platform based on clinical need Working hours should be performed in a secure location as patient privacy is required Utilize EMR proficiently to provide acute care to members during all shifts and holiday hours Care Delivery: Deliver cost-effective, quality care to members Manage both medical and behavioral, chronic, and acute conditions effectively, and in collaboration with a physician or specialty provider Perform comprehensive assessments and document findings in a concise/comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations Responsible for ensuring encounter is documented appropriately to support the diagnosis at that visit The APC is responsible for ensuring that all quality elements are addressed and documented Utilizes evidence-based practice guidelines Must attend and complete all mandatory educational and MyLearning training requirements Care Coordination: Coordinate care as members transition through different levels of care and care settings Monitor the needs of members and families while facilitating any adjustments to the plan of care as situations and conditions change Review orders and interventions for appropriateness and response to treatment to identify the most effective plan of care that aligns with the patients’ needs and wishes Address and be able to have advanced care plan conversations with members and families Evaluate the plan of care for cost effectiveness while meeting the needs of members, families, and providers to decrease high costs, poor outcomes and unnecessary hospitalizations Program Enhancement Expected Behaviors: This is a virtual patient facing role that requires excellent customer service to all parties including members/families, facilities, the entire interdisciplinary care team (PCPs/specialists) and Optum staff Regular and effective communication with internal and external parties including physicians, patients, key decision-makers, nursing facilities, field staff and other provider groups Ability to meet shift scheduling requirements, and attendance expectations Exhibit original thinking and creativity in the development of new and improved methods and approaches to concerns/issues Function independently and responsibly with minimal need for supervision Demonstrate initiative in achieving individual, team, and organizational goals and objectives Participate in quality initiatives Availability to check Optum email intermittently for required trainings, communications, and monthly scheduling You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
At Midi Health, we're on a mission to revolutionize healthcare for women at midlife—to relieve their symptoms, support their wellbeing, and ensure they feel seen, heard, and cared for. Our care is personalized, evidence-based, and covered by insurance, making it more accessible to women across the country. Wherever they live. Whatever their health story. We’re rapidly growing and looking for passionate full-time Nurse Practitioners to join our dedicated clinical team. You’ll help close the gender health gap by guiding women through perimenopause, menopause, and other midlife transitions with compassionate, evidence-based care.
Mission-Driven Impact: Join us in transforming healthcare for women in midlife—making a meaningful difference every day. Remote Role with Structured Hours: Work fully remote from within the United States with patient-facing hours scheduled between 7:00 AM and 7:00 PM, adjusted by patient location and licensure. This is not a digital nomad role; work may not be performed while you are outside the United States. Continuous Learning: Access weekly clinical education to stay sharp and advance your expertise in women’s midlife health. Purposeful Visits: Our appointments provide you with time to listen, educate, and deliver personalized care that truly supports your patients. Technology + Clinical Support: Benefit from structured onboarding, user-friendly tech, and operational assistance—including elements of logistics, scheduling, and clinical operations—so you can focus on care without being on your own. Community of Care: Be part of a collaborative, respectful team passionate about women’s health and dedicated to your professional growth.
Active, unrestricted, and unencumbered Nurse Practitioner license in at least one U.S. state. *Multiple state licenses are highly preferred. Prescriptive authority as a Nurse Practitioner. Active national board certification (FNP, WHNP, AGNP, or similar). Minimum 3 years of recent experience (within the last 5 years) practicing as a Nurse Practitioner in Primary Care, Women’s Health, or Gynecology. Ability to work independently and make sound clinical decisions. High proficiency and efficiency with technology (telehealth platforms, EMRs, communication tools). A strong passion for caring for women navigating menopause and midlife health transitions.
Quality visits, better conversations: Appointments designed to allow time to listen, educate, and personalize care. Evidence-based protocols: Trained in expert-developed clinical pathways combining hormonal therapy, lifestyle coaching, and medication when appropriate. Care beyond the screen: Patients receive labs, prescriptions, supplements, and referrals as needed—our platform makes it seamless. You’re never alone: Supported by a collaborative team of clinicians, care coordinators, and clinical leaders, with opportunities to grow and specialize over time. Meaningful specialty focus: Practice in women’s midlife health, a critically underserved area where you help close one of the most persistent gaps in care. Mission-aligned, patient-centered culture: Join a team dedicated to empathy, equity, and clinical excellence.
At Midi Health, we're on a mission to revolutionize healthcare for women at midlife—to relieve their symptoms, support their wellbeing, and ensure they feel seen, heard, and cared for. Our care is personalized, evidence-based, and covered by insurance, making it more accessible to women across the country. Wherever they live. Whatever their health story. We’re rapidly growing and looking for passionate full-time Nurse Practitioners to join our dedicated clinical team. You’ll help close the gender health gap by guiding women through perimenopause, menopause, and other midlife transitions with compassionate, evidence-based care.
Mission-Driven Impact: Join us in transforming healthcare for women in midlife—making a meaningful difference every day. Remote (U.S.–Based) Role with Structured Hours: Work fully remote from within the United States with patient-facing hours scheduled between 7:00 AM and 7:00 PM, adjusted by patient location and licensure. This is not a digital nomad role; work may not be performed while you are outside the United States. Continuous Learning: Access weekly clinical education to stay sharp and advance your expertise in women’s midlife health. Purposeful Visits: Our appointments provide you with time to listen, educate, and deliver personalized care that truly supports your patients. Technology + Clinical Support: Benefit from structured onboarding, user-friendly tech, and operational assistance—including elements of logistics, scheduling, and clinical operations—so you can focus on care without being on your own. Community of Care: Be part of a collaborative, respectful team passionate about women’s health and dedicated to your professional growth.
Active, unrestricted, and unencumbered Nurse Practitioner license in at least one U.S. state.*Multiple state licenses are highly preferred. Prescriptive authority as a Nurse Practitioner. Active national board certification (FNP, WHNP, AGNP, or similar). Minimum 3 years of recent experience (within the last 5 years) practicing as a Nurse Practitioner in Primary Care, Women’s Health, or Gynecology. Ability to work independently and make sound clinical decisions. High proficiency and efficiency with technology (telehealth platforms, EMRs, communication tools). A strong passion for caring for women navigating menopause and midlife health transitions.
At Midi, you’ll practice with purpose in a virtual-first care model that puts women’s needs front and center: Quality visits, better conversations: Appointments designed to allow time to listen, educate, and personalize care. Evidence-based protocols: Trained in expert-developed clinical pathways combining hormonal therapy, lifestyle coaching, and medication when appropriate. Care beyond the screen: Patients receive labs, prescriptions, supplements, and referrals as needed—our platform makes it seamless. You’re never alone: Supported by a collaborative team of clinicians, care coordinators, and clinical leaders, with opportunities to grow and specialize over time. Meaningful specialty focus: Practice in women’s midlife health, a critically underserved area where you help close one of the most persistent gaps in care. Mission-aligned, patient-centered culture: Join a team dedicated to empathy, equity, and clinical excellence.
Our Mission: Serving People With Compassion and Dignity Our Vision: To Provide the Exceptional Hospice Experience Good Shepherd Hospice is a growing provider of hospice care with a clear vision for our future, strong leadership to guide us and great opportunities for all current and future employees. At Good Shepherd Hospice, our culture of ownership is based on 4 key drivers: 1. Commitment: Commitment To Our Mission, Vision and Values 2. Engagement: Engagement With Our Customers, Our Co-Workers, With the Work Itself 3. Passion: Enthusiasm for the Work and Fellowship in the Workplace 4. Pride: Pride in the Organization, the Job and Ourselves Every member of our medical team – and volunteer staff – receives comprehensive, ongoing training. We are a member of the National Hospice and Palliative Care Association, Medicare Certified and State Licensed. Good Shepherd Hospice opened its first office in Oklahoma City in 1995. Today, we have a regional presence serving Oklahoma, Kansas, Missouri and Texas. Along the way, we've touched the lives of more than 20,000 patients and shepherded 50,000+ family members through their time of need, offering bereavement support for as long as they desired it. In 2007, Good Shepherd Hospice established the Hospice Care Foundation to provide special support for patients and families, community outreach programs and hospice-related educational opportunities for staff members.
The Hospice Triage RN provides nursing assessment, planning and care to maximize the comfort and health of patients and families. The Triage RN responds to all phone calls promptly and appropriately after hours. Hospice experience required
Minimum one (1) Year of Hospice Experience Required Multi-state license Strong Organizational and Self-Management Skills Critical Thinker with Good Judgment Commitment to Providing Excellent Customer Service to Patients and Families Valid Driver’s License Can Successfully Pass Background Checks
Respond to Phone Calls Promptly Professional Management of the Patient and Family Communication with Medical Professionals, the Hospice Team and Others Training the Patient and Caregiver Elevating Necessary Matters to the Attention of the Patient Care Manager Cultivate communication and bereavement skills Maintaining Accurate, Up-to-Date Records
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Leads and manages multidisciplinary team of healthcare services professionals in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), and/or other special programs. Ensures members reach desired outcomes through integrated delivery and coordination of care across the continuum, and contributes to overarching strategy to provide quality and cost-effective member care.
Required Qualifications: At least 7 years experience in health care, and at least 3 years of managed care experienced in one or more of the following areas: utilization management, care management, care transitions, behavioral health, long-term services and supports (LTSS), or equivalent combination of relevant education and experience. At least 1 year of health care management/leadership experience. Must be a Registered Nurse (RN), Clinical licensure and/or certification required ONLY if required by state contract (Preferably New York), regulation, business operating model, or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. Experience working within applicable state, federal, and third party regulations. Demonstrated knowledge of community resources. Proactive and detail-oriented. Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. Ability to work independently, with minimal supervision and demonstrate self-motivation. Responsive in all forms of communication, and ability to remain calm in high-pressure situations. Ability to develop and maintain professional relationships. Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. Excellent problem-solving and critical-thinking skills. Excellent verbal and written communication skills. Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications: Registered Nurse (RN). License must be active and unrestricted in state of practice. Certified Case Manager (CCM), Certified Professional in Health Care Management certification (CPHM), Certified Professional in Health Care Quality (CPHQ) or other health care or management certification. Medicaid/Medicare population experience. Clinical experience.
Responsible for leading and managing performance of one or more of the following activities: care review, care management, utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), transition of care, health management, behavioral health, long-term services and supports (LTSS), and/or member assessment. Facilitates integrated, proactive healthcare services management - ensuring compliance with state and federal regulatory and accrediting standards and implementation of the Molina clinical model. Manages and evaluates team member performance, provides coaching, employee development and recognition, ensures ongoing appropriate staff training, and has responsibility for selection, orientation and mentoring of new staff. Performs and promotes interdepartmental/multidisciplinary integration and collaboration to enhance continuity of care. Oversees interdisciplinary care team (ICT) meetings. Functions as hands-on manager responsible for supervision and coordination of daily integrated healthcare service activities. Ensures adequate staffing and service levels and maintains customer satisfaction by implementing and monitoring staff productivity and other performance indicators. Collates and reports on care access and monitoring statistics including plan utilization, staff productivity, cost-effective utilization of services, management of targeted member population, and triage activities. Ensures completion of staff quality audit reviews; evaluates services provided, outcomes achieved and recommends enhancements/improvements for programs and staff development to ensure consistent cost-effectiveness and compliance with all state and federal regulations and guidelines. Maintains professional relationships with provider community, internal and external customers, and state agencies as appropriate, while identifying opportunities for improvement. Local travel may be required (based upon state/contractual 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.
This Case Manager - Registered Nurse (RN) position is with Aetna’s National Medical Excellence (NME) team and is a fully remote position. Candidates from any state are welcome to apply, however, preference is for candidates in compact Registered Nurse (RN) states. This role is a blended role doing both Case Management and Utilization Management. The RN Case Manager is responsible for telephonically and/or face to face assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.
Required Qualifications: Candidate must have an active, current and unrestricted compact Registered Nurse (RN) licensure in the state of residence 5 years clinical practice experience as an Registered Nurse (RN) 2+ years’ experience in critical care 6+ months case management or utilization management experience Must be able to work Monday - Friday 8 AM to 5 PM in the time zone of residence (There are currently no nights, weekends, and holidays; however, is subject to change based on business needs) Must be able to obtain multi state Registered Nurse (RN) licensures Preferred Qualifications: Case Management Certification Transplant experience: Education Associate's Degree in Nursing (REQUIRED) Bachelor's Degree in Nursing (PREFERRED) License: Must have an active, current and unrestricted compact Registered Nurse (RN) licensure in the state of residence
Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness through integration. Through the use of clinical tools and information/data review, conducts an evaluation of member’s needs and benefit plan eligibility and facilitates integrative functions as well as smooth transition to Aetna programs and plans. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. Assessments consider information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Reviews prior claims to address potential impact on current case management and eligibility. Assessments include the member’s level of work capacity and related restrictions/limitations. Using a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality. Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.
Heartbeat Health is the leading virtual-first cardiovascular care company in the country, providing patients with convenient, high-quality heart care through a combination of telemedicine, diagnostics, and virtual care programs. By leveraging real-time data and AI-powered insights, Heartbeat Health empowers providers and patients with personalized treatment plans, reducing hospitalizations and improving long-term heart health outcomes. Heartbeat Health is redefining how cardiovascular care is delivered in the digital age, led by our medical group of cardiologists, advanced practitioners, nurses, and care coordinators.
We are seeking a skilled and compassionate Registered Nurse located in the Pacific Time zone to provide remote consultation and expertise in the field of cardiology.
Must hold a current and unrestricted Registered Nurse (RN) license (Compact) At least 3+ years of experience in cardiology. Experience in telemedicine is a bonus Excellent communication and interpersonal skills, especially in a virtual environment. Team-player is a must Ability to effectively educate patients and collaborate with a multidisciplinary healthcare team, including cardiologists and advanced practitioners Ability to work independently and make clinical decisions under appropriate supervision Proficiency in using telehealth platforms and electronic health records Commitment to patient-centered care and empathy for patients with chronic cardiology conditions Compassion and empathy when working with patients and their families, especially when delivering challenging diagnoses or managing chronic cardiac conditions
Education and Counseling: This role is a remote, patient-facing role. As part of our RN team, you will provide education about a patient’s diagnosis, test results and treatment plan. Collaboration: Collaborate closely with cardiologists, PCPs and other healthcare professionals to ensure comprehensive and coordinated care for patients. Discuss complex cases and participate in multidisciplinary care teams. Utilize clinical decision making to escalate concerns to the care team. Documentation: Maintain accurate and detailed patient records, including patient interactions, medical histories, assessments, treatment plans, progress notes, and discharge summaries within scope of practice. Ensure compliance with legal and ethical standards Follow-Up Care: Schedule and conduct follow-up virtual visits to monitor patients' progress and address any concerns or questions Patient Advocacy: Serve as an advocate for patients' needs and preferences, ensuring that they receive appropriate care and support throughout their healthcare journey. Compliance: Adhere to legal and ethical guidelines, including patient confidentiality and telemedicine regulations, while providing virtual care Prioritization & Triage: Efficiently triage incoming patient requests and manage patient panel by prioritizing patients based on need and client SLAs. Continuing Education: Pursue ongoing education and professional development in the field of cardiology to stay updated on the latest advancements and maintain relevant certifications Quality Assurance: Participate in quality assurance programs to monitor and improve the quality of cardiology care provided within the organization
Welcome to DataAnnotation! We pay smart folks to train AI. We offer a remote, flexible work model- you choose your own hours and get to work when you want, whenever you want. Apply now through our open Job Listings.
We are looking for a L&D Nurse to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of each model.
In this role you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include: Physicians of all specialties (e.g., Internists, Cardiologists, Oncologists), Physician Assistants, Nurse Practitioners, Certified Nurse-Midwives, Certified Registered Nurse Anesthetists, Clinical Nurse Specialists, Registered Nurses. Therapists Physical Therapists, Occupational Therapists, Speech-Language Pathologists, Respiratory Therapists, Athletic Trainers, Massage/Recreational Therapists. Diagnostic & Laboratory Professionals Radiologic Technologists, Sonographers, MRI & Nuclear Medicine Technologists, Medical Laboratory Scientists, Phlebotomists, Histology & Genetics Technicians. Public Health & Specialized Roles Dietitians/Nutritionists, Genetic Counselors, Epidemiologists, Public Health Nurses. Qualifications: Fluency in English (native or bilingual level) A current or in progress medical degree
Give AI chatbots diverse and complex healthcare related problems and evaluate their outputs Evaluate the quality produced by AI models for correctness and performance Ensure the medical accuracy of model performance
NPHire connects top NP talent with leading healthcare employers and staffing agencies. We're the only job-matching platform built exclusively for Nurse Practitioners, simplifying both the job search and the hiring process so the best match rises to the top every time.
A nationwide telehealth program is hiring Family Nurse Practitioners (FNPs) for a fully remote, flexible contract role focused on follow-up care, chronic disease management, and care coordination. This position is ideal for NPs who prefer lower-acuity, relationship-based visits rather than high-volume urgent care. Most encounters include reviewing recent visits, monitoring symptoms, adjusting treatment plans, and supporting patients with ongoing health needs. New graduates with strong primary care training are welcome.
Active NP license in at least one U.S. state FNP certification required Comfortable with chronic care and follow-ups Strong communication and patient engagement skills Telehealth experience helpful but not required New graduates encouraged to apply
Conduct virtual follow-up visits Manage chronic conditions (HTN, diabetes, asthma, etc.) Review labs, medications, and care plans Provide patient education and reassurance Coordinate next steps and referrals as needed Document visits efficiently in EMR
For over 25 years, Southwest Care Center has been providing exceptional healthcare to the communities of Santa Fe and Albuquerque, NM. We are a non-profit, FQHC-LAL providing medical, behavioral health, case management, community outreach, diabetes education, and pharmacy services. We are proud to offer gender equity medicine, syringe exchange, and HIV/Hep C treatment, testing and other services within our communities.
Southwest Care Center is currently seeking a remote part-time RN Care Coordinator. This role will provide occasional on site in clinic support, therefore candidate must reside in the local market area of Albuquerque or Santa Fe, New Mexico. The primary functions of the RN role will include care plan management, triage, and inbox management.
Minimum 1 year of RN experience within an ambulatory/primary care environment preferred. LPN or Medical Assisting experience may be considered in lieu of this requirement. Completion of an associate degree in nursing required. Bachelors of nursing preferred. Valid Registered Nurse License in the state of New Mexico or other compact state.
Serves as a key member of the interdisciplinary care team to identify high risk, high acuity patients that would benefit from care coordination. In collaboration with other providers and team members, develops interdisciplinary care plans for identified patients. Orients and educates patients (and family/support members as identified) by explaining the care coordination process and initiating their care plan. Coordinates care information and requirements with other care providers, resolves issues that could affect progression, and fosters peer support and education to others regarding the care coordination process. Continually evaluates adherence to and effectiveness of the care plan toward desired outcomes, modifying as necessary, to ensure the best outcome for the patient. Measures intervention effectiveness. Interacts both inside of SCC as well as externally to facilitate appointments, scheduling and completion of tests or other procedures, and to remove or minimize other barriers to adherence to care. May provide clinical care in compliance with SCC policy as well as the provisions of the New Mexico Nurse Practice Act. In collaboration with treating provider, refers patients to additional providers or resources to support specialized needs. Documents appropriately and timely in the EMR. Collects and analyzes data to support development and improvement of clinical best practice and SCC Quality programs. Supports research studies around care protocols, care planning and interventions. Participates in staff meetings and attends other meetings and seminars as requested. Performs other related duties as required and assigned.
Commonwealth Health is a trusted community healthcare provider serving Northeastern Pennsylvania with compassionate, high‑quality care. Our hospitals, clinics, and outpatient services are dedicated to ensuring accessible healthcare close to home for patients and families across the region. We share a commitment to exceptional care – from modern treatments and technology to the talented doctors, nurses and staff working together to make our network a great places to receive care. As part of Tenor Health Foundation, Commonwealth Health remains fully operational with no interruptions in care. Our providers, staff, and services remain in place so patients can continue receiving care from the teams they know and trust. Just as with other Tenor Health Foundation hospitals, our nonprofit ownership reinforces a mission‑driven focus on community health, stability, and long‑term sustainability. This allows us to invest in quality care now and for the future.
The Transfer Coordinator - RN is responsible for coordinating patient transfers and admissions into and out of CHS facilities. This role performs initial admission screening using approved clinical criteria, ensuring each transfer aligns with policy and clinical standards. The Transfer Coordinator works closely with the Bed/Capacity Coordinator, hospital departments, and external healthcare providers to facilitate efficient patient flow and address barriers to patient throughput.
Qualifications: Associate Degree in Nursing required Bachelor's Degree in Nursing preferred 1-3 years of clinical nursing experience in an acute care setting required Prior experience in transfer coordination or patient flow in ED or Critical Care preferred Knowledge, Skills and Abilities: Strong clinical assessment and decision-making skills for managing patient transfers. Knowledge of healthcare regulations, including EMTALA and medical necessity guidelines. Excellent communication skills and ability to work effectively with multidisciplinary teams. Strong organizational skills with the ability to prioritize multiple tasks in a dynamic environment. Proficient in using electronic health record systems and standard office software. Ability to provide superior customer service and facilitate positive patient experiences. Licenses and Certifications: RN - Registered Nurse - State Licensure and/or Compact State Licensure in the state of Tennessee required
Coordinates all aspects of patient transfers, admissions, or consultations from referring facilities, ensuring appropriate level of care and transport. Conducts admission screening using approved criteria to verify appropriateness of care level and bed assignments. Collaborates with Bed/Capacity Coordinator to prioritize transfers, bed assignments, and ensure patient information accuracy. Acts as a liaison between physicians, healthcare providers, patients, and families to streamline the admission/transfer process. Maintains and updates the Electronic Health Record (EHR) with accurate patient transfer information and outcomes. Identifies barriers to patient throughput, tracks trends, and recommends actions to improve efficiency and patient flow. Complies with regulatory and CHS policy standards, including EMTALA and quality initiatives, while adapting processes to ensure compliance. Utilizes medical necessity criteria to evaluate admissions, ensuring bed types and patient statuses are appropriate. Builds and maintains collaborative relationships with hospital staff, nursing units, and external healthcare providers to support quality patient care. Performs other duties as assigned. Maintains regular and reliable attendance. Complies with all policies and standards.
NPHire connects top NP talent with leading healthcare employers and staffing agencies. We're the only job-matching platform built exclusively for Nurse Practitioners, simplifying both the job search and the hiring process so the best match rises to the top every time.
A fast-growing telehealth women’s health program is hiring full-time Nurse Practitioners licensed in California to provide virtual care for women navigating midlife health transitions. This is a fully remote role focused on primary care, women’s health, and menopause care, with structured patient-facing hours and strong clinical support. Providers deliver thoughtful, evidence-based care through longer visits designed for education, prevention, and personalized treatment.
Active California Nurse Practitioner license National board certification (FNP, WHNP, AGNP, or similar) Prescriptive authority 3+ years of recent experience in primary care, women’s health, or gynecology Comfort working independently in a telehealth environment Strong communication and patient education skills
Provide virtual visits focused on women’s midlife health Manage primary care and gynecologic concerns Support patients through perimenopause and menopause Prescribe and manage treatments using evidence-based protocols Document care efficiently in a telehealth EMR Collaborate with a multidisciplinary clinical team
Heartbeat Health is the leading virtual-first cardiovascular care company in the country, providing patients with convenient, high-quality heart care through a combination of telemedicine, diagnostics, and virtual care programs. By leveraging real-time data and AI-powered insights, Heartbeat Health empowers providers and patients with personalized treatment plans, reducing hospitalizations and improving long-term heart health outcomes. Heartbeat Health is redefining how cardiovascular care is delivered in the digital age, led by our medical group of cardiologists, advanced practitioners, nurses, and care coordinators.
We are seeking a skilled and compassionate Registered Nurse located in the Pacific Time zone to provide remote consultation and expertise in the field of cardiology.
Must hold a current and unrestricted Registered Nurse (RN) license (Compact). At least 3+ years of experience in cardiology. Experience in telemedicine is a bonus. Excellent communication and interpersonal skills, especially in a virtual environment. Team-player is a must. Ability to effectively educate patients and collaborate with a multidisciplinary healthcare team, including cardiologists and advanced practitioners. Ability to work independently and make clinical decisions under appropriate supervision Proficiency in using telehealth platforms and electronic health records Commitment to patient-centered care and empathy for patients with chronic cardiology conditions Compassion and empathy when working with patients and their families, especially when delivering challenging diagnoses or managing chronic cardiac conditions.
Education and Counseling: This role is a remote, patient-facing role. As part of our RN team, you will provide education about a patient’s diagnosis, test results and treatment plan. Collaboration: Collaborate closely with cardiologists, PCPs and other healthcare professionals to ensure comprehensive and coordinated care for patients. Discuss complex cases and participate in multidisciplinary care teams. Utilize clinical decision making to escalate concerns to the care team. Documentation: Maintain accurate and detailed patient records, including patient interactions, medical histories, assessments, treatment plans, progress notes, and discharge summaries within scope of practice. Ensure compliance with legal and ethical standards. Follow-Up Care: Schedule and conduct follow-up virtual visits to monitor patients' progress and address any concerns or questions. Patient Advocacy: Serve as an advocate for patients' needs and preferences, ensuring that they receive appropriate care and support throughout their healthcare journey. Compliance: Adhere to legal and ethical guidelines, including patient confidentiality and telemedicine regulations, while providing virtual care. Prioritization & Triage: Efficiently triage incoming patient requests and manage patient panel by prioritizing patients based on need and client SLAs. Continuing Education: Pursue ongoing education and professional development in the field of cardiology to stay updated on the latest advancements and maintain relevant certifications. Quality Assurance: Participate in quality assurance programs to monitor and improve the quality of cardiology care provided within the organization.
Join us as we transform immunology and deliver medicines that help autoimmune patients get their lives back. argenx is preparing for multi-dimensional expansion to reach more patients through a rich pipeline of differentiated assets, led by VYVGART, our first-in-class neonatal Fc receptor blocker approved for the treatment of gMG, and with the potential to treat patients across dozens of severe autoimmune diseases. We are building a new kind of biotech company, one that maintains its roots as a science-based start-up and pushes our commitment to innovate across all corners of our business. We strive to inspire and grow our company, our partnerships, our science, and our people, because when we do, we deliver more for patient
The Nurse Case Manager (NCM) is the single point of contact for patients and their caregivers. They are aligned regionally and are responsible for educating patients, caregivers and families affected by generalized Myasthenia Gravis (gMG) about the disease and argenx’s products and support services. The NCM may provide resources to help patients better manage their disease and coordinate their treatment. The NCM is responsible for participating in one-on-one communications with patients and their caregivers. Desired Location: EST, and ability to cover CST as needed.
Skills and Competencies: Demonstrated effective presentation skills; ability to motivate others; excellent interpersonal (written and verbal) skills – with demonstrated effectiveness to work cross-functional and independently Demonstrated ability to develop, follow and execute plans in an independent environment Demonstrated ability to effectively build positive relationships both internally & externally Demonstrated ability to be adaptable to changing work environments and responsibilities Must be able to thrive in team environment and willing to contribute at all levels with flexibility and a positive attitude Fully competent in MS Office (Word, Excel, PowerPoint) Flexibility to work weekends and evenings, as needed Participate in and complete required pharmacovigilance training Comply with all relevant industry laws and argenx’s policies Travel requirements less than 50% of the time Education, Experience and Qualifications: Current RN License in good standing Bachelor’s degree required Bilingual in Spanish, required 5+ years of clinical experience in healthcare to include hospital, home health, pharmaceutical or biotech 2-5+ years of case management 2+ years of experience in pharmaceutical/biotech industry strongly preferred Reimbursement experience a plus
Provide direct educational training and support to patients and caregivers about gMG and prescribed argenx products Will manage patient cases across regions as coverage and volume requires Communicate insurance coverage updates and findings to the patient and/or caregiver Review and educate the patients and/or caregivers on financial assistance programs that they may be eligible for Coordinate logistical support for patients to receive therapy and manage their disease Collaborate with argenx Patient Access Specialist, Case Coordinator, and Field Reimbursement Manager teams to troubleshoot and resolve reimbursement-related issues Engage with patients and provider case coordinators to ensure appropriate support is being given on an individualized basis Provide patient-focused education to empower patients to advocate on their behalf Develop relationships and manage multiple and complex challenges that patient and caregivers are facing Ensure compliance with relevant industry laws and argenx’s policies Aligned regional travel will be required for patient education to support patient programs Must be an excellent communicator and problem-solver Demonstrated time management skills; planning and prioritization skills; ability to multi-task and maintain prioritization of key projects and deadlines
At Homeland, we stand at the forefront of boutique recruitment, specializing in IT, Engineering, and Executive roles across various industries. We excel in providing comprehensive staffing solutions tailored to meet the diverse needs of modern workplaces—covering contract, contract to hire, and permanent placements, as well as confidential and hyper-focused retained roles. Homeland maintains a 'small-town approach with big-time results,' ensuring the ideal match between candidates and companies.
Homeland has partnered with a leading national chronic care management organization to hire an LPN Personal Care Coordinator to join a growing care team. This organization delivers chronic care management (CCM) services to patients across the U.S., supporting individuals with two or more long-term health conditions expected to last at least 12 months. Their programs help patients stay connected to their healthcare providers and receive ongoing support between office visits. In this role, the LPN Personal Care Coordinator provides personalized, patient-centered care while working closely with the patient’s broader care team. Through outbound phone calls, LPN Personal Care Coordinator will help monitor chronic conditions, identify new or evolving health concerns, and connect patients with the resources they need to improve their health, well-being, and quality of life. This opportunity is ideal for nurses who are passionate patient advocates and value building long-term, collaborative relationships to help patients make meaningful lifestyle improvements. Additional Information This is a day-shift position, operating Monday through Friday. Candidates must be in EST or CST time zone. Available shifts are: 8:30–5:30 pm EST, 9:00–6:00 pm EST, 10:00–7:00 pm EST, 11:00–8:00 pm EST, 12:00–9:00 pm EST. This is a full-time, fully remote role with full benefits. All necessary equipment will be provided. Benefits This position offers a competitive hourly pay rate of $18.25–$19.25 per hour, along with a comprehensive benefits package that includes medical, dental, and vision insurance, a 401(k) retirement plan, paid time off, and paid training.
LPN/LVN diploma from an accredited nursing program Current, active, compact LPN/LVN license Strong ability to follow established clinical protocols and procedures with accuracy and consistency Flexible and adaptable, with the ability to shift between tasks efficiently Collaborative team player who is eager to support coworkers and contribute to overall team success
Conduct monthly care management calls with assigned patients to assess and support their ongoing healthcare needs Educate patients on available resources and services across the continuum of care Identify patient-specific health concerns, goals, and interventions using clear, action-oriented, and time-based care plans Maintain accurate and compliant patient documentation, including medical history, medications, immunizations, allergies, surgical history, and family history Monitor changes in patient conditions or circumstances and adjust care plans, goals, and preferences as needed, while recognizing potential barriers to care Provide appropriate health education to support improved health outcomes Escalate patient concerns and clinical issues to the triage nurse team as appropriate
WellMed, part of the Optum family of businesses, is seeking a RN Senior Clinical Quality Consultant to join our team anywhere within the U.S. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone. At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.
The WellMed Quality Clinical Programs team supports WellMed Medical Management by delivering patient-centered, clinically collaborative telephonic outreach to help people live healthier lives. Our team focuses on the design, execution, and delivery of telephonic and digital engagement strategies designed to close STARs measure gaps in care, e.g. medication adherence, care for older adults, medication reconciliation post discharge, A1c, etc. Our interdisciplinary service delivery team is comprised of Registered Nurses, Licensed Vocational Nurses, and Social Workers. The Registered Nurse will report into the Manager of Clinical Programs. The Registered Nurse will perform telephonic, patient-centered clinical consults focused on Care for Older Adults annual pain and functional assessments. In addition, the RN will outreach telephonically for Transition of Care following hospital discharge to complete reviews as well as assist with appointment scheduling. The RN will be required to meet or exceed established productivity and quality metrics and work a flexible schedule to support the hours of operation of the business You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Must have a compact license and willing to support CST.
Required Qualifications: Active, unrestricted Registered Nurse license Have Compact License and willing to support CST 4+ years of RN experience, including experience in a managed care setting 2+ years of experience in HEDIS/Star programs, preferably in a clinical quality consultant role. 2+ years of call center experience 2+ years of experience with data analysis and/or quality chart reviews. Must be able to review paper and electronic medical records and charts Proven solid knowledge of the Medicare HEDIS/Stars measures Experienced using Microsoft office applications, including databases, word-processing, outlook, and excel spreadsheets. Must be proficient in Excel Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels Demonstrated ability to manage multiple complex, concurrent projects Proven excellent written and verbal communication and relationship building skills Demonstrated solid problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action Proven excellent customer service skills and communication skills Preferred Qualifications: Undergraduate degree or post graduate degree Billing and CPT coding experience Clinical data abstraction experience Proven adaptable to change Proven good business acumen, especially as it relates to Medicare
Strictly adheres to department’s metrics and established advanced protocols and to handle incoming contacts including, but not limited to, prescription refill requests, lab results, x-ray results, medical inquiries, patient education and referral requests Primarily to make outbound calls but occasionally help manage the inbound call queue from patients, patient representatives, providers and other medical staff, while strictly adhering to established protocols and scripting Review patient chart (in EMR) to ensure core measures are being addressed and met per protocol and takes appropriate action when they are not, i.e., schedule services Complete patient assessments for Transition of Care Medication Reconciliation Post Discharge, Care for Older Adults Pain and Function Assessments Educate patients on health conditions and necessity of route screening but assisting with appointment scheduling (A1c, Breast Cancer Screening, Colorectal Cancer Screening, Diabetic Eye Exam, etc.) Communicate with providers and offices to obtain needed evidence of completed lab work, screenings and care provided Review available medical records for core measures to submit for closure of HEDIS/STARS measures Assist patients with identification of and connectivity to community and program resources to assist with non-medical needs, (Pharmacy assistance programs, meals on wheels, LIS) Document thoroughly all calls and actions taken within core systems Hours of Operations: Mon-Fri 8am-6pm Central and Required Rotating – Saturdays 8am-5:30pm Central. Performs all other related duties as assigned
At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. We are looking for dedicated and motivated individuals who share our vision of transforming healthcare. As a Blue Cross associate, you are joining a culture that is built on values of succeeding together, finding a better way, and doing the right thing. If you are ready to make a difference, join us.
The Case Manager is a critical component of Blue Cross and Blue Shield of Minnesota Care Management team as the primary clinician providing condition and case management services to members. The position exists to support member needs across the continuum of care by leveraging member partnership, case and disease management processes, skill sets and tools.
Required Skills And Experience: Registered nurse with current MN license and with no restrictions. 3 years relevant direct clinical care experience. All relevant experience including work, education, transferable skills, and military experience will be considered. CCM Certification or ability to obtain within 3 years of starting in the position. Excellent communication skills. Excellent conceptual thinking skills. Excellent relationship management skills. Excellent organizational skills. Computer application proficiency. Flexibility to work varied hours. High school diploma (or equivalency) and legal authorization to work in the U.S. Preferred Skills And Experience: 1+ years of managed care experience; e.g. case management/health coach, utilization management and/or auditing experience. Outstanding telephonic skills.
Receives referral and/or reaches–out to member and leverages clinical knowledge, motivational interviewing and behavioral modification techniques. Conducts comprehensive clinical assessments; gathers, analyzes, synthesizes and prioritizes member needs and opportunities. Collaborates and communicates with member, family, or designated representative on a plan of care that produces positive clinical results and promotes high-quality effective outcomes. Identifies relevant BCBSMN and community resources and facilitates warm program and network referrals. Monitors and evaluates plan of care over time. Ensures member data is documented according to BCBSMN application protocol and regulatory standards. Maintains outstanding level of service at all points of customer contact. Understands broad–based goals of assigned market segment(s) including clinical and service availability. Collaborates and coordinates with team members to facilitate day to day functions and enhance the overall operation of the department. Engage providers telephonically in reviewing and understanding treatment plans, including alignment with benefits and medical reimbursement policies to facilitate optimal treatment plans, care coordination, and transition of care between settings.
Imagine360 is an integrated health plan addressing one of the greatest challenges on behalf of self-funded employers: healthcare costs are harming the bottom line, they're increasingly unaffordable for employees, and the experience remains poor. We help businesses and their employees navigate through clutter and chaos and bring deep cost savings that protect everyone’s well-being and budgets. It’s way more than a health plan. It’s a promise. We’ve helped hundreds of self-funded clients. Our solutions are ready to be implemented. The results are proven and impactful. Imagine360’s innovative payment model includes preferential contracting with providers and health systems, and additional price protection through reference-based pricing, saving employers 15-30% on average compared to the national carriers. With more than 17 years’ experience, and 25-million-months of member data, Imagine360 offers care coordination and medical management to proactively guide members through the complexities of healthcare. We bring employers a reimagined health plan solution, created to provide the flexibility, service and support employers need to take good care of employees, their families and business. We do this through: Assistance with plan design and expert administration with integrated third-party administration Built-in price protection from the #1 reference-based pricing solution in healthcare Provider contracts with Imagine Health’s top-rated providers and health systems Comprehensive member support throughout their healthcare journey It’s more than a health plan. It’s our promise to deliver a better health plan experience.
Imagine360 is seeking a Behavioral Health RN Case Manager to join the team! The Behavioral Health RN Case Manager is responsible for delivering case management services to individuals covered by group health plans administered by imagine360, drawing on nursing education, clinical experience, and professional judgment. The RN is a case manager serving patients with medical, behavioral health, mental health, and/or neurodevelopmental disorder needs. They adhere to department criteria, collaborating with physicians, providers, members, and other stakeholders to assess, plan, coordinate, monitor, evaluate, and advocate for necessary options and services to address comprehensive health needs of individuals and families. They leverage communication and resources to enhance quality and cost-effective outcomes, acting as a liaison to providers, physicians, and members. The RN will receive member referrals from non-Behavioral Health Case Managers and Disease Management clinicians to support the Behavioral Health needs of those members. The Registered Nurse operates within the scope of nursing practice while fulfilling these responsibilities. Position Location: 100% remote
Required Experience/Education: Nursing degree from an accredited college, university, or nursing school. Bachelor's degree in nursing preferred but not required. 3+ years' experience working with Behavioral/Mental Health patients or programs. 1+ years in Case Management, discharge planning or managed care experience or transferrable nursing experience and skills. Experience with Utilization Management and standardized criteria. Experience working in a URAC accredited Case Management program Experience working within an insurance agency or TPA specializing in employee benefits and self-funded medical plans. Skills and Abilities: Ability to work independently in a home office environment. Computer skills include proficiency in Microsoft Outlook, Word, Excel, and PowerPoint, and navigation using the internet. Ability to resolve problems independently and demonstrate ability to multi-task. Strong written, oral, and telephonic communication skills. Strong presentation skills. Ability to demonstrate a commitment to building new skills and fostering a positive work environment. Demonstrated organizational skills, problem-solving, analytical skills, and detail oriented. Demonstrated ability to prioritize workloads, multi-task, and manage priorities to meet deadlines. Ability to maintain the confidentiality of protected health information in compliance with HIPAA regulations. License and Certifications: Current, active, and unrestricted compact Registered Nurse license. Must maintain CEU's as required by the State Board of Nursing. Must be willing to obtain and maintain additional license(s) as required to perform the job functions of the organization. Current Certified Case Manager (CCM) Certificate preferred; if Certification is not current, employee must pursue and achieve CCM Certification within three years of employment.
Identify, collect, process, and manage data to perform the Case Management process by utilization Imagine360 approved clinical guidelines and following Medical Management Policy and Procedures Conducts comprehensive clinical assessments according to established policies and procedures to identify and provide appropriate care and coordination of behavioral health, mental health, neurodevelopmental disorder diagnoses. Manage members with behavioral health, mental health, neurodevelopmental disorder diagnoses, and for members with medical diagnoses that also have behavioral health, mental health, neurodevelopmental disorder diagnoses. Utilize clinical knowledge, expertise, and educational resources to provide verbal and/or written educational resources to members regarding diagnosis, procedures and/or treatment. Assess the need for and collaborate with community resources for members in case management. Uses assigned software accurately to document and complete all steps of review of medical necessity and case management processes, including time slips. Facilitate the Patient Satisfaction Surveys Assess for cost savings and document the cost savings in assigned software platform. Appropriately escalates complex cases to Supervisor, IDCT, or designee as needed. Performs essential activities of case management while maintaining members' confidentiality, safety, advocacy, adherence to ethical, legal, accreditation and regulatory standards. Performs assessments of each member to identify Case Management needs. Consistently exercises discretion and judgment to analyze, interpret, make deductions, and then decide what actions are necessary based on the varying facts and circumstances of each individual case. Determines measurable goals utilizing motivational interviewing and behavior change model and coaches' clients while monitoring self-care practices. Utilizes industry standard tools to guide individuals with chronic/ongoing health conditions through coaching, assessments, listening, and other techniques as appropriate. Executes activities or interventions to achieve the goals in the plan. Organizes, integrates, and modifies the resources needed to reach the goals in the plan. Monitors all information from all relevant sources in the plan and its activities and services to determine the plan's effectiveness. At repeated intervals, evaluates to determine ultimate effectiveness of plan and modifies plan appropriately to meet the goals. Research medical procedures, treatments, and coding when necessary. Measures the outcomes of interventions. Adheres to practicing the care management core components throughout the continuum of care: Case Management Concepts Case Management Principles and Strategies Psychosocial and Support Systems Healthcare Management and Delivery Healthcare Reimbursement Vocational Concepts and Strategies. Customer Service Acts as a role model in demonstrating the core values in customer service delivery. Provides timely and thorough follow-up with internal and external customers. Appropriately escalates difficult issues up the chain of command. Quality Assurance Serves on committees, work groups, and/or process improvement teams, as assigned, to assist in improving quality/customer satisfaction. Recognizes and alerts appropriate supervisor of trends within their scope of responsibility that fall outside of quality parameters. Performs self-quality monitoring to develop and execute plans to meet established goals. Provides ongoing feedback to help optimize quality performance. Collaborates with others and cross-departmentally to improve or streamline procedures. Develops new or improves current internal processes to improve quality. Attend and participate in team meetings, trainings, and other job specific events as required. Communicates (in compliance with HIPAA) with brokers, vendors, Relationship Managers, HR representatives and stop loss as needed. Communicates professionally and effectively. Adhere to established internal regulations regarding Department of Labor, HIPAA, ERISA and department and company policies and procedures. Participate in the Quality Management Program via collecting and adhering to performance metrics. Complete HIPAA Training Annually. Perform all tasks in accordance with HIPAA/PHI guidelines. Complete duties in accordance with scope of licensure and certifications held or requested. Perform other duties and projects as assigned. Areas of Responsibility Scope of Practice: In addition to performing standard duties, the Registered Nurse is involved in clinical decision-making and patient education. The scope of practice includes, but is not limited to: Evaluating clinical data Assessment and evaluation of the acquired clinical data to assess for appropriateness of treatment based on Imagine360 clinical guidelines Coordination of treatment plans, interventions, and outcome measurements Rationale for the effects of medication and treatments Provide patient education and educational resources. Accurately report: Administration of medication and treatments Client response Contact other health care team members. Respect the client's right to privacy by protecting confidential information. Promote and participate in education and counseling to a participant based on health needs. Clarify any treatment believed to be inaccurate, non-efficacious, or contraindicated by consulting with appropriate practitioner. The RN will have knowledge and practice the core components of Case Management that include: Case Management Concepts Principles of Practice HealthCare Management & Delivery Healthcare Reimbursement Psychosocial Aspects of Care Rehabilitation Professional Development & Advancement Quality and Outcomes Evaluation and Measurement Ethical, Legal, and Practice Standards
At Total Life, we’re on a mission to support healthier aging and address mental health challenges by making high-quality, affordable emotional support services accessible to all older adults. As a behavioral health organization dedicated to older adult care, we use evidence-based practices to help clients live emotionally healthy, connected, and fulfilling lives.
Job Title: Registered Nurse (Florida Licensed) – Geriatric Behavioral Health Care Manager (Telehealth) Position Overview We are seeking a Florida-licensed Registered Nurse to serve as a Care Manager for our geriatric behavioral health program. This telehealth role focuses on ongoing mental health support, dementia care management, and caregiver guidance for older adults. The RN will provide structured monthly patient engagement and coordinate care within a multidisciplinary team that includes psychiatry, nurse practitioners/physician assistants, psychology, and nutrition services. This position offers a predictable daytime schedule with no evenings, weekends, or call requirements. Patient Population Adults age 65 and older Patients in assisted living, long-term care, and community settings Common conditions include dementia, mild cognitive impairment, depression, anxiety, behavioral symptoms of dementia, and complex medical and psychosocial needs
Active, unrestricted Florida RN license (required) Experience in geriatric care, behavioral health, dementia care, or care management strongly preferred Strong understanding of mental health conditions and behavioral symptoms in older adults Experience supporting caregivers and families Comfortable delivering care via telehealth and phone-based outreach Excellent communication, organization, and care coordination skills Ability to work independently within a structured, team-based care model
Provide a minimum of 60 minutes of patient and/or caregiver touchpoints per month through scheduled telehealth or phone-based care management Monitor mental health symptoms, cognitive and behavioral changes, medication adherence, and overall functioning Support dementia care planning, behavioral strategies, and safety considerations Provide education and emotional support to caregivers and family members Identify clinical concerns and escalate to psychiatry or medical providers as appropriate Reinforce treatment plans developed by psychiatry, PA/NP, psychology, and nutrition Coordinate services and ensure continuity of care across the multidisciplinary team Maintain timely and accurate documentation within the EMR
Tuesday Health is a value-based palliative care provider group dedicated to transforming serious illness and end-of-life care. We deliver goal-centered care focused on alleviating physical symptoms and emotional stress for individuals and their caregivers. Our interdisciplinary care teams reduce avoidable hospitalizations and improve quality of life wherever individuals call home. Through our leading-edge care model, Tuesday Health is shaping the future of community-based palliative care nationwide.
The Complex Care Navigator LPN plays a key role in delivering coordinated, compassionate care for members with serious illnesses. Working closely with nurse practitioners and registered nurses, the LPN administers clinical assessments and screenings throughout the care journey. They prioritize member needs based on assessment results and collaborate with the interdisciplinary team to develop and execute individualized care plans. The LPN ensures seamless communication, participates in care rounds, and leverages Tuesday Health’s electronic tools to optimize the member experience. Trust-building, empathy, and consistent member engagement are essential to the role, enabling a truly person-centered approach to care.
Active and unrestricted licensed practical nurse license in the State of Texas without any board action Experience in clinical/medical setting preferred Experience in a multi-disciplinary care model working across network providers, health plan care management support, and employed clinicians Strong communication and organization skills Ability to multitask and work under pressure without sacrificing a positive member experience Ability to know when to escalate and potentially act professionally in an emergent situation Strong technical skills to navigate different documentation systems and tools; as well as ability to learn new systems as the company grows and evolves Strong written skills Ability to drive during daytime, nighttime, or inclement weather Valid driver's license with safe driving record State minimum automobile insurance coverage Comfort with change and ambiguity; you understand that rapid changes to the business, strategy, organization, and priorities will come with rapid evolution of our business
Administer multiple assessments and screening tools within the clinical model at different times throughout the care timeline with the support of nurse practitioners and registered nurses Prioritize needs based on assessment results and task interdisciplinary care team Be accountable for care plan development within the multidisciplinary care team Participate in internal and joint rounds to ensure the member experience is optimal and coordinated Learn the Tuesday Health electronic systems, tools, technology, to deliver a coordinated approach to ensure the members have a unique experience Build a strong, trusting relationship with every member, where listening and empathy are the foundation of every interaction Serve as the quarterback of the multidisciplinary team transforming care for members with serious illness
Clever Care was created to meet the unique needs of the diverse communities we serve. Our innovative benefit plans combine Western medicine with holistic Eastern practices, offering benefits that align with our members’ culture and values.
The Clinical Review Nurse evaluates medical records and clinical documentation to support the resolution of claims, member grievances, appeals, and quality-of-care concerns. Using clinical judgment and appropriate application of CMS regulations, Medicare Advantage requirements, and evidence-based guidelines, this role conducts retrospective clinical reviews and prepares complete, accurate, and audit-ready case files for Medical Director review and determination. Claims are defined as: Initial payment determinations for covered Part C and Part D services Post-service claims requiring clinical review to support payment accuracy and benefit application Claims requiring medical necessity, level-of-care, or appropriateness-of-care assessment Claims involving retrospective review of medical records or clinical documentation Provider payment disputes requiring clinical validation (non-appeal) High-dollar, complex, or high-risk claims requiring clinical review prior to final determination Claims requiring coordination with Medical Management, Claims Operations, or Medical Director review Appeals and Grievances are defined as: Organization Determinations / Coverage Requests (pre-service) Part C reconsiderations (standard & expedited) Part D redeterminations/coverage determinations (if applicable) Payment disputes/claim appeals (if in scope) Quality of Care grievances Appeal withdrawals/dismissals & validity checks (authorized rep, timeliness, etc.) The Clinical Review Nurse applies clinical acumen to assess medical necessity, appropriateness of care, and quality of services rendered; documents findings in designated medical management systems; and collaborates with non-clinical staff to ensure timely, compliant, and defensible case resolution.
Education & Experience: Graduate from an accredited school of nursing Active, unrestricted RN or LVN/LPN license Must hold a current CCS or CPC certificate; both are preferred Three (3) or more years of Appeals and Grievances and/or Utilization Management experience within a Health Plan, IPA, MSO, or managed care environment Demonstrated experience supporting Medicare Advantage Appeals and Grievances, including clinical appeal review and Medical Director case preparation Two (2) or more years of direct clinical nursing experience Knowledge of Medicare Advantage regulations related to claims, appeals, grievances, and quality of care reviews Experience applying clinical decision support tools (e.g., InterQual, MCG, NCDs/LCDs) and evidence-based guidelines Familiarity with medical coding and billing concepts (CPT, HCPCS, ICD-10, DRG, Revenue Codes) Knowledge of regulatory timelines to ensure compliance with CMS and state requirements Skills: Strong clinical judgment and analytical skills Strong organizational skills with the ability to manage multiple cases and deadlines Excellent written and verbal communication skills, including clinical summary preparation Strong attention to detail and documentation accuracy Proficiency with Windows-based applications and Microsoft Office (Word, Excel, PowerPoint) Ability to adapt to new systems and regulatory requirements Excellent typing and documentation skills
Provide clinical review support for claims, claim appeals, grievances, provider disputes, and quality of care grievances, including retrospective review of medical records and claims. Conduct clinical reviews to assess medical necessity, appropriateness of care, and quality of services rendered, using clinical judgment and applicable CMS guidelines, Medicare manuals, and plan policies. Prepare clear, concise clinical summaries and recommendations for Medical Director review, including identification of key clinical facts, regulatory considerations, and applicable coverage or clinical criteria. Support the preparation and review of Quality of Care (QOC) grievance cases for Medical Director evaluation, including identification of potential care issues, documentation gaps, and quality concerns. Apply nationally recognized clinical decision support tools and guidelines (e.g., InterQual, MCG, NCDs/LCDs, specialty society guidance) as applicable to clinical reviews. Review and interpret medical coding and billing information (CPT, HCPCS, ICD-10-CM/PCS, DRG, Revenue Codes) to support accurate clinical assessment. dentify missing or insufficient clinical documentation and coordinate with providers or internal departments to obtain additional information. Enter, maintain, and validate clinical documentation and review outcomes in medical management and case tracking systems. Ensure cases are prepared and routed within required CMS and contractual turnaround timeframes; maintain awareness of standard vs expedited timeframes and tolling requirements when records are pending. Escalates risks to prevent late determinations; escalates cases at risk of noncompliance same day when barriers arise (missing records, invalid auth rep, misrouted cases). Respond accurately and timely to Medical Directors, Claims, Appeals and Grievances staff, and other internal stakeholders regarding clinical findings. Assist with CTM-related clinical case review and provide clinical input to support compliant complaint resolution. Participate in audit readiness activities, including case file review, universe validation, and response to regulatory or oversight entity requests. Audit clinical reviews to ensure compliance with Claims, Appeals and Grievances, and medical management policies and procedures. Provide clinical guidance and act as a clinical resource to non-clinical staff. Participate in special projects related to Claims, Appeals and Grievances operations, quality improvement, or regulatory compliance. Participate in required training and assist with onboarding and education of new or existing staff as needed. Ensures all case documentation supports CMS audit and legal defensibility, including record inventory, clinical criteria citations, decision rationale, and accurate system time stamps. Differentiates and prioritizes standard vs expedited requests and applies tolling/extension rules as applicable per policy. Maintains HIPAA compliance and secure handling of PHI in all systems and remote work environments. Other duties as assigned.
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.
Community Care Case Manager use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes.
Required Qualifications: Candidate must have active and unrestricted Compact Registered Nurse (RN) Licensure 3+ years of clinical practical experience preference: (diabetes, CHF, CKD, post-acute care, hospice, palliative care, cardiac, Home Health) with Medicare members 2+ years of case management, discharge planning and/or home health care coordination experience Proficiency with standard corporate software applications, including Microsoft Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications Able to work in a fast paced high volume environment and utilize time management and prioritization skills. Efficient and effective computer skills including navigating multiple systems and keyboarding Preferred Qualifications: Excellent analytical and problem-solving skills Effective communications, organizational, and interpersonal skills Certified Case Manager National professional certification (CRC, CDMS, CRRN, COHN, or CCM) Education: Associate's Degree in Nursing or Nursing Diploma (REQUIRED) Bachelor's Degree in Nursing (PREFERRED) License: Active and unrestricted Compact Registered Nurse (RN) Licensure
Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services. Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person. Prepares all required documentation of case work activities as appropriate. Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes. May make outreach to treating physician or specialists concerning course of care and treatment as appropriate. Provides educational and prevention information for best medical outcomes. Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources. Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. Utilizes case management processes in compliance with regulatory and company policies and procedures. Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes, as well as opportunities to enhance a member’s/client’s overall wellness through integration. Monitors member/client progress toward desired outcomes through assessment and evaluation.
CircleLink Health is a company of passionate clinicians, technologists and businesspeople tackling the $600B problem of preventable chronic and post-acute complications. We’re building a world-class Care Management platform to enable providers while accelerating the shift to preventative care instead of status quo reactive care. Learn more about us here.
This is a remote role. CircleLink Health is looking for passionate, tech savvy ILLINOIS registered nurses to work remotely and serve patients enrolled in Medicare’s Chronic Care Management Program. In this part time role (requires about 20 to 25 hours per week, depending on caseload), an RN Care Coach will be assigned a group of patients that they will be following and calling each month. In these monthly calls the Care Coach will provide education, coordinate care, close preventive care gaps, and coach on strategies for self-management to keep patients out of the hospital. This Role Requires Precision, Discipline, and Accountability Role: The Care Manager role is not a step back from bedside nursing — it’s a step into a more complex, structured, and performance-driven environment. To succeed, you must bring more than clinical knowledge: Excellent documentation skills — Your charting must be complete, timely, and accurate. Strong time management — Case tasks must be prioritized and closed on schedule. Ownership of outcomes — Each case is closely tracked for quality, compliance, and effectiveness. Expectations are high, and performance is regularly reviewed. This is not a role where details can be missed or timelines pushed — we need professionals who take initiative, stay organized, and consistently deliver.
Requirements: Fluent in English Self-directed, able to work independently with little supervision while meeting performance metrics Passion for nursing and improving patient outcomes Good with technology and eager to learn and use new software Excellent organizational and time management skills Strong communication and telephonic skills Strong critical thinking and problem-solving skills Education And Experience: Current, unrestricted Illinois RN license is required. Proficiency with EHRs (electronic health records) and web-based applications 3 or more years' experience as a Registered Nurse Preferred Education And Experience: Case Management or Chronic Disease Management experience highly preferred Certified Diabetes Educator desired, but not required Experience with Motivational Interviewing or other behavior change communication techniques is a plus. Scheduling And Other Requirements: Must have a STRONG internet-connected computer. Equipment is NOT provided by the company. A minimum of 20 hours of day time availability per week is required. You will commit to your own schedule using our software. This is a 1099 contract position with no end date. Care Coaches are responsible for their own equipment, taxes and insurance.
Utilize our specialized care management software to call a full caseload of Medicare patients with two or more chronic conditions (Diabetes, CHF, Chronic Pain, COPD, etc.) on a monthly basis Build and maintain rapport with patients to help coach them to improved health through SMART goals and education on self-management strategies Implement and improve the Plan of Care by updating medications, appointments due, biometrics, symptoms, and interventions made Connect the patient with community resources as needed, including transportation, personal care needs, prescription/DME assistance, social services, etc. Conduct Transitional Care Management activities to high-risk patients discharged from the hospital and the ER to reduce unnecessary readmissions. Close care gaps by encouraging preventive care measures, i.e. annual well visits, vaccines, cancer screens, follow-up/specialist appointments, etc.
Catholic Health Initiatives, a nonprofit, faith-based health system formed in 1996 through the consolidation of four Catholic health systems, expresses its mission each day by creating and nurturing healthy communities in the hundreds of sites across the nation where we provide care. One of the nation’s largest nonprofit health systems, Englewood, Colo.-based CHI operates in 18 states and comprises 100 hospitals, including two academic health centers, major teaching hospitals and 30 critical-access facilities; community health-services organizations; accredited nursing colleges; home-health agencies; living communities; and other facilities and services that span the inpatient and outpatient continuum of care. In fiscal year 2018, CHI provided more than $1.14 billion in financial assistance and community benefit for programs and services for the poor, free clinics, education and research. Financial assistance and community benefit totaled approximately $2.1 billion with the inclusion of the unpaid costs of Medicare. The health system, which generated operating revenues of $15 billion in fiscal year 2018, has total assets of approximately $20.5 billion. Learn more at www.catholichealthinitiatives.org
As our Virtually Integrated Care RN, you will be a pivotal provider, empowering patients toward optimal health through comprehensive remote support and collaborative care coordination. You will be instrumental in bridging care gaps and enhancing engagement in a dynamic virtual environment. Every day you will meticulously assess patient needs, develop personalized care plans, and provide direct clinical coaching. You will proactively monitor progress, coordinate diverse services, and leverage telehealth, diligently tracking compliance, documenting interactions, and contributing to quality improvement. To be successful in this vital role, you will leverage advanced clinical expertise, communication, and technological proficiency for high-quality virtual care. You will collaborate seamlessly with providers and teams, optimizing complex pathways.
Bachelors Of Nursing and a minimum of 3 years of overall acute care nursing experience; with a minimum of 2 years of nursing preceptor experience 2 years in a nursing leadership role (Charge RN role applicable) Registered Nurse: AZ AHA Basic Life Support - CPR, within 7 - days Adult Abuse training, within 90 days High-function computer technical skills.
Collaborates virtually with physicians, nurses and other health care team members in the provision of clinical care for the patient Guide clinical teams on the protocols, rules and regulations of the facility Assesses virtually the medical, physical, and psychological status of patients by reviewing patient records, obtaining a comprehensive problem-oriented health history and monitoring and evaluating laboratory, x-ray, EKG, and other diagnostic studies as medically indicated Interprets available data in order to establish a primary plan of care. The plan is developed through an interdisciplinary team approach and through multi-dimensional patient care conferences, ongoing patient assessments, and re-evaluation of patient problems or needs Teach clinical problem solving through instructing, modeling, coaching and facilitating through the utilization of the Virtual Care Delivery Platform Responds to routine, urgent and emergent patient problems appropriately by demonstrating effective decisionmaking and provides follow-up to ensure that patient problems are resolved
Catholic Health Initiatives, a nonprofit, faith-based health system formed in 1996 through the consolidation of four Catholic health systems, expresses its mission each day by creating and nurturing healthy communities in the hundreds of sites across the nation where we provide care. One of the nation’s largest nonprofit health systems, Englewood, Colo.-based CHI operates in 18 states and comprises 100 hospitals, including two academic health centers, major teaching hospitals and 30 critical-access facilities; community health-services organizations; accredited nursing colleges; home-health agencies; living communities; and other facilities and services that span the inpatient and outpatient continuum of care. In fiscal year 2018, CHI provided more than $1.14 billion in financial assistance and community benefit for programs and services for the poor, free clinics, education and research. Financial assistance and community benefit totaled approximately $2.1 billion with the inclusion of the unpaid costs of Medicare. The health system, which generated operating revenues of $15 billion in fiscal year 2018, has total assets of approximately $20.5 billion. Learn more at www.catholichealthinitiatives.org
Job Summary And Responsibilities Up to $5000 Sign On Bonus Offered** Paid out in FULL after 30 days of employment This position is a Remote Triage Clinic RN role - you must live within the Omaha metro area to be considered. This position WILL require 90 day in person training before remote position will start. Location: Midland's OB Clinic - Hwy 370 & 84th St Schedule: Monday-Friday 8a-530p Are you a seasoned Registered Nurse (RN) with a passion for women's health, a knack for astute assessment, and the ability to connect with patients from afar? Do you thrive in a fast-paced environment where your expertise directly impacts patient care, all from the comfort of your home office? Then we have an incredible opportunity for you! CHI Health Midland's OB is a leading OB/GYN practice dedicated to providing comprehensive and compassionate care to women through all stages of life. We believe in leveraging innovative solutions to enhance patient access and support, which is why we're adding a remote triage RN position. We're seeking a skilled and empathetic Remote Triage Clinic RN to be a vital part of our patient care network.
Minimum Qualifications: Current Registered Nurse (RN) license that allows you to practice in our state Graduate of an accredited nursing program Basic Life Support (BLS) from the American Heart Association required Where You'll Work From primary to specialty care, as well as walk-in and virtual services, CHI Health Clinic delivers more options and better access so you can spend time on what matters: being healthy. We offer more than 20 specialties and 100 convenient locations; with some clinics offering extended hours
You will be the primary point of contact for patients calling with a wide range of OB/GYN concerns, from routine questions to urgent symptoms, via telephone and secure messaging platforms. Utilizing advanced clinical judgment and established protocols, you will expertly assess patient symptoms, prioritize their needs, and determine the appropriate level of care. Provide clear, concise, and compassionate education regarding symptoms, self-care measures, medication instructions, and preventive health strategies, empowering patients to manage their health effectively. Based on your assessment, you will accurately direct patients to the most suitable care pathway, including scheduling same-day appointments, future appointments, advising on emergency room visits, or providing home care instructions. Collaborate effectively with our on-site providers, MAs, and administrative staff, relaying critical patient information and ensuring coordinated care. Maintain meticulous and timely electronic health record (EHR) documentation of all patient interactions, assessments, advice given, and follow-up plans, adhering to all professional and regulatory standards.
Tuesday Health is a value-based palliative care provider group dedicated to transforming serious illness and end-of-life care. We deliver goal-centered care focused on alleviating physical symptoms and emotional stress for individuals and their caregivers. Our interdisciplinary care teams reduce avoidable hospitalizations and improve quality of life wherever individuals call home. Through our leading-edge care model, Tuesday Health is shaping the future of community-based palliative care nationwide.
Complex Care Navigator LPN *Bi-lingual, Spanish preferred* Location: Dallas, Texas The Complex Care Navigator LPN plays a key role in delivering coordinated, compassionate care for members with serious illnesses. Working closely with nurse practitioners and registered nurses, the LPN administers clinical assessments and screenings throughout the care journey. They prioritize member needs based on assessment results and collaborate with the interdisciplinary team to develop and execute individualized care plans. The LPN ensures seamless communication, participates in care rounds, and leverages Tuesday Health’s electronic tools to optimize the member experience. Trust-building, empathy, and consistent member engagement are essential to the role, enabling a truly person-centered approach to care.
A strong candidate will demonstrate the following: Active and unrestricted licensed practical nurse license in the State of Texas without any board action Experience in clinical/medical setting preferred Experience in a multi-disciplinary care model working across network providers, health plan care management support, and employed clinicians Strong communication and organization skills Ability to multitask and work under pressure without sacrificing a positive member experience Ability to know when to escalate and potentially act professionally in an emergent situation Strong technical skills to navigate different documentation systems and tools; as well as ability to learn new systems as the company grows and evolves Strong written skills Ability to drive during daytime, nighttime, or inclement weather Valid driver's license with safe driving record State minimum automobile insurance coverage Comfort with change and ambiguity; you understand that rapid changes to the business, strategy, organization, and priorities will come with rapid evolution of our business
Administer multiple assessments and screening tools within the clinical model at different times throughout the care timeline with the support of nurse practitioners and registered nurses Prioritize needs based on assessment results and task interdisciplinary care team Be accountable for care plan development within the multidisciplinary care team Participate in internal and joint rounds to ensure the member experience is optimal and coordinated Learn the Tuesday Health electronic systems, tools, technology, to deliver a coordinated approach to ensure the members have a unique experience Build a strong, trusting relationship with every member, where listening and empathy are the foundation of every interaction Serve as the quarterback of the multidisciplinary team transforming care for members with serious illness
Tuesday Health is a value-based palliative care provider group dedicated to transforming serious illness and end-of-life care. We deliver goal-centered care focused on alleviating physical symptoms and emotional stress for individuals and their caregivers. Our interdisciplinary care teams reduce avoidable hospitalizations and improve quality of life wherever individuals call home. Through our leading-edge care model, Tuesday Health is shaping the future of community-based palliative care nationwide.
Director of Clinical Operations Location: Remote (must be located in ET or CT) The Director, Clinical Operations, is accountable for the day-to-day execution, performance, and continuous improvement of Tuesday Health’s clinical model. This role leads clinical and quality operations, overseeing clinical managers and care teams to deliver exceptional patient experience, strong clinical and quality outcomes, and execution of our care model. In close partnership with clinical/provider leadership, the Director drives operational excellence through standardized workflow, onboarding and training, disciplined performance management, and continuous improvement. The Director also serves as a primary liaison to health plan care management teams ensuring effective collaboration, coordinated workflows, and partner satisfaction. Across the organization, this role partners with Product, Analytics, Member Services, and Market Operations to optimize systems, tools, and processes that improve outcomes, efficiency, and reliability of care delivery.
A strong candidate will demonstrate the following: 7+ years of progressive leadership experience in clinical operations, care management, population health, or managed care. Experience in value-based care strongly preferred RN required, Bachelor’s degree in Nursing, Healthcare Administration, or a related field preferred Demonstrated experience leading clinical managers and interdisciplinary teams, including coaching, performance management, and accountability routines Highly analytical and metrics-driven; skilled in translating organizational goals into measurable KPIs, dashboards, and sustained performance improvement Strong cross-functional leadership and change management skills; able to partner effectively in a matrixed environment Ability to streamline workflows, improve efficiency, and scale operations while maintaining high-quality, patient-centered care Experience developing and executing onboarding, training, and competency pathways for clinical staff and managers; ability to drive adoption and refreshers over time Strong understanding of health plan operations and collaboration with payer care management teams Excellent communication and stakeholder management skills, including executive presence, conflict resolution, and service recovery in escalated situations Knowledge of healthcare regulations, compliance requirements, and accreditation standards
Provide direct supervision, coaching, and performance oversight to clinical managers, fostering a culture of accountability, teamwork, and excellence Serve as a primary operational liaison between Tuesday Health clinical teams and health plan care management teams, ensuring alignment on care coordination workflows, communication standards, documentation standards, and escalation pathways Oversee onboarding and training for care teams and clinical managers, ensuring consistent readiness standards, operating routines, and competency development across new team members. Lead quality operations, including monitoring and improving adherence to clinical workflows, care standards, and documentation requirements to support outcomes and reduce variation Ensure regulatory compliance, adherence to clinical guidelines, and best practices in patient care management Own performance against operational, clinical, and quality goals; implement targeted improvement initiatives as needed Partner with cross-functional teams to improve patient engagement, care coordination, and workflow optimization, that enables high-performance care delivery Address escalated operational issues and implement solutions to enhance service delivery and patient outcomes Partner with clinical/provider leadership to ensure appropriate staffing models, workload balancing, and operational coverage across teams Establish clear operating rhythms and accountability structures to support consistent execution and team performance
Tuesday Health is a value-based palliative care provider group dedicated to transforming serious illness and end-of-life care. We deliver goal-centered care focused on alleviating physical symptoms and emotional stress for individuals and their caregivers. Our interdisciplinary care teams reduce avoidable hospitalizations and improve quality of life wherever individuals call home. Through our leading-edge care model, Tuesday Health is shaping the future of community-based palliative care nationwide.
Location: Remote (must be located in Houston, TX) *Bi-lingual in Spanish preferred** The Complex Care Navigator RN is a vital leader in delivering comprehensive, person-centered care to individuals with serious illness. This role involves administering and interpreting a variety of assessments and screening tools to identify and prioritize member needs. As a key member of the multidisciplinary team, the RN is responsible for developing individualized care plans and leading care coordination efforts through active participation in internal and joint rounds. Utilizing Tuesday Health’s electronic systems and tools, the RN ensures a streamlined, technology-enabled approach to care. Central to this role is building strong, empathetic relationships with members, driving collaboration and transforming the member experience.
A strong candidate will demonstrate the following: Active and unrestricted Registered Nurse license in the State of Texas without any board action Experience in clinical/medical setting preferred Experience in a multi-disciplinary care model working across network providers, health plan care management support, and employed clinicians Strong communication and organization skills Ability to multitask and work under pressure without sacrificing a positive member experience Ability to know when to escalate and potentially act professionally in an emergent situation Strong technical skills to navigate different documentation systems and tools; as well as ability to learn new systems as the company grows and evolves Strong written skills Ability to drive during daytime, nighttime, or inclement weather Valid driver's license with safe driving record State minimum automobile insurance coverage Comfort with change and ambiguity; you understand that rapid changes to the business, strategy, organization, and priorities will come with rapid evolution of our business Bi-lingual in Spanish preferred
Administer multiple assessments and screening tools within the clinical model at different times throughout the care timeline Interpret responses to assessments and screening tools and support prioritization of need based on responses Be accountable for care plan development within the multidisciplinary care team Lead in internal and joint rounds to ensure the member experience is optimal and coordinated Learn the Tuesday Health electronic systems, tools, technology, to deliver a coordinated approach to ensure the members have a unique experience Build a strong, trusting relationship with every member, where listening and empathy are the foundation of every interaction Serve as the quarterback of the multidisciplinary team transforming care for members with serious illness
Inizio Engage is a strategic, commercial, and creative engagement partner that specializes in healthcare. Our passionate, global workforce augments local expertise and diverse mix of skills with data, science, and technology to deliver bespoke engagement solutions that help clients reimagine how they engage with their patients, payers, people and providers to improve treatment outcomes. Our mission is to partner with our clients, improving lives by helping healthcare professionals and patients get the medicines, knowledge and support they need. We believe in our values: We empower everyone/We rise to the challenge/We work as one/We ask what if/We do the right thing, and we will ask you how your personal values align to them.
Inizio Engage has a long-standing partnership with a leading Biotechnology company, across Commercial, Patient Solutions and Medical Affairs businesses. To deliver telephonic educational support to identified patients within in the field of a designated disease state to meet all relevant standards as set by the company and Clinical Manager. This is your opportunity to join Inizio Engage and represent a top biotechnology company! What’s in it for you? Competitive compensation Excellent Benefits – accrued time off, medical, dental, vision, 401k, disability & life insurance, paid maternity and paternity leave benefits, employee discounts/promotions Employee discounts & exclusive promotions Recognition programs, contests, and company-wide awards Exceptional, collaborative culture Best Places to Work in BioPharma (2022, 2023, & 2024) Certified Great Place to Work (2022, 2023, 2025)
Current U.S. Healthcare professional license (RN, RT) Associate degree/Bachelor’s/BSN or equivalent work-related experience Preferred minimum of 2 years of experience working in respiratory disease state or related field A highly motivated self-starter with a desire to update professional knowledge base regularly Competency with Call Center Telephone Technology Preferred Demonstrate effective and professional communication Excellent interpersonal skills with pleasant telephone manner and articulate phone voice Demonstrable organizational skills and the ability to manage multiple tasks Ability to multitask while maintaining high attention to detail and accuracy Process excellence and ability to problem solve and be proactive Strong working knowledge of Microsoft Office, client-specific applications, and database systems Ability to join frequent meetings and calls without disruption or disconnecting
To provide inbound or outbound non-promotional disease state related education and/or support to identified customers as directed by the client company To provide therapy education and support To collect, confirm and enter demographic data into the designated Client Relationship Management system (CRM) for program enrollment and program documentation, as required Maintaining excellent quality and provide superior customer service while adhering to program call guides, talking points, FAQs. To use only approved materials provided by Inizio or by the client, without changing, copying, or distributing the information To attend and successfully complete all trainings, courses and related competency assessments per the program requirements within an appropriate standard and specified timeframe Complete all required administrative responsibilities within the deadlines required for the program, and Inizio Engage. e.g. computer updates, emails, and time reporting Attend local and national program meetings and/or conferences, as required and if possible Adhere to all company and client policies, procedures and training requirements Perform other reasonable duties as requested Must safeguard patient privacy and confidentiality in remote setting by following the guidelines set forth in the Privacy and Security Rules of the Health Insurance Portability and Accountability Act (HIPAA) including call monitoring of Inizio Engage staff to ensure they are adhering to this requirement set forth by US Department of Health and Human Services Return and maintain all company equipment and materials according to company instructions
A healthcare technology company on a mission to make clinical care more effective and efficient by combining cutting-edge artificial intelligence with real clinical expertise. Their AI-powered platform works alongside multidisciplinary care teams to help healthcare providers extend their capabilities, improve patient outcomes, and streamline workflows without disrupting existing operations.
Job Title: Clinical Operations Nurse (RN/LPN) Location: This role may be remote or hybrid. NYC-based candidates are a plus but can sit anywhere in the US. Schedule/Shift: M-F, 9-6 EST Pay: $45-55/hr We are looking for a passionate, versatile nurse to join as a foundational member of our clinical operations team. This is a broad-scope “utility player” role for a clinician who is equally comfortable performing hands-on care management work, collaborating with product and engineering teams to refine automated technology workflows, and coaching staff on quality and clinical standards. You will work across the full portfolio of care team agents, supporting everything from chronic condition management and care gap outreach to complex prior authorizations and clinical documentation improvement. In this role, you will serve as an expert-in-the-loop: the clinical voice that ensures we deliver safe, high-quality care at scale.
Active clinical licensure: Current LPN or RN clinical license in good standing. Multi-state or Compact licensure is a plus. Strong clinical experience: 5+ years spanning direct patient care and virtual or telephonic care delivery, with meaningful exposure to care management, utilization management, prior authorization, or population health workflows. Healthtech experience: Prior experience in a healthtech company, venture-backed startup, health plan, or technology-enabled clinical services organization. Quality mindset and entrepreneurial approach: You are detail-oriented, comfortable delivering constructive feedback, and energized by early-stage environments where you’re creating processes from the ground up.
Deliver high-impact clinical work: Perform care management outreach, chronic condition follow-ups, care gap closure, and other clinical activities powered by AI platforms. Support complex clinical operations workflows: Review prior authorizations, appeals, and other clinical-administrative tasks that require human clinical judgment. Partner with product and engineering: Serve as a clinical subject matter expert, participating in workflow design sessions, testing new agent capabilities, identifying edge cases, and providing feedback. Provide quality oversight: Conduct quality audits of clinical operations activities, identify trends in errors or gaps, and develop remediation plans. Maintain and evolve quality scorecards and clinical rubrics. Develop clinical content and coach staff: Build the clinical protocols, scripts, and decision-support content that power AI agents, and onboard and train clinical team members on platform, workflows, and quality standards.
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