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CVS Health is the leading health solutions company, delivering care like no one else can. We reach more people and improve the health of communities across America through our local presence, digital channels and over 300,000 dedicated colleagues. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by simplifying health care one person, one family and one community at a time. Follow @CVSHealth on social media.
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Required Qualifications: Candidate must reside in an Eastern Standard Time Zone (EST) state Candidate must have active and unrestricted Compact Registered Nurse (RN) licensure in state of residence 2+ years of experience in care management 2+ years of Medicare experience Preferred Qualifications: Geriatric experience Experience working in a Multicultural setting, or person multicultural experience Certified Case Manager National professional certification (CRC, CDMS, CRRN, COHN, or CCM) Education: Associate’s Degree in Nursing AND relevant experience in a health care-related field (REQUIRED) Bachelor’s Degree in Nursing (PREFERRED) License: Active and unrestricted Compact Registered Nurse (RN) licensure in state of residence
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.
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 Care Transition 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 Clinical Documentation & HIM, Medication Management (PharmD), Laboratory Medicine and Pathology Services (MLS, MD), Quality Improvement & Patient Safety, Regulatory Compliance, Accreditation & Medical Staff, Care Coordination & Case Management, Population Health & Value-Based Care, and Managed Care & Utilization Management. Benefits: Full-time or part-time remote position Choose which projects you want to work on Flexible schedule Projects are paid hourly starting at $50+ per hour Bonuses available for high-quality and high-volume work Notes: Payment is made via PayPal. We will never ask you for any money. PayPal will handle any currency conversions from USD. Only applicants in the United States will be considered for this role. This is an independent contractor position.
Fluency in English (native or bilingual level) A current or in-progress medical or healthcare-related degree
Provide AI chatbots with diverse and complex healthcare-related problems Evaluate AI outputs for logic, accuracy, and performance Ensure the medical accuracy and overall quality of model responses
Akima is a global enterprise delivering comprehensive solutions to the federal government in the core areas of information technology; facilities & ground logistics; aerospace solutions; protective services; systems engineering; mission support; furniture, fixtures & equipment (FF&E); and construction. As a subsidiary of NANA, an Alaska Native Corporation owned by more than 15,000 Iñupiat shareholders, Akima’s core mission is to enable superior outcomes for our customers’ missions while simultaneously creating a long-lived asset for NANA consistent with our Iñupiat values. In 2023, Akima ranked #34 on Washington Technology’s Top 100 list and in the top 70 of Bloomberg Government’s BGOV200 list of top federal contractors for the last three years. Akima ensures non-discrimination in all programs and activities in accordance with Title VI of the Civil Rights Act of 1964. If you need more information or special assistance for persons with disabilities or limited English proficiency, contact the Project Manager in charge of the worksite or Human Resources at TitleVIcompliance@akima.com or call (571) 353-7050.
Serves as a member of a multidisciplinary team to provide assessment, planning, implementation, coordination, evaluation and monitoring of ATC Candidates throughout the medical clearance process.
The candidate must possess, at minimum, an active RN license and a bachelor’s degree in nursing (BSN). This education must have been accredited by the Commission on Collegiate Nursing Education, Council on Accreditation of Nurse Anesthesia Educational Programs, Accreditation Commission for Midwifery Education, or an accrediting body recognized by the U.S. Department of Education at the time the degree was obtained. Shall have at least ten (10) years of practical, recognizable experience in clinical. nursing with an emphasis on case management. These positions do not require FAA certification, however, a Commission for Case Manager Certification (CCM) or American Case Management (ACM) certification may be substituted for 3 years of experience.
Assessing new applicants by gathering information, reviewing diagnoses and analyzing medical test results. Scheduling appointments for drug screening, medical examiners, and MMPI-2. Updating patient medical records after each contact. Extensive knowledge of medicine and anatomy. Strong verbal and written communication skills to interact with patients and medical providers. Interpersonal skills to work with people of a broad range of socioeconomic and cultural backgrounds. Multitasking skills to provide care for multiple patients. Analytical skills to review documented medical information and use it to inform care plans. Problem-solving skills to identify shortcomings and revise them accordingly. Familiarity with word processors, spreadsheets, electronic record management programs and other software. Organizational skills to plan patient appointments and meetings and to coordinate the activities of medical providers.
SSM Health is a Catholic, not-for-profit, fully integrated health system dedicated to advancing innovative, sustainable, and compassionate care for patients and communities throughout the Midwest and beyond. The organization’s 40,000 team members and 13,900 providers are committed to fulfilling SSM Health’s Mission: “Through our exceptional health care services, we reveal the healing presence of God.” With care delivery sites in Illinois, Missouri, Oklahoma and Wisconsin, SSM Health includes hospitals, physician offices, outpatient and virtual care services, comprehensive home care and hospice services, a fully transparent pharmacy benefit company, a health insurance company and an accountable care organization. It is one of the largest employers in every community it serves. For more information, visit ssmhealth.com
It's more than a career, it's a calling WI-REMOTE Worker Type: Regular Preferred Candidates: proficient in a clinical setting creating initiatives Training would require on site needs (MUST BE WISCONSIN RESIDENT) Job Summary: Provides services as a patient navigator throughout the continuum of care.
EDUCATION: Graduate of accredited school of nursing or education equivalency for licensing Experience Three years' registered nurse experience Physical Requirements: Constant use of speech to share information through oral communication. Constant standing and walking. Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs. Frequent sitting, reaching and keyboard use/data entry. Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors. Frequent use of smell to detect/recognize odors. Frequent use of hearing to receive oral communication, distinguish body sounds and/or hear alarms, malfunctioning machinery, etc. Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs. Occasional lifting/moving of patients. Occasional bending, stooping, kneeling, squatting, twisting, gripping and repetitive foot/leg and hand/arm movements. Occasional driving. Rare crawling and running. Required Professional License And/Or Certifications State of Work Location: Illinois Basic Life Support HealthCare Provider (BLS HCP) - American Heart Association (AHA) And Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR) State of Work Location: Missouri Basic Life Support HealthCare Provider (BLS HCP) - American Heart Association (AHA) And Registered Nurse (RN) - Missouri Division of Professional Registration Or Registered Nurse (RN) Issued by Compact State State of Work Location: Oklahoma Basic Life Support HealthCare Provider (BLS HCP) - American Heart Association (AHA) And Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Oklahoma Board of Nursing (OBN) State of Work Location: Wisconsin Basic Life Support HealthCare Provider (BLS HCP) - American Heart Association (AHA) And Registered Nurse (RN) Issued by Compact State Or Registered Nurse (RN) - Wisconsin Department of Safety and Professional Services
Functions as a liaison for management staff, administration, physicians, managed care companies, community organizations, and other customers. Collaborates with physicians and advanced practice providers to ensure quality outcomes. Coordinates efforts for treatment and promotes quality improvement and educational efforts. Compiles data, tracks outcomes, and makes recommendations for process improvement. Provides referrals/support for follow-up care for patients who are uninsured or underinsured. Utilizes the nursing process of assessment, planning, intervention, and evaluation in all patient encounters. Assists medical provider with processing of diagnostic results bringing significant values to the provider’s attention. Exhibits knowledge of tests and procedures and their significance as related to patient care. Recognizes the implementation of dosages, interactions, side effects, adverse effects, routes of administration of drugs as they apply to individual patients. Uses knowledge of medications in instructing patients about medication therapy. Establishes working relationships teaching protocols for patient education, family counseling and general public information. Works in a constant state of alertness and safe manner. Performs other duties as assigned.
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.
Contract | Remote | We're hiring 10 elite nurses CircleLink Health is building a team of top-tier Compact Registered Nurses who want more than a typical remote role. This is a performance environment for nurses who thrive on ownership, efficiency, and measurable impact — and who want their income to reflect their output. If you want predictable shifts and low expectations, this isn't the role for you. If you want autonomy, scale, and the ability to grow your earnings, keep reading. You'll manage a large panel of Medicare patients with chronic conditions, delivering monthly clinical calls that drive real outcomes and reduce hospitalizations. This role is built for nurses who can operate independently, manage complexity, and execute consistently at a high level. We expect our Care Coaches to treat this role as their primary professional focus, not a side gig.Schedule & Structure Flexible scheduling between 8am-5pm EST, Monday-Sunday Fully remote 1099 contractor role You own your schedule, your workflow, and your results.
Compact RN licensed Extremely self-directed Comfortable owning large caseloads ( >70 patients/month) Highly organized and metrics-driven Tech fluent and fast learners Motivated by performance and results Comfortable working with minimal supervision with multiple practices, workflows and EHRs Accountable, disciplined, and reliable Requirements: Current unrestricted Compact RN license 3+ years clinical experience Strong internet and dedicated workspace Confident with multiple software platforms Strong communication and critical thinking skills Strongly preferred: Case management or chronic disease management EHR experience Motivational interviewing Diabetes education
Run monthly clinical calls with chronic care patients Drive behavior change through coaching and education Maintain precise, compliant documentation using our platform Close preventive care gaps and coordinate services Update care plans and track interventions Support transitions of care to reduce readmissions Manage your panel efficiently and consistently
Achieve Financial Freedom by empowering yourself with the knowledge and skills of Financial Literacy, we will show you how
Whether you’ve served in healthcare, or human services, your commitment to protecting and serving others makes you the perfect fit to help families build lasting financial security and create freedom for yourself. REMOTE Opportunity – Work from Home or Anywhere with WiFi FLEXIBLE Hours – Part-Time or Full-Time NO PRIOR EXPERIENCE IN FINANCE NEEDED – Full Training Provided NOT an Internship – This is a Career-Building Opportunity Commission-Based (1099) with Strong Growth Potential Who We’re Looking For: Are you someone who has served healthcare in your community — and ready to build a new kind of impact? Your dedication, integrity, and ability to work under pressure are exactly what we value. We’re actively seeking individuals with strong communication skills, reliability, and a passion for helping others—who are ready to build a mission-driven career with purpose, flexibility, and the potential for financial freedom.
Profile: Must be a legal resident of the U.S. Cannot be on a work visa or student visa (OPT, F-1, etc.) Willing to obtain financial licenses within 30 days Background check required
Educate individuals and families on how to build wealth, protect their income, and secure their legacy. Guide clients through tailored solutions in life insurance, retirement strategies, investments, and tax-advantaged planning. Build your own book of business, with ongoing support from experienced mentors and leaders. Use our proven, duplicatable system to grow both your income and your impact.
Renalogic is dedicated to helping our clients manage the human and financial costs of chronic kidney disease. To help us in our mission, we hire people who are humble, hungry, and smart. And it sure helps if you have a sense of humor. We're not perfect, but we're trying to build a company that we are all proud of. Our 96% client retention suggests we're on the right path.
Compensation: $50,000 - $60,000 annual salary, plus annual potential for bonus and merit increases Employment Type: Full-Time, Salaried, Exempt Reports to: Director of Oncology and Infusion Location: US, must live in Pacific, Mountain, or Central time zone; fully remote with minimal travel Schedule: Mostly standard business hours, with some flexing to support members in every US time zone As the Clinical Nurse Coordinator (LPN), you'll support care navigation across the continuum of cancer by facilitating guideline-aligned treatment, symptom tracking, and member re-education. You'll collaborate with RNs, providers, and interdisciplinary teams to ensure care plans, referrals, and authorizations are coordinated and care transitions are smooth. As the LPN of a growing department, you'll also assist with clinical trial participation, manufacturer assistance programs, and identifies grants or foundations to provide insight and guidance to the team and our members. You'll review active infusion medications to coordinate with external resources for infusion services, help with claim reviews, and manage administrative tasks, all while maintaining your own caseload of members and following up per each member's unique cadence. You'll be an integral expansion of other team members' responsibilities by emphasizing coordination, documentation, member engagement, and resource navigation within an LPN scope of practice.
LPN/LVN license in good standing within a compact state, plus willingness to obtain licensure in other states as needed. A minimum of 4 years' LPN/LVN experience, plus clinical experience in oncology and infusions are required. Experience with care navigation, treatment support, and/or complex case management is strongly preferred. Must live in either PST, MST, or CST and flex your work schedule to support members in every US time zone, which means working some evening and weekend hours. Ability to speak, write, and communicate fluently in Spanish is strongly preferred. Utilization Review and/or Care Management preferred. Experience working 100% remote as a nurse is highly preferred. Ability and willingness to travel occasionally, which will include overnight stays for corporate gatherings, conferences, and health fairs. Ability to attend and professionally engage in video meetings. Proficient technological skills, meaning you can effectively and efficiently use computers, peripheral equipment, and applications/systems, including Microsoft products. Autonomous self-starter who is comfortable with ambiguity. Creative mindset and ability to appropriately challenge the status quo. Superb written and oral communication skills. Ability to overcome obstacles with a ‘yes if...' approach. Ability to effectively balance competing deadlines without losing focus on the bigger picture. Reliable internet and power with a designated area to conduct work with minimal interruptions.
Maintain regular contact with assigned oncology members via phone, text, email, and video calls to provide follow-up and support. Assist and coordinate with the RN in member care delivery by communicating with providers and pharmacies and facilitating referrals to third-party infusion services for cost containment. Identify, coordinate, and facilitate referrals to infusion services, clinical resources, or supportive care programs. Address social determinants of health (SDOH) affecting members' access to care, adherence, and overall well-being. Provide education and guidance on treatment logistics, medication access, and community or program resources, reinforcing physician-directed care. Provide emotional support and connect members to counseling, support groups, survivorship resources, and other supportive services. Collect, document, request, and send member information in the EHR per HIPAA; escalate clinical concerns to the RN as appropriate. Track member interactions and support the RN in meeting enrollment, engagement, and quality metrics. Collaborate with the RN and interdisciplinary team to ensure members receive timely, coordinated oncology care.
Abridge was founded in 2018 with the mission of powering deeper understanding in healthcare. Our AI-powered platform was purpose-built for medical conversations, improving clinical documentation efficiencies while enabling clinicians to focus on what matters most—their patients. Our enterprise-grade technology transforms patient-clinician conversations into structured clinical notes in real-time, with deep EMR integrations. Powered by Linked Evidence and our purpose-built, auditable AI, we are the only company that maps AI-generated summaries to ground truth, helping providers quickly trust and verify the output. As pioneers in generative AI for healthcare, we are setting the industry standards for the responsible deployment of AI across health systems. We are a growing team of practicing MDs, AI scientists, PhDs, creatives, technologists, and engineers working together to empower people and make care make more sense. We have offices located in the Mission District in San Francisco, the SoHo neighborhood of New York, and East Liberty in Pittsburgh.
As the Clinical Success Director/Manager - Nursing, you will be at the forefront of defining, launching, and growing our generative AI platform for nurses. Your work will directly contribute to improving the cognitive burden associated with clinical documentation. You will collaborate with clients, partners, product managers, designers, machine learners, and healthcare professionals to bring to life products that bridge the gap between clinical conversations and actionable data.
5+ years of experience as an RN, preferably in the inpatient setting Experience with electronic record systems (Epic is a definite plus) Passion for deeply understanding nursing workflows and improving inefficiencies Proven track record of leading successful initiatives from conception through launch Ability to build relationships with different layers of an organization, from front-line staff to executives Strong understanding of the healthcare industry, specifically clinical workflows and regulatory requirements Experience working with cross-functional teams in a fast-paced, startup environment ***This role requires 30% travel*** ***To be hired you must be based in the Pacific time zone***
Evaluate new product offerings and provide subject matter expertise to our product teams. Build and maintain relationships across customers, including onboarding users, listening to customer feedback, optimizing nursing workflows, and identifying opportunities for improved engagement and success. Design and recruit a council of trusted nurse advisors to guide product strategy and roadmap. Develop a use case-specific end-user survey and a set of success metrics to help communicate impact and value. Evangelize product capabilities and direction to prospective customers by creating sales collateral, conducting product demos, training, and more.
CareOregon is a nonprofit, mission-driven health plan, focused on providing care to low-income Oregonians. The CareOregon family includes Columbia Pacific CCO, Jackson Care Connect, Housecall Providers and our work as part of Health Share of Oregon. We also support recruitment for the Oregon Health and Education Collaborative.
The Clinical Systems Trainer is responsible for training staff in the correct and effective use of decision tools used for utilization management activities and assess staff readiness to begin their specific role in the Division at the conclusion of training. As new initiatives and functionalities arise, they work jointly with Clinical Operations leadership to identify training opportunities and implement strategies to ensure ongoing training needs are met. They are responsible for onboarding and orientation of new clinical employees to clinical guideline tools (InterQual); they author guidelines from regulatory requirements or customize from nationally recognized clinical content or organizational criteria to meet CareOregon’s needs. They lead the ongoing training of clinical staff as new guidelines are developed. They develop training and reference materials to ensure staff have the tools needed to streamline operational workflows and overall meet regulatory compliance. They support audit activities as requested.
Required: Registered Nurse (RN) license Minimum 2 years of clinical experience working with clinical guidelines Preferred: Experience in clinical content creation or medical writing Experience with InterQual: Experience with training and onboarding Knowledge, Skills and Abilities Required Knowledge: Proficiency with nationally accepted clinical guidelines, such as InterQual or MCG High degree of competence in continual improvement, project management, change management, and program development Knowledge of clinical workflows Knowledge of learning collaborative and practice facilitation strategies Strong computer literacy Basic understanding of software development phases Skills and Abilities: Ability to work with minimum supervision Ability to develop, test, and evaluate programmatic initiatives Strong abilities in building relationships with multiple entities Excellent written and verbal communication skills Ability to work independently and as part of a team Strong attention to detail and organizational skills Ability to manage multiple projects and meet deadlines Strong people management skills, including the ability to coach and motivate teams Excellent critical thinking, analytical and problem-solving skills; ability to effectively analyze program goals and objectives to determine successes and opportunities for improvement Ability to communicate effectively, both verbally and in writing, including strong presentation and change management skills Ability to influence and build consensus Ability to work in an environment with matrix reporting Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, hear, speak clearly and perform repetitive finger and wrist movement for at least 6 hours/day Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to hear and speak clearly for at least 3-6 hours/day Working Conditions Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home
Conduct onboarding training sessions for newly hired clinical staff in utilization management workflows. Develop and maintain job aids to support core workflows. Facilitate remediation training for identified deviation by individuals and/or teams from policies, procedures, and processes. Lead ongoing training refresher sessions for clinical staff. Build evaluation of staff training and provides feedback to respective managers. Responsible for departmental reporting of aggregate training activities. Track all activities which can be used as support documentation for CMS or OHA audits. Identifies training opportunities and implements strategies to ensure ongoing training needs are met. Assist in internal and external audits as requested. Implements strategies to ensure staff comply with internal or external plan of corrections. Develop, review, and update clinical content, ensuring accuracy and relevance. Ensure all content complies with current clinical standards and regulations. Maintain up-to-date knowledge of clinical practices and Medicare and Medicaid guidelines. Assist in the development of training materials and educational resources. Participate in quality improvement initiatives and projects. Design, develop, and update clinical content through the review and understanding of information gathered from regulatory and organizational requirements. Collect and incorporate feedback from internal customers to ensure clinical accuracy and usability. Perform Quality Assurance testing of clinical content and create and maintain clinical documentation. Serve as a clinical resource for both internal customers, including training of new content both created and as part of the product. Collaborate with Medical Directors and Clinical Operations leadership team for organizational criteria. Participate in developing project plans, monitoring tasks and ensuring on-time delivery of clinical content. Organizational Responsibilities: Perform work in alignment with the organization’s mission, vision and values. Support the organization’s commitment to equity, diversity and inclusion by fostering a culture of open mindedness, cultural awareness, compassion and respect for all individuals. Strive to meet annual business goals in support of the organization’s strategic goals. Adhere to the organization’s policies, procedures and other relevant compliance needs. Perform other duties as needed.
CareOregon is a nonprofit, mission-driven health plan, focused on providing care to low-income Oregonians. The CareOregon family includes Columbia Pacific CCO, Jackson Care Connect, Housecall Providers and our work as part of Health Share of Oregon. We also support recruitment for the Oregon Health and Education Collaborative.
The Registered Nurse - Utilization Management I is responsible for supporting specific utilization management (UM) program functions within the Clinical Operations department. UM program functions include Benefit Management, Benefit Review, Appeals and Grievances and Health Related Services (HRS). Together they support the healthcare needs of members, determine the best medically appropriate services, and apply clinical-based criteria for decision-making while managing medical expenses. NOTE: This position focuses on Appeals and Grievance.
Required: Current unrestricted Oregon RN license Minimum 2 years RN experience [OR 1 year RN experience AND 3 years’ experience in healthcare setting role(s) such as billing, coding, medical assistant, etc.] Preferred: More than 1 year RN experience Healthcare utilization management experience in the functional focus area (Appeals and Grievance, Benefits Review or Benefit Management) Experience with Medicaid and/or Medicare utilization management Knowledge, Skills and Abilities Required Knowledge: Knowledge of Medicaid health plan and Medicare benefits Knowledge of applicable DMAP rules and regulations Knowledge of ICD-10, CPT, and HCPCS codes Familiarity with the principles of utilization management Familiarity with healthcare documentation systems Skills and Abilities: General computer skills including use of Microsoft Office applications and internet search functions Ability to use review criteria in accordance with departmental policies Ability to adhere to HIPAA regulations e.g., maintaining confidentiality of protected health information Ability to interpret and apply complex policies and procedures Ability to review work for accuracy Ability to independently prioritize work Ability to use critical thinking and problem-solving skills Strong spoken and written communication skills Strong interpersonal and customer service skills Ability to work effectively with diverse individuals and groups Ability to learn, focus, understand, and evaluate information and determine appropriate actions Ability to accept direction and feedback, as well as tolerate and manage stress Ability to see, read, and perform repetitive finger and wrist movement for at least 6 hours/day Ability to hear and speak clearly for at least 3-6 hours/day Working Conditions Hazards: May include, but not limited to, physical and ergonomic hazards. Equipment: General office equipment Travel: May include occasional required or optional travel outside of the workplace; the employee’s personal vehicle, local transit or other means of transportation may be used. Work Location: Work from home
Communicate with members and/or providers in a professional manner and in accordance with State and Federal requirements as needed to complete requests. Maintain confidentiality of all discussions, records, and other data in connection with quality management activities according to professional standards. Refer members to care coordination per policies and procedures. Maintain accurate and complete documentation. Collaborate with Medical Directors to determine medical necessity and appropriateness of care for benefits requested and/or rendered. Work with clinical support staff to ensure service requests, authorizations and/or grievances are managed in accordance with state and federal guidelines. Identify and refer potential quality of care issues for peer review. Ensure that authorization decisions are based on organizational policy and state and federal coverage rules. Gather and submit documents for third party case review; this includes all documentation and follow-up activities. Issue denial notices based on established unit protocols and state and/or federal requirements. Assist with periodic audits, general quality management and improvement activities, and other regulatory activities as needed. Foster collaboration with teams across the Clinical Operations department to ensure work and goals are met. Meet or exceed department production, timelines, and quality standards established for level I. May participate in departmental workgroups or projects as assigned. Support testing for system updates and implementations as assigned. May help train new staff and teammates as assigned. Cross train in additional functional focus areas as assigned. Duties Specific to Functional Focus Area Benefit Management: Review provider pre-service requests and determine benefit coverage according to Medicare, Medicaid and/or organizational guidelines. Benefit Review: Determine appropriate level of care and length of stay for inpatient members to include hospitals, skilled nursing facilities, long term acute care hospitals, inpatient rehabilitation hospitals, and respite care programs. Review inpatient admission for re-insurance clinical reporting. Appeals and Grievance: Assemble evidence and build clinical cases for administrative hearings or Independent Review Entity (IRE) reviews. Function as a CareOregon representative in administrative hearings. Assist with the analysis and summary of data for written reports and public presentations as needed. Communicate with members, providers, health plan administrators to manage grievances and appeals and provide case status updates as needed. Investigate and use clinical judgement to identify quality of care or safety issues and present findings to an oversight committee. Health Related Services: Review provider and member submitted HRSN and Flexible Services requests and determine benefit eligibility according to Medicaid and/or organizational guidelines.
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
As a Clinical Grievances Nurse, you will be responsible for reviewing incoming retrospective cases to determine if the appropriate care was given along with current cases to ensure the members immediate needs are being addressed. In providing consumer - oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. If you are able to work PST hours, you'll enjoy the flexibility to work remotely* from anywhere in the U.S. as you take on some tough challenges. The working hours for this role are Monday - Friday, 8 am - 5pm PST or CST (Whichever time zone you are within).
Required Qualifications: Current, unrestricted RN license in the state of residency 3+ years of total RN experience including recent clinical experience in an inpatient / acute setting or similar setting Demonstrated clinical documentation skills and critical thinking skills Demonstrated proficiency in computer skills - Windows, Instant Messaging, Clinical Platforms, Microsoft Suite including Word, Excel, and Outlook Designated workspace and access to install secure high speed internet via cable / DSL in home Reside in and work 8 am-5 pm in Central or Pacific Standard time zone Preferred Qualifications: Bachelor's in Nursing or higher Experience with Managed Care Clinical Quality Programs Case management experience Clinical appeals and grievances experience Audit / chart review experience Experience in a telecommuting role Ability to effectively utilize UHG applications, including but not limited to authorization applications, auto correspondence, and member & provider demographic systems
Perform clinical assessment of healthcare services provided to our members for appropriateness Understand relevant state and federal grievance and peer review requirements and accreditation standards applicable for processes supported Receives cases from the QIS non- clinical team and reviews them against required clinical information, assessing for appropriateness and consulting with a Medical Director Document relevant chronology of case review and provide rationale for severity level, descriptor codes, and any applicable Improvement Action Plan (IAP) implemented Facilitate telephonic discussion with health care providers and/or members to obtain additional clinical information Provide timely, quality service to members and providers while upholding UnitedHealthcare culture values Act as a resource for others with less experience Work independently and collaborating with Medical Directors and non-clinical partners Function as a member of a self-directed team to meet specific individual and team performance metrics Manage and maintain quality and productivity metrics 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.
Valeris is a fully integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. Formed by the merger of PharmaCord and Mercalis, Valeris™ revolutionizes the path from life sciences innovation to real-life impact to build a world in which every patient gets the care they need. Valeris works on behalf of life sciences companies to improve the patient experience so that patients can access and adhere to critical medications. Backed by proven industry expertise, a deep commitment to patient care, the latest technology, and exceptionally talented team members, Valeris provides the data and strategic insights, patient support services and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Valeris provides commercialization solutions to more than 500 life sciences customers and has provided access and affordability support to millions of patients. The company is headquartered in Morrisville, North Carolina and Jeffersonville, Indiana.
The Patient Support Nurse is a blended role to 1) facilitate a successful patient journey to and while on therapy by providing care coordination, education, and psychosocial support, 2) provide medication and disease state education, and 3) provide clinical feedback to enhance the clinical portion of patient support programs.
AD or Bachelor’s Degree in Nursing (BSN, RN) with a valid nursing license in one or more states Four or more years of nursing experience; prior telephonic experience a plus Knowledge of medical insurance terminology and reimbursement/insurance, healthcare billing, physician office, health insurance processing or related reimbursement experience a plus Ability to communicate clearly and effectively orally and in writing-may be asked to submit a written test sample Proficient with Microsoft products Experience and comfort with a digital CRM required Attention to detail and committed to following through in communication with patients and providers Empathetic listening skills in order to interact effectively with patients and providers Willingness to work in a fast-paced environment and have the ability to multi-task and pivot with ease Strong customer service experience and skills Must be eligible to obtain licensure in all 50 states!! Physical Demands & Work Environment: While performing the duties of this job, the employee is regularly required to talk or hear. The employee is frequently required to sit for long periods of time, use hands to type, handle or feel; and reach with hands and arms. Prefer candidates who can type at least 35 words per minute with 97% accuracy. Although very minimal, flexibility to travel as needed is preferred. This job operates in a professional office environment. This role routinely uses standard office equipment such as computers, phones, photocopiers, etc.
Provide education and support to patients, caregivers and health care providers regarding assigned therapeutic areas and maintain accurate record of activity per program setup Establish relationships, develop trust, and maintain rapport with patients, caregivers, and healthcare providers in a 100% telephonic setting Counsel and educate new/existing patients on the use of products, dosing and administration, use of devices, drug insurance coverage/reimbursement challenges in a telephonic, or virtual setting Evaluate and contribute to development of program resources Coordinate and utilize resources to share and secure financial options for those with financial need. Follow program guidelines and escalate complex cases according to program policy and procedures. Receive and make calls to patients and/or caregivers regarding assigned disease states, products, and patient needs to include discussions regarding insurance coverage and available financial support options for the particular therapy Accurately maintain, constantly update, and successfully navigate patient account records in a digital CRM (Customer Relationship Management System) Support health care provider offices regarding questions, concerns, or challenges with prescription Report and document adverse events and product/safety complaints as per program SOPs Participate in program specific customer meetings and training sessions Participate in program specific orientation meetings and demonstrate clinical and program competency on written, evaluated tests Serve as an advocate to patients and health care providers regarding insurance coverage, medical billing, reimbursement process, and general access for complex pharmaceuticals. Participate in a shared on-call, after hours nurse service that spans multiple programs May be asked to perform related job duties that are not specifically set-forth in this job description.
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
The Clinical Nurse Liaison, RN is responsible for patient education and strategic oversight in support of our sales strategy. This RN will work directly with sales to process Optum infusion referrals within the hospital system, serve as a key resource and effectively anticipates the needs of the customers and patients to develop solutions for their needs. This position requires sales training as directed by the Regional Sales Director. If you are located in Western US, you will have the flexibility to work remotely* as you take on some tough challenges.
Required Qualifications: Current, unrestricted RN license in the state of practice 2+ years of experience working with laptops and/or tablets - including the ability to type and talk at the same time and toggle between multiple applications 1+ years of experience in a Clinical Liaison role 1+ years of leadership and/or management experience 1+ years of clinical educator experience Ability to travel within local assigned territory up to 50%; minimal overnight travel to occur Preferred Qualifications: 2+ years of home healthcare experience 1+ years of sales and customer service experience Knowledge of the Infusion Nursing standards (INS) and nursing process Meets expectations on most recent Common Review Demonstrated effective communication and teaching skills with patients, family members, and other staff members Proven understanding of business goals and sales strategy to build upon Demonstrated ability to solve complex problems and develop innovative solutions Demonstrated ability to work autonomously, managing own workload and seeking out opportunities to expand service opportunities
Conduct welcome calls and provide patient education on therapy, monitoring, and side effects; ensure patient is provided with the updates and tools they need for successful infusions both during our intake process and once on service Maintain and grow provider relationships and provide responsive customer service with assigned accounts Conduct initial clinical assessment based on clinical information provided. Assist in creating letters of medical necessity as well as provide assistance the office/patient with the necessary clinical evidence to overturn a denial Assist sales representatives in ensuring assigned referrals result in a start of care Manage clinical and account liaison team providing leadership/mentorship through regular 1:1 check ins and development calls Lead regular cadence of meetings to foster a positive team culture and learn from best practices Facilitate, along with Sales RRVP, all hiring, training and onboarding of Clinical Liaisons and maintain ongoing competency checkoffs as required Field training and coaching by working alongside liaisons as determined by sales leadership team Collaborate with regional leadership on development of growth strategies and initiatives Manage metrics associated with defined roles and responsibility 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.
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
The Utilization Management Nurse Lead is responsible for reviewing requests for inpatient and prior authorization services for all plan members. Works in collaboration with UM leaders and providers to ensure timely processing of referrals to provide the highest quality medical outcomes at the appropriate level of care. Oversees supports the team of UM Nurses with clinical decision-making tasks related to processing UM’s clinical referrals. Schedule: Monday - Friday, 8:00 AM - 5:00 PM Pacific Time
Education Required: Successful completion of an accredited Licensed Vocational Nursing or Registered Nursing Program Specialized Skills Required: Knowledge of Medicare Managed Care Manuals and CMS regulatory requirements. Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others. Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors; Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution. Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment. Report Analysis Skills: Comprehend and analyze statistical reports. Licensure Required: Must have and maintain an active, valid, and unrestricted LVN or RN license in California (Non-Compact) Immediately upon hire, must be willing to obtain LVN and / or RN licensure in Nevada, (Non-compact), Arizona (Compact), North Carolina (Compact), and Texas (Compact) which will be reimbursed by company. Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus. Pay Range: $85,696.00 - $128,543.00 Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.
Reviews reporting to assign tasks to UM Nurses for completion of time sensitive items. Works closely as a liaison between management and the team to ensure that new cases assigned are worked in a timely manner. Participates in department quality audits and vendor audits to assess timeliness of cases. Effectively communicates and keeps the Utilization Management leadership team informed of all departmental operations, activities, data, program performance, issues or any other pertinent information that would impact the overall program compliance or achievement of internal goals. Assists with team coverage plans as needed. Including jumping into operational support/work queues when needed. Collaborates with other leaders in the department to develop and improve processes and workflows. Acts as a resource to the team, members, providers, and community partners. Establishes and maintains effective interpersonal relationships with staff at all levels, providers, other departments, or programs. Leads, initiates and follows through on multiple projects simultaneously in a team environment. Lead Responsibilities: Onboarding & training of new hires, including live training sessions and presentations Mentors, trains, audits and coaches a team of UM Nurses to ensure compliance with Alignment policies and procedures and all regulatory requirements. Serves as first-line SME/resource for inpatient UM questions Provides 1:1 coaching/shadowing support when needed Available and approachable/supportive while still helping to maintain accountability Provides guidance to staff or directly manages complicated requests from members, providers, or staff. Other duties as assigned.
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
Location: Fully Remote (Must be licensed in California) Schedule: Monday–Friday, 8:00 AM – 5:00 PM PT Language: Bilingual candidates strongly preferred (Spanish and Vietnamese) Join the Team That’s Redefining Healthcare! Are you a compassionate Registered Nurse with a passion for improving the lives of seniors and complex care patients? Join Alignment Health as a Telephonic RN Case Manager for our Special Needs Plan (SNP) members — all from the comfort of your home! This is a fully remote, phone-based position where you'll play a vital role in helping members navigate their care journeys, close gaps in care, and overcome barriers to better health. (HIPAA compliant work space)
Must-Haves: Active, unrestricted RN license in California (Non-Compact) Minimum 2 years of clinical nursing experience At least 1 year of case management experience Proficiency with Microsoft Office (Word, Excel, Outlook) Nice-to-Haves: Bilingual (Spanish, Korean, Mandarin, etc.) Previous health plan or IPA experience Bachelor's Degree in Nursing (BSN) Licensure Requirement Upon Hire: Active, unrestricted RN license in California (Non-Compact) Must be willing to obtain RN licensure in Nevada, Arizona, North Carolina, and Texas (company reimburses costs) Work Environment Fully remote — work from anywhere in the U.S., but must work Pacific Time hours All communication is conducted via phone, email and Teams. Company-provided equipment and IT support included
Provide telephonic case management to medically complex and chronically ill members Conduct comprehensive health assessments and create individualized care plans Coordinate care with internal and external partners, including physicians and specialists Educate members and caregivers on disease management and preventive care Monitor member progress and advocate for timely, appropriate interventions Identify and help resolve service or access issues impacting care quality
Conviva Senior Primary Care provides proactive, preventive care to seniors, including wellness visits, physical exams, chronic condition management, screenings, minor injury treatment and more. As part of Humana’s Primary Care Organization, which includes CenterWell Senior Primary Care, Conviva’s innovative, value-based approach means each patient gets the best care, when needed most, and for the lowest cost. We go beyond physical health – addressing the social, emotional, behavioral and financial needs that can impact our patients' well-being.
The Utilization Management Nurse uses clinical nursing skills to support the coordination, documentation and communication of medical services and benefit administration determinations.
Required Qualifications: Active and unrestricted Registered Nurse license (RN) in the (appropriate state) with no disciplinary action 3+ years of Medical Surgery, Heart, Lung or Critical Care Nursing experience Previous experience in utilization management Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting Comprehensive knowledge of Microsoft Word, Outlook and Excel Preferred Qualifications: Health Plan experience Previous Medicare/Medicaid Experience Bilingual in English and Spanish with the ability to read/write/speak in both languages Work environment: This is a remote position. Additional Information To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
The Utilization Management Nurse uses clinical knowledge, towards interpreting criteria and procedures to provide the best treatment, care or services for members. You will coordinate and communicate with providers, members, or other parties to facilitate care and treatment. You will understand department, segment, and organizational strategy and operating goals, including their linkages to related areas. You will report to a Utilization RN Manager.
As Tennessee's largest health plan, we've been helping Tennesseans find their own unique paths to good health for more than 70 years. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow. Our mission is simple: peace of mind through better health. We're an independent, not-for-profit, locally governed health plan company – meaning we live and work alongside our Tennessee business customers and plan members. Our 6,000 employees across the state have built our strong reputation for integrity, excellent service and community leadership. But we are also part of the BlueCross BlueShield Association, a nationwide association of health care plans. Because of this, our plan members have access to the same quality health benefits while traveling or living out of state that they have while in Tennessee.
License: Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law. Experience: 3 years - Clinical experience required Skills\Certifications: Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint) Working knowledge of URAC, NCQA and CMS accreditations Must be able to work in an independent and creative manner. Excellent oral and written communication skills Strong interpersonal and organizational skills Ability to manage multiple projects and priorities Adaptive to high pace and changing environment Customer service oriented Superior interpersonal, client relations and problem-solving skills Proficient in interpreting benefits, contract language specifically symptom-driven, treatment driven, look back periods, rider information and medical policy/medical review criteria
Initiate referrals to ensure appropriate coordination of care. Seek the advice of the Medical Director when appropriate, according to policy. Assists non-clinical staff in performance of administrative reviews Performing comprehensive provider and member appeals, denial interpretation for letters, retrospective claim review, special review requests, and UM pre-certifications and appeals, utilizing medical appropriateness criteria, clinical judgement, and contractual eligibility. Occasional weekend work may be required. Must be able to pass Windows navigation test. Testing/Assessments will be required for Digital positions. Effective 7/22/13: This Position requires an 18 month commitment before posting for other internal positions.
As Tennessee's largest health plan, we've been helping Tennesseans find their own unique paths to good health for more than 70 years. More than that, we're your neighbors and friends – fellow Tennesseans with deep roots of caring tradition, a focused approach to physical, financial and community good health for today, and a bright outlook for an even healthier tomorrow. Our mission is simple: peace of mind through better health. We're an independent, not-for-profit, locally governed health plan company – meaning we live and work alongside our Tennessee business customers and plan members. Our 6,000 employees across the state have built our strong reputation for integrity, excellent service and community leadership. But we are also part of the BlueCross BlueShield Association, a nationwide association of health care plans. Because of this, our plan members have access to the same quality health benefits while traveling or living out of state that they have while in Tennessee.
The Complex Care Team at BCBST is seeking a compassionate and highly skilled RN Case Manager to support members with advanced and multifaceted healthcare needs. In this role, you will provide comprehensive, member-centered care for individuals with complex and chronic conditions, including high-risk diagnoses, through a proactive, advocacy-driven approach. You will collaborate across multidisciplinary teams to coordinate care, reduce barriers, and improve health outcomes while supporting cost-effective utilization of services. Success in this position requires the ability to manage a dynamic caseload with strong critical thinking, attention to detail, and exceptional telephonic and digital communication skills. Ideal candidates will bring demonstrated experience in case management or acute care settings such as ICU, Med-Surg, Oncology, or Home Health, along with strong technical proficiency and a willingness to leverage enterprise-approved digital and AI tools to enhance care delivery and operational efficiency. Note: Although we are based in Chattanooga, TN, this is a fully remote role. Sponsorship is not available for this position.
License: Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law. Experience 3 years - Clinical experience required 5 years - Experience in the health care industry For Select Community & Katie Beckett: 2 years experience in IDD for Select Community is required Skills\Certifications: Excellent oral and written communication skills PC Skills required (Basic Microsoft Office and E-Mail) N/a
Supporting utilization management functions for more complex and non-routine cases as needed. Serving as a liaison between members, providers and internal/external customers in coordination of health care delivery and benefits programs. Overseeing highly complex cases identified through various mechanisms to ensure effective implementation of interventions, and to ensure efficient utilization of benefits Performing the essential activities of case management: assessment: planning, implementation, coordinating, monitoring, outcomes and evaluation. Digital positions must have the ability to effectively communicate via digital channels and offer technical support. Effective 7/22/13: This Position requires an 18 month commitment before posting for other internal positions. Various immunizations and/or associated medical tests may be required for this position. This job requires digital literacy assessment.
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The RN Case Manager will be the primary care manager for a panel of members with complex medical/behavioral needs. Care coordination activities will focus on supporting member's medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care. If you reside in the state of Arizona, you will have the flexibility to work remotely* as you take on some tough challenges.
Required Qualifications: Current, unrestricted independent licensure as a Registered Nurse in Arizona 4+ years of clinical experience 1+ years of experience with MS Office, including Word, Excel, and Outlook Reside in Arizona Preferred Qualifications: BSN, Master's Degree or Higher in Clinical Field CCM certification 1+ years of community case management experience coordinating care for individuals with complex needs 1+ years of experience working with Medicaid and/or Medicare Experience working in team-based care Background in Managed Care DSNP experience Physical Requirement: Ability to remain stationary for long periods of time to complete computer or tablet work duties
Engage members telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team 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.
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
As an SCA Nurse Advice Line RN, you will play a critical role in delivering high-quality, evidence-based care to Beneficiaries across the globe. Using advanced clinical decision support tools, you will provide real-time health education and symptom triage through phone, chat, and video platforms-helping individuals make informed decisions about their health when they need it most. This is a dynamic, fast-paced role ideal for nurses who thrive on variety, critical thinking, and meaningful patient interaction-all in a virtual environment. This position will work as part of a 24/7 Call Center line and we have full-time positions available. Training, regardless of schedule will be 40 hours per week for 4 weeks during regular daytime business hours, Monday - Friday. You'll enjoy the flexibility to work remotely from a compact state* as you take on some exciting challenges. Available shifts listed below and will either be a 5X8, 4X10 or 3X12 schedule. Shifts Available (noted in Central Time Zone). Day shift schedules: 5am - 1:30pm - Sun, Mon, Thurs, Fri, Sat 5:30am - 2pm - Sun, Mon, Tues, Wed, Thurs 6:30am-7pm - Sun, Mon, Sat 6:30am - 5pm - Sun, Thurs, Fri and Sat 9am - 7:30pm - Sun, Mon, Fri and Sat Evening shift schedules: 1:30pm - 12am - Sun, Wed, Fri, Sat 1:30pm - 12am - Mon, Tues, Fri, Sat 1:30pm - 12am - Mon, Thurs, Fri, Sat 2:30pm - 1am - Mon, Thurs, Fri, Sat 3:30pm - 12am - Sun, Mon, Thurs, Fri, Sat 3:30pm - 12am - Sun, Mon, Tues, Fri, Sat 3:30pm - 12am - Sun, Mon, Tues, Wed, Thurs 11am - 7:30pm - Sun, Mon, Tues, Wed, Thurs
Current active compact RN license in home state Ability to get licensed in non-compact states (If home state is FL - school has to be nationally certified) Ability to pass security clearance 3+ years recent clinical experience Solid clinical experience with ability to triage all age groups Advanced technical skills - use multiple programs simultaneously, multiple monitors, and multitasking while on call Hard wired Internet Preferred Qualifications: Experience with military Bilingual - Spanish
Clinical Competence: Provide symptom triage and health education for patients of all ages using evidence-based protocols Assess a wide range of medical concerns and guide patients toward appropriate care Documentation and Care Delivery: Provide high-quality clinical services within scope of practice and in alignment with established team processes and protocols Conduct comprehensive assessments, including thorough health history collection Accurately document all interactions in a timely manner in accordance with policy Quality and Communication: Communicate effectively with beneficiaries to ensure clear understanding of care recommendations and health guidance Collaborate and communicate promptly with internal staff to support continuity of care Determine appropriate dispositions and deliver tailored health education Teamwork and Collaboration: Partner with leadership and teammates to meet performance and service expectations Support onboarding and development of new team members as a preceptor or mentor Participate in team meetings, training, and continuous improvement efforts 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.
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 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.
Requirements: Active, unrestricted RN license required Bachelor's degree required; 6+ years of RN experience including 3+ years in case management may be considered in lieu of degree 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
HeartCentrix Solutions is a premier IT staffing and workforce solutions provider that delivers technically vetted, culturally aligned talent to enterprise teams, high-growth startups, and consulting firms. With a heart-centered approach and a data-backed process, we help you hire with confidence.
We are seeking compassionate and dedicated Registered Nurses (RNs) to join our healthcare teams across multiple locations in the United States, supporting a variety of patient populations and care settings. We are hiring across several specialties, including: Community Health Nursing Long-Term Care / Skilled Nursing Behavioral & Mental Health Nursing Acute and Chronic Care Support Residential / Small Facility Nursing In this role, you’ll provide hands-on clinical care while supporting health maintenance, disease prevention, and coordinated care planning to ensure high-quality patient outcomes.
Active Registered Nurse (RN) license in the United States Strong clinical assessment and patient care experience Experience in one or more of the specialties listed above Ability to work collaboratively in interdisciplinary healthcare teams Strong communication, documentation, and organizational skills Prior experience in community, long-term care, behavioral health, or acute care settings is a plus This is a great opportunity for RNs who are passionate about delivering high-quality care across diverse healthcare environments and making a meaningful impact in patient lives.
Assess, plan, implement, and evaluate nursing care for individuals with varying health needs Monitor patient conditions and communicate changes to physicians and care teams Coordinate and manage individualized care plans across disciplines Oversee medication management, including administration, monitoring, and documentation Ensure compliance with clinical policies, infection control, and safety standards Maintain accurate and timely nursing documentation and patient records Coordinate medical appointments and follow-up care Support admissions, discharges, and transitions of care Provide training and guidance to staff on health, safety, and patient-specific needs Supervise and support LPNs/LVNs and unlicensed staff as needed
The University of Utah, located in Salt Lake City near the Wasatch Mountains, is a leading institution for higher education with a strong focus on innovation, collaboration, and student engagement. Serving over 31,000 students, it offers a wide range of undergraduate and graduate programs, including law and medicine. Known for its active lifestyle opportunities and close proximity to seven world-class ski resorts, the university fosters a holistic approach to learning. The University of Utah Health Care system has received nationwide recognition for excellence in patient care, quality, and innovation. It is also a leader in startup creation and plays a key role in driving Utah’s thriving economy.
This is a part-time, remote position for a Registered Nurse. Responsibilities include conducting patient assessments, coordinating care plans, administering medications and treatments, providing patient and family education, maintaining accurate medical records, and collaborating with interdisciplinary teams. The role also involves ensuring compliance with healthcare safety standards and protocols.
Strong clinical skills, including patient assessment, medication administration, and care plan development Proficiency in health record management, documentation, and compliance with regulatory standards Excellent communication and interpersonal skills for patient and family education Ability to work independently and remotely while collaborating effectively with a healthcare team Active RN license, with experience in academic medical centers or specialized care preferred BSN or higher degree in Nursing is preferred Competence in using telehealth technologies and remote patient monitoring tools is a plus Commitment to delivering high-quality, patient-centered care
Hi, we're Oscar. We're hiring a Case Management Nurse to join our Case Mangement team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.
You will educate members on improving health outcomes, assist with transitions from care settings, participate in process improvement and other pilot programs as they arise, and work with support teams to ensure exceptional care for our members. You will report into the Associate Director, Clinical. Work Location: This is a remote position, open to candidates who reside in: Alabama; Arizona; Arkansas; Colorado; Connecticut; District of Columbia; Florida; Georgia; Idaho; Illinois; Indiana; Iowa; Kansas; Kentucky; Maine; Maryland; Massachusetts; Michigan; Minnesota; Missouri; Nevada; New Hampshire; New Jersey; New Mexico; North Carolina; Ohio; Oregon; Pennsylvania; Rhode Island; South Carolina; Tennessee; Texas; Utah; Vermont; or Virginia.You will be fully remote; however, our approach to work may adapt over time. Future models could potentially involve a hybrid presence at the hub office associated with your metro area. #LI-Remote Pay Transparency: The base pay for this role is: $39.28 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.
Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license Ability to obtain additional state licenses to meet business needs 2+ years of clinical experience to include payer, hospital, outpatient or community based care management 1+ years of experience in Care Coordination and Navigation Bonus points: CCM Certification Bilingual in Spanish and/or creole reading, writing, speaking BSN Working knowledge of Milliman Guidelines
Assist in the coordination of care across a variety of settings (inpatient, outpatient, post acute, ER, home care) Actively reach out to members undergoing difficult health challenges and develop care plans Proactively reach out to hospital case managers to assist with discharge planning Communicate with members via phone or secure messaging to provide education on health conditions, new medications, and procedures. Compliance with all applicable laws and regulations Other duties as assigned
Sixty million Medicare seniors live with chronic disease. The care system sees most of them twice a year. Cadence is building the infrastructure to support them every day. Cadence is a clinical AI company that delivers continuous, proactive care for older adults with chronic conditions like hypertension, heart failure, and diabetes. We pair patients with a dedicated clinical team, integrate deeply into health system EMRs and workflows, and use our Clinical Intelligence platform to monitor vitals, surface risk early, optimize medications, and close care gaps between visits. The result: patients engage with care 100x more than before Cadence, clinicians focus on judgment instead of administrative work, and Medicare saves $2M a week. We operate as a full clinical care delivery organization, not a software vendor. Our clinicians work alongside health system partners, extending the reach of local primary care providers into patients' homes. We're now applying AI agents across these workflows – from alert review and medication titration to lifestyle coaching and care coordination – with clinicians always in control of clinical decisions.
We’re hiring an RN Supervisor (Alerts) to lead the daily operations, clinical quality, and workflow performance of a remote team of nurses managing real-time patient alerts generated through Cadence’s remote monitoring programs. You’ll oversee a high-volume, queue-based triage environment where speed, clinical accuracy, and operational consistency directly impact patient outcomes and provider trust. This role sits at the center of Cadence’s technology-enabled care delivery model, partnering closely with clinical leadership to coach frontline clinicians, manage throughput in real time, and strengthen the systems that support scalable chronic disease management between office visits.
Active, unencumbered compact RN license required. Minimum of 5 years of experience as a practicing Registered Nurse in triage, acute care, ICU, urgent care, remote patient monitoring, or chronic disease management settings. Minimum of 1 year of supervisory or management experience leading nurses in high-volume, queue-based, triage, or remote care delivery environments. Demonstrated experience evaluating clinical quality, triage decision-making, escalation appropriateness, and documentation accuracy in alert-driven workflows. Strong operational management experience with performance metrics including alert volume, throughput, call handling time, staffing coverage, and productivity targets. Experience managing remote teams, including scheduling, PTO coordination, staffing coverage, and performance management in continuous operations environments preferred. Strong written and verbal communication skills with experience leading team meetings, conducting 1:1s, and collaborating cross-functionally with clinical leadership. Comfort with AI-assisted clinical tools (such as Gemini, Open Evidence, or comparable platforms)
Lead the day-to-day operations of a remote team of RNs and LPNs responsible for reviewing and resolving real-time patient alerts across remote monitoring workflows. Monitor queue performance, alert resolution times, throughput, billable activity, and staffing coverage to ensure operational targets and clinical service levels are consistently met. Conduct clinical audits and chart reviews to evaluate triage quality, documentation accuracy, escalation appropriateness, and adherence to guideline-directed care protocols. Provide structured coaching, real-time feedback, and formal performance management to improve both clinical judgment and productivity in a fast-paced, metric-driven environment. Partner with RN Managers and clinical leadership on escalation pathways, staffing models, workflow optimization, and ongoing clinical education initiatives. Support hiring and onboarding efforts by evaluating candidates for triage readiness, clinical decision-making, communication skills, and operational fit within a queue-based care environment. Contribute directly to patient care as needed, supporting alert management workflows and ensuring continuity of care during periods of high volume or staffing constraints.
Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders. Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home. Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum.
The MH FIRST Remote RN - Float is pivotal in providing critical support to field teams facing urgent and complex patient concerns. The Registered Nurse has expertise that will ensure patients receive the care, resources, and support they need, especially during high-stress situations and environmental crises.
Maintain a current and valid RN license, allowing you to practice across state lines. Minimum of 3 years of clinical nursing experience, with a preference for emergency care, critical care, or triage backgrounds. Availability to adjust shift flexibly in response to peak coverage or staffing needs. Demonstrate the ability to communicate calmly and confidently during high-stress situations. Build strong relationships with team members and patients through effective rapport-building. Exhibit meticulous attention to detail and outstanding organizational skills. Show unwavering dedication to patient safety and delivering high-quality care.
Utilize licensing and crisis management skills to assess and address urgent needs. Assess care plan requirements and assist in their implementation. Utilize proficiency in documentation and technology to streamline member care. Offer valuable support and guidance to patients and their families in critical situations. Primary point of contact for patients, Monogram field staff, and care center personnel needing immediate support. Provide seamless transitions by providing comprehensive handoffs to incoming staff. Conduct chart auditing during non-peak call volumes. Emergency/disaster outreach as events occur. Support service level agreement (SLA) compliance for annual assessments and care plans. Assist in post-hospital outreach to ensure patient needs are met, with no outstanding needs that could result in readmissions.
Government Employees Health Association, Inc. (G.E.H.A) is a nonprofit member association that provides health and dental benefits that millions of federal employees and retirees, military retirees and their families have counted on since 1937. Offering one of the largest health and dental benefit provider networks available to federal employees in the United States, G.E.H.A empowers health and wellness by meeting its members where they are, when they need care. G.E.H.A has one mission: To empower federal workers to be healthy and well.
The Nurse Consultant II provides professional nursing care within Clinical Operations, supporting members through assessment, planning, evaluation, and evidence-based practice to advance a positive member experience and ensure appropriate, cost-effective services across the care continuum. The role applies professional nursing, epidemiological, and analytical skills to understand, react to, and plan for current and emerging healthcare needs—both at the individual member level and across larger populations. Serving as a clinical advocate and liaison across departments and external partners, the Nurse Consultant II uses multiple systems to inform decisions, communicate effectively, and document care. The role may manage a large member population, evaluate and make recommendations on escalated clinical issues, and assess G.E.H.A’s emerging health trends to recommend targeted improvements that support divisional and organizational objectives.
Knowledge, Skills, and Abilities: BSN and 4-6 years of relevant experience. Active/Good standing RN license, including accountability for maintaining all requirements of licensing post hire, must be eligible to be licensed in all US states and territories. Autonomously able to objectively analyze a variety of information and provide actionable insights for decision making and problem solving. Skilled communicator with strong written, verbal, and active listening skills, effectively engaging through modern communication technologies. Experience reviewing complex medical necessity appeals. Preferred Qualifications: Clinical proficiency and expertise pertinent to role. Case Management or Utilization Management experience. Relevant certifications in case management or utilization management. Experience in utilization management F.E.H.B. payor appeals. Work-at-home requirements: Must have the ability to provide a non-cellular High Speed Internet Service such as Fiber, DSL, or cable Modems for a home office. A minimum standard speed for optimal performance of 30x5 (30mpbs download x 5mpbs upload) is required. Latency (ping) response time lower than 80 ms Hotspots, satellite and wireless internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information
Evaluates member health metrics and professional resources to inform, develop, select, implement, and sustain targeted UM/CM initiatives and programs. Evaluates member level information regarding prospective Care Management or Utilization Management to determine whether intervention is necessary to meet the member’s needs. Refers member and providers to G.E.H.A resources and programs, as indicated. Leverages a spectrum of hard and soft skills to collaborate with others across the service continuum to address member and provider daily and escalated needs. Using effective engagement techniques, guides, assists and informs members when appropriate in a manner that maximizes their health plan benefits including but not limited to coordinating services, accessing in-network providers. closing gaps in care and altering health behavior. Encourages members to participate in their health care decisions and assists members with researching treatment options. Proactively identifies potential barriers, proposes and implements solutions. Maintains a clear understanding of Plan Benefits. Monitors and evaluates program effectiveness, tracks relevant metrics, and reports outcomes. Performs in-depth and root cause analysis to identify barriers to care or member/provider experience.
At nTech Workforce, we specialize in providing comprehensive staffing and recruiting solutions tailored to meet the unique needs of our clients. Our approach is rooted in understanding industry dynamics and leveraging our extensive network to connect top-tier talent with leading organizations. We emphasize quality placements through rigorous testing and personalized recruitment strategies, ensuring both client satisfaction and candidate success. Our commitment extends beyond mere staffing; we foster long-term partnerships by continuously adapting to industry trends and client requirements. By prioritizing candidate training and professional development, we empower individuals to excel in their roles and contribute effectively to organizational growth.
Title: Utilization Management Nurse Specialist Location: 100% Remote Terms of Employment W2 Contract, 6 months This position is 100% remote. The selected candidate must be based in EST or CST time zone and must be comfortable working 8:00 AM – 5:00 PM (EST).
Required Qualifications: Active RN or LPN license with Compact State status. Minimum of 5 years of clinical experience in direct patient care. Minimum of 2 years of experience in Care Management or Utilization Management. Mandatory proficiency in MCG (Milliman Care Guidelines) with the ability to navigate the system independently. Ability to work core business hours in the Eastern Time Zone. Preferred Qualifications: Specific experience in Home Health or Infertility utilization reviews. Experience using Facets and/or Health Edge (Guiding Care) software.
Work with a leading healthcare organization as a Utilization Management Nurse Specialist. This role is critical to the Utilization Services team, focusing on high-volume clinical reviews to ensure members receive appropriate care. You will join a fast-paced environment where your clinical expertise in Home Health and Infertility services will directly impact member outcomes and operational efficiency. You will… Conduct clinical reviews for commercial and Federal Employee Program (FEP) plans. Review a variety of cases including inpatient scheduled surgeries/admissions, physical therapy, occupational therapy, and speech therapy. Perform high-volume home health and infertility reviews, which constitute the majority of the workload. Navigate and utilize MCG (Milliman Care Guidelines) to determine the medical necessity of requested services. Maintain a high production rate of 30 to 35 case reviews per day. Utilize internal systems including Facets and Health Edge (Guiding Care) for authorization and documentation.
Stormont Vail Health is a nonprofit integrated health care system that has been serving the health care needs of northeast Kansas for more than 130 years. It is comprised of Stormont Vail Hospital, a 586-bed acute care Magnet®-designated hospital, and Cotton O’Neil Clinic, a multi-specialty physician group with more than 250 physicians. Nearly 5,000 employees provide care and support services for patients in the hospital and 35 other locations, including the Cotton O’Neil Heart Center, Cancer Center, Diabetes & Endocrinology Center, Digestive Health Center, Pediatrics clinics, 10 regional primary care clinics and six Express Care clinics. Stormont Vail Health is committed to its mission of improving the health of the community by being a national leader in providing compassionate, high-quality and efficient integrated care through collaboration that results in a healthier community. Stormont Vail Health is a member of the Mayo Clinic Care Network, a group of more than 40 health care organizations who have joined together to complement their local expertise with the knowledge and experience of Mayo Clinic health care professionals. Stormont Vail's local partnerships include housing the Bachelor of Science in Nursing program of the Baker University School of Nursing, providing athletic training services to Washburn University Athletics and being a founding partner of the Powercat Health Partnership with Kansas State University and the Kansas Health Foundation.
Position Status: Full time Shift: First Shift (Days - Less than 12 hours per shift) (United States of America) Hours Per Week: 40 Job Information Exemption Status: Non-Exempt A Brief Overview: The LPN in this role will provide professional nursing care for clinic patients following established standards and practices, with a focus on the safe refill of prescribed medications. The delivery of professional nursing care at Stormont Vail Health is guided by Jean Watson's Theory of Human Caring and the theory of Shared governance, both of which are congruent with the mission, vision, and values of the organization.
Licenses and Certifications: Licensed Practical Nurse - KSBN Required Required for All Jobs Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health Performs other duties as assigned Patient Facing Options Position is Not Patient Facing Remote Work Guidelines Workspace is a quiet and distraction-free allowing the ability to comply with all security and privacy standards. Stable access to electricity and a minimum of 25mb upload and internet speed. Dedicate full attention to the job duties and communication with others during working hours. Adhere to break and attendance schedules agreed upon with supervisor. Abide by Stormont Vail’s Remote Worker Policy and will review and acknowledge the Remote Work Agreement annually. Remote Work Capability: Full-Time Scope No Supervisory Responsibility No Budget Responsibility
Refill prescribed medications per standing orders. Triage patient telephone calls, evaluating the physical and psychosocial health status of the patient. Clarify medication orders and refills to pharmacies as directed by providers. Provide patient education regarding medications. Document medical information using the appropriate electronic applications and/or forms. Utilize appropriate channels to communicate patient safety and patient care issues to appropriate parties. Adheres to infection control, emergency, safety, fire and disaster plans and policies, completing required initial training and updates per hospital policy.
OpTech is a woman-owned company that values your ideas, encourages your growth, and always has your back. When you work at OpTech, not only do you get health and dental benefits on the first day of employment, but you also have training opportunities, flexible/remote work options, growth opportunities, 401K and competitive pay. Apply today! To view our complete list of openings, please visit our website at www.optechus.com. OpTech is an equal opportunity employer and is committed to creating a diverse environment. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, pregnancy, status as a parent, disability, age, veteran status, or other characteristics as defined by federal, state or local laws.
We have a great employment opportunity for a RN Medical Case Manager! TRAVEL IS REQUIRED! Location: Potterville, MI Remote with some travel required to attend patient medical appointments; Distance: Up to 2 hour drive. Gas expense is reimbursed. ***MUST LIVE IN AND HAVE STATE OF MICHIGAN RN LICENSE*** Salary range: Up to $84k. Excellent employee benefits. Eligible for monthly performance bonuses! Highly preferred: Registered Nurses (State of Michigan) that have their CCM certifications!! RESPONSIBILITIES: The Case Manager RN leads the coordination of a multidisciplinary team to deliver a holistic, person centric care management program to a diverse health plan population with a variety of health and social needs. They serve as the single point of contact for members, caregivers, and providers using a variety of communication channels including phone calls, emails, text messages and Our Client’s online messaging platform. The Case Manager RN uses the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the member’s health across the care continuum. They work in partnership with the member, providers of care and community resources to develop and implement the plan of care and achieve stated goals.
EDUCATION AND EXPERIENCE: Nursing Diploma or Associates degree in nursing required Bachelor’s degree in nursing strongly preferred 3 years of clinical nursing experience in a clinical, acute/post-acute care, and community setting required 1 year of case management experience in a managed care setting strongly preferred Experience managing patients telephonically and via digital channels (mobile applications and messaging) preferred CERTIFICATES, LICENSES, REGISTRATIONS: Current, active, and unrestricted Michigan Registered Nurse license required Certification in Case Management (CCM) required or to be obtained within 18 months of hire Certification in Chronic Care Professional (CCP) preferred
Lead the coordination of a regionally aligned, multidisciplinary team to provide holistic care to meet member needs telephonic and/or digitally The multidisciplinary team is inclusive of Medical and Behavioral Health Social Workers, Registered Dietitians, Pharmacists, Clinical Support Staff and Medical Directors. Use the case management process to assess, develop, implement, monitor, and evaluate care plans designed to optimize the members’ health across the care continuum Assess the member's health, psychosocial needs, cultural preferences, and support systems Engage the member and/or caregiver to develop an individualized plan of care, address barriers, identify gaps in care, and promotes improved overall health outcomes Arrange resources necessary to meet identified needs (e.g., community resources, mental health services, substance abuse services, financial support services and disease-specific services) Coordinate care delivery and support among member support systems, including providers, community-based agencies, and family Advocate for members and promote self-advocacy Deliver education to include health literacy, self-management skills, medication plans, and nutrition Monitor and evaluate effectiveness of the care management plan, assess adherence to care plan to ensure progress to goals and adjust and reevaluate as necessary Accurately document interactions that support management of the member Prepare the member and/or caregiver for discharge from a facility to home or for transfer to another healthcare facility to support continuity of care Educate the member and/or caregiver about post-transition care and needed follow-up, summarizing what happened during an episode of care Secure durable medical equipment and transportation services and communicate this to the member and/or caregiver and to key individuals at the receiving facility or home care agency Adhere to professional standards as outlined by protocols, rules and guidelines meeting quality and production goals Continue professional development by completing relevant continuing education and maintaining Certified Case Manager (CCM)
Mercy, one of the 15 largest U.S. health systems and named the top large system in the U.S. for excellent patient experience by NRC Health, serves millions annually with nationally recognized care and one of the nation’s largest and highest performing Accountable Care Organizations in quality and cost. Mercy is a highly integrated, multi-state health care system including 55 acute care and specialty (heart, children’s, orthopedic and rehab) hospitals, convenient and urgent care locations, imaging centers and pharmacies. Mercy has over 1,000 physician practice locations and outpatient facilities, more than 5,000 physicians and advanced practitioners and more than 50,000 caregivers serving patients and families across Arkansas, Illinois, Kansas, Missouri and Oklahoma. Mercy also has clinics, outpatient services and outreach ministries in Arkansas, Louisiana, Mississippi and Texas. In fiscal year 2025 alone, Mercy provided more than half a billion dollars of free care and other community benefits, including traditional charity care and unreimbursed Medicaid.
Location: Surgery Center at Mercy Hospital Oklahoma City (W Memorial Rd) Shift: Full Time (40 hours/week) 5 8-hr shifts/week Schedule: 8a-4:30p Monday-Friday NO CALL
Education: Graduated from a school of nursing (Associate's Degree, Diploma, or BSN). Preferred Experience: 2 years with Optime scheduling Licensure: Is personally responsible for obtaining, and maintaining, a current RN license within the hiring state and/or compact licensure in which nursing duties are performed and must meet all state board of nursing requirements. Certifications: Basic Life Support certification through the American Heart Association or successful completion of course within 30 days of hire; one or more of the certifications below may be required based on the position/unit hired to, or acquisition of certification within department required timeframe: ACLS (Advanced Cardiac Life Support), NRP (Neonatal Resuscitation Program), ENPC (Emergency Nursing Pediatric Course), TNCC (Trauma Nursing Core Course), CPHON (Certified Pediatric/Hematology/Oncology Nurses), OCN (Oncology Certified Nurse), PALS (Pediatric Advanced Life Support), PEARS (Pediatric Assessment Recognition and Stabilization), S.T.A.B.L.E. (Sugar, Temperature, Airway, Blood Pressure, Lab Work, And Emotional Support) Six Assessment & Care Modules, C-EFM (Fetal Monitor Certification), other unit-specific certifications as required.
Responsible for assessing patients referred by physicians to assure patients are appropriate. Assesses medical history, surgical and anesthesia history, medications and determines if any pretreatment or additional medical clearance is needed prior to procedure. Provides patient education as needed for procedure and medication management. Performs duties and responsibilities in a manner consistent with our mission, values, and Mercy Service Standards.
Mercy, one of the 15 largest U.S. health systems and named the top large system in the U.S. for excellent patient experience by NRC Health, serves millions annually with nationally recognized care and one of the nation’s largest and highest performing Accountable Care Organizations in quality and cost. Mercy is a highly integrated, multi-state health care system including 55 acute care and specialty (heart, children’s, orthopedic and rehab) hospitals, convenient and urgent care locations, imaging centers and pharmacies. Mercy has over 1,000 physician practice locations and outpatient facilities, more than 5,000 physicians and advanced practitioners and more than 50,000 caregivers serving patients and families across Arkansas, Illinois, Kansas, Missouri and Oklahoma. Mercy also has clinics, outpatient services and outreach ministries in Arkansas, Louisiana, Mississippi and Texas. In fiscal year 2025 alone, Mercy provided more than half a billion dollars of free care and other community benefits, including traditional charity care and unreimbursed Medicaid.
Nurse Auditor will be a representative for Mercy in defense audit processes, while driving the evaluation and implementation of improved charge capture procedures to ensure compliance, accuracy, and revenue integrity.
Education: Bachelor's degree in a clinical area Licensure: RN Experience: 3-5 years of related healthcare experience, Certifications: Other: . A strong understanding of CPT4 and UB coding required. Must have excellent written, oral and human relations skills, attention to detail and follow through and the ability to handle confidential information.
At Included Health, we’re redefining what it means to have access to great healthcare. We’re seeking board-certified Family Nurse Practitioners to join our Virtual Primary Care team. In this role, you’ll provide comprehensive, ongoing care to patients of all ages nationwide through video and phone visits; helping them understand not just what their care plan is, but how and why it supports their health.
The ideal candidate is skilled at managing their own patient panel, fostering lasting relationships, and working closely with a multidisciplinary team to deliver compassionate, patient-centered care. They communicate clearly in patient-friendly language, and demonstrate the ability to balance multiple priorities in a high-volume clinical environment. Above all, they are passionate about raising the standard of healthcare for everyone.
Minimum of four years experience delivering primary care in an ambulatory/outpatient family medicine or internal medicine setting. Experience independently managing a patient panel as the designated primary care provider. Active, unrestricted Nurse Practitioner and RN license in state of residence; ability to be licensed in additional states as required. Current and active board certification by a national certifying body through ANCC or AANP. Must maintain active Medicare status and not be excluded, sanctioned, or reprimanded by any state or federal healthcare program (including Medicare/Medicaid), the OIG, or the GSA. Comfortability addressing a broad variety of medical conditions, including acute and chronic conditions as well as preventative issues. Ability and willingness to treat all ages across the lifespan. Must have a professional, private, and secure home office environment for virtual patient visits. Demonstrated ability to provide empathetic, compassionate care and support to patients and families during challenging situations. Ability to manage high patient volumes and competing priorities in a dynamic clinical environment while maintaining quality of care. Strong proficiency with technology and electronic health platforms; experience with telehealth preferred. Shift Obligations: 40 hours per week, consisting of 8-hour shifts Monday through Friday. Additionally, staff are required to work one 8-hour shift on either Saturday or Sunday every fourth weekend. When a weekend shift is worked, one weekday off will be provided that week to maintain a 40-hour schedule. Standard shift hours fall between 8:00 AM and 5:00 PM in the clinicians time zone, including one evening shift per week that extends until at least 7:00 PM.
Provide high-quality virtual primary care through video visits, including assessment, diagnosis, treatment, and patient education. Manage a panel of patients, delivering comprehensive care across acute, chronic, and preventive needs. Collaborate with the Care and Case Management team to develop care plans and support successful outcomes. Partner with supervising physicians as required by state and practice guidelines. Work with the Credentialing Team to obtain additional state licenses as needed. Maintain patient satisfaction and quality metrics by practicing evidence-based medicine with exemplary bedside manner. Utilize telehealth technology to deliver patient care, while effectively managing multiple tasks in a fast-paced clinical environment. Stay current with medical knowledge, treatments, and medications. Adhere to assigned schedules, including some evenings and weekends. Strictly adhere to HIPAA and security regulations to safeguard patient information Contribute to a culture of humility, curiosity, and collaboration.
MOBE guides people to better health and more happiness. We help people discover connections between aspects of their lifestyle that affect health and well-being, including their medications and supplements. Behind our innovative solutions are robust data analytics, digital application, and a uniquely human philosophy. With one-to-one connection and compassion, we motivate people to transform their lives. MOBE is a high-growth organization with a culture built on trust and collaboration and our team is our most significant asset. Supporting and empowering others is at the core of our service and is also the foundation of our culture. We value a workforce made up of people with differences who are eager to learn from each other and grow personally and professionally. We extend this approach to our partners and communities, seeking to increase understanding and expand opportunities across all groups. Go to https://www.mobeforlife.com/DEI for more about diversity, equity, and inclusion at MOBE. Company overview MOBE helps people discover new ways to live healthier. We are the whole-person, cross-condition solution that goes further to deliver better health and lower overall costs through evidence-based individual health guidance and pharmacist-led medication management. We empower individuals to make meaningful changes that improve their health and overall well-being. Behind our innovative solutions are robust data analytics, digital application, and a uniquely human philosophy. With one-to-one connection and compassion, we uncover opportunities, overcome challenges, and motivate people to transform their lives. At MOBE our team is our most significant asset. We cultivate a culture grounded in curiosity, innovation, and growth. We encourage new ideas, fresh solutions, and meaningful impact. We value a workforce made up of people with differences who are eager to learn from each other and grow personally and professionally. We extend this approach to our partners and communities, seeking to increase understanding and expand opportunities across all groups.
As MOBE builds out a new Complex Care Management program, the Contract Recruiter, RN Case Manager is responsible for sourcing, screening, and delivering qualified registered nurse case managers and RN managers on the cadence required to meet our launch and ramp commitments. This is a high-volume, high-velocity individual contributor role. The recruiter will own the full life cycle — intake, sourcing, screening, scheduling, offers, pre-boarding handoff and will partner closely with MOBE’s Talent Acquisition Partner, HR Generalists, Clinical Operations leadership, and the contracted background and licensure verification vendors to keep candidates moving through the funnel within an 8–12-week req-to-start cycle. Success in this role is measured by on-time class filling, candidate quality, offer-accept rate, and candidate experience consistent with MOBE’s values. This is a 6-month contract role with a pay range of $50–$60 per hour, based on experience and qualifications. Full-Time/Part-Time: Full-Time Location Remote
Required: Minimum 5 years of full-cycle recruiting experience, with at least 2 years recruiting registered nurses, case managers, or other clinical talent. Demonstrated track record of high-volume healthcare hiring — proven ability to deliver 20+ RN hires per quarter on time and to quality. Active sourcing skills using LinkedIn Recruiter, Indeed, Boolean search, and at least two niche nursing or healthcare sourcing channels. Hands-on experience navigating multi-state RN licensure verification, compact-state nuances, and the realities of a fully remote, telephonic clinical workforce. Strong applicant-tracking-system fluency (Paychex preferred) — clean data hygiene, pipeline reporting, and audit-ready records. Excellent written and verbal communication — able to represent MOBE to passive candidates with credibility and to brief hiring managers and HR leadership clearly. Strong project-management discipline — able to track 6+ open reqs simultaneously, hit weekly milestones, and proactively raise risks. Comfortable working as a contractor in a fast-moving startup environment, with the autonomy to make sourcing and screening calls without daily direction. Preferred: Prior experience recruiting for telephonic care management, complex care management, transitional care, or care-coordination programs. Familiarity with NCQA-credentialed Case Management or Complex Care Management programs and the documentation expectations that come with delegated health-plan services. Experience supporting a health-plan delegation launch or new-program build, including hiring against a defined class cadence. Background partnering with managed-care or health-plan clients on staffing commitments and SLAs. Bachelor’s degree in Human Resources, Business, Healthcare Administration, or a related field. Values: People First. We show we care because we believe in the power of human connection Spark Positivity. We each have the power to turn any challenge into something awesome. Stay Curious. We relentlessly discover and embrace new ideas to keep moving forward.
Run the full life cycle for all RN case manager and RN manager hires for the Complex Care Management program. Build and maintain an active pipeline of telephonic RN case managers, complex care nurses, transitional care nurses, and managed-care RNs. Source candidates through LinkedIn Recruiter, Indeed, niche nursing job boards, employee referrals, alumni networks, professional nursing associations, and Boolean-based passive search; maintain documented sourcing-channel performance and adjust the mix weekly to hit throughput targets. Conduct phone screens that assess clinical fit (case management vs. acute care experience, telephonic comfort, member-engagement style), shift availability, multi-state licensure status, technology readiness for fully remote work, and alignment with MOBE values. Coordinate interview loops with RN Managers and Clinical Operations leadership — managing scheduling across time zones, prepping interviewers, capturing structured feedback, and driving same-day debriefs to keep velocity high. Manage offers — present, negotiate within approved limits, secure verbal acceptance, and offer-letter generation, start-date confirmation, and class assignment. Own the candidate experience end to end — proactive communication, transparent timelines, prompt updates after each stage, and a respectful close-out for candidates not selected. Partner with contracted background-check and licensure verification vendors to confirm RN license is active and unencumbered in all required states, and to surface any issues that could jeopardize start-date commitments. Track and report weekly recruiting metrics — reqs open, candidates in pipeline by stage, time-to-fill, offer-accept rate, decline reasons, and class-fill progress Maintain accurate, timely data in the applicant tracking system, ensuring auditable records that meet OFCCP and EEO requirements as well as health plan delegation-oversight expectations. Surface risks early — if a class is trending behind on candidate volume or quality, raise it with enough lead time to adjust sourcing, expand criteria, or trigger contingent-staffing conversations.
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.
Reviews and evaluates requested medical or behavioral health service claims by reviewing clinical documentation, applicable policies, and line-of-business guidelines to determine appropriateness. This role involves comparing service requests to records and established criteria to make informed determinations on each case.
Required Skills and Experience Registered nurse with current MN license and no restrictions or pending restrictions. All relevant experience including work, education, transferable skills, and military experience will be considered. 3 years of related, progressive clinical experience (i.e. RN or LPN to RN mix). Demonstrated ability to research, analyze, problem solve and resolve complex issues. Demonstrated strong organizational skills with ability to manage priorities and change. Proficient in multiple PC based software applications and systems. Demonstrated ability to work independently and in a team environment. Adaptable and flexible with the ability to meet deadlines. Able to negotiate resolve or redirect, when appropriate, issues pertaining to differences in expectations of coverage, eligibility and appropriateness of treatment conditions. Maintains a thorough and comprehensive understanding of state and federal regulations, accreditation standards and member contracts in order to ensure compliance. High school diploma (or equivalency) and legal authorization to work in the U.S. Preferred Skills and Experience 5+ years of RN or relevant clinical experience. 1+ years of managed care experience (e.g. case management, utilization management and/or auditing experience). Bachelors degree in nursing. Certification in utilization management or a related field. Experience in UM/CM/QA/Managed Care. Knowledge of state and/or federal regulatory policies and/or provider agreements, and a variety of health plan products. Coding experience (e.g. ICD-10, HCPCS, and CPT).
Review service requests and associated documentation to determine appropriateness based on policy, clinical guidelines, and line-of-business requirements. Conduct thorough chart reviews, render decisions, and document outcomes promptly to maintain workflow efficiency. Manage assigned case volume and achieve daily productivity goals, typically completing an target number of cases per day, with targets varying by team. Collaborate with physicians and other clinical professionals as needed to ensure accurate determinations and adherence to regulatory standards. Ensure decisions comply with state and federal regulations, benefit plans, and organizational policies, maintaining accuracy and consistency. Work within strict timelines and adapt to shifting priorities, managing multiple cases and urgent requests under tight turnaround requirements. Support team expansion efforts by mentoring new associates and sharing best practices to improve overall performance and case throughput. Participate in side projects and process improvement initiatives, collaborating with peers and leadership to enhance operational efficiency.
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.
Utilizing key principles of case management, the RN Specialist will research and analyze the member’s health needs and health care cost drivers and will work closely with an interdisciplinary care team to ensure members have an effective plan of care that leads to optimal, cost-effective outcomes. Leveraging clinical expertise, strong critical thinking skills and a keen business sense, the RN Specialist will work closely with the member and their family to avoid unnecessary hospitalizations and emergency department utilization, optimize site of care whenever possible, and ensure evidence-based treatment is being applied. An experienced case manager with managed care experience will be successful in this role.
Registered nurse with current MN license and with no restrictions All relevant experience including work, education, transferable skills, and military experience will be considered. 5 years relevant clinical care experience CCM Certificate or ability to obtain within 3 years of starting in the position Excellent telephonic skills Keen business skills Excellent communication skills Excellent conceptual thinking skills Excellent relationship management skills Excellent organizational skills Computer application proficiency Strong resiliency and flexibility skills Excellent research, analytical, and creative problem-solving skills Flexibility to work varied hours High school diploma (or equivalency) and legal authorization to work in the U.S. Preferred Skills and Experience: 2+ years of managed care experience; e.g. case management/health coach, utilization management and/or auditing experience (may be included in the 5 years relevant clinical experience).
Receives referral for member identified with high cost, complex medical conditions and telephonically outreaches to the member, family and providers to engage in complex case management program. Conducts clinical assessments with members and providers utilizing motivational interviewing; gathers, analyzes, synthesizes and prioritizes member needs and opportunities based upon the clinical assessment and research and collaborates with the interdisciplinary care team to develop a comprehensive plan of care. Collaborates and communicates with the health care team; e.g. member, family, designated representative, health care provider on a plan of care that produces positive clinical results and promotes high–quality, cost effective outcomes. Identifies relevant BCBSMN and community resources and facilitates program and network referrals. Monitors, evaluates, and updates 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 the strategic and financial goals of the department, complex care management teams, and the enterprise Knowledgeable of health plan operations (e.g. networks, eligibility, benefits) Promotes innovative solutions to improve day to day functions and enhance the overall operation of the department. Collaborates with interdisciplinary care team to develop a comprehensive plan of care to identify key strategic interventions to address member’s needs and health care cost drivers. 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. Identifies and implements cost saving opportunities to ensure optimal and cost-effective health outcomes.
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.
Utilizing key principles of case management, the RN Specialist will research and analyze the member’s health needs and health care cost drivers and will work closely with an interdisciplinary care team to ensure members have an effective plan of care that leads to optimal, cost-effective outcomes. Leveraging clinical expertise, strong critical thinking skills and a keen business sense, the RN Specialist will work closely with the member and their family to avoid unnecessary hospitalizations and emergency department utilization, optimize site of care whenever possible, and ensure evidence-based treatment is being applied. An experienced case manager with managed care experience will be successful in this role.
Registered nurse with current MN license and with no restrictions All relevant experience including work, education, transferable skills, and military experience will be considered. 5 years relevant clinical care experience CCM Certificate or ability to obtain within 3 years of starting in the position Excellent telephonic skills Keen business skills Excellent communication skills Excellent conceptual thinking skills Excellent relationship management skills Excellent organizational skills Computer application proficiency Strong resiliency and flexibility skills Excellent research, analytical, and creative problem-solving skills Flexibility to work varied hours High school diploma (or equivalency) and legal authorization to work in the U.S. Preferred Skills and Experience: 2+ years of managed care experience; e.g. case management/health coach, utilization management and/or auditing experience (may be included in the 5 years relevant clinical experience).
Receives referral for member identified with high cost, complex medical conditions and telephonically outreaches to the member, family and providers to engage in complex case management program. Conducts clinical assessments with members and providers utilizing motivational interviewing; gathers, analyzes, synthesizes and prioritizes member needs and opportunities based upon the clinical assessment and research and collaborates with the interdisciplinary care team to develop a comprehensive plan of care. Collaborates and communicates with the health care team; e.g. member, family, designated representative, health care provider on a plan of care that produces positive clinical results and promotes high–quality, cost effective outcomes. Identifies relevant BCBSMN and community resources and facilitates program and network referrals. Monitors, evaluates, and updates 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 the strategic and financial goals of the department, complex care management teams, and the enterprise Knowledgeable of health plan operations (e.g. networks, eligibility, benefits) Promotes innovative solutions to improve day to day functions and enhance the overall operation of the department. Collaborates with interdisciplinary care team to develop a comprehensive plan of care to identify key strategic interventions to address member’s needs and health care cost drivers. 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. Identifies and implements cost saving opportunities to ensure optimal and cost-effective health outcomes.
At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: Comprehensive health benefits that start day one! Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship, development, and leadership programs… and more!
The Utilization Review (UR) Specialist is a Registered Nurse responsible for conducting thorough medical necessity reviews to assist with determining appropriate patient class designation. The UR Specialist will perform timely and comprehensive reviews of the patient chart utilizing InterQual Criteria accurately in conjunction with the UR Department workflows/processes, clinical nursing judgement, and when necessary, discussions with the provider team and/or Medical Director of UR.
Travel: Less than 10% of the time may be required. Work Type: This position is a remote position outside traditional office, often from home or another remote setting. Minimum Qualifications: Education - Associate degree in nursing. Experience - Minimum of 5 years of recent acute hospital experience or a minimum of two years of previous utilization review experience. Licensure - Must have a valid, active unencumbered Registered Nurse license approved by the Georgia Licensing Board. Skills - Must meet all quality and productivity expectations and successfully complete yearly competencies. Preferred Qualifications: Education - Bachelor's degree in Nursing strongly preferred. Certification - Case Management certification preferred. Skills - InterQual Level of Care Criteria experience. Previous utilization review experience strongly preferred.
Operational Support: Conducts thorough medical necessity reviews to assist with determining appropriate patient class designation. 2. Performs timely and comprehensive reviews of the patient chart utilizing InterQual Criteria accurately in conjunction with the UR Department workflows/processes, clinical nursing judgement, and when necessary, discussions with the provider team and/or Medical Director of UR. 3. Performs appropriate and accurate initial, admission (episode day one) and concurrent utilization reviews as guided by InterQual Criteria and UR Department workflows on all observation, inpatient, and extended recovery admissions as required based on Emory Healthcare's Utilization Management Plan and the UR Department's processes. 4. Ensures that all InterQual reviews are supported with provider team documentation and/or clinical data. 5. When appropriate, the UR Specialist will utilize the UR Department's Severity of Illness/Intensity of Service template to document the medical necessity of the admission or continued stay. 6. While conducting utilization reviews, will identify any Avoidable Delays and accurately document the delay(s) based on the workflow. 7. Follow the UR Department's denial workflows as appropriate. 8. Prioritizes work with minimal guidance for optimal reimbursement and to avoid financial risk to both patient and hospital. Compliance: Will identify and complete Medicare Outpatient Observation Notices (MOON), Medicare Change of Status Notice (MCSN), Condition Code 44s and Medicare Hospital Issued Notices of Non-Coverage (HINNs) for Medicare beneficiaries as appropriate. 2. Ensures compliance with all state of Georgia and Federal regulatory requirements as designated in Emory Healthcare's Utilization Management Plan. 3. Maintains all required annual competencies, metrics, and fully participate and engage in department process improvements. Collaboration: Responsible for timely communication to the provider team and interdisciplinary team as it relates to patient class designation and medical necessity of an admission or continued stay on individual patient basis based on UR Department workflows. 2. In a team effort, the UR Specialist will work closely with the UR Department's Case Management Authorization Specialist IP to ensure that authorized days and patient actual LOS are reconciled to ensure appropriate reimbursement for services provided. 3. Responsible for communicating medical necessity denials for in-house patients to the Medical Director of UR, and when designated to the provider team. 4. Serves as a resource to the provider team, Interdisciplinary Care Team, and patient to explain external UR regulations. 5. Provides effective and efficient proactive communication to internal and external customers. 6. Assists in collaborative efforts with the Case Management Department, Revenue Cycle, Physician Advisors, and other required departments. Additional Duties: Ability to multi-task in a fast-paced environment while efficiently handling multiple priorities and ensuring deadlines are met. 2. Performs other duties and tasks as assigned.
Sixty million Medicare seniors live with chronic disease. The care system sees most of them twice a year. Cadence is building the infrastructure to support them every day. Cadence is a clinical AI company that delivers continuous, proactive care for older adults with chronic conditions like hypertension, heart failure, and diabetes. We pair patients with a dedicated clinical team, integrate deeply into health system EMRs and workflows, and use our Clinical Intelligence platform to monitor vitals, surface risk early, optimize medications, and close care gaps between visits. The result: patients engage with care 100x more than before Cadence, clinicians focus on judgment instead of administrative work, and Medicare saves $2M a week. We operate as a full clinical care delivery organization, not a software vendor. Our clinicians work alongside health system partners, extending the reach of local primary care providers into patients' homes. We're now applying AI agents across these workflows – from alert review and medication titration to lifestyle coaching and care coordination – with clinicians always in control of clinical decisions.
The Cadence Health team is seeking a remote Licensed Practical Nurse (internally known as a Clinical Navigator) to provide virtual patient support across Cadence care programs. In this role, you will support Medicare patients living with chronic conditions by reinforcing care plans, encouraging adherence to medications and preventive care, and providing education that helps patients better manage their health. Clinical Navigators deliver proactive, patient-centered outreach and follow-through. Depending on program needs, your work may include structured patient check-ins, coaching and goal-setting, care coordination to close gaps in care, and addressing barriers such as access to resources, transportation, or medication refills. You will document patient interactions in the Cadence platform and collaborate closely with the clinical team to escalate concerns, coordinate next steps to ensure patients feel supported, informed, and engaged throughout their care journey. Schedule: This is a full-time, remote position based in the United States. Standard working hours are Monday through Friday, from 8:00 AM to 5:00 PM or 9:00 AM to 6:00 PM in the Pacific time zone.
Education, licenses, and experiences required for this role: An active compact multi-state LPN/LVN license in the state where you currently reside is required At least 5 years of clinical experience as a Licensed Practical Nurse is required Remote work readiness (including stable high-speed WiFi) is required An active CA state LVN license is required Fluency in Spanish is strongly preferred Experience providing patient education and support to individuals managing chronic conditions is preferred Cadence Clinical Navigators also demonstrate: Strong patient education, coaching, and care coordination skills Skilled in supporting patients in managing their health and chronic conditions by meeting them where they are in life - considering their age, lifestyle, and diet Strong documentation habits and attention to detail Reliable attendance and strong schedule adherence Exceptional written, verbal, and interpersonal communication skills Ability to work independently in a remote, fast-paced environment with evolving workflows Tech-savvy and comfortable navigating and/or troubleshooting multiple systems while engaging patients virtually
Conducting outbound telephonic patient outreach to support patients enrolled in Cadence care programs Provide one-on-one coaching and support to patients managing chronic conditions, including but not limited to type 2 diabetes, hypertension, and cardiovascular disease Help patients execute personalized care plans and achieve their goals by providing education and coaching focused on behavior modification, nutrition, physical activity, and self-management strategies using evidence-based techniques such as motivational interviewing and SMART goals Conduct comprehensive assessments of patients' health status, lifestyle behaviors, nutritional habits, and readiness to change Support patient care delivery by performing assigned tasks in accordance with Cadence clinical policies and established protocols, under appropriate clinical supervision Educate patients on disease management, medication adherence, symptom recognition, and prevention strategies Monitor patients' progress, adherence to treatment plans, and health outcomes through regular check-ins and remote monitoring tools Documenting patient interactions, outcomes, and follow-up plans in the Cadence platform Identifying barriers to care (including social needs) and connecting patients with resources or internal support pathways Collaborating in real time with clinicians and patient support teams using tools such as our Cadence Platform, Google Workspace, and Slack Contributing feedback to improve workflows in a fast-moving, change-oriented environment These responsibilities are intended to describe the general nature and level of work being performed by personnel assigned to this job classification. They are not to be construed as an exhaustive list of job duties performed by personnel in this classification. Other job related duties may be assigned by management.
Sixty million Medicare seniors live with chronic disease. The care system sees most of them twice a year. Cadence is building the infrastructure to support them every day. Cadence is a clinical AI company that delivers continuous, proactive care for older adults with chronic conditions like hypertension, heart failure, and diabetes. We pair patients with a dedicated clinical team, integrate deeply into health system EMRs and workflows, and use our Clinical Intelligence platform to monitor vitals, surface risk early, optimize medications, and close care gaps between visits. The result: patients engage with care 100x more than before Cadence, clinicians focus on judgment instead of administrative work, and Medicare saves $2M a week. We operate as a full clinical care delivery organization, not a software vendor. Our clinicians work alongside health system partners, extending the reach of local primary care providers into patients' homes. We're now applying AI agents across these workflows – from alert review and medication titration to lifestyle coaching and care coordination – with clinicians always in control of clinical decisions.
As a Nurse Practitioner Supervisor at Cadence, you will split your time between direct patient care and leading a team of Nurse Practitioners delivering remote monitoring for patients managing CHF, Type 2 Diabetes, and hypertension.. Your clinical decisions and your leadership shape the standard of care experienced by patients who depend on Cadence between office visits. This role sits at the center of Cadence's care delivery model, where clinical excellence and team performance are the same objective.
Who you are: A clinician-leader who is equally at home managing a complex patient panel and developing the people responsible for one — you bring structure and judgment to both without confusing the two Fluent in data: you interpret clinical and operational metrics, identify what the numbers are telling you, and translate findings into clear actions for your team and your patients Experienced with AI-assisted clinical workflows or remote monitoring platforms and able to evaluate how these tools support — or should support — sound clinical decision-making at scale A communicator who leads change without losing the team: you frame new policies, shifting priorities, and performance expectations in ways that build trust rather than erode it Skilled at holding a high standard in a distributed environment, including the ability to maintain clinical quality, team cohesion, and accountability across time zones and schedules Comfortable operating in a fast-moving environment where processes are maturing alongside the business — you bring structure where it is needed and adapt when priorities shift Someone who takes ownership of outcomes, not just activities — when something is off with a patient or a team metric, you move toward it What you need: Master's degree as a Nurse Practitioner Board certification and active NP license required (ANCC or AANP) Multi-state compact RN licensure; willingness to obtain additional state licensure as Cadence expands markets 5 or more years of NP experience treating patients with chronic conditions including heart failure, type 2 diabetes, and hypertension in outpatient or inpatient settings 5 or more years leading clinical teams comprising NPs Experience with remote patient monitoring technology is a strong plus Availability to work Monday through Friday, 9am to 6pm MT or PT
Manage patients through virtual encounters, reviewing vital signs, laboratory results, and symptoms in coordination with Clinical Navigators and RNs to drive timely, guideline-concordant treatment adjustments Initiate and optimize guideline-directed medical therapy for heart failure, type 2 diabetes, and hypertension, responding promptly to escalations surfaced through the RPM platform Conduct monthly clinical audits, monitor team performance data for trends, and implement quality improvement strategies that measurably improve patient outcomes and health system alignment Coach, mentor, and develop a team of Nurse Practitioners through regular feedback, structured onboarding, and ongoing clinical education that raises the ceiling on team-wide performance Oversee team operations including scheduling, PTO and CME approval, staffing coverage across time zones, and participation in the recruitment and onboarding of new clinical team members Translate updated clinical guidelines, organizational policies, and care pathway changes into team practice, escalating operational and compliance matters to leadership as appropriate
Sixty million Medicare seniors live with chronic disease. The care system sees most of them twice a year. Cadence is building the infrastructure to support them every day. Cadence is a clinical AI company that delivers continuous, proactive care for older adults with chronic conditions like hypertension, heart failure, and diabetes. We pair patients with a dedicated clinical team, integrate deeply into health system EMRs and workflows, and use our Clinical Intelligence platform to monitor vitals, surface risk early, optimize medications, and close care gaps between visits. The result: patients engage with care 100x more than before Cadence, clinicians focus on judgment instead of administrative work, and Medicare saves $2M a week. We operate as a full clinical care delivery organization, not a software vendor. Our clinicians work alongside health system partners, extending the reach of local primary care providers into patients' homes. We're now applying AI agents across these workflows – from alert review and medication titration to lifestyle coaching and care coordination – with clinicians always in control of clinical decisions.
Cadence is hiring a Medical Director to serve as a key clinical liaison for our partner providers. This field-first role is critical to building long-term relationships, resolving provider concerns, and driving adoption of Cadence’s clinical programs. You'll work alongside our Provider Relations Managers (PRMs) to represent the clinical voice of Cadence in the field, ensuring our model meets the needs of providers and their patients while identifying opportunities to enhance care delivery.
Who you are: A field-oriented Nurse Practitioner who thrives in a fast-moving environment and brings structure and credibility to complex, multi-stakeholder relationships A skilled communicator who can engage peer-to-peer with physicians, earn trust quickly, and navigate partnerships with confidence and openness Someone with a working knowledge of RPM, CCM, APCM, and Medicare billing frameworks - able to speak fluently to both the clinical and operational dimensions of these programs Experienced in provider-facing roles within health systems, digital health platforms, or care coordination models, with a track record of building durable clinical partnerships Proficient in clinical informatics - comfortable interpreting and presenting data to guide care decisions and influence clinical strategy Fluent with AI-assisted tools in clinical or operational contexts and able to evaluate and apply emerging AI capabilities as they become relevant to provider engagement and care delivery Someone who takes ownership of outcomes, follows problems through to resolution, and operates with a bias toward action What you need: Board certification and active NP license required (ANCC or AANP) Multi-state compact RN licensure preferred; willingness to obtain additional state licensure as Cadence expands markets 5+ years clinical experience as a Nurse Practitioner in primary care, internal medicine, family medicine, or a related field At least 2 years working with physicians or clinic leadership in a provider-facing role focused on onboarding, clinical relationship management, workflow adoption, or ongoing partnership support Demonstrated ability to build trusted, long-term relationships with clinicians and clinical leadership across diverse practice settings Familiarity with RPM, CCM, APCM, or comparable digital health frameworks, including associated Medicare billing and regulatory requirements Proficiency in Google Suite, Notion, and Slack; comfort with AI tools preferred Willingness and ability to travel approximately 2 to 3 days per week, with flexibility based on partner needs; candidates must be U.S.-based and live within reasonable distance of a major airport
Serve as the lead clinical liaison for partner providers across multiple regions, representing Cadence’s care model with clinical authority and consistency Partner with PRMs on clinic visits and ongoing relationship management to strengthen long-term program engagement Communicate the clinical rationale behind Cadence’s care protocols, data practices, and service offerings Lead onboarding and training for new clinic partners Resolve provider concerns with empathy, clinical judgment, and structured follow-through to deepen partner relationships Translate field insights into actionable intelligence for clinical, product, and engineering teams, directly informing service improvements and care model refinement
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.
Join Aetna’s Long-Term Services and Supports (LTSS) team as a UM Nurse Associate and play a vital role in supporting high-quality, coordinated care for members across Virginia. This fully remote opportunity offers a structured weekday schedule (Monday–Friday, 8:00 AM–5:00 PM) and is ideal for a detail-oriented, compassionate Licensed Practical Nurse who thrives in a collaborative, fast-paced environment. What makes this role appealing: Meaningful work supporting vulnerable populations in the LTSS space Consistent weekday schedule with no weekends Fully remote role with a supportive, team-based culture Opportunity to apply clinical judgment beyond bedside care If you’re looking to transition your clinical expertise into a role that blends care coordination, utilization management, and member advocacy—this is an excellent opportunity to grow your career while making a meaningful impact.
Required Qualifications: Must be an Active unrestricted Licensed Practical Nurse in the state of Virginia Must reside in Eastern Standard Time Zone 3 years clinical experience (preferably in medical surgical nursing, behavioral health, long term care, etc. Strong multitasking, prioritization, and computer navigation skills Comfort working in a performance-driven, evolving environment Preferred Qualifications: Typical office working environment with productivity and quality expectations Long Term Shared Services Supports Experience Managed Care Experience Education Completion of State Accredited Practical Nursing Program
In this role, you will review medical records and treatment plans to ensure care is appropriate, effective, and delivered in a timely manner. You’ll contribute to improving member outcomes while helping manage healthcare resources responsibly. Key responsibilities include evaluating personal care and private duty nursing requests, ensuring alignment with clinical guidelines and member needs. You will be part of a mission-driven team focused on empowering members to live safely and independently within their communities. Your clinical expertise, critical thinking skills, and ability to navigate multiple systems will directly impact the quality of care our members receive.
HealthEdge is on a mission to drive a digital transformation in healthcare. We’re connecting health plans, providers, and patients with end-to-end digital technology solutions to support new business models, reduce administrative costs and improve health outcomes. Our growing portfolio of products (HealthRules® Payer, HealthEdge Source™, HealthEdge® Provider Data Management, GuidingCare®, and Wellframe™) provides talented and passionate professionals with opportunities to lead change and make a lasting, global impact in healthcare. Driving our mission are 2,000+ professionals worldwide. Together, we are committed to innovating a world where healthcare can focus on people.
The Manager, Clinical Quality is responsible for management and oversight of activities related to quality assurance and monitoring of clinical UM and A&G staff on behalf of health plan customers for Utilization Management, Appeals & Disputes, Quality Improvement and other programs requiring clinical quality oversight. This position provides effective and efficient solutions to complex business problems. Responsibilities include maintaining effective relationships within and across teams, key vendors, and clients to ensure that the clinical quality issues and needs of health plan customers are represented and prioritized in all clinical programs. This role is also responsible for strategizing, innovating, analyzing, planning, organizing, reporting, collaboration and other functions that are required to maintain and operate the clinical quality team.
EMPLOYMENT QUALIFICATIONS: Bachelor’s degree in nursing is required. Master’s degree in nursing or related field and/or CPHQ is preferred. Continuous learning, as defined by the Company’s learning philosophy, is required. Active RN license is required. 10+ years experience with progressive responsibility in healthcare administration, clinical quality or a health plan with demonstrated technical knowledge that provides the necessary knowledge, skills, and abilities required. 5+ years management experience in Health Management required with a focus on Quality and Utilization Management. Ability/willingness to develop, recommend and execute solutions to ad hoc issues and challenges that may arise with a process efficiency mindset. Strong knowledge of clinical and quality improvement processes and concepts. Subject matter expertise in Medicare Advantage and Utilization Management Strong knowledge of CMS regulations for Medicare Advantage, Utilization Management, and/or Appeals & Disputes. Knowledge of CMS regulatory reporting for Utilization Management Ability and willingness to delegate, guide and oversee work of team. Excellent analytical, organizational, planning, verbal, and written communication skills required. Must be self-motivated, results-oriented and can work well under pressure with multiple clients and multiple systems Ability to effectively present information and respond to questions from internal and external contacts at all levels of the organization. Proficient in current industry standard PC applications and systems and health management systems. Extensive knowledge of operations and ability to lead a team to meet industry standard SLA’s and metrics. Must demonstrate leadership ability and team building skills to effectively supervise professional and non-professional staff and interact with all levels of management. Ability to effectively exchange information, verbal or written, by sharing ideas, reporting facts and other information, responding to questions, and employing active listening techniques. Ability to establish workflows, manage multiple projects, and meet necessary deadlines. Ability to maintain confidentiality. Ability to manage both an onshore and offshore team efficiently and effectively across multiple locations and time zones. Geographic Responsibility: Remote, US Type of Employment: Full-time, permanent FLSA Classification (USA Only): Exempt Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job: The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus. Work across multiple time zones in a hybrid or remote work environment. Long periods of time sitting and/or standing in front of a computer using video technology. May require travel dependent on company needs.
Management and oversight of a quality team conducting quality assurance activities across multiple locations, UM training, and UM regulatory reporting. Oversight of key metrics, including quality, productivity, and compliance Responsible for the successful execution of the Quality Improvement Program in accordance with CMS requirements including review and submission of Quality of Care & Quality of Service grievances. Support all related compliance audits on behalf of health management programs. Plans, organizes, and directs activities of Clinical Quality, including, but not limited to, planning, training, motivation, staff development, staff selection, and communication. Ensures subject matter expertise and support related to clinical quality management inquiries within requests for proposals and customer presentations. Maintains and promotes quality relationships with internal and external customers. Compiles and analyzes data and prepares activity related reports, staffing needs, inventories and monitors workflows within the clinical quality unit. Leads and participates in workgroups to complete special assignments/projects. Resolves high priority inquiries– including issues of non-compliance with related vendors or programs. Recommends processes to control expenditures and promotes efficient use of resources. Responsible for balancing workload to optimize the effectiveness of the department. DIRECTION EXERCISED: Directly supervises staff in accordance with company policies and applicable Federal and State Laws. Responsibilities include, but are not limited to, effectively interviewing, hiring, terminating, and training employees; planning, assigning, and directing work; appraising performance; rewarding and counseling employees; addressing complaints and resolving problems; supporting and encouraging the engagement process.
InnovAge operates PACE (Program of All-inclusive Care for the Elderly) centers offering coordinated medical and social services to help seniors remain safely in their homes and communities.
Visiting After Hours Registered Nurse (RN) Our Visiting After Hours Registered Nurse (RN) work a rotational on-call after-hours schedule as part of the comfort care and after-hours team. They respond timely to afterhours calls from staff or the participant (or their family) to assess and triage the situation. As licensed clinicians they determine the appropriate response or treatment which may include performing a home visit, communicating with the provider on call and/or coordinating care at a facility. The work also includes providing clinical guidance and education to the participant, family and caregivers as needed. Our Visiting After Hours Nurse (RN) works with the In-Home Services and Primary Care team reporting into the Director of After-Hours Nursing and Comfort Care Services team. After Hours - 4:30pm to 8am Salaried position with mileage reimbursement at $.65/mile Provides phone triage and drives to participant's home/community for direct care as needed. Will support enrolled participants for their designated PACE center The responsibilities include: From incoming calls supports on-call assessments with participant/family initiating appropriate intervention, including identifying and respond to emergency situations with the ability to handle on-call assessments and triage appropriately. VANs use their discretion to assess symptoms (through a physical or verbal assessment, or a telephonic conversation), analyze potential diagnoses, and based on such diagnoses, determine the appropriate level of intervention (i.e.; education, clinic visit, urgent care, emergency room), recommend a course of treatment, and begin treatment. Develops a comprehensive assessment of the participant's needs (assimilating participant's history from various sources), follows plan of care implemented by IDT team, provides services and/or treatments requiring specialized nursing skill, councils the client and family in meeting nursing need, coordinates services, informs the physician and other staff of changes in the client's needs, and assists with transfers of care (respite, discharge from facility). Demonstrates assessment ability by applying clinical judgment as it relates to the patient population served. Ability to make an appropriate analysis of calls, including working with providers to determine, based on clinical judgment, the necessity of an order or higher level of direction, and initiate appropriate intervention/triage when necessary. Initiates appropriate preventive and rehabilitative nursing procedures and provides treatments and procedures that contribute to the physiological and psychosocial outcomes and stability of the patient. Demonstrates ability to delegate and prioritize tasks to facilitate quality participant care and ensure all participant care needs are met. For example, the VAN is expected to use their discretion to determine call priority by distinguishing between emergent situations, such as end of life crises, and non-emergent clinical needs. Recognizes and responds to variances of patient care/condition and appropriately notifies physician and team in a timely manner, utilizing the latest PACE standards per departmental policy. Educates and counsels family members on the end-of-life process including the interpretation of changes to a participant's condition, stages of the dying process, interactions with the participant during the final phase of life, and how family members can manage their emotions during this time. Supports proactive visits and calls to participants based on the recommendation of the clinical or other interdisciplinary team members. Additionally, they are responsible for facility transition planning when on call. Demonstrates flexibility and assures patients receive consistent, competent, and ethical care. Addresses customer's needs, regardless of assignment, within a timely manner. Performs a handoff with peers and center-based teams when changing shifts reporting current condition and needs of high-risk participants for after-hours care. Participates in interdisciplinary and clinical team huddles on care plan reviews either virtually or in person on a regular basis. Comes into the PACE Center on a regular basis and as requested to work with the clinical team, attend educational programs, demonstrate competency, and participate in meetings. Accurately completes all required clinical documentation consistently per InnovAge standards in electronic medical record which includes completing and signing or routing participants EMR notes and orders to physician. Maintains a safe patient care environment by complying with InnovAge policies/procedures/regulatory requirements that support National Safety Patient Goals, ADC and PACE Federal regulations and Quality Initiatives. Completes required continuing education classes applicable to related services; as assigned in a timely manner and stays current in regards to clinical knowledge. Required: Current State issued Registered Nurses License Current First Aid and BLS certifications are required prior to hire. Acceptable vendors for certifications are from either American Heart Association and/or American Red Cross. 2+ yrs health care with an emphasis in geriatrics, with at least one year home health services Requires reliable personal transportation, current state issued driver's license, good driving record and auto insurance. Associates Degree in Nursing Preferred: Bachelor's degree in nursing 3+ yrs health care experience with emphasis in geriatrics Experience and knowledge of supportive/bereavement counseling techniques, strategies and available resources and the ability to apply/inform family members and/or caregivers. Experience in end of life/hospice setting. Bi-lingual-Spanish, Russian, Punjabi or Hmong InnovAge is dedicated to empowering seniors to live independently, allowing them to age in their own homes and communities safely. InnovAge offers an alternative to nursing homes through its Program of All-inclusive Care for the Elderly (PACE), which provides enrolled seniors with customized healthcare and social support at PACE Adult Day Health Centers. These centers are staffed by medical professionals who are committed to creating personalized care plans for each participant. At InnovAge, our team members are our greatest asset and have a significant impact on the lives of our participants every day. When you join InnovAge, you'll work alongside talented, respectful, and passionate colleagues within a patient-centered care model. InnovAge is committed to equal opportunity and affirmative action, and we strive to create a diverse and inclusive workplace. We consider all qualified candidates for employment without discrimination based on race, color, religion, sex, sexual orientation, gender identity/expression, national origin, disability, protected veteran status, pregnancy, or any other protected status. Salaries are determined by various factors such as qualifications, experience, and location, and do not include potential bonuses or benefits. Our extensive benefits package includes medical/dental/vision insurance, short and long-term disability, life insurance and AD&D, supplemental life insurance, flexible spending accounts, 401(k) savings, paid time off, and company-paid holidays. Applicants are considered until the position is filled. $38.80 - $50.48 Compensation Disclaimer The pay may vary depending on job related factors, such as work location, experience, knowledge, skills, education, certifications, training and internal equity. InnovAge offers a comprehensive benefits package, which includes medical, dental, vision, 401(k) plan with company match, short and long-term disability, life insurance, supplemental life insurance, ADD, flexible spending account, paid time off and company paid holidays. Attention Florida Applicants This position requires a background screening through the Florida Care Provider Background Screening Clearinghouse. For more information, please visit the Clearinghouse Education and Awareness website: Agency Disclaimer InnovAge will not accept unsolicited resumes from search firms for this employment opportunity. Regardless of past practices, all candidates/resumes submitted by search firms to InnovAge by any means without a valid written search agreement in place for that position will be deemed the property of InnovAge and no fee will be paid in the event such candidate is hired by InnovAge.
A healthcare organization offering telehealth and remote patient monitoring services; specific company details are limited and the job posting appears hosted via an external aggregator.
The Telehealth Nurse (RN/LVN) is responsible for providing remote clinical support, patient monitoring, triage, education, and care coordination for home health patients through telehealth and remote patient monitoring (RPM) programs. This role serves as the primary clinical contact for patients enrolled in telehealth services and plays a critical role in early identification of health concerns, intervention, prevention of hospitalizations, and improving patient outcomes. The Telehealth Nurse conducts virtual patient interactions, reviews RPM alerts and vital signs, documents all encounters in the EMR, escalates clinical concerns appropriately, and collaborates closely with field clinicians, physicians, and care coordination teams. Salary $80,000-$95,000 Key Responsibilities Remote Patient Monitoring & Virtual Care • Monitor daily patient biometric data including: • Blood pressure • Pulse oximetry • Weight • Blood glucose • Heart rate • Temperature • Review and respond to RPM alerts in a timely manner based on established clinical protocols. • Conduct scheduled and as-needed telehealth calls/video visits with patients and caregivers. • Identify early signs of clinical deterioration and intervene appropriately. • Provide ongoing chronic disease management support for conditions such as: • CHF • COPD • Diabetes • Hypertension • Post-hospital recovery • Reinforce physician orders, medication compliance, diet, and care plans during telehealth interactions. Patient Triage & Escalation • Perform remote nursing assessments and symptom triage. • Escalate urgent or worsening patient conditions to: • Physicians • Field Clinicians • Clinical managers • Emergency services when appropriate • Coordinate interventions to prevent avoidable ER visits and hospital readmissions. • Document all patient interactions, assessments, and escalations in the EMR. Patient Engagement & Education • Educate patients and caregivers on: • Use of telehealth/RPM equipment • Disease management • Medication adherence • Symptom monitoring • When to seek medical attention • Support patient engagement and encourage compliance with daily monitoring requirements. • Assist patients experiencing technology or connectivity challenges. • Build therapeutic relationships with patients through consistent communication and follow-up. Clinical Coordination • Collaborate with: • Home health nurses • Therapists • Physicians • Branch leadership • Intake and scheduling teams • Communicate significant patient status changes promptly to the care team. • Support continuity of care between hospital discharge and home recovery. • Participate in interdisciplinary case conferences as needed. Documentation & Compliance • Maintain accurate and timely EMR documentation for all telehealth encounters. • Ensure compliance with: • HIPAA regulations • Medicare and Medicaid guidelines • Home health documentation standards • Organizational telehealth policies • Follow established telehealth workflows and escalation protocols. Quality & Performance • Support organizational goals related to: • Reduction in hospital readmissions • Reduce LUPAs • Reduce missed visits • Improved patient satisfaction • Increased patient engagement • Better clinical outcomes • Meet productivity and responsiveness expectations for telehealth encounters and alert management. • Participate in quality improvement initiatives and telehealth program optimization efforts. Qualifications Education • Graduate of an accredited nursing program required. • Associate or Bachelor of Science in Nursing (ASN/BSN) preferred. Licensure/Certifications • Active and unrestricted RN or LVN/LPN license in the applicable state required. • BLS certification required. • Telehealth, case management, or chronic care management certifications preferred. Experience • Minimum 1–3 years of nursing experience required. • Experience in one or more of the following preferred: • Home health • Telehealth • Remote patient monitoring (RPM) • Care management • Chronic disease management • Post-acute care • Familiarity with EMR/EHR systems required. • Knowledge of Medicare home health regulations preferred. Required Skills • Strong clinical assessment and triage skills • Excellent phone and virtual communication skills • Ability to recognize early warning signs of patient decline • Strong documentation and organizational skills • Ability to multitask and manage high call volumes • Comfortable using telehealth platforms and digital health technology • Compassionate and patient-centered communication style KPIs / Performance Metrics • RPM alert response times • Patient call completion rates • Telehealth adherence and patient engagement • Reduction in avoidable hospitalizations/readmissions • Documentation accuracy and timeliness • Patient satisfaction scores • Escalation and intervention effectiveness • Decrease in LUPA rates • Decrease in missed visits • Productivity metrics (daily calls, monitored patients, completed follow-ups) Physical & Work Requirements • Prolonged periods of sitting and computer use. • Ability to work in a fast-paced remote monitoring environment. • May require evening/weekend rotation depending on patient coverage needs. • Remote or hybrid work environment may be available based on organizational needs. 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RPM (Roman Pennsylvania Medical, P.C.) is a telehealth practice affiliated with Ro, providing remote, patient-centered care across mental health, women’s and men’s health, fertility, metabolic health, and skincare through a nationwide provider network.
About RPM Roman Pennsylvania Medical, P.C. (RPM) is a telehealth practice dedicated to providing high-quality, patient-centric care. RPM is part of the provider network affiliated with Ro, a direct-to-patient healthcare company. Providers help patients seeking care through Ro’s platform for their mental health, women’s health, men’s health, fertility, metabolic health, and skincare needs. RPM providers benefit from using technology, tools, and solutions designed to support safe and appropriate care, reduce administrative burden, and help them seamlessly connect with patients throughout their care journeys. As part of RPM’s affiliation with Ro, providers help expand access to affordable, high-quality care to more patients. RPM’s nationwide network of providers is made up of board-certified physicians, nurse practitioners, and nurses licensed to treat patients in all 50 states and Washington, DC. As a 6-month contracted Virtual Registered Nurse, you’ll partner with RPM Providers and work independently to provide high-quality patient care through EMR messaging and communications, and triage to ensure safety, productivity, and team optimization are maintained at the practice level. You are passionate about working in non-traditional healthcare settings and expanding patient access. You can troubleshoot challenging situations as they arise and ensure high-quality patient care is provided per RPM principles and guidelines. You will report to an RN Lead throughout the length of your contract. Who are you? That's a great question. You are a Virtual Registered Nurse who refuses to settle for the status quo. You apply your nursing knowledge and your desire to help people live happier, more productive lives to your daily work. You have excellent written and verbal communication skills, you are highly technologically savvy, and you are a problem solver who enjoys working collaboratively with others. We don’t expect you to know everything about medicine or telemedicine, but we do expect you to be ready to dive in and learn. The annualized base salary for this position is $90,000. At Ro, we believe that our diverse perspectives are our biggest strengths — and that embracing them will create real change in healthcare. As an equal opportunity employer, we provide equal opportunity in all aspects of employment, including recruiting, hiring, compensation, training and promotion, termination, and any other terms and conditions of employment without regard to race, ethnicity, color, religion, sex, sexual orientation, gender identity, gender expression, familial status, age, disability and/or any other legally protected classification protected by federal, state, or local law. See our California Privacy Policy here. Apply tot his job Apply To this Job
Lindus is a clinical operations and technology company focused on improving how clinical trials are run, supporting participant recruitment and trial execution with platform-driven services for research teams.
🍊Our mission We're powering biology's century with radically faster, more reliable clinical trials. Every new treatment needs clinical trials to prove safety and efficacy, but today's infrastructure is stuck in the past- driving up cost, causing delays and ultimately meaning new treatments don’t get to patients. We're fundamentally changing that- not just being a "better CRO," but transforming how people think about developing new treatments, so patients can access breakthrough treatments faster. Our impact speaks for itself: Since March 2021, we've powered 100+ clinical trials involving tens of thousands of patients. We recently raised a $55M Series B from Balderton Capital, alongside backing from Creandum, Firstminute, Seedcamp, and Visionaries. 🍊What's it like to work here? When you join us, you’ll experience: • High-Impact, Mission-Driven Work: Lindus is disrupting an outdated industry, giving you the chance to directly improve patients’ lives and see tangible results from your work. • Fast-Paced Growth & Ownership: We recognise hard work and outcomes over anything else. You’ll take on real responsibility, work across different areas, and actively shape the company’s success. • Collaborative, No-Ego Culture: Work with smart, driven people in a supportive and informal environment. At Lindus we break down silos, fun is a core value, and creativity is encouraged. Ready to power biology's century? We'd love to hear from you. 🍊 About the role We're looking for a Participant Recruitment Coordinator to join our Clinical Operations team on a freelance basis to support the growth of our team and manage participant interactions across our trials. This role requires you to be a Registered Nurse (RN) with active NMC registration. 🍊 About you We'd love to hear from you if… • You are a Registered Nurse with current, active NMC registration (this is essential for the role) • You have experience utilising various tech tools; bonus points if these include Calendly, DocuSign, Medi2data, Dialpad, Florence and Sealed Envelope • You have experience in patient onboarding and set-up, including running screening calls and patient follow-up • You have experience maintaining a tracking system and executing follow-up procedures • You have high agency and a bias for action, can adhere to protocol timelines and stay flexible in response to shifting work priorities and issues • You're passionate and curious about our mission: changing how the healthcare industry operates and how new health treatments are developed • You want to learn what life is like at a high-growth, mission-driven VC-funded startup You belong here! If your experience and interests match some of the above (and you hold an active NMC registration), we'd love you to apply. 🍊 What you'll focus on • Conduct all participant-facing tasks, ensuring a positive trial experience and excellent data accuracy within our platform, Citrus • Apply your clinical expertise as a Registered Nurse to support participant safety, clinical judgement and trial conduct • Oversee data collection and in-person processes (e.g. MRI scans), ensuring everything runs smoothly • Maintain and update participant trackers and the Investigator Site File (ISF) • Assist the PI with day-to-day trial implementation and respond to CRO queries • Respond to any CRO data queries • Escalate safety, data integrity or trial operational issues to the TL/CRO team • Report AEs and SAEs in line with protocol and regulatory requirements • Collaborate effectively with trial teams to ensure seamless participant experiences throughout the trial journey • Contribute to team discussions by sharing participant feedback and suggesting process improvements • Work cross-functionally with Clin Ops, keeping the TL and STM updated at all times and ensuring other PRCs are aware of trial status 🍊 Our hiring process We believe hiring should be transparent, respectful of your time, and give you a real feel for what Lindus is like. Here's what to expect: • Initial conversation with our ClinOps Talent Partner (15 minutes) — get to know each other, discuss the role, and answer any questions about Lindus • Technical/functional interview with a member of our Clinical Operations team (30 minutes) — this will include a task you'll work through during the interview We will only contact you from lindushealth.com email addresses. Please check the spelling of emails which appear to come from Lindus carefully before responding. We will never ask for your financial information over email. We are an equal opportunity employer committed to building a diverse and inclusive workforce. We evaluate all candidates based solely on their skills, experience, and qualifications relevant to the role. We do not discriminate on the basis of race, ethnicity, religion, gender, gender identity, sexual orientation, age, disability, veteran status, or any other legally protected status
Jaybird Senior Living operates senior living communities providing care and support for older adults. Founded in 2004, the company focuses on resident-centered services and employs clinical and caregiving staff across its communities.
Virtual Triage Nurse ( RN or LPN) The Virtual Triage Nurse (RN or LPN) independently provides remote clinical triage and guidance to community caregivers and floor nurses under the supervision of the Director of Clinical Operations. This role requires sound clinical judgment, adherence to state regulations, and a commitment to Jaybird Senior Living's core values. Key Responsibilities • Act as the primary on-call triage resource for property staff, providing clinical advice and directing appropriate action based on resident care plans and regulations. • Identify and manage emergent situations, instructing staff to contact emergency services when necessary. • Analyze resident conditions (symptoms/incidents) to determine and communicate next steps and expected outcomes to callers. • Maintain clear, complete, and confidential documentation of all conversations and directives, ensuring HIPAA compliance. • Utilize clinical and administrative platforms to review resident data and documentation. • Identify call trends and collaborate with corporate leadership to develop proactive solutions and improve resident outcomes/length of stay. • Consult and collaborate with internal/external clinical staff on quality improvement projects and research. • Troubleshoot basic access concerns for clinical platforms. Required Qualifications & Skills • License: Active RN or LPN license in good standing (LPN must be overseen by an RN). • Expert Knowledge: State-specific training, program, and regulatory requirements. • Skills: Outstanding verbal/written communication, organizational skills (tracking calls/outcomes), and the ability to relate professionally to staff at all levels. • Tech: Proficiency with Microsoft Windows (Outlook, Word, Excel), Internet, Clinical Platforms, and Apple iPad. • Physical/Cognitive: Ability to sit, talk, hear, and use hands regularly. Ability to read/analyze professional journals and solve practical problems. • Reports To: Director of Clinical Operations • FLSA: Non-Exempt The Perks That Matter: • Competitive salary and bonus opportunities • Health, dental, vision, disability, and life insurance • 401(k) with match • Paid time off and flexible hours • Employee assistance program and on-demand pay • Career growth in a fast-growing company About Jaybird Senior Living We provide seniors with the exceptional care they deserve, in an extraordinary living environment. Our communities offer seniors the freedom to enjoy each day as they see fit, with the right level of care and support; helping them approach life with renewed confidence and purpose. Since 2004, we’ve created a culture where our staff can innovate and grow — while our residents thrive and their families enjoy peace of mind. The Minnesota Equal Pay for Equal Work Act requires employers in the state of Minnesota to disclose the following information. If the position applied to is not located in Minnesota, the following information may not apply. The base range represents the low and high end of the pay range for this position. Actual pay will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. The range listed is just one component of our total compensation package for employees. Other rewards may include annual bonuses, short- and long-term incentives, and program-specific awards. In addition, we provide a variety of benefits to employees, including medical, dental, and vision insurance coverage, disability insurance, 401(k) with match, paid time off (PTO), Flexible hours for better work-life balance, Employee assistance program, on-demand pay. We are committed to providing equal employment opportunities to all employees and applicants. We prohibit discrimination and harassment of any kind, regardless of race, color, religion, age, sex, national origin, disability status, genetics, veteran status, sexual orientation, gender identity, or any other protected characteristic under federal, state, or local laws.
Fuze Health is a healthcare organization that offers telehealth services and hires remote nursing professionals to provide virtual patient care and support.
Fuze Health is looking for a Registered Nurse to provide telehealth care. This role involves conducting remote patient assessments, ensuring compliance with healthcare measures, and educating patients on their conditions. Ideal candidates will have a BSN, 2+ years of nursing experience, and skills in telehealth. The position offers $38.00–$40.00/hour with great benefits like flexible vacation and health insurance.
WelbeHealth is a value-based healthcare organization focused on improving outcomes for vulnerable seniors through programs including home-based primary care and telehealth services.
Role Description The WelbeHealth Advocate Supervisor, RN oversees the daily operations of the triage call center team, providing leadership and clinical guidance to RNs and LVNs to ensure timely, high-quality patient care and efficient call management. This role is accountable for process development and improvement, team management, staff scheduling, and training and development initiatives to support operational excellence and regulatory compliance. This role is different because the WelbeHealth Advocate Supervisor, RN at WelbeHealth: • Has the opportunity to lead and develop a fully remote team of RNs and LVNs, promoting flexibility and work-life balance while driving high-quality patient care. • Is part of a value-based care organization focused on improving patient outcomes through collaboration, innovation, and meaningful clinical impact. On the day-to-day, you will: • Lead the onboarding, training, coaching, and ongoing development of the WelbeHealth Advocate Nurses within the WelbeHealth Advocate Hub to ensure high-quality performance and engagement. • Oversee daily operations for the WelbeHealth Advocate Nurse team, including delegation of work, scheduling, and other duties required to meet the expected performance targets and goals, and service level expectations. • Identify systemic and operational issues and contribute to process improvement initiatives including root-cause analysis, solution implementation, and outcome monitoring. • Ensure team compliance with all organizational policies, regulatory requirements, performance standards, and departmental procedures. • Collaborate with cross-functional partners and market leaders as needed to resolve issues, improve coordination, and standardize processes across teams. Qualifications • Graduate of accredited school of nursing required; BSN required. • Unencumbered RN license required. • Minimum of five (5) years of nursing experience required, with at least two (2) years of experience in telehealth preferred. • Proficiency with technology, especially computers, software applications, and phone systems, including experience using electronic medical records systems. • Two (2) years of supervisory experience with demonstrated ability to mentor and develop team members. • Experience leading in a data-driven organization, leveraging reports and data to prioritize and manage people and projects. • Ability to work independently with minimal supervision and prioritize in a fast-paced environment. • Must be willing and able to work a varied schedule that may include evenings, nights, weekends, and overtime. Benefits • Medical insurance coverage (Medical, Dental, Vision). • Work/life balance - 17 days of personal time off (PTO), 12 holidays observed annually, and 6 sick days. • 401K savings + match. • Comprehensive compensation package including base pay and bonus. • Additional benefits. Compensation Offering $109,240.54 — $144,197.50 USD COVID-19 Vaccination Policy At WelbeHealth, our mission is to unlock the full potential of our vulnerable seniors. In this spirit, please note that we have a vaccination policy for all our employees and proof of vaccination, or a vaccine declination form will be required prior to employment. Our Commitment to Diversity, Equity and Inclusion At WelbeHealth, we embrace and cherish the diversity of our team members, and we're committed to building a culture of inclusion and belonging. We're proud to be an equal opportunity employer. Beware of Scams Please ensure your application is being submitted through a WelbeHealth sponsored site only. Our emails will come from @welbehealth.com email addresses. You will never be asked to purchase your own employment equipment.
CORE Health Networks is a provider of integrated occupational medicine services, offering employer-focused injury management, triage, and case management solutions to support workplace health and workers' compensation needs.
The Leading Provider of Integrated Occupational Medicine Services CORE Health Networks, the recognized leader in Integrated Occupational Medicine Services, provides integrated solutions to your occupational healthcare needs. Our programs are designed to align with each clients’ missions, goals, and values to achieve desired outcomes and exceed expectations. As we continue to grow, we are expanding our team of talented professionals. We are currently seeking a full-time Triage Registered Nurse to work from home. We have two openings on a Monday through Friday 9:30am to 6:00pm, Central Time work schedule. We offer a highly competitive total compensation package which includes Health, Dental, Vision, Life, 401(k), Six Paid Holidays, Vacation and Sick Leave, Long-term disability and short-term disability benefits, and much more. To learn more about this exciting opportunity, review the job specifications below: Position Overview: Under the direction of the Director of Injury Management, the Triage Nurse administers the intake of calls from contracted clients, an injured worker, Worker’s Compensation Insurance adjusters, Medical providers, and clinic staff. Provides exceptional service and quality treatment options to the patient and client throughout the injury management life-cycle. Principal Duties and Responsibilities (Essential Functions): • Triage injury/illness calls to determine if emergent/non-emergent • Determine if injury/illness requires immediate treatment or first aid advice • Research/locate the nearest facility to utilize for injury • Contact medical facility to determine the availability of adequate services to meet the needs of the particular injury/illness; Coordination of visit via phone/fax. • Speak with Medical personnel regarding the mechanism of injury/illness and discuss appropriate treatment pathways, obtaining UDS and BAT when applicable, and workplace accommodation availability. • Inform client/injured worker of name/location and contact information of medical facility available. • Notify appropriate contacts via email of injury/illness details with initial information within one hour of notification, unless an extreme situation. • Provide updates of diagnosis, work status, plan of care and follow up appointments to appropriate personnel with injured worker’s employer and adjuster. • Provide updates, diagnosis, clinic notes and treatment authorization requests to designated representative for client and Worker’s Compensation insurance adjuster. • Log injury/illness details on spreadsheet; Client specific • Bill time for each case according to services rendered. • Generating letters to providers, for clarification of work-relatedness and or treatment plan. • Obtaining and reviewing Medical records and diagnostics with relation to present injury/illness, prior history and/or forwarding to Specialty providers when allocated. • Proper documentation of phone calls made and received, interpretation of medical records from each exam, work status, and all emails transpired with regard to each case. • Assist Upper Management in CM activities as requested. • Answer phones in a professional manner when receptionist is not available. • Attend and participate in staff meetings. • Assists in office related tasks as needed. • Participate in opportunities for learning and skill maintenance/development, including internal and external training and workshops. • Other duties assigned by the supervisors. Licensures/Certification: • Must possess and retain a valid RN license for the state of LA (or compact multistate license). • Obtain a CWCP certification within two (2) years of employment. Experience: • Previous triage experience in ER or Urgent Care preferred; previous Occupational Health experience preferred • Minimum two (2) years practicing as a Registered Nurse Training: • Training for this position will be held primarily remotely, but may require in-office training at our corporate office depending on demands of training. IMPORTANT NOTICE: PLEASE ATTACH (ALL LICENSURES, CERTIFICATIONS, EDUCATION, AND DOCUMENTATION TO THE UPLOAD PORTION OF THE APPLICATION CORE, CHN, and our subsidiaries are Equal Opportunity Employers. EOE/ADAAA/AA. Applicants have rights under Federal Employment Laws. Please review the linked posters for more information: http://www.dol.gov/whd/regs/compliance/posters/fmla.htm https://www.eeoc.gov/employers/eeo-law-poster http://www.dol.gov/whd/regs/compliance/posters/eppa.htm
Baba provides care navigation for older adults by pairing them with expert advocates—often nurses or social workers—who coordinate medical care, appeals, and social support through a telehealth-enabled platform.
Telehealth Nurse Practitioner | Remote 1099 | Structured Intake & Care Navigation About Baba Baba is rebuilding healthcare for older adults. Navigating healthcare can be overwhelming. By 2030, over 65 million older adults will make up nearly a quarter of the U.S. population, creating one of the largest and most urgent challenges in healthcare. Baba makes it easier by pairing older adults with an expert advocate (usually a nurse or social worker) who coordinates their care. Baba's insurance-covered advocates have supported thousands of families by writing insurance appeals, researching specialists, getting medical equipment and cheaper medications, and scheduling appointments. Baba's investors include General Catalyst, Genius Ventures, Soma Capital, and Ground Up Ventures, along with angel investors who were founders or executives of leading companies. More than 50% of the Baba team are former founders, with backgrounds from MIT, Carnegie Mellon, Stripe, Palantir, and Liquid AI. About the Role As an Intake Consultations Nurse Practitioner at Baba, you’ll perform brief, structured telehealth visits that establish medical necessity for our care navigation programs. These intake visits are the cornerstone of Baba’s service— identifying high-risk conditions, unmet social needs, and confirming eligibility for ongoing care navigation services. You’ll work with our care advocates and clinical operations team to ensure patients are enrolled safely, compliantly, and compassionately into the right level of support. This is a remote, 1099 (contractor) position, suitable for physicians seeking flexible, high-impact telehealth work. What You’ll Do • Conduct initiating visits. Perform telehealth-based E/M or Annual Wellness Visits (AWVs) to establish medical necessity for care navigation services and identify high-risk conditions or unmet social needs. • Document findings in Baba’s platform, ensuring accurate coding and use of SDOH Z-codes, diagnoses, and risk factors. • Validate care plans. Develop and approve individualized care plans to ensure alignment with the patient’s medical treatment plan and documentation of continued medical necessity. • Collaborate with advocates and nurse care managers to finalize individualized care plans aligned with each patient’s medical and social needs. What You Bring • Education: Completion of an accredited Nurse Practitioner program. (Required) • Licensure: Active Nurse Practitioner or APRN license, in good standing - licensed in multiple states. (Required) • Experience: 2+ years of experience in primary care, telehealth, or care management. (Required) • Familiarity with Medicare programs, including care navigation, incident-to requirements, and SDOH documentation. • Proficiency with EMRs, care management platforms, and telehealth workflows. Why Join Baba • Help shape a new model of integrated, tech-enabled care advocacy that unites clinical oversight with social support. • Work remotely and flexibly while ensuring patients receive high-quality care. • Join a mission-driven team building the care copilot that every patient deserves.
Advocate Health (Advocate Aurora Health/Atrium Health) is a large nonprofit integrated health system operating hospitals and clinics across multiple states, offering clinical services and employment for a broad range of healthcare professionals.
Department: 37716 AMC Grafton - Preadmission Assessment Status: Part time Benefits Eligible: Yes Hours Per Week: 20 Schedule Details/Additional Information: • 0.5 FTE • Working hours between 0800-1630, 5 days in a pay period (3 days one week/2 days other week) • Remote • No weekends, no holidays, no call Pay Range $38.20 - $57.30 Registered Nurse (RN) – Pre Admission Testing Grafton, WI, United States Be the Nurse Who Redefines Care. At Advocate Health, being a nurse means more than delivering exceptional clinical care—it means leading with purpose, compassion, and boldness. As part of our One Advocate Nurse community, you’ll join a unified team committed to lifting others up, embracing innovation, and creating inclusive spaces where everyone can thrive. You’ll be empowered to think boldly, collaborate with humility, and drive change through fearless curiosity. Whether you're at the bedside, in the community, or advancing care through research and education, you’ll help shape the future of health—because here, we’re redefining care for you, for us, for all. Your feedback matters. Every nurse’s voice is vital in shaping our culture and improving care. We value your insights and experiences because they help us grow stronger together Where You Will Work: Join the Pre-Admit Testing team at Aurora Medical Center Grafton, where you will play an important role in preparing patients for their upcoming surgical experience through the first phone call and pre-procedure coordination. This is typically a remote position. The department supports patients across the Main OR, GI, Anesthesia, MRI, and Radiology areas and is staffed by a collaborative team of 4 RNs and 1 HUC each day. New team members can expect a thoughtful 3-month orientation, schedules planned 2 months in advance, and a welcoming culture built on daily communication, teamwork, and strong support among nurses and HUCs. We’re Looking For: • Completion of an accredited or approved program in nursing • Registered Nurse license issued by the state in which the teammate practices • Basic Life Support (BLS) for Healthcare Providers certification issued by the American Heart Association • The ideal candidate will have previous preadmit or surgical services experience. What You’ll Do: • As a skilled and compassionate RN, you will play a pivotal role in providing and coordinating comprehensive patient care through the nursing process to deliver safe, therapeutic care in accordance with established standards, policies, and procedures. • Using evidence-based practice, clinical decision making, compassion, and skills communication while leading efforts to create the safest patient environment and the best patient experience across the continuum. About This Location: Aurora Medical Center - Grafton a 132 bed facility is recognized as a leading destination for healthcare, offering private patient rooms, comfortable family areas, and a comprehensive selection of specialized services. Supported by a team of more than 450 Nurses, Grafton provides thoughtful amenities such as tranquil meditation gardens and a welcoming cafeteria, all designed to enhance comfort and peace of mind. With a strong focus on accessibility and advanced technology, the facility is preparing for a significant expansion, with a new patient tower scheduled to open in 2027. In addition to its core departments, Aurora Medical Center - Grafton delivers exceptional care in cardiovascular health, women’s services, orthopedics, emergency medicine, surgery, and neuroscience. The hospital’s commitment to professional development, state-of-the-art equipment, and diverse campus resources reflects its enduring tradition of compassionate, community-oriented care. Join our Grafton team today for a rewarding future in a supportive growing facility. Ready to Take the Next Step: Apply Now! This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties. Our Commitment to You: Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including: Compensation • Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training • Premium pay such as shift, on call, and more based on a teammate's job • Incentive pay for select positions • Opportunity for annual increases based on performance Benefits and more • Paid Time Off programs • Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability • Flexible Spending Accounts for eligible health care and dependent care expenses • Family benefits such as adoption assistance and paid parental leave • Defined contribution retirement plans with employer match and other financial wellness programs • Educational Assistance Program Note: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview. About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.
Teladoc Health is a global telemedicine and virtual care company that provides remote medical consultations, virtual care services, and digital health solutions.
Join the team leading the next evolution of virtual care. At Teladoc Health, you are empowered to bring your true self to work while helping millions of people live their healthiest lives. Here you will be part of a high-performance culture where colleagues embrace challenges, drive transformative solutions, and create opportunities for growth. Together, we’re transforming how better health happens. Summary Of Position The Nurse - RX Fulfillment (N-RXF) plays an integral part in ensuring superior care of patients treated through Teladoc. The N-RXF will apply professional knowledge in processing prescriptions ordered by Teladoc providers (either via phone or electronically), support Teladoc providers as dictated by established policies and guidelines and provide member support by phone or electronic messages. Essential Duties And Responsibilities • Deliver exceptional service to members, providers, care team members and external facilities representing Teladoc Health in a professional and courteous manner through a variety of communication channels including written, telephone, and video. (50%) • Apply professional knowledge to ensure prescriptions are processed accurately and in a timely manner using established protocols, guidelines, and provider communication • Communicate empathetically with members, using conflict resolution and service recovery skills as needed • Conducts health coaching related to Tobacco Cessation • Maintain detailed and accurate case documentation in the electronic health record • Manage daily assignment to meet department-specific performance metrics by applying clinical knowledge to support members with post-Teladoc visit needs (50%) • Works collaboratively and with appropriate clinical urgency to meet expected turnaround times • Maintain knowledge of Teladoc policies and prescribing guidelines • Analyze complex clinical situations and appropriately provide solutions based on established protocols and policies. • Review laboratory results and use established processes to escalate as needed • Maintain member confidentiality and adhere to all applicable regulations, including HIPAA The time spent on each responsibility reflects an estimate and is subject to change dependent on business needs. Supervisory Responsibilities No Preferred Qualifications • BSN Preferred • Recent experience in the outpatient/urgent care setting preferred • Virtual work experience preferred. • Ability to work independently and as part of a high performing team. • Strong knowledge base of prescription medications • Demonstrated proficiency in mathematics, particularly with medication dosage calculations • Exceptional customer service skills. • Excellent written and verbal communication skills • Bilingual-Spanish Speaking a plus • Strong time management and organizational skills, with ability to effectively manage multiple, competing priorities. • Possess high degree of computer literacy and ability to manage multiple systems including Microsoft software. • Ability to work a flexible schedule including evenings, weekends, and holidays as assigned weekly based on business need. Required License Or Credential Needed To Perform Job • Active RN, BSN or MSN, NP in good standing. • 1-3 years of clinical experience. • Customer service experience in a health care setting. The above qualifications, knowledge, experience, and/or background are expected but not required for this role. The base salary range for this position is $80,000k-$88,000k. In addition to a base salary, this position is eligible for a performance bonus and benefits (subject to eligibility requirements) listed here Teladoc Health Benefits 2026. Total compensation is based on several factors including, but not limited to, type of position, location, education level, work experience, and certifications. This information is applicable for all full-time positions. We follow a Flexible Vacation Policy, intended for rest, relaxation, and personal time. All time off must be approved by your manager prior to use. You will also receive 80 hours of Paid Sick, Safe, and Caregiver Leave annually. This applies to full-time positions only. If you are applying for a part-time role, your recruiter can provide additional details. As part of our hiring process, we verify identity and credentials, conduct interviews (live or video), and screen for fraud or misrepresentation. Applicants who falsify information will be disqualified. Teladoc Health will not sponsor or transfer employment work visas for this position. Applicants must be currently authorized to work in the United States without the need for visa sponsorship now or in the future. Why join Teladoc Health? • Teladoc Health is transforming how better health happens. Learn how when you join us in pursuit of our impactful mission. • Chart your career path with meaningful opportunities that empower you to grow, lead, and make a difference. • Join a multi-faceted community that celebrates each colleague’s unique perspective and is focused on continually improving, each and every day. • Contribute to an innovative culture where fresh ideas are valued as we increase access to care in new ways. • Enjoy an inclusive benefits program centered around you and your family, with tailored programs that address your unique needs. • Explore candidate resources with tips and tricks from Teladoc Health recruiters and learn more about our company culture by exploring #TeamTeladocHealth on LinkedIn. As an Equal Opportunity Employer, we never have and never will discriminate against any job candidate or employee due to age, race, religion, color, ethnicity, national origin, gender, gender identity/expression, sexual orientation, membership in an employee organization, medical condition, family history, genetic information, veteran status, marital status, parental status, or pregnancy). In our innovative and inclusive workplace, we prohibit discrimination and harassment of any kind. Teladoc Health respects your privacy and is committed to maintaining the confidentiality and security of your personal information. In furtherance of your employment relationship with Teladoc Health, we collect personal information responsibly and in accordance with applicable data privacy laws, including but not limited to, the California Consumer Privacy Act (CCPA). Personal information is defined as: Any information or set of information relating to you, including (a) all information that identifies you or could reasonably be used to identify you, and (b) all information that any applicable law treats as personal information. Teladoc Health’s Notice of Privacy Practices for U.S. Employees’ Personal information is available at this link.
CVS Health (Aetna Resources, LLC) is a large healthcare company offering pharmacy services, health insurance and employer-sponsored health programs; they hire clinicians for telehealth, care management and remote member services.
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. Remote Case Manager RN – Costco Team (San Antonio, TX) 100% Remote | Full-Time | Weekday Schedule Join our dedicated Costco Team as a Remote Case Manager RN and make a meaningful impact on members’ health and wellness from the comfort of your home. What You’ll Do As a Case Manager RN, you’ll play a vital role in improving health outcomes by: Assessing member needs and developing personalized care plans Coordinating care and connecting members with appropriate resources Identifying risks and removing barriers to better health Collaborating with multidisciplinary teams to drive positive outcomes Supporting members through telephonic and occasional virtual interactions What We’re Looking For - REQUIRED Active, unrestricted multi-state RN license in the state of residence 3+ years of clinical RN experience Comfort using multiple systems (Microsoft Office and other tools) Ability to work Monday–Friday, 8 AM–5 PM CST (with occasional 10 AM–7 PM rotation) Willingness to obtain additional state licenses (covered by employer) Associate degree in nursing Nice to Have Preference for those living within 45 minutes of San Antonio, TX Integrated case management experience Bilingual (Spanish/English) BSN Why Join Us? Fully remote flexibility Meaningful, patient-focused work Supportive team environment Opportunity to expand licensure at no cost Apply today to help drive healthier outcomes for members nationwide Anticipated Weekly Hours 40 Time Type Full time Pay Range The typical pay range for this role is: $60,522.00 - $129,615.00 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above. Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families. This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility. Additional details about available benefits are provided during the application process and on Benefits Moments. We anticipate the application window for this opening will close on: 06/06/2026 Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws. Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.
Infomedia Group, Inc., dba Carenet Healthcare Services, is a provider of nurse triage, care navigation, and telehealth services supporting healthcare organizations and patients remotely.
A healthcare service provider is seeking a Bilingual Registered Nurse (RN) to work from home. The nurse will conduct telehealth assessments, deliver patient care through phone or online interactions, and document interactions while monitoring performance metrics. Candidates should have a minimum of 3 years of direct patient care experience, an unrestricted RN license in the specified states, and must be bilingual in English and Spanish. An associate's degree in nursing is required, with a preference for a bachelor's degree.
Fira Health is a healthcare organization offering telehealth and remote nursing services, including remote patient monitoring and home health support.
The Telehealth Nurse (RN/LVN) is responsible for providing remote clinical support, patient monitoring, triage, education, and care coordination for home health patients through telehealth and remote patient monitoring (RPM) programs. This role serves as the primary clinical contact for patients enrolled in telehealth services and plays a critical role in early identification of health concerns, intervention, prevention of hospitalizations, and improving patient outcomes. The Telehealth Nurse conducts virtual patient interactions, reviews RPM alerts and vital signs, documents all encounters in the EMR, escalates clinical concerns appropriately, and collaborates closely with field clinicians, physicians, and care coordination teams. Salary $80,000-$95,000 Key Responsibilities Remote Patient Monitoring & Virtual Care • Monitor daily patient biometric data including: • Blood pressure • Pulse oximetry • Weight • Blood glucose • Heart rate • Temperature • Review and respond to RPM alerts in a timely manner based on established clinical protocols. • Conduct scheduled and as-needed telehealth calls/video visits with patients and caregivers. • Identify early signs of clinical deterioration and intervene appropriately. • Provide ongoing chronic disease management support for conditions such as: • CHF • COPD • Diabetes • Hypertension • Post-hospital recovery • Reinforce physician orders, medication compliance, diet, and care plans during telehealth interactions. Patient Triage & Escalation • Perform remote nursing assessments and symptom triage. • Escalate urgent or worsening patient conditions to: • Physicians • Field Clinicians • Clinical managers • Emergency services when appropriate • Coordinate interventions to prevent avoidable ER visits and hospital readmissions. • Document all patient interactions, assessments, and escalations in the EMR. Patient Engagement & Education • Educate patients and caregivers on: • Use of telehealth/RPM equipment • Disease management • Medication adherence • Symptom monitoring • When to seek medical attention • Support patient engagement and encourage compliance with daily monitoring requirements. • Assist patients experiencing technology or connectivity challenges. • Build therapeutic relationships with patients through consistent communication and follow-up. Clinical Coordination • Collaborate with: • Home health nurses • Therapists • Physicians • Branch leadership • Intake and scheduling teams • Communicate significant patient status changes promptly to the care team. • Support continuity of care between hospital discharge and home recovery. • Participate in interdisciplinary case conferences as needed. Documentation & Compliance • Maintain accurate and timely EMR documentation for all telehealth encounters. • Ensure compliance with: • HIPAA regulations • Medicare and Medicaid guidelines • Home health documentation standards • Organizational telehealth policies • Follow established telehealth workflows and escalation protocols. Quality & Performance • Support organizational goals related to: • Reduction in hospital readmissions • Reduce LUPAs • Reduce missed visits • Improved patient satisfaction • Increased patient engagement • Better clinical outcomes • Meet productivity and responsiveness expectations for telehealth encounters and alert management. • Participate in quality improvement initiatives and telehealth program optimization efforts. Qualifications Education • Graduate of an accredited nursing program required. • Associate or Bachelor of Science in Nursing (ASN/BSN) preferred. Licensure/Certifications • Active and unrestricted RN or LVN/LPN license in the applicable state required. • BLS certification required. • Telehealth, case management, or chronic care management certifications preferred. Experience • Minimum 1–3 years of nursing experience required. • Experience in one or more of the following preferred: • Home health • Telehealth • Remote patient monitoring (RPM) • Care management • Chronic disease management • Post-acute care • Familiarity with EMR/EHR systems required. • Knowledge of Medicare home health regulations preferred. Required Skills • Strong clinical assessment and triage skills • Excellent phone and virtual communication skills • Ability to recognize early warning signs of patient decline • Strong documentation and organizational skills • Ability to multitask and manage high call volumes • Comfortable using telehealth platforms and digital health technology • Compassionate and patient-centered communication style KPIs / Performance Metrics • RPM alert response times • Patient call completion rates • Telehealth adherence and patient engagement • Reduction in avoidable hospitalizations/readmissions • Documentation accuracy and timeliness • Patient satisfaction scores • Escalation and intervention effectiveness • Decrease in LUPA rates • Decrease in missed visits • Productivity metrics (daily calls, monitored patients, completed follow-ups) Physical & Work Requirements • Prolonged periods of sitting and computer use. • Ability to work in a fast-paced remote monitoring environment. • May require evening/weekend rotation depending on patient coverage needs. • Remote or hybrid work environment may be available based on organizational needs.
Sutter Health is a not-for-profit, integrated health system based in Northern California that operates hospitals, physician organizations, and other health services across multiple states.
We are so glad you are interested in joining Sutter Health! Position Overview: Aids patients in obtaining the correct level of care with the appropriate provider at the right time. Provides advance clinical telephone support to Sutter Health patients, other callers, in-basket and other remote support for physicians, and limited in-clinic support. Uses the nursing process, input from physicians, and Sutter Health's approved telephone nursing guidelines and protocols to maintain highly efficient operations, to provide quality care, and to ensure positive patient outcomes. Assesses patients' needs, appropriately dispositions cases, collaborates with the clinic and hospital-based providers to renew electronic prescriptions, identifies hospital and community resources, consultations and referrals, and preforms nursing follow-up activities. Clinical support includes assisting physician partners with message management and other communications within the electronic medical record (EMR) system, as well as limited patient care in an outpatient setting. Additional Requirements: DISCLAIMER 1 Applicants must be a resident of one of the following states to be eligible for consideration for this position: Utah, Idaho, Arizona, Arkansas, Louisiana, Tennessee, Missouri, Montana, or South Carolina. DISCLAIMER 2 This is a Work from Home position, therefore internet minimum speeds of 15 mbps download and 5 mbps upload are required. EDUCATION Graduate of an accredited school of nursing CERTIFICATION & LICENSURE RN-Registered Nurse of California (You can submit application without the CA RN license, but must acquire it prior to your start date if selected). RN-Registered Nurse in State of Residence PREFERRED EXPERIENCE AS TYPICALLY ACQUIRED IN: 2 years' experience of practical nursing in a hospital, clinic, urgent care, or emergency room/department 2 years' experience with several specialties and subspecialties. OB/GYN experience preferred. SKILLS AND KNOWLEDGE Professional knowledge of clinical nursing protocols, regulations and institutional standards of care and risk management with an emphasis in the areas of disease processes, emergencies, health sciences and pharmacology. Advanced clinical knowledge of medical diagnoses, procedures, protocols, treatments, and terminology, including a working knowledge of state and federal regulations and guidelines. Solid analytical and project management skills, including the ability to analyze problems, situations, practices, and procedures, reach practical conclusions, recognize alternatives, provide solutions, and institute effective changes. Communication, interpersonal, and interviewing skills, including the ability to build rapport and explain medical lab results or sensitive information clearly and professionally to diverse audiences (patients). Proficient computer skills, including Microsoft Office Suite and experience working electronic medical/health records. Work independently, as well as part of a multidisciplinary team, while demonstrating exceptional attention to detail and organizational skills. Manage multiple priorities/projects simultaneously, sometimes with rapidly changing priorities, while maintaining event/project schedules. Recognize unsafe or emergency situations and respond appropriately and professionally. Ensure the privacy of each patient’s protected health information (phi). Analyze possible solutions using precedents, existing departmental guidelines and policies, experience and good judgment to identify and solve standard problems. Build collaborative relationships with peers, physicians, nurses, administrators, and public to provide the highest quality of patient care. SHIFT: There are 40hr, 32hr, 30hr, and 28hr per week shifts available. PAY: Starting wage is $37.19/hr + shift differential (non-negotiable) for the following states: Arizona, Arkansas, Idaho, Louisiana, Missouri, Montana, and South Carolina. Starting wage is $40.91/hr + shift differential (non-negotiable) for the following states: Colorado, Florida, Georgia, Illinois, Michigan, Minnesota, Nevada, North Carolina, Ohio, Oregon, Pennsylvania, Texas, and Virginia. Job Shift: Varied Schedule: Full Time Shift Hours: 8/10 Blended Days of the Week: Variable Weekend Requirements: Rotating Weekends Benefits: Yes Unions: No Position Status: Non-Exempt Weekly Hours: 40 Employee Status: Regular Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans. Pay Range is $37.19 to $48.71 / hour The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health’s comprehensive total rewards program. Eligible positions also include a comprehensive benefits package. Working at Sutter Health Sutter Health values and supports the unique talents and strengths that each employee brings to our organization. As a result, you are empowered to apply your passion for healing in innovative ways to care for patients and their families.
Crossing Hurdles is a global recruitment consultancy that connects employers with talent; this listing represents a telehealth primary care role placed for a digital healthcare platform.
Crossing Hurdles is a global recruitment consultancy firm that assists our clients to hire best talent. About The Company A fast-growing digital healthcare platform transforming outpatient care by making high-quality medical services simple, fast, and affordable. Led by the founders of a major healthcare venture acquired by a global tech leader, the organization is building the go-to destination for most non-emergency medical needs through clinical excellence and intuitive virtual technology. Position: Telehealth Nurse Practitioner Type: Part-time Compensation: Upto $75/hr Location: Remote (United States) Commitment: 20 hours/week Role Responsibilities • Deliver high-quality virtual care through triage, chat, and video consultations. • Assess and manage patients across a wide range of acuity and clinical complexity. • Coordinate expedited labs, imaging, referrals, and specialist input within the care network. • Utilize modern telehealth platforms to maintain clear, timely, and accurate documentation. • Support and guide clinical workflows, policies, and best practices across teams. • Adapt quickly to new tools, workflows, and next-generation digital health models. Requirements • Background in Family Medicine or Internal Medicine. • Minimum of 6,240 clinical practice hours (equivalent to 3 years full-time experience). • 5–10 years of total experience in Family or Internal Medicine. • 4+ years of telehealth experience. • Active U.S. medical licensure covering at least 40% of the U.S. population, including CA, TX, FL, and NY. • Prior leadership experience overseeing clinical teams, workflows, or policies. • Strong comfort with triage-based decision-making. • Fast learner with digital tools and remote care processes. • U.S.-based candidates only (visa sponsorship not available).
Sutter Health is a not-for-profit healthcare network operating hospitals, medical foundations, and outpatient services, primarily serving communities in California and nearby regions.
We are so glad you are interested in joining Sutter Health! Position Overview: Aids patients in obtaining the correct level of care with the appropriate provider at the right time. Provides advance clinical telephone support to Sutter Health patients, other callers, in-basket and other remote support for physicians, and limited in-clinic support. Uses the nursing process, input from physicians, and Sutter Health's approved telephone nursing guidelines and protocols to maintain highly efficient operations, to provide quality care, and to ensure positive patient outcomes. Assesses patients' needs, appropriately dispositions cases, collaborates with the clinic and hospital-based providers to renew electronic prescriptions, identifies hospital and community resources, consultations and referrals, and preforms nursing follow-up activities. Clinical support includes assisting physician partners with message management and other communications within the electronic medical record (EMR) system, as well as limited patient care in an outpatient setting. Additional Requirements: DISCLAIMER 1 • Applicants must be a resident of one of the following states to be eligible for consideration for this position: Utah, Idaho, Arizona, Arkansas, Louisiana, Tennessee, Missouri, Montana, or South Carolina. DISCLAIMER 2 • This is a Work from Home position, therefore internet minimum speeds of 15 mbps download and 5 mbps upload are required. EDUCATION • Graduate of an accredited school of nursing CERTIFICATION & LICENSURE • RN-Registered Nurse of California (You can submit application without the CA RN license, but must acquire it prior to your start date if selected). • RN-Registered Nurse in State of Residence PREFERRED EXPERIENCE AS TYPICALLY ACQUIRED IN: • 2 years' experience of practical nursing in a hospital, clinic, urgent care, or emergency room/department • 2 years' experience with several specialties and subspecialties. OB/GYN experience preferred. SKILLS AND KNOWLEDGE • Professional knowledge of clinical nursing protocols, regulations and institutional standards of care and risk management with an emphasis in the areas of disease processes, emergencies, health sciences and pharmacology. • Advanced clinical knowledge of medical diagnoses, procedures, protocols, treatments, and terminology, including a working knowledge of state and federal regulations and guidelines. • Solid analytical and project management skills, including the ability to analyze problems, situations, practices, and procedures, reach practical conclusions, recognize alternatives, provide solutions, and institute effective changes. • Communication, interpersonal, and interviewing skills, including the ability to build rapport and explain medical lab results or sensitive information clearly and professionally to diverse audiences (patients). • Proficient computer skills, including Microsoft Office Suite and experience working electronic medical/health records. • Work independently, as well as part of a multidisciplinary team, while demonstrating exceptional attention to detail and organizational skills. • Manage multiple priorities/projects simultaneously, sometimes with rapidly changing priorities, while maintaining event/project schedules. • Recognize unsafe or emergency situations and respond appropriately and professionally. • Ensure the privacy of each patient’s protected health information (phi). • Analyze possible solutions using precedents, existing departmental guidelines and policies, experience and good judgment to identify and solve standard problems. • Build collaborative relationships with peers, physicians, nurses, administrators, and public to provide the highest quality of patient care. SHIFT: • There are 40hr, 32hr, 30hr, and 28hr per week shifts available. PAY: • Starting wage is $37.19/r + shift differential (non-negotiable) Job Shift: Varied Schedule: Full Time Shift Hours: 8/10 Blended Days of the Week: Variable Weekend Requirements: Rotating Weekends Benefits: Yes Unions: No Position Status: Non-Exempt Weekly Hours: 40 Employee Status: Regular Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans. Pay Range is $37.19 to $48.71 / hour The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate’s experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health’s comprehensive total rewards program. Eligible positions also include a comprehensive benefits package.
Health Readiness Resources appears to be a healthcare organization providing remote clinical services focused on medical readiness and health assessments, supporting military and government health programs.
Are you a compassionate and reliable healthcare professional looking to make a meaningful impact? We are seeking licensed Nurse Practitioners (NP/APNP) holding an active U.S. Virgin Islands license to conduct remote health assessments for U.S. military service members. This fully remote position offers total scheduling flexibility, allowing you to choose your own hours while supporting the health, safety, and mission readiness of those who serve. Key Responsibilities: • Conduct telehealth medical evaluations, including Periodic Health Assessments (PHA) and Post-Deployment Health Reassessments (PDHRA). • Review patient medical histories to evaluate overall health and deployment readiness. • Provide clear patient education and communicate medical findings professionally. • Refer complex cases to physicians or Military Treatment Facilities (MTFs) when advanced care is necessary. • Complete accurate, timely, and concise electronic medical documentation for all assessments. • Maintain strict HIPAA compliance, follow SC PHA guidelines, and participate in routine quality audits. Strict Qualifications & Requirements: • Licensure: Active, unrestricted NP/APNP license in the U.S. Virgin Islands (VI). • Insurance: Current, active malpractice insurance meeting or exceeding contract requirements. • Supervision: An active collaborative agreement or supervising physician (MD) already established, as required by local regulations. • Training: Completion of required HIPAA and SC PHA training (available as initial and refresher courses through JKO). • Excellent communication skills and a strong commitment to high-quality patient care. Why Join Us: • 100% Remote: Enjoy the freedom of working completely from home. • Flexible Schedule: Set a workday routine that fits your lifestyle. • Mission-Driven: Directly contribute to the health and readiness of U.S. military personnel. Job Types: Part-time, Contract Pay: $30.00 - $90.00 per hour Benefits: • Flexible schedule Experience: • Nurse Practitioner: 1 year (Required) License/Certification: • Virgin Islands (Required) • Malpractice Insurance (Required) • Supervising Physician (Preferred) Work Location: Remote
HealthEdge is on a mission to drive a digital transformation in healthcare. We’re connecting health plans, providers, and patients with end-to-end digital technology solutions to support new business models, reduce administrative costs and improve health outcomes. Our growing portfolio of products (HealthRules® Payer, HealthEdge Source™, HealthEdge® Provider Data Management, GuidingCare®, and Wellframe™) provides talented and passionate professionals with opportunities to lead change and make a lasting, global impact in healthcare. Driving our mission are 2,000+ professionals worldwide. Together, we are committed to innovating a world where healthcare can focus on people.
In this role you should independently be able to effectively and efficiently process the transactions assigned in a timely manner, clarify complex transactions to others and ensure that quality of output and accuracy of information is maintained, in alignment with SLAs. Geographic Responsibility: Remote, US Type of Employment: Full-time, permanent FLSA Classification (USA Only): Exempt
EDUCATION: Bachelor’s degree in nursing, allied health, business, or related field preferred. Registered Nurse with current unrestricted Registered Nurse license required. Certification in Case Management may be preferred based upon designated department assignment. EXPERIENCE: Minimum two (2) years of clinical experience which may include acute patient care, discharge planning, case management, and utilization review, etc. Demonstrated clinical knowledge and experience relative to patient care and health care delivery processes. One (1) year health insurance plan experience or managed care environment preferred. SKILLS/KNOWLEDGE/ABILITIES (SKA) REQUIRED: Unrestricted USRN mainland license At least 2 years experience in utilization management / review Demonstrated clinical knowledge and experience relative to patient care and healthcare delivery processes. Medicare Advantage experience an advantage Excellent written and verbal communication skills. Excellent customer service and interpersonal skills. Working knowledge of current industry Microsoft Office Suite PC applications. Ability to apply clinical criteria/guidelines for medical necessity, setting/level of care, and concurrent patient management Knowledge of current standard medical procedures/practices and their application as well as current trends and developments in medicine and nursing, alternative care settings, and levels of service Knowledge of applicable accreditation standards, and local, state, and federal regulations Appeals and grievance experience required. Strong problem-solving skills, facilitation skills, and analytical skills. Work Environment: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job: The employee is occasionally required to move around the office. Specific vision abilities required by this job include close vision, color vision, peripheral vision, depth perception, and ability to adjust focus. Work across multiple time zones in a hybrid or remote work environment. Long periods of time sitting and/or standing in front of a computer using video technology. May require travel dependent on company needs.
Investigate and process complex grievances and appeals requests from members and providers Perform reviews of inpatient, outpatient, ambulatory and ancillary services for medical necessity Review, research, and prepare documentation related to appeals and grievances in accordance with local, state, and federal regulatory and designated accreditation (e.g., NCQA) standards Prepare recommendations to either uphold or deny appeal and work with the Medical Director for further review Document and logs appeal/grievance information on relevant tracking systems Generate written correspondence to providers, members, and regulatory entities Serve as a subject matter expert for appeals, grievances, and quality of care issues Utilize leadership skills Assist with or perform other relevant essential functions as required This position description identifies the responsibilities and tasks typically associated with the performance of the position. Other relevant essential functions may be required.
Prolific is not just another player in the AI space – we are building the biggest pool of quality human data in the world. Over 35,000 AI developers, researchers, and organizations use Prolific to gather data from paid study participants with a wide variety of experiences, knowledge, and skills.
We’re looking for Registered Nurses to help train and evaluate cutting-edge AI models. If you have the necessary experience, we’ll send you a quick test to assess your skills and suitability for AI tasks. If successful, you’ll be invited to join Prolific as a Domain Expert participant, where you’ll get paid to train and evaluate powerful AI models. Researchers looking for your skills tend to pay $80-$150p/h per AI task completed. You must be prepared to complete paid tasks that require one hour of uninterrupted work, though many are shorter.
Verified status as a registered nurse (e.g., current license/registration in good standing; board certification or equivalent where applicable) Recent clinical experience and comfort evaluating clinical reasoning and decision-making Willingness to complete a short skills/eligibility screener to join our Domain Expert pool Strong attention to detail and the ability to focus on complex tasks for up to one hour A reliable, fast internet connection and access to a computer Willingness to self-declare earnings (participants are self-employed) A PayPal account to receive payments from our clients
Reviewing AI-generated responses to clinical scenarios and rating them for accuracy, clinical appropriateness, safety, and reasoning quality Comparing multiple model answers and selecting/justifying the best response Writing improved exemplars, rationales, or structured feedback to help models learn where they fall short
Call 4 Health is a leading medical call center and nurse triage service with a genuine understanding of the patient’s perspective. Delivering compassionate commitment with quality medical solutions to our clients since 1997, Call 4 Health has a keen understanding of what it is like to face trauma and has developed a sound system to seamlessly balance professionalism with compassion. Our altruistic approach places patients and their families first by using state-of- the-art technology and compassionate training initiatives. Call 4 Health is always ready with real solutions consistent with the needs of both the client and the patient.
We are seeking experienced Registered Nurses with an active Compact State RN License plus multiple state licenses. Candidates with active IL, MA, NY, MN, and DC licenses are highly preferred. Additional active licenses in CA, NV, OR, AK, CT, and MI are required. Applicants must have open availability and flexibility to work days, nights, weekends, and rotating schedules based on business needs. Job Summary: The Registered Nurse (RN) will play a crucial role as a physician extender within the healthcare team, operating in a remote capacity. In this role, the RN will support providers by efficiently managing Electronic Health Records (EHR), addressing patient inquiries, and delivering clinical guidance to ensure optimal patient care. This position involves responding to calls for a multi-state nurse triage telephone service, managing inbound and outbound patient calls, triaging patient needs, conducting follow-ups, and facilitating effective communication among healthcare professionals and patients, ultimately enhancing patient outcomes and team effectiveness.
Education and/or Experience: Bachelor’s or Associate’s Degree in Nursing. Minimum of 2-4 years of full-time clinical experience as a Registered Nurse, preferably in areas such as ER/Urgent Care, Adult, Pediatric, OB/GYN, Orthopedic, Ambulatory Care, Home Health, or ICU. Previous telephone triage experience using electronic triage systems and at least two Bachelor’s or Associate’s Degree in Nursing. Minimum of 2-4 years of full-time clinical experience as a Registered Nurse, preferably in areas such as ER/Urgent Care, Adult, Pediatric, OB/GYN, Orthopedic, Ambulatory Care, Home Health, or ICU. Previous telephone triage experience using electronic triage systems and at least two Qualifications & Skills: We are committed to providing our employees with the support they need. At Call 4 Health, we offer eligible employees an attractive benefit package that includes medical, wellbeing, dental and vision benefits along with some unique benefits including: Teamwork: Demonstrated ability to collaborate effectively with peers, cross-functional teams, and leadership. Leadership: Proactive in stepping up to lead, when necessary, capable of motivating colleagues, and sharing knowledge for the enhancement of team performance. Customer Service: Exceptional empathy, patience, and active listening skills to understand and address patient needs effectively. Quality: Strong attention to detail in charting, utilizing correct grammar, spelling, and medical terminology to ensure complete and accurate patient documentation. Organization and Time Management: Highly organized, capable of handling and documenting at least four calls per hour during peak times Physical Requirements: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The employee must be able to sit for extended periods, talk, and engage in active listening without visual contact with patients. Occasional standing and the use of hands for operating office equipment are required, with infrequent stooping, kneeling, or crouching. Ability to hear in normal range and wear a headset/ earpiece Good visual acuity to read computer screens, scripts, forms etc. Able to work remotely at home in a private HIPAA compliant workspace Able to house company equipment needed to perform job Broadband Internet Access Participation (via telephone or video) in staff meetings Work Environment Able to thrive in a fast-paced environment. Demonstrated capability to maintain professional relationships with diverse personalities. Must be flexible and adaptable to change, managing stress effectively. May require occasional overtime or adjusted start times.
The following duties and responsibilities reflect the expectations of this position but are not all-inclusive. Track and respond to calls for a multi-state nurse triage telephone service, receiving inbound calls from patients and placing outbound calls, while utilizing Schmitt-Thompson telephone triage protocols to document patient interactions effectively within clients’ EHR and/or a Call 4 Health platform. Provide clinical assessment based on established protocols and triage patients by phone or through patient portal. Provide administrative support and perform clinical tasks such as medication prescription refills per established protocols, notifying providers of critical results, and coordinating follow-up care post-discharge or post-operative. Facilitate referrals and collaborate on addressing prior authorization requests that require clinical consultation, while also assisting with requests from other agencies such as hospitals, nursing homes, funeral homes, and Departments of Labor or Motor Vehicles. Participate in Remote Patient Monitoring (RPM) initiatives by tracking patients' vital signs and delivering education on managing chronic diseases such as diabetes, hypertension, and COPD. Screen and qualify patients for clinical trials. Perform follow-ups and patient education. Carry out additional responsibilities as needed to assist the healthcare team and enhance the delivery of patient care.
Call 4 Health is a leading medical call center and nurse triage service with a genuine understanding of the patient’s perspective. Delivering compassionate commitment with quality medical solutions to our clients since 1997, Call 4 Health has a keen understanding of what it is like to face trauma and has developed a sound system to seamlessly balance professionalism with compassion. Our altruistic approach places patients and their families first by using state-of- the-art technology and compassionate training initiatives. Call 4 Health is always ready with real solutions consistent with the needs of both the client and the patient.
The Nurse Manager at Call 4 Health provides clinical and operational leadership for a high-volume, fully remote Nurse Triage call center. This role is accountable for driving workforce efficiency, schedule adherence, service-level performance, and clinical quality while leading and developing a distributed team of Registered Nurses. The ideal candidate brings deep experience partnering with Workforce Management (WFM), leveraging Calabrio for forecasting, scheduling, real-time monitoring, and performance analysis, and balancing clinical excellence with operational metrics in a telehealth environment. This position works closely with internal stakeholders and client partners to ensure seamless, compliant, and patient-centered service delivery.
Education & Experience Education: BSN required; MSN or MHA preferred Licensure: Active, unrestricted RN license (Compact required) Experience: Minimum 5 years of nurse triage experience At least 2–3 years in a Nurse Manager or call center leadership role Demonstrated experience working with Workforce Management teams and Calabrio in a contact center or telehealth environment Required Qualifications Calabrio Experience: Hands-on experience using Calabrio for forecasting, scheduling, real-time monitoring, adherence tracking, and performance reporting. Workforce Management Partnership: Proven success collaborating with WFM to optimize staffing, reduce shrink, and maintain service levels. AWS Experience Call Center Leadership: Experience leading clinical teams in a high-volume, metrics-driven environment. Data-Driven Decision Making: Ability to translate workforce and QA data into actionable coaching and operational improvements. Remote Leadership: Strong ability to manage, motivate, and hold teams accountable in a fully remote setting. Nice-to-Have Experience supporting 24/7 or after-hours triage operations Multi-client or multi-state telehealth program leadership Advanced QA calibration or clinical coaching program ownership
Workforce Management & Call Center Operations: Partner closely with Workforce Management (WFM) to manage forecasting, scheduling, coverage planning, shrink, and real-time staffing adjustments using Calabrio. Monitor and analyze service-level performance, queue activity, occupancy, adherence, and productivity to ensure SLAs and KPIs are consistently met. Use Calabrio dashboards and reports to identify trends, risks, and opportunities; proactively implement corrective actions. Lead real-time operational decision-making in collaboration with WFM to address call volume fluctuations, absenteeism, and intraday staffing challenges. Ensure operational workflows support safe, efficient nurse triage while maintaining regulatory and client requirements. Staff Leadership & Performance Management: Lead, coach, and develop approximately 30 RN direct reports in a remote call center environment. Drive accountability for schedule adherence, attendance, productivity, and quality metrics. Conduct performance evaluations informed by Calabrio data, QA findings, and operational reports. Partner with QA and Training to implement targeted coaching plans based on performance and trend analysis. Foster a culture of ownership, transparency, and continuous improvement. Clinical Quality & Patient Safety: Ensure adherence to triage protocols, escalation pathways, and clinical documentation standards. Support QA calibration, call monitoring, and chart audits to maintain clinical excellence and compliance. Address escalations and patient concerns promptly while maintaining professional and compassionate communication. Ensure compliance with HIPAA and all applicable state and federal regulations. Collaboration & Reporting: Act as a key liaison between Operations, Workforce Management, QA, IT, Training, and client stakeholders. Prepare and present operational and workforce performance reports, including adherence, SLA attainment, staffing efficiency, and quality outcomes. Participate in strategic planning, workflow optimization, and operational improvement initiatives.
Call 4 Health is a leading medical call center and nurse triage service with a genuine understanding of the patient’s perspective. Delivering compassionate commitment with quality medical solutions to our clients since 1997, Call 4 Health has a keen understanding of what it is like to face trauma and has developed a sound system to seamlessly balance professionalism with compassion. Our altruistic approach places patients and their families first by using state-of- the-art technology and compassionate training initiatives. Call 4 Health is always ready with real solutions consistent with the needs of both the client and the patient.
The Registered Nurse (RN) plays a critical role as a physician extender within a remote healthcare team. In this position, the RN supports providers by efficiently managing Electronic Health Records (EHR), responding to patient inquiries, and delivering timely clinical guidance to promote high-quality patient care. This role includes responding to calls for a multi-state nurse triage telephone service, managing inbound and outbound patient communications, assessing and triaging patient needs, conducting follow-up outreach, and facilitating effective communication between patients and healthcare professionals. The RN contributes directly to improved patient outcomes and overall team effectiveness.
Education and Experience: Associate’s or Bachelor’s Degree in Nursing. Minimum of 2–4 years of full-time clinical experience as a Registered Nurse, preferably in areas such as Emergency Room/Urgent Care, Adult or Pediatric Care, OB/GYN, Orthopedics, Ambulatory Care, Home Health, or ICU. Prior telephone triage experience using electronic triage systems and experience with at least two different Electronic Health Record (EHR) platforms. Active, unencumbered Enhanced Nurse Licensure Compact (eNLC) license required. Additional non-compact state licensure is considered an asset. Candidates must be willing to obtain additional state licenses as requested by the company. Qualifications and Skills Teamwork: Proven ability to collaborate effectively with peers, cross-functional teams, and leadership. Leadership: Willingness to step into leadership when needed, motivate colleagues, and share knowledge to enhance team performance. Customer Service: Strong empathy, patience, and active listening skills to effectively address patient needs. Quality and Accuracy: Excellent attention to detail in documentation, including correct grammar, spelling, and medical terminology. Organization and Time Management: Highly organized, with the ability to manage and accurately document a minimum of four calls per hour during peak times. Physical Requirements: The physical demands described below are representative of those required to successfully perform the essential functions of this role. Reasonable accommodations may be made for individuals with disabilities. Ability to sit for extended periods while speaking and actively listening without visual contact with patients. Occasional standing and use of hands for operating office equipment; infrequent stooping, kneeling, or crouching. Ability to hear within normal range and comfortably wear a headset or earpiece. Adequate visual acuity to read computer screens, scripts, and forms. Ability to work remotely from a private, HIPAA-compliant home workspace. Ability to house company-provided equipment necessary for job performance. Reliable broadband internet access. Ability to participate in staff meetings via telephone or video. Work Environment: Ability to thrive in a fast-paced, remote environment. Demonstrated capability to maintain professional relationships with diverse personalities. Flexibility and adaptability to change, with effective stress-management skills. May require occasional overtime or adjusted start times based on operational needs.
The duties and responsibilities outlined below represent the general expectations of the role but are not all-inclusive. Track and respond to calls for a multi-state nurse triage telephone service, including receiving inbound patient calls and placing outbound calls, while utilizing Schmitt-Thompson telephone triage protocols to accurately document patient interactions within client EHR systems and/or the Call 4 Health platform. Provide clinical assessments based on established protocols and triage patients via telephone or patient portals. Perform administrative and clinical support tasks, including medication prescription refills per established protocols, notifying providers of critical results, and coordinating follow-up care after hospital discharge or surgical procedures. Facilitate referrals and collaborate on prior authorization requests requiring clinical consultation. Assist with inquiries from external agencies such as hospitals, nursing homes, funeral homes, and Departments of Labor or Motor Vehicles. Participate in Remote Patient Monitoring (RPM) programs by reviewing patient vital signs and providing education related to chronic disease management, including diabetes, hypertension, and COPD. Screen and qualify patients for clinical trials, conduct follow-up outreach, and provide patient education as required. Perform additional duties as assigned to support the healthcare team and enhance patient care delivery.
Call 4 Health is a leading medical call center and nurse triage service with a genuine understanding of the patient’s perspective. Delivering compassionate commitment with quality medical solutions to our clients since 1997, Call 4 Health has a keen understanding of what it is like to face trauma and has developed a sound system to seamlessly balance professionalism with compassion. Our altruistic approach places patients and their families first by using state-of- the-art technology and compassionate training initiatives. Call 4 Health is always ready with real solutions consistent with the needs of both the client and the patient.
The Licensed Practical Nurse (LPN) will play a crucial role within the Call4Health care team, operating in a remote capacity. In this role, LPN will support Call4Health clients by efficiently managing Electronic Health Records (EHR) and patient portals. In addition, the LPN will provide patient education, troubleshoot Remote Patient Monitoring (RPM) equipment and results, counsel patients with chronic diseases, follow up with patients in between provider visits, and refill medications per protocol. The LPN will follow established protocols in order to facilitate effective communication among healthcare professionals and patients, ultimately enhancing patient outcomes and relieving provider stress.
Education and/or Experience Licensed Practical Nurse 5+ years of full-time clinical experience as an LPN, particularly in primary care for adult, pediatric and geriatric patients. Experience in OB/GYN, Orthopedic, Ambulatory Care or Home Health are also Experience using at least two electronic health record (EHR) systems is required An active unencumbered e-NCL or Enhanced Nurse Licensure Compact license, additional non-compact state licensure would be considered an asset; candidates should also be willing to obtain additional licenses at the company’s request. Qualifications & Skills Teamwork: Demonstrated ability to collaborate effectively with peers, cross-functional teams, and client Leadership: Proactive in stepping up to lead, when necessary, capable of motivating colleagues, helping to troubleshoot problems and sharing knowledge for the enhancement of team Customer Service: Exceptional empathy, patience, and active listening skills to understand and address patient needs Quality: Strong attention to detail in charting, utilizing correct grammar, spelling, and medical terminology to ensure complete and accurate patient Organization & Time Management: Highly organized, capable of handling and documenting tasks, delegating to others where possible, and providing thorough communications to providers, patients and staff. Physical Requirements The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The employee must be able to sit for extended periods, talk, and engage in active listening without visual contact with Occasional standing and the use of hands for operating office equipment are required, with infrequent stooping, kneeling, or Ability to hear in normal range and wear a headset/ earpiece Good visual acuity to read computer screens, scripts, forms Able to work remotely at home in a private HIPAA compliant workspace Able to house company equipment needed to perform job Broadband Internet Access Participation (via telephone or video) in staff meetings Able to thrive in a fast-paced Demonstrated capability to maintain professional relationships with diverse Must be flexible and adaptable to change, managing stress May require occasional overtime or adjusted starting Experience Required 2 years: Primary Care Experience 5 years: Full Time Clinical Experience as an LPN
The following duties and responsibilities reflect the expectations of this position but are not all- inclusive. Monitor Physician EHR inboxes and patient portal requests and perform tasks within LPN scope of practice, and respond to patient inquiries according to established protocols. Refill prescription requests by established protocols, notify providers and ensure patient care tasks are completed for critical results, and coordinate follow-up care post-discharge or post-operative. Facilitate referrals and collaborate on addressing prior authorization requests that require clinical consultation, while also assisting with requests from other agencies such as hospitals, Public Health departments, nursing homes, funeral homes, and Departments of Labor or Motor Manage Remote Patient Monitoring (RPM) results by tracking patients' real-time disease results and delivering education on managing chronic diseases such as diabetes, hypertension, and COPD. Medically screen and qualify patients for clinical trials. Perform follow-ups and patient education. Carry out additional responsibilities as needed to assist the healthcare team and enhance the delivery of patient
Onco360 is a unique Oncology Pharmacy model created to serve the needs of community, oncology and hematology physicians, patients, payers, and manufacturers. Our Onco360 Pharmacy in Louisville, KY has a need for a Oncology Nurse Navigator to join our growing team! The hours for this position will be 11:30-8 EST M-F. This position is remote but you must live within commutable distance to our pharmacy location in Louisville, KY.
Starting salary of $72K and above The Oncology Nurse Navigator is a nursing professional who specializes in caring for people with cancer. This position will provide professional services to Oncology patients in a manner that maximizes quality and patient safety. This position is responsible for helping to coordinate the many aspects of care throughout the patient’s cancer treatment. They will manage and counsel patients and follow set policies and procedures that are established for Onco360 pharmacies.
Education/Learning Experience Required: Bachelors of Science in Nursing Desired: 1+ years’ experience in oncology Work Experience Required: 1+ years in a healthcare setting Desired: 1+ years in specialty pharmacy setting Skills/Knowledge Required: compassion, good communication skills, critical thinking, adaptability, attention to detail Desired: clinical and/or case management experience Licenses/Certifications Required: Current license as registered nurse Desired: ONCC or ONS certification Behavior Competencies Required: compassionate, outgoing and energetic attitude, multi-tasking ability, good listening skills
Communicate with patients helping them understand the disease, treatment plan and possible side effects. Provides medication therapy management. Assist health care providers and patients, greeting them by phone, answering questions and requests. Review medical and health history of patients. Communicates with patients and physician’s office staff. Complies with professional practice and patient confidentiality laws. Document any adverse drug reactions according to manufacturer guidelines. Informs pharmacy manager of medication errors. Documents all communication with physicians, or other healthcare providers. Follow up with patients and providers to monitor progress towards meeting drug treatment goals.
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 growing nationwide telehealth organization is hiring Nurse Practitioners to provide virtual women’s health and primary care for adult patients across the U.S. This fully remote position offers structured hours, clinical autonomy, and strong professional support, ideal for providers who value balance, flexibility, and purpose-driven care. Whether you’re an experienced NP or looking to expand your telehealth experience, this is an opportunity to make an impact through modern, patient-first care—without leaving home.
Active NP license in at least one U.S. state (multi-state licenses preferred) FNP, WHNP, or ANP certification required Excellent communication and EMR documentation skills Comfortable practicing independently in a telehealth environment
Conduct telehealth visits for women’s health, wellness, and midlife care Manage hormonal and lifestyle-related health needs using evidence-based guidelines Provide education and personalized treatment options for every patient Collaborate with a supportive, nationwide clinical team Participate in continuous training and clinical development
Precision Financials is committed to fostering financial freedom by equipping individuals with essential financial literacy skills and knowledge. Our mission is to empower professionals to take control of their financial future and achieve their personal and professional goals. We offer educational tools and guidance to cultivate confidence and expertise in financial decision-making. At Precision Financials, we are a team of driven financial professionals dedicated to empowering individuals and families through financial education and leadership. We believe that financial literacy is the cornerstone of true financial independence—and our mission is to equip our clients with the knowledge, tools, and confidence they need to take control of their financial future
This remote role is designed for licensed healthcare professionals such as Registered Nurses (RN), Nurse Practitioners (NP), or Respiratory Care Practitioners (RCP) who are interested in expanding their expertise to include financial literacy and planning. The Financial Professional will work with clients to educate, develop personalized financial plans, and provide insights into financial processes. Work From Home Opportunity — Ideal for Nurses (LPNs, RNs, NPs), and Respiratory Therapists (RCP) Founded by an ER RN | Helping People Beyond the Bedside 100% Remote | Work from Anywhere with Wi-Fi Flexible Schedule | Part-Time or Full-Time High Income Potential | Full Training Provided Are you a Registered Nurse, Nurse Practitioner, or Respiratory Care Practitioner who’s passionate about helping people—but seeking a career that offers more freedom, less burnout, and long-term financial stability? You’re not alone. Many healthcare professionals are discovering a new way to serve others—without sacrificing their own health, time, or family life. This opportunity was founded by a career Emergency Room RN who spent years on the frontlines, and now empowers nurses and other purpose-driven professionals to transition from bedside care to financial care. About the Role: Financial Professional (No Experience Required) As a licensed Financial Professional, you'll educate families, individuals, and small business owners on how to protect and build wealth through services such as: Life Insurance with Living Benefits Retirement Planning (401k rollovers, indexed accounts, annuities) College Savings Plans Business Protection Strategies You’ll receive full training, licensing support, mentorship, and ongoing professional development—even if you have no prior experience in finance or business. Why Nurses and Healthcare Professionals Thrive in This Role Healthcare providers naturally excel in financial services because the skills that make you great in healthcare—empathy, problem-solving, and the ability to educate—are exactly what’s needed here: You’re used to making complex topics understandable You know how to build trust and listen deeply You care about helping others plan for the “what ifs” in life You want work that aligns with your values but fits your life This is a commission-based (1099) opportunity. It’s ideal for nurses, respiratory therapists, and healthcare professionals who are ready to build a meaningful new career—helping others plan, protect, and thrive financially. We're looking for individuals ready to invest in their future and create lasting impact If you’re ready to shift from healthcare to wealthcare—and still change lives—apply today and discover how to help others without the burnout
Basic Qualifications: Able to pass a background check Live in and eligible to work in the United States including Puerto Rico Willing to obtain a state financial license (we support you) Professional, ethical, and strong communication skills Working in a remote setting Accept a background check Authorized to work in the United States
Day-to-day responsibilities include guiding financial decision-making, educating families, and ensuring clients are informed and confident in achieving their financial goals.
Join Silverado Hospice CA Regional and be part of a nationally recognized team ranked in the top 10 nationwide by Fortune Magazine’s Best Workplaces in Aging Services™. Since 1997, Silverado has been delivering exceptional care to individuals with neurodegenerative conditions and those facing life-limiting illnesses through our Hospice services. We’re a certified Great Place to Work® and proud to offer competitive pay, benefits, and growth opportunities.
We’re hiring a Regional Triage Nurse (RN) – a skilled and compassionate professional who provides telephonic triage, clinical oversight, and coordination of after-hours care across multiple hospice sites. This role is essential to ensuring timely, high-quality care for patients and families during critical moments. Be a Difference-Maker with a Hospice Care Leader You lead with clinical expertise, empathy, and strong communication skills. You thrive in a mission-driven environment and are passionate about supporting patients and families while ensuring smooth coordination of care. Schedule: Monday - Friday 5:00pm - 12:00am, Saturday and Sunday
Active RN licenses in good standing in both California and Texas Minimum of 1 year RN experience, including at least 1 year in end-of-life care Certification as a Hospice and Palliative Nurse (CHPNA) preferred but not required Must clear criminal background check, physical, and drug screening Valid driver’s license, good driving record, and reliable transportation required Willingness to travel to patient locations as needed Ability to work outside regular hours depending on business needs
Oversee and assign on-call/after-hours RN runners for supported hospice sites Provide telephonic assessments and implement appropriate interventions based on patient’s terminal diagnosis and reported symptoms Collaborate with attending physicians, Medical Directors, and interdisciplinary hospice teams Utilize EMR systems (HCHB workflow) as assigned Act as liaison with patients, families, and healthcare professionals while maintaining confidentiality and dignity
At Strive Health, patients come first. We’re on a mission to transform chronic conditions by identifying risk earlier, coordinating thoughtful care, and supporting people through every stage of their health journey. Our work reduces emergency visits, improves outcomes, and helps patients live fuller lives. You’ll work alongside passionate Strivers who care deeply about making an impact, show up for one another as One Team, and find ways to elevate the everyday. If you’re looking for meaningful work where your contributions truly matter, you’ll feel right at home at Strive! Benefits & Perks Hybrid-Remote Flexibility – Work from home while fulfilling in-person needs at the office, clinic, or patient home visits. Comprehensive Benefits – Medical, dental, and vision insurance, employee assistance programs, employer-paid and voluntary life and disability insurance, plus health and flexible spending accounts. Financial & Retirement Support – Competitive compensation with a performance-based bonus program, 401k with employer match, and financial wellness resources. Time Off & Leave – Paid holidays, vacation time, sick time, and paid birthgiving, bonding, sabbatical, and living donor leaves. Wellness & Growth – Family forming services through Maven Maternity at no cost and physical wellness perks, mental health support, and an annual professional development stipend.
As the Clinical Quality Auditor, you will be responsible for completing quality review processes for care management and care delivery programs. This role is responsible for ensuring appropriate clinical and care delivery practices are utilized and case documentation meets established standards consistently to support meeting internal and external quality standards, compliance, and expectations. As an auditor, you will utilize clinical experience, expertise, and quality guidelines to review patient files, care plans and interactions and care plans against appropriate applicable quality criteria in conjunction with program, accreditation and industry requirements. You will support various Kidney Hero roles (clinical and non-clinical) regarding case auditing, outcomes and coaching, quality improvement strategies, resource development and other activities to promote continuous quality improvement. This quality improvement support will be provided to operational managers and leadership to communicate and facilitate resolution for quality risks, such as root cause analysis and remediation recommendations. As a quality auditor, you will serve as a quality liaison and advisor to various Strive roles and departments such as kidney heroes, operational leadership and managers, education and training colleagues. You will serve as a care manager and quality subject matter expert, applying critical thinking and decision-making skills to determine medical appropriateness while maintaining production goals and Quality Assurance standards. This role reports to the Sr. Manager, Clinical Quality Performance.
Minimum Qualifications: Active, unrestricted NP license. 6+ years combined of related education, experience, or certification. Internet Connectivity - Min Speeds: 3.8Mbps/3.0Mbps (up/down): Latency Ability to travel and be onsite to meet business needs. Preferred Qualifications: Application of NCQA program(s) accreditation standards and processes experience. Experience in GDMT protocols along with knowledge of proper care of patients with multiple complex medical conditions. Familiar with documentation and coding standards for HCC and HEDIS. NCQA Accreditation Survey experience or other industry related audits. Proficiency in Microsoft Office, Adobe Acrobat and internet/web navigation. Case Management Certification. Knowledge of the organization of medical records, medical terminology, and disease process. About You: Strong clinical assessment and critical thinking skills. Attention to excellence - quality driven, detailed oriented, innovative, and accountable. Excellent verbal and written communication skills. Ability to work in a team environment. Flexibility and strong organizational skills needed.
Review clinical documentation and encounters (assessments/surveys, plans of care, recorded encounters) to ensure alignment with clinical guidelines, NCQA standards, and industry best practices. Meet auditing productivity targets (daily/weekly/monthly) while maintaining quality assurance standards. Validate timeliness and accuracy of internal assessments and plans of care against NCQA Case Management and Population Health requirements. Communicate audit findings and provide coaching/education to Kidney Heroes and clinical leaders, clearly documenting deficiencies and improvement opportunities. Develop and maintain audit tools and resources by supporting updates to processes, templates, and guidance materials. Identify, support resolution, and escalate risks/gaps impacting quality, compliance, safety, or accreditation readiness. Flag system or operational barriers that impede attainment of quality performance standards and recommend improvements. Accurately abstract and submit audit documentation using designated tools and route required materials to appropriate stakeholders. Support compliance and accreditation activities (case prep/review, action plans) while maintaining HIPAA confidentiality and professionalism.
At Alight, we believe a company’s success starts with its people. At our core, we Champion People, help our colleagues Grow with Purpose and true to our name we encourage colleagues to “Be Alight.” We are passionate about connecting purpose with impact. Alight empowers clients to build a healthier and more financially secure workforce by unifying the benefits ecosystem across health, wealth, wellbeing, navigation, and absence management. Our Benefits With a comprehensive total rewards package, Alight offers programs and plans that support your mind, body, wallet, and life. Benefits include health, dental and vision coverages starting Day One. Additionally, Alight colleagues enjoy wellbeing programs, retirement plans with contribution matching, generous time off, parental leave, continuing education, and career growth opportunities – all within a thriving global organization. Flexible Working So that you can be your best at work and home, we consider flexible working arrangements wherever possible. Alight has been a leader in the flexible workspace and “Top 100 Company for Remote Jobs” 6 years in a row. Great Place to Work Thanks to the work of every colleague, Alight has received multiple awards of recognition including “Great Place to Work” for the past 7 years and Fortune’s “Best Companies to Work For.” To learn more about our company culture and awards Click Here. If you, Champion People, seek to Grow with Purpose, and embody the meaning of Be Alight – We invite you to join our team! Learn more at careers.alight.com .
The Clinical Case Manager-RN will offer clinical expertise, act as a liaison in disability cases, and utilize MDGuidelines to support medically sound decisions. They will ensure effective administration of absence and disability claims while delivering compassionate care to client employees.
Be a Registered Nurse, Nurse Practitioner, or comparable license with experience, with working knowledge of disability, client processes, and case management. Have minimum of 5 years medical advisory experience in occupational health, worker compensation, disability, health case management, or utilization review. Have minimum of 2 years' experience as a Clinical Case Manager. Demonstrate dedication to providing high quality customer service, using diplomacy, patient advocacy, and professional competency. Foster interest in collaborating with compassionate clinicians and leaders who prioritize mutual care and the well-being of customers and employees. Have relevant education and valid licensure.
Serving as primary resource on team managing medical disability and accommodation cases. Delivering case presentations to a panel, utilizing compelling communication, critical thinking, negotiation, holistic case analysis, and proactive case management skills. Displaying a professional/corporate presence and presentation style with the ability to demonstrate excellent problem-solving skills when questioned on your case management plans. Consulting on medical, behavioral health, and accommodation claims as needed, if within the scope of licensure and clinical expertise. Supporting employee-clients in making informed decisions through patient advocacy aligned with Medical Disability Guidelines (MDG), employer benefit plans, and disability management regulations. Acting as a liaison between all parties required in case management to facilitate continuous communication and consensus. Serving as a liaison to the client's EAP, coordinate care, and encourage referrals to top behavioral health providers. Providing documentation, feedback, and reports to diverse occupational populations with an underlying emphasis on returning medically able individuals to productive endeavor. Managing caseload efficiently, organizing priorities, provides timely interventions, and maintains sensitivity to confidential records. Driving return to work process from beginning of case to closure. Ensuring quality standards for case management are met; implement Alight’s continuous quality improvement process whenever efficiencies or quality standards are not met.
Verita AI builds high-trust data pipelines that enable AI systems to understand real-world workflows across healthcare, finance, and operations. We work with domain experts to help frontier AI systems reason through complex operational tasks the same way experienced professionals do in practice. Our founding team includes alumni of Mercor, Hudson River Trading, Citadel, IDEO, Stanford, and Yale. We partner with leading AI labs and researchers advancing the next generation of intelligent systems.
We are hiring Utilization Review and Case Management Nurses with Epic EHR experience to help train and evaluate advanced AI systems on real-world patient review and care coordination workflows. This role focuses on medical necessity review, level of care evaluations, payer authorization processes, discharge planning coordination, and patient chart analysis. You will help AI systems better understand how utilization management and care coordination workflows function inside modern healthcare environments. Hourly Rate: $108/hr
Requirements: 2–6+ years of professional Epic EHR experience in utilization review, case management, or clinical operations RN background with experience reviewing patient care workflows and payer authorization processes Strong familiarity with medical necessity review and level of care decision-making Ability to navigate patient charts, clinical notes, and healthcare documentation workflows accurately Strong written communication and operational reasoning skills High attention to detail and workflow consistency Preferred Backgrounds: Candidates with experience in the following areas are especially encouraged to apply: Utilization Review Case Management Care Coordination Discharge Planning Payer Authorization Hospital Nursing Operations Clinical Documentation Review Medical Necessity Evaluation Experience with CCM credentials, InterQual, MCG criteria, or payer review workflows is a plus.
Review AI-generated utilization review and patient management scenarios for operational accuracy Evaluate Epic workflows involving chart review, payer authorization, and care coordination Analyze healthcare scenarios tied to medical necessity, discharge planning, and utilization management Translate real-world patient review workflows into structured AI evaluation tasks Provide detailed written feedback on healthcare operational workflows and clinical reasoning Document workflow decisions clearly and consistently across patient review scenarios
Ascend Learning, a leading healthcare and learning technology company, is the connection between a powerful portfolio of brands serving students, educators, and employers with outcomes-based, data-driven solutions across the lifecycle of learning. From testing to certification, Ascend Learning products are used by physicians, emergency medical professionals, nurses, allied health professionals, certified personal trainers, financial advisors, skilled trades professionals and insurance brokers. Headquartered in Burlington, MA, with additional office locations and hybrid and remote workers in cities across the U.S., Ascend Learning was recognized by Newsweek and Plant-A Insights Group as one of America’s 2025 Greatest Workplaces as well as America’s Best Places to work for Mental Well-Being for 2025. We're always looking for talented, passionate professionals to join us in our mission to help change lives. If this sounds like an environment where you'd thrive, read on to learn more. Ascend Learning's Nursing Category is fueled by a commitment to excellence as we support the full learning journey of future nurses. Our nursing brands — ATI, APEA, and NursingCE — offer evidence-based solutions designed to develop practice-ready nurses who are prepared for board certification and clinical practice. We use data analytics and engaging learning tools to help nursing students master core content. And we provide nursing education administrators and faculty with best-in-class support and expertise from some of the sharpest minds in nursing education. We aid nurse educators in understanding students' comprehension based on nearly two decades of data — including more than 12 million proctored assessments — that detail student learning and performance. The result is customers who are confident in their program offerings and positioned for healthy outcomes.
The Nurse Practitioner Educator is a high‑impact role responsible for delivering live nurse practitioner certification review courses both onsite and online, while creating and curating high‑quality, evidence‑based content across multiple certification tracks. This role collaborates with cross‑functional teams to develop and update certification prep materials, delivers immersive exam review experiences for APRN students, and partners with product and editorial teams to address market needs through effective educational solutions. As a subject matter expert, the educator also serves as a thought leader, contributing to product strategy, team development, and external engagement through conferences, training, and professional content. WHERE YOU’LL WORK This role offers the flexibility of remote work within the United States with an expected 60% travel commitment during peak seasons to support onsite live review course delivery and in‑person educator training across the U.S.
Master’s degree in Nursing required; doctoral degree (DNP or PhD) preferred. Current, active national APRN certification (AANP or ANCC) in good standing as a Family Nurse Practitioner (FNP) or Psychiatric Mental Health Nurse Practitioner (PMHNP); dual certification preferred. Minimum of three years of experience as an academic NP educator or preceptor, supporting NP students in didactic or clinical learning environments. Demonstrated experience as a podium presenter at state and/or national conferences, with the ability to deliver engaging, high‑impact educational content to professional audiences. Expertise with NONPF Competencies and NTF Standards for APRN education. Active clinical practice (full‑time or part‑time) within the past five years, ensuring currency with contemporary NP practice standards. Certified Nurse Educator (CNE) credential preferred. Deep expertise in nurse practitioner practice and nursing education, with current knowledge of APRN clinical, educational, and certification trends. Proven ability to deliver engaging live education in both in‑person and virtual formats, translating complex clinical content into clear, learner‑centered instruction. Strong emotional intelligence and collaboration skills, including the ability to build rapport, adapt communication styles, and work effectively with cross‑functional teams and stakeholders. Proficient in applying adult learning principles to live instruction, content development, assessment, and remediation. Ability to develop high‑quality educational content across core and population‑focused NP curricula accurately and on time. Highly organized, adaptable, and effective in a remote, fast‑paced, business‑driven environment; comfortable with up to 60% travel and proficient with common virtual and presentation technologies. Technologically proficient, including strong working knowledge of Teams, PowerPoint, Zoom, Microsoft Word, Excel, and virtual presentation and engagement platforms.
Serve as a subject matter expert in advanced practice nursing, maintaining deep, current knowledge of NP clinical practice and national certification standards. Deliver high‑quality, engaging, certification‑focused live review courses for nurse practitioner students, both onsite and online, serving as a lead instructor and mentor to the part time educators and as a trusted clinical educator. Develop, update, and curate educational content across multiple learning modalities, including live review presentations, and other strategic content such as: tutorials, case studies, clinical updates, and assessment items with evidence‑based rationales. Monitor emerging APRN practice trends, certification blueprint updates, and market needs to inform content strategy and drive innovation in educational products that support APRN program and learner outcomes. Maintain and continuously improve existing product lines to ensure alignment with current clinical guidelines, best practices, and evolving NP practice standards. Act as a professional thought leader by representing APEA, ATI, and Ascend Learning at professional conferences, meetings, and internal forums, contributing to faculty development, product strategy, and brand credibility.
Ascend Learning, a leading healthcare and learning technology company, is the connection between a powerful portfolio of brands serving students, educators, and employers with outcomes-based, data-driven solutions across the lifecycle of learning. From testing to certification, Ascend Learning products are used by physicians, emergency medical professionals, nurses, allied health professionals, certified personal trainers, financial advisors, skilled trades professionals and insurance brokers. Headquartered in Burlington, MA, with additional office locations and hybrid and remote workers in cities across the U.S., Ascend Learning was recognized by Newsweek and Plant-A Insights Group as one of America’s 2025 Greatest Workplaces as well as America’s Best Places to work for Mental Well-Being for 2025. We're always looking for talented, passionate professionals to join us in our mission to help change lives. If this sounds like an environment where you'd thrive, read on to learn more.
As a Nursing Education Specialist, you will combine your experience as a prelicensure nursing educator with comprehensive generalist nursing knowledge to develop content solutions that meet real world learning needs. In addition to generalist nursing knowledge, focused areas of expertise in one or more of the following specialty nursing areas is required: adult medical-surgical, mental health, maternal–newborn, or pediatrics. The Nursing Education Specialist uses a variety of resources, including database searches and literature reviews, to author original content and update existing content. This individual must have strong writing skills, proficiency with test blueprints and the NCSBN®, and an understanding of prelicensure nursing curricula. This position exists to provide accurate, evidence-based content across products and provide input on product development. WHERE YOU’LL WORK This position has the flexibility of remote work within the United States. Occasional travel will be required.
MSN and current RN license required. Five years of experience as a full-time faculty member in a prelicensure nursing program (responsible for teaching both theory and clinical). Three years of clinical nursing practice experience in adult medical surgical or mental health or maternal newborn or pediatric nursing. Expertise teaching prelicensure adult medical surgical or mental health or maternal newborn or pediatric nursing, as well as the ability to create generalist-level content across the nursing curricula. Knowledge of current nursing practice and trends in prelicensure nursing education. Knowledge of and ability to align products with the NCLEX-PN® and NCLEX-RN® detailed test plans. Excellent writing skills. Ability to conduct literature searches using a variety of research databases and search engines. Ability to analyze research articles and other resources to create professional-level, original content. Ability to write multiple choice, alternate format, and Next Generation NCLEX® style items following an assessment blueprint. Proficient with Microsoft Office products, Adobe Acrobat, and the internet.
Create original and review or update existing nursing content to ensure alignment with current evidence-based practice. Content includes assessment items, tutorials, simulations, and/or other products as defined. Demonstrate strong presentation, organizational, problem-solving, and communication skills while working with cross-functional teams. Balance multiple projects and tasks while meeting ongoing and overlapping deadlines. Lead and/or participate in item review meetings with internal or external subject matter experts. Respond appropriately to internal and external client inquiries in a timely fashion. Assist with training and coordinating internal and external contributors on projects. Conduct beta testing and quality assurance checks on products prior to release.
As the health care system of the Medical University of South Carolina, MUSC Health is dedicated to delivering the highest quality and safest patient care while educating and training generations of outstanding health care providers and leaders to serve the people of South Carolina and beyond. In 2025, for the 11th consecutive year, U.S. News & World Report named MUSC Health the No. 1 hospital in South Carolina. To learn more about clinical patient services, visit muschealth.org.
Entity: Medical University Hospital Authority (MUHA) Worker Type: Employee Worker Sub-Type: Regular Cost Center: CC005073 CHS - Clinical Documentation Pay Rate Type: Salary Pay Grade: Health-28 Scheduled Weekly Hours: 40
Bachelor's degree in nursing from an accredited school of nursing and at least five years' clinical nursing experience preferred. Strong clinical experience and critical thinking skills required. Extensive knowledge of patient care, and knowledge of clinical measurement tools and clinical outcomes; ability to establish cooperative working relationships with diverse groups and individuals, medical staff and other health care disciplines. Licensure as a registered nurse by the South Carolina Board of Nursing or compact state. Position may require extensive walking. May require frequent bending, stooping, or stretching. May require lifting and carrying up to 20 lbs. Requires eye-hand coordination and manual dexterity. Requires the use of office equipment, such as computer terminals, telephones, and copiers. Requires normal vision range and the absence of color blindness. Continuous – 6-8 hours per shift; Frequent – 2-6 hours per shift; Infrequent – 0-2 hours per shift Ability to perform job functions while standing. Ability to perform job functions while sitting. Ability to perform job functions while walking. Ability to climb stairs. Ability to work indoors. Ability to work outside in temperature extremes. Ability to work from elevated areas. Ability to work in confined/cramped spaces. Ability to perform job functions from kneeling positions. Ability to bend at the waist. Ability to twist at the waist. Ability to squat and perform job functions. Ability to perform “pinching” operations. Ability to perform gross motor activities with fingers and hands. Ability to perform firm grasping with fingers and hands. Ability to perform fine manipulation with fingers and hands. Ability to reach overhead. Ability to perform repetitive motions with hands/wrists/elbows and shoulders. Ability to fully use both legs. Ability to use lower extremities for balance and coordination. Ability to reach in all directions. Ability to lift and carry 50 lbs. unassisted. Ability to lift/lower objects 50 lbs. from/to floor from/to 36 inches unassisted. Ability to lift from 36” to overhead 25 lbs. Ability to exert up to 50 lbs. of force. Ability to see and recognize objects close at hand or at a distance. Ability to match or discriminate between colors. Ability to determine distance/relationship between objects; depth perception. Good peripheral vision capabilities. Ability to maintain hearing acuity, with correction. Ability to perform gross motor functions with frequent fine motor movements. Ability to deal effectively with stressful situations. Ability to work rotating shifts. Ability to work overtime as required. Ability to work in a latex safe environment. Ability to maintain tactile sensory functions.
The RN (Registered Nurse) – Clinical Documentation Specialist I report to their respective Manager, Clinical Documentation. Under general supervision, the RN – Clinical Documentation Specialist I conduct reviews of inpatient electronic medical records to identify missing, vague, and/or incomplete diagnoses and collaborate with and facilitate appropriate provider documentation to accurately reflect appropriate DRG (Diagnosis Related Group) assignment, patient severity of illness and risk of mortality. In addition, the CDI (Clinical Documentation Integrity) specialist risk adjusts for expected mortality/length of stay and clinically validates key diagnoses. The RN – Clinical Documentation Specialist I is responsible for a baseline understanding of interpreting quality metrics and participates in appropriate ICCE meetings, QAPIs, and/or other identified educational opportunities across the system.
The healthcare industry still relies on faxes and phone tag to coordinate critical care for patients at home. We think patients and the clinicians who serve them deserve better than a system stuck in 1995. Verse Medical is building the modern software infrastructure to make it happen. We're a well-funded Series C company (backed by General Catalyst, SignalFire, and Sapphire Ventures) on a mission to heal a fragmented system. Our platform connects the dots between providers, payors, and patients, ensuring people get the high-quality care they need, reliably and right where they live. We’re growing fast and looking for people who are driven by this mission to join us! Our Values: The Principles That Guide Us Our values are the operating system for how we work together and with our partners. They aren't just words on a wall; they are the principles we bring to every decision, every day. We are transparent, upfront and direct. We operate with honesty and clarity. We share information openly, the good and the bad, and believe that direct, respectful feedback is the foundation of trust and progress. We value speed of iteration. We are building something new, which means we learn by doing. We prioritize rapid iteration and getting solutions into the hands of users, believing that progress is more valuable than perfection. We give 110% effort, 30% of the time. We are passionate about our mission, and there are moments that require us to go the extra mile. We believe in focused intensity when it counts, balanced by a sustainable pace that keeps our team energized for the long run. We empathize with customers to a fault. When our users face a problem, we own it. Instead of asking them to change, we ask ourselves, "How can we make this better?" We believe true innovation comes from deep empathy and a relentless focus on solving the real-world challenges of healthcare.
We are building a high-performing clinical review operation to support documentation and compliance for durable medical equipment (DME), starting with surgical dressings. This role sits at the intersection of clinical judgment and operations. You will utilize our internal software and your clinical background to evaluate patient documentation against structured coverage criteria, identify gaps, and produce clear, standardized review outputs at high throughput. This is not a traditional bedside or case management role. Success in this role requires attention to detail, comfort with structured workflows, and the ability to operate efficiently at scale.
Required: Active RN license (BSN preferred but not required) 2+ years of clinical experience OR prior utilization review / documentation review experience Extremely strong attention to detail Fast learning rate of new concepts Ability to follow structured workflows and apply rules consistently Comfort working in a high-throughput, metrics-driven environment Strong written communication skills DME, Medicare regulations/surgical dressing reviews preferred but not required
Review patient charts and documentation against defined coverage criteria Work with internal AI software that enables review productivity Apply structured processes to determine documentation sufficiency Identify missing or inconsistent documentation and flag appropriately Produce clear, standardized written summaries of review outcomes Meet daily throughput and quality targets (e.g., reviews/day, QA pass rates) Incorporate feedback from QA and continuously improve accuracy and speed Collaborate with product team to refine software over time
Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member engagement, provider solutions, payment integrity, claims cost containment, and analytics. Sagility has more than 25,000 employees across 5 countries.
The role of an RN Assistant Manager Operations is to assist in managing overall account performance and financial profits by coaching and developing Supervisors to deliver quality performance. Managing Supervisors to ensure day to day operations are successful. Location: Work@Home USAUnited States of America
Education: Associate degree or diploma in nursing. Bachelor’s degree in nursing preferred Experience: 3 years experience in a clinical call center environment or telehealth environment preferred. 2 years of leadership experience Healthcare preferred Mandatory Skills: Active, unrestricted nursing license (for nurses) Strong management, interviewing, hiring, coaching, and counseling skills Ability to manage multiple projects to successful and timely completion Excellent communication skills; written, verbal Strong presentation skills Demonstrated sound problem-solving analytical and decision-making skills Knowledge of quality improvement processes Possesses leadership qualities of courage, integrity, the ability to motivate others and the ability to promote harmony in the workplace Works effectively leading a team and participating on a team Strong member advocate: willing to go above and beyond normal responsibilities to provide the best service possible Ability to assist member in navigating the healthcare system and community-based resources. Culturally sensitive and competent regarding membership served Ability to work remotely Ability to determine when to escalate issues appropriately and in a timely manner. Proficient computer skills. Thorough knowledge of case management. Knowledge of/experience in disease management. Understanding of family and group dynamics. Familiarity with change behavior techniques. Demonstrates empathy Must have experience managing teams in a virtual environment Preferred Skills: Basic financial acumen (cost-effectiveness, cost-benefit etc.)
Shift Management Function: Accountable for the shift operations. Ensures execution of contingency and disaster recovery plans. Ensures Contact Center meets productivity standards and client service levels are met or exceeded. Reviews and analyses productivity reports prepared by the team leaders before the reports are submitted to the Operations Manager. Submits periodic productivity/service performance reports to the Operations Manager. Prepares the schedule /Team Leaders assignments to ensure that all operational hours are supervised. Regularly conducts dialogues, communication sessions with agents/front liners (skip meetings). Ensures that workplace is safe, conducive, and a healthy working environment. Implements operational management policies in order to ensure adherence to service level agreements between clients. Coordinates with workforce with regards to approval/disapproval of request for unscheduled leaves and tardiness and the necessary adjustments to schedules of available manpower in order to meet requirements. Ensures preparation of client required reports and makes necessary endorsements to ensure that deadlines for submission of reports are met. Be able to analyze and recommend measures in order to meet set metrics based on trends. Ensures all team monitor service calls to observe employee’s demeanor, technical accuracy, and conformity to company policies. Be able to ensure that operations run smoothly on a daily basis. Be able to coordinate with Workforce to ensure Service Levels and program goals are met. Recommends corrective services within client limits to adjust customer complaints. Answers questions about service to Team Leaders and works to develop so repeat questions do not arise. Strives to help the entire team when in need of assistance. *Communicates policy changes, program developments, and company news to their respective teams, supporting the business decisions while supporting the staff in any required adjustments Clinical Management Function: Takes escalated calls to resolve provider and member concerns that cannot be handled by supervisors and front-line staff. Follows through with pending client escalations’ requests (example: pre-authorization requests) requiring supervisor’s assistance; reviewing outcome of case rework prior to handing it over to the clients. Quality Management/Standards Compliance Function: Conducts performance reviews and appraisals for Team Leaders (monthly/midyear/yearly). Reviews preliminary investigation of disciplinary cases and approves/disapproves/escalates disciplinary actions in adherence to the provisions of the Company Code of Conduct. Conducts regular inter and intradepartmental operations, feedback, action planning, meetings for dissemination of policies and products, hardware issues, troubleshooting, review of status reports, etc. Participates in the development of contingency plans, escalation procedures, and disaster recovery plans. Regularly reviews staffing requirements, actual headcount vs. budget, and requisitions for manpower when necessary. Ensures implementation of customer complaint escalation and turnaround time for complaint resolution to meet service level agreements. Participates in the preparation of the department’s annual business plan and budget to support Sagility’s objectives and goals. Ensures operation’s compliance with the client’s requirements and policies. Provides recommendations in the setting of call center systems pameters. Be able to implement action plans to ensure alignment between the other support groups. Be able to communicate as needed with other departments within the Contact Center about operational and personnel needs. Be able to analyze situation arises outside the established guidelines or parameters and be able to evaluate such situation for impact on present. Be able to give recommendations and implement these recommendations once approved to ensure process improvement in order to help the program achieve its goals. Studies and standardizes procedures to improve efficiency of subordinates. Informs all parties when system is not working effectively. Works with call center Director to develop better ways for system to improve quality. Be able to be responsible in the performance of his/her team. Responsible for the development and implementation of policies and procedures pertaining to HIPAA and ensures the center follows Privacy Rules Standard Staff Development Function: Be able to provide bi-monthly one-on-one coaching and feedback to drive performance and reduce cost. Be able to provide immediate coaching regarding TL or team performance when the need arises using documented personal observations or critical incidences to improve TL and team performance. Be able to ensure timely and accurate communication regarding updates to team leaders. Be able to initiate and support all employee satisfaction and workplace programs. Disciplines and creates incentives for all staff in conjunction with meeting performance measurements. Be able to answer questions about service to the Team Leaders. Be able to recommend and apply corrective measures for staff members who do not meet minimum performance metrics. Be able to monitor key performance indicators within and across teams to assure that standards are met across the board. Be able to work with Team Leaders to resolve concerns of agents as well as their own. Be able to follow-up personnel issues (e.g. Payroll, HR, etc.) as reported by TLs. Be able to meet with TLs at least once a week to discuss program and team performance and share best practices. Be able to ensure TLs submit accurate and timely reports (ex. Coaching logs, performance review, etc.). Be able to create specific Individual Development Plans for TLs over a given period of time to prepare them to the next level. Administrative Function: Be able to file accurate and timely agent coaching logs from TLs. Be able to file the weekly / monthly team performance reviews. Be able to implement programs to ensure high levels of Quality. Be able to develop initiatives to optimize results. Be able to partner with other Shift Managers to share / implement best practices. Be able to monitor team performance in Chronicle on a daily basis. Submit weekly and monthly team operations review to Operations Manager. Others: Perform tasks assigned by the Operations Manager. Prepare composite reports from the individual reports of subordinates. Communicate as needed with other departments within the Contact Center about operational and personnel issues. Interviews and staff supervisor team. Handle the overall project, Budgeting & Financials, Strategies to improve teams KPIs, SPOC for the client relations, profitability of the project, Planning & Process improvements. General Safety and Security: Protects the organization’s assets by upholding the principles of the Quality Information Security Management System (QISMS) Ensures confidentiality, integrity, and availability of information critical to fulfilling the organization’s business functions Remain compliant with the relevant business, local and international regulatory and legislative requirements particularly the Health Insurance Portability and Accountability Act of 1996 (HIPAA), HITECH Act and URAC The above statements are intended to indicate the general nature and level of work being performed by employees within this classification. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of employees assigned to this job. Employees in this job may perform other duties as assigned.
CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers – all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.
Shift/availability details: Part time 20 hours a week. The schedule is Monday-Thursday from 5:30pm-8:30pm EST and Saturday from 8am-4:30pm EST. Required to work a rotating holiday schedule. This is a work-from-home telephonic Registered Nurse position. As a Care Manager, Telephonic Nurse, you will report directly to the Manager, Care Management. You will help to ensure optimal continuity of care for patients transitioning into and out of our services. You will be responsible for being knowledgeable regarding post-acute levels of care, and an expert regarding CenterWell Home Health services including home health, hospice, and palliative care. You will communicate with the CenterWell Home Health clinical team and help facilitate patient follow-up for patients in need of (additional) services.
Required Experience/Skills: Associates Degree required. BSN preferred. We require a compact state RN license. Business needs may require additional state licensures be obtained. At least 3 years post-acute nursing experience. Home health or hospice experience preferred. Knowledge of home health, hospice, and palliative care services. Learn and master information related to locations and services of clients. Analytical and can problem-solve. Excellent verbal and interpersonal skills. Communication with empathy over the phone. Must read, write and speak fluent English. Current CPR certification. To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Home or Hybrid Home/Office employees will be provided with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required
Be a CenterWell Home Health representative in supporting patients who have been discharged from service or for those who may need post-acute services. Navigate healthcare options; care services post-acute offerings, Medicare coverage, billing issues, and accessing healthcare resources. Use a variety of tools and methods to quickly provide patient options and education including but not limited to sites of service, specialty offerings, post-acute care, and other related questions. Handle a variety of customer issues including location lookup, directions, and complaints. Make clinical level of care determination based on discussion, medical records, and any other important clinical data. Match these needs to a service site location or, if not available, look up and provide alternative services. Be a customer advocate throughout the referral process to ensure timely response and to maximize referral to admission conversion rate. Follow-up and track referral and admission outcomes. Maintain awareness and orientation to department performance objectives, meets standards, and assures patient satisfaction goals are met. Assist in the admissions process by acting as an ambassador for patients who meet the admissions requirements. Focus on placing the right patient to the right care setting at the right time Adhere to and participates in Company's mandatory training which includes but is not limited to HIPAA privacy program/practices, Business Ethics and Compliance programs/practices, and Company policies and procedures. Review and adhere to all Company policies and procedures. Provide education regarding Home Health, Hospice, and Palliative Care Services. Help with clinical eligibility review for alternate services Participate in special projects and perform other responsibilities as assigned.
Since 1968, Neighborcare Health has been removing barriers to health care for our neighbors. We believe everyone deserves a place to call their health care home, where a team of medical, dental and mental health professionals work in collaboration with each patient to develop a personal health improvement plan. We are one of the largest providers of primary medical, dental and behavioral health care services in the Seattle area serving low-income and uninsured families and individuals, seniors on fixed incomes, immigrants, and people experiencing homelessness. Each year we care for nearly 60,000 patients at our nearly 30 non-profit medical, dental and school-based clinics. We ask everyone to pay what they can, but no one is turned away due to inability to pay. Our clinics are located in neighborhoods where health disparities are the greatest, and our care teams, who speak over 55 languages and dialects, are as diverse as our patients. No matter who you are, or where you come from, regardless of your insurance, income or immigration status, you are welcome at Neighborcare Health.
The Primary Care Registered Nurse works in partnership and joint accountability within an interdisciplinary team to achieve Neighborcare’s Mission, Guiding Principles and goals. The primary focus of the RN is to optimize the health status of patients across the lifespan through working in partnership and joint accountability, patient education, emergent triage, and performing complex procedures. RNs build relationships with their patients through face-to-face, virtual, and telephonic care and work in partnership with other care team members to meet the needs of patients throughout Neighborcare Health. The RN follows the Nursing Process to assess, diagnose, plan, implement and evaluate nursing care in an outpatient clinic setting. Remote work schedule for candidates local to the Seattle Metropolitan area. Health, Wellness & Retirement benefits: Medical, dental & vision insurance Paid time off & paid holidays Retirement with contribution match Life & AD&D, pet insurance Employee assistance program, & more! Union: SEIU Healthcare 1199NW Compensation: The target wage range for the position is $38.71 per hour to $47.88 per hour. Final offers are individually based on various factors, including skill set, years of experience, location, qualifications, work schedule and other job-related reasons. $5,000 Sign-on Bonus!
Clinical Knowledge & Skills: Knowledge and understanding of a broad range of physical and mental health conditions across the lifespan. Knowledge, skill, and ability to provide condition- and population-specific education and coaching, including but not limited to wound care, foot care, and injections. Knowledge of medical terminology and clinical procedures; anatomy, physiology, biology, human growth and development; asepsis and universal precautions; medical documentation. Ability to start and operate emergency equipment, perform CPR, provide basic first aid, and respond professionally in emergent situations. Ability to demonstrate sound clinical judgment and work resourcefully and independently in the absence of detailed instructions. Ability to self-assess knowledge and nursing skill and continuously develop clinical expertise through Neighborcare Health and community-based continuing education. Patient & Interpersonal Skills: Ability to work effectively with patients and communicate respectfully with individuals from varied cultures, languages (including through interpreters), educational and socio-economic backgrounds, as well as individuals with disabilities and contagious diseases. Ability to work effectively independently and as part of a team, interact appropriately with co-workers and patients, and develop and maintain rapport with a wide range of individuals. Ability to comply with HIPAA/Confidentiality policies and handle confidential and sensitive patient and staff information. Skills in written and verbal communication in English and basic math. Professional & Technical Attributes: Ability to demonstrate reliable and timely attendance. Willingness to travel to clinic with the most need based on Nurse Manager staffing. Ability to demonstrate flexibility, adaptability, willingness, and openness to learn and change. Ability to follow written and verbal directions and complete assigned tasks in a timely manner. Ability to work with supervision, receiving instructions/feedback, coaching/counseling and/or action/discipline, and learn from directions, observations, and mistakes. Preferred Skills: Skills in Motivational Interviewing and application of a harm reduction model Skills in care for chronic wounds, including conservative sharp debridement Knowledge of unique health needs of specific patient populations pertinent to the role/site Knowledge of community resources Education/Experience Requirements: Completion of an accredited RN program Valid Washington State Registered Nurse license BLS certificate Preferred Requirements: BSN desirable 1+ years RN experience in a primary care, hospital and/or home care setting or comparable social service setting Board Certification in applicable specialty areas
Working in Partnership and Joint Accountability: Provide care to patients in the outpatient clinic setting as part of Neighborcare’s nursing team, maintaining shared accountability with the clinic team and the medical program as a whole. Collaborate with team members and leaders to define and reassess priorities, and to plan, communicate, and execute patient care. Participate in quality and performance improvement initiatives to improve patient outcomes. Serve as a preceptor for new staff and/or students completing clinical rotations at Neighborcare. Patient Care & Health Management: Partner with patients and families in person, virtually, and by phone to support optimal health outcomes. Identify patient goals for improving health status and managing chronic physical and mental health conditions. Apply the nursing process (assess, diagnose, plan, implement, evaluate) to meet patient needs. Assess patient understanding of their condition and readiness for behavior change. Deliver wound care, foot care, chronic disease management, and ongoing injections. Monitor, track, and follow up to ensure care needs are met. Apply Neighborcare Health guidelines, standing orders, and evidence-based clinical practices. Patient Education: Provide education across the lifespan. Identify barriers to learning and tailor education to patients’ individual needs and learning styles. Educate patients on medications, abnormal lab results, and management of acute and chronic conditions. Promote preventive care and wellness strategies. Use motivational interviewing and harm reduction counseling to support patient-centered care. Triage & Clinical Procedures: Respond to emergent health issues in person and by phone; provide assessment, advice, first aid, and Basic Life Support as needed. Perform clinical procedures within RN licensure and individual competency, which may include wound care, foot care, IM injections, IV insertion and administration of fluids/medications, and urinary catheter insertion/removal. Administer injections and medications per standing orders and protocols. Triage and Advice Registered Nurse: Work remotely or can request a location at a Neighborcare location receiving incoming calls from patients as directed by call center and contacting patients identified for triage. Conduct telephone triage using standardized protocols and clinical judgment to assess patient symptoms and determine appropriate disposition (self-care, urgent/same-day visit, ER/911, etc.). Provide education and reassurance to patients and families regarding acute health concerns. Document triage encounters promptly and accurately in the electronic health record. Collaborate with providers and clinic staff to facilitate timely access to care. Escalate high-risk or complex cases to providers as appropriate. Address and manage patient messages (MyChart, call center, Inbasket pools) within designated timeframes. Family Practice/Medicine Registered Nurse: Rotate between clinics, programs, and patient populations based on organizational needs and training. Assignments will be made by the Nurse Manager. Provide anticipatory guidance and education to families regarding development, preventive care, and wellness. Support families with multiple members receiving primary care by aligning care plans and facilitating communication. Work closely with providers to support all ages and all health needs. Participate in activities to support preventive care and family health. Provide hands-on nursing care including wound care, foot care, and controlled substance injections. Partner with Care Management RNs to provide in-person care to identified patients.
GlobeStar Systems is a leader in integrated clinical communication. Our cornerstone product, Connexall®, is an award-winning Enterprise grade IoT platform, purpose built for the healthcare industry. Connexall® delivers a customizable suite of integration solutions to meet the unique and specific communications requirements of any organization. Connexall® services over 1,500 healthcare providers around the world, helping customers improve clinical workflow and driving better patient and staff outcomes.
Job Title: Clinical Informatics Specialist - RN Type: Full-Time Start Date: Immediate Location: US (Remote) – Preference will be given to candidates located in Central or Western time zones to support business operations. Job Summary: Reporting to the Director of Clinical Services and Outcomes, the Clinical Informatics Specialist - RN will provide professional services and clinical support to our customers throughout the Connexall project lifecycle. The successful candidate combines clinical workflow design, data analytics, application implementation, and customer relationship skills to successfully excel Connexall Software offerings. They will work cross-functionally to ensure the customer’s business and clinical goals are understood and appropriately considered throughout all project phases. Serving as an internal and external subject matter expert and advisor, the Clinical Informatics Specialist - RN provides support and guidance to sales, solutions delivery and product development teams and initiatives.
Current Registered Nurse BSN degree or higher, Master’s preferred. 5+ years clinical experience providing Clinical Practice, Educational Training, and Project Implementation required. Nursing or Clinical Informatics experience preferred. Previous experience with Connexall is an asset. Proficiency in Microsoft Office Suite including Word, Excel, PowerPoint, and Visio. Excellent interpersonal skills, communication skills, and presentation skills with the ability to speak with individuals at all levels of an organization. Excellent documentation and written skills. Ability to convey product features in clinical environments for varying levels of participants. Ability to work with various internal teams and customers to define the scope and content of assigned projects. Must act as a subject matter expert to assist other members of the company, as necessary. Ability to translate technical information into clinically focused training and educational materials. Strong computer skills and technical aptitude. Ability to work independently and as part of a collaborative team. Ability to lead discussions and drive to consensus. Ability to implement quality and workflow improvements in a clinical setting. Ability to align clinical practices and understanding of products into a customized, consultative program for customers. Flexibility in adapting to a rapidly changing, energetic environment. Ability to multitask, establish priorities, work independently, and proceed with objectives without supervision. Passion for redefining healthcare. Must have a flexible schedule and be able to work Mon–Fri, evenings/weekends as needed. Ability to travel about 50% (including overnight travel).
Provide professional services and clinical support to customers throughout the Connexall project lifecycle, including pre-sales demonstrations, solution design workshops, customer workflow analysis and mapping, user training, go-live support, and post-implementation consulting. Serve as a clinical and educational resource both internally and externally during the sales and implementation process. Participate in key account sales presentations, demonstrations, clinical evaluations, and clinical training. Provides clinical expertise across the sales enablement and customer success lifecycle, serving as a subject matter expert on Connexall solutions. This includes offering consultative guidance on clinical workflow optimization, demonstrating the clinical value of the platform, and supporting sales teams in articulating solution impact to prospective customers. Act as a resource to train internal teams, answer clinical product questions, and facilitate highest possible patient outcomes. Document needs assessment, processes, system requirements, dashboard design requirements, change management, and user training materials to ensure successful communication to both technical team and end user. Provide clinical support to customers during implementation, post-implementation, and into project maturity, working with customers to ensure they are maximizing their use of Connexall. Understand customer’s current clinical workflow by conducting interviews with staff in appropriate units, from admittance to discharge. Evaluate current state of customer’s site to determine bottlenecks and inefficiencies, by making clinical workflow observations and documentations and assessing technology tools and HIS systems in place. Work with customer to design and create a schema outlining an updated clinical workflow design, using Connexall to achieve the customer’s desired future state of clinical workflow. Responsible for clinical stakeholder engagement through all stages of implementation ensuring operational readiness and clinical adoption. Support process improvement projects, address clinical workflow concerns, and identify opportunities for improvement. Collaborate internally to communicate opportunities for product improvement using direct customer feedback. Assist with the development of case studies and use cases to share best practices with other customers. Keep up to date with industry standards thereby making recommendations and sharing information that will result in the best practice and use of Connexall. Other duties as required.
Sedgwick is the world’s leading risk and claims administration partner, helping clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.
Sedgwick is currently seeking Triage Nurses to join our Crisis Care team. This is a remote PRN position offering up to 20 hours per week. The team operates 24/7, with the greatest staffing needs during afternoon, evening hours, overnight and weekends. Current shift needs (CST) are: 3:00 PM to 9:00 PM 9:00 PM to 6:00 AM, 24 hour weekend shifts - 6:00 AM Saturday - 6:00 AM Sunday or 6:00 AM Sunday to 6:00 AM Monday PRIMARY PURPOSE: Triages incoming catastrophic injury referral calls from clients; gathers vital case details, obtains and provides medical status updates to the customer, and assigns a Field Case Manager (FCM) for onsite visits as appropriate. Ensures that client service guidelines are followed and communicated to the appropriate parties and promotes quality cost-effective outcomes through communication and available resources. ARE YOU AN IDEAL CANDIDATE? We are looking for enthusiastic candidates who thrive in a collaborative environment, who are driven to deliver great work.
Education & Licensing: Bachelor's degree in nursing (BSN) from an accredited college or university preferred. Licenses as required. Active unrestricted RN license issued in a state or territory of the United States required. Experience: Six (6) years of related experience or equivalent combination of education and experience required to include three (3) years of recent clinical practice or Telephonic/ Field Case Management experience in Worker’s Compensation. Skills & Knowledge: Strong knowledge of nursing practice and theory Demonstrate a high level of clinical skills and triage ability Ability to apply critical thinking under pressure Knowledge of the insurance industry and claims processing Knowledge of field case management Excellent oral and written communication skills, including presentation skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills Excellent interpersonal skills Excellent negotiating skills Ability to work in a team environment Ability to meet or exceed Performance Competencies WORK ENVIRONMENT: When applicable and appropriate, consideration will be given to reasonable accommodations.
Provides professional and timely responses to incoming catastrophic referral calls from clients, applying all phases of the nursing process, i.e. assessment, planning, implementation, and evaluation when triaging calls. Triages the catastrophic referral utilizing critical reasoning, the department triage log, and associated workflow; utilizes customer specific guidelines to obtain pertinent data. Identifies life-threatening emergencies and recommends appropriate interventions. Assigns appropriate Field Case Manager assignment and facilitates initial onsite hospital visit for the claim. Maintains communication with the customer, Client Service Director, and Claims Examiner providing timely updates on changes in injured worker status and FCM estimated time of arrival. Communicates phone advice in a calm manner, ensuring it is properly received and understood. Ensures triage benchmarks are met, activity is professionally documented and enters incident data into computer system. Educates the assigned FCM on Sedgwick benchmarks and customer specific guidelines. Maintains ongoing communication with the client, Client Service Director, and Claims Examiner until the assigned Field Case Manager arrives onsite. Adheres to quality assurance standards. DDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned.
We recognize that work is a part of life, not separate from it, and foster a flexible environment where your health and wellbeing are prioritized. At Capital you will work alongside a caring team of supportive colleagues, and be encouraged to volunteer in your community. We value your professional and personal growth by investing heavily in training and continuing education, so you have the tools to do your best as you develop your career. And by doing your best, you’ll help us live our mission of improving the health and well-being of our members and the communities in which they live.
At Capital Blue Cross, we promise to go the extra mile for our team and our community. This promise is at the heart of our culture, and it’s why our employees consistently vote us one of the “Best Places to Work in PA.” The Health Navigator collaborates with members, family, healthcare providers, community resources and other members of the healthcare team to coordinate services and address barriers including access to health care, health literacy, transportation, wellness, gaps in care etc. The Health Navigator will guide members to achieve optimal and vibrant health by providing tools, information, and assistance to help understand their healthcare options, take control of their healthcare needs, bridge the current gap between social-economic and medical and behavioral needs, and navigate the otherwise often confusing steps along the path to efficient and effective care.
Skills: Critical thinking and problem-solving skills; and ability to handle critical situations. Excellent written, oral communication, listening, and organizational skills. Ability to operate a personal computer (PC), including proficiency in Microsoft Office Products. Ability to use computer system while conversing telephonically. Able to demonstrate strong customer service skills, including tact and diplomacy, both in person and telephonically when communicating with internal and external customers. Ability to appropriately prioritize workload and assignments and perform accurate, detailed and timely completion of assigned duties. Ability to work autonomously and as part of an interdisciplinary team Demonstrates sound judgment that affirms the rights and responsibilities of Member’s, families, health care professionals and health care organizations. Knowledge: Knowledgeable on how to navigate all aspects of medical, behavioral, and social systems. Knowledge of NCQA standards for Population Health Management for health plan accreditation, DMAA standards for disease management and CMSA Standards of Practice for Case Management, Act 68, CMS Knowledge of current and emerging medical treatment modalities and best practice guidelines with the ability to analyze and interpret medical and benefit coverage interrelationships. Knowledge of adult learning principles, motivational interviewing and intrinsic coaching techniques. Experience: At least three (3) years’ recent/related experience working in health and wellness promotion, inpatient or other appropriate clinical setting. Behavioral Health experience beneficial but not required. Education And Certifications: Patient Navigation certification preferred or obtained within 1-year employment. Licensed Practical Nurse active license or degree in healthcare related field and 3 years of experience directly related to the duties and responsibilities specified.
Identifying, facilitating, and securing access to needed healthcare, social services benefits and community resources. Assist members with navigating the steps along the path to efficient and effective care. Coordinate appointments with and transportation to physicians and non-physician providers to ensure timely and efficient delivery of diagnostic and treatment services when needed. Actively monitors incoming calls, conducts outgoing calls, and responds to voice mail requests in a timely manner. This could include, but is not limited to, closing gaps in care, HRAs, upcoming education/health events, and provider follow-up. Identify and assess members’ medical, behavioral, social, emotional, and financial needs. Effectively and efficiently utilize the resources available of social, economic, behavioral, and support systems and programs to connect at-risk members with appropriate community resources to address barriers and adherence. Conducts health education. Builds relationships with members, their families, and care givers and provides support in achieving their health care goals. Provide emotional support and/or referring to community-based or physician/provider for greater level of psychosocial intervention Completes education to assigned members and engages them into programs, completes interventions to meet member needs and identifies and refers candidates who require complex interventions to other programs/resources utilizing established criteria and documentation processes to support whole-person care. Completes surveys and assessments for assigned members to support health & wellness needs, and engagement in care programs. Delivers education—basic condition‑specific education, medication adherence, preventive care guidance, and navigation of available health benefits—to empower members in managing their health. Addresses identified gaps in care, reinforce provider care plans, and promote adherence to evidence‑based practices for members. Collaborates with interdisciplinary teams to support whole‑person care, improve quality outcomes, and enhance the member experience. Identifies and reports quality of care issues in accordance with established departmental policies and procedures. Maintains member confidentiality at all times. Documents all care navigator activities in the care management documentation system, according to established policies and procedures. Attends company and departmental meetings and training sessions as required. Assist with assigned population processes including, but not limited to, retrieving and assigning referrals, completing monthly reconciliation report between documentation system(s).
We’re elevating patient access so patients can get healthcare how, when, and where they need it. We partner with healthcare systems to transform how patients access care, enabling their providers to focus on what matters most – caring for patients. By managing patient access as a technology-enabled service, we help health systems stabilize costs and improve patient experience while creating good jobs that attract and retain talent in the industry. Our team of experts is obsessed with the connection between the people, processes, and technology that make healthcare organizations hum. Join us and help build the healthcare experience we want for our communities, our families, and ourselves.
Help patients get the right level of care with calm, clinically sound guidance over the phone. As a Triage Nurse at Hummingbird, you’ll be the first clinical voice many patients hear when they’re unsure what to do next. You’ll provide telephone triage in a remote, centralized contact center — assessing symptoms, determining urgency, and guiding patients to safe next steps using client-specific protocols and Epic’s Nurse Triage module. Most of your day will be on the phone managing back-to-back calls, using your nursing judgment and clear guidelines to advise patients, route them appropriately, and support follow-up care. You’ll work with a supportive team of nurses and non-clinical colleagues and receive training, coaching, and feedback to grow your skills, handle increasingly complex scenarios, and continuously improve how we deliver care. The Details Employment Eligibility: Candidates must be legally authorized to work in the United States without sponsorship. FLSA Status: Non-exempt Work Location: Remote. You must work from a location within the United States with consistent Internet service. Wired Internet is required. Schedule: Full-time, Monday-Friday; shifts vary between the hours of 7:00AM - 6:30PM EST Compensation: Expected range is $30.43 - $35.00 per hour. New hires usually start between $31.00 and $33.00, depending on experience and internal equity. Benefits: Comprehensive medical, dental, and vision coverage; paid time off; 401(k); parental leave; career development support; and more Training: Paid, structured onboarding that includes Epic workflows, client-specific protocols, and ongoing education and coaching.
Current, unrestricted RN license in North Carolina; willingness to obtain additional licensure if needed. 1+ years outpatient telephone triage experience or 3+ years clinical nursing experience (ideally primary care, emergency, home health, or med-surg). Strong clinical assessment skills and sound judgment, with the ability to follow standardized guidelines and know when to pause and escalate. Excellent communication skills — you translate complex medical information into clear, patient-friendly language and maintain a calm, steady presence when patients are anxious or unsure. Comfort in a remote contact center setting with back-to-back calls, defined performance metrics, and real-time use of multiple systems (EHR and contact center tools) while documenting and typing ~50 WPM. A strong commitment to patient privacy and strict adherence to HIPAA and all relevant policies. Nice to Have Previous telephone triage or contact center experience Experience using Epic Compact nursing license or eligibility for compact licensure, depending on state and client requirements What Helps You Shine Please note that we use both your resume and your written and oral communication throughout the hiring process to understand your fit for this role. Thoughtful, clear responses help us see your attention to detail, your professionalism, and your ability to communicate with care - skills that are essential for success on our team.
Note: This posting is for our ongoing Triage Nurse Talent Pool. We interview continuously and anticipate frequent openings, with start dates typically 2-6 months after your application. What You’ll Do: In this role, you’ll combine clinical judgment, technology, and communication skills to guide patients safely and efficiently: Provide telephone triage with Epic’s Nurse Triage module, asking focused questions to assess symptoms, rule out red flags, and recommend the right level of care. Verify and update patient information, protect privacy under HIPAA, and coordinate with clinic teams to schedule or adjust appointments and escalate urgent or complex cases. Document calls in real time in the EHR while using Epic and contact center tools to navigate charts, follow protocols, and meet quality and performance expectations. Handle emotionally charged situations with empathy and professionalism, ensuring patients feel heard, informed, and confident about next steps. Take part in ongoing training and continuous improvement, sharing trends and feedback to strengthen workflows, quality, and team culture. Expectations for Focus & Presence: To support patients and each other, this role requires your full attention during scheduled work hours. Our Outside Employment Policy doesn’t allow overlapping work or “job stacking,” so any outside work must happen fully outside your Hummingbird schedule. We’re a camera-ready team, and you’ll need to be on-camera during training and when needed during the workday after training ends. We value connection, teamwork, and being present, which is what keeps our patients safe and our team supported. If that’s what you’re looking for, you’ll feel at home here. If you’re hoping to hold another job during the same hours, this job won’t be the best match.
WelbeHealth PACE helps seniors stay in their homes and communities by providing comprehensive medical care and community-based services. We serve the most vulnerable seniors with better quality and compassion in a value-based model. The WelbeHealth Advocate Nurse provides outstanding continuity of care when the PACE center is closed within their scope of practice. The WelbeHealth Advocate Nurse is accountable for answering phones after hours (evening, nights, weekends, and holidays), resolve logistical issues that arise both over the phone and during visits to participants’ residences or acute care settings, and consulting with other clinical staff on call, as needed.
**LOCATION: REMOTE ** SCHEDULE: MON - FRI (WORK EVERY OTHER WEEKEND) **SHIFT: WORK 8 HRS WITHIN THE TIME FRAME OF 8 AM - 12 AM (WEEK 1 & 3 OF THE MONTH = SAME HOURS; WEEK 2 &4 OF THE MONTH = SAME HOURS) This role is different because WelbeHealth Advocate Nurses at WelbeHealth: Work fully remote and are not on call Build relationships with participants rather than providing short-term care We care about our team members. That’s why we offer: Medical insurance coverage (Medical, Dental, Vision) Work/life balance - We mean it! 17 days of personal time off (PTO), paid holidays observed annually, and 6 sick days 401k savings + match Comprehensive compensation package including base pay and bonus And additional benefits We are seeking a WelbeHealth Advocate Nurse that ideally has triaging experience. If you’re ready to join a holistic care team that values both its participants and providers, we’d love to hear from you!
Graduate of an Accredited School of Nursing with an unencumbered RN license Nursing knowledge and skills necessary to treat frail, elderly participants and manage complex clinical situations Highly motivated, self-directed, able to execute tasks in a quickly changing environment, and able to make sound decisions in emergency situations Excellent clinical, organizational, and communication skills in settings with seniors, their families, and interdisciplinary team members Able to work assigned shift which may include days, evenings, nights, weekends, holidays, and overtime
Handle calls (inbound/outbound) as assigned, responding as appropriate within their scope of practice, and consulting with other clinicians, including on-call providers Coordinate telehealth meetings between participants and clinicians Ensure timely care delivery, as well as resolve basic issues, escalating to management as necessary Troubleshoot and effectively resolve logistical care delivery issues relating to aspects such as transportation, medication delivery, and hospital discharge when daytime care teams or responsible central teams are not available Support the clinical care and home health teams to manage smooth care transitions between settings (hospitals, skilled nursing facilities, etc.), escalating changes in participants’ conditions as appropriate
WelbeHealth PACE helps seniors stay in their homes and communities by providing comprehensive medical care and community-based services. We serve the most vulnerable seniors with better quality and compassion in a value-based model. The WelbeHealth Advocate Nurse provides outstanding continuity of care when the PACE center is closed within their scope of practice. The WelbeHealth Advocate Nurse is accountable for answering phones after hours (evening, nights, weekends, and holidays), resolve logistical issues that arise both over the phone and during visits to participants’ residences or acute care settings, and consulting with other clinical staff on call, as needed.
**WORK LOCATION: REMOTE **SCHEDULE: PART-TIME; 20 HRS A WEEK **SHIFT: DAYS/HOURS WORKED FLEXIBLE (MUST BE ABLE TO WORK EVERY OTHER WEEKEND) This role is different because WelbeHealth Advocate Nurses at WelbeHealth: Work a fully remote, flexible schedule Build relationships with participants rather than providing short-term care We care about our team members. That’s why we offer: 401k savings + match 1 hour of sick time accrued for every 30 hours worked We are seeking a WelbeHealth Advocate Nurse that ideally has triaging experience. If you’re ready to join a holistic care team that values both its participants and providers, we’d love to hear from you!
Graduate of an Accredited School of Nursing with an unencumbered RN license Nursing knowledge and skills necessary to treat frail, elderly participants and manage complex clinical situations Highly motivated, self-directed, able to execute tasks in a quickly changing environment, and able to make sound decisions in emergency situations Excellent clinical, organizational, and communication skills in settings with seniors, their families, and interdisciplinary team members Able to work assigned shift which may include days, evenings, nights, weekends, holidays, and overtime
Handle calls (inbound/outbound) as assigned, responding as appropriate within their scope of practice, and consulting with other clinicians, including on-call providers Coordinate telehealth meetings between participants and clinicians Ensure timely care delivery, as well as resolve basic issues, escalating to management as necessary Troubleshoot and effectively resolve logistical care delivery issues relating to aspects such as transportation, medication delivery, and hospital discharge when daytime care teams or responsible central teams are not available Support the clinical care and home health teams to manage smooth care transitions between settings (hospitals, skilled nursing facilities, etc.), escalating changes in participants’ conditions as appropriate
We are on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase access and transparency, and feature a personalized, human approach. We strive to ensure members live happier, healthier lives. Evry Health is the major medical division of Globe Life (NYSE:GL). Globe Life has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, Globe Life has earned an A (Excellent) rating or higher from A.M. Best Company.
Evry Health is seeking a tech-savvy Nurse to join our team for Care Coordination. As a Care Coordinator you work with members to improve their wellness and engage with our health plan's benefits. You build good relationships with both our health plan members and our medical providers through phone calls, emails, and texts. This is an exciting role allowing the ability to work with members across the continuum. Our teams are 100% virtual. While this is a remote role, you must reside in the United States and in the Eastern or Central time zone.
You have 1-2 years of experience working at a health plan, preferably with a commercial population. You have 3-5 years of nursing experience in a clinical setting assisting with direct patient care, such as a hospital or ambulatory setting. Must have a current, unrestricted Texas nursing license or Compact License. Please include your license number(s) and the corresponding state(s) in your resume. Diploma from an accredited school/college of nursing required. You have working knowledge of medical and insurance industry terminology including basic understanding of health plan benefits, CPT/ICD10, authorizations, and digital health programs. You have an area of interest or experience within cardiology/pulmonology, women’s health, orthopedic surgery/physical medicine, primary care/pediatrics, and oncology. You have experience outreaching and educating members telephonically. You have an innovative and entrepreneurial spirit with a passion to contribute to a much-needed change in our health care system. Bonus: Familiarity with Salesforce/Healthcloud/CareIQ. Bonus: Experience working in a call center. Bonus: Spanish fluency (conversational). Telecommuting Requirements This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas. Company business hours are weekdays 9-5 CST. We will only consider candidates in the United States who reside in the CST or EST time zones. Required to have a dedicated work area established that is separate from other living areas and provides information privacy. Ability to keep all company sensitive documents secure. Must live in a location that receives an existing high-speed internet connection/service.
Communicate and provide education to members and providers on insurance plan benefits and digital health solutions. Use negotiation and motivational interviewing techniques to increase engagement. Pro-active and reactive support for members, including outbound phone/email/text outreach. Employ active listening & motivational interviewing skills, and can handle difficult calls tactfully, courteously, professionally and document accordingly that can build patient trust and engagement. Ability to effectively excel in a virtual work environment through active participation in team huddles, Supervisor 1:1s, Instant Messaging, or check-ins, efficiently answering and documenting member/provider calls. Accurately track and document work on a variety of internal software tools and platforms. Consult with supervisors, utilization management team, medical directors, as needed to overcome barriers. Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure. Assist departmental staff with coding, medical records/documentation, pre-certification, reimbursement, and claim denials/appeals. Ability to interact with external facility or providers as needed to gather clinical information to support the medical necessity review process and plan of care.
Opportunities with Advantage Plus Network of Connecticut, part of the Optum family of businesses. When you work at Advantage Plus Network of Connecticut, your contributions directly sustain the health and well-being of our community. Discover high levels of teamwork, robust medical resources and a deep commitment to exceptional care and service. Join a leading community-based medical group and discover the meaning behind Caring. Connecting. Growing together.
Position Details: Location: Telecommuter position, possible travel to Farmington, CT for training/meetings Department: Case Management Schedule: Full time, 40 hours/weekly, Monday through Friday, 8:00AM - 4:30PM
Physical & Mental Requirements: Ability to lift up to 25 pounds Ability to sit for extended periods of time Ability to stand for extended periods of time Ability to use fine motor skills to operate office equipment and/or machinery Ability to receive and comprehend instructions verbally and/or in writing Ability to use logical reasoning for simple and complex problem solving 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. Required Qualifications: Bachelor of Science in Nursing (BSN), or 5+ years case management experience in lieu of BSN Unrestricted current RN licensure in state of Connecticut 2+ years experience in health plan case management, complex and disease case management Experience in a remote and telephonic role Proficient in Microsoft Office and Adobe products Ability to travel to Farmington, Connecticut as necessary for training, meetings, or as requested by supervisor/manager Preferred Qualifications: Master's Degree in Nursing (MSN) Certified Case Manager Certification (CCMC) Case management experience serving community based members residing in Connecticut Experience in discharge planning Experience in utilization review, concurrent review, or risk management A background in managed care Ability to work on a multi-disciplinary team Proven solid critical thinking and decision-making skills Proven excellent interpersonal and communication skills (both written and oral) Bilingual with English and Spanish, Polish, Mandarin, or Vietnamese
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential functions. Member Care Coordination Collaborates with physicians and multidisciplinary teams to develop and maintain up to date, coordinated care plans Acts as a liaison between members and the healthcare team to ensure effective communication and alignment of care plans Member Referral Support Assists physicians, members, and families in obtaining referrals to specialists Provides counseling and support tailored to the clinical needs of the member Care Plan Development Creates comprehensive member-centric care plans that include member-driven goals and interventions Partners with designated physicians to create and maintain individualized Member Care Plans Clinical Improvement Actively participates in developing and deploying Coordination of Care activities aimed at enhancing the clinical experience for both referred members and referring physicians Liaison Role Facilitates communication among care team members to address the needs of both the member and the physician Provider/Member Education Provides education to member on health management and maintenance for optimal health outcomes Educates members and care team participants about available community and health plan benefits and services Performs additional tasks as assigned to support the overall goals of the Medical Management department
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
The Clinical Program Manager oversees a remote team of Behavioral Health Care Advocates responsible for utilization management (UM) and case management (CM) of inpatient and outpatient Behavioral Health services. UM is performed via an inbound telephonic queue and requires team members to work a holiday rotation. Case managers work directly with members both telephonically and in the field. The schedule is Monday - Friday, 8a - 5p EST and may include working some holidays. If you are located in New York, you will have the flexibility to work remotely* as you take on some tough challenges.
Required Qualifications: Licensed Clinician in the State of New York with one of the following licensures. Licenses must be active and unrestricted. Licensed Clinical Social Worker (LCSW) Licensed Mental Health Counselor (LMHC) Licensed Psychologist (LP) Registered Nurse (RN) with 5+ years of Behavioral Health experience 6+ years of Behavioral Health experience including Mental Health and Substance Use Disorders (SUD) 5+ years of experience working with Children / Adolescents 3+ years of management experience in a Behavioral Health setting 3+ years of experience with New York public and commercial mental health and substance abuse services delivery system Experience overseeing documentation in Electronic Medical Records (EMR) Experience with Medicare and NY Medicaid regulations Intermediate proficiency in Microsoft Office Suite, including MS Excel Ability to work holidays based on business needs Dedicated, distraction-free workspace and access to high-speed internet in home Residency in New York Preferred Qualifications: Experience working in a Managed Care Organization (MCO) Experience working with the New York provider network Experience managing clinical and non-clinical phone queues Knowledge of evidence-based practices and procedures Solid customer service orientation Familiarity with prior authorizations, concurrent reviews, and appeal processes Familiarity with case management services Demonstrated competence in clinical care management, solid leadership and organization skills, interpretation of State and federal laws, and regulations relevant to the mental health program area
Oversight of utilization management of adults, adolescents and children as well as dual eligible Medicare/Medicaid populations with SMI, SUD, co-occurring physical health, co-occurring disorders of MH and SUD, and co-occurring mental health and/or substance use disorders Manages and is accountable for professional employees and supervisors Sets team direction, resolves problems, and provides guidance to members of team May oversee work activities of other supervisors Adapts departmental plans and priorities to address business and operational challenges Influences or provides input to forecasting and planning activities Oversight of new product implementations Initiating process for state initiatives and directives Updating and creation of Quick Reference Guides Oversight and coordination of care with internal and external partners Experience interfacing with regulatory agencies Interview, hire and onboard new employees Review reports to insure team member adherence to established benchmarks Cover for management team as needed Foster relationship with leadership and medical directors 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.
Optum NY, is seeking a RN Post-Acute Liaison to join our team in Poughkeepsie, NY. 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 RN Post-Acute Liaison, in partnership with the Medical Management team and Physician Leadership, will serve as a clinical problem solver to ensure our patients receive care that is safe, high quality, patient-centered, and cost efficient. This includes collaborating with post-acute network facilities, vendors, and Optum partners on complex patient care coordination. If you are located in Poughkeepsie, NY, you will have the flexibility to work remotely* as you take on some tough challenges.
Required Qualifications: Bachelor's Degree or higher in Nursing Unrestricted current NY RN License 2+ years of experience as a nurse case manager 2+ years of experience managing complex disease cases Ability to travel within commutable distance of Poughkeepsie for internal and external on-site meetings 25% of the time Preferred Qualifications: Certified Case Manager 5+ years of experience as a nurse case manager 5+ years of experience managing complex disease cases Experience coordinating patient care in the post-acute setting
Clinical Liaison: Clinical problem solver with facilities, providers, resolution of issues concerning members, benefit interpretation, program definition and clarification Clinical Operations Analysis: Monitors and analyzes medical management activities; provides analytical support to clinical programs; may perform clinical assessments and clinical audits Clinical Program Management: Development, implementation and/or on-going management and administration of a clinical program(s). Provides strategic oversight and support, measurement standards and revisions as needed for delivery of programs focused on quality, affordability and outcomes Communicates with members of the Care Team as appropriate to coordinate the identified Member and physician's needs Provider/Member Education: Educate Member and care team participants on community/health plan benefit services available Performs various duties as needed to successfully fulfill the function of the position in conjunction with Medical Management as needed Identifies solutions to non-standard requests and problems Solves moderately complex problems and/or conducts moderately complex analyses Works with minimal guidance; seeks guidance on only the most complex tasks; Translates concepts into practice Provides explanations and information to others on difficult issues Provides feedback, and guides others Acts as a resource for others with less experience Optum NY/NJ was formed in 2022 by bringing together Riverside Medical Group, CareMount Medical and ProHealth Care. The regional alignment combines resources and services across the care continuum - from preventative medicine to diagnostics to treatment and beyond across New York, New Jersey, and Southern Connecticut. As a Patient Centered Medical Home, Optum NY/NJ can provide patient-focused medical care to the entire family. You will find our team working in local clinics, surgery centers and urgent care centers, within care models focused on managing risk, higher quality outcomes and driving change through collaboration and innovation. Together, we're making health care work better for everyone. 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.
Medix provides workforce solutions to clients and creates opportunity for talent in the Healthcare, Life Sciences, Engineering and Technology fields. Through our core purpose of positively impacting lives, we have earned our reputation as an industry leader by providing unsurpassed customer service and top quality professionals to our clients.
Utilization Management Nurse (RN/LPN) – Managed Care / Appeals & Authorization (Remote) Overview: We are seeking an experienced and detail-oriented Utilization Management Nurse to support clinical review operations within a fast-paced managed care environment. This role is responsible for conducting medical necessity reviews, processing appeals, coordinating with providers and external review agencies, and ensuring compliance with CMS and state regulatory requirements. The ideal candidate will bring strong clinical judgment, utilization management expertise, and the ability to navigate complex cases while maintaining exceptional documentation standards.
Required: Active, unrestricted RN or LPN license. Minimum 3 years of experience in Utilization Management, Clinical Appeals, Care Coordination, or Discharge Planning. Strong knowledge of CMS Medicaid/Medicare regulations and appeal timelines. Experience using InterQual or MCG criteria for medical necessity and level-of-care determinations. Proficiency with UM and clinical documentation platforms such as HealthEdge, Jiva, or Salesforce Health Cloud. Ability to exercise sound clinical judgment and escalate cases appropriately. Preferred: Certified Case Manager (CCM) or ABQAURP certification. Experience with Medicare Advantage, MLTC, SNP, or other managed care lines of business. Prior experience handling external appeals or regulatory audits involving CMS or DOH. Clinical expertise in Behavioral Health, Oncology, or Complex Surgical Services. Experience conducting internal UM quality audits for NCQA or URAC compliance. Bilingual proficiency strongly preferred. Ideal Candidate: The ideal candidate is highly organized, analytical, and comfortable working in a deadline-driven managed care environment. They possess strong communication skills, exceptional attention to detail, and the ability to collaborate effectively with interdisciplinary teams, providers, and regulatory partners.
Utilization Management Operations: Perform inpatient admission certification, concurrent review, and outpatient/ancillary authorization reviews. Evaluate medical necessity, level of care (LOC), and length of stay (LOS) using InterQual, CMS/Medicare guidelines, and internal medical policies. Ensure all reviews and determinations are completed within required turnaround times (TATs). Appeals & Clinical Review: Review clinical appeals and summarize findings for Physician Advisor or Medical Director review. Coordinate external appeal processes with External Review Agencies (ERA) and Clinical Peer Reviewers. Ensure timely submission of external review documentation and accurate implementation of final determinations. Documentation & Compliance: Maintain accurate and audit-ready documentation within UM and Appeals platforms. Document clinical findings, decision rationales, and review outcomes in accordance with regulatory and accreditation standards. Support compliance with CMS, NCQA, URAC, and state-mandated guidelines. Provider & Member Collaboration: Partner with PCPs and providers to obtain clinical information necessary for case review. Communicate authorization and appeal determinations to providers and members. Educate stakeholders on appropriate treatment alternatives and next steps when applicable. Reporting & Trend Analysis: Analyze pharmacy claims, encounter data, and health risk assessments to identify utilization trends and member needs. Escalate complex or high-risk cases appropriately to Physician Advisors or Medical Directors.
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 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 Full 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 24/7 coverage Position requires a minimum commitment of 40 hours per week Every other weekend coverage between 8-12 hour shifts covering both day and night shifts is required based on business needs Expectations that your are working or have approved PTO for 26 weekends a year. Each FT/PT employee is eligible to have 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 need Holidays are required for all APCs on a rotation basis Holiday scheduling is completed at the beginning of the year for advanced planning. Holiday coverage is provided beginning at 5pm, the end of the last business day, to 8am of the resumption of business hours
Required Qualifications: Education: NP: Graduate of an accredited Master of Science Nursing or Doctor of Nursing Practice program Active and unrestricted license in the state which you reside, as well as State of New York and the State of Massachusetts, 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 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 Active and unrestricted license in the additional states: Connecticut, Rhode Island, New Jersey 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 You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
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 evidenced 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 UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
As part of a care management team who will manage complex members, the Care Coordinator will be the primary care manager for a panel of older adult members with a variety of medical and/or behavioral health needs. Care coordination activities will focus on supporting members' medical, behavioral, and socioeconomic needs to promote appropriate utilization of services and improved quality of care. Work Schedule: Monday through Friday 8:00 am to 5:00 pm If you reside within the state of Indiana, you will have the flexibility to telecommute* as you take on some tough challenges.
Required Qualifications: Current, unrestricted independent licensure as a Registered Nurse in Indiana 2+ years of experience in long-term support services or working with older adults 1+ years of experience with local behavioral health providers and community support organizations addressing SDoH (e.g., food banks, non-emergent transportation, utility assistance, housing/rapid re-housing assistance, etc.) 1+ years of experience with MS Office, including Word, Excel, and Outlook Ability to travel 75% of the time within assigned territory to meet with members and providers Reside in Indiana Access to reliable transportation & valid US driver's license Preferred Qualifications: Demonstrated experience/additional training or certifications in Motivational Interviewing, Stages of Change, Trauma-Informed Care, Person-Centered Care Experience working in team-based care Experience in serving individuals with co-occurring disorders (both mental health and substance use disorders) Background in Managed Care Bilingual in Spanish or other language specific to market populations Case management experience Physical Requirements: Ability to remain stationary for long periods of time to complete computer or tablet work duties
Serve as primary care manager for high medical risks / needs members with comorbid behavioral health needs Engage members telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic (SDoH) needs Develop and implement individualized, person-centered care plans inclusive of goals, opportunities and interventions aligned with a person's readiness to change to support the best health and quality of life outcomes by meeting the members where they are Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan Provide referrals and linkage as appropriate and accepted by member (may include internal consult opportunities such as Housing Navigator, Pharmacy Team, Peer Specialist, etc. or community-based provider referrals such as PCP, specialists, medication assisted therapy referrals, etc.)
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The Secondary Review Nurse plays a critical role in evaluating clinical requests for Home and Community-Based Services (HCBS). This position ensures that care provided is medically necessary, cost-effective, and tailored to the individual needs of each member, while remaining compliant with state regulations. If you reside within the state of Indiana, you will enjoy the flexibility to work remotely * as you take on some tough challenges.
Required Qualifications: Current, unrestricted RN license in the state of Indiana 3+ years of clinical experience in a hospital, acute care, home health / hospice, direct care or case management, able to quickly identify needs and issues 2+ years of experience with completing functional assessments for LTSS services 2+ years of experience with Medicaid, Medicare, or Managed Care and Long Term Services and Supports Intermediate level of knowledge of LTSS experience determining eligibility and appropriate allocation of services Intermediate level of computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications Preferred Qualifications: Pre-authorization experience Utilization Management experience Case Management experience Knowledge of state and federal guidelines Home health or hospice Proven problem-solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
Participate in secondary reviews for HCBS services and Medicaid services Review and process prior authorization requests for LTSS and HCBS services Apply clinical judgment and decision support tools to determine medical necessity and appropriateness of services Collaborate with care managers, physicians, and other stakeholders to ensure continuity of care and alignment with the members' service plan Monitor utilization patterns and identify opportunities for improved care coordination and cost containment Document all clinical decisions and communications in accordance with regulatory and organizational standards Support quality improvement initiatives and participate in developing education and training for staff Identify potential quality of care concerns, including instances of over/or underutilization of services and escalate these issues as needed Stay current with established guidelines and regulatory requirements You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together
The Preservice Review RN is responsible for reviewing requests received from providers, using approved protocols and criteria. (Milliman Care Guidelines or Healthcare Operations Protocols). The RN is expected to approve those requests that meet medical necessity, along with benefit level, and the contractual status of the provider / facility as appropriate for self-funded lines of business. This position is also a resource to new staff and may precept as well. Candidates must be available to work Monday - Friday from 8:00 am - 5:00 pm PST. *** You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Required Qualifications: A current, unrestricted RN license for the state of Nevada 2+ years of recent critical care, ER and/or med-surg nursing experience Proficient with Microsoft Word to create, edit, save and send documents Proven ability to navigate a Windows environment, Microsoft Outlook, and conduct Internet searches Preferred Qualifications: 2+ years Utilization Management experience in managed care, acute or rehab setting Knowledge of utilization review process and prior authorization process in a managed health care industry Knowledge of ICD9 / CPT coding and Milliman Care Guidelines Soft Skills: Detail oriented, excellent organizational skills Ability to work well under pressure with sound decision making ability Excellent written and oral communication skills All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Evaluate and assess each request verifying eligibility and specific product Determine benefit level based on site of service Utilize written criteria to approve, pend or send the case to the medical director for review Send cases for pending process when appropriate Maintain at least 98% accuracy of clinical review case notes in Facets Maintain productivity standards and maintain compliance with all regulatory agencies including NCQA, DOL, DOI for each state, Medicaid, CMS and OPM Maintain at least 98% accuracy in summarizing cases for the Medical Director to review using appropriate protocols based members clinical and benefit information Maintain compliance with turnaround times based on the member's product, the type of request and the specific regulatory agency Be knowledgeable of and comply with the Nurse Practice Act for each state that licensure is required to perform SHL business Precepts / act as a resource for new staff 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.
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
The Clinical Team Lead will provide operational support to managers and supervisors for the assigned program. The Team lead is an individual contributor. Team lead assignments will be highly dependent on operational needs and priorities. The team leader will work closely with leaders to use data and reporting to identify and prioritize supports needed. They will act as subject matter experts for system and program support. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Prefers Southern California, but candidates could live outside of California if they have a good candidate.
Professional Competencies: Demonstrate knowledge of PC applications including MS Office Suite Ability to use written and oral communication skills Ability to read and interpret data Skill in writing clear, grammatically correct, easy-to-use instructional documentation Ability to identify learning needs, set goals and seek educational opportunities Ability to analyze problems and formulate appropriate plans, solutions and courses of action Knowledge of age specific communication is needed with the ability to listen actively and respond to internal and external customers in a timely, competent manner both verbally and nonverbally Ability to work with frequent interruptions Ability to establish and maintain cooperative working relationships with individuals at all levels of the organization and affiliates Ability to maintain confidentiality of patient and all related entity business matters of the organization and its partners Ability to manage detail and work with accuracy Ability to recognize and act appropriately in situations where patient care needs exceed medical certification Skill in working with a team; ability to collaborate on projects with colleagues Skill in working effectively under deadlines and changing priorities Skills: All staff members are to promote a positive and productive work environment by acting maturely and responsibly, satisfactorily performing his or her job responsibilities and conducting themselves in a professional, courteous, and respectful manner toward fellow employees, physicians and patients Must relate to other people beyond giving and receiving instructions: (a) get along with co-workers or peers without exhibiting behavioral extreme; (b) perform work activities requiring negotiating, instructing, supervising, persuading, or speaking with others; and (c) respond openly and appropriately to feedback regarding performance from a supervisor Integrates Lean principles, practices, and tools to improve operational efficiency, reduce costs and increase customer satisfaction Perform all duties in a manner which promotes and supports the Core Values and Mission Statement Working knowledge of health care delivery systems Work as an interdisciplinary team member with members, physicians, administration, staff and other managers Frequently follow written and oral instructions and complete routine tasks independently Ensures confidentiality of patient information following HIPAA guidelines and company policies Attends/completes training to meet requirements of the job position and as needed or mandated by company policies and regulations Has regular and predictable attendance Required Qualifications: Unrestricted RN license California license 3+ years of broad-based clinical experience and an expert in their respected function Preferred Qualifications: Bachelor's degree BLS if working in a clinical setting
Onboarding new teammates, provide training for the assigned work and monitor quality of work performance during the probationary period In collaboration with the management team will provide ongoing training to teammates identified through quality auditing where opportunities are identified to improve performance or productivity In collaboration with the management will develop and provide training to teams for all new, updated processes and workflows. Training attendance will be documented and submitted with the Operational Support team Manage patient and provider escalations or grievances by providing research into the inquire and provide a summary to the leadership for actions needed Manage health plan escalations in collaboration with the delegation oversight team Development and maintenance of all job aids that support system and processes for the assigned team Support for organizational realignment and change management by providing training, document updates and communication Support resource planning and allocation by reviewing daily assignments, shifting resource assignments when necessary to manage daily workloads Teammate scheduling when applicable Internal messaging and communication on upcoming changes and plans for operational readiness related to membership, programs, regulations or health plan changes Technology training and change readiness monitoring in support of system modifications Post implementation program/process monitoring and re-training to assure quality and performance meet team goals Implementation and monitoring of process changes needed to support CAP remediation in close collaboration with the Delegation oversight team Works with teams to bring forward patients for IDT collaboration Monitors team caseloads and productivity and make recommendations to leadership for workforce management *Note: This job description is not comprehensive of all duties/responsibilities performed. Management retains the right to alter this job description at any time. * The information listed above is not comprehensive of all duties/responsibilities performed. This job description is not an employment agreement or contract. Management has the exclusive right to alter this job description at any time without notice. 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 Precision Financials, we are a team of driven financial professionals dedicated to empowering individuals and families through financial education and leadership. We believe that financial literacy is the cornerstone of true financial independence—and our mission is to equip our clients with the knowledge, tools, and confidence they need to take control of their financial future
Work From Home Opportunity — Ideal for Nurses (RNs, NPs) Founded by an ER RN | Helping People Beyond the Bedside 100% Remote | Work from Anywhere with Wi-Fi Flexible Schedule | Part-Time or Full-Time High Income Potential | Full Training Provided Please Read the Full Description Before Applying Are you a Registered Nurse or Nurse Practitioner who’s passionate about helping people—but seeking a career that offers more freedom, less burnout, and long-term financial stability? You’re not alone. Many healthcare professionals are discovering a new way to serve others—without sacrificing their own health, time, or family life. This opportunity was founded by a career Emergency Room RN who spent years on the frontlines, and now empowers nurses and other purpose-driven professionals to transition from bedside care to financial care.
Basic Qualifications 18 years or older U.S. Social Security Number Able to pass a background check Willing to obtain a state financial license (we support you) Professional, ethical, and strong communication skills
As a licensed Financial Professional, you'll educate families, individuals, and small business owners on how to protect and build wealth through services such as: Life Insurance with Living Benefits Retirement Planning (401k rollovers, indexed accounts, annuities) College Savings Plans Business Protection Strategies You’ll receive full training, licensing support, mentorship, and ongoing professional development—even if you have no prior experience in finance or business.
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.
The Care Manager—Registered Nurse is a key member of our Special Needs Plan (SNP) care team, responsible for coordinating care for members who often face multiple chronic medical and behavioral health conditions, as well as various social determinants of health (SDoH) needs. This role involves conducting comprehensive assessments to evaluate members’ needs and addressing SDoH challenges by connecting them with appropriate resources and support services. The Social Worker provides education and guidance to members and their families on managing chronic conditions and navigating the healthcare system. Additionally, the Care Manager develops and implements individualized care plans, monitors member progress, advocates for necessary services, and collaborates with the interdisciplinary care team to ensure optimal health outcomes. Accurate and timely documentation of assessments and interventions is essential, as is participation in team meetings to discuss member status and care strategies.
Required Qualifications: Candidate must have active and unrestricted Registered Nurse (RN) licensure in the state of Pennsylvania (PA) OR Compact Registered Nurse (RN) licensure in state of residence Proficient in Microsoft Office Suite, including Word, Excel, Outlook, OneNote, and Teams, with the ability to effectively utilize these tools within the context of the Care Manager Registered Nurse (RN) role Access to a private, dedicated space to conduct work effectively to meet the requirements of the position Confidence working at home / independent thinker, using tools to collaborate and connect with teams virtually 3+ years of nursing experience 2+ years of case management, discharge planning and/or home healthcare coordination experience Preferred Qualifications: Experience providing care management for Medicare and/or Medicaid members. Experience working with individuals with SDoH needs, chronic medical conditions, and/or behavioral health. Experience conducting health-related assessments and facilitating the care planning process. Bilingual skills, especially English-Spanish Education: Associate’s of Science in Nursing (ASN) degree and relevant experience in a health care-related field (REQUIRED) Bachelor’s of Science in Nursing (BSN) (PREFERRED) License: Active and unrestricted Registered Nurse (RN) licensure in the state of Pennsylvania (PA) OR Compact Registered Nurse licensure in state of residence
Key Responsibilities: 50-75% of the day is dedicated to telephonic engagement with members and the coordination of their care. Compiles all available clinical information and partners with the member to develop an individualized care plan that encompasses goals and interventions to meet the member’s identified needs. Provides evidence-based disease management education and support to help the member achieve health goals. Ensure the appropriate members of the interdisciplinary care team are involved in the member’s care. Provides care coordination to support a seamless health care experience for the member. Meticulous documentation of care management activity in the member’s electronic health record. Collaborate with other participants of the Interdisciplinary Care Team to address barriers to care and develop strategies for maintaining the member’s stable health condition. Identifies and connects members with health plan benefits and community resources. Meets regulatory requirements within specified timelines. The Care Manager RN supports other members of the Care Team through clinical decision making and guidance as needed. Additional responsibilities as assigned by leadership to support team objectives, enhance operational efficiency, and ensure the delivery of high-quality care to members. This may include participating in special projects, contributing to process improvement initiatives, or assisting with mentoring new team members. Essential Competencies and Functions: Ability to meet performance and productivity metrics, including call volume, successful member engagement, and state/federal regulatory requirements of this role. Conduct oneself with integrity, professionalism, and self-direction. Experience or a willingness to thoroughly learn the role of care management within Medicare and Medicaid managed care. Familiarity with community resources and services. Ability to navigate and utilize various healthcare technology tools to enhance member care, streamline workflows, and maintain accurate records. Maintain strong collaborative and professional relationships with members and colleagues. Communicate effectively, both verbally and in writing. Excellent customer service and engagement skills.
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.
Candidate must reside in a compact state As a Nurse Case Manager, you will play a crucial role in providing healthcare support, care coordination and/or case management to members enrolled in a comprehensive healthcare program. Your expertise in nursing and healthcare management will be instrumental in assessing individuals' health needs, providing education and resources, and empowering them to make informed decisions about their health following a hospitalization, Emergency Department discharge, and/or a change to a higher level of acuity. SCOPE: Concierge Clinical Ops Case Managers, Triage Case Managers WORK SCHEDULE: This is a Monday thru Friday work schedule: 8 am to 5 pm your time zone with on flex day per week, 12 pm to 9 pm OR split flex 9 am to 1 pm and 5 pm to 9 pm your time zone.
Education: RN Diploma, Associates or Bachelor’s in nursing REQUIRED SKILLS: Registered Nurse (RN) licensure with a minimum of 3 years of clinical experience. Aptitude for computer skills, proficiency with Microsoft and web-based applications. Experience in health management, care coordination, or telephonic nursing is preferred. Strong clinical knowledge and understanding of chronic diseases, preventive care, and health promotion. Excellent communication and interpersonal skills, with the ability to engage individuals over the phone and build rapport. Demonstrate utmost level of professionalism in all work interactions Empathetic and patient-centered approach to care, with a focus on empowering individuals to take control of their health. Ability to understand and explain complex medical information in a clear and understandable manner. Strong organizational and time management skills, with the ability to prioritize tasks and manage a caseload effectively. Proficiency in using telehealth platforms and digital technology for individualized member monitoring which may include toggling between multiple applications during member calls Ability to handle both inbound and outbound calls providing timely and accurate nursing support and guidance as needed. Ability to multitask while working independently and collaboratively in a remote and fast-paced environment. Commitment to ongoing professional development and staying updated on the latest healthcare trends and guidelines. Certified Case Manager Certification, CCM, strongly preferred. If candidate does not currently hold certification, they must obtain within 4 years of employment. A Registered nurse must hold an unrestricted license in their state of residence, with multi-state compact privileges and have the ability to be licensed in all non-compact states, territories and the District of Columbia based on the needs of the business. Preferred Qualifications: Certified Case Manager Certification is a plus Previous telephonic/telehealth experience in health care Epic software experience
Clinical Assessments: Conduct comprehensive health assessments of members enrolled in healthcare programs through telephonic and/or digital tool interactions. Gather relevant medical, social, and lifestyle information to develop a holistic understanding of each member’s current status. Identify potential key risks, gaps in care, and opportunities for enhancing well-being. Education and Coaching: Provide telephonic and/or digital education, nursing interventions, and coaching to members on various health topics, including chronic disease management, preventive care, and healthy lifestyle choices. Empower members to take an active role in managing their health by providing them with the knowledge and tools needed. Collaborate with members to set achievable health goals and develop personalized action plans. Care Coordination and Referrals: Coordinate with healthcare providers and community resources to facilitate access to necessary services and support. Facilitate referrals to internal multidisciplinary care team members including Health Management Nurses and Resource Specialists. Assist members in navigating the healthcare system, including understanding insurance coverage and finding appropriate providers and resources. Health Monitoring and Follow-up Regularly monitor individuals' health status and progress towards their health goals through telephonic and/or digital tool check-ins. Provide ongoing support, encouragement, and accountability to individuals to help them stay on track with their health management plans. Collaborate with healthcare providers to ensure continuity of care and timely interventions when necessary. Documentation Reporting Maintain accurate and up-to-date documentation of telephonic and/or digital tool interactions, assessments, care plans, and outcomes. Ensure compliance with privacy and confidentiality regulations, including HIPAA guidelines. Ensure adherence to quality benchmarks and standards in all documentation, maintaining accuracy, clarity, and compliance with organizational guidelines. Demonstrate timely completion of case management activities in alignment with organizational protocols and NCQA accreditation standards, including documentation, care planning, and follow-up within required timeframes. Perform additional duties as assigned based on the evolving needs of the business.
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