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Dane Street is the industry's fastest growing national IME and Peer Review provider with a panel of board-certified, active-practice physicians in all 50 states. Services are provided to the Workers Compensation, Pharmacy, Disability, Group Health and Auto/Liability lines of business. Dane Street's Review and Evaluation services provide improved report quality, faster turnaround time and higher adjuster/nurse satisfaction and productivity.
Dane Street is seeking experienced Registered Nurses (RNs); or Nurse Practitioner (NP) ; or Practicing Assistants (PAs) to support our disability case review process. In this role, you will perform clinical reviews of disability claims, providing essential support to our decision-making team. These reviews will follow a structure similar to those performed by MDs, but are specifically designated for RN-level review. THIS IS PRN ONLY Previous experience in disability peer reviews required
Active, unrestricted RN; NP or PA license (multi-state preferred) Experience with Evidence of Insurability (EOI) Previous experience in disability reviews required Strong attention to detail and critical thinking skills Excellent written and verbal communication Comfortable working independently in a remote setting Experience with insurance or occupational health is a plus
Conduct thorough clinical reviews of disability claims Analyze medical records for accuracy and completeness Apply clinical expertise to evaluate claim validity Follow established review protocols and documentation standards
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.
*Must possess RN NY license** 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: Must have active and unrestricted Registered Nurse (RN) licensure in the state of NY 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 CM 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. Minimum 3+ years of nursing experience Minimum 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: Must have active and unrestricted Registered Nurse (RN) licensure in the state of NY
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.
Phaxis is one of the nation's leading recruiting and consulting firms. Working directly with our clients, candidates and consultants, our team is focused on bringing the right people together. Despite working nationally, we never forget our local roots. Whether it’s recruiting for technology, travel healthcare, allied or local healthcare, finance & accounting, or support services, legal or marketing, our team understands how to deliver results. Since 2002, we have been dedicated to tailoring our approach to both our client’s and candidate’s unique journey.
Remote RN Utilization Management Nurse (MLTC) Remote | NY RN License Required $62/hour We are seeking an experienced Registered Nurse (RN) with MLTC experience for a Remote Utilization Management role with a leading healthcare organization.
Active NY RN License MLTC experience required Utilization Review / Case Management experience preferred Strong clinical assessment and documentation skills Weekend rotation required
Review clinical records and evaluate requests for medical services Perform prior authorization and concurrent reviews Determine medical necessity and appropriate level of care Collaborate with providers, care managers, and interdisciplinary teams Ensure compliance with state and federal regulations
Nsight Health is transforming how care is delivered through Remote Patient Monitoring (RPM), Chronic Care Management (CCM), and Behavioral Health Integration (BHI). We empower healthcare providers to manage chronic conditions using real-time data, AI-enabled technology, and 24/7 clinical support. Our HIPAA-compliant platform connects patients and care teams nationwide—improving outcomes, adherence, and peace of mind. Join a fast-growing, mission-driven team that blends healthcare and technology to make a measurable difference in people’s lives. Nsight Health — Where Technology Meets Compassion.
We are seeking a motivated and detail-oriented LVN/LPN to join our Remote Patient Monitoring Department. In this role, you will be responsible for supporting patients with real-time health monitoring, respond to alerts and deliver timely life-improving interventions, and educate and empower patients through ongoing care.
Required: Active LVN/LPN license required Proficient with computers, EMRs, and telehealth tools Strong communication and organizational skills Bilingual Proficiency: Fluent in English and Spanish Preferred: At least 1 year of nursing experience preferred (RPM, telehealth, or chronic care experience is a plus) Work From Home Requirements Minimum internet speed of 50 Mbps download / 10 Mbps upload Hardwired internet connection required Speed test submission required during the offer process Private, HIPAA-compliant workspace Schedule This position operates on a 4-day work week structure, consisting of 10-hour shifts. Must be available to work rotating holidays throughout the year. Requires mandatory coverage of a minimum of two (2) weekends per month. Training Requirements All new hires must complete a comprehensive training program: Duration: Five weeks Schedule: Monday through Friday, 9:00 AM – 6:00 PM Eastern Time Attendance is mandatory to ensure readiness prior to independently supporting patients. Compensation & Benefits Competitive base pay of $24-$26 per hour. Shift Differentials: Evening Differential: +$1.50/hour for hours worked after 7:00 PM ET Late-Night Differential: +$2.00/hour for hours worked after 10:00 PM ET Weekend Differential: +$1.50/hour for all hours worked Saturday and Sunday Shift differentials are paid in addition to base hourly wages and reflected in the applicable payroll cycle.
Conduct outbound phone calls to check in on patients and address health concerns (expected call volume ranges from 70 to 90 calls per day) Handle inbound phone calls and route appropriately based on clinical urgency Route non-clinical inbound calls to the appropriate departments across the company Monitor and respond to Remote Patient Monitoring (RPM) alerts, escalating concerns when clinically indicated Collaborate with providers to coordinate timely and effective patient care Perform monthly wellness assessments and complete comprehensive chart reviews Accurately document all patient interactions in our clinical platform in real time Consistently meet or exceed individual and team performance metrics related to care quality, patient engagement, response times, and adherence to protocol standards Maintain compliance with company policies and applicable regulations Perform other duties as assigned
Come join our team at Three Oaks Hospice and our sister companies—Agape Hospice Care, Sage Hospice, Primary and Palliative Care, Elevation Hospice of Colorado, Elevation Hospice, and Primary and Palliative Care of Utah. We are growing and looking for compassionate professionals who want to make a meaningful impact while building a rewarding career in hospice and palliative care. Together, we share a unified mission to deliver best-in-class care to patients and families. While each organization maintains its own identity and local culture, we operate as one connected network—using shared systems and support to create a smooth, consistent, and candidate-friendly hiring experience. Why Work for Us: We are committed to being an employer of choice, offering a supportive culture centered on patient care, clinical excellence, and employee success. If you’re looking for purpose, stability, and growth—this is the place to be. Join our team!
Registered Nurse with current license to practice professional nursing in assigned state(s). Associate or bachelor’s degree in nursing from an accredited program. Three (3) years of management or supervisory experience in hospice or related healthcare organizations. Must have reliable transportation, proof of current automobile insurance, and a valid driver’s license. ROLE REQUIREMENT: Must have compact nursing license Hospice Experience Must be willing to travel SKILLS/ABILITIES/KNOWLEDGE: Demonstrated ability to coach, mentor, develop, supervise, and direct assigned staff. Demonstrated planning and organization skills to effectively manage multiple priorities simultaneously. Ability to proficiently manage workflow within the EMR. Ability to support an interdisciplinary team concept and be able to work as part of a team. Demonstrated skill in managing patient service issues, service recovery, and professionally managing customer relations. Excellent observation, verbal, written, and interpersonal skills. Knowledge of business management, government regulations, and ACHC standards. Proficient in Microsoft Office
The Triage Registered Nurse RN is responsible for the operational oversight and management of all patient care activities and outcomes during their assigned shifts. The On-call Triage Supervisor ensures a culture of compliance, accountability, quality patient outcomes, and clinical excellence is maintained while adhering to the standards of quality care and contributing to the organization’s mission, vision, and values.
StudyFetch is the #1 AI-native learning platform globally, transforming how millions of students learn through personalized AI-powered education. We’re growing fast with backing from top-tier investors and a mission that’s redefining the future of education and ethical learning.
About the role: We're looking for an experienced registered nurse to join our content quality team as an Expert Question Reviewer for NCLEX-RN exam preparation materials. You'll review practice questions across all NCLEX-RN content areas — including Medical-Surgical, Maternal/Newborn, Pediatrics, Psychiatric/Mental Health, and Pharmacology — ensuring clinical accuracy, appropriate difficulty, and alignment with current NCSBN standards. This is a contract position — flexible, remote, and project-based. You'll work independently through our review platform to evaluate questions at your own pace, leaving detailed feedback and comments directly in the tool. You're a great fit if you've spent years at the bedside and now want to shape how the next generation of nurses prepares for licensure. You're the kind of nurse who catches the subtle clinical error others miss — the wrong lab range, the outdated guideline, the distractor that's technically also correct. You're comfortable working independently and equally comfortable debating a tricky question with peers.
Active RN license (BSN minimum) 5+ yrs clinical experience spanning Medical-Surgical, Maternal/Newborn, Pediatrics, or Psychiatric nursing Strong knowledge of the NCSBN Clinical Judgment Measurement Model (CJMM) and all Next Generation NCLEX item types NCLEX prep instruction or item-writing experience strongly preferred
Log into our review portal and work through your assigned question queue at your own pace Read each question's clinical stem, answer options, and detailed explanation Mark each question as Approved, Needs Revision, or Reject using the platform's built-in tools Leave specific, actionable comments on any question that needs changes (e.g., "Distractor B is also defensible because..." or "Dose range for metoprolol should be...") Validate that all 19 NGN item types (bow-tie, trend, matrix, highlight, drag-and-drop, unfolding case studies) are structurally correct and test clinical judgment rather than recall Cross-check pharmacology content: drug names, dosages, side effects, nursing implications, and interactions Verify difficulty is appropriate for NCLEX-RN level and that rationales address every answer option Flag ambiguous distractors or stems that could have multiple defensible answers Confirm bow-tie items have exactly 5 correct selections, trend items show realistic progressions, and unfolding case studies have realistic clinical progression
Pinnacle Method Consulting stands at the summit of specialized business transformation. We've mapped the paths to operational excellence, and we guide organizations through proven methodologies that guarantee results. Our consultants are sherpas of change management, Agile implementation, and process optimization. We don't believe in one-size-fits-all—we customize our ascent strategy for each client, but the destination remains the same: the peak of your industry.
Pinnacle Method Consulting's mission is to help job seekers reach their career peak by accessing top-tier opportunities. We are not a staffing firm or agency. Pinnacle Method does not hire for these roles—we systematically source and verify them from premier employers. Employer Industry: Healthcare Services Why Consider This Job Opportunity Salary up to $70,000 Comprehensive benefits package including health, dental, and vision coverage for employees and their families Opportunities for performance bonuses and retirement plans Generous paid time off policy to ensure work-life balance Support for remote work with provided Apple equipment and media stipend Fast-paced, high-performance culture with opportunities for professional growth
What Is Required (Qualifications): Unrestricted LVN/RN license from an accredited program Minimum of 2 years of clinical nursing experience At least 1 year of previous experience in Utilization Management Proficient in written and spoken communication Strong organizational skills with attention to detail How To Stand Out (Preferred Qualifications): Experience in a fast-paced healthcare environment Familiarity with medical management platforms and utilization review processes Strong problem-solving skills and ability to handle multiple tasks Knowledge of regulatory prerequisites and state standards for utilization review Advanced skills in Microsoft Office tools
Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines Examine and evaluate patient records to verify the quality of care and necessity of services provided Offer clinical expertise and serve as a reference for non-clinical staff Input and manage essential clinical details within various medical management platforms Communicate effectively with management teams, physicians, and the Medical Director to foster high-quality patient care
At Nsight Health, you’ll be part of a fast-growing organization that sits at the intersection of healthcare, technology, and compassion. We’re looking for people who care deeply about improving patient lives and building the future of connected care. Our team culture is collaborative, agile, and purpose-driven. Every role—from clinical operations and customer success to marketing, technology, and leadership—directly contributes to improving how healthcare organizations care for their patients.
We are seeking a motivated and detail-oriented LVN/LPN to join our Remote Patient Monitoring Department (Night Shift). In this role, you will be responsible for supporting patients with real-time health monitoring, respond to alerts and deliver timely life-improving interventions, and educate and empower patients through ongoing care.
Required: Active LVN/LPN license required Proficient with computers, EMRs, and telehealth tools Strong communication and organizational skills Preferred: At least 1 year of nursing experience preferred (RPM, telehealth, or chronic care experience is a plus) Work From Home Requirements Minimum internet speed of 50 Mbps download / 10 Mbps upload Hardwired internet connection required Speed test submission required during the offer process Private, HIPAA-compliant workspace Schedule This position operates on a 4-day work week structure, consisting of 10-hour shifts. Must be available to work overnight hours. Must be available to work rotating holidays throughout the year. Requires mandatory coverage of a minimum of two (2) weekends per month. Training Requirements All new hires must complete a comprehensive training program: Duration: Five weeks Schedule: Monday through Friday, 9:00 AM – 6:00 PM Eastern Time Attendance is mandatory to ensure readiness prior to independently supporting patients.
Conduct outbound phone calls to check in on patients and address health concerns (expected call volume ranges from 70 to 90 calls per day) Handle inbound phone calls and route appropriately based on clinical urgency Route non-clinical inbound calls to the appropriate departments across the company Monitor and respond to Remote Patient Monitoring (RPM) alerts, escalating concerns when clinically indicated Collaborate with providers to coordinate timely and effective patient care Perform monthly wellness assessments and complete comprehensive chart reviews Accurately document all patient interactions in our clinical platform in real time Consistently meet or exceed individual and team performance metrics related to care quality, patient engagement, response times, and adherence to protocol standards Maintain compliance with company policies and applicable regulations Perform other duties as assigned
Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives.
The Utilization Review Nurse will provide professional assessments and review for the medical necessity of treatment requests and plans. The standard work schedule is Monday through Friday, 8:00 AM–5:00 PM Pacific Time, with rotating weekend coverage required.
Education and Experience: Current RN license in the United States or U.S. territory. Associate’s degree or diploma (Nursing program) required. 1+ year clinical experience required. Required Knowledge, Skills, and Abilities Required Knowledge, Skills, and Abilities Ability to perform the essential job functions safely and successfully with or without reasonable accommodation, including meeting qualitative and/or quantitative productivity standards. Ability to maintain regular, punctual attendance. Ability to sit for 6-8 hours. Constant use of computer keyboard and mouse; repetitive use of both hands. Occasional to frequent twisting of neck; occasional bending of neck and at waist. Work Environment: At Personify Health we value and celebrate diversity, and we are committed to creating an inclusive environment for all employees. We believe in creating teams made up of individuals with various backgrounds, experiences, and perspectives. Why? Because diversity inspires innovation, collaboration, and challenges us to produce better solutions. But more than this, diversity is our strength, and a catalyst in our ability to change lives for the good. Physical Requirements: Must be able to remain in a stationary position 50% of the time. The person in this job needs to occasionally move about inside the office to access office machinery, filing cabinets and meeting facilities. Constantly operates a computer and other office productivity machinery, such as copy machine, computer printer, calculator, etc. Frequently positions self to maintain files in file cabinets. Frequently moves boxes or equipment weighing up to 25 pounds. Must communicate information and ideas so others understand. Must be able to exchange accurate information in these situations. Must be able to observe details at close range.
Provide professional assessment and review for the medical necessity of treatment requests and plans. Provide first level review for all outpatient and ancillary pre-certification requests for medical appropriateness; inpatient hospital stay including mental health, substance abuse, skilled nursing, and rehabilitation for medical necessity; and post claim or post service reviews. Staff are expected to cross train, and provide cross coverage as needed. Work to the top of the RN license and ensure proper referral to medical director for denial authorizations through independent review organizations (IRO). Work with hospital staff to prepare patients for discharge and ensure a smooth transition to the next level of care. Refer requests that fall outside of established guidelines to advance review or senior care consultants. Process appeals for non-certification of services, complete non-certification letters when appropriate. Review plan document for benefit determinations; attempt to redirect providers and patients to PPO providers. Identify and refer potential cases to case management, wellness, chronic disease and Nurturing Together programs. Complete documentation for all reviews in appropriate documentation software. Utilize guidelines in appropriate hierarchy. Guidelines include MCG guidelines, internal medical policies, group specific policies, and NCCN. Ability to meet productivity, quality, and turnaround times daily. Ability to pass external audits to include URAC and NCQA. Maintain HIPPA compliance per company’s policy and procedures. Maintain confidentiality and minimum requirement rules. Complete all required yearly training per company’s expected time limit. Complete and pass all annual testing including IRRA at 90% or higher. Ability to meet productivity, quality, and turnaround times daily. Ability to pass external audits to include URAC and NCQA. Maintain HIPPA compliance per company’s policy and procedures. Maintain confidentiality and minimum requirement rules. Complete all required yearly training per company’s expected period
MDS Solutions is a consulting organization that employs only RAC-CT certified MDS experts with experience in the post-acute industry. We help providers capture the reimbursement they're owed! We do this by keeping up on all the regulatory requirements and changes enacted by states and the federal government. In addition, we ensure facilities stay in compliance and are meeting 5-Star criteria to maximize your potential! We provide MDS teams hands on training and education. MDS Solutions experts can also assist in your MDS completion, capturing accurate quality care, educating your teams around regulatory changes, and optimize clinical reimbursement. We are able to step in and provide assistance for both short-term and long-term coverage. We assist with intermittent rises in census, coverage during vacations or those unexpected leaves of absence. We are your partners in financial success!
MDS Solutions, a division of Key Rehabilitation, is looking for fun, energetic, and self-driven team members to join our remote MDS consulting group. The role of the Remote MDS Coordinator is to work with our contract partners to plan, organize, and coordinate the completion of the Minimum Data Set (MDS) in accordance with current Federal and State Regulations. If you are looking for something that is flexible and collaborative, come join us! We thrive on Quality Resident Care.
Nursing Experience in MDS Assessment: 3+ year RAC-CT preferred RN or LPN Thorough understanding of PDPM requirements Able to negotiate through EMR and possess strong computer skills Promotes and demonstrates excellence in customer service
MDS scheduling and coordinating to ensure timeliness of assigned sections of MDS per RAI guidelines, including coordinating care plan development and completion with the interdisciplinary team. Provide Medicare, Medicaid (case mix), and Managed Care oversight to ensure appropriate clinical services are provided and appropriate reimbursement is received for each resident. Develop an individualized, comprehensive resident care plan in collaboration with the interdisciplinary team to ensure care area triggers are addressed. Ensure care plans are reviewed quarterly and updated as needed to reflect current resident status with individualized problems, goals, and interventions. Review and verify MDS documentation and charting requirements to support the clinical services provided for each resident. Ensure timely submission of all Minimum Data Sets to the state data base and ensures that the necessary follow-up action is taken. Promote highest degree of quality care through QI/QM data with facility team and identify trends to assist facility in advancing facility processes, improve resident outcomes, and optimize reimbursement.
Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986, PCG employs approximately 2,000 professionals throughout the U.S.—all committed to delivering solutions that change lives for the better. The firm is a member of a family of companies with experience in all 50 states, and clients in three Canadian provinces and Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit www.publicconsultinggroup.com.
PCG is currently seeking a Utilization Review Nurse. The Utilization nurse will also be responsible for utilizing a medical management software system on a day-to-day basis. The purpose of the Fund is to provide a funding source for future health care costs associated with birth‐related neurological injuries.
Required Skills: Possesses effective verbal/written communication skills, especially via phone, with the ability to interact with various levels of personnel. Able to work in a fast-paced environment, demonstrate excellent problem solving, critical thinking, and organizational skills. Performs multiple tasks efficiently and accurately, have exceptional attention to detail and perform consistent work product Self-motivated, self-directed, team oriented, and responsible, with a positive attitude and a proactive style Possesses the ability to operate in a highly variable work environment. Presents a courteous and competent demeanor to our clients and teammates. Excellent customer service skills Strong computer skills Ability to easily navigate through website research. Qualifications: Graduated from an accredited School of Nursing, Associate Degree, Bachelor’s preferred Minimum of 2 years of direct clinical nursing experience Minimum of 2 years of experience with medical management activities in a managed care environment, Medicaid or hospital utilization management RN required Working Conditions: Remote
Performs prior authorization, concurrent and retrospective reviews Use clinical documentation and clinical review criteria to make determinations regarding qualifying health care costs Accurately records all review determinations and supporting documentation Contacts providers and members according to established timeframes Identifies and refers cases that do not meet established clinical or other criteria to the Case Management Supervisor Identifies and communicates quality issues to the Case Management Supervisor Communicates information to other team members Utilizes knowledge of community resources and the member’s benefit structure Interacts with providers, vendors, and facilities in a professional and respectful manner Recognizes quality of care issues and escalates the issues appropriately Understand and facilitate the Appeals and Grievances process Assists members with the coordination of services from various settings as appropriate Performs other duties as assigned
At Medcor, we’re passionate about caring for our advocates as much as you are passionate about caring for your patients! Join our team and receive the support you need to be successful in your practice and to focus on your patients. In addition to a collaborative work environment, we offer great pay and benefits, and an emphasis on your wellness.
Medcor is looking to hire a full-time Float Nurse (RN) to provide onsite staffing relief and training in the client’s workplace clinics in both primary and occupational health care in multiple sites across multiple states. The Float Nurse is expected to deliver care according to Medcor protocols. This position requires significant travel. The work week is generally Monday through Friday although some weekend travel and coverage may be required. Here are some reasons our medical professionals say they value their jobs at Medcor: Time to engage with patients, to get the job done right the first time, and truly make a difference in the lives of patients. Support. You will be a part of a team with ongoing support from operations, technology, and clinical colleagues. A business model that is transparent, free from conflicts of interest and not claims-driven. No quotas or referral pressures – we don’t even bill insurance. That’s good for you, the patient, the client, and us. Clients who value your clinical experience and expertise. Opportunity to build relationships and accomplish meaningful work that is appreciated. We hope that speaks to you as much as it does to us. The position requires a good working relationship with multiple employers, supervising /collaborative physicians and Medcor’s medical leadership. The Float Nurse will work in close cooperation with Medcor’s operational and clinical leadership to ensure optimal clinic operation and high patient satisfaction. In addition to providing staffing support, the Float Nurse will also assist with new clinic set-up and associate training needs. Candidates will be required to possess an unencumbered RN licensure in IL and IA and must be able to travel, sometimes with short notice, and work at various clinics in multiple cities.
Have valid unrestricted multi-state Nurse licensures (RN) Have current CPR/BLS certifications Have at least three years of relevant clinical experience Have experience and working knowledge of workers' compensation and occupational health Have strong computer and other technology skills (navigate cell phones, texting, fax machines, etc), as well as familiarity with EMR software Have strong Microsoft (Word, Excel, PowerPoint, etc) skills Be strong enough to lift a 50lb emergency response bag Possess excellent verbal and written communication skills – with patients, clients and colleagues Have a positive and outgoing personality, and be a collaborative team player Be willing to go above and beyond to give excellent customer service It’s a Plus If: You are comfortable working in a worksite clinic environment You are COHN certification You are DOT/BAT/CAOHC certified Travel Requirements: Greater than 75% travel is required as this full-time Float Nurse position will float to multiple clinics in Illinois and Iowa to assist with: clinic set-up, associate training, vacation and time off requests, interim nursing coverage of new sites, etc. Travel will include weekends to accommodate Monday-Friday clinical shifts and may occasionally require short notice. Position should be based within 30 minutes of a major metropolitan airport and ideally located in the Midwest. During times that you are not covering the clinics, you will be supporting the operations team with projects, tasks, initiatives, etc, from home.
Evaluation and treatment of illnesses and injuries according to Medcor protocols while functioning as an advocate for both the patient/employee and the employer Provide the following services to employees: Evaluation and treatment of work related injuries Various types of surveillance testing Preventive care programs (i.e. screening for hypertension, diabetes and high cholesterol) Various types of immunizations (i.e. influenza, Hep B, and Tetanus) Participate in, support, develop and help motivate others to participate in wellness programs Assist with pre-employment and employee drug screens Discuss patient care with the supervising/collaborative physician, the patient’s primary care physician (where applicable) and other care-givers as appropriate Compliance with CDC guidelines for vaccine storage, handling, and administration Initial evaluation and stabilization of patients who present with illnesses or injuries that require a higher level of care or EMS transport Complete and timely documentation of care in the electronic medical record in compliance with Medcor’s documentation standards Exceptional customer service skill Prompt, predictable attendance Strict adherence to HIPAA regulations, ability to appropriately handle sensitive/personal medical information Assist with clinic set-ups and training and other duties as assigned
With over 30 years in the telehealth industry servicing clients across North America, Fonemed prides itself on providing outstanding client experience and practicing a culture of care in everything we do. We are a growing company who values our greatest resource - our people! We provide a collaborative company culture and a welcoming team.
Telehealth Triage Nurse (Remote) Full Time 0.8 - 1.0 FTE - Part Time may be considered based on availability Must have compact nursing license Fonemed is recruiting full time remote Registered Nurses to join our team! We are looking for experienced and dependable Registered Nurse who are dedicated to providing quality nursing care to patients. If you are a Registered Nurse who is looking for a challenge and a company who values you, apply today! Position Overview: Our nurses provide telephone triage and health advice to callers across the United States remotely from the comfort of their own home using world renowned Schmitt-Thompson protocols and provide nursing care advice virtually to patients. Calls received can vary greatly in subject matter and complexity. In addition to triage calls, we receive questions requesting information on medical conditions, medications, diagnostic tests, etc., and provide patient support through addressing their medical questions and concerns. Registered Nurses must be attentive and engaged listeners who have strong critical thinking and clinical assessment abilities and are able to make decisions independently and document clear clinical data. All calls are documented electronically, and all telephone encounters are recorded.
Completion of a recognized Nursing program Minimum 3 years of recent 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 An active license in CA is required, along with active compact license in your home state. Active licensure in all 50 states would be an asset or the willingness to obtain licenses at the company’s request Previous telephone triage experience using electronic triage software and computerized medical protocols will be considered an asset Experience using the Barton Schmitt/David Thompson guidelines will be considered an asset Strong communication skills Strong clinical assessment skills Strong computer skills within a Windows environment and keyboarding ability Bilingual English/Spanish will be considered an asset
Role Responsibilities: Provide telephone triage and advice to callers to assist them in making timely medical decisions Exercise clinical judgement in combination with utilization of protocols to arrive at the appropriate disposition to provide timely and accurate level of care to patients Promptly complete confidential medical records as per company documentation standards Provide clear and concise information and direction during patient encounters Expectations of Nurse: Full time work with a commitment of 32-40 hours per week and the opportunity to pick up additional shifts when available at your own discretion Part time work may be considered with open availability Private HIPAA compliant home office with high-speed internet connectivity (wired/ethernet highly recommended) Must be able to provide own computer equipment (computer or laptop, second monitor, keyboard, mouse, wired USB headset and high-speed internet) Participation (via telephone or video) in staff meetings Full compliance with FONEMED policies and procedures, including HIPAA privacy requirements Scheduling and Licensure: Full time work with a commitment of 32-40 hours per week and the opportunity to pick up additional shifts when available at your own discretion Part time work may be considered with open availability Shift work type schedule that could include mornings, days, evenings, nights, weekends, holidays and occasional split shifts Our current major hiring need is for shifts that would fall between 06:00am ET and 22:00pm ET daily. Please note that we are not able to offer a set schedule at this time, your schedule would vary week to week Work every other weekend, option to work additional weekends also available Must possess a compact nursing license and a California license would be an asset
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, but must be able to independently travel to Farmington, CT for training/meetings Department: Case Management Schedule: Full time, 40 hours/weekly, Monday through Friday, 8:00AM - 4:30PM If you have a CT nursing license and based in CT, MA, NY, or RI., you will have the flexibility to work remotely* as you take on some tough challenges.
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: Unrestricted current RN licensure in state of Connecticut Bachelor of Science in Nursing (BSN), or 5 years case management experience in lieu of BSN 2+ years experience in health plan case management, complex and disease case management Prior 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 A background in managed care Experience in discharge planning Experience in utilization review, concurrent review, or risk management Strong critical thinking and decision-making skills Ability to work on a multi-disciplinary team 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
Relationships. Respect. Understanding. These are just a few reasons why clients and candidates choose to partner with Hub Technology Group, a full service technology staffing company providing solutions catered to the needs of clients and employees. Our services include contract placement, contract to permanent, and permanent placement solutions. We work across all industries and find talent fort technology, human resources, Office Administration, Finance and more.
The Inpatient Utilization Management Clinician is responsible for evaluating all inpatient medical treatments for medical necessity, monitoring ongoing treatment, facilitating discharge planning to ensure smooth and successful transitions of care, and collaborating with care management and medical directors to support members in achieving optimal health outcomes.
Determine medical appropriateness of services following evaluation of medical guidelines applying evidenced-based InterQual® criteria, Medical Policy and benefit determination. Perform utilization review activities, including pre-certification, concurrent and retrospective reviews according to guidelines. Determine medical necessity of each request by utilizing approved evidenced based guidelines / criteria Utilize decision-making and critical-thinking skills in the review and determination of coverage Reviews, documents, and communicates all utilization review activities and outcomes Refers cases to Physician Reviewer when the treatment request does not meet medical necessity per guidelines Payor experience required
NPHire connects top NP talent with leading healthcare employers and staffing agencies. We're the only job-matching platform built exclusively for Nurse Practitioners, simplifying both the job search and the hiring process so the best match rises to the top every time.
A nationwide telehealth program is hiring Family Nurse Practitioners (FNPs) for a fully remote, flexible contract role focused on follow-up care, chronic disease management, and care coordination. This position is ideal for NPs who prefer lower-acuity, relationship-based visits rather than high-volume urgent care. Most encounters include reviewing recent visits, monitoring symptoms, adjusting treatment plans, and supporting patients with ongoing health needs. New graduates with strong primary care training are welcome.
Active NP license in at least one U.S. state FNP/AGPCNP certification required Comfortable with chronic care and follow-ups Strong communication and patient engagement skills Telehealth experience helpful but not required New graduates encouraged to apply
Conduct virtual follow-up visits Manage chronic conditions (HTN, diabetes, asthma, etc.) Review labs, medications, and care plans Provide patient education and reassurance Coordinate next steps and referrals as needed Document visits efficiently in EMR
Zenith Grace Home Care is seeking an experienced and dependable Part-Time Supervisor Registered Nurse (RN) to provide clinical oversight and regulatory supervision for our non-medical home care agency in New Jersey. This role is primarily supervisory, quality-assurance and compliance-focused and does not involve routine hands-on bedside nursing care. The Supervisor RN supports quality assurance by conducting required client assessments, developing and reviewing plans of care, supervising caregivers, and ensuring compliance with New Jersey Division of Consumer Affairs home care regulations. The ideal candidate is organized, detail-oriented, and comfortable working independently while collaborating with agency leadership. This position is well-suited for an RN seeking flexible, part-time work, such as a hospital RN, school nurse, case manager, or nurse with regulatory or home care experience. This role does not include direct medical treatment, medication administration, or skilled nursing services unless separately authorized and licensed. This position is required to meet New Jersey home care agency licensing and regulatory requirements, and continued employment is contingent upon the agency maintaining all applicable state approvals. The Supervisor RN plays a key role in maintaining care standards, supporting caregivers, and ensuring the agency operates with integrity, professionalism, and compassion.
Skills: Strong knowledge of New Jersey home care regulations or ability to quickly learn and apply regulatory requirements Excellent clinical assessment and care planning skills Ability to provide clinical supervision and guidance to caregivers and CHHAs High level of attention to detail with accurate documentation and record-keeping Strong organizational and time-management skills in a part-time, independent role Effective written and verbal communication skills Ability to work independently with minimal supervision Professional judgment and problem-solving skills related to client care concerns Experience with or comfort using electronic documentation systems Ability to collaborate with administrative leadership in a compliance-focused environment Reliable transportation and willingness to travel locally for assessments when needed
Conduct initial, annual, and change-of-condition client assessments in accordance with New Jersey home care regulations Develop, review, and update Plans of Care to ensure client safety, appropriateness of services, and regulatory compliance Provide clinical supervision and oversight to caregivers and Certified Home Health Aides (CHHAs) Participate in caregiver orientation, training, and competency evaluations as required Serve as a clinical resource for caregivers and administrative staff regarding client care concerns Review and follow up on incident reports, complaints, and adverse events, and assist with corrective action plans when needed Ensure services are delivered in compliance with NJ Division of Consumer Affairs – Health Care Service Firm requirements Collaborate with agency leadership to support quality assurance and performance improvement initiatives Maintain accurate and timely clinical documentation in accordance with agency policies and state regulations Be available for on-call consultation related to clinical oversight as required
At Chesterfield Hospitality Executive Recruiters, we specialize in connecting world-class talent with elite hospitality brands. Our boutique search firm is rooted in a passion for excellence, with a focus on luxury hotels, resorts, restaurants, and casinos that demand the highest caliber of talent. We partner closely with clients to understand their brand DNA, then deliver exceptional candidates who align not only in skill, but in culture, service standards, and vision. From Forbes Five-Star properties to Michelin-rated restaurants, we are trusted by the industry’s finest to deliver executive placements that elevate the guest experience and drive results. Let us help you build your dream team!
Staff Provider (Telemedicine‑Focused) We’re partnering with a mission‑driven healthcare organization to hire a compassionate, flexible Staff Provider (APRN/RN/NP) to support rapid‑access intakes, early‑treatment medical care, and ongoing maintenance support for members in recovery. This role blends clinical expertise, telemedicine, and team‑based care to help members stay safe, engaged, and supported throughout treatment. Must be licensed to practice with a DEA certification in either Kentucky, Tennessee, or West Virginia.
What We’re Looking For: Advanced Practice Nurse, Nurse Practitioner, or Physician Assistant with active license Ability to obtain additional state licenses (supported and reimbursed) Experience treating OUD with buprenorphine (1+ year preferred) Background in team‑based care with behavioral health professionals Experience working with similar patient populations (2+ years) Strong telemedicine comfort and reliable internet connectivity Empathy, flexibility, and a member‑first mindset If you’re passionate about expanding access to recovery care and thrive in a collaborative, fast‑moving clinical environment, we’d love to connect. *Must be currently authorized to work in the United States* *Must be currently located in the United States*
Rapid‑access telemedicine intakes across multiple markets Medical decision‑making for treatment eligibility and MAT initiation Early‑treatment support during weeks 1–4 of care Ongoing maintenance care for a dedicated member panel Collaboration with counselors, providers, and support staff Cross‑coverage for colleagues and rotating on‑call responsibilities Accurate, same‑day documentation and prescription management Participation in new‑market launches and medical service‑line pilots
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.
Nurse Practitioner – After Hours Telehealth (Remote | Part-Time OR Full-Time) Location: Remote (U.S.) Schedule: ~24 hours/week | Evenings, Nights, Weekends, Holidays About the Role: We are seeking an experienced Nurse Practitioner (NP) to join a national after-hours care team supporting residents in senior living and skilled nursing facilities.
Schedule & Coverage ~24 hours/week with a consistent, set schedule (Part time) Full time 36 Hours per week Nights, Weekends, or Holidays Ideally would be 2-3 12 hour shifts, but flexible if needed Required Qualifications: Master’s Degree as a Nurse Practitioner Active, unrestricted NP license in at least two states Willingness to obtain additional state licenses as needed National certification (ANP, FNP, or GNP) Eligible for prescriptive authority & DEA licensure Minimum 3+ years of NP clinical experience Experience managing adult/geriatric acute & chronic conditions
Provide after-hours clinical support via phone and telehealth platforms Assess and manage acute, chronic, and behavioral health conditions Support facility staff with real-time clinical decision-making Coordinate care across settings (SNFs, hospitals, outpatient providers) Conduct thorough assessments and document encounters in the EMR Apply clinical protocols to support treatment-in-place when appropriate Participate in ongoing training and quality initiatives
Datavant is the data collaboration platform trusted for healthcare. Guided by our mission to make the world’s health data secure, accessible and actionable, we provide critical data solutions for organizations across the healthcare ecosystem - including providers, health plans, researchers, and life sciences companies. From fulfilling a single patient’s request for their medical records to powering the AI revolution in healthcare, Datavanters are building the future of how data is connected and used to improve health. By joining Datavant today, you’re stepping onto a driven and highly collaborative team that is passionate about creating transformative change in healthcare.
As a Clinical Documentation Quality Improvement (CDQI) Specialist, you will play a pivotal role in elevating the impact of our medical record documentation. You will conduct daily evaluations and engage in direct communication with providers to enhance documentation clarity, completeness, and overall medical record quality. By ensuring accurate and comprehensive physician documentation, you will be at the forefront of influencing the precision of code assignment, making a tangible difference in the accuracy of healthcare data. Join us in this critical role where your efforts will have a direct and meaningful impact on the quality and effectiveness of patient care. Preferred: A candidate that can perform daily evaluations pertaining to the quality and accuracy of clinical documentation in medical records.
3+ years of CDI experience 3+ years of clinical experience in an academic medical center Registered Nurse license, Bachelor's degree in Nursing CCDS or CDIP certification required Must pass a CDI skills competency assessment Must be able to accommodate a min of 15 hours per week
Conduct timely, accurate, and complete documentation reviews for selected inpatient records, addressing inadequate or conflicting documentation. Collaborate with physicians and caregivers to ensure appropriate reimbursement and clinical severity for DRG-based payer patients. Demonstrate understanding of complications, co-morbidities, severity of illness, risk of mortality, case mix index, secondary diagnoses, and procedure impact on DRG. Improve coding specificity by educating physicians and caregivers on the importance of clear documentation throughout a patient's stay. Follow AHA guidelines and coding clinics for accurate coding and required documentation to ensure compliance. Query physicians regarding missing, unclear, or conflicting health record documentation to obtain necessary details. Maintain daily production logs for evaluation, tracking cases reviewed, queries placed/responded, etc. Perform follow-up reviews to confirm recorded points of clarification in the patient's medical record. Ensure confidentiality of all files, documents, and records. Meet or exceed production and quality metrics.
At Collabera, we bridge top talent with industry-leading companies, creating a platform for meaningful career growth. With over 30 years of global expertise, we are an AI-first, people-centric organization empowering professionals with the right opportunities, resources, and networks to grow and lead.
Pay Range: $46-$47/hr Candidates must be licensed in WASHINGTON STATE (RN/LPN/LVN)
Active WA RN/LPN/LVN license 2+ years clinical experience (Utilization Management and Case management) Prior Authorization/Utilization Review Knowledge of InterQual & medical necessity guidelines
Review inpatient cases for medical necessity Handle prior authorizations & concurrent reviews Ensure compliance with InterQual/CMS guidelines Collaborate with providers & internal teams
At Curana Health, we’re on a mission to radically improve the health, happiness, and dignity of older adults—and we’re looking for passionate people to help us do it. As a national leader in value-based care, we offer senior living communities and skilled nursing facilities a wide range of solutions (including on-site primary care services, Accountable Care Organizations, and Medicare Advantage Special Needs Plans) proven to enhance health outcomes, streamline operations, and create new financial opportunities. Founded in 2021, we’ve grown quickly—now serving 200,000+ seniors in 1,500+ communities across 32 states. Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds, all working together to deliver high-quality, proactive solutions for senior living operators and those they care for. If you’re looking to make a meaningful impact on the senior healthcare landscape, you’re in the right place—and we look forward to working with you.
The Care Manager delivers telephonic care management for Curana patients enrolled in a Value-Based Care Program such as but is not limited to Advanced Primary Care Management (APCM) or Chronic Care Management (CCM). These patients often have complex, emerging health risks, or recent care transitions. Working with Curana Providers and the interdisciplinary team, the Care Manager supports quality, cost-effective care.
Exhibits knowledge of pathophysiology and accepted treatment protocols for common health diagnoses (i.e., diabetes, chronic heart failure, chronic obstructive pulmonary disease). Ability to analyze patient records to identify gaps in care and report to the provider. Ability to work in a remote environment that is free of distractions. Proficient computer skills and ability to adapt to various technology platforms. Excellent written communication skills. Demonstrated experience in the usage of clinical data to guide decision making. Must have the ability to function independently and as a member of the interdisciplinary care team. Required Education and Experience: Must hold an active, unrestricted compact LPN license. Ability to obtain additional state licenses, as needed 2+ years of experience in nursing is required. Care settings may include inpatient, outpatient, or skilled nursing facilities. Preferred Education and Experience: Case Management experience CCM certification (strongly preferred) Experience working with Electronic Health Records Travel Requirements: 100% remote position requires a reliable high-speed internet connection.
Patient and Caregiver Support Review electronic health records (EHR) to identify gaps in care for patients residing in a Long-term Care Nursing Facility. Review and approve initial and ongoing health questionnaires completed by a member of the care management team. Serve as a health coach to educate patients and/or caregivers about their disease process. Develop patient-centered care plans. Educate patients and their durable medical power of attorney (DPOA) on the benefits of APCM or CCM. Provider Support Support quality gap closure through clinical discovery. Schedule Provider visits for at-risk patients Coordinate with the Transitional Care Manager to schedule patient visits and inform the TCM nurse if a patient is discharged to acute or SNF. Ensure orders, referrals, and prior authorizations are facilitated by the virtual care support team. Escalate abnormal diagnostic test results to Curana providers. Communication Support Communicate patient health updates to the Curana providers. Communicate treatment plans and health updates to the patient’s caregiver in an effective and caring manner. Primary liaison between the provider and administrative support team. Other duties as assigned
MDS Solutions is a consulting organization that employs only RAC-CT certified MDS experts with experience in the post-acute industry. We help providers capture the reimbursement they're owed! We do this by keeping up on all the regulatory requirements and changes enacted by states and the federal government. In addition, we ensure facilities stay in compliance and are meeting 5-Star criteria to maximize your potential! We provide MDS teams hands on training and education. MDS Solutions experts can also assist in your MDS completion, capturing accurate quality care, educating your teams around regulatory changes, and optimize clinical reimbursement. We are able to step in and provide assistance for both short-term and long-term coverage. We assist with intermittent rises in census, coverage during vacations or those unexpected leaves of absence. We are your partners in financial success!
MDS Solutions, a division of Key Rehabilitation, is looking for fun, energetic, and self-driven team members to join our remote MDS consulting group. The role of the Remote MDS Coordinator is to work with our contract partners to plan, organize, and coordinate the completion of the Minimum Data Set (MDS) in accordance with current Federal and State Regulations. If you are looking for something that is flexible and collaborative, come join us! We thrive on Quality Resident Care.
Nursing Experience in MDS Assessment: 3+ year RAC-CT preferred RN or LPN Thorough understanding of PDPM requirements Able to negotiate through EMR and possess strong computer skills Promotes and demonstrates excellence in customer service
MDS scheduling and coordinating to ensure timeliness of assigned sections of MDS per RAI guidelines, including coordinating care plan development and completion with the interdisciplinary team. Provide Medicare, Medicaid (case mix), and Managed Care oversight to ensure appropriate clinical services are provided and appropriate reimbursement is received for each resident. Develop an individualized, comprehensive resident care plan in collaboration with the interdisciplinary team to ensure care area triggers are addressed. Ensure care plans are reviewed quarterly and updated as needed to reflect current resident status with individualized problems, goals, and interventions. Review and verify MDS documentation and charting requirements to support the clinical services provided for each resident. Ensure timely submission of all Minimum Data Sets to the state data base and ensures that the necessary follow-up action is taken. Promote highest degree of quality care through QI/QM data with facility team and identify trends to assist facility in advancing facility processes, improve resident outcomes, and optimize reimbursement.
Description - Full Time or Part Time Performs primary data abstraction duties for NCDR CathPCI Registry and ensures high levels of abstraction accuracy for assigned accounts via validation activities. Demonstrates strong communication, documentation, organizing, and planning skills to ensure strong leadership of multiple accounts concurrently.
Experience abstracting in the NCDR CathPCI Registry within the last 2 years is required. Familiar with medical records, billing/documentation practices, and standard healthcare quality concepts. Ability to work independently. Relies on experience and judgment to plan/accomplish goals. Maintains a strict level of confidentiality in all aspects of work. Demonstrates a high standard of accuracy and attention to detail. Excellent interpersonal communication skills. Proficient in Microsoft Office. MSN, BSN, or RN preferred. CPHQ preferred.
Collects and abstracts data from patient medical records, especially those related to cardiac care. This includes information on diagnoses, treatments, procedures, and outcomes. Ensures the accuracy and completeness of the abstracted data. This involves cross-referencing information from multiple sources within a patient's medical record. Adheres to specific clinical data abstraction guidelines and standards, such as those set by the American College of Cardiology. Enters the abstracted data into a database or registry, often using specialized software. This includes maintaining and updating the data as necessary. Participates in quality assurance processes to ensure data integrity. This involves routine audits of the data or the abstraction process. Remains informed about developments in cardiac care and data management to ensure ongoing competency in the role.
At Commence, we’re the start of a new age of data-centric transformation, elevating health outcomes and powering better, more efficient process to program and patient health. We combine quality data-driven solutions that fuel answers, technology that advances performance, and clinical expertise that builds trust to create a more efficient path to quality care. With human-centered, healthcare-relevant, and value-based solutions, we create new possibilities with data. We provide proof beyond the concept and performance beyond the scope with a focus on efficiencies that transform the lives of those we serve. With a culture driven by purpose, straightforward communication and clinical domain expertise, Commence cuts straight to better care.
We’re growing our network of clinical reviewers and are actively seeking Nurse Case Reviewer who are passionate about quality, accountability, and patient outcomes. As a member of our reviewer panel, you'll play a key role in ensuring the appropriateness, necessity, and quality of care delivered to military members and their families.
Hold an active, unrestricted U.S. license/certification Registered/Licensed Minimum of 5 years of clinical experience in your specialty Currently practicing and seeing patients an average of at least 20 hours per week Preferred Qualifications: Experience with QIO, peer review, utilization review, or appeals work Familiarity with military or federal healthcare programs (e.g., TRICARE, Medicare) Previous experience with legal or regulatory case reviews Why This Role: Fully remote, contract-based (1099) Flexible workload – cases assigned based on your availability and specialty Impactful work that contributes to high-quality care and oversight Per-case pay ranging from $100–$340 depending on case complexity Most cases take 1–3 hours to complete; shorter reviews may take less than 1 hour Strong written communication skills and attention to detail Ability to review cases objectively and meet turnaround deadlines Comfortable working independently in a secure, remote environment
Conduct independent, remote case reviews evaluating medical necessity, appropriateness, or quality of care. Provide evidence-based assessments and written determinations following established clinical guidelines and review criteria. Support case types including: Utilization review, Appeals and hearings, Quality of care and standard of care concerns Uphold the highest standard of clinical integrity, neutrality, and objectivity.
ARCHER Systems is a leading technology enabled legal services company that provides pre-settlement and post-settlement administration services for single event, mass tort, and class action cases with the goal of helping claimants access their settlement proceeds more efficiently and quickly. The company plans to continue leveraging technology and top tier talent to enhance customer service and offer new product lines and services. ARCHER’s core offering is post-settlement Healthcare Lien Resolution Administration and QSF (Qualified Settlement Fund) Administration and payments processing for multi-claimant (mass tort and class action) litigation. Other services include claims administration, single event lien resolution, probate and bankruptcy coordination, release administration, medical records review, and plaintiff fact sheet and other intake/census preparation and management. ARCHER enables law firms to focus on their litigation while ensuring that critical pre-settlement and post-settlement administration documents, services, business analytics and reporting are handled efficiently and effectively.
The Legal Nurse Consultant works collaboratively with the Pre‑settlement and Claims Administration teams to perform clinical reviews of medical information based on case‑specific methodologies. Responsibilities may include preparing chronologies and timelines, developing medical summaries, applying mass‑tort‑specific medical matrix criteria, and offering clinical opinions relevant to case validity and valuation. Location: Remote
SKILLS & QUALIFICATIONS: Proficiency in Microsoft Word, Adobe, and Excel Strong ability to analyze, prioritize, and evaluate complex medical information Effective team collaborator with the ability to work across all levels of staff to meet business goals Ability to manage multiple priorities, work under pressure, and meet strict deadlines Working knowledge of healthcare data analysis and clinical review principles Detail oriented, organized, and capable of managing multiple tasks simultaneously 1–3 years of medical review experience required Strong computer skills across multiple software platforms, including (but not limited to) healthcare charting systems REQUIRED CERTIFICATION: Active Registered Nurse License (RN) or other applicable medical license MINIMUM EDUCATION: Associate Degree in Nursing (ADN) or nursing diploma required Bachelor’s degree in nursing (BSN) preferred REQUIRED EQUIPMENT: Windows PC running Windows 11 with 16GB RAM and 5GB available hard drive space or Apple MacBook (Pro or Air) running Tahoe or newer with 16GB RAM and 5GB available hard drive space. Cell phone with Microsoft Authenticator installed. Secure high speed internet connection
Analyze and summarize medical records for both pre settlement and post settlement projects Apply knowledge of pharmaceutical, mass tort, and product liability cases (experience preferred) Assist with the transcription, editing, and formatting of physician reviews Ensure all work is completed within contractual deadlines and that deliverables meet all required components Deliver final work product in accordance with client specific guidelines Communicate effectively with internal teams and external stakeholders regarding case reviews Evaluate, identify, and report on medical care issues and other relevant findings Participate in project data analysis, reporting processes, and continuous feedback cycles
Explore opportunities with [agency name], a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together.
As the Registered Nurse you will provide and direct provisions of nursing care to patients in their homes as prescribed by the physician and in compliance with applicable laws, regulations, and agency policies. You will also coordinate total plan of care with other health care professionals involved in care and helps to achieve and maintain continuity of patient care by planning and exchanging information with physician, agency personnel, patient, family, and community resources. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Required Qualifications: Current and unrestricted RN licensure in the state of practice Current driver's license, vehicle insurance and access to a dependable vehicle or public transportation Current CPR certification Ability to function in any home situation regardless of age, race, creed, color, sex, disability, or financial condition of the client State Specific Requirements: LA: 1+ years of clinical experience as a Registered Nurse 1+ years of clinical experience as a Registered Nurse 1+ years of clinical experience as a Registered Nurse may be waived for a Registered Nurse with recent clinical experience as an LPN RN licensure must have no restrictions Preferred Qualifications: 1+ years of RN experience Able to work independently Good communication, writing, and organizational skills
Provide high-quality clinical services within scope of practice and infection control standards Coordinate care with other members of the patient/client's care team from admission to discharge Complete clinical nursing assessments per federal/state program requirements and payer needs Ensure patient/client eligibility and medical necessity for services as defined by payer and agency policy Develop and revise individualized plans of care/service plans with other community providers Ensure plan of care frequency and duration meets patient needs and initiate revisions with physician approval 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.
LearningMate is a technology company offering domain expertise in teaching and learning solutions - leveraging digital, cloud, process automation, data, and strong learning design principles. For more than twenty years, LearningMate has been working with education institutions across the globe to help them build, deploy, and streamline their digital infrastructure. Through our powerful mix of products and services, we are proud to help lead the world toward a future where education is accessible, affordable, and effective. Since 2001, we have grown to employ more than 3,500 associates spread across the world and serve a global clientele of education publishers, traditional and nontraditional EdTech companies, K-20 schools, universities and career colleges, government agencies, non-profits, corporate training, and education consortia.
We are seeking an experienced Subject Matter Expert (SME) Author to develop original instructional content for a Medication Safety course designed for prelicensure nursing students. This role involves creating engaging, evidence-based modules and assessments that support foundational nursing knowledge, clinical judgment, and safe medication administration practices. The SME Author will utilize assigned textbooks to develop original, academically sound content aligned with nursing education standards and best practices. This is a contract-based role ideal for nurse educators, clinicians, or content developers with a strong background in pharmacology and medication safety.
Required Qualifications: Active, unencumbered RN license (BSN required; MSN or higher preferred) Minimum of 3–5 years of clinical nursing experience Minimum of 3–5 years in nursing education, curriculum development, or item writing Strong knowledge of: Pharmacology and medication safety principles Prelicensure nursing education standards NCLEX and/or NGN frameworks (preferred) Ability to translate complex concepts into clear, student-appropriate language Strong written communication and attention to detail. Preferred Qualifications: Prior experience as an SME or content author for nursing education products Experience working with instructional design teams or digital learning platforms. Work Expectations: Contract-based, remote position Adherence to project timelines and deliverables Participation in periodic check-ins or content reviews.
Develop original course content for a Medication Safety curriculum, including: Instructional modules (didactic content) Assessments and learning activities Translate textbook content into learner-centered, application-focused material appropriate for prelicensure nursing students Integrate concepts related to: Safe medication administration (e.g., rights of medication administration) Dosage calculations Medication error prevention and reporting Collaborate with instructional designers and project leads to ensure consistency, alignment, and quality Revise content based on editorial and peer feedback Maintain academic integrity by producing fully original content.
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
We support providers who care for UnitedHealthcare (UHC) Medicaid and CHIP members across five counties in southeastern Pennsylvania: Philadelphia, Montgomery, Bucks, Chester, and Delaware. Our team includes a Clinical Quality Manager, a Quality Director, and a Quality Nurse. This role will serve as the second Quality Nurse on the team. Within our same department we have a member outreach team also and another responsible for NCQA policy and Performance Improvement Projects. Our primary goal is to promote our local Pay‑for‑Performance program and support providers in achieving the highest possible incentive outcomes by meeting HEDIS® and state quality measures. In addition, we provide ongoing support to provider groups engaged in value‑based contracts, which also include HEDIS® and state‑mandated quality measures tied to defined performance benchmarks. You'll enjoy the flexibility to work remotely * within Montgomery and surrounding counties as you take on some tough challenges.
Required Qualifications: Registered Nurse licensure in the state of PA Experience in clinical quality, patient safety, risk management, or performance improvement Experience leading or facilitating performance improvement within scope Knowledge of HEDIS® measures technical specifications Familiarity with quality measurement tools, such as dashboards, scorecards, databases, or EHR reporting tools Intermediate proficiency in Microsoft Office applications, particularly Excel and PowerPoint Demonstrated solid documentation and organization skills Willingness to travel to community-based events for assigned groups up to 10% Driver's License and access to reliable transportation Key Competencies: Attention to detail and accuracy Critical thinking and clinical judgment Collaboration and relationship building Ability to educate providers or administrative staff and provide feedback constructively on performance Adaptability and comfort with change All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Quality Program Leadership & Provider Support Oversee ongoing provider practice engagement and community education related to state specific quality measures Collaborate closely with the Quality Manager and Quality Director to coordinate an interdisciplinary approach that improves provider's performance Serve as the primary resource for provider focused clinical quality improvement and management programs Educate providers and office staff on quality program requirements, including analysis of provider level outcomes, monitoring of key metrics, and support in meeting quality standards, contractual obligations, and pay for performance targets Clinical Quality & Compliance Ensure activities align with State, CMS, NCQA, and other regulatory requirements Support providers in evaluating member care, identifying care gaps, and developing action plans using evidence based guidelines and quality tools (HEDIS®, NCQA, CMS, state specifications) Conduct onsite medical record audits to assess coding, documentation, quality compliance, and service delivery standards Investigate documentation gaps or system issues impacting measure performance, provide feedback, and monitor resolution to completion Data Analysis, Reporting & Record Management Analyze quality data to identify trends, opportunities for structured data, and gaps in care at the provider and member levels Maintain care opportunity reports, track encounter history, and support quality related studies or initiatives as directed by the Health Plan Support medical record collection and abstraction processes for Pre Season (April-January), Hybrid (January-April), PAPM Maternity (April-July) and other review periods to optimize measurement and reporting Prepare and distribute reporting, and analytics related to care gaps, performance trends, and member outreach opportunities Provider Practice Transformation & Education Lead targeted practice level quality improvement initiatives through clinical education and deployment of approved materials The role assists contracted providers with analyzing member care, trending quality compliance at the provider level, and developing action plans and programs to support provider practices in continuous quality improvement using approved clinical practice guidelines, HEDIS®, CMS, NCQA and other tools Provider education regarding the quality improvement program involves analysis and review of quality outcomes at the provider level, monitoring, measuring, and reporting on key metrics to assist providers in meeting quality standards, state contractual requirements and pay for performance initiatives based on HEDIS® measures Deliver training on documentation, coding, billing, state mandated quality metrics, profiling, pay for performance methodologies, and medical record review criteria Serves as subject matter expert (SME) for assigned HEDIS®/ State Measures, preventive health topics, leads efforts with clinical team to research and design educational materials for use in practitioner offices; serves as liaison with key vendors supporting HEDIS® / State Measures; consults with vendors to design and implement initiatives to innovate and then improve HEDIS®/State Measure rates Care Gap Closure & Targeted Quality Improvement Drive closure of open care opportunities, including preventive services, chronic condition management, and other quality measures through HEDIS® data collection Identify population level barriers to care and recommend evidence based strategies to close clinical gaps and improve outcomes Provide follow up education or interventions for practitioners based on chart audit findings to support continuous quality improvement Relationship Management & Community Engagement Build and maintain solid relationships with internal and external stakeholders, including providers, practice staff, community organizations, and public health partners Participates, coordinates, and/or represents the Health Plan at community-based organization events, clinic days, health department meetings, and other outreach events focused on quality improvement, member health education, and disparity programs as assigned Document and escalate non clinical or service related provider concerns to appropriate departments (Provider Relations, Chief Medical Officer, etc.) Operational & Cross Functional Collaboration Coordinate with other departments on projects and initiatives that intersect with quality performance, regulatory activities, or provider engagement Work independently and within a highly matrixed team environment, managing competing priorities while meeting deadlines Perform additional duties as assigned by Quality Leadership Challenges of the role This Role Can Be Challenging For Individuals Who Struggle with managing multiple priorities at once, as quality work often involves juggling several projects, deadlines, and stakeholders simultaneously Are not naturally self sufficient or self motivated, since the role often requires taking initiative, problem solving independently, and driving improvements without constant direction Are uncomfortable working with data, including reviewing and analyzing information in Excel, running or interpreting reports, and creating clear, professional presentations Do not feel confident presenting information or speaking in public, as sharing findings with leadership, committees, or clinical teams is a core part of the work Prefer routine, predictable tasks, because quality roles frequently shift based on organizational needs, audit findings, or emerging quality concerns Have difficulty navigating change, as the job involves implementing new workflows, policies, and performance improvement initiatives across teams Are uncomfortable giving feedback or addressing performance gaps, even in a constructive, supportive way Do not enjoy collaborating across multiple departments, since relationship building with clinicians, leadership, and operational partners is essential Struggle with regulatory or compliance details, as the role requires understanding, interpreting, and applying standards from accrediting and regulatory bodies Have trouble documenting processes, writing summaries, or communicating findings clearly and concisely 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.
Built around a mission to improve the lives of nurses and patients, IntellaTriage has been providing after-hours nurse triage for hospice and home health providers since 2008. Utilizing best-in-class technology, IntellaTriage provides round-the-clock direct access to licensed, registered nurses using client-customized protocols for patient-centered, compassionate care. We are growing rapidly and excited to support our clients’ nursing staff in the field by leveraging our remote team of nurses to manage after-hours care delivery. Our triage nurses become an extension of our clients’ care team, and they trust us to support them and their patients during their non-core hours.
We are seeking a compassionate registered nurse (RN) to join our growing team! In this role, you will provide critical after-hours support, triaging hospice patients and family needs over the phone wit professionalism and empathy. You will help ensure timely interventions and coordination of care for patients receiving hospice services.
Active multistate Registered Nurse (RN) license Hospice, palliative, or end-of-life care is strongly preferred Must be comfortable with technology and electronic medical records (EMR) utilized for documentation of calls Ability and comfort with typing documentation and notes in a fast-paced environment Must be able to handle stress and multitask when receiving calls (minimum of 5 calls per hour on weekdays, and up to 8 per hour on weekends) Strong communication and critical thinking skills Ability to work independently in a remote environment This is a remote position that requires consistent attendance, active communication, and reliable internet connectivity during all scheduled shifts to support timely patient care coordination
Provide telephone triage for hospice patients and families Assess patient conditions and determine appropriate next steps Collaborate with on-call teams to coordinate care and resources Accurately document all communications and interventions Maintain a calm and professional demeanor while handling urgent calls.
Nsight Health is transforming how care is delivered through Remote Patient Monitoring (RPM), Chronic Care Management (CCM), and Behavioral Health Integration (BHI). We empower healthcare providers to manage chronic conditions using real-time data, AI-enabled technology, and 24/7 clinical support. Our HIPAA-compliant platform connects patients and care teams nationwide—improving outcomes, adherence, and peace of mind. Join a fast-growing, mission-driven team that blends healthcare and technology to make a measurable difference in people’s lives. Nsight Health — Where Technology Meets Compassion.
We are seeking a motivated and detail-oriented LVN/LPN to join our Chronic Care Management team. In this role, you will play a critical role in patient care by conducting comprehensive assessment calls, developing and educating patients on care plans, performing Behavioral Health Integration (BHI) assessments, and assisting patients with medical device troubleshooting. Shift Differentials: Evening Differential: +$1.50/hour for hours worked after 7:00 PM ET Late-Night Differential: +$2.00/hour for hours worked after 10:00 PM ET Weekend Differential: +$1.50/hour for all hours worked Saturday and Sunday Shift differentials are paid in addition to base hourly wages and reflected in the applicable payroll cycle. Additional Compensation (If Applicable): Sign-On Bonus: $2,000 paid after 120 days of continuous employment, contingent upon active employment and satisfactory performance at time of payout. Monthly Bonus Potential: Up to $1,500 5% Bilingual Pay Allowance Benefits Include: 11 Paid Company Holidays annually Paid Time Off (PTO) Medical, Dental, Vision, and supplemental insurance options 401(k) Plan with 3.5% Company Match Company-provided equipment
Required: Active LPN/LVN Compact License required. Strong communication and organizational skills Bilingual Proficiency: Fluent in English and Spanish Proficient with computers, EMRs, and telehealth tools Preferred: Passionate about patient care, possessing the ability to relate with empathy and compassion. A passion for patient teaching is a must. At least 1 year of nursing experience preferred (RPM, telehealth, or chronic care experience is a plus) Work From Home Requirements Minimum fiber internet speed of 50 Mbps download / 10 Mbps upload Hardwired internet connection required Speed test submission required during the offer process Private, HIPAA-compliant workspace Schedule Varying Shifts Training Requirements All new hires must complete a comprehensive training program: Duration: Five weeks Schedule: Monday through Friday, 9:00 AM – 6:00 PM Eastern Time Attendance is mandatory to ensure readiness prior to independently supporting patients.
Conduct thorough assessment calls with patients to gather relevant information about their health status, concerns, and needs Identify and escalate patient needs, including refill requests, appointment scheduling, and connecting patients with community resources Develop comprehensive care plans based on patient assessments Perform Behavioral Health Integration (BHI) assessments to evaluate and address the mental health aspects of patient care Maintain compliance with company policies and applicable regulations Perform other duties as assigned
DaVita means “to give life,” reflecting our proud history as leaders in dialysis—an essential, life-sustaining treatment for those living with end stage kidney disease (ESKD). Today, our mission is to minimize the devastating impacts of kidney disease across the full spectrum of kidney health care. At DaVita, we’re a community first and a company second. We care for our teammates with the same intensity with which we care for our patients—and encourage our teammates to bring their hearts to work. That is, we can be the same people inside and outside of work because for us, it’s not work, it’s our passion.
The DaVita Integrated Kidney Care Supportive Care Case Manager/Palliative Care (RN) serves as a clinical subject matter expert and specialized support layer for patients with advanced Chronic Kidney Disease (CKD) and End Stage Kidney Disease (ESKD) who are experiencing significant health decline and assisting them in navigating a challenging healthcare system. This role leverages deep expertise in Palliative care to lead complex Goals of Care (GOC) and advance care planning discussions, navigate patients to comfort resources and empower patients to make healthcare decisions aligned with their values.
Must have Palliative Care Experience Full-time Fully Remote position, work from your designated home office Monday- Friday schedule with the ability to accommodate patient’s availability. We serve patients nationwide Collaborate with Operations Manager, Clinical Services Manager, Nurse Practitioners, Social Worker, and Case Managers to review patient cases, identify gaps/barriers, and coordinate on advance patient care plan Lead complex conversations and conduct in-depth, compassionate telephonic discussions to support patients with potentially declining conditions to educate on treatment options, ensure patients care aligned with their wishes, and navigate to appropriate resources Lead Goals of Care (GOC) discussions with ability to translate patient wishes into actionable care plans; document and update GOC to ensure alignment across the entire healthcare team (Nephrologists, Dialysis Centers, IKC RNs). Educate patients on Advanced Directives (MOLST/POLST) and encourage completion to prevent unwanted aggressive interventions. Assess symptom burden (pain, anxiety, dyspnea) and collaborate with providers to implement nursing interventions that improve Quality of Life (QOL). Strong clinical acumen with the ability to recognize the trajectory of chronic illness, identify critical changes to proactively identify those at risk of rapid decline or readmission and intervene immediately for transition to supportive care. Expertly assess patient appropriateness and readiness for palliative care or hospice and facilitate seamless transitions to these external services. Educate pts on curative treatments, palliative support, and hospice care, to help reduce barriers to access. Exceptional active listening and motivational interviewing skills; ability to discuss sensitive topics (death, dying, prognosis) with empathy and clarity. Ability to work independently in a remote environment, managing a caseload of high-complexity patients with minimal supervision. Facilitate patient/family communication and develop and/or update advance care plans. Provide comfort case management for patients where palliative care is not available or when patients are not ready to stop dialysis but would like to pursue comfort care Coordinate care for patients’ care including care transitions, management of complex/at risk patients, managing ongoing needs and establishing a treatment plan in partnership with the care team Requirements: Minimum of 2+ years experience as an RN in Palliative medicine required Minimum of five (5) years experience as an RN required 2+ years of care plan creation, proactive discharge planning and utilization. Current RN License is required, BSN preferred. Current Cardiopulmonary Resuscitation (CPR) or Basic Life Support (BLS) certification. Proficiency in EMR systems (Cerner), Microsoft Office (Teams, Excel), and virtual communication platforms. Home office with internet connectivity at a minimum of 1MB upload and 1MB download speed required. Preferred Qualifications: IKC Experience as a DaVita IKC RN Case Manager 2+ years of Case Management or Chronic Care Management Minimum of two (2) years experience in renal nursing preferred Compact License - Highly preferred
This role functions autonomously to support the primary Integrated Kidney Care team with high-acuity patients, coordinating between the dialysis center, Nephrologist, primary care, and external agencies to facilitate quality, consistent, cost-effective care, ensuring a holistic, compassionate approach to end-of-life planning, symptom management to minimize care fragmentation and prevent unnecessary hospitalizations.
Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986, PCG employs approximately 2,000 professionals throughout the U.S.—all committed to delivering solutions that change lives for the better. The firm is a member of a family of companies with experience in all 50 states, and clients in three Canadian provinces and Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit www.publicconsultinggroup.com.
Client Service Associates will be integral members of the EDPlan Innovations Team. This position will be responsible for engaging client stakeholders for EDPlan Innovation projects. Client Service Associates are responsible for managing, maintaining, and growing client relationships with state agency and/or local education agency stakeholders across multiple states/projects. This will be accomplished through direct client interaction, as well as collaboration with Regional Teams. This role must effectively integrate capabilities in client management and project management in addition to promote strong connectivity with the other Client Service Associates and the EDPlan Innovations team. The Client Service Associate role will focus on multiple products and services within EDPlan with a focus on EDPlan Health, an electronic health record documentation system for school nurses, within EDPlan.
Skills for Success: Proven success at client relationship building Effective communication skills (presentation, facilitation, and written) Proven success or the ability to gain a deep understanding of electronic nursing documentation software Collaboration skills (with peers, staff, and leadership) Ability to manage multiple projects and clients simultaneously with a keen attention to detail Ability to be decisive, consistent, transparent, and open to feedback Highly organized and skilled at prioritization Ability to lead virtual and in person trainings on EDPlan Innovations Professional maturity and ability to put the best interests of the client and PCG above self-interest Advanced knowledge of Microsoft Office products: Excel, Word, PowerPoint, Teams Preferred Experience: Must be located in or around the state of OK Registered nurse (RN) with expertise in the specialty of school nursing. Experience with electronic nursing documentation (SIS or EHR) 2-5 years' experience managing client relationships Strong understanding of EDPlan, specifically EDPlan Health Expertise using Asana or comparable task management, or project management, tools Qualifications: Bachelor’s degree preferred or additional relevant years’ experience required Working Conditions Remote
Clients: Focus on developing long-term client relationships – expand influence, increase retention, solve issues, and drive satisfaction Model best practices in terms of client, project, and change management Lead client engagements/interactions (e.g., status update meetings) Proactively identify problems and provide solutions to clients Build client excitement in terms of new features, functionality, and services Provide feedback regarding the evolving needs of our clients and how we can remain responsive, competitive, and good partners Provide training on use of the system for end users and administrators as needed Provide Tier 2 or 3 support via Zendesk (helpdesk) for EDPlan Innovations Ability to manage multiple projects and clients simultaneously with a keen attention to detail Collaboration & Coordination Contribute to a professional and respectful team dynamic with a culture of mutual accountability Deliver results in terms of client success metrics, both individually and collaboratively Collaborate and coordinate with Regional Teams and other functional areas to meet our clients’ needs. Examples include: Coordinate with EDPlan Innovation Product Leads and Regional Team in terms of the creation of status update meeting materials, respond to data or reporting requests, and evolve our services based on training and helpdesk feedback Serve as a main point of contact internally for Regional Teams - review new opportunities for viability, potential market shifts, and areas of risk Serve as the client contact re: change request process and involve appropriate team members from EDPlan Innovations Coordination with Technical Business Analyst to articulate change requests and product feedback and support execution of changes in the form of user acceptance testing (UAT) and training documentation
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.
Per Diem requirement - must be able to provide a minimum of 9 hours of availability per week. Qualified candidates must hold a current, unrestricted license in Tennessee and live within three hours of the Tennessee border to meet minimum qualifications for this position. If hired, must be willing and able to obtain additional licensure. Internal candidates cannot maintain a full-time or part-time position in core and a PRN position in Virtual Care. The MinuteClinic Telehealth Nurse Practitioner (Provider) delivers patient care services through a remote technology platform. You will work in collaboration with a dedicated team of professionals as you independently provide holistic, evidenced based care inclusive of accurate assessment, diagnosis, treatment, management of health problems, health counseling, and disposition planning for our patients ranging in age 18 months and above. Encounters are documented utilizing an electronic health record (EHR). MinuteClinic Telehealth providers report directly to the Senior Practice Manager
WORKING ENVIRONMENT: Dedicated virtual care providers must meet minimum requirements for remote care delivery, including: broadband connectivity, a quiet setting with a neutral background to conduct visits from, and the ability to uphold patient privacy per CVSH guidelines. Ability to hardwire into connection preferred. While performing the duties of the job, the employee is regularly required to interact with customers in a remote manner, site, write, operate the computer and phone, speak intelligibly, and hear patient responses. Specific vision abilities include the ability to view and read a computer screen and other electronic devices Candidates must be currently licensed in one of the following states to be considered: Tennessee Minimum of two years of medically-relevant experience or equivalent Effective verbal, written, and electronic communication skills Outstanding organizational skills and ability to multi-task Initiative, problem solving ability, adaptability and flexibility Ability to work without direct supervision and practice autonomously Is proficient with information management and technology Capacity to collaborate with professional colleagues as necessary to provide quality care Depending on the market, the ability to be proficient in both speaking and writing in additional languages not limited to but including Spanish may be required Education: Completion of a Master’s Degree level Family Nurse Practitioner program with current National Board Certification and State of Employment license to practice in the Advanced Practice Nurse role required
Provide holistic, evidenced based care inclusive of accurate assessment, diagnosis, treatment, management of health problems, health counseling, and disposition planning for our patients. This includes education and treatment for pregnancy prevention, STI Prevention and safer sex practices. Evaluate primary care, acute, chronically ill, and transitional care patients, in addition to providing healthcare education and counseling, and disposition planning for our patients ranging in age 18 months and above. Provide patient counseling; inclusive of pregnancy prevention, STI Prevention/safer sex practices, contraceptive care counseling and medication management Educate patients on health maintenance and respond to patient care inquiries Document all patient care within an EHR according to MinuteClinic policies and procedures Provide care and coordination of our patients with internal and external colleagues, including the broader patient centered medical home, ensuring the highest standard of care is provided for all patients. Effectively work within a patient care team, including fellow Providers, Collaborative Physicians, paraprofessionals, Pharmacists and other members of the health care team Work independently , prioritize and solve problems, take initiative, and advocate for their patients and their practice
Dane Street is the industry's fastest growing national IME and Peer Review provider with a panel of board-certified, active-practice physicians in all 50 states. Services are provided to the Workers Compensation, Pharmacy, Disability, Group Health and Auto/Liability lines of business. Dane Street's Review and Evaluation services provide improved report quality, faster turnaround time and higher adjuster/nurse satisfaction and productivity.
The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately. They review medical records, treatment plans, and patient information to determine the necessity and appropriateness of medical procedures, tests, and treatments. Utilization Management Nurse Reviewers collaborate with healthcare providers, insurance companies, and patients to optimize healthcare delivery, control costs, and maintain quality care. Their responsibilities include assessing medical necessity, coordinating care, conducting utilization reviews, providing recommendations for care plans, and ensuring adherence to regulations and guidelines. This role requires strong clinical knowledge, critical thinking skills, communication abilities, and the ability to make informed decisions regarding patient care pathways. Shifts available: Sunday - Thursday 8 - 4:30 pm EST Monday - Friday 7 - 3:30 pm EST Tuesday - Saturday 9 - 5:30 pm EST
Proficient in both written and spoken communication. Capable of maintaining professional communication with physicians and clients. Skilled at handling multiple tasks and adjusting swiftly in a dynamic office setting. Possesses a keen organizational sense and pays close attention to details. Adept at resolving intricate and multifaceted problems. Experienced with Microsoft tools such as Word, Excel, PowerPoint, and Outlook. Background in medical or clinical practice through education, training, or professional engagement. Holds an unrestricted LVN/RN license from an accredited vocational nursing program (for LVNs) or a nursing degree from an accredited college (for RNs). EDUCATION/CREDENTIALS: Licensed Practical/Vocational Nurse with an active and unrestricted license to practice. JOB RELEVANT EXPERIENCE: 2 yrs minimum clinical nursing experience is required. One year of previous experience in Utilization Management is required. JOB RELATED SKILLS/COMPETENCIES: Demonstrate strong abilities in both spoken and written communication, along with effective interpersonal skills. Possess a proficient understanding of computer operations, particularly the Internet, Microsoft Word, Microsoft Access, Microsoft Excel, and Windows. Show the capability to acquire new skills and competencies to address the evolving requirements of systems, software, and hardware. WORKING CONDITIONS/PHYSICAL DEMANDS: Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of sitting and computer work. WORK FROM HOME TECHNICAL REQUIREMENTS: Supply and support their own internet services. Maintaining an uninterrupted internet connection is a requirement of all work from home position. Requirements: Beginning compensation will depend on several factors including the candidate's experience, education, and specific skills. In addition to the base salary, we offer a comprehensive benefits package including health insurance, retirement plans, and performance bonuses.
Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual, or health plan specific guidelines/criteria). Examine and evaluate patient records to verify the quality of patient care and the necessity of provided services. Offer clinical expertise and serve as a clinical reference for non-clinical staff members. Input and manage essential clinical details within various medical management platforms. Keep up-to-date with regulatory prerequisites (such as URAC) and state standards for utilization review. Apply clinical reasoning to determine the suitable evidence-based guidelines. Foster efficient and high-quality patient care by effectively communicating with management teams, physicians, and the Medical Director. Additional Duties: May provide oversight to the work of the team members. Continuously improves processes that help to facilitate better turnaround time, peer to peer success rates and lessens returned reports by clients for clarification purposes, ultimately resulting in higher client satisfaction. Responsible for the final approval on cases for release to the client. Will act as a liaison and coordinate quality issue reports along with all new reviewer reports with the VP of Clinical Operations.
The New Weight Watchers is built for the GLP-1 era, delivering comprehensive clinical services and a complete weight health solution. Whether direct or through Weight Watchers for Business’ full-spectrum platform for employers, health plans, and payers, we combine scientific expertise, medication, cutting-edge technology, and human connection. With more than 60 years of experience, Weight Watchers is the most studied commercial weight management program in the world, delivered through its No. 1 U.S. doctor-recommended weight-loss program. Its holistic, personalized approach also includes U.S.-based clinical interventions and access to GLP-1 medications when clinically appropriate, and a global network of coaches and community support. Since 1963, the company has led with science to deliver its members the personalized support they need to reach and sustain their goals.
Med+ is a telehealth service where you have access to certified clinicians, if needed GLP-1 medications, and our GLP-1 program right at their fingertips. The GLP-1 Program is a first-of-its-kind program customized to guide and support those taking GLP-1 weight-loss medications. Weight health is a spectrum that's unique to every individual. Med+ provides a supportive community and tips for developing healthy habits.
Nurse Practitioner with a degree from an accredited university. Currently board certified by ANCC or AANP to include Family, Adult, or Adult Gerontology. General Practice Experience (including obesity medicine experience) At least 2-3 years of practice post-residency. 1+ years of telemedicine experience, with an understanding of sync and async practice. Experience with menopause management preferred. Skilled at using online tools and technology to deliver care, communicate with patients, and maintain an excellent virtual “bedside” manner. Availability of 15-20 hours/week, including at least 8 hours/week available for synchronous visits. Must have 2-4 hours available daily, Monday through Friday, for work. The number of needed hours may increase during our busy season. Must have at least 2-3 state licenses. Proficiency in Zoom, Google Workspace (G Cal), and Slack Must have an operating system that includes: Memory of at least 16GB OS = Mac and Windows (No Chrome OS) Mac OS 26.0 or higher Windows 11
You will build a patient panel with continuity of care. Provide compassionate, patient-centered clinical care using our state-of-the-art telehealth platform, Weight Watchers Med+. Review and discuss patient intake information and medical history through video and chat consultations to provide appropriate clinical guidance and treatment. Maintain ongoing clinician-patient relationships through regular treatment evaluations and progress check-ins. Educate patients on scientific principles of obesity, potential treatment options, and lifestyle adjustments.
We’re unique. You should be, too. We’re changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy? We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team. The Advanced Practice Provider, Care Line is responsible for diagnostic patient care primarily through virtual, remote consultation via video conference or telephone. The incumbent in this role serves as the dispositional authority for after-hours and weekend clinical calls. They are accountable for assessing, diagnosing, treating and precisely documenting patients' physical and psychosocial health status through the collection of health data. The schedule for this position will rotate each week with one required weekend shift per month.
Bachelor’s degree in Nursing (BSN) and graduate of a school of nursing for Advanced Practice Nursing with certification in area of specialty required; Master's degree in Nursing required. For NPs: Board certification by AANP or ANCC required Basic Life Support (BLS) certification from the American Heart Association or American Red Cross required upon hire. Multi state licensure to include FL, VA, and at least 2 licenses in the following states: GA, MI, MO, OH, PA, TN, TX, IL, KY, LA, KS. Compact multistate nursing license required A minimum of 3 years' acute/primary care clinical work experience required A minimum of 2 years' telehealth work experience preferred Must be open to travel twice a year to TN and once a year to GA required.
Through virtual video conference or telephone, assesses acute and non-acute clinical problems. Performs and documents physical evaluations and patient histories, analyzes trends in patient conditions and develops, documents and implements a patient management plan based on interpretation of findings. Aids in the development of a plan of care that may include health education, physician referrals, case management referrals and patient/family counseling. Evaluates need for immediate nursing intervention, consultation and/or referral and facilitates the necessary patient care. Plans patient care based on knowledge of the patient population and/or protocol. Considers the patient's cultural background, level of understanding, personality and support systems to anticipate and identify physiological and/or psychological problems. Serves as patient advocate. Collects comprehensive and focused data relating to the health needs of patients and families. Analyzes data to determine appropriate health maintenance and/or improvement methods. Confers with the patient's PCP and other medical providers to report health data and ensure compliance with guidelines. Consults with patients and/or family members on health outcomes and works with them to maintain positive health habits and/or improve opportunities. Ensures achievement of optimal patient outcomes through use of Telemedicine. Collaborates with on-call PCP, as needed, to support expected clinical outcomes. Implements the appropriate protocol to attain expected outcomes. Evaluate progress toward expected outcomes. Documents assessments, interventions and progress toward outcomes in an easy-to-understand and translate format. Works with key contributors to enhance the quality of telehealth practices and systems through the utilization of data demonstrating program effectiveness and success. Communicates using a variety of formats, tools and technologies to build professional relationships and deliver care across the continuum. Utilizes appropriate resources to plan and provide services that are safe, effective and financially responsible. Provides extraordinary customer service and professionalism to all internal and external customers. May also participate in clinical rounds and conferences, risk and quality management programs, clinical and other relevant meetings. Adheres to strict departmental goals/objectives, standards of performance, regulatory compliance, quality patient care compliance, policies, and procedures. Practices in accordance with a written or electronic practice agreement. Participates with the physician in the formulation of telehealth/telemedicine policies, procedures and protocols. Initiates/participates in quality improvement activities that result in approved outcomes Participates with committee(s) to support growth Provides feedback regarding the practice of others to improve patient care Coordination of services with other programs Performs other duties as assigned and modified at manager’s discretion.
StudyFetch is the #1 AI-native learning platform globally, transforming how millions of students learn through personalized AI-powered education. We’re growing fast with backing from top-tier investors and a mission that’s redefining the future of education and ethical learning.
About The Role: We're looking for an experienced practical nurse to join our content quality team as an Expert Question Reviewer for NCLEX-PN exam preparation materials. Your primary mission is ensuring every question stays squarely within LPN/LVN scope of practice — the most critical quality dimension for PN content. You'll also validate clinical accuracy, pharmacology within PN scope, safety protocols, and NGN item format compliance. This is a contract position — flexible, remote, and project-based. You'll work independently through our review platform to evaluate questions at your own pace, leaving detailed feedback and comments directly in the tool. You're ideal for this role if you have deep practical nursing experience and an instinct for spotting when a question is really testing RN-level skills disguised as PN content. You understand the nuances of LPN/LVN scope across states, you're meticulous about medication administration boundaries, and you care about making sure PN students aren't studying content that's above their practice level.
Active LPN/LVN license 5+ yrs practical nursing experience Deep understanding of LPN/LVN scope of practice across multiple states PN program teaching or clinical preceptor experience preferred Familiarity with NGN item types
Log into our review portal and work through your assigned question queue independently Read each question's clinical scenario, answer options, and rationale carefully Mark each question as Approved, Needs Revision, or Reject Leave clear, specific comments on any issues (e.g., "This asks the LPN to perform an initial assessment — that's RN scope" or "IV push is outside LPN scope in most states") Verify EVERY question stays within LPN/LVN scope — no RN-level assessment, independent diagnosis, or unsupervised clinical decisions Flag delegation scenarios that incorrectly assign RN tasks to LPNs Confirm medication administration routes match PN scope (oral, SQ, IM — flag IV push or titration) Validate safety and infection control content against current CDC/OSHA guidelines Check that delegation scenarios correctly reflect what LPNs can and cannot accept Verify NGN item type structure for all applicable formats
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 What makes your nursing career greater with UnitedHealth Group? You can improve the health of others and help heal the health care system. You will work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And, when you contribute, you'll open doors for yourself that simply do not exist in any other organization, anywhere.
For consideration you must be available to work Saturday and Sunday 8am until 5pm as well as three additional work week days 8am until 5pm and reside within the state of VA. If you reside within the state of Virginia, and you will have the flexibility to work remotely* as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
Required Qualifications: Unrestricted, active RN license 3+ years of RN experience in an acute setting Ability to create, edit, save and send documents utilizing Microsoft Word. Ability to navigate a Windows environment, Microsoft Outlook, and conduct Internet searches Preferred Qualifications: HCBS authorization experience Utilization management, prior authorization, and case management experience Managed care experience Working knowledge of ICUE and CAT_LaunchPad
Authorization review and entry for HCBS authorizations using Virginia specific criteria Review of state specific documents required for HCBS services Communication with HCBS Providers Gather clinical information to assess and expedite care needs Consult with the Care Manager and/or Medical Director as needed to troubleshoot difficult or complex cases 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.
Accredo, Evernorth Health Services' specialty pharmacy, serves patients with complex and chronic health conditions, including PAH, Immune Deficiencies, Hereditary Angioedema, Lysosomal Storage Disorders, Blood Disorders, Parkinson's, and many others. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an hourly rate of 33 - 56 USD / hourly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan.
The Telephonic Critical Support Nurse supports a busy 24/7 clinical call center, responding to a wide variety of incoming calls from patients, clinicians, referral sources, and hospitals. The team provides support for chronic therapies, including Home Infusion Therapy, and handles after-hour calls for all divisions of Accredo Health Group Specialty Pharmacies.
Registered Nurse (RN) with multistate license in good standing, with ability to obtain licensure in all 50 states. Valid RN license in state of primary residence. Compact license required. Bachelor of Nursing degree (BSN) preferred. Minimum of 5 years of relevant RN experience in critical care or home infusion. Ability to work the shifts listed above. Proficiency with Microsoft Office software (Outlook, Word, Excel, PowerPoint, OneNote). Understanding of legal and regulatory issues. Ability to compile data and statistics. Strong customer service focus and ability to counsel patients. Ability to develop and maintain a cross-section of networks. Strong oral and written communication and organizational skills. Schedule Information: Shift will be four 10 hour days. Schedule will vary. Days off will vary week-to-week Must be flexible to work adjusted hours for team PTO coverage Evening, overnight, and weekend shifts include a shift differential All shifts include every third weekend and some holidays
Triage incoming calls from patients, clinicians, hospitals, and other sources. Intervene to address life-threatening medication interruptions. Guide patients, caregivers, and clinicians through assessment of potential disruptions in medication administration, including pump malfunction, central line problems, and patient error. Troubleshoot issues with infusion devices, answer infusion access questions, and provide therapy support. Coordinate communication between patients, caregivers, pharmacists, nurses, hospital staff, and physicians. Ensure timely provision of products and supplies. Contact appropriate personnel as needed and document transactions in patients’ electronic charts. Maintain up-to-date knowledge of all services, products, and resources provided by Accredo, incorporating new product and service information. Identify trends and needs within the scope of customer/client contact.
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.
Responsible for health care management and coordination within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum. Supports Transitions of Care (TOC) to ensure timely access and coordination of follow up care, adherence to discharge plans and member education to support improved health outcomes. Coordinates and monitors Alignment Health member’s progress and services to ensure consistent cost-effective care that complies with Alignment policy and all state and federal regulations and guidelines. Performs duties mostly telephonically
Required: 3 years of clinical case management experience; or any combination of education and experience, which would provide an equivalent background Preferred: Medicare Advantage Health plan experience Education/Licensure Required: Active, valid, and unrestricted Registered Nursing (RN) license in California Willing to obtain licensure in other designated states within the first 6 months of employment (licensure fees reimbursed by the 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.
Supports inpatient program engagement for Alignment members currently inpatient in an acute or skilled nursing facility setting. Manages Transitions of Care (TOC) for members moving from inpatient, SNF, and emergency services to lower level of care facilities or home, in accordance with established workflows. Manages TOC activities including post-discharge follow up appointment scheduling and monitoring for kept appointments Ensures member access to services appropriate to their health needs. Identifies, assesses, and manages high risk/complex members per established criteria and health risk status. Develops, monitors, and evaluates the effectiveness of the care management plans and modifies, as necessary to support improved health outcomes. Interfaces with Primary Care Physicians, Hospitalists, Nurse Practitioners, and specialists on the development of care management treatment plans. Assists in problem solving with providers, claims or service issues. Measures the effectiveness of interventions to determine case management outcomes. Counsels and engages in personal discussions with patients and their families on available care options. Helps them to determine their appropriate and preferred course of action.
At Theron Solutions, we are passionate about connecting exceptional talent with some of the most innovative and industry-leading organizations worldwide. With deep expertise in hiring for Marketing and Advertising Agencies, Management Consulting Firms, IT Services Companies, Healthcare & Life Sciences, and Semiconductor organizations, we understand the pulse of each industry and deliver customized recruitment strategies that drive business impact. We take pride in our ability to scale teams across diverse functions and leadership levels. We specialize in permanent hiring, executive search, and project-based hiring. Our global hiring footprint spans Japan, China, Taiwan, South Korea, Singapore, Australia, Germany, Italy, India, France, the Netherlands, Ireland, the United States, the United Kingdom, and many more. Whether you are a high-growth startup or a global enterprise, our agile and client-centric approach ensures you have the right people to power your vision. Let’s connect: career@theronsolutions.com Theron Solutions – Bridging Talent with Opportunity, Worldwide.
Must be a Registered Nurse with current state/compact RN License Degree in Nursing from an accredited nursing program (Associate’s or Bachelor’s). BLS Certification required. ACLS, and PALS required within six months of hire.
Perform comprehensive patient assessments and document clinical findings. Administer medications, treatments, and therapies in accordance with physician orders and facility protocols. Monitor patient conditions, identify changes, and respond promptly using critical‑thinking and clinical judgment. Coordinate patient care with physicians, therapists, CNAs, and other care team members. Maintain accurate medical records and ensure compliance with regulatory and safety standards. Educate patients and families regarding care plans, medications, and discharge instructions. Provide compassionate support while maintaining professionalism during high‑stress or critical situations. Participate in quality‑improvement initiatives and follow patient‑safety protocols. Depending on unit placement (ICU, Med‑Surg, Telemetry, ER, etc.), may perform specialized interventions and support complex medical condition
For 25 years, DrFirst has empowered providers and patients to achieve better health through intelligent medication management. We improve healthcare workflows and help patients start and stay on therapy with end-to-end solutions that enhance prescription access, affordability, and adherence. Our solutions help 100 million patients a year and are used by more than 420,000 prescribers, 71,000 pharmacies, 270 EHRs and health information systems, and over 2,000 hospitals in the U.S. This is a great opportunity to be a part of a successful Healthcare IT company experiencing significant growth. Here you'll get to work with some of the smartest and most interesting people around, solving unique and complex challenges in healthcare on a scale matched by few companies. If you get excited about stretching yourself in new ways, developing yourself to your fullest potential, and care about working with smart colleagues, we want to talk to you! About Backline by DrFirst Backline is DrFirst's clinical communication, collaboration, and workflow orchestration platform. We transform how healthcare teams coordinate care, moving beyond basic messaging into intelligent workflow execution and AI-powered clinical assistance. Our mission: make communication errors, documentation burden, and workflow friction relics of the past. We operate as a small, entrepreneurial business unit within DrFirst. You will have a seat at the table, direct impact on what we build and sell, and the opportunity to grow as we grow.
We are looking for a curious, tech-savvy clinician who wants to do something different with their career. This is a versatile, cross-functional role for someone with a clinical background who is drawn to the business and technology side of healthcare. You will work across customer success, business development, and product, helping us grow our customer base, deepen existing relationships, and shape the products we bring to market. Your clinical experience becomes the foundation for everything: understanding what customers need, demonstrating how our platform solves real clinical problems, and translating frontline insights into product and business decisions. This role was designed for a nurse or clinician who is comfortable with technology, fascinated by AI, and eager to build skills in business development, customer engagement, and product strategy. Who Will Love This Role: A clinician-turned-innovator who has always been the first to adopt new systems on the unit and sees technology as a tool to improve patient care A relationship builder who connects with frontline nurses, department heads, and C-suite executives with equal ease An AI-forward professional who uses tools like ChatGPT or Claude daily, not just as a novelty, but as a real productivity multiplier A self-starter who thrives with autonomy and is comfortable wearing multiple hats in a small, fast-moving team A bridge builder who can translate clinical workflow problems into product requirements and business decisions A growth-minded professional who sees this role as a launchpad, not a landing spot
Required: Bachelor's degree in Nursing (BSN), or equivalent clinical or healthcare degree Hands-on patient care experience in a hospital, health system, or post-acute care setting Genuine interest in technology, healthcare IT, and the business side of healthcare Active and regular use of AI tools (ChatGPT, Claude, Copilot, or similar) as part of your daily workflow Strong communicator who can engage clinical end-users, department heads, and executives with equal ease Self-starter who thrives with autonomy in a small, fast-moving team Preferred: Active clinical license (RN, NP, or equivalent) Experience with EHR systems such as Epic, Cerner, or MEDITECH Exposure to clinical informatics, nursing informatics, or health IT project work Familiarity with SaaS products, CRM tools (Salesforce, HubSpot), or customer success platforms Experience in a customer-facing, sales, or business development role, even informally Understanding of clinical communication workflows: secure messaging, on-call management, care coordination, patient handoffs MSN, informatics certification, or coursework in healthcare administration or business Physical Requirements Up to 20% travel for customer visits, conferences, and team collaboration 80% remote desk and virtual meeting work #LI-GF1 #LI-Remote
Customer Engagement and Growth: Build and maintain trusted relationships with healthcare customers as a clinical peer who understands their workflows, challenges, and goals Conduct product demonstrations, clinical workflow reviews, and business conversations with prospective and existing customers Identify opportunities to expand how current customers use Backline, including new departments, additional features, and upgraded plans Support renewals and customer health by proactively engaging accounts, understanding satisfaction drivers, and addressing concerns before they become churn risks Gather and synthesize customer feedback to inform how we sell, market, and improve the platform Business Development and New Customer Acquisition: Help generate and qualify new business opportunities through outreach, referrals, conference engagement, and digital channels Lead or support clinical sales conversations where your nursing background provides instant credibility with prospects Research target markets including hospitals, health systems, home health, hospice, and ASCs, and help develop messaging that resonates with clinical buyers Collaborate with Marketing on content, webinars, and campaigns that speak authentically to clinical audiences Track opportunities in Salesforce CRM and contribute to pipeline development and reporting Product and Clinical Intelligence: Serve as the clinical lens on the product team, helping evaluate feature requests, prioritize roadmap items, and validate that what we build solves real problems Translate clinical workflows and pain points into product requirements that engineering can act on Participate in product testing, beta programs, and early adopter engagements to ensure new features work in real-world clinical settings Help develop clinical use cases, ROI narratives, and success stories that demonstrate Backline's value in language healthcare leaders understand AI-Powered Productivity: Use AI tools daily to enhance your work across research, writing, analysis, customer preparation, outreach personalization, and workflow automation Identify opportunities where AI can improve how the team works, from support efficiency to sales enablement to customer onboarding Stay current on AI developments in healthcare and business productivity, bringing new ideas and tools to the team Contribute to how we position AI capabilities within our product to clinical audiences, drawing on your firsthand experience as both a clinician and an AI user
Public Consulting Group LLC (PCG) is a leading public sector solutions implementation and operations improvement firm that partners with health, education, and human services agencies to improve lives. Founded in 1986, PCG employs approximately 2,000 professionals throughout the U.S.—all committed to delivering solutions that change lives for the better. The firm is a member of a family of companies with experience in all 50 states, and clients in three Canadian provinces and Europe. PCG offers clients a multidisciplinary approach to meet challenges, pursue opportunities, and serve constituents across the public sector. To learn more, visit www.publicconsultinggroup.com.
PCG is currently seeking a Utilization Review Nurse. The Utilization nurse will also be responsible for utilizing a medical management software system on a day-to-day basis. The purpose of the Fund is to provide a funding source for future health care costs associated with birth‐related neurological injuries.
Required Skills: Possesses effective verbal/written communication skills, especially via phone, with the ability to interact with various levels of personnel. Able to work in a fast-paced environment, demonstrate excellent problem solving, critical thinking, and organizational skills. Performs multiple tasks efficiently and accurately, have exceptional attention to detail and perform consistent work product Self-motivated, self-directed, team oriented, and responsible, with a positive attitude and a proactive style Possesses the ability to operate in a highly variable work environment. Presents a courteous and competent demeanor to our clients and teammates. Excellent customer service skills Strong computer skills Ability to easily navigate through website research. Qualifications: Graduated from an accredited School of Nursing, Associate Degree, Bachelor’s preferred Minimum of 2 years of direct clinical nursing experience Minimum of 2 years of experience with medical management activities in a managed care environment, Medicaid or hospital utilization management RN required Working Conditions: Remote
Performs prior authorization, concurrent and retrospective reviews Use clinical documentation and clinical review criteria to make determinations regarding qualifying health care costs Accurately records all review determinations and supporting documentation Contacts providers and members according to established timeframes Identifies and refers cases that do not meet established clinical or other criteria to the Case Management Supervisor Identifies and communicates quality issues to the Case Management Supervisor Communicates information to other team members Utilizes knowledge of community resources and the member’s benefit structure Interacts with providers, vendors, and facilities in a professional and respectful manner Recognizes quality of care issues and escalates the issues appropriately Understand and facilitate the Appeals and Grievances process Assists members with the coordination of services from various settings as appropriate Performs other duties as assigned
What makes Lockton stand apart is also what makes us better: independence. Our private ownership empowers our 13,100+ Associates doing business in over 140+ countries to focus solely on clients' risk and insurance needs. With expertise that reaches around the globe, we deliver the deep understanding needed to accomplish remarkable results.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. The physical demands described here are those which must be met while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Proficiency in critical thinking and ability to deal with issues using solid nursing judgment and sound decision-making Effectively organize large case loads and prioritize work demands Exceptional communication and relationship building skill Accountability and autonomy Occasional overnight travel (10% of time) for client meetings, training and / or corporate meetings This job is a remote/work from home position
Current unencumbered Registered Nurse Licensure Minimum of three years nursing experience working with chronic conditions and condition management Current BLS certification Competence in Microsoft office, web-based program use, and an ability to readily learn new computer-based skills Bilingual Spanish speaker strongly preferred Health or wellness coaching, case management, disease management experience preferred
Responsible for educating, coaching, monitoring, and coordinating resources for individuals with identified health risks. Provides telephonic and/or web-based outreach to program participants Provides health coaching, education, clinical advocacy, and navigation assistance for individuals participating in the LNA and/or wellness program(s) Documents client out-reach, engagement, referrals, and follow-up Leverages all available tools and resources from the organization’s carriers, third party administrators and other available providers and sources. Shares the responsibility of maintaining program timelines and resources with the Nurse Advocate program manager, project manager and other key contacts Assists in the development and presentation of health and wellness-focused information and educational programs Remains current of health promotion industry trends, products and best practices.
The New Weight Watchers is built for the GLP-1 era, delivering comprehensive clinical services and a complete weight health solution. Whether direct or through Weight Watchers for Business’ full-spectrum platform for employers, health plans, and payers, we combine scientific expertise, medication, cutting-edge technology, and human connection. With more than 60 years of experience, Weight Watchers is the most studied commercial weight management program in the world, delivered through its No. 1 U.S. doctor-recommended weight-loss program. Its holistic, personalized approach also includes U.S.-based clinical interventions and access to GLP-1 medications when clinically appropriate, and a global network of coaches and community support. Since 1963, the company has led with science to deliver its members the personalized support they need to reach and sustain their goals.
Med+ is a telehealth service where you have access to certified clinicians, if needed GLP-1 medications, and our GLP-1 program right at their fingertips. The GLP-1 Program is a first-of-its-kind program customized to guide and support those taking GLP-1 weight-loss medications. Weight health is a spectrum that's unique to every individual. Med+ provides a supportive community and tips for developing healthy habits.
Nurse Practitioner with a degree from an accredited university. Currently board certified by ANCC or AANP to include Family, Adult, or Adult Gerontology. General Practice Experience (including obesity medicine experience) At least 2-3 years of practice post-residency. 1+ years of telemedicine experience, with an understanding of sync and async practice. Experience with menopause management preferred. Skilled at using online tools and technology to deliver care, communicate with patients, and maintain an excellent virtual “bedside” manner. Availability of 15-20 hours/week, including at least 8 hours/week available for synchronous visits. Must have 2-4 hours available daily, Monday through Friday, for work. The number of needed hours may increase during our busy season. Must have at least 2-3 state licenses. Proficiency in Zoom, Google Workspace (G Cal), and Slack Must have an operating system that includes: Memory of at least 16GB OS = Mac and Windows (No Chrome OS) Mac OS 26.0 or higher Windows 11
You will build a patient panel with continuity of care. Provide compassionate, patient-centered clinical care using our state-of-the-art telehealth platform, Weight Watchers Med+. Review and discuss patient intake information and medical history through video and chat consultations to provide appropriate clinical guidance and treatment. Maintain ongoing clinician-patient relationships through regular treatment evaluations and progress check-ins. Educate patients on scientific principles of obesity, potential treatment options, and lifestyle adjustments.
Nsight Health is transforming how care is delivered through Remote Patient Monitoring (RPM), Chronic Care Management (CCM), and Behavioral Health Integration (BHI). We empower healthcare providers to manage chronic conditions using real-time data, AI-enabled technology, and 24/7 clinical support. Our HIPAA-compliant platform connects patients and care teams nationwide—improving outcomes, adherence, and peace of mind. Join a fast-growing, mission-driven team that blends healthcare and technology to make a measurable difference in people’s lives. Nsight Health — Where Technology Meets Compassion.
We are seeking a motivated and detail-oriented LVN/LPN to join our Remote Patient Monitoring Department. In this role, you will be responsible for supporting patients with real-time health monitoring, respond to alerts and deliver timely life-improving interventions, and educate and empower patients through ongoing care.
Required: Active LVN/LPN license required Proficient with computers, EMRs, and telehealth tools Strong communication and organizational skills Preferred: At least 1 year of nursing experience preferred (RPM, telehealth, or chronic care experience is a plus) Work From Home Requirements Minimum internet speed of 50 Mbps download / 10 Mbps upload Hardwired internet connection required Speed test submission required during the offer process Private, HIPAA-compliant workspace Schedule This position operates on a 4-day work week structure, consisting of 10-hour shifts. Must be available to work rotating holidays throughout the year. Requires mandatory coverage of a minimum of two (2) weekends per month. Training Requirements All new hires must complete a comprehensive training program: Duration: Five weeks Schedule: Monday through Friday, 9:00 AM – 6:00 PM Eastern Time Attendance is mandatory to ensure readiness prior to independently supporting patients.
Conduct outbound phone calls to check in on patients and address health concerns (expected call volume ranges from 70 to 90 calls per day) Handle inbound phone calls and route appropriately based on clinical urgency Route non-clinical inbound calls to the appropriate departments across the company Monitor and respond to Remote Patient Monitoring (RPM) alerts, escalating concerns when clinically indicated Collaborate with providers to coordinate timely and effective patient care Perform monthly wellness assessments and complete comprehensive chart reviews Accurately document all patient interactions in our clinical platform in real time Consistently meet or exceed individual and team performance metrics related to care quality, patient engagement, response times, and adherence to protocol standards Maintain compliance with company policies and applicable regulations Perform other duties as assigned
Centene Corporation is a leading healthcare enterprise committed to helping people live healthier lives. Centene offers affordable and high-quality products to more than 1 in 15 individuals across the nation, including Medicaid and Medicare members (including Medicare Prescription Drug Plans) as well as individuals and families served by the Health Insurance Marketplace. Centene believes healthcare is best delivered locally. Our local health plans provide fully integrated, high-quality, and cost-effective services to government-sponsored and commercial healthcare programs, focusing on under-insured and uninsured individuals. Centene’s hiring practices reflect the composition of the members and communities we serve, allowing us to deliver quality, culturally sensitive healthcare to millions of members. Centene employees help change the world of healthcare and transform our communities. To learn more about career opportunities with Centene, visit: https://jobs.centene.com/
You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member.
Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. 2+ years of acute care experience required. Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: LPN - Licensed Practical Nurse - State Licensure required For Health Net of California: RN license required RN - Registered Nurse - State Licensure and/or Compact State Licensure For State of Nevada required *Must be licensed in Nevada. Location: Position is remote.
Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines Reviews member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities Collaborates with care management on referral of members as appropriate Performs other duties as assigned. Complies with all policies and standards.
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.
Nurse Practitioner – In-Home Health Assessments Washington (Multiple Locations) Key Highlights Full-time W2 position with full benefits Salary: $100,000 – $160,000 annually (based on experience and location) Flexible schedule options: 4x10s or 5x8s 6–9 patient visits per day (~45 minutes per visit) 100% field-based role (in-home and community settings) Travel within a 60-mile territory (mileage reimbursement provided) 5-week paid training program Locations Colville, WA Longview, WA Wenatchee, WA Vancouver, WA Yakima, WA Moses Lake, WA Chehalis, WA Position Overview: We are seeking a Nurse Practitioner to provide preventive care and comprehensive health assessments in patients’ homes and community-based settings. This role focuses on completing initial evaluations, identifying care gaps, and coordinating appropriate follow-up care—without managing an ongoing patient panel. Schedule Options Option 1: 4x10 Schedule • 8:00 AM – 7:00 PM • 8–9 visits per day • 1 Saturday per month required Option 2: 5x8 Schedule • 3 days: 8:00 AM – 5:00 PM • 2 days: 10:00 AM – 7:00 PM • 6–7 visits per day
Work Environment Patient homes Skilled nursing facilities Community-based settings Requirements: Licensed Family Nurse Practitioner or Adult Nurse Practitioner Active and unrestricted state license DEA license BLS certification Minimum 1 year of NP experience Valid driver’s license and reliable transportation Comfortable working in a field-based setting Preferred Experience: Home health, community health, or public health Experience working with underserved or vulnerable populations
Perform comprehensive history and physical exams Identify care gaps and preventive health needs Evaluate and manage chronic and acute conditions Establish diagnoses and develop care plans Order labs and diagnostic testing as appropriate Coordinate care and refer patients to specialists when needed Provide post-discharge follow-up to reduce readmissions Document all encounters in an electronic medical record system Participate in occasional community-based clinics
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Opportunity for a TX licensed RN with experience working in women’s health; specifically, OB, L&D, or postpartum, to join our Texas Health Plan as a Care Manager. Your caseload will consist of members who are pregnant, many of them high risk. Telephonically you will complete assessments needed for determining the types of services we need to provide and overseeing the resources and providing support until they are discharged from your service. The ideal candidate will have experience as a Case Manager within a managed care organization (MCO) like Molina, but we also consider RNs with a strong background in women’s health. Hours are Monday – Friday, 8 AM – 5 PM CST working from home. Solid experience with Microsoft Office Suite is necessary, especially with Outlook, Excel, and Teams as well as being confident in moving between different programs to complete the necessary forms and documentation. Excellent computer skills and attention to detail are very important to multitask between systems and talk with members on the phone while entering accurate contact notes. This is a fast-paced position and productivity is important. Job Summary: Provides support for care management/care coordination long-term services and supports specific activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum for members with high-need potential. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.
At least 2 years experience in health care, including at least 1 year experience in care management, managed care, and/or experience in a medical or behavioral health setting, and at least 1 year of experience working with persons with disabilities, chronic conditions, substance abuse disorders, and long-term services and supports (LTSS), or equivalent combination of relevant education and experience. Registered Nurse (RN). License must be active and unrestricted in state of practice. Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. Ability to operate proactively and demonstrate detail-oriented work. Demonstrated knowledge of community resources. Ability to work within a variety of settings and adjust style as needed - working with diverse populations and various personalities and personal situations. Ability to work independently, with minimal supervision and demonstrate self-motivation. Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. Ability to develop and maintain professional relationships. Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. Excellent problem-solving and critical-thinking skills. Strong verbal and written communication skills. Microsoft Office suite/applicable software program(s) proficiency. In some states, must have at least one year of experience working directly with individuals with substance use disorders. Preferred Qualifications: Certified Case Manager (CCM). Experience working with populations that receive waiver services.
Completes comprehensive member assessments within regulated timelines, including in-person home visits as required. Facilitates comprehensive waiver enrollment and disenrollment processes. Develops and implements care plans, including a waiver service plan in collaboration with members, caregivers, physicians and/or other appropriate health care professionals and member support network to address the member needs and goals. Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. Promotes integration of services for members including behavioral health care and long-term services and supports (LTSS) and home and community resources to enhance continuity of care. Assesses for medical necessity and authorizes all appropriate waiver services. Evaluates covered benefits and advises appropriately regarding funding sources. Facilitates interdisciplinary care team (ICT) meetings for approval or denial of services and informal ICT collaboration. Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. Assesses for barriers to care and provides care coordination and assistance to members to address psycho/social, financial, and medical obstacles concerns. Identifies critical incidents and develops prevention plans to assure member health and welfare. May provide consultation, resources and recommendations to peers as needed. Care manager RNs may be assigned complex member cases and medication regimens. Care manager RNs may conduct medication reconciliation as needed. 25-40% estimated local travel may be required (based upon state/contractual requirements).
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care. This role supports the Washington Jail Transition Re-entry Program to support incarcerated Medicaid members.
Required Qualifications: At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. Registered Nurse (RN). License must be active and unrestricted in state of practice. Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA). Demonstrated knowledge of community resources. Ability to operate proactively and demonstrate detail-oriented work. Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. Ability to work independently, with minimal supervision and self-motivation. Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. Ability to develop and maintain professional relationships. Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. Excellent problem-solving, and critical-thinking skills. Strong verbal and written communication skills. Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases. Preferred Qualifications: Certified Case Manager (CCM). Prior medical experience in carceral environments to include jails, prisons, penitentury, juvenile and state based facilities.
Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments. Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals. Conducts telephonic, face-to-face or home visits as required. Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. Maintains ongoing member caseload for regular outreach and management. Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care. Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration. Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. Assesses for barriers to care, provides care coordination and assistance to member to address concerns. May provide consultation, resources and recommendations to peers as needed. Care manager RNs may be assigned complex member cases and medication regimens. Care manager RNs may conduct medication reconciliation as needed. 25-40% estimated local travel may be required (based upon state/contractual requirements).
Molina Healthcare is a FORTUNE 500 company that is focused exclusively on government-sponsored health care programs for families and individuals who qualify for government sponsored health care. Molina Healthcare contracts with state governments and serves as a health plan providing a wide range of quality health care services to families and individuals. Molina Healthcare offers health plans in Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Mississippi, Nevada, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Virginia, Washington and Wisconsin. Molina also offers a Medicare product and has been selected in several states to participate in duals demonstration projects to manage the care for those eligible for both Medicaid and Medicare.
Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care. The schedule for this role can include weekends and holidays.
Required Qualifications: At least 2 years experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. Registered Nurse (RN). License must be active and unrestricted in state of practice. Ability to prioritize and manage multiple deadlines. Excellent organizational, problem-solving and critical-thinking skills. Strong written and verbal communication skills. Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications: Certified Professional in Healthcare Management (CPHM). Recent hospital experience in an intensive care unit (ICU) or emergency room.
Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. Analyzes clinical service requests from members or providers against evidence based clinical guidelines. Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors (MDs) and presents them in a consistent and efficient manner. Requests additional information from members or providers as needed. Makes appropriate referrals to other clinical programs. Collaborates with multidisciplinary teams to promote the Molina care model. Adheres to utilization management (UM) policies and procedures.
IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide.
The Bilingual Nurse Patient Access Specialist serves as the primary point of contact for patients, healthcare providers, and field representatives within a Patient Support Services (PSS) program. This role is responsible for facilitating patient access to therapy by conducting benefit investigations, verifying insurance eligibility, supporting prior authorizations and appeals, and assisting with copay and patient assistance programs. Bilingual Clinical Care Managers may also discuss the patient’s disease state and treatment options. Bilingual Nurse Patient Access Specialist support patients throughout their treatment journey while ensuring a high level of service, compliance, and coordination across stakeholders. Schedule: Available for an 8-hour shift between 8:00 AM – 8:00 PM EST 8:00AM - 5:00 PM 9:00 AM - 6:00 PM EST 11:00 AM - 8:00 PM EST Ability to work varying shifts, including evenings as needed Remote role requiring a compliant home workspace
Required Qualifications: Licensed Practical Nurse or Registered Nurse with 1 year post registration experience; or equivalent of education, training and experience with previous experience providing patients with education on self-injections or use of injectable devices. Bilingual- Spanish speaker 3–5+ years of experience in medical billing, reimbursement, or insurance verification Robust understanding of payer coverage and reimbursement (medical and pharmacy) Experience in a contact center or patient support environment Proficiency with Microsoft Office and CRM systems Strong written and verbal communication skills High attention to detail and multitasking ability Ability to work independently in a virtual environment Problem-solving and solution-oriented mindset Knowledge of HIPAA and data privacy requirements Must reside in the country where the role is posted Preferred Qualifications: Licensed Practical Nurse or Registered Nurse with previous case/care manager experience in the hematology field and/or rare diseases. Experience in a Patient Support Services (Hub) environment with focus on rare diseases Healthcare or pharmaceutical customer service experience This role is posted under a market-aligned title to better reflect the scope and candidate profile. The internal title for this position is Clinical Care Manager within PASS.
Bilingual – Spanish- ability to easily communicate with patients in Spanish regarding the program services Support clinical discussions with patients regarding the disease state and products supported by the program. Provide patient education on self-injections or use of injectable devices in accordance with program SOPs Serve as the primary point of contact for patients, providers, and stakeholders Conduct inbound and outbound calls to support program services Perform insurance benefit investigations and verify coverage Support prior authorizations and appeals processes Assist with copay and patient assistance program enrollment Provide ongoing patient support and adherence coordination Document all interactions accurately and timely Deliver high-quality customer service across communication channels Collaborate with field representatives and internal teams Manage patient caseloads with timely follow-up Ensure compliance with HIPAA and regulatory requirements Identify and report adverse events and product complaints Troubleshoot issues and escalate as needed Maintain knowledge of program policies and processes Support onboarding and training of new employees Meet quality standards and KPIs Perform additional duties as assigned
IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide.
The Nurse Patient Access Specialist serves as the primary point of contact for patients, healthcare providers, and field representatives within a Patient Support Services (PSS) program. This role is responsible for facilitating patient access to therapy by conducting benefit investigations, verifying insurance eligibility, supporting prior authorizations and appeals, and assisting with copay and patient assistance programs. Bilingual Clinical Care Managers may also discuss the patient’s disease state and treatment options. Nurse Patient Access Specialist support patients throughout their treatment journey while ensuring a high level of service, compliance, and coordination across stakeholders. Schedule: Available for an 8-hour shift between 8:00 AM – 8:00 PM EST 8:00 AM – 5:00 PM EST 9:00 AM - 6:00 PM EST 11:00 AM - 8:00 PM EST Ability to work varying shifts, including evenings as needed Remote role requiring a compliant home workspace
Licensed Practical Nurse or Registered Nurse with 1 year post registration experience; or equivalent of education, training and experience with previous experience providing patients with education on self-injections or use of injectable devices. 3–5+ years of experience in medical billing, reimbursement, or insurance verification Robust understanding of payer coverage and reimbursement (medical and pharmacy) Experience in a contact center or patient support environment Proficiency with Microsoft Office and CRM systems Strong written and verbal communication skills High attention to detail and multitasking ability Ability to work independently in a virtual environment Problem-solving and solution-oriented mindset Knowledge of HIPAA and data privacy requirements Must reside in the country where the role is posted Preferred Qualifications: Licensed Practical Nurse or Registered Nurse with previous case/care manager experience in the hematology field and/or rare diseases. Experience in a Patient Support Services (Hub) environment with focus on rare diseases Healthcare or pharmaceutical customer service experience This role is posted under a market-aligned title to better reflect the scope and candidate profile. The internal title for this position is Clinical Care Manager within PASS
Support clinical discussions with patients regarding the disease state and products supported by the program. Provide patient education on self-injections or use of injectable devices in accordance with program SOPs Serve as the primary point of contact for patients, providers, and stakeholders Conduct inbound and outbound calls to support program services Perform insurance benefit investigations and verify coverage Support prior authorizations and appeals processes Assist with copay and patient assistance program enrollment Provide ongoing patient support and adherence coordination Document all interactions accurately and timely Deliver high-quality customer service across communication channels Collaborate with field representatives and internal teams Manage patient caseloads with timely follow-up Ensure compliance with HIPAA and regulatory requirements Identify and report adverse events and product complaints Troubleshoot issues and escalate as needed Maintain knowledge of program policies and processes Support onboarding and training of new employees Meet quality standards and KPIs Perform additional duties as assigned
We provide comprehensive, trusted prep for nurses pursuing specialty board certification.
We are hiring a U.S.-based licensed nurse for a short-term remote tele-calling and sales support role. The position involves calling prospective customers, answering basic questions, and following up with leads.
Active U.S. nursing license required Must be located in the United States Strong communication skills Comfortable making outbound calls Must be flexible with timings 60 to 90-minute calls/day that can be completed in one-sitting or in parts Preferred: Previous tele-calling or sales experience Prior remote work experience Healthcare education or nursing certification experience is a plus
At MD Integrations, we partner with digital health brands to power clinical care at scale. We specialize in men's and women’s health, dermatology, endocrinology, and weight management, offering telehealth solutions that help patients receive expert, personalized care—all from the comfort of their home. Join our team and be part of the movement to make specialty care more accessible and impactful. MD Integrations is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We are unable to support US visa sponsorship at this time.
We are seeking a dedicated and experienced Offerings and Intakes Nurse (RN) to support our Clinical team evaluating and performing quality control with dosing calculation inputs from partners and pharmacies. This role is critical in ensuring the safety, accuracy, and compliance of prescription (Rx) product offerings from our partners. The ideal candidate will have a strong pharmacy background - preferably with an understanding of common medications (including compounded medications) for dermatology, reproductive health, endocrinology, or weight management conditions with a deep understanding of dosing, pharmacological safety, and care coordination in a telehealth environment. This position reports to our Director, Clinical Operations and will work closely with clinical and customer teams to support an efficient onboarding process for partners. This position is fully remote and is expected to be available Monday through Friday during core hours to take video calls and meetings, with some intraday flexibility. Candidates must have access to a quiet, secure work environment and reliable high-speed internet. If you're tech-savvy, detail-oriented, and love working in a fast-paced digital healthcare environment, we’d love to meet you!
Minimum 2 years as an RN or Pharmacy Technician, preferably with experience working with compounding pharmacies and extensive experience reviewing dosing calculations. Experience working for a telehealth company supporting internal quality review processes to support compliant care, strongly preferred Strong knowledge of pharmacology, medication safety, and dosing calculations Exceptional attention to detail and sincere love of spreadsheets, color-coding, and minutia, Type A is a plus in this role! Comfortable speaking as the SME on internal quality control measures, safety standards and regulatory compliance on video calls with customers and internal teams. Experience collaborating with cross-functional teams remotely in a regulated healthcare environment Excellent written and verbal communication skills with diverse audiences both synchronously and asynchronously Proficient with standard corporate tools for collaboration and task management, such as Slack, Gsuite, Asana, and Hubspot (preferred)
Offering Review & Validation. Collaborate with clinical and medical teams to assess partner-submitted Rx product offerings for format accuracy, therapeutic appropriateness, and clinical safety before order sets go live. Quality Control. Perform quality checks on incoming clinical requests to ensure accuracy, clarity, and alignment with clinical best practices. Coordinate with the internal clinical team, partners and occasionally pharmacies to convert doses accurately according to provider instructions and standard medical protocols. Compliance & Risk Management. Draft, add and review safety and risk warnings for all Rx offerings. Coordinate with internal teams to ensure compliance with clinical safety standards, regulatory guidelines and internal processes. Update partner accounts with appropriate documentation. Intake Creation. Assist with creation of medical intake forms in the software on behalf of partners. Collaborate with our internal clinical team to review for thoroughness and exceptional end user experience. Error Tracking & Troubleshooting. Proactively identify, troubleshoot, and track prescription-related errors, ensuring corrections are made before implementation. Work directly with our internal clinical team and external partners to ensure quality offerings. Route of Administration Coordination. Communicate directly with pharmacies and prescribing providers to confirm the correct route of administration for medications and therapies. Identify and correct errors in the offering. Triage & Communication. Act as a liaison with internal and external partners and pharmacies to triage requests, clarify ambiguities, and facilitate timely resolutions to ensure compliance and safety in dosing recommendations.
Sage Clinical RCM is a tech-enabled clinical revenue cycle firm transforming how healthcare organizations achieve clarity, accuracy, and performance across the revenue cycle. Built on decades of leadership in clinical operations, HIM, documentation integrity, and revenue strategy, Sage unites deep subject-matter expertise with intelligent, data-driven technology to strengthen compliance, elevate quality, and accelerate financial outcomes. Our service portfolio spans Workforce Augmentation, Technology Adoption Services, and Advisory Services, supported by a bench of clinical, HIM, and revenue cycle specialists. Our experts deliver scalable staffing, targeted assessments, leadership support, process redesign, and operational optimization. We partner with organizations to modernize CDI, coding, UM, and quality workflows; streamline vendor oversight; and drive sustainable performance improvements grounded in measurable ROI. At the foundation of our technology ecosystem is the SageIQ™ platform, a clinical intelligence and analytics suite that unifies data across the revenue cycle to reveal actionable insights. SageIQ™ powers our proprietary solutions (VERO, Veridian AI, Validity, and Veritas), and each are designed to solve complex operational challenges. Together, these solutions create a powerful, integrated value chain that supports organizational leaders with transparent insights, defensible documentation, operational consistency, and stronger financial stewardship. By aligning strategy, talent, and technology, Sage Clinical RCM equips healthcare organizations to make informed decisions, reduce burden, streamline workflows, and achieve transformative improvements in quality, compliance, and revenue integrity. Sage Clinical RCM delivers the intelligence, partnership, and innovation needed to navigate an increasingly complex healthcare environment and empowers organizations to move forward with confidence, clarity, and control.
The Clinical Documentation Improvement (CDI) specialist is responsible for facilitating the improvement in the overall quality and completeness of provider-based clinical documentation in the medical record. This position will be responsible for assisting treating providers to ensure that documentation in the medical record accurately reflects the severity of illness of the patient as well as the level of services rendered. The CDI Specialist assesses clinical documentation through extensive review of the medical record, interaction with physicians, nursing staff, other patient care givers, and Health Information Management (HIM) coding staff to ensure that appropriate reimbursement is received for the level of services rendered to patients and the clinical information utilized in profiling and reporting outcomes is complete and accurate.? Location: This position will be remote. Minimal travel may be required.
Minimum Knowledge And Skills Required: Work requires the knowledge of theories, principles, and concepts typically acquired through completion of a Bachelor’s Degree in Nursing. Minimum of five years recent, broad-based clinical experience in an inpatient pediatric setting required. Knowledge of ICD10 coding, as well as strong computer skills preferred, however content training in coding will be provided. Work requires superior interpersonal skills and demonstrated ability to communicate effectively with physicians is essential. Required: Certification, Registration, or Licensure Required Active Accreditation as a CDIS or CCDS by either AHIMA or ACDIS Active RN (Preferred) or MD-Equivalent (Acceptable). CCS registration a plus. At least two years of experience performing CDI reviews and related activities.
Facilitates appropriate clinical documentation to support appropriate diagnosis coding and to ensure the level of service rendered to all patients is recorded. Collaborates with HIM coding staff to promote complete and accurate clinical documentation and correct negative trends. Communicates with physicians, nurse practitioners, case managers, coders and other members of the care team to facilitate comprehensive medical record documentation to reflect treatment, decision-making and medical documentation.? Assigns a working APR-DRG and severity level using coding rules and guidelines with follow up reviews as required by LOS standards. Analyze clinical information to identify areas within the chart for potential gaps in physician documentation. Queries physicians on a concurrent basis. Works with physicians to clarify documentation in the medical record. Formulate credible clinical documentation clarifications to improve clinical documentation of principal diagnosis, co-morbidities, present on admission (POA), quality core measures, and patient safety indicators (PSI). Conducts post discharge reviews for comparative analysis of CDI Specialist and HIM APR-DRG and severity level assignment. Reviews clinical issues with the coding staff to assign a working DRG. Develops and conducts ongoing education for new staff, including new CDI Specialists, physicians and nursing. Utilizes software systems (including APR-DRG encoder) to collect, track, and report outcomes. Requires proficiency in abstracting and data entry into all databases used for clinical documentation. Maintains integrity of data collection. Participates in ongoing education of staff. Develops educational material and tools relative to documentation improvement practices for individual practitioners and groups of clinicians presented as handouts, PowerPoint, etc.
Maryland Care Management, Inc. (MCMI) manages Maryland Physician Care's (MPC) statewide provider network of hospitals and physicians. Maryland Physicians Care has been providing services to the HealthChoice Medicaid populations since 1996, and we are proud of our footprint in the community. With over 230,000 members, MPC consistently has been one of MD's largest Medicaid-managed care organizations.
This position is responsible for the planning, development, implementation, and timely oversight of care plans for members with identified Care Management (CM) needs. The incumbent is responsible for managing the care management process as defined by improving coordination, continuity, accessibility, and appropriate utilization of health care services and community resources for high-risk and special needs members.
Knowledge and Skills: The ability to successfully utilize Microsoft Office suite and common computer and office hardware is necessary. Ability to conduct presentations and training before small and large groups. Knowledge of the American with Disabilities Act of 1990. Education and Work Experience: Registered Nurse with current state license. Must have experience helping members using community agencies. 2 years of managed care experience preferred. Experience with pediatrics, NICU, postpartum, or maternal health is required Registered Nurse with BSN preferred.
Assists in developing, maintaining, and monitoring processes to promote the timely identification and assessment of high risk and special needs members. Serves as an interdisciplinary team member in management of identified members, performing clinical/social determinants of health assessments and in collaboration with physicians, determining medical needs. Conducts telephone or face-to-face interviews of members to identify risk factors and the need for care management. Fosters professional networks and relationships with service and resource providers to promote continuity and quality of care for members. Initiates, develops, plans, and implements care plans designed to promote the delivery of quality care and service to members with identified CM needs. Utilizes clinical judgment to discharge members from care management according to plan policies and procedures. Maintains care management records according to plan policies and procedures and ensures data integrity in health plan information systems. Collects, evaluates, and reports clinical, functional and program activity as applicable. Educates members' medical providers regarding the members' special needs to ensure consideration to the unique needs of the patients in treatment planning. Coordinates and communicates with community support and social service systems for members. Reduced care costs without sacrificing quality through effective service coordination and multidisciplinary collaboration. Secondary Functions Assists with special projects to meet plan and departmental goals. Following HIPAA guidelines, the Care Manager maintains confidentiality of patient information and adheres to appropriate release of medical information procedures. Identifies and reports gaps in the service delivery system.
Medasource is a leading consulting and professional services firm supporting organizations across the healthcare ecosystem – including Life Sciences, RCM/Payers, Technology, Government and Nursing & Allied Health. Recognized for our commitment to our employees, consultants, and the communities we serve, we deliver solutions that drive meaningful progress across healthcare. With a nationwide footprint of 33 offices and 1,900+ active consultant placements across 120+ clients who are actively engaging Medasource talent, we continue to expand our impact as we advance the future of healthcare, one client at a time.
The Prior Authorization RN is responsible for reviewing and processing medical prior authorization requests to ensure services are medically necessary, meet evidence-based guidelines, and align with the health plan’s policies. This RN plays a critical role in supporting cost-effective care while ensuring quality and compliance in alignment with regulatory and accreditation standards.
Active RN license -- AZ License or Compact State License Experience working in inpatient & outpatient settings Focus on Outpatient Prior Auths for surgeries and DME (Durable Medical Equipment) Medicare review experience is highly preferred Experience with reviewing guidelines (this position is more pre-service) Experience with MCG criteria, CareWebQI & Interqual Utilization Management experience required Payer background major plus
Manages health Plan consumer/beneficiaries across the health care continuum to achieve optimal clinical, financial, operational, and satisfaction outcomes. Provides pre-service determinations, concurrent review, and case management functions within Medical Management. Ensures quality of service and consistent documentation. Works collaboratively with both internal and external customers in assisting health Plan consumers/beneficiaries and providers with issues related to prior authorization, utilization management, and/or case management. Meets internal and external customer service expectations regarding duties and professionalism. Performs transfer of accurate, pertinent patient information to support the pre-service determination(s), the transition of patient care needs through the continuum of care, and performs follow-up calls for advanced care coordination. Documents accurately and timely, all interventions and necessary patient-related activities in the correct medical record. Evaluates the medical necessity and appropriateness of care, optimizing health Plan consumer/beneficiary outcomes. Identifies issues that may delay patient services and refers to case management, when indicated, to facilitate resolution of these issues, pre-service, concurrently, and post-service. Provides ongoing education to internal and external stakeholders who play a critical role in the continuum of care model. Training topics consist of population health management, evidence-based practices, and all other topics that impact medical management functions. Identifies and refers requests for services to the appropriate Medical Director and/or other physician clinical peer when guidelines are not clearly met. Conducts call rotation for the health plan, as well as departmental call rotation for holidays. Maintains a thorough understanding of each plan, including the Evidence of Coverage, Summary Plan Description, authorization requirements, and all applicable federal, state, and commercial criteria, such as CMS, MCG, and Hayes.
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.
Remote - The Case Manager – Transitions of Care (Outpatient) Are you a California-licensed RN who wants to make a real difference in patients’ lives? Join us as a Remote Case Manager and help members transition safely from hospital or skilled nursing facility stays back to their homes. This is your chance to provide education, support, and coordination that directly impacts health outcomes. Remote Case Manager – Transitions of Care Nurse (CA RN License) Are you a California-licensed RN passionate about guiding patients through safe, seamless care transitions? Join our team as a Remote Case Manager, where you’ll make a direct impact on patient outcomes by coordinating discharge planning, referrals, and community resources.
2–3 years of clinical care management experience (3–5 preferred). Active, unrestricted RN license in California (willing to obtain other state licenses). Knowledge of Medicare Managed Care Plans, insurance regulations, and community resources. Strong communication, problem-solving, and organizational skills.
Create individualized discharge plans with patients, families, and the care team. Coordinate care with providers, rehab facilities, and home health agencies. Monitor patient progress and adjust plans as needed. Educate and empower patients and families for self-care and follow-up. Advocate for patient needs and connect them to community support services. Participate in care conferences, quality improvement initiatives, and interdisciplinary collaboration.
PromptCare is a leading national provider of high-tech, hands-on respiratory services and home and alternate site infusion therapies. With 40 years of providing compassionate clinical care to patients with chronic, complex, and rare health conditions, PromptCare holds accreditations from industry quality organizations URAC and ACHC. Our compassionate, skilled team of pharmacists, respiratory therapists, nurses, and dietitians treats patients across the United States. For more information, please visit us at promptcare.com.
Job Type Part-time Description Promptcare is seeking experienced and compassionate Registered Home Infusion Nurses to join our team of healthcare professionals. As a Registered Home Infusion Nurse, you will be responsible for providing specialized nursing care to patients in their homes. You will be responsible for assessing, planning, implementing, and evaluating patient care plans and administering intravenous medications and treatments. You will also be responsible for educating patients and their families about home care, medications, and treatments. The ideal candidate will possess excellent communication and interpersonal skills, as well as a dedication to providing the highest quality of care. If you are a compassionate and dedicated Registered Home Infusion Nurse, we would love to have you join our team. To learn about our company and services, please visit us at PromptCare In-home Respiratory and Infusion Reports to: Nurse Manager Job Type: Per Diem Location: Omaha, NE
Must be a Registered Nurse in the state inquiring of employment and in good standing Must have a valid driver’s license and automobile insurance Professional Liability Insurance CPR Certification Knowledge of PIV, Mid-Line, PICC Line, Tunneled Catheters, and Ports At least 2 years’ experience as a home infusion nurse, or equivalent experience working in another field-based home nursing organization, is required ED experience preferred Demonstrated proficiency in IV insertion, vascular access devices, and infusion pumps Specific training and/or certification as a heart failure nurse is highly desirable Strong pediatric peripheral IV skills preferred Certified Nurse Infusionist (CRNI) preferred Experience with the following IV therapies is a major advantage: inotropes, intravenous immunoglobulin, and Total Parenteral Nutrition (TPN) Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. While performing job duties, the employee is frequently required to communicate verbally and listen attentively. This position is highly active and requires standing, walking, bending, kneeling, stooping, crouching, crawling, twisting, climbing, maneuvering in small areas and frequently lifting and/or moving 30 pounds or more.
Conducts initial nursing assessments for home infusion therapy Trains patients/caregivers on procedures and equipment Develop and revises care plans with the healthcare team Visits patients, documents compliance, and provides direct care Assuming on-call duties and managing patient supplies Coordinates care with other agencies and counsels patients on therapy Collaborate with Pharmacists for therapy adjustments Plans efficient daily routes and submits nursing notes promptly Triages field problems and adheres to SOPs and regulations Delivers "white glove" service and submits travel expense reports Projects a positive attitude and participates in employee activities Provides nursing services as requested, including weekends and evenings Performs other duties as assigned
At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!
This position is a fully remote role and requires working hours in CST, MST, or PST. An active and clear RN and APRN or Physician Assistant license in AL, AZ, GA, IL, OH and/or TX is required at time of hire. Candidates must be comfortable conducting clinical assessments in Spanish & English. This position represents an amazing opportunity for an experienced nurse practitioner (NP) or physician assistant (PA) with a big heart and entrepreneurial spirit with extensive clinical experience offering care for cardiology patients. Your primary focus will be delivering world class, virtual first, advanced primary care cardiology care to our members in the Devoted Medical Heart Center. In this role you will be working in a next generation virtual heart clinic that dramatically expands access to care for America's most vulnerable seniors. The clinic focuses on providing highly accessible, high quality care for members with general cardiology conditions. As part of the clinic you will also provide dedicated clinical services during part of your clinical time to our heart failure clinic which is a highly tailored, specialty center focused on providing best in class heart failure management including optimizing guideline directed medical therapy, providing health coaching, and managing volume overload. You will be a key member of our interprofessional team. On a day-to-day basis you will work closely with RNs who are assigned as clinical guides for each patient in the heart failure clinic. You will also work closely with an interdisciplinary team including physicians, pharmacists, social workers and medical assistants. You will utilize and help improve our home-grown technology and electronic health information platform to carry out virtual visits.
Attributes to success: You are experienced working on an interprofessional team and enjoy team-based care. You have great clinical and non-clinical judgment. You are thorough and take the time to address the needs of your patients. You are deeply empathetic and humanistic, and want to go the last mile for your patients. You enjoy a fast-paced, high-energy, organization. Agility and collaboration are key as we will change and improve quickly. You welcome learning and using new technologies that are being developed in parallel. You thrive on knowing your work can help make these technologies better for you and your patients. You learn from every experience and are not afraid to fail - that's how you're wired. Finally and most importantly, you have a passion for making healthcare better, solving complex problems, and supporting the delivery of healthcare that we would want for our own family members. Desired skills and experience: NP or PA with 5 or more years working in cardiology clinical practice with ideally 2 years in an outpatient cardiology setting. Bilingual in English & Spanish. You will be conducting comprehensive clinical assessments in both languages. Experience performing visits over telehealth video platforms and strong desire to continue practicing virtually - you believe in the mission of bringing care to where the patient lives. A secure & private workspace with a strong & reliable internet connection. Highly comfortable with technology (EMRs, messaging platforms, online portals, AI chat) Willingness to work 8-5 in Central Time zone or later time zone (MT, PCT) Willingness to obtain and maintain multistate licensure within the first 90 days (support and reimbursement provided) An understanding of managed care is a plus, including how to appropriately assess STARS/HEDIS measures, code clinical comorbidities, and identify clinical care gaps. Licensure and Certification: An active and clear RN and APRN or PA license in the state of Texas, Ohio, Arizona, Illinois, Georgia or Alabama as well as APRN certification is required at time of hire and must be maintained while employed at Devoted Medical. Cardiovascular Nurse Practitioner Certification is a plus.
Conduct focused and thorough assessments of patients with general cardiology and heart failure needs through virtual consultations including ordering diagnostics as needed, interpreting labs and imaging data, and developing a treatment plan in collaboration with the specialty care clinic team. We expect that 80-90% of your time will be performing virtual visits. Formulate accurate diagnoses and develop individualized treatment plans for patients with heart failure and general cardiology clinical conditions, including medication management, volume monitoring and management, and lifestyle modifications. Initiate, titrate, and manage guideline-directed medical therapies (GDMT) for a diverse group of members with heart failure. Provide proactive management of heart failure and comorbid conditions, and address potential barriers to optimal care to mitigate the risks of heart failure exacerbation and hospitalizations. Assess and intervene in weight fluctuations and acute volume overload management of patients who are enrolled in the clinic. Assess, diagnose, and manage the range of general cardiology conditions that are suitable for virtual care including stable coronary artery disease, hypertension, hyperlipidemia, stable atrial arrhythmias, peripheral arterial disease and chronic venous disease. You will be ordering in-home diagnostics including echocardiograms, EKGs, and Holters and working with community cardiology practices for other diagnostics including stress testing and advanced cardiac imaging. Collaborate closely with other members of the care team including PCPs, cardiologists and other Devoted team members including pharmacy, clinical nursing, social work, as well as interfacing with family members and caregivers to coordinate holistic care for the member, to ensure continuity of care and deliver a collaborative care plan. Serve as the clinical advisor and provide clinical escalation support for the speciality clinic staff and other teams during business hours. Utilize our home grown electronic health information system for visits while also providing feedback on how to improve the interface. Maintain accurate and up-to-date patient medical records, ensuring compliance with relevant legal and ethical guidelines. Participate in quality improvement initiatives and ongoing professional development to stay current on best practices and advancements in cardiovascular care. Adhere to all relevant laws, regulations, and industry standards, including patient privacy and telehealth regulations.
At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!
Job Description: To ensure we can support our members in specific regions, this role requires you to be based in the Mountain (MT) or Pacific (PT) time zone AND hold an active multi-state Compact RN license. The Cardiology Nurse, known as the Clinical Guide, is a vital part of Devoted Medical's Congestive Heart Failure (CHF) specialty clinic. This program is dedicated to enhancing the health of our members living with heart failure. The clinic delivers three concurrent interventions: 1) Health Coaching: Educating members to become proactive self-managers of their chronic condition. 2) Volume Optimization and Weight Monitoring: Closely tracking member weight for fluid management. 3) Medication Optimization: Initiating or intensifying Guideline Directed Medical Therapy (GDMT). Clinical Guides manage a panel of enrolled members. They provide virtual guidance, primarily through phone and video visits, supporting members until they successfully "graduate" as competent self-managers. Throughout this journey, they collaborate with a multidisciplinary team, including cardiology-trained nurse practitioners, pharmacists, social workers, and care coordinators. Looking ahead, we are developing a virtual Heart Center of Excellence, which will expand the role and responsibilities of the nurses within the heart failure clinic to support this significant new initiative.
Required skills and experience: An unrestricted, compact RN license A minimum of 4 years of RN experience with at least 2 years in a non-ICU cardiac focused setting, outpatient being ideal A secure & private workspace with a strong & reliable internet connection. Bilingual in English & Spanish. Will be required to conduct patient assessments in Spanish. Strong interpersonal and communication skills, your nursing care will be delivered verbally 100% of the time Highly comfortable with technology (EMRs, messaging platforms, online portals, AI chat) Ability to multi-task: you’ll be listening, talking and typing all at the same time. Team player mentality with a can-do attitude. Comfortable with fast paced and evolving workflows, we will change and improve quickly. Willingness to work 8-5 in Mountain Time zone or later time zone (MT, PCT) Desired skills and experience: Telehealth/remote experience strongly preferred Bilingual in Spanish Experience working in the Medicare Advantage landscape
Working with our members Completing remote (telephonic/video) visits to conduct nursing assessments of heart failure, comorbid conditions, ED/hospitalization history, medications, psychosocial factors, and member values and preferences Provide comprehensive clinical education tailored to individual needs (disease process, medications, symptom monitoring, lifestyle counseling, contingency planning). Developing care plans in partnership with members and their caregivers - problems, SMART goals, interventions - while continuously evaluating the member’s progress. Working with and interdisciplinary team Collaborating with an interdisciplinary team of registered nurses, advanced practice nurses, physicians, social workers, and pharmacists on shared members, to ensure we’re working together to meet the needs of the members. Collaborating closely with our PCP partners, as well as other clinical teams within Devoted Medical Group, to coordinate care and deliver evidence based, effective, and accessible health care. Participating in weekly team huddles and patient rounds presentations Improving how we work Adapting to evolving workflows and care delivery models as we continue to grow and develop an emerging Heart Center or excellence Providing feedback and potential solutions to help improve the operational processes, software tools, and clinical care.
At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!
To ensure we can support our members in specific regions, this role requires you to be based in the Mountain (MT) or Pacific (PT) time zone AND hold an active multi-state Compact RN license. The Cardiology Nurse, known as the Clinical Guide, is a vital part of Devoted Medical's Congestive Heart Failure (CHF) specialty clinic. This program is dedicated to enhancing the health of our members living with heart failure. The clinic delivers three concurrent interventions: 1) Health Coaching: Educating members to become proactive self-managers of their chronic condition. 2) Volume Optimization and Weight Monitoring: Closely tracking member weight for fluid management. 3) Medication Optimization: Initiating or intensifying Guideline Directed Medical Therapy (GDMT). Clinical Guides manage a panel of enrolled members. They provide virtual guidance, primarily through phone and video visits, supporting members until they successfully "graduate" as competent self-managers. Throughout this journey, they collaborate with a multidisciplinary team, including cardiology-trained nurse practitioners, pharmacists, social workers, and care coordinators. Looking ahead, we are developing a virtual Heart Center of Excellence, which will expand the role and responsibilities of the nurses within the heart failure clinic to support this significant new initiative.
Required skills and experience: An unrestricted, compact RN license A minimum of 4 years of RN experience with at least 2 years in a non-ICU cardiac focused setting, outpatient being ideal A secure & private workspace with a strong & reliable internet connection. Strong interpersonal and communication skills, your nursing care will be delivered verbally 100% of the time Highly comfortable with technology (EMRs, messaging platforms, online portals, AI chat) Ability to multi-task: you’ll be listening, talking and typing all at the same time. Team player mentality with a can-do attitude. Comfortable with fast paced and evolving workflows, we will change and improve quickly. Willingness to work 8-5 in Mountain Time zone or later time zone (MT, PCT) Desired skills and experience: Telehealth/remote experience strongly preferred Bilingual in Spanish Experience working in the Medicare Advantage landscape
Working with our members Completing remote (telephonic/video) visits to conduct nursing assessments of heart failure, comorbid conditions, ED/hospitalization history, medications, psychosocial factors, and member values and preferences Provide comprehensive clinical education tailored to individual needs (disease process, medications, symptom monitoring, lifestyle counseling, contingency planning). Developing care plans in partnership with members and their caregivers - problems, SMART goals, interventions - while continuously evaluating the member’s progress. Working with and interdisciplinary team Collaborating with an interdisciplinary team of registered nurses, advanced practice nurses, physicians, social workers, and pharmacists on shared members, to ensure we’re working together to meet the needs of the members. Collaborating closely with our PCP partners, as well as other clinical teams within Devoted Medical Group, to coordinate care and deliver evidence based, effective, and accessible health care. Participating in weekly team huddles and patient rounds presentations Improving how we work Adapting to evolving workflows and care delivery models as we continue to grow and develop an emerging Heart Center or excellence Providing feedback and potential solutions to help improve the operational processes, software tools, and clinical care.
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.
Required Qualifications: Active Registered Compact Nurse license (RN) in the home state with no disciplinary action and ability to obtain non compact licensure 3+ years of Medical Surgery, Heart, Lung or Critical Care Nursing clinical experience in Acute care (skilled or rehab clinical settings) Work rotation and possible holiday coverage required Preferred Qualifications: Utilization management experience BSN or Bachelor's degree in a related field Health Plan experience Previous Medicare or Medicaid Experience Bilingual English and Spanish 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.
As a Utilization Management Nurse, you will use clinical knowledge skills. These skills will be applied towards interpreting criteria, policies, and procedures. The goal is to provide the best and most appropriate 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 Management Manager. This is a remote position.
ROMTech is the developer of a breakthrough, patented medical technology for knee and hip rehabilitation. The ROM technology enables knee and hip patients to recover 50% faster, saving money for patients, medical facilities and payors.
We are seeking a dedicated and licensed RN to join our telehealth pilot program on a contract basis. This role is designed to expand patient access and enhance care delivery through innovative remote services. As part of this program, you will provide patient support, education, and care coordination in a virtual setting, while contributing to the development of new healthcare delivery models. While some initiatives may include Chronic Care Management (CCM), the primary focus is on telehealth-based patient engagement and coordinated care
Bi-lingual (English & Spanish) required Prior telehealth and/or Care Management experience preferred Active RN license with compact privileges (required) Excellent communication and organizational skills Proficiency with technology and electronic health records (EHR) Demonstrated commitment to patient-centered care and healthcare innovation
Conduct telehealth outreach to patients, providing education, follow-up, and support Monitor patient progress and assist with care coordination activities Collaborate with a multidisciplinary clinical team to support patient care goals Participate in pilot program workflows and provide feedback to improve processes Accurately document patient interactions in compliance with regulations and organizational policies Support CCM activities as needed to enhance patient outcomes
IntePros is an established, woman-owned, privately-held technology and business services consulting agency committed to building long-term relationships and helping more companies leverage the power of a more diverse workforce.
Utilization Management RN | Contract-to-Hire Location: Remote (Must reside in PA, NJ, or DE) Licensure Required: Active PA RN license or Nurse Licensure Compact including PA Department: Care Management & Utilization Review About the Role We’re hiring an experienced Utilization Review Nurse to join our Utilization Management team. This fully remote role is ideal for a clinically strong UM nurse who thrives in a fast-paced, review-driven environment and brings sound judgment, attention to detail, and a member-focused mindset.
Required: Active Pennsylvania RN license or Nurse Licensure Compact license including PA Minimum 3 years of Utilization Management/Utilization Review Experience 2+ years of Insurance/Payer-side UM experience Preferred: Prior authorization, precertification, or acute care experience Experience applying Interqual or CMS Guidelines
Review medical records and clinical documentation to determine medical necessity for requested services. Apply established clinical guidelines, including InterQual Criteria, medical policy, and care management policies. Evaluate requests for therapy services, inpatient admissions, procedures, and ancillary services. Communicate with providers to clarify treatment plans and obtain additional clinical information when needed. Approve services that meet medical necessity criteria and escalate cases not meeting criteria to Medical Directors for further review. Identify discharge planning opportunities and collaborate with care teams to support transitions to appropriate care settings. Refer members to case management or disease management programs when appropriate. Monitor utilization trends and escalate quality or care delays when identified. Ensure all utilization decisions comply with state, federal, and accreditation requirements. Maintain accurate documentation and meet required turnaround times and productivity goals.
At Sword, we’re building AI to heal billions and unlock humanity’s full potential. In doing so, we’re pioneering AI Care, a fundamentally new approach to healthcare built for medical reasoning, safety, and real-time treatment, not generic technology applied after the fact. As both a clinical-centric frontier AI lab and an applied AI platform, Sword is reimagining how care is delivered at scale, removing traditional barriers like appointments, waiting rooms, and stigma so more people can access the care they need—and ultimately get back to lives lived in full. Since 2020, Sword has expanded across physical therapy, women’s health, cardiometabolic, and mental health, and is now moving beyond the session to a fully AI-native, 24/7 care program that brings physical activity, therapeutic exercise, psychotherapy, nutrition, and behavior change into one connected experience. More than 700,000 members across three continents have completed over 10 million AI sessions, helping 1,000+ enterprise clients avoid more than $1 billion in unnecessary healthcare costs. Backed by 42 clinical studies, 44+ patents, and more than $500 million raised from leading investors including Khosla Ventures, General Catalyst, and Founders Fund, Sword is defining a new standard for healthcare.
Sword Health is seeking a specialist trained as a Nurse Practitioner with menopause certification (MSCP) to join the Bloom team. As a specialist-led, AI-powered women's health platform, Bloom brings together the right clinical expertise across every life stage because women's health compounds, overlaps, and evolves, and the care she receives should too. This role is central to delivering on that vision. In this remote, variable-hour role, you will serve women in the Menopause and Midlife pathways. You bring the expert guidance, and Bloom's AI handles detection and routing. AI Proficiency at Sword Health AI fluency is a core expectation at Sword Health. Every candidate is assessed against our three-level framework — be ready to share real examples of how AI is already part of how you work. Explorer (Level 1) — Uses AI daily to boost personal productivity Builder (Level 2) — Creates workflows and tools that elevate the whole team Integrator (Level 3) — Embeds AI into products and processes at scale Every hire must demonstrate at least Level 1. The expected level will vary depending on the seniority of the role.
Current, unrestricted Nurse Practitioner licensure; national certification required MSCP (Menopause Society Certified Practitioner) certification required Experience in telehealth or digital health A passion for personalized, whole-body care and a genuine belief that technology can close the gaps women face in menopause and midlife healthcare Excellent interpersonal skills that translate into a digital care environment, with ability to build trust and engagement Ability to balance clinical rigor with a strong focus on member empowerment, behavioral change, and motivational support Hard-working and able to operate effectively in a fast-paced, high-growth environment A strong commitment to data security and privacy What We Would Love To See: 3+ years of clinical experience in menopause care or midlife medicine Thorough understanding and experience in wellness services Clear understanding of scope boundaries within wellness model This range includes base, variable and equity
Deliver personalized guidance on the functional, physical, and emotional aspects for perimenopause through post-menopause Coordinate care for members pursuing hormone therapy through Bloom’s partner clinician network Identify when member needs fall outside wellness scope and require clinical evaluation Contribute to the program protocol and AI development and participate in quality review Support Bloom’s operations by shaping workflows and helping scale consistent, high-quality care delivery Coordinate with Bloom's multidisciplinary team
The Judge Group is an international leader in business technology consulting, talent solutions, and learning and development. With over 30 locations across the U.S., Canada & India, Judge is proud to partner with the best and brightest companies in business today, including over 60 of the Fortune 100. We serve organizations in financial services, healthcare, life sciences, insurance, government, aerospace & defense, manufacturing, and technology & telecommunications. Judge has always been committed to doing what’s right – for our colleagues, our client partners, and our communities. At Judge, we cultivate an inclusive environment that empowers our employees to produce their best work. As a family-owned business, we’re not just a high-performing team, but a high-performing family. Through building relationships and our cultural commitment to caring, we support one another. Our People-powered Business Solutions Talent & Executive Search From temporary consultants to C-level executives, The Judge Group works across all industries and domains to find exceptional talent. IT Consulting We take an end-to-end approach to technology, working alongside your teams to design, build, implement, and manage all of your organization’s IT resources. Our enterprise IT consulting services and solutions encompass the full technology spectrum, from IT and business transformation, and cloud migration to digital strategies and execution, strategic roadmaps and delivery, process and governance optimization, and IT infrastructure and wireless solutions. Learning Solutions As a leading provider of corporate learning services for companies of all sizes and industries, Judge employs a strategic approach to learning that meets organizational training goals while strengthening business outcomes. Regardless of when, where, or how you want to train your team, our solutions are engineered to engage and support employees throughout their learning journey.
We invite compassionate healthcare professionals to join a mission‑driven team committed to healing and inspiring the human spirit. The Care Manager, LVN partners with providers, hospitals, medical groups, community agencies, caregivers, and Members to support coordinated care, collaborating closely with RN Care Managers and the interdisciplinary care team (ICT). This role helps advance organizational quality program goals, including HEDIS, CAHPS, and NCQA standards.
Education & Experience: Minimum 3 years of care management experience in a healthcare delivery setting; internal candidates with 2+ years in Care Management and strong performance may substitute. Experience in HMO or managed care preferred. At least 1 year of clinical experience in acute care, SNF, home health, or clinic setting preferred. High school diploma or GED required. Active, unrestricted LVN license issued by the relevant state Board of Vocational Nursing & Psychiatric Technicians. Required Skills & Abilities Valid driver’s license and reliable transportation as required by the role. Clinical assessment skills and basic knowledge of care planning and chronic disease management. Strong verbal and written communication skills; ability to educate Members and engage caregivers. Proficiency with electronic health records, telephonic outreach, and standard documentation practices. Ability to lift/move up to 25 lbs and perform physical tasks such as standing, walking, bending, and stair climbing when required. Ability to meet vision and hearing requirements essential for safe patient care and documentation. Must meet telecommute expectations and attend on‑site meetings as required by the employer. Working Conditions & Telecommuting This is a remote role with required occasional on‑site attendance for meetings or business needs. Schedule may include evenings or weekends on an as‑needed basis for urgent Member needs or events.
Act as a resource for Members and Providers on care management and coordination. Screen Members for care management needs using approved tools (for example, Health Risk Assessment) and escalate findings to the RN Care Manager. Contribute to development, review, and modification of Individualized Care Plans (ICPs); discuss ICP recommendations with RN Care Managers and ICT. Provide Member education using approved care plans and materials; document education and readiness for change. Communicate unexpected clinical results or social determinants concerns to RN Care Managers and ICT promptly. Advocate for Members and serve as liaison between Members, caregivers, and the interdisciplinary team. Facilitate and coordinate referrals and support services (examples: CCS, multi‑organ transplant programs, LTSS, Independent Living and Disability Services, Behavioral Health, community resources). Assist Members with urgent access, referrals, and authorization issues as needed. Use evidence‑based communication techniques (e.g., Motivational Interviewing) during Member interactions and team coordination. Build and maintain strong working relationships with Providers through in‑person contact, telephone, secure messaging, and fax as required. Support quality improvement initiatives and HEDIS gap‑closure efforts. Coordinate medical and behavioral health access with PCPs, specialists, and ancillary services. Perform other duties as assigned under the supervision of RN Care Managers or leadership.
Bicycle Health is a telemedicine group that specializes in the evidence-based treatment of individuals with Opioid Use Disorder using buprenorphine. We’ve grown our clinical staff of medical providers caring for patients, across 32 states, and we employ a large ancillary staff for support with technologic and administrative needs, clinical and behavioral support, and care coordination. Our innovative model has achieved clinical outcomes that exceed expectations for standard-of-care in-person treatment nationally. Our mission is to increase access to high quality, affordable, convenient and confidential Opioid Use Disorder treatment for all.
The Opioid Epidemic is a public health crisis with a highly effective but underutilized clinical intervention - millions of Americans are physically dependent on Opioids but only 10% of those likely to have OUD actually access treatment. Bicycle Health addresses this gap by maximizing accessibility, affordability, and overall quality of care by enabling highly qualified clinicians to reach patients broadly and efficiently through our online platform. The Part Time Patient Access Provider is an addiction medicine Nurse Practitioner, a clinical position with responsibility for the initial intake and induction of patients under care primarily for opioid use disorder. The Advanced Practice Clinician will assess new patients presenting for telemedicine-based care of opioid use disorder, determine appropriateness of enrollment in our care setting, and oversee their transfer to another provider for continuity of care. At times, the clinician may be asked to help cover patients receiving maintenance care should an acute need arise. The Part Time Patient Access Provider role is to aid in low-barrier, quick access to addiction medicine evaluation and treatment. Note: to be considered for this role you must have at least ONE of the following state licenses: CA, TX, MI, FL, AZ, or CO What You Can Expect: Choose your days - You have the flexibility to select which days you work, with the expectation that your schedule remains consistent each week. Choose your shifts - Choose 2, 3, or 4 hour shifts Choose your start time - Shifts are always in the evening and you can start anytime between 4pm-6pm in your timezone during the week. No weekends. Location Flexibility - Work from home and work from anywhere in your state (subject to change depending on regulations) No Call - Our Access Providers do not participate in the on-call rotation Target Pay Range: $70-$78/per hour - Salary to be determined by the education, experience, knowledge, skills, and abilities of the applicant, internal equity, and alignment with market data. Benefits: Accrued sick time $50 monthly Remote Work Stipend All equipment provided All licensing and credentialing costs paid
We are currently only considering Nurse Practitioners for this role. You must have at least ONE of the following state licenses: CA, TX, MI, FL, AZ, or CO & DEA license in your home state. Must be eligible and willing to obtain licenses in multiple states. Meet at least one of these clinical requirements: 1 year of experience as a provider delivering high-volume buprenorphine inductions, preferably in a telehealth environment. OR 3 years of experience as a provider in an in-person addiction medicine setting with emphasis on treating OUD OR 5 years of experience as a provider within a primary care, ED, or psychiatric setting with comfort caring for high-acuity patients diagnosed with OUD Strong communication skills, ability to build an effective provider-patient relationship that fosters engagement and adherence to a collaboratively developed care plan. Experience working in a fast-paced environment with the ability to adjust and be flexible with minimal notice. Comfort with risk/benefit balancing and a love for problem solving are required attributes. Motivational Interviewing experience preferred. Consistent access to a private work environment with high speed internet and professionally appropriate surroundings for frequent video conferencing and a workstation setup conducive to remote work needs. Preference for providers with telehealth experience. This is a part-time (8-29 hours per week) remote position.
Work a minimum of 8 hours per week Provide assessment and initial treatment for patients with Opioid Use Disorder. Provide diagnosis of Opioid Use Disorder and co-occurring mental health conditions. Safely and effectively start treatment with buprenorphine-naloxone for OUD, and manage the early induction and stabilization phases of care with close follow-up. Order and interpret labs including drug screens, provide patient counseling, and modify the assessment and care plan based on results. Utilize motivational interviewing and other engagement and rapport-building techniques to achieve optimal patient outcomes. Monitor your performance, and meet practice and personal clinical quality improvement goals related to patient outcomes, practice standards, and productivity. Develop a thorough understanding of practice policies and procedures, and actively participate in feedback and development. Develop an understanding of your local and regional referral resources and utilize them. Utilize a suite of web-based platforms to manage patient care and collaborate with your team. Engage in collaborative and/or supervisory practice agreements with Bicycle Health Physicians, and fulfill all obligations of these agreements to maintain practice compliance and quality. Continuously work towards obtaining and maintaining full licensure and credentialing statuses within a respective region during employment. Adhere to all federal and state laws and regulations concerning patient privacy and data security, including HIPAA's Privacy and Security Rules and 42 CFR Part 2. Regular and predictable attendance is required. Participation in testing and/or piloting new technologies or workflows All other duties as assigned.
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
This is a 6-month PRN contract position; provider must be able to provide a minimum of 9 hours of availability per week including every third weekend. The available shifts are for evening and overnight hours. Qualified candidates must hold a current, unrestricted license in Tennessee and live within three hours of the Tennessee border to meet minimum qualifications for this position. If hired, must be willing and able to obtain additional licensure. Internal candidates cannot maintain a full-time or part-time position in core and a PRN position in Virtual Care. The MinuteClinic Virtual Care Nurse Practitioner (Provider) delivers patient care services through a remote technology platform. You will work in collaboration with a dedicated team of professionals as you independently provide holistic, evidenced based care inclusive of accurate assessment, diagnosis, treatment, management of health problems, health counseling, and disposition planning for our patients ranging in age 18 months and above. Encounters are documented utilizing Epic. WORKING ENVIRONMENT: Dedicated virtual care providers must meet minimum requirements for remote care delivery, including: broadband connectivity, a quiet setting with a neutral background to conduct visits from, and the ability to uphold patient privacy per CVSH guidelines. Ability to hardwire into connection preferred. While performing the duties of the job, the employee is regularly required to interact with customers in a remote manner, site, write, operate the computer and phone, speak intelligibly, and hear patient responses. Specific vision abilities include the ability to view and read a computer screen and other electronic devices
Candidates must be currently licensed in one of the following states to be considered: Tennessee Minimum of two years of medically-relevant experience or equivalent Effective verbal, written, and electronic communication skills Outstanding organizational skills and ability to multi-task Initiative, problem solving ability, adaptability and flexibility Ability to work without direct supervision and practice autonomously Is proficient with information management and technology Capacity to collaborate with professional colleagues as necessary to provide quality care Depending on the market, the ability to be proficient in both speaking and writing in additional languages not limited to but including Spanish may be required Education: Completion of a Master’s Degree level Family Nurse Practitioner program with current National Board Certification and State of Employment license to practice in the Advanced Practice Nurse role required
Provide holistic, evidenced based care inclusive of accurate assessment, diagnosis, treatment, management of health problems, health counseling, and disposition planning for our patients. This includes education and treatment for pregnancy prevention, STI Prevention and safer sex practices. Evaluate primary care, acute, chronically ill, and transitional care patients, in addition to providing healthcare education and counseling, and disposition planning for our patients ranging in age 18 months and above. Provide patient counseling; inclusive of pregnancy prevention, STI Prevention/safer sex practices, contraceptive care counseling and medication management Educate patients on health maintenance and respond to patient care inquiries Document all patient care within an EHR according to MinuteClinic policies and procedures Provide care and coordination of our patients with internal and external colleagues, including the broader patient centered medical home, ensuring the highest standard of care is provided for all patients. Effectively work within a patient care team, including fellow Providers, Collaborative Physicians, paraprofessionals, Pharmacists and other members of the health care team Work independently , prioritize and solve problems, take initiative, and advocate for their patients and their practice
AddiNurse is a nurse-led healthcare coordination company focused on supporting providers through Chronic Care Management (CCM), Remote Patient Monitoring (RPM), Behavioral Health Integration (BHI), Transitional Care Management (TCM), care coordination, and value-based care initiatives. Our mission is to help healthcare organizations improve patient outcomes, increase patient engagement, strengthen continuity of care, reduce administrative burden, and support scalable value-based care models.
Company: AddiNurse Location: Remote | United States Partnership Opportunity
We are actively seeking providers and provider organizations interested in partnering to expand chronic care and preventative care services for Medicare and high-risk patient populations. Ideal partners may include: Physicians (MD/DO) Nurse Practitioners (NPs) Primary Care Providers Internal Medicine Practices Behavioral Health Providers Community Health Centers Mobile & House Call Providers ACO & Value-Based Care Organizations Senior Care & Post-Acute Medical Groups Preferred Criteria: Medicare patient population Patients with 2 or more chronic conditions Interest in CCM, RPM, BHI, or value-based care initiatives Commitment to improving patient outcomes and preventative care Interest in collaborative care coordination models
Nurse-led CCM/RPM/BHI support Patient engagement and care coordination Workflow optimization and documentation support Chronic disease management support Transitional care follow-up Assistance with preventative and value-based care initiatives Administrative support to help improve operational efficiency Scalable partnership opportunities designed to support provider growth and recurring revenue opportunities
At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it’s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people’s lives. It takes empathy, precision, and a strong sense of partnership—and that’s exactly what you’ll find here. We’re a team of fast-paced fixers, empathetic experts, and outcomes drivers — people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you’ll play a vital role in helping businesses and individuals move forward with confidence. Here, you’ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you’re here, you’re part of something bigger. You’re part of a team that shows up, stands together, and leads with purpose.
Gallagher Bassett is looking for a seasoned leader to join our Nurse Triage team within Incident Management. The leader will direct a team of licensed Nurses and care coordinators who provide early intervention and guidance to injured workers using clinically based protocols. The team’s objective is to provide great claimant experiences, get treatment and claim processing started quickly and efficiently, and reduce claims costs for our clients, differentiating Gallagher Bassett in the marketplace. How you'll make an impact: The Nurse Triage Director will be the business owner responsible for the product P&L and all aspects of it – Managing 24/7/365 operations (split between US and offshore), Client Relations, Growth/Retention, Finance, Technology, Analytics, HR, Legal and Compliance. The team is expected to begin managing injured worker calls in 2026, and the leader will be responsible for transitioning an existing business from a wholly vended model to an owned solution with vendor augmentation. Designing process, informing the final build of the platform, hiring, onboarding, and training team members will be key responsibilities in the near term. Driving growth, increasing penetration, optimizing the model, and staffing expansion are longer term milestones.
Required: Minimum of 8 years of experience in case management or related field. Minimum of 5 years supervisory experience. Bachelors degree required. Must be able to travel approximately 50% of the time and non traditional work hours. Preferred/Desired Requirements: Strong intake and/or call center experience Strong track record or performance and progression as a leader Strong data and analytics acumen Comfortable exploring and using new technologies Ability to work cross-functionally Innovative thinker, adept at envisioning future opportunities Work Traits: Self-starter with an ability to influence others, make decisions, and get things done Ability to work independently and problem solve without much oversight Creative, innovative, and growth mindset Motivator, mentor, and coach Strong organizational and time management skills
Operations – Establish and manage all aspects of the operation, delivering compassion and clinical guidance through RNs and care coordinators Financials – Manage revenue projections, expense, and margin Technology – Support delivery of platform technology and continually optimize through automation, AI, and other leading-edge initiatives HR – Hire, train, onboard, and performance manage onshore and offshore teams Client reporting and support – Work with GB Account Managers and client Risk Managers for client presentations, outcomes/operational reporting, and issue resolution Sales and Marketing – Support new sales, cross-sell, and retention activities Cross-functional collaboration – Work cross functionally with stakeholders to ensure operational efficiency, driving tighter integration with other services Process Improvements – Drive continuous improvement Analytics – Track performance through metrics and use data to improve operations Legal, Compliance, and Licensing – Understand Work Comp state laws and RN license requirements; ensure proper compliance across the organization
At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it’s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people’s lives. It takes empathy, precision, and a strong sense of partnership—and that’s exactly what you’ll find here. We’re a team of fast-paced fixers, empathetic experts, and outcomes drivers — people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you’ll play a vital role in helping businesses and individuals move forward with confidence. Here, you’ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you’re here, you’re part of something bigger. You’re part of a team that shows up, stands together, and leads with purpose.
Candidates must be actively licensed in Michigan as an RN. This role will operate Monday - Friday, 8:00am - 5:00pm ET, occassionally flexing to cover evening hours, 11:00am - 8:00pm ET. Stella Health Navigation aims to provide the guidance and care of a nurse to the plan members who need it the most. We simplify the healthcare journey, enhance partner solutions, and build trust-based relationships, supported by advanced analytics and integration with high-value partners. We are seeking a compassionate and knowledgeable Stella Health Navigator to join our team. The ideal candidate will play a crucial role in assisting our members with their health needs, understanding their health benefits, and connecting them to partner solutions. This position involves educating members on their health conditions, scheduling doctor appointments, and providing guidance on navigating the healthcare system. We offer a supportive work environment, opportunities for professional development, and a chance to make a meaningful impact in the lives of our members.
Required: Degree from applicable program of training and a minimum of 3 years clinical experience in an acute care setting required. Active Registered Nursing license or equivalent within the state of practice or states in which Case Management is performed. Preferred: Bachelor's degree preferred. Certification in related field preferred. Experience in care navigation, case management, or a related field is preferred. Strong understanding of health benefits and insurance plans. Excellent communication and interpersonal skills. Experience in scheduling and coordinating healthcare services. Compassionate and patient-centered approach to care. Ability to communicate effectively in English and Spanish preferred. Behaviors: Demonstrates adequate knowledge of managed care with emphasis on use of criteria, guidelines and national standards of practice. Demonstrates good written and oral communications, organizational and leadership skills. Ability to work collaboratively in a team environment. Ability to educate and empower members regarding their health and wellness. Skilled in Microsoft 365 suite, electronic charting systems, and remote collaboration tools. Demonstrates good time management skills. Comfortable adjusting to evolving workflows and team needs. Takes initiative in problem-solving and process improvement. Current nursing license(s) to be maintained and willing to pursue additional licensure as business needs arise.
Engage with members to understand their health needs and provide personalized support. Educate members on their health benefits and how to maximize them. Connect members with partner solutions and resources to address their health concerns. Schedule and coordinate doctor appointments and follow-up care. Support members by connecting them with clinical education and other resources. Serve as a liaison between members and healthcare providers to ensure seamless communication. Assist members in navigating the healthcare system and overcoming barriers to care. Maintain accurate and confidential member records and documentation. Continuous documentation and evaluation of operational processes for improvement.
Oscar Health is a leading healthcare technology company, whose mission is to make a healthier life accessible and affordable for all.
You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions. You will report into the Supervisor, Utilization Review. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. Pay Transparency: The base pay for this role is: $35.00 - $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 as defined by the Nurse Licensure Compact (NLC) Associate Degree - Nursing or Graduate of Accredited School of Nursing Or Successful completion of Diploma Program in Practical Nursing of Accredited School of Nursing Ability to obtain additional state licenses to meet business needs 1+ year of utilization review experience in a managed care setting Strong experience utilizating MCG (Milliman Care Gudielines) 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital) Bonus points: BSN Previous experience conducting concurrent or inpatient reviews for a managed care plan
Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines Meet required decision-making SLAs Refer members for further care engagement when needed Compliance with all applicable laws and regulations Other duties as assigned
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 up to $65/hr 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 in evaluating clinical reasoning 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
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: Full time 40 hours a week scheduled for 10 hour shifts, 4 days a week. The schedule is Monday, Thursday, and Friday from 10:30am-9pm EST. Required to work every other weekend on Saturday & Sunday from 10:30am-9pm 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 highly 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.
Use your skills to make an impact: 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.
Are you ready to link your passion with a purpose? At AirStrip, we build technology that enables clinicians to diagnose earlier than ever before, accelerate life-saving interventions, reduce the cost of care, and save lives. We provide mobile-first clinical surveillance and alarm communication management technology that unlocks siloed data from patient monitors and transforms it into contextually rich information easily accessible on mobile devices and the Web. We’re seeking innovative thinkers who love doing meaningful work. If you’re looking to bring your skills and expertise to a growing technology company, it’s time for you to join us!
AirStrip is adding a Clinical Product Specialist to our product development team. This role will Pprovide clinical and medical expertise across AirStrip product lines and programs to ensure alignment with real-world healthcare workflows. Translate clinical workflows and scenarios into detailed use cases, supporting software requirements, design, and validation activities. Act as a clinical product advocate, representing end-user needs and ensuring clinical relevance across product development efforts. Build and maintain strong cross-functional relationships with Product, Engineering, QA/Regulatory, and customer-facing teams to support design and delivery. Lead triage and management of field requests, incorporating clinical best practices to influence prioritization and product direction. Collaborate across departments to ensure solutions meet clinical expectations, improve workflows, and drive high customer satisfaction.
Education & Experience Requirements: Bachelor's degree from an accredited university in Science of Nursing Minimum 5 years' clinical experience in bedside nursing role (critical care, Emergency Department, Telemetry) Minimum 3 Years' experience in clinical software solutions Active Professional License as Registered Nurse (BSN) CSM Certifications Required Knowledge, Skills, and Abilities: Communication Skills: In addition to basic communication skills, the ability to communicate complex information clearly and accurately in a clinical setting. Strong listening skills are also essential Knowledge of EHR: Proficient in the protocols, requirements, and emerging trends around the management of electronic health records Healthcare Workflow Knowledge: Thorough understanding of the operations and workflows of clinical care provider organizations, including health systems leadership, delivery of care, outcomes, and strategic planning Problem-solving skills: Ability to face challenges around product feedback, issues, and improvements to benefit workflow enablement Travel Requirements Willingness to travel with overnights, as high as 10% travel requirement to client locations and corporate offices. The salary range for applicable US-based applicants to this position is below. The specific rate will depend on the successful candidate’s qualifications, prior experience as well as geographic location.
Serves as a clinical expert for AirStrip product and innovation initiatives Develops clinical best practices to support new product features and functionality Guides product design by contributing clinical insight into product workflows Translates clinical use cases and workflow processes into clear, actionable software requirements, ensuring medical relevance and impact Maintains current expertise in safe patient practices and evolving clinical trends to inform cross-functional decision-making Leads the planning and execution of clinical data collection to support engineering near and long-term product development Cultivate relationships with clinical leaders on behalf of product and engineering to evaluate prototypes, proofs of concept, and R&D programs Attendance at professional tradeshows and conferences to build on knowledge base, foster clinical relationships, and understand evolving trends in the industry Advise product team with rationale on new use cases for upcoming releases Partners with Marketing and Regulatory teams, in validation components of design controls Performs additional duties as assigned by product leadership
We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most. We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
At Clover Health, we are committed to providing high-quality, affordable, and easy-to-understand healthcare plans for America’s seniors. We prioritize preventive care while leveraging data and technology through the Clover Assistant, a powerful tool that helps physicians make informed health recommendations. By giving doctors a holistic view of each member’s complete health history, we ensure better care at a lower cost—delivering the highest value to those who need it most. The Utilization Management (UM) team plays a vital role in supporting Clover members throughout their care journey. The team is made up of experienced clinicians who combine clinical expertise with data-driven insights to support evidence-based decision-making. Working closely with providers and care partners, the UM team ensures that care transitions are smooth, efficient, and always focused on improving member outcomes while maintaining compliance with CMS guidelines.
You hold a current and valid Compact Registered Nurse (RN) license (required). You have experience in Utilization Management - Prior Authorization Reviews (required). You have at least 1 year of experience performing medical necessity reviews using CMS Medicare criteria (required). You have strong knowledge of CMS guidelines, NCD/LCD and evidence based criteria (MCG, Interqual) You are comfortable working in a remote, fast-paced, and data-driven environment with productivity standards You have excellent interpersonal skills and ability to communicate with patients and colleagues.
Perform medical necessity reviews for prior authorization and concurrent review across acute inpatient, post-acute (SNF, IRF, LTACH) and outpatient services Apply CMS Medicare guidelines, NCD/LCD policies, and MCG criteria to support determinations Manage cases end-to-end from prior authorization through concurrent review and discharge Collaborate with providers and facilities to obtain clinical information and support care coordination Ensure compliance with CMS turnaround times and regulatory requirements Participate in Quality Assurance (QA) activities, including case audits and peer reviews to ensure accuracy and consistency in decision-making Have strong personal accountability, responsibility and independent decision-making abilities.
Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.
Monitor admissions and perform initial and continued stay medical necessity reviews. Maintain thorough knowledge of payer guidelines and regulatory requirements and manages concurrent and pre-bill denials to prevent loss of reimbursement. Collaborate and communicate with the multidisciplinary care team regarding patient status and concurrent denials. Build relationships to promote interdisciplinary collaboration. Ensure requested clinical information is communicated, monitors daily discharge reports, and follows up with insurance carriers to obtain complete authorization. Other duties as assigned.
Education: Associate's of Nursing [Required] Bachelor's of Nursing [Preferred] Schedule: 0630-1700 four days per week, including every other weekend, and rotating holidays Work Experience: 3+ years clinical nursing [Required] 5+ years clinical nursing in an acute care setting [Preferred] Experience working in electronic health records [Preferred] Utilization Management or Case Management [Preferred] Additional Information: N/A Licenses and Certifications: Registered Nurse (RN) [Required] AND Accredited Case Manager (ACM) [Preferred] OR Certified Case Manager (CCM) [Preferred]
Must be able to demonstrate knowledge and skills necessary to provide appropriate status recommendations. Demonstrates knowledge of the principles of growth, development, and disease states as it relates to the different life cycles. Ability to understand differences between notification, reference, and authorization numbers. Maintains up-to-date concurrent authorizations for in-house patients, utilizing daily commercial authorization reports. Accesses and reviews payer portals for authorization numbers in collaboration with department assistants; ensures proper update of authorization fields within EMR accordingly, delegating appropriate tasks to support staff. Familiarizes self with authorization requirements for assigned payers, based on payer matrix. Assists in assuring proper patient status authorization, by reviewing patient admission status within the electronic health record and matching with the correct authorization. Expedites communication with insurance contacts to assure timely authorization is received to avoid unnecessary denials. Demonstrates working knowledge and understanding of state and federal guidelines pertinent to care management, as well as current procedural terminology (CPT) codes and inpatient-only procedures. Ability to provide appropriate status recommendations based on medical necessity indicators, findings, and documentation. Navigates and utilizes other related software and databases to perform required actions that encompass Utilization Management. Demonstrates strong analytical, problem-solving skills, and the ability to analyze complex data. Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization; serves as a resource to less experienced staff. Excellent interpersonal communication and negotiation skill. Strong analytical, data management, and computer skills. Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components. Thorough knowledge of medical admission screening requirements to assist in determining appropriateness of admission, treatment requested, for a variety of conditions, per evidence-based guidelines. Knowledge of hospital reimbursement models and trends and their impact. Previous experience with and working knowledge of medical necessity screening tool.
About Conviva Senior Primary Care: 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.
Required Qualifications: Active Registered Compact Nurse license (RN) in the home state with no disciplinary action and ability to obtain non compact licensure 3+ years of Medical Surgery, Heart, Lung or Critical Care Nursing clinical experience in Acute care (skilled or rehab clinical settings) Work rotation and possible holiday coverage required Preferred Qualifications: Utilization management experience BSN or Bachelor's degree in a related field Health Plan experience Previous Medicare or Medicaid Experience Bilingual English and Spanish 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.
As a Utilization Management Nurse, you will use clinical knowledge skills. These skills will be applied towards interpreting criteria, policies, and procedures. The goal is to provide the best and most appropriate 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 Management Manager. This is a remote position.
At Homeland, we stand at the forefront of boutique recruitment, specializing in IT, Engineering, and Executive roles across various industries. We excel in providing comprehensive staffing solutions tailored to meet the diverse needs of modern workplaces—covering contract, contract to hire, and permanent placements, as well as confidential and hyper-focused retained roles. Homeland maintains a 'small-town approach with big-time results,' ensuring the ideal match between candidates and companies.
Homeland has partnered with a leading national chronic care management organization to hire an Inbound Care Coordinator (LPN) to join a growing remote care team. This role supports patients across the U.S. by handling incoming clinical calls and coordinating care between patients, providers, and internal teams. This is a high-volume, fast-paced role best suited for nurses who enjoy problem-solving, multitasking, and working efficiently in a structured environment. As an Inbound Care Coordinator (LPN), you can expect an environment similar to urgent care or ER-level pace, but in a remote, call center setting. Additional Information Schedule: 24/7 operation (day, mid/bridge, and night shifts available; flexibility required) Monday-Tuesday, Thursday-Friday: 12 pm - 10:30 pm EST Monday-Thursday: 12 pm - 10:30 pm EST Tuesday-Friday: 12 pm - 10:30 pm EST Wednesday-Saturday: 9am - 7:30 pm EST Sunday-Wednesday: 9am - 7:30 pm EST Training: 3 weeks (mandatory, no absences) Monday–Friday, 10:00 AM – 6:30 PM EST. Includes live “nesting” experience in final week. Compensation: Competitive hourly pay ($18.25/hour based on experience), shift differentials for evenings/nights, monthly performance-based bonus (individual + team metrics) Work Environment: Fully remote (equipment provided), structured, performance-driven setting Hours: Full-time (40 hours per week)
Active compact LPN/LVN license required Strong multitasking and time management skills in a fast-paced environment Comfortable handling back-to-back calls and switching between tasks quickly High level of computer proficiency and ability to navigate multiple systems simultaneously Ability to follow structured clinical protocols and workflows Strong communication skills and ability to work collaboratively across teams Prior inbound call center experience, preferred Experience in high-volume clinical settings (ER, urgent care, etc.), preferred
Manage a high volume of inbound patient calls (30–35 per day) Assess patient needs quickly and determine appropriate next steps Prioritize incoming calls while managing real-time documentation and follow-up tasks simultaneously Coordinate with pharmacies, providers, and internal teams for refills, referrals, and care needs Support triage by escalating urgent or emergent situations appropriately Complete patient documentation, charting, and communication tasks accurately and efficiently Maintain performance standards related to call handling, productivity, and quality
Lutheran Social Services of Illinois (LSSI), is a leading not-for-profit organization providing healing, justice and wholeness to people and communities. For over 150 years, LSSI has made a difference in the lives of children and families, and we're still a strong, viable presence in the State of Illinois, continuing that commitment to making a difference.
LSSI is hiring a part-time Nurse RN that will service both 28-day residential programs: Kenmore and Elgin Next Steps. This position is fully remote. A minimum of 10 hours/week and maximum of 25 hours/week. The Nurse RN will be responsible for conducting an initial medical screening with clients as well as conducting screenings with outpatient clients at identified facilities. Benefits and Perks: LSSI is growing! Come be a part of this rewarding environment, and enjoy the knowledge that you’re helping make a positive difference in the lives of others, as well as these career advantages: On Demand Flexible Paydays for earned wages through an app called Dayforce Wallet. Competitive salary based upon relevant education, experience, and licensure. Salary $35-$45/Hourly. Opportunity for advancement. Comprehensive benefits package for Full-time employees includes healthcare insurance, up to 26 days of paid time off per calendar year, 11 paid holidays, sick time, 403(b) plan, Employee Assistance Program, and flexible hours. The paid training you need to learn, grow, and succeed!
High school diploma or equivalent required. RN required. One (1) to three (3) years of experience in mental health and/or substance used field preferred. Familiarity with accreditation and licensure standards required. Trained and proficient in utilizing an Electronic Health Record required. Demonstrated ability to communicate in a clear, comprehensible manner, verbally and written. Excellent organization, presentation, and pc/computer skills, including experience using Microsoft Office (Outlook, Teams, Word, Excel, PowerPoint) along with other related software. Annual TB test required. Background check clearance required. Valid driver’s license, in good standing for the state of residency preferred. Access to reliable transportation preferred. Valid IL statutory minimum liability insurance coverage, bodily injury, and property damage preferred.
Review each client’s risk for HIV and TB infection as well as medications (prescribed and over-the-counter) used by the client. Complete Medical Screening tool in the EHR platform. Indicate immediate recommendations regarding physical examination, psychiatric examinations prenatal care and/or other client care needs. Provide clint with referrals for medical, surgical, obstetric, prenatal, psychiatric, or laboratory services as needed. Ensure adherence to ethical standards of treatment, including NASW Code of Ethics. Maintain familiarity with emergency procedures. Ensure all documentation is completed in a timely manner and meets all requirements. Comply with documentation and productivity standards. Demonstrate professional, positive behavior and carry out responsibilities with integrity, treating clients, families, other LSSI workforce members, and collaborative organizations and/or individual in a dignified, respectful, honest, and fair manner.
Ennoble Care is a mobile primary care, palliative care, and hospice service provider with patients in New York, New Jersey, Maryland, DC, Virginia, Oklahoma, Kansas, Pennsylvania, and Georgia. Ennoble Care’s clinicians go to the home of the patient, providing continuum of care for those with chronic conditions and limited mobility. Ennoble Care offers a variety of programs including, remote patient monitoring, behavioral health management, and chronic care management, to ensure that our patients receive the highest quality of care by a team they know and trust. We seek individuals who are driven to make a difference and embody our motto, “To Care is an Honor.” Join Ennoble Care today!
Ennoble Care is looking for a full-time LPN to work remotely on a weekend schedule in an administrative position. This position is responsible for ensuring Ennoble Care is providing high quality care services. They work with clinicians, staff and patients to reach healthcare goals and keep the lines of communication open. As a care coordinator you should be compassionate, experienced, and highly organized. In this role, you will play an important part in our ability to provide exceptional care by managing the individual care providers, including scheduling and providing support for the caregivers and families.
Equipment Operation: Utilization of a computer, telephone, copy machine, and other office equipment as necessary Qualifications: Must be a Licensed Practical Nurse (LPN) Must be comfortable with speaking on the phone for large amounts of the day Must be compassionate and empathetic towards our patients, always demonstrating exceptional customer service Ability to take accurate notes to document each task in a timely manner Ability to multitask between different patients and workstreams while remaining organized and efficient with time Ability to thrive in a fast-paced environment Must be able to work from Saturday and Sunday 8:00am to 4:30pm (EST), as well as Monday, Tuesday, and Wednesday 9:30am to 6:00pm (EST) Must be proficient in using a computer, including Outlook and other Microsoft Office programs Knowledge of basic healthcare terms, conditions, roles, and basic care principles is helpful Candidate must be able to pass a drug screen, background check, have a positive attitude, adapt positively to change, be a team player, and be willing to learn new skills on a continuous basis
Complete individualized patient care plans and perform care management and care coordination services using Ennoble Care’s electronic medical record system Frequent contact with patients to provide care coordination, support, and manage compliance with the care management programs to increase positive outcomes Document all client communications (verbal or written) accurately Communication to and from Primary Care Clinician or designee regarding patient emergent needs and/or life-threatening episodes and to ensure comprehensive care plans are complete and accurate Keep Team Supervisor informed of all issues pertinent to the care plan process and any known or perceived issues Demonstrate ability to work with various cross-organizational areas to meet the needs of Ennoble Care’s patients, their family members, and partner facilities Become skilled at using technology including secure email, telephone system, electronic medical records, etc. Adherence to documentation protocols and best practices for daily work logs, escalation of client issues, and internal communications Excellent customer service skills demonstrated by positive feedback from customers and patients Contribute as a positive member of the department by supporting all members of the team in a productive and constructive manner
As an integrated health system, we provide care throughout Iowa, western Illinois and southern Wisconsin in not-for-profit hospitals, clinics and home health settings. Each year, we serve nearly 8 million patient visits of all different types, including around 100,000 surgeries and deliver more than 20,000 babies. Whatever stage of life you’re in, our goal is to make your care easier and more personal. At UnityPoint Health, we put people first. And we start from the inside out. We care deeply about making UnityPoint Health a great place to work because our team members are the compassionate core of who we are and how we serve. We’re proud to be recognized as one of the Top Places to Work in Healthcare by Becker’s Healthcare for five years in a row. We've worked diligently to invest in our team members across key areas, including: o Team Member Empowerment o Leadership Effectiveness o Community Impact and Engagement o Career Development
RN Call Center 10:30PM-7:00AM, every other weekend, holiday rotation Full Time Benefits **REMOTE - Candidate must reside in a compact license state** My UnityPoint Nurse Call Center offers a free health information service for the public, sponsored by UnityPoint Health and staffed by registered nurses 24-hours a day, 7 days a week. The nurses at My UnityPoint Nurse provide medical assessment and triage, up-to-date health information and physician and clinic referral service. My UnityPoint Nurse Call Center is a centralized function of UnityPoint Health providing clinical support to UnityPoint Health and affiliates.
Qualifications/Experience: Requires active and unrestricted license to practice nursing in the states of Iowa and Illinois. Requires a minimum of 1-2 years of clinical nursing experience providing direct patient care or equivalent work experience - 2-3 years preferred Strong time management and organizational skills Possesses excellent written and verbal communications. Proficiency in use of computer applications such as Microsoft Office and electronic health systems. Requires knowledge of federal healthcare laws and regulations. Requires highly developed communication skills to effectively work with all levels of management throughout the UnityPoint Health, its subsidiaries and affiliates. Excellent academic credentials with a track record of professional accomplishments, which demonstrate superior performance, leadership and vision. Ability to work as a team member, creating and maintaining effective working relationships. Ability to understand and apply guidelines, policies and procedures. Education: Graduate from an accredited nursing program. Bachelors of Science (BSN) preferred Compliance with Mandatory Child/Adult Abuse Reporting
The UnityPoint IntelliCenter nurse is an RN who provides care over the telephone by thoroughly assessing symptoms to identify acuity to disposition caller or patient appropriately utilizing best-practice updated protocols. Protocols are embedded within the eMR to support guidance in appropriate care delivery. Nursing services are provided telephonically and, in some cases, virtually. May include triage, care management, referral management and telehealth support. Must have proficient keyboarding/typing skills and have a technical aptitude to learn new computer software systems quickly. Ability to handle a “call center” environment: work quickly and multi-task, utilizing clinical critical skill thinking while navigating computer software to meet the required turnaround time to support key performance indicators which support patient care delivery and operational costs. We are a 24/7 operation with the bulk of our services provided in the evenings and weekends. Operations: Performs symptom assessment triage utilizing protocols to guide best practice care delivery and disposition. Documents call criteria in eMR within a timely manner. Promotes and educates appropriate callers regarding second level triage and virtual care visits with NP and MDs when appropriate. Serves as a resource to customers seeking physician referral and community-based resource information. Provides health information to customers via UnityPoint Health’s approved resources Maintains strict confidentiality of all employee and customer information Adhere to all UnityPoint Clinic personnel Policies and Procedures and safety guidelines. Supports change transformation initiatives Identifies with shift change requirements as call volume dictates in order to support staffing needs appropriately Perform other duties as assigned. Support team efforts in patient care delivery objectives. Provides assistance with other reasonable related duties as assigned by supervisor or manager. Ability to handle confidential and sensitive information. Ability to communicate effectively on the telephone. Ability to relate to persons with diverse educational, socioeconomic and ethnic backgrounds. Ability to handle a “call Center” environment: work quickly and multi-task. Ability to demonstrate good customer service. Exhibits discretion and sound judgment in all aspects of the job.
Mercalis is an integrated life sciences commercialization partner that provides comprehensive solutions that span the entire healthcare value chain. The company partners closely with its clients to deliver an end-to-end spectrum of commercial capabilities that work together seamlessly and flexibly. Backed by proven industry expertise and results-driven technology, Mercalis provides the data and strategic insights, patient support services, and healthcare provider engagement tools to help life sciences companies successfully commercialize new products. Above all, Mercalis helps navigate the complex life sciences marketplace to accelerate value and enhance patient lives. Founded in 2000, Mercalis 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. For more information about Mercalis, please visit www.mercalis.com.
SHIFT AVAILABLE IS 8A-4:30P EST M-F + ROTATING WEEKENDS/ON-CALL AS ASSIGNED** 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. To learn more about Valeris, please visit www.valeris.com . 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 Two or more years of Psychiatry Therapeutic Area Experience 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!!
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.
For more than six decades, BlueCross BlueShield of South Carolina has been part of the national landscape. Our roots are firmly embedded in the state. We are the largest insurance company in South Carolina. We are also the only one that has an A+ Superior A.M. Best rating. We are one of the nation's leading government contract administrators. We operate one of the most sophisticated data processing centers in the Southeast and have a diverse family of subsidiary companies. Our full-time employees enjoy benefits like a 401(k) retirement savings plan with company match, subsidized health plans, free vision coverage, life insurance, paid annual leave and holidays, wellness programs and education assistance. If you are a full-time employee in the National Guard or reserves, we will cover the difference in your pay if you are called to active duty. BlueCross has a dedicated corporate culture of community support. Our employees are some of the most giving in the country. They support dozens of nonprofit organizations every year. If you're ready to join a diverse company with secure, community roots and an innovative future, apply for a position now! BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.
We are currently hiring for a Case Management Coordinator to join BlueCross BlueShield of South Carolina. In this role as a Case Management Coordinator, care management interventions focus on improving care coordination and reducing the fragmentation of the services the recipients of care often experience, especially when multiple health care providers and different care settings are involved. Taken collectively, care management interventions are intended to enhance client safety, well-being, and quality of life. These interventions carefully consider health care costs through the professional care manager's recommendations of cost-effective and efficient alternatives for care. Thus, effective care management directly and positively impacts the health care delivery system, especially in realizing the goals of the "Triple Aim," which include improving the health outcomes of individuals and populations, enhancing the experience of health care, and reducing the cost of care. The professional care manager performs the primary functions of assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy. Integral to these functions is collaboration and ongoing communication with the client, client's family or family caregiver, and other health care professionals involved in the client's care. Location: This position is full-time (40 hours/week) Monday-Friday from 8:30am-5:00pm and will be fully remote within SC.
Required Education: Associates in a job-related field. Degree Equivalency: Graduate of Accredited School of Nursing OR 2 years job related work experience. Required Experience: 4 years recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedics, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical. Required Skills and Abilities: Working knowledge of word processing software. Knowledge of quality improvement processes and demonstrated ability with these activities. Knowledge of contract language and application. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service, organizational, and presentation skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Required Software and Tools: Microsoft Office. Required License/Certificate: An active, unrestricted RN license from the United States and in the state of hire OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) OR, active, unrestricted licensure as counselor, or psychologist from the United States and in the state of hire (in Div. 75 only). For Div. 75 and Div. 6B, except for CC 426: URAC recognized Case Management Certification must be obtained within 4 years of hire as a Case Manager. We Prefer That You Have the Following: Preferred Work Experience: Previous experience in Pediatrics Prior knowledge of Medicaid 7 years-healthcare program management. Preferred Education: Bachelor's degree- Nursing Preferred Skills and Abilities: Bilingual in Spanish Working knowledge of spreadsheet, database software. Thorough knowledge/understanding of claims/coding analysis, requirements, and processes. Preferred Licenses and Certificates: Case Manager certification, clinical certification in specialty area.
Provides active care management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Provides telephonic support for members with chronic conditions, high-risk pregnancy or other at-risk conditions that consist of: intensive assessment/evaluation of condition, at-risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement. Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. May identify, initiate, and participate in on-site reviews. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and/or health and disease management programs. Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members. Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal). Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services.
For more than six decades, BlueCross BlueShield of South Carolina has been part of the national landscape. Our roots are firmly embedded in the state. We are the largest insurance company in South Carolina. We are also the only one that has an A+ Superior A.M. Best rating. We are one of the nation's leading government contract administrators. We operate one of the most sophisticated data processing centers in the Southeast and have a diverse family of subsidiary companies. Our full-time employees enjoy benefits like a 401(k) retirement savings plan with company match, subsidized health plans, free vision coverage, life insurance, paid annual leave and holidays, wellness programs and education assistance. If you are a full-time employee in the National Guard or reserves, we will cover the difference in your pay if you are called to active duty. BlueCross has a dedicated corporate culture of community support. Our employees are some of the most giving in the country. They support dozens of nonprofit organizations every year. If you're ready to join a diverse company with secure, community roots and an innovative future, apply for a position now! BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association.
We are currently hiring for a Case Management Coordinator to join BlueCross BlueShield of South Carolina. In this role as a Case Management Coordinator, care management interventions focus on improving care coordination and reducing the fragmentation of the services the recipients of care often experience, especially when multiple health care providers and different care settings are involved. Taken collectively, care management interventions are intended to enhance client safety, well-being, and quality of life. These interventions carefully consider health care costs through the professional care manager's recommendations of cost-effective and efficient alternatives for care. Thus, effective care management directly and positively impacts the health care delivery system, especially in realizing the goals of the "Triple Aim," which include improving the health outcomes of individuals and populations, enhancing the experience of health care, and reducing the cost of care. The professional care manager performs the primary functions of assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy. Integral to these functions is collaboration and ongoing communication with the client, client's family or family caregiver, and other health care professionals involved in the client's care. Location: This position is full-time (40 hours/week) Monday-Friday from 8:00am-5:00pm EST and will be remote in South Carolina.
Required Education: Associates in a job-related field. Degree Equivalency: 2 years job related work experience. Required Experience: 4 years recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedics, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical. Required Skills and Abilities: Working knowledge of word processing software. Knowledge of quality improvement processes and demonstrated ability with these activities. Knowledge of contract language and application. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service, organizational, and presentation skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Required Software and Tools: Microsoft Office. Required License/Certificate: An active, unrestricted RN license from the United States and in the state of hire OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) OR, active, unrestricted licensure as counselor, or psychologist from the United States and in the state of hire (in Div. 75 only). For Div. 75 and Div. 6B, except for CC 426: URAC recognized Case Management Certification must be obtained within 4 years of hire as a Case Manager. We Prefer That You Have the Following: Preferred Work Experience: At least 4 years of Case Management, Home Health, and/or Acute Care experience. 7 years-healthcare program management. Preferred Education: Bachelor's degree- Nursing Preferred Skills and Abilities: Working knowledge of spreadsheet, database software. Thorough knowledge/understanding of claims/coding analysis, requirements, and processes. Preferred Licenses and Certificates: Case Manager certification, clinical certification in specialty area.
Provides active care management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Provides telephonic support for members with chronic conditions, high-risk pregnancy or other at-risk conditions that consist of: intensive assessment/evaluation of condition, at-risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement. Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. May identify, initiate, and participate in on-site reviews. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and/or health and disease management programs. Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members. Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal). Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services.
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.
Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.
CareBridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through home-care and community based services. Location: Virtual: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Alternate locations may be considered if candidates reside within a commuting distance from an office. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Work Hours: Monday – Sunday with mandatory 2 weekends a month (4, 10 hour shifts) Eastern Time: 8:00AM – 7:00PM All other time zones: 7:00AM – 6:00PM, 8:00AM -7:00PM or 9:00AM -8:00PM The Transitions of Care RN- Carebridge - Bilingual Preferred is responsible for participating in delivery of patient education and disease management interventions and for performing health coaching for members, across multiple lines, for health improvement/management programs for chronic diseases.
Minimum Qualifications: Requires AS in nursing and minimum of 2 years of condition specific clinical or home health/discharge planning experience; or any combination of education and experience, which would provide an equivalent background. Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities and Experiences: RN compact license is highly preferred BS in nursing preferred Prior case management experience preferred Bilingual in Spanish is highly preferred Experience working with members that have chronic diseases is highly preferred Experience working in home health is preferred
Conducts behavioral or clinical assessments to identify individual member knowledge, skills and behavioral needs. Identifies and/or coordinates specific health coaching plan needs to address objectives and goals identified during assessments. Interfaces with provider and other health professionals to coordinate health coaching plan for the member. Implements and/or coordinates coaching and/or care plans by educating members regarding clinical needs and facilitating referrals to health professionals for behavioral health needs. Uses motivational interviewing to facilitate health behavior change. Monitors and evaluates effectiveness of interventions and/or health coaching plans and modifies as needed. Directs members to facilities, community agencies and appropriate provider/network. Refers member to catastrophic case management.
CareBridge Health is a proud member of the Elevance Health family of companies, within our Carelon business. CareBridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through home-care and community based services.
Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. Work Shift: Full time (40 hours a week) position that will require holidays and weekend rotation. The LPN/LVN is responsible for the examination and treatment of patients under the direction of the physician.
Minimum Requirements: Requires an LPN or LVN and minimum of 2 years of experience as an LPN/LVN; or any combination of education and experience, which would provide an equivalent background. Current LPN/LVN license in the applicable state required. For Carelon Health business unit, satisfactory completion of a Tuberculosis test is a requirement for this position. Preferred Experience, Skills, And Capabilities: Bi-lingual (English/Spanish) preferred. Experience with Telephonic Triage preferred. Acute care experience (e.g., urgent care or ER) preferred.
Reviews patient medical records, interviews patients and records vital signs. Provides nursing interventions and coaching in accordance with the scope of practice and standing orders. Facilitates patient transfers to alternate level of care. Facilitates patient transfers to an alternate level of care as needed. Documents using standard templates. Ability to be on the phone engaging with patients up to 80% of the shift. Ability to work assigned weekends per standard team rotation. Reliable internet and a high level of customer service.
Headquartered in Utah with locations in six primary states and additional operations across the western U.S., Intermountain Health is a nonprofit system of 34 hospitals, 400+ clinics, a medical group of more than 4,800 employed physicians and advanced care providers, a health plan division called Select Health with more than one million members, and other health services. With more than 68,000 caregivers on a mission to help people live the healthiest lives possible, Intermountain is committed to improving community health, and is widely recognized as a leader in transforming healthcare. We strive to be a model health system by taking full clinical and financial accountability for the health of more people, partnering to proactively keep people well, and coordinating and providing the best possible care. At Intermountain, every caregiver helps us fulfill our mission of helping people live the healthiest lives possible. Interested in joining our team? Check out our career website and apply today at https://intermountainhealthcare.org/careers/.
The RN in the Clinical Communication Call Center ensures a superior customer service experience for all who interact with the Clinical Communication Call Center. The RN provides consultation, education, and strategic guidance related to patient questions and health needs via a phone, email, text or other communication method. The Registered Nurse has responsibility to provide accurate, safe and relevant information and support to the patients who are contacting Intermountain for advice or have been recently discharged. Key responsibilities for incoming calls include receiving, triaging and responding to telephone calls/contact from patients and family members. Outbound calls for patients discharged from a hospital, emergency department or outpatient surgical center. Both services will require the ability to assess patients by phone, provide recommendations, offer referral, education and when necessary, direct them to the appropriate level of care. ** Please note that a video interview through Microsoft Teams will be required as well as potential onsite interviews and meetings. ** We are committed to offering flexible work options where approved and stated in the job posting. However, we are currently not considering candidates who reside or plan to reside in the following states: California, Connecticut, Hawaii, Illinois, New York, Pennsylvania, Rhode Island, Vermont, Washington Posting Specifics Benefits Eligible: No Shift Details: PRN - Work week is Monday - Friday 8:00 am - 5:00 pm MST. PRN caregivers are expected to support staff on an as needed basis and help cover - sick calls, vacations, period of increased operational need. PRN Caregivers are expected to attempt to work a minimum of 8 hours per week. Orientation for all PRN staff will be full time, 5 8 hours shifts per week. This orientation period will be a minimum of 2 months or until the caregiver is competent in independent triage. Unit/Location: Fully remote. Ideal Candidate would have an Intermountain Health caresite near to them. Preferred Qualifications: Experienced RN · Five years of clinical RN experience, with a strong background in emergency nursing, telephone triage, primary care, or medical-surgical nursing, demonstrating well developed assessment and decision making skills. Spanish speaking RN is highly preferred. Additional Details: This position will be providing triage phone support for Primary Care Clinics throughout the canyons region. Caregivers can expect to be on the phone the majority of their shifts, but will have scheduled breaks. Scope Outbound and Inbound call center activities, including telephone, email, text and other communication methodologies. Call center will function 24 hours a day, 7 days a week. Triage, assess, educate, and refer within the nurse call function and according to policy and procedures.
Minimum Qualifications: Current RN Licensure in the state of practice. Basic Life Support certification (BLS) for healthcare providers. Five years of clinical experience. Exceptional verbal and written communication skills. Strong ability for conceptual thinking, problem resolution and planning. Intermediate knowledge and skill of word processing software. RNs hired or promoted into this role need to have or obtain their BSN within three years of hire or promotion. Preferred Qualifications: Bachelor's degree in Nursing (BSN). Education must be obtained from an accredited institution. Degree will be verified. Seven years of Clinical Experience in direct patient care. Experience with Patient Education. Experience in triage clinical area. Spanish or second language. Ongoing need for employee to see and read information, labels, monitors, identify equipment and supplies, and be able to assess patient needs. - and - Frequent interactions with patient care providers, patients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, alarms, needs, and issues quickly and accurately, particularly during emergency situations. - and - Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use and typing for documenting patient care, accessing needed information, etc.
Ability to adapt to unpredictable situations in the work setting. Strong clinical background and understanding with ability to triage, assess needs, and refer clients as appropriate, maintaining clinical skills and competency of nursing practice. Understanding of regulatory, compliance, patient safety, and policy/procedures of Intermountain Excellent communication skills and ability to communicate in a clear and timely manner with variety of people and levels of education. Provides accurate and relevant information using a variety of protocol and charting tools. Maintains sensitive, confidential information. Ability to work independently or in a team environment Provide general health information, education and direction on appropriate level of care. Documents all calls and charts as appropriate, while utilizing relevant data, listening skills and problem resolution skills.
Join the dynamic journey at Vynca, where we're passionate about transforming care for individuals with complex needs. We’re more than just a team; we're a close-knit community. Our shared commitment to caring for each other and those we serve is what sets us apart. Guided by our unwavering core values: Excellence, Compassion, Curiosity, and Integrity, we forge paths of success together. Join us in this transformative movement where you can contribute to making a profound difference every day. At Vynca, our mission is to provide comprehensive care for more quality days at home.
We're seeking an exceptional LVN Case Manager (internal title: Clinical Lead Care Manager (CLCM)) to join our team. Under the direction of the ECM Clinical Manager, the CLCM serves as the client’s primary point of contact and works with all their providers such as doctors, specialists, pharmacists, social services providers, and others to make sure everyone is in agreement about the client’s needs and care. The CLCM manages client cases, coordinates health care benefits, provides education and facilitates member access to care in a timely and cost-effective manner. The CLCM collaborates and communicates with the client’s caregivers/family support persons, other providers, and others in the Care Team to promote wellness, recovery, independence, resilience, and member empowerment, while ensuring access to appropriate services and maximizing member benefit. This is a critical role that we're looking to fill as soon as possible.
Active, unrestricted Licensed Vocational Nurse (LVN) license in California required Willing and able to work Monday-Friday 8:30am-5:00pm Pacific Time, with the possibility of evenings and weekends 2+ years of experience as a care manager, care navigator, or community health worker supporting vulnerable populations Working knowledge of government and community resources related to social determinants of health Excellent oral and written communication skills Positive interpersonal skills required Must have general computer skills and a working knowledge of Google Workspace, MS Office, and the internet Bilingual (English/Spanish), highly preferred At this time we are only considering applicants in the following states: Arizona, California, Colorado, Florida, Georgia, Illinois, Nevada, North Carolina, Oregon, Texas, and Washington.
Assess member needs in the areas of physical health, mental health, SUD, oral health, palliative care, memory care, trauma-informed care, social supports, housing, and referral and linkage to community-based services and supports Oversees the development of the client care plans and goal settings Offer services where the member resides, seeks care, or finds most easily accessible, including office-based, telehealth, or field-based services Connect clients to other social services and supports that are needed Advocate on behalf of the client with health care professionals (e.g. PCP, etc.) Utilize evidence-based practices, such as Motivational Interviewing, Harm Reduction, and Trauma-Informed Care principles Conduct outreach and engagement activities in order to facilitate linkage to the ECM program and log activity in the Client Relationship Management (CRM) system Evaluate client’s progress and update SMART goals Provide mental health promotion Arrange transportation (e.g., ACCESS) Complete all documentation, including outcome measures within the timeframes established by the individual care plans Maintain up-to-date patient health records in the Electronic Medical Record (EMR) system and other business systems Complete monthly reporting to ensure program compliance Attend training as assigned
An independent licensee of the Blue Cross Blue Shield Association, Highmark Inc., together with its Blue-branded affiliates, collectively comprise the fifth largest overall Blue Cross Blue Shield-affiliated organization in the country with approximately 7.1 million members in Pennsylvania, Delaware, West Virginia and western and northeastern New York. The following entities, which serve the noted regions, are independent licensees of the Blue Cross Blue Shield Association: Western and Northeastern PA: Highmark Inc. d/b/a Highmark Blue Cross Blue Shield; CPA/SEPA: Highmark Inc. d/b/a Highmark Blue Shield; Delaware: Highmark BCBSD Inc. d/b/a Highmark Blue Cross Blue Shield; West Virginia: Highmark West Virginia Inc. d/b/a Highmark Blue Cross Blue Shield; Western NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Cross Blue Shield; Northeastern NY: Highmark Western and Northeastern New York Inc. d/b/a Highmark Blue Shield. All references to “Highmark” are to Highmark Inc. and/or to one or more of its affiliated Blue companies. We're proudly part of Highmark Health.
This job has primary ownership and oversight over a specified panel of members that range in health status/severity and clinical needs. The incumbent assesses health management needs of the assigned member panel and utilizing data/analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member. The incumbent will be supported by a multi-disciplinary team and will use clinical judgment to refer members to appropriate multi-disciplinary resources. In addition to identifying the appropriate clinical interventions and referrals, the incumbent will manage an active case load of members in his/her panel that are enrolled in case management. The incumbent conducts outreach to members enrolled in case management including but is not limited to: developing a care plan, encouraging behavior changes, identifying and addressing barriers, helping members to coordinate care, and identifying various resources to assist members in achieving their personal health goals. The incumbent monitors, improves and maintains quality outcomes (clinical, financial and functional) for the specified panel of members.
Required: High School Diploma/GED Substitutions: None Preferred: Bachelor's Degree in Nursing EXPERIENCE: Required 7 years of any combination of clinical, case management and/or disease/condition management experience, provider operations and / or health insurance experience Preferred: Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing or dialectical behavior therapy (DBT) Experience working with the healthcare needs of diverse populations Understanding of the importance of cultural competency in addressing targeted populations LICENSES AND CERTIFICATIONS Required: Current State of PA RN licensure OR Current multi-state licensure through the enhanced Nurse Licensure Compact (eNLC) or WV or DE or NY is required. Other RN license(s), if applicable, must be obtained within the first 6 months of employment. Preferred: Certification in Case Management SKILLS: Written and verbal presentation skills, negotiation skills, and skills in positively influencing others with respect and compassion Broad knowledge of disease processes Understanding of healthcare costs and the broader healthcare service delivery system Proficiency in MS Excel and strong analytic skills with ability to interpret, evaluate and act on clinical and financial data, including analysis of statistical data Excellent interpersonal/ consensus building skills as well as the ability to work with a variety of internal and external colleagues from all levels of an organization Ability to work in a high performing team environment that requires flexibility Demonstrated ability to handle multiple priorities in a fast paced environment. Excellent organizational, time management and project management skills Self-directed; self-starter, ability to work successfully with indirect supervision and moderate autonomy LANGUAGE REQUIREMENT (Other than English) None TRAVEL REQUIREMENT 0% - 25% PHYSICAL, MENTAL DEMANDS AND WORKING CONDITIONS Position Type Office-Based Teaches/Trains others regularly Rarely Travels regularly from the office to various work sites or from site-to-site Rarely Works primarily out-of-the office selling products/services (Sales employees) Does Not Apply Physical Work Site Required No Lifting: up to 10 pounds Rarely Lifting: 10 to 25 pounds Rarely Lifting: 25 to 50 pounds Rarely
Maintain oversight over specified panel of members by performing ongoing assessment of members’ health management needs, identifying the right clinical interventions to address member needs and/or triaging members to appropriate resources for additional support. For assigned case load, create care plans to address members’ identified needs, remove barriers to care, identify resources, and conduct a number of other activities to help improve the health outcomes of members; care plans include both long and short term goals and plan of regular contacts for re-assessment. Ensure targeted percentage of patient goal achievement (i.e., realization of member care plan), and other patient outcomes, as applicable, are achieved. Ensure all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards. Maintain current knowledge and adheres to applicable CMS, state, local, and regulatory agency requirements and applicable standards of practice for case management including those published by CMSA and/or ACMA, as required by the organization. Other duties as assigned or requested.
InnovAge helps seniors age in their own homes with dignity through the Program of All-inclusive Care for the Elderly (PACE). InnovAge is dedicated to expanding this successful program to serve as many seniors as possible across the country. We hire exceptional people for our programs in California, Colorado, New Mexico, Pennsylvania, Virginia, and Florida. Our mission is to sustain and enhance the independence and quality of life for those we serve, on their terms. Our purpose is to help older adults remain mobile, prolong their health, and continue living in their own homes.
*Work-from-Home, responding to phone calls triaging care which may include visiting participant's residence when medically necessary* 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 clinician 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.
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
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 l 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. LEARN MORE - Nursing at InnovAge
Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
Provides support for care transition activities. Facilitates transitional care processes and coordination for member discharge from hospital admission to all other settings. Strives to ensure that best possible services are available to members at time of hospital discharge, and focuses on goal to reduce member readmissions. Contributes to overarching strategy to provide quality and cost-effective member care.
At least 2 years experience in health care, with at least 1 year of experience in hospital discharge planning, care management or behavioral health setting, or equivalent combination of relevant education and experience. Registered Nurse (RN). License must be active and unrestricted in state of practice. Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. Knowledge of or experience using the Care Transitions Intervention (CTI) or similar model. Background in discharge planning and/or home health. Demonstrated knowledge of community resources. Proactive and detail-oriented. Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. Ability to work independently, with minimal supervision and demonstrate self-motivation. Responsive in all forms of communication, and ability to remain calm in high-pressure situations. Ability to develop and maintain professional relationships. Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. Excellent problem-solving, and critical-thinking skills. Excellent verbal and written communication skills. Microsoft Office suite/other applicable software program(s) proficiency. Preferred Qualifications: Behaviroal Health Experience Transitions of care sub-specialty certification and/or Certified Case Manager (CCM). Hospital discharge planning or home health experience.
Follows member throughout a 30 day program that starts at hospital admission and continues oversight through transitions from acute setting to all other settings, including nursing facility placement/private home, with the goal of reduced readmissions. Ensures safe and appropriate transitions by collaborating with the hospital discharge planner, as well as collaborating with hospitalists, outpatient providers, facility staff, and family/support network. Ensures member transitions to setting with adequate caregiving and functional support, as well as medical and medication oversight support. Works with participating ancillary providers, public agencies or other service providers to make sure necessary services and equipment are in place for safe transition. Conducts face-to-face visits of all members while in the hospital and, home visits high-risk members post-discharge as needed. Coordinates care and reassesses member needs using the Coleman Care Transition model post-discharge. Educates and supports member focusing on seven primary areas (Transition of Care Pillars): medication management, use of personal health record, follow-up care, signs and symptoms of worsening condition, nutrition, functional needs and or home and community-based services, and advance directives. Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. Assesses for barriers to care, provides care coordination and assistance to member to address concerns. Facilitates interdisciplinary care team meetings (ICT) and collaboration. Provides consultation, recommendations and education as appropriate to non-behavioral health care managers. 40-50% local travel may be required (based upon state/contractual requirements).
UPMC is a world-renowned, nonprofit health care provider and insurer committed to delivering exceptional, people-centered care and community services. Headquartered in Pittsburgh and affiliated with the University of Pittsburgh Schools of the Health Sciences, UPMC is shaping the future of health through clinical and technological innovation, research, and education. Dedicated to advancing the well-being of our diverse communities, we provide nearly $2 billion annually in community benefits, more than any other health system in Pennsylvania. Our 100,000 employees — including more than 5,000 physicians — care for patients across more than 40 hospitals and 800 outpatient sites in Pennsylvania, New York, and Maryland, as well as overseas. UPMC Insurance Services covers more than 4 million members, providing the highest-quality care at the most affordable price. To learn more, visit UPMC.com.
UPMC Health Plan has an exciting opportunity for a Telephonic Care Manager position in the Community Healthchoices department. This is a full time position working Monday through Friday 8:00 a.m. to 5:00 p.m. with flexibility. This is a remote position, but due to offices located in Pennsylvania for onsite needs of technology or operational reasons candidates are expected to reside in Pennsylvania. The Telephonic Care Manager is responsible for care coordination and health education for identified Health Plan members through telephonic collaboration with members and their caregivers and providers.
Prefer experienced: positive, teachable Telephonic Care Manager to maintain NFI caseload while primary focus is Complex Care Unit and challenging, successful discharges. Managing complex cases, such as Forensic, EPSDT, LIFE, and MCO transfer cases in addition to Participants with complex circumstances such as traumatic brain injury, ventilator dependence, or other diagnoses. Responsible for timely management of NFI caseload activities such as tasking, referrals, and collaboration with other stakeholders. Ability to work as a team member and HCBS liaison in addition to listening and carrying out instructions via Supervisor directives and Workflows/Job Aids independently. Provide expedited care coordination through initial outreach, assessment, and stabilization of CHC benefits. CCU’s focus is to stabilize incoming CHC Participants until a primary HCBS SC is assigned. As needed, CCU may also assist HCBS SC’s by providing additional support for certain established Participants such as with Nursing Facility discharges, Nursing Home Transitions, or other complex facility discharges. Should be an RN. Need to be a registered nurse. Qualifications: Minimum of 2 years of experience in a clinical setting and case management nursing required. BSN preferred. Ability to interact with physicians and other health care professionals in a professional manner required. Excellent verbal and written communication and interpersonal skills required. Computer proficiency required. Meet minimum internet system/service and speed/ latency requirements as set forth by UPMC. Equipment must be connected directly or hard-wired to the internet modem/router with an ethernet cable. Most cable and fiber optic providers can meet the requirement. Private, secure designated workspace required in the home office setting or the ability to work from a designated UPMC office location daily. Licensure, Certifications, and Clearances: Case management certification or approved clinical certification preferred Registered Nurse (RN) Act 34 *Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state.
Warm transfers member for IEB referrals as appropriate. Successful manipulation of Excel Spreadsheets and accurate Excel spreadsheet data management is required. Present complex members for review by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization, case management interventions. Update the plan of care following review and communicate recommendations to the member and providers. Contact members with gaps in preventive health care services and assist them to schedule required screening or diagnostic tests with their providers. Review member’s current medication profile; identify issues related to medication adherence, and address with the member and providers as necessary. Conduct comprehensive assessments that include the medical, behavioral, pharmacy, and social needs of the member. Review UPMC Health Plan data for services the member has received and identify gaps in care based on clinical standards of care. Refer members to appropriate health plan programs based on assessment data. Engage members in education or self-management programs. Provide members with appropriate education materials or resources to enhance their knowledge and skills related to physical health, emotional health, or lifestyle management. Successfully engage member to develop an individualized plan of care in collaboration with their primary care provider that promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinates and modifies the care plan with member, caregivers, PCP, specialists, community resources, behavioral health contractor, and other health plan and system departments as appropriate. Document all activities in the Health Plan’s care management tracking system following Health Plan standards and identify trends and opportunities for improvement based on information obtained from interaction with members and providers. Conduct member outreach in response to assist with member issues or concerns or facilitate specific population health goals. Seek input from clinical leadership to resolve issues or concerns.
UPMC is a world-renowned, nonprofit health care provider and insurer committed to delivering exceptional, people-centered care and community services. Headquartered in Pittsburgh and affiliated with the University of Pittsburgh Schools of the Health Sciences, UPMC is shaping the future of health through clinical and technological innovation, research, and education. Dedicated to advancing the well-being of our diverse communities, we provide nearly $2 billion annually in community benefits, more than any other health system in Pennsylvania. Our 100,000 employees — including more than 5,000 physicians — care for patients across more than 40 hospitals and 800 outpatient sites in Pennsylvania, New York, and Maryland, as well as overseas. UPMC Insurance Services covers more than 4 million members, providing the highest-quality care at the most affordable price. To learn more, visit UPMC.com.
The Manager, Clinical Informatics – Service Line serves as the primary informatics leader and strategic partner for assigned clinical service lines. This role will support the Laboratory Service Line and collaborates closely with service line leadership, clinicians, IT, and enterprise informatics teams to ensure clinical workflows, documentation, and EHR functionality align with organizational standards, patient care goals, and the overall EHR strategy. The manager leads planning, design, build, testing, implementation, and optimization of clinical applications and EHR enhancements specific to service line needs, while supporting effective end-user adoption and proficiency. Through proactive issue identification, risk management, training coordination, and use of clinical data, this role ensures informatics solutions promote safe, efficient, and high-quality patient care while supporting operational, regulatory, and strategic initiatives across the system.
Bachelor’s degree in nursing or health-related field required, master’s degree preferred. Minimum of four to five years of clinical and/or informatics experience. One year of leadership experience required. Experience participating in or supporting clinical informatics implementations, upgrades, or optimization efforts related to service-line workflows and patient care processes. Informatics certification (ANCC Nursing Informatics or CPHIMS) required within three years. Active clinical license maintained if applicable. Preferred experience: Experience with EPIC Clinical laboratory experience Strong computer skills and communications skills. Background in IT
Serve as the primary clinical informatics liaison for assigned service lines. Partner with clinical service line leaders to optimize workflows and clinical documentation. Ensure alignment between service line needs and enterprise EHR strategy. Lead planning, design, build, testing, implementation, and optimization of EHR functionality and clinical applications within assigned service lines. Coordinate service line–specific EHR enhancements and configuration changes. Identify project risks and workflow issues and proactively implement solutions or escalate as needed. Coordinate and deliver service line–specific training for new implementations, upgrades, and workflow changes. Assess end-user adoption and proficiency and develop remediation strategies as needed. Serve as a point of escalation for end-user issues within assigned service lines. Ensure assigned service lines are prepared for planned and unplanned EHR downtime events. Support compliance with enterprise downtime policies and procedures. Collaborate with IT, informatics peers, and operational leaders to ensure seamless integration of systems and workflows. Communicate service line priorities, risks, and opportunities to leadership team. Leverage clinical data to support quality improvement, patient safety, and regulatory initiatives. Ensure informatics solutions promote safe, effective, and efficient patient care.
UPMC is a world-renowned, nonprofit health care provider and insurer committed to delivering exceptional, people-centered care and community services. Headquartered in Pittsburgh and affiliated with the University of Pittsburgh Schools of the Health Sciences, UPMC is shaping the future of health through clinical and technological innovation, research, and education. Dedicated to advancing the well-being of our diverse communities, we provide nearly $2 billion annually in community benefits, more than any other health system in Pennsylvania. Our 100,000 employees — including more than 5,000 physicians — care for patients across more than 40 hospitals and 800 outpatient sites in Pennsylvania, New York, and Maryland, as well as overseas. UPMC Insurance Services covers more than 4 million members, providing the highest-quality care at the most affordable price. To learn more, visit UPMC.com.
Are you an experienced nurse with an interest in care management? Do you have a passion for the long-term care management of patients with chronic conditions? Is project management something you’re experienced with and enjoy doing? We are you looking for you! UPMC Health Plan is hiring a full-time Telephonic Care Manager to support our Community Medicine Inc. team and PCMH Learning Network initiatives, primarily serving UPMC for You Medicaid members. This telephonic role is primarily remote, with standard daylight hours (Monday–Friday) and occasional travel within Pennsylvania. The Telephonic Care Manager is responsible for care coordination and health education for identified Health Plan members through telephonic collaboration with members and their caregivers and providers. Identifies members’ medical, behavioral, and social needs and barriers to care. Develops a comprehensive care plan that assists members to close gaps in preventive care, addresses barriers to care, and supports the member’s self-management of chronic illness based on clinical standards of care. Collaborates and facilitates care with other medical management staff, other departments, providers, community resources and caregivers to provide additional support. Members are followed by telephone or other electronic communication methods. Title and salary will be determined based upon education and nursing experience for Sr. Professional Care Manager within the Insurance Services Division.
Minimum of 2 years of experience in a clinical setting and case management nursing required. BSN preferred. Project Management experience is a bonus! Ability to interact with physicians and other health care professionals in a professional manner required. Excellent verbal and written communication and interpersonal skills required. Computer proficiency required. Meet minimum internet system/service and speed/ latency requirements as set forth by UPMC. Equipment must be connected directly or hard-wired to the internet modem/router with an ethernet cable. Most cable and fiber optic providers can meet the requirement. Private, secure designated workspace required in the home office setting or the ability to work from a designated UPMC office location daily. Licensure, Certifications, and Clearances: Case management certification or approved clinical certification preferred Registered Nurse (RN) Act 34 *Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state.
Present complex members for review by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization, case management interventions. Update the plan of care following review and communicate recommendations to the member and providers. Contact members with gaps in preventive health care services and assist them to schedule required screening or diagnostic tests with their providers. Review member’s current medication profile; identify issues related to medication adherence, and address with the member and providers as necessary. Refers member for Comprehensive Medication Review as appropriate. Conduct comprehensive assessments that include the medical, behavioral, pharmacy, and social needs of the member. Review UPMC Health Plan data for services the member has received and identify gaps in care based on clinical standards of care. Refer members to appropriate health plan programs based on assessment data. Engage members in education or self-management programs. Provide members with appropriate education materials or resources to enhance their knowledge and skills related to physical health, emotional health, or lifestyle management. Successfully engage member to develop an individualized plan of care in collaboration with their primary care provider that promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinates and modifies the care plan with member, caregivers, PCP, specialists, community resources, behavioral health contractor, and other health plan and system departments as appropriate. Document all activities in the Health Plan’s care management tracking system following Health Plan standards and identify trends and opportunities for improvement based on information obtained from interaction with members and providers. Conduct member outreach in response to assist with member issues or concerns or facilitate specific population health goals. Seek input from clinical leadership to resolve issues or concerns.
MPHI is a Michigan-based and nationally engaged, non-profit public health institute. We are a team of teams, process and content experts, dedicated to building A world where tomorrow is healthier than today!
Title: Nursing Case Management Coordinator $69,992 - $100,630.40 / Posted Thru: 5-24-26 Location: Remote/Virtual – Occasional in-person at Lansing, MI office required - Occasional statewide travel required - Must Live and Work in Michigan Purpose: The position is a Nursing Case Management Coordinator in the Care Coordination Section Nursing Case Management Unit. This nursing case management coordinator will provide nursing consultation and technical assistance to health care providers and local health departments to assist in cases of children with elevated blood lead levels. The nursing case management coordinator will assist with ongoing improvement of health initiatives, practices and standards related to childhood lead poisoning prevention. Additionally, this position will help assist with development and implementation of the lead-related responses across Michigan. This person will provide nursing expertise and guidance to MDHHS Environmental Health Bureau lead-related efforts around educational events, testing events, and provider education in high-risk communities. This position will be housed in the MDHHS Environmental Health Bureau in Lansing.
Education: Possession of a master's degree in public health, health communication, health services administration, community development, urban planning, population and health sciences, international studies, political science, health policy or a public health related field such as nursing, epidemiology, health education, health economics, dietetics/nutrition management, genetics, or speech and audiology; a master's degree in social work; master's degree in counseling; master’s degree in education or special education with specialization in blind/visual disabilities; or a master’s degree in public or business administration with a health care concentration required. A valid Michigan registered nurse license is required. Experience: Three years of professional experience as a consultant in a field of public health equivalent to a Public Health Consultant required.Preferred: Clinical nursing experience. Highly desirable: Educational background in or experience in public health nursing and/or environmental health programming. Important Skills and Knowledge: Knowledge of general nursing principles, practices and standards. Knowledge of medical services, social services, dietary services, rehabilitation services, and environmental services pertaining to lead poisoning. Knowledge of the activities of educational and social agencies related to local health care. Effective oral and written communication skills. Attention to detail. Ability to handle multiple tasks and assignments. Excellent organizational skills. Knowledge of public health system in Michigan. Work Environment and Physical Requirements: Physical effort typical of working in a standard office environment. In-state travel to high-risk communities and/or medical provider practices required. Requires valid vehicle operator’s license and occasional travel within the State, including overnights. There may be times when work outside of regular hours is necessary for the completion of a project. Materials and supplies can be bulky and may weigh up to 40 lbs. RESPONSIBILITY FOR THE WORK OF OTHERS: No assigned responsibility.
Serve as nursing subject matter expert on EHB lead-related projects as needed, and appropriate based on LHD jurisdictions assignment. Independently review daily and weekly blood lead testing result reports, and initiate contact with local health departments and/or other health care professionals as needed. Provide nursing support and expertise to health care providers and local health departments as needed. Develop educational training to support nursing case management activities. Independently develop targeted outreach plan to high-risk communities based on EBL rates and CLPPP surveillance reports. Notify managers of important trends in elevated blood lead levels and case management activities. Develop a plan to provide public health nursing interventions to address concerning trends. Maintain records and nursing notes and prepare reports and correspondence to support Nursing Case Management program and CLPPP technical assistance to local health department nursing staff. Develop policies and standards of nursing practice for childhood lead services; adapt nursing procedures and practices to meet the changing needs of nursing and health initiatives. Disseminate MDHHS/CLPPP lead screening/testing recommendations to medical providers and other MDHHS program staff (Medicaid, MIHP, WIC). Collaborate on evaluation of nursing case management activities. Designing and implementing nursing intervention programs for EHB lead-related projects. Develop and implement quality improvement projects related to nursing case management activities including but not limited to documentation in nursing case management database, conducting care coordination, and educating health care providers. Always represent the best interests of MDHHS and MPHI. Conduct other duties as required.
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