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The Supervisor is responsible for overseeing the daily operations of the Central Intake Clinical Care Representative team, including guidelines/protocols, processes, metrics adherence, call flows, and technical support. The Supervisor is responsible for leading and providing feedback to aid Clinical Care Representatives in meeting/exceeding performance expectations and the needs of our patients.
Bachelor’s degree desired, preferably in nursing or healthcare Successful completion of RN program; unencumbered Maine RN license Minimum 2 years supervisory experience in a clinical setting preferred Call Center experience preferred Proficiency in MS office applications; Word, Excel, Power Point, Outlook Excellent analytical skills, professional judgment and decision-making ability Proven Leadership skills Excellent communication skills both oral and written Ability to foster an enhanced team environment Ability to prioritize, organize, and plan work independently Committed to excellence in customer service and clinical care
Directly supervises clinical staff Coordinate training with the Clinical Educator and Department Coordinator for new staff members within department Works with the Quality Analyst and Clinical Educator to perform initial and regular competencies and quality reviews of clinical staff to assure clinical standards are met and maintained Evaluates staff performance and effectiveness and facilitates quarterly meetings with individual staff to discuss performance and goals or on an as-needed basis more frequently. Mentors and counsels staff to include progressive disciplinary actions Acts as first line resource for Clinical Care Representative staff and assists with escalated patient issues Monitor call center metrics based on call volumes, average speed to answer, abandonment rate and service levels. Utilizes analytical tools and data-centric thinking to evaluate and inform decisions regarding daily operations and Clinical Care Representative performance. Focus on ensuring patient satisfaction, compliance, and efficiency Perform duties of a Clinical Care Representative when required such as during peak volume timeframes Evaluates workloads, patient flow and efficiencies and collaborates with Practice Manager, Department Coordinator and Clinical Educator on improvements Acts as first line resource for IT issues Collaborate with Clinical Educator to coordinate a competency structure for staff to include program development, content, assessment, documentation, and maintenance of training records Collaborates with Clinical Educator and Department Coordinator to develop and implement new programs and processes to better serve our patients and team members Provides coverage for Practice Manager and Department Coordinator in his/her absence (blocks, reschedules, On-Call) Conducts Clinical Care Representative staff interviews and is involved in hiring decisions.
The Clinical Care Representative (CCR) is a telephone triage nurse, providing a variety of services and information to patients over the phone in a fast-paced call center environment. The CCR utilizes written protocols and clinical judgement to guide their practice and determine the urgency of care needed. The CCR schedules appointments or directs callers to health care providers as needed. The goal of this unique form of nursing is to decrease unnecessary visits to physicians, nurse practitioners, and the emergency room, as well as to provide information for self-care. The person in this role is expected to have exceptional customer service abilities, strong clinical judgment, and excellent computer and typing skills. While this position can be performed remotely, it requires in-person training and in-person work when technical issues arise preventing the ability to work remotely.
Graduate from an accredited school of nursing Unencumbered active registered nurse or LPN licensure in state of Maine Previous experience in a primary care or hospital setting required Triage experience preferred Proficient computer knowledge and accurate typing skills with Windows based programs, including electronic medical records programs Ability to proficiently use telephone system Excellent typing and computer ability while simultaneously maintaining a telephone conversation Ability to consistently meet and adhere to performance and quality metrics Compassion, empathy, and teaching ability, as patients may require instruction for self-care and/or symptom management Strong organizational and critical thinking skills Ability to demonstrate and uphold InterMed’s Values Professional appearance On-site, in-person training is required for this position. Training is expected to take 3-4 weeks depending on experience State of Maine residence is required
Answer phone calls and web messages for primary care practices of all ages in a fast-paced call center environment Provide triage to symptomatic patients to determine placement within InterMed’s practice, referring to ED/Urgent Care, or providing homecare advice as appropriate Utilize superior verbal communication skills to provide excellent customer service and nursing care via telephone Ability to remain calm in high-stress situations, utilizing crisis intervention skills when appropriate Refill prescriptions according to standard protocol Provide test results according to standard protocol Provide patient education under provider’s direction Fulfill administrative responsibilities which may include: Obtaining medical records information Referral information Completing forms/requisitions Schedule routine appointments Flexibility and willingness to work as a team member Ability to prioritize work and handle multiple tasks and computer applications Excellent professional judgment and technical skills Other responsibilities as directed by management
Optum Home & Community Care, part of the Optum family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs - helping patients access and navigate care anytime and anywhere. As a team member of our Optum team, together in an interdisciplinary care environment, we help patients navigate the health care system and connect them to key support services. This preventive care can help patients stay well at home. We're connecting care to create a seamless health journey for patients across settings. Join us to start Caring. Connecting. Growing together.
The Telehealth Urgent Care program is a comprehensive integrated care delivery program. The National On Call advanced practice clinician (APC) is responsible for providing telephonic/telehealth care and direction to patients, caregivers and facility staff providing 24/7 coverage including holidays. In this remote role you will provide virtual care for patients in various settings. This excellent opportunity affords a collaborative role bringing enormous satisfaction in the care and comfort of our patients. In this role you will have the ability to achieve work life balance. Optum is transforming care delivery with innovative and personal care. As one of the largest employers of APCs, Optum offers unparalleled career development opportunities. Scheduling: This is a Full Time, work from home position requiring various shift coverage with a mix of weekday, weeknights, weekend, and holiday coverage. While shift times can vary, we provide coverage to members 24/7 including all company recognized holidays. Flexibility and the ability to adapt are a must as you will cross cover multiple markets and teams Availability and Coverage expectations for this role 24/7 coverage Position requires a minimum commitment of 40 hours per week Every other weekend coverage between 8-12 hour shifts covering both day and night shifts is required based on business needs Expectations that your are working or have approved PTO for 26 weekends a year. Each FT/PT employee is eligible to have up to 6 weekend shifts a year for PTO Unapproved time away/Unpaid Time Off will result in need to add additional weekend shift to your schedule based on need Holidays are required for all APCs on a rotation basis Holiday scheduling is completed at the beginning of the year for advanced planning. Holiday coverage is provided beginning at 5pm, the end of the last business day, to 8am of the resumption of business hours You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Education: NP: Graduate of an accredited Master of Science Nursing or Doctor of Nursing Practice program Active and unrestricted license in the state which you reside, as well as States of Ohio, Missouri, Indiana or Wisconsin, and ability to obtain in other required locations Ability to gain a collaborative practice agreement, if applicable in your state APCs working in jurisdictions that authorize APCs to practice autonomously or without formal supervision must have obtained approval to practice autonomously or without formal supervision from their licensing board, if applicable. New hires who are eligible and have not applied prior to hire date, must apply to practice autonomously or without supervision within 1 month of hire. If not eligible to practice autonomously or without formal supervision at hire, the APC must begin working towards meeting the requirement within 1 month of hire, if applicable, and apply for approval to practice autonomously or without formal supervision within 3 months of becoming eligible Active Nurse Practitioner certification through a national board: NP: Board certified through the American Academy of Nurse Practitioners or the American Nurses Credentialing Center, with certification in one of the following: Family Nurse Practitioner Adult Nurse Practitioner Gerontology Nurse Practitioner Adult-Gerontology Acute Care Nurse Practitioner Current, active DEA licensure/prescriptive authority or ability to obtain post-hire, per state regulations (unless prohibited in state of practice) Ability to work scheduled shifts in accordance with scheduling policies Proficient computer skills including the ability to document medical information with written and electronic medical records Preferred Qualifications: 3+ years of clinical experience as an APC Active and unrestricted license in the additional states: Ohio, Wisconsin, Missouri, Indiana Experience in meeting the medical needs of patients with complex behavioral, social and/or functional needs Experience working in a nursing home, or with seniors in an acute care facility Understanding of Geriatrics, Chronic Illness, and acute disease management Understanding of Advanced Illness and end of life discussions Ability to develop and maintain positive customer relationships Adaptability to change
Available on provided telephonic platform, both taking and placing calls to coordinate and manage care for members between care givers, facilities, hospitals, primary care providers and the Optum field colleagues Available to use video platform based on clinical need Working hours should be performed in a secure location as patient privacy is required Utilize EMR proficiently to provide acute care to members during all shifts and holiday hours Care Delivery Deliver cost-effective, quality care to members Manage both medical and behavioral, chronic, and acute conditions effectively, and in collaboration with a physician or specialty provider Perform comprehensive assessments and document findings in a concise/comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations Responsible for ensuring encounter is documented appropriately to support the diagnosis at that visit The APC is responsible for ensuring that all quality elements are addressed and documented Utilizes evidenced based practice guidelines Must attend and complete all mandatory educational and MyLearning training requirements Care Coordination Coordinate care as members transition through different levels of care and care settings Monitor the needs of members and families while facilitating any adjustments to the plan of care as situations and conditions change Review orders and interventions for appropriateness and response to treatment to identify the most effective plan of care that aligns with the patients' needs and wishes Address and be able to have advanced care plan conversations with members and families Evaluate the plan of care for cost effectiveness while meeting the needs of members, families, and providers to decrease high costs, poor outcomes and unnecessary hospitalizations Program Enhancement Expected Behaviors This is a virtual patient facing role that requires excellent customer service to all parties including members/families, facilities, the entire interdisciplinary care team (PCPs/specialists) and Optum staff Regular and effective communication with internal and external parties including physicians, patients, key decision-makers, nursing facilities, field staff and other provider groups Ability to meet shift scheduling requirements, and attendance expectations Exhibit original thinking and creativity in the development of new and improved methods and approaches to concerns/issues Function independently and responsibly with minimal need for supervision Demonstrate initiative in achieving individual, team, and organizational goals and objectives Participate in quality initiatives Availability to check Optum email intermittently for required trainings, communications, and monthly scheduling You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence Health Plan Partners and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them. Providence Health Plan welcomes 100% remote work for applicants who reside in the following states: Washington Oregon
Required Qualifications: Current unencumbered Registered Nurse License in state of residency upon hire. 5 years Clinical nursing experience. Experience working with physicians in the collaboration and management of patient care. Preferred Qualifications: Bachelor's Degree in Nursing or Health Education. Current nursing experience in the following areas: cardiology, endocrinology, pediatrics, obstetrics, oncology, respiratory, health education.
The purpose of this position is to provide care coordination services to Providence Health Plans(PHP) members. Care coordination services include: disease management programs, including educating, motivating and empowering members to manage their disease. Case management including: triage and referral, transition of care planning, end of life care planning, other acute and catastrophic case management. These services are offered to members and their families who have acute and complex health care needs; members with chronic conditions at risk for poor health outcomes and members who are terminal and nearing end of life.
Founded in 2021, VitalCaring has grown into a leading provider of home health and hospice services, with over 65 locations across the country. We are committed to fostering a culture of support, growth, and excellence for our team that is the backbone of how we ensure we deliver exceptional patient care.
This is a remote position eligible to those who reside in Alabama, Mississippi, Texas, Louisiana, Oklahoma, Kansas, Missouri, Arizona or Florida
Graduate of an accredited school of nursing with a current Compact RN License Managerial Experience Current license in state of practice and CPR certification Bachelor's degree, preferred Minimum of 3 years of experience as a home health nurse Excellent verbal and written communication skills and critical thinking skills Proficient in HCHB, Microsoft Office products (Teams, Outlook, Excel, Word)
Promotes the agency philosophy and mission by presenting a positive image to patients and families. Demonstrates professional qualities as evidenced by being dependable, punctual, and maintaining a positive attitude, showing enthusiasm, and striving for excellence. Understands and uses various forms of communication which may include phone system, software, reports, tools, and metrics. Provides effective communication to patients and families, team members, and other healthcare professionals. Triage patient care needs over the phone, providing medical advice, and coordinating with healthcare providers to address urgent concerns. Uses motivational interviewing and active listening skills to understand patient needs and effectively communicate to identify/resolve issues. Takes detailed notes and enters them into the patient's electronic medical record. Follows up with patients as required to ensure their needs have been met. Maintains confidential medical records for each patient in accordance with HIPAA guidelines. Stays up to date on company policies and procedures. Communicate with external call center to ensure all patient care needs are met. Managing incoming referrals from time of receipt to admission to ensure timely initiation of care. Frequent login and access to e-referral portals to ensure timely review and acceptance of referrals. Receive and act on emergent care and inpatient facility alerts via the ADT platform to ensure timely care coordination with branch, physician, and patient Implement strategies to prevent hospital re-admissions, including patient education, follow up telephonic touchpoints, and care coordination. Collaborate with clinicians to manage all patient scheduling needs Communicate summary of afterhours/holiday activity with appropriate branch leaders Participate in regular training and continuing education to stay current with best practices in home health care. Ensure appropriate communication at the onset of on call shift and effective handoff at the end of on call shift. Ensure that all required portal systems are frequently accessed with current login credentials. Performs all other duties as assigned.
At Wellstar Health System, our mission is to enhance the health and well-being of every person we serve. Nationally ranked and locally recognized for our high-quality care, inclusive culture, and exceptional doctors and caregivers, Wellstar is one of the largest most integrated healthcare systems in Georgia. Our specialists and primary care providers work in a multi-disciplinary environment with nearly 30,000+ diverse team members throughout our 11 hospitals, 300+ medical offices, outpatient centers, health parks, a pediatric center, and hospice and home care services. We’re proud to be home to the second-largest Emergency Department in the country, as well as being one of the only systems in Georgia operating multiple trauma centers. But we’re also known for being a great place to work! We are proud to be featured on the Fortune 100 Best Companies to Work For ® and the Seramount Best Company for Multicultural Women® lists. We continue to attract the best and the brightest in healthcare. At a time when our industry is changing rapidly, Wellstar remains committed to exceeding patients’ – and team members’ – expectations, while transforming healthcare delivery. We stand behind our values to serve with compassion, pursue excellence, and honor every voice.
The RN Remote, WMG is a member of an interdisciplinary team of licensed and unlicensed caregivers who ensure that patients, families, and significant others receive individualized, high quality, safe, and timely patient care. This position is fully remote, practicing in a non-traditional clinical setting where patient care and interaction are delivered over the telephone, or via secure messaging. This position is led by a nurse supervisor, nurse manager, or other nursing leader. This nurse has a range of responsibilities that focus on providing patient care and support without being physically present in a healthcare facility. Some of the main responsibilities include patient assessment and triage, hospital follow up, patient education, pre and post procedure/surgery care, patient results communication, and support for preventative care. While this role functions in a remote work setting, the nurse's responsibilities and essential functions are considered an extension of the practice, and the nurse remains accountable to the delivery of appropriate and timely patient care. It is expected that all remote nurses are licensed, knowledgeable and uphold the practice of nursing as outlined by the Georgia Professional Nurse Practice Act and implements the Scope of Practice and Code of Ethics Standards put forth by the American Nurses Association. It is expected that the individual upholds the voice of the patient, system policies and procedures while supporting service excellence goals.
Required Minimum Education: Diploma (Nurse) Nursing or Bachelors Nursing-Preferred Required Minimum License(s) and Certification(s): All certifications are required upon hire unless otherwise stated. RN - Reg Nurse (Single State) or RN-COMPACT - RN - Multi-state Compact BLS - Basic Life Support or ARC-BLS - Amer Red Cross Basic Life Support or BLS-I - Basic Life Support - Instructor Additional License(s) and Certification(s): Required Minimum Experience: Minimum 2 years Experience with direct patient care in any care setting. Required and Minimum 1 year Experience in the physician practice setting in specific specialty area. Preferred and Minimum 1 year Experience with virtual care services (e.g., telehealth, triage, other remote nursing function). Preferred Required Minimum Skills: Excellent interpersonal, verbal, and written communication skills High Strong computer and technical skills High Excellent time management/organization skills High Effective problem solving and critical thinking skills. High Ability to work in a fast paced environment with constantly changing priorities. High Join us and discover the support to do more meaningful work—and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.
Exemplary Practice and Outcomes Performs the Nursing Process (assessment; diagnosis; identification of outcomes; planning; implementation and evaluation) in the performance of patient triage, using evidence-based practice and protocols. Performs initial and follow-up assessments via telephone, or secure messaging platforms to evaluate the patients health, symptoms, and concerns. Determine the severity of patient issues and prioritize care, referring patients for in-person or virtual visits, or urgent or emergency care, when needed. Upholds all health care system/organizational and WMG policies and procedures and clinical competencies put forth by this job description. Collects, updates, and reviews patient health histories to ensure accurate and up-to-date records, which help guide decision-making. Utilizes the electronic health record to access patient results, communicate results/relay provider messages in a timely manner. Provides pre procedure/surgery instructions and education ensuring that patients are well-prepared both mentally and physically for their upcoming procedures or surgeries. This involves educating patients about what to expect, how to prepare, and what post-procedure care to follow. Reaches out to patients after theyve been discharged and/or undergone a procedure or surgery to check on their recovery progress, ensures they're following their discharge instructions, and assesses their general well-being. Provides reminders and education on preventative screenings, vaccinations, and lifestyle interventions to reduce the risk of illness with an emphasis on preventative care. Creates a supportive environment for patients to ask questions about their acute or chronic illness/es, medications, or any health concerns they may have. Teamwork and Collaboration Coordinates the delivery and documentation of safe, quality, and timely patient care. Maintains consistent, clear, and timely communication with providers, and other healthcare team members through digital tools such as secure messaging platforms, telephone, and email. Participates in regular team meetings to evaluate care processes and patient outcomes, offering feedback on workflows and identifying areas for improvement in remote care delivery. Participates in the onboarding of new team members to the remote nursing role. Helps colleagues become familiar with Epic tools, phone system, and other technologies that facilitate remote care. Provides guidance on best practices for delivering care remotely to ensure smooth team operation. Although a primarily remote role, the nurse will be required to report in person to a clinic or other designated location for onboarding, training, staff meetings, committees/workgroups/working sessions etc. at the request of leadership. Professional Development and Initiative Completes all initial and ongoing professional competency assessment, required mandatory education, and role-specific education. Demonstrates leadership by identifying areas for improvement in remote care delivery (e.g., patient engagement, follow-up care, or the implementation of new technology), and suggesting innovative solutions. Participates in workgroups, committees, and shared decision-making groups. Regularly reflects on personal performance and areas of strength or weakness. Uses this insight to seek out relevant training or mentorship to continuously improve. Resources and Support Proactively plans for the care of patients across the care continuum in the course of providing remote patient care. Participates in the development and enhancement of protocols and procedures when called upon or through self-initiation in collaboration with managers and other members of the remote nursing team to achieve best practice outcomes. Functions as a part of a larger remote nursing team providing coverage for absences, vacation, and leave. Performs other duties as assigned Complies with all Wellstar Health System policies, standards of work, and code of conduct.
P3 Health Partners is a population health management group founded and led by fellow physicians who want to shift the industry’s focus from managing illness to cultivating wellness. We are health plan agnostic and work with most plans in our markets. As the conduit between you and the health plan, we want to make a difference where it counts - with your patients, their families, and the communities where we live. The mission of P3 is simple. We want to help providers and their patients embrace a new kind of care. A kind of care that gives patients the tools and resources they need to manage their long-term health and wellness.-
Are you a compassionate mission-driven Nurse Practitioner looking to make a meaningful impact on the lives of complex medical patients? As a telehealth nurse practitioner, you’ll bring hope and healing to patients with complex medical needs. In this full-time role, you’ll be a vital member of an interdisciplinary team, transforming lives and empowering primary care physicians to deliver exceptional care to those who need it most. The goal of a telehealth nurse practitioner is to provide telephonic or televideo access to care for P3 Health Partner patients in Oregon. Televideo interactions are preferred. You may be requested to assist with other P3 markets (other states) pending business needs. The hours of operation are 8am-5pm, Monday through Friday excluding holidays. There can be a request for some flexible staffing hours pending different outreach campaigns. This will be an exception and not the rule agreed upon by both parties. The telehealth provider is expected to be a team player which may involve tasks outside of direct patient care such as outreach or onboarding a peer. The scope of practice for the telehealth nurse practitioner includes predominately providing comprehensive annual visits care. Additionally, you may participate in care for non-life or limb threatening urgent or non-urgent concerns or triaging to an appropriate level of care as well as transition of care visits. Patient and caregiver education combined with support and follow-up phone calls enhance your outcomes. The above actions, combined with preventive and timely patient care by the comprehensive care teams, afford emergency department and hospital admission avoidance which is a known factor in decreasing complications while maintaining a higher quality of life in this subset of patients.
Active and unencumbered nurse practitioner licenses in all states where P3 Health Partners is located and where you are requested to obtain a license to practice. P3 Health Partners will fund any additional licenses and fees if requested by P3. Current DEA license in Oregon Experience in telehealth and annual comprehensive visits preferred Experience in geriatric acute care preferred Flexible, self-driven, collaborative and innovative personality
Serve as a positive and collaborative team member. Uphold high standards of clinical excellence within the call center. Perform evaluations and provide treatment using sound clinical judgment. Identify care gaps and communicate recommended interventions to the member’s primary care provider and to the complex care team. Properly document risk adjustment and close quality gaps. Be able to comfortable discuss goals of care, advanced care planning and hospice options. Triage to appropriate level of care and manage non-life or limb threatening conditions. Collaborate with interdisciplinary teams using data-driven clinical tools to support coordinated, value-based care. Collaborate with the VPMA or designee when assistance in clinical decision making is identified. Communicate opportunities to advance the clinical model. Educate P3 team members when necessary. Educate patients, their families and caretakers on health maintenance, chronic disease management, medications, and preventive care. Confidently use technology and evidence-based medicine to guide care planning and decision-making. Ensure patient privacy and adherence to all HIPAA regulations and standards for handling PHI. Participate in quality improvement initiatives, documentation audits, and other activities that support clinical excellence and operational efficiency. Maintain compliance with required trainings, timely chart closures, chart queries, meeting attendance, email responses and other requirements. Serve as a positive and collaborative leader and team member. Maintain a license and DEA certificate in good standing. Role model the P3 Health Partners core values.
The Clinical Supervisor is responsible for overseeing the daily operations of the Central Intake Clinical Care Representative team, including guidelines/protocols, processes, metrics adherence, call flows, and technical support. The Supervisor is responsible for leading and providing feedback to aid Clinical Care Representatives in meeting/exceeding performance expectations and the needs of our patients.
Bachelor’s degree desired, preferably in nursing or healthcare Successful completion of RN program; unencumbered Maine RN license Minimum 2 years supervisory experience in a clinical setting preferred Call Center experience preferred Proficiency in MS office applications; Word, Excel, Power Point, Outlook Excellent analytical skills, professional judgment and decision-making ability Proven Leadership skills Excellent communication skills both oral and written Ability to foster an enhanced team environment Ability to prioritize, organize, and plan work independently Committed to excellence in customer service and clinical care
Directly supervises clinical staff Coordinate training with the Clinical Educator and Department Coordinator for new staff members within department Works with the Quality Analyst and Clinical Educator to perform initial and regular competencies and quality reviews of clinical staff to assure clinical standards are met and maintained Evaluates staff performance and effectiveness and facilitates quarterly meetings with individual staff to discuss performance and goals or on an as-needed basis more frequently. Mentors and counsels staff to include progressive disciplinary actions Acts as first line resource for Clinical Care Representative staff and assists with escalated patient issues Monitor call center metrics based on call volumes, average speed to answer, abandonment rate and service levels. Utilizes analytical tools and data-centric thinking to evaluate and inform decisions regarding daily operations and Clinical Care Representative performance. Focus on ensuring patient satisfaction, compliance, and efficiency Perform duties of a Clinical Care Representative when required such as during peak volume timeframes Evaluates workloads, patient flow and efficiencies and collaborates with Practice Manager, Department Coordinator and Clinical Educator on improvements Acts as first line resource for IT issues Collaborate with Clinical Educator to coordinate a competency structure for staff to include program development, content, assessment, documentation, and maintenance of training records Collaborates with Clinical Educator and Department Coordinator to develop and implement new programs and processes to better serve our patients and team members Provides coverage for Practice Manager and Department Coordinator in his/her absence (blocks, reschedules, On-Call) Conducts Clinical Care Representative staff interviews and is involved in hiring decisions.
The Clinical Care Representative (CCR) is a telephone triage nurse, providing a variety of services and information to patients over the phone in a fast-paced call center environment. The CCR utilizes written protocols and clinical judgement to guide their practice and determine the urgency of care needed. The CCR schedules appointments or directs callers to health care providers as needed. The goal of this unique form of nursing is to decrease unnecessary visits to physicians, nurse practitioners, and the emergency room, as well as to provide information for self-care. The person in this role is expected to have exceptional customer service abilities, strong clinical judgment, and excellent computer and typing skills. While this position can be performed remotely, it requires in-person training and in-person work when technical issues arise preventing the ability to work remotely.
Graduate from an accredited school of nursing Unencumbered active registered nurse or LPN licensure in state of Maine Previous experience in a primary care or hospital setting required Triage experience preferred Proficient computer knowledge and accurate typing skills with Windows based programs, including electronic medical records programs Ability to proficiently use telephone system Excellent typing and computer ability while simultaneously maintaining a telephone conversation Ability to consistently meet and adhere to performance and quality metrics Compassion, empathy, and teaching ability, as patients may require instruction for self-care and/or symptom management Strong organizational and critical thinking skills Ability to demonstrate and uphold InterMed’s Values Professional appearance On-site, in-person training is required for this position. Training is expected to take 3-4 weeks depending on experience State of Maine residence is required
Answer phone calls and web messages for primary care practices of all ages in a fast-paced call center environment Provide triage to symptomatic patients to determine placement within InterMed’s practice, referring to ED/Urgent Care, or providing homecare advice as appropriate Utilize superior verbal communication skills to provide excellent customer service and nursing care via telephone Ability to remain calm in high-stress situations, utilizing crisis intervention skills when appropriate Refill prescriptions according to standard protocol Provide test results according to standard protocol Provide patient education under provider’s direction Fulfill administrative responsibilities which may include: Obtaining medical records information Referral information Completing forms/requisitions Schedule routine appointments Flexibility and willingness to work as a team member Ability to prioritize work and handle multiple tasks and computer applications Excellent professional judgment and technical skills Other responsibilities as directed by management
At Olmsted Medical Center, we value our employees and are committed to providing a comprehensive and competitive benefits package. To keep up with the evolving trends, Olmsted Medical Center offers the following for employees who are employed at a 0.5 FTE or higher.
1.0 FTE - Day Shift (This is a remote position) Starting Pay - $39.41 to $54.19 (based on experience) Offers for external candidates are generally made between the minimum and 3/4 point of the range, based on experience.
Graduate of an accredited school of professional registered nursing Current Minnesota Registered Nurse license Greater than five years of nursing experience preferred, preferably in ambulatory or hospital care BLS certification required Ability to work both independently and collaboratively as an effective member of a healthcare team
Practice of Professional Nursing includes but is not limited to: Provides a comprehensive assessment of the health status of a patient through the collection, analysis, and synthesis of data used to establish a health statue baseline and plan of care. The RN also addresses changes in the patient condition. Collaborates with the healthcare team to develop and coordinate an integrated plan of care. Develops nursing interventions to be integrated into the plan of care. Implements nursing care through the execution of independent nursing actions. Implements interventions that are delegated, ordered, or prescribed by a licensed healthcare provider. Delegates nursing tasks or assigns nursing activities to implement the plan of care. Provides safe and effective nursing care. Promotes a safe and therapeutic environment. Advocates for the best interests of individual patients. Evaluates responses to interventions and the effectiveness of the plan of care. Collaborates and coordinates with other healthcare professional in the management and implementation of care within and across care settings and communities. Provides health promotion, disease prevention, care coordination, and case finding. Designs and implements teaching plans based on patient need, and evaluates teaching effectiveness. Participates in the development of healthcare policies, procedures, and systems. Accountable for the quality of care delivered, recognizing the limits of knowledge and experience; addresses situations beyond the nurse’s competency; and performs at the level of education, knowledge, and skill ordinarily expected of an individual who has completed an approved professional nursing education program. Manages, supervises, and evaluates the practice of nursing. Maintains OMC organization competencies and nursing competencies pertinent to area of practice. Manages information in accordance with state and federal regulations. Assists with training of new staff and ongoing training of staff. Performs medical documentation and phone triage per OMC policies. Provides approved education information to the patient and other care team members based on medical conditions and accurately documents information in the patient chart.
At ConcertoCare, we believe seniors and older adults with complex care needs deserve a more holistic, equitable, and compassionate approach to health and wellness. ConcertoCare is a provider of team-based, at-home care focused on seniors and other adults. Our goal is to take a human-first approach to orchestrate care for the country’s most medically complex patients. We know that providing care for loved ones requires trusted partners—we’ve redefined how we manage and deliver at-home care, and our company culture reflects our mission-driven team that’s committed to providing compassionate, quality care to our patients.
The ConcertoCare Market Registered Nurse provides virtual clinical care and clinical navigation support for our patients to ensure they get the right care, in the right place, by the right person, and at the right time. Key activities include patient evaluation and management, clinical triage, patient and caregiver education, and support for care coordination in partnership with the provider and extended care team. This position reports to the Practice Manager with clinical oversight from the Medical Director. This is an ideal position for a registered nurse who seeks an opportunity for “top of license” clinical practice, enjoys a collaborative multidisciplinary team-based approach to care, and is excited to engage in developing and nurturing our innovative, value-based clinical model focused on caring for patients with complex needs who are inadequately served by traditional healthcare delivery systems. This exciting role allows you to deliver clinical care, virtually from your own home, with the support of clinical providers, community health workers, medical assistants, nurse case managers, clinical social workers, and clinical pharmacists. This position also affords professional development via dedicated clinical education programming and real-time support from our on-staff world-class experts in geriatric medicine, palliative care, geriatric psychiatry, clinical pharmacy, care management, and social determinants of health and health equity.
Bachelor’s degree in Nursing and/or commensurate clinical experience. Active nurse licensure in the state of California in good standing or must be willing to obtain a California license upon hire. Unencumbered multistate license preferred or compact licensure eligible highly preferred. Recent telephonic triage, urgent care, or ER/ED experience required. Clinical experience caring for aging adults and adults with complex care needs required. Advanced training in geriatrics and/or palliative medicine preferred. Previous experience with managed care and/or value-based healthcare delivery preferred. Average to advanced computer and software skills required.
Provision of compassionate, individualized, and holistic patient care that aligns with our value-based care delivery model, reflects appropriate patient risk stratification, integrates with multidisciplinary team-based care, and identifies and addresses gaps in care. Delivery of exceptional clinical care, guidance, and education virtually with a focus on urgent needs for rising-risk patients and chronic condition management for high-risk patients. Emergent and urgent telephonic triage to ensure our patients receive the right care, in the right place, at the right time. Care coordination for acute needs and/or limited duration needs for patients who are not receiving formal transitions of care and/or longitudinal case management support. Development, implementation, and modification of individualized action plans for patients to improve clinical outcomes. Clinical supervision for licensed practical nurse (LPN) and/or medical assistant (MA) activities as requested. Accurate and timely documentation in the medical record of all patient care activities. Integration of clinical practice, data dashboards, and operational processes that support the achievement of company performance goals into daily clinical approaches and workflows. Promotion of and participation in patient engagement and experience initiatives and efforts. Active participation in care team huddles, operational huddles, organizational meetings, and clinical partnership meetings as requested including preparation and follow-up activities. Adherence to medical policies, protocols, criteria, and clinical guidelines to ensure best practices are maintained for clinically effective and efficient care delivery. Adherence to compliance policies, procedures, and standards of conduct including all applicable laws and regulations. Other market-specific duties as assigned.
Delivering smart solutions with an eye on People, Process, and Technology Our team is comprised of individuals rich with recruiting experience, technology knowledge, and customer service. Dedicated to their community, clients and associates, these individuals have a common mantra: “We will make it happen, deliver on our promises and manage every detail along the way.” Our internal slogan of P.R.I.D.E. (Putting Remarkable Into Daily Efforts) is our driving focus. Our skilled associates, led by this team of professionals, enable organizations to achieve their business and personnel needs both quickly and cost effectively.
As a Clinical Reviewer, you will use your clinical background to review medical records and support accurate, timely determinations, helping ensure consistency with established guidelines and program requirements. This role may also support comprehensive behavioral health assessments for children and adolescents, contributing to level-of-care determinations and service eligibility decisions within statewide healthcare programs. This full-time, remote position requires a Maine license and offers the opportunity to apply your clinical expertise in support of statewide healthcare programs.
Required Qualifications: Active, unrestricted LCPC or LCSW license. Must hold an active license in the State of Maine. Experience with medical record review and clinical documentation. Working knowledge of medical terminology. Strong written and verbal communication skills. Preferred Qualifications: Experience supporting public sector or government healthcare programs. Strong organizational skills with the ability to manage multiple priorities. Comfortable working in a remote, production-driven environment. Proficiency with Microsoft Office (Word, Excel, Outlook) and web-based systems.
Conduct or support behavioral health assessments for pediatric populations, including evaluating functional needs, risk factors, and clinical history. Contribute to level-of-care determinations and eligibility decisions for moderate to high-intensity behavioral health services. Review and synthesize clinical, behavioral, and psychosocial information to support comprehensive assessment outcomes and care planning. Review assigned cases for accuracy, completeness, and timeliness in alignment with program requirements and regulatory standards. Manage daily caseload and prioritize work to meet established turnaround times. Apply clinical guidelines and criteria to support consistent, well-documented determinations. Participate in quality assurance and continuous improvement efforts. Stay current on clinical standards, regulatory updates, and review criteria. Communicate with providers as needed to clarify information and support issue resolution. Handle a variety of review types based on business needs. Collaborate with internal teams to ensure efficient workflow and consistent outcomes. Participate in training, team meetings, and ongoing professional development. Follow all company policies, including strict adherence to HIPAA privacy and security requirements.
Delivering smart solutions with an eye on People, Process, and Technology Our team is comprised of individuals rich with recruiting experience, technology knowledge, and customer service. Dedicated to their community, clients and associates, these individuals have a common mantra: “We will make it happen, deliver on our promises and manage every detail along the way.” Our internal slogan of P.R.I.D.E. (Putting Remarkable Into Daily Efforts) is our driving focus. Our skilled associates, led by this team of professionals, enable organizations to achieve their business and personnel needs both quickly and cost effectively.
If you’re an experienced RN or LCSW looking to make a meaningful impact beyond crisis care, this role offers the opportunity to support at-risk youth and help prevent unnecessary residential placements—while using your clinical judgment and working collaboratively across systems. As an Integrated Care Manager, you’ll partner with providers, families, and community organizations to coordinate care, influence treatment decisions, and improve long-term outcomes.
Active, unrestricted RN or LCSW license in Virginia 2+ years post-degree experience in intensive care management or behavioral health settings Strong clinical assessment, critical thinking, and communication skills Familiarity with InterQual and/or ASAM guidelines Basic proficiency in Microsoft Office
Conduct initial and ongoing clinical reviews for youth at risk of residential placement Assess medical necessity and effectiveness of behavioral health and substance use services Collaborate with interdisciplinary teams on care planning and discharge strategies Partner with DSS, CSBs, schools, and community providers to ensure coordinated support Participate in quality improvement initiatives and provider network development
As part of the SCP Health team, you have an opportunity to make a difference. At our core, we work to bring hospitals and healers together in the pursuit of clinical effectiveness. With a portfolio of over 8 million patients, 7500 providers, 30 states, and 400 healthcare facilities, SCP Health is a leader in clinical practice management spanning the entire continuum of care, including emergency medicine, hospital medicine, wellness, telemedicine, intensive care, and ambulatory care. Why you will love working here: Strong track record of providing excellent work/life balance. Comprehensive benefits package and competitive compensation. - Commitment to fostering an inclusive culture of belonging and empowerment through our core values - collaboration, courage, agility, and respect.
SCP Health is a team of clinical specialists serving patients, clinicians, and communities nationwide in emergency, hospital, and critical care medicine and beyond. We partner with hospitals and health systems to deliver high-quality patient care. Our history SCP Health was founded on a vision of finding a better way to deliver better care. From that strong foundation and with a deliberate roadmap for advancing clinical and operational capabilities, we have continued to grow and evolve. Today, as one of the largest health care partners in the country, we continue to live the aim of our physician founders – serving patients in moments that matter.
Knowledge, Skills, and Abilities: Must have excellent verbal and written communication skills with patients and all members of the healthcare team. Must have excellent organizational skills and ability to complete competing priorities Must have advanced computer skills. Must be team oriented. EDUCATION (Required and/or Preferred): High School Diploma – Required FIELD OF STUDY: Nursing-LPN WORK EXPERIENCE/QUALIFICATIONS: LPN bedside nursing experience Home Health, Med Surg, or Emergency Department experience preferred REQUIRED LICENSES: LPN License Multistate License issued under the NLC (Nurse Licensure Compact) LOCATION: Remote Role (SCP-Home Based) Must reside in Louisiana and able to work Eastern time zone (shift starts at 8:30am EST)
Provide telephonic clinical assessment, nursing triage, health information and patient education to a wide variety of patients across the health continuum and/or health education to culturally diverse population recently discharged from in-patient admission Assists in directing patients to the most appropriate level of care. Work closely with other members of the team to ensure adequate coordination. Ability to use critical thinking skills and respond quickly and professionally under stressful, sometimes emergent situations. Adheres to and participates in the Care Management process. Provide outbound follow-up calls as necessary. All other duties as assigned.
Established in 1998, BCforward, a Black-owned firm headquartered in Indianapolis, IN, pioneers workforce management and digital product delivery solutions globally. With a team of 6,000+ consultants across the world, they champion human potential, guided by core values of People-Centricity, Excellence, and Diversity. As a market leader, BCforward provides a best-in-class workplace, emphasizing equal opportunity employment and fostering a culture of accountability and optimism.
Job Title: Transition Specialist Location: Remote – Indiana (IN) Duration: Temporary (7+ Months) Pay Rate: $20.00/hour (W2) Schedule: Monday – Friday, 8:00 AM – 5:00 PM EST (Overtime may be available based on business needs) We are seeking a highly organized and detail-oriented Transition Specialist to support the coordination and management of member transitions across various levels of healthcare services. This role plays a critical part in ensuring members experience smooth, timely, and well-supported transitions within the healthcare system.
Required Qualifications: Bachelor’s degree or equivalent relevant experience 2–4 years of related experience in healthcare coordination or similar field Strong organizational and time management skills Proficiency in Microsoft Excel Ability to collaborate effectively across teams and departments Preferred Qualifications: Experience in care coordination, case management, or healthcare transitions Knowledge of healthcare systems, services, and member support processes Pay: $20.37 per hour Experience: Behavioral health: 2 years (Required) Inbound & outbound calling: 2 years (Required) Location: Indiana (Required) Work Location: Remote
Collaborate with care coordination teams, providers, and healthcare professionals to develop and implement effective transition plans Support the transition of members based on enrollment or changes in care services Identify new members requiring transition services in partnership with care management teams Ensure continuity of care by honoring existing authorizations and resolving transition-related issues Educate members, families, and caregivers on services, requirements, limitations, and exclusions Track and maintain transition metrics, including member assessments and transition volumes Assist in developing care plans and transition strategies for optimal member outcomes Contribute to the creation of educational materials and training programs for staff and providers Coordinate communication between members, caregivers, and healthcare providers Document all transition-related activities accurately and in compliance with policies Perform additional duties as assigned
Prevounce is a leader in remote care management, revolutionizing healthcare delivery to improve patient outcomes and lower costs. Founded by a multidisciplinary team of physicians, practice managers, and attorneys, our proprietary software, smart devices, and highly integrated services deliver an efficient, patient-focused, and fully compliant user experience for our partners and clients. We are rapidly growing and expanding our impact across the healthcare landscape.
Must Reside in one of these states: MI / IN / FL / MA / CO / GA / AZ / OH/ IL/ NM / TX / NC / TN The Opportunity: We are seeking dedicated and compassionate Care Managers to join our growing team. This is an exciting time to contribute to a company at the forefront of remote care, where your work directly impacts patient engagement and improves health outcomes. As a Care Manager, you will serve as a vital advocate for our patients, utilizing your clinical insight and communication skills to make a real difference. The Role: We are looking for a dedicated care managers who can be a compassionate communicators and advocates for our patients. Clinical work as an LPN, RN, LSCW, LSW, MA, or EMT is appreciated. As we grow at this exciting time, we are searching for qualified candidates, who are excited about improving patient engagement and increasing better outcomes. The Care Manager role will be responsible for patient communication and outreach programs, as well as reading and reviewing patients’ vitals data. This position will also have interactions with the client and patients’ clinical staff. This role will work closely with Prevounce’s care team and will report directly to the Manager of Care Management.
Skills: Exceptional Communication: Proven ability to communicate complex information clearly and empathetically with patients, families, and clinical staff. Patient Advocacy: Demonstrated patience, empathy, and a nuanced understanding of patient engagement, particularly with chronic conditions. Clinical Acumen: Strong understanding of chronic conditions and the ability to follow and implement care plans. Technical Proficiency: Experience with Electronic Health Records (EHRs) and a willingness to quickly learn new software and technology tools. Organizational & Time Management: Excellent organizational skills and efficient time management to handle a dedicated patient panel. Healthcare System Knowledge: Clear understanding of the U.S. healthcare system, including physician practice workflows and operations. Team Collaboration: A collaborative spirit with a strong commitment to team participation and shared goals. Education and Requirements: A minimum of 3 years of experience in a healthcare setting, or at least with 1+ year(s) experience in case management, care coordination, or remote patient monitoring is preferred. Previous clinical work as a LPN, MA, EMT is preferred Any training or education in Nursing, Social Work, Hospital Administration, or another directly related clinical field is appreciated Call center communication work with patients work experience is preferred Previous Experience at a physician group or provider is appreciated Compliance: This position requires full compliance with all applicable healthcare laws and statutes (local, state, and federal) and Prevounce Health policies and procedures. The Care Manager must respect clients and their patients by recognizing their rights, maintaining confidentiality, and working tirelessly to earn and keep their trust. Each team member is expected to perform all duties and demonstrate behaviors and attitudes consistent with Prevounce Health’s Mission Statement and Core Values.
Proactively conduct inbound and outbound calls, serving as a compassionate communicator and advocate for patients and their families. Build strong rapport and maintain lasting relationships with a dedicated patient panel. Identify and address barriers to care, well-being, environmental factors, and social determinants of health. Proactively educate patients on improving quality of care and self-management skills. Read, monitor, and report to Physicians (via escalation protocols) vital signs and health data. Accurately input and maintain comprehensive patient records, ensuring compliance and reporting requirements are met. Adhere strictly to patient chronic condition care plans and disease-specific protocols as defined per clinic and patient cohort. Follow client-specific guidelines and notification preferences for reporting patient updates and abnormal results to provider teams. Collaborate with the care team to optimize outreach efficiency and enhance patient interactions. Ensure strict adherence to all HIPAA regulations and healthcare laws (local, state, federal).
Vivo HealthStaff is a healthcare consulting firm specializing in clinical staffing, healthcare program development, and telemedicine implementation. Based in the San Francisco Bay Area, we provide physicians, nurse practitioners, and behavioral health staffing to healthcare organizations nationwide.
Vivo HealthStaff is recruiting Multi-State licensed Telemedicine Nurse Practitioners for a national, tech-enabled medical group delivering comprehensive adult care through telemedicine.
Looking for clininicians with 40% of US licenses - 20 or more Minimum 1 year of telemedicine experience Comfortable using EMR systems and digital health tools; experience w/ Athena is a plus Passionate about modern healthcare delivery and virtual care innovation
Provide virtual primary care to adult patients across multiple states Utilize digital tools, including AthenaHealth, to manage clinical workflows Support the development of innovative, patient-centered care pathways Hours: Part-time to full-time hrs (Min hours is 20 hrs/wk; No max cap) Schedule: Flexible schedules available; choose 4–6 hours blocks between 7 AM–7 PM MT on weekdays, 10-2PM on weekend, and evening expansion underway. Type: 1099 contractor; 20hours/week minimum expected commitment.
Arima Health is a rapidly growing virtual care provider focused on diagnosing and treating sleep-related conditions at scale. Our mission is to make high-quality sleep care accessible to patients across the U.S. through cutting-edge virtual platforms and expert clinical support.
Employment Type: Part-Time or Full-Time | Contract (1099) Location: Fully Remote Start Date: Immediate We are seeking Nurse Practitioners (NPs) with extensive multi-state licensure to support our expanding telehealth services. This role can be structured as a 1099 contract or employed position, depending on availability and fit. In this position, you will conduct remote patient visits, assess and treat sleep-related conditions such as insomnia and sleep apnea, and work alongside a distributed clinical team.
Nurse Practitioner (NP) with 30+ active U.S. state licenses Experience with telehealth or virtual care delivery preferred Background or exposure to sleep medicine, pulmonary care, or behavioral health is a plus Strong communication skills and comfort with digital tools Ability to work independently in a remote setting
Perform virtual patient consultations using our telehealth platform Evaluate symptoms and develop appropriate treatment plans Manage and monitor sleep-related conditions Complete documentation accurately and in a timely manner Work collaboratively with physicians and care team members
Lumina Care is focused on unifying, coordinating, and managing care for geriatric patients in nursing facilities and at home. We offer a range of services to improve health outcomes and quality of life for patients, including afterhours telehealth, transitional care, chronic care, remote patient monitoring, behavioral health, and telehealth psychiatry.
Job title: After Hours Telehealth Clinician Purpose: We are seeking a Nurse Practitioner or Physician Assistant to join our after-hours team as a fully remote clinician, providing medical care via telemedicine to patients residing in skilled nursing facilities. Schedule: Evening shift: Weekdays, 5:00 PM - 8:00 PM Night shift: Weekdays, 8:00 PM - 8:00 AM Day shift: Weekends, 8:00 AM - 8:00 PM Night shift: Weekends, 8:00 PM - 8:00 AM
Active and unrestricted state licensure in a minimum of five states and willingness to obtain additional if requested. Collaborative practice agreements will be supplied by Lumina Care as required. When a Nurse Practitioner meets requirements and becomes eligible for autonomous practice in an autonomous state, they will be required to complete the autonomous process and the collaborative practice agreement will be ended. Active and unrestricted Advanced Practice Nurse, National Board certification (AANP, ANCC or AACN) OR active and unrestricted Physician’s Assistant NCCPA board certification. Active DEA licensure, or willingness to obtain in the states of practice is required upon hire. Must have an active national provider number (NPI). Must have active Medicare & Medicaid provider numbers, or willingness to obtain them upon hire. Must be eligible to participate in the Medicare & Medicaid programs as a provider Working conditions: A quiet home work space and a functional computer are required for this remote role. Typing is required, as well as using virtual technology to visualize patients during visits. Periods of prolonged sitting or standing can be expected. The ability to work weekends, nights, and holidays is required. Travel requirements could occur based on specific state licensure.
Deliver comprehensive clinical care, including acute care, through virtual care delivery platform, ensuring the wellbeing of patients. Maintain professionalism adhering to company dress code and policies. Educate patients on recommended treatments and personalized care plans for their specific health needs. Oversee patient follow-ups for ongoing care programs, ensuring continuity and effectiveness of treatment. Prescribe & deprescribe medication, as well as provide timely refills, ensuring patients have necessary medications. Collaborate with other healthcare professionals to provide patient care. Maintain accurate and up-to-date medical records. Document in real time with scribe support. Complete company education as assigned. Must be aligned with company goals, mission, vision, and values.
Imagine Pediatrics is a tech enabled, pediatrician led medical group reimagining care for children with special health care needs. We deliver 24/7 virtual first and in home medical, behavioral, and social care, working alongside families, providers, and health plans to break down barriers to quality care. We do not replace existing care teams; we enhance them, providing an extra layer of support with compassion, creativity, and an unwavering commitment to children with medical complexity.
The primary location for this position is remote (EST required) with quarterly travel to Tampa, FL. Expected schedule will be 3x12s (Monday-Wednesday or Wednesday-Friday) 7:00am-7:00pm EST. Nurses must physically be working in the United States. What You'll Do: As a Pediatric Registered Nurse at Imagine Pediatrics, you are the primary point of contact for our families as you work to deeply know our patients through frequent virtual touchpoints and are the first line of defense when our patients are having a clinical problem. You leverage an integrated technology platform and are complimented by an entire interdisciplinary team including MDs, APPs, social workers, navigators, pharmacists, and dietitians.
First and foremost, you're passionate and committed to creating the world our sickest children deserve. You want an active role in building a diverse and values-driven culture. Things change quickly in a startup environment; you accept that and are willing to pivot quickly on priorities. In this role, you will need: Licensed RN in at least one state with eligibility to register for other state licensures. Bachelor's in nursing from an accredited university required. Pediatrics experience required in outpatient (primary care and/or subspecialty), home health, complex care, pediatric ICU, emergency medicine, etc. Minimum 1 year care coordination or case management experience preferred. Bilingual Spanish preferred Familiarity with Medicaid regulations and services a plus Value Based Care (VBC) experience a plus Virtual care experience a plus
Provide professional and friendly proactive care and triage for clinical issues. Embed a family centered care philosophy in care delivery. Demonstrate cultural competence and sensitivity as ability to work with culturally diverse populations and seek out additional resources when needed. Transition of care for ED/IP/UC care coordination with clinical providers following discharge. Perform a comprehensive assessment of a patient's clinical, psychosocial, discharge planning and financial needs. Establishes clinical milestones and goals related to these issues. Establish rapport and a relationship with the patient and family in order to understand their needs and expectations and to assist them in setting realistic and mutual goals. Integrate an awareness of cultural factors in the patient/family interview process and elicit clinically relevant cultural information. In conjunction with the physician, the patient and interdisciplinary team, establishes a comprehensive plan of care to appropriately address clinical milestones. Communicate plan of care, including changes and issues related to plan of care to patient/family, physicians and other members of the healthcare team. Gather sufficient information from all relevant sources to determine the effectiveness of the plan of care to assure it is done in an accurate, safe, timely and cost-effective manner. Document all care management assessments and interventions. Refer to Social Worker or Behavioral Health for complex psychosocial and discharge planning issues (per criteria) and ensures appropriate follow-up. Consults with other members of the interdisciplinary team (dietary, pharmacy, etc.) to provide safe discharge as appropriate. Perform other duties as assigned
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 Registered Nurse, Telehealth is responsible for providing telephonic triage directional patient care advice for general and specific illnesses, health related issues, client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. The incumbent in this role provides remote clinical advice and assessments within license and as possible given the technology and medium. He/She collaborates with primary caregivers and others on the interdisciplinary care plan team to provide a team approach of care. The schedule for this position is as follows: Wednesdays 1630-0430 Fridays 1700-2100 Saturdays 0800-2000 Sundays 0830-2030
KNOWLEDGE, SKILLS AND ABILITIES: Advanced-level business acuity In-depth knowledge and understanding of general/core Nursing-related functions, practices, processes, procedures, techniques and methods Broad nursing knowledge and understanding Ability and willingness to provide extraordinary customer service and professionalism to all customers Maintains current nursing knowledge and competency to stays abreast of budding nursing trends and best practices Excellent written and verbal communication skills through a variety of formats, tools and technologies Capable of building trust and professional relationships to deliver VIP care across the continuum Ability to demonstrate excellent clinical judgement Ability to problem solve Ability to prioritize and work under pressure Ability to provide constructive feedback Ability to effectively collaborate with physicians, patients, family members, colleagues and other team members in a courteous and professional manner Ability to effectively collaborate with a multidisciplinary team Proficient skill in Microsoft Office Suite products including Excel, Word, PowerPoint and Outlook; competent in other systems required for the position Ability and willingness to travel locally, within South Florida, to attend meetings and trainings up to 10% of the time; flexible and available to cover after-hours and to work weekends as needed Spoken and written fluency in English; bilingual (Spanish/Creole) a plus This job requires use and exercise of independent judgment EDUCATION AND EXPERIENCE CRITERIA: Associate Degree in Nursing required, Bachelor’s Degree in Nursing preferred Nurse Licensure Compact required; Multistate Nursing license required Must reside within the Continental United States within a state where the company exists as a legal entity Michigan and Illinois Nurse Licensure required within 90 days of hire, ability to obtain additional licenses as requested by the organization within 90 days of hire Basic Life Support (BLS) certification from the American Heart Association or American Red Cross required Minimum of 3 years acute clinical nursing work experience required in emergency services, urgent care, or with emergency triage responsibilities highly preferred Minimum of 1 year virtual care experience preferred
Connects with patients via phone or video call. Interviews and questions patients to collect health history and uses a computer system to record and store comprehensive and focused data relating to the health needs of patients and families. Provides health assessment and treatment solutions, monitors patient health and at-home care, aids in emergency scenarios and promotes patient wellness. Based on the technology available, monitors a patient’s oxygen levels, heart rate, respiration, blood glucose and other assessment measures. With the help of video chatting, identifies patient’s symptoms and conditions. Analyzes data to determine the appropriate health maintenance and identify appropriate outcome for the patient and family. Collaborates with on-call PCP as needed to support expected clinical outcomes. Implements the appropriate protocol to attain the expected outcome. Evaluates and documents progress toward the anticipated outcome. Assists in ensuring achievement of optimal patient outcomes through use of Telemedicine. Documents interventions in readable, understandable language. Aids in enhancing the quality and effectiveness of the organization’s telehealth practices and professional nursing practice through successful utilization and improvement of outcomes that demonstrate program effectiveness. Utilizes appropriate resources to plan and provide services that are safe, effective and fiscally responsible. Performs other duties as assigned and modified at manager’s discretion.
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 Supervisor, Advanced Practice Providers (APP), CareLine is responsible for overseeing diagnostic patient care primarily through virtual, remote consultation via video conference or telephone delivered by a remote team of RNs and APPs. The incumbent in this role serves as the supervisory authority for after-hours and weekend clinical calls in their assigned pod. They are further accountable for assessing, diagnosing, treating and precisely documenting patients' physical and psychosocial health status through the collection of health data while operating in a clinical function.
KNOWLEDGE, SKILLS AND ABILITIES: Expert-level business acuity Expert knowledge and understanding of general/core job-related functions, practices, processes, procedures, techniques and methods Knowledge and understanding of medical practices to function independently as a certified practitioner and in collaboration and consultation with licensed physicians, specialists and other medical providers Demonstrated record of consistently achieving clinical performance metrics Technical capability to conduct telemedicine visits in accordance with state and federal regulations Ability to demonstrate excellent clinical judgement Ability to problem solve Ability to prioritize and work under pressure Ability to provide constructive feedback Ability to communicate and collaborate with physicians, patients and other team members in a professional manner Ability to operate effectively with a multidisciplinary team Proficient skill in Microsoft Office Suite products including Excel, Word, PowerPoint and Outlook; competent in keyboarding and other systems required for the position Must be available to work evening, weekends and holidays Spoken and written fluency in English; bilingual (Spanish/Creole) a plus This job requires use and exercise of independent judgment Acquires knowledge and skills to maintain expertise in area of practice. EDUCATION AND EXPERIENCE CRITERIA: 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. Basic Life Support (BLS) certification from the American Heart Association (AMA) or American Red Cross required within first 90 days of employment. For NPs: Board certification by AANP (American Association of Nurse Practitioners) or ANCC (American Nurses Credentialing Center) required. Must reside within the Continental United states and within a state where the company is establised as a legal business entity Multi state licensure to include FL, VA, and at least 2 licenses in the following states: GA, KS, MI, MO, OH, PA, TN, TX, IL, KY, LA. A minimum of 3 years of leadership experience is required. A minimum of 3 years acute/primary care clinical work experience required. A minimum of 2 years telehealth work experience highly preferred Ability to travel 25% of the time within the United States is required Weekend availability required
Coordinates services with other programs, including other COEs and Center-based clinical teams. Evaluates and develops programs to improve clinical operations. Develops and oversees APP during regularly scheduled shifts; managing workflow. Assist/manage team schedules. Educates colleagues and/or trainees and serves as a preceptor/mentor/trainer. Participates with and/or leads committee(s) to support growth/development. Provides feedback regarding the practice of others to improve patient care. 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. In collaboration with the Manager owns talent lifecycle of Registered Nurse population including selection, training, development, building engagement, and performance management. 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. Leads efforts to ensure 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 Performs other duties as assigned and modified at manager’s discretion.
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 Registered Nurse 1, Care Line, is responsible for providing telephonic triage directional patient care advice for general and specific illnesses, health related issues, client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. Providing on-call coverage, the incumbent in this role provides remote clinical advice and assessments within license and as possible given technology and medium. The registered nurse collaborates with primary caregivers and others on the interdisciplinary care plan team to provide a team approach of care. The schedule for this position is as follows: Wednesdays Thursdays and Fridays 0430-0830 Saturdays 0800-2000
Associate Degree in Nursing required, Bachelor’s Degree in Nursing preferred Nurse Licensure Compact multistate license required Michigan and Illinois Nurse Licensure required within 90 days of hire, ability to obtain additional licenses as requested by the organization within 90 days of hire Basic Life Support (BLS) certification from the American Heart Association or American Red Cross required Minimum of 3 years acute clinical nursing work experience working in emergency services, urgent care, or geriatric care highly preferred Minimum of 1 year virtual care experience preferred Must reside within the Continental United States where company is established as a legal business entity
Connects with patients via phone or video call. Interviews and questions patients to collect health history and uses a computer system to record and store comprehensive and focused data relating to the health needs of patients and families. Provides health assessment and treatment solutions, monitors patient health and at-home care, aids in emergency scenarios and promotes patient wellness. Based on technology available, monitors a patient’s blood oxygen levels, heart rate, respirations, blood pressure and blood glucose as well as other assessment measures. With the help of video chatting, identifies patient’s symptoms and conditions. Analyzes data to determine the appropriate health maintenance and identify appropriate outcomes for patient and family. Collaborate with on-call providers as needed to support expected clinical outcomes for the patient and family. Evaluates and documents progress toward the anticipated outcome. Assist in ensuring achievement of optimal patient outcomes using Telemedicine. Documents interventions in a readable, understandable language. Aids in enhancing the quality and efficacy of the organization’s telehealth practices and professional nursing practice through successful utilization and improvement of outcomes that demonstrate program efficacy. Utilizes appropriate resources to plan and provide services that are safe, effective and fiscally responsible. Performs other duties as assigned and modified at manager’s discretion.
VirtuAlly is an innovative virtual care company based in Charleston, South Carolina, experiencing rapid growth as we transform healthcare delivery. Our virtual nursing model supports patients and care teams during critical moments of care, enhancing safety, efficiency, and quality outcomes. Our work is guided by our core values: Be Authentic, Be Compassionate, Celebrate, and Aspire.
We are seeking a highly experienced, detail-oriented, and tech-savvy Registered Nurse to serve as a Virtual Emergency Department Triage Nurse. In this remote role, you will support Emergency Department operations through two-way audio and video technology by conducting virtual triage assessments, supporting clinical decision-making, and reducing documentation burden for bedside teams. This position is ideal for emergency nurses who thrive in fast-paced environments and are passionate about improving patient flow, safety, and outcomes through virtual care.
Active, unrestricted South Carolina RN license OR a valid, active multistate compact RN license issued by South Carolina or North Carolina Current Basic Life Support (BLS) certification (ACLS preferred, if applicable) Minimum of 5 years RN experience, with at least 2 years in Emergency Department or acute care settings Strong clinical assessment and critical thinking skills in high-acuity environments Ability to multitask and make rapid, sound clinical decisions Technical proficiency with EMR systems and multiple software applications Ability to work independently from a designated, private home workspace
Conduct virtual triage assessments for Emergency Department patients using established acuity scales (e.g., ESI or facility-specific protocols) Perform rapid, focused patient assessments to determine acuity level, clinical risk, and urgent care needs Support early identification of clinical deterioration, including sepsis, stroke, and other time-sensitive conditions Collaborate in real time with bedside nurses, providers, and ED leadership to support safe patient prioritization and throughput Complete and/or support triage documentation, nursing assessments, and ED intake documentation within the EMR Review EMR data to ensure completeness, accuracy, and compliance with Emergency Department quality measures Assist with medication reconciliation, allergy verification, and initial safety screenings Provide patient and family education regarding ED processes, wait times, and next steps in care Support standardized workflows to reduce left-without-being-seen (LWBS) events and improve patient experience Practice in alignment with VirtuAlly’s core values and evidence-based emergency nursing standards
At Cottingham & Butler, we sell a promise to help our clients through life’s toughest moments. To deliver on that promise, we aim to hire, train, and grow the best professionals in the industry. We look for people with an insatiable desire to succeed, are committed to growing, and thrive on challenges. Our culture is guided by the theme of “better every day” constantly pushing ourselves to be better than yesterday – that’s who we are and what we believe in. As an organization, we are tremendously optimistic about the future and have incredibly high expectations for our people and our performance. Our ability to grow as a company, fuels investments in new resources to better serve our clients and provide the amazing career opportunities our employees want and deserve. This is why we are a growth company and why we are committed to being better every day.
Location: Onsite in Dubuque, IA. Also accepting remote applicants. We are seeking a compassionate and detail-oriented Bilingual RN Case Manager to join our team. This role is responsible for delivering comprehensive case management services across the continuum of care. The RN Case Manager will assess, plan, implement, coordinate, monitor, and evaluate care for assigned consumers, ensuring quality outcomes and cost-effective treatment. This role is based in our Dubuque office and is also available remotely.
Bilingual: the ability to speak Spanish Education: RN licensure in the State of Iowa required. BSN or higher preferred. Experience: Minimum 2 years of clinical practice. Case management or utilization review experience strongly preferred. Skills: Strong communication, problem-solving, and computer skills. Ability to work independently.
Provide telephonic case management and utilization review for assigned consumers. Develop, implement, and monitor individualized care plans to ensure quality and cost-effective outcomes. Collaborate with healthcare providers, payors, and internal teams to coordinate care. Serve as a liaison between consumers and benefit administrators, ensuring clear communication and support. Track and report case outcomes, including cost savings and quality improvements.
Progyny (Nasdaq: PGNY) is a global leader in women’s health and family building solutions, trusted by the nation’s leading employers, health plans and benefit purchasers. We envision a world where everyone can realize dreams of family and ideal health. Our outcomes prove that comprehensive, inclusive and intentionally designed solutions simultaneously benefit employers, patients and physicians. Our benefits solution empowers patients with concierge support, coaching, education, and digital tools; provides access to a premier network of fertility and women's health specialists who use the latest science and technologies; drives optimal clinical outcomes; and reduces healthcare costs. Our mission is to empower healthier, supported journeys through transformative fertility, family building and women’s health benefits. Headquartered in New York City, Progyny has been recognized for its leadership and growth as a TIME100 Most Influential Company, CNBC Disruptor 50, Modern Healthcare's Best Places to Work in Healthcare, Forbes' Best Employers, Financial Times Fastest Growing Companies, Inc. 5000, Inc. Power Partners, and Crain's Fast 50 for NYC. For more information, visit www.progyny.com.
Progyny is looking for a Contact Center Manager who will be responsible for managing multiple supervisors, ensuring the achievement of service-level targets, operational efficiency, inventory management and overall customer satisfaction. This role involves planning, team development, and performance management.
5+ years of contact center experience, including 3+ years in a leadership role. Must hold a valid RN license, with Fertility or Labor and Delivery experience preferred Proven track record of improving customer service performance and efficiency Excellent communication and leadership skills Proven problem-solving and analytical skills Strong understanding of contact center technology, analytics, and metrics Please note: This is not a digital nomad or remote international position; candidates must be based in the United States. Progyny is unable to provide visa sponsorship for this position. Candidates must be authorized to work in United States without the need for sponsorship, now or in the future.
Manage the day-to-day operations of the contact center, ensuring that all member impacting processes and procedures are optimized. This individual will be leading both Clinical and non-clinical team members Develop and implement strategies to improve productivity, member satisfaction, and operational efficiency Communicate a clear and consistent message regarding departmental goals and company policies to produce desired results Support training and development initiatives for all contact center agents Analyze contact center data and generate reports for senior management on performance metrics Work closely with other departments to enhance cross-functional processes and resolve customer-related issues Drive continuous improvement initiatives within the contact center Attend and serve as a liaison in Member Services impacting meetings and cross-functional collaborations
Ethos is a new expert network built by a McKinsey/SoftBank/DeepMind team and backed by world-leading investors like General Catalyst. We connect experts with investors and consultancies for paid expert calls, speaking engagements, and advisory opportunities.
Note: This is a flexible, part-time opportunity that is 5-20 hours per week at $75 per hour (up to $1.5k/week). It can be done remotely and can be done both alongside or instead of full-time employment. We're working with a leading foundational AI lab to find experienced registered nurses who can help train their latest language model on clinical nursing tasks. We're looking for RNs with 5+ years of experience in acute care or specialty settings at top hospitals to create, evaluate, and refine AI-generated work across core nursing workflows: patient assessment documentation, care planning, clinical handoff notes, medication administration records, patient education materials, and incident reporting. Compensation: $75/hour Commitment: Flexible, up to 20 hours per week (up to $1.5k/week) Location: Fully remote, work on your own schedule Start date: April
Registered Nurse with 5+ years in acute care or specialty practice at a top hospital Strong clinical expertise and experience with complex patient populations Excellent written communication and attention to detail
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.
We’re Hiring: Registered Nurse – Independent Dispute Resolution (IDR) Remote | 🕘 Monday–Friday, 9:00 AM – 5:00 PM (flexibility available) Contract through September 30, 2026 We are seeking a detail-oriented and experienced Registered Nurse (RN) to support State and Federal Independent Dispute Resolution (IDR) processes. This role plays a critical part in ensuring accurate clinical reviews, fair determinations, and compliance with regulatory requirements.
Active New York Registered Nurse (RN) license (required) Bachelor’s Degree in Nursing (BSN) or graduate of an approved RN program Minimum of 2 years of clinical experience (inpatient or outpatient) Experience with electronic medical records (EMR) systems Strong analytical, problem-solving, and collaboration skills Excellent written and verbal communication Ability to work independently in a fast-paced, deadline-driven environment Adaptable, flexible, and solutions-oriented mindset What You’ll Bring: Clinical expertise combined with strong attention to detail Ability to interpret medical documentation and regulatory requirements A collaborative approach to working with cross-functional teams A passion for ensuring accuracy, fairness, and quality in healthcare determinations
Perform comprehensive clinical reviews through the appeal level, including chart screening and documentation analysis Compile regulatory guidance and research payer requirements Complete electronic worksheets and prepare final case determinations Support Medical Review Analysts and Physician Consultants in the IDR process Serve as a resource for clinical and administrative staff, offering guidance and clarification Provide training, mentoring, and onboarding support for new RNs Participate in team huddles, collaborative trainings, and process improvement initiatives Conduct claims assessment and adjudication Contribute to additional project activities as needed
At Prime Therapeutics (Prime), we are a different kind of PBM, with a purpose beyond profits and a unique ability to connect care for those we serve. Looking for a purpose-driven career? Come build the future of pharmacy with us.
Under supervision, is responsible for performing referral services to support independent physician offices with maintaining member drug infusions in office or to help offices locate a lower cost alternative treatment site (e.g., home infusion) for drug infusion services versus the hospital outpatient facility.Discusses financial and clinical considerations with members who are considering care at a higher cost treatment site, researches available financial programs to decrease members' out-of-pocket expense for drug services in office, and coordinates lower cost site of service for drug administration if provider is referring due to convenience factors (e.g., distance, non-typical infusing provider, etc.). Performs functions under supervision.
Minimum Qualifications: Bachelors - Nursing RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt 5 years of Clinical experience Must be eligible to work in the United States without the need for work visa or residency sponsorship Additional Qualifications: Registered Nurse (RN). 5 years of post-degree clinical experience. Experience in managed care, specialty drugs, care management and utilization review. Meets Credentialing criteria. At minimum must have current and active nursing license. Ability to apply knowledge in relation to clinical findings from evidence based guidelines. Ability to function independently and as a team member. Good organizational, time management and communication skills. Possesses the ability to achieve organizational goals through development of effective teams. Comprehensive clinical knowledge of medical specialty drugs and the management of those drugs. Understanding of the clinical aspect of the infusion of those drugs within various sites of service. Preferred Qualifications: 5+ years of Oncology Nursing experience 5+ years in Oncology Infusion
Provides site of service solutions to patients seeking care at non-preferred treatment sites (e.g., Hospital inpatient or outpatient facilities, non-par cancer treatment centers, etc.). Discusses the financial aspect of the specialty drugs to both the member and the ordering physician (or office staff) and to agree to find a lower cost versus higher cost sites of service, coordinating drug infusion at an alternate lower cost treatment site and coordinating concomitant services to support infusion administration in lower cost sites. Provides member with resources to optimize their treatment outcomes, by utilizing critical thinking skills and providing specific resources related to their complex illness. Actions include supporting member copay-assistance programs, research and coordination to decrease member out of pocket financial responsibility in an office or home setting for drug services. Will actively maintain a required case load and the activities to reach overall goals of switching site of service treatment to a lower cost setting while maintaining members' satisfaction during the process. Documents and enters data of these cases in web-based application and spreadsheets. Supports clinical services such as the appeals program. Participates in meetings and consults with management on regular basis to discuss member interaction and program outcomes. Maintains appropriate par levels of literature. Familiarizes self with community resources available, benefit information or any other information that is valued with the program. Maintains an active case load and accurate case records, adhering to all company policies and laws governing patient records including documentation of all daily activities. Performs related duties as requested. Clinical and Quality oversight for this program is provided by the Manager, Patient Programs.
Join PrairieCare: Transform Lives Through Meaningful Work! Are you ready to embark on a rewarding career in psychiatric healthcare? At PrairieCare, we are passionate about delivering exceptional mental health services to individuals in need. Our comprehensive approach covers the entire spectrum of care, creating a wealth of diverse roles for those who aspire to make a real impact. We believe in nurturing talent and fostering professional growth in a supportive environment. Here, you won’t just find a job—you’ll discover a fulfilling career path in the mental health field. If you're eager to contribute to a mission-driven organization and help change lives for the better, we invite you to join our dedicated team at PrairieCare. Together, we can make a profound difference in the lives of those we serve!
Are you passionate about making a difference in the lives of those with psychiatric illnesses? Do you thrive in a collaborative environment where your expertise can shine? If so, we have the perfect opportunity for you! What You'll Do: As our Behavioral Health Liaison, you will be the vital link between our dedicated clinical treatment team and third-party payers, ensuring that every patient receives the appropriate treatment they deserve. Your role will include:
At least two (2) years of work experience in the behavioral health field. Active license or credential in a behavioral health field preferred. Bachelor’s or Master’s in a behavioral health related specialty preferred.
Securing Authorizations: Obtain initial behavioral health authorizations and conduct thorough concurrent reviews to keep our patients on the path to recovery. Collaborative Decision-Making: Work closely with the clinical treatment team to assess the need for denial of stay when patients no longer meet acute care criteria, facilitating timely and appropriate actions. Stay Informed: Maintain an up-to-date understanding of contract requirements for all third-party payor groups, ensuring compliance and optimal patient care. Track Progress: Monitor each patient’s treatment journey through inpatient, partial hospitalization, and Intensive Outpatient Programs (IOP), ensuring they receive the best possible support. Cultural Competence: Bring your knowledge of gender, cultural differences, and age-appropriate care to the forefront of Utilization Review, enhancing our approach to diverse patient needs.
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.
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
We’re growing our network of clinical reviewers and are actively seeking Licensed Practical Nurse (LPN) 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. Qualifications: 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
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.
The Health Management Academy (THMA) brings together health system leaders and innovators to collectively address the industry’s biggest challenges and opportunities. By assisting executives in cultivating peer networks, understanding key strategic trends, establishing pragmatic partnerships, and developing next-generation leaders, our members are better positioned to lead industry transformation. The Health Management Academy offers a dynamic atmosphere with significant opportunities for employees. If you are interested in contributing to a member-centric, creative, and collaborative workforce while deeply influencing top leaders and institutions in healthcare, THMA could be the right place for you!
We are developing a mobile coaching app designed specifically for nurse managers — one that delivers AI-powered coaching, task assistance, role-play scenarios, skill assessments, and micro-learning modules grounded in real-world nursing leadership practice. Our content library covers a wide range of competencies including change leadership, quality management, accountability, conflict resolution, financial management, and psychological safety, aligned with AONL standards. We're looking for an experienced nurse leader to serve as a content reviewer and subject matter expert. Your role is to ensure our modules are accurate, practical, and genuinely useful to nurse managers navigating the realities of today's healthcare environment — not just theoretically sound, but field-tested in feel.
Experience: Minimum 5 years of experience as a nurse manager or in a comparable frontline nursing leadership role (e.g., charge nurse with management duties, assistant nurse manager, unit director) Direct experience managing nursing staff, overseeing unit operations and finance, navigating interdepartmental relationships, and working within hospital administration structures Familiarity with quality management processes, regulatory compliance, unit financial management, and staff performance management in a healthcare setting Inpatient management experience preferred Knowledge: Working knowledge of AONL nurse manager competencies or equivalent leadership frameworks Understanding of the unique pressures nurse managers face: staffing, shift coverage, staff engagement, communication up and down the hierarchy, budget constraints, etc. Writing & Communication: Strong written communication skills — you can revise a paragraph and hand it back clean, not just leave margin comments Functional, competent knowledge of basic grammar and punctuation standards Ability to write in a clear, direct, coaching-oriented voice appropriate for a mobile learning platform Comfortable working with structured content formats (e.g., scenario-based learning, reflection prompts, action steps) Nice to Have Experience in nursing education, staff development, or preceptorship Familiarity with use of large language models for AI-based content creation BSN required; MSN or other advanced degree preferred Logistics: Engagement type: Freelance / consulting contract Hours: Flexible; hourly rate or volume-based (paid per module reviewed) Timeline: We estimate this project will require 75-100 hours of work but can be flexible on time to completion depending on your availability. We would like the work to be completed by July 2026.
Review AI-drafted micro-learning modules (typically 300–600 words each) for clinical accuracy, role accuracy, and real-world applicability to the nurse manager audience Identify content that misrepresents the nurse manager's scope, authority, or day-to-day constraints — and recommend specific corrections Suggest examples, scenarios, or language that will resonate with frontline nurse managers Make direct edits and revisions to module drafts (not just notes — usable, publication-ready copy) Flag content that may be overly theoretical, hierarchically unrealistic, or inconsistent with how healthcare systems actually operate Provide input on new content topics and competency areas as the library expands
At the heart of health care, you’ll find Kaiser Permanente. As the nation’s leading not-for-profit, integrated health plan, we make a difference in the lives of members, patients, and communities across the country. With 39 hospitals and more than 734 locations in eight states and the District of Columbia, we proudly serve more than 12.7 million members from coast to coast. Whether you choose to join a hospital in the Northwest, a clinic in Southern California, or a medical office in the Mid-Atlantic, we have many opportunities for you to shape the future of care. Our teams are empowered to advance impactful and extraordinary care for all by pioneering health outcomes, encouraging diverse viewpoints, and creating new opportunities for learning and advancement. This covers more than our members and our employees; it also reaches far into our communities. Together, we’re proudly working as one for a healthier today and tomorrow.
Provides remote consultative and supportive nursing care to critically ill patients in the Intensive Care Units (ICUs) to multiple medical centers utilizing the in-room camera and EPIC technology from a remote, centralized hub. Collaborates with intensivists, hospitalists, MODs, nurses, respiratory therapists, and other staff to provide timely intervention for critically ill patients to achieve optimal patient outcomes. Guides, coaches, and assists the clinical team in the daily needs of critical care patients according to AACN guidelines.
Basic Qualifications: Minimum five (5) years minimum experience working in Intensive Care Units (ICUs). Education Bachelors degree in Nursing or related field. License, Certification, Registration Critical Care Registered Nurse Certificate within 12 months of hire OR Critical-Care Registered Nurse Knowledge Professional - Adult (AACN) within 12 months of hire OR Critical-Care Registered Nurse (Tele-ICU) - Adult (AACN) within 12 months of hire OR Critical-Care Registered Nurse Knowledge Professional - Pediatric (AACN) within 12 months of hire Registered Nurse License (California) Additional Requirements Demonstrates effective communication and listening skills. Communicating with patients, families, peers, and colleagues as appropriate, across a broad range of socio-economic and cultural backgrounds. Providing cultural sensitivity; identifying language barriers impeding understanding of patients condition. Showing sensitivity, honesty, and compassion in difficult conversations in collaboration with TCC physicians, ICU RNs, patients, and families. Displaying insight and understanding about emotions and human responses to emotions that allow one to develop and manage interpersonal interactions. Works effectively with others as a member or informal leader. Demonstrates professionalism when using audio/visual (AV) equipment or during phone consultation/support through Compassion, integrity, and respect for others, Respect for patient privacy, Sensitivity and responsiveness to a diverse patient population, including diversity in gender, age, culture, race, religion, disabilities, and sexual orientation, and Commitment to ethical principles & confidentiality at all times. Demonstrates conflict resolution and mediation skills with the ability to secure action from persons outside their supervision. Ability to think critically. Must be able to work in a Labor/Management Partnership environment. Preferred Qualifications One (1) year ICU supervisory or Clinical Nurse Specialist specializing in Critical Care. Masters Degree in Nursing or related field.
Performs video monitoring and assessment of ICU patient data. Performs safety oversight rounds. Collaborates with the TCC physician located in the remote hub to ensure timely consultation and intervention on ICU patients requiring immediate intervention Responds to requests by ICU RNs for nursing care consultation on ICU patients. Works remotely with bedside nurses in providing real-time, clinical decision support for ICU patients with conditions requiring immediate attention such as physiologic changes resulting from actions or inactions of the care team during evening and night shifts Collaborates in continuous performance improvement activities with remote interprofessional teams to achieve optimal patient and family outcomes. Leverages technology in gathering and evaluating quality metrics to measure and report on patients data. Reviews critical care quality metrics Provides consultation as a resource for education, assessment, and treatment of critical care patients Maintains knowledge of evidence-based practice and new recommendations from specialty nursing organizations (e.g., American Association of Critical Care Nurses) Identifies opportunities for improvement and reports this information to the Physician-in-Charge (PIC), Clinical Lead, and performance improvement teams Monitors practice to assure policies & procedures are in effect and takes appropriate actions and follows up as needed Co-leads and participates in regional committees Serves as a subject matter expert for critical care recommendations from various organizations (e.g., AACN, TJC) Develops strategies to ensure that performance improvement gains can be sustained over time. Serves as a resource to regional committees for P&P development, implementation, and dissemination.
Optum WA, (formerly The Everett Clinic) is seeking a RN Call Us First to join our team in Everett, WA. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone. At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.
Position in this function is under general supervision, the Staff RN/Consulting Nurse is responsible for providing telephone triage assessment to Primary Care patients by using state of the art telecommunications, information technology and approved protocols; to clients ensuring the efficient use of medical and nursing, facilities and equipment and to provide excellent customer service. Schedule: Week 1: Mon, Tues, Fri, Sat = 32 hours 10pm-7am PST and Week 2: Sun, Mon or Fri, Wed, Thurs = 32 hours 10pm-7am PST If you are located in the PST time zone, you will have the flexibility to work remotely* as you take on some tough challenges.
Required Qualifications: WA State RN license 3+ years of experience in a clinical setting (Med/Surg, critical care, ER, etc.), disease management, home health, discharge planning, utilization review, patient education and telephonic nursing Ability to work the following schedule: Week 1: Mon, Tues, Fri, Sat = 32 hours 10pm-7am PST and Week 2: Sun, Mon or Fri, Wed, Thurs = 32 hours 10pm-7am PST Preferred Qualifications: Bachelor of Science in Nursing American Academy of Ambulatory Care Nursing (AAACN) 1+ years of Call Center Nursing experience Case Management experience All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Utilizes clinical expertise and approved protocols to provide health advice to consumers with clinical questions and makes referrals for health services as appropriate via telephone Able to document calls in applicable system in a timely manner and exhibits a willingness to master new work routines and methods Documents all inquiries according to department standards for legal/statistical purposes Excellent written and verbal communication skills Able to problem solve issues independently as well as work with teams collaboratively situations require assessment, decision-making within the framework of established protocols, excellent listening and communication skills, knowledge of computers, critical thinking skills and the nursing process Speaks with a pleasant, professional phone voice and provides superior customer service to internal and external customers Ensures performance standards are met and accepts constructive feedback The Everett Clinic joined Optum in 2019, working together across the Puget Sound, the partnership means we're able to expand our services and locations to offer even more services. As we grow, we'll keep on giving you top-quality care, just as we always have. Together, we're making health care work better for everyone. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
At EVERSANA, we are proud to be certified as a Great Place to Work across the globe. We’re fueled by our vision to create a healthier world. How? Our global team of more than 7,000 employees is committed to creating and delivering next-generation commercialization services to the life sciences industry. We are grounded in our cultural beliefs and serve more than 650 clients ranging from innovative biotech start-ups to established pharmaceutical companies. Our products, services and solutions help bring innovative therapies to market and support the patients who depend on them. Our jobs, skills and talents are unique, but together we make an impact every day. Join us! Across our growing organization, we embrace diversity in backgrounds and experiences. Improving patient lives around the world is a priority, and we need people from all backgrounds and swaths of life to help build the future of the healthcare and the life sciences industry. We believe our people make all the difference in cultivating an inclusive culture that embraces our cultural beliefs. We are deliberate and self-reflective about the kind of team and culture we are building. We look for team members that are not only strong in their own aptitudes but also who care deeply about EVERSANA, our people, clients and most importantly, the patients we serve. We are EVERSANA.
The Nurse Navigator is to provide virtual and telephonic support to patients and healthcare providers. This role combines patient advocacy, education, and clinical expertise to ensure patients have the resources and knowledge they need for optimal therapy adherence and improved health outcomes. The Nurse Navigator will provide inbound and outbound patient support, respond to inquiries, troubleshoot clinical issues, conduct virtual training sessions, and collaborate with internal stakeholders to resolve patient needs efficiently and effectively. The ideal candidate will have experience with specialty therapies, a strong clinical background, and a passion for delivering exceptional patient care.
EXPECTATIONS OF THE JOB: Travel: Up to 25 % as needed for customer interactions or business meetings Hours: Full Time position 5 days a week ~ 45 hours per week Qualifications MINIMUM KNOWLEDGE, SKILLS AND ABILITIES: The requirements listed below are representative of the experience, education, knowledge, skill and/or abilities required. Education: Actively licensed registered nurse (RN), Nurse Practitioner (NP), or equivalent with degree in nursing or a related healthcare field from an accredit college or university. Experience and/or Training: Comfortable using virtual communication platforms and electronic documentation systems. 2+ years of experience in customer service or a combination of education and patient care experience in a chronic condition setting Experience with injectable therapies Licenses/Certificates Active, unrestricted Registered Nurse (RN) license required. Must hold an active RN license and obtain licensure in all states within the assigned territory within 90 days of hire. PREFERRED QUALIFICATIONS: Experience: 3–5 years of experience in the healthcare or pharmaceutical industry, particularly in a patient support or nurse educator role. Experience in HIV care or related disease states is highly desirable. Experience working with infusion and/or subcutaneous injection therapies. Education: Advanced Practice degree (Nurse Practitioner, Physician Assistant, PharmD, or MSN a plus (i.e. degree required) Technology/Equipment: Advanced knowledge of Word, PowerPoint, Excel, Outlook and videoconferencing platforms (Teams, Zoom, GoTo Meeting)
Our employees are tasked with delivering excellent business results through the efforts of their teams. These results are achieved by: Engage in telephonic and virtual interactions with patients and healthcare providers to provide support, guidance, and disease-state education in accordance with brand policies and compliance guidelines. Serve as a clinical resource to ensure optimal therapy adherence, addressing patient and provider inquiries related to medication administration, side effects, and best practices. Collaborate with internal teams to stay informed on brand-specific guidelines, ensuring accurate and up-to-date information is shared. Act as a liaison between healthcare professionals and patients, helping to navigate therapy access challenges. Foster patient empowerment and adherence by providing education on self-administration techniques (if applicable), infusion/subcutaneous injection protocols, and symptom management strategies. Maintain detailed documentation of interactions and follow-up activities in compliance with regulatory and company policies. All other duties as assigned
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities.
ReqID: 424644 Company: Providence Job Category: Nursing-Patient Facing Shift: Day Schedule: Full time Work Location: Providence System Offices Discovery Park-Irvine The Manager of Utilization Management provides a key role in leading, facilitating and managing the hospital utilization management program in the Southern California Region. Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence California Regional Services and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Required Qualifications: Bachelor's Degree in Nursing or other related area Upon hire: California Registered Nurse License 5 years healthcare management experience related to acute care utilization management or appeals management. Preferred Qualifications: Master's Degree in Nursing or other related area Coursework/Training: Case Management Certification 2 years minimum of two years direct patient care experience in an acute care setting is preferred. Other direct patient care experience may consider in lieu of acute care. Previous experience working with denials and appeals in/for an acute care setting. Previous experience working with a remote UR team. Previous experience as a case manager in an acute care setting.
The Manager assists the Regional Director of Utilization Management, Appeals & Clinical Training through the provision of ongoing assessment and evaluation of hospital activities related to patient admission, transfers, and discharges in a variety of clinical settings. Accomplishes results through multiple experienced individual staff members who exercise latitude and independence in their assignments. Fosters team collaboration, sharing of workload and enhanced productivity.
At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable. Posted are the minimum and the maximum wage rates on the wage range for this position. The successful candidate's placement on the wage range for this position will be determined based upon relevant job experience and other applicable factors. These amounts are the base pay range; additional compensation may be available for this role, such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities. Providence offers a comprehensive benefits package including a retirement 401(k) Savings Plan with employer matching, health care benefits (medical, dental, vision), life insurance, disability insurance, time off benefits (paid parental leave, vacations, holidays, health issues), voluntary benefits, well-being resources and much more. Learn more at providence.jobs/benefits. Applicants in the Unincorporated County of Los Angeles: Qualified applications with arrest or conviction records will be considered for employment in accordance with the Unincorporated Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.
Providence caregivers are not simply valued – they’re invaluable. Join our team at Providence California Regional Services and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.
Required Qualifications: Associate's Degree in Nursing. Upon hire: California Registered Nurse License 2 years Direct patient care experience in an acute care setting. Other direct patient care experience may considered (in lieu of acute care). 2 years experience as a case manager in an acute care setting. Preferred Qualifications: Bachelor's Degree in Nursing., Or Master's Degree in Nursing. Upon hire: Case management certification Experience working with denials and appeals in/for an acute care setting. Experience in a multi-hospital and/or integrated healthcare system.
The Care Management Recovery Advocate (CMRA) is responsible for providing overall management and communication of clinically-based appeals between Providence Health and Services, California Region (PH&S) outside payers. Activities will be patient-focused, uniform, compliant, and support steadfast advocacy for reimbursement of services provided to patients served within the PH&S ministries.
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.
At Mercy Health, we understand that every family is a universe. A network of people who love, and support, and count on one other to be there. Everybody means the world to someone and we are committed to care for others so they can be there for the ones they love. With nearly 35,000 employees across regions of Ohio and Kentucky, we’re one of the largest health care systems in the country. At each of our more than 600 points of care, we deliver high-quality, compassionate care with one united purpose: to help our patients be well in mind, body and spirit.
The RN Transfer Center Specialist coordinates patient transfer logistics using workflows identified by client to assist with patient acceptance and bed placement. This RN understands cases are related to ensuring patient care is accepted in an environment that can facilitate a higher level or care or capability as well as continuity of care. Performs functions based on defined standards of performance and practice to meet or exceed operational expectations. The position works collaboratively to foster relationships with referring facilities, physicians, and hospital staffs in representation of Conduit Health Partners Mission and Values. Works closely through collaboration with clinical, medical staff and leadership teams to identify, trend, and report barriers to patient access and throughput. Professional, clinical standards, policy and evidence-based research will guide practice and service delivery. Participates in professional development, peer development and evaluation as well as shared leadership. Assistance with data collection for quality purposes will be expected . We currently have full-time opportunities available across all shifts - days, evenings, and nights . Schedules are set and follow a six-week rotation, which includes an every-other-weekend requirement. There is also an on-call component and a rotating holiday requirement for all positions. Once you're placed into a schedule, you'll be expected to work that set schedule for at least six months before any schedule change request is considered. Please note that while schedule change requests are reviewed every six weeks, they are not guaranteed and are evaluated based on our established standard operating procedures. During orientation, you will follow the schedule of your assigned preceptor. Leadership will make every effort to match you with a preceptor on your designated shift (days, evenings, or nights), but final assignments are based on preceptor availability and may not always align perfectly with your shift preference. Hours subject to change based on need of operations
Licensing/Certification: Active Registered Nurse (RN) – Required Active multistate/compact registered nurse (RN) licensure - Required (if applicable based on state of residence) Education: Associate Degree of Nursing or diploma (ADN) - Required Bachelor’s degree of nursing (BSN) – Preferred Work Experience: 1 year of acute care experience – Required. 3+ years of acute care experience – preferred Healthcare contact center – preferred Training: Epic electronic health record – preferred Genesys contact center – preferred Office Setting: Must have a designated workspace with a locked door, per HIPAA regulations. Associates are encourages to also identify a secondary work location, meeting HIPAA regulations in case of power outages as well. IT Requirements: Minimum internet speed of primary and secondary work locations is: Download speed of 100Mpbs Upload speed of 20Mbps Skills: Customer Service oriented Microsoft Office Tools (Outlook, MS Teams, Excel, Word, etc.) Technology savvy Multitasking Review & interpret patient transfer case information. Escalate/Inform regarding patient status changes. Record tasks and conversations regarding patient transfer. Attention to detail. Acceptance of authority Critical thinking Communication with clinical care team members Teamwork Active listening Relationship building Agility and adaptability Excellent oral and written communication skills Performance driven.
Coordinates functions to identify appropriate level of care, accepting provider, consultation, and access from all potential referral sources to include but not limited to hospitals, clinics, extended care facilitates, and physician offices to initiate acceptance and expedite decision making relative to a potential access, Focusing on quality, safety and efficiency. Works directly with clinicians at each client facility to ensure communication of accurate clinical presentation, timely access, appropriate bed assignment, and accurate patient information documentation to assist with an appropriate destination plan of care at receiving facility using critical thinking, clinical decision making as well as established workflows. Proficient in EHR data entry, telephony systems, office systems as required to support operations, ensuring accurate, timely data entry, protection of PHI. Uses problem-solving skills to make recommendations that promotes the best potential patient outcome based on clinical information, patient and / or physician preferences, and the capability / capacity of both transferring and receiving facilities. Utilizes effective and professional communication to act as liaison on behalf of patient and client facilities between physicians, hospital staff, and outside agencies. Monitors individual and team compliance and performance. Implements and supports process change to ensure compliance with regulatory and quality initiatives. Demonstrates knowledge of regulatory components to include but not limited to EMTALA, Ethics and Compliance, quality initiatives, and HIPAA. Reports risks related to safety, compliance as well as operational inefficiencies using defined Chain of Command in a timely manner and offers recommendations for resolution or improvement if applicable. Works directly with providers and other healthcare providers at each client facility as well as client footprint facility to ensure timely acceptance and access to appropriate level of care/bed assignment using applicable workflows. Participates in process improvement, professional development, and peer review. Maintains active RN licensure within the states transfer center services are provided. Responsible for other tasks and analysis as requested /directed. This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.
CVS Health is the leading health solutions company, delivering care like no one else can. We reach more people and improve the health of communities across America through our local presence, digital channels and over 300,000 dedicated colleagues. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by simplifying health care one person, one family and one community at a time. Follow @CVSHealth on social media.
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Medicare Clinical Predetermination Nurse Must be willing and able to work Monday through Friday, 9am - 6:00 pm EST or CST with occasional holiday rotation.
Required Qualifications: 3+ years of experience as a Registered Nurse Must have active current and unrestricted RN licensure in state of residence 1+ years of Med/Surg experience 1+ years of experience with Microsoft Office applications (Outlook, Teams, Excel) Must be willing and able to work Monday through Friday, 9:00am to 6:00 pm eastern or central time with occasional holiday rotation. Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours Preferred Qualifications Prior Authorization or Utilization Management experience Managed care experience Experience using MedCompass Ambulatory surgery experience Education Associates degree required BSN preferred
Utilization Management is a 24/7 operation and work schedules will include holidays and evening hours. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline, policy, procedure and clinical judgment to render coverage determination/recommendation along the continuum of care. Communicates with providers and other parties to facilitate care/treatment Identifies members for referral opportunities to integrate with other products, services and/or programs Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity. At SCAN, we believe scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.
The Care Management Coordinator - ICD is responsible for coordinating and managing care services for patients, ensuring high-quality, timely, and coordinated care, with documentation in compliance with International Classification of Diseases (ICD) coding standards. They work closely with healthcare providers in developing care plans, coordinating referrals, and ensuring patient progress. The role also involves reviewing medical records, identifying coding discrepancies, and providing education and guidance to internal and external staff on ICD coding guidelines. Strong attention to detail, work ethic, knowledge of ICD coding principles, and effective communication skills are essential for success in this role.
High School Diploma or equivalent experience 0-3+ years of related experience. Performs work under minimal supervision. Handles complex issues and problems, and refers only the most complex issues to higher-level staff. Possesses comprehensive knowledge of subject matter. Provides leadership, coaching, and/or mentoring to a subordinate group. May act as a lead or first-level supervisor. PC Skills including: Email, Word, Excel, PowerPoint Technical expertise - Basic technical skills for functional area Problem Solving - Basic problem-solving skills Communication - Good communication and interpersonal skills Oral and written communication skills Interpersonal skills Customer/client orientation Customer service skills Problem/Situation Analysis
Ensures that member needs are addressed and that members are referred to the appropriate service provider(s) Administers policies and procedures for verifying member identity, membership status, and entitlement to services Maintains current and accurate membership databases and records Suggests new service offerings or revisions to existing programs based on member feedback or in response to member needs or gaps in coverage May participate in member retention or renewal efforts Other duties as assigned. Actively support the achievement of SCAN’s Vision and Goals. We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.
Founded in 1977 as the Senior Care Action Network, SCAN began with a simple but radical idea: that older adults deserve to stay healthy and independent. That belief was championed by a group of community activists we still honor today as the “12 Angry Seniors.” Their mission continues to guide everything we do. Today, SCAN is a nonprofit health organization serving more than 500,000 people across Arizona, California, Nevada, New Mexico, Texas, and Washington, with over $8 billion in annual revenue. With nearly five decades of experience, we have built a distinctive, values-driven platform dedicated to improving care for older adults. Our work spans Medicare Advantage, fully integrated care models, primary care, care for the most medically and socially complex populations, and next-generation care delivery models. Across all of this, we are united by a shared commitment: combining compassion with discipline, innovation with stewardship, and growth with integrity. At SCAN, we believe scale should strengthen—not dilute—our mission. We are building the future of care for older adults, grounded in purpose, accountability, and respect for the people and communities we serve.
The Care Manager will coordinate care for members in collaboration with the Integrated Care Team, ensuring members receive high-quality, timely, and coordinated care, are directed to the optimal facility for their needs, and have all necessary services, supplies, and information. The Care Manager authorizes services based on well-developed knowledge and skills in areas of utilization management, medical necessity, and patient status determination. Conducts pre-service and concurrent review following established guidelines. Applies care management principles and practices to ensure medical needs, care, and service are coordinated.
Associate's Degree or equivalent experience 3-5 years of related experience CA LVN license Performs work under direct supervision . Handles basic issues and problems, and refers more complex issues to higher-level staff Possesses beginning to working knowledge of subject matter. Provides leadership, coaching, and/or mentoring to partner care coordinators. Technical Expertise Problem-Solving Strong Communication Customer/client focused Detail oriented Responsible
Serve as point person to speak with patients, family members, and providers to address concerns pertaining to care, transfers and authorizations Ensure necessary inpatient and outpatient care or other services are rendered to SCAN members at the right time, the right level of care and at the right location, with end-to-end coordination, while adhering to all policies and procedures Coordinate discharge needs from inpatient acute settings and skilled nursing facilities as appropriate for each member. Coordinate timely delivery of last cover day letters to skilled nursing facilities Discharge needs may include: durable medical equipment, home health services, specialist referrals, skilled nursing placement, transportation, and other needs Issue determinations within required regulatory timeframes Apply evidenced-based criteria and guidelines, as well as clinical judgment and expertise, to help develop treatment plans Review tasks assigned by Integrated Care Nurse Practitioners and coordinate member care accordingly, including services such as: home health; DME ordering, wound care, Foley catheter, Enteral, colostomy supplies, infusion orders and outpatient services Review all acute/skilled nursing appeals and create detail explanation of non-coverage and reinstatement letters Refer cases that do not meet established criteria to the Medical Directors for secondary review Prepare, participate and facilitate high risk huddles and/or skilled nursing rounds Maintain a list of high risk patients and conduct regular outreach calls to check on their health status Develop effective working relationships and collaboration with and provide clinical guidance to Care Coordinators on clinical matters. Demonstrate excellent organizational, decision-making and multi-tasking skills as demonstrated by problem-solving and successful outcomes Promote the mission, vision, and values of SCAN Health Plan and serve as an ambassador when interfacing and collaborating with external stakeholders, including contracted medical groups and vendors. Other duties as assigned. Actively support the achievement of SCAN’s Vision and Goals. We seek Rebels who are curious about AI and its power to transform how we operate and serve our members.
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a purpose-driven company that will invest in your professional development.
Required Job Qualifications: Registered Nurse (RN) with current, valid, unrestricted license to practice in state of operations. 3 years clinical practice experience. Experience utilizing various software packages. Verbal and written communication skills. Analytical skills. Incumbents with nursing licenses in positions/departments requiring multi-state licenses are required to obtain and maintain additional current, valid, and unrestricted applicable nursing licenses in other states as determined by management. Multi-state license fees will be provided by HCSC. Incumbents with other clinical licenses are not required to obtain multi-state licenses. Preferred Job Qualifications: Familiarity with UM/CM activities and standardized criteria set. Knowledge of ancillary services including HHC, SNF, Hospice, etc.
This position is responsible for performing concurrent review in accordance with approved departmental guidelines; performing discharge planning and identifying alternate treatment programs; conducting episodic case management, consulting and collaborating with providers, members, and other resources as appropriate; assessing, planning, and implementing options and services required to meet an individuals health needs within the scope of their benefit plan.
This is where you change your story… At Meadows we understand that new directions to career advancing, and improvement can be scary, but we are excited to offer you a possible new rewarding chapter with us! Come join us in transforming lives! Who are we? Meadows Behavioral Healthcare is a leader in the behavioral health industry. Meadows Behavioral Healthcare offer a range of specialized programs including residential, outpatient and virtual treatment. We provide care for drug and alcohol addiction, trauma, sexual addiction, behavioral health conditions, and co-occurring disorders. We offer state-of-the-art care including neurofeedback and other services. Our evidence-based approach is rooted in decades of clinical experience, with more than 45 years in the field. Our approach is different and success stories from our patients are the proof.
Are you compassionate, innovative and have a passion to make an impact? Are you looking to get your foot in the door with a company that will believe in your abilities and train you to advance? 80% of our current top-level executive staff are organic internal promotions from within. We might be a perfect fit for you! Position Summary: As the Utilization Review Coordinator, you will develop and implement systems for authorizations for Inpatient, RTC, PHP and IOP Services. You will conduct pre-certs, concurrent and extended reviews. You will ensure quality documentation of patient care.
Education and Experience: Bachelor's degree required 3-5 years of experience in utilization review in a behavioral health setting Strong communication skills Ability to work in a fast-paced environment
Utilization Review: Provide professional and thorough communication with external representatives to obtain authorization for admission and continued stay. Monitor each step of the authorization process to proactively identify potential problems and optimize outcome. Minimize the number of cases that need to be referred for psychiatric peer/peer review. Interact with patient care staff to assure patient assessment and treatment plan is accurately and consistently reflected in facility documentation. Prioritize multiple and various types of case activity, coordinate with UM team to ensure all deadlines are met with highest possible quality of delivery. Maintain cumulative documentation regarding action taken during the UR process. Conduct reviews to ensure that services and documentation conform to the facility protocols, and the requirements of third-party payer sources. Clinical Team Member: Interact with patient care staff as noted above. Attend treatment staffing and other scheduled meetings to obtain and present information on patient status, care and stay. Communicate authorization status, issues or problems to appropriate staff/departments. Payer Management: Obtain and maintain authorization for each patient. Problem-solve issues relating to stay or service. Respond quickly and effectively to requires for information. Nurture positive and professional relationships with external (third-party payers) sources.
At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all of your unique abilities. Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions. Come be a part of the Brightest Ideas in Healthcare™.
BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working remotely.
Current Licensed Practical Nurse (LPN) with state licensure. Must retain active and unrestricted licensure throughout employment. Proficient in Microsoft Office (Outlook, Word, Excel and PowerPoint) Must be able to work independently. Must be detail oriented and have strong organizational and time management skills. Adaptive to a high pace and changing environment- flexibility in assignment. Proficient in Utilization Review process including benefit interpretation, contract language, medical and policy review. Proficient in MCG and CMS criteria sets Experience with both inpatient and outpatient reviews including Behavioral Health, DME, Genetic Testing, Clinical Trials, Oncology, and/or elective surgical cases preferred.• Working knowledge of URAC and NCQA. 2+ years’ experience in a UM team within managed care setting. 3+ years’ experience in clinical nurse setting preferred. TPA Experience preferred.
Performs clinical utilization reviews using evidenced based guidelines, policies and nationally recognized clinical criteria and internal policies/procedures. Identifies potential Third-Party Liability and Coordination of Benefit Cases and notifies appropriate parties/departments. Collaborates with healthcare partners to ensure timely review of services and care. Provides referrals to Case management, Disease Management, Appeals & Grievances, and Quality Departments as needed. Develop and review member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards Identifies potential quality of care issues, service or treatment delays and intervenes as clinically appropriate. Triages and prioritizes cases and other assigned duties to meet required turnaround times. Prepares and presents cases to Medical Director (MD) for medical director oversight and necessity determinations. Communicates determinations to providers and/or members in compliance with regulatory and accreditation requirements. Duties as assigned.
At Brighton Health Plan Solutions, LLC, our people are committed to the improvement of how healthcare is accessed and delivered. When you join our team, you’ll become part of a diverse and welcoming culture focused on encouragement, respect and increasing diversity, inclusion and a sense of belonging at every level. Here, you’ll be encouraged to bring your authentic self to work with all of your unique abilities. Brighton Health Plan Solutions partners with self-insured employers, Taft-Hartley Trusts, health systems, providers as well as other TPAs, and enables them to solve the problems facing today’s healthcare with our flexible and cutting-edge third-party administration services. Our unique perspective stems from decades of health plan management expertise, our proprietary provider networks, and innovative technology platform. As a healthcare enablement company, we unlock opportunities that provide clients with the customizable tools they need to enhance the member experience, improve health outcomes and achieve their healthcare goals and objectives. Together with our trusted partners, we are transforming the health plan experience with the promise of turning today’s challenges into tomorrow’s solutions. Come be a part of the Brightest Ideas in Healthcare™. Company Mission Transform the health plan experience – how health care is accessed and delivered – by bringing outstanding products and services to our partners. Company Vision Redefine health care quality and value by aligning the incentives of our partners in powerful and unique ways.
UM Denials Coordinator - LPN BRIGHTON HEALTH PLAN SOLUTIONS Remote – 100% Full Time BHPS provides Utilization Review services to its clients. The UM Denials Coordinator supports the Utilization Management function by reviewing denied and partially denied authorizations and preparing denial correspondence within the Utilization Management system. This role is responsible for drafting, editing, and formatting denial and partial denial letters to ensure clarity, accuracy, completeness, and appropriate readability, while maintaining compliance with regulatory requirements and client-specific service level agreements. The position works closely with physicians and nursing staff and may require follow-up phone calls or email communication to clarify determinations, obtain additional information, or resolve discrepancies prior to letter release. The UM Denials Coordinator reports to the Clinical Services team and performs a range of moderately complex administrative and operational tasks in support of UM activities. This is a fast-paced, productivity-driven role that requires strong attention to detail, sound judgment, and the ability to manage competing priorities.
Essential Qualifications: LPN license required. Two or more years of experience, in Utilization Management or medical necessity Appeals. Strong verbal and written communication skills. Demonstrated customer service skills, including effective written and verbal communication. Proficient in Microsoft Office applications, including Word, Excel, and Outlook, in a Windows-based environment. Ability to adapt quickly to changing business needs and learn new processes and systems Preferred Qualifications: Previous experience reviewing or writing UM denial letter language Proficient/Experienced with CPT4 and ICD-10 codes Working knowledge of URAC and NCQA documentation standards
Review denied authorization cases within the Utilization Management system to understand the clinical determination and supporting rationale prior to letter creation or finalization. Draft, edit, and format denial and partial denial letters based on authorization determinations, including creation of member friendly letter language, accurately copying and inserting approved clinical statements, criteria citations, and other information into correspondence templates. Apply working knowledge of Utilization Management processes and sound judgment to ensure all written correspondence is clear, readable, complete, and accurate. Ensure all letter content, data fields, and member, provider, and service details are accurately populated to prevent compliance risks or downstream operational issues. Communicate with physicians and nursing staff as needed to clarify determinations, obtain missing information, or resolve discrepancies prior to letter release. Prioritize and triage denied authorization cases in alignment with client-specific requirements and regulatory turnaround times. Respond to and resolve member and provider inquiries related to denied authorizations and denial correspondence. Responsible for pulling and analyzing reporting around denial processes and presenting analysis to leadership. Perform other related duties as assigned.
Conduit Health Partners™ connects patients and providers, partnering with your health system in patient navigation. Aimed at encouraging volume growth through patient acquisition and retention, our services help you effectively manage inbound and outbound transfers. Let our experienced call center nurses guide you in finding the best locations and practitioners for patient needs, to ease access to care for patients. Conduit makes moving patients the least of your worries—so you can focus on other aspects of your business.
The Behavioral Health Access Specialist coordinates the acceptance and throughput of behavioral health patients meeting criterial for inpatient admission from one facility to another in a call center environment. This employee performs functions based on defined standards of performance and practice to meet or exceed operational expectations related to transfer center/ access center services. The employee works collaboratively with internal and external partners to facilitate patient access according to mental health needs. The Behavioral Health Access Specialist will foster relationships with referring and receiving facility physicians and employees as well as community agencies in representation of Conduit Health Partners' Mission and Values. We currently have opportunities available across all shifts - days, evenings, and nights - with both full-time and part-time positions. Schedules are set and follow a six-week rotation, which includes an every-other-weekend requirement. There is also an on-call component and a rotating holiday requirement for all positions. Once you're placed into a schedule, you'll be expected to work that set schedule for at least six months before any schedule change request is considered. Please note that while schedule change requests are reviewed every six weeks, they are not guaranteed and are evaluated based on our established standard operating procedures. During orientation, you will follow the schedule of your assigned preceptor. Leadership will make every effort to match you with a preceptor on your designated shift (days, evenings, or nights), but final assignments are based on preceptor availability and may not always align perfectly with your shift preference. *Hours subject to change based on need of operations
Licensing/Certification: Active multistate/compact registered nurse (LPN) licensure - Required (compact licensure applicable based on state of residence. If unable to obtain compact licensure due to state of residence, must have active License-Practical Nursing (LPN)) or Licensed Social Worker (LSW) – Required Education Vocational Training, Licensed Practical Nurse (LPN) (required) or Bachelors degree, Social Work (required) Work Experience 1 year of mental health intake (required) Healthcare contact center (preferred) Training Epic electronic health record (preferred) Genesys contact center (preferred) Office Setting Must have a designated workspace with a locked door, per HIPAA regulations. Associates are encourages to also identify a secondary work location, meeting HIPAA regulations in case of power outages as well. IT Requirements Minimum internet speed of primary and secondary work locations is: Download speed of 100Mpbs Upload speed of 20Mbps Skills Customer Service oriented Microsoft Office Tools (Outlook, MS Teams, Excel, Word, etc.) Technology savvy Multitasking Review & interpret patient transfer case information. Escalate/Inform regarding patient status changes. Record tasks and conversations regarding patient transfer. Attention to detail. Acceptance of authority Critical thinking Communication with clinical care team members Teamwork Active listening Relationship building Agility and adaptability Excellent oral and written communication skills Performance driven.
Coordinates functions in order to support destination placement for the mental health patient meeting criteria for inpatient admission from potential referral sources to include but not limited to hospitals, clinics, extended care facilities, and physician offices to initiate acceptance and expedite decision making relative to potential access. Proficient in EHR data entry, telephony systems, office systems as required to support operations, ensuring accurate, timely data entry, protection of PHI. Demonstrates the ability to process resulting level of care needs utilizing critical thinking, clinical decision making, and acquired knowledge skills to facilitate placement as requested by referring provider or entity. Uses problem-solving skills to make recommendations that promotes the best potential patient outcome based on clinical information, patient and / or physician preferences, and the capability / capacity of both transferring and receiving facilities. Communicates an accurate clinical presentation of the patient for consulting or accepting provider and caregivers Utilizes effective and professional communication to act as liaison on behalf of patient and client facilities between physicians, hospital staff, and outside agencies. Demonstrates knowledge of regulatory components to include but not limited to EMTALA, Ethics and Compliance, quality initiatives, and HIPAA. Works directly with providers and other healthcare providers at each client facility as well as client footprint facility to ensure timely acceptance and access to appropriate level of care/bed assignment using applicable workflows. Reports risks related to safety, compliance as well as operational inefficiencies using defined Chain of Command in a timely manner and offers recommendations for resolution or improvement if applicable. Participates in process improvement, professional development and peer review Responsible for other tasks and analysis as requested /directed. This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.
Conduit Health Partners™ connects patients and providers, partnering with your health system in patient navigation. Aimed at encouraging volume growth through patient acquisition and retention, our services help you effectively manage inbound and outbound transfers. Let our experienced call center nurses guide you in finding the best locations and practitioners for patient needs, to ease access to care for patients. Conduit makes moving patients the least of your worries—so you can focus on other aspects of your business.
The RN Transfer Center Specialist coordinates patient transfer logistics using workflows identified by client to assist with patient acceptance and bed placement. This RN understands cases are related to ensuring patient care is accepted in an environment that can facilitate a higher level or care or capability as well as continuity of care. Performs functions based on defined standards of performance and practice to meet or exceed operational expectations. The position works collaboratively to foster relationships with referring facilities, physicians, and hospital staffs in representation of Conduit Health Partners Mission and Values. Works closely through collaboration with clinical, medical staff and leadership teams to identify, trend, and report barriers to patient access and throughput. Professional, clinical standards, policy and evidence-based research will guide practice and service delivery. Participates in professional development, peer development and evaluation as well as shared leadership. Assistance with data collection for quality purposes will be expected. We currently have full-time opportunities available across all shifts - days, evenings, and nights . Schedules are set and follow a six-week rotation, which includes an every-other-weekend requirement. There is also an on-call component and a rotating holiday requirement for all positions. Once you're placed into a schedule, you'll be expected to work that set schedule for at least six months before any schedule change request is considered. Please note that while schedule change requests are reviewed every six weeks, they are not guaranteed and are evaluated based on our established standard operating procedures. During orientation, you will follow the schedule of your assigned preceptor. Leadership will make every effort to match you with a preceptor on your designated shift (days, evenings, or nights), but final assignments are based on preceptor availability and may not always align perfectly with your shift preference. *Hours subject to change based on need of operations
Licensing/Certification: Active Registered Nurse (RN) – Required Active multistate/compact registered nurse (RN) licensure - Required (if applicable based on state of residence) Education: Associate Degree of Nursing or diploma (ADN) - Required Bachelor’s degree of nursing (BSN) – Preferred Work Experience: 1 year of acute care experience – Required. 3+ years of acute care experience – preferred Healthcare contact center – preferred Training: Epic electronic health record – preferred Genesys contact center – preferred Office Setting Must have a designated workspace with a locked door, per HIPAA regulations. Associates are encourages to also identify a secondary work location, meeting HIPAA regulations in case of power outages as well. IT Requirements Minimum internet speed of primary and secondary work locations is: Download speed of 100Mpbs Upload speed of 20Mbps Skills Customer Service oriented Microsoft Office Tools (Outlook, MS Teams, Excel, Word, etc.) Technology savvy Multitasking Review & interpret patient transfer case information. Escalate/Inform regarding patient status changes. Record tasks and conversations regarding patient transfer. Attention to detail. Acceptance of authority Critical thinking Communication with clinical care team members Teamwork Active listening Relationship building Agility and adaptability Excellent oral and written communication skills Performance driven. As a Bon Secours Mercy Health associate, you're part of a Mission that matters. We support your well-being—personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way.
Coordinates functions to identify appropriate level of care, accepting provider, consultation, and access from all potential referral sources to include but not limited to hospitals, clinics, extended care facilitates, and physician offices to initiate acceptance and expedite decision making relative to a potential access, Focusing on quality, safety and efficiency. Works directly with clinicians at each client facility to ensure communication of accurate clinical presentation, timely access, appropriate bed assignment, and accurate patient information documentation to assist with an appropriate destination plan of care at receiving facility using critical thinking, clinical decision making as well as established workflows. Proficient in EHR data entry, telephony systems, office systems as required to support operations, ensuring accurate, timely data entry, protection of PHI. Uses problem-solving skills to make recommendations that promotes the best potential patient outcome based on clinical information, patient and / or physician preferences, and the capability / capacity of both transferring and receiving facilities. Utilizes effective and professional communication to act as liaison on behalf of patient and client facilities between physicians, hospital staff, and outside agencies. Monitors individual and team compliance and performance. Implements and supports process change to ensure compliance with regulatory and quality initiatives. Demonstrates knowledge of regulatory components to include but not limited to EMTALA, Ethics and Compliance, quality initiatives, and HIPAA. Reports risks related to safety, compliance as well as operational inefficiencies using defined Chain of Command in a timely manner and offers recommendations for resolution or improvement if applicable. Works directly with providers and other healthcare providers at each client facility as well as client footprint facility to ensure timely acceptance and access to appropriate level of care/bed assignment using applicable workflows. Participates in process improvement, professional development, and peer review. Maintains active RN licensure within the states transfer center services are provided. Responsible for other tasks and analysis as requested /directed. This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Employees may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation.
At Intermountain Health, we use the artificial intelligence ("AI") platform, HiredScore to improve your job application experience. HiredScore helps match your skills and experiences to the best jobs for you. While HiredScore assists in reviewing applications, all final decisions are made by Intermountain personnel to ensure fairness. We protect your privacy and follow strict data protection rules. Your information is safe and used only for recruitment. Thank you for considering a career with us and experiencing our AI-enhanced recruitment process.
The RN Transition and Triage Care Manager offers comprehensive, time-limited services to patients and their families, ensuring continuity of care as they move across healthcare settings and clinicians. This role aims to prevent health complications, connect patients to resources, and guide them to the appropriate level of care. Utilizing clinical expertise, technology, and evidence-based practices, the manager assesses, plans, implements, and evaluates patient care through telephone or digital communication methods. Effective collaboration with patients, families, healthcare providers, payers, community-based providers, and other involved parties is essential to deliver efficient, effective, and patient-centered care management services. The manager operates in various settings, including triage, transitions of care, clinics, communities, and post-acute care environments. Position Details: The RN Triage and Transition is a remote position; however the caregiver must reside in Colorado or Montana and be within close proximity to an Intermountain Health Facility (preferably under an hour).
Skills: Assessment Care Planning Transitions of Care Motivational Interviewing Critical Thinking Time Management Customer Service Patient Education Communication Prioritization Minimum Qualifications: Current Registered Nurse (RN) license in state of practice. Bachelor of Science in Nursing (BSN) from an accredited institution (degree verification required). RNs hired or promoted into this role must obtain their BSN within four (4) years of hire or promotion date. Demonstrated clinical nursing experience in chronic disease management, and familiarity with chronic disease terminology and processes. Demonstrated understanding of disease management including treatment, length of stay, identifying barriers to delivery of care and any variation. Basic computer skills and knowledge of Microsoft Office software. Preferred Qualifications: Bachelor of Science in Nursing (BSN) from an accredited institution. Care Management Certification. Experience in ambulatory transitional of care or telephonic triage. Intermediate computers skills and knowledge of Microsoft Office software. Physical Requirements: Ongoing need for employee to see and read information, labels, assess patient needs, operate monitors, identify equipment and supplies. 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. 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, medication preparation, etc. May be expected to stand in a stationary position for an extended period of time. For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles.
Patient Identification and Assessment: Identifies patients for proactive interventions using specific screening criteria, medical record review, payor models, medical risk scores, or referrals. Assesses patients' medical, functional, and social conditions per department policy/guidelines to develop individualized care plans, care recommendations, or referrals as appropriate. Care Plan Management: Coordinates with internal and external services for social determinants of health (SDoH) needs and care in the community. Evaluates the effectiveness of the patient’s care plan and outcomes. Modifies the plan of care or specific interventions, as appropriate. Acute Symptom Triage: Conducts remote nursing assessments: Utilizes critical thinking skills to assess patient symptoms, medical history, and concerns, applying evidence-based protocols to determine appropriate care recommendations. Patient Support: Supports patient self-management and behavior change through health coaching, care navigation, care coordination, and education of identified patient/caregiver/family to identify and address barriers to optimal health outcomes. Education and Advocacy: Educates healthcare team members about transitions and triage processes, appropriate referrals, and advocate for patient rights. Educates patients about their medical/behavioral health conditions and self-management. Multidisciplinary Collaboration: Collaborates with physicians and other healthcare team members on the patient’s behalf to ensure patient receives quality and timely care and resolve any delays or issues. Participates in rounds or case conferences when necessary. Utilizes team-based care approach referring and consulting with social work, nutrition, pharmacy, rehabilitation, behavioral health, etc. resources as appropriate. Relationship Building: Develops and maintains collaborative partnerships with hospital care management, post-acute providers, and other care managers to ensure seamless transitions and continuity of care. Avoids duplicative care management services/programs. Process Improvement: Actively participates in system and regional initiatives to improve transitions of care and avoid duplicative services. Data Analysis: Conducts root cause analysis of extended post-acute stays, inappropriate utilization, readmissions, and track key data elements or metrics. Identifies, analyzes, and monitors industry, regulatory, technology, and market-based trends that impact ambulatory and post-acute services. Mission and Values driven: Promotes the mission, vision, and values of Intermountain Health, and abides by service behavior standards.
Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives. Learn even more about the work that drives us at personifyhealth.com.
We are seeking a Part-Time Chronic Disease Case Manager, RN to provide telephonic wellness and disease management support to members with chronic conditions. This role focuses on proactive outreach, care coordination, and individualized care planning to improve health outcomes and close gaps in care using nationally recognized clinical guidelines. This is a part-time position (20–28 hours per week), Monday through Friday during Pacific Standard Time (PST) business hours, with occasional weekend availability required. This is a part-time position. The Highlights: Part-time schedule designed around your availability and life priorities Access to learning and development opportunities alongside full-time colleagues Mentorship and skill-building that translates to career advancement Competitive hourly compensation that values your expertise Technology and equipment support to set you up for success. Compensation: This position offers a base salary range of $31-$38 per hour, depending on location, skills, and experience. Part-time employees are not eligible for health benefits.
KEY COMPETENCIES: To be successful in a remote healthcare environment, individuals must demonstrate strong technical aptitude, communication skills, and the ability to work independently. Upon Hire, must have: Basic computer literacy with the ability to navigate multiple systems simultaneously. Ability to work on multiple screens with proficient typing skills. Proficiency in software applications including, but not limited to, Microsoft Word, Microsoft Excel, and Microsoft Outlook. Strong verbal and written communication skills, including the ability to clearly explain complex or technical information and accurately interpret information received from others. Ability to work independently, manage time effectively, utilize written resources to problem-solve and make informed decisions. Foundational knowledge of medical claims processing and medical terminology, including ICD10, CPT, and HCPCS coding. Post‑Training Expectations: After completion of initial training and a structured ramp period (approximately three [3] months total), demonstrate proficiency in required systems and tools, including but not limited to: Microsoft Teams (on- and off-camera), SharePoint, shared drives, VPN UM Web, Health Notes, MyCare, ADP, Confluence Phone system with headset Ability to quickly adapt to additional systems or tools as job responsibilities evolve What You Bring to Our Team QUALIFICATIONS: Graduate of an accredited Registered Nurse (RN) program with a current, unrestricted Registered Nurse license issued in the United States. The organization may require additional state licensure(s) to meet operational and business needs. California, Washington and Oregon Licenses required after hire Prior experience in case management, wellness or disease management coordination, or an equivalent combination of education, clinical training, and relevant professional experience. Demonstrated ability to apply clinical knowledge in a managed care, population health, or remote healthcare environment. Willingness to travel
Telephonically coordinate wellness and disease management for members with chronic conditions, including but not limited to diabetes, asthma, COPD, CAD, CHF, atrial fibrillation, hypertension, and hyperlipidemia. Proactively contact targeted members to promote health and restore optimal functioning by applying nationally recognized care guidelines and comparing current care with industry standards. Review gaps in care and medical and pharmacy paid claims data to develop a comprehensive clinical profile; create individualized care plans and provide close follow-up for actively managed patients. Collaborate with members to ensure assignment to a primary care provider; facilitate referrals to specialists as needed; assist with obtaining durable medical equipment and reviewing pricing for high-cost medications. Support the Utilization Review process for assigned members in accordance with organizational and regulatory standards. Assess member needs and initiate referrals to case management, prenatal, wellness programs, and external vendor services as appropriate. Maintain complete, accurate, and timely documentation of case-managed members in designated systems; document all interventions and patient contacts while ensuring confidentiality and privacy of member records. Track and monitor moderate and high-risk member populations and associated interventions to demonstrate improvements in overall health outcomes. Meet established productivity, quality, and turnaround time standards on a daily, weekly, monthly basis. Successfully participate in and pass external audits, including NCQA and URAC. Maintain HIPAA compliance and confidentiality requirements in accordance with company policies and procedures. Complete all required annual training within designated timeframes.
Because health is personal. That's why Personify Health created the first and only personalized health platform—bringing health plan administration, holistic wellbeing solutions, and comprehensive care navigation together in one place. We serve employers, health plans, and health systems with data-driven solutions that reduce costs while actually improving health outcomes. Together, our team is on a mission to empower people to lead healthier lives. Learn even more about the work that drives us at personifyhealth.com.
We are seeking Utilization Review Nurse RN to join our team on a part-time basis, working a minimum of 28 hours per week. The Utilization Review Nurse will provide professional assessments and review for the medical necessity of treatment requests and plans. The standard operating hours are Monday through Friday, 8:00 AM–5:00 PM Pacific Standard Time, weekend available is required. This is a part-time position. This job description is not intended to contain a comprehensive list of activities, duties, or responsibilities, but constitutes a general description of the scope and function of the role within the company. Activities, duties, and responsibilities are subject to change at any time with or without notice. Benefits The Highlights: Part-time schedule designed around your availability and life priorities Access to learning and development opportunities alongside full-time colleagues Mentorship and skill-building that translates to career advancement Competitive hourly compensation that values your expertise Technology and equipment support to set you up for success Compensation: This position offers a base salary range of $30-$38 per hour, depending on location, skills, and experience. Part-time employees are not eligible for health benefits.
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 This role requires strong technical proficiency, independent work capability, and effective communication skills to successfully perform in a remote healthcare environment. 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. 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 Complete and pass all annual testing including IRRA at 90% or higher
Point C is a National third-party administrator (TPA) with local market presence that delivers customized self-funded benefit programs. Our commitment and partnership means thinking beyond the typical solutions in the market – to do more for clients – and take them beyond the standard “Point A to Point B.” We have researched the most effective cost containment strategies and are driving down the cost of plans with innovative solutions such as, network and payment integrity, pharmacy benefits and care management. There are many companies with a mission. We are a mission with a company.
The Nurse Care Navigator – Drug Optimization & Pharmacy Coordination is a licensed nurse responsible for coordinating and overseeing case management services related to medication optimization, international drug sourcing, and pharmacy benefit management (PBM) collaboration. This role serves as a clinical liaison among members, PBMs, international sourcing partners, providers, and internal teams to ensure safe, cost effective, and clinically appropriate medication use.
Active, unrestricted RN or LPN/LVN license (compact preferred, where applicable) Nursing degree or diploma from an accredited program 3–5+ years of experience in nursing, case management, care coordination, or a related clinical role Strong knowledge of pharmacology and medication management Experience collaborating across multiple stakeholders, including providers, PBMs, and pharmacy partners Experience in case management, PBMs, specialty pharmacy, or medication access programs preferred Familiarity with evidence-based guidelines (e.g., MCG, InterQual) preferred Experience in a TPA, managed care, or employer-sponsored health plan environment preferred Strong clinical judgment within scope of licensure Excellent communication skills and attention to detail, with a focus on accurate documentation Ability to coordinate member-focused care across cross-functional teams Working knowledge of regulatory and compliance requirements
Coordinate case management activities related to medication optimization, adherence, and therapeutic appropriateness Review medication regimens and clinical documentation to identify optimization opportunities Collaborate with providers, PBMs, and pharmacy partners to support evidence-based medication use and access Support specialty and high-cost medication coordination initiatives Coordinate international drug sourcing programs, including partner collaboration, member education, and continuity of care Serve as a clinical liaison across PBMs, pharmacy vendors, and internal teams to align on formulary options and access strategies Conduct member outreach, education, and follow-up to support adherence and understanding Review clinical records, pharmacy data, and provider documentation; escalate complex cases as needed Ensure compliance with nursing scope of practice, regulatory requirements, and organizational policies Maintain accurate and timely clinical documentation
Healthmap Solutions is the future of specialty health management that focuses on progressive diseases, with a particular expertise in kidney health populations. Healthmap Solutions uses clinical big data resources and high-powered analytics to power complex specialty health management programs. Healthmap Solutions is a diverse, growing company committed to our clients and our employees. We are champions for better health, for those who need us most.
Position Summary: The Registered Nurse, Care Navigator will be responsible for case management specific to kidney health management. The Care Navigator will complete activities for the continuum of care to facilitate and promote high quality, cost-effective outcomes for patients and focus on the whole patient and care delivery coordination. Managing a set caseload of mixed acuity members, reviewing and/or obtaining member data and entry in HealthMap’s Care Management documentation system (Compass), completing member health and social determinants of health screenings, medication reconciliation, creation and maintaining member-centric care plans, updates of identified problems, barriers, interventions, and goals and assistance with ongoing case management. The Care Navigator will collaborate with internal and external (physicians, nurses, and other healthcare personnel) to assure positive patient outcomes and care coordination. Location: This position is 100% Remote for candidates that are located in the Eastern or Central time zones.
Requirements: Active, unrestricted RN license required Bachelor's degree required CCM preferred Three (3) years of experience in case management preferred Experience in a dialysis center or transplant center preferred Experience with Medicare and Medicaid preferred Skills: Advocate and energize a culture of collaboration, positivity, and motivation Strategic thinking and planning Deliver effective communication – verbal and written Succeed in a challenging environment with changing priorities
Handle in and outbound calls delivering world-class service to our members Educate kidney health and related co-morbid conditions as well as optimizing renal replacement therapy by educating members on the types of dialysis and transplant options Engage members into HealthMap’s Kidney Health Program Follow up with members based on complexity and cadence by policy Serve as patient advocate for responding and working to resolve concerns or barriers Utilize community resources and programs in care planning Serve as liaison between the patient, the patient’s support network, treating physician, and other ancillary providers as a member of an interdisciplinary care team to coordinate care, resolve nursing problems and assist patients in meeting individualized goals Notify providers of identified patient needs based on policy Comply with HIPAA privacy laws and all other federal, state, and local regulations Comply with company-defined operational policies and procedures Comply with company security policies Accountable for individual metrics and key performance indicators and identified by the organization Navigate technical applications - Excel, OneNote, Outlook, and Word Support after hours and various time zones based on business need Drive patient and families in their own care and to support self-management
Texas Oncology is the largest community oncology provider in the country and has approximately 600+ providers in 220+ sites across Texas and southeastern Oklahoma. Our founders pioneered community-based cancer care because they believed in making the best available cancer care accessible to all communities, allowing people to fight cancer at home with the critical support of family and friends nearby. Our mission is still the same today—at Texas Oncology, we use leading-edge technology and research to deliver high-quality, high-touch, evidence-based cancer care to help our patients achieve “More breakthroughs. More victories.” ® in their fight against cancer. Today, Texas Oncology treats half of all Texans diagnosed with cancer on an annual basis. Why work for us? Come join our team that is responsible for helping lead Texas Oncology in treating more patient diagnosed with cancer than any other provider in Texas. We offer our employees a competitive benefits package that includes Medical, Dental, Vision, Life Insurance, Short-term and Long-term disability coverage, a generous PTO program, a 401k plan that comes with a company match, a Wellness program that rewards you practicing a healthy lifestyle, and lots of other great perks such as Tuition Reimbursement, an Employee Assistance program and discounts on some of your favorite retailers.
Texas Oncology is looking for a Virtual Triage Nurse (RN) to join our team! These positions will support the Virtual Care Program and will work remotely. We are willing to consider candidates across the state of Texas or outside of Texas as long as you have an RN license that is recognized by the state of Texas. What does the Virtual Triage Nurse (RN) do? The telephone triage nurse assesses patient needs over the telephone, collaborates with a physician or qualified staff member to meet those needs, then documents all elements of care in the patient’s medical record. The telephone triage nurse will accurately identify patients with high risk conditions and will direct care to the appropriate resources if they cannot be managed by the nurse and/or within the clinic. Under general supervision, provides professional nursing care for patients adhering to national and organizational standards and guidelines for specialty care and scope of practice per state licensing board. Must recognize physical, psychological, and spiritual aspects of care and participates in company-wide quality initiatives. Supports and adheres to the US Oncology Compliance Program, to include the Code of Ethics and Business Standards.
The ideal candidate for the Virtual Triage Nurse (RN) will have the following background and experience: Graduate from an accredited program for professional nursing education, BSN preferred. Minimum of 3 years oncology nursing experience needed. Willing to consider a mid or senior level experienced candidate. Oncology or applicable specialty experience required. Current RN state license with the applicable State Board of Nursing. Current CPR certification required. Working Conditions: Traditional office environment. The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly exposed to the risk of blood borne pathogens, carcinogenic drugs and other conditions common to a clinic environment. Physical Requirements: Large percent of time performing computer-based work is required. 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 stand; use hands to finger, handle, or feel; and reach with hands and arms. The employee frequently is required to walk and talk or hear. The employee is occasionally required to sit; climb or balance; and stoop, kneel, crouch, or crawl. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds.
Addresses patient calls, portal messages and emails in a timely manner concerning a wide range of symptom / side effect related topics Assesses urgency of patient symptoms / side effects and addresses them appropriately, aggressively managing them to prevent unnecessary emergency department and hospital utilization Documents all conversations with patients to maintain a comprehensive medical record Provides clear instruction and education to patients via the telephone Collaborates with physicians via electronic communication, face to face, or the telephone to discuss patient care needs that cannot be independently and appropriately addressed using standing orders or practice protocols Sets up same day and/or future provider/infusion room appointments to address symptom management concerns
Revolution Medicines is a late-stage clinical oncology company developing novel targeted therapies for patients with RAS-addicted cancers. The company’s R&D pipeline comprises RAS(ON) inhibitors designed to suppress diverse oncogenic variants of RAS proteins. The company’s RAS(ON) inhibitors daraxonrasib (RMC-6236), a RAS(ON) multi-selective inhibitor; elironrasib (RMC-6291), a RAS(ON) G12C-selective inhibitor; zoldonrasib (RMC-9805), a RAS(ON) G12D-selective inhibitor; and RMC-5127, a RAS(ON) G12V-selective inhibitor, are currently in clinical development. As a new member of the Revolution Medicines team, you will join other outstanding professionals in a tireless commitment to patients with cancers harboring mutations in the RAS signaling pathway.
The Nurse Case Manager (RNCM) role sits at the intersection of patient advocacy, insurance policy, and product access – making this a critical role in supporting patients who have been prescribed a Revolution Medicines’ therapy. The RNCM Team will operate in a hybrid model in close partnership with a third-party HUB responsible for intake, benefits investigation, and Customer Relationship Management (CRM) operations. RNCMs will work directly with patients, healthcare providers, insurers, field reimbursement team, and other key stakeholders to help patients understand their coverage, access the company’s patient support programs, and connect with external resources that help overcome access barriers. This regionally aligned team (Northeast, Southeast, Central, and West) will manage the launch and ongoing lifecycle of Revolution Medicines’ approved therapies using a patient centric model. This role requires a strategic, independent worker with deep expertise in oncology market access, clinical knowledge, and a passion for ensuring no patient is left behind.
Required Skills, Experience and Education: Bachelor’s Registered Nurse degree required with current state license. 7 to 9+ years of experience in oncology, Patient Access, market access, or pharmaceutical patient service programs. Proven experience supporting specialty or oral oncology launches (start-up or high-growth environments strongly preferred). Deep understanding of payer dynamics, specialty pharmacy and distribution models, reimbursement processes, and patient support program operations. Exceptional skills in communication, compliant documentation, and cross-functional collaboration. Extensive knowledge of HIPPA regulations and Adverse Event (AE) reporting. Preferred Skills: Advance degree (MSN, MBA, MHA, other). Launch and customer-facing experience. Experience with targeted oncology product experience strongly preferred. Experience in a smaller, rapidly growing company preferred.
By acting as a single point of contact, the RNCM will proactively manage and work individual patient cases to ensure access and financial barriers are compliantly overcome —including benefit verifications, Prior Authorization (PA) delays, denials, appeals hurdles, specialty pharmacy (SP) and non-commercial pharmacy routing issues, affordability barriers, complex Center for Medicare and Medicaid cases (CMS), community resources and more. Execute smooth transition of all Expanded Access Programs (EAP) patients with urgency upon FDA approval. Manage the standardized escalation frameworks with the Field Reimbursement Team (FRDs), specialty pharmacies, non-commercial pharmacy and insurance providers to ensure rapid and compliant issues of resolution. Ensure timely contact with patients and providers during each step from enrollment to closure of case, benefit verification, PA status, appeals, specialty and noncommercial pharmacy dispense and refills. Monitor all patient cases for delays or bottlenecks, ensuring immediate contact with the appropriate stakeholder (patient, healthcare provider (HCP), third party HUB, and FRD team) to ensure follow-up of unresolved cases. To include regularly scheduled meetings to address any issues. Maintain rigorous documentation standards to ensure access barriers are tracked, addressed, and compliantly resolved in alignment with a “no patient left behind” mindset. Foster a culture grounded in patient advocacy, compassion, compliance, customer centricity, urgency, and collaboration. Create and manage a “one-team” mindset with other critical access teams, including third-party hub provider, non-commercial pharmacy, third-party copay provider, FRD Team, Medical, Quality Control, and Patient Access leadership. Travel as needed to home office as applicable and external meetings and conferences. Other duties as assigned.
At Curana Health, we’re on a mission to radically improve the health, happiness, and dignity of older adults—and we’re looking for passionate people to help us do it. As a national leader in value-based care, we offer senior living communities and skilled nursing facilities a wide range of solutions (including on-site primary care services, Accountable Care Organizations, and Medicare Advantage Special Needs Plans) proven to enhance health outcomes, streamline operations, and create new financial opportunities. Founded in 2021, we’ve grown quickly—now serving 200,000+ seniors in 1,500+ communities across 32 states. Our team includes more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds, all working together to deliver high-quality, proactive solutions for senior living operators and those they care for. If you’re looking to make a meaningful impact on the senior healthcare landscape, you’re in the right place—and we look forward to working with you. For more information about our company, visit CuranaHealth.com.
At Curana Health, we are committed to supporting the health, dignity, and comfort of residents in senior living communities. Our National After-Hours Call Team plays a vital role by providing compassionate telephonic care and clinical direction during evenings, nights, weekends, and holidays—ensuring that residents receive timely, high-quality support without unnecessary transfers. In this work-from-home role, you’ll deliver after-hours care virtually (primarily by phone) to aging residents across multiple states. This position offers both autonomy and purpose—you’ll be the trusted voice and clinical partner helping residents and facility staff during critical times, making an immediate impact in the lives of older adults. The ideal Provider is comfortable managing high call volumes and performing at least 30% telehealth visits, including evaluation of acute changes, falls, and controlled substance visits. Providers must be able to manage multiple calls independently while providing care across several states.
Scheduling & Hours: While shift times can vary, we provide coverage to skilled nursing and senior living facilities on weeknights from 5pm- 8am local time, continuous coverage from Friday at 5pm to Monday at 8am. Holiday coverage is also provided beginning at 5pm of the end of the last business day to 8am of the resumption of business hours. Availability and Coverage expectations for this role Weeknight shifts between 5pm and 8am Every other weekend coverage both Saturday and Sunday for 12-hour shifts covering day shifts (For Example: 9am-9pm or 11am-11pm CST or MST) Overnight and holidays are required for all After Hours Call Team Members, 2 holidays per year required Holiday scheduling is completed at the beginning of the year for advanced planning Qualifications Education and Experience: Master's Degree as a Nurse Practitioner Active, unrestricted licensure in Texas and Louisiana and/or Tennessee, or another approved state is required. Additional active licenses in Mississippi, Arkansas, Alabama, Kentucky, Arizona, Colorado, Nevada, and New Mexico are strongly preferred. Nurse Practitioner national certification as ANP, FNP, or GNP Ability to obtain DEA licensure / Prescriptive Authority Background in acute and chronic disease management Clinical background in adult, family, or geriatrics 3+ years of experience as a NP Ability to gain a collaborative practice agreement, if applicable in your state(s) Ability to work scheduled shifts in accordance with scheduling policies Proficient computer skills including the ability to document medical information with written and electronic medical records Preferred Qualifications: Experience working in a nursing home, or with seniors in an acute care facility Understanding of Geriatrics, Chronic Illness, and acute disease management Understanding of Advanced Illness and end of life discussions Ability to develop and maintain positive customer relationships Adaptability to change
Serve as the first line of support for residents and facility staff after-hours, providing direction and medical care over the phone. Use Curana’s telephonic platform to take and place calls, coordinating care between facilities, hospitals, and clinics. Deliver high-quality, cost-effective care to patients—addressing acute, chronic, and behavioral health needs in collaboration with physicians and specialty providers. Perform comprehensive assessments and document encounters accurately and thoroughly in the EMR, ensuring compliance with CMS requirements. Apply Curana’s clinical protocols and practice guidelines to support safe, effective treatment in place whenever possible. Participate in mandatory education and training to stay current with standards of care.
At Sentara, our differences are our strengths. The unique backgrounds, skills, and experiences that each Sentara colleague brings to work make Sentara special and allow us to deliver excellent service and care to our patients, members, and communities.
Sentara Health in Richmond, VA is looking to hire an Integrated Case Manager, RN. This is a remote position; however, candidates must reside in Richmond and surrounding areas as travel is required. The Integrated Case Manager is responsible for case management services within the scope of licensure; develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum. Performs telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical and behavioral health, social services and long-term services.
Demonstrates the minimum knowledge, skills and abilities to care for the individualized needs of the patient to include physical, psychological, socio-cultural, spiritual and cognitive needs as well as functional abilities including the need for diversified use of such practices. Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills Education: Associates Bachelors preferred Certification: Registered Nurse required Experience: 3 years of nursing experience required Managed care preferred Discharge planning experience preferred
Identifies members for high-risk complications and coordinates care in conjunction with the member and health care team. Manages chronic illnesses, co-morbidities, and/or disabilities ensuring cost effective and efficient utilization of health benefits; conducts gap in care management for quality programs. Assists with the implementation of member care plans by facilitating authorizations/referrals within benefits structure or extra-contractual arrangements, as permissible. Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on care management treatment plans. Presents cases at case conferences for multidisciplinary focus. Ensure compliance with regulatory, accrediting and company policies and procedures. May assist in problem solving with provider, claims or service issues.
CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S., from clinics and hospitals to home-based care and virtual care services, CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources, CommonSpirit is committed to building healthy communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen, both inside our hospitals and out in the community.
Opportunity to work remotely after orientation on site if in Omaha area As our Medical Access RN, you will contribute to the mission of our organization by assuring that each patient's hospital care is meticulously planned and coordinated to provide a safe and positive experience, focusing on holistic well-being. Every day you will evaluate the appropriateness of the level of care, diagnostic and clinical procedures, and identify quality and clinical risk issues. You will also ensure accurate and complete medical record documentation, providing services that encompass the spiritual, physiological, social, and psychological aspects of patient care, disease prevention, and health conservation. To be successful in this role, you will demonstrate exceptional clinical judgment, strong organizational skills in care coordination, and meticulous attention to documentation.
Job Requirements Graduate of an accredited school of Licensed Nursing Registered Nurse: NE, upon hire
Performs duties according to department specific expectations. Identify the care and resources required for accessing hospital services for surgical, procedural, non-invasive diagnostic, invasive diagnostic, admitted, and clinical procedure patients. Evaluates the appropriateness of levels of care, diagnostic testing and clinical procedures. Provides timely, accurate and complete medical record documentation and data collection initiating the electronic medical record and patient assessment clinical documentation. Establishes positive working relationships with physicians and their office staff with a focus on customer service and ease of access to hospital services. Collects clinical history and evaluates existing diagnostic findings to initiate clinical protocols for additional diagnostic testing by interviewing the patient or care giver.
At Midi Health, we're on a mission to revolutionize healthcare for women at midlife—to relieve their symptoms, support their wellbeing, and ensure they feel seen, heard, and cared for. Our care is personalized, evidence-based, and covered by insurance, making it more accessible to women across the country. Wherever they live. Whatever their health story. We’re rapidly growing and looking for passionate full-time Nurse Practitioners to join our dedicated clinical team. You’ll help close the gender health gap by guiding women through perimenopause, menopause, and other midlife transitions with compassionate, evidence-based care.
Why Work With Midi? Mission-Driven Impact: Join us in transforming healthcare for women in midlife—making a meaningful difference every day. Remote (U.S.–Based) Role with Structured Hours: Work fully remote from within the United States with patient-facing hours scheduled between 7:00 AM and 7:00 PM, adjusted by patient location and licensure. This is not a digital nomad role; work may not be performed while you are outside the United States. Continuous Learning: Access weekly clinical education to stay sharp and advance your expertise in women’s midlife health. Purposeful Visits: Our appointments provide you with time to listen, educate, and deliver personalized care that truly supports your patients. Technology + Clinical Support: Benefit from structured onboarding, user-friendly tech, and operational assistance—including elements of logistics, scheduling, and clinical operations—so you can focus on care without being on your own. Community of Care: Be part of a collaborative, respectful team passionate about women’s health and dedicated to your professional growth.
Active, unrestricted, and unencumbered Nurse Practitioner license in at least one U.S. state.*Multiple state licenses are highly preferred. Prescriptive authority as a Nurse Practitioner. Active national board certification (FNP, WHNP, AGNP, or similar). Minimum 3 years of recent experience (within the last 5 years) practicing as a Nurse Practitioner in Primary Care, Women’s Health, or Gynecology. Ability to work independently and make sound clinical decisions. High proficiency and efficiency with technology (telehealth platforms, EMRs, communication tools). A strong passion for caring for women navigating menopause and midlife health transitions.
At Midi, you’ll practice with purpose in a virtual-first care model that puts women’s needs front and center: Quality visits, better conversations: Appointments designed to allow time to listen, educate, and personalize care. Evidence-based protocols: Trained in expert-developed clinical pathways combining hormonal therapy, lifestyle coaching, and medication when appropriate. Care beyond the screen: Patients receive labs, prescriptions, supplements, and referrals as needed—our platform makes it seamless. You’re never alone: Supported by a collaborative team of clinicians, care coordinators, and clinical leaders, with opportunities to grow and specialize over time. Meaningful specialty focus: Practice in women’s midlife health, a critically underserved area where you help close one of the most persistent gaps in care. Mission-aligned, patient-centered culture: Join a team dedicated to empathy, equity, and clinical excellence.
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.
As a leader in the care of older adults, we are seeking an Advanced Practice Provider (Nurse Practitioner or Physician Assistant) who enjoys managing complex patients in a collaborative, highly coordinated home-based setting. The provider will work closely with physicians, advanced practice providers, social workers, case managers, nutritionists, and other members of our health care team, as well as participate in multidisciplinary conferences that focus on the most high-risk members. He/she will have access to advanced technology, including an innovative, patient-friendly home monitoring system, Epic EMR, and a proprietary decision support tool that synthesizes data from a variety of sources into actionable alerts that drive care.
Minimum Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.The requirements listed below are representative of the knowledge, skill, and/or ability required.Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Minimum Experience: Computer literacy/EMR proficiency At least one (1) year prior clinical experience Education/Licensure: Active state license as a Nurse Practitioner/Physician Assistant Active Nurse Practitioner/Physician Assistant Board Certification Medicare Part D Prescriber Valid driver license and current automobile insurance NP (Nurse Practitioner): Active NP License (Must, upon hire) Furnishing number (Must, upon hire) NPI Number (Must, upon start) DEA Number (Must, within 6 months of start) Board Certification: AANP, ANCC (Must, within 6 months of start) Valid BLS (Basic Life Support) (Must, upon start) Valid ACLS (Advanced Cardiovascular Life Support (Preferred) PA (Physician Assistant): Active PA License (Must, upon hire) NPI Number (Must, upon start) DEA Number (Must, within 6 months of start) Board Certification: NCCPA (Must, within 6 months of start) Valid BLS (Basic Life Support) (Must, upon start) Valid ACLS (Advanced Cardiovascular Life Support (Preferred) Other: Knowledge of current clinical standards of care Ability to work independently Experience in care of older adult (geriatric) patients preferred Home care experience preferred Excellent administrative, organizational, and verbal skills preferred Effective communication skills especially with older adults preferred Previous EPIC experience preferred but not required preferred Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 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.
M-F Traditional Work Hours, No Call, and No Weekends. Schedule: 3.5 days a week Conduct in-home assessments (with some outpatient clinical work) on health plan members (Max 5 per day) and the other 1.5 days a week work from home. In-Home Assessments will include obtaining comprehensive history, physical exam, medication review, and appropriate cognitive/depression/safety screenings. Comfort with End-of-life care discussions imperative. Laboratory specimen collection in the home setting when appropriate. Identify diagnoses to be used in active medical management and care management of patients with focus on chronic disease management. Communicate findings of the patient assessment to inform the PCP of potential gaps in care. Provide patient/family/caretaker education, with an emphasis on close monitoring and follow up of patient needs. Emphasis on knowledge of appropriate community resources for referral. Comply with all HIPAA regulations and maintain security of protected health information (PHI). Supervisory responsibilities: N/A
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
Alignment Health is seeking a remote Utilization Management (UM) Nurse – Pre-Service (LVN or RN, active California license required) to join our growing UM team. In this role, you’ll review prior authorization requests for medical necessity across inpatient and outpatient services, applying CMS guidelines and Milliman Care Guidelines (MCG) to support timely, accurate determinations. You’ll partner closely with providers and medical directors to ensure members receive high-quality, cost-effective care. This is a fast-paced, production-driven role ideal for nurses with recent pre-service UM experience in a managed care setting who are comfortable managing multiple cases, meeting turnaround time expectations, and collaborating cross-functionally in a fully remote environment. Schedule: Monday – Friday, 8:00 AM – 5:00 PM Pacific Time (must be able to consistently work these hours) Candidates must reside within Pacific, Mountain, or Central time zones to align with business hours. Weekend rotation: approximately 1 weekend day every 5–6 weeks (4–8 hour shift between 8:00 AM – 5:00 PM Pacific Time)
Required: Minimum (3) years' nursing experience in clinical setting. Minimum (1) year experience UM experience with pre-service. Minimum (1) year experience with managed care (Medicaid and / or Medicare). Minimum 1 year of experience with the application of UM criteria (i.e., CMS National and Local Coverage Determinations, etc.) Minimum (1) year experience in a medical setting working with IPAs, entering referrals / prior authorizations preferred Minimum (1) Experience with the application of clinical criteria, specifically Milliman Care Guidelines (MCG) Education Required: High School Diploma or GED. Preferred: Associates or Bachelor's degree in Nursing Licensure Required: Must have and maintain an active, valid, and unrestricted LVN or RN license in California (Non-Compact) Immediately upon hire, must be willing to obtain LVN and / or RN licensure in Nevada, (Non-compact), Arizona (Compact), North Carolina (Compact), and Texas (Compact) which will be reimbursed by company. Preferred: CPHQ or ABQAURP, or Six Sigma certification Medical Terminology Certificate. Training Required: None Preferred: Medical Terminology. Six Sigma Specialized Skills Required: Knowledge of ICD-10, CPT codes, managed care plans, medical terminology and referral system (Access Express / Portal / N-coder). Knowledgeable with CMS (Chapter 13) guidelines and regulations. Computer Skills: Word, Excel, Microsoft Outlook Language Skills: Effective written and verbal communication skills; able to establish and maintain a constructive relationship with diverse members, management, employees and vendors. Mathematical Skills: Able to perform mathematical calculations and calculate simple statistics correctly. Reasoning Skills: Able to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution. Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment. Report Analysis Skills: Comprehend and analyze statistical reports. Preferred Bilingual English and Spanish Transplant knowledge a plus 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.
Review pre-certification requests for medical necessity and refer to medical director any referral that requires additional expertise. Utilize CMS guidelines (LCD, NCD) to assist in determinations of referrals and utilize Milliman Care Guidelines (MCG) to assist in determinations of referrals. Maintain goals for established turn-around time (TAT) for referral processing. Initiate single service agreements (SSA) when services required are not available in network. Maintain a professional rapport with providers, physicians, support staff and patients in order to process pre-certification referrals as efficiently as possible. Verify eligibility and / or benefit coverage for requested services. Verify accuracy of ICD 10 and CPT coding in processing pre-certification requests. Contact requesting provider and request medical records, orders, and / or necessary documentation in order to process related pre-service requests / authorizations when necessary. Review referral denials for appropriate guidelines and language. Assist medical directors in reviewing and responding to appeals and Grievances Contact members and maintain documentation of call for expedited requests. Other duties as assigned.
SwedishAmerican is now UW Health. At UW Health, our commitment is to serve through medical innovation and unparalleled compassion. We provide expertise and quality care to patients and families throughout Wisconsin, Northern Illinois and beyond. In 2015, SwedishAmerican, a community health system based in Rockford, Ill., with a proud 100-year legacy, became part of UW Health. In 2021, the UW Health brand was introduced at SwedishAmerican’s 2 hospitals and 30 primary care and multi-specialty clinic locations across Northern Illinois. Through this partnership, Northern Illinois patients and families have the best of both worlds – a familiar, convenient network of primary and specialty care locations combined with easy access to UW Health experts for highly complex situations, especially for patients with cancer or heart disease. Moreover, mothers and babies – most of whom are cared for at the new Women’s and Children’s Hospital in Rockford – also have easy access to neonatology experts at American Family Children’s Hospital in Madison, in situations when a higher level of care is needed.
Work Schedule: 50%FTE, hours variable, this is a remote position Additional components of compensation may include: Evening, night, and weekend shift differential Overtime On-call pay
Qualifications: Graduate of an approved Registered Nursing program. Required Must provide copy of HS diploma or equivalent, or highest level of completed degree obtained. Required Work Experience 2 years of clinical experience in acute or ambulatory care. Required Licenses & Certifications: Current RN licensure from the State of Illinois. Required
Competitive pay and comprehensive benefits package including: PTO, Medical, Dental, Vision, retirement, short and long-term disability, paternity leave, adoption assistance, tuition assistance Annual wellness reimbursement Opportunity for on-site day care through UW Health Kids Tuition reimbursement for career advancement--ask about our fully funded programs! Abundant career growth opportunities to nurture professional development Strong shared governance structure Commitment to employee voice
We've made a lot of progress since opening the doors in 1942, but one thing has never changed - our commitment to serve, heal, lead, educate, and innovate. We believe that every award earned, every record broken and every patient helped is because of the dedicated employees who fill our hallways. At Ochsner, whether you work with patients every day or support those who do, you are making a difference and that matters. Come make a difference at Ochsner Health and discover your future today!
This job ensures the financial security of scheduled inpatient and outpatient (excluding ED) accounts for the company's patients by obtaining/initiating prior authorization of ordered services based on payer requirements, after benefits and eligibility have been determined. Coordinates with physician and/or staff for appropriate level of care setting and essential clinical documentation to support medical necessity of services ordered and works collaboratively with Case Management to establish level of care for direct admits and inpatient stays. Also acts as a resource for the Revenue Cycle staff within Pre-Service and performs duties under general supervision and following moderately complex procedures and guidelines. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential duties. This job description is a summary of the primary duties and responsibilities of the job and position. It is not intended to be a comprehensive or all-inclusive listing of duties and responsibilities. Contents are subject to change at the company's discretion.
Education: Required - Licensed Practical Nurse (LPN) diploma. Work Experience Required - 3 years of hospital based experience in the delivery of patient care. Preferred - Ambulatory Experience. Certifications Required - Current LPN license in the state of practice. Knowledge Skills And Abilities (KSAs) Proficiency in using computers, software, and web-based applications. Effective verbal and written communication skills and ability to present information clearly and professionally. Excellent customer service skills and ability to gather and disseminate information with a diverse range of people, either in person or over the phone. Excellent interpersonal skills including and ability to work collaboratively with other departments and functional areas and handle high-pressure, difficult situations. Good organizational and time management skills and ability to work with minimal supervision. Excellent decision making, critical thinking, and analytical skills and ability to pay strong attention to detail. Proficiency in application of medical necessity criteria, standards of practice, and research regarding pre-certification guidelines. Ability to prioritize tasks and manage multiple tasks with efficiency and quality. Working knowledge of terminology associated with CPT and ICD-10 coding, Medicare guideline, HMO and PPO contracts and other insurance billing processes.
Secures clinical documentation and performs pre-service medical necessity reviews to obtain prior authorizations. Maintains professional and technical knowledge and certifications. Ensures all regulatory requirements are met within department. Assists in the day-to-day operations of the department. Consistently supports the company and its business services goals and core values. Performs other duties as assigned.
Senior Helpers® is a leading provider of in-home senior care, dedicated to helping seniors maintain independence despite age-related challenges. Since 2002, Senior Helpers has grown to over 320 locations across the United States, Canada, and Australia, caring for tens of thousands of seniors. Known for its specialized training programs, such as Senior Gems® for Alzheimer’s and Dementia care, and the Parkinson’s Care training program, Senior Helpers ensures the highest level of compassionate care. Recognized as the first national in-home care provider certified as a Great Place to Work, the company values the meaningful contributions of its team members. Senior Helpers places a strong emphasis on creating an impactful, rewarding work environment.
This is a part-time remote role for a Registered Nurse, based in the St Paul-Roseville, MN area. The Registered Nurse will be responsible for assessing clients’ care needs, developing care plans, training and supervising caregivers, and ensuring compliance with all state and company care standards. Additional duties include conducting quality assurance visits to clients' homes, providing health education to clients and their families, and maintaining accurate documentation of care and compliance-related activities.
Skills in client assessment, care planning, and evaluating individual healthcare needs Proficiency in training and supervising caregivers to maintain quality care standards Strong communication and interpersonal abilities for working with clients, families, and team members Knowledge of health regulations, quality assurance procedures, and documentation requirements Active Registered Nurse (RN) license and relevant clinical experience Ability to work effectively traveling in the St Paul-Roseville, MN, area and remotely. Experience or training in Alzheimer’s, Dementia, or Parkinson’s care is a plus Dedication to providing compassionate, high-quality care
Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.
CAREER OPPORTUNITY OFFERING: Bonus Incentives Paid Certifications Tuition Reimbursement Comprehensive Benefits Career Advancement This position pays between $56,800.00 – $108,900.00 based on experience The RN Clinical Appeals performs all appeals for clinically related claim denials across Ensemble Health Partners, or in a role that primarily assists with analyzing and reviewing records to prevent future denials, provide clinical records to payers, and prepare for provider-to-provider (P2P) reviews. Job duties include, but are not limited to, contacting insurance plans to determine reasons claims were denied, analyzing the claims and determining if appeal is necessary, preparing the appeal materials which may include correcting and resubmitting claims, gathering additional information, including reviews of medical records, acting as a liaison between healthcare providers for any additional medical documentation or clarification, and submitting appeals in a timely manner. In addition, the Specialist will work closely with other departments, such as Case Management, HIM, Physician Advisory, Clinical Denials, Denial Prevention, Accounts Receivable, Bedded Inpatient Authorization and Virtual Utilization review, to ensure denial trends and outcomes are communicated in a timely manner. The Specialist will perform these duties while meeting the mission of Ensemble Health Partners, as well as meeting the regulatory compliance requirements.
Employment Qualifications: Current unrestricted license to practice nursing (LPN, RN) CRCR or other approved professional certification required with 9 months of date of hire Job Experience: 1 to 3 Years Desired Education Level: Associates Degree or Equivalent Experience Preferred Area of Study: Nursing Other Preferred Knowledge, Skills and Abilities: 4 year/ Bachelors Degree Preferred Minimum Education - Specialty/Major: Registered Nurse (RN) or relevant discipline Minimum Years and Type of Experience: 2 years of denials, utilization review, or case management experience strongly preferred Other Knowledge, Skills and Abilities Required: Proficient computer skills, including Microsoft Suite Experience in hospital operations, chart audit/review, and provider relations. Demonstrated advanced usage of AI and the management of teams using AI to lean in to process and technological improvements, to include the exploration, experimentation, and application of AI. This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require.
Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results. Contacting insurance plans to determine reasons claims were denied, analyzing the claims and determining if appeal is necessary, preparing the appeal materials which may include correcting and resubmitting claims, gathering additional information, including reviews of medical records, acting as a liaison between healthcare providers for any additional medical documentation or clarification, and submitting appeals in a timely manner. In addition, work closely with the Case Management Department and HIM Department to ensure denial trends and outcomes are communicated in a timely manner. This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Associates may be required to perform other job related duties as required by their supervisor, subject to reasonable accommodation.
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Job Title: Personal Financial Strategist Location: Remote Employment Type: Part-Time or Full-Time (1099 Commission Based) Experience Level: No Prior Financial Experience Required Full Training Provided About the Opportunity Are you looking to take your people skills, work ethic, and leadership experience into a career with flexibility, purpose, and unlimited growth potential? We are expanding our national team and seeking motivated individuals with backgrounds in Health Care who are ready to build a new professional path. Your Health Care experience has already equipped you with the discipline, communication skills, and reliability needed to succeed in this role. This is not an internship or a short-term side job it’s a career building opportunity with structured training, mentorship, and a clear path for growth.
Ideal Candidate Profile Excellent interpersonal and communication skills. Reliable, self motivated, and comfortable in performance based roles. Coachable, with a strong desire for personal and professional growth. U.S. Citizen Willing to obtain financial licenses within 30 days (training provided). Ability to pass a background check. This Opportunity Is Not a Fit If You: Are a full-time student or require visa sponsorship. Are seeking short-term or hourly employment. Prefer a salaried, clock-in/clock-out position. Compensation Type: Commission Based (1099) Earning Potential: Growth based income with commissions
Educate individuals and families on strategies to build wealth, protect income, and secure their legacy. Guide clients through tailored financial solutions, including life insurance, retirement strategies, investments, and tax advantaged planning. Build and manage your own client base, with ongoing support from experienced mentors and leaders. Utilize a proven, duplicatable system to grow your business, income, and impact. Develop leadership skills and the opportunity to build and lead your own team.
firsthand supports individuals living with SMI (serious mental illness). Our holistic approach includes a team of peer recovery specialists, benefits specialists and clinicians. Our teams focus on meeting each individual where they are and walking with them side by side as a trusted guide and partner on their journey to better health. firsthand's team members use their lived experience to build trust with these individuals and support them in reconnecting to the healthcare they need, while minimizing inappropriate healthcare utilization. Together with our health plan partners, we are changing the way our society supports those most impacted by SMI. We are cultivating a team of deeply passionate problem-solvers to tackle significant and complex healthcare challenges with us. This is more than a job—it's a calling. Every day, you will engage in work that resonates with purpose, gain wisdom from motivated colleagues, and thrive in an environment that celebrates continuous learning, creativity, and fun.
The Centralized Health Guide is a licensed Nurse Practitioner who leads the medical aspects of virtual care for individuals with serious mental illness that firsthand serves. The Centralized Health Guide is responsible for virtual whole person assessments and management of our vulnerable population, collaborating closely with community primary care and behavioral health providers, as well as an internal team of triage registered nurses and psychiatric nurse practitioners.
Passion for serving individuals suffering from mental illness Display a positive attitude and team player mentality within team Intrinsic motivation to be a top performer Above average comfort with technology Desire to perform data driven care Natural ability to adapt to various assignments and moving target goals Empathy, compassion, and approachability Excellent listening, communication, and interpersonal skills Ability to maintain professional boundaries and engagement skills with a population with challenges and in non-traditional work conditions Willingness to become certified in psychiatric nursing (on the RN level) Licenses in FL, MI, OH, VA, WA or willingness to get licensed in these states The experience you bring to this role includes: 3+ years clinical care as a Nurse Practitioner, ideally in a primary care setting or emergency department Working with and managing a population with challenges such as behavioral health and/or SUD conditions Care management and coordination Psych RN cert (optional, willingness to become certified)
Perform a virtual whole-person clinical assessment, including: Assessing both behavioral and physical health conditions with a thorough history and virtual physical examination Treating conditions including prescribing medications on an ongoing and short-term basis Capturing conditions not yet diagnosed, ordering additional studies where indicated to confirm or rule out the diagnosis Collaborating with a team of support including medical records and clinical documentation specialists, certified coders, and medical assistants Making individualized recommendations and/or referrals for programs/care provided by firsthand and/or outside providers, based on the assessed need Supporting individuals in developing and exercising self management skills and skills skills person-centered care around their individual goals and preferences via motivational interviewing and holistic care planning Organizing the information in a manner that supports appropriate clinical documentation and successful disability applications (if appropriate) Perform virtual unscheduled care assessments and transition of care, including: Provide exemplary customer service to individuals with SMI and maintain a NPS score of 90% or higher Commitment to reducing ER visits within 7 days of your interaction with individual Provide urgent-care treatment for conditions such as COPD exacerbations, uncontrolled diabetes, CHF exacerbations, Cold and Flu Symptoms, UTI, pain, anxiety, depression, and SI. Transition of care visits for individuals within 7 days of discharge from ER/hospitalization Provide Guidance and Support to In-person Health Guides and firsthand guides including: Leads individual progress reviews in partnership with firsthand guides Assist with implementing new interventions and work processes
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.
Position Type: Contract (Remote) Education Requirement: Master of Science in Nursing (MSN) or higher Experience Required: Minimum 2 years teaching experience in nursing education with familiarity in NGN formats. Position Overview: We are seeking a highly qualified Subject Matter Expert (SME) to create case studies aligned with the Next Generation NCLEX (NGN) framework. The SME will develop original, evidence-based assessment items that reflect clinical judgment competencies and support high-stakes readiness across nursing disciplines.
Master’s degree (MSN) or higher in nursing; doctoral preparation preferred. Minimum of 2 years of experience teaching nursing content in an academic setting. Demonstrated knowledge of NGN item types and the NCSBN Clinical Judgment Measurement Model. Familiarity with the NCLEX-RN test plan, AACN Essentials, and nursing competencies frameworks. Prior experience writing NCLEX-style or high-stakes licensure exam questions. Strong attention to clinical accuracy, test validity, and academic rigor. Excellent written communication skills and ability to meet deadlines.
Author NGN-style assessment items (e.g., matrix multiple response, dropdown cloze, bowtie, highlight text, and extended multiple response) based on the NCSBN Clinical Judgment Measurement Model (CJMM). Ensure items are level-appropriate, clinically accurate, and aligned with NCLEX-RN test plan categories and subcategories. Write clear, complete rationales for response options, including references when applicable. Collaborate with assessment leads and instructional designers to ensure consistency with item-writing guidelines and curricular alignment. Revise items as needed based on editorial and psychometric feedback.
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 (APP) I, 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 on our telehealth CareLine. 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 includes weekends and after hours. The schedule for this position is for every weekend as follows: Mondays 1700-0000 Fridays 1630-2100 Saturdays 0700-2100 Sundays 0700-2030
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. A minimum of 3 years' acute/primary care clinical work experience required; with experience in emergency service, urgent care, primary care or value based care highly preferred A minimum of 2 years' telehealth work experience preferred For Nurse Practitioners: 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 or VA, and at least 2 licenses in the following states: GA, MI, MO, OH, PA, TN, TX, IL, KY, LA. Must hold a compact multistate nursing license and 3 additional licenses in states where company is an active business entity Must be willing to travel once a year to GA and twice a year to TN. Travel costs are provided by company.
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.
For over 50 years, Verisk has been the leading data analytics and technology partner to the global insurance industry by delivering value to our clients through expertise and scale. We empower communities and businesses to make better decisions on risk, faster. At Verisk, you'll have the chance to use your voice and build a rewarding career that's as unique as you are, with work flexibility and the support, coaching, and training you need to succeed. For the eighth consecutive year, Verisk is proudly recognized as a Great Place to Work® for outstanding workplace culture in the US, the fourth consecutive year in the UK, Spain, and India, and the second consecutive year in Poland. In addition, we’ve been recognized by The Wall Street Journal as one of the Best-Managed Companies and by Forbes as a World’s Best Employer, testaments to the value we place on workplace culture. We’re 7,000 people strong. We relentlessly and ethically pursue innovation. And we are looking for people like you to help us translate big data into big ideas. Join us and create an exceptional experience for yourself and a better tomorrow for future generations.
We are seeking Medical Analysts with experience in preparing Medicare Set Asides and Medical Cost Projections. This includes reviewing records, preparing the narrative and an appropriate allocation for medical treatment and prescription medications. Candidates will demonstrate knowledge of CMS policies related to preparing MSAs. Strong writing skills, analysis skills and application of guidelines are required for this position. Medical Analysts will work closely with our attorneys and other members of the medical team to prepare Medicare Set-Asides and Medical Cost Projections.
Bachelor’s Degree, Associate Degree or Diploma in Nursing required 3-5 years’ experience in Nursing preferred Registered Nurse (RN) license in good standing with applicable Board of Nursing required Experience in preparing medical review reports, medical bill reviews and utilization reviews in injury cases preferred Certification in any of the following preferred: Medicare Set-aside Certified Consultant (MSCC), Life Care Planner (CLCP or CNLCP), Certified Case Manager (CCM), Medical Coding, Legal Nurse Consulting, Rehabilitation Counseling, Disability Management, Utilization Review Strong interpersonal, oral, and written communication skills including report preparation preferred Ability to work effectively both independently and as a member of a team Ability to gather data, compile and synthesize information, including medical information, claims payment histories and billing, to identify level and types of services utilization
Through a review of relevant medical files and related documentation, provides a narrative and cost projection for future treatment related to Workers Compensation and Liability injuries consistent with the current guidelines Collaborates with a team of attorneys and medical professionals in identifying negotiating and documenting guidelines and cost reductions on future treatment plans Uses ISO Claims Partners proprietary information technology tools to identify diagnoses, treatment guidelines, and prescription medication pricing, and documents the case when applicable Provides additional analysis and medical recommendations as needed Identifies cost drivers and cost savings opportunities on all files and completes client specific -cost mitigation activities on files where applicable This is a full-time position, but additional hours may be required during peak time Occasional travel
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 remote Hospital at Home program in California is seeking an Acute Care Nurse Practitioner to support patient evaluation and care coordination through a telemedicine-based hospitalist model. This role allows clinicians to deliver hospital-level care remotely while patients recover safely at home. Providers will work closely with hospitalists, home health teams, and care coordinators to assess patient eligibility, manage treatment plans, and ensure continuity of care in a virtual care environment.
Active California NP license AGACNP preferred 4+ years clinical experience in hospital medicine, emergency medicine, or internal medicine Telemedicine or virtual care experience preferred Must reside within California
Conduct comprehensive telemedicine assessments for acute care patients Determine eligibility for Hospital at Home admission Review labs, imaging, and patient medical histories Develop and manage hospital-level care plans remotely Coordinate with home health providers and hospitalist teams Monitor patient progress and adjust care plans as needed Educate patients and caregivers on home-based care protocols Maintain accurate documentation in EHR systems (EPIC preferred)
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
Alignment Health is seeking a remote Utilization Management (UM) Nurse – Pre-Service (LVN or RN, active California license required) to join our growing UM team. In this role, you’ll review prior authorization requests for medical necessity across inpatient and outpatient services, applying CMS guidelines and Milliman Care Guidelines (MCG) to support timely, accurate determinations. You’ll partner closely with providers and medical directors to ensure members receive high-quality, cost-effective care. This is a fast-paced, production-driven role ideal for nurses with recent pre-service UM experience in a managed care setting who are comfortable managing multiple cases, meeting turnaround time expectations, and collaborating cross-functionally in a fully remote environment. Schedule: Monday – Friday, 8:00 AM – 5:00 PM Pacific Time (must be able to consistently work these hours) Candidates must reside within Pacific, Mountain, or Central time zones to align with business hours. Weekend rotation: approximately 1 weekend day every 5–6 weeks (4–8 hour shift between 8:00 AM – 5:00 PM Pacific Time)
Required: Minimum (3) years' nursing experience in clinical setting. Minimum (1) year experience UM experience with pre-service. Minimum (1) year experience with managed care (Medicaid and / or Medicare). Minimum 1 year of experience with the application of UM criteria (i.e., CMS National and Local Coverage Determinations, etc.) Minimum (1) year experience in a medical setting working with IPAs, entering referrals / prior authorizations preferred Minimum (1) Experience with the application of clinical criteria, specifically Milliman Care Guidelines (MCG) Education Required: High School Diploma or GED. Preferred: Associates or Bachelor's degree in Nursing Licensure Required: Must have and maintain an active, valid, and unrestricted LVN or RN license in California (Non-Compact) Immediately upon hire, must be willing to obtain LVN and / or RN licensure in Nevada, (Non-compact), Arizona (Compact), North Carolina (Compact), and Texas (Compact) which will be reimbursed by company. Preferred: CPHQ or ABQAURP, or Six Sigma certification Medical Terminology Certificate. Training Required: None Preferred: Medical Terminology. Six Sigma Specialized Skills Required: Knowledge of ICD-10, CPT codes, managed care plans, medical terminology and referral system (Access Express / Portal / N-coder). Knowledgeable with CMS (Chapter 13) guidelines and regulations. Computer Skills: Word, Excel, Microsoft Outlook Language Skills: Effective written and verbal communication skills; able to establish and maintain a constructive relationship with diverse members, management, employees and vendors. Mathematical Skills: Able to perform mathematical calculations and calculate simple statistics correctly. Reasoning Skills: Able to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution. Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment. Report Analysis Skills: Comprehend and analyze statistical reports. Preferred: Bilingual English and Spanish Transplant knowledge a plus 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.
Review pre-certification requests for medical necessity and refer to medical director any referral that requires additional expertise. Utilize CMS guidelines (LCD, NCD) to assist in determinations of referrals and utilize Milliman Care Guidelines (MCG) to assist in determinations of referrals. Maintain goals for established turn-around time (TAT) for referral processing. Initiate single service agreements (SSA) when services required are not available in network. Maintain a professional rapport with providers, physicians, support staff and patients in order to process pre-certification referrals as efficiently as possible. Verify eligibility and / or benefit coverage for requested services. Verify accuracy of ICD 10 and CPT coding in processing pre-certification requests. Contact requesting provider and request medical records, orders, and / or necessary documentation in order to process related pre-service requests / authorizations when necessary. Review referral denials for appropriate guidelines and language. Assist medical directors in reviewing and responding to appeals and Grievances Contact members and maintain documentation of call for expedited requests. Other duties as assigned.
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
Alignment Health is seeking a care coordinator to join the transitions of care case management team. As a care coordinator, you partner closely with an RN case manager to support members through transitions of care, helping ensure they receive timely, coordinated services following hospital or SNF discharge. In this role, the care coordinator works directly with members to schedule appointments, coordinate services such as home health and DME, assist with authorizations, and help close care gaps—playing a key role in improving outcomes for seniors with complex and chronic conditions. This is a highly collaborative, member-facing role ideal for someone with care coordination or case management experience who is comfortable navigating healthcare systems and supporting members telephonically throughout the day. If you are hungry to learn and grow, want to be part of a growing organization, and make a positive impact in the lives of seniors – we’re looking for you! Schedule: Monday - Friday, 8:00 AM - 5:00 PM Pacific Time (flexible start between 7:30 AM – 8:30 AM). No overtime required. Location: Fully Remote (must be based in California or Pacific Time Zone)
Required: Minimum 1 year of experience in care coordination, case management, or transitions of care within a health plan, IPA, MSO, or medical office setting Experience supporting members/patients with scheduling, authorizations, referrals, and coordination of services (e.g., home health, DME, follow-up care) Experience interacting directly with patients/members in a telephonic or care coordination setting Preferred: Experience supporting hospital or SNF discharges, including requesting and reviewing discharge summaries Education Required: High School Diploma or GED and / or (4) years' relevant experience in lieu of education. Preferred: Bachelor's degree Training Preferred: Medical assistant training, Medical terminology training. Specialized Skills Required: Bilingual English and Spanish Able to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals. Ability to write routine reports and correspondence. Communicates effectively using good customer relations skills. Able to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others. Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment. Knowledge of Managed Care Plans Knowledge of Medi-Cal Proficient Computer Skills, Able to type 35 WPM by 10-key touch (Microsoft Outlook, Excel, Word) Mathematical Skills: Able to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s. Able to perform these operations using units of American money and weight measurement, volume, and distance. Reasoning Skills: Able to apply common sense understanding to carry out detailed but uninvolved written or verbal instructions. Able to deal with problems involving a few concrete variables in standardized situations. Licensure Required: None Preferred: Medical assistant certificate, Medical terminology certificate 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. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Create cases, tasks, and complete documentation in the Case Management module for all Hospital and SNF discharges Reach out to members telephonically to assist with referrals, authorizations, home health care (HHC), durable medical equipment (DME), medication refills, and scheduling provider appointments and follow-ups Request and upload medical records from PCPs, specialists, hospitals, and other providers, including discharge summaries Work as a team with the RN Case Manager to engage and manage a panel of members Manage new alerts and update the Case Manager of changes in condition, admission, discharge, or new diagnoses Complete and document tasks assigned by nurse Establish relationships with members, earn their trust, and act as a patient advocate Escalate concerns to nurse if members appear to be non-compliant or there is a change in condition Assist with outreach activities to members across all levels of case management programs Assist with maintaining and updating member records Assist with mailing or faxing correspondence to members, primary care physicians (PCPs), and/or specialists Meet specific deadlines by prioritizing tasks according to department policies, standards, and business needs Maintain confidentiality of information between and among healthcare professionals Other duties as assigned by case management leadership
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. Why Join Us: Fully remote role with flexible scheduling. Opportunity to lead impactful patient care initiatives. Collaborate with a supportive, interdisciplinary team. Professional growth and continuous learning opportunities.
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.
Liberty Healthcare is a leading health and human services management company that operates treatment programs, supports population health, and provides health workforce outsourcing. For over three decades we have embraced healthcare challenges that seem to defy solutions. We are distinguished by our reputation, leadership and performance. No other organization offers Liberty’s depth and diversity of programs or experience. Agile and innovative, we are ready to take on any challenge that our customers present and transform them into successful programs with desired outcomes. We are nationally recognized, certified by the Joint Commission and CMS, and accredited by NADD, CARF, and APPIC. We’re Liberty…and we give you the freedom to succeed.
Registered Nurses are encouraged to consider a full-time Clinical Reviewer position with Liberty Healthcare. As a Clinical Reviewer, you will be an active contributor with a large-scale program which endeavors to enrich the lives of older adults and people who are living with developmental disabilities. This is a remote-first position which will primarily allow you to work in your home office with an occasional need to attend in-person meetings in Nebraska. This is a non-direct care role which does not involve patient contact or nursing care. As a valued full-time employee of Liberty Healthcare and Clinical Reviewer, you can expect: $80,000 annual salary Health insurance, dental insurance, vision insurance, life insurance, and disability insurance 30 days of paid time off each year for holidays, vacation, sick leave, and personal days Health Savings Account, 401k plan, and other perks Full details on Liberty's benefits plan are available at www.libertyhealthcare.com/upload/138.pdf
You are a good fit for this position if you possess the following: Professionally licensed as a Registered Nurse in Nebraska Experience providing nursing services to older adults and people who are living with developmental disabilities Knowledge of quality assurance methodologies Outstanding analytical and report writing skills Nebraska residency
Your role will focus on the review and analysis of health information of recipients of Medicaid HCBS waiver services, and your day-to-day responsibilities will include: Reviewing medical records and personal health information Conducting root cause analyses of critical incidents and deaths Forming objective evidence-based opinions Writing detailed reports Leading and participating in committee and team meetings Providing technical assistance and training Collaborating with stakeholders
Savoy Life is a distributed senior living platform focused on bridging the gap between senior living communities and healthcare. With a team of specialized clinicians, including nurses and geriatricians, Savoy Life offers a tech-enabled solution that empowers senior living operators to do their jobs more effectively and efficiently so they can move residents into their communities faster and keep them healthier for longer.
Savoy Life is a distributed senior living platform focused on bridging the gap between senior living communities and healthcare. With a team of specialized clinicians, including nurses and geriatricians, Savoy Life offers a tech-enabled solution that empowers senior living operators to do their jobs more effectively and efficiently so they can move residents into their communities faster and keep them healthier for longer. Location: Remote Reports to: Chief Clinical Officer Position Overview: Savoy Life is seeking a motivated and experienced Nurse Practitioner (NP) to join our growing team as a telemedicine provider. This role is fully remote and focuses on supporting senior living communities by collaborating with on-site RNs to deliver high-quality, individualized care. The NP will play a critical role in completing care plans, conducting virtual visits, and helping shape the future of telemedicine services within our organization.
Qualifications: Active, unencumbered NP license. Active licenses in Washington, Oregon, and Arizona, with the ability to obtain additional licenses as required. Strong experience in geriatric medicine and chronic disease management. Expertise in developing care plans for patients with multiple chronic conditions. Excellent documentation skills and proficiency in using EMR systems. Ability to work autonomously in a remote setting, solve problems independently, and adapt to evolving workflows. Skills & Competencies: Strong clinical decision-making and diagnostic skills. Excellent communication and collaboration abilities. Flexibility to adapt to a dynamic and growing organization. Proficiency in telemedicine platforms and technology. Travel Requirement: Occasional travel for opening new facilities or team meetings, though not part of daily responsibilities.
Conduct new patient and establish-care visits via telemedicine, focusing on chronic condition management. Collaborate with on-site RNs to develop individualized care plans tailored to patients' chronic disease burdens. Perform telemedicine priority care visits for common ailments experienced by residents in senior living communities. Partner with the Chief Clinical Officer to adjust workflows and processes based on feedback and the evolving needs of senior living partners. Assist in scoping and developing training materials and workflows to onboard additional clinicians as the organization expands. Maintain detailed and accurate documentation in the electronic medical record (EMR) system. Provide clinical insights to support the growth and innovation of telemedicine services. Ability to be on-call after hours and weekends as second line of defense (RNs answer phone calls first). Note this is rotating and will be at least every 3-week rotation.
Optum Home & Community Care, part of the Optum family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual's physical, mental and social needs - helping patients access and navigate care anytime and anywhere. As a team member of our Optum HouseCalls team, together in an interdisciplinary care environment, we help patients navigate the health care system and connect them to key support services. This preventive care can help patients stay well at home. We're connecting care to create a seamless health journey for patients across settings. Join us to start Caring. Connecting. Growing together.
The HouseCalls Clinical Support Team (HCCST) supports Advanced Practice Clinicians in the HouseCalls program by providing telephonic consultation to plan members post HouseCalls visit. This position is completely telephonic in a call center environment. Goals of the program include providing a one-time outreach to members for follow up post HouseCalls visit to provide education and clarification on any concerns raised during their HouseCalls visit. The main objective of this program is to ensure successful transition of care from the HouseCalls Advanced Practice Clinician back to the members Primary Care Provider. This team includes nurse care managers and social workers. The Nurse Care Manager (NCM) will report directly to the Manager/or Director of Clinical Operations of HCCST. The NCM interacts via telephonic consult with members and providers to assist with education and clarification on any concerns raised during the HouseCalls visit and ensure the member has/or assist in obtaining an appointment with the provider to transition care. They work to ensure members receive quality customer service by answering questions, addressing concerns, providing education, providing resource information, and entering referrals. The schedule is Monday through Friday from 9AM to 5:30PM Eastern or 9AM to 5:30PM Central respectively.
Required Qualifications: Current, unrestricted Compact RN (Registered Nurse) license in the state of residence Willing and able to obtain additional licensure in assigned states within 6 months of hire 3+ years of clinical experience in a hospital, acute care, home health / hospice, direct care, or case management position Computer/typing proficiency to enter and retrieve data in electronic clinical records Proficient with Microsoft Word, Outlook, and Excel Proven solid problem-solving skills Proven ability to communicate complex or technical information in a manner that others can understand and the ability to understand and interpret complex information from others Proven ability to perform positively and efficiently in production driven environment Dedicated, distraction-free space in home and access to company approved high-speed internet (Broadband Cable, DSL, Fiber) Bilingual in Spanish Preferred Qualifications: Telephonic case management experience Home care / field based case management Medicaid, Medicare, or managed care experience Experience working remotely from home Experience working in a call center environment Experience working in a metrics-driven environment Demonstrated excellent customer service skills Reside in the Central or Eastern time zone
Perform telephonic outreach to members identified by the Advance Practice Clinician for specific referral related issues Ensure member has scheduled appointment with Primary Care Provider (PCP)/specialty provider; help scheduling appointment, if needed Refer members to internal departments such as Social Work, or Clinical Help Desk when appropriate Gather clinical information telephonically from patient/family Assist patients/members with urgent needs requiring acute intervention that arise during the call Identify triggers for hospitalization and barriers to meeting healthcare goals as they arise during the call Complete required documentation in compliance with auditing standards and policies Provide patient/family education on disease process and trigger management that arise during the call or are directly related to referral reasons Assist with connections to appropriate community resources if needed Understand and maintain confidentiality of legal and ethical issues Maintain compliance with all HIPAA (Health Insurance Portability and Accountability Act) regulations Enhance the experience of both internal and external customers by providing excellent customer service while maintaining production metrics Serve as a clinical resource and consultant for other clinicians Attend and participate in team huddles and staff meetings Work with Supervisor to identify system improvements that could be made to drive operational advancements and efficiencies Provide cross-coverage support across the team and assist with special projects, as needed Assume other duties as assigned and directed by the Supervisor or Manager of Clinical Call Center Operations 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.
Be inspired. Be rewarded. Belong. At Emory Healthcare. At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: Comprehensive health benefits that start day 1 Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship, development, leadership programs...and more!
11:00a-7:30p / Full-Time / 40 hours The Assistant Nurse Manager, Ortho/Neuro Surgery Inpatient plays a key leadership role in the Leadership Team, overseeing daily clinical and operational functions to ensure seamless patient care across the continuum. This role demands a dynamic leader capable of managing both clinical excellence and operational performance, all while ensuring that patient care remains the top priority. You will lead staff, drive clinical practice development, and manage patient care delivery, while being accountable for team performance, quality, safety, compliance, financials, throughput, workflow, and scheduling. Reporting to the Nurse Manager, you will develop, implement, and evaluate systems that promote high-quality, cost-effective, and safe care.
Minimum Required Qualifications: Bachelor's degree in nursing (BSN) required A minimum of (3) years of professional nursing practice experience in acute and/or ambulatory care nursing practice setting with 1 year of lead, supervisory, management, and/or leadership experience in nursing and/or health system position/role. A valid, unencumbered Registered Nursing License approved by the Georgia Board of Nursing. Virtual Care Setting: If managing remote clinical care team members, active compact/multistate license (eNLC) within 60 days of hire. BLS required. ACLS may be required for certain departments, post hire. Additional certifications may be required based on department and specialty. Proven leadership skills in a clinical setting, with experience in nursing practice oversight and team management. In-depth knowledge of quality assurance, performance management, and regulatory compliance. Ability to create a positive, inclusive workplace and foster professional development. Strong problem-solving and decision-making skills, with the ability to resolve technical and operational challenges. Excellent communication and interpersonal skills, with the ability to work collaboratively with other healthcare professionals. Preferred Qualifications: Education: Master's of Science in Nursing (MSN) or related field preferred. Experience: A minimum of (3) years of professional nursing practice experience in acute and/or ambulatory care nursing practice setting with 2 years of lead, supervisory, management, and/or leadership experience in nursing and/or health systems position/role in a complex academic health system preferred.
Leadership & Team Development Foster a culture of collaboration, excellence, and mutual respect within inter-professional care teams. Develop, manage, and evaluate team performance, ensuring alignment with organizational goals. Provide education, coaching, and guidance to staff, ensuring adherence to clinical standards. Support staff onboarding, competency assessment, and continuous professional development. Clinical & Operational Management Oversee clinical and operational workflows, ensuring patient integration and service efficiency. Lead quality and safety initiatives specific to your area, aligning with organizational objectives. Implement and monitor financial and productivity goals within your area of responsibility. Performance & Compliance Manage performance, providing feedback and addressing issues related to patient care and professional conduct. Ensure compliance with regulatory standards, accreditation requirements, and organizational policies. Lead continuous quality improvement efforts through data analysis and problem-solving. Strategic & Operational Oversight Plan, prioritize, and execute operations efficiently, anticipating resource needs and achieving results within budget in partnership with the triad leadership team. Address operational challenges and apply problem-solving skills to resolve issues with the triad leadership team. Advocate for the optimal allocation of resources to support patient care. Workplace Culture & Staff Well-Being Foster an inclusive and diverse work environment that values individual differences and promotes staff well-being. Create and support a healthy work environment that encourages professional growth and high staff morale. Professional Practice Oversight: Actively monitor nursing practice to ensure adherence to established standards, policies, and procedures. Provide ongoing education and training to nurses, ensuring up-to-date clinical skills and regulatory knowledge. Advocate for patient safety and optimal care by addressing concerns regarding staffing, resources, and care delivery.
Be inspired. Be rewarded. Belong. At Emory Healthcare. At Emory Healthcare we fuel your professional journey with better benefits, valuable resources, ongoing mentorship and leadership programs for all types of jobs, and a supportive environment that enables you to reach new heights in your career and be what you want to be. We provide: Comprehensive health benefits that start day one! Student Loan Repayment Assistance & Reimbursement Programs Family-focused benefits Wellness incentives Ongoing mentorship, development, and leadership programs… and more!
The Utilization Review (UR) Specialist is a Registered Nurse responsible for conducting thorough medical necessity reviews to assist with determining appropriate patient class designation. The UR Specialist will perform timely and comprehensive reviews of the patient chart utilizing InterQual Criteria accurately in conjunction with the UR Department workflows/processes, clinical nursing judgement, and when necessary, discussions with the provider team and/or Medical Director of UR. This position requires a commitment of one weekend (Saturday/Sunday) every four weeks with one day off during the week. Travel: Less than 10% of the time may be required. Work Type: This position is a remote position outside traditional office, often from home or another remote setting.
Minimum Qualifications: Education - Associate degree in nursing. Experience - Minimum of 5 years of recent acute hospital experience or a minimum of two years of previous utilization review experience. Licensure - Must have a valid, active unencumbered Registered Nurse license approved by the Georgia Licensing Board. Skills - Must meet all quality and productivity expectations and successfully complete yearly competencies. Preferred Qualifications: Education - Bachelor's degree in Nursing strongly preferred. Certification - Case Management certification preferred. Skills - InterQual Level of Care Criteria experience. Previous utilization review experience strongly preferred.
Conducts thorough medical necessity reviews to assist with determining appropriate patient class designation. 2. Performs timely and comprehensive reviews of the patient chart utilizing InterQual Criteria accurately in conjunction with the UR Department workflows/processes, clinical nursing judgement, and when necessary, discussions with the provider team and/or Medical Director of UR. 3. Performs appropriate and accurate initial, admission (episode day one) and concurrent utilization reviews as guided by InterQual Criteria and UR Department workflows on all observation, inpatient, and extended recovery admissions as required based on Emory Healthcare's Utilization Management Plan and the UR Department's processes. 4. Ensures that all InterQual reviews are supported with provider team documentation and/or clinical data. 5. When appropriate, the UR Specialist will utilize the UR Department's Severity of Illness/Intensity of Service template to document the medical necessity of the admission or continued stay. 6. While conducting utilization reviews, will identify any Avoidable Delays and accurately document the delay(s) based on the workflow. 7. Follow the UR Department's denial workflows as appropriate. 8. Prioritizes work with minimal guidance for optimal reimbursement and to avoid financial risk to both patient and hospital. Compliance: Will identify and complete Medicare Outpatient Observation Notices (MOON), Medicare Change of Status Notice (MCSN), Condition Code 44s and Medicare Hospital Issued Notices of Non-Coverage (HINNs) for Medicare beneficiaries as appropriate. 2. Ensures compliance with all state of Georgia and Federal regulatory requirements as designated in Emory Healthcare's Utilization Management Plan. 3. Maintains all required annual competencies, metrics, and fully participate and engage in department process improvements. Collaboration: Responsible for timely communication to the provider team and interdisciplinary team as it relates to patient class designation and medical necessity of an admission or continued stay on individual patient basis based on UR Department workflows. 2. In a team effort, the UR Specialist will work closely with the UR Department's Case Management Authorization Specialist IP to ensure that authorized days and patient actual LOS are reconciled to ensure appropriate reimbursement for services provided. 3. Responsible for communicating medical necessity denials for in-house patients to the Medical Director of UR, and when designated to the provider team. 4. Serves as a resource to the provider team, Interdisciplinary Care Team, and patient to explain external UR regulations. 5. Provides effective and efficient proactive communication to internal and external customers. 6. Assists in collaborative efforts with the Case Management Department, Revenue Cycle, Physician Advisors, and other required departments. Additional Duties: Ability to multi-task in a fast-paced environment while efficiently handling multiple priorities and ensuring deadlines are met. 2. Performs other duties and tasks as assigned.
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.
Care Management Coordinator (RN) – Utilization Management Location: Remote (PA, DE, NJ only) Schedule: Part-Time (2 weekdays + every other weekend, 9:00 AM – 5:00 PM) We are seeking an experienced Registered Nurse (RN) with a strong background in Utilization Management to join a dynamic care management team. This role is ideal for a clinically strong, detail-oriented professional who thrives in a fast-paced, decision-driven environment and is passionate about ensuring patients receive appropriate, high-quality care. The Care Management Coordinator plays a critical role in evaluating medical necessity, supporting care coordination, and ensuring compliance with regulatory standards—while serving as both a clinical resource and patient advocate. Position Overview In this role, you will independently review medical records and apply established clinical criteria to determine the appropriateness of services. You will collaborate closely with providers, case management teams, and leadership to support care decisions, facilitate appropriate treatment plans, and ensure optimal patient outcomes. This position has the authority to approve medically necessary services and escalate cases that do not meet criteria to the Medical Director for further review.
Qualifications: Active Registered Nurse (RN) license in Pennsylvania or Nurse Licensure Compact (NLC) including PA BSN preferred Minimum 3+ years of Medical/Surgical nursing experience Prior experience in Utilization Management within an acute care setting Strong working knowledge of InterQual (IQ) criteria Skills & Expertise: Strong clinical judgment and critical thinking skills Excellent communication and provider engagement abilities Proven ability to work independently and make sound clinical decisions Highly organized with strong time management and prioritization skills Comfortable working with clinical systems and Microsoft Office tools Adaptable, collaborative, and solutions-oriented mindset What Success Looks Like: Consistently makes accurate, timely utilization decisions Effectively collaborates with providers and internal teams to optimize care outcomes Maintains regulatory compliance and documentation integrity Identifies opportunities to improve efficiency, care quality, and member experience This is an excellent opportunity for a Utilization Management RN seeking a flexible, part-time schedule while continuing to make a meaningful impact on patient care and healthcare delivery.
Conduct comprehensive reviews of medical records to determine medical necessity, level of care, and length of stay Apply clinical guidelines such as InterQual and Medical Policy to support decision-making Collaborate with providers to clarify clinical information and treatment plans Identify cases that do not meet criteria and escalate to the Medical Director for review Support discharge planning and care coordination, ensuring appropriate level of care and transitions Ensure all determinations align with federal, state, and accreditation standards Maintain accurate, timely documentation and data entry within care management systems Monitor and report utilization trends and opportunities for process improvement Partner with internal teams to address delays in care and improve patient outcomes Serve as a resource and advocate for members navigating the healthcare system
Since our establishment in 2008, TEEMA has been at the forefront of revolutionizing the staffing industry. We take immense pride in serving over 1,200 clients spanning Canada, the United States, and international markets, specializing in delivering comprehensive staffing solutions. Our offerings, ranging from contract and temporary placements to payroll, permanent, and executive staffing, cater to various verticals, including Information Technology, Engineering, and Healthcare.
Job Title: CLINICAL QUALITY REVIEWER (RN or LCSW) Location: USA- Remote in approved states Overview: TEEMA is partnering with a leading organization supporting a large-scale federal healthcare program to identify a Clinical Quality Reviewer. This role focuses on reviewing clinical cases, identifying potential quality or safety concerns, and supporting quality improvement initiatives across a complex healthcare delivery network. This is an excellent opportunity for a licensed clinical professional with experience in clinical review, utilization management, or healthcare quality within health plans, hospital systems, or government-supported programs.
Active, unrestricted license as a Registered Nurse (RN) or Licensed Clinical Social Worker (LCSW) Minimum 3+ years of clinical experience (medical/surgical and/or behavioral health) U.S. Citizenship required Ability to obtain and maintain a Department of Defense (DoD) background clearance Strong analytical and critical thinking skills Excellent written communication skills Nice to have: Bachelor’s degree in Nursing or healthcare-related field Experience in clinical quality, utilization review, or case review Familiarity with federal or government healthcare programs Experience with clinical criteria tools (InterQual or similar) Exposure to healthcare data analysis or reporting Technical SkillsProficiency with Microsoft Office (Word, Excel, Outlook) Comfortable working across multiple systems and electronic medical records What makes you successfulStrong clinical judgment and attention to detail Ability to work independently and manage multiple priorities Analytical mindset with problem-solving ability Clear and professional communication skills Comfortable working in a structured, compliance-driven environment Other Information:Remote or onsite depending on business needs Must have a secure home office setup if remote Occasional extended hours may be required
Review medical records to identify potential quality, safety, and utilization concerns Conduct detailed case analysis and prepare clear, well-documented summaries and recommendations Support peer review processes and quality improvement initiatives Analyze trends and assist in identifying patterns in care delivery and outcomes Collaborate with clinical leadership, including Medical Directors, to review findings Participate in quality committees and performance improvement efforts Ensure compliance with regulatory requirements and program standards Coordinate with cross-functional teams such as case management, care coordination, and program integrity
In our 50 year history, Help at Home has provided care for individuals, helping them to remain independent and able to live their best lives in their own homes. Our clients have always been like family. As the leading national provider of high-quality, relationship-based home care for seniors and people living with disabilities, we’re uniquely positioned as the home care company of choice. Our person-centered home care services create Great Days and Meaningful Moments for individuals, while also driving high-quality, low-cost outcomes. We provide in-home, community-based care in 11 states and 200+ locations with the help of 60,000 highly trained, compassionate caregivers who have relationships with 70,000+ clients.
Flexible APRN or ARNP Virtual Assessments – $80+ per assessment Caregiver Services Inc., a Help at Home® company, is looking for 1099 - Advanced Practice Registered Nurses (APRNs) or Advanced Registered Nurse Practitioners (ARNPs) who want flexible work in your area to support patient assessments. This is a great opportunity for nurses who want to earn more per assessment, control their schedule, and work independently while assessing patients’ needs for services. Why This Opportunity Stands Out $80+ per telephonic assessment Set your own schedule directly with patients (24-48 hour turn around required) Per assessment based model – no long shifts No travel required! Conduct from your home.
This position is ideal for an APRN/ARNP who: Wants flexible or supplemental income Prefers independent, home-based work RNs wanting to step away from long shifts or facility work Requirements: Advanced Practice Registered Nurse (APRN) or Advanced Registered Nurse Practitioner (ARNP) license Strong clinical judgment and communication skills Ability to work independently and manage your own schedule
Conduct over-the-phone assessments to clinically qualify patients for services. Conduct 3008 assessments via phone Evaluate physical, cognitive, and psychosocial status Accurately document findings and complete required state forms Determine and recommend appropriate level of care and services Ensure compliance with all state and program regulations Submit completed assessments within required timeframes Communicate with care coordination teams as needed
ISG specializes in delivering transformative consulting and BPO services that empower businesses to thrive in a competitive, ever-changing market.
This role requires either Saturday or Sunday as part of their regular scheduled shift. This is a REMOTE position, but candidates must reside in either TX, IL, NM, OK, MT or TN Contract: 2026-04-13 to 2026-08-13
RN and current unrestricted nursing license required.
Delivers specific delegated tasks assigned by a supervisor in the Nurse Case Management job family. Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan. Utilizes clinical skills to assess, plan, implement, coordinate, monitor and evaluate options and services in order to facilitate appropriate healthcare outcomes for members. Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained. Provides clinical assessments, health education, and utilization management to members. Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient services. Manages own caseload and coordinates all assigned cases. Completes day-to-day Nurse Case Management tasks without immediate supervision but has ready access to advice from more experienced team members. Tasks involve a degree of forward planning and anticipation of needs/issues. Resolves non-routine issues escalated from more junior team members.
National University is a veteran-founded, San Diego-based nonprofit. Since 1971, our mission has been to provide accessible higher education to adult learners. Today, we educate a diverse student body from across the U.S. and around the globe, with more than 230,000 alumni worldwide. Our eight schools and two colleges offer more than 200 accredited and licensed graduate and undergraduate programs. National University holds accreditation through the Western Senior College and Universities Commission (WSCUC).
Compensation Range: Hourly: $52.84 - $69.81 National University – San Diego, California Part-time Faculty: Master of Nursing - Family Nurse Practitioner (FNP) Location: Remote California, Remote Texas The Department of Nursing, in the School of Health Professions at the National University invites applications for part-time faculty in Nursing with a specialization in Family Nurse Practitioner (FNP). The successful candidate will have a demonstrated record of or potential for excellence in teaching in their field and a commitment to serving the university’s diverse adult student body. The successful candidate will have the potential for a commitment to serving the university’s diverse adult student body. This position primarily works closely with the Academic Program Director and other faculty within the program and contributes to ensuring program quality, student engagement, and success. This is an excellent opportunity for a Part-Time Faculty to join our highly engaged faculty in Nurse Practitioner program. As an integral and vital part of our teaching staff, the successful candidate will provide students with unique and valuable perspectives by helping them to develop critical thinking, communication, and therapeutic nursing skills within the framework of transcultural nursing. Note: We are looking for Part-Time Assistant Professors that can teach 12-week courses online or 16 week courses when NU moves to the semester system.
Required Qualifications: Master of Science in Nursing, Family Nurse Practitioner, or Doctor of Nurse Practitioner with a Family Nurse Practitioner specialization. At least two years of continuous clinical practice in the NP role and currently working at least part-time in the NP role. Active, current, and unencumbered FNP state license in either Texas or California. (Note: Once hired, Faculty are required to have both RN and FNP licenses in both California and Texas. The department will pay for new faculty to obtain their license in either California or Texas if the applicant doesn’t already have both state licenses. Minimum of two 2 years’ current experience in an FNP role, including diagnosing and treating patients in a clinic setting. Preferred Qualifications: Doctor of Nurse Practitioner with a Family Nurse Practitioner specialization. National board certification - FNP specific. Online higher education experience is strongly preferred. Demonstrated experience in developing and maintaining courses. Experience with the following course topics is preferred: QI & Project Management, EBP for Advanced NSG Practice, Advanced Pharmacology I, Advanced Pharmacology II, FNP: Women’s Health/Pediatrics, Women’s health/Pediatric Practicum, and FNP Capstone.
Efficiently deliver didactic and/or clinical instruction online to students. Plan and deliver an effective “classroom” experience through Zoom, that promotes learning of course/program learning objectives and prepares the student to be a competent, beginning Nurse Practitioner. Effectively engage students, utilizing a variety of teaching methods. Evaluate students in classroom and clinical settings utilizing effective educational methods and tools. Grading assignments and responding to student inquiries within 48 hours of assignment submission. Responding to students' inquiries via email within 24 hours of receipt of the email, thus providing timely feedback to students' questions and concerns. Communicate effectively with students, staff, and faculty, both verbally and through written communication. Focus on student-centered learning in all aspects of the curriculum.
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 Nurse Practitioners: 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 at minimum FL or VA (both preferred), and at least 2 licenses in the following states: GA, MI, MO, OH, PA, TN, TX, IL, KY, LA, KS. A minimum of 3 years' acute/primary care clinical work experience required; with experience in emergency service, urgent care, primary care or value based care highly preferred A minimum of 2 years' telehealth work experience highly preferred Must be willing to travel twice a year to TN and once a year to GA required. Travel costs are provided by company.
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
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.
The Universal RN (Registered Nurse) provides skilled nursing care in accordance with InnovAge policies, clinical standards, and all applicable regulations. This universal role supports participants in both clinic and in-home settings (as assigned), partners with the interdisciplinary team (IDT) to develop and execute individualized Plans of Care, and supports safe, efficient care delivery for frail and elderly participants. Physical presence at an InnovAge center and/or participant home is essential to performing the duties of this role.
Required: Current, unrestricted Registered Nurse (RN) license in the state of practice. Current First Aid and BLS certifications from American Heart Association and/or American Red Cross (required prior to hire). 1+ year experience working with frail or elderly populations. For assignments that include in-home care: personal transportation, valid state driver’s license, acceptable driving record, and auto insurance as required by law. Preferred: Bachelor’s degree in nursing Certification as a Gerontological Nurse 3 years of health care experience with emphasis in geriatrics Bi-lingual-Spanish, Russian, Punjabi or Hmong is a plus InnovAge Service Standards Requirements Safety- Maintains a safe work place. Reports all unsafe work conditions to supervisor and/or Safety & Loss Control Manager and works in conjunction with supervisor, Safety & Loss Control Manager, and staff to correct unsafe work conditions. Follows and enforces all safety policies. Accountability Commitment – Commits to his/her job and to the success of the company. Continuously puts forth the effort to achieve goals and continuous quality improvement. Degree to which employee goes the extra step to ensure job/task completion. Takes initiative to offer ideas to improve processes or results. Cooperativeness – Consistently supports management decisions as demonstrated by his/her actions. Demonstrates a “can do” attitude by responding positively to instructions. Follows instructions and works harmoniously with others to complete the job or task. Attendance – Meets or exceeds punctuality and attendance expectations/requirements. Faithfully reports to work and conforms to scheduled work hours. When necessitated, follows call-in procedures and informs others of absences. Caring Customer Service - Embraces the organization's commitment to internal and external customer service and demonstrates a customer-centric approach when interacting with co-workers, participants, clients, and all other business contacts. Confidentiality – Maintains confidentiality of employee, participant, and client data/information, and any other sensitive organization information as appropriate. Integrity Adherence to Company Policy – Follows and enforces guidelines as established by policies. Conforms to company and job standards and requirements. Shows respect for others. Acts in the best interests of the company at all times. Serves as an example for others. Conducts business in an ethical fashion. Reliability – Completes responsibilities with minimal direct supervision. Follows through with assigned jobs and tasks all the way through completion. Puts forth the effort to achieve goals and objectives under varying circumstances. Alignment with Company Goals & Objectives – Supports the organization’s mission, vision, and values and holding self-accountable for applying these principles daily and personally living them when working with co‑workers, participants, clients, and all other business contacts. Quality Quantity of Work / Productivity – Produces at a high volume. Always puts forth the effort to maximize productivity. Meets or exceeds established work deadlines. Engages in a productive work effort whenever possible. Meets goals and objectives. Quality of Work – Produces work that is accurate and reliable. Accomplishes work quickly and efficiently. Works in a thorough and organized manner while minimizing down time. Results are consistently within acceptable quality standards. Job Knowledge – Demonstrates a thorough understanding of his/her job processes and procedures. Integrates knowledge to efficiently accomplish job requirements. Efficiently uses resources (including staff and management) to obtain additional knowledge. Communication – Exhibits good interpersonal skills. Develops and fosters professional relationships with co-workers, participants, clients, and vendors. Keeps others informed as directed by operational demands and need-to-know. Keeps self informed of announcement made via established company venues
Perform comprehensive assessments, reassessments, and ongoing monitoring to identify needs, changes in condition, and appropriate level of care; update Plans of Care accordingly. Implement provider orders (MD/DO/NP/PA), including administering medications, treatments, wound care, and other skilled nursing interventions. Triage participant and staff calls to determine priority and route/escalate appropriately. Provide medication administration, reconciliation, and training in self-administration for non-scheduled medications; monitor and promote adherence. Educate participants and caregivers/families on conditions, medications, equipment, safety, and disease management. Schedule and coordinate outside specialist visits, diagnostics, and hospital admissions as needed; arrange transportation when applicable. Observe, record, and promptly report participant condition and response to treatments/medications to providers. Participate in IDT meetings, family conferences, and case reviews; contribute to the development and adjustment of Plans of Care. Complete timely, accurate documentation in the medical record; meet all agency and regulatory charting, reporting, certification/recertification, and discharge summary requirements. Support utilization review, peer review, and quality management activities as assigned. Setting-Specific Responsibilities Clinic (Center-Based): Prepare, stock, and maintain exam and triage rooms; ensure availability of required supplies and materials. Assist with participant examinations, testing, and treatments performed in the clinic. In the absence of the Nursing Services Director/Clinic Nurse Supervisor, supervise clinic staff and support overall clinic workflow. In-Home Services: Provide skilled nursing care in the participant’s place of residence; deliver preventive, restorative, and rehabilitative nursing procedures. Determine type and amount of nursing care needed for each participant and coordinate with Home Care resources. Supervise LPNs at least every 30 days and HHAs/CNAs at least every 14 days ( [PT1] or per regulatory requirements); provide teaching and competency reinforcement. Supervises unskilled care every 90 days. Conduct supervisory visits, care conferences, and periodic participant/caregiver check-ins; trend data and collaborate with the Home Care Manager and Nursing Services Director to ensure quality care delivery. Safety, Compliance & Operations: Adhere to InnovAge policies and all applicable federal, state, and local regulations (e.g., HIPAA, OSHA, infection prevention, medication safety, scope of practice). [DF2] [JA3] Use PPE and follow standard, transmission-based, and universal precautions. Participate in on-call, after-hours, and holiday coverage as assigned. Support continuous improvement, patient safety initiatives, and cost stewardship. Other Duties As Assigned: Will as required, coordinate necessary tasks related to the center operation, as directed by leadership
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 respected national telehealth network is expanding and hiring Nurse Practitioners for multiple fully remote roles across the U.S. These positions support a wide range of virtual care services: from primary case visits to acute care, psych, women’s health, wellness, chronic care, and evidence-based lifestyle medicine. Whether you're a new graduate seeking your first telehealth role or an experienced NP looking for flexible, high-paying remote opportunities, NPHire has nationwide openings that match every schedule, specialty, and career goal.
Qualifications: Active NP license in at least one U.S. state (multi-state a plus) FNP, PMHNP, AGNP, WHNP, ANP, or similar certification Strong communication and independent clinical decision-making skills Ability to work autonomously in a fully remote setting
Conduct scheduled or on-demand virtual visits for acute, primary, or wellness-focused care Perform patient assessments, develop treatment plans, and prescribe when appropriate Manage follow-ups, messaging, and EMR documentation through modern telehealth platforms Provide compassionate, patient-centered care across diverse populations Collaborate with supportive clinical and operations teams as needed
For over 50 years, our history has been rooted in commitment to quality improvement for organizations — and quality of life for the people they serve. We began as Delmarva Foundation for Medical Care in 1973 on Maryland’s Eastern Shore as one of the country’s first quality review organizations for the Centers for Medicare and Medicaid. Through the decades, we created entities that became nationally known, including Delmarva Foundation, Health Integrity, and Quality Health Strategies. Today, we’ve brought together these extensive resources and the expertise of more than 500 professionals under one name — Qlarant — serving some of our nation’s most important programs in health, human services, government and insurance & financial services. Qlarant has a strong commitment to protecting the integrity of national and state health care systems in Medicare, Medicaid, and the private sector. In addition, The Qlarant Foundation issues annual grant awards to various programs that provide programs to underserved communities. Qlarant offers a broad range of innovative services: we’re proud to deliver our solutions for Quality Improvement; Fraud, Waste, & Abuse; and Data Sciences & Technology. Our Real-time Predictive Modeling and Data Analytics tools sift through billions of claims and public criminal records to detect aberrant trends and alert users for early investigative and audit actions with high accuracy and performance. We also provide quality review programs, auditing, training, and have an in-house call center ready to meet your needs. Visit www.qlarant.com for further information.
Performs medical record and claims review for Medicare, Medicaid, and/or other claims data in order to ensure that proper guidelines have been followed and assesses for potential overpayment, fraud, waste, and abuse with regards to Medicare, Medicaid, and/or other claims.
Level of Supervision Received: Plans and arranges own work; works with manager to prioritize projects Education (can be substituted for experience): Minimum Bachelor's Degree preferred, RN license required Work Experience (can be substituted for education): 2 - 4 years of experience in medical claims review required; 5 - 7 years preferred Certification(s): Current, active and non-restricted RN licensure required Coding certification preferred
Reviews beneficiary, provider, and/or pharmacy cases for potential overpayment, fraud, waste, and abuse. Completes desk review or field audits to meet applicable contract requirements and to identify evidence of potential overpayment or fraud. Consults with benefit integrity investigation experts and pharmacists for advice and clarification. Completes case summaries and provides results to investigators to support the investigative process. Provides case specific or plan specific data entry and reporting. Participates in internal and external focus groups, as required. Participates in provider onsite visits and beneficiary interviews, as required, for field audits/investigations. Testifies at various legal proceedings, as necessary. Provides job-specific orientation and training, as needed. Helps develop training content, resources, and programs specific to job functions.
U.S. Renal Care is the largest privately held and fastest-growing dialysis provider in the nation. We partner with nephrologists to care for more than 36,000 people living with kidney disease across 32 states in the U.S. Since 2000, U.S. Renal Care has been a leader in clinical quality, innovation, and operational excellence – delivering the best experience and outcomes for our patients. Together, our team members and physician partners share a common passion to improve the lives of those we serve. Our company’s core values of excellence, partnership, inclusion and compassion are at the center of everything we do. In fact, Newsweek named U.S. Renal Care as a “Greatest Workplace” of 2024! Learn more about our employee experience on our website: https://www.usrenalcare.com/careers/
The incumbent in this role is expected to float based on the needs of the organization determined by the Home Therapies Operations Excellence Team. The expected geography may include all states. California nursing licensure is preferred. In addition, the length of assignments will vary and will require overnight stays. The incumbent is expected to perform all duties of the role as outlined in the job description (e.g. opening, closing, working weekends, etc.). The Home Therapy Registered Nurse -- Traveler, as qualified by federal and state regulations, travels to various U.S. Renal Care locations to provide patient training and ongoing support for all patients choosing a home dialysis modality. This position provides nursing relief/support for assigned programs on a temporary or short-term basis.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements include: Current RN license in multiple states. Prefer California licensure. All licenses must be maintained as current and in good standing. Must obtain applicable state license, based on assignment, within state specified time frames. 12 months or more current nursing experience; 6 months or more home modality experience required. Flexibility with schedule and willingness to travel to assignment locations throughout the U.S. and Guam. CPR certification required prior to patient care assignment. Confirmation of ability to distinguish all primary colors. Must successfully complete the Home Therapy Nurse Orientation program and maintain annual demonstration of skills and competency applicable for the modality assigned. Demonstrated working knowledge of the English language and ability to communicate verbally and in writing. Must have basic computer skills; proficiency in all USRC clinical applications required within 90 days of hire. Must meet any practice requirement(s) for the applicable state. Ability to meet minimum hiring standards which may include additional background clearances and orientation requirements if applicable to the program assigned to for employment.
GROWTH: Participate in and support corporate initiatives that promote improved care and increase growth of the home department. Understand vendor product delivery methods and associated fees. Teach patients the importance of proper and timely order placement. Ensure patients receive all supplies in timely manner to not disrupt care. Assist with clinic and patient supply inventory, ensuring usage is appropriate for patient prescriptions and place orders in timely manner to avoid fees and penalties. May assist with equipment management including equipment tracking and retrieval as needed. Perform duties as assigned to meet the patient care or operational needs of the program. OUTCOMES: May assist with improving patient outcomes through tracking and trending of program and patient performance, use of critical thinking skills and root cause analysis to improve patient and quality outcomes. May assist in obtaining data for the continuous quality improvement activities. Obtain routine and non-routine laboratory tests as ordered and communicate critical lab values and urgent patient needs to the responsible physician or physician extender in a timely manner. May complete and document monthly review of patient medication profiles as directed. Administer medications as ordered by the physician. Provide patient education and follow up as needed. Assist with program's target goals for patient outcomes in accordance with quality patient care and Company goals. OPERATIONAL READINESS OPERATIONAL READINESS Knowledge of and comply with federal, state, local laws and regulations, including health care professionals practice act requirements as they pertain to home dialysis program and patient care requirements. Perform duties at all times within limitations established by and in accordance with company policy and procedures, applicable state and federal laws and regulations. Train patient (and/or care partner) in the practice of self-care Peritoneal Dialysis or Hemodialysis upon meeting federal and state regulations governing Registered Nurse qualifications. May conduct home visits to assess the patient's home environment per policy and as needed to improve care. Inform (Direct Supervisor) and program Administrator of all incidents, conditions, and concerns related to patient care, staff and patient safety, and in accordance with company policy. Document all nursing services in the Electronic Medical Record including but not limited to training sessions, routine and non-routine in-person interactions, and phone conversations. Documentation should accurately reflect the patient status and nursing interventions and be written to ensure continuity of care. May assist with developing and implementing the patient plan of care with the interdisciplinary team. Participate in infection control monitoring, implementation, and recording as requested. Use personal protective equipment as necessary. Be familiar with emergency equipment and all emergency operational procedures. Communicate and regularly review Emergency Preparedness procedures with all home patients, including but not limited to emergency disconnection from dialysis equipment, what to do and who to contact if displaced from home. Communicate on-call system to patients and ensure patients have access to nursing support at all times. Teach patients the importance of timely communication. May perform on call nursing services, nights and weekends, on a rotational basis as needed or assigned. Flexible with staffing locations and hours to accommodate patient and USRC home program needs. Regular and reliable attendance is required for the position. Home Hemodialysis Only: May coordinate home evaluation with technical services department to ensure that the necessary electrical, plumbing and drainage requirements for proper equipment operation are met prior to patient acceptance into home program. May assist with ensuring required and appropriate water sampling is complete per policy and product requirements. Monitor and report water sample and culture results. PARTNERSHIPS: Communicate results of patient assessment, reassessment, and ongoing monitoring to the physician, team members, and others as appropriate to the individual needs of the patient. Maintain a positive/collaborative working relationship with physicians, state agencies and the community. Actively promote GUEST customer service standards; develop effective relationships at all levels of the organization. Respond effectively to inquiries or concerns. STAFF DEVELOPMENT/ RETENTION Participate in staff meetings as required. Attend in-service and continuing education offerings in compliance with company policy and procedure. May delegate tasks to competent licensed and unlicensed staff per applicable state practice act. Assist with staff training as requested. Lead staff in team concepts and promote a team effort.
We are a talent solutions firm with offices in Pune, India, Atlanta, GA, USA, and London, United Kingdom. Our hybrid approach ensures seamless operations—our U.S.-based account managers bring deep expertise in workforce planning and role alignment, while our India-based sourcing specialists efficiently identify top professionals. Qualified Recruiter has developed an extensive and structured training program, equipping our team with industry-leading expertise. Every specialist undergoes a rigorous certification process, ensuring they possess the precision and skill required to connect businesses with exceptional professionals. Organizations partnering with Qualified Recruiter gain access to a dynamic framework designed to support a wide range of workforce requirements. Our experienced U.S.-based consultants streamline the entire journey, ensuring a smooth and efficient experience for both businesses and professionals. By combining a performance-driven strategy with a cost-effective global delivery model, Qualified Recruiter empowers organizations to secure high-performing individuals who drive business success. Our mission is to provide companies with a strategic solution that helps them identify and onboard their most valuable asset—exceptional talent.
We are seeking a detail-oriented Registered Nurse (RN) with experience in Clinical Documentation Improvement (CDI) to support concurrent and retrospective chart reviews. The ideal candidate will have hands-on experience with Iodine/APR methodologies and familiarity with Epic (preferred).
Active RN license CDI experience with concurrent reviews CCDS required Proficiency in Epic (preferred) and 3M 360 Strong analytical and communication skills
Perform concurrent and post-discharge reviews of patient records Identify documentation gaps and opportunities for physician queries prior to coding Ensure accuracy and completeness of clinical documentation Review 6–10 cases per day while maintaining a target query rate of 30% Utilize tools such as Epic and 3M 360 for documentation review and workflow management Collaborate with clinical and coding teams to improve documentation quality
Renalogic is committed to managing risks associated with dialysis and Chronic Kidney Disease (CKD). We empower clients with our proprietary repricing, risk-stratification and specialty case management. The Renalogic mission to revolutionize the industry has allowed us to become the leader in managing all aspects of renal risk analytics, management and dialysis cost containment. Our professional team includes leaders in healthcare administration, case management, clinical experts in renal disease, legal specialists in The Employee Retirement Income Security Act of 1974 (ERISA) and healthcare law, contract negotiation and payer/provider negotiation. Our professional staff provides an end-to-end solution for identifying risk of renal disease in member populations, providing specific, targeted Chronic Kidney Disease (CKD) management programs and industry-leading dialysis cost containment services.
Salary: $90,000 - $105,000 annually, depending on skills and certifications Employment Type: Full-Time, Salaried, Exempt Reports to: Director of Oncology and Infusion Location: US, must live in Pacific or Mountain time zone, remote; fully remote with minimal travel Hours: PST or MST with some evening and weekend hours Who We Are Renalogic is dedicated to helping our clients manage the human and financial costs of chronic kidney disease. To help us in our mission, we hire people who are humble, hungry, and smart. And it sure helps if you have a sense of humor. We're not perfect, but we're trying to build a company that we are all proud of. Our 96% client retention suggests we're on the right path. Position Overview The Clinical Nurse Navigator (RN) serves as the primary Nurse for oncology care navigation, coordination, guideline-based treatment oversight, symptom assessment, escalation, and survivorship planning. This role functions across the full cancer continuum and provides clinical leadership to ensure care delivery is evidence-based, safe, member-centered, and cost-conscious. The RN role encompasses advanced clinical oversight, pathway alignment, interdisciplinary coordination, and escalation authority to providers. The RN inherits and expands upon all Clinical Nurse Coordinator (LPN) responsibilities.
RN license in good standing within a compact state and willingness to pursue additional state nursing licenses as required A minimum of 4 years' RN experience in a related role; clinical experience in oncology, infusions or critical care, including care navigation, treatment support, and/or complex case management is required. Must be in and able to work within the Mountain Time (MST) or Pacific Time (PST) zones. Be able to speak, write, and communicate fluently in English and Spanish. Utilization Review and/or Care Management preferred. Experience working 100% remote as a nurse is highly preferred. Ability and willingness to travel occasionally, which will include overnight stays for corporate gatherings, conferences, and health fairs. Ability to attend and professionally engage in video meetings. Proficient technological skills, meaning you can effectively and efficiently use computers, peripheral equipment, and applications/systems, including Microsoft products. Autonomous self-starter who is comfortable with ambiguity. Creative mindset and ability to appropriately challenge the status quo. Superb written and oral communication skills. Ability to overcome obstacles with a ‘yes if...' approach. Ability to effectively balance competing deadlines without losing focus on the bigger picture. Reliable internet and power with a designated area to conduct work with minimal interruptions.
Establish and maintain contact with assigned oncology members via phone, text, email, and video calls. Initiate nursing care plans, educating members on treatment regimens, symptom management, side effects, and disease-specific program benefits. Obtain and use clinical information to develop individualized member and clinician-centered care plans that complement oncologist guidance/plan of care. Utilize motivational interviewing to empower members, support adherence, and encourage enrollment of new or inactive members in employer-sponsored programs. Coordinate care among providers, pharmacies, and support services; facilitate access to medications, infusion services, and financial assistance programs. Identify and educate members eligible for clinical trials or therapy adjustments, coordinating logistics with providers and sponsors. Monitor adherence, side effects, and treatment response; escalate issues when needed to support physician-directed care. Provide emotional support and connect members to counseling, support groups, and survivorship resources. Document, request, and send member information per HIPAA; track interactions and outcomes in the EHR. Meet assigned metrics, including call volume and enrollment requirements; adapt approaches using multiple communication channels.
NPHire connects top NP talent with leading healthcare employers and staffing agencies. We're the only job-matching platform built exclusively for Nurse Practitioners, simplifying both the job search and the hiring process so the best match rises to the top every time.
A growing network of remote healthcare organizations is hiring Nurse Practitioners to deliver virtual care across multiple specialties, including primary care, women’s health, wellness, chronic care, and acute telehealth consults. Whether you’re looking for flexible part-time telemedicine work or a full-time remote role, we’ll help match you with an opportunity that fits your schedule and clinical strengths.
Active Nurse Practitioner license in at least one U.S. state (multi-state preferred) FNP, AGNP, WHNP (and related certifications considered, depending on role) Strong communication skills and patient-centered approach to care Comfort using telehealth platforms and EMRs (training provided) New graduates welcome to apply for select roles
Conduct virtual consultations for wellness, chronic care, and acute conditions Perform patient assessments, prescribe when appropriate, and manage follow-ups Document visits and communicate with patients using telehealth platforms and EMRs Collaborate with experienced clinical and administrative support teams Choose from contract, part-time, or full-time opportunities Enjoy flexible scheduling that works around your life
Ensemble is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.
CAREER OPPORTUNITY OFFERING: Bonus Incentives Paid Certifications Tuition Reimbursement Comprehensive Benefits Career Advancement This position pays between: RN pay scale $32.65 - $35.85/hr based on experience LPN pay scale $24.65 - $26.35/hr based on experience $$ Shift Differential for Select Shifts $$ **Must have Current unrestricted LPN or RN license (required) or RN compact license (preferred)** We are seeking Virtual Utilization Review Specialists who are interested in compressed, weekend work schedules. The schedules we are offering include: Work Schedule: Full-time: Friday, Saturday, Sunday: 7:00 AM - 7:00 PM with a 4 hour shift on Wednesday Part-time: Saturday and Sunday: 10 hour shift each day (MUST have IL license)
Experience: Bachelor's Degree or equivalent experience; Specialty/Major: Nursing or related field Current unrestricted LPN or RN license required; RN compact license preferred Five years nursing experience in an acute care environment preferred Utilization review/discharge planning experience preferred Recent experience or working knowledge of medical necessity review criteria preferred Current working knowledge of quality improvement processes Must be inquisitive and demonstrate openness to innovation including AI to explore better processes and ways to alleviate friction and improve patient and client experiences. This is a remote position; however, candidates must be willing and able to travel to and work onsite at client, temporary, or corporate office locations as business needs require. Other Knowledge, Skills, and Abilities Required: Ability to work a compressed weekend schedule This is a remote role which requires access to high speed internet Excellent interpersonal, communication and negotiation skills in interactions with physicians, payors, and health care team colleagues Commitment to exceptional customer service at all times Communicate ideas and thoughts effectively verbally and in writing Strong clinical assessment, organization and problem-solving skills Ability to assess and identify appropriate resources, internal and community, on assigned caseload, and to work collaboratively with health care team, providers, and payors to achieve the desired patient, quality, and financial outcomes Ability to prioritize, organize information, and complete multiple tasks effectively in a fast-paced environment Resourceful and able to work independently
Resource Utilization: Utilizes proactive triggers (diagnoses, cost criteria, and complications) to identify potential over/under utilization of services Initiates appropriate referral to physician advisor in a timely manner Understands proper utilization of health care resources and assists with identifying barriers to patient progress and collaborates with the interdisciplinary team Collaborates with financial clearance center, patient access, financial counselors and/or business office regarding billing issues related to third party payers Medical Necessity Determination: Conducts medical necessity review of all admissions. Utilizes approved clinical review criteria to determine medical necessity for admissions including appropriate patient status and continued stay reviews, possibly from an offsite location Provides inpatient and observation (if indicated) clinical reviews for commercial carriers to the Financial Clearance Center (FCC) within one business day of admission Communicates all medical necessity review outcomes to in-house care management staff and relevant parties as needed Collaborates with the in-house staff and/or physician to clarify information, obtain needed documentation, present opportunities and educate regarding appropriate level of care Collaborates with the financial clearance center, patient access, financial counselors, and/or business office regarding billing issues related to third party payers Denial Management: Coordinates the P2P process with the physician or physician advisor, FCC, Revenue Cycle team when necessary and when assigned and maintains documentation relevant to the appeal process Maintains appropriate information on file to minimize denial rate Assist in recording denial updates; overturned days and monitor and report denial trends that are noted Monitor for readmissions Quality/Revenue Integrity Demonstrates active collaboration with other members of the health care team to achieve the outcomes management goals including CMS indicators Accurately records data for statistical entry and submits information within required time frame Responsible for ConnectCare and ADT work queues assigned to VUR for revenue cycle workflow Accurately records data for statistical entry and submits information within required time frame Documentation will reflect all work and communication related to the FCC, payor, physician, physician advisor and in-house care management Second-level physician reviews will be sent as required and responses/actions reflected in documentation Facilitation of Patient Care: Prioritizes patient reviews based on situational analysis, functional assessment, medical record review, and application of clinical review criteria Collaborates with the in-house care manager Maintains rapport and communication with the in-house care manager Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assignment Demonstrates knowledge of the principles of growth and development of the life span and possesses the ability to assess data reflective of the patient's status and interprets the appropriate information needed to identify each patient's requirements relative to his or her age, specific needs and to provide the care needed as described in departmental policies and procedures Communication: Directs physician and patient communication regarding non-coverage of benefits Maintains positive, open communication with the physicians, nurses, multidisciplinary team members and administration Educates hospital and medical staff regarding utilization review program Maintains a calm, rational, professional demeanor when dealing with others, even in situations involving conflict or crisis Voicemail, Skype, and email will be utilized and answered in timely fashion Hospital provided communication devices will be used during work hours Staff is expected to respond and/or acknowledge communication from the FCC via approved communication guidelines and standardized service-line agreements Staff must be available as designated for meetings or training, onsite or online, unless prior arrangements are made Team Affirmation: Works collaboratively with peers to achieve departmental goals in daily work as evidenced by appropriate and timely communication which is respectful and clear. Sensitive to workload of peers and shares responsibilities, fills in and offers to help Actively participates in departmental process improvement team; planning, implementation, and evaluation of activities Provides back-up support to other departmental staff as needed Other Job Functions: Complies with FCC and department policies and procedure, including confidentiality and patient’s rights Maintains clinical competency and current knowledge of regulatory and payer requirements to perform job responsibilities (i.e., medical necessity criteria, MS-DRGs, POA) Actively participates in departmental meetings and activities Participates in FCC and community committees as assigned Actively participates in conferences, committees, and task forces as directed by the FCC division Associates may be required to perform other job-related duties as required by their supervisor, subject to reasonable accommodation
You Health Medical Groups employs telehealth practitioners serving patients on the Hims & Hers platform. The Hims & Hers Telemedicine Team handles the business operations, allowing practitioners to concentrate on delivering top-notch patient care.
You Health Medical Groups is seeking a Clinical Escalations Provider to provide health care services to patients via the Hims and Hers telehealth platform. The Clinical Escalations Provider is responsible for managing high-acuity and escalated patient cases, particularly those involving business disruptions or complex clinical needs. This role provides counseling and clinical support to patients utilizing diagnostic or other healthcare services that require follow-up care. The Clinical Escalations Provider will be primarily responsible for managing patient escalations, providing counseling to patients utilizing our diagnostic or other services that require follow-up. Through proactive communication and compassionate care, the Clinical Escalations Provider ensures that every patient receives exceptional support and continuity of care, even in challenging or urgent circumstances. This role reports to the You Health Associate Director of Clinical Safety and participates as an active team member focused on clinical quality, patient experience, and performance improvement. Current You Health 1099 Independent Contractors cannot work concurrently as a W2 provider and would need to terminate 1099 IC contracts.
Board Certified Nurse Practitioner (Family, Adult Gerontology, Acute Care, Women's Health) 1+ years of previous telehealth experience 3+ years of experience in clinical practice, exclusive of orientation/training Extremely strong clinical judgment and the ability to respond rapidly in escalated scenarios, and provide empathetic patient care along the way. Excellent written and verbal communication with an emphasis on clarity and compassion. Skilled at using online tools and technology to deliver care and communicate with patients. Resilient and flexible with the ability to thrive and adapt in a fast-paced, high-growth, and rapidly changing environment. Multiple state licenses (Minimum of 20 licenses, 40+ a strong plus).
Deliver high-quality clinical care for a range of patient-reported concerns and side effects Manage patient escalations and ensure appropriate responses and follow-up, including results from diagnostics that require timely and sensitive follow-up. These interactions will be mostly synchronous. Comply with safety legislation and healthcare industry practices Provide after-hours and weekend support for urgent patient escalations on a rotating on-call basis Serve as a specialist/subject matter expert for treatment services offered on the platform, providing clinical expertise, guidance, and support to both patients and internal teams Conduct ongoing patient care duties, special projects as needed, and additional duties as assigned by their manager and/or clinical leadership. Adhere to the Hims and Hers platform guidelines and policies, and complete all required training Maintain competence through Continuing Medical Education/Continuing Education Maintain applicable Board Certification
You Health Medical Groups employs telehealth practitioners serving patients on the Hims & Hers platform. The Hims & Hers Telemedicine Team handles the business operations, allowing practitioners to concentrate on delivering top-notch patient care.
The Clinical Educator (NP) supports clinical quality and education for Nurse Practitioners and physicians delivering care on the Hims & Hers platform. This role reinforces clinical protocols and documentation standards, provides targeted coaching on platform workflows and clinical decision-making, and ensures safe, high-quality patient care in standard and moderately complex scenarios by leveraging QA and chart audit data. Clinical Educators work on a small team of NPs reporting to the Senior Manager, Clinical Education & Development, allowing for close collaboration and mentorship. Clinical Educators independently manage a broad range of education, coaching, and quality-related responsibilities with minimal oversight. They serve as trusted clinical resources, offering real-time guidance to providers and using QA and quality metrics to inform actionable coaching, improve workflows, and optimize provider performance. In addition to direct coaching, Clinical Educators proactively identify trends and risks to patient safety and quality KPIs, while identifying opportunities to improve provider training, operational processes, and workflows. They also work to scale manual processes (such as automating coaching interventions or standardizing provider guidance) to keep pace with provider growth alongside Hims & Hers. Clinical Educators collaborate closely with Clinical Leadership, Training & Content, and other cross-functional partners to enhance education programs, strengthen clinical quality, and optimize the overall provider experience.
NP licensure and board certification required and in good standing 3–5+ years of direct patient care experience, including diagnosing, prescribing, and establishing treatment plans 3–5+ years of experience in clinical education, provider coaching or mentoring, clinical quality improvement, or clinical operations Strong understanding of clinical quality standards, chart audit processes, and performance coaching Demonstrated ability to use data to inform coaching, identify trends, and drive improvement initiatives Experience collaborating cross-functionally with clinical and non-clinical stakeholders (e.g., Product, Training, Ops) Excellent communication, facilitation, and documentation skills Ability to thrive in a fast-paced, mission-driven, and rapidly evolving telehealth environment Bonus: Current or prior certification as an Advanced Education Specialist Bonus: Prior experience providing care on the Hims & Hers platform or other telehealth platforms Bonus: Experience treating patients across key domains including weight management, hair loss, sexual health, hormone replacement therapy (HRT), and testosterone support
Provider Coaching & Clinical Guidance Serve as the primary clinical resource for providers by responding to inquiries and providing guidance on protocol interpretation, platform/EMR workflows, documentation standards, and clinical decision-making. Provide coaching to reinforce adherence to clinical standards, protocols, and quality expectations, supporting providers in standard and moderately complex scenarios. Work closely with providers requiring additional support due to quality trends or low QA scores, offering targeted, actionable coaching. Connect with Subject Matter Experts (SMEs) when necessary for further clinical guidance Onboarding & Training Conduct live training and shadowing sessions for newly onboarded providers, ensuring they ramp efficiently and understand quality expectations early in their tenure. Periodically practice on the platform as a provider to maintain firsthand familiarity with workflows and the EMR, using this experience to enhance coaching, training, and operational insights. Quality & Risk Management Proactively identify trends, clinical risks, documentation issues, or protocol adherence concerns and escalate as appropriate. Support initiatives to improve provider quality and mitigate risks to patient safety. Continuous Improvement & Operational Insight Synthesize trends from provider questions, operational challenges, and recurring issues to identify opportunities and implement scalable solutions—such as improved education materials, coaching automations, and workflow enhancements—to optimize provider support and efficiency. Take ownership of discrete initiatives, service lines, resources, or playbooks within the Clinical Education function. Cross-Functional Collaboration Serve as a trusted internal resource on clinical workflows, provider experience, and protocol application. Partner with Training & Content and other teams to enhance provider education programs and materials. Represent the Clinical Education team in cross-functional projects and discussions, providing feedback on workflow challenges, protocol clarity, and opportunities to improve the provider experience.
The Clinical Nurse Consultant provides relevant training and consultation on ICU Medical’s clinical products/software and clinical services programs. They participate as part of a cross-functional team comprised of Project Managers, Nurses and Pharmacists.
Knowledge & Skills: Must be self-motivated, well-organized with the ability to work under time-sensitive deadlines. Excellent communication and collaboration skills are required Must have proficient in MS Office skills with Outlook, Excel and Power Point. Knowledge of leading web-ex meetings is highly preferred. Analytical skills and knowledge of statistics desired Minimum Qualifications, Education & Experience: Must be at least 18 years of age Prior leadership role in nursing is highly desirable Bachelor’s degree preferably in Nursing is required; Masters degree preferred, with current US RN license A Minimum of 7+ recent RN experience preferably in areas of oncology, trauma, ED or critical care areas Experience working with Infusion systems/safety software/EMR is a plus Experience leading/participating in virtual meetings is desirable Work Environment: This is largely a sedentary role. This job operates in a professional office environment and routinely uses standard office equipment. Typically requires travel 20-50% of the time
Clinical Nursing Lead, while collaborating with internal and external teams; such as Pharmacy, Nursing, IT, Project Management, Materials Management Involvement in technology integration of ICU Medical infusion devices with EHR vendors for full five right medication administration at the bedside Assessment of current state clinical workflow in facilities, and provide consultation on future state workflow Planning, execution and follow up to education of hospital clinicians on the use of infusion devices Escalate risks and customer issues to project manager Provide go-live and post go-live customer facing support on use of ICU Medical products and solutions Presenting to a variety of audiences in a variety of settings Clinical Subject Matter Expert for internal and external customers Other duties as assigned
ICU Medical has consistently provided you with clinical innovations that help solve real-world challenges. With the acquisition of Hospira Infusion Systems in 2017 and Smiths Medical in 2022, we are now a global market leader with a complete line of clinically-essential IV therapy and high-value critical care products for hospital, alternate site, and home care settings. We're ready to bring you consistent quality, innovation, and value in more areas than ever. Our focus allows us to bring you: Dedicated and non-dedicated IV sets and needlefree connectors clinically proven to provide an effective barrier against bacterial transfer and colonization. The industry’s broadest IV smart pump offering covering large volume, pain management, and ambulatory needs. IV medication safety software providing full IV-EHR interoperability with the highest customer satisfaction and compatibility with more EHR systems than any other company. Significant US IV solutions manufacturing and supply capabilities. This role is based remotely; the incumbent may be remote in any state other than Colorado; California; Connecticut; Montana, Maine or New York.
The Customer Success Nurse Consultant (CSNC) is responsible for ensuring post-go-live success for ICU Medical’s full line of infusion devices and consumables. This role focuses on exceeding customer expectations following implementation by providing proactive support, clinical guidance, infusion data analysis, and strategic follow-up. CSNC works closely with the implementation teams to ensure a seamless transition and serves as a trusted resource for customers during the post-implementation phase.
BSN required Unrestricted [RN] nursing license required Unrestricted driver license required Minimum of 5 years acute care clinical experience, preferably in infusion therapy or related fields. Experience in clinical consulting, clinical informatics, or post-implementation support is highly desirable. Experience in clinical education and leadership is a plus Experience using Tableau is a plus • Strong communication, presentation, and interpersonal skills. Proficiency in Microsoft Office Suite and CRM/business automation systems. Travel Requirements Up to [50 %] travel may be required for customer site visits, optimization, and support
Customer Engagement & Support o Serve as the primary clinical contact for assigned post-implementation accounts. o Provide timely responses to customer inquiries and proactively follow up to ensure satisfaction. o Deliver customer-facing presentations and training as needed. Cross-Functional Collaboration o Partner with Sales and professional services to develop strategies that enhance customer experience. o Collaborate with the Implementation Team, Technical Support Center (TSC), and Global Complaint Management (GCM) to ensure coordinated post-go-live support. Support Data Analytics Program o Ability to analyze infusion data o Ability to analyze and interpret clinical reports across multiple infusion platforms o Present data analysis and strategies to customer stakeholders to improve outcomes Performance Monitoring & Strategic Insights o Create, implement, and monitor key performance indicators (KPIs) that drive long-term customer success. o Provide clinical expertise to enhance the customer experience in support of customer satisfaction initiatives Tools & Documentation o Develop customer-facing tools, templates, and status reports for leadership and Professional Services. o Maintain accurate and timely documentation of customer interactions, communications, and complaints in the business automation system. Product Expertise o Maintain a deep understanding of ICU Medical’s infusion products and services to provide expert guidance and support. o Strong clinical practice background Customer Success Nurse Consultant
Aledade is a physician-led public benefit corporation and national leader in value‑based care. We help primary care organizations deliver better patient outcomes and thrive financially by keeping people healthy. Through our accountable care organizations, over 3,000 primary care partners in 46 states and the District of Columbia share in the rewards of improved care for over 3 million patients — supported by advanced insights, AI‑driven technology, personal coaching, policy expertise and 200+ value-based contracts. To learn more, visit www.aledade.com or follow us on LinkedIn, X, Facebook, Instagram and YouTube.
As a Clinical Outreach Specialist, you will serve as a vital clinical bridge for high-risk patients, utilizing your nursing expertise to navigate the critical window between hospital discharge and home recovery. In this high-impact, telephonic role, you will perform complex medication reconciliations, identify looming clinical red flags, and proactively close care gaps to prevent unnecessary ER visits and readmissions. By blending empathetic patient education with data-driven population health tools, you will empower patients to manage their health effectively while collaborating directly with primary care practices to ensure no one falls through the cracks of the healthcare system. We are flexible with respect to geographic location, and the ideal candidate will be comfortable working remotely/work from home across US time zones.
Minimum Qualifications: Bachelor’s Degree in Nursing (BSN) Active, unrestricted Registered Nurse (RN) license; Valid Compact RN license Minimum of 2 years clinical experience in case management or discharge planning Experience with telephonic patient outreach and clinical assessments Demonstrated ability to prioritize and manage high-acuity cases Excellent communication and interpersonal skills Experience with electronic health records (EHRs) and population health tools Critical thinking and clinical judgement in complex and rapidly changing environments Adaptability and resilience in a fast-paced, evolving healthcare setting Ability to work both independently and as part of an interdisciplinary team Preferred Qualifications: Experience in a remote environment Experience in Value Based Care Certification in Case Management (CCM, ACM) or Care Transitions Experience working with diverse and underserved populations Physical Requirements: Prolonged periods of sitting at a desk and working on a computer.
Patient Outreach & Coordination: Conduct targeted patient outreach to address and close care gaps, ensure timely care transitions, and immediate follow-up as needed. Daily responsibilities will include both inbound and outbound calls. Deliver high-touch engagement for high-risk patients to prevent readmissions through post-discharge follow-up, medication reconciliation, and care coordination (i.e. Labs, screenings, and follow-up appointments). Document interventions, assessments, and medication reconciliation across multiple EHRs while maintaining accuracy and compliance. Provide patient education and assess eligibility for concurrent programsPersistently address patient reluctance or hesitation through education, empathy, and active listening. Meet and sustain performance metrics Practice Collaboration & Relationship Management: Collaborate with Practices to support interventions such as Transitional Care Management (TCM), Osteoporosis Management in Women (OMW), ED follow-ups, and other care gap initiatives. Serve as a clinical resource to foster collaboration and alignment with Aledade’s clinical programs. Collaborate across teams to support patient engagement strategies and organizational goals. Address challenges proactively, adapting strategies as needed and identifying areas for process improvement. Other duties as assignedWe are flexible with respect to geographic location, and the ideal candidate will be comfortable working remotely/work from home across US time zones.
Founded in Port Charlotte, Florida, in 2008, and now headquartered in Fort Myers, Millennium Physician Group is one of the largest comprehensive physician-led groups with more than 900+ healthcare providers and 200+ locations now including FL, TX, NC, and GA. Services center on primary care and are complemented by specialty care, walk-in centers, radiology and lab services, physical therapy, telehealth, wellness programs, home health, hospital care, and much more. Nationally recognized as a leader in value-based care with consistently high levels of physician engagement, Millennium aims to create a genuinely connected healthcare experience for patients by providing a comprehensive and coordinated approach to healthcare… and be Your Connection to a Healthier Life.
Remote Triage Nurse (RN) plays a vital role in healthcare settings, providing timely and efficient support to patients through remote communication channels. You will be responsible for gathering information from patients, conducting initial assessments, and making decisions regarding the appropriate level of care needed. Your ability to quickly and accurately identify urgent medical situations will be essential in ensuring the timely and appropriate treatment of patients How will you make an impact & Requirements Millennium Job Description: ACO REMOTE TRIAGE NURSE Position Philosophy/Summary Millennium Physician Group Remote Triage Nurse (RN) plays a vital role in healthcare settings, providing timely and efficient support to patients through remote communication channels. You will be responsible for gathering information from patients, conducting initial assessments, and making decisions regarding the appropriate level of care needed. Your ability to quickly and accurately identify urgent medical situations will be essential in ensuring the timely and appropriate treatment of patients.
Required Knowledge and Experience Graduate of an accredited School of Nursing, Registered Nurse Current Registered Nurse with Multi State License Prefer minimum of 5+ years of recent clinical experience in critical care/ emergency and/or telephonic triage Participation in continuing education program Strong communication and interpersonal skills Must be able to pass a basic test on the computer, clinical knowledge and typing skills. Knowledge and Abilities: Communication Excellent organizational abilities and documentation skills. Must be logical and clearly expressed. An ability to establish and maintain effective working relationships with patients, physicians, coworkers, staff and medical service providers. Compassion - The responsibility to put a patient or person’s interests first, including the duty not to harm, deliver proper care, and maintain confidentiality. Compassionate and empathetic approach to patient care. Reasoning Ability: Must be capable of making independent nursing decisions. Must be able to work well under stress and relate to the patients, and members of the healthcare team in a tactful manner. Computer Skills: Must have adequate typing skills and basic computer skills. Proficiency with EMR systems and software applications, including Microsoft Office Suite. Advanced knowledge of Excel needed. Athena knowledge preferred. 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. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The Remote Triage Nurse will be assigned a computer terminal and headset. The nurse must have good manual and finger dexterity, excellent verbal and written communication, hearing, visual acuity and color distinction. The nurse must sit in front of a computer screen for a prolonged period of time. While performing the duties of this Job, the employee is regularly required to stand; walk; use hands to finger, handle, or feel; reach with hands and arms; climb or balance; talk or hear and smell. The employee is occasionally required to sit and stoop, kneel, crouch, or crawl. The employee must frequently lift and/or move up to 10 pounds and occasionally lift and/or move up to 25 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and ability to adjust focus. Work Environment The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The nurse must sit in front of a computer screen for a prolonged period of time while wearing a headset.
Uphold and support the mission, objectives and policies of Millennium Physician Group. Respond promptly to incoming calls Triage the caller’s stated symptoms and provide assessment to determine the appropriate level of care required to safely meet the patient's medical needs (Emergent, urgent, non-urgent or home care setting) When appropriate provide home care instructions using the approved, written guidelines as well as approved reference materials provided. Utilize all resources and guidelines at his/her disposal to effectively assess, prioritize, advise, schedule physician appointments, or refer calls when necessary to the appropriate medical facility, personnel or specialized community service. Document patient encounters within the Electronic Medical Record utilizing the appropriate computer software in compliance with the approved policies and procedures. Actively participate in new employee orientation, ongoing in-service programs, staff meetings, continuous quality improvement and periodic performance/protocol evaluations and development. Maintain current nursing licensure by completing applications for renewal in a timely manner and complying with all requirements for continuing education. No nurse will be scheduled to work any shift if their nursing license has expired or has been revoked for any reason. It is the nurse’s responsibility to notify their manager immediately if their license status changes. Failure to comply with requirement will result in suspension or termination of employment. Maintain current nursing skills and knowledge base by completion of mandatory continuing education and other education provided by Manager. Work their assigned rotating set schedule from 0800 to 2000 EST, to include every other weekend and /or holidays (see employee handbook for company approved holidays).
A fast-growing digital healthcare platform transforming outpatient care by making high-quality medical services simple, fast, and affordable. Led by the founders of a major healthcare venture acquired by a global tech leader, the organization is building the go-to destination for most non-emergency medical needs through clinical excellence and intuitive virtual technology.
Position: Telehealth Nurse Practitioner Type: Part-time Compensation: Upto $75/hr Location: Remote (United States) Commitment: 20 hours/week
Background in Family Medicine or Internal Medicine. Minimum of 6,240 clinical practice hours (equivalent to 3 years full-time experience). 5–10 years of total experience in Family or Internal Medicine. 4+ years of telehealth experience. Active U.S. medical licensure covering at least 40% of the U.S. population, including CA, TX, FL, and NY. Prior leadership experience overseeing clinical teams, workflows, or policies. Strong comfort with triage-based decision-making. Fast learner with digital tools and remote care processes. U.S.-based candidates only (visa sponsorship not available). Desired Skills and Experience: Family Medicine, Primary Care
Deliver high-quality virtual care through triage, chat, and video consultations. Assess and manage patients across a wide range of acuity and clinical complexity. Coordinate expedited labs, imaging, referrals, and specialist input within the care network. Utilize modern telehealth platforms to maintain clear, timely, and accurate documentation. Support and guide clinical workflows, policies, and best practices across teams. Adapt quickly to new tools, workflows, and next-generation digital health models.
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