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We are America’s first research university, founded in 1876 on the principle that by pursuing big ideas and sharing what we learn, we can make the world a better place. For more than 140 years, our faculty and students have worked side by side in pursuit of discoveries that improve lives. Johns Hopkins enrolls more than 24,000 full- and part-time students throughout nine academic divisions. Our faculty and students study, teach, and learn across more than 260 programs in the arts and music, the humanities, the social and natural sciences, engineering, international studies, education, business, and the health professions.The university has four campuses in Baltimore; one in Washington, D.C.; one in Montgomery County, Maryland; and facilities throughout the Baltimore-Washington region as well as in China and Italy. The university takes its name from 19th-century Maryland philanthropist Johns Hopkins, an entrepreneur who believed in improving public health and education in Baltimore and beyond.
We are currently seeking a Sr. Research Nurse to implement and oversee multiple, single-center and multi-site national studies as assigned for the division of Transplant Oncology and Infectious Disease (TOID). Our primary research is related to the use of novel organ sources to address the national organ shortage, such as HIV+ to HIV+ transplant under the HOPE Act. The Sr. Research Nurse should be someone who works well in a fast-paced collaborative atmosphere but can also maintain a high degree of independence. This position will report directly to the TOID Research Nurse Manager, Operational Manager, and Principal Investigator.
Minimum Qualifications: Individual must be a registered nurse, licensed in the State of Maryland Minimum of two years of experience in the specialty or a related area required. Classified Title: Sr. Research Nurse Role/Level/Range: ACRP/04/MF Starting Salary Range: $38.51 - $67.53 HRLY ($80,000 targeted; Commensurate w/exp.) Employee group: Casual / On Call Schedule: flexible FLSA Status: Exempt Location: Remote Department name: SOM DOM Infectious Disease Personnel area: School of Medicine
Project Management Pre-study Anticipates research requirements for designated patient populations. Collaborates in development & writing of protocols and consent forms, as appropriate. Collaborates in the development and preparation of regulatory documents as appropriate Applies knowledge of study design to evaluate new protocols. Applies knowledge of federal & local regulations when evaluating new protocols. Reviews & assesses new protocols for clarity, thoroughness, logistical feasibility, maintaining subject safety, etc., for assigned protocols. Collaborates in the determination of roles & responsibilities of research team members in the implementation of assigned trials. Evaluates the impact on & availability of resources for assigned clinical trials. Lists & clarifies concerns & questions about new protocols with Research Nurse Manager and PI. Proposes & negotiates alternatives to improve protocol implementation. Pre-initiation Collaborates in the design of appropriate methods for the collection of data required for assigned trials. Oversees & collaborates in development of study tools, including data collection forms, eligibility checklists, preprinted orders, & distribution of the protocol on the Web Library and Internet (where applicable). Develops study-specific CRFs. Participates in the development of study-specific databases, assuring clinical data is appropriate for answering study-specific endpoints. Develops study-specific laboratory and operational manuals. Oversees that regulatory requirements are met for designated studies. Assures compliance with local, national, and international regulatory standards; as appropriate, prepares & submits required regulatory documents. Develop training materials for assigned studies/projects. Monitors for and notifies PI of IRB approval/request for further information as appropriate. Determines that IRB approval has been received before initiation of research activity. Represents the department at research and protocol initiation meetings. Assures that all elements of a trial are in place before activating sites. Participates in communications with protocol sponsors, NCI, and the cooperative group and coordinates plans to address issues with the PI. Recruitment & enrollment Responsible for evaluating and assuring recruitment and study/project goals are met by the research team and participating sites. Responsible for the development of recruitment strategies to ensure patient accrual within protocol timeframes. Prepares and presents study-specific updates to Research Nurse Manager, Operations Manager, and Investigators as requested. Identify and provide recommendations to remediate issues of concern. Data Management/Document maintenance Ensures collection of pertinent data from internal & external sources & monitors compliance with requirements of assigned clinical trials. Applies clinical/pharmacological knowledge to ensure that safety reporting processes for assigned studies are implemented and maintained. Prepares and submits protocol amendments and revisions as appropriate. Demonstrates ability to manage multiple projects at different stages of the clinical research process. Demonstrates ability to integrate new clinical trials with current research activity. Quality Assurance Evaluates outcomes of clinical trials. Monitors external sites' compliance with required study procedures & GCP standards. Performs/monitors ongoing data analysis regarding clinical research studies, including toxicities, dose modifications, dose levels, adverse reactions, & response. Assumes responsibility for specific QA activities for research teams (i.e., participates in institutional QA process). Participates in sponsor/cooperative group/internal audits/monitoring. Assists with development & review of TOID SOPs for the performance of clinical research. Maintains records of correspondence of faxes, e-mails, IRB/JCCI submissions, FDA submissions, etc. Staff Education Participates in the orientation process for new Clinical Research Nurses and Clinical Research Coordinators, including the mentoring and management of other clinic personnel to promote quality, safety, and excellence in care. Coordinates and/or presents continuing education/in-service programs for Clinical Research Nurses, Clinical Associates, Data Managers, and others involved in the research process. Attends and participates in in-service and external trainings, workshops, conferences, and other relevant programs for professional growth and development. Other Collaborates with other members of the research team in preparing study results for presentation/publication. Authors/coauthors manuscripts for publication in the nursing literature and/or presentation at conferences related to areas of expertise. Identifies nursing research questions related to protocol populations/issues and, with assistance, collaboration, and appropriate financial support, implements nursing research within departmental priorities. Takes advantage of opportunities to make presentations in the local community regarding research projects, areas of expertise, etc.
Eventus WholeHealth was founded in 2014 to provide physician-led healthcare services for residents and patients of skilled nursing and assisted living facilities. With our highly-trained team of physicians, psychiatrists, nurse practitioners, physician assistants, psychotherapists, podiatrists, optometrists, audiologists, and support staff, our comprehensive, evidence-based model provides collaborative interdisciplinary care with the seamless and vital integration of a wide range of specialties. Our differentiated approach not only empowers the facilities to reach their own goals and objectives but also ensures better patient outcomes.
Eventus WholeHealth delivers an integrated model of care to adults who reside in a variety of settings including but not limited to skilled nursing facilities, assisted living facilities, independent living and in personal homes. These services are provided through a network of Eventus WholeHealth providers who include Physicians, Nurse Practitioners, Physician Assistants, Care Team Advocates, and in-house Support Staff. Telemedicine uses videoconferencing equipment to send and receive patient medical information and pictures. Telemedicine providers also render medical consultations with family, facility staff and specialty providers when necessary. Hours for this position include 7 pm - 7 am shift with some weekends Eventus WholeHealth delivers an integrated model of care to adults who reside in a variety of settings including but not limited to skilled nursing facilities, assisted living facilities, independent living and in personal homes. These services are provided through a network of Eventus WholeHealth providers who include Physicians, Nurse Practitioners, Physician Assistants, Care Team Advocates, and in-house Support Staff. Telemedicine uses videoconferencing equipment to send and receive patient medical information and pictures. Eventus WholeHealth telemedicine providers deliver medical services to patients at assigned contract sites according to site-specific protocols. Telemedicine providers also render medical consultations with family, facility staff and specialty providers when necessary. Medical services are provided via telemedicine.
Knowledge: Knowledge of theory, practice, and regulations to give and evaluate patient care. Knowledge of rules and regulations of bodies governing health care. Knowledge of Eventus WholeHealth policies and procedures. Knowledge of common safety hazards and precautions to establish/maintain a safe work environment. Skills Required: Skill in gathering and analyzing physiological, socioeconomic, and emotional patient data. Skill in accurately evaluating patient problems and providing appropriate advice, intervention, or referral. Skill in documenting clinical services Skill in using computer technology Skill in exercising a high degree of self-direction, judgment, and discretion. Abilities: Ability to communicate clearly and establish/maintain effective working relationships with patients, medical staff, and the public. Ability to react calmly and effectively in emergency situations. Ability to interpret, adapt and apply guidelines and procedures. Ability to work collaboratively with all members of the health care team. Ability to make responsible decisions within the scope of the provider’s license Ability to evaluate and make recommendations for continuous quality improvement. Ability to handle confidential and sensitive information. Physical/Mental Demands: Sedentary physical demands. Ability to lift equipment and small items which is generally not more than 10 pounds needed. Flexibility of schedule at times may be required. Work may be busy and demand multi-tasking. Qualifications/Education: Master’s degree in Nursing from an accredited educational institution and a current and valid license to practice advanced practice nursing issued by the state where you are providing tele triage. All certifications necessary to perform one’s responsibilities must be current and valid. Specialization in geriatric, family, or internal medicine desired. Licensed in NC., IN or KY. Additional state licenses may be required as requested. OR Have graduated from a physician assistant educational program that is accredited by a National Commission on Accreditation of Allied Education Programs. Have passed the national certification examination of the National Commission on Accreditation of Certification of Physician Assistants. Licensed in NC. Additional state licenses may be required as requested. Specialization in geriatric, family, or internal medicine desired.
Provide primary-care telemedicine services in accordance with Eventus site-specific protocols and consistent with the standard of care for the specialty of family medicine, geriatric medicine, and/or internal medicine. Perform other duties and activities as appropriate and/or assigned by Eventus Management as pertains to providing quality or timely medical care and or administrative responsibilities. Manage facility and other partners relationships, organization, patient consents, CCM and billing. Provide on call tele triage per established protocol policy. Confirm treatment and telehealth consents are signed prior to telemedicine visit. Follow Eventus telehealth visit etiquette protocols. Include family members in the visit, as appropriate. Be familiar with telemedicine equipment, delivery platform and software. Ensure the patient has the proper equipment available. If a patient, family, or site staff report faulty or lack of equipment, the provider is to notify the director of tele triage. Providers are to complete documentation and sign all orders specific for the telemedicine visit immediately after completing the visit. All narcotic prescriptions are to be managed per Eventus RX Policy. Notify patient’s regular provider of visit and triage treatment plan via EMR. On-call telehealth scheduling may be modified as needed. Providers are expected to adhere to the newest agreed upon triage schedule. Establish and maintain open and positive communications with facility staff and administration. Provide verbal and/or written instruction or feedback regarding medications and other pertinent caregiver information. Give time for questions to be asked by patient, family, or staff members. Establish when the patient should be seen next. All required data to be collected and documented same day. Be knowledgeable of and adhere to Eventus standards, policies, and procedures. Be aware of and adhere to all legal and regulatory agencies' rules, guidelines, and professional ethical standards. Comply with all regulatory agencies governing health care delivery. Always conduct self in a professional manner, this includes avoiding gossip, avoiding negative comments about other staff or competitors, maintaining appropriate interpersonal boundaries, and avoiding dual relationships (this includes refraining from offering medical or psychotherapy services to facility staff or family members, avoiding accepting gifts from patients, etc.), and observing appropriate professional attire when on call. Perform other duties and activities as appropriate and/or assigned by Eventus Management. Always maintain patient confidentiality including appropriate use of Cell phone, emails text messaging, patient charts and EMR. Agrees to abide by and be knowledgeable of HIPAA rules and regulations Maintain multiple practice licenses and comply with each state’s practice regulations, as requested by Eventus.
Eventus WholeHealth was founded in 2014 to provide physician-led healthcare services for residents and patients of skilled nursing and assisted living facilities. With our highly trained team of physicians, psychiatrists, nurse practitioners, physician assistants, psychotherapists, podiatrists, optometrists, audiologists, and support staff, our comprehensive, evidence-based model provides collaborative interdisciplinary care with the seamless and vital integration of a wide range of specialties. Our differentiated approach not only empowers the facilities to reach their own goals and objectives but also ensures better patient outcomes. For more information, please visit www.eventuswholehealth.com.
Eventus WholeHealth delivers an integrated model that provides holistic care for medically vulnerable adults achieving extraordinary outcomes for the people we serve. We do this through a value driven framework of excellence, integrity, person-centeredness, stewardship and teamwork. This care is provided to adults who reside in skilled nursing, assisted living facilities and private residences through a network of healthcare providers including Physicians, Nurse Practitioners, Physician Assistants, Psychologists, Licensed Clinical Social Worker, Clinical and Administrative Support Staff. Hours: 7a-7p every other weekend Work Environment: Remote
Qualifications/Education: High School Diploma or equivalency Certified Medical Assistant degree a plus Typing speed of 45wpm or greater Medical Scribing experience preferred
Provider Support: Ensure that all clinical providers are able to focus on triaging and taking care of patients Prepare clinical documentation for the provider as requested Complete basic opening of encounter note for acute Tele Triage visits Perform medication reconciliation on patients who are being seen for acute Tele Triage visits Enter lab and imaging results into patient’s chart Document appropriate triage note encounter and time for CCM services Send updates to PCPs for patients that are triaged Make phone calls to facilities to gather information for provider Patient Support: Check all forms of communication several times daily to ensure patient needs are met. Primarily will be using Telemediq. Inform patient and family of recent visits, new orders and defer to provider when needed Communicate transitions of care to Tele Triage team to enhance patient care and education
Eventus WholeHealth was founded in 2014 to provide physician-led healthcare services for residents and patients of skilled nursing and assisted living facilities. With our highly-trained team of physicians, psychiatrists, nurse practitioners, physician assistants, psychotherapists, podiatrists, optometrists, audiologists, and support staff, our comprehensive, evidence-based model provides collaborative interdisciplinary care with the seamless and vital integration of a wide range of specialties. Our differentiated approach not only empowers the facilities to reach their own goals and objectives but also ensures better patient outcomes.
Eventus WholeHealth delivers an integrated model of care to adults who reside in a variety of settings including but not limited to skilled nursing facilities, assisted living facilities, independent living and in personal homes. These services are provided through a network of Eventus WholeHealth providers who include Physicians, Nurse Practitioners, Physician Assistants, Care Team Advocates, and in-house Support Staff. Telemedicine uses videoconferencing equipment to send and receive patient medical information and pictures. Telemedicine providers also render medical consultations with family, facility staff and specialty providers when necessary. Hours for this position include 7 pm - 7 am shift with some weekends Eventus WholeHealth delivers an integrated model of care to adults who reside in a variety of settings including but not limited to skilled nursing facilities, assisted living facilities, independent living and in personal homes. These services are provided through a network of Eventus WholeHealth providers who include Physicians, Nurse Practitioners, Physician Assistants, Care Team Advocates, and in-house Support Staff. Telemedicine uses videoconferencing equipment to send and receive patient medical information and pictures. Eventus WholeHealth telemedicine providers deliver medical services to patients at assigned contract sites according to site-specific protocols. Telemedicine providers also render medical consultations with family, facility staff and specialty providers when necessary. Medical services are provided via telemedicine.
Knowledge: Knowledge of theory, practice, and regulations to give and evaluate patient care. Knowledge of rules and regulations of bodies governing health care. Knowledge of Eventus WholeHealth policies and procedures. Knowledge of common safety hazards and precautions to establish/maintain a safe work environment. Skills Required: Skill in gathering and analyzing physiological, socioeconomic, and emotional patient data. Skill in accurately evaluating patient problems and providing appropriate advice, intervention, or referral. Skill in documenting clinical services Skill in using computer technology Skill in exercising a high degree of self-direction, judgment, and discretion. Abilities: Ability to communicate clearly and establish/maintain effective working relationships with patients, medical staff, and the public. Ability to react calmly and effectively in emergency situations. Ability to interpret, adapt and apply guidelines and procedures. Ability to work collaboratively with all members of the health care team. Ability to make responsible decisions within the scope of the provider’s license Ability to evaluate and make recommendations for continuous quality improvement. Ability to handle confidential and sensitive information. Physical/Mental Demands: Sedentary physical demands. Ability to lift equipment and small items which is generally not more than 10 pounds needed. Flexibility of schedule at times may be required. Work may be busy and demand multi-tasking. Qualifications/Education: Master’s degree in Nursing from an accredited educational institution and a current and valid license to practice advanced practice nursing issued by the state where you are providing tele triage. All certifications necessary to perform one’s responsibilities must be current and valid. Specialization in geriatric, family, or internal medicine desired. Licensed in NC., IN or KY. Additional state licenses may be required as requested. OR Have graduated from a physician assistant educational program that is accredited by a National Commission on Accreditation of Allied Education Programs. Have passed the national certification examination of the National Commission on Accreditation of Certification of Physician Assistants. Licensed in NC. Additional state licenses may be required as requested. Specialization in geriatric, family, or internal medicine desired.
Provide primary-care telemedicine services in accordance with Eventus site-specific protocols and consistent with the standard of care for the specialty of family medicine, geriatric medicine, and/or internal medicine. Perform other duties and activities as appropriate and/or assigned by Eventus Management as pertains to providing quality or timely medical care and or administrative responsibilities. Manage facility and other partners relationships, organization, patient consents, CCM and billing. Provide on call tele triage per established protocol policy. Confirm treatment and telehealth consents are signed prior to telemedicine visit. Follow Eventus telehealth visit etiquette protocols. Include family members in the visit, as appropriate. Be familiar with telemedicine equipment, delivery platform and software. Ensure the patient has the proper equipment available. If a patient, family, or site staff report faulty or lack of equipment, the provider is to notify the director of tele triage. Providers are to complete documentation and sign all orders specific for the telemedicine visit immediately after completing the visit. All narcotic prescriptions are to be managed per Eventus RX Policy. Notify patient’s regular provider of visit and triage treatment plan via EMR. On-call telehealth scheduling may be modified as needed. Providers are expected to adhere to the newest agreed upon triage schedule. Establish and maintain open and positive communications with facility staff and administration. Provide verbal and/or written instruction or feedback regarding medications and other pertinent caregiver information. Give time for questions to be asked by patient, family, or staff members. Establish when the patient should be seen next. All required data to be collected and documented same day. Be knowledgeable of and adhere to Eventus standards, policies, and procedures. Be aware of and adhere to all legal and regulatory agencies' rules, guidelines, and professional ethical standards. Comply with all regulatory agencies governing health care delivery. Always conduct self in a professional manner, this includes avoiding gossip, avoiding negative comments about other staff or competitors, maintaining appropriate interpersonal boundaries, and avoiding dual relationships (this includes refraining from offering medical or psychotherapy services to facility staff or family members, avoiding accepting gifts from patients, etc.), and observing appropriate professional attire when on call. Perform other duties and activities as appropriate and/or assigned by Eventus Management. Always maintain patient confidentiality including appropriate use of Cell phone, emails text messaging, patient charts and EMR. Agrees to abide by and be knowledgeable of HIPAA rules and regulations Maintain multiple practice licenses and comply with each state’s practice regulations, as requested by Eventus.
Hims & Hers is the leading health and wellness platform, on a mission to help the world feel great through the power of better health. We are redefining healthcare by putting the customer first and delivering access to care that is affordable, accessible, and personal, from diagnosis to treatment to delivery. No two people are the same, so we provide access to personalized care designed for results. By normalizing health & wellness challenges and innovating on their solutions, we’re making better health outcomes easier to achieve. Hims & Hers is a public company, traded on the NYSE under the ticker symbol “HIMS.” To learn more about the brand and offerings, you can visit hims.com/about and hims.com/how-it-works . For information on the company’s outstanding benefits, culture, and its talent-first flexible/remote work approach, see below and visit www.hims.com/careers-professionals.
We are currently hiring an Analyst, Clinical Quality who will report into our Director, Clinical Quality to join our Clinical Quality team. This role will collaborate and contribute to the overall clinical quality program including chart audits, monitoring quality metrics, and continuous performance improvement for all clinical services and for the medical provider team. We are looking for a creative, dedicated and driven individual who ensures quality principles are applied in all duties, is passionate about healthcare quality, and loves solving problems through innovative solutions.
Nurse Practitioner with 5+ years of experience in healthcare field Working knowledge of clinical best practices and performance improvement Creative and practical operationalization of clinical services/care Familiarity with relevant tools and programs (i.e. Epocrates, Excel) Self-starter aptitude and ability to work independently: you’ll be working in a fast-paced environment and managing competing priorities Willingness to grow, learn, and work as a member of a cross-functional team Past experience in Clinical Quality & Clinical Education is helpful but not required Bilingual (Spanish) a plus
Monitor clinical quality through evaluation of completed clinical visits against approved clinical guidelines Participate in ongoing quality improvement processes (i.e., reconsideration flow) Demonstrate expertise in correlating data trends to implementation of clinical practice behaviors Collaborate with key internal clinical and business operations team members for strategic direction and operational logistics of new clinical initiatives Maintain consistent communication with key internal stakeholders Maintain highly organized and accurate documentation on all quality metrics and performance improvement initiatives Perform research and documentation for service expansions Other duties as needed
We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.
Required Qualifications: 2+ years of experience as a Registered Nurse in adult acute care/critical care setting Must have active current and unrestricted RN licensure in state of residence Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and evening hours Preferred Qualifications: 2+ years of clinical experience required in med surg or specialty area Managed Care experience preferred, especially Utilization Management Preference for those residing in EST zones Education: Associates Degree required BSN preferred
Utilization Management is a 24/7 operation and work schedules will include weekends, 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. Typical office working environment with productivity and quality expectations. Work requires the ability to perform close inspection of hand written and computer generated documents as well as a PC monitor. Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer. Ability to multitask, prioritize and effectively adapt to a fast paced changing environment. Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding. Effective communication skills, both verbal and written
Healthmap Solutions is the future of specialty health management that focuses on progressive diseases, with a particular expertise in kidney health populations. Healthmap Solutions uses clinical big data resources and high-powered analytics to power complex specialty health management programs. Healthmap Solutions is a diverse, growing company committed to our clients and our employees. We are champions for better health, for those who need us most.
The Registered Nurse, Care Navigator will be responsible for case management specific to kidney health management. The Care Navigator will complete activities for the continuum of care to facilitate and promote high quality, cost-effective outcomes for patients and focus on the whole patient and care delivery coordination. Managing a set caseload of mixed acuity members, reviewing and/or obtaining member data and entry in HealthMap’s Care Management documentation system (Compass), completing member health and social determinants of health screenings, medication reconciliation, creation and maintaining member-centric care plans, updates of identified problems, barriers, interventions, and goals and assistance with ongoing case management. The Care Navigator will collaborate with internal and external (physicians, nurses, and other healthcare personnel) to assure positive patient outcomes and care coordination. Location We are hiring candidates located in Ohio. This position is 100% remote for Ohio residents.
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
Healthmap Solutions is the future of specialty health management that focuses on progressive diseases, with a particular expertise in kidney health populations. Healthmap Solutions uses clinical big data resources and high-powered analytics to power complex specialty health management programs. Healthmap Solutions is a diverse, growing company committed to our clients and our employees. We are champions for better health, for those who need us most.
The Registered Nurse, Care Navigator will be responsible for case management specific to kidney health management. The Care Navigator will complete activities for the continuum of care to facilitate and promote high quality, cost-effective outcomes for patients and focus on the whole patient and care delivery coordination. Managing a set caseload of mixed acuity members, reviewing and/or obtaining member data and entry in HealthMap’s Care Management documentation system (Compass), completing member health and social determinants of health screenings, medication reconciliation, creation and maintaining member-centric care plans, updates of identified problems, barriers, interventions, and goals and assistance with ongoing case management. The Care Navigator will collaborate with internal and external (physicians, nurses, and other healthcare personnel) to assure positive patient outcomes and care coordination. Location We are hiring candidates located in New York. This position is 100% remote for New York residents.
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
Healthmap Solutions is the future of specialty health management that focuses on progressive diseases, with a particular expertise in kidney health populations. Healthmap Solutions uses clinical big data resources and high-powered analytics to power complex specialty health management programs. Healthmap Solutions is a diverse, growing company committed to our clients and our employees. We are champions for better health, for those who need us most.
The Registered Nuse Care Navigator will be responsible for case management specific to kidney health management. The Care Navigator will complete activities for the continuum of care to facilitate and promote high quality, cost-effective outcomes for patients and focus on the whole patient and care delivery coordination. Managing a set caseload of mixed acuity members, reviewing and/or obtaining member data and entry in HealthMap’s Care Management documentation system (Compass), completing member health and social determinants of health screenings, medication reconciliation, creation and maintaining member-centric care plans, updates of identified problems, barriers, interventions, and goals and assistance with ongoing case management. The Care Navigator will collaborate with internal and external (physicians, nurses, and other healthcare personnel) to assure positive patient outcomes and care coordination.
Requirements: Active, unrestricted RN license required Bachelor's degree required 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
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.
Location: Fully Remote (Must be licensed in California) (HIPAA compliant work space) Schedule: Monday–Friday, 8:00 AM – 5:00 PM PT Language: Bilingual candidates strongly preferred (Spanish and Vietnamese) Join the Team That’s Redefining Healthcare! Are you a compassionate Registered Nurse with a passion for improving the lives of seniors and complex care patients? Join Alignment Health as a Telephonic RN Case Manager for our Special Needs Plan (SNP) members — all from the comfort of your home! This is a fully remote, phone-based position where you'll play a vital role in helping members navigate their care journeys, close gaps in care, and overcome barriers to better health. (HIPAA compliant work space)
Must-Haves: Active, unrestricted RN license in California (Non-Compact) Minimum 2 years of clinical nursing experience At least 1 year of case management experience Proficiency with Microsoft Office (Word, Excel, Outlook) Nice-to-Haves: Bilingual (Spanish, Korean, Mandarin, etc.) Previous health plan or IPA experience Bachelor's Degree in Nursing (BSN) Licensure Requirement Upon Hire: Must be willing to obtain RN licensure in Nevada, Arizona, North Carolina, and Texas (company reimburses costs) Work Environment Fully remote — work from anywhere in the U.S., but must work Pacific Time hours All communication is conducted via phone, email and Teams. Company-provided equipment and IT support included
As a Fully Remote RN Case Manager (SNP), you will: Provide telephonic case management to medically complex and chronically ill members Conduct comprehensive health assessments and create individualized care plans Coordinate care with internal and external partners, including physicians and specialists Educate members and caregivers on disease management and preventive care Monitor member progress and advocate for timely, appropriate interventions Identify and help resolve service or access issues impacting care quality
At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it’s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people’s lives. It takes empathy, precision, and a strong sense of partnership—and that’s exactly what you’ll find here. We’re a team of fast-paced fixers, empathetic experts, and outcomes drivers — people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you’ll play a vital role in helping businesses and individuals move forward with confidence. Here, you’ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you’re here, you’re part of something bigger. You’re part of a team that shows up, stands together, and leads with purpose.
Primarily focused on applying medical knowledge and research, in a legal setting, to advise in the review and analysis of General Liabiliy and Auto claims. Collaborates with claims handling professionals and attorneys to identify and evaluate liability and causation issues to assist in the defense of healthcare provider defendants in litigation.
Required: Bachelor's degree in Nursing (BSN) or equivalent; Registered Nurse (RN) license is required. Minimum of 3 years of clinical nursing experience. Must have proficient knowledge of medical malpractice and personal injury law. Strong knowledge of medical terminology, healthcare regulations, and legal procedures. Excellent research and analytical skills, with the ability to interpret complex medical information and apply it to legal cases. Proficient in using medical research databases, electronic medical record systems, and legal research tools. Excellent written and verbal communication skills, with the ability to effectively communicate complex medical concepts to claims handling professionals, attorneys and other team members. Proficient in using Microsoft Office Suite (Word, Excel, PowerPoint) and legal case management software. Strong Analytical and interpretive skills. Ability to create and complete comprehensive, accurate and constructive written reports. Desired: Experience in a hospital or medical-legal setting preferable. Paralegal certification or equivalent legal education and experience is highly desirable. Prior experience working for a law firm, insurance company, third party claims administrator or in-house legal team assisting in the management and defense of General Liability and Auto litigation is strongly preferred. Work Traits: Strong ethical standards and commitment to maintaining confidentiality. Stays updated and abreast on current healthcare regulations, industry trends, and legal developments related to medical malpractice and personal injury cases. Maintains strict confidentiality of all medical and legal information in accordance with all applicable regulations.
Conducting thorough medical malpractice case reviews, including reviewing and analyzing medical records; Preparing detailed medical chronologies, summaries, and reports for use in legal proceedings; Participating in the review and/or preparation of legal documents, including pleadings, motions, and discovery requests related to medical issues; Coordinating and communicating with opposing counsel and expert witnesses to gather necessary information and expert opinions; and Reviewing and analyzing medical literature, research studies, and industry standards to support legal arguments and strategies. Attends meetings, depositions, and trials to provide medical expertise and support to attorneys. Collaborates with the legal team to develop case strategies, conduct legal research, and assist in trial preparation.
AACN is the largest specialty nursing organization in the world, representing the interests of more than 500,000 nurses who are charged with the responsibility of caring for acutely and critically ill patients. The association is dedicated to providing our members with the knowledge and resources necessary to provide optimal care to critically ill patients.
Clinical Practice Specialist (CPS), CNECT (Clinical Nursing Education and Content Team) Department: Practice Excellence Reports to: Practice Excellence CNECT Supervisor About the Organization: The American Association of Critical-Care Nurses (AACN) is the largest specialty nursing organization in the world, representing the interests of more than 550,000 nurses who care for acutely and critically ill patients. AACN is dedicated to creating a healthcare system driven by the needs of patients and families, in which acute and critical care nurses can make their optimal contributions. Visit us online at http://www.aacn.org . AACN is an equal opportunity employer and prohibits discrimination against or harassment of any person employed by or seeking employment with AACN on the basis of race, color, religion, creed, sex and gender (including pregnancy, childbirth, breastfeeding or related medical conditions, gender identity, gender expression, and sexual orientation), ancestry, national origin, age (40 or older), disability (mental and physical), military or veteran status, marital status, medical condition, or genetic information and any other basis protected by federal, state or local law or ordinance or regulation. Application Instructions: To view the full job description and apply, please visit our Careers Page here and search for the “Clinical Practice Specialist, Clinical Nursing Education & Content Team (CNECT)” job posting. You can also email jobs@aacn.org with any questions. The position can be performed remotely. Some travel may be required. Position Purpose: The Clinical Practice Specialist (CPS), CNECT, oversees the development, review, and validation of acute, progressive, and critical care nursing content for AACN’s products and services. This role collaborates with internal and external experts and stakeholders to deliver innovative, industry-leading, and cost-effective products and services. It operates independently and without close supervision.
Skills Required: Proven project management, with emphasis on planning, design, launch and evaluation of programs. Excellent written and verbal communication skills, including strong facilitation skills. Proven skills in leading and collaborating within a cross-functional team environment. Demonstrated ability to co-create with others to cultivate engagement and develop content and services. Demonstrated experience providing mentorship and feedback to others. Ability to use and adapt to technology and willingness to develop new skills. Proficient or able to quickly learn various business, project, and productivity software (examples may include: Google Suite, Microsoft Office Suite, Zoom, and Smartsheet). Demonstrates emotional intelligence and ability to work effectively in a remote environment with diverse time zones, including time management and engagement with others in various synchronous and asynchronous platforms Education and/or Experience: Bachelor’s degree in Nursing; Master’s or doctorate degree preferred with CNS/ACNP certification Holds an unencumbered RN licensure in the United States Creation of successful new initiatives that meet or exceed organizational objectives 5-7 years’ healthcare experience Experience in progressive or critical care nursing Experience implementing or using eLearning programs is preferred Physical Requirements: The physical demands described here represent those that must be met by an individual to successfully perform the essential responsibilities of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Position is eligible for remote work. Some travel may be required for the role. Prolonged periods sitting/standing at a desk and working on a computer. Ability to operate standard office equipment and keyboards. Candidates selected for the interview process are welcome to request accommodations through their designated recruiter/AACN contact. Any candidates selected for hire with AACN must satisfactorily complete a background check, obtain clearance, and provide documentation verifying their identity and eligibility to work in the U.S. We are not able to provide visa sponsorship at this time.
Ensures effective strategies and systems to deliver expert clinical practice knowledge across projects, programs, and services. Collaborates with internal and external stakeholders to build a resource network that supports the needs of various content experts. Actively conducts environmental scanning to provide current perspectives and address issues important to nurses and the healthcare environment. Synthesizes information from environmental scans and shares insights with internal stakeholders to guide AACN’s work. Plans and collaborates to develop new products, programs, and services, making sure current nursing practices and issues are central to planning and design. Assesses resource needs for internal and external projects. Develops and implements processes to ensure the right people with the required skills are chosen for each project. Serves as a liaison and facilitator with project subject matter experts (SMEs) and community groups. Provides leadership in ensuring content quality and integrity for clinical products, programs and services. Working collaboratively, establishes and maintains systems for content-quality assessment of new products and reviews of existing products. Ensures accuracy, context and relevance of clinical content used in products. Leads clinical content review of products, programs and services, identifying needed updates. Ensures products and services are consistent with national standards and AACN mission, vision and values. Acts as a resource for the AACN community on practice issues, engaging the appropriate processes and groups to address them. Develops, mentors, and delivers feedback to volunteers and SMEs in order to support their professional development and contributions. Collaborates with internal stakeholders and/or leads project development, implementation, and evaluation processes for assigned projects. Organizes and leads project teams, ensuring coordination and alignment with internal departments. Supports and facilitates SME work on projects, providing an overarching perspective to ensure alignment with AACN project goals and objectives. Develops and/or collaborates on project schedules and budgets aligned with internal and external resources, coordinates to meet project goals, and manages project plans to closure. Facilitates project meetings, builds consensus and addresses conflict to ensure project outcomes are met. Collaborates to ensure an evaluation is finished following project completion. Applies technology solutions to support the development and representation of our content, products, services, and interactions with the community. Collaborates as needed to ensure the process of assessing, planning, implementing, and evaluating CE activities adheres to current ANCC and CA BON program approval criteria. Ensures appropriate education design principles are used and processes are consistent with the requirements of the ANCC and CA BON. Coordinates processes to ensure proper assignment of CE to learning activities. Ensures that program approval processes are completed for assigned projects.
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The CAPABLE Transplant study seeks a Registered Nurse (RN) to serve adults on a casual basis as part of a research study. The research study seeks to adapt the existing CAPABLE program for older adults on the kidney transplant waitlist. This role will work under the direction of the research study Principal Investigator (Dr. Melissa Hladek), in collaboration with the Lead CAPABLE Occupational Therapist. The RN will implement the CAPABLE Transplant study protocol after completion of CAPABLE training through Johns Hopkins University School of Nursing CAPABLE on-line training. The CAPABLE Transplant program consists of up to four RN home visits over 4-5 months. The RN will work with CAPABLE participants on their self-selected goals, assess and implement strategies. The RN meets with participants in the home. The RN uses training and motivational interviewing techniques to conduct a comprehensive interview to identify and prioritize issues that matter to the participants. These goals become the foundation for brainstorming and action plan development and implementation. The RN documents the participant's own goals in up to 3 Action Plans. The RN interacts and communicates with the CAPABLE Occupational Therapist (OT) and other team members as needed to ensure close collaboration throughout the research study. This is a remote position but have to be able to commute to Baltimore city and surrounding county areas to participants' homes.
Additional Knowledge, Skills, And Abilities: Ability to work from a collaborative, client-directed model. Willingness and ability to implement a protocol and balance with clinical judgment. Able to commute to Baltimore City, County, and surrounding county areas (within a 40 min radius of the Johns Hopkins School of Nursing) to participant homes. Minimum Qualifications: Individual must be a registered nurse, licensed in the State of Maryland or state where practicing. Current CPR certification with the American Heart Association or the American Red Cross. Must maintain current licensure and certification during the duration of employment. Additional education may substitute for required experience, and additional related experience may substitute for required education beyond a high school diploma/graduation equivalent, to the extent permitted by the JHU equivalency formula. Preferred Qualifications: Bachelor's Degree in Nursing or related discipline preferred. Experience working with home care with older adults. Experience in motivational interviewing.
Conduct a comprehensive, semi-structured interview to identify and prioritize issues related to medications, pain, depression, strength and balance, primary care provider communication, and other topics as prioritized by the older adult. Engage participants in problem-solving to identify behavioral and environmental contributors that may impact function. Coach and guide the older adult in building self-efficacy and confidence. Reinforce brainstorming techniques, strategic thinking, and more independent problem-solving to promote the ability to live at home and in the community. Provide education and resources to address future needs and the participant's priorities. Communicate with the OT and other team members weekly. Document visits according to the organization's guidelines.
Aurora Health Care is the largest health system in Wisconsin and a national leader in clinical innovation, health outcomes, consumer experience and value-based care. The state’s largest private employer, the system serves patients across 17 hospitals, more than 70 pharmacies and more than 150 sites of care. Aurora Health Care, in addition to Advocate Health Care in Illinois and Atrium Health in the Carolinas, Georgia and Alabama, is now part of Advocate Health, the third-largest nonprofit, integrated health system in the United States. Committed to providing equitable care for all, Advocate Health provides nearly $5 billion in annual community benefits.
Must live within 1 hour of Mint Hill, NC Primary Care Office to be considered for this remote opportunity.
Preferred qualifications: 3+ years RN: experience in case management, triage, with prior telephonic/remote experience. This is a weekend position, hours of operation 8am to 8:30pm with a potential to include holidays. This is a remote work from home position. Must have high speed internet. Must live within 1 hour of Mint Hill, NC Primary Care office. Licensure, Registration, and/or Certification Required: Registered Nurse license issued by the state in which the team member practices. Education Required: Bachelor's Degree in Nursing or related field. Experience Required: Typically requires 5 years of experience in clinical nursing or 1-2 years of care management experience. Knowledge, Skills & Abilities Required: Applicable certification is encouraged. Must be self-directed with the ability to work well independently and within a team environment while recognizing and meeting the individual needs of external and internal partners/customers. Ability to demonstrate excellent oral, written and interpersonal skills. Ability to demonstrate critical thinking, problem solving and excellent organizational skills. Ability to work productively and effectively in a complex environment that includes multiple changing priorities. Demonstrated ability to work well with physicians and other healthcare professionals in a direct and positive manner. Proficient computer/Microsoft-suite skills and previous Epic EMR experience. Ability to handle multiple responsibilities. Physical Requirements and Working Conditions: Position may require travel between clinic sites so there may be exposure to road and weather conditions. Manual dexterity required for operation computer and calculator. Visual acuity required to facilitate review of written documents/computer screens, medical records, and to record information accurately. Clear oral communications and hearing acuity required for receiving instructions and converse on standard telephone. Functional speech and hearing to allow for effective communication of instructions and conversation over the telephone. Exposed to normal office environment; including usual hazards related to operating electrical equipment. Operates all equipment necessary to perform the job.
Facilitates communications among patient/family, multidisciplinary team, medical management team, community resources and other disciplines to anticipate, identify, evaluate, and act to resolve any potential barriers and constraints to delivery of care in a timely manner. Understands and interprets multiple contracts and contractual obligations in order to enable the care management team to achieve maximum clinical and financial outcomes. Collaborates with the patient/family and inter-professional team including the primary care team, hospital care team, post acute care managers, and other care partners to provide a model of care that ensures the delivery of quality, efficient, and cost-effective healthcare services. May work embedded within a provider office or telephonically working with a care team. Uses evidenced-based approaches to increase patient and family activation and engagement in their own care. As appropriate to the population, partners with patient and family to develop SMART (specific, measurable, attainable, relevant, time-bound) goals. Assists in the development, procurement, and adoption of patient self-management educational resources. Identifies potential barriers to learning and/or to the optimal delivery of care. Reports abnormal findings to the responsible provider/care team, and collaborates to develop a plan. Independently manages CM caseload according to department expectations. Ensures timely completion of tasks and documentation related to MCO, regulatory and contractual requirements. Partners with identified at-risk patients throughout the diagnosis, treatment and follow-up in order to deliver continuity of care. Anticipates the needs of the patient, recognizes and responds to changes in a patient’s status and determines priorities of patient care based on essential patient needs. Coordinates patient information and communication between and among the patient/family, the referring/accepting facilities and physicians, community caregivers (as applicable) and other members of ACM to ensure smooth transitions of care. Coordinates referrals to other internal AAH departments and/or external community resources as necessary. Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards.
Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including: Compensation Base compensation within the position’s pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate’s job Incentive pay for select positions Opportunity for annual increases based on performance Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program
Looking for full time RNs – Position is 100% remote **Candidate MUST have 2+ years' acute care experience (ED, Urgent Care, ICU and some Med/Surg will be considered) is required within the last 4 years to be considered.** Due to complex requirements, remote work is NOT permitted from the following states: CA, CO, CT, HI, MA, MD, MN, NJ, NY, OR, RI, VT, WA Schedule: Full time position Start times days: 8a-10a or PM 12p-2p (or later) 8 hour or 10 hour shifts are available for different shifts MUST be available to work every 4th weekend and holiday rotation.
Licensure, Registration, and/or Certification Required: Registered Nurse license issued by the state in which the team member practices. Education Required: Associate's Degree (or equivalent knowledge) in Nursing. Experience Required: Typically requires 2+ years' of acute care experience, preferably within the last 4 years (ED, Urgent Care, ICU and some Med Surg will be considered). Knowledge, Skills & Abilities Required: Critical thinking skills necessary to independently determine and prioritize the needs of patients using sound judgment and strong problem-solving skills. Knowledge of a variety of healthcare specialties, including levels of care, symptom identification and proven treatment recommendations. Ability to incorporate past experience with established protocols. Excellent verbal communication skills demonstrating empathy, respect, restatement, open-ended questions, active listening and diplomacy with a diverse customer population. Ability to develop rapport and maintain positive, professional relationships with a variety of patients, staff and physicians. Proven ability to independently organize and prioritize work, managing multiple priorities and maintaining a flexible schedule in a fast paced, dynamic customer service environment. Excellent customer service and follow-up skills including the ability to stay calm during stressful situations. Demonstrated proficiency as a technology user with computers, internet, desktop software packages and multiple-line telephone systems. Ability to converse with customers/patients while researching and documenting calls on multiple systems. Knowledge of documentation techniques for communication Physical Requirements and Working Conditions: Required stable and secure internet connection Must have functional vision, touch, speech, and hearing. Required sitting a majority of the workday. Operates all equipment necessary to perform the job. Must have quiet space to make and receive phone calls Ability to lift 15 lbs.
Uses the nursing process and guidance of established protocols to assess the needs of the patient telephonically including the patient, guardian, or family in the conversation when necessary. Determines most appropriate level of care needed, provides detailed education, establishes a plan of care including interventions, and communicates follow up instructions to the patient. Escalates and collaborates with the appropriate on call provider when additional guidance is needed. Prioritizes patient interactions by acuity and need considering all available information and resources. Applies evidence-based practice to deliver patient care. Implements strategies to reduce patient risk and increase patient safety. Assesses patient and family readiness to learn and individualizes the approach as necessary. Works collaboratively to develop strategies to meet the learning needs of the patient and family. Supports shared governance activities and initiatives to improve processes and patient outcomes. Participates in department quality/process improvement initiatives aimed at enhancing the patient care experience. Participates in professional activities which contribute to personal professional development and the development of others. Seeks opportunities to be taught, coached, and mentored. Attends required meetings/educational programs and completes annual competencies in a timely manner. Demonstrates effective communication, feedback, and conflict resolution skills. Promotes collaboration with clinicians and other healthcare team members to coordinate patient-centered care. Promotes a culture of safety through identifying threats to patient safety and intervening to prevent patient harm. Reports patient safety events and near misses in a timely manner. Seeks to identify potential safety issues and assists in the implementation of corrective action. Applies ethical decision making, demonstrates respect and understanding for peers, and other clinical disciplines. Participates as an effective member of the patient care team to formulate an integrated, unbiased, individualized approach to care. Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret appropriate information needed to identify each patient’s requirements relative to his/her age specific needs and provide the care advice/disposition outlined in the departments policies, procedures, and protocols. Schedules appointments with emphasis on making the appointment in correlation to the recommended end point of the protocol used. Collaborates with other health care team members to coordinate medical and nursing management of patient care, including procedures and medication refills. Accurately maintains and updates the patient’s clinical records according to agency, State and Federal guidelines. Documents all call encounters utilizing the patient’s Electronic Medical Record at the time of the call. Communicates information relating to the patient’s physical and psychological status to the physician, Advanced Practice Clinician and/or additional members of the interdisciplinary team as appropriate. Provides pertinent and concise reports describing patient’s response to medical and nursing plans of care. Participates in team meetings and works on special projects/tasks as assigned by leadership. Participates in the ongoing development of comprehensive health information resources, system and operational efficiencies and resources. Assists in interpreting department policies and procedures and advises staff on procedural changes.
Advocate Health Care is proud to be a part of Advocate Health, the third-largest nonprofit integrated health system in the U.S. Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin and Michigan, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs nearly 162,000 team members across 68 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides nearly $5 billion in annual community benefits.
Part Time Care Transitions Nurse - This is a part-time remote role that requires high-speed internet and requires some evening and weekend coverage. Care Transitions role for both 30 and 90-day programs Medicare/ACO patient population/Medicare FFS program post-hospital discharge. This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
Bachelor`s Degree in Nursing. Typically requires 2 years of experience in nursing in an acute care or community setting with an emphasis in palliative care or senior services. Excellent written and verbal communication skills. Strong organizational analytical and problem-solving skills. Ability to educate clinical staff and the community. Ability to work well with physicians and other healthcare professionals. Ability to work in a team-based multidisciplinary environment. Registered Nurse license issued by the state in which the team member practices. May need to operate a motorized vehicle to facilitate home visits as appropriate. Must be able to sit stand and walk without restriction. Must have the ability to move about in confined spaces including bending twisting kneeling squatting and occasionally reaching one or both arms overhead. Must be able to concentrate on detailed information, tasks and functions for prolonged periods of time. Must be able to speak clearly and hear in order to communicate in-person or via telephone.
Responsible for ensuring an efficient and coordinated hospital discharge and transition process for patients recently hospitalized or treated in the emergency room that are at high risk for increased use of healthcare resources. Accountabilities: Identifies the needs of patients and families and coordinates internal and external community resources within the first month of hospital discharge.
The Tampa General Hospital (TGH) Cancer Institute and Cancer Center of South Florida (CCSF) partnership delivers top-tier, academic-level care to patients in South Florida and beyond. Our team, led by renowned medical oncologists and hematologists, provides local, highly personalized patient care and state-of-the-art medical treatments, combined with access to Tampa General, an academic health system with multidisciplinary experts, advanced clinical trials, and comprehensive support services. Our physicians, advanced practice providers, oncology nurses, navigators, and pharmacy staff work collaboratively to understand each individual’s condition, develop customized medical options, and choose the most effective treatment plan. Throughout the patient journey, our care team ensures that each member delivers compassionate and unmatched support, making a powerful and positive difference for patients and their loved ones. Established in 2008 in Palm Beach County, CCSF formed an alliance with TGH in 2020, enabling patients in Palm Beach and the Treasure Coast to receive the world-class care and complex services a major academic health system provides close to home. Today, TGH Cancer Institute and CCSF have two locations in Palm Beach County and one in Hillsborough and 20 specialized oncologists. For more information, visit cancercenterofsouthflorida.com
An oncology telephone triage nurse helps existing oncology and hematology patients with care over the phone. They often provide a cursory assessment of the patients and help them decide if they need to seek emergency treatment, make an appointment with a doctor, or treat themselves at home collaborating with other health care providers to deliver care and document outcomes.
REQUIRED EDUCATION & EXPERIENCE: Associate's Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN) from an accredited nursing program required. At least 1–2 years of oncology and/or infusion nursing experience preferred Required Certificates, License Or Registration: Current Registered Nurse (RN) license in the applicable state (required) Oncology Certified Nurse (OCN) – preferred Basic Life Support (BLS) certification – preferred Required Knowledge, Skills Or Abilities: Solid understanding of oncology and hematology conditions, treatments, and symptom management. Proficient in clinical triage protocols, including assessing symptom severity and guiding appropriate care pathways. Knowledge of HIPAA regulations and documentation standards in electronic health records (EHR), such as EPIC.
Triage incoming calls from patients and physician offices, prioritizing and returning calls on the same day. Manage scan authorizations and ensure timely approval of radiology orders. Collaborate with providers on treatment side effects and appropriate actions. Maintain therapeutic communication with patients and families. Assist with prescriptions, refills, and review lab/imaging results with providers. Place orders for tests and procedures as confirmed by providers. Address clinical issues and escalate serious concerns to providers. Reduce unnecessary clinic visits and ER trips by providing self-care and symptom management advice. Arrange appointments for non-urgent cases and consult with providers as needed. Provide phone consultations, education, and triage based on oncology guidelines. Determine urgency of care based on assessment and patient history. Record consultations and treatments in the EHR system. Assist in implementing oncology policies and NCCN guidelines.
Momentum Life Sciences is the leading provider of patient engagement solutions integrating human connection, advanced technology, and real-world data to deliver holistic support in a personalized environment. Leveraging 30+ years’ experience in patient engagement, our One Voice™ model empowers biopharma teams to optimize the right mix of interventions for each patient. On behalf of our biopharma partners, we deliver 1M+ patient and healthcare provider engagements in person and virtually through our network of 800+ nurse educators nationwide. Our seasoned senior executive team is led by President and CEO Andrea Heslin Smiley. Momentum has been certified as a Great Place to Work® for 7 years running, additionally resulting in being named a Great Place to Work for Women, a Great Place to Work for Giving, and a FORTUNE® 100 Best Medium Workplace. Other distinctions include Best Place to Work in Indiana, Working Mother magazine’s Best Women-owned Companies, Inc. 500 Fastest Growing Companies in America, Growth 100 company by the Kelley School of Business Johnson Center for Entrepreneurship and Innovation, and a Fortune 500 pharmaceutical client Global Supplier of the Year. Momentum continues to grow at a rapid pace. We are seeking candidates who thrive in an entrepreneurial environment and a culture of innovation. To inquire about our products and services, please email: businessdevelopment@momentumls.com.
The Bilingual (Spanish) Nurse Case Manager will be responsible for utilizing their professional nursing skills, clinical experience, ability to foster relationships, strong empathy, and to provide personalized high-touch virtual support to patients and healthcare professionals (HCPs) with an emphasis on reimbursement, patient access, and therapy coordination. The role will engage with patients and HCPs to ensure patients have seamless access to treatment. The NCM will guide HCPs through any access barriers for their patients while also heavily collaborating cross-functionally with the REMS vendor, HUB, specialty pharmacy, and field teams to optimize the patient treatment journey. You will leverage your clinical knowledge while combining technical expertise to deliver best-in-class support, customer service, and ongoing guidance to these patients and providers.
Required Education and/or Experience: Bachelors degree preferred Experience in a telephonic support role centered in patient access, reimbursement, or care coordination/case management roles Experience with high volume inbound/outbound call center Required License and/or credential(s): Current, unrestricted nursing license (RN, NP) Required Skills: High emotional intelligence and ability to exhibit empathy to meet each patient where they are Demonstrated flexibility and adaptability in a fast-paced environment with shifting priorities, new information, and changing business demands Strong clinical skills and experience with medication compliance, specialty pharmacy knowledge, understanding of the insurance approval process, and motivational interviewing Maintain strong time management and organizational discipline while coordinating concurrent workstreams and navigating frequent interruptions Desire and ability to create an individualized relationship with patients as they progress through their journey Ability to accurately recognize and report AEPQC information. Optimistic, upbeat, and enthusiastic in times of challenge and constant change. Ability to deliver outstanding patient experience Demonstrate experienced competency and ability to independently navigate technology using multiple platforms, computer screens, and other technical components. (Ex: Telephony Systems, CRM tools, Microsoft Suite) Advanced knowledge of written and verbal communication skills and problem-solving techniques Detail-oriented, highly organized, and able to work through ambiguity Able to work independently, self-motivated, managing workload with minimal supervision Ability to maintain cases and complete calls on time Ability to maintain compliant conversations and documentation in a high-volume role Ability to maintain patient confidentiality by using the headset during all conversations, maintaining a private environment for home office without distraction Ability to maintain great flexibility in an ever-changing environment and willingness to learn other therapies or float to other brands as needed Willingness to assist in shift coverage as needed outside of typical hired shift Special Position Requirements: Travel: As required; less than 10% Working Conditions: Work is generally sedentary in nature but may require standing and walking for up to 10% of the time. The working environment is generally favorable. Lighting and temperature are adequate, and there are no hazardous or unpleasant conditions caused by noise, dust, etc. Work is generally performed within an office environment, with standard office equipment available. Physical Requirements: Must be able to read, write, and communicate fluently in Spanish and English. Ability to communicate effectively (hear, listen, speak) with or without reasonable accommodations.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Provide virtual high-volume omnichannel support through email, chat, text, virtual connections, and inbound or outbound calls to patients, HCP’s, REMS vendor, HUB, specialty pharmacy, and field teams Demonstrate strong empathy and high emotional intelligence to engage patients/HCP’s effectively, creating individual relationships built on trust and rapport Provide proactive support to HCP office issues related to REMS, reimbursement, insurance coverage, and product dispense Act as a primary point of contact for patients to provide comprehensive disease/therapy education and access to therapy (including benefit verification, prior authorizations, and navigating insurance reimbursement processes) Prepare structured case status reports for ongoing HCP email or telephonic review Collaborate and work cohesively with Momentum Inbound team to identify gaps, barriers, and opportunities to improve process and overall patient/HCP experience Communicate complex information effectively and empathetically to patients/HCP’s Accurately complete patient engagements based on provided criteria Ensure the success of the program through collaborative partnerships with patients, HCPs, field, and operational partners Lead and facilitate weekly touchpoint meetings with field partners to review wins, priorities and action items; document outcomes and drive timely follow-through Monitor and prioritize daily and weekly workload to anticipate needs, rebalance tasks, and ensure timely follow-through on commitments Work and communicate cohesively within a team to identify collaborative opportunities, enable process improvement and escalate as needed Provide manager and the account team voice of the customer feedback on the product, support, and insights to enable enhancements Ensure all activities are conducted in a manner that complies with all Momentum, client, and industry-mandated rules and regulations. Complete AEPQC reporting and provide all communications in a compliant manner. Other duties: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
Momentum Life Sciences is the leading provider of patient engagement solutions integrating human connection, advanced technology, and real-world data to deliver holistic support in a personalized environment. Leveraging 30+ years’ experience in patient engagement, our One Voice™ model empowers biopharma teams to optimize the right mix of interventions for each patient. On behalf of our biopharma partners, we deliver 1M+ patient and healthcare provider engagements in person and virtually through our network of 800+ nurse educators nationwide. Our seasoned senior executive team is led by President and CEO Andrea Heslin Smiley. Momentum has been certified as a Great Place to Work® for 7 years running, additionally resulting in being named a Great Place to Work for Women, a Great Place to Work for Giving, and a FORTUNE® 100 Best Medium Workplace. Other distinctions include Best Place to Work in Indiana, Working Mother magazine’s Best Women-owned Companies, Inc. 500 Fastest Growing Companies in America, Growth 100 company by the Kelley School of Business Johnson Center for Entrepreneurship and Innovation, and a Fortune 500 pharmaceutical client Global Supplier of the Year. Momentum continues to grow at a rapid pace. We are seeking candidates who thrive in an entrepreneurial environment and a culture of innovation. To inquire about our products and services, please email: businessdevelopment@momentumls.com.
The Nurse Case Manager will be responsible for utilizing their professional nursing skills, clinical experience, ability to foster relationships, strong empathy, and to provide personalized high-touch virtual support to patients and healthcare professionals (HCPs) with an emphasis on reimbursement, patient access, and therapy coordination. The role will engage with patients and HCPs to ensure patients have seamless access to treatment. The NCM will guide HCPs through any access barriers for their patients while also heavily collaborating cross-functionally with the REMS vendor, HUB, specialty pharmacy, and field teams to optimize the patient treatment journey. You will leverage your clinical knowledge while combining technical expertise to deliver best-in-class support, customer service, and ongoing guidance to these patients and providers.
Required Education And/or Experience: Bachelors degree preferred Experience in a telephonic support role centered in patient access, reimbursement, or care coordination/case management roles Experience with high volume inbound/outbound call center Required License And/or Credential(s) Current, unrestricted nursing license (RN, NP) Required Skills: High emotional intelligence and ability to exhibit empathy to meet each patient where they are Demonstrated flexibility and adaptability in a fast-paced environment with shifting priorities, new information, and changing business demands Strong clinical skills and experience with medication compliance, specialty pharmacy knowledge, understanding of the insurance approval process, and motivational interviewing Maintain strong time management and organizational discipline while coordinating concurrent workstreams and navigating frequent interruptions Desire and ability to create an individualized relationship with patients as they progress through their journey Ability to accurately recognize and report AEPQC information. Optimistic, upbeat, and enthusiastic in times of challenge and constant change. Ability to deliver outstanding patient experience Demonstrate experienced competency and ability to independently navigate technology using multiple platforms, computer screens, and other technical components. (Ex: Telephony Systems, CRM tools, Microsoft Suite) Advanced knowledge of written and verbal communication skills and problem-solving techniques Detail-oriented, highly organized, and able to work through ambiguity Able to work independently, self-motivated, managing workload with minimal supervision Ability to maintain cases and complete calls on time Ability to maintain compliant conversations and documentation in a high-volume role Ability to maintain patient confidentiality by using the headset during all conversations, maintaining a private environment for home office without distraction Ability to maintain great flexibility in an ever-changing environment and willingness to learn other therapies or float to other brands as needed Willingness to assist in shift coverage as needed outside of typical hired shift Travel Special Position Requirements: As required; less than 10% Working Conditions Work is generally sedentary in nature but may require standing and walking for up to 10% of the time. The working environment is generally favorable. Lighting and temperature are adequate, and there are no hazardous or unpleasant conditions caused by noise, dust, etc. Work is generally performed within an office environment, with standard office equipment available. Physical Requirements: Must be able to read, write, and communicate fluently in English. Ability to communicate effectively (hear, listen, speak) with or without reasonable accommodations.
Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Provide virtual high-volume omnichannel support through email, chat, text, virtual connections, and inbound or outbound calls to patients, HCP’s, REMS vendor, HUB, specialty pharmacy, and field teams Demonstrate strong empathy and high emotional intelligence to engage patients/HCP’s effectively, creating individual relationships built on trust and rapport Provide proactive support to HCP office issues related to REMS, reimbursement, insurance coverage, and product dispense Act as a primary point of contact for patients to provide comprehensive disease/therapy education and access to therapy (including benefit verification, prior authorizations, and navigating insurance reimbursement processes) Prepare structured case status reports for ongoing HCP email or telephonic review Collaborate and work cohesively with Momentum Inbound team to identify gaps, barriers, and opportunities to improve process and overall patient/HCP experience Communicate complex information effectively and empathetically to patients/HCP’s Accurately complete patient engagements based on provided criteria Ensure the success of the program through collaborative partnerships with patients, HCPs, field, and operational partners Lead and facilitate weekly touchpoint meetings with field partners to review wins, priorities and action items; document outcomes and drive timely follow-through Monitor and prioritize daily and weekly workload to anticipate needs, rebalance tasks, and ensure timely follow-through on commitments Work and communicate cohesively within a team to identify collaborative opportunities, enable process improvement and escalate as needed Provide manager and the account team voice of the customer feedback on the product, support, and insights to enable enhancements Ensure all activities are conducted in a manner that complies with all Momentum, client, and industry-mandated rules and regulations. Complete AEPQC reporting and provide all communications in a compliant manner. Other Duties This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.
Doing something meaningful starts with a simple decision, a commitment to changing lives. At The Cigna Group, we’re dedicated to improving the health and vitality of those we serve. Through our divisions Cigna Healthcare and Evernorth Health Services, we are committed to enhancing the lives of our clients, customers and patients. Join us in driving growth and improving lives.
The Clinical Waste & Abuse (CWA) Complex Claim Program leader oversees pre- and post-pay medical record reviews to support accurate coding, billing, medical necessity determinations, and coverage decisions in alignment with the benefit plan and Cigna Medical and Reimbursement Policies. This leader manages and develops a team of Registered Nurses and drives a quality, cost-effective approach to high-cost claim review operations.
Required Qualifications: Active, unrestricted Registered Nurse (RN) license in state of residency. Three years of experience in Complex Claim Review (CCR) or Clinical Waste & Abuse (CWA) review. Experience with CCR/CWA operations, including high-dollar bill review. Three years of working knowledge of the insurance industry and end-to-end claims processes. Preferred Qualifications: Prior people leadership experience. Strong problem-solving skills with the ability to apply systems thinking to business solutions and manage change. Medical coding experience. Ability to manage multiple priorities, meet objectives, and maintain attention to detail. Proficient critical thinking and decision-making skills. Ability to think strategically, design action plans, and execute. Attention to detail Detailed understanding of cover policies and reimbursement policies. Demonstrated strong leadership skills. Demonstrated excellence in the application of decision-making skills. Demonstrated ability to initiate, research, prioritize, plan, coordinate and organize Excellent written and verbal communication and strong interpersonal skills. Proficiency in Microsoft Office (Excel, PowerPoint) and other common business tools. Knowledge of applicable state and federal statutes and regulations related to claim processing. Experience in training and staff development. Experience managing remote staff. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
Hire, onboard, and retain staff; foster engagement and accountability. Monitor daily inventory, capacity, and financial performance to ensure alignment with goals. Serve as the subject matter expert for clinical pre-pay requests and key matrix partner needs. Coach the team on workflows, processes, and tools; reinforce best practices and quality standards. Track service metrics and quality results; review work regularly and take action to address trends and gaps. Set clear objectives and performance expectations for direct reports aligned to operational priorities. Provide ongoing performance coaching, career development support, and feedback; support talent planning and succession. Communicate effectively with stakeholders across the Complex Claim Unit, including Medical Directors and matrix partners.
Evenings, Weekend Only, Full-time & Part-time opportunities available (20hrs +) Hiring for evenings and weekends (*weekends and holidays are required) Incentives for Bilingual Spanish Telephone Triage RNs! Are you looking for an exciting way to utilize your nursing skills and expertise to deliver quality nursing care in a remote setting? AccessNurse, where technology meets compassionate care, is looking for professional nurses & offering flexibility, balance and a modern work environment. AccessNurse-TeamHealth is the premier medical call center, delivering 24/7 telephone nurse triage, answering services and health information services to hospitals, physician offices, and insurance plans across the country. We serve more than 20,000 clinicians and practices along with healthcare systems, health plans, and federally qualified health centers across the country. From day one, you’ll work from home using advanced evidence-based clinical decision tools to help patients get the right level of care at the right time. Why Nurses Love This Role: 100% remote- work from home No bedside lifting or hospital burn out The variety of scheduling options Competitive Pay + excellent benefits Supportive, collaborative team culture Paid training & equipment is provided Opportunities for bilingual pay incentive As a Telephone Triage RN, you’ll use clinical expertise and technology to guide patients across the lifespan & determine the best way to address their medical issues and concerns over the phone
Qualifications / Experience: Current multi-state RN license with no restrictions; nurses currently holding a single-state RN license must obtain a multi-state license prior to being made a job offer 1+ years of RN experience Proficiency using computers and type a minimum of 25 wpm Excellent listening and comprehension skills to determine key information by patient Remote Workstation / HIPAA Requirements Must have a high-speed internet connection Workstation must be in a room where door can be locked Desk should be large enough to hold 2 monitors, computer, accessories + hands-free headset Ability to handle confidential information; HIPAA compliance is mandatory
Assess symptoms using physician-developed clinical algorithms Deliver & document health education to assist patients in managing their symptoms when indicated Assist in getting patients to the appropriate level of care (e.g. home care, an office visit, emergency room) Consult with physicians as needed
At UnityPoint Health, you matter. We’re proud to be recognized as a Top 150 Place to Work in Healthcare by Becker's Healthcare several years in a row for our commitment to our team members. Our competitive Total Rewards program offers benefits options that align with your needs and priorities, no matter what life stage you’re in. Here are just a few: Expect paid time off, parental leave, 401K matching and an employee recognition program. Dental and health insurance, paid holidays, short and long-term disability and more. We even offer pet insurance for your four-legged family members. Early access to earned wages with Daily Pay, tuition reimbursement to help further your career and adoption assistance to help you grow your family. With a collective goal to champion a culture of belonging where everyone feels valued and respected, we honor the ways people are unique and embrace what brings us together. And, we believe equipping you with support and development opportunities is a vital part of delivering an exceptional employment experience. Find a fulfilling career and make a difference with UnityPoint Health.
Area of Interest: Nursing FTE/Hours per pay period: 0.8 Department: Call Center Shift: 10:30pm-7:00am, every other weekend, holiday rotation Job ID: 180474 Overview RN Call Center 10:30PM-7:00AM, every other weekend, holiday rotation Full Time Benefits REMOTE - Candidate must reside in a compact license state**
Qualifications/Experience: Requires active and unrestricted license to practice nursing in the states of Iowa and Illinois. Requires a minimum of 1-2 years of clinical nursing experience providing direct patient care or equivalent work experience - 2-3 years preferred Strong time management and organizational skills Possesses excellent written and verbal communications. Proficiency in use of computer applications such as Microsoft Office and electronic health systems. Requires knowledge of federal healthcare laws and regulations. Requires highly developed communication skills to effectively work with all levels of management throughout the UnityPoint Health, its subsidiaries and affiliates. Excellent academic credentials with a track record of professional accomplishments, which demonstrate superior performance, leadership and vision. Ability to work as a team member, creating and maintaining effective working relationships. Ability to understand and apply guidelines, policies and procedures. Education: Graduate from an accredited nursing program. Bachelors of Science (BSN) preferred Compliance with Mandatory Child/Adult Abuse Reporting
The UnityPoint IntelliCenter nurse is an RN who provides care over the telephone by thoroughly assessing symptoms to identify acuity to disposition caller or patient appropriately utilizing best-practice updated protocols. Protocols are embedded within the eMR to support guidance in appropriate care delivery. Nursing services are provided telephonically and, in some cases, virtually. May include triage, care management, referral management and telehealth support. Must have proficient keyboarding/typing skills and have a technical aptitude to learn new computer software systems quickly. Ability to handle a “call center” environment: work quickly and multi-task, utilizing clinical critical skill thinking while navigating computer software to meet the required turnaround time to support key performance indicators which support patient care delivery and operational costs. We are a 24/7 operation with the bulk of our services provided in the evenings and weekends. Primary Function and Relationship to the Total Organization: My UnityPoint Nurse Call Center offers a free health information service for the public, sponsored by UnityPoint Health and staffed by registered nurses 24-hours a day, 7 days a week. The nurses at My UnityPoint Nurse provide medical assessment and triage, up-to-date health information and physician and clinic referral service. My UnityPoint Nurse Call Center is a centralized function of UnityPoint Health providing clinical support to UnityPoint Health and affiliates. Operations: Performs symptom assessment triage utilizing protocols to guide best practice care delivery and disposition. Documents call criteria in eMR within a timely manner. Promotes and educates appropriate callers regarding second level triage and virtual care visits with NP and MDs when appropriate. Serves as a resource to customers seeking physician referral and community-based resource information. Provides health information to customers via UnityPoint Health’s approved resources Maintains strict confidentiality of all employee and customer information Adhere to all UnityPoint Clinic personnel Policies and Procedures and safety guidelines. Supports change transformation initiatives Identifies with shift change requirements as call volume dictates in order to support staffing needs appropriately Perform other duties as assigned. Support team efforts in patient care delivery objectives. Provides assistance with other reasonable related duties as assigned by supervisor or manager. Ability to handle confidential and sensitive information. Ability to communicate effectively on the telephone. Ability to relate to persons with diverse educational, socioeconomic and ethnic backgrounds. Ability to handle a “call Center” environment: work quickly and multi-task. Ability to demonstrate good customer service. Exhibits discretion and sound judgment in all aspects of the job.
At the forefront of health tech innovation, CopilotIQ+Biofourmis is transforming in-home care with the industry's first AI-driven platform that supports individuals through every stage of their health journey-from pre-surgical optimization to acute, post-acute and chronic care. We are helping people live healthier, longer lives by bringing personalized, proactive care directly into their homes. With CopilotIQ's commitment to enhancing the lives of seniors with chronic conditions and Biofourmis' advanced data-driven insights and virtual care solutions, we're setting a new standard in accessible healthcare. If you're passionate about driving real change in healthcare, join the CopilotIQ+Biofourmis Team!
We are looking for a full-time Nurse Practitioner specializing in cardiology and heart failure with experience overseeing complex chronic care programs. Bilingual candidates (English and Spanish speaking) are highly preferred. You will manage a growing panel of patients and contribute to the growth and development of a telemedicine program that leverages first in class medication management titration algorithms combined with patient management principles. We are seeking full-time coverage Monday through Friday from 8:00 AM to 5:00 PM PST.
2+ years as a Board-Certified Nurse Practitioner specializing in heart failure and/or internal medicine in an ambulatory or inpatient setting. Actively licensed in California, multiple state licenses strongly preferred. Willingness to obtain additional state licenses as needed. Fluency in English and Spanish is highly preferred. Previous experience overseeing complex chronic care programs strongly preferred. Previous telehealth experience strongly preferred. Willingness to work in a changing, dynamic environment with a growing company Ability to work from home in a HIPAA compliant environment is required. Motivated to provide health education and have a grounding in health promotion techniques. Ability to learn and proficiently use multiple EMRs and various communication applications, including Google products.
Virtually evaluate patients entering the program and assist in creating a care plan based on patient specific needs and predesignated protocols. Respond to alerts escalated from the nursing team related to patients’ deviations in vitals and physiologic data; symptoms; weight changes. Independently manage changes in clinical status that are within the APP’s scope of practice (e.g. dose change in diuretic after 3 pounds of weight gain over 24 hours). Escalate out of scope clinical changes to lead MD. Liaise with the nursing team to ensure proper medications, labs and virtual appointments are ordered and communicated to the patient. Partner with the nursing team to ensure that medications are reconciled on program entry and exit. Serve as the point of contact for each patient’s primary care teams, relaying information to them and tailoring this communication to individual providers’ needs. Provide education to patients about healthy behaviors and self-management.
At the forefront of health tech innovation, CopilotIQ+Biofourmis is transforming in-home care with the industry's first AI-driven platform that supports individuals through every stage of their health journey-from pre-surgical optimization to acute, post-acute and chronic care. We are helping people live healthier, longer lives by bringing personalized, proactive care directly into their homes. With CopilotIQ's commitment to enhancing the lives of seniors with chronic conditions and Biofourmis' advanced data-driven insights and virtual care solutions, we're setting a new standard in accessible healthcare. If you're passionate about driving real change in healthcare, join the CopilotIQ+Biofourmis Team!
The Telehealth Nurse (LVN/LPN) shall monitor and screen incoming alerts, calls and chat communications. The Telehealth Nurse schedules and participates in audio-visual calls with patients participating in the chronic care remote monitoring program. They shall report abnormal values or other patient concerns to the Provider Team, which they shall work closely with. The Telehealth Nurse acts as a liaison for patients to ensure that all needs are met during monitoring. They shall work with all members of the clinical care team to enhance health care outcomes and take the initiative to ensure clinical care and related support services are made available to patients. They shall think critically and creatively about what is needed to provide virtual in-home support while assisting with the low-level tech support and troubleshooting for patients. We are seeking full-time coverage Monday through Friday from 8:00 AM to 4:30 PM PST.
Must have a current, active, unrestricted LVN/LPN compact license and an active, unrestricted LVN license in the state of California. Must be in good standing with the Board of Nursing. A minimum of 2 years hands on nursing experience is required; telehealth and chronic care management experience is strongly preferred. Fluency in English and Spanish is a plus. Experience with patient phone triage either in-office or via telemedicine. Ability to learn and proficiently use multiple EMRs and various communication applications, including Google products. Must be comfortable with the virtual use of episodic vital sign monitoring devices. Ability to work from home in a HIPAA compliant environment is required. Some holidays may be required.
Conduct patient onboarding via phone, providing a clear explanation of program goals and responsibilities. Register patients in the EHR system. Assist in reviewing patient records and documentation. Receive and perform follow-up calls and document all information obtained on the call in the appropriate charting systems and tools. Support participants' physical and emotional wellness with a holistic health approach. Communicate concerns, changes in condition and all medical complaints to the Provider Team. Troubleshoot issues with technology and escalate technical difficulties that cannot be resolved. Schedule task appointments in the EHR.
At SimiTree Healthcare Consulting we are focused on providing the right talent to help our clients achieve more, and working with them to develop strategies to retain that talent. As the recognized leader in talent recruitment and retention solutions for Home Care and Hospice providers, Simitree Healthcare Consulting has over a decade of experience in recruiting top talent to help clients succeed. We have vetted thousands of Home Care and Hospice professionals for interim or permanent placement at every level, from C-suite to field level staff. Simitree Healthcare Consulting focuses on providing the right talent to help clients achieve more and works with them to develop strategies to retain that talent.
Quality Assurance Manager - Home Health If you are an experienced Director of Quality, Director of Nursing / DON, Director of Clinical Services / DOCS or Patient Care Manager, or Clinical Manager / Clinical Supervisor with QAPI Home Health experience, then you need to read on... Quality Assurance Manager Opportunity Description Our client is a well-established Home Health organization. They have a current opening for a Quality Assurance Manager for their Maryland service area. This is a REMOTE position with very occasional travel. Candidates must be based in Maryland (norther Washington D.C. area). A Registered Nurse with Medicare Home Health Quality Assurance is required. Staff development, training, preceptor experience is preferred.
Quality Assurance Manager Job Requirements Medicare Home Health management experience as a Registered Nurse. Excellent understanding of state/federal regulations, OASIS, and PDGM. Maryland RN license required
Quality Assurance Manager Job Responsibilities Review OASIS and clinical documentation for accuracy. Ensure compliance with all state / federal regulations. Educate clinical team on proper documentation and regulations. Occasional office or field visits as necessary.
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.
Help us elevate our patient care to a whole new level! Join our Aetna team as an industry leader in serving dual eligible populations by utilizing best-in-class operating and clinical models. You can have life-changing impact on our members who are enrolled in Medicare and Medicaid and present with a wide range of complex health and social challenges. With compassionate attention and excellent communication, we collaborate with members, providers, and community organizations to address the full continuum of our members’ health care and social determinant needs. Join us in this exciting opportunity as we grow and expand to change lives in new markets across the country. Facilitate the delivery of appropriate benefits and/or healthcare information which determines eligibility for benefits while promoting wellness activities. Develops, implements, and supports Health Strategies, tactics, policies and programs that ensure the delivery of benefits and to establish overall member wellness and successful and timely return to work. Services and strategies, policies and programs are comprised of network management, clinical coverage, and policies. Our Case Managers use a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual’s and family’s comprehensive health needs through communication and available resources to promote quality, cost effective outcomes. Remote Work Expectations This is a remote-hybrid role; candidates must have a dedicated workspace free of interruptions Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.
Required Qualifications: Minimum 3-5 years clinical practical experience preference required Minimum 2-3 years CM, discharge planning and/or home health care coordination experience Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually Must possess reliable transportation and be willing and able to travel up to 50-75% of the time in the Southloop, Chinatown and surrounding areas. Mileage is reimbursed per our company expense reimbursement policy Excellent analytical and problem-solving skills Effective communications, organizational, and interpersonal skills Ability to work independently Proficiency with standard corporate software applications, including MS Word, Excel, Outlook and PowerPoint, as well as some special proprietary applications. Efficient and Effective computer skills including navigating multiple systems and keyboarding Preferred Qualifications Certified Case Manager Bilingual in English AND Cantonese or Mandarin Education Associates Required, Bachelor's preferred License: Active and unencumbered Registered Nurse License in the state of Illinois
Acts as a liaison with member/client /family, employer, provider(s), insurance companies, and healthcare personnel as appropriate. Implements and coordinates all case management activities relating to catastrophic cases and chronically ill members/clients across the continuum of care that can include consultant referrals, home care visits, the use of community resources, and alternative levels of care. Interacts with members/clients telephonically or in person. May be required to meet with members/clients in their homes, worksites, or physician’s office to provide ongoing case management services. Assesses and analyzes injured, acute, or chronically ill members/clients medical and/or vocational status; develops a plan of care to facilitate the member/client’s appropriate condition management to optimize wellness and medical outcomes, aid timely return to work or optimal functioning, and determination of eligibility for benefits as appropriate. Communicates with member/client and other stakeholders as appropriate (e.g., medical providers, attorneys, employers and insurance carriers) telephonically or in person. Prepares all required documentation of case work activities as appropriate. Interacts and consults with internal multidisciplinary team as indicated to help member/client maximize best health outcomes. May make outreach to treating physician or specialists concerning course of care and treatment as appropriate. Provides educational and prevention information for best medical outcomes. Applies all laws and regulations that apply to the provision of rehabilitation services; applies all special instructions required by individual insurance carriers and referral sources. Conducts an evaluation of members/clients’ needs and benefit plan eligibility and facilitates integrative functions using clinical tools and information/data. Utilizes case management processes in compliance with regulatory and company policies and procedures. Facilitates appropriate condition management, optimize overall wellness and medical outcomes, appropriate and timely return to baseline, and optimal function or return to work. Develops a proactive course of action to address issues presented to enhance the short and long-term outcomes, as well as opportunities to enhance a member’s/client’s overall wellness through integration. Monitors member/client progress toward desired outcomes through assessment and evaluation.
BC Forward is hiring for Care Coordinator - OB/Maternal Health at Indiana - Remote Position: Care Coordinator II Location: Indiana Duration: 12 Months (Possible Extension) Work Type: Remote Shift: Training 8am-5pm EST 4 weeks CAMERA ON THROUGHOUT TRAINING | M-F 8am to 5pm EST. No overtime. Opportunity for schedule flexibility (After 120 days contractor is eligible to move shift if needed. Work 10 hour days, start earlier or later on the day. Shift stays at 40H a week) Pay Rate: $21/hr Position Purpose: Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. Interacts with members by performing member outreach telephonically or through home-visits and documents the plan for care/services of activities.
Requires a High School diploma or GED Requires 1 – 2 years of related experience Must haves: Organized and able to handle fast-paced environment. Knowledge and comfortable navigating. Microsoft software (Word, excel, teams). Requires 1 – 2 years of related experience Nice to haves: OB background, Experience in providers offices or hospital setting, Telephonic outreach experience and exceptional communication High volume call center experience
Coordinates care activities based on the care plan/service plan and works with healthcare and community providers and partners, and members/caregivers to accommodate changes or progress, as needed Serves as support on various member and/or provider inquiries, requests, or concerns related to care plan/service plan Communicates with care managers, practitioners, and others as needed to facilitate member services and to ensure continuity of care/service May support performing service assessments/screenings for members and documenting the member’s care needs Supports documenting and maintaining member records in accordance with state and regulatory requirements and distribution to providers as needed Follows standards of practice and policies compliant with contractual requirements and regulatory guidelines and standards Ability to identify needs and make referrals to Care Manager, community based organizations, and Disease Manager Provide education on benefits and resources available Performs other duties as assigned. Complies with all policies and standards.
Pager Health is a connected health platform company that enables healthcare enterprises to deliver high-engagement, intelligent health experiences for their patients, members and teams through integrated technology, AI and concierge services. Our solutions help people get the right care at the right time in the right place and stay healthy, while simultaneously reducing system friction and fragmentation, powering engagement, and orchestrating the enterprise. Pager Health partners with leading payers, providers and employers representing more than 28 million individuals across the United States and Latin America. We believe that healthcare should work for everyone. We believe that it’s too important to be as cumbersome and difficult as it is. And we believe that there is a better way to deliver a simplified, more meaningful healthcare experience for all – one that we’re determined to enable.
To be considered for this position, all applicants must submit a resume in English This position is for a full-time, fully-remote, Registered Nurse who is willing to think creatively and utilize their clinical skills in the field of Telehealth! We are seeking motivated Registered Nurses with 1+ years of clinical hospital experience to work in Pager Health's Command Center where our nurseline serves our members 24/7. This person must be based in Puerto Rico, and have an active, unencumbered RN license in Puerto Rico. In addition, licensure in one or more US states is a HUGE plus. This position entails working the 2:00pm - 10:30pm shift, 5 days per week, including alternating weekends. The core objective of the Triage RN, Nurse Navigator is to use technology to build trust and triage patients to the right care at the right time while providing an exceptional virtual care experience.
Candidate Profile for the Triage RN, Nurse Navigator: Passionate about patient care and triage Enjoy helping others Ability to use critical thinking when presented with new and challenging situations Relish solving problems, seeking out answers, and trying new things Kind, empathetic and possess a strong social perceptiveness Positive, energetic, and fun! Outstanding multitasking skills Enthusiasm and savviness for new technology Mastery of oral and written language along with strong typing skills Ability to assess and communicate with patients via a text-based platform Flexible and fast learner, comfortable in a fast-paced and changing environment Eager to challenge the status quo of traditional healthcare Detail oriented and an organized self-starter with outstanding interpersonal skills Ability to give and receive actionable feedback Qualifications: 2+ years of clinical hospital experience working as an RN An active unencumbered RN license in Puerto Rico Minimum of an Associate's Degree in Nursing (ADN) Be a permanent resident of Puerto Rico Fluent in spoken and written English and Spanish is required; All applicants must submit a resume in English to be considered Prior call center experience strongly preferred
Provide exceptional customer service and virtual care by communicating with patients via phone, live messaging, video, and/or email Document within EMR Follow and apply clinically validated triage protocols Ensure the highest quality customer service for patients and providers Complete basic nursing responsibilities, outpatient testing, medications, etc… Troubleshoot technology with patients Work to ensure a seamless patient call center experience Coordinate lab orders, prescription orders, radiology tests, and any aspect of patient care Work on projects that will optimize operational efficiency and improve the patient’s telemedicine experience Assist in identifying technology needs that improve patient experience Additional projects as assigned
Comagine Health is a national, mission-driven, nonprofit organization that has engaged in health care quality consulting and quality improvement services for more than 50 years. We are leaders in assisting front-line providers and engaging health care partners to improve care delivery and patient outcomes. Our talented remote workforce spans the country and plays a vital role in our success. We go beyond merely providing a remote work option; we support and embrace it. We offer opportunities to make a difference from anywhere in the U.S. and enjoy better work-life balance. An annual stipend gives you the freedom to enhance your workspace with options that suit your needs.
Are you passionate about improving access to behavioral health services in the community? Do you enjoy using your clinical expertise to evaluate needs, support care decisions, and help individuals receive the right services at the right time? In this role, you will review clinical documentation to determine medical necessity and appropriateness of services, complete functional needs assessments that evaluate how mental health symptoms impact daily living, and support service coordination that connects children, youth, and adults to in-home and community-based care. You will manage referrals, follow-ups, reviews, and assessments within an electronic medical record system; apply evidence-based criteria to utilization management reviews; document clinical determinations; provide subject matter expertise to stakeholders; support quality activities and audits; and travel for in-person assessments as needed across your assigned region. If you are someone who demonstrates strong clinical judgment, builds trusting relationships with members and partners, and effectively manages a high-volume workload while meeting timelines, we encourage you to apply. If you bring a collaborative mindset, accountability in your work, curiosity to ask questions and learn, and comfort using technology to navigate systems and documentation, you will be well-positioned for success on this team. This is a remote position based in Oregon and travel is required.
Current, active, unrestricted clinical licensure as required by the Oregon contract (e.g., RN or behavioral health licensure such as LCSW, LPC, LCPC, LPA, PsyD, PhD) Master's in physical or occupational therapy OR Master's in psychology, counseling, or social work OR Bachelor’s degree in nursing and licensed by the State of Oregon 3 years of clinical (direct patient care) experience; behavioral health preferred Candidates must reside in Oregon, have personal transportation, and ability to travel. Valid Driver License and Proof of Auto Insurance are required. You May Have (Desired Qualifications) Experience with Medicaid Knowledge of the Oregon behavioral health system of care 2 years of utilization review or other medical management experience 2 years of full-time substance use disorder and/or behavioral health disorder experience You Bring (Competencies): Clinical documentation review expertise, including use of the Oregon Health Plan Prioritized List of Health Services and InterQual Strong organizational skills and ability to manage multiple tasks in a team environment Excellent oral and written communication skills Strong interpersonal and problem-solving skills Proficiency with MS Office Suite and familiarity with database software Ability to apply clinical review criteria, policies, and guidelines to determine medical necessity Ability to document utilization review determinations accurately and timely in designated systems Capability to provide clinical and utilization review subject matter expertise and respond to stakeholder questions or concerns
Review clinical documentation to substantiate medical necessity and appropriateness for requested services Perform initial and continued stay reviews using standardized, evidence-based criteria to ensure services align with individualized behavioral health needs Apply clinical review criteria, organizational policies, guidelines, and screening tools to determine medical necessity of healthcare services Document utilization review determinations accurately and timely in designated systems Consult with physician or practitioner reviewers when cases do not meet clinical review criteria Refer cases to other clinicians when appropriate Provide clinical and utilization review subject matter expertise and respond to stakeholder questions or concerns Support quality assurance activities, audits, and other program support as assigned Provide guidance or oversight to non-clinical staff performing support activities, as appropriate Perform other duties as assigned
Locklab is a fast-growing telehealth platform providing evidence-based hair loss treatment through asynchronous care. We focus on safe, effective prescription treatments and high-quality patient support in a space often filled with misinformation. We’re expanding our clinical team and hiring a multi-state licensed Nurse Practitioner to conduct patient visits, manage clinical triage, and support patients throughout their treatment journey.
READ THIS FIRST: We Think You’ll Be Perfect for This Role If You’re comfortable delivering direct patient care in an asynchronous telehealth environment You enjoy educating patients, answering questions, and helping them feel confident moving forward with treatment You replay patient conversations in your head - not because you’re anxious, but because you want to understand what landed, what didn’t, and how to communicate more clearly next time. You’re licensed in at least 10 states and comfortable practicing via telehealth You believe patient outcomes are often determined by how well information is explained and framed The Role: This is a hands-on clinical role with real ownership and patient impact. You will conduct telehealth patient visits on the Locklab platform, review patient intake information, assess clinical eligibility, triage side effects, respond to patient messages, and support patients via secure messaging and phone. A core part of this role is patient education. Hair loss treatment requires trust, clear communication, and realistic expectations. You’ll help patients understand why treatments work, what results look like over time, and how consistency impacts outcomes. Many patient interactions involve guiding, reassuring, and educating patients so they can make informed decisions about starting or continuing treatment. You’ll be expected to think critically about how patients respond to your communication and adapt your approach to improve outcomes over time.
Active Nurse Practitioner or PA license Licensed in 10+ U.S. states (multi-state coverage required) Eligible to perform telehealth visits in assigned states (full practice authority) Independent prescriptive authority (in states where applicable) Experience conducting telehealth or asynchronous visits preferred Strong clinical judgment and risk awareness Excellent written communication skills Excellent patient phone skills Comfortable handling both clinical care and patient support responsibilities Experience with EHRs and telehealth platforms strongly preferred Compact / multi-state licensure preferred What Success Looks Like Patient visits are completed accurately and compliantly Patients understand their treatment and feel confident moving forward Clinical issues are identified early and escalated appropriately Patients receive timely, clear, and reassuring communication that leads to understanding, confidence, and follow-through Patient satisfaction remains high as volume scales Schedule & Coverage Full-time, salaried position Defined coverage hours (may include evenings or weekends) Expected to manage patient visits and message queues during scheduled hours
Patient Visits & Clinical Care: Conduct asynchronous telehealth patient visits on the Locklab platform Review patient intake forms, medical history, and contraindications Assess clinical appropriateness of treatment per established protocols Document visits accurately, thoroughly, and compliantly Follow all state-specific scope-of-practice and telehealth regulations Clinical Triage & Messaging: Respond to patient messages related to symptoms, side effects, and medication questions Receive inbound calls from patients and place outbound calls when appropriate Respond to patient portal messages, create orders, and route to appropriate parties Triage clinical concerns and determine next steps Identify urgent or concerning symptoms and escalate per protocol Support refill-related clinical questions within scope Patient Support & Customer Experience: Respond to non-clinical issues (shipping, billing, account questions) Respond to general patient questions regarding treatment expectations and timeline Educate patients on hair loss mechanisms, treatment timelines, and expected outcomes to support informed treatment decisions Provide clear, calm, patient-appropriate education using approved guidance Act as a clinical resource for the customer support team when medical context is needed Reflect on patient interactions and continuously improve communication to better guide patients toward informed, better decisions Help ensure patients feel supported, informed, and safe throughout treatment Quality, Compliance, & Collaboration: Adhere to clinical protocols and documentation requirements Collaborate with physicians and clinical leadership on escalations Participate in quality assurance reviews and protocol improvements Help refine visit workflows, triage pathways, and patient messaging templates
Wasef Health is a nationwide telemedicine group that provides high-quality virtual care through partnerships with leading digital-health companies across the United States. We focus on creating an efficient, tech-enabled clinical environment that allows providers to focus on patient care while our support and operational teams handle logistics. Our clinicians work with a wide range of telehealth programs, including weight loss, hair loss, hormone and anti-aging therapies, general wellness, and more — all through a unified digital platform.
Telemedicine Nurse Practitioner (NP) — Multi-State Licensed (Full-Time, Remote) Company: Wasef Health Location: Remote (U.S.) Employment Type: Part Time Available, Full-Time Preferred (1099 salaried structure) Compensation: $75,000 - 150,000 / year Schedule: Monday–Friday, 9:00 AM – 5:00 PM EST; after hours and weekends available We’re hiring full-time, multi-state licensed Nurse Practitioners (NPs) to join our national telemedicine team. This role combines both asynchronous and synchronous patient consults. Asynchronous consults are available anytime. Scheduled availability for synchronous consults. You’ll work within our secure telemedicine platform to review consults, manage patient messages, and collaborate with the Wasef Health team via Slack.
Active Nurse Practitioner (NP) license in good standing. Minimum of 25 active state licenses required; 50-state licensure preferred. At least 2 years of telemedicine experience, preferably with asynchronous consults. Experience treating common telehealth conditions, including: Weight loss / GLP-1 therapy Hair loss Hormone and anti-aging therapies General wellness and preventive care Men’s and women’s health Strong written communication, attention to detail, and clinical judgment. Proficiency in Slack or similar communication platforms. Reliable internet connection and ability to maintain consistent weekday coverage.
Complete assigned asynchronous and synchronous patient consults daily, meeting monthly consult targets. Review patient intakes, evaluate medical history, and prescribe appropriate treatments. Respond to patient follow-up messages. Communicate with the clinical operations team via Slack for care coordination. Ensure timely, accurate, and compliant chart documentation. Participate in team meetings, case reviews, and performance discussions.
At Allegiance Hospice, we are a team of care givers and health care professionals who have come together with over 50 years of combined experience in the health care field. Our team members enhance the lives of patients with life-limiting illnesses and their loved ones, during a time when compassionate care is needed most. We are looking to add dedicated team members who can make difference in the lives of our patients and their families by respecting patient choice, providing comfort and promoting dignity, while creating positive contributions in their community.
Hospice Registered Nurse - Weekends - Triage/On-Call Runner (RN) We are looking for a compassionate, talented and experienced Hospice Registered Nurse - Weekends - Triage/On-call (RN) for our Houston TX area, to join a dynamic team of professionals who have proven that home health care is not just a business. At Allegiance Hospice, we strive to support and improve the overall quality of life for the patients we serve.
Education and Experience: Must have current or compact RN licensure in the state of Texas. Hospice Nurse Certification (CHPN) preferred. Valid Driver’s License and Automobile Insurance. Pass the Background check. At least two years of experience , preferred, as a Hospice Nurse, hospital, nursing home, home health agency, or long term care facility. Skills and Abilities: Shall have a genuine interest in geriatrics, preferably, shall have experience in geriatric care. Must be able to assess, evaluate and communicate effectively. Must demonstrate sound knowledge and actions in patient care and decision making. CPR certification required Participates in continuing education to broaden knowledge and acquire skills necessary to be effective in all aspects of job performance. Must have reliable transportation and a valid driver’s license.'
Available to Triage calls and do Visits as needed on the weekends. Report patient care/condition/progress to patient's physician and Clinical Manager on a continuous basis. Follows infection control standard precautions and uses personal protective equipment as required. Implement patient care plan in conjunction with patient and family to assist them in achieving optimal resolution of needs/problems. Prepare appropriate medical documentation on all patients, including any case conferences, patient contacts, medication order changes, re-certifications, progress updates, and care plan changes. Prepare visit/shift reports, updates/summarizes patient records, and confers with other health care disciplines in providing optimum patient care. Confer with physician in developing any necessary changes to current treatment based on physician's orders and initial patient assessment. Provide hands-on care, management and evaluation of the care plan and teaching of the patient in accordance with physician orders, under Clinical Manager's supervision. Revise plan in consultation with physician based on ongoing assessments and as required by policy/regulation. Administer on-going care for each patient, provide necessary follow-up as directed by the Clinical Manager. Provide admission, and follow-up skilled nursing visits for hospice patients. Participates in weekly team meetings on Friday evenings, as necessary, to assure appropriate care and service are provided to the patient during weekend coverage. Exhibits an attitude which promotes harmony and goodwill in the workplace. Promotes quality, comprehensive services through a team approach. Performs other duties as assigned. Communicate with Families/Facility after each visit to encourage strong continuity of care.
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
This is a remote, telephonic position, but you must live in Puerto Rico. The RN Care Manager uses clinical knowledge to assess and evaluate members' needs to achieve and maintain optimal wellness. They also guide members with chronic conditions toward and facilitate interaction with resources appropriate for their care and wellbeing. The Care Manager reports to a Manager of Care Management, and work assignments frequently require interpretation and independent determination of the appropriate courses of action. We require you to be bilingual in English/Spanish and will test you for both languages - Speaking/Reading/Writing included. Please submit your resume in English.
Required Qualifications: Bachelor's Degree in Nursing (BSN) Bilingual in English and Spanish (and able to pass language proficiency tests in both languages) Active RN license without restrictions in Puerto Rico Active RN license without restrictions in Florida Affiliated with the CPEPR (Colegio de Profesionales de Enfermería de Puerto Rico). Prior clinical experience in adult acute care, skilled nursing, rehabilitation or discharge planning Knowledge in Chronic Condition management (treatment, pharmacological treatment, signs and symptoms), including Diabetes, Hypertension, COPD, and chronic kidney disease. Shift is 8-hours, plus 1 hour for lunch, from 8:30 AM to 5:30 PM EST and we adjust for Daylight Savings. We adjust the work schedule according to business needs including necessary overtime and weekends. Preferred Qualifications: Health Plan experience Previous Case Management Experience Call center or triage experience Previous experience managing Medicare members Work-At-Home Requirements To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can only be used if leadership approves it. Humana will provide Work-At-Home employees with telephone equipment appropriate to meet the requirements for their position. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Language Proficiency Testing Any Humana associate who speaks with a member in a language other than Spanish must take a language proficiency assessment, provided by an outside vendor, to ensure competency. The Federal Government requires applicants to take the Interagency Language Rating (ILR) test.
The Care Manager, Telephonic Nurse employs a variety of strategies and techniques to manage a member's physical, environmental and psycho-social health issues. Responsibilities include the following: Resolve barriers that hinder care. Assess members with chronic conditions to determine their state of wellness and determine next steps, if any. Ensure patient is progressing towards desired outcomes by managing patient care through assessments and evaluations. May create member care plans. Understand department, segment, and organizational strategy and operating goals, including their linkages to related areas. Require minimal direction and receive guidance where needed. Follow established guidelines/procedures.
TeamHealth was founded in 1979 with a vision of developing the best teams of healthcare professionals. With the relentless pursuit to advance patient care through strong leadership, innovation and teamwork, we're proud to say that over the years we have made great strides towards our goals. The impressive growth of TeamHealth should come as no surprise to hospitals and clinicians aware of our reputation for efficiency and commitment to excellence and collaboration. Originally founded to provide emergency department administrative and staffing services, TeamHealth is one of the nation's largest providers of hospital-based clinical outsourcing in multiple departments, including Anesthesia, Hospital Medicine, in addition to Emergency Medicine. Although we are a national organization, our operating philosophy is essentially the same as when we started. TeamHealth is committed to a patient-centric model of healthcare delivery with hospitals, physician groups and TeamHealth working collaboratively to deliver compassionate, effective, efficient and safe patient care. More than ever before, healthcare executives today face enormous challenges, including financial performance, healthcare reform, government mandates, safety and quality, physician relations, patient satisfaction, personnel shortages and the uninsured. They've turned to TeamHealth for help. Executives know they can benefit from our large pool of resources, infrastructure and best practices while maintaining accountability; clinicians know they can take their career to the next level and do what they do best, focus on patient care. All of this is demonstrated by our 97% average annual client retention rate and 93% physician retention rate. Most importantly, it shows in what our customers are saying: "What most impressed me about our association with TeamHealth is that they were truly a great partner. TeamHealth is an outstanding organization with quality people who drive great results." "I knew we selected the right partner for the job. With TeamHealth's expertise and our mutual commitment to excellence, our operational efficiency and the overall morale in the emergency department are the best they've been in years." In 2015, TeamHealth was named among “The World’s Most Admired Companies” by Fortune magazine and among “150 Great Places to Work in Healthcare” by Becker’s Hospital Review. In 2014, TeamHealth was named among "America's 100 Most Trustworthy Companies" by Forbes magazine. For more information visit www.teamhealth.com.
Come grow with us at AccessNurse! Are you looking for an exciting alternative to bedside nursing? Are you bilingual? Are you tired of 12-hour shifts and the physical wear and tear of working in the hospital? AccessNurse has an opportunity for you! The AccessNurse-TeamHealth Medical Call Center is a 24/7 Call Center offering remote telephone triage and Health Information services to Hospitals, Physician Offices, and Insurance Plans across the country. If you want to be a part of a growing industry and work from home from day one, contact us today! We are searching for registered nurses of all backgrounds with at least 2 years of experience who are seeking an exciting and rewarding alternative to direct patient care. If you are looking for a way to continue to positively impact patients and use your nursing skills without the wear and tear of working in a hospital you should send your resume today! We promote success through a supportive work environment, provide excellent benefits, and offer competitive pay and paid time off. Part-time and full-time weekend and evening shifts are currently available. Now also recruiting for bilingual nurses who can fluently speak both Spanish and English.
Current multi-state RN license with no restrictions Computer Skills a MUST 2+ years of Nursing Experience Ability to train for minimum of 3 weeks Successful Completion of Background Check, Drug Screen, and References
Homeland has partnered with a leading national chronic care management organization to hire an LPN Personal Care Coordinator to join a growing care team. This organization delivers chronic care management (CCM) services to patients across the U.S., supporting individuals with two or more long-term health conditions expected to last at least 12 months. Their programs help patients stay connected to their healthcare providers and receive ongoing support between office visits.
In this role, the LPN Personal Care Coordinator provides personalized, patient-centered care while working closely with the patient’s broader care team. Through outbound phone calls, LPN Personal Care Coordinator will help monitor chronic conditions, identify new or evolving health concerns, and connect patients with the resources they need to improve their health, well-being, and quality of life. This opportunity is ideal for nurses who are passionate patient advocates and value building long-term, collaborative relationships to help patients make meaningful lifestyle improvements. Additional Information This is a day-shift position, operating Monday through Friday. Candidates must be in EST or CST time zone. Available shifts are: 8:30–5:30 pm EST, 9:00–6:00 pm EST, 10:00–7:00 pm EST, 11:00–8:00 pm EST, 12:00–9:00 pm EST. This is a full-time, fully remote role with full benefits. All necessary equipment will be provided.
LPN/LVN diploma from an accredited nursing program Current, active, compact LPN/LVN license Strong ability to follow established clinical protocols and procedures with accuracy and consistency Flexible and adaptable, with the ability to shift between tasks efficiently Collaborative team player who is eager to support coworkers and contribute to overall team success
Conduct monthly care management calls with assigned patients to assess and support their ongoing healthcare needs Educate patients on available resources and services across the continuum of care Identify patient-specific health concerns, goals, and interventions using clear, action-oriented, and time-based care plans Maintain accurate and compliant patient documentation, including medical history, medications, immunizations, allergies, surgical history, and family history Monitor changes in patient conditions or circumstances and adjust care plans, goals, and preferences as needed, while recognizing potential barriers to care Provide appropriate health education to support improved health outcomes Escalate patient concerns and clinical issues to the triage nurse team as appropriate
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com
Duration: 6 months contract Position Overview: The Telehealth Nurse Practitioner provides virtual patient care through a remote platform, delivering evidence-based, patient-centered services. This role involves independent clinical decision-making while collaborating with a multidisciplinary care team. The provider will assess, diagnose, treat, and manage patients (ages 18 months and above), while ensuring accurate documentation in an Electronic Health Record (EHR) system.
Required Qualifications: Minimum 2+ years of medically relevant experience Active, unrestricted Nurse Practitioner license in: Florida (FL), Massachusetts (MA), and/or Ohio (OH) Ability to obtain multi-state/compact licensure Basic Life Support (BLS) certification Master’s Degree in Family Nurse Practitioner (FNP) program Current National Board Certification Strong communication, organizational, and multitasking skills Ability to work independently in a remote environment Proficiency with EHR systems and healthcare technology
Patient Care & Clinical Quality: Conduct assessments for acute, chronic, and primary care conditions Diagnose, treat, and manage patient health concerns Provide health education, counseling, and preventive care guidance Offer counseling on: Pregnancy prevention STI prevention and safer sex practices Contraceptive care and medication management Document all patient encounters in EHR systems Coordinate care with physicians, pharmacists, and healthcare teams Ensure high standards of patient safety and care quality Patient Experience & Customer Service: Deliver a high-quality, patient-first experience Maintain a warm, professional communication style Respond effectively to patient inquiries and concerns Enhance patient satisfaction through feedback integration Ensure compliance with HIPAA and patient confidentiality standards Clinical & Operational Management: Manage patient flow and prioritize care needs Adapt quickly to new care models and services Handle administrative tasks such as: Lab follow-ups Inventory management Phone calls and coordination Maintain a collaborative and positive work environment Business & Practice Management: Support clinic performance goals and operational efficiency Handle responsibilities related to: Billing and insurance verification Payment collection Documentation for revenue cycle management Contribute to achieving business targets and patient outcomes Autonomy & Professional Development: Work independently with strong decision-making ability Demonstrate initiative, adaptability, and problem-solving skills Participate in ongoing professional development Maintain compliance with continuing education requirements
US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com .
This is a remote position but does require a BH licenses, those have to be active in Arizona Position Summary: The Utilization Management Clinical Consultant (UMCC) applies clinical expertise and evidence-based criteria to review behavioral health services for adult and child/adolescent members. This role evaluates medical necessity, supports appropriate utilization of benefits, and collaborates with providers to ensure quality, cost-effective care across the continuum of services.
Active Arizona license: LCSW (Licensed Clinical Social Worker) LPC (Licensed Professional Counselor) LMFT (Licensed Marriage and Family Therapist) OR RN with active compact license and behavioral health focus Master’s degree required for behavioral health clinicians Associate’s degree required for RN applicants Experience in behavioral health utilization management or clinical review Strong knowledge of medical necessity criteria (InterQual, MCG, ASAM, LOCUS preferred) Excellent communication and documentation skills Ability to work independently in a remote environment
Review clinical documentation to determine medical necessity and appropriateness of behavioral health services Apply clinical guidelines and tools such as InterQual, MCG, ASAM, or LOCUS Conduct initial, concurrent, and discharge reviews Coordinate with healthcare providers regarding authorizations and care planning Identify members who may benefit from care management or community resources Support continuity of care and safe discharge planning Provide urgent or emergent triage support when required Ensure accurate documentation and compliance with policies and regulatory standards Participate in quality improvement and utilization initiatives
Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care. Our clinical team treats physical, behavioral, and social health needs when and where a patient needs help. Everyone on our team from our doctors, nurses, and Care Specialists to our HR, Technology, and Business Services staff are driven by a desire to improve the lives of our patients. We are able to treat a wide range of needs – everything from addressing poorly controlled blood sugar to combatting anxiety to accessing medically tailored meals – because we know that health requires care for the whole person. It's no wonder 98% of patients report being fully satisfied with Upward Health!
The Nurse Practitioner (NP) is responsible for providing high-quality, patient-centered, comprehensive primary care. Utilizing Upward Health's proprietary Facilitated Virtual Care platform, the NP delivers care that improves outcomes and reduces costs for patients with complex diagnoses and co-morbid, chronic conditions. This role primarily involves virtual patient care with periodic or as needed in-person care to support transitions of care, annual wellness visits, risk adjustments, primary care needs, and urgent visits. The NP collaborates closely with a multidisciplinary team to provide whole-person care to our patients in their homes.
Knowledge, Skills & Abilities: Perform and document accurate and thorough risk assessments for the purpose of accurate documentation of condition(s). Expertise in managing complex, polychronic patients, with demonstrated ability to assess and treat high-acuity patients. Familiarity with caring for Medicare and Medicaid populations, with experience in both inpatient and outpatient or home care settings. Proficiency in motivational interviewing, trauma-informed care, and supporting vulnerable populations is preferred. Excellent written, computer, and oral communication skills, with the ability to communicate efficiently and proactively with the clinical team. Dedication to health equity and transforming care for patients in their homes. Strong organizational skills and ability to provide clinical leadership and coordination. Qualifications: Minimum of 5 years' experience as a provider, with a minimum of 3 years in a primary care, or related, setting. Multi-state Advanced Nursing License or willingness to obtain. A valid driver's license and auto liability insurance. Willingness and ability to travel as needed, though responsibilities are primarily performed virtually. Experience in urgent/emergent care settings is a plus. Key Competencies: Clinical Leadership: Ability to provide decision support and leadership to the care team. Patient-Centered Care: Focused on delivering high-quality, compassionate care to improve patient outcomes. Collaboration: Works effectively within a multidisciplinary team to provide comprehensive care Adaptability: Thrives in a dynamic, fast-paced environment with evolving protocols. Problem-Solving: Proactively identifies and addresses challenges in patient care and team coordination.
Triage, diagnose, and treat patients in person or via our virtual care platform. Serve as a day-to-day clinical leader, providing decision support and directing the multidisciplinary team under the guidance of the Medical Director. Conduct primary care, urgent visits, and annual wellness exams, ensuring all appropriate screening tests and quality measures are addressed. Refer patients appropriately for behavioral health and specialty services. Coordinate care transitions to prevent hospital readmissions by collaborating with PCPs, hospitalists, and SNF providers. Participate in the on-call provider schedule to support the 24/7 patient hotline, requiring after-hours and weekend availability on a rotating and recurring basis. Foster a collaborative working environment with all members of the interdisciplinary team, contributing to daily huddles, team meetings, and patient discussions. Monitor and respond to remote patient data collected through monitoring devices. Perform other duties as assigned.
At Allegiance Hospice, we are a team of care givers and health care professionals who have come together with over 50 years of combined experience in the health care field. Our team members enhance the lives of patients with life-limiting illnesses and their loved ones, during a time when compassionate care is needed most. We are looking to add dedicated team members who can make difference in the lives of our patients and their families by respecting patient choice, providing comfort and promoting dignity, while creating positive contributions in their community.
Hospice Registered Nurse - Weekends - Triage/On-Call Runner (RN) We are looking for a compassionate, talented and experienced Hospice Registered Nurse - Weekends - Triage/On-call (RN) for our Houston TX area, to join a dynamic team of professionals who have proven that home health care is not just a business. At Allegiance Hospice, we strive to support and improve the overall quality of life for the patients we serve.
Education and Experience: Must have current or compact RN licensure in the state of Texas. Hospice Nurse Certification (CHPN) preferred. Valid Driver’s License and Automobile Insurance. Pass the Background check. At least two years of experience , preferred, as a Hospice Nurse, hospital, nursing home, home health agency, or long term care facility. Skills and Abilities: Shall have a genuine interest in geriatrics, preferably, shall have experience in geriatric care. Must be able to assess, evaluate and communicate effectively. Must demonstrate sound knowledge and actions in patient care and decision making. CPR certification required Participates in continuing education to broaden knowledge and acquire skills necessary to be effective in all aspects of job performance. Must have reliable transportation and a valid driver’s license.'
Available to Triage calls and do Visits as needed on the weekends. Report patient care/condition/progress to patient's physician and Clinical Manager on a continuous basis. Follows infection control standard precautions and uses personal protective equipment as required. Implement patient care plan in conjunction with patient and family to assist them in achieving optimal resolution of needs/problems. Prepare appropriate medical documentation on all patients, including any case conferences, patient contacts, medication order changes, re-certifications, progress updates, and care plan changes. Prepare visit/shift reports, updates/summarizes patient records, and confers with other health care disciplines in providing optimum patient care. Confer with physician in developing any necessary changes to current treatment based on physician's orders and initial patient assessment. Provide hands-on care, management and evaluation of the care plan and teaching of the patient in accordance with physician orders, under Clinical Manager's supervision. Revise plan in consultation with physician based on ongoing assessments and as required by policy/regulation. Administer on-going care for each patient, provide necessary follow-up as directed by the Clinical Manager. Provide admission, and follow-up skilled nursing visits for hospice patients. Participates in weekly team meetings on Friday evenings, as necessary, to assure appropriate care and service are provided to the patient during weekend coverage. Exhibits an attitude which promotes harmony and goodwill in the workplace. Promotes quality, comprehensive services through a team approach. Performs other duties as assigned. Communicate with Families/Facility after each visit to encourage strong continuity of care.
We are seeking a dynamic and compassionate Licensed Mental Health Nurse Practitioner (NP) to join our mental health care team in Florida. This vital role involves providing comprehensive mental health assessments, developing personalized treatment plans, and delivering evidence-based therapy to diverse patient populations. The ideal candidate will bring enthusiasm, expertise, and a proactive approach to improving mental well-being across our community. You will work collaboratively with multidisciplinary teams, utilizing advanced clinical skills to promote recovery and resilience. This position offers an exciting opportunity to make a meaningful impact while advancing your professional growth in a vibrant healthcare environment.
Valid licensure as a Nurse Practitioner with board certification in mental health or psychiatric-mental health nursing. Proven experience in behavioral health settings with exposure to diverse populations including pediatrics, geriatrics, or assisted living environments. Strong knowledge of clinical research methodologies related to mental health treatments. Familiarity with EMR/EHR systems such as Epic or Athenahealth for efficient documentation and patient management. Experience with medication administration including injections and IV infusions; knowledge of CPT coding for billing purposes is preferred. Ability to perform comprehensive physical examinations and mental status assessments accurately. Excellent communication skills with the ability to triage urgent cases effectively and provide clear patient education. Additional Skills & Experience: Experience working within hospital settings such as Level I Trauma Centers or critical care units is advantageous. Knowledge of substance use disorder treatments like botulinum toxin therapy or esthetic laser treatments is a plus. Prior experience in telehealth platforms or working with individuals with developmental disabilities further strengthens your candidacy. Join us in delivering innovative mental health services that transform lives! We are dedicated to fostering a supportive environment where your expertise makes a real difference—empowering patients on their journey toward wellness while advancing your career in a thriving healthcare community.
Conduct thorough psychiatric evaluations and mental health assessments for patients across age groups, including children and seniors. Develop, implement, and monitor individualized treatment plans incorporating psychotherapy, medication management, and crisis intervention when necessary. Administer medications, including psychopharmacology treatments, following best practices and regulatory guidelines. Collaborate with physicians, social workers, case managers, and other healthcare professionals to coordinate patient care effectively. Utilize company's electronic health record (EHR) system for accurate documentation of patient encounters and treatment progress. Provide telehealth services to expand access to mental health support for remote or underserved populations. Educate patients and families on mental health conditions, coping strategies, and available resources to foster ongoing recovery and wellness.
New England Life Care (NELC) is one of the fastest growing home infusion therapy companies in New England and is the region’s only non-profit home infusion provider. NELC is a hospital collaborative serving more than 70 hospital systems in Maine, New Hampshire, and Massachusetts. NELC was created by local hospitals to ensure their patients have access to a provider that reflects their commitment to excellence in patient care, quality, and service. Like our owner hospitals, NELC provides patient focused care. New England Life Care has and continues to build a diverse, inclusive, and authentic workplace, so if you’re energized by this opportunity, but your experience doesn’t support every qualification in the job posting, we encourage you to apply! You still may be the person we are looking for!
New England Life Care currently has an opening for a Clinical Resource Nurse to be a lifeline, as-needed for our patients during the overnight hours. These nurses must reside in either New Hampshire, Maine, or Massachusetts. We would like these nurses to eventually be licensed in MA/NH/ME, although not an initial requirement. NELC will reimburse any costs associated with attaining additional licenses outside of the home license. **Only hiring remotely in the following states: Maine, Massachusetts, and New Hampshire** Job Summary: The RN in this position is responsible for providing patient and VNA triage as well as subsequent coordination of care services. In addition, the RN in this position is competent in the duties of the Infusion Nurse as described by NELC, Inc. Benefits: Remote / Work From Home Position Room for growth and potential for advancement Generous employer-matched 403(b) savings program Paid time off And much more!
Education: Associate degree or diploma in Nursing required. BS in Nursing preferred. Two (2) years intravenous therapy experience in hospital or homecare required. Oncology experience preferred. CRNI preferred. R.N. license in good standing in the state(s) where providing care / services required Current BLS Certification required. Skills and Requirements: Valid driver’s license required. Excellent driving record required. Knowledge of HIPAA Privacy and Security Regulations preferred. Knowledge of the Joint Commission accreditation process and overall JC standards preferred. Excellent patient assessment skills required. Working / practical knowledge of home infusion therapy administration / equipment use preferred. Ability to communicate effectively with all customers and members of the healthcare team verbally and in writing. Good interpersonal skills required. Good organizational skills required. Ability to work independently as well as a part of a team required. Working / practical knowledge of microcomputer systems including patient documentation systems, Microsoft Office (Word, Excel, Outlook). Dependability in attendance and job performance required.
Accepts patient phone calls and provides appropriate triage interventions, determines if a nursing visit is needed based on the unique situation of the patient. If necessary, the resource nurse will coordinate a nursing visit (with NELC or Home Health Agency (HHA) nurse) in the appropriate time frame to meet the healthcare needs of the patient. Accurately performs initial and ongoing patient assessments of home infusion/enteral therapy patients. Provides comprehensive initial and ongoing patient and caregiver education relating to the prescribed home infusion/enteral therapy. Effectively communicates with the scheduling team to facilitate adequate and timely PRN nursing visits. Effectively communicates ongoing patient requirements, concerns, and/or changes in patient status / level of care to appropriate members of NELC multidisciplinary teams and on-call staff, as well as the HHA staff involved in meeting the patient’s home health needs. Actively participates as a member of the patient’s care management team to identify and provide care coordination and/or guidance to care team, providers, and patients referred to NELC for infusion/enteral therapy, providing updated patient information as needed. Comprehensively documents all interactions with patient and members of the healthcare team in the patient record and/or electronic progress notes. Demonstrates competency in the use and troubleshooting of all equipment and/or supplies dispensed by NELC. Demonstrates competency in home infusion medication administration, side effects, goals of therapy, and patient care expectations to include aseptic administration and monitoring of all therapy types provided by NELC. Reviews needs and abilities of the patient and caregivers, participates in development and implementation of a patient specific training plan when appropriate as needed to assist Out-patient Resource team. Assists in coordinating services with other home health agencies. Acts as resource between NELC and all care providers. This includes, but is not limited to, the medical staff, care coordination team, and social services as needed.
Mission Hospice & Home Care serves patients and families in the San Francisco Peninsula and South Bay with quality care and compassionate end-of-life support and education. Founded in 1979, we are a local, independent nonprofit that has provided thousands of patients and their families with physical, emotional, and spiritual support throughout the journey from a life-threatening diagnosis through death and bereavement.
The Hospice Triage RN will receive phone calls from Hospice patients and families. They will assess the needs of the patient and family, and coordinate the needed care and/or scheduling of home visits as needed. The triage nurse will collaborate with the transdisciplinary team members and facilitate communication among the transdisciplinary team, Hospice, and the patient’s Attending Physician. Schedule: Per diem; 4 shifts per month; 4:00pm - 12:30am Location: Remote Mission Hospice & Home Care follows all CDPH vaccine requirements for healthcare personnel.
Education/Experience: Bachelor’s degree in nursing from an accredited nursing program Minimum of three (3) years of experience as a professional nurse within the last five (5) years At least one (1) year of hospice or palliative care experience Experience working effectively with an interdisciplinary group Certificates, Licenses, Registrations: California RN license CHPN certification
Receives phone calls from hospice patients and families Assesses the needs of the patients and families to coordinate needed care over the phone and scheduling visits as needed Managing patients’ pain and symptoms pursuant to physicians’ orders; obtaining changes in orders as need and updating the patient’s plan of care and medication list accordingly Assessing the patient and family’s needs for home visits, contacting the appropriate clinicians to schedule the visit, and notifying the patient and family of expected visit times
The major strength of Weeks Medical Center is found in the ability of our physicians and staff to offer extensive services utilizing state-of-the-art technology while maintaining the personalized care of a community hospital. Weeks is a 25-bed critical access hospital offering medical, surgical, and intensive care services. In addition, a wide variety of outpatient services are available, including cardiac and physical rehabilitation; a fully-staffed oncology department; 24-hour emergency care; a fully equipped laboratory; and an extensive radiology department. Weeks is blessed with strong leadership and a dedicated community that allows us to meet the ever-changing requirements of today's healthcare environment.
Graduate from an accredited school of professional nursing. Current NH License and BLS & ACLS certifications required, PALS (preferred). Must be proficient in oral and written communication skills and have excellent interpersonal, organizational, and time management skills. Current clinical experience preferred.
The Registered Nurse (RN) is responsible for managing individualized patient care by promoting and restoring patients' health through the nursing process; collaborating with physicians and multidisciplinary team members; providing physical and psychological support to patients, friends, and families; and supervising assigned team members. The RN is responsible to their Nurse Manager and ultimately, Chief Nursing Officer.
We’re striving to make respect a part of everything we do at UMass Memorial Health – for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.
At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day. This position supports a multidisciplinary clinical team by delivering high-quality, patient-centered care through remote modalities. This role emphasizes clinical triage, ongoing patient follow-up, medication education, and adherence support across diverse patient populations. Also conducts lifestyle and behavioral assessments to promote safe, effective care, optimize outcomes, and ensure alignment with established clinical protocols and care plans.
Required: Current and active LPN license Experience/Skills Required: Minimum 2 years of clinical experience (ambulatory, primary care, specialty, or telehealth preferred) Strong communication and patient education skills Ability to work independently in a remote environment Proficiency with telehealth technologies and remote patient communication Preferred: Experience supporting patients with chronic disease management Clinical patient triage and symptom assessment evaluation Familiarity with electronic medical record systems, preferably Epic
Conduct telephonic and video-based patient triage to assess symptoms, medication tolerance, and clinical concerns. Perform structured side-effect assessments and escalate findings to appropriate clinical staff as needed. Complete nurse visits focused on medication administration education (including injectables) and lifestyle/behavioral assessments. Provide comprehensive patient education on medications, side-effect mitigation strategies, lifestyle interventions, and program requirements. Support pre-initiation workflows, including baseline assessments, laboratory coordination, and pharmacy/provider collaboration. Participate in ongoing patient monitoring, including safety labs, refill timing, and insurance or authorization requirements. Respond to patient communications via phone, secure messaging, and other approved channels within established service-level timeframes. Coordinate care and communicate patient updates with clinical, administrative, pharmacies, payers, and external providers. Document all clinical encounters, assessments, and communications accurately and timely within the EMR, ensuring compliance with protocols. Participate in team meetings, case discussions, quality improvement initiatives, and virtual visits while maintaining a secure, private workstation environment.
PeopleOne Health is one of the fastest-growing providers of value-based primary care and has earned the best-in-class member satisfaction scores. We deliver exceptional healthcare that reduces costs and significantly improves health outcomes by focusing on preventive care, behavior change, and keeping people healthier. The key to our successful culture is living our motto: care for yourself; care for each other; care for our members.
PeopleOne Health is seeking a Family Medicine Nurse Practitioner (NP) to deliver virtual-first care for new patients and provide remote urgent-care coverage for established members. This strictly remote role focuses on welcoming and engaging new members through their first appointment, ensuring a positive introduction to PeopleOne Health, and supporting timely access to care by addressing acute, episodic, and urgent health needs via telehealth.
SKILLS & ABILITIES: Strong skills in telehealth-based assessment and triage. Ability to work efficiently in a high-access, episodic care model. Excellent communication and patient education skills. Comfort with technology, telemedicine platforms, and EHRs. Collaborative, flexible, and responsive to patient needs. Requirements EDUCATION & CERTIFICATIONS: Master’s Degree in Nursing (MSN) or Doctor of Nursing Practice (DNP) Current and unrestricted Nurse Practitioner license National Board Certification in Family Medicine (FNP) DEA Certificate (as required) EXPERIENCE: Minimum 2+ years practicing in Family Medicine or Urgent Care Telehealth experience strongly preferred Experience in value-based or team-based care models is a plus PHYSICAL REQUIREMENTS: (The physical requirements 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 position’s essential functions.) 100% remote position using secure telehealth platforms Requires reliable internet, private workspace, and compliance with HIPAA standards May involve flexible scheduling, including evenings or weekends, to meet urgent care access needs
SUPERVISORY RESPONSIBILITIES: This position provides supervision to others: No ESSENTIAL JOB FUNCTIONS: Conduct Virtual First Appointments – Perform new patient intake visits, review health history, establish baseline assessments, and introduce members to the PeopleOne Health model. Provide Remote Virtual Urgent Care Coverage – Manage same-day or next-day appointments for acute conditions (e.g., infections, minor injuries, medication needs, symptom evaluations). Support Care Coordination – Appropriately triage patients to in-person care, diagnostics, or specialists when necessary. Promote Patient-Centered Health – Educate and counsel patients during virtual visits on self-care, medication use, and follow-up needs. Document and Manage Care in EHR – Complete accurate, timely, and compliant documentation of all virtual encounters. Collaborate with Interdisciplinary Team – Communicate with primary providers, clinical pharmacists, registered dietitians, health coaches, and care coordinators to ensure seamless handoff and follow-up. Champion Access and Experience – Serve as a welcoming, accessible first point of contact for patients and contribute to a positive member experience. Collaborate with Client Success and Member Experience teams to maximize impact on patient engagement. Hours of availability to work until 8pm ET two nights per week to allow for access outside of patients’ normal work hours. Incentive for quality, patient feedback, and more.
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.
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. 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: Sun, Mon, Tues, Fri = 40 hours 8:30am-7:30pm PST and Week 2: Mon, Tues, Wed, Sat = 40 hours 8:30am-7:30pm PST If you live in Washington State, 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 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
Compassion. Accountability. Collaboration. Foresight. Joy. These are the Aspirus Core Values; and we are looking for the BEST around to join us as we demonstrate those values Every. Single. Day.
Aspirus Health is currently seeking a Triage RN for our new Nurse Call Center. HOURS: Supplemental or 3 FTE, 24 hours every pay period. Varied shifts including Day/PM/ Nights and rotating weekends. We are looking for someone with strong Primary or Specialty Clinic experience to triage these clinic related calls. **** This is remote position.
PROFESSIONAL EXPERIENCE/QUALIFICATIONS Current State of WI or MI RN license required at time of hire; must obtain both MI and WI within 90 days of hire. Knowledge of patient care standards and practices normally acquired through graduation from an accredited RN program. CPR/BLS required within 60 days of hire; ACLS desired
The Triage RN utilizes the nursing process when assisting with the delivery of primary health care and patient care management in the clinic setting. The Triage RN performs a wide variety of patient care activities including documentation within the medical record. The Triage RN utilizes nursing skills when assessing and triaging patients and recommending follow-up care. The position requires the ability to make decisions consistent with nursing practice, clinic policies and observance of confidentiality of patient information. The Triage RN in addition to triaging responsibilities serves also as a liaison between the patient, their family and health care providers.
Aspirus Health is a nonprofit, community-directed health system based in Wausau, Wisconsin, serving northeastern Minnesota, northern and central Wisconsin and the Upper Peninsula of Michigan. The integrated health system operates 18 hospitals and 130 outpatient locations with nearly 14,000 team members, including 1,300 employed physicians and advanced practice clinicians.
REGISTERED NURSE - NURSE CALL CENTER Aspirus Health Full Time (.8 FTE, 64 hours every pay period) Day/PM rotation, 10-hour shifts, every third weekend *** REMOTE POSITION*** Compassion. Accountability. Collaboration. Foresight. Joy. These are the Aspirus Core Values; and we are looking for the BEST around to join us as we demonstrate those values Every. Single. Day.
We are looking for someone with strong Primary or Specialty Clinic experience to triage these clinic related calls. Experience/Qualifications: Current State of WI or MI RN license required at time of hire; must obtain both MI and WI within 90 days of hire. Knowledge of patient care standards and practices normally acquired through graduation from an accredited RN program. CPR/BLS required within 60 days of hire; ACLS desired
The Triage RN utilizes the nursing process when assisting with the delivery of primary health care and patient care management in the clinic setting. The Triage RN performs a wide variety of patient care activities including documentation within the medical record. The Triage RN utilizes nursing skills when assessing and triaging patients and recommending follow-up care. The position requires the ability to make decisions consistent with nursing practice, clinic policies and observance of confidentiality of patient information. The Triage RN in addition to triaging responsibilities serves also as a liaison between the patient, their family and health care providers.
Our mission is powerful, yet simple. We are committed to creating communities that thrive by offering living and working experiences centered on health, wellbeing, and hospitality. For nearly 15 years, The Waters Senior Living has helped seniors and their families thrive. We provide a full spectrum of care options that include independent living, assisted living, memory and Alzheimer's care, and enhanced care. Our unique approach to wellbeing influences everything we do. Instead of only focusing on physical wellness, we believe that all dimensions of a person are important – The Waters Senior Living looks for talented team members who are passionate about working with seniors and want to make a difference in the lives of those they serve. Our mission is powerful, yet simple. We are committed to creating communities that thrive by offering living and working experiences centered on health, wellbeing, and hospitality. This is The Waters Way. It is in how we design our buildings, hire, train, and treat our team members.
On Call/potential nocs for vacations Telecommute position; must live in Minnesota The mission of The Waters is 'To create a sense of community where everyone THRIVES' We recognize that every team member is a direct reflection of The Waters. Attracting and investing in professional, caring, and compassionate team members is essential to our mission. We want our team members to feel inspired and to THRIVE, just as our residents do. The Clinical Triage Nurse is a remote support role to on-site team members and Assisted Living residents who require nursing or emergent consultation after business hours. In this role, the triage nurse will support the Directors of Health and Wellbeing in upholding, reinforcing and ensuring clinical excellence continues throughout all hours of care.
Provides clinical assessment and intervention using the nursing process and The Waters Senior Living policies and procedures to ensure consistency and improve health care outcomes for residents. Evaluates and assesses resident's health care needs based on resident's signs and symptoms, utilizing critical thinking skills. Ensures appropriate triage phone assessment, direction, and action for resident's medical situations based on information provided by the caller. Ensures appropriate communications between team members, family, and providers to coordinate resident health needs as assessed in the triage on-call role. Obtains appropriate input and direction from the provider as needed to determine the best clinical course of action and recommendation for specific resident health care needs. Accurately documents in the electronic health record (EHR), including but not limited to: triage assessment, changes to plan of care, caller agreement/response to the plan, any actions and interventions and the resolution of each interaction. Assures that pertinent medical information is forwarded to proper departments for continuity of resident care, by completing a nightly report for each community. Responsible to uphold financial integrity through billing triage services as appropriate for each state. As needed, performs other nursing functions as assigned, including resident chart audits, etc. Attends regularly scheduled in-services, team member meetings, and educational opportunities.
Achieve Whole Recovery is seeking a Registered Nurse to support patients receiving addiction medicine and psychiatry services. This role focuses on patient outreach, nurse triage, and care coordination to help ensure continuity of care between appointments. The RN provides patient education, responds to clinical concerns through nurse triage, and communicates laboratory results when delegated by providers. Working closely with physicians, nurse practitioners, and the Clinical Nurse Supervisor, this role helps patients stay engaged in treatment while supporting safe, responsive, and coordinated care. This remote position is ideal for a nurse who enjoys building patient relationships, coordinating care, and supporting recovery-focused treatment. Schedule & Work Expectations: Part-time position working 2–3 days per week Schedule includes one consistent Monday or Friday commitment Work occurs during regular clinic business hours Schedule supports patient outreach, nurse line coverage, and care coordination Limited schedule flexibility may be available with advance approval from the Clinical Nurse Supervisor
Licensure: Current unrestricted Registered Nurse (RN) license in the State of Colorado (required) Experience: Minimum 2 years of clinical nursing experience preferred Experience in addiction medicine, psychiatry, behavioral health, primary care, or care coordination strongly preferred Clinical Knowledge: Understanding of addiction medicine principles and medication-assisted treatment (MAT) Familiarity with psychiatric conditions and psychotropic medications preferred Skills: Strong verbal and written communication skills Ability to build rapport with patients and collaborate with interdisciplinary teams Strong clinical judgment for triage and patient guidance Experience using electronic health records (EHR) Professional Attributes: Commitment to patient confidentiality Trauma-informed care approach Alignment with Achieve Whole Recovery’s mission of compassionate, whole-person care
Patient Outreach & Care Coordination: Conduct follow-up outreach to patients after initial addiction medicine appointments or when requested by providers Provide patient-centered education on medications, treatment plans, recovery resources, and follow-up care Assist patients with scheduling and navigating ongoing treatment appointments Identify barriers to treatment adherence and communicate concerns to providers Support patient engagement in recovery through compassionate and supportive communication Nurse Line Triage: Provide coverage for the Achieve Whole Recovery nurse line during clinic hours Assess patient concerns including medication questions, treatment-related issues, and general health concerns Provide triage guidance consistent with provider treatment plans and clinic protocols Escalate urgent or complex clinical concerns to providers when appropriate Support triage needs across addiction medicine and psychiatry services Laboratory Result Notifications: Notify patients of laboratory results when delegated by providers Communicate urine drug screen (UDS) results and other clinically relevant laboratory findings Provide patient education regarding next steps or follow-up care Coordinate provider follow-up when additional clinical evaluation is needed Document patient notifications in accordance with clinic documentation standards Documentation & Clinical Communication: Document all patient interactions in the electronic health record (EHR) in a timely and accurate manner Communicate relevant patient updates and concerns to providers and clinical staff Maintain organized records of outreach and follow-up efforts Ensure documentation supports continuity of care across the interdisciplinary team Collaboration & Team Support: Collaborate with physicians, nurse practitioners, psychiatrists, therapists, and clinical staff Work closely with the Clinical Nurse Supervisor to follow established clinical workflows Support nursing workflows designed to improve patient engagement and continuity of care Participate in team meetings or clinical training as needed
We are looking for PASSPORT Case Managers/MyCare Level of Care Assessor! Are you looking for a rewarding career? The Area Agency on Aging Region 9, is dedicated in helping older adults and people with disabilities remain happy, healthy, and at home in the counties we serve. We are seeking a self-motivated, energetic, detail oriented, highly organized, tech-savvy Licensed Practical Nurse (LPN), Registered Nurse (RN), or Licensed Social Worker (LSW) to serve as a PASSPORT Case Manager/MyCare Level of Care Assessor.
Active Ohio or multi-state RN, LSW, or LPN license Strong organizational and communication skills Ability to work independently in a remote environment Reliable transportation, valid driver’s license, and auto insurance
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.
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. 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: Sun, Mon, Tues, Fri = 40 hours 8:30am-7:30pm PST and Week 2: Mon, Tues, Wed, Sat = 40 hours 8:30am-7:30pm PST If you live in Washington State, 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 Preferred Qualifications: Bachelor of Science in Nursing American Academy of Ambulatory Care Nursing (AAACN) 1+ years of Call Center Nursing experience Case Management experience
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.
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
The Utilization Review Nurse, RN is responsible for providing clinically efficient and effective Inpatient utilization management. Reviews inpatient criteria for acute hospital admissions and concurrent review and or prior authorization requests for appropriate care and setting by following evidence based clinical guidelines, medical necessity criteria and health plan guidelines. Reviews and applies hierarchy of criteria to all inpatient admission and preauthorization requests from providers that require a medical necessity determination. Is involved in assuring that the patient receives high-quality cost-effective care. Uses sound clinical judgement and managed care principles in the coordination of care. Prepares any case that does not meet medical necessity guidelines for medical appropriateness of procedure, service or treatment for review with the Medical Director for a decision. Required hours are 8am-5pm in PST or MST to include one weekend day, either Sunday-Thursday or Tuesday-Saturday, after the 3-6 month training period. Training for the first 3-6 months (or potentially longer depending on training progress) will be Monday-Friday 8am-5pm PST before moving to your regular schedule. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Required Qualifications: Current unrestricted Registered Nurse (RN) license in state of residence 3+ years of clinical nursing experience in acute care hospital or LTAC setting 1+ years of Utilization Management experience in hospital or insurance setting Experience applying Medicare and/or Medicaid guidelines Experience with Milliman (MCG) or InterQual guidelines Experience researching and preparing clinical information for case review with Physician Leadership for patient treatment and care planning Experience providing accurate and timely documentation of clinical review and supporting rational of decision in care management systems Experience employing analytical skills necessary for quality case management, utilization review, and quality improvement to meet organizational objectives Experience using various computer software applications with an intermediate level of competence, including Microsoft Word and Excel Ability to work Monday-Friday 8am-5pm in Pacific Time Zone or Mountain Time Zone to include one weekend day, either Sunday-Thursday or Tuesday-Saturday, after the 3-6 month training period. Training for the first 3-6 months (or potentially longer depending on training progress) will be Monday-Friday 8am-5pm PST before moving to your regular schedule Preferred Qualifications: Inpatient Utilization Management experience Utilization Management experience for insurance or managed care organization Prior Authorization experience Primary residence in Pacific Time Zone or Mountain Time Zone
Maintains clinical expertise and knowledge of scientific progress in nursing and medical arena and incorporates this information into the clinical review and care coordination processes Performs clinical review for appropriate utilization of medical services by applying appropriate medical necessity criteria guidelines Authorizes healthcare services in compliance with contractual agreements, Health Plan guidelines and appropriate medical necessity criteria Documents clinical reviews in care management system. Provide accurate and timely documentation and supporting rational of decision in care management system Utilizes care management system and resources to track and analyze utilization, variances and trends, patient outcomes and quality indicators Research and prepares clinical information for case review with Physician Leadership for patient treatment and care planning Utilizes knowledge of resources available in the health care system to assist the physician and patient effectively Identifies members who are appropriate for care coordination programs and collaborates with the Medical Management team for care coordination of the member's needs along the continuum of care Successfully completes the Interrater Reliability Testing to ensure consistency of review and application of criteria Meets timeliness standards for decision, notification, and prior authorization activities Serves as an advocate for all providers and their patients Demonstrates a positive attitude and respect for self and others and responds in a courteous manner to all customers, internal and external Maintains the confidentiality of all company procedures, results, and information about patients, contracts, and all other proprietary information regarding Optum business Performs other duties as required or requested in a positive and helpful manner to enable the department to achieve its goals 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.
ColigoMed is a US-based digital health company. At ColigoMed, our AI-enabled continuum platform connects patients, medical providers, and payers and provides the scale for at-home and virtual care programs to improve healthcare quality and patient outcomes. Our application is driven by our proprietary AI engine, ColigoAssist, which serves as a digital care assistant for both patients and providers—enabling better management of chronic medical conditions. Our provider portal delivers real-time clinical visibility across hospitals, clinics, and connected monitoring devices. ColigoMed is focused on helping patients live healthier, more independent lives. To achieve this, we recruit high-caliber professionals who combine deep clinical excellence with compassion and accountability. Our global team culture is built on trust, innovation, performance, and mission-driven care delivery.
We are seeking experienced LPNs with active compact multistate licensure to support our remote CCM and RPM programs across the United States. This is a high-engagement, patient-facing role where you will manage an assigned panel of patients and deliver ongoing patient management and care delivery through regular telephonic outreach and digital care platforms. The role requires the ability to interact with multiple patients daily, maintain accurate documentation, and operate effectively within a structured, performance-driven environment. You will work as part of a remote clinical team, collaborating closely with providers and internal staff to assess patient needs, implement care plans, and support improved health outcomes through consistent patient engagement. This role is primarily focused on outbound patient engagement, with the majority of daily work consisting of proactive patient calls and ongoing care management. This position is best suited to nurses who enjoy structured workflows, consistent patient interaction, and working independently in a remote environment. While this is a high-volume role, we provide onboarding support and guidance to help nurses build confidence and succeed.
Education and Licenses: LPN/LVN with an active compact multistate license (required) Minimum 6–10 years of nursing experience including chronic disease management Core Experience Requirement Candidates must meet one of the following pathways: Path A – Direct CCM / RPM Experience (Strongly Preferred) At least 2 years of direct CCM or RPM experience involving: Ongoing patient management Regular outbound patient interaction Telephonic or remote care delivery Use of EMR and digital care management platforms Path B – Equivalent Longitudinal Care Experience Candidates without direct CCM/RPM experience will be considered only if they demonstrate all of the following: At least 5 years of experience in case management, transition of care (TOC), or longitudinal chronic care Ongoing responsibility for managing the same patient population over time Regular, proactive patient communication as a core part of daily workflow Demonstrated ownership of care plans, patient follow-up and coordination across providers Other Experience Requirements Experience working in structured, high-volume patient engagement environments is required. (typically, 15–20+ patient interactions per day or equivalent workload and/or managing 150–300 patients per month) Demonstrated use of EMR systems, telehealth platforms & digital care tools Experience with Medicare or Medicare Advantage populations preferred Stable employment history Knowledge and Skills: Ability to work effectively in a remote, structured environment Strong organizational and time management skills Excellent communication skills with patients and providers Ability to manage multiple patients and priorities concurrently Strong clinical knowledge in chronic disease management High attention to detail and documentation accuracy Team-oriented with strong collaboration skills Bilingual (Spanish) preferred
Program Enrollment, Onboarding & Initial Patient Engagement (Transitional Phase) During the initial phase, you will support patient onboarding and program setup for CCM and RPM services. Key responsibilities include: Manage an assigned panel of patients and conduct regular outreach interactions using digital care platforms, requiring consistent execution of approximately 15–20 patient interactions per day as part of ongoing CCM/RPM care delivery. Deliver structured, scheduled patient interactions to support chronic disease management, including medication review, care plan updates, patient education, and escalation of clinical concerns where appropriate. Maintain accurate, timely documentation of all patient interactions and care activities within digital systems, ensuring compliance and continuity of care. Initiate outreach and onboarding calls for Medicare and Medicare Advantage patients Explain CCM/RPM programs, including expectations and device usage Obtain and document patient consents in line with CMS guidelines Conduct initial patient assessments Create and maintain care plans in collaboration with providers Perform medication reconciliation and escalate concerns Coordinate RPM device setup and usage Respond to patient inquiries and support ongoing engagement Manage allocated patient case load to meet required timelines, quality care standards and meet billing metrics of average fifteen (15) CCM units per day Collaborate with providers and internal teams Role Evolution This role will transition into a dedicated CCM/RPM Care Coordinator position focused on managing an ongoing patient panel as program volumes stabilize.
NCA is in search of a Nurse Case Manager based in the Denver area who will be responsible for case management services responsive to special needs and eldercare client care and quality of life challenges and collaboration with the primary family caregivers, attorneys, financial planners and trustees that are also serving the client.
Bachelor of Science in Nursing (BSN) required, CCM or CRRN preferred Minimum of 5 years clinical Nursing experience – experience in field case management or workers’ compensation case management, preferred Experience with third party benefits – health insurance, Medicaid, Social Security, Developmental Disability services Excellent communication skills – written and verbal Proficient in using MacOS and a variety of related software applications (including MS Office) Strong ability to quickly learn and adapt to new technologies and tools in a Mac environment Highly motivated self-starter comfortable working in a virtual company/office, with solid time management and organization skills Proven ability to collaborate as necessary to accomplish goals and work through conflicts Ability to research and develop solutions to challenges presented by the client Excellent customer service skills Overnight travel required regionally 1-2 times per month and occasional nationwide travel Willingness to meet timely documentation requirements
Wheel Medical Group is a physician owned professional corporation that serves patients across the United States; evolving the traditional care ecosystem by equipping the nation's most innovative companies with a premier platform to deliver high-quality virtual care at scale. We offer proven strategies and cutting-edge technologies to foster consumer engagement, build brand loyalty, and maximize return on investment. Wheel solutions include configurable virtual care programs, an intuitive consumer interface, and access to a nationwide network of board-certified clinicians. Discover how Wheel is transforming the future of healthcare by visiting www.wheel.com.
Wheel Medical Group is seeking nurse practitioners with multiple state licenses to join our network of world-class clinicians delivering virtual care. Wheel Medical Group offers a better way to work in virtual care by enabling clinicians to work with multiple telehealth companies — all in one platform. Clinicians in our nationwide network are credentialed, trained, and matched with vetted companies delivering the highest quality patient care. You could have the opportunity, based on experience and interest, to provide care in a number of programs such as: Primary Care Urgent Care Women’s Health Men’s Health Weight Management Dermatology Pediatrics
Board certified nurse practitioner 20 state licenses Must be licensed in CA or TX Must be licensed in at least 9 of these states: AK, AZ, DE, DC HI, ID, IA, KS, ME, MD, MA, MI, MT, NE, NV, NH, NM, ND, OR, RI, SD, UT, VT, WA, WY) Must also be licensed in at least 10 of the following states: OK, AR, CA, CO, CT, FL, IL, KY, MA, MN, NY, NJ, VA, WV 2+ years of clinical experience as a nurse practitioner in emergency, urgent care, or family medicine/primary care experience Available a minimum of 12 hours per week (including 6 weekend hours per month). Ability to perform both synchronous and asynchronous consults Providers with Full Practice Authority preferred At least 1 year of telemedicine experience preferred Ability to treat pediatric patients required Comfort providing medical weight loss patients required Outstanding clinical expertise Strong verbal and written communication skills Comfortable with technology
Deliver high-quality, evidence-based asynchronous and synchronous virtual care. Review comprehensive patient intake information, including medical history, medication lists, and patient-submitted photos, to ensure safe and appropriate prescribing decisions. Conduct thorough clinical assessments aligned with Wheel clinical guidelines, utilizing clinical snippets and workflows to tailor education and treatment plans. Prescribe medications responsibly, ensuring alignment with patient eligibility, formulary guidance, and safety parameters such as blood pressure ranges, contraindicated medications, and clinical red flags. Document each patient encounter using a complete and structured SOAP note, including rationale for prescribing or referring, patient counseling, and follow-up recommendations. Engage in clear and compassionate communication with patients through secure messaging or live video visits, maintaining a professional and supportive web-side manner. Refer patients to in-person care when clinical guidelines are not met, documenting rationale and providing clear patient instructions. Maintain compliance with quality assurance standards, incorporating feedback from periodic chart audits and actively participating in continuous improvement efforts. Escalate urgent clinical concerns such as suicidal ideation or harassment according to platform protocols, ensuring patient safety and clinician protection. Collaborate with Wheel’s clinical operations team for onboarding, platform support, and guideline updates to ensure consistent, high-quality care delivery.
Wheel Medical Group is a physician owned professional corporation that serves patients across the United States; evolving the traditional care ecosystem by equipping the nation's most innovative companies with a premier platform to deliver high-quality virtual care at scale. We offer proven strategies and cutting-edge technologies to foster consumer engagement, build brand loyalty, and maximize return on investment. Wheel solutions include configurable virtual care programs, an intuitive consumer interface, and access to a nationwide network of board-certified clinicians. Discover how Wheel is transforming the future of healthcare by visiting www.wheel.com.
Wheel Medical Group is seeking nurse practitioners with multiple state licenses to join our network of world-class clinicians delivering virtual care for a primary care client. Minimum of 2 licenses are required. Clinicians with the following license combinations will be considered: DC and VA DC and IL DC and WA CA and one of the following: IL,MD,NJ,VA or WA NY and one of the following: IL,MD,NJ,VA or WA Wheel Medical Group offers a better way to work in virtual care by enabling clinicians to work with multiple telehealth companies — all in one platform. Clinicians in our nationwide network are credentialed, trained, and matched with vetted companies delivering the highest quality patient care. You could have the opportunity, based on experience and interest, to provide care in a number of programs such as: Primary Care Urgent Care Women’s Health Men’s Health Weight Management Dermatology Pediatrics
Board certified Family Nurse Practitioner (FNP) with a national certification Multiple state licenses with at least 1 license from each category: Category 1: DC or CA Category 2: IL,MD,NJ,VA or WA Collaborative agreement preferred for CA Attestation for independence required for IL, FL, NY, VA 2 years of experience in an outpatient primary care setting or 1 year in an outpatient primary care setting, coupled with either a 1 year primary care fellowship or 1+ year in an urgent care setting. seeing patients of all ages Available a minimum of 12 hours per week with the ability to work a combination of weekdays, weekends, daytime and evening shifts (flexible 24/7 scheduling); 1099 Contract Position Pediatric experience / willingness to see pediatric patients required Ability to perform both synchronous and asynchronous consults required Providers with Full Practice Authority preferred Outstanding clinical expertise Strong verbal and written communication skills Comfortable with technology
Deliver high-quality, evidence-based asynchronous and synchronous virtual care. Review comprehensive patient intake information, including medical history, medication lists, and patient-submitted photos, to ensure safe and appropriate prescribing decisions. Conduct thorough clinical assessments aligned with Wheel clinical guidelines, utilizing clinical snippets and workflows to tailor education and treatment plans. Prescribe medications responsibly, ensuring alignment with patient eligibility, formulary guidance, and safety parameters such as blood pressure ranges, contraindicated medications, and clinical red flags. Document each patient encounter using a complete and structured SOAP note, including rationale for prescribing or referring, patient counseling, and follow-up recommendations. Engage in clear and compassionate communication with patients through secure messaging or live video visits, maintaining a professional and supportive web-side manner. Refer patients to in-person care when clinical guidelines are not met, documenting rationale and providing clear patient instructions. Maintain compliance with quality assurance standards, incorporating feedback from periodic chart audits and actively participating in continuous improvement efforts. Escalate urgent clinical concerns such as suicidal ideation or harassment according to platform protocols, ensuring patient safety and clinician protection. Collaborate with Wheel’s clinical operations team for onboarding, platform support, and guideline updates to ensure consistent, high-quality care delivery.
Wheel Medical Group is a physician owned professional corporation that serves patients across the United States; evolving the traditional care ecosystem by equipping the nation's most innovative companies with a premier platform to deliver high-quality virtual care at scale. We offer proven strategies and cutting-edge technologies to foster consumer engagement, build brand loyalty, and maximize return on investment. Wheel solutions include configurable virtual care programs, an intuitive consumer interface, and access to a nationwide network of board-certified clinicians. Discover how Wheel is transforming the future of healthcare by visiting www.wheel.com. Wheel Medical Group offers a better way to work in virtual care by enabling clinicians to work with multiple telehealth companies — all in one platform. Clinicians in our nationwide network are credentialed, trained, and matched with vetted companies delivering the highest quality patient care. You could have the opportunity, based on experience and interest, to provide care in a number of programs such as: Primary Care Urgent Care Women’s Health Men’s Health Weight Management Dermatology Pediatrics
Wheel Medical Group is seeking nurse practitioners with multiple state licenses to join our network of world-class clinicians delivering virtual care. Must be available to work weekends.
Board certified nurse practitioner Multiple state licenses (7 minimum with at CA or TX) Must be available to work a minimum of 8 hours per week Willing to do video sync and async visits 2+ years of clinical experience as a nurse practitioner in emergency, urgent care, or family medicine/primary care experience Providers with Full Practice Authority in FL, VA, NJ, IL, CT, CO preferred At least 1 year of telemedicine experience preferred Experience treating pediatric patients preferred Outstanding clinical expertise Strong verbal and written communication skills Comfortable with technology Multiple telehealth opportunities. With just one application, one credentialing effort, and one schedule, Wheel offers a simple and flexible way to work with multiple telehealth companies. Unlimited and uncapped earnings. Flexible schedule. Create your own schedule and work when you want, whether that’s evenings, part-time, or full-time. Contract position. 100% remote. Provide rewarding patient care from the comfort and safety of your home or office. Clinician community. Join a collaborative community of clinicians working in virtual care. Clinical compliance.Wheel supports brand GLP-1s only and does not operate compounded GLP-1 programs. Clinical, operational, administrative, and technical support. Wheel works to offer guidance and support for your virtual care practice, handling payments, credentialing, onboarding, and more. Simple to use. Utilize our secure and HIPAA-compliant platform that includes video conferencing, scheduling, and patient information tools. We protect clinicians. We vet all of our telehealth company partners for clinical safety and standard of care procedures to help protect your clinical practice. We also provide malpractice insurance, including tail coverage.
Deliver high-quality, evidence-based asynchronous and synchronous virtual care. Review comprehensive patient intake information, including medical history, medication lists, and patient-submitted photos, to ensure safe and appropriate prescribing decisions. Conduct thorough clinical assessments aligned with Wheel clinical guidelines, utilizing clinical snippets and workflows to tailor education and treatment plans. Prescribe medications responsibly, ensuring alignment with patient eligibility, formulary guidance, and safety parameters such as blood pressure ranges, contraindicated medications, and clinical red flags. Document each patient encounter using a complete and structured SOAP note, including rationale for prescribing or referring, patient counseling, and follow-up recommendations. Engage in clear and compassionate communication with patients through secure messaging or live video visits, maintaining a professional and supportive web- side manner. Refer patients to in-person care when clinical guidelines are not met, documenting rationale and providing clear patient instructions. Maintain compliance with quality assurance standards, incorporating feedback from periodic chart audits and actively participating in continuous improvement efforts. Escalate urgent clinical concerns such as suicidal ideation or harassment according to platform protocols, ensuring patient safety and clinician protection. Collaborate with Wheel’s clinical operations team for onboarding, platform support, and guideline updates to ensure consistent, high-quality care delivery.
Psychiatric Mental Health Nurse Practitioner (PMHNP) – 1099 Fern & Fathom Mental Health Solutions, PLLC Remote | Multi‑State | Austin, TX–Based Fern & Fathom is a growing integrative private practice offering telehealth mental health services across multiple states. We are seeking a PMHNP who values thoughtful, patient‑centered care over high‑volume schedules. Role Highlights 1099 Independent Contractor 50/50 revenue split (increase potential based on caseload/performance) Set your own schedule Remote/telehealth model Credentialing support in states where you hold licensure Texas‑based in‑person location planned for those who prefer this model Existing caseload strongly preferred, but not required.
Important Prescribing Note Fern & Fathom does not prescribe controlled substances. PMHNPs must maintain active DEA licensure in each credentialed state for payer and regulatory requirements. Requirements: Active PMHNP certification & unrestricted license DEA license (active) Malpractice insurance Strong psychopharmacology knowledge Ethical, collaborative, patient‑focused approach
Psychiatric evaluations & diagnoses (ICD‑10) Medication management (non‑controlled substances only) Individualized treatment planning Telehealth outpatient care Accurate EMR documentation
Reshaping Access We offer more sites of care than any other health system in the Midwest, but we're also exploring the latest technologies to deliver care to patients exactly where they are and exactly when they need it. Inspiring Professionals With our dynamically inclusive workforce and strong connections to the places where we live and work, we'll touch lives and contribute to stronger and more vibrant communities. Transforming Care We're redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in a dozen specialties.
Schedule: Part-time, either 3 (10 hour) shifts or 4 (8 hour) shifts. Day/pm hours available. Every fourth weekend and holiday rotation. **Candidate MUST have 2+ years' acute care experience (ED, Urgent Care, ICU and some Med/Surg will be considered) is required within the last 4 years to be considered.** Due to complex requirements, remote work is NOT permitted from the following states: CA, CO, CT, HI, MA, MD, MN, NJ, NY, OR, RI, VT, WA Schedule: Part time position (30 or 32 hours) start times mornings 8a,9a or 10a, PMs 12p, 1p, 2p or later 8 hour or 10 hour shifts are available for different shifts MUST be available to work every 4th weekend and holiday rotation
Licensure, Registration, and/or Certification Required: Registered Nurse license issued by the state in which the team member practices. Education Required: Associate's Degree (or equivalent knowledge) in Nursing. Experience Required: Typically requires 2+ years' of acute care experience, preferably within the last 4 years (ED, Urgent Care, ICU and some Med Surg will be considered). Knowledge, Skills & Abilities Required: Critical thinking skills necessary to independently determine and prioritize the needs of patients using sound judgment and strong problem-solving skills. Knowledge of a variety of healthcare specialties, including levels of care, symptom identification and proven treatment recommendations. Ability to incorporate past experience with established protocols. Excellent verbal communication skills demonstrating empathy, respect, restatement, open-ended questions, active listening and diplomacy with a diverse customer population. Ability to develop rapport and maintain positive, professional relationships with a variety of patients, staff and physicians. Proven ability to independently organize and prioritize work, managing multiple priorities and maintaining a flexible schedule in a fast paced, dynamic customer service environment. Excellent customer service and follow-up skills including the ability to stay calm during stressful situations. Demonstrated proficiency as a technology user with computers, internet, desktop software packages and multiple-line telephone systems. Ability to converse with customers/patients while researching and documenting calls on multiple systems. Knowledge of documentation techniques for communication Physical Requirements and Working Conditions: Required stable and secure internet connection Must have functional vision, touch, speech, and hearing. Required sitting a majority of the workday. Operates all equipment necessary to perform the job. Must have quiet space to make and receive phone calls Ability to lift 15 lbs.
Uses the nursing process and guidance of established protocols to assess the needs of the patient telephonically including the patient, guardian, or family in the conversation when necessary. Determines most appropriate level of care needed, provides detailed education, establishes a plan of care including interventions, and communicates follow up instructions to the patient. Escalates and collaborates with the appropriate on call provider when additional guidance is needed. Prioritizes patient interactions by acuity and need considering all available information and resources. Applies evidence-based practice to deliver patient care. Implements strategies to reduce patient risk and increase patient safety. Assesses patient and family readiness to learn and individualizes the approach as necessary. Works collaboratively to develop strategies to meet the learning needs of the patient and family. Supports shared governance activities and initiatives to improve processes and patient outcomes. Participates in department quality/process improvement initiatives aimed at enhancing the patient care experience. Participates in professional activities which contribute to personal professional development and the development of others. Seeks opportunities to be taught, coached, and mentored. Attends required meetings/educational programs and completes annual competencies in a timely manner. Demonstrates effective communication, feedback, and conflict resolution skills. Promotes collaboration with clinicians and other healthcare team members to coordinate patient-centered care. Promotes a culture of safety through identifying threats to patient safety and intervening to prevent patient harm. Reports patient safety events and near misses in a timely manner. Seeks to identify potential safety issues and assists in the implementation of corrective action. Applies ethical decision making, demonstrates respect and understanding for peers, and other clinical disciplines. Participates as an effective member of the patient care team to formulate an integrated, unbiased, individualized approach to care. Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status and interpret appropriate information needed to identify each patient’s requirements relative to his/her age specific needs and provide the care advice/disposition outlined in the departments policies, procedures, and protocols. Schedules appointments with emphasis on making the appointment in correlation to the recommended end point of the protocol used. Collaborates with other health care team members to coordinate medical and nursing management of patient care, including procedures and medication refills. Accurately maintains and updates the patient’s clinical records according to agency, State and Federal guidelines. Documents all call encounters utilizing the patient’s Electronic Medical Record at the time of the call. Communicates information relating to the patient’s physical and psychological status to the physician, Advanced Practice Clinician and/or additional members of the interdisciplinary team as appropriate. Provides pertinent and concise reports describing patient’s response to medical and nursing plans of care. Participates in team meetings and works on special projects/tasks as assigned by leadership. Participates in the ongoing development of comprehensive health information resources, system and operational efficiencies and resources. Assists in interpreting department policies and procedures and advises staff on procedural changes.
GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.
This position, under the direction of the Supervisor, Care Management, performs and manages all aspects of care management to improve the long-term wellness of members, becoming an advocate for our members through coordination of care.
EDUCATION AND EXPERIENCE: Active Registered Nurse license in the state of Oklahoma required Active multi-state RN license is preferred Previous experience in managed care/utilization management preferred KNOWLEDGE, SKILLS AND ABILITIES: Knowledge of current nursing processes, techniques, and established standards, including disease management, medications, and community resources. Strong attention to detail and good organization and time management skills, including ability to multi-task, learn new skills and reach set goals. Must be able to communicate, both orally and in writing, clearly and effectively Knowledge of Microsoft software programs including Word, Excel, and PowerPoint. Proven ability to work independently or as a member of a team. WORK ENVIRONMENT: Work is normally performed in a professional setting. Work involves standing and walking for brief periods of time, but most duties are performed from a seated position. Work may include occasional pushing and/or pulling, lifting, and carrying objects weighing up to 20 pounds. Work requires normal vision and hearing as might be required in typical conversational use along with finger dexterity and eye-hand coordination to operate a computer keyboard at a moderate skill level. TRAVEL: N/A
Conducts telephonic case management for complex, high-risk members to include identification and assessment of needs, planning and coordination of care, and monitoring outcomes in accordance with GlobalHealth and the departments policies and procedures. Coordinates with providers when applicable to ensure holistic, healthy, beneficial outcomes. Communicates with respect to family culture, ethnic origin, race, language, gender, age, religion, socioeconomic status, sexual orientation, mental and/or physical challenges. Through interdepartmental communication, network communication, and member outreach the Case Manager remains aware of patient needs and changes in condition, providing patient advocacy, support, assessing and ensuring quality care, and providing crisis intervention. Coordination of services for members, including community resources and collaboration with other members of the care team. Educate members and their caregivers on conditions and self-management techniques. Initiate and participate in all elements of the SNP MOC, including completing HRA, creating ICP, and initiating ICT. Complete TOC activities to include post-discharge assessment, medication reconciliation/review, and ensuring member has access to follow up care. OTHER DUTIES: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.
This position performs utilization management review. This position determines appropriateness of services, medical necessity, and location of services required to encourage effective, high-quality care and cost-efficient outcomes through. This position requires excellent verbal and written communication, organization and time management skills.
EDUCATION AND EXPERIENCE: Current active LPN license in Oklahoma/Texas or compact Experience in managed care/utilization management preferred Minimum of 3-5 years of clinical experience required KNOWLEDGE, SKILLS AND ABILITIES: Working knowledge of ICD-10/CPT codes preferred Working knowledge of Microsoft software programs Excellent organizational skills Strong communication skills Proven ability to work independently and as a member of a team WORK ENVIRONMENT: Current work environment is remote; however, some state exclusions apply. Must have access to a reliable and secured internet connection source. Work environment must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. This position will also be required to use reasonable and necessary safeguards to protect GlobalHealth records from unauthorized access, disclosure or damage and will adhere to all GlobalHealth privacy and security policies. TRAVEL: May require limited travel for offsite meetings or training
Reviews preservice requests, appropriateness of services, and ensure timely determination Communicates with customers, both internal and external, regarding status of referral/referral process. Utilizes NCDs, LCDs, MCG, and additional guidelines to assist in determining coverage of the request. Maintains current knowledge of managed care issues (benefits, contracted providers, health plan guidelines, MCG, NCD, LCD and community standards of practice and regulatory developments, and new and experimental procedures). Collaboration with internal team to support member needs, including but not limited to discharge planning, provider relations, and care management. Adheres to company and department policies and procedures. Performs other duties as assigned SUPERVISORY RESPONSIBILITY: This position has no supervisory responsibility OTHER DUTIES: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
We are seeking an experienced Registered Nurse (RN) to provide Chronic Care Management (CCM) and Principal Care Management (PCM) services. Candidates with neurology experience or experience supporting patients with chronic neurological conditions are strongly preferred. This role involves patient outreach, care coordination, and ongoing support for individuals with chronic or complex conditions. Schedule Part‑time/Contract(W-9) Flexible hours
Application Question(s): Do you have an - Active, unrestricted RN license (GA) License/Certification: RN License (Required)
Provide CCM/PCM services including monthly outreach and care plan updates Conduct telephonic or virtual patient check‑ins Support patients with chronic neurological conditions (e.g., migraines, neuropathies, Parkinson’s, epilepsy, MS) Collaborate with providers and care teams Document all encounters in the EMR Identify care gaps and coordinate follow‑up Educate patients on disease management and available resources
Hi, we're Oscar. We're hiring a Utilization Review Nurse, BPO Supervisor to join our team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.
You will provide daily oversight and management of the team. You will own the daily Nurse off-shore team operations, including queue and volume throughput and staffing, and also serves as the primary escalation point for their teams. You will supports strategic and clinical initiatives. You will report into the Manager, Utilization Review. Work Location:This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; Illinois; Iowa; Kansas; Michigan; Missouri; Nebraska; New Jersey; North Carolina; Ohio; Oklahoma; Pennsylvania; South Carolina; Tennessee; Texas; or Virginia. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events.#LI-Remote Pay Transparency: The base pay for this role is: $91,980 - $120,629 per year. You are also eligible for employee benefits, participation in Oscar's unlimited vacation program, and annual performance bonuses.
Requirements: 3+ years of utilization review experience at a managed care plan or provider organization Active, unrestricted Registered Nurse (RN) licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) 2 + years of off-shore managing vendor experience 2+ year of leadership experience Associate Degree and/or Bachelors of Nursing from an accredited school of nursing 5+ years healthcare experience (including at least 2 years clinical practice in an acute care setting) Milliman (MCG) experience Bonus points: Bachelors of Nursing (BSN) degree Masters of Science in Nursing (MSN) degree, or MBA/Healthcare administration degree Project management certification (e.g. Six Sigma, SCRUM, Agile)
Own daily workforce management, including staffing and queue assignments, PTO/leave, and payroll/compensation. Manage queue on a daily basis, ensuring compliance with regulatory timelines, staff coverage, and coordination with internal teams for forecasting and timely handling of ad hoc escalations Ensure on-shore team adheres to department policies and workflows and serve as continual champion of the Oscar mission. Drive and own the success of clinical auditing and performance through ongoing evaluations; effectively use Oscar tools to monitor and trend nurse productivity and auditing data for assessment and reporting. Support the onboarding and training of newly-hired clinicians and partner with the Clinical Quality & Training team on the development and maintenance of clinical training and resource material. Partner with the Talent Acquisition team on clinical hiring initiatives. Complete medical necessity and level of care reviews using clinical judgment and the Plan's designated clinical guidelines, if applicable. Comply with department performance and quality metrics, and adhere to training and remediation requirements. Compliance with all applicable laws and regulations Other duties as assigned
Revolution Medicines is a clinical-stage precision oncology company focused on developing novel targeted therapies to inhibit frontier targets in RAS-addicted cancers. The company’s R&D pipeline comprises RAS(ON) Inhibitors designed to suppress diverse oncogenic variants of RAS proteins, and RAS Companion Inhibitors for use in combination treatment strategies. As a new member of the Revolution Medicines team, you will join other outstanding Revolutionaries 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.
We’re moving people forward by providing transformative technology services, digitally enabled customer experiences, and clinical health services that change lives. Our employees share an authentic desire to make vital services available to the public and support the missions of our customers.
Maximus is seeking a Clinical Supervisor (RN) to lead our clinical team supporting the Colorado HMA (Health Maintenance Activities) Review Program. This role oversees a team of clinical reviewers, ensures program goals and service level agreements (SLAs) are met, and fosters a high‑performance culture. The Supervisor serves as a program subject matter expert, ensures adequate staffing coverage, partners with leadership on process improvements, required contract reporting, and participates in stakeholder meetings. **Position is contingent upon contract award** Work Schedule: This position is scheduled Monday through Friday from 8:00 a.m. to 5:00 p.m. Mountain Time with some weekend coverage required based on business needs.
Bachelor's degree or equivalent combination of education, technical training, or relevant experience in lieu of degree Minimum of two years of related experience. Current Registered Nurse (RN) license valid in the state of practice is required Associate degree in Nursing An active Registered Nurse license in the state of Colorado or a compact license is required Minimum 4 years of experience working with people with complex disabilities, including pediatric and geriatric populations Familiarity with Home and Community Based Services waivers (HCBS) Minimum 2 years of experience Supervising clinical staff Proficiency in Microsoft Office applications Preferred Requirements: Prior experience conducting document-based reviews Prior experience delivering clinical training Prior experience working remotely Prior experience with data analytics, including preparation of monthly reports and collaboration with state partners Home Office Requirements Maximus provides company-issued computer equipment Reliable high-speed internet service Minimum 20 Mpbs download speeds/50 Mpbs for shared internet connectivity Minimum 5 Mpbs upload speeds Private and secure workspace
Supervise a team of employees through cultivation of a high performance team Ensure adequate staff coverage for assigned program area Serve as subject matter expert for identified area of program knowledge Ensure assigned team is meeting contract and individual SLA's, and related requirements Work with contract management and shared services to identify opportunities for improvement and efficiencies May attend client and stakeholder meetings Performs other related duties as assigned.
Ascension is a leading nonprofit Catholic health system with a culture and associate experience grounded in service, growth, care and connection. We empower our 99,000+ associates to bring their skills and expertise every day to reimagining healthcare, together. Recognized as one of the Best 150+ Places to Work in Healthcare and a Military-Friendly Gold Employer, you’ll find an inclusive and supportive environment where your contributions truly matter.
Location: Remote Department: CPD National Schedule: Full-time Salary: $146,000 - $248,200 per year Eligible for an annual bonus incentive Life at Ascension: Where purpose meets opportunity
Licensure / Certification / Registration: Registered Nurse obtained prior to hire date or job transfer date required. Education Master's degree required. Work Experience 5 years of experience required. 10 years of experience preferred. 2 years of leadership or management experience required. 5 years of leadership or management experience preferred. What Additional Preferences We're Seeking Doctoral degree in Nursing (PhD, DNP, EdD, or equivalent) preferred. National certification in nursing professional development or education preferred. Experience in system-level or multi-site health care organizations preferred. Active engagement with national nursing education and professional development organizations (ANPD, NLN, AACN, AONL) preferred.
Lead the design and execution of enterprise-wide nursing development programs that align clinical excellence with the organization’s long-term strategic goals. Design robust competency management systems and transition-to-practice programs to ensure every clinician is prepared to provide safe, high-quality patient care. Partner with executive nursing and HR leadership to identify future workforce needs, creating proactive education pathways that close competency gaps before they impact care. Integrate evidence-based research and clinical standards into daily practice, empowering nursing teams to improve patient outcomes. Mentor and develop the next generation of nurse leaders and clinical educators, fostering a culture of continuous professional growth and certification. Evaluate program success using data analytics to refine educational strategies, ensuring our training investments result in measurable improvements for both staff and patients.
Classet automates the most time-consuming recruiting tasks with voice AI. Our view is that recruiters provide the highest level of impact to candidates when they spend their time building relationships and helping candidates succeed. Transform your hiring with Classet's AI-powered instant interview solution. Automate screening, schedule effortlessly, and hire top talent faster than ever. Experience the future of recruitment now! We don't use AI to replace the human touch desperately needed in recruiting - we use AI to augment and accelerate it, while providing a best-in-class candidate experience!
Chronic Care Staffing is Hiring a Remote Bilingual Care Coordinator (LPN)! Location: Remote (Must reside in MST or PST) Schedule: Monday - Friday (No Weekend Work) Employment Type: Full-Time Pay Rate: $23.50 - $26.50 per hour Overview Chronic Care Staffing is seeking a compassionate and detail-oriented Bilingual Care Coordinator (LPN) to support patients managing chronic conditions in a fully remote setting. This role is ideal for nurses who enjoy patient engagement, care coordination, and improving long-term health outcomes through consistent communication and support. You'll play a critical role in helping patients stay on track with care plans while collaborating closely with providers and internal teams.
Must Have: Active, unencumbered LPN/LVN license Must live in MST or PST (required) Fluent in English and Spanish Active BLS certification Strong proficiency with EHR systems Proficiency in Google Suite Ability to work independently in a HIPAA-compliant home office Strong clinical reasoning, problem-solving, and communication skills Excellent verbal and written communication abilities Nice to Have: Experience in care coordination, CCM, TCM, or remote patient monitoring Familiarity with community resource navigation Experience educating patients/families on chronic conditions Knowledge of CMS compliance, reporting, or quality measures Team-oriented mindset in a remote environment Home Office Requirements Private, distraction-free, HIPAA-compliant workspace Reliable high-speed internet Dual monitor setup
Conduct monthly Chronic Care Management (CCM) outreach calls and enroll patients Perform health risk assessments and support Transitional Care Management (TCM) Assist with Remote Patient Monitoring (RPM) and chronic condition tracking Educate patients and families on diagnoses, medications, and care plans Coordinate care between patients, providers, and internal teams Encourage adherence to treatment plans and patient self-management Accurately document all interactions in EHR systems Maintain productivity targets while delivering empathetic patient care Ensure compliance with HIPAA, CMS, and company standards
CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.
We are seeking a dedicated and compassionate Registered Nurse with a Bachelor of Science in Nursing (BSN) to join our team as a Care Manager, Telephonic Nurse 2. In this pivotal role, you will play a crucial part in our Patient Management Program, focusing on individuals with specialized and complex health conditions, including autoimmune disorders, pulmonary diseases, neuromuscular disorders, infectious diseases, cancer(s), and other rare ailments. This position is a call center based environment. There is a set schedule that is provided daily with inbound and outbound tasks to perform. This position is for 10am-6:30pm EST three days a week M-F, and two days a week hours of 11:30am-8pm EST. There will be a Friday late night requirement on a rotation of 11:30am-8pm. There will be a Saturday rotation hours of 8:30am-12:30pm EST. Overtime is required on an as needed basis. There is a Holiday rotation that will be worked. Workable holidays for the pharmacy include Martin Luther King Day, Memorial Day, Juneteenth, 4th of July, Labor Day, The day after Thanksgiving, and New Years Day.
Use your skills to make an impact Bachelors of Science in Nursing (REQUIRED) MUST BE COMPLETED! 3 - 5 years of clinical acute care experience as an RN. Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action Must live in OH, KY, FL, AZ, TX. Comprehensive knowledge of Microsoft Office applications including Word, Excel, and Outlook Managed care experience Must be passionate about contributing to an organization focused on continuously improving consumer experiences Schedule Adherence Preferred Qualifications: Experience with care management, patient education for adult care, auto dialer experience Bilingual English/Spanish Auto Dialer Experience Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
As a Care Manager, Telephonic Nurse your primary responsibility will be to assess and evaluate the conditions of our members, with a particular emphasis on medication therapy, through telephonic interactions to ensure they achieve and maintain optimal wellness. Additionally, you will develop and implement comprehensive care plans, monitor patient progress through regular assessments, and utilize advanced telecommunication systems to provide medication education. The ideal candidate will demonstrate strong clinical expertise, exceptional communication skills, and the ability to work independently while adhering to established protocols and guidelines. This position offers the opportunity to make a significant impact on the lives of patients with serious and rare health conditions within a supportive and professional environment.
Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.
Our Evernorth Workplace Care Team delivers high-quality care where you are—with convenient onsite or virtual access to workplace-based health and wellness centers, health coaching and wellness events. Clinical Nurse Trainer & Health Center Support Nurse – Evernorth Full time 40 hour/week position The experienced Clinical Nurse Trainer & Health Center Support Nurse is responsible for providing coverage in our Evernorth Workplace Care Health Centers.
Graduate of approved RN program Current RN or LPN Compact licensure is required and ability to maintain as needed At least three or more years of experience in a primary care clinic or provider office. Travel Nursing experience strongly preferred Current BCLS required and ability to maintain Strong Phlebotomy skills Current driver's license and clean motor vehicle record Solid Computer skills with proficiency in MS Office Suite and Electronic Health Records Excellent customer service skills required Team oriented Strong time management skills Responsible and reliable Excellent customer skills, and care deeply about providing empathetic, quality care to customers Dynamic personality Leadership experience (indirect or direct) is a plus Ability to travel to US sites to provide coverage for health center, telehealth, health coaching and or training; Expected travel is 60-75%; Travel will be Monday - Friday Strong preference for this nurse to be based in North New Jersey / NY area (Bergen County NJ) or greater Orlando FL. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload.
Travel to workplace health centers across the US - 60-75% travel Conduct patient assessment; obtain patient history Assist in development of care plans and coordination of care. Support the clinician to help manage the complex healthcare needs of patients, lead and support the back and front office staff with regards to patient’s concerns or center needs Assist in implementing provider orders and order follow-up, medication refills, patient/family education, identifying opportunities for preventative screening, notification of member’s test results. Triage patient calls and concerns; where applicable, schedule appointments Communicate effectively to provider to resolve issues. Set up all patients for procedures, exams and obtains vital signs. Utilize phlebotomy skills for Blood draws Ensure day-to-day operations in the clinic, use your organizational skills to help manage the health care needs of our varied patient population. Properly document your efforts of all the care and information provided to our patients. Maintain supplies in exam room Additional responsibilities in alignment with the scope of your certification or licensure Train new employees as needed May be Cross Trained in Health Coaching as needed Work with MDLive partners as needed
WPS, a health solutions company, is a leading not-for-profit health insurer and federal government contractor headquartered in Madison, Wisconsin. WPS offers health insurance plans for individuals, families, seniors and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS has been making healthcare easier for the people we serve for nearly 80 years. Proud to be military and veteran ready.
Our Utilization Management RN (Registered Nurse) evaluates efficiency, appropriateness, and medical necessity for medical services, and procedures for our Health Plan. This role uses clinical knowledge to provide judgment to review medical services with evidence-based criteria, authorize requested services as appropriate. Our Utilization Management RN will be responsible for referring questionable cases to medical directors to prevent unnecessary procedures, treatments, or prolonged hospital stays. Work Location We are open to remote work in the following approved states: Colorado, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, New Jersey, North Carolina, Ohio, South Carolina, Texas, Virginia, Wisconsin
Minimum Qualifications: Registered Nurse (RN) with current licensure in the state of Wisconsin. 4 or more years of experience as a Registered Nurse in varied clinical settings (i.e., hospital, clinic, home care, skilled nursing facility, etc.). 2 or more years of experience in Managed Care (i.e., prior authorization, utilization review). Demonstrated experience managing and coordinating care effectively for case managed members. Strong knowledge of current medical practices, medical coding, trends and patterns of care. Familiarity with health plan operations, payer/provider relationships, and insurance benefits. Strong diverse experience and expertise that includes: The ability to work independently, manage a case load, and prioritization. Excellent analytical, critical thinking, problem-solving skills and decision-making skills. Excellent communication and interpersonal skills to work with members, providers, and teams Proficiency in Microsoft Office and healthcare software and systems. Preferred Qualifications: Bachelor’s degree in nursing (BSN). Health insurance background in Point of Service (POS), Preferred Provider Organization (PPO), or Medicare Supplement) plans. Knowledge of Utilization Review Accreditation Commission (URAC). Certified Managed Care Nurse (CMCN). Technical experience with word processing, spreadsheets, and proficiency with electronic medical record (EMR) systems and/or other managed care software. Remote Work Requirements: High speed cable or fiber internet Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net) Please review Remote Worker FAQs for additional information
Enjoy working with healthcare professionals to facilitate appropriate and quality services in a cost-effective manner to positively impact medical loss ratio. Can work closely with Medical Directors to facilitate decision-making process for the Health Services department. Have experience reviewing medical and behavioral health prior authorization requests for medical necessity and appropriateness of requested treatment according to medical policies and evidence-based criteria. Have experience working closely with members of Health Services, and key contacts in Sales, Member Services, Claims, Provider Contracting, and Billing & Enrollment. Can document case summaries and refer cases to Medical Director that do not meet internal or external guidelines, policies, or medical criteria. Like to be accountable to monitor and maintain inventory in the Utilization Management queue to meet productivity standards. Enjoy evaluating, analyzing, and reporting trends in utilization changes in all healthcare delivery areas. Can make recommendations and implement changes consistent with Health Services objectives of quality care and reasonable cost. Would enjoy identifying opportunities and provide recommendations to improve department processes. Have Identified legal or liability issues and refer potential ethical or risk management issues to the appropriate department for resolution. Have participated in training new nursing staff on department workflows, policies, and procedures. Can work cross functionally to support other departmental efforts to ensure overall efficiency, quality, productivity, and compliance with all departmental, regulatory and URAC standards.
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 Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.
Optum WA, is seeking a RN Call Assist 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. 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: Sun 8am-8pm, Mon 10am-9:30pm, Tues 10am-9:30pm, Wed Off, Thurs Off, Fri Off, Sat Off = 32 hours Week 2: Sun Off, Mon 10am-9:30pm, Tues 10am-9:30pm, Wed Off, Thurs Off, Fri Off, Sat 8am-8pm = 32 hours If you have the ability to work PST hours, you'll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges.
Required Qualifications: Unrestricted WA State or Compact 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 PST work schedule to include: Week 1: Sun 8am-8pm, Mon 10am-9:30pm, Tues 10am-9:30pm, Wed Off, Thurs Off, Fri Off, Sat Off = 32 hours, Week 2: Sun Off, Mon 10am-9:30pm, Tues 10am-9:30pm, Wed Off, Thurs Off, Fri Off, Sat 8am-8pm = 32 hours Preferred Qualifications: Bachelor of Science in Nursing American Academy of Ambulatory Care Nursing (AAACN) 1+ years of Call Center Nursing experience Case Management experience
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 Be 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 Be 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 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.
ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages.
Craving a New Adventure? Flex Your Clinical Skills Right from Your Couch! Are you a Nurse (LPN, LVN or RN) seeking a role that challenges you, helps you grow, and lets you work from the comfort of your own home? ExamWorks has the perfect opportunity for you! We’re looking for a Clinical Quality Assurance Coordinator to join our team! In this role, you’ll ensure Peer Review case reports meet the highest standards of quality, integrity, and compliance with client agreements, regulatory guidelines, and federal/state mandates. Why This Role Rocks: 100% Remote - Enjoy the flexibility of working from home! Impactful Work - You’ll play a key role in ensuring the quality and compliance of critical reports. Schedule - 9:30am-6:00pm CT, either Wednesday-Sunday or Monday and Wednesday-Saturday (some flexibility); Monday-Friday with weekend rotations may also be an option!
High school diploma or equivalent required. A minimum of two years clinical or related field experience; or equivalent combination of education and experience. Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability. Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values. Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages. Must be a qualified typist with a minimum of 40 W.P.M Must be able to operate a general computer, fax, copier, scanner, and telephone. Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. Must possess excellent skills in English usage, grammar, punctuation and style. Ability to follow instructions and respond to upper managements’ directions accurately. Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met. Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed. Must be able to work independently, prioritize work activities and use time efficiently. Must be able to maintain confidentiality.
Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews. Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations. Ensure that all client instructions and specifications have been followed and that all questions have been addressed. Ensure each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications. Ensure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards. Ensure the appropriate board specialty has reviewed the case in compliance with client specifications or state mandates and is documented accurately on the case report. Verify that the peer reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists. Ensure the provider credentials and signature are adhered to the final report. Identify any inconsistencies within the report and contacts the Peer Reviewer to obtain clarification, modification or correction as needed. Assist in resolution of client complaints and quality assurance issues as needed. Ensure all federal ERISA and state mandates are adhered to at all times. Provide insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications. Promote effective and efficient utilization of company resources. Participate in various educational and or training activities as required. Perform other duties as assigned.
This opportunity is available through a leading AI-driven work platform that connects domain experts with frontier AI research projects. Experts contribute to improving advanced AI systems by providing specialised expertise across real-world workflows, structured evaluation, model training support, and domain-specific professional knowledge.
We are sharing a specialised part-time consulting opportunity for experienced Registered Nurses with strong professional expertise in clinical care, nursing workflows, patient support, and real-world healthcare practice. This role supports a research project for one of the world's top AI companies and focuses on using real-world occupational expertise to design high-quality questions related to the day-to-day work of Registered Nurses. Selected professionals will apply their domain knowledge to help shape structured project content grounded in real professional practice, contributing occupation-specific expertise that supports advanced AI training and evaluation work. Contract Details: Independent contractor role Fully remote with flexible scheduling Hourly compensation listed at $60–$100 per hour for U.S.-based applicants Compensation will vary depending on professional background and geographic location Candidates must be based in the US, UK, or Canada This project is a short-term sprint with a high number of work hours expected to be available A desktop or laptop computer is required for this project Chromebook users cannot be accepted for this role Projects may be extended, shortened, or concluded early depending on project needs and performance Weekly payments via Stripe or Wise Work will not involve access to confidential or proprietary information from any employer, client, or institution Please note: We are unable to support H1-B or STEM OPT candidates at this time Start date: Immediate
Strong candidates may have: 4+ years of full-time work experience as a Registered Nurse Strong professional background in nursing practice, patient care, clinical workflows, or related healthcare environments Ability to contribute real-world occupational insight to structured research work Strong written communication and analytical thinking skills Reliable availability for intensive short-term project participation Current location in the US, UK, or Canada Preferred qualifications: Experience translating professional knowledge into structured content or research inputs Strong understanding of nursing workflows, patient care responsibilities, and clinical decision-making processes Ability to contribute precise, profession-specific material in a consistent and high-quality way
Occupational Expertise & Research Input: Use professional experience as a Registered Nurse to support a research project for a leading AI company Contribute domain knowledge grounded in real-world full-time work experience Help ensure project outputs reflect authentic occupational practice and professional standards Question Design & Content Development: Design questions related to the occupation of Registered Nurse Translate day-to-day professional knowledge into structured, high-quality research content Contribute occupation-specific material that supports AI training and evaluation initiatives Project Participation & Quality Contribution: Engage consistently in a structured remote project environment Contribute professional judgment shaped by registered nursing experience Support high-quality output through reliable participation and strong subject-matter expertise
TOXICOLOGY ASSOCIATES, INC, headquartered in Houston, Texas, specializes in delivering professional and reliable services in the field of toxicology. With its main office located on Bellaire Boulevard, the company is dedicated to excellence and innovation. As a trusted name in the industry, TOXICOLOGY ASSOCIATES, INC emphasizes a commitment to high standards and quality care for its clients. The company strives to provide effective solutions while fostering a positive work environment for its team.
This is a full-time remote Licensed Vocational Nurse (LVN) position.
Proficiency in providing direct patient care, including medical evaluations and administering medications as permitted. Strong skills in clinical documentation, maintaining patient records, and ensuring compliance with healthcare standards. Effective communication skills for educating patients and collaborating with healthcare professionals. A valid Licensed Vocational Nurse (LVN) certification and state licensure. Knowledge of toxicology or experience in a healthcare environment is a plus. Ability to work remotely while maintaining a high level of professionalism and organization.
The primary responsibilities include providing patient care, conducting routine medical evaluations, administering medications under physician guidance, and maintaining accurate clinical documentation. The LVN will coordinate patient care plans, educate patients on healthcare practices, and collaborate with healthcare teams to ensure patient well-being and compliance with prescribed treatments.
Elite Care is a leading nationwide telemedicine network dedicated to matching top-tier clinical professionals with digital health organizations across all 50 states. Our network comprises board-certified MDs, PAs, and NPs with expertise in dynamic fields such as longevity, GLP-1 therapies, and hormone optimization. By combining thorough regulatory compliance and expert medical oversight, we provide the infrastructure needed to scale virtual care operations. Our mission is to deliver innovative, credible, and life-enhancing patient care.
We are seeking a qualified healthcare provider to join our team as a 1099 independent contractor. This role involves conducting SYNC telehealth consultations focused on Medical Weight Loss (MWL). Key Details: Compensation: $30 per consult (SYNC) (paid monthly) Typical volume: 2–3 consultations per hour Schedule: Minimum availability of 10–15 hours per week
Active licenses in 5 or more full practice authority states Experience conducting Medical Weight Loss (MWL) clinical visits Proficiency with telehealth platforms and workflows Fluent, clear, and easily understandable English communication Comfortable with consultations being recorded, with recordings accessible to patients (audio or transcript format) Ability to provide at least 48 hours’ notice for schedule changes to allow for patient rescheduling
MyMichigan Health is a partnership of health providers, services and facilities in the heart of Michigan. It is a non-profit, tax-exempt health system affiliated with the University of Michigan Health. As a non-profit, all excess revenues go back into providing care, upgrading services, fairly compensating employees and creating a supportive work environment. The quality of its medical facilities and campuses have been enhanced by the generosity of local foundations and donors. Serving more than one million residents in a 26-county region, MyMichigan Health acts as a parent organization with various joint ventures and management contracts. In fiscal year 2025, MyMichigan Health provided $243 million in community benefits and other uncompensated care. MyMichigan also contributes significantly to the health of its local economies. Listed by Forbes among ‘America’s Best Employers by State’ for four consecutive years from 2022 to 2025, as well as named to Forbes’ list of ‘America’s Best Employers for Healthcare Professionals’ in 2025, MyMichigan is a major employer in all the areas it serves with employees having earned $815 million in wages and $147 million in benefits in fiscal year 2025.
This position plays a pivotal role in maintaining the fiscal health of the organization by ensuring the organization is fully reimbursed. Educating and consulting with the physician and the health care team to ensure accuracy of medical necessity criteria and to ensure timely and appropriate level of care is achieved. This requires excellent time management and prioritization skills along with collaboration with the provider and case management teams.
Credential:RN: Registered Nurse Equivalent Experience Qualification Source: Essential: true Required Education Education: Associates Degree Education Specialization Essential: true Other Information Experience, Training And Skills Three to five years clinical experience. Prior UR experience and/or certification in U/R or Case Management preferred. Basic knowledge of coding preferred. Physical/Mental Requirements And Typical Working Conditions Exposure to stressful situations, including those involving public contact, as well as trauma, grief and death. Is able to move freely about facility with or without an assisted device and must be able to perform the functions of the job as outlined in the job description. Overall vision and hearing are necessary with or without assisted device(s). Frequently required to sit/stand/walk for long periods of time. May require frequent postural changes such as stooping, kneeling or crouching. Ability to handle multiple tasks, get along with others, work independently, regular and predictable attendance and ability to stay awake. Overall dexterity is required including handling, reaching, grasping, fingering and feeling. May require repetition of these movements on a regular to frequent basis. Physical Demand Level: Sedentary. Must be able to occasionally (0-33% of the workday) lift or carry 0-10 lbs.
(30%)* Performs admission, concurrent and focused reviews using the medical necessity criteria and complies with CMS requirements. Perform admission/continued stay/discharge reviews when applicable. (30%)* Determines necessity of second-level review and implement process per hospital policy. Provide educational information to physicians and other staff members as appropriate regarding medical necessity criteria, documentation guidelines, admission status, etc. and collaborates with the care team. (15%)* Assist UR Committee and subcommittees in identifying areas of mis-utilization. Perform Hospital- wide quality assurance activities as requested. (15%)* Facilitate appropriate insurance pre-certification, appropriate admission and status of patient. Successfully negotiates patient status with the payer. (10%)* Attend and participate in case management and discharge planning as required. Other Duties And Responsibilities Complete denial appeals with physician and additional chart information, coordinate information and send in appeal. Coordinate with Appeals RN, as needed. Maintain documentation of reviews, telephone contacts, appeal activity and progress. Provides pertinent clinical data to designated outside agencies to assure compliance with their requirements. Participates in Continuous Quality Improvement as required by the Medical Center and the job description. Is skilled in determining the need for and implementing the hospital notice of non coverage. Understands and is accountable for the Health System's customer service standards.
At AnsibleHealth, we aren't just managing patients; we are preventing "predictable" emergencies. Backed by top-tier investors (Bessemer, First Round) and led by experts from Google, Johns Hopkins, and Columbia, we are a virtual multi-specialty group redefining chronic disease management through a high-tech, high-touch model.
We are seeking a clinically sharp, "slightly rebellious" RN. What does "Slightly Rebellious" mean to us? It means you are tired of the healthcare status quo. You are frustrated by the fragmented "conveyor belt" of traditional medicine where patients fall through the cracks. You are someone who refuses to accept "that’s just how it’s always been done" when a patient's life is on the line. You are the conductor of a clinical symphony, turning complex data into a proactive, life-saving performance. The Schedule: Weekend Anchor We value your time and clinical focus. This role offers a consistent, fixed schedule that provides elite work-life harmony: Work Days: Saturday through Tuesday (9:00 AM – 7:00 PM EST). The Anchor: You take pride in being the steady, expert presence for high-risk patients during the critical weekend window. The Partnership: You aren't on an island. On the weekends, you will work closely with a dedicated Nurse Practitioner (NP) to co-manage patient care, escalate concerns, and execute clinical interventions in real-time. Who You Are The "Outside the Box" Thinker: You don't just identify a problem; you architect a solution. If a high-risk patient is struggling with social barriers or a complex clinical hurdle, you don't just "chart it and move on"—you brainstorm, advocate, and innovate until that patient is safe. The Status Quo Challenger: You believe healthcare should be better, and you’re here to help build it. You aren't afraid to challenge existing protocols if you see a more effective, human-centric way to deliver care. The "Why" Expert: You don’t just follow a checklist. You have a deep understanding of pathophysiology and ask "why" until you find the root cause of a patient’s decline. You spot the nuances of fluid overload or respiratory distress before they become crises. The Tech-Forward Learner: You are comfortable in a digital environment. We use Google Workspace (Gmail, Docs, Sheets, Meet) for everything. You don't need to be a "techie," but you must be a "quick study" who is happy to leave paper charts behind in favor of modern, efficient tools.
Requirements License: Active Registered Nurse (RN) license in good standing. Multistate/Compact (NLC) license is required. Clinical Foundation: 5+ years of experience in Internal Medicine, Geriatrics, ER, or ICU; with 1+ years specifically focused on chronic cardiopulmonary conditions (CHF/COPD). Technical Proficiency: Experience using Google Workspace for professional communication and office needs. A proven ability to learn new software or platforms quickly. Reliable high-speed internet (min. 25 Mbps) and a quiet, HIPAA-compliant home office. Education: BSN preferred; ADN required.
RPM & Triage: Monitor real-time physiological alerts (BP, HR, O2, weight) via our proprietary portal. Use specialized tools to differentiate between "stable" and "urgent" for high-risk outpatients. Virtual Care Delivery: Perform telemedicine visits for patient education and monitor telehealth exercise sessions to improve mobility and function. Case Management & Advocacy: Act as the continuous point of contact for families. Activate community resources for social stressors (transportation, nutrition, housing) and coordinate with PCPs and DME providers. Clinical-Tech Collaboration: Work in a tight-knit team, collaborating daily with Nurse Practitioners, physicians, and engineers to provide feedback on our clinical dashboards and care models.
Mindlance is a global Talent, Teams, Projects, and Workforce Solutions partner, serving leading enterprises across industries since 1999. With a 5,000 strong footprint across multiple countries, we deliver scalable, AI native solutions that help organizations build, optimize, and transform their workforce.
Job Titles- Nurse Case Management Senior Analyst / (Utilization Review or Utilization Management) / Certified Case Manager / Case Manager Location: 100 % Remote Term: 3 Plus Months (Possible extension)
Minimum requirements: Active unrestricted Registered Nurse (RN) license in state or territory of the United States. Compact RN license a required for this role. Two years full-time equivalent of direct clinical care to the consumer.
Nurse Case Management Senior Analyst Nurse Case Management Senior Analyst. For this position, Nurse Case Manager Senior Analyst, through the case management process, will promote the improvement of health outcomes to members. Also assist those members experiencing the burdens of illness and injury. The Case Manager will assess, plan, implement, coordinate, monitor and evaluate options and services to meet an individual’s health needs within case load assignments of a defined population. The Case Manager will promote quality cost-effective outcomes managing care needs through the continuum of care utilizing effective verbal and written communication skills and a consumerism approach through education and health advocacy to members serviced. Ability to work independently and effectively communicate to internal and external customers in a telephonic environment. Responsibilities: Establishes a collaborative relationship with client (plan participant/member), family, physician(s), and other providers to determine medical history, current health status, and assess the options for optimal outcomes. Promote consumerism through education and health advocacy. Assesses member’s health status and treatment plan and identifies any gaps or barriers to healthcare. Establishes a documented patient centric case management plan involving all appropriate parties (client, physician, providers, employers, etc), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved. Implements, coordinates, monitor and evaluate the case management plan on an ongoing, appropriate basis. Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures. Participates in unit and corporate training initiatives and demonstrates evidence of continuing education to maintain clinical expertise and certification as appropriate. Demonstrates sensitivity to culturally diverse situations, clients and customers.
At OHSU, we deliver breakthroughs for better health. We're driven by the belief that better health starts with innovations in the lab, in the classroom, at the bedside and in our communities. From cancer to Alzheimer's to cardiovascular care, we collaborate every day to identify and deliver new ways to understand disease, treat illness and train the next generation of scientists and health professionals. It takes all of us - from scientists, clinicians and nurses to a top-notch professional staff.
The Nursing Professional Development (NPD) Practitioner is a Registered Nurse (RN) who serves as a strategic leader in advancing nursing practice and workforce development across the health system. With authority to design and implement clinical education and competency strategies, the NPD Practitioner plays a key role in aligning professional development efforts with organizational priorities, regulatory standards, and nursing excellence goals. Grounded in the core competencies defined by the Association for Nursing Professional Development (ANPD), the NPD Practitioner leads care area-based and system-wide initiatives in education, onboarding, role development, and competency management. This role supports the transition to practice, sustains professional role competence, and promotes lifelong learning among nurses and interprofessional partners. The NPD Practitioner represents nursing profession by shaping and executing strategies that influence policy, practice, and operations. This includes leading enterprise-level projects, designing and evaluating education programs, coaching clinical staff, and supporting regulatory and accreditation readiness. The role also contributes to advancing quality, safety, and health equity through education and practice innovation. Work Schedule: Variable with intermittent remote options. Must live in Oregon, Washington, Portland-Vancouver metroplex, within a 100-mile radius of OHSU main campus and clinics. Travel: Based on professional development opportunities, including out-of-town conferences.
Required Qualifications: Masters Degree in Nursing or current enrollment in a Masters Degree in Nursing 3-years experience as a registered nurse in a related clinical area of Practice or Focus Adult Learning Theory Educational Design Facilitation Giving & Receiving Feedback Program Management Microsoft 365 Unencumbered RN License BLS from AHA required. New hires will be enrolled and required to complete during orientation Nursing Professional Certification Preferred Qualifications: Master’s Degree in Nursing Education 2 years of recent leadership experience Learning Management System Administration System Program Management ANCC Program Accreditation NPD-BC Certification
Onboarding and Orientation: Supports recruitment, hiring and retention efforts in collaboration with care area or department-based leaders for Clincial RNs and other clinical roles as assigned. Leads the process of orienting and integrating new team members with a focus on patient safety, professional and clinical performance, and retention. Use principles of equity to design, develop, and evaluate orientation curriculums to support the needs of the learner. Evaluates clinical performance and provides consistent coaching and communication regarding performance expectations and measurable goals during orientation. Competency Management: Collaborates with NPD leaders and colleagues, Nursing Practice Specialist partners, Professional Governance and other key partners to determine initial, annual, and ongoing competency needs, including annual regulatory standards and policy requirements. Develops a competency demonstration plan for each clinical role that aligns to OHSU competency model and nursing professional practice model. Collaborates with unit and department leadership to ensure that staff comply with all competency and regulatory requirements. Education and Learning Facilitator: Accountable for annual needs assessment and evaluation for Clinical RNs and other clinical roles as assigned. Responsible for developing and implementing a plan to address practice gaps for target audiences, including interprofessional learners at all levels. Develop and evaluate specific outcomes intended to measure improvement in deficits related to knowledge, skill, practice or behavior and attitude. Applies knowledge of learning domains and innovative teaching strategies to facilitate knowledge retention and behavior change. Evaluates impact of educational initiatives in support of professional development of nurses and other clinic roles as assigned. Professional Role Development: Identify and apply strategies to facilitate continuous growth through ongoing professional learning. Responsible for transitions in practice, including Clinical RN residents and nurses new to specialty through specialized programs and curricula designed to meet unique learning needs. Supports the development of nurses and other team members in role mastery and skill acquisition through regular monitoring and evaluation of individual and team performance. Leads preceptor and mentor competency and professional development through coaching and feedback. Support organizational engagement and retention initiatives through mentorship and coaching of Clinical RNs in planning their professional development goals. Ensures specialty based professional development and learning opportunities are available. Provides resources to support professional certification, such as review courses. Encourages certification among all nursing staff. Scientific Inquiry: Supports research, quality improvement (QI) and evidence-based practice (EBP) activities at various levels. Uses best available evidence to guide education and practice decisions. Disseminates research, QI and EBP findings through educational programs, courses, and other activities. Incorporates Continuous Improvement principles and resources into daily work and process improvement opportunities. Leadership and Change Management: Aligns work with organizational goals and strategic plan. Demonstrates commitment to financial stewardship and resource management while fostering innovation and embracing change. Collaborates with other leaders to identify problems and propose solutions. Support change management by assessing readiness for change, developing goals, exhibiting creativity and flexibility, and implementing change strategies that support staff ability to sustain change. Health Equity, Diversity, and Inclusion (EDI): Supports a healthy work environment by aligning responsibilities to organizational EDI strategic plans and goals. Evaluates clinical learning environments for opportunities to eliminate bias and discrimination and increase inclusivity. Support education programs and process/program improvement related to health equity, diversity and inclusion as assigned.
Residex® delivers Intelligent Care through a secure, all-in-one assisted living software platform that empowers caregivers with data-driven tools for smarter, safer, and more efficient care. With expert nursing support and proactive insights, Residex helps prioritize well-being and drive better outcomes. Designed specifically for assisted living, memory care, and residential care communities, Residex offers 16 integrated modules that streamline operations, simplify compliance, and support caregivers every step of the way.
At Residex, we’ve reimagined senior care management from the ground up. We are seeking a dynamic Sales Executive in Texas to drive growth for Residex with our comprehensive EHR/eMAR/Staff Scheduling software platform that serves the senior care industry. You must be an RN and have at least 5 years of experience in a clinical setting. Must be located in Texas.
BSN in Nursing required 5+ years of clinical experience, preferably in Assisted Living, In-Home / Private Care, Group Homes and Memory Care Comfortable with healthcare terminology and the challenges with technology adoption. Dope verbal & written communication with ability to simplify complex technical concepts Consultative selling approach with active listening skills and strong needs-analysis. Self-motivated with proven ability to manage time effectively + setting & completing tasks. Detail-oriented with strong organizational and follow-up and follow-through discipline. Collaborative mindset with willingness to support team goals and work across the org. Technical Skills: Proficiency with CRM platforms like HubSpot or Salesforce. Advanced knowledge of Microsoft suite (Teams, PowerPoint, Excel, Word). Comfortable demonstrating healthcare software applications.
Lead Management: Self generate and qualify/work inbound leads from multiple channels including trade shows, website inquiries, client referrals and direct outreach. Solution Evangelist: Conduct discovery and compelling virtual and in-person presentations/demos that align our software capabilities with prospect pain points & regulatory requirements. Sales Cycle Management: Own the full sales cycle from initial contact through contract execution, maintaining accurate pipeline data in our CRM. Strategic Partnerships: Identify complimentary industry partners to work with building brand awareness and generating additional qualified opportunities for the sales team. Account Growth: Identify upsell and cross-sell opportunities by promoting additional modules and features to existing customers based on evolving needs. Product & Marketing Collaboration Content Development: Partner with marketing to create sales enablement materials including case studies, comparison sheets, webinar content and event ideas that can help drive leads and meaningful interactions. Product Feedback Loop: Serve as a customer voice by documenting feature requests, usability concerns, and competitive insights for the product development team. Market Intelligence: Monitor industry trends, conference intel, regulatory changes, and competitor positioning to inform and revise sales strategy.
Residex® delivers Intelligent Care through a secure, all-in-one assisted living software platform that empowers caregivers with data-driven tools for smarter, safer, and more efficient care. With expert nursing support and proactive insights, Residex helps prioritize well-being and drive better outcomes. Designed specifically for assisted living, memory care, and residential care communities, Residex offers 16 integrated modules that streamline operations, simplify compliance, and support caregivers every step of the way.
At Residex, we’ve reimagined senior care management from the ground up. We are seeking a dynamic Sales Executive in Wisconsin to drive growth for Residex with our comprehensive EHR/eMAR/Staff Scheduling software platform that serves the senior care industry. You must be an RN and have at least 5 years of experience in a clinical setting. Must be located in Wisconsin.
Required Qualifications: BSN in Nursing required 5+ years of clinical experience, preferably in Assisted Living, In-Home / Private Care, Group Homes and Memory Care Comfortable with healthcare terminology and the challenges with technology adoption. Dope verbal & written communication with ability to simplify complex technical concepts Consultative selling approach with active listening skills and strong needs-analysis. Self-motivated with proven ability to manage time effectively + setting & completing tasks. Detail-oriented with strong organizational and follow-up and follow-through discipline. Collaborative mindset with willingness to support team goals and work across the org. Technical Skills: Proficiency with CRM platforms like HubSpot or Salesforce. Advanced knowledge of Microsoft suite (Teams, PowerPoint, Excel, Word). Comfortable demonstrating healthcare software applications.
Lead Management: Self generate and qualify/work inbound leads from multiple channels including trade shows, website inquiries, client referrals and direct outreach. Solution Evangelist: Conduct discovery and compelling virtual and in-person presentations/demos that align our software capabilities with prospect pain points & regulatory requirements. Sales Cycle Management: Own the full sales cycle from initial contact through contract execution, maintaining accurate pipeline data in our CRM. Strategic Partnerships: Identify complimentary industry partners to work with building brand awareness and generating additional qualified opportunities for the sales team. Account Growth: Identify upsell and cross-sell opportunities by promoting additional modules and features to existing customers based on evolving needs. Product & Marketing Collaboration Content Development: Partner with marketing to create sales enablement materials including case studies, comparison sheets, webinar content and event ideas that can help drive leads and meaningful interactions. Product Feedback Loop: Serve as a customer voice by documenting feature requests, usability concerns, and competitive insights for the product development team. Market Intelligence: Monitor industry trends, conference intel, regulatory changes, and competitor positioning to inform and revise sales strategy.
Residex® delivers Intelligent Care through a secure, all-in-one assisted living software platform that empowers caregivers with data-driven tools for smarter, safer, and more efficient care. With expert nursing support and proactive insights, Residex helps prioritize well-being and drive better outcomes. Designed specifically for assisted living, memory care, and residential care communities, Residex offers 16 integrated modules that streamline operations, simplify compliance, and support caregivers every step of the way.
At Residex, we’ve reimagined senior care management from the ground up. We are seeking a dynamic Sales Executive in Colorado to drive growth for Residex with our comprehensive EHR/eMAR/Staff Scheduling software platform that serves the senior care industry. You must be an RN and have at least 5 years of experience in a clinical setting. Must be located in Colorado.
Required Qualifications: BSN in Nursing required 5+ years of clinical experience, preferably in Assisted Living, In-Home / Private Care, Group Homes and Memory Care Comfortable with healthcare terminology and the challenges with technology adoption. Dope verbal & written communication with ability to simplify complex technical concepts Consultative selling approach with active listening skills and strong needs-analysis. Self-motivated with proven ability to manage time effectively + setting & completing tasks. Detail-oriented with strong organizational and follow-up and follow-through discipline. Collaborative mindset with willingness to support team goals and work across the org. Technical Skills: Proficiency with CRM platforms like HubSpot or Salesforce. Advanced knowledge of Microsoft suite (Teams, PowerPoint, Excel, Word). Comfortable demonstrating healthcare software applications.
Lead Management: Self generate and qualify/work inbound leads from multiple channels including trade shows, website inquiries, client referrals and direct outreach. Solution Evangelist: Conduct discovery and compelling virtual and in-person presentations/demos that align our software capabilities with prospect pain points & regulatory requirements. Sales Cycle Management: Own the full sales cycle from initial contact through contract execution, maintaining accurate pipeline data in our CRM. Strategic Partnerships: Identify complimentary industry partners to work with building brand awareness and generating additional qualified opportunities for the sales team. Account Growth: Identify upsell and cross-sell opportunities by promoting additional modules and features to existing customers based on evolving needs. Product & Marketing Collaboration Content Development: Partner with marketing to create sales enablement materials including case studies, comparison sheets, webinar content and event ideas that can help drive leads and meaningful interactions. Product Feedback Loop: Serve as a customer voice by documenting feature requests, usability concerns, and competitive insights for the product development team. Market Intelligence: Monitor industry trends, conference intel, regulatory changes, and competitor positioning to inform and revise sales strategy.
Mobile Nurse Practitioner (1099 – Independent Contractor) Idaho Outreach Medicine | Boise & Treasure Valley This is not a traditional clinic role. If you’re looking for a fast-paced, high-volume schedule with 15-minute visits — this isn’t it. If you’ve ever thought “there has to be a better way to practice medicine” — keep reading. Idaho Outreach Medicine is a mobile, relationship-based healthcare practice bringing care directly to patients across the Treasure Valley. We provide longer visits, real connection, and thoughtful care — without the constraints of a traditional clinic.What this role offers: Autonomy — practice independently and think critically Flexibility — help shape your own schedule Meaningful care — visits average ~45 minutes Variety — care delivered in homes, workplaces, and communities A different model — no assembly-line medicine
We’re looking for a provider who: Is self-motivated and comfortable working independently Has strong clinical judgment Values relationships over volume Enjoys problem-solving in real-world settings Wants more ownership in how they practice Nurse Practitioner or Clinical Nurse Specialist (Idaho licensed) Independent Contractor (1099) Competitive per-visit compensation Travel throughout the Treasure Valley
Mobile primary care (house calls) Chronic disease management + acute visits Preventive care and follow-ups Coordination with specialists and care teams Telehealth as appropriate
HealthSnap (healthsnap.io) empowers patients and their physicians to improve health outcomes using an innovative platform for modern, proactive patient care. We help healthcare organizations easily manage chronic conditions remotely, and deliver personalized patient experiences when it's needed most. Be part of an organization built on teamwork, innovation, mutual respect, and equality for all. We believe in the power of prevention over treatment, after our co-founders experienced how modern healthcare failed their loved ones, they knew there had to be a better way. We believe that every patient deserves to receive the right care, at the right time, and in the right location - regardless of their condition or status. We lead with empathy above all else, and place the patient at the center of everything we do. Working at HealthSnap means being part of a family and a team where if you win, we all win, no matter how big or small the accomplishment. We take ownership - and lead with empathy - and expect each employee to recognize that real patients rely on HealthSnap every day.
We are hiring LPNs in multiple states to support patients who are enrolled in chronic care management and/or remote patient monitoring programs. This is done in partnership with the patients’ care team which may include primary or specialty physician practices or healthcare systems. Successful candidates will bring experience in educating patients on chronic diseases such as hypertension and diabetes. This is a full-time position that operates Monday through Friday, 9:00 am to 5:30 p.m. Eastern Time, unless otherwise specified. As a Care Navigator, you will be trained in HealthSnap’s remote patient monitoring platform and will be responsible for communicating with enrolled patients in conjunction with the patients’ care team. Care Navigators typically have an assigned group of patients for which the Care Navigator is responsible for assisting throughout the month. Care Navigators also assist with other patients or patient tasks as assigned. Above all else, you will play an essential role in establishing a relationship with assigned patients that allows you to empower them to manage their chronic illnesses and improve their health. **Compact Nursing License required unless otherwise specified**
Education: A current, valid, and in good standing Multistate/Compact Nursing License (LPN/LVN) Additional state licenses may be required and will be reimbursed by HealthSnap Experience: 3+ years of experience in primary care practice, cardiology, internal medicine, home care, or chronic care management/remote patient monitoring Skills: Strong communication and interpersonal skills Excellent organizational and time management abilities Proficiency in using electronic health records (EHR) and care management software Ability to work independently and as part of a team Empathy and a patient-centered approach to care Technical Requirements: Reliable internet connection and HIPAA-compliant work area and proficiency with virtual communication tools (e.g., Zoom, Slack)
Patient Support: Complete phone consultations with patients enrolled in care management and/or remote patient monitoring programs providing support and education about their chronic conditions. Education and Empowerment: Educate patients about their health conditions and empower them with lifestyle and behavior strategies to actively manage their chronic conditions. Assist patients to set and reach goals in line with their provider-approved care plans. Documentation: Maintain accurate and up-to-date patient records, ensuring all interactions and care plans are documented per protocol. Problem Solving: Address patient concerns and barriers to care, working to find practical solutions to improve patient adherence and outcomes. Communication: Provide clear, compassionate, and effective communication to patients. Follow approved workflows regarding communicating patient needs to their providers. Continuous Improvement: Participate in training sessions, team meetings, and quality improvement initiatives to enhance the care navigation process and patient experience. Evaluation and Responding: Respond to remotely transmitted patient data such as blood pressure, blood glucose, weight, and pulse oximetry according to approved partner workflows.
HealthSnap (healthsnap.io) empowers patients and their physicians to improve health outcomes using an innovative platform for modern, proactive patient care. We help healthcare organizations easily manage chronic conditions remotely, and deliver personalized patient experiences when it's needed most. Be part of an organization built on teamwork, innovation, mutual respect, and equality for all. We believe in the power of prevention over treatment, after our co-founders experienced how modern healthcare failed their loved ones, they knew there had to be a better way. We believe that every patient deserves to receive the right care, at the right time, and in the right location - regardless of their condition or status. We lead with empathy above all else, and place the patient at the center of everything we do. Working at HealthSnap means being part of a family and a team where if you win, we all win, no matter how big or small the accomplishment. We take ownership - and lead with empathy - and expect each employee to recognize that real patients rely on HealthSnap every day.
We are hiring LPNs in multiple states to support patients who are enrolled in chronic care management and/or remote patient monitoring programs. This is done in partnership with the patients’ care team which may include primary or specialty physician practices or healthcare systems. Successful candidates will bring experience in educating patients on chronic diseases such as hypertension and diabetes. This is a full-time position that operates Monday through Friday, 9:00 am to 5:30 p.m. Eastern Time, unless otherwise specified. As a Care Navigator, you will be trained in HealthSnap’s remote patient monitoring platform and will be responsible for communicating with enrolled patients in conjunction with the patients’ care team. Care Navigators typically have an assigned group of patients for which the Care Navigator is responsible for assisting throughout the month. Care Navigators also assist with other patients or patient tasks as assigned. Above all else, you will play an essential role in establishing a relationship with assigned patients that allows you to empower them to manage their chronic illnesses and improve their health. ** Massachusetts Nursing License Required ** Please note: Pay is state-specific. The posted range applies to MA residents; candidates in other states will receive compensation aligned with their state of residence. ** Additional Compact Nursing License Preferred **
Education: A current, valid, and in good standing Multistate/Compact Nursing License (LPN/LVN) Additional state licenses may be required and will be reimbursed by HealthSnap Experience: 3+ years of experience in primary care practice, cardiology, internal medicine, home care, or chronic care management/remote patient monitoring Skills: Strong communication and interpersonal skills Excellent organizational and time management abilities Proficiency in using electronic health records (EHR) and care management software Ability to work independently and as part of a team Empathy and a patient-centered approach to care Technical Requirements: Reliable internet connection and HIPAA-compliant work area and proficiency with virtual communication tools (e.g., Zoom, Slack)
Patient Support: Complete phone consultations with patients enrolled in care management and/or remote patient monitoring programs providing support and education about their chronic conditions. Education and Empowerment: Educate patients about their health conditions and empower them with lifestyle and behavior strategies to actively manage their chronic conditions. Assist patients to set and reach goals in line with their provider-approved care plans. Documentation: Maintain accurate and up-to-date patient records, ensuring all interactions and care plans are documented per protocol. Problem Solving: Address patient concerns and barriers to care, working to find practical solutions to improve patient adherence and outcomes. Communication: Provide clear, compassionate, and effective communication to patients. Follow approved workflows regarding communicating patient needs to their providers. Continuous Improvement: Participate in training sessions, team meetings, and quality improvement initiatives to enhance the care navigation process and patient experience. Evaluation and Responding: Respond to remotely transmitted patient data such as blood pressure, blood glucose, weight, and pulse oximetry according to approved partner workflows.
HealthSnap (healthsnap.io) empowers patients and their physicians to improve health outcomes using an innovative platform for modern, proactive patient care. We help healthcare organizations easily manage chronic conditions remotely, and deliver personalized patient experiences when it's needed most. Be part of an organization built on teamwork, innovation, mutual respect, and equality for all. We believe in the power of prevention over treatment, after our co-founders experienced how modern healthcare failed their loved ones, they knew there had to be a better way. We believe that every patient deserves to receive the right care, at the right time, and in the right location - regardless of their condition or status. We lead with empathy above all else, and place the patient at the center of everything we do. Working at HealthSnap means being part of a family and a team where if you win, we all win, no matter how big or small the accomplishment. We take ownership - and lead with empathy - and expect each employee to recognize that real patients rely on HealthSnap every day.
We are hiring Bilingual LPNs in multiple states to support patients who are enrolled in chronic care management and/or remote patient monitoring programs. This is done in partnership with the patients’ care team which may include primary or specialty physician practices or healthcare systems. Successful candidates will bring experience in educating patients on chronic diseases such as hypertension and diabetes. This is a full-time position that operates Monday through Friday, 9:00 am to 5:30 p.m. Eastern Time, unless otherwise specified. As a Care Navigator, you will be trained in HealthSnap’s remote patient monitoring platform and will be responsible for communicating with enrolled patients in conjunction with the patients’ care team. Care Navigators typically have an assigned group of patients for which the Care Navigator is responsible for assisting throughout the month. Care Navigators also assist with other patients or patient tasks as assigned. Above all else, you will play an essential role in establishing a relationship with assigned patients that allows you to empower them to manage their chronic illnesses and improve their health. **Compact Nursing License required unless otherwise specified**
Education: A current, valid, and in good standing Multistate/Compact Nursing License (LPN/LVN) Additional state licenses may be required and will be reimbursed by HealthSnap Experience: 3+ years of experience in primary care practice, cardiology, internal medicine, home care, or chronic care management/remote patient monitoring Skills: Strong communication and interpersonal skills Excellent organizational and time management abilities Proficiency in using electronic health records (EHR) and care management software Ability to work independently and as part of a team Empathy and a patient-centered approach to care Technical Requirements: Reliable internet connection and HIPAA-compliant work area and proficiency with virtual communication tools (e.g., Zoom, Slack)
Patient Support: Complete phone consultations with patients enrolled in care management and/or remote patient monitoring programs, providing support and education about their chronic conditions. Education and Empowerment: Educate patients about their health conditions and empower them with lifestyle and behavior strategies to actively manage their chronic conditions. Assist patients to set and reach goals in line with their provider-approved care plans. Documentation: Maintain accurate and up-to-date patient records, ensuring all interactions and care plans are documented per protocol. Problem Solving: Address patient concerns and barriers to care, working to find practical solutions to improve patient adherence and outcomes. Communication: Provide clear, compassionate, and effective communication to patients. Follow approved workflows regarding communicating patient needs to their providers. Continuous Improvement: Participate in training sessions, team meetings, and quality improvement initiatives to enhance the care navigation process and patient experience. Evaluation and Responding: Respond to remotely transmitted patient data such as blood pressure, blood glucose, weight, and pulse oximetry according to approved partner workflows.
At Vision Legacy Management in partnership with Innovate Financials, we are a team of driven financial professionals dedicated to empowering individuals and families through financial education and leadership. We believe that financial literacy is the cornerstone of true financial independence—and our mission is to equip our clients with the knowledge, tools, and confidence they need to take control of their financial future.
Are you a Licensed Practical Nurse, Registered Nurse, Nurse Practitioner or Physician Assistant who's passionate about helping families - but seeking a career that offers freedom of time, less burnout and long term financial stability? You're not alone. You'll be trained and supported by a team made up primarily of fellow medical professionals. This is a fully remote, work-from-home opportunity as a Financial Professional—ideal for Nurses (RNs/NPs) looking to transition or diversify. Flexible Schedule | Part-Time or Full-Time | Not a Nursing Position High Income Potential | Full Training Provided & Mentorship Important Role Details (Please Read Carefully) Compensation Type: 100% commission-based Employment Status: Independent Contractor (1099) Licensing fees required. (Reimbursement Options)
Nurses are naturally positioned to succeed in the financial industry because of the qualities and skills they already possess: Empathy & Care – Just like in healthcare, financial services require deep care for people’s well-being. Nurses already lead with heart, making them trusted advisors in both health and wealth. Strong Communication – Nurses are trained to explain complex medical information clearly to patients. That same skill translates powerfully into breaking down financial concepts for clients. Problem Solvers – Nurses are trained to assess, analyze, and respond quickly. In financial services, they use those same instincts to guide clients toward solutions that protect and grow their assets. Service-Driven Mindset – The profession is rooted in service—and that doesn’t change. Nurses find deep fulfillment helping families not just heal, but thrive financially. Respected & Trusted – Nurses hold one of the most trusted roles in society. That reputation carries into financial services, where trust is everything.
Educate individuals and families on key financial concepts such as income protection, retirement planning, debt management, and wealth building Guide clients through life’s transitions—whether it’s protecting a new baby, preparing for college, or planning for retirement Build genuine, trust-based relationships with clients through empathy, education, and integrity Collaborate with a team of professionals (many with medical backgrounds like yours) for ongoing training, mentorship, and support Maintain and grow your own client base with flexible scheduling—full-time or part-time
Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.
The Nurse Auditor 2 performs clinical audit/validation processes to ensure that medical record documentation and coding for services rendered is complete, compliant, and accurate to support optimal reimbursement. You will report to the Supervisor, Payment Integrity.
Use your skills to make an impact : Active RN license Experience with outpatient CPT/HCPCS codes Experience with review of medical records 2+ years clinical experience 3+ years' experience in the health industry Preferred Qualifications: Certified Professional Coder (CPC) Familiar with lab or genetic testing Fraud, Waste, and Abuse Investigative experience. Clinical auditing experience Bachelor's degree Familiarity with CMS and Humana regulatory policies Knowledge of general lab billing Additional Information WORK STYLE: Remote/work at home. WORK HOURS: Business hours are Monday-Friday, expected to work 8 hours/day, 5 days/week HireVue: As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Work at Home: To Ensure Home Or Hybrid Home/Office Employees' Ability To Work Effectively, The Self-provided Internet Service Of Home Or Hybrid Home/Office Employees Must Meet The Following Criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
Validate and interpret medical documentation to ensure capture of all relevant coding. Apply clinical and coding experience to conduct reviews of provider codes and billing focus on laboratory services and involve medical auditing of genetics, drug testing and infection agent testing claims that require interpretation and independent determination of the appropriate courses of action. Reviews involve the review of Fraud Waste and abuse case determinations and require documentation and follow up regarding the result of these cases.
Luminary Hospice is dedicated to providing compassionate, patient-centered care that upholds dignity and respect at the most critical times in life. We focus on delivering tailored end-of-life care to meet individual and family needs, ensuring comfort and support throughout the journey. Our mission reflects our unwavering commitment to brightening lives through understanding, empathy, and exceptional service. We are honored to be a trusted partner in the communities we serve.
This full-time remote role as a Registered Nurse at Luminary Hospice involves delivering high-quality hospice care to patients and providing support to their families. Responsibilities include conducting initial and ongoing patient assessments, developing and implementing care plans, and managing pain and symptom relief. The role also involves offering emotional and educational support to patients and their families, coordinating care with interdisciplinary teams, and ensuring compliance with hospice regulations and policies.
Licensed Registered Nurse (RN) with a valid and active nursing license Strong clinical skills, including patient assessment and care planning Proficiency in pain and symptom management Excellent communication and interpersonal skills to support patients and their families Experience in end-of-life care and hospice care is preferred Ability to work independently in a remote setting with strong time management and organizational skills Adaptability to work with diverse patient populations in various circumstances CPR certification and valid driver’s license may be required
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.
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.
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 Physical and Mental Requirements: Ability to perform the essential functions of the position safely and effectively, with or without reasonable accommodation, including meeting established qualitative and/or quantitative productivity standards. Ability to maintain regular, punctual attendance in accordance with organizational policies. Ability to remain seated for extended periods of time (approximately six [6] to eight [8] hours per workday). Continuous use of a computer workstation, including frequent keyboarding and mouse usage, requiring repetitive hand and finger movements. Ability to perform frequent neck twisting and occasional bending of the neck and waist as required to perform job duties. This job description is not an exclusive or exhaustive list of all job functions that an employee in this position may be asked to perform. Duties and responsibilities can be changed, expanded, reduced, or delegated by management to meet the business needs of MedCom a Personify Health Company.
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.
At WNS HealthHelp (A Capgemini Company), our mission is to collaborate with payors and providers to improve patient safety and deliver quality care through an evidence-based, educative, and collaborative model, focused on improving outcomes and reducing healthcare costs. We’re revolutionizing healthcare delivery by ensuring patients receive the most appropriate, cost-effective care while supporting healthcare providers in their decision-making process.
SCHEDULE: 7AM – 5PM PST/9AM – 7PM CST Monday- Friday while you should remain flexible based on business needs which could include weekends or alternative daytime hours.
N graduate from an accredited school of nursing (BSN preferred) Current, active unrestricted RN license in the state or territory of the U.S. (USRN equivalent) Two (2) years of experience in an acute care setting, required Two (2) years of inpatient clinical nursing, utilization management, or case management experience, preferred Experience with InterQual or similar evidence-based clinical decision support criteria, preferred Willingness to complete and maintain InterQual certification and ongoing competency requirements Familiarity with inpatient level-of-care criteria, observation versus inpatient status determinations, and transitional care planning, preferred Working knowledge of medical necessity criteria, level-of-care determination standards, and payer-specific utilization review requirements Knowledge of insurance terminology Experience working with state and federal regulatory and compliance standards, preferred Proficient technical skills in Microsoft Office (Word, Excel, and PowerPoint), required Good organizational and time management skills Excellent written and verbal communication skills Ability to utilize critical thinking skills Highly motivated, self-starter who can work efficiently and independently, or as a team member
Performs concurrent inpatient utilization review using InterQual criteria to determine if the request meets medical necessity criteria, including: Admission reviews Continued stay reviews Transitional care reviews (Skilled Nursing Facility, Inpatient Rehabilitation Facility, Long-Term Acute Care Hospital) Related follow-up activities and documentation updates Engage in clinical collaboration with attending physicians, hospitalists, and care teams to obtain clinical information, discuss medical necessity determinations, and support appropriate level-of-care decisions Capable of communicating clinical rationale to attending physicians, hospitalists, and facility staff during real-time concurrent review interactions Facilitates resolution of escalated cases that may require special handling Refers cases to a Physician Reviewer or to a Specialty Program Medical Director per guidelines Assists Physician Reviewers and Medical Directors, as necessary, to ensure compliance with review timeframes Maintains written documentation according to HealthHelp’s documentation policy Has a working knowledge of regulations, accreditation requirements, and payer-specific guidelines by state and market; applies InterQual level-of-care criteria and applicable HealthHelp or client medical policies to inpatient review determinations Adheres to all HIPAA, state, and federal regulations pertaining to the clinical programs Complies with URAC & NCQA standards or other requisite regulating bodies Ensures consistency in implementation of policy, procedure, and regulatory requirements in collaboration with Nursing Management Keeps current with regulation changes as provided by Compliance Department and Nursing Management Functions as subject matter expert to support Compliance Department initiatives and updates Collects and enters confidential information ensuring the highest level of confidentiality in all areas Performs clinical intake and reviews cases according to the policies and procedures of HealthHelp for markets and cases requiring expedited turnaround times Maintains availability to support concurrent review coverage requirements, which may include non-standard business hours, weekends, or holidays as determined by client contractual obligations and regulatory review timeframes Ability to perform multiple tasks simultaneously, prioritize projects, work independently under pressure, and meet critical deadlines Appropriately identifies and refers quality issues to UM Leadership Collaborates with client personnel to resolve customer concerns Provides quality customer service through interaction with providers, administrative staff, and others Creates, encourages, and supports an environment that fosters teamwork, respect, diversity, and cooperation with others Promotes business focus which demonstrates an understanding of the company’s vision, mission, and strategy Participates in the HealthHelp Quality Management Program, as required Performs other related duties and projects as assigned to meet business needs
EXL (NASDAQ: EXLS) is a leading data analytics and digital operations and solutions company. We partner with clients using a data and AI-led approach to reinvent business models, drive better business outcomes and unlock growth with speed. EXL harnesses the power of data, analytics, AI, and deep industry knowledge to transform operations for the world’s leading corporations in industries including insurance, healthcare, banking and financial services, media and retail, among others. EXL was founded in 1999 with the core values of innovation, collaboration, excellence, integrity and respect. We are headquartered in New York and have more than 54,000 employees spanning six continents. For more information, visit www.exlservice.com.
EXL Health offers an exciting, fast paced, and innovative environment, which brings together a group of sharp and entrepreneurial professionals who are eager to influence business decisions. From your very first day, you get an opportunity to work closely with highly experienced, world class Healthcare consultants You can expect to learn many aspects of businesses that our clients engage in. You will also learn effective teamwork and time-management skills—key aspects for personal and professional growth We provide guidance/coaching to every employee through our mentoring program wherein every junior-level employee is assigned a senior-level professional as an advisor The sky is the limit for our team members. The unique experiences gathered at EXL Health sets the stage for further growth and development in our company and beyond
Qualifications: RN required; Bachelor’s or Master’s degree preferred Deep understanding of HIPPS billing codes, MDS 3.0 coding rules, and case management Minimum 5 years of experience in a Skilled Nursing Facility and/or Long Term Care, auditing, or payment integrity Strong experience with PDPM (Patient-Driven Payment Model) Experience with MDS assessments, SNF documentation, and reimbursement structures Minimum 3 years of experience delivering training, facilitation, or coaching within a coding or audit environment Knowledge and Skills: Strong working knowledge of MDS, PDPM components, and MDS-driven reimbursement Ability to interpret clinical documentation and apply classification logic accurately in an audit setting Demonstrated ability to facilitate instructor-led, virtual, and blended training for adult learners Ability to translate complex regulatory and clinical concepts into clear, practical, and engaging learning experiences Strong analytical skills to identify error patterns, knowledge gaps, and training opportunities based on audit data Effective communication and facilitation skills, with the ability to engage learners and manage group dynamics Ability to collaborate cross-functionally with Quality, Audit, and SME partners Strong organizational and time management skills to manage multiple priorities and deadlines Proficiency with Excel, PowerPoint, Word, Outlook, and Encoder tools (Optum, TrueCode, 3M, Webstrat) and training / collaboration tools (e.g., LMS, MS Teams, Excel, PowerPoint)
Deliver structured training and facilitation for SNF/PDPM auditors, including new hire onboarding and ongoing development Translate audit findings and error trends into targeted training, coaching, and reinforcement activities Provide one-on-one and group coaching to address performance gaps and improve audit accuracy and consistency Support trainees in developing strong clinical documentation interpretation and classification logic for SNF claims Reinforce application of PDPM components, including MDS-driven reimbursement factors Conduct observation sessions, case reviews, and teach-back activities to validate learner understanding and application Utilize progress reports and performance data to identify trends, root causes, and opportunities for intervention Support trainees in achieving performance expectations and progressing efficiently through training to independent production Partner with Quality, Audit, and SMEs to ensure alignment on audit logic, regulatory guidance, and training priorities Maintain accurate training documentation, including progress tracking, coaching notes, and performance updates Own and contribute to the development and enhancement of training materials, case studies, and job aids
Nsight Health is transforming how care is delivered through Remote Patient Monitoring (RPM), Chronic Care Management (CCM), and Behavioral Health Integration (BHI). We empower healthcare providers to manage chronic conditions using real-time data, AI-enabled technology, and 24/7 clinical support. Our HIPAA-compliant platform connects patients and care teams nationwide—improving outcomes, adherence, and peace of mind. Join a fast-growing, mission-driven team that blends healthcare and technology to make a measurable difference in people’s lives. Nsight Health — Where Technology Meets Compassion.
We are seeking a motivated and detail-oriented LVN/LPN to join our Chronic Care Management team. In this role, you will play a critical role in patient care by conducting comprehensive assessment calls, developing and educating patients on care plans, performing Behavioral Health Integration (BHI) assessments, and assisting patients with medical device troubleshooting.
Required: Active LPN/LVN Compact License required. Strong communication and organizational skills Bilingual Proficiency: Fluent in English and Spanish Proficient with computers, EMRs, and telehealth tools Preferred: Passionate about patient care, possessing the ability to relate with empathy and compassion. A passion for patient teaching is a must. At least 1 year of nursing experience preferred (RPM, telehealth, or chronic care experience is a plus) Work From Home Requirements Minimum fiber internet speed of 50 Mbps download / 10 Mbps upload Hardwired internet connection required Speed test submission required during the offer process Private, HIPAA-compliant workspace Schedule Varying Shifts Training Requirements All new hires must complete a comprehensive training program: Duration: Five weeks Schedule: Monday through Friday, 9:00 AM – 6:00 PM Eastern Time Attendance is mandatory to ensure readiness prior to independently supporting patients.
Conduct thorough assessment calls with patients to gather relevant information about their health status, concerns, and needs Identify and escalate patient needs, including refill requests, appointment scheduling, and connecting patients with community resources Develop comprehensive care plans based on patient assessments Perform Behavioral Health Integration (BHI) assessments to evaluate and address the mental health aspects of patient care Maintain compliance with company policies and applicable regulations Perform other duties as assigned
At Nsight Health, you’ll be part of a fast-growing organization that sits at the intersection of healthcare, technology, and compassion. We’re looking for people who care deeply about improving patient lives and building the future of connected care. Our team culture is collaborative, agile, and purpose-driven. Every role—from clinical operations and customer success to marketing, technology, and leadership—directly contributes to improving how healthcare organizations care for their patients.
Nsight Health is transforming how care is delivered through Remote Patient Monitoring (RPM), Chronic Care Management (CCM), and Behavioral Health Integration (BHI). We empower healthcare providers to manage chronic conditions using real-time data, AI-enabled technology, and 24/7 clinical support. Our HIPAA-compliant platform connects patients and care teams nationwide—improving outcomes, adherence, and peace of mind. Join a fast-growing, mission-driven team that blends healthcare and technology to make a measurable difference in people’s lives. Nsight Health — Where Technology Meets Compassion. We are seeking a motivated and detail-oriented LVN/LPN to join our Chronic Care Management team. In this role, you will play a critical role in patient care by conducting comprehensive assessment calls, developing and educating patients on care plans, performing Behavioral Health Integration (BHI) assessments, and assisting patients with medical device troubleshooting.
Required: Active LPN/LVN Compact License required. Strong communication and organizational skills Preferred: Passionate about patient care, possessing the ability to relate with empathy and compassion. A passion for patient teaching is a must. Work From Home Requirements Minimum fiber internet speed of 50 Mbps download / 10 Mbps upload Hardwired internet connection required Speed test submission required during the offer process Private, HIPAA-compliant workspace Schedule Varying Shifts Training Requirements All new hires must complete a comprehensive training program: Duration: Five weeks Schedule: Monday through Friday, 9:00 AM – 6:00 PM Eastern Time Attendance is mandatory to ensure readiness prior to independently supporting patients.
Conduct thorough assessment calls with patients to gather relevant information about their health status, concerns, and needs Identify and escalate patient needs, including refill requests, appointment scheduling, and connecting patients with community resources Develop comprehensive care plans based on patient assessments Perform Behavioral Health Integration (BHI) assessments to evaluate and address the mental health aspects of patient care Maintain compliance with company policies and applicable regulations Perform other duties as assigned
Healthcare equality is at the center of Devoted’s mission to treat our members like family. We are committed to a diverse and vibrant workforce. At Devoted Health, we’re on a mission to dramatically improve the health and well-being of older Americans by caring for every person like family. That’s why we’re gathering smart, diverse, and big-hearted people to create a new kind of all-in-one healthcare company — one that combines compassion, health insurance, clinical care, service, and technology - to deliver a complete and integrated healthcare solution that delivers high quality care that everyone would want for someone they love. Founded in 2017, we've grown fast and now serve members across the United States. And we've just started. So join us on this mission!
Schedule: This role supports our weekend operations and requires availability every Saturday and Sunday. The weekly schedule is a 5-day (8-hour) schedule, totaling 40 hours per week. Shifts are scheduled within the hours of 8:00 AM–8:00 PM ET. A bit about this role: As a Clinical Guide, you'll have the opportunity to make a difference in the lives of our members. You'll be responsible for providing clinical review of cases using standard criteria to determine the medical appropriateness of inpatient and outpatient services while supporting our members through assessment, care, and conservation. You'll serve as an advocate for our members, coordinating care and ensuring they have the necessary resources and support to achieve their health goals (recovering from an illness, improving quality of life, overall well-being, etc.) Our Clinical Guide is committed to integrity and excellence and empowering members to confidently navigate the healthcare system and live healthier lives. Our ideal Clinical Guide is caring, compassionate and solutions-oriented, and is enthusiastic about providing outstanding experience for Devoted Health’s members.
Required skills and experience: Ability to work in a startup, fast paced environment. An unrestricted RN license. A minimum of 4 years of RN experience. A minimum of 3 years’ experience doing utilization management at a health plan. The ability to comfortably multi- task: you’ll be listening, talking, and typing all at the same time. Team player mentality with a can-do attitude. Understanding of CMS guidelines and MA requirements. Desired skills and experience: A desire to make a change in the health care experience: you love to serve and make a difference. Proven success in building relationships. The ability to adjust your tone and approach to different people. The ability to articulate and break down complex information. Adaptability and comfort in a dynamic, startup environment. Transparency in your work - what’s going well and what’s not.
Engage with members and understand their needs, using technology and data to better understand the member and any unspoken needs. Performs initial, concurrent, and discharge reviews of all cases, including using medical guidelines to determine the medical appropriateness of inpatient and outpatient services; assessing, interpreting, and responding to the needs or requirements of patients; identifying, escalating and resolving complex cases or issues as required. Reviews current charts for appropriateness and correct admission status (inpatient, observation, bedded outpatients). Alerts and collaborates with appropriate leadership concerning patients who do not meet medical appropriateness criteria. Obtains admission and continued stay certification or recertification. Communicates with an attending physician regarding patients who do not meet criteria to identify additional documentation needs or potential status change. Coordinates care and discharge planning. Makes arrangements for appropriate post-hospital care, including physical and behavioral medicine, transportation, equipment, home health care, etc. Identifies, documents, and communicates potential quality assurance or risk management issues as appropriate. Conduct holistic assessment to identify co-morbid conditions, ED/ hospitalization history, medications, psycho-social factors, and member values and preferences. Collaborate with our PCP partners. Develop care plans in partnership with members and their caregivers - problems, goals, interventions - continuously evaluating the member’s progress. Work closely with Local Service Guides to identify community-based organizations to support the members in meeting their goals. Collaborate with members, providers, and caregivers to ensure a positive outcome. Explain complicated medical terms in plain language. Educate members on appropriate care and settings based upon their healthcare needs. Support members in understanding diagnostic tests and treatments, including costs, risks, and alternatives so they can make an informed decision. Prepare members for their inpatient and outpatient treatments and coordinate post-treatment care. Support and coach members to improve management of their chronic conditions, including medication adherence and compliance.
Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member. Location: Remote within US only Position Summary The PRN Clinical Review Specialist provides clinical review support on an as-needed basis to assist with fluctuations in inventory and client demand. This role is responsible for reviewing medical records for medical necessity, level of care, authorization compliance, and payer guideline alignment across inpatient and outpatient services. The position supports timely appeal submissions and inventory management while maintaining quality and compliance standards.
Required Qualifications: Active, unrestricted RN license (compact preferred) Minimum 3–5 years of clinical experience 2+ years of Utilization Review, Appeals, or Clinical Review experience Strong knowledge of medical necessity criteria and payer guidelines Experience writing appeals letters Experience reviewing inpatient and/or outpatient hospital claims Proficiency with EMRs and review platforms (Epic preferred) Strong written clinical documentation and time management skills Experience with payer appeals (medical necessity, no-auth, readmissions) Familiarity with InterQual, MCG, or payer-specific criteria Prior remote clinical review experience Multi-client or vendor-side experience Knowledge of Medicare, Medicaid, and commercial payer processes Schedule & Work Expectations: PRN / variable hours based on inventory needs Remote, independent work with defined productivity expectations Availability may include weekdays and/or short-term surge support Performance Expectations: Timely completion of assigned reviews Accurate application of clinical criteria and payer policy Clear, compliant documentation Ability to adapt to changing inventory and priorities Physical Demands Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
Perform clinical reviews for medical necessity, level of care, and authorization-related denials Review inpatient and outpatient medical records to support appeal submissions Apply payer-specific guidelines (CMS, Medicaid, commercial) and internal policies Identify documentation gaps and support clear, defensible clinical narratives Meet assigned turnaround times while maintaining quality standards Document review findings accurately in designated systems Collaborate with clinical leadership as needed for escalations or complex cases A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.
GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.
This position performs utilization management review. This position determines appropriateness of services, medical necessity, and location of services required to encourage effective, high-quality care and cost-efficient outcomes through. This position requires excellent verbal and written communication, organization and time management skills.
EDUCATION AND EXPERIENCE: Current active LPN license in Oklahoma/Texas or compact Experience in managed care/utilization management preferred Minimum of 3-5 years of clinical experience required KNOWLEDGE, SKILLS AND ABILITIES: Working knowledge of ICD-10/CPT codes preferred Working knowledge of Microsoft software programs Excellent organizational skills Strong communication skills Proven ability to work independently and as a member of a team WORK ENVIRONMENT: Current work environment is remote; however, some state exclusions apply. Must have access to a reliable and secured internet connection source. Work environment must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. This position will also be required to use reasonable and necessary safeguards to protect GlobalHealth records from unauthorized access, disclosure or damage and will adhere to all GlobalHealth privacy and security policies. TRAVEL: May require limited travel for offsite meetings or training
Reviews preservice requests, appropriateness of services, and ensure timely determination Communicates with customers, both internal and external, regarding status of referral/referral process. Utilizes NCDs, LCDs, MCG, and additional guidelines to assist in determining coverage of the request. Maintains current knowledge of managed care issues (benefits, contracted providers, health plan guidelines, MCG, NCD, LCD and community standards of practice and regulatory developments, and new and experimental procedures). Collaboration with internal team to support member needs, including but not limited to discharge planning, provider relations, and care management. Adheres to company and department policies and procedures. Performs other duties as assigned SUPERVISORY RESPONSIBILITY: This position has no supervisory responsibility OTHER DUTIES: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.
PURPOSE OF THE JOB: Provides nurse advice and triage services to consumers calling with clinical questions. SUMMARY OF KEY RESPONSIBILITES: Provide appropriate compassionate advice to callers using evidence based clinical decision tools to help callers make personal health decisions. Make cross referrals as indicated. Facilitate referrals and event registration through internal transfer mechanisms.
Knowledge: Demonstrates knowledge and understanding of organizational and departmental policies, procedures and systems Skills: Communicates clearly and concisely both verbally and in writing Establishes and maintains long-term customer relationships, building trust and respect Abilities: Demonstrates good judgment in handling situations not covered by written or verbal instructions Able to work effectively with internal and external customers Able to perform basic mathematical calculations, balance and reconcile figures, punctuate properly, spell correctly, and transcribe accurately Able to handle multiple priorities and manage stress appropriately EDUCATION: The position requires an entry knowledge level generally obtained through completion of an Associate's Degree or an equivalent in demonstrated work experience. EXPERIENCE: Minimum of three (3) years of experience in acute care nursing, required, telehealth preferred. Please note that ACUTE is a critical aspect (Acute – In hospital care bedside) CERTIFICATE(s)/LICENSE(s): Active RN Compact license in state of residence required and ability to obtain licensure in all states served by HCA. PHYSICAL DEMANDS, WORKING CONDITIONS, ESSENTIAL FUNCTIONS: Manual Dexterity, hand-eye coordination Repetitive arm/hand movements Sight Acuity – far, near, depth perception Sitting for prolonged periods of time Reaching, bending, stooping, kneeling, crawling Location: Plantation, Florida
DUTIES AND RESPONSIBILITIES: Utilizes nursing skill and along with approved protocols to provide telephone nurse triage and/or health advice to consumers with clinical questions or symptoms. Facilitates referrals for health services as appropriate via telephone and performs all components of call processing Ensures performance standards are met and accepts constructive feedback Speaks with a pleasant, professional phone voice and provides superior customer service to create an exceptional patient experience. Documents caller information and outcomes in a relational database system in accurately and as prescribed by current standards and policies Maintains confidentiality, HIPAA and PHI compliance Communicates appropriately and clearly with departmental management, co-workers and callers and exhibits willingness to master new work routines and methods Practices and adheres to HCA’s “Code of Conduct” and “Mission and Value Statement” Provides homecare, advice and/or education to callers that respects the cultural, spiritual, intellectual/educational, and psychosocial differences of individuals and preserves caller’s autonomy, dignity and rights. Maintains and contributes to a collaborative professional and ethical work environment. Actively participates in team meetings and engages in the processes of the contact center
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