UCare

Care Coordinator – MSHO/MSC+ / Active, Unrestricted LSW or RN License required. Travel required throughout designated counties in Minnesota.

Posted on:

May 30, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Minnesota

UCare is an independent, nonprofit health plan providing health care and administrative services to more than 600,000 members throughout Minnesota and parts of western Wisconsin. UCare partners with health care providers, counties, and community organizations to create and deliver Medicare, Medicaid and Individual & Family health plans. The health plan addresses health care disparities and care access issues through a broad array of community initiatives. UCare is the highest ranked health plan in the USA Today 2024 Top Workplaces and has received Top Workplaces honors from the Star Tribune for 15 consecutive years since the rankings began in 2010.

The current hiring base salary range for this role is: $84,436.00/year – $94,990.50/year UCare anticipates paying within the above-references salary range for this position. The actual base salary offer for this position will be determined by a variety of components including but not limited to work experience, education, certifications, location of the role, internal equity, and other relevant factors. LOCATION: Minneapolis, MN (Work from Home) Travel Required to Designated Counties in Minnesota Position Description: As the Care Coordinator – MSHO/MSC+, you will be responsible to coordinate services across the continuum of health care to meet the health and/or social service needs of members in Government plan products as assigned.Coordinate member services with appropriate primary care clinics/providers, care systems, specialists, clinic, county, and UCare personnel to achieve the most appropriate and cost-effective member care to optimize the long-term health of the member.

Education: B.S. in nursing or B.A. in social work or a closely related field. Registered Nurse with a nursing diploma (3-year program) or associate degree in nursing with five or more years' experience also considered. Current and unrestricted Minnesota license as an RN is required or social worker is required. Licensure requirements may depend on assigned product(s). Required Experience: Two year's experience in care coordination/case management across the continuum of health care (hospital, clinic, nursing home, home care etc.) with primary emphasis in working with complex social and medical problems. MnCHOICES certified assessor credential in place or with a plan to receive assessor credential within 3 months of hire date. Preferred Experience: Managed care experience, experience with government programs, particularly Medicare, Medicaid and other State Public Programs. Experience working with multi-cultural populations desired.Bilingual in Hmong, Spanish, Russian, Somali or Vietnamese.

Collaborate with treatment providers, county and community agencies, and contracted and non-contracted providers to identify and coordinate provision of health care services for Government plan product members. Appropriately apply care coordination criteria, protocols and procedures. Understand and accurately interpret and apply relevant contractual requirements, policies, procedures, and regulations for members which care coordination is a provided service. Collaborate with members and/or family members, primary care physicians, clinic staff, providers, and other relevant agencies to assure appropriateness of service that meets member needs and ensures desired outcomes. Complete in-person comprehensive assessment of assigned members.Appropriately utilize interpreter services as needed.Identify and monitor member needs, including needed preventive medical care, and significant changes in condition which may warrant early intervention for medical problems.Develop care plans to meet each member’s individual needs. Incorporate ethnic and culturally appropriate approaches to care planning. Present information on assigned members at assessment conferences and case reviews as appropriate.Enter member information in the clinical documentation system, GuidingCare software.Complete accurate, thorough, and timely required documentation. Meet and maintain all established caseload and performance metrics. Ensure safe transitions when members move from one setting to another (i.e. being discharged from a hospital or skilled nursing facility).Ensure the plan of care is communicated between the sending and receiving settings for both planned and unplanned transitions.Support members and member families through care transitions between various facilities, acute and/or chronic settings, and community-based living situations including home. Use appropriate communication tools per contractual and care model requirements. Monitor and report all quality-of-care issues through the appropriate internal or external systems. Assist with CMS Star Rating initiatives or HEDIS quality initiatives and project improvement planning as appropriate. Attend internal and external meetings, including staff meeting, discharge planning conferences, community meetings. Provide back-up coverage for other care coordinators as assigned. Must have reliable transportation to travel through designated counties in Minnesota. Other projects and duties as assigned.

Optum

LPN Supervisor - Remote

Posted on:

May 30, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

LPN/LVN

State License:

Minnesota

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 Supervisor LPN is responsible for coordinating and implementing the HEDIS and STAR’s call center campaigns and works in collaboration with the Director of STARS Call Center to develop strategies for achieving a 5 STAR rating. Directly responsible to manage teams of clinical and nonclinical staff who perform central call initiatives such as performing telephonic outreach to retrieve and/or disseminate appropriate information as relates to member care and CMS quality measures as well as to resolve quality gaps. Coordinates, supervises and is accountable for the daily functions of the patient navigator team. The Supervisor LPN provides support to various corporate interdepartmental teams in the implementation of strategies of the call center for closing care gaps. This role works closely and collaboratively with various functional areas of the healthcare and quality team to achieve the goals and objectives of the Quality Improvement Program. through CAHPS & HOS initiatives, Medication Adherence initiatives, and Part C Gap closures. The Supervisor LPN assists the department with business process and policy development of programs and productivity initiatives. Develops and analyzes monthly reports and a variety of ad hoc reports to support key departmental and corporate initiatives. Schedule: Monday - Friday 8 hour work day between the hours of 7:00 a.m. - 8:00 p.m. CST. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Required Qualifications: Unrestricted Nursing License 3+ years of experience within a healthcare environment including experience within a managed care setting, including 2+ years of supervisory experience 1+ years of experience with data analysis HEDIS/STAR experience Advanced experience using Microsoft office applications, including but not limited to databases, word-processing, spreadsheets, and graphical displays Demonstrated ability to delegate task appropriately to meet established timelines Basic understanding of quality improvement standards such as HEDIS, CAHPS, HOS and CMS Proven capability to work with people at all levels in an organization Proven excellent training and presentation skills with solid communication capabilities and practices, both oral and written Demonstrated effective organizational skills Proven excellent communication, writing, proofreading and grammar skills Proven solid attention to detail and accuracy, excellent Evaluative and Analytical skills Proven solid teamwork, interpersonal, verbal, written, and administrative and customer service skills Proven solid interpersonal skills and the ability to work independently, as well as a member of a team Preferred Qualifications: 2+ years of related experience in a call center or service operation 2+ years of hands on experience with forecasting, capacity planning and scheduling methodologies in a call center environment 2+ years HEDIS & STARs experience Hands on experience with forecasting, capacity planning and scheduling software Auditing experience Proven excellent written and verbal communication skills Proven excellent relationship building skills Proven planning and organizational skills to demonstrate leadership and initiative Physical & Mental Requirements: Ability to lift up to 25 pounds Ability to sit for extended periods of time Ability to use fine motor skills to operate office equipment and/or machinery Ability to receive and comprehend instructions verbally and/or in writing Ability to use logical reasoning for simple and complex problem solving All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Oversees the Patient Navigator Team and the day-to-day operation of the call center campaigns Provides leadership and support in establishing and executing the STARS Call Center Initiatives in alignment with corporate goals Supervises and coordinates the work activities of the team Monitors productivity, call center metrics, documentation and call quality to ensure established standards are met Coach and develop management team to acquire and refine necessary job skills through constructive feedback, ongoing training, and other coaching techniques. Conduct regular performance reviews and one-on-one meetings with direct reports to evaluate performance against KPIs Oversight and analysis of daily, weekly, and monthly operational reports and the development and implementation of action plans to address deficiencies Provide regular communication to Senior Leadership regarding current operational performance and make recommendations for improvements and increasing capacity at scale Partner with Senior Leadership and Human Resources to execute strategic recruiting and employee engagement programs to attract and retain top performers Oversight of the execution of short and long-term performance goals developed by Senior Leadership Team Work with internal teams on strategy and capacity planning Responsible for oversight of call center operational strategies including but not limited to conducting needs assessments, performance reviews, capacity planning, and cost/benefit analyses; identifying and evaluating state-of-the-art technologies; defining user requirements; establishing technical specifications, and production, productivity, quality, and customer service standards Oversight of SOPs and Workflows for the STARS Call Center Team Ability to perform work with minimal supervision Performs all other related duties as assigned

The Judge Group

Clinical Documentation Specialist Nurse (RN or LPN)

Posted on:

May 30, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Pennsylvania

Job Title: Clinical Documentation Integrity RN or LPN (Remote) Job Type: W2 contract to hire/ temp to perm (conversion to full time after 6 months) Location: Remote (U.S. Based) Schedule: Monday to Friday, 8:00 AM–4:30 PM EST (Training start between 8–9 AM EST) Job Summary: We are seeking a highly skilled and coachable Clinical Documentation Integrity (CDI) RN or LPN to join our team. This role focuses on improving the accuracy and quality of clinical documentation through concurrent and retrospective reviews of medical records. The ideal candidate has strong DRG knowledge, is query-proficient, and brings 2–5+ years of recent adult bedside CDI experience.

Minimum Requirements License: Active RN or LPN/LVN licensure (NPs also considered) Certification Required: CCDS (Certified Clinical Documentation Specialist) through ACDIS Verify at: acdis.org Not Accepted: CDIP certification Optional: CRCR (Certified Revenue Cycle Representative) through HFMA Verify at: hfma.org Experience: 2–5+ years of CDI experience in adult bedside settings (5 years preferred) DRG assignment and query development proficiency required Experience with MS-DRG and APR-DRG focused reviews strongly preferred Skills & Abilities: Proficiency in querying and clinical code assignment Solid understanding of healthcare reimbursement models and documentation compliance Exceptional written/verbal communication and interpersonal skills Strong public speaking and training skills Ability to lead cross-functional collaboration and education initiatives Adaptable, highly coachable, and a proactive team contributor Proficient in Microsoft Office Suite and EMR systems Additional Information: A pre-submission assessment mirroring the CCDS exam will be required (provided by R1 upon conditional approval) Candidates must demonstrate a track record of teamwork and adaptability in high-performance environments How to Apply: Submit your resume along with your CCDS certification and licensing details. Qualified candidates will be contacted to complete the required assessment.

Conduct clinical documentation reviews to ensure accurate severity of illness, risk of mortality, and complexity of care. Initiate and formulate provider queries when documentation is unclear or incomplete. Lead education efforts for providers and CDI teams based on audit trends and findings. Evaluate CDI team accuracy and standardize review findings and reporting. Collaborate with HIMS, Coding, and Quality teams for complete documentation and accurate DRG assignment. Maintain expert knowledge in CDI best practices, regulatory compliance, and coding guidelines (MS-DRG, APR-DRG). Participate in special reviews such as mortality, PSI, and other quality-driven documentation assessments.

Theratechnologies Inc.

Nurse Navigator

Posted on:

May 30, 2025

Job Type:

Part-Time

Role Type:

Telehealth

License:

RN

State License:

New Jersey

Theratechnologies is a global specialty biopharmaceutical company headquartered in Montreal, Canada with business units in the US, Canada, and Ireland. Theratechnologies is focused on addressing unmet medical needs by bringing to market specialty therapies for people of greatest need.

Part-Time - Remote (West Coast) Evening Shift 2 PM - 7 PM (Monday - Friday) We are seeking a highly motivated and compassionate Part-Time Nurse Navigator to provide virtual and telephonic support to patients and healthcare providers. This role is instrumental in offering education on specific disease states and product use, ensuring optimal therapy application, and enhancing patient satisfaction for improved health outcomes. The ideal candidate will have a strong clinical background and a passion for patient advocacy, with experience in specialty therapies. Remote – Candidates must be based on the West Coast.

Minimum Qualifications Required Education: Bachelor’s degree in nursing or a related healthcare field. Licensure: Active Registered Nurse (RN) license or Advanced Practice degree (Nurse Practitioner, Physician Assistant, PharmD, or MSN). Technical Skills: Comfortable using virtual communication platforms and electronic documentation systems. Preferred Qualifications: Industry Experience: 3–5 years of experience in the healthcare or pharmaceutical industry, particularly in a patient support or nurse educator role. Therapeutic Area Knowledge: Experience in HIV care or related disease states is highly desirable. Specialty Product Expertise: Experience working with infusion and/or subcutaneous injection therapies.

Engage in telephonic and virtual interactions with patients and healthcare providers to provide support, guidance, and disease-state education in accordance with brand policies and compliance guidelines. Serve as a clinical resource to ensure optimal therapy adherence, addressing patient and provider inquiries related to medication administration, side effects, and best practices. Collaborate with internal teams to stay informed on brand-specific guidelines, ensuring accurate and up-to-date information is shared. Act as a liaison between healthcare professionals, and patients, helping to navigate therapy access challenges. Foster patient empowerment and adherence by providing education on self-administration techniques (if applicable), infusion/subcutaneous injection protocols, and symptom management strategies. Maintain detailed documentation of interactions and follow-up activities in compliance with regulatory and company policies.

SPECTRAFORCE

Safety Review Nurse

Posted on:

May 30, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Illinois

Job Title: Safety Review Nurse 100 % remote Duration: 12 Months Provides timely assessment of reported clinical trial data and participates in applicable safety surveillance activities for assigned studies including review of labs, vital signs, cardiac, medications, medical history, and can communicate with Study Lead any findings. Provide review of safety-related data from clinical trials for content, quality, potential study level trend identification, and adherence to regulatory guidance and protocols utilizing critical thinking skills. Monitoring of safety-related queries to Investigators. Adheres to regulatory guidance, protocols, departmental processes and policies under minimum supervision. Current with knowledge of ICH, FDA, and EMA regulatory guidance’s affecting safety surveillance.

Bachelor's degree with related health science background. RN or clinical pharmacy experience strongly preferred. A minimum of 2 years of clinical practice experience is required and 1-year drug safety experience preferred. Strong critical thinking skills with the ability to apply clinical knowledge to adverse event data collection and data assessment. Ability to present accurate and medically sound safety data, both orally and in writing. Effective communication skills in delivering study-related information. Proficiency in Computers (Windows, Word, Excel).

Responsibilities include medical review, which involves in-house review of Case Report Forms (CRFs) including query resolution and addenda writing, QA of data listings. May manage the activities of regional contract CRAs, and organizes the files and budgets associated with several clinical studies. Provides medical support which may include: Adverse Event Reporting - the investigation and reporting of medical product experiences, in depth investigation of medical adverse events and works with Medical Affairs, Clinical, and Regulatory Affairs in the preparation of documentation on adverse events for the FDA; or Medical Communication which includes writing standard and custom responses to communication requests. In-depth assistance to the medical and lay community by responding to inquiries with medical/scientific information that is more complex and requires more data than is supplied in the package insert or the standard letter database. Off-label information would be disseminated at this level. May provide training internally and at investigator meetings on safety issues, responsible for serious adverse events and CRF completion, writing study summaries, and review protocols, study summary investigator brochures and IND annual updates for safety data verification.

Medasource

Prior Authorization RN

Posted on:

May 30, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

Medasource is a leading consulting and professional services firm serving the healthcare industry, including Life Sciences, RCM/Payers, Technology, and Government. We’ve been recognized by both KLAS and Modern Healthcare for being good to our employees, consultants, clients, and communities. With over 100 clients, more than 2,000 active consultants, and over 30 locations across the U.S., we’re focused on propelling the future of healthcare, one client at a time.

The Prior Authorization RN is responsible for reviewing and processing medical prior authorization requests to ensure services are medically necessary, meet evidence-based guidelines, and align with the health plan’s policies. This RN plays a critical role in supporting cost-effective care while ensuring quality and compliance in alignment with regulatory and accreditation standards.

Active, unrestricted Registered Nurse (RN) license in [Arizona or Compact State]. Minimum of 3 years of RN experience in any clinical setting. 3–5 years of experience in case management, prior authorization, or utilization management (UM). Experience working in primarily outpatient settings, with working knowledge of inpatient care coordination. Utilization Management experience is required. Familiarity with reviewing and applying evidence-based clinical guidelines (this is a pre-service focused role). Proficient in the use of MCG (CareWebQI) and InterQual for clinical reviews. Strong clinical judgment and communication skills. High level of attention to detail and documentation accuracy

Manages health Plan consumer/beneficiaries’ across the health care continuum to achieve optimal clinical, financial, operational, and satisfaction outcomes. Provides pre-service determinations, concurrent review, and case management functions within Medical Management. Ensures quality of service and consistent documentation. Works collaboratively with both internal and external customers in assisting health Plan consumer/beneficiaries’ and providers with issues related to prior authorization, utilization management, and/or case management. Meets internal and external customer service expectations regarding duties and professionalism. Performs transfer of accurate, pertinent patient information to support the pre-service determination(s), the transition of patient care needs through the continuum of care, and performs follow-up calls for advanced care coordination. Documents accurately and timely, all interventions and necessary patient related activities in the correct medical record. Evaluates the medical necessity and appropriateness of care, optimizing health Plan consumer/beneficiaries’ outcomes. Identifies issues that may delay patient services and refers to case management, when indicated to facilitate resolution of these issues, pre-service, concurrently and post-service. Provides ongoing education to internal and external stakeholders that play a critical role in the continuum of care model. Training topics consist of population health management, evidence based practices, and all other topics that impact medical management functions. Identifies and refers requests for services to the appropriate Medical Director and/or other physician clinical peer when guidelines are not clearly met. Conducts call rotation for the health plan, as well as departmental call rotation for holiday. Maintains a thorough understanding of each plan, including the Evidence of Coverage, Summary Plan Description authorization requirements, and all applicable federal, state and commercial criteria, such as CMS, MCG, and Hayes.

University of Miami

Registered Nurse 2 (H) (remote) - UHealth SoLé Mia

Posted on:

May 30, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Florida

The University of Miami UHealth at SoLé Mia opening September 2025, will bring high-quality academic medicine to North Miami, Aventura, and surrounding communities. Our expert team of physicians and staff will represent a wide range of specialties, including NCI–designated Sylvester Comprehensive Cancer Center and Bascom Palmer Eye Institute, the number one eye hospital in the nation. UHealth at SoLé Mia will also deliver the latest in urologic treatments from the renowned Desai Sethi Urology Institute as well as top-notch care from UHealth’s nationally ranked neurology and neurosurgery programs. The University of Miami UHealth – Gastroenterology Satellites at SoLé Mia has an exciting opportunity for a Registered Nurse.

The Registered Nurse 2 (H) delivers patient-family centered care in a culturally competent manner utilizing evidence-based standards of quality, safety, and service while ensuring population-specific patient care, collaborating with physicians and multi-disciplinary professional staffs and providing physical and psychological support for patients and their friends and families. Sign on Bonus $10,000

Education: Bachelor of Science in nursing required Certification and Licensing: Registered Nurse License; Basic Life Support Certification (BLS) Advance Cardia Life Support (ACLS) Certified Gastroenterology Registered Nurse (CGRN) preferred. Experience: Minimum of 2 years relevant experience in medical surgical unit or any procedural based departments. Knowledge, Skills and Attitudes: Knowledge of medical terminology Knowledge of nursing care methods and procedures In-depth knowledge of health and safety guidelines and procedures (i.e. sanitation, decontamination etc.) Excellent patient experience skills Ability to recognize, analyze, and solve a variety of problems Ability to maintain effective interpersonal relationships Ability to communicate effectively in both oral and written form Skill in completing assignments accurately and with attention to detail. Ability to analyze, organize and prioritize work under pressure while meeting deadlines. Ability to process and handle confidential information with discretion. Ability to work evenings, nights, and weekends as necessary. Commitment to the University’s core values. Ability to work independently and/or in a collaborative environment. Good clinical assessment skills, flexibility and basic computer skills. Ability to work under stress, moderate periods of sitting, walking, standing and computer use. Analytical abilities necessary to successfully identify a problem and develop a sound action plan for resolution. Ability to work collaboratively with governing committees, health systems quality committees, business office, clinical staff and physicians. Able to work flexible hours in assuming responsibility and accountability in providing patient care. Ability to educate for staff development and in-service education (e.g., annual mandatory programs and department related education needs). Ability to supervise nursing and ancillary staff and delegates authority as appropriate to qualified staff members. Able to assure compliance with accreditation department, federal or state guidelines (e.g., maintain records, report logs, etc. Good clinical assessment skills, flexibility and basic computer skills.

Assesses assigned patients and evaluates plans to include documentation of nursing care. Reports symptoms and changes in patients’ condition and vital signs. Modifies patient treatment plans as indicated by patients’ responses and conditions, and physician orders. Reviews, evaluates and reports diagnostic tests to assess patient’s condition. Consults with physicians and other healthcare professionals related to assigned patients to assess, plan, implement and evaluate patient care plans. Prepares patients for, and assists with examinations, procedures and treatments. Considers patient age and culture during patient treatments and provides any needed information regarding treatment plan. Nurtures a compassionate environment by providing psychological support. Performs appropriate patient tests and safely administers medications within the scope of practice. Administers and maintains accurate records related to medications and treatments as per regulatory bodies, policies, procedures and physician orders. Communicates plan of care in a timely manner to patient and family, as well as the appropriate team members, ensuring compliance with all regulatory guidelines (i.e. HIPAA). Uses best practices for transition of patient care. Uses available resources to assist in discharge planning. Plans, prioritizes, and adjusts assignments to accomplish goals and render superior patient care; seeks assistance when needed. Adapts to changing work demands and environment. Operates the appropriate medical equipment. Adheres to University and unit-level policies and procedures and safeguards University assets.

CorroHealth

Lead, Provider Risk Adjustment (RN required)

Posted on:

May 30, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Texas

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. Lead, Provider Risk Adjustment Coding Services As a member of the CorroHealth team, the Coding Lead utilizes coding knowledge to assist the Director of Coding Services and other members of the Management team in maintaining a high level of client satisfaction through managing the overall quantity and quality of coding production for assigned clients. The candidate will supervise a team of Client Account Coders. Essential Functions Note: The essential duties and primary accountabilities below are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Incumbents may perform all or most of the primary accountabilities listed below. Specific tasks, responsibilities or competencies may be documented in the incumbent’s performance objectives as outlined by the incumbent’s immediate supervisor or manager.

RN or LPN license required National certification through AAPC or AHIMA required, CCDS or CDIP a plus At least 3+ years of previous provider-based risk adjustment coding experience with strong understanding of physician query compliance and composition Previous supervisory experience is preferred Strong computer skills, proficient in Microsoft Office applications including Word and Excel. Ability to navigate in a variety of EMR environments and review hand-written charts Strong verbal and written communication skills are required Ability to prioritize workload, to meet deadlines and to maintain a high level of quality and accuracy Initiative, resourcefulness, and attention to detail Regular, predictable, and punctual attendance is required

Collaborators with global leaders on daily production quantity and quality for each assigned client while maintaining client service level agreement metrics and delivery expectations Review pending accounts and second level quality reviews and for errors or assigns to appropriate staff for remediation and completion Monitors client reports – production, quality, query compliance, and response and resolves issues as necessary Assists in research and resolution of QA disputes and education/trends Tests system and workflow changes related to specific client hospitals Assist assigned Coding Director with independent responsibilities for client reporting and data analysis Recommended staffing modifications and FTEs, assist in overtime planning when necessary Recommend and process salary changes/adjustments/promotions as necessary Responsible for training assistance of new and existing HCC Coding Specialists Participate in and/or lead special projects requiring coding and/or auditing for clients across the organization, as needed Develops and communicates coder schedule and resolves changes to schedule Assist direct reports with accurate application of diagnosis and procedure codes utilizing CMS/HHS HCC models, ICD-10-CM, ICD-10-PCS, CPT®, and HCPCS Provide and/or aid direct reports with interpretation of coding guidelines for accurate code assignment Identify and ensure that direct reports understand the importance of documentation on code assignment and the subsequent reimbursement impact Align personal conduct with and build a team culture that aligns conduct with AHIMA's Standards of Ethical Coding and the Company’s Code of Ethics and Business Conduct Comply with, promote and support direct report’s compliance with all internal policies and procedures Actively participate in Company provided training and education and ensure that direct reports complete mandatory training and education by established deadlines and are able to properly implement and/or practice the principles taught via the Company’s training and education program Ensure individual and direct report compliance with all privacy and security rules and regulations and commit to the protection of all Company confidential information, including but not limited to, Personal Health Information Thoughtfully evaluate risk, participate in the development of risk mitigation activities and engage in correcting deficiencies

CorroHealth

Independent Contractor-Hospital RN (Appeal Writing/Denials Mgmt) (Remote)

Posted on:

May 29, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Texas

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.

This will be a generic IC profile for any clinician that is contracted to work with Corro. 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. At CorroHealth 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. Job Description: Status – Independent Contractor (Part-Time/Flexible) (20 hours per week min.) **Must complete and pass a technical and inpt clinical assessment. (link to be sent) ** JOB SUMMARY: As a Denial Management Appeals Clinician, you will have the unique opportunity to evaluate hospitalizations across the country while utilizing your medical knowledge and gaining experience as an expert advisor. You will perform retrospective clinical case reviews and draft appeals that focus on establishing the Medical Necessity of the services performed, both Inpatient and Outpatient.

RN or MD degree with strong clinical knowledge - Active unrestricted clinical license in at least one state within the United States. Minimum of 5 years recent acute-care hospital experience, preferred. Minimum of 2 years Utilization Review / Case Management experience within the last 5 years. Managed care payor experience a plus in either Utilization Review, Case Management or Appeals. Must have excellent attention to detail, written communication skills and be computer proficient. Work will be assigned on an as-needed basis. It will consistent and weekly for the next several months at least. As such, Consultant will receive a queue assignment/ report a) on Tuesday each week with a due date of the end of the business day the following Thursday and b) on Friday each week with due date of the end of the business day the following Monday. Consultant must provide a minimum of 20 hours per week and not exceed 40 hours per week unless approved by manager.

Performs retrospective medical necessity reviews to determine appeal eligibility of clinical disputes/denials. Constructs and documents a succinct and fact-based clinical case to support appeal utilizing appropriate medical necessity criteria and other pertinent clinical facts. Pertinent clinical facts include, but are not limited to, documentation preventing a safe transfer/discharge or documentation of medical necessary services denied for no authorization. Demonstrates ability to critically think, problem solve and make independent decisions supporting the clinical appeal process.

Dane Street

Utilization Management Nurse Reviewer (RN/LPN)

Posted on:

May 29, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Florida

The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately. They review medical records, treatment plans, and patient information to determine the necessity and appropriateness of medical procedures, tests, and treatments. Utilization Management Nurse Reviewers collaborate with healthcare providers, insurance companies, and patients to optimize healthcare delivery, control costs, and maintain quality care. Their responsibilities include assessing medical necessity, coordinating care, conducting utilization reviews, providing recommendations for care plans, and ensuring adherence to regulations and guidelines. This role requires strong clinical knowledge, critical thinking skills, communication abilities, and the ability to make informed decisions regarding patient care pathways. Shifts available: Evening shift (12-8PM EST) and weekends as needed (11-7 PM EST) and weekends as needed

Proficient in both written and spoken communication Capable of maintaining professional communication with physicians and clients Skilled at handling multiple tasks and adjusting swiftly in a dynamic office setting Possesses a keen organizational sense and pays close attention to details Adept at resolving intricate and multifaceted problems Experienced with Microsoft tools such as Word, Excel, PowerPoint, and Outlook Background in medical or clinical practice through education, training, or professional engagement Holds an unrestricted LVN/RN license from an accredited vocational nursing program (for LVNs) or a nursing degree from an accredited college (for RNs) EDUCATION/CREDENTIALS: Licensed Practical/Vocational Nurse with an active and unrestricted license to practice. Licensed RN with an active and unrestricted license to practice. JOB RELEVANT EXPERIENCE: 2 Yrs Minimum Clinical Nursing Experience Is Required. One year of previous experience in Utilization Management is required. JOB RELATED SKILLS/COMPETENCIES: Demonstrate strong abilities in both spoken and written communication, along with effective interpersonal skills. Possess a proficient understanding of computer operations, particularly the Internet, Microsoft Word, Microsoft Access, Microsoft Excel, and Windows. Show the capability to acquire new skills and competencies to address the evolving requirements of systems, software, and hardware. WORKING CONDITIONS/PHYSICAL DEMANDS: Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of sitting and computer work. WORK FROM HOME TECHNICAL REQUIREMENTS: Supply and support their own internet services. Maintaining an uninterrupted internet connection is a requirement of all work from home position.

Conduct assessments of medical services to validate their appropriateness using established criteria and guidelines, ensuring the medical necessity of treatments (e.g., CMS, Milliman Care Guidelines, InterQual, or health plan specific guidelines/criteria) Examine and evaluate patient records to verify the quality of patient care and the necessity of provided services Offer clinical expertise and serve as a clinical reference for non-clinical staff members Input and manage essential clinical details within various medical management platforms Keep up-to-date with regulatory prerequisites (such as URAC) and state standards for utilization review Apply clinical reasoning to determine the suitable evidence-based guidelines Foster efficient and high-quality patient care by effectively communicating with management teams, physicians, and the Medical Director Additional Duties: May provide oversight to the work of the team members Continuously improves processes that help to facilitate better turnaround time, peer to peer success rates and lessens returned reports by clients for clarification purposes, ultimately resulting in higher client satisfaction. Responsible for the final approval on cases for release to the client Will act as a liaison and coordinate quality issue reports along with all new reviewer reports with the VP of Clinical Operations

Pyramid Consulting, Inc

HEDIS Abstraction nurse

Posted on:

May 29, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Texas

Immediate need for a talented HEDIS Abstraction nurse. This is a 06+months contract opportunity with long-term potential and is located in Dallas, TX (Remote). Please review the job description below and contact me ASAP if you are interested. Job ID: 25-72555 Pay Range: $33 - $35/hour. Employee benefits include, but are not limited to, health insurance (medical, dental, vision), 401(k) plan, and paid sick leave (depending on work location).

Key Skills; HEDIS Abstraction EMR Required: 2- or 4-year degree Required: LPN, RN or 5 years abstraction.

Assess vendor-delegated abstraction activities and compare results to HEDIS standards and/or custom or other measure set standards Review medical records and abstract data for HEDIS and other measure sets in compliance with standards Track and report on issues and outcomes related to abstractions and over-reads Communicate outcomes of abstraction and over-sight activities with health plans and vendors when required Perform other quality initiatives as necessary

OpenLoop

Telemedicine RN - Contract

Posted on:

May 29, 2025

Job Type:

Contract

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

OpenLoop Health was founded with the vision to deliver healing anywhere. We do so by thoughtfully pairing leading clinicians (like you!) with innovative telehealth companies providing patient care in all 50 states. Our team of Clinician Advocates and full-service support staff are dedicated to helping you land the right virtual care positions aligned to your expertise, passions, and schedule. Consider OpenLoop your all-access pass to rewarding work, great pay, and the flexibility you’ve been looking for.

We are seeking a compassionate and dedicated Registered Nurse (RN) to join our team as a Telemedicine RN. This is an incredible work opportunity in a fast-paced, innovative company that puts the patient at the center. This role is for a clinical care professional who delivers nursing care using telemedicine modalities exclusively, including video, phone, connected devices, and asynchronous messages (chat/email). Registered nurses are members of an interdisciplinary care team working as staff clinicians with OpenLoop. As a, you'll be at the forefront of healthcare delivery, providing vital support to patients over the phone. Your role will involve assessing patient needs, offering medical advice, coordinating care plans, ensuring optimal health outcomes, and providing an outstanding patient experience. If this sounds like a team you want to join - we'd love to connect! This position offers an opportunity to make a meaningful impact on patient satisfaction and quality of care while contributing to the continuous improvement of healthcare services. If you are a dedicated RN with a passion for patient advocacy, excellent communication skills, and love using technology to work in fast-paced environments, , we encourage you to apply for this rewarding position.

Must have an Active and Unencumbered Compact Registered Nursing license, preference for additional licensure This licensure MUST be reflected on a current CV or provided upon application to be considered MUST live in the state in which the Compact was granted to be considered Must have Associate degree in Nursing (A.D.N) from an accredited school of nursing required; Bachelor of Science in Nursing (B.S.N): Registered Nurse (RN) license At least 3+ years of clinical experience in settings such as telemedicine, acute care, or case management Strong interpersonal and communication skills, with the ability to empathize with patients and effectively convey information Above average proficiency in using telecommunication technology and electronic health record (EHR) systems Commitment to providing high-quality patient-centered care. Ability to work independently and as part of a team in a fast-paced environment. Excellent organizational skills and attention to detail, with the ability to manage multiple tasks simultaneously in a fast-paced environment Minimum of 20-hours per week availability required Day, evening, and weekend availability preferred Timely and professional Telemedicine or virtual care experience a plus Fluency in Spanish (both written and spoken) is a plus

Conduct outbound calls to patients who have been discharged from the hospital within a specified time frame. Conduct outbound calls to communicate patient lab results. Receive inbound calls from patients who have clinical questions or concerns. Provide medication administration support, recommendations for managing side effects, and care plan support. Engage with patients in a courteous and empathetic manner, demonstrating sensitivity to their healthcare needs and concerns. Complete detailed documentation of patient care interactions in the ticketing system and electronic medical record. Collaborate with healthcare providers, clinical leaders and other team members to follow up on any issues or discrepancies identified during the survey process. Maintain confidentiality and adhere to HIPAA regulations when handling patient information. Participate in ongoing training and professional development activities to stay updated on survey protocols, healthcare regulations, and best practices. Meet productivity targets and quality standards established by the organization.

Moses/Weitzman Health System

Population Health Nurse

Posted on:

May 29, 2025

Job Type:

Part-Time

Role Type:

Primary Care

License:

RN

State License:

Conneticut

Community Health Center, Inc. (CHC) is one of the country’s most creative and dynamic providers of primary medical, dental, and behavioral health services, and a leader in practice-based research, health professionals training, and use of innovative technologies to advance health and healthcare. CHC is designated as a federally qualified health center and a patient-centered medical home by HRSA, the Joint Commission, and NCQA, respectively. We deliver more than 500,000 patient visits per year from primary care hubs and community clinics across the state of CT, all connected by technology and common standards for quality. We employ several hundred medical, dental, and behavioral health providers who are engaged in practice, teaching, and research. Our Weitzman Institute is devoted to research and practice transformation and is recognized around the country as one of the premier research institutes focused on improving health care and health outcomes for special and vulnerable populations. In addition, the organization has developed three wholly owned subsidiaries from the original pilot developments within the Weitzman Institute: the National Nurse Practitioner Residency and Fellowship Training Consortium (NNPRFTC), the National Institute for Medical Assistant Advancement and ConferMed.

The Population Health Nurse provides high quality comprehensive, professional nursing care to individuals throughout the lifespan. The PHN provides patients with both general and focused health education regarding preventive, chronic and episodic health care issues.

Required Skills and Education: Registered nurse, in good standing. A minimum of Bachelor’s Degree A minimum of 1 year experience working successfully in a healthcare environment Ability to recognize signs of patient health distress and address appropriately Familiarity with medication names; ability to read prescriber’s directions for use Comfortable using a variety of technology resources; ability to concurrently listen while typing quickly and accurately into patient record in a clear and concise manner Possesses sound organizational skills and accuracy at all levels of job Proven excellent communication and customer service skills Preferred Skills: Current Connecticut RN license Bachelor’s Degree in Nursing (BSN) preferred Fluent in both English and Spanish with ability to pass fluency exams 1+ year of experience as a nurse in ambulatory care, preferred. Experienced nurses from other settings with a strong interest in chronic disease management and primary care nursing are encouraged to apply Commitment to care of underserved populations Excellent written and oral communication skills Comfort using motivational interviewing techniques Required Licenses/Certifications: Connecticut Registered Nurse License Physical Requirements/Work Environment Daily and continuous computer use. Daily and frequent telephone use. Alternating of sitting and standing as home-work environment allows Requires manual dexterity to perform administrative tasks, minimal physical activity required Fully Remote and therefore requires a clean/organized space that is free from distractions at home to complete work (see CHC’s Remote Worker Policy for more information) Demonstrates a HIPAA compliant work environment Follows CHC policies around remote work space and connectivity requirements

Outreach to patients to provide health care education during patient visits, by video and by telephone. Follows up on emergency room visits and hospital discharges. Accurately documents all aspects of patient care in the medical chart on a timely basis. Completes medication reconciliation processes Retrieves hospital discharge summaries from the appropriate portal and uploads into patient records, as needed Addresses care gaps related to value based metrics as assigned Other work as delegated by the Population Health Department Director or Supervisor Additional Activities and Responsibilities: Participates in quality improvement projects. Precepts others Participates in on going nursing education activities. Communicates client information to providers and the clinical team accurately. Accurately takes messages, and communicates on the telephone. Communicates effectively with other administrative staff, collaborates with medical providers, nursing staff and members of leadership. Access to clients’ charts and health care information within appropriate parameters. Maintains client confidentiality. Possess desire to collaborate with a team in a positive manner, providing insightful and evidence–based information This Position is available for remote work.

SSM Health

LPN-Virtual Health, Continuum of Care/Weekends Part time

Posted on:

May 29, 2025

Job Type:

Part-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Compact / Multi-State

It's more than a career, it's a calling MO-REMOTE Worker Type: Regular Job Highlights: These roles are for our Remote Patient Monitoring program. We are looking for a nurse who has a genuine interest in virtual health. The patients on this service receive equipment for them to check daily vitals and respond to symptom / risk screening questions on a device. The LPN role for this program does a review of all the patients on the program each day – looking at their daily vitals / survey responses of the patients and calling them if anything is outside of goal to discuss / reinforce education / escalate to the RN or provider as needed. It can be both outgoing and incoming calls – phone or video. Schedule: Friday, Saturday, Sunday $8.50 differential in addition to base wage A comfort with technology is a must for this position. Experience in triage / virtual health is preferred. This position may be a great fit for a nurse who has great direct patient care / bedside experience but is looking to use those skills in a different way and would prefer more of a care management / patient education centered position vs a skills based one. Job Summary: Provides remote care to patients under the direction of a registered nurse or qualified health care provider, functioning within the scope of license.

EDUCATION: Graduate of an accredited school of nursing or education equivalency for licensing EXPERIENCE: One-year licensed practical nurse experience Remote experience preferred but not required PHYSICAL REQUIREMENTS: Constant use of speech to share information through oral communication. Constant standing and walking. Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs. Frequent sitting, reaching and keyboard use/data entry. Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors. Frequent use of smell to detect/recognize odors. Frequent use of hearing to receive oral communication, distinguish body sounds and/or hear alarms, malfunctioning machinery, etc. Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs. Occasional lifting/moving of patients. Occasional bending, stooping, kneeling, squatting, twisting, gripping and repetitive foot/leg and hand/arm movements. Occasional driving. Rare crawling and running. REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS State of Work Location: Illinois Licensed Practical Nurse (LPN) - Illinois Department of Financial and Professional Regulation (IDFPR) State of Work Location: Missouri, Oklahoma, Wisconsin Licensed Practical Nurse (LPN) Nurse Licensure Issued by Compact State

Completes department LPN workflows per department protocols including program referral processing and daily patient metrics review and escalation. Delivers safe and quality care that is in line with provider orders, remote patient monitoring department protocols, and established nursing care standards. Provides documentation that follows the established treatment plan, supports coordination of patient care, meets regulatory requirements, and ensures reimbursement. Communicates with management team, patient care team (including clinical staff and providers), and patient/patient caregiver(s) per department protocols. Uses computer for data collection, documentation, information gathering, and communication. Manages relationships with individuals and departments inside and outside of the ministry structure. Delivers care with customer service and a positive patient care experience at the forefront. Works in constant state of alertness and in a safe manner. Performs other duties as assigned.

Cadence

Nurse Practitioner Supervisor

Posted on:

May 29, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

NP/APP

State License:

Compact / Multi-State

Across the United States, 6 in 10 adults – or 133 million Americans, live with one or more chronic conditions. Chronic disease is today’s leading cause of death and disability in the US and the leading driver of the nation’s $4.1 trillion in annual healthcare costs. Patients who live with chronic conditions require far more touch points than our primary care physicians have time to deliver and the result is countless health emergencies and costly ER visits that could be prevented. Workforce shortages and lack of technologies make it difficult to give patients the attention they need. At Cadence, our mission is to deliver life-changing care to over one million patients living with chronic disease by the end of the decade. We mitigate the impact of chronic disease by using technology and a world-class clinical team to remotely monitor, manage, and support patients at home. Together with our growing network of health system partners, we deliver guideline-directed care to tens of thousands of patients today while producing best-in-class clinical outcomes.

The Cadence Health team seeks a Nurse Practitioner Supervisor to join the team. This individual will dedicate 60% of their time performing the duties as a Nurse Practitioner and 40% of their time leading and supporting other Nurse Practitioners. (This is subject to change based on the needs of the team and the company). You will be responsible for ensuring the delivery of high-quality patient care making sure every healthcare interaction with Cadence is an exceptional experience that prioritizes the well-being of the patient and aligns with the goals of the health system. The schedule for this role: Mon- Fri 9 am-6 pm MT or PT time zone.

5+ years Nurse Practitioner experience treating patients with chronic diseases (T2D, Hypertension, CHF) either in an outpatient or inpatient setting at a high performing medical center. Master’s Degree as a Nurse Practitioner with willingness to expand state licensure as Cadence adds new markets and partners. 5+ years of leading a clinical team NPs, RNs, and/or MAs. Board certification and active license required (ANCC/AANP). Multi-state compact RN licensure. Ability to thrive in an environment founded on trust, autonomy, and direct feedback. Excellent communication skills when leading and managing change initiatives. Analytical mindset with the ability to interpret data, derive actionable insights, and make data-driven decisions. Strong project management skills, with the ability to prioritize tasks and meet deadlines. Proven success in motivating and inspiring a clinical team. Experience coaching and training a team of clinicians. Passion for the patient / customer experience and systematically improving healthcare with digital innovation Prior experience working in a startup environment. Experience working with remote patient monitoring technology is a plus.

Supervise the tracking of patient vital signs, symptoms, and laboratory results in coordination with our Clinical Navigators and Registered Nurses (RNs) Coordinate the patient's treatment regimen and medications, focusing on starting and adjusting guideline-recommended medical therapy (GDMT) for Heart Failure, as well as other relevant guidelines for Type 2 Diabetes (T2D) and Hypertension. Address patient escalations promptly, including abnormal vital signs, symptoms, and laboratory findings identified through Remote Patient Monitoring (RPM). Conduct regular virtual meetings with patients to discuss laboratory results and optimize adherence to GDMT Nurse Practitioner Supervisor responsibilities: Ensure adherence to clinical quality standards and compliance targets by conducting monthly audits, monitoring data for trends, and implementing performance enhancement strategies. Identify areas for quality improvement to enhance patient outcomes and satisfaction, and communicate objectives to the team, monitoring progress towards goals. Provide ongoing guidance, coaching, and mentoring to team members, fostering a collaborative and supportive environment conducive to teamwork and open communication. Assist in communicating policies, procedures, and care pathways, escalating matters to leadership when necessary, and collaborating with Team Leads to ensure adequate coverage. Manage staffing needs, approve PTO and CME, and complete time cards as required for the team. Participate in the recruitment process, interview prospective team members, and assist with onboarding and licensure. Stay updated on healthcare advancements and regulations, integrating them into organizational processes. Demonstrate flexibility to work across time zones to ensure team coverage. Ensuring every healthcare interaction with Cadence is an exceptional experience that prioritizes the well-being of the patient and aligns with the goals of the health system. Support internal growth efforts to help Cadence scale exceptional care delivery to patients with CHF and other chronic conditions including hypertension, Type 2 diabetes, and COPD. Be instrumental in shaping the culture of one of the fastest growing teams at Cadence.

Cadence

Clinical Operations Lead

Posted on:

May 29, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

None Required

State License:

California

Across the United States, 6 in 10 adults – or 133 million Americans, live with one or more chronic conditions. Chronic disease is today’s leading cause of death and disability in the US and the leading driver of the nation’s $4.1 trillion in annual healthcare costs. Patients who live with chronic conditions require far more touch points than our primary care physicians have time to deliver and the result is countless health emergencies and costly ER visits that could be prevented. Workforce shortages and lack of technologies make it difficult to give patients the attention they need. At Cadence, our mission is to deliver life-changing care to over one million patients living with chronic disease by the end of the decade. We mitigate the impact of chronic disease by using technology and a world-class clinical team to remotely monitor, manage, and support patients at home. Together with our growing network of health system partners, we deliver guideline-directed care to tens of thousands of patients today while producing best-in-class clinical outcomes.

Cadence Health is seeking an experienced Clinical Operations Lead to design, lead, and scale a best-in-class Care Management team. This leader will be responsible for driving operational excellence, ensuring clinical impact, and aligning our delivery model with regulatory, patient, and partner expectations.

Inspirational leader with a proven track record of leading high-performing clinical teams. Experience scaling care delivery models, with a balance of strategic and operational thinking. Strong grasp of clinical care delivery, with the ability to turn clinical needs into scalable workflows. Demonstrated ability to rapidly implement and refine programs based on feedback and data. Proven project management and prioritization skills across cross-functional teams. Regularly partners with product and engineering teams to improve systems and tooling. Strong communicator capable of influencing across teams, levels, and disciplines. Comfortable operating in ambiguity and navigating change in fast-paced environments.

Build and lead a high-performing Care Management team, including NPs, RNs, MAs, and clinical support staff. Drive productivity and consistency through clear performance metrics, feedback loops, and ongoing training. Design and refine scalable, standardized workflows that ensure efficient and high-quality care delivery. Ensure all care delivery adheres to evidence-based clinical standards and is tailored to patient needs. Lead initiatives that improve core clinical outcomes. Optimize outreach models and engagement strategies to increase patient impact. Develop and enforce rigorous compliance processes that meet all regulatory and contractual obligations. Foster a culture of accountability and clinical integrity across teams. Drive high levels of satisfaction among patients, providers, and health system partners. Collaborate cross-functionally to ensure operational alignment with strategic goals and partner expectations. Actively engage in feedback loops that improve service and strengthen stakeholder relationships.

Cadence

Care Management RN

Posted on:

May 29, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

Across the United States, 6 in 10 adults – or 133 million Americans, live with one or more chronic conditions. Chronic disease is today’s leading cause of death and disability in the US and the leading driver of the nation’s $4.1 trillion in annual healthcare costs. Patients who live with chronic conditions require far more touch points than our primary care physicians have time to deliver and the result is countless health emergencies and costly ER visits that could be prevented. Workforce shortages and lack of technologies make it difficult to give patients the attention they need. At Cadence, our mission is to deliver life-changing care to over one million patients living with chronic disease by the end of the decade. We mitigate the impact of chronic disease by using technology and a world-class clinical team to remotely monitor, manage, and support patients at home. Together with our growing network of health system partners, we deliver guideline-directed care to tens of thousands of patients today while producing best-in-class clinical outcomes.

The Cadence Health team seeks a Registered Nurse to support patients in our care management programs and help patients better manage their conditions. The schedule for this role is Monday through Friday, 8:00 AM to 5:00 PM PST, MST, or CST.

Multi-state RN Compact State Licensure Associate Degree in Nursing Science 5+ years of clinical experience in a chronic care management program. To ensure that our clinicians have the necessary tools for a successful remote work environment, home office setups must have consistently stable wifi with strong upload and download speeds. A wifi speed test is required before participating in the interview process to verify that these standards are met. Skilled in nursing processes. Excellent clinical acumen. Exceptional written, verbal, and interpersonal communication skills. EMR experience, preferably in Athena and EPIC. Works effectively with minimum supervision. Strong collaboration with cross-functional partners. Ability to support the delivery of health care to patients by performing a variety of activities and procedures that are prescribed by and performed under the direction of the Cadence Nurse Practitioner and Cadence clinical policies and procedures. Patient assessment competency. Technical fluency with the ability to work in multiple platforms and systems, including Notion, Athena, EPIC, Zendesk, and G Suite.

Continuously monitor patient vitals, symptoms, and lab results to proactively identify care gaps and patients requiring clinical intervention. Create and manage personalized care plans to address patients' specific health needs, ensuring alignment with treatment goals and physician recommendations. Address patient concerns and escalations via phone and text, providing timely and empathetic responses. Conduct virtual follow-up appointments to guide patients through program enrollment, update treatment plans, support medication adherence, and achieve lifestyle and health goals. Document clinical interactions thoroughly and prepare detailed care summaries to share with patients’ physicians, ensuring seamless care coordination. Assist in developing workflows and processes to enhance our care management programs, ensuring efficiency, scalability, and patient-centered care. Ensure every patient interaction reflects Cadence’s commitment to delivering exceptional care and aligns with the goals of partnering health systems. Collaborate with the team to scale care delivery for patients with chronic conditions, including CHF, hypertension, and type 2 diabetes, as Cadence grows.

Twig Health

Remote Nurse - Bilingual Spanish / English

Posted on:

May 29, 2025

Job Type:

Contract

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

Twig Health (www.twig.health) is an AI-guided front-desk for patient care. Our nurses communicate with patients mostly via SMS texting (and sometimes phone calls) to coordinate care, verify adherence, answer questions, provide support, and address any issues before they become problems.

We’re seeking registered nurses to join our team for a part-time, contract position. Benefits of working for Twig: 100% remote, telehealth position An opportunity to work with advanced technology such as generative AI (ChatGPT) Collaboration with other nurses and team members Providing concierge-level care to all patients Startup environment with new and exciting opportunities 1099 contract agreement

Located in the US. At least 1 year of Remote work experience. BSN (preferred) or ADN Compact License. Additional license - are an advantage High ability to express yourself in written form Excellent grammar, attention to detail Efficient at writing medical information at a patient level Typing speed > 45 WPM (check yourself on typingtest.com) Tech savvy and excited about technology in healthcare

Collaborate with patients based on their care plans (proactive engagement) and based on incoming patient needs (reactive engagement) Be empathetic, professional, pleasant and responsive when engaging with patients Collaborate with the rest of the patient’s care team Schedule appointments and follow-ups Collaborate with the Twig team to continually improve our level of service

Solace

Healthcare Advocate (Remote 1099)

Posted on:

May 29, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

None Required

State License:

California

Solace is a healthcare advocacy marketplace that connects patients and families to experts who help them understand and take charge of their personal health. By harnessing the power of human connection through technology, Solace is transforming healthcare in the U.S. Healthcare in the U.S. is fundamentally broken. The system is so complex that 88% of U.S. adults do not have the health literacy necessary to navigate the system without help. By helping people work with professional health advocates, Solace serves as an integral, personal support layer for health issues in a way that the health system can’t. Using proprietary technology to match patients with experienced advocates, Solace cuts through the red tape of healthcare and helps individuals and families make informed decisions that result in better outcomes. Solace is a Series B startup founded in 2022 and backed by Inspired Capital, Craft Ventures, Torch Capital, Menlo Ventures and Signalfire. We have a lean, fully-remote U.S. team distributed coast-to-coast.

As an Healthcare Advocate for Solace, you will work with Medicare patients throughout their healthcare journey. In this role, you will navigate patients through difficult and complex health concerns to help them achieve their health and wellness goals while addressing Social Determinants of Health (SDOH). You’ll be an empathetic listening ear and an action-oriented guide who knows what to do to solve patient problems—and actually does it. Please note that this is a 1099 role. You can choose to work part time or full time. The role is remote.

3+ years proven experience in care management, patient advocacy, or healthcare navigation. Deep understanding of Social Determinants of Health and experience working with diverse patient populations. Endless empathy for people, and a strong ability to fight for those who cannot. Strong clinical skills paired with exceptional organizational abilities. You can balance multiple tasks and work under pressure without sacrificing clarity in your communications and documentation. Pride in your technical savvy; you can quickly and fluently learn new systems and software. An extreme bias toward action and execution. A willingness to provide fearless feedback. You care about forging a system that empowers better patients outcomes, and are not shy about sharing your thoughts. This is a remote position. Applicants must be based in the United States.

Learn the Solace systems, tools, technology, partners, and expectations, while also providing your unique expertise in every interaction. Build strong, trusting relationships with Medicare patients, where listening and empathy are the foundation for every interaction. Be able to identify and prioritize Medicare patients’ needs and assist them to maintain a streamlined care continuum. Develop comprehensive patient care plans that holistically address social determinants of health, i.e. food resources, transportation access, and support at home. Build the systems of the future in working with Medicare patients.

Sanford Health

Clinical Informatics Analyst - CI OPS Post Acute

Posted on:

May 28, 2025

Job Type:

Full-Time

Role Type:

Informatics

License:

RN

State License:

Minnesota

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

Facility: Remote MN Location: Remote, MN Address: Shift: 8 Hours - Day Shifts Job Schedule: Full time Weekly Hours: 40.00 Salary Range: $26.00 - $41.50 Department Details Monday thru Friday, limited on call, daytime hours, no nights, weekends or holidays.

Associate’s degree required; Bachelor’s degree preferred. Minimum of two years experience in healthcare setting required. Previous experience in nursing/healthcare management, education, development, and/or healthcare information management preferred. Possess analytical, problem solving, critical thinking, and strong verbal and written communication skills. Electronic Medical Record (EMR) experience preferred. Licensed/registered in a clinical field required. Home Health & Hospice experience required.

The Clinical Informatics Analyst demonstrates a clinical background with special interest and expertise in use of the electronic health record (EHR) and other technology that enhances clinical practice. Acts as a liaison between assigned departments, facilities, providers and Information Technology (IT) staff in order to facilitate optimal use of applications. Experienced EHR user with previous experience providing instruction to others for integration of workflows and processes into daily practice to support safe, efficient, effective patient care and outcomes. Responsible to assist assigned departments, geographical areas or specific functions with utilization of Sanford's electronic medical record (EMR) and associated technology. Research, analyze and make recommendations for application workflow improvements. Create and analyze reports using multiple reporting mechanisms. Perform with a high level of customer service with all support and training requirements. Promote and participate in a team approach. Proficiency in the use of Microsoft Office software required. Comfortable managing change with excellent problem solving skills. Time management and prioritization necessary on a daily basis. Proficient verbal and written communication is essential. A positive attitude and excellent customer service skills are expected. Fosters a work environment of respect, professionalism, accountability and teamwork. Key areas of accountability include individual and classroom training, onsite and remote end-user support, development of supporting clinical workflows, investigation and resolution of application and workflow issues, and participation in committees that promote both the standardization and optimization of clinical informatics changes to Sanford's EMR and other associated technology. May require some periodic day and overnight travel, non-business hour scheduled support or meetings as well as on-call rotation for end-user support.

Sanford Health

Utilization Management Coordinator (Home-Based) - Prior Authorization

Posted on:

May 28, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

Compact / Multi-State

Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.

Facility: Remote WI Location: Remote, WI Address: Shift: Day Job Schedule: Full time Weekly Hours: 40.00 Salary Range: $21.50 - $28.00

Monitors the utilization of resources, risk management and quality of care for patients in accordance to established guidelines and criteria for designated setting and status. Collection of clinical information necessary to initiate commercial payor authorization. Obtain and maintain appropriate documentation concerning services in accordance to reimbursement agency guidelines. Consult with interdepartmental departments and staff to assure all relevant information regarding patient status and diagnosis are accurately reported. Provide information via multiple sources of technology applications to insurance companies and contracted vendors to assure authorization for patients. May participate in providing assistance in financial aid and/or counseling if applicable. Accurately recognizes coding principle diagnosis and principle procedures including complicating/comorbid diagnoses for accurate diagnosis-related group (DRG) assignment during hospitalization. Monitors patient hospitalization to ensure prospective payment limit is not exceeded without due notice to the attending physician. May also need to notify physician and patient of authorization denials. Inputs collected data into computer system for insurance communication, DRG grouping, data abstraction for monitoring and evaluation, and when applicable, Medicare National and Local Coverage Determinations (NCD/LCD), and Joint Commission (TJC) required functions and credentialing. Assists medical records coding personnel as needed to correctly identify diagnoses and procedures, and obtains physician documentation as needed. Monitors patient hospitalization to ascertain medical necessity and appropriateness. Assists with retrospective review of specified charts as required. Ability to interact on an interpersonal basis with both providers and nursing staff. Demonstrates proficiency with computers, Microsoft applications, and additional designated technology within the department. Will perform multiple administrative duties including accurate record keeping and electronic data management when needed. Ability to work with growth and development needs of pediatric to geriatric populations.

Parkview Health

Telehealth Triage Nurse - RN

Posted on:

May 28, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Here, you’ll find a health system dedicated to meeting your needs throughout your health journey. With 14 hospitals, 50+ clinical specialties, an extensive network of expert providers, and access to advanced technologies typically only found at academic medical centers, Parkview is improving the health of our entire region. We are continually expanding our knowledge, discovering novel ways to care for patients, and connecting our community to the supportive expertise they deserve. We are Parkview. And we are advancing healthcare to be better for you every day.

This position is eligible for a $5,000 sign-on bonus *Once fully trained (6 months to 1 year) option to be remote* Purpose: Triages or manages symptom-based encounters with a patient over the phone or video, utilizing evidence-based triage protocols. Decreases unnecessary visits to physicians, APP’s, and the emergency room and provides information for self-care. Uses excellent communication and information-gathering skills to determine the best course of action for the patient with appropriate disposition. Deals with the entire spectrum, from healthy patients to the acute and chronically ill. Telehealth triage nursing is based on the six-step nursing process: nursing assessment, diagnosis, goal/outcome identification, planning, implementation, and evaluation. Interventions commonly applied by the Triage Nurse are as follows: identifying and clarifying patient needs; conducting health education; promoting patient advocacy and self-efficacy; and assisting the patient to navigate the health care system.

Education: Must be a graduate of a School of Nursing, BSN preferred. Must complete general orientation. Licensure/Certification: Must have a current, active RN license and currently hold a compact license or apply for the Nurse Licensure Compact as a part of the hiring process. Experience: Minimum of five years’ experience as a registered nurse. Previous emergency department or telephone triage experience is desired for this role. Experience in use of computers – hardware and software, and use of an electronic medical record. Other Qualifications: Critical thinking skills. Ability to determine the problem or patient need through conversation with a patient. Superior verbal communication skills are essential. Ability to communicate in a clear, concise, courteous and professional manner, exhibit quality vocal skills through speech rate, volume, enunciation and pronunciation. Strong assessment skills and excellent clinical judgement. Crisis intervention skills. Ability to remain calm in high-stress situations. Teaching ability. Typing and computer ability to keep track of information gathered during the telephone conversation,ability to type 40 wpm with 98% accuracy, document precisely in a concise manner. Demonstrates the ability to work independently and learn applications relevant to the position. Strong organizational skills and attention to detail. Ability to successfully function in a fast paced, service-oriented environment.

Accepts telephone calls from patients with varying levels of acuity and types of medical concerns. Promotes clear and coherent verbal communication following an appropriate line of questioning. Utilizes the electronic medical record to access and review patient records, step through triage protocols to review possible conditions, relatable signs and symptoms, and evidence-based treatments, and facilitate next steps which could include scheduling a clinic appointment. Provides clear health information, assistance with medication refills as needed, thorough patient education, recommendation for use of over-the-counter medications as appropriate, and recommendations for the next steps to take. Evaluates the significance of the patient’s concern, determine if emergency care is needed, if a medical appointment should be made, or if the concern should be reported to the appropriate physician. Works for first call resolution of patient’s concern or need as appropriate. Completes Transitional Care Management telephone encounters for post hospital patients. Functions independently in a fast-paced environment.

Accredo Specialty Pharmacy

Home Infusion Nurse-Accredo- Bowling Green,-Ohio-Per Diem

Posted on:

May 28, 2025

Job Type:

Part-Time

Role Type:

License:

RN

State License:

Ohio

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.

Take your nursing skills to the next level by helping to improve lives with Accredo, the specialty pharmacy division of Evernorth Health Services. We are looking for dedicated registered nurses like you to administer intravenous medications to patients in their homes. As a Home Infusion Registered Nurse at Accredo, you'll travel to patients' homes to provide critical infusion medications. However, this job is about more than just administering meds; it’s about building relationships with patients and seeing the positive impact of your care. You'll work independently, making decisions that lead to the best outcomes for your patients. You’ll drive growth in your career by challenging yourself to use your nursing skills, confidence, and positive attitude to handle even the toughest situations, with the support from your team. For more than 30 years, Accredo by Evernorth® has delivered dedicated, first-class care and services for patients. We partner closely with prescribers, payers, and specialty manufacturers. Bring your drive and passion for purpose. You’ll get the opportunity to make a lasting impact on the lives of others.

Active RN license in the state where you’ll be working and living 2+ years of RN experience 1+ year of experience in critical care, acute care, or home healthcare Strong skills in IV insertion Valid driver’s license Willingness to travel to patients’ homes within a large geographic region Ability to do multiple patient visits per week (can include days, evenings, and weekends, per business need) Flexibility to work different shifts on short notice and be available for on-call visits as needed 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.

Empower Patients: Focus on the overall well-being of your patients. Work with pharmacists and therapeutic resource centers to ensure that patients’ needs are met and to help them achieve their best health. Administer Medications: Take full responsibility for administering IV infusion medications in patients’ homes. Provide follow-up care and manage responses to ensure their well-being. Stay Connected: Be the main point of contact for updates on patient status. Document all interactions, including assessments, treatments, and progress, to keep track of their journey.

Anchor Health, LLC

Clinical Liaison, RN On Call, Music Therapist, Community Outreach

Posted on:

May 28, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

We have multiple opportunities for the right people, those who combine empathy, teamwork, accountability and commitment towards the goal of bringing the highest quality end-of-life care to those who need it.

Atrium

Oncology Nurse Navigators - 155550

Posted on:

May 28, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Our client, a value-based cancer care company, is seeking compassionate Oncology Nurse Navigators to join their team! Salary/Hourly Rate $39.90/hr Position Overview The Oncology Nurse Navigators will provide triage, support, and education to members during their cancer journey via phone, email, and video.

Required Experience/Skills for the Oncology Nurse Navigators: The Oncology Nurse Navigator should possess OCN. Must possess compact licensure. Must have recent oncology navigation or oncology case management experience. Minimum 3 years of nursing experience, including 2 years in direct patient care in outpatient infusion or navigation. Experience in outpatient infusion or navigation. Education Requirements: Bachelor of Science in Nursing is required.

The Oncology Nurse Navigators will establish trusting relationships with members and their care network. Support members throughout their cancer care journey, including screening, survivorship, and end-of-life care. Assist members with care coordination, symptom management, nutritional support, discharge planning, and provider referrals. Assist with urgent clinical escalations and provide clinical consultative support.

HV Occupational Health & Safety

Remote Occupational Telehealth Nurse - Night Shift (LPN, LVN, RN)

Posted on:

May 28, 2025

Job Type:

Role Type:

Telehealth

License:

LPN/LVN

State License:

Compact / Multi-State

At HV Occupational Health and Safety, we are passionate about fostering growth and embracing change to create thriving, safe work environments. As a double minority-owned company, we bring a unique perspective to workplace safety, offering exceptional services that help businesses achieve the best outcomes. Our commitment to honesty, integrity, and respect defines everything we do. We take pride in being problem solvers—delivering practical, responsive solutions to complex challenges. Our team isn’t just clinical; we’re collaborative, clear-headed professionals who value family, hard work, and doing right by people.

**This role is 100% remote and available to LVNs, LPNs, and RNs. We are looking for experienced telehealth nurses to join our case management team. Candidates should be available to work night shift hours consistently. Triage experience is highly preferred.** ike. Whether guiding a patient back to work or coordinating care across borders, you bring a calm, clinical presence that earns trust fast. Your emergency care background makes you decisive, and your case management expertise ensures those decisions lead to smart outcomes—clinically, administratively, and operationally. You move with both compassion and clarity. You’re not just checking boxes—you’re actively driving cases forward, advocating for both the employee and the employer, and ensuring every touchpoint reflects professionalism, integrity, and care.

Active RN, LVN, or LPN license (compact license required). 5+ years of clinical experience in emergency care, urgent care, or occupational health. Strong understanding of OSHA recordability, workers’ comp processes, and return-to-work strategies. High emotional intelligence—able to earn trust quickly with employees, managers, and providers. Excellent communication, documentation, and decision-making skills. Bilingual (English/Spanish or English/French) strongly preferred for international case support. Tech-savvy with the ability to manage telehealth, digital documentation, and fast-paced coordination.

Injury Intake & Assessment: Answer incoming calls during business hours. Conduct after-hours initial intakes, gathering key details such as company info, employee demographics, and medical history. Assess injuries via video (when possible) in collaboration with the Safety Manager and onsite medics. Perform nursing assessments and administer first aid treatment. Determine the best course of action: conservative treatment, telemedicine consult, or emergency care. Manage intakes for employees in Mexico and Canada. Provide FAFs (Functional Abilities Forms) and coordinate follow-ups for Canadian clients. Telemedicine & Follow-Up: Schedule telemedicine appointments with HV physicians. Review physician notes for completeness before distribution. Distribute reports and ensure accurate documentation. Conduct follow-ups for first aid cases and monitor recovery progress. Collaboration & Coordination: Partner with Safety personnel, medics, paramedics, and other nurses. Assist with clinic vetting and coordinate referrals and diagnostics. Support case management efforts, ensuring quality employee care. Communicate with workers’ comp carriers, Risk Management, and HR for proper case handling and approvals. Work closely with HV Physicians and CMAs to ensure case resolution and closure. Documentation: Maintain detailed and timely documentation for all visits and communications. Take clinical photos to support injury tracking and case documentation. Collaborate with HV Physicians for ongoing case discussions. Request and manage medical records as needed.

Cleveland Clinic

Telephone Triage RN - REMOTE, PRN

Posted on:

May 28, 2025

Job Type:

Role Type:

Triage

License:

RN

State License:

Ohio

Responsible for providing over the phone assessment through active listening and questioning process, documenting phone encounters and providing hospice instruction based on established protocol. Coordinate patient care activities with patient, family, caregivers or hospice staff. Performs direct patient care home visits as assigned. This PRN position is to work from home after orientation. Due to technical support and meetings, this position is for candidates who live within an hour of Cleveland.

Education: Graduate of an accredited school of professional nursing required. BSN preferred. Certifications: Current state licensure as Registered Nurse (RN). Basic Life Support (BLS) through American Heart Association (AHA). Valid Ohio Driver's license upon hire; per policy 8-175 thereafter. Proof of automobile insurance coverage with $100,000/$300,000 coverage, upon hire; per policy 8-175 thereafter. Competencies: Good clinical judgment, careful listening, critical thinking skills and assessment / problem solving skills. Strong customer service skills, including both verbal and written communication skills. Strong computer skills. The ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Work Experience: Minimum one year current clinical experience as a registered nurse. Minimum one year experience in an acute medical-surgical or critical care setting. Previous hospice experience is preferred. Previous telephone triage experience is preferred. Physical Requirements: Manual dexterity to operate office equipment. Requires good visual acuity through normal or corrected vision. Must be able to hear normal conversation. Requires full range of body motion including handling and lifting packages, manual and finger dexterity, and eye-hand coordination. Requires standing and walking for extensive periods of time. Medium Work – Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects. Physical Demand requirements are in excess of those for Light Work. Personal Protective Equipment: Follows standard precautions using personal protective equipment as required.

Responsible for effectively triaging and providing resolution to all hospice department telephone calls regarding active or referred patients. Accepts verbal telephone orders from physicians to add/change services being provided to active patients and processes accordingly in the system. Assesses patient needs, determines and initiates appropriate action or response to meet identified needs. Assesses physician needs, provides requested information and/or guidance or service as appropriate or forwards to the appropriate person on the management team. Initiates and independently completes appropriate follow-up activities, including appropriate communication with patient/caregiver, agency staff, physician (as applicable) and complete documentation of events and interventions. Communicates as applicable to field staff, office staff, and physicians. Assists, reviews, researches, and resolves active patient and referral complaints and records outcomes accordingly to meet regulatory compliance standards. Performs direct patient care home visits as assigned during periods of high volume, low staffing, or as patient needs indicate the need for increased staffing. When working in the field in the role of RN, Hospice: Performs accurate and complete admission assessments and reassessments within specified time frame. Assesses patient for safety risks, abuse and neglect. Assesses and documents patient’s pain using appropriate pain scale and manages patient’s pain. Prioritizes and documents patient problems based on assessed needs/problems in collaboration with patient, family and health care team. Plans delivery of patient care in collaboration with other disciplines to promote wellness and facilitate the discharge planning process. Delegates appropriate components of the care plan to other members of the disciplinary team. Provides supervision, assessment, planning and direct patient care to hospice patients in accordance with agency policies and procedures and the plan of care established by the interdisciplinary team. Administers medication and treatments safely and accurately with a focus on patient comfort. Coordinates care for managing a caseload of patients. Documents changes in patient condition and effectiveness and timeliness of care/interventions. Evaluates, updates and revises plan of care to facilitate achievement of expected outcomes. Assesses educational needs of patients, care givers and family considering cultural issues and other special challenges. Provides teaching and educational material to the patient and/or significant other concerning the following topics when applicable: diagnosis, diagnostic tests and procedures, safe and proper use of equipment, reason for and safe use of medication food/drug interactions, injury prevention, self-care and nutritional needs. Other duties as assigned.

IntellaTriage

Remote Hospice Triage RN- PT 3:30p-8:30p rotating Sat & Sun 3:30-12a CST

Posted on:

May 28, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

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 outsourced 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. Learn more at www.intellatriage.com.

We invite you to join our growing team! IntellaTriage Nurses enjoy the benefits of working from home, providing care, without the stress and expense of commuting each day! **MUST have or be willing to obtain a Compact RN license **MUST live in/work from a Compact US state **Experience with end-of-life care is required **Must have high speed internet **Must be tech savvy, enjoy a fast-paced environment, and have keyboard competence **Part-time nurses only work 5 or 6 days out of a 14-day pay period Part- time schedule: Work a minimum 1-2 evening shift weekly 3:30p-8:30p CST (shift times are set/ week day flexes) Work every other weekend, both Saturday and Sunday 3:30p-12a CST

MUST have or be willing to obtain a Compact RN license (states with pending or future implementation dates are not considered current compact states until the implementation date) You must remain in good standing and ensure your home state license remains active. IntellaTriage will cover the cost of non-compact state licensure if necessary for client support. Hospice, palliative, end-of-life care is strongly preferred Experience in a fast-paced environment: ED, surgical services, or critical care, etc. Must be comfortable accessing multiple technology applications to document during calls Ability and comfort with typing in a fast-paced environment Fluency in English is required, additional languages are a bonus Must physically reside in the U.S. and be legally eligible to work for any employer Must be able to complete three weeks of remote paid training that is conducted during days and evenings Must be available to work every other Saturday & Sunday Must be available to work some Holidays as required 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) Must be able to communicate empathically with patients while adhering to protocols Must maintain CEU’s as designated by the states in which you are answering calls Must attend any in-services, and additional training on an as needed basis Must pass background check and nurse licensing check

Our Hospice Triage Nurses: Have experience in hospice, palliative, end-of-life care and in fast-paced environments: ED, critical care, surgical services, etc. Part-time nurses work a minimum of 1 week day shift & every other weekend both Saturday & Sunday Receive three weeks of remote paid training. The training schedule varies based on availability You can pick up additional shifts, if available, for the clients’ you are trained to support. We will provide you with a laptop and headset. You’re required to use your own high-speed internet You’ll need a quiet space, away from noise and distraction, while you work (privacy/HIPAA compliant space is required). You’ll access EMRs for charting and utilize our internal applications to perform job functions You MUST be able to follow instructions, read directions, and be confident using technology A minimum of 30 minutes paid shift prep is required prior to taking calls You’ll spend 30 minutes to 2 hours, at the end of your shift, completing remaining charting before clocking out

Optum

APR-DRG CVA RN Auditor - National Remote - 2283954

Posted on:

May 27, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Minnesota

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 diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

In this position as a DRG CVA RN Auditor, you will apply your expert knowledge of the MS-DRG and APR-DRG coding/reimbursement methodology systems, ICD-10 Official Coding Guidelines, and AHA Coding Clinic Guidelines in the auditing of inpatient claims. Employing both industry and Optum proprietary tools, you will validate ICD-10 diagnosis and procedure codes, DRG assignments, and discharge statuses billed by hospitals to identify overpayments. Utilizing excellent communications skills, you will compose rationales supporting your audit findings. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Required Qualifications: Associate’s degree (or higher) Unrestricted RN (Registered Nurse) license CCS/CIC or willing to obtain certification within 6 months of hire 3+ years of MS DRG/APR DRG coding experience in a hospital environment with expert knowledge of ICD-10 Official Coding Guidelines and DRG reimbursement methodologies 2+ years of ICD-10-CM coding experience including but not limited to expert knowledge of principal diagnosis selection, complications/comorbidities (CCs) and major complications/comorbidities (MCCs), and conditions that impact severity of illness (SOI) and risk of mortality (ROM) 2+ years of ICD-10-PCS coding experience including but not limited to expert knowledge of the structural components of PCS such as selection of appropriate body systems, root operations, body parts, approaches, devices, and qualifiers Preferred Qualifications: Experience with prior DRG concurrent and/or retrospective overpayment identification audits Experience working with Utilization Management Experience with readmission reviews of claims Experience with DRG encoder tools (ex. 3M) Experience using Microsoft Excel with the ability to create / edit spreadsheets, use sort / filter function, and perform data entry Healthcare claims experience Managed care experience Knowledge of health insurance business, industry terminology, and regulatory guidelines Soft Skills: Ability to use a Windows PC with the ability to utilize multiple applications at the same time Ability to work independently in a remote environment and deliver exceptional results Demonstrate excellent written and verbal communication skills, solid analytical skills, and attention to detail Excellent time management and work prioritization skills Physical Requirements and Work Environment: Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer Have a secluded office area in which to perform job duties during the work day Have reliable high – speed internet access and a work environment free from distractions *All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Conduct MS-DRG and APR-DRG coding reviews to verify the accuracy of DRG assignment and reimbursement with a focus on overpayment identification Utilize expert knowledge to identify the ICD-10-CM/PCS code assignment, appropriate code sequencing, present on admission (POA) assignment, and discharge disposition, in accordance with CMS requirements, ICD-10 Official Guidelines for Coding and Reporting, and AHA Coding Clinic guidance Apply current ICD-10 Official Coding Guidelines and AHA Coding Clinic citations and demonstrate working knowledge of clinical criteria documentation requirements used to successfully substantiate code assignments Perform clinical coding review to ensure accuracy of medical coding and utilizes clinical expertise and judgment to determine correct coding and billing Utilize solid command of anatomy and physiology, diagnostic procedures, and surgical operations developed from specialized training and extensive experience with ICD-10-PCS code assignment Write clear, accurate and concise rationales in support of findings using ICD-10 CM/PCS Official Coding Guidelines, and AHA Coding Clinics Utilize proprietary workflow systems and encoder tool efficiently and accurately to make audit determinations, generate audit rationales and move claims through workflow process correctly Demonstrate knowledge of and compliance with changes and updates to coding guidelines, reimbursement trends, and client processes and requirements Maintain and manage daily case review assignments, with a high emphasis on quality Provide clinical support and expertise to the other investigative and analytical areas Work in a high-volume production environment that is matrix driven

IntellaTriage

Remote Hospice Triage RN- PT 2 shift 3:30p-12a rotating Sat & Sun 7:30-4 CST

Posted on:

May 27, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

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 outsourced 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. Learn more at www.intellatriage.com.

We invite you to join our growing team! IntellaTriage Nurses enjoy the benefits of working from home, providing care, without the stress and expense of commuting each day! **MUST have or be willing to obtain a Compact RN license **MUST live in/work from a Compact US state **Experience with end-of-life care is required **Must have high speed internet **Must be tech savvy, enjoy a fast-paced environment, and have keyboard competence **Part-time nurses only work 6 days out of a 14-day pay period Part- time schedule: Work a minimum 2 evening shift weekly 3:30p-12a CST (shift times are set/ week day flexes) Work every other weekend, both Saturday and Sunday 7:30a-4p CST

MUST have or be willing to obtain a Compact RN license (states with pending or future implementation dates are not considered current compact states until the implementation date) You must remain in good standing and ensure your home state license remains active. IntellaTriage will cover the cost of non-compact state licensure if necessary for client support. Hospice, palliative, end-of-life care is strongly preferred Experience in a fast-paced environment: ED, surgical services, or critical care, etc. Must be comfortable accessing multiple technology applications to document during calls Ability and comfort with typing in a fast-paced environment Fluency in English is required, additional languages are a bonus Must physically reside in the U.S. and be legally eligible to work for any employer Must be able to complete three weeks of remote paid training that is conducted during days and evenings Must be available to work every other Saturday & Sunday Must be available to work some Holidays as required 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) Must be able to communicate empathically with patients while adhering to protocols Must maintain CEU’s as designated by the states in which you are answering calls Must attend any in-services, and additional training on an as needed basis Must pass background check and nurse licensing check

Our Hospice Triage Nurses: Have experience in hospice, palliative, end-of-life care and in fast-paced environments: ED, critical care, surgical services, etc. Part-time nurses work a minimum of 1 week day shift & every other weekend both Saturday & Sunday Receive three weeks of remote paid training. The training schedule varies based on availability You can pick up additional shifts, if available, for the clients’ you are trained to support. We will provide you with a laptop and headset. You’re required to use your own high-speed internet You’ll need a quiet space, away from noise and distraction, while you work (privacy/HIPAA compliant space is required). You’ll access EMRs for charting and utilize our internal applications to perform job functions You MUST be able to follow instructions, read directions, and be confident using technology A minimum of 30 minutes paid shift prep is required prior to taking calls You’ll spend 30 minutes to 2 hours, at the end of your shift, completing remaining charting before clocking out

HarmonyCares

Telephonic RN Nurse Care Manager- Remote in Toms River, NJ

Posted on:

May 27, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

New Jersey

HarmonyCares is one of the nation’s largest home-based primary care practices. HarmonyCares is a family of companies all dedicated to providing high-quality, coordinated health care in the home. This includes HarmonyCares, HarmonyCares Medical Group, HarmonyCares Home Health and HarmonyCares Hospice. Our Mission – To bring personalized, quality-based healthcare to the home of patients who have difficult accessing care. Our Shared Vision – Every patient deserves access to quality healthcare. Our Values – The way we care is our legacy. Every interaction counts. Go the extra mile. Empower and support each other.

The Nurse Care Manager is an integral member of the care team and is vital to enhancing the health outcomes of HCMG patients. This position will manage a caseload of high-risk patients where he/she is responsible for managing their care and barriers. These duties will include, but are not limited to Transitional Care Management, Chronic Care Management, Disease Management Education, Medication Education, and the development and management of patient care plans. The Nurse Care Manager will serve as co-chair of the pod alongside the pod leader, focusing on driving and prioritizing patient needs to improve patient outcomes.

In this role you may work with: Executive Directors Market Leaders Pod Leaders Clinical Social Worker Patient Health Coordinator Population Health Team Required Knowledge, Skills and Experience: Active Registered Nurse License 2+ years of care management experience in community, health plan or hospital systems Possesses strong clinical skills and proactive thinking Effective communication skills Ability to perform extensive telephone assessment Knowledge of Medicare regulations and home care and hospice standards Experience with small group presentations and teaching/training Exhibits excellent interpersonal skills Exhibits excellent written and oral skills Working knowledge of computer programs (email, Word, Excel, PowerPoint, etc.) Manages time effectively to ensure all duties and documentation requirements are completed in a timely manner Preferred Knowledge, Skills and Experience: Bachelor of Science in nursing or related field May be required to obtain multi-state licensing Strong knowledge of population health, quality measures, care gap closure and value-based care models

Coordinates care services with pod leader to ensure that patients have access to a comprehensive set of services tailored to their needs throughout their healthcare journey Works collaboratively within the care team to develop and manage personalized care plans, address care gaps, and engage with other resources to ensure access to care Coordinates the transition of care for patients throughout the continuum to ensure patient needs are met accordingly and to ensure that avoidable hospital admissions do not occur Coordinates and facilitates High Risk Huddles along with ensuring that follow-up actions are completed Prioritizes patients based on the severity and urgency of their conditions to ensure that the most critical cases receive immediate attention Reviews medical records to identify gaps in care and coordinate services with the care team to manage these issues Regularly updates patient care plans Performs thorough nursing assessments via telephone of patients to maximize or improve current health outcomes Provides education to patients and/or their caregivers on disease education, medication, health maintenance, and disease prevention to promote self-management and improve health outcomes Demonstrates strong clinical skills, critical thinking abilities, and effective communication in their interactions with patients, caregivers, providers, fellow care team members, etc. Documents necessary interactions, assessments, updates, etc. in patient’s medical records according to processes and guidelines Serves as liaison between patients, providers, resources, etc. to ensure seamless care delivery Facilitates communication of patient status and plan of care during transitional experiences such as home to hospital, hospital to post-acute care and back to home

CorVel Corporation

Case Management Supervisor RN

Posted on:

May 27, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Illinois

CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!).

The Case Management Supervisor is responsible for directing the operations of their designated department, which may include one or more of the following functions: human resources, customer service, and limited sales management. This is a remote position.

KNOWLEDGE & SKILLS: Ability to write and speak clearly, easily communicating complex ideas across multiple platforms Ability to remain poised in stressful situations and communicate diplomatically via telephone, computer, fax, correspondence, etc. Ability to skillfully manage multiple, complex projects and competing priorities concurrently while working under pressure to meet deadlines and maintaining strong customer service orientation Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets Must have technical knowledge of the laws, policies, and procedures in defined territory Strong interpersonal, time management and written communication skills Great attention to detail, and results focused EDUCATION/EXPERIENCE: Graduate of accredited school of nursing with a diploma/Associates degree (Bachelor of Science degree or Bachelor of Science in Nursing preferred) Current RN licensure in state of operation 3 or more years of recent clinical experience, preferably in rehabilitation National certification (CRC, CIRS, CCRN, CVE, CCM, etc.), CCM preferred Demonstrated experience in management or supervision

Responsible for directing a designated group of employees in their day-to-day operations Responsible for quality of service provided Responsible for human resources matters directly related to department supervised Requires regular and consistent attendance Comply with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP) May be required to travel overnight and attend meetings May perform daily, weekly, monthly reviews of various reports, invoices, logs and expenses May be responsible for limited marketing and sales activities May be required to oversee case management clinical activities (dependent on whether or not unit manager is an RN) For Supervisors who are not RN’s, the clinical oversight and direction will be performed by a designated RN with a nationally recognized certification. This could be a case management supervisor, another manager or local executive May perform case management responsibilities (dependent on whether or not unit manager is an RN for medical case management activities or qualified for vocational case management) Additional duties as required

IntellaTriage

Remote Hospice Triage RN- 2 PT 4:30a-10a rotating Sat & Sun 4:30a-10a

Posted on:

May 27, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

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 outsourced 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. Learn more at www.intellatriage.com.

We invite you to join our growing team! IntellaTriage Nurses enjoy the benefits of working from home, providing care, without the stress and expense of commuting each day! **MUST have or be willing to obtain a Compact RN license **MUST live in/work from a Compact US state **Experience with end-of-life care is required **Must have high speed internet **Must be tech savvy, enjoy a fast-paced environment, and have keyboard competence Part- time schedule: Work a minimum 2 shifts weekly 4:30a-10a CST (shift times are set/ week day flexes) Work every other weekend, both Saturday and Sunday 4:30a-10a CST

MUST have or be willing to obtain a Compact RN license (states with pending or future implementation dates are not considered current compact states until the implementation date) You must remain in good standing and ensure your home state license remains active. IntellaTriage will cover the cost of non-compact state licensure if necessary for client support. Hospice, palliative, end-of-life care is strongly preferred Experience in a fast-paced environment: ED, surgical services, or critical care, etc. Must be comfortable accessing multiple technology applications to document during calls Ability and comfort with typing in a fast-paced environment Fluency in English is required, additional languages are a bonus Must physically reside in the U.S. and be legally eligible to work for any employer Must be able to complete three weeks of remote paid training that is conducted during days and evenings Must be available to work every other Saturday & Sunday Must be available to work some Holidays as required 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) Must be able to communicate empathically with patients while adhering to protocols Must maintain CEU’s as designated by the states in which you are answering calls Must attend any in-services, and additional training on an as needed basis Must pass background check and nurse licensing check

Our Hospice Triage Nurses: Have experience in hospice, palliative, end-of-life care and in fast-paced environments: ED, critical care, surgical services, etc. Part-time nurses work a minimum of 1 week day shift & every other weekend both Saturday & Sunday Receive three weeks of remote paid training. The training schedule varies based on availability You can pick up additional shifts, if available, for the clients’ you are trained to support. We will provide you with a laptop and headset. You’re required to use your own high-speed internet You’ll need a quiet space, away from noise and distraction, while you work (privacy/HIPAA compliant space is required). You’ll access EMRs for charting and utilize our internal applications to perform job functions You MUST be able to follow instructions, read directions, and be confident using technology A minimum of 30 minutes paid shift prep is required prior to taking calls You’ll spend 30 minutes to 2 hours, at the end of your shift, completing remaining charting before clocking out

Thyme Care

Remote Oncology Case Manager (Transitions of Care) (11:30 - 8PM EST Shift)

Posted on:

May 27, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Tennessee

Imagine building a better healthcare journey for patients with cancer, where individuals and their loved ones feel seen, supported, and heard by their care team – both in and out of the clinic. Where fast access to high-quality care is the norm, not the exception. Where patients have access to a care navigator to guide them through their diagnosis and trusted support all along the way. At Thyme Care, we share a passion for transforming the cancer care experience – not just for patients but also for their caregivers and loved ones, as well as those delivering and paying for their care. Today, Thyme Care is known predominantly as a cancer care navigation company enabling value-based cancer care; in the next few years, we will become a nationally recognized technology-driven and provider-centric care delivery model, reshaping the landscape of cancer care access, delivery, and experience. Our commitment runs deep—we're not satisfied with the status quo but determined to redefine it. To make this happen, we’re building a diverse team of problem solvers and critical thinkers to drive innovation and shape the future of healthcare. If you share our vision and want to be part of something truly meaningful, we want to hear from you. Together, we can revolutionize cancer care and make a difference that lasts a lifetime.

Thyme Care Inc., the management company to Thyme Care Medical PLLC, is the employing entity with your duties to be performed for Thyme Care Medical PLLC, a medical practice, and its patients. As an Oncology Nurse - Transitions of Care, you will be on the frontlines serving our members diagnosed with cancer. This role reports to our RN Care Team Lead. In it, you will conduct clinical assessments, monitor for changes in health, coordinate care, including transitions, and educate members and caregivers about their diagnosis and treatment over the phone to support our members as they move through the oncology care continuum. You will demonstrate a strong clinical focus, supporting the need for culturally competent care. Additionally, you will help improve Thyme Care’s service offerings by communicating feedback from members and providers to our clinical leadership. You will also assist with other administrative projects as needed. This role can be remote or hybrid based in our Nashville office. Most of your day will be dedicated to speaking with members and handling clinical escalations and tasks. We maintain a schedule that includes your lunch and breaks to ensure sufficient clinical coverage.

A member-first approach. You’re personally motivated by our mission and by what we are building. You seek to understand problems and help people solve them, especially this one. A BSN. You must have a Bachelor of Science Degree in Nursing, an unrestricted Registered Nurse (RN) license, and a willingness to obtain additional state licenses as needed. Experience. You have at least 5 years of nursing experience with 3 years of oncology nursing or case management experience and are a Certified Case Manager (CCM). Organized. You’re skilled in juggling multiple tasks and working under pressure without sacrificing organization in your communications and documentation. Effective listener and communicator. You are winsome and articulate, but you always start with listening and hearing what may not be voiced because you listen intently to others. You build rapport and great working relationships with members and colleagues. Comfort with ambiguity. Start-ups are fast-paced environments, and you understand that rapid changes to the business, strategy, organization, and priorities are par for the course… and part of the adventure. A desire to learn how to use new technologies. We are a technology company focused on interacting with folks during the season when they need it most. Experience with video chatting, Google Suite, Slack, electronic health records, or comfort in learning new technology is important. Identify priorities and take action. You know how to identify and prioritize a member's needs and do what it takes to address urgent and important needs immediately.

Have completed training and are up to speed on Thyme Care systems, tools, technology, partners, and expectations. Have built strong, trusting relationships with your members, where listening and empathy are the foundation for every interaction. Be comfortable following Care Team policies and procedures, escalation pathways, communications best practices, and documentation standards. Your ability to effectively engage and support our members is reflected in our efficiency metrics and quality standards. Identify and prioritize a member's needs and help them remain safe in the community. Assist members with care coordination and care management following admissions. Coordinate discharge plans with hospital case managers and follow-up care with providers. Monitor member progress, provide regular updates, and establish targeted support plans with the healthcare team in case conferences. Build strong, trusting relationships with payers and providers to optimize care and prevent readmissions for our members. Partner with non-clinical Care Team members to support the member’s social determinants of health needs, such as food resources, transportation access, and support at home. Conducting telephonic assessments, including pain assessments and medication reconciliation. Ensure members have access to medications and appointments, providing referrals and support as appropriate. Perform virtual home safety evaluations and assess the need for DME/supplies. Provide referrals to PT, OT, skilled nursing, palliative care, hospice care, etc., as appropriate. Be available for urgent clinical escalations and clinical consult support.

Thyme Care

Complex Oncology Nurse Navigator

Posted on:

May 27, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Tennessee

Imagine building a better healthcare journey for patients with cancer, where individuals and their loved ones feel seen, supported, and heard by their care team – both in and out of the clinic. Where fast access to high-quality care is the norm, not the exception. Where patients have access to a care navigator to guide them through their diagnosis and trusted support all along the way. At Thyme Care, we share a passion for transforming the cancer care experience – not just for patients but also for their caregivers and loved ones, as well as those delivering and paying for their care. Today, Thyme Care is known predominantly as a cancer care navigation company enabling value-based cancer care; in the next few years, we will become a nationally recognized technology-driven and provider-centric care delivery model, reshaping the landscape of cancer care access, delivery, and experience. Our commitment runs deep—we're not satisfied with the status quo but determined to redefine it. To make this happen, we’re building a diverse team of problem solvers and critical thinkers to drive innovation and shape the future of healthcare. If you share our vision and want to be part of something truly meaningful, we want to hear from you. Together, we can revolutionize cancer care and make a difference that lasts a lifetime.

Thyme Care Inc., the management company to Thyme Care Medical PLLC, is the employing entity with your duties to be performed for Thyme Care Medical PLLC, a medical practice, and its patients. As a Complex Nurse Navigator, you will be on the frontlines serving our members diagnosed with cancer. This role reports to our RN Care Team Lead. In it, you will conduct clinical assessments, monitor for changes in health, coordinate care, including transitions, and educate members and caregivers about their diagnosis and treatment over the phone to support our higher-acuity members as they move through the oncology care continuum. You will demonstrate a strong clinical focus, supporting the need for culturally competent care. Additionally, you will help improve Thyme Care’s service offerings by communicating feedback from members and providers to our clinical leadership. You will also assist with other administrative projects as needed. This role can be remote or hybrid based in our Nashville office. Most of your day will be dedicated to speaking with members and handling clinical escalations and tasks. We maintain a schedule that includes your lunch and breaks to ensure sufficient clinical coverage.

A member-first approach. You’re personally motivated by our mission and by what we are building. You seek to understand problems and help people solve them, especially this one. A BSN. You must have a Bachelor of Science Degree in Nursing, an unrestricted Registered Nurse (RN) license, and a willingness to obtain additional state licenses as needed. Experience. You have at least 5 years of nursing experience with 3 years of high-acuity, adult oncology experience. Organized. You’re skilled in juggling multiple tasks and working under pressure without sacrificing organization in your communications and documentation. Effective listener and communicator. You are winsome and articulate, but you always start with listening and hearing what may not be voiced because you listen intently to others. You build rapport and great working relationships with members and colleagues. Comfort with ambiguity. Start-ups are fast-paced environments, and you understand that rapid changes to the business, strategy, organization, and priorities are par for the course… and part of the adventure. A desire to learn how to use new technologies. We are a technology company focused on interacting with folks during the season when they need it most. Experience with video chatting, Google Suite, Slack, electronic health records, or comfort in learning new technology is important. Identify priorities and take action. You know how to identify and prioritize a member's needs and do what it takes to address urgent and important needs immediately.

Have completed training and are up to speed on Thyme Care systems, tools, technology, partners, and expectations. Have built strong, trusting relationships with your members, where listening and empathy are the foundation for every interaction. Be comfortable following Care Team policies and procedures, escalation pathways, communications best practices, and documentation standards. Your ability to effectively engage and support our members is reflected in our efficiency metrics and quality standards. Identify and prioritize a member's needs and help them remain safe in the community. Assist members with care coordination and care management following admissions. Coordinate discharge plans with hospital case managers and follow-up care with providers. Monitor member progress, provide regular updates, and establish targeted support plans with the healthcare team in case conferences. Build strong, trusting relationships with payers and providers to optimize care and prevent readmissions for our members. Partner with non-clinical Care Team members to support the member’s social determinants of health needs, such as food resources, transportation access, and support at home. Conducting telephonic assessments, including pain assessments and medication reconciliation. Ensure members have access to medications and appointments, providing referrals and support as appropriate. Perform virtual home safety evaluations and assess the need for DME/supplies. Provide referrals to PT, OT, skilled nursing, palliative care, hospice care, etc., as appropriate. Be available for urgent clinical escalations and clinical consult support.

Molina Healthcare

Care Review Clinician, PA (RN) (Must work PST)

Posted on:

May 27, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Arizona

Molina Healthcare is a nationwide fortune 500 organization with a mission to provide quality healthcare to people receiving government assistance. If you are seeking a meaningful opportunity in a team-oriented environment, come be a part of a highly engaged workforce dedicated to our mission. Bring your passion and talents and together we can make a difference in the lives of others. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. HCS staff work to ensure that patients progress toward desired outcomes with quality care that is medically appropriate and cost-effective based on the severity of illness and the site of service.

Required Education: Completion of an accredited Registered Nurse (RN). Required Experience: 1-3 years of hospital or medical clinic experience. Required License, Certification, Association: Active, unrestricted State Registered Nursing (RN) license in good standing.

Assesses services for members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines. Analyzes clinical service requests from members or providers against evidence based clinical guidelines. Identifies appropriate benefits and eligibility for requested treatments and/or procedures. Conducts prior authorization reviews to determine financial responsibility for Molina Healthcare and its members. Processes requests within required timelines. Refers appropriate prior authorization requests to Medical Directors. Requests additional information from members or providers in consistent and efficient manner. Makes appropriate referrals to other clinical programs. Collaborates with multidisciplinary teams to promote Molina Care Model Adheres to UM policies and procedures. Occasional travel to other Molina offices or hospitals as requested, may be required. This can vary based on the individual State Plan. Must be able to travel within applicable state or locality with reliable transportation as required for internal meetings.

ArchWell Health

Occupational Health Nurse

Posted on:

May 27, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Tennessee

ArchWell Health is re-imagining the practice of primary care. We are putting the relationship between patient and physician at the center of a value-based model focused on outstanding patient experience, improved access, and better outcomes. In our medical clinics, we provide comprehensive primary care for senior adults with Medicare Advantage plans, focused on delivering improved quality, better patient experience and lower total cost of care.

The Occupational Health nurse will be directly responsible for maintaining and monitoring colleague health screening, required training and immunization status. Reports to the Sr Director of Practice Health and Safety.

Required Skills/Abilities: Strong knowledge of occupational health and safety regulations. Excellent communication and interpersonal skills. Ability to manage confidential information with discretion. Ability to promote health and wellness in the workplace Proficiency in Microsoft Office Suite and health management software. Education and Experience: Registered Nurse (RN) license Bachelor’s degree in nursing or related field (preferred) Certification in Occupational Health Nursing (preferred). Minimum of 5 years of nursing experience. Minimum of 3 years of Occupational Health Nursing experience (preferred)

Manage and document workplace injuries and illnesses. Conducts studies and investigations on health or safety- related colleague issues and prepare reports, summaries, and recommendations. Develop and implement health and safety programs that focus on promotion and restoration of health, prevention of illness and injury, and protection from work-related hazards. Educate employees on health and safety practices. Monitor and assess effectiveness of health and safety programs or practices. Serves as a resource on colleague health matters, health promotion and risk-reduction strategies., creating/maintaining policies and procedures related to colleague health. Ensure compliance with Occupational Safety and Health Administration (OSHA) regulations and other laws that affect the workplace. Keeps logs, documents and reports required by the Occupational Safety and Health Administration (OSHA) and state agencies as required by law. Maintain accurate health records and reports. Collaborate with the HR team regarding workers’ compensation claims and Case Management Collaborate with HR and management on health-related issues (e.g., ADA/reasonable accommodation requests) Coordinate with external healthcare providers, as necessary.

Gainwell Technologies

Nurse/Coder Ideation Specialist- Remote

Posted on:

May 27, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Nebraska

It takes great medical minds to create powerful solutions that solve some of healthcare’s most complex challenges. Join us and put your expertise to work in ways you never imagined possible. We know you’ve honed your career in a fast-moving medical environment. While Gainwell operates with a sense of urgency, you’ll have the opportunity to work more flexible hours. And working at Gainwell carries its rewards. You’ll have an incredible opportunity to grow your career in a company that values work-life balance, continuous learning, and career development.

The Nurse/Coder Ideation Specialist is responsible for the development and performance of our clinical and coding products including Itemized Bill Review, DRG Validation, Outpatient clinical and other Coding Solutions. This role also provides SME support to the clinical and coding organization. This role requires expertise in healthcare payment methodologies, inpatient coding, outpatient coding, payment integrity audits and review criteria to target key claims for review and recovery. Proven experience in rule and content development, claims recovery, and coding expertise is essential. Experience in developing and performing Itemized Bill Review concepts (IBR) is preferred. Key responsibilities include developing content, tracking performance, providing implementation and client support, conducting research, and reviewing claims as needed.

7-10 years reviewing and or auditing ICD 10 CM/PCS, MS-DRG, APR DRG claims and proficient with encoder products. In addition, experience with APC and EAPG preferred. Registered Nurse and/or Inpatient Coding Certification Required (i.e CCS, CIC, RHIA, RHIT), or other coding certification (CPC) with inpatient coding experience. RN with Coding credentials is preferred. Ability to research State and Federal regulations, clinical policies, coding guidelines to develop and implement policies, clinical/coding resources, and tools to support Gainwell’s Clinical Claim Review products. Itemized Bill Review product expertise required to support solution development and enhancements. Deep experience with principals of inpatient and outpatient billing and coding audits with ability to provide Subject Matter Expert (SME) level support to the clinical organization. Independently perform research and data analysis leveraging claims data to develop new audit strategies, solutions, edits and targets.

Content Development: Work in conjunction with the Medical Directors and Innovation Teams to develop new clinical and coding products. The product focus is identifying overpayments made to provider by insurance companies through data review, data analytics, and application of coding guidelines. Develop innovative strategies to enhance claim selection processes, significantly contributing to payment integrity for our clients. Data Analysis and Organization: Leverages data analysis expertise and strong organizational skills to innovate new ideas and new concepts including development of Itemized Bill Review, outpatient claim reviews, other inpatient coding solutions. Performing research and scoping analysis for development of coding and clinical target and edits. Claim Selection Methodology: Utilizes a comprehensive understanding of claim selection methods to refine and execute methodologies that enhance claim selection strategies, particularly focused on inpatient claims. Program Performance: Monitor and analyze current and new concepts and target performance. Present results to clinical leadership team. Recommend and implement program changes to improve performance. Enhance Clinical and Coding Solutions: Utilize expertise to assist in the enhancement and review of clinical and coding solutions. Research: Research industry standard guidelines, State/Federal regulations, and client billing and reimbursement policies, to develop and configure improper payment algorithms Regulatory Monitoring: Assess and adjust written rules by monitoring their effectiveness, keeping up with regulatory updates, and making necessary changes. Monitor and research changes in coding guidelines and regulations and determines impact to Gainwell programs. Analytical Problem-Solving: Performs detailed analysis of client data to identify areas of high risk and drives concept development in those areas. Policy and Process Documentation: Develop departmental policies, processes, and training standards. Provide internal and external partners with evidence and references supporting industry standards, auditing guidelines, and review stances. Research and Special Projects: Assist with research, special projects, and ad hoc claim reviews as needed. Clinical and Coding Content: Develop clinical and coding content that will drive decision-making and documentation for the Clinical Services, Quality and Appeals teams. Develop training and education, and work with clinical teams to make sure that coding content standards are well understood by all levels of the organization. SME Support: Maintain expertise in current Gainwell clinical and coding program processes, workflows and outcomes. Provide primary SME support regarding clinical policy, clinical and coding review programs and processes to account management, sales, clients, and clinical teams. Client and Sales Support: Provide RFP SME Support. Meet with clients to explain programs and processes, discuss policy concerns, identify issues and develop proactive solutions to problems that clients may be having or anticipate having with Gainwell clinical and coding review programs.

Alive Hospice

Registered Nurse, Remote Call Center

Posted on:

May 27, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Tennessee

Registered Nurse - Triage/Call Center Location: Nashville, TN (Must live in Tennessee) Status: PRN Hours: 7a-11p If you have a passion for people and a desire to provide outstanding care and comfort to patients and their families, while working within a professional team focused on clinical excellency, then we can't wait to speak with you! SUMMARY: Performs triage functions for after hours program. Receives calls, plans for care interventions, dispatches on call nurses or provides phone support as needed, notifies appropriate nurse, team or outside agency of any changes in LOC.

EDUCATION and/or EXPERIENCE: Registered Nurse with a current nursing license, BSN preferred. Ability to apply for TN license within 30 days of hire. Knowledge of or willingness to learn hospice care. Minimum one year nursing practice or equivalent experience required. Hospice, Oncology, or Home Health and/or long-term care preferred. CERTIFICATES, LICENSES, REGISTRATIONS: Current TN RN License. If required to drive to carry out the duties of this position: current driver's license and automobile insurance as required by Tennessee State Law.

Mentors on call staff as appropriate. Performs triage role utilizing nursing judgment and process to provide effective, timely and compassionate care to patients. Dispatches on call nurses as needed and makes home visits if dictated by workload or geographical distance. Provides telephone support to family at time of death. Serves as clinical and procedural resource for on call staff. Participates in planning, implementation and evaluation of patient services. Reviews triage documentation to assure accurate and timely notes. Attends meetings as requested. Communicates with M.D. and other care providers as needed. Ensures adherence to policies. Notifies on call administrator of problems. Covers after hours needs if office is unable to open. Other duties may also be assigned.

EK Health Services Inc.

Care Coordinator - Case Management - REMOTE ! M-F 8-5 Mountain or Central Time

Posted on:

May 27, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

None Required

State License:

Arizona

Reporting to the CM Operations Manager, the Care Coordinator will work closely with the Case Managers for reporting, care coordination phone calls, and other administrative duties. The Care Coordinator will increase efficiency of operations by providing general customer support duties and by supporting the Case Manager and operations staff in a team environment. Position Specifics: Non-Exempt, Full-time, Standard eight (8) hour workday, Monday-Friday, 8am-5pm MT or CT - Remote

AS/AA degree or two (2) years of college preferred Experience in a medical office environment preferred Medical terminology strongly preferred Previous customer service experience in fast paced environment preferred Professional demeanor with excellent written and oral communication skills Strong organization skills Able to communicate with customers at all levels Must be computer literate with a high comfort level with computers and computer programs (i.e. MS Word, MS Excel, Email, and Internet) Physical Requirements: Candidate must be able to sit the majority of an 8-hour day except for lunch and break times. Candidate must be able to keyboard the majority of an 8-hour day except for lunch and break times. Candidate must have manual dexterity. Candidate must be able to speak on the telephone intermittently throughout the day. Candidate must be able to read and write English fluently. Candidate must be able to provide and confirm a safe home office environment. Home office must be HIPAA compliant. *Requires DSL, fiber, or cable internet connection from home 100 Mbps preferred or better. *

Provide accurate information to callers based on customer requests; triaging telephone calls to direct the caller for clinical consultation and for case manager Enter new claims data into the claims management system accurately; maintain data integrity in scanning, uploading, indexing and data entry Maintain the data integrity of the Ahshay database, which involves verifying and updating information for service providers, adjusters, and attorneys Use predetermined client criteria to triage new Case Management referrals. Complete the triage process, which does not include medical assessment. When applicable, transition to full Telephonic Case Management and assign to the designated Case Managers Generate appropriate letters and reports in Ahshay and distribute them to the appropriate parties per client guidelines and EK workflow Support clinical staff through the completion of components of case management, including but not limited to appointment scheduling, diagnostic test scheduling, requesting medical records, faxing materials, mailing/e-mailing already identified education materials, scheduling delivery of already negotiated and approved DME, and facilitating claims adjudication Professional interaction with Case Managers, Adjusters, Employers, Physicians, and other medical professionals Other duties as assigned

EK Health Services Inc.

Certified Legal Nurse Consultant (RN) - Contractor - REMOTE!

Posted on:

May 27, 2025

Job Type:

Contract

Role Type:

License:

RN

State License:

California

Expert Exams, a subsidiary of EK Health, is looking for a Certified Legal Nurse Consultant - RN (Contractor) to join the team! A Certified Legal Nurse Consultant uses medical expertise to consult with and advise attorneys on injury cases. A Legal Nurse Consultant analyzes complex medical information and renders an informed and objective opinion on the medical-legal matters. This position requires a minimum of 2-3 years' experience as a Certified Legal Nurse Consultant, preferably in defense work. NOTE: this position is that of an independent contractor (1099) and will require proof of liability insurance. LNC Certification required. This position is a part-time Contractor position. This position pays $40-45/hr based on experience.

2-3 years' experience as a Certified Legal Nurse Consultant, preferably in personal liability defense work Graduate of an accredited school of nursing Med-legal coursework preferred Valid state-appropriate RN license in good standing with no restrictions LNC Certification required Possesses and can demonstrate the professional and technical skills of a Registered Nurse Excellent Written and Oral Communication Skills Excellent Interpersonal Skills Strong Organization Skills High comfort level with computers and computer programs (MS Word, MS Excel, Email) Ability to work independently with minimal supervision

Review and summarize medical records, communicating essential highlights and important details efficiently and effectively to appropriate parties Determine an injured-party’s long-term medical requirements and estimate costs for that care Prepare chronologies or timelines for medical records Be objective and honest in evaluating the facts of the case Research and cite medical resources/ professional literature related to the case as applicable Locate and interview other medical experts to testify

Akkodis

Clinical Claims Nurse

Posted on:

May 27, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Florida

Job Title: Clinical Claims Nurse Location: 100% Remote Pay Rate: $36.25/hour on W-2 (Contract-to-Hire), $65K conversion salary Schedule: M–F, 8-hour shifts (Core hours: 9am–3pm ET) Akkodis is hiring a Clinical Claims Nurse for a fully remote contract-to-hire opportunity with a leading healthcare compliance organization. This role is ideal for professionals with medical coding, medical billing, and insurance claims experience at a health plan (e.g., Humana, BCBS, UnitedHealthcare). If you're detail-oriented, tech-savvy, and enjoy problem-solving in a structured yet fast-paced environment, this role offers a great opportunity to apply your coding and payer-side experience in a meaningful way.

3+ years of clinical nursing experience (ICU, ER, Med Surg, or PACU) and electronic charting experience.(required). Experience handling insurance claims from the payer side (e.g., Humana, BCBS, Aetna). Ability to read and interpret EOBs, remark codes, and medical claim language. Familiar with dispute resolution, appeals processes, and healthcare regulations. Medicaid experience is a plus. Comfortable using tools like Microsoft Excel, Word, Outlook, Teams, and OneNote. Must hold an active RN or LPN license. Associate’s degree or higher required. Strong written and spoken grammar/communication skills. Flexibility to adapt to evolving processes. Proficiency in Excel (beyond basic formulas is highly preferred). Ideal Candidate Background: Has worked as a medical claims analyst, coding specialist, insurance appeals coordinator, or similar. Comes from a health plan or third-party administrator (TPA). Understands the logic behind coverage decisions and coding disputes—not just how to code, but why codes matter. Appeals or IDRE (Independent Dispute Resolution Entity) experience is a major plus, but not required.

Review Explanation of Benefits (EOBs) and appeals from providers and health plans under the No Surprises Act. Resolve disputes related to out-of-network provider charges by following detailed internal policies. Research service codes, fees, and coverage policies using digital tools and online databases. Use your knowledge of remark codes, CPT codes, and medical service codes to make impartial and binding recommendations. Handle 24+ insurance dispute cases per day, documenting decisions accurately in the CMS IDR Portal.

Aquarius Strategies

Care Coordinator

Posted on:

May 26, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

None Required

State License:

Idaho

This is a remote position. Aquarius Strategies has been retained to find a Care Coordinator (CC) for a National company that provides access to the nation’s elite medical minds for a variety of expert medical services. This organization aims to improve the quality and appropriateness of care by ensuring that expert medical advice is at the center of care delivery. Their innovative telehealth platform creates a digital front door providing direct access to the nation’s elite medical minds. This organization facilitates the execution of virtual second opinions for clients seeking expert medical advice. They serve two distinct markets: the Business-to-Consumer (B2C), for concierge and international clients, and Business-to-Business (B2B), for professional athletes, insurance companies, self-insured employers and third party administrators. This organization has grown significantly in the worker’s compensation space, working with several large carriers to provide expert medical opinions for injured workers. This organization comprises an expert network of 450+ fellowship-trained physicians, is invitation-only, and the providers are carefully selected based on reputation, training, years of experience, involvement in academic research, and other factors. Their services are represented across 7 base specialties and 84 sub-specialties within Orthopedics, Internal Medicine, Surgery, Psychiatry, Radiology, Oncology and OBGYN.

This organization is looking for a Care Coordinator (CC) to join their team to provide exceptional support to both physicians and clients. This person will be a representation of the company as the first point of contact for all customer support. This individual will work closely with the VP of Clinical Solutions and Director of Client Success & Partnerships, as well as other members of the Care Coordination Team to ensure the highest level of care is delivered to clients for each and every consultation. The ideal candidate has an interest in the medical field, entry-level clinical experience, and is both a team player and an independent problem-solver. Every hire for this organization becomes an integral member of the team with the autonomy to make a significant impact both at the company and the clients they service. In addition, Care Coordinators have the opportunity to progress into account management roles, providing avenues for professional growth and advancement within the organization.

Passionate about healthcare The ability to handle confidential information with discretion Team player with ability to work in a fast-paced environment Excellent spoken and written communication skills Proficiency in Technological Information Systems and Google Workspace Preference given to applicants who: 4 year bachelor’s degree Have prior work experience in a healthcare environment or insurance company Are bilingual (English/Spanish, preferred) Have experience providing supportive care services for a technology platform Are open to working weekend shifts

Care Coordinators (CC) serve as the crucial link between physicians and clients, managing case coordination and ensuring seamless communication and support throughout the care coordination process. CCs are expected to perform the following tasks: Provide support to expert physicians Onboard, train and work with the nation’s most highly respected surgeons and physicians, including team physicians for the NBA, NFL, MLS, MBL, NHL and Olympics: Provide support to current and prospective clients Triage and manage client inquiries via phone and email related to services and products Assist in procurement, organization and screening of medical records and imaging Assist in client success strategies to promote referrals and increased utilization: Provide support to the Clinical Operations team Manage cases from inception to completion Analyze clinical outcomes of cases Manage quality assurance procedures Ensure high degree of customer satisfaction via individual outreach before and after each consultation Comply with all applicable regulations (i.e. URAC, HIPAA, SOC2)

CVS Health

Appeals Nurse Consultant - Remote Position

Posted on:

May 26, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Mississippi

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

This position will be working from home anywhere in the US. Standard business hours 8a-5p in time zone of residence Monday - Friday.

Required Qualifications: 3+ years of clinical experience required Active and unrestricted RN licensure in state of residence Preferred Qualifications: Managed Care experience Utilization Management experience Appeals experience Pre Certification experience Pre Authorization experience Education: Associates Degree minimum required Bachelors Degree preferred

The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare appeals for participating providers. Primary duties may include, but are not limited to: Requesting clinical, research, extrapolating pertinent clinical, applying appropriate Medicare Guidelines, navigate through multiple computer system applications in a fast-paced department. Must work independently as well as in a team environment while working remotely. Fast paced sedentary position, talking on the telephone, looking at computer screens, utilizing templates in Word, and typing on the computer.

LifeBridge Health

Remote RN - Monitoring Prgm

Posted on:

May 26, 2025

Job Type:

Part-Time

Role Type:

Telehealth

License:

RN

State License:

Maryland

As one of the largest health care providers in Maryland, with 13,000 team members, We strive to CARE BRAVELY for over 1 million patients annually. LifeBridge Health includes Sinai Hospital of Baltimore, Northwest Hospital, Carroll Hospital, Levindale Hebrew Geriatric Center and Hospital and Grace Medical Center, as well as our Community Physician Enterprise, Center for Hope, Practice Dynamics, and business partners: LifeBridge Health & Fitness, ExpressCare and HomeCare of Maryland.

CANDIDATES MUST RESIDE IN MD, DC, PA, VA OR WVA

Associate's Degree in Nursing Registered Nurse License - Current Maryland license 3-5 years of experience Rate $30 per hour

Under general supervision and according to established policies and procedures, provide remote Blood Pressure (BP) monitoring for all patients enrolled in the Remote Care program. Communicates significant blood pressure changes and patient concerns to appropriate physician. Communicate with each assigned patient at least once every month and more when blood pressure is in the alert range.

Seva Medical

Remote Night/Weekend RN- Patient Triage & Care Coordination

Posted on:

May 26, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Join the gold standard in Geriatric Mobile Primary Care. At Seva Medical, we deliver compassionate, value-based care to seniors in adult family homes, assisted living, and memory care communities—where they feel most at home.

As a Remote RN, you’ll provide after-hours triage and chronic care management (CCM) to patients with complex needs. You’ll play a critical role in reducing ER visits and ensuring seamless, patient-centered care. Shift Options Evenings: 5 PM – 1:30 AM Overnights: 12 AM – 8:30 AM Weekends All Three Shifts Including: 8 AM – 5 PM

Active RN license (unrestricted); Compact license (eNLC) preferred 2+ years of nursing experience (triage, CCM, home health, geriatrics) BLS certification Tech-savvy: EHR, secure messaging, telehealth tools Quiet home office + high-speed internet Evening, weekend, or overnight availability Preferred: 3+ years RN experience Telehealth or long-term care background Familiarity with CMS CCM billing Strong communication & patient education skills

Triage patient calls using protocols and clinical judgment Coordinate care with providers, caregivers, and facilities Manage chronic conditions like CHF, COPD, diabetes, etc. Engage in proactive CCM tasks during non-call hours Document assessments, interventions, and escalations clearly

Privia Health

Nurse Care Manager

Posted on:

May 26, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Florida

Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.

Privia is looking for a forward thinking, organized, energetic Nurse Care Manager that delivers on objectives and seeks an opportunity to develop, implement, and deliver change within our medical group and affiliated partners. Working closely with the population health teams, networked facility partners, primary care providers, and practice operations at Privia Health, the Nurse Care Manager will provide extensive care coordination for Privia’s highest risk patients.

BS in Nursing (or equivalent) preferred and at least 3+ years of case management or care coordination experience. Active unrestricted license in FL Strong computer and EHR skills and expertise Must comply with all HIPAA rules and regulations Technical Requirements (for remote workers only, not applicable for onsite/in office work): In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like https://www.speedtest.net/. This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.

Develop trust and build rapport with a select Privia patient population with a goal of reduction in high cost utilization and improvement in clinical outcomes Engage patients telephonically, in office, in facility, or where needed Act as the liaison between the patient and Value-Based Care Programs Assist patients in accessing care at the appropriate source Holistic assessment of patients (medical, social, economic, behavioral) to identify opportunities or barriers to improve outcomes Work collaboratively with patient and care center teams to develop a plan of care to improve patient outcomes Provide other billable services as needed and allowed by licensure for our patient population virtually or at assigned office locations, to include assessment of vital signs, administration of vaccines, and review of past, family, and social medical history, medications, and preventive health care needs. In-person and telephonic follow up with our high risk patient populations for education and collaborative goal setting to work towards improving patient outcomes and decreasing high cost utilization Telephonic follow up with patients testing positive for COVID-19 and participating in CVFP’s and PTC’s ambulatory monitoring protocol. Where applicable all tasks, including assessments and care planning, are completed by a RN or LPN under the supervision of an RN, and follow established protocols and standing orders. Understand and utilize the Athena and Privia Applications to identify high value opportunities to decrease utilization and close quality gaps Maintain a courteous and helpful manner when working with patients, physicians, and associates Participate in special projects and perform other duties as assigned

HEALTHNET INC

Registered Nurse - Primary Care Triage (Remote)

Posted on:

May 26, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Indiana

HealthNet is a nonprofit 501 (c) (3) organization of community-based health centers located in Indianapolis and Bloomington, IN Since 1968, HealthNet has improved the health status of the neighborhoods it serves by making quality health services accessible to everyone. HealthNet annually provides affordable health care to more than 61,000 individuals through its network of 9 primary care health centers 5 dental clinics, 9 school-based clinics, a mobile health unit, and additional support services. HealthNet’s mission is to improve lives with compassionate health care and support services, regardless of ability to pay.

The Registered Nurse position is a combination of education, experience and environmental awareness that provides high quality, person-centered care to patients. When you’ll work as a Registered Nurse at HealthNet: Full-time Potential schedule includes Monday-Friday 8-5, with rotation of evening and Saturday shifts. Health centers are open until 8pm and closed on Sundays. Hours of Operation may differ between each health center location.

What you’ll need as a Registered Nurse at HealthNet: Currently not sponsoring work visa. Requires an Associates of Nursing (ASN). Bachelor of Nursing (BSN) preferred. Requires that the RN has graduated from a nationally accredited nursing program. Requires current state of Indiana license as Registered Nurse. Requires Basic Life Support certification through the AHA. Other advanced life support certifications may be required per unit/department specialty according to patient care policies The skills you’ll bring as a Registered Nurse at HealthNet: Upbeat, positive personality with a passion to serve and educate patients. Critical thinking skills. Strong customer service skills. Strong communication skills. Ability to work individually and as a team member. Reliable transportation required. May require travel between health centers. Physical Requirement: Able to be involved in degrees of prolonged standing, walking, sitting, bending, squatting, and stooping; as well as abilities of repeated bending, stooping, and squatting. Able to lift, push, and/or pull equipment, light to moderately heavy weight up to 20-30 pounds is a necessary function of this position. Able to perform duties during periods of varied and/or prolonged work hours. Will be exposed to all patient elements. Must be able to read, write, hear, and communicate effectively in the English language by both orally and written.

Assess patient’s condition by observing and recording patient behavior. Conduct accurate clinical assessments. Administer medications and other treatment options. Assist all units/staff with problem-solving to obtain necessary equipment, medications, and supplies on an as needed basis. Collaborate with providers and care teams. Assist with procedures Point of care testing Administrative duties such as patient paperwork Develop and maintain on-going relationships with patients Maintain accurate reporting to health department

HV Occupational Health & Safety

Remote Occupational Telehealth Nurse - PRN (LPN, LVN, RN)

Posted on:

May 26, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

At HV Occupational Health and Safety, we are passionate about fostering growth and embracing change to create thriving, safe work environments. As a double minority-owned company, we bring a unique perspective to workplace safety, offering exceptional services that help businesses achieve the best outcomes. Our commitment to honesty, integrity, and respect defines everything we do. We take pride in being problem solvers—delivering practical, responsive solutions to complex challenges. Our team isn’t just clinical; we’re collaborative, clear-headed professionals who value family, hard work, and doing right by people.

**This role is 100% remote and available to LVNs, LPNs, and RNs. We are looking for experienced telehealth nurses to join our case management team. Candidates should be available to work night shift hours consistently. Triage experience is highly preferred.** ike. Whether guiding a patient back to work or coordinating care across borders, you bring a calm, clinical presence that earns trust fast. Your emergency care background makes you decisive, and your case management expertise ensures those decisions lead to smart outcomes—clinically, administratively, and operationally. You move with both compassion and clarity. You’re not just checking boxes—you’re actively driving cases forward, advocating for both the employee and the employer, and ensuring every touchpoint reflects professionalism, integrity, and care.

Active RN, LVN, or LPN license (compact license required). 5+ years of clinical experience in emergency care, urgent care, or occupational health. Strong understanding of OSHA recordability, workers’ comp processes, and return-to-work strategies. High emotional intelligence—able to earn trust quickly with employees, managers, and providers. Excellent communication, documentation, and decision-making skills. Bilingual (English/Spanish or English/French) strongly preferred for international case support. Tech-savvy with the ability to manage telehealth, digital documentation, and fast-paced coordination.

Injury Intake & Assessment: Answer incoming calls during business hours. Conduct after-hours initial intakes, gathering key details such as company info, employee demographics, and medical history. Assess injuries via video (when possible) in collaboration with the Safety Manager and onsite medics. Perform nursing assessments and administer first aid treatment. Determine the best course of action: conservative treatment, telemedicine consult, or emergency care. Manage intakes for employees in Mexico and Canada. Provide FAFs (Functional Abilities Forms) and coordinate follow-ups for Canadian clients. Telemedicine & Follow-Up: Schedule telemedicine appointments with HV physicians. Review physician notes for completeness before distribution. Distribute reports and ensure accurate documentation. Conduct follow-ups for first aid cases and monitor recovery progress. Collaboration & Coordination: Partner with Safety personnel, medics, paramedics, and other nurses. Assist with clinic vetting and coordinate referrals and diagnostics. Support case management efforts, ensuring quality employee care. Communicate with workers’ comp carriers, Risk Management, and HR for proper case handling and approvals. Work closely with HV Physicians and CMAs to ensure case resolution and closure. Documentation: Maintain detailed and timely documentation for all visits and communications. Take clinical photos to support injury tracking and case documentation. Collaborate with HV Physicians for ongoing case discussions. Request and manage medical records as needed.

Guideway Care

Triage Nurse RN (Telehealth) | Weekends

Posted on:

May 26, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

California

Sequence Health is working to provide superior patient conversion solutions to healthcare organizations. Our value system is centered around continuously improving the patient healthcare experience. We pride ourselves on hiring team members who can work independently but also enjoy being part of a team and like to continuously learn and grow. We believe you exemplify these qualities and are excited to have you join our team to continue to make a difference for patients and their families. Since 2004, Sequence Health has offered a wide breadth of innovative patient engagement and patient management solutions to help optimize operational efficiency, elevate brand awareness, and grow physician practices and healthcare businesses.

We are seeking a Registered Nurse who will provide nursing and administrative support to a range of practices across the country. Candidates should have strong computer skills and excellent phone skills to work with providers, patients, and administrators. The pay range is a $25-30 hourly rate. This position is full time being offered remotely. Work Schedule Three 12-hour shifts per week: Saturdays and Sundays from 7:00 AM to 7:30 PM CT (Required) One weekday shift from 9:30 AM to 10:00 PM CT (weekday varies) Weekday shifts are assigned in advance and included in a monthly schedule

Registered Nurse Current demonstration of clinical proficiency Excellent written and oral communication skills Excellent critical thinking and problem-solving skills Ability to work within approved procedure and clinical guidelines Electronic Medical Record Experience, i.e EPIC, Cerner, Greenway Ability to use windows-based computer software including ADOBE, MS Word, MS Excel, Fax and others Minimum Requirements: Registered Nurse with Unencumbered e-NCL Licensure. Licensure in California required. Minimum of 3 years’ experience in Adult Nursing Oncology nursing experience preferred Able to work remotely at home in a private HIPAA compliant workspace Able to house company equipment needed to perform job Broadband Internet Access Immigration or work visa sponsorship will not be provided Physical Demands: Ability to hear in normal range and wear a headset / earpiece Good visual acuity to read computer screens, scripts, forms etc. May sit 100% of the time when taking calls Internet download speed must be at least 24 mbps and upload speed at least 4 mbps Immigration or work visa sponsorship will not be provided

Receive inbound calls from patients and place outbound calls to patients. Provide clinical assessment based on established protocols and triage patients by phone or through patient portal. Respond to patients’ messages in patient portal, create orders and route to appropriate parties. Provide administrative support for patients’ and providers’ needs in terms of FMLA, ADA, and LTD/STD Communicate with Health Care Provider through approved methods as needed. Any other duties necessary to drive our values, fulfill our mission, and abide by our company values

Humana

Pre-Authorization Registered Nurse

Posted on:

May 26, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Kentucky

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 Pre-Authorization Nurse 2 reviews prior authorization requests for appropriate care and setting, following guidelines and policies, and approves services or forward requests to the appropriate stakeholder. The Pre-Authorization Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Required Qualifications – What it takes to Succeed Licensed Registered Nurse (RN) in the state of Kentucky with no disciplinary action and ability to hold licenses in multiple states without restriction Minimum 3 years of experience as a nurse in a clinical setting Strong Proficiency with MS Office Suite Word, Excel, Power Point and ability to learn multiple systems Experience with the development and implementation of policies and procedures Preferred Qualifications: Bachelor's Degree Health Plan experience working with large carriers Previous Medicare/Medicaid experience a plus Previous experience in utilization management, case management, discharge planning and/or home health or rehab Experience working with MCG and HCG guidelines Workstyle: Remote Work at Home Location: Must reside within a 2-hour driving distance of Louisville, Kentucky office to attend meetings and trainings as needed Schedule: Must be available Monday-Friday 9:00 AM - 6:00 PM Eastern Time with very limited rotating on-call coverage and oversight during weekends and holidays. Travel: Meet quarterly in Louisville office for meetings Work At Home Requirements: WAH requirements: Must have the ability to provide a high-speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required Satellite and Wireless Internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

The Pre-Authorization Nurse 2 completes medical necessity and level of care reviews for requested services using clinical judgment and refers to internal stakeholders for review depending on case findings. Educates providers on utilization and medical management processes. Enters and maintains pertinent clinical information in various medical management systems. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Humana

Care Manager, Telephonic Nurse (Disease Management)

Posted on:

May 26, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Virginia

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.

Humana Healthy Horizons in Virginia is seeking a Care Manager, Telephonic Nurse 2 (Disease Management) who will assess and evaluate member’s needs with emphasis on preventing, monitoring, and managing chronic conditions effectively, in a telephonic environment. This position assists members with their health care needs and obtain the right services, skills, and supports needed to achieve optimal health and life functioning in the community.

Required Qualifications: Must reside in the Commonwealth of Virginia. Active Registered Nurse (RN) license in the Commonwealth of Virginia without disciplinary action. Three (3) years clinical RN experience including educating members/patients on chronic conditions. Intermediate to advanced computer skills and experience with Microsoft Word, Outlook, and Excel. Knowledge of community health and social service agencies and additional community resources. Exceptional oral and written communication and interpersonal skills with the ability to quickly build rapport. Ability to work with minimal supervision within the role and scope. Ability to use a variety of electronic information applications/software programs including electronic medical records. Excellent keyboard and web navigation skills. Preferred Qualifications: Bachelor's degree in nursing (BSN). Case Management Certification (CCM). Managed Care experience. Certified Diabetes Educator. Certified Asthma Educator. Motivational Interviewing Certification and/or knowledge. Experience with health promotion, coaching and wellness. Bilingual or Multilingual: English/Spanish, Arabic, Vietnamese, Amharic, Urdu or other - Must be able to speak, read and write in both languages without limitations and assistance. See "Additional Information" section for additional information. Additional Information Workstyle: This is a remote position. Travel: You may be required to travel to Humana Healthy Horizons office in Glen Allen, VA for collaboration and face to face meetings. Workdays and Hours: Monday – Friday; 8:00am – 5:00pm Eastern Standard Time (EST). Language Assessment Statement: Any Humana associate who speaks with a member in a language other than English must take a language proficiency assessment, provided by an outside vendor, to ensure competency. Applicants will be required to take the Interagency Language Rating (ILR) test as provided by the Federal Government. WAH Internet Statement: 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. 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.

Strengthens care management activities and support the improvement of member well-being, reducing unnecessary healthcare costs and enhancing healthcare delivery. Provides episodic care coordination that is short term (e.g., up to 12 weeks, based on member need) focusing on education and support to enhance lifestyle modifications and self-management techniques. Coordinates with Care Managers and other identified care team members as needed along with UM staff, physicians and providers as necessary and arrange services necessary to address the member’s condition and current needs. Assesses, monitors, and evaluates member’s chronic condition as well as provide and document meaningful interventions and outcomes. May contribute to interdisciplinary care planning and meetings. Meet requirements for contractual and regulatory compliance. Follows established guidelines/procedures. Other duties as required.

Sutter Health

Clinical Triage Nurse, Work From Home

Posted on:

May 26, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

California

Aids patients in obtaining the correct level of care with the appropriate provider at the right time. Provides advance clinical telephone support to Sutter Health patients, other callers, in-basket and other remote support for physicians, and limited in-clinic support. Uses the nursing process, input from physicians, and Sutter Health's approved telephone nursing guidelines and protocols to maintain highly efficient operations, to provide quality care, and to ensure positive patient outcomes. Assesses patients' needs, appropriately dispositions cases, collaborates with the clinic and hospital-based providers to renew electronic prescriptions, identifies hospital and community resources, consultations and referrals, and preforms nursing follow-up activities. Clinical support includes assisting physician partners with message management and other communications within the electronic medical record (EMR) system, as well as limited patient care in an outpatient setting. DISCLAIMER Applicants must be a resident of one of the following states to be eligible for consideration for this position: Utah, Idaho, Arizona, Arkansas, Tennessee, Missouri, Montana, or South Carolina. DISCLAIMER 2 This is a Work from Home position, therefore internet minimum speeds of 15 mbps download and 5 mbps upload are required.

EDUCATION: Graduate of an accredited school of nursing CERTIFICATION & LICENSURE: RN-Registered Nurse of California (You can submit application without the CA RN license, but must acquire it prior to your start date if selected RN-Registered Nurse in State of Residence PREFERRED EXPERIENCE AS TYPICALLY ACQUIRED IN: 2 years' experience of practical nursing in a hospital, clinic, urgent care, or emergency room/department 2 years' experience with several specialties and subspecialties. OB/GYN experience necessary

Professional knowledge of clinical nursing protocols, regulations and institutional standards of care and risk management with an emphasis in the areas of disease processes, emergencies, health sciences and pharmacology. Advanced clinical knowledge of medical diagnoses, procedures, protocols, treatments, and terminology, including a working knowledge of state and federal regulations and guidelines. Solid analytical and project management skills, including the ability to analyze problems, situations, practices, and procedures, reach practical conclusions, recognize alternatives, provide solutions, and institute effective changes. Communication, interpersonal, and interviewing skills, including the ability to build rapport and explain medical lab results or sensitive information clearly and professionally to diverse audiences (patients). Proficient computer skills, including Microsoft Office Suite and experience working electronic medical/health records. Work independently, as well as part of a multidisciplinary team, while demonstrating exceptional attention to detail and organizational skills. Manage multiple priorities/projects simultaneously, sometimes with rapidly changing priorities, while maintaining event/project schedules. Recognize unsafe or emergency situations and respond appropriately and professionally. Ensure the privacy of each patient’s protected health information (phi). Analyze possible solutions using precedents, existing departmental guidelines and policies, experience and good judgment to identify and solve standard problems. Build collaborative relationships with peers, physicians, nurses, administrators, and public to provide the highest quality of patient care.

Intermountain Health

Registered Nurse Triage and Transition Ambulatory Care PRN

Posted on:

May 25, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

This position functions as a vital member of the healthcare team who contributes to the success of the practice by demonstrating customer/patient focus, effective communication, professionalism, and teamwork. Utilizes the nursing process to assess, plan, implement, and evaluate comprehensive care provided to selected patient populations and their families. This position is responsible for timely and effective management of patient calls requiring medical triage and coordinating care during the transition of care following an inpatient medical stay. Provides guidance, education and facilitates resources for the management of the at-risk population. This is a virtual position, serving a region of the health system. This position is a remote position. If you are currently an internal caregiver for Intermountain Health, you must reside in either CO or MT close to an Intermountain care site. If you are not a current caregiver for Intermountain Health and are applying externally, you must currently reside in Colorado or Montana near an Intermountain Health care site.

Minimum Qualifications: ASN / ADN from an accredited program with the ability to obtain your BSN from an accredited program within four (4) years of hire unless you possess a minimum of fifteen (15) years of proven continuous Registered Nurse experience in an acute care setting, required Current Colorado ( or Montana if living in MT) RN license or compact license with the ability to obtain Colorado or Montana RN license, required Current BLS certification endorsed by the American Heart Association required Preferred Qualifications: Bachelor's Degree in Nursing (BSN). Education must be obtained from an accredited institution. Degree will be verified. One year experience in a clinic setting or inpatient acute hospital setting is strongly preferred KNOWLEDGE, SKILLS, AND ABILITIES: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements list must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Regular attendance to perform work on site during regularly scheduled business hours or scheduled shifts is required Ability to work nights and/or weekends is required for identified positions

Performs clinical triage, including a comprehensive assessment, disposition and education using established triage protocols and guidelines Manages transitions of care to ensure appropriate follow up care and mitigate risks associated with readmission. Contacts patients following emergency department visits to ensure appropriate follow up Uses registry data to identify gaps in services and initiates intervention Refers patients to a variety of resources, including behavioral health, transportation services, nutrition, etc. Educates patients and families about health status, health maintenance, and management of acute and chronic conditions. Provides patient care based on practice guidelines, standards of care, and federal/state laws and regulations. Documents patient assessment and intervention data using established medical record forms/automated systems and documentation practices. Participates in multidisciplinary teams to improve patient care processes and outcomes. Interacts with all staff, colleagues and team members in a professional and collegial manner Promotes mission, vision, and values of SCL Health, and abides by service behavior standards. Performs other duties as assigned

CareXM

Registered Nurse – Hospice - Remote (Sunday, Tuesday, Thursday, Saturday, 4:00 pm to 9:00 pm MST)

Posted on:

May 25, 2025

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Remote Status: Remote Job Title: Registered Nurse Location: Remote Pay: $26/hour Training Schedule: The training is four weeks long. You will meet each week, Monday, Wednesday & Friday from 5:00 pm to 8:30 pm (MST) for two weeks On the third week, you will meet on Thursday + one additional weekday that will be assigned by your Trainer In your fourth week, you will work two weekdays that will be assigned by your Trainer Work Schedule: Sunday, Tuesday, Thursday, Saturday, 4:00 pm to 9:00 pm MST States we are currently not entertaining applications from: Alaska, California, Connecticut, DC, Hawaii, Illinois, Massachusetts, Michigan, Minnesota, Nevada, New York, Oregon, Pennsylvania, Rhode Island, Washington or any US territories (e.g.Puerto Rico). Summary: CareXM is seeking a remote Registered Nurse (RN) to provide after-hours telephone triage care to patients and caregivers of hospice and home health partners. This is a flexible position that offers the opportunity to work from home while making a meaningful difference in the lives of others.

RN license in a compact state (in good standing) 4+ years of clinical nursing experience required. Experience in home health, palliative, med-surg, geriatrics, ICU, ER, and/or hospice care is preferred but not required English fluency is required. Spanish is a plus Proficiency with computers and telecommunications equipment Ability to work independently and as part of a team Ability to work flexible hours, including evenings and weekends Must be able to pass a background check and drug test for pre-employment screening Must be able to meet California RN Required Prerequisites for RN Examination and Endorsements as outlined here: https://www.rn.ca.gov/status.shtml Personal Computer Requirements: You will use your Personal Computer to work. As each system configuration is unique, our requirement specialist and IT team will confirm your configuration will meet the necessary standards. Internet connection (Satellite broadband and mobile hotspots are NOT permitted) Webcam Windows: 11 or MAC OS: 14 (Sonoma) or newer CPU: 2.5 GHz RAM: 6GB

Provide fast access to quality, compassionate after-hours RN telephone triage care to patients and caregivers of hospice and home health partners Communicate with empathy and understanding, especially when callers are experiencing a difficult situation Assess patient needs and provide appropriate care instructions Coordinate care with other members of the healthcare team Document patient care in the electronic health record (EHR)

Maximus

Consultant - Nurse (remote)

Posted on:

May 25, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Virginia

Maximus is currently hiring for a Consultant - Nurse to join our QIC Part B team. This is a remote opportunity. *Position is contingent upon contract award*

Minimum Requirements: Bachelor's degree with 3 - 5 years of experience, OR Associate's degree with 5-7 years of experience. Bachelor's degree or in lieu of degree equivalent experience Registered Nurse (RN) license required Three Years of Medicare experience preferred Medicare work experience in both Part A and Part B Must be US Citizen or have lived the last 5 years working continuously for 3 Please note: For this position Maximus will provide equipment to use. Home Office Requirements: Internet speed of 20mbps or higher required / 50 Mpbs for shared internet connectivity (you can test this by going to www.speedtest.net) Minimum 5mpbs upload speed Connectivity to the internet via either Wi-Fi or Category 5 or 6 ethernet patch cable to the home router Private work area and adequate power source Must currently and permanently reside in the Continental US

Responsible for reviewing favorable and partially favorable determinations in accordance with applicable regulations. Render determinations for cases assigned. Resolve all other technical issues within reconsideration assigned. Review cases or sites assigned to determine and summarize facts and assess any issues identified. Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary. Perform other duties as assigned by management. Render medical necessity determinations for Medicare Part B QIC reconsideration cases assigned. Resolve all other technical issues within Medicare Part B QIC reconsiderations assigned Review cases to determine and summarize facts of each case assigned and assesses issues involved in the case Review file to determine whether all relevant information has been submitted Research issues using federal and state law, federal and state regulations, relevant contract law and other sources as defined by the client contract Perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary Meet or exceed all performance standards established for this position Perform other duties as assigned by management

HV Health and Safety

Remote Occupational Telehealth Nurse - PRN (LVN or RN)

Posted on:

May 25, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Compact / Multi-State

At HV Occupational Health and Safety, we are passionate about fostering growth and embracing change to create thriving, safe work environments. As a double minority-owned company, we bring a unique perspective to workplace safety, offering exceptional services that help businesses achieve the best outcomes. Our commitment to honesty, integrity, and respect defines everything we do. We take pride in being problem solvers—delivering practical, responsive solutions to complex challenges. Our team isn’t just clinical; we’re collaborative, clear-headed professionals who value family, hard work, and doing right by people.

**This role is 100% remote and available to LVNs, LPNs, and RNs. We are looking for experienced telehealth nurses to join our case management team. Candidates should be able to work at least 2 12-hour night or day shifts per week. Triage experience is highly preferred.** You’re an experienced telehealth nurse who thrives in fast-moving environments where no two days are alike. Whether guiding a patient back to work or coordinating care across borders, you bring a calm, clinical presence that earns trust fast. Your emergency care background makes you decisive, and your case management expertise ensures those decisions lead to smart outcomes—clinically, administratively, and operationally. You move with both compassion and clarity. You’re not just checking boxes—you’re actively driving care forward, advocating for both the employee and the employer, and ensuring every touchpoint reflects professionalism, integrity, and care.

Active RN, LVN, or LPN license (compact license required). Able to work occaisional 10-12 hour night or weekend shifts consistently 5+ years of clinical experience in emergency care, urgent care, or occupational health. Strong understanding of OSHA recordability, workers’ comp processes, and return-to-work strategies. High emotional intelligence—able to earn trust quickly with employees, managers, and providers. Excellent communication, documentation, and decision-making skills. Bilingual (English/Spanish or English/French) strongly preferred for international case support. Tech-savvy with the ability to manage telehealth, digital documentation, and fast-paced coordination.

Answer incoming calls during business hours. Conduct after-hours initial intakes, gathering key details such as company info, employee demographics, and medical history. Assess injuries via video (when possible) in collaboration with the Safety Manager and onsite medics. Perform nursing assessments and administer first aid treatment. Determine the best course of action: conservative treatment, telemedicine consult, or emergency care. Manage intakes for employees in Mexico and Canada. Provide FAFs (Functional Abilities Forms) and coordinate follow-ups for Canadian clients. Schedule telemedicine appointments with HV physicians. Review physician notes for completeness before distribution. Distribute reports and ensure accurate documentation. Conduct follow-ups for first aid cases and monitor recovery progress. Partner with Safety personnel, medics, paramedics, and other nurses. Assist with clinic vetting and coordinate referrals and diagnostics. Support case management efforts, ensuring quality employee care. Communicate with workers’ comp carriers, Risk Management, and HR for proper case handling and approvals. Work closely with HV Physicians and CMAs to ensure case resolution and closure. Maintain detailed and timely documentation for all visits and communications. Take clinical photos to support injury tracking and case documentation. Collaborate with HV Physicians for ongoing case discussions. Request and manage medical records as needed.

HV Health and Safety

Occupational Telehealth Nurse - Night Shift (Remote)

Posted on:

May 25, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

At HV Occupational Health and Safety, we are passionate about fostering growth and embracing change to create thriving, safe work environments. As a double minority-owned company, we bring a unique perspective to workplace safety, offering exceptional services that help businesses achieve the best outcomes. Our commitment to honesty, integrity, and respect defines everything we do. We take pride in being problem solvers—delivering practical, responsive solutions to complex challenges. Our team isn’t just clinical; we’re collaborative, clear-headed professionals who value family, hard work, and doing right by people.

**We are looking for experienced telehealth nurses to join our case management team. This role is 100% remote and available to LVNs, LPNs, and RNs. We are looking for nurses who want to work the night shift consistently. Triage experience is highly preferred.** You’re an experienced telehealth nurse who thrives in fast-moving environments where no two days are alike. Whether guiding a patient back to work or coordinating care across borders, you bring a calm, clinical presence that earns trust fast. Your emergency care background makes you decisive, and your case management expertise ensures those decisions lead to smart outcomes—clinically, administratively, and operationally. You move with both compassion and clarity. You’re not just checking boxes—you’re actively driving care forward, advocating for both the employee and the employer, and ensuring every touchpoint reflects professionalism, integrity, and care.

Active RN, LVN, or LPN license (compact license required). Able to work 10-12 hour night shifts consistently 5+ years of clinical experience in emergency care, urgent care, or occupational health. Strong understanding of OSHA recordability, workers’ comp processes, and return-to-work strategies. High emotional intelligence—able to earn trust quickly with employees, managers, and providers. Excellent communication, documentation, and decision-making skills. Bilingual (English/Spanish or English/French) strongly preferred for international case support. Tech-savvy with the ability to manage telehealth, digital documentation, and fast-paced coordination.

Answer incoming calls during business hours. Conduct after-hours initial intakes, gathering key details such as company info, employee demographics, and medical history. Assess injuries via video (when possible) in collaboration with the Safety Manager and onsite medics. Perform nursing assessments and administer first aid treatment. Determine the best course of action: conservative treatment, telemedicine consult, or emergency care. Manage intakes for employees in Mexico and Canada. Provide FAFs (Functional Abilities Forms) and coordinate follow-ups for Canadian clients. Schedule telemedicine appointments with HV physicians. Review physician notes for completeness before distribution. Distribute reports and ensure accurate documentation. Conduct follow-ups for first aid cases and monitor recovery progress. Partner with Safety personnel, medics, paramedics, and other nurses. Assist with clinic vetting and coordinate referrals and diagnostics. Support case management efforts, ensuring quality employee care. Communicate with workers’ comp carriers, Risk Management, and HR for proper case handling and approvals. Work closely with HV Physicians and CMAs to ensure case resolution and closure. Maintain detailed and timely documentation for all visits and communications. Take clinical photos to support injury tracking and case documentation. Collaborate with HV Physicians for ongoing case discussions. Request and manage medical records as needed.

HV Health and Safety

Occupational Telehealth Nurse - (Remote)

Posted on:

May 25, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

At HV Occupational Health and Safety, we are passionate about fostering growth and embracing change to create thriving, safe work environments. As a double minority-owned company, we bring a unique perspective to workplace safety, offering exceptional services that help businesses achieve the best outcomes. Our commitment to honesty, integrity, and respect defines everything we do. We take pride in being problem solvers—delivering practical, responsive solutions to complex challenges. Our team isn’t just clinical; we’re collaborative, clear-headed professionals who value family, hard work, and doing right by people.

**We are looking for experienced telehealth nurses to join our case management team. This role is 100% remote and available to LVNs, LPNs, and RNs. Triage experience is highly preferred.** You’re an experienced telehealth nurse who thrives in fast-moving environments where no two days are alike. Whether guiding a patient back to work or coordinating care across borders, you bring a calm, clinical presence that earns trust fast. Your emergency care background makes you decisive, and your case management expertise ensures those decisions lead to smart outcomes—clinically, administratively, and operationally. You move with both compassion and clarity. You’re not just checking boxes—you’re actively driving care forward, advocating for both the employee and the employer, and ensuring every touchpoint reflects professionalism, integrity, and care.

Active RN, LVN, or LPN license (compact license required). Able to work 10-12 hour night shifts consistently 5+ years of clinical experience in emergency care, urgent care, or occupational health. Strong understanding of OSHA recordability, workers’ comp processes, and return-to-work strategies. High emotional intelligence—able to earn trust quickly with employees, managers, and providers. Excellent communication, documentation, and decision-making skills. Bilingual (English/Spanish or English/French) strongly preferred for international case support. Tech-savvy with the ability to manage telehealth, digital documentation, and fast-paced coordination.

Answer incoming calls during business hours. Conduct after-hours initial intakes, gathering key details such as company info, employee demographics, and medical history. Assess injuries via video (when possible) in collaboration with the Safety Manager and onsite medics. Perform nursing assessments and administer first aid treatment. Determine the best course of action: conservative treatment, telemedicine consult, or emergency care. Manage intakes for employees in Mexico and Canada. Provide FAFs (Functional Abilities Forms) and coordinate follow-ups for Canadian clients. Schedule telemedicine appointments with HV physicians. Review physician notes for completeness before distribution. Distribute reports and ensure accurate documentation. Conduct follow-ups for first aid cases and monitor recovery progress. Partner with Safety personnel, medics, paramedics, and other nurses. Assist with clinic vetting and coordinate referrals and diagnostics. Support case management efforts, ensuring quality employee care. Communicate with workers’ comp carriers, Risk Management, and HR for proper case handling and approvals. Work closely with HV Physicians and CMAs to ensure case resolution and closure. Maintain detailed and timely documentation for all visits and communications. Take clinical photos to support injury tracking and case documentation. Collaborate with HV Physicians for ongoing case discussions. Request and manage medical records as needed.

UnitedHealthcare

Field Based HSS Clinical Coordinator RN - Southwest Kansas - Multiple Counties

Posted on:

May 25, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Kansas

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The Long-Term Services and Supports (LTSS) Care Coordinator RN is responsible for establishing a set of person-centered goal-oriented, culturally relevant, and logical steps to ensure that a person receiving LTSS receives services in a supportive, effective, efficient, timely and cost-effective manner. Care coordination includes case management, disease management, discharge planning, transition planning, and addressing social determinants of health and integration into community. This position is a Field-Based position with a Home Based office. Expected travelling 2-3 days per week within 30-60 mile radius. The counties covered by this position are Barton, Stafford, Pawnee, Edwards, Kiowa, Komache, Hodgeman, Ford, Clark, Gray, Meade, Seward, Haskell, Finney, Lane, Scott, Wichita, Greeley, Hamilton, Kearny, Grant, Stanton, Morton, Stevens. If you reside locally to or within 30 miles of one of these counties, KS or surrounding area, you’ll enjoy the flexibility to work remotely* as you take on some tough challenges.

Required Qualifications: Current, unrestricted independent licensure as a Registered Nurse in Kansas 2+ years of experience working within the community health setting in a health care role 1+ years of experience working with persons with long-term care needs 1+ years of experience working with persons receiving services on one of the homes and community-based waivers in KS 1+ years of experience working with MS Word, Excel and Outlook Ability to travel in assigned region to visit Medicaid members in their homes and / or other settings, including community centers, hospitals, or providers’ offices Must reside in or within 30 miles of one of the following Kansas Counties – Barton, Stafford, Pawnee, Edwards, Kiowa, Komache, Hodgeman, Ford, Clark, Gray, Meade, Seward, Haskell, Finney, Lane, Scott, Wichita, Greeley, Hamilton, Kearny, Grant, Stanton, Morton, Stevens Preferred Qualifications: Licensed Social Worker or clinical degree Background in managing populations with complex medical or behavioral needs Experience with electronic charting Experience with arranging community resources

Assess, plan, and implement care strategies that are individualized by the individual and directed toward the most appropriate, least restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the person-centered service/support plan throughout the continuum of care Communicate with all stakeholders the required health – related information to ensure quality coordinated care and services are provided expeditiously to all persons Advocate for persons and families as needed to ensure the persons needs and choices are fully represented and supported by the health care team Conduct home visits in coordination with person and care team, which may include a community service coordinator Conduct in-person visits which may include nursing homes, assisted living, hospital or home Serve as a resource for community care coordinator, if applicable

Availity

UM Nurse Analyst (Remote)

Posted on:

May 25, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Florida

Availity delivers revenue cycle and related business solutions for health care professionals who want to build healthy, thriving organizations. Availity has the powerful tools, actionable insights and expansive network reach that medical businesses need to get an edge in an industry constantly redefined by change. At Availity, we're not just another Healthcare Technology company; we're pioneers reshaping the future of healthcare! With our headquarters in vibrant Jacksonville, FL, and an exciting office in Bangalore, India, along with an exceptional remote workforce across the United States, we're a global team united by a powerful mission. We're on a mission to bring the focus back to what truly matters – patient care. As the leading healthcare engagement platform, we're the heartbeat of an industry that impacts millions. With over 2 million providers connected to health plans, and processing over 13 billion transactions annually, our influence is continually expanding. Join our energetic, dynamic, and forward-thinking team where your ideas are celebrated, innovation is encouraged, and every contribution counts. We're transforming the healthcare landscape, solving communication challenges, and creating connections that empower the nation's premier healthcare ecosystem.

The position of UM Nurse Analyst will report to the Medical Director of Availity’s Auth AI solution. The UM Nursing Analyst is responsible for the interpretation of payer medical policy guidelines and the construction of NLP/AI–enabled decision trees that accurately reflect medical necessity criteria. The role requires in-depth knowledge of utilization management principles, the role and purpose of medical necessity guidelines and prior authorization adjudication practices. This individual will work in a team environment and will be expected to perform highly complex tasks while collaborating with team members with both clinical and engineering/programming backgrounds. The successful candidate will be detail oriented with strong analytic reasoning skills, demonstrate strong communication and organizational skills while remaining open-minded, embracing change and the spirit of innovation. Sponsorship, in any form, is not available for this position. Location: Remote, US

Bachelor’s degree in nursing. At least 3+ years of experience in an outpatient Utilization Management program, either with an insurer or with a healthcare provider OR equivalent clinical experience with familiarity with prior authorization submission practices. Additional experience in fields of billing / coding, claims review or inpatient utilization management, while not necessary, would enhance the application. “Computer smart” – General power user of technology and confident with navigating new technologies and applications. Familiarity and understanding of interpreting medical records to be able to identify how physicians may document conditions and findings. You will set yourself apart: If you have exceptional critical thinking and reasoning skills. If you can synthesize complex, abstract problems, and collaborate effectively with team members with diverse skillsets to create solutions. If you are self-motivated and a quick learner with an ability to multi-task.

Reviewing payer Medical Policy Guidelines to identify pertinent medical necessity criteria related to specific Procedural codes or CPT codes. Use programming language to construct attestation questions that reflect medical necessity criteria. Assign coded medical constructs to attestation trees based on clinical relevance to facilitate automation of responses to the questions. Identify medical terms that should be added to the existing vocabulary of coded medical concepts. Serve as Subject Matter Expert and general medical resource to engineering teams and developers

IntePros

Part-Time Utilization Management RN

Posted on:

May 25, 2025

Job Type:

Part-Time

Role Type:

Utilization Review

License:

RN

State License:

Pennsylvania

Part-Time Utilization Management RN (Remote – Saturdays Only) Schedule: Saturdays, 9:00 AM – 5:00 PM (Mandatory weekday training prior to start) Location: Fully Remote Employment Type: Part-Time We are actively seeking a Part-Time Utilization Management Registered Nurse (RN) to join our team. This role is ideal for an experienced RN with a background in utilization review who is looking for consistent weekend work in a fully remote setting. Position Summary: Under the direction of a designated Manager, the Utilization Management RN performs telephonic reviews of inpatient hospital admissions, evaluating the medical necessity of continued stays and identifying opportunities for timely discharge planning. This role plays a vital part in promoting high-quality, cost-effective healthcare and facilitating optimal transitions of care.

Education: Registered Nurse required; BSN preferred. Experience: Minimum of 3 years of clinical experience in an acute care hospital setting. Required Background: Prior experience in utilization management and/or discharge planning. Licensure: Active RN license in good standing. Skills and Competencies: Strong verbal and written communication skills Ability to assess complex clinical situations and recommend appropriate levels of care Proficiency with medical software and electronic documentation systems Exceptional organizational and time management skills Collaborative, team-oriented approach with a customer-service mindset

Conduct telephonic utilization reviews of inpatient admissions using established criteria. Assess medical necessity for inpatient and continued stay; recommend alternative levels of care when appropriate. Collaborate with attending physicians, hospital utilization departments, and discharge planners to support care coordination. Refer cases to Medical Directors when admissions do not meet criteria. Support early identification of discharge planning needs and help coordinate transitions to home or alternative settings. Refer patients to Case Management or Disease Management as needed. Identify quality of care concerns and refer to Quality Management when applicable. Ensure timely and accurate documentation in compliance with regulatory and accreditation standards. Provide outstanding customer service and contribute to ongoing provider education. Participate in reporting and trend analysis for utilization patterns or issues.

Integrated Resources, Inc ( IRI )

Nurse Case Manager II

Posted on:

May 25, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Illinois

The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires an RN, LCSW, or LCPC with unrestricted active license. Experience with case management and IL waiver services is preferred. Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member's needs to ensure appropriate administration of benefits Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures Position Summary: The Case Manager utilizes a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual s benefit plan and/or health needs through communication and available resources to promote optimal, cost-effective outcomes. Requires unrestricted driver's license and car. Requires RN, LCSW, or LCPC with unrestricted active license.

MUST HAVE: IL resident who lives in one of the counties listed below and is interested in doing field case management with the elderly and individuals with disabilities who are approved for in-home or nursing facility care. We have 1 position total. ***On each resume, please clearly list which county/counties the candidate is applying for.*** **CM that lives on the Southside of Chicago, Suburban Cook (Chicago Heights, South Chicago Heights, Lynwood, Ford Heights, Sauk Village, Matteson Olympia Fields, Park Forest, Richton Park) Position will require travel to members' homes up to 50-75% travel. Must live near areas listed due to travel requirement and will work at home in between visits. We want someone who is organized, efficient, and can work independently. RN, LCSW, or LCPC with current unrestricted state licensure in IL. REQUIRED Experience: Minimum 3-5 years clinical practical experience preferred Minimum 2-3 years Care Management, discharge planning and/or home health care coordination experience preferred Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually Excellent analytical and problem-solving skills Effective communications, organizational, and interpersonal skills. Ability to work independently Effective computer skills including navigating multiple systems and keyboarding Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications

Through the use of clinical tools and information/data review, conducts comprehensive assessments of referred member's needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services. Application and/or interpretation of applicable criteria and guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or member s needs to ensure appropriate administration of benefits. Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Recora

Remote Cardiac Rehab Intake Specialist - Contractor

Posted on:

May 24, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

None Required

State License:

New York

Recora was founded in 2020 by seasoned digital health entrepreneurs. In past roles, we've founded and scaled high-growth startups, run large health systems, advised government programs, built technology you use every day, and provided healthcare for millions of lives. We're backed by leading VCs including SignalFire, Pear, GFC , 2048, Great Oaks, MGV and more. Over the last year, we've built the leading virtual cardiac recovery and management platform for members with cardiac conditions. For every member we serve, we add an average of five years to their lifespan. We're growing – fast. Our member base is doubling every month and we're looking to 3x our team size quickly. This will allow us to scale nationally and accelerate product development across the continuum of heart health.

Recora is hiring a Cardiac Rehab Intake Specialist to join our cardiac recovery program to partner with our users to provide personalized care for cardiac recovery patients. In this role, you will partner with our exercise physiologists, patient experience, product, and marketing teams to support patients via video calls, track individual progress, and provide feedback and support for patients. The right person for this role is familiar with the management of cardiac conditions, CHF, other chronic conditions, smoking cessation, women’s health, substance abuse, mental health, or recent nutrition, and exercise trends.

A minimum of three years of experience helping people manage their health, ideally in a clinical setting and/or a remote health coaching setting A degree in a health-related field Experience with counseling or education of disease management in a medical setting as well as recent nutrition and exercise trends. Passion and enthusiasm for helping people change their lives A diversity- and inclusion-first mindset Detail-oriented and team-first mindset A resourceful nature, and creativity to help people engage in their health Fluent in English (written and verbal) Bilingual in English and Spanish a huge plus Some experience in a clinical setting Some knowledge of cardiac rehabilitation Experience working with an elderly patient population Bonus Points Experience - coaching in smoking cessation, diabetes management, and special populations.

Conducting initial assessments for patients who are enrolling in our virtual cardiac recovery program. Educating patients on program benefits and the importance of risk factor modification. Coaching individuals through electronic (chat) messaging and video sessions. Problem-solving and supporting individuals’ current and evolving goals. Adapting in-clinic best practices to a remote-care delivery model. Completing individualized treatment plans for patients starting the program to include: nutrition assessment, psychosocial assessment, fitness assessment, and co-morbidities assessment. Translating the latest up-to-date, evidence-based best practices for chronic condition management into a relatable and empowering approach. Motivating and encouraging patients during initial visits. Basic understanding of cardiac procedures and medications. Reviewing medical history. Goal setting and motivational interviewing for special populations. Basic understanding of clinical documentation

Recora

Intake Specialist (Care Management and Navigation)

Posted on:

May 24, 2025

Job Type:

Part-Time

Role Type:

Care Management

License:

None Required

State License:

New York

Recora was founded in 2020 by seasoned digital health entrepreneurs. In past roles, we've founded and scaled high-growth startups, run large health systems, advised government programs, built technology you use every day, and provided healthcare for millions of lives. We're backed by leading VCs including SignalFire, Pear, GFC , 2048, Great Oaks, MGV and more. Over the last year, we've built the leading virtual cardiac recovery and management platform for members with cardiac conditions. For every member we serve, we add an average of five years to their lifespan. We're growing – fast. Our member base is doubling every month and we're looking to 3x our team size quickly. This will allow us to scale nationally and accelerate product development across the continuum of heart health.

Recora is hiring an Intake Specialist to join our cardiac recovery program to partner with our users to provide personalized care for cardiac recovery patients. In this role, you will partner with our exercise physiologists, patient experience, product, and marketing teams to support patients via video calls, track individual progress, and provide feedback and support for patients. The right person for this role is familiar with the management of cardiac conditions, CHF, other chronic conditions, smoking cessation, women’s health, substance abuse, mental health, or recent nutrition, and exercise trends.

A minimum of three years of experience helping people manage their health, ideally in a clinical setting and/or a remote health coaching setting A degree in a health-related field Experience with counseling or education of disease management in a medical setting as well as recent nutrition and exercise trends. Passion and enthusiasm for helping people change their lives A diversity- and inclusion-first mindset Detail-oriented and team-first mindset A resourceful nature, and creativity to help people engage in their health Fluent in English (written and verbal) Bilingual in English and Spanish a huge plus Some experience in a clinical setting Some knowledge of cardiac rehabilitation Experience working with an elderly patient population Bonus Points Experience - coaching in smoking cessation, diabetes management, and special populations.

Conducting initial assessments for patients who are enrolling in our virtual cardiac recovery program. Educating patients on program benefits and the importance of risk factor modification. Coaching individuals through electronic (chat) messaging and video sessions. Problem-solving and supporting individuals’ current and evolving goals. Adapting in-clinic best practices to a remote-care delivery model. Completing individualized treatment plans for patients starting the program to include: nutrition assessment, psychosocial assessment, fitness assessment, and co-morbidities assessment. Translating the latest up-to-date, evidence-based best practices for chronic condition management into a relatable and empowering approach. Motivating and encouraging patients during initial visits. Basic understanding of cardiac procedures and medications. Reviewing medical history. Goal setting and motivational interviewing for special populations. Basic understanding of clinical documentation

Recora

Healthcare Advocate - Nurse Patient Advocate

Posted on:

May 24, 2025

Job Type:

Contract

Role Type:

Case Management

License:

RN

State License:

New York

Our mission is to empower individuals facing health challenges by providing compassionate, expert-guided care advocacy services. We are dedicated to ensuring that every patient receives personalized support, clear guidance, and seamless care coordination. Healthcare is complicated and overwhelming. We are committed to helping our patients navigate these complexities with clarity, empathy, and unwavering support.

You are deeply committed to ensuring that patients receive the care, guidance, and support they need to navigate their health journey with confidence. You believe in breaking down barriers to care, advocating for patients' needs, and making high-quality care more accessible—especially from the comfort of home. You’re known for your empathy, strong communication skills, and ability to build trust with patients and caregivers. Your problem-solving mindset and ability to collaborate with clinical teams fuel your success in helping patients overcome obstacles, access critical resources, and actively participate in their own care. Patient Advocates will act as a liaison between patients with chronic conditions and the healthcare system. This role focuses on ensuring patients receive comprehensive, coordinated care, and that they are empowered to make informed decisions about their health.

Education & Licensure: Registered Nurse (RN) with an active and unrestricted state license. Bachelor of Science in Nursing (BSN) preferred, but Associate Degree in Nursing (ADN) with relevant experience considered. Experience: Minimum of 2 years of clinical nursing experience, preferably in case management, patient advocacy, home health, chronic disease management, or a similar role. Experience working with Medicare patients and high-risk populations preferred. Skills & Competencies: Strong knowledge of healthcare systems, care coordination, and patient advocacy principles. Excellent communication and interpersonal skills to engage with patients, families, and healthcare providers. Ability to assess patients' health needs, develop care plans, and educate patients on self-management strategies. Familiarity with social determinants of health and ability to connect patients to community resources. Critical thinking and problem-solving abilities to navigate complex healthcare situations. Proficiency in electronic health records (EHR) and telehealth platforms preferred. Other Requirements: Ability to work independently while collaborating within a multidisciplinary care team. Empathy, patience, and a commitment to patient-centered care. Flexibility to adapt to a fast-paced and evolving healthcare environment

Conduct detailed assessments of patients' health status, needs, and preferences. Develop and coordinate individualized care plans in collaboration with the healthcare team. Educate patients and their families about disease processes, treatment options, and self-care strategies. Advocate for patients' needs within the healthcare system, ensuring timely access to services and treatments. Assist patients in scheduling appointments, managing referrals, and coordinating among multiple healthcare providers.

EPITEC

Nurse

Posted on:

May 24, 2025

Job Type:

Contract

Role Type:

Case Management

License:

RN

State License:

Michigan

Remote in Michigan *Must have an active RN License in the state of Michigan* Holidays: department is open 365 – all contractors are required to work “minor holidays” such as the day after thanksgiving, Christmas eve, NYE, - They do work Christmas day, New Years Day, Labor Day, memorial day Weekend time: rotating schedule for weekends – it’s typically 4 weekend days per quarter is the bare minimum. A sign up sheet is sent out months prior for folks to sign up for weekends they are and are not available. Stays at 40 hours each week.

Top 3 Required Skills/Experience – Strong Clinical Background - Ability to critically evaluate clinical data and medical records to ensure accuracy and compliance with utilization management/clinical decision support for Medicare Advantage member Attention to detail and organization skills - Reviewing the medical documents across multiple programs. Advanced Computer Skills - Proficiency in using various software tools and platforms for data analysis and reporting Required Skills/Experience – The rest of the required skills/experience. Include: Certification in Case Management or Utilization Review - experience in the review process for post acute care settings ie Skilled Nursing Facility, Long Term Acute Care and / or Home Health Care. Time Management Skill - Ability to manage multiple reviews and meet deadlines in a fast-paced environment. Advanced Computer Skills – experience with various software tools, Microsoft Office and utilization of multiple monitors with WPM at minimum of 45-50.

Otsuka Pharmaceutical Companies (U.S.)

Senior Manager, Clinical Management

Posted on:

May 24, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

New Jersey

Under the direction of the Director/Associate Director of Clinical Management, the Senior Clinical Study Manager is responsible for the oversight and management of Otsuka clinical studies, including coordination with other relevant parties (e.g., other Otsuka departments, external service providers (ESPs), etc.). Responsibilities include the planning, execution and completion of clinical trials according to applicable regulations and guidance; ICH Guidelines Good Clinical Practices (GCP), and Otsuka SOPs, within agreed-upon timeframes and budget.

Knowledge/ Experience and Skills: Comprehensive knowledge of clinical operations, drug development process, roles, and responsibilities of individuals within the project team, standard operating procedures (SOPs) and GCP/ICH regulations. Thorough knowledge of contract research organizations (CROs), outsourcing, and evaluation of work performed against vendor Statement of Work (SOW). Strong understanding of the clinical and scientific basis for assigned clinical program, with the ability to translate that knowledge in operational management. Strong understanding of global regulatory requirements. Strong communication, organization, planning, analytical, problem solving, and people management skills. Demonstrated experience with working with the Microsoft suite of programs (e.g., Word, Excel, PowerPoint, Outlook, etc.) Good understanding of clinical trial related software (e.g., eCRFs, IRT, CTMS, etc.). Ability to travel up to 25%. Educational Qualifications Required: Bachelor’s Degree or Registered Nurse (RN). Minimum of 10 years industry experience with seven (7) years in clinical trial management experience. Preferred: Previous supervisory experience. Competencies Accountability for Results - Stay focused on key strategic objectives, be accountable for high standards of performance, and take an active role in leading change. Strategic Thinking & Problem Solving - Make decisions considering the long-term impact to customers, patients, employees, and the business. Patient & Customer Centricity - Maintain an ongoing focus on the needs of our customers and/or key stakeholders. Impactful Communication - Communicate with logic, clarity, and respect. Influence at all levels to achieve the best results for Otsuka. Respectful Collaboration - Seek and value others’ perspectives and strive for diverse partnerships to enhance work toward common goals. Empowered Development - Play an active role in professional development as a business imperative.

Provides oversight and management of clinical studies at Otsuka, including planning, execution, and completion of clinical trials according to all applicable regulations and guidance, ICH/GCP, and Otsuka SOPs. Contribute to the development and review of all critical clinical study documents, including clinical protocols, informed consent forms, or other study-related clinical documents. Provide input into and approval of the identification, evaluation, and selection of CROs, outside vendors (e.g., central labs, central IRB, IVRS, etc.), and investigative sites. Provide leadership and guidance to clinical team to ensure all clinical study activities are completed in accordance with applicable regulations and guidance; ICH GCP, and Otsuka SOPs. Communicates and coordinates clinical project-related activities and progress across all relevant cross-functional departments. Provide management personnel with timely updates on progress and changes in scope, schedule, and resources as required. Participate in forecasting study expenditures and resourcing needs. Ensure internal clinical team and vendors manage and monitor study-related budget and expenses to meet forecast. Provide timely communication of any variances in budget forecast to the Director/Associate Director. Establish communication flow with CRO and investigative sites to maximize compliance with study protocol. Provide oversight of ESP in its conduct of the day-to-day operations of assigned trial(s), as assigned. Participates in ongoing review of clinical trial data focusing on data integrity, trending and consistency. Supports project level inspection readiness activities, including responsibility for ensuring the completeness, timeliness and quality of the TMF. Serve as Clinical Management representative for review of protocols within and across portfolios, as assigned. Participate in program-level risk mitigation strategies and collaborate with ESPs on study-level risk mitigation and management activities. Represent Clinical Management in departmental and cross-functional initiatives, as assigned. Leads and/or contributes to assigned departmental, ESP and corporate standardization and continuous improvement efforts. May have supervisory responsibilities including: Coordinating the training and onboarding of new employee(s) on corporate culture, corporate goals/vision and departmental policies and processes. Assuring compliance with departmental, SOP, compliance, and corporate training Ensuring assigned staff have access to all required materials, systems, and training to complete job responsibilities. Setting clear performance expectations and individual development plans and providing specific and frequent feedback to the employee on his/her performance.

Otsuka Pharmaceutical Companies (U.S.)

Associate Director, Thought Leader Liaison, Renal Rare Disease - Southeast

Posted on:

May 24, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

New Jersey

The Associate Director, TLL, Renal Rare Disease, is a field-based, customer facing, non-sales position on Otsuka’s Rare Renal team focused on enhancing and improving interactions with Renal Key Opinion Leaders (KOLs) at academic centers and leading community practices. The TLL will work closely with cross-functional leaders from Marketing, Medical Affairs, Sales, Key Accounts, Market Access, Patient Access and the Renal Leadership Team to ensure alignment with overall strategy and tactical execution. The attributes that are critical for success include leadership, strategic thinking, clinical and disease state acumen, strong collaboration, communication, and the ability to execute key initiatives and provide timely feedback. Position Overview: The Thought Leader Liaison (TLL) is a senior, field-based role within the commercial organization, responsible for engaging with Key Opinion Leaders (KOLs) to support strategic marketing initiatives, insight generation, and promotional activities. This role serves as a critical link between the company and KOLs ensuring alignment with business objectives and compliance with regulatory guidelines.

Education: Understand, interpret, present and educate/present to KOLs and customer groups on complex and scientific/clinical information. Assess and understand KOL level of clinical acumen of complex and clinical topics. Qualifications: Bachelor’s degree required; advanced degree preferred (MD, PharmD, PhD, RN/BSN, PA). Experience in the biotechnology/pharmaceutical industry. Experience in product marketing, field sales, clinical roles, or thought leader engagement. Strong clinical, technical, and scientific knowledge in complex disease states. Ability to travel extensively (>50% of the time) including overnight and weekend travel. Skills and Competencies: Excellent communication and interpersonal skills. Strong analytical and strategic thinking abilities. Proven ability to build and maintain professional relationships. Experience working cross-functionally in a matrixed environment. Ability to manage multiple projects compliantly, efficiently, and effectively. Proficiency in developing and executing field-based marketing initiatives. Experience with thought leader engagement, advisory boards, and speaker bureau management. Other Requirements: Willingness to travel >50% of the time, including significant overnight and weekend travel. Ability to travel for meetings, conferences, and KOL engagements. Candidates must live within the stated geography or be willing to relocate. Competencies Accountability for Results - Stay focused on key strategic objectives, be accountable for high standards of performance, and take an active role in leading change. Strategic Thinking & Problem Solving - Make decisions considering the long-term impact to customers, patients, employees, and the business. Patient & Customer Centricity - Maintain an ongoing focus on the needs of our customers and/or key stakeholders. Impactful Communication - Communicate with logic, clarity, and respect. Influence at all levels to achieve the best results for Otsuka. Respectful Collaboration - Seek and value others’ perspectives and strive for diverse partnerships to enhance work toward common goals. Empowered Development - Play an active role in professional development as a business imperative.

KOL Development and Advocacy: From a Commercial perspective identify, build and maintain relationships with KOLs and Renal organizations. Develop and maintain KOL engagement plans. Plan and execute national and regional congress engagement plans with a focus on meaningful engagements with senior leadership. Support commercial KOL influence mapping initiatives by developing profiles. Monitor KOL insights about current and future treatment patterns that may impact the commercial strategy and provide feedback for consideration. Act as a liaison between KOLs and the company for on-label activities, including office-based cross-functional colleagues and teams (Marketing, Medical, Diagnostics, and Executive leadership). Assist in the facilitation and execution of commercial advisory boards through the identification of key advisors equipped to provide compelling insights. Promotional Speaker Bureau Management: Identify and recruit KOLs for National and Regional faculty and speaker bureaus. Train, evaluate, and educate physician speakers to provide high-quality compliant focused branded and unbranded education. Ensure appropriate and compliant execution of speaker programs. Monitor speaker performance at live programs. Work with marketing and contracted speakers to gain and synthesize feedback in support of the evolution of promotional programming content, case studies for potential publications, and other commercial projects. Insight Generation: Collaborate with cross-functional commercial teams to provide KOL insights to help shape brand strategy. Identify market and brand gaps and provide feedback for content development or change of strategic direction. Disseminate KOL insights to broader stakeholders, including marketing, sales, and market access teams. Initiate and pursue opportunities to involve the company in meaningful programs with thought leaders. Congress and Event Leadership: Identify, sponsor, attend and gather intelligence and KOL insights at all relevant congresses and society meetings. Lead, plan and execute KOL engagement plans at all relevant Congresses Facilitate clinical and commercial conversations and provide guidance & updates to on label scientific content and materials with KOLs through 1:1 and group engagements.

Otsuka Pharmaceutical Companies (U.S.)

Patient Nurse Case Manager

Posted on:

May 24, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

New Jersey

The Patient Nurse Case Manager (PNCM) is a dynamic, field-based role that serves as a crucial educator for patients. This position helps to execute against a “patient empowerment” care model, and combines the responsibilities of patient disease-state and education, injection training support, and access management to provide comprehensive support throughout the patient journey. The PNCM is an empathetic and trusted resource, responsible for engaging with the patient community, and addressing barriers to treatment adherence.

Minimum Requirements: Bachelor's degree Nursing degree 5+ years of business experience in the healthcare or biotech industry Experience engaging with patients and caregivers, preferably in the relevant therapy area Familiarity with legal and regulatory components of the pharmaceutical and biotech industries (e.g., FDA regulations, Anti-Kickback Statute, HIPAA) Valid driver's license and ability to travel 60-80% of the time, including evenings and weekends Preferred Qualifications: Advanced degree in a related field Background in advocacy, counseling, nursing, or social work Case management experience in the specific therapy area Bilingual skills, particularly Spanish Key Skills: Exceptional empathy and active listening abilities Excellent written and verbal communication Problem-solving and critical thinking capabilities Ability to influence without authority and collaborate across teams Adaptability and positive attitude in a fast-paced environment Superior organizational and time management skills Customer service focus and professionalism Physical Requirements: This role requires the ability to travel by various means of transportation, work comfortably in clinical settings, use computers and communication devices, engage in complex problem-solving, and maintain general availability during standard business hours. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job. Join our team and make a meaningful impact on patients' lives by combining education, advocacy, and access support in this rewarding role! Competencies: Accountability for Results - Stay focused on key strategic objectives, be accountable for high standards of performance, and take an active role in leading change. Strategic Thinking & Problem Solving - Make decisions considering the long-term impact to customers, patients, employees, and the business. Patient & Customer Centricity - Maintain an ongoing focus on the needs of our customers and/or key stakeholders. Impactful Communication - Communicate with logic, clarity, and respect. Influence at all levels to achieve the best results for Otsuka. Respectful Collaboration - Seek and value others’ perspectives and strive for diverse partnerships to enhance work toward common goals. Empowered Development - Play an active role in professional development as a business imperative.

Develop and execute regional patient engagement plans that align with commercial priorities, in collaboration with Patient Advocacy Educate patients and caregivers in 1:1 sessions about disease state, how to understand their bodies and navigate their lifestyle to manage their disease, and recommending advocacy programs Conduct comprehensive assessments of individual patient needs inclusive of understanding of their disease state, if they are “injection naïve” and their comfort with their support system Build and maintain relationships with patients and their caregivers to promote patient empowerment Serve as the primary point of contact for resolving issues impacting treatment initiation and ongoing therapy Coordinate with cross-functional teams to ensure compliant and effective patient outreach and support Track and communicate progress on data-driven performance objectives to leadership and stakeholders

Syneos Health

Research Nurse - Corpus Christi, Texas (per-diem)

Posted on:

May 24, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Texas

Illingworth Research Group provides a range of patient focused clinical services to the pharmaceutical, healthcare, biotechnology and medical device industries. These include mobile research nursing, patient concierge, medical photography and clinical research services. Illingworth are experts with experience across all study phases and in a diverse range of therapeutic areas. Illingworth Research Group is a global organization operating in over 45 countries, bringing clinical research directly into the home of the patient, to improve the experience of patients involved in clinical trials and the quality of their lives.

Are you a Registered Nurse who would like to be involved in working in a variety of research projects for ground-breaking patient treatments? We are looking for motivated and enthusiastic nurses who combine high quality clinical skills with a compassionate, engaging personality and a dedication to ensure exceptional patient outcomes.

Experienced Registered Nurse (Adult or Pediatric) Experience and knowledge of working in clinical research trials with ICH-GCP (Good Clinical Practice) Certification - (Training can be provided) Attention to detail and highly organized Ability to prioritize and manage multiple tasks Excellent verbal and written communication skills in English and the ability to complete detailed data Ability to work with initiative independently and as part of a wider team Good IT (Information Technology) skills and a working knowledge of computer software Trained in Handling and Transport of Hazardous Substances (preferable- training can be provided) Our studies require a variety of Clinical skills (some desirable and not all essential, depending on project requirements). Phlebotomy skills (Venipuncture) and handling, processing of blood. Sub cutaneous injections ECGs, observations and taking specimen collections. Cannulation and administration of Intravenous Therapies Experience working with central venous access PLEASE NOTE This role will require you to travel, a driving license and access to a vehicle is essential.

Netsmart

Clinical Appeals Nurse (PRN)

Posted on:

May 24, 2025

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

RN

State License:

Kansas

Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart’s sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart’s third party screening provider.

Responsible for reviewing medical records and preparing clinical appeals in response to medical necessity denials and diagnosis-related groups (DRG) reassignments

Required: Bachelor's of Science in Nursing (BSN) or equivalent degree Current and unrestricted RN license At least 5 years of clinical experience in acute care settings At least 3 years of experience in case management, utilization review, or clinical appeals Exceptional written and verbal communication skills Proficiency with MS Office suite, particularly Word and Excel Strong analytical and problem-solving skills with attention to detail Preferred: Experience with payer-side case management or medical director-level review Expectations: Comfortable with remote work arrangements and virtual collaboration tools May require occasional travel for conferences, client meetings, or in-person hearings Physical demands include extended periods of sitting, computer use, and telephone communication

Prepare and submit clinical appeals in response to denials from managed care organizations, governmental entities, and Recovery Audit Contractors (RACs) for hospital clients Review medical records and utilize industry guidelines, Medicare policies, and best practice standards to support appeal arguments Participate in Administrative Law Judge (ALJ) Hearings, presenting oral arguments to support the reversal of Medicare denials Analyze denial patterns and contribute insights to help reduce future denials Collaborate with the appeals team and hospital clients to provide updates on appeal statuses and outcomes Maintain current knowledge of healthcare regulations, coding guidelines, and payer policies relevant to the appeals process

Alignment Health

RN Case Manager – Transition of Care (Outpatient, Bilingual Spanish or Vietnamese) – Remote

Posted on:

May 24, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

California

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

Alignment Health is seeking a remote, bilingual Spanish or Vietnamese, RN Case Manager, TOC (Transition of Care) to join the case management team (Must have California RN License). The Case Manager – Transitions of Care (Outpatient) ensures a smooth transition for members after a hospital or Skilled nursing facility discharge by coordinating care, providing resources, and educating members/families about the post discharge care plan to support optimal health outcomes. Responsibilities include all aspects and activities responsible for monitoring the delivery of care to Alignment Healthcare members. Performs duties mostly telephonically. Schedule: Must be willing to work Mon - Fri, 8am - 5pm Pacific Time

Job Requirements: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Experience Required: 2-3 years of clinical care management experience; or any combination of education and experience, which would provide an equivalent background. Preferred: 3-5 years of clinical care management experience; or any combination of education and experience, which would provide an equivalent background. Education/Licensure Required: Active, valid, and unrestricted Registered Nursing (RN) license in California (non-compact) Willing to obtain licensure in other designated states (Non-compact: NV; Compact: AZ, NC, TX) within the first 6 months of employment (licensure fees reimbursed by the company) Preferred: Case Management Certification. Knowledge: Knowledge of Medicare Managed Care Plans, insurance regulations and community resources Specialized Skills Required: Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others. Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors; Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution. Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment. Report Analysis Skills: Comprehend and analyze statistical reports. Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Develop and implement individualized discharge plans in collaboration with the interdisciplinary team, patients, and families. Coordinate with healthcare providers, home health agencies, rehabilitation facilities, and community resources to ensure continuity of care. Facilitate timely referrals to necessary services, including home health, physical therapy, occupational therapy, and social support. Monitor patient progress and adjust discharge plans as needed. Provide comprehensive education to patients and families regarding their medical condition, treatment plan, medications, and post-discharge care instructions. Answer questions and address concerns related to discharge planning and post-discharge care. Empower patients and families to actively participate in their care and self-management. Identify and access appropriate resources and services for patients and families, including financial assistance, transportation, and community support programs. Advocate for patients' needs and ensure access to necessary resources. Maintain accurate and up-to-date patient records and documentation related to discharge planning and post-discharge care. Communicate effectively with all members of the interdisciplinary team, patients, and families. Participate in care conferences and team meetings to ensure effective communication and coordination of care. Participate in quality improvement activities to identify areas for improvement in discharge planning and post-discharge care. Stay current with best practices and trends in care management and discharge planning.

Alignment Health

Inpatient SNF Review Nurse (RN or LVN California License Required)

Posted on:

May 24, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

Alignment Health is seeking a remote Inpatient SNF Review Nurse (RN or LVN California License Required) to join the utilization management team. The Inpatient SNF Review Nurse assists patients through the continuum of care in collaboration with the patient’s primary care physician, facility case manager, discharge planner and employing contracted ancillary service providers and community resources as needed. Assures that services are provided at the most appropriate, cost effective level of care needed to meet the patient’s medical needs while maintaining safety and quality.

Experience: Required: Minimum 3 years of general case management skills. Minimum of two years of experience utilizing Milliman Care Guidelines to justify Inpatient versus Observation Length of stay: including review of diagnosis and length of stay. Two consecutive years related experience in a managed care setting as an inpatient case manager Preferred: Experience with a Senior population. Education Required: Successful completion of an accredited Licensed Vocational Nursing Program Preferred: Associates or Bachelors Degree Specialized Skills Required: Ability to communicate positively, professionally and effectively with others; provide leadership, teach and collaborate with others. Excellent critical thinking skills related to nursing utilization review Knowledge of Medicare Managed Care Plans Effective written and oral communication skills; ability to establish and maintain a constructive relationship with diverse members, management, employees and vendors; Mathematical Skills: Ability to perform mathematical calculations and calculate simple statistics correctly Reasoning Skills: Ability to prioritize multiple tasks; advanced problem-solving; ability to use advanced reasoning to define problems, collect data, establish facts, draw valid conclusions, and design, implement and manage appropriate resolution. Problem-Solving Skills: Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment. Report Analysis Skills: Comprehend and analyze statistical reports. Preferred: Knowledge and experience in complex/catastrophic case management preferred Licensure Required: Current, Active and Unrestricted California (Non-Compact) Licensed Vocational Nurse. Immediately upon hire, must be willing to obtain LVN and / or RN licensure in Nevada, (Non-compact), Arizona (Compact), North Carolina (Compact), and Texas (Compact) which will be reimbursed by company. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. Essential Physical Functions: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to sit; use hands to finger, hand, or feel and talk or hear. The employee is frequently required to reach with hands and arms The employee is occasionally required to climb or balance and stoop, or kneel The employee must occasionally lift and/or move up to 20 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception and the ability to adjust focus.

Performs reviews of inpatients with complex medical and social problems. Generates referrals to contracted ancillary service providers and community agencies with the agreement of the patient’s primary care physician. Performs follow-up reviews and evaluations of patients in the ambulatory care or lower level of care setting. Reviews inpatient admissions timely and identifies appropriate level of care and continued stay based on acceptable evidence-based guidelines used by AHC. Effectively communicates with patients, their families and or support systems, and collaborates with physicians and ancillary service providers to coordinate care activities. Identifies Members who may need complex or chronic case management post discharge and warm handoff to appropriate staff for ambulatory follow up, as necessary. Communicates and collaborates with IPA/MG as necessary for effective management of Members. Assigns and provides daily oversight of the activities and tasks of the CCIP Coordinator. Records communications in EZ-Cap and/or case management database. Arranges and participates in multi-disciplinary patient care conferences or rounds. Monitors, documents, and reports pertinent clinical criteria as established per UM policy and procedure. Monitors for any over utilization or underutilization activities. Generates referrals as appropriate to the QM department. Enters data as necessary for the generation of reports related to case management. Reports the progress of all open cases to the Medical Director, Director of Healthcare Services and Manager of Utilization Management. Performs other duties as assigned.

Bluestone Physician Services

Behavioral Health Care Manager / Dementia Case Manager - Part-time 24 hrs/week

Posted on:

May 24, 2025

Job Type:

Part-Time

Role Type:

Behavioral Health

License:

None Required

State License:

Florida

Bluestone Physician Services delivers great outcomes by bringing exceptional care to patients living with complex, chronic conditions and disabilities. Our unique, robust model of care goes beyond primary care services — our multidisciplinary care teams collaborate with patients, their families and other healthcare providers to deliver care that is preventative, proactive and tailored to their unique needs. Using an evidence-based approach focused on quality care management and data-driven medical decisions, Bluestone care teams collaborate to manage patients’ chronic conditions, address social determinants of health, manage transitions to and from inpatient settings, provide behavioral health support and more. Under our model of care, Bluestone patients experienced 21% fewer ER visits, 36% fewer hospitalizations and 41% fewer hospital readmissions compared to patients with similar conditions and complexities over the same time period. Our care teams travel directly to patients who reside in Assisted Living, Memory Care and Group Home communities throughout Minnesota, Wisconsin and Florida and are supported by clinical operations and administrative colleagues who work remotely or at our corporate offices in Stillwater, Minnesota, and Tampa, Florida. Our success is only possible through the hard work of our employees who bring our core values of Dedication, Excellence, Collaboration and Caring to life every day. Bluestone has been named to the Star Tribune's Top Workplace list for the 12th year in a row! Bluestone also achieved Top Workplace USA 2021-2024! In 2022, Bluestone Accountable Care Organization (ACO) was the best performing ACO in the country as measured by the overall savings per Medicare beneficiary.

The Behavioral Health Care Manager / Dementia Case Manager (Part-time 24 hrs./week) is a core member of the collaborative care team, which includes a Bluestone's Primary Care Providers, Nurses, Care Managers and other medical professionals. The Behavioral Health Care Manager is a patient-focused role, primarily working with a complex geriatric population and their families within their home environment (Assisted Living, Memory Care, and/or Independent Living). Additionally, this role is an expert in the field of dementia care, Alzheimer's, memory loss, and/or mental health targeting interventions that improve the patient's overall quality of life. Schedule: Part-time position, day shift hours, no evenings, weekends or holidays. Location: This position entails a mix of remote work, as well as direct patient care mainly throughout Apopka, Celebration, Mount Dora, Ocoee, Orlando, Tavares, Winter Garden. Salary Range: $33,000 - $39,000, Salary will be commensurate with experience.

Education/Certification/Experience: Formal education or specialized training in behavioral health, including social work, nursing, psychology, gerontology, music therapy or related fields One or more years of experience in memory care and/or dementia-related care Valid driver’s license required Knowledge/Skills/Abilities: Knowledge of behavioral health, dementia, and care planning Knowledge of assessments, screenings, and care planning for mental health disorders Ability to engage patients in a therapeutic relationship when appropriate Ability to work independently with excellent time-management and organizational skills Ability to maintain professional relationships with patients and other members of the care team Ability to communicate effectively and professionally, both verbally and in writing, with diverse populations Intermediate-level computer proficiency with email, fax, word processing, spreadsheets, and databases Excellent customer service skills Demonstrated ability to read, write, speak, and understand the English language

Provide ongoing necessary education and support to patient's care team on Alzheimer's disease and related memory loss/dementia and their impact on cognitive function Provide ongoing necessary education and support to patient’s care team on Mental Illness diagnoses and their impact on cognitive function Establish care plans that outline interventions to reduce behavioral episodes and improve function and safety Provide behavioral interventions using evidence-based techniques such as motivational interviewing, problem-solving, modeling, active listening, other techniques as appropriate Identify and provide de-escalation strategies and crisis resources for caregivers, patients, and families Provide effective non-pharmacological behavior prevention and reduction solutions Identify strategies to anticipate and calmly de-escalate distress behaviors Systematically track treatment response and monitor patients for changes in clinical symptoms and treatment side effects or complications Complete validated rating scales monthly to monitor and assess response to care plan interventions Participate in weekly caseload consultations with psychiatric consultants Facilitate referrals for the clinically indicated services outside of the organization (e.g. mental health specialty care, social services, support groups, etc.) Act as a Bluestone ambassador for community staff through education and relationship building

Bluestone Physician Services

Clinical Liaison, LPN or CMA (Remote in MN, WI or FL)

Posted on:

May 24, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

Minnesota

Bluestone Physician Services delivers great outcomes by bringing exceptional care to patients living with complex, chronic conditions and disabilities. Our unique, robust model of care goes beyond primary care services — our multidisciplinary care teams collaborate with patients, their families and other healthcare providers to deliver care that is preventative, proactive and tailored to their unique needs. Using an evidence-based approach focused on quality care management and data-driven medical decisions, Bluestone care teams collaborate to manage patients’ chronic conditions, address social determinants of health, manage transitions to and from inpatient settings, provide behavioral health support and more. Under our model of care, Bluestone patients experienced 21% fewer ER visits, 36% fewer hospitalizations and 41% fewer hospital readmissions compared to patients with similar conditions and complexities over the same time period. Our care teams travel directly to patients who reside in Assisted Living, Memory Care and Group Home communities throughout Minnesota, Wisconsin and Florida and are supported by clinical operations and administrative colleagues who work remotely or at our corporate offices in Stillwater, Minnesota, and Tampa, Florida. Our success is only possible through the hard work of our employees who bring our core values of Dedication, Excellence, Collaboration and Caring to life every day. Bluestone has been named to the Star Tribune's Top Workplace list for the 12th year in a row! Bluestone also achieved Top Workplace USA 2021-2024! In 2022, Bluestone Accountable Care Organization (ACO) was the best performing ACO in the country as measured by the overall savings per Medicare beneficiary.

The Clinical Liaison plays a pivotal role in coordinating clinical care for our geriatric and disabled patient population. They are responsible for and assist with the delivery of high-quality healthcare services to meet the needs of our patients. The Clinical Liaison will work collaboratively with internal and external customers to facilitate needed services. Facilitate the coordination of care for patients, ensuring a comprehensive and patient-centered approach. Clinical Liaisons work remotely and provide support during our regular business hours. Schedule: Full time position, day shift hours, no evenings, weekends or holidays. Hours are 8am to 4:30pm Monday thru Thursday & 8am to 3pm on Fridays. Location: This remote role must be located in one of the Bluestone Markets (Minnesota, Wisconsin or Florida). Salary: $23.00 - $25.00 per hour. Salary will be commensurate with experience.

Education/Certification/Experience: Medical certification or license required; CMA, LPN 3-5 years of relevant medical office experience Knowledge/Skills/Abilities: Proficient in navigating electronic medical record systems and working with patient care Clear and effective verbal and written communication skills Excellent interpersonal and customer service skills Detail oriented and accurate Demonstrated ability to work independently Ability to work with Site Supervisors, Providers and others on the care team Computer proficient Medical terminology knowledge and understanding of patient care notes Demonstrated ability to read, write, speak, and understand the English language

The main responsibility of this Clinical Liaison role is to support the clinical call line to address clinical inquiries and provide necessary information to patients, families, external healthcare agencies, etc. Foster clear and efficient communication channels within the internal and external healthcare team. Provide continuity of care for our patient care team by connecting patients to resources and services Monitors continuous quality improvement for optimal patient outcomes Maintain a good working relationship and effective communication both within the department and with other departments for the benefit of the patient Additional duties include: Schedule and coordinate appointments with specialty providers. Assist in medication refill process and support pharmacy inquiries. Complete prior authorizations for medications, specialty visits and durable medical equipment. Assist with the durable medical equipment process and ensure timely order submission and follow-up. Maintain records and enter lab, diagnostic imaging, and immunization history. Complete home-health reviews. Provide education about healthcare directives and assist with completion as needed Complete health plan delegated annual chart reviews to assess for gaps in care

Amerit Consulting

Medicare Clinical Appeals RN ** 100% Remote for California Residents **

Posted on:

May 24, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

California

Amerit Consulting is an extremely fast-growing staffing and consulting firm. Amerit Consulting was founded in 2002 to provide consulting, temporary staffing, direct hire, and payrolling services to Fortune 500 companies nationally, as well as small to mid-sized organizations on a local & regional level. Currently, Amerit has over 2,000 employees in 47 states. We develop and implement solutions that help our clients operate more efficiently, deliver greater customer satisfaction, and see a positive impact on their bottom line. We create value by bringing together the right people to achieve results. Our clients and employees say they choose to work with Amerit because of how we work with them - with service that exceeds their expectations and a personal commitment to their success. Our deep expertise in human capital management has fueled our expansion into direct hire placements, temporary staffing, contract placements, and additional staffing and consulting services that propel our clients’ businesses forward.

Our client, a mutual benefit corporation and health plan provider, seeks an accomplished Medicare Clinical Appeals RN. *** Candidate must be authorized to work in USA without requiring sponsorship *** *** Location: Rancho Cordova, CA (100% Remote acceptable) *** Duration: 5 months contract w/ possible extension or conversion to FTE role Notes: Work hours: 08:00am – 05:00pm PT or 08:30am – 05:30pm PT. 100% remote for California residents.

Qualifications: The ideal candidate will have previous insurance/managed care experience and hold at least a Bachelor’s Degree in Nursing. Higher-level certifications are highly desirable. Knowledge of Medicare benefits and appeal reviews. Requires 2-4 years of health insurance or related experience. Demonstrate the ability to act independently using sound clinical judgement. Preferred Qualifications: Experience with pharmacy clinical reviews. Works well in a fast-paced team environment. Excellent communication skills.

The Medicare Appeals and Grievances team is responsible for clinically reviewing member appeals and grievances that are the result of either preservice, post service or claim denial. In this role you will be responsible for performing first level appeal reviews for members utilizing the National Coverage Determination (NCD) guidelines, Local Coverage Determination (LCD) Guidelines, pharmacy policies and nationally recognized sources such as MCG, NCCN, and ACOG. Reviews may also be performed for medical necessity, non-covered benefits and to meet the criteria for the coding billed.

Florida Blue

Concurrent/Post-Acute Review Nurse RN - Remote

Posted on:

May 24, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

Join our team as a Concurrent/ Acute Review Nurse RN, where you'll play a vital role in ensuring our members receive the right care at the right time. As a CRN, you'll build strong relationships with facility case managers, identify opportunities for care transitions, and help reduce hospital readmissions - all while making a meaningful impact on the lives of our members.

2+ years’ recent experience (within the past 3-5 years) clinical experience in a hospital, LTAC, Rehab, Skilled Nursing Facility setting evaluating hospital benefit determination, medical necessity and appropriate level of care RN - Registered Nurse - State Licensure And/Or Compact State Licensure Florida Experience in one or more of the following: home health care, rehab, SNF, utilization review, discharge planning or case management Referrals for possible Case Management activities that focus on acute and non-acute services, outpatient services and/or community resources Experience with the Healthcare industry and Managed Care Related Bachelor’s degree or additional related equivalent work experience Nursing What is Preferred: Experience in post-acute care admission Bachelor’s degree Nursing, Healthcare or Business General Physical Demands Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.

Serve as a point of contact for providers to assist in navigating members them through the continuum, educate regarding benefits, identify candidates for Care Programs and provide information pertaining to the network and network access Evaluate members in the Hospital, Skilled Nursing Facility, LTAC, Acute Inpatient Rehab for benefit determination, medical necessity and appropriate level of care utilizing member benefits and InterQual or other medical necessity criteria. Determine member's discharge status and identify and coordinate any additional needs and services that require ongoing Care Coordination services Collaborate with Medical Directors, Managers, Co-workers and other departments including Case Management and Care Partners and participate in weekly case review

Corewell Health

PA/NP - Virtual Urgent Care - Remote

Posted on:

May 23, 2025

Job Type:

Full-Time

Role Type:

License:

NP/APP

State License:

Michigan

he Corewell Health West Medical Group is part of a not-for-profit health system serving 13 counties in West Michigan. Corewell Health West is a region of Corewell Health™, formerly the BHSH System (Beaumont Health and Spectrum Health) that provides care and coverage with an exceptional team of 60,000+ dedicated people—including more than 11,500 physicians and advanced practice providers and more than 15,000 nurses providing care and services in 22 hospitals, 300+ outpatient locations and several post-acute facilities—and Priority Health, a provider-sponsored health plan serving over 1.2 million members. Through experience and collaboration, we are reimagining a better, more equitable model of health and wellness.

Our Virtual Urgent Care team is looking for an experienced Physician Assistant or Nurse Practitioner to join their team. In this role, you will be providing virtual medical care to patients of varying type and acuity. This is a full-time position. As we care for patients of all ages, we cannot consider Adult/Gerontology trained Nurse Practitioners.

Physician Assistant: Required Master's Degree Graduate of an accredited Physician Assistant educational program LIC-Physician Assistant - STATE_MI State of Michigan Upon Hire required CRT-Physician Asst Certified (PA-C) - NCCPA National Commission on Certification of Physician Assistants Upon Hire required CRT-Basic Life Support (BLS) - AHA American Heart Association 90 Days required Or CRT-Basic Life Support (BLS) - ARC American Red Cross 90 Days required CRT-Pediatric Adv Life Support (PALS) - AHA American Heart Association 120 Days required CRT-Adv Cardiovascular Life Support (ACLS) - AHA American Heart Association 120 Days required Nurse Practitioner: Required Master's Degree Nurse Practitioners who obtained their education and certification after 2000 must show evidence of completion of a master’s, post-master’s or doctorate from a Nurse Practitioner program that is accredited by the Commission on the Collegiate of Nursing Education or the National League for Nursing Accrediting Commission 3 years of relevant experience current, relevant clinical experience Previous experience functioning in a collaborative role as a Nurse Practitioner LIC-Nurse Practitioner (NP) - State of Michigan CRT-Basic Life Support (BLS) CRT-Neonatal Resuscitation Program (NRP) CRT-Pediatric Adv Life Support (PALS)

CVS Health

Appeals Nurse Consultant - Fully Remote

Posted on:

May 23, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Conneticut

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day. This position will be working from home anywhere in the US. Standard business hours 8:00am-5:00pm in time zone of residence Monday - Friday.

Required Qualifications: 3+ years of clinical experience required. Active and unrestricted RN licensure in state of residence. Preferred Qualifications: Managed Care experience. Utilization Management experience. Appeals experience. Pre Certification experience. Pre Authorization experience . Education: Associates Degree minimum OR Diploma RN required Bachelors Degree preferred

The Appeals Nurse Consultant position is responsible for processing the medical necessity of Medicare appeals for participating providers. Primary duties may include, but are not limited to: Requesting clinical, research, extrapolating pertinent clinical, applying appropriate Medicare Guidelines, navigate through multiple computer system applications in a fast-paced department. Must work independently as well as in a team environment while working remotely. Fast paced sedentary position, talking on the telephone, looking at computer screens, utilizing templates in Word, and typing on the computer.

Valor Health

Remote Program Manager - Nurse Call Center

Posted on:

May 23, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

None Required

State License:

Texas

Valor Healthcare is looking for a call center program manager to join our proposal team for a government contract to support the Global Nurse Advice Line (NAL) which is a service to Military Health System (MHS) eligible beneficiaries. Position Summary: The Global NAL will provide access to telehealth registered nurses for triage services, self-care advice, and general health inquiries 24 hours a day, 7 days a week. The NAL also offers customer service and care coordination services to include, provider locator support, specified military treatment facility appointing services, urgent care referral submissions, and customized military treatment facility transfers to support the military treatment facility’s capability for eligible MHS beneficiaries. The ideal candidate will have extensive experience in supervisory healthcare call centers or nurse triage positions with strong leadership and communication skills in implementing programs and projects. Schedule and Remote Eligibility: This position is remote eligible as long as you are living in one of the US states. The schedule will be a general 40 hour work week on a day shift, Monday through Friday.

Bachelor’s degree in healthcare management, business administration, communication, IT, social science, or a related field 5 years of experience with managing multiple call centers. Demonstrate knowledge of URAC Health Call Center Standards, experience in customer service, performance evaluation, and process improvement. Demonstrate experience in large volume staff training and coaching. Demonstrated strong interpersonal and communication skills.

Works with partners to develop and drive service solutions and business case development across functional groups. Involved in the coordination of translating business strategy into work programs and processes. Reviews and provides input to high-level project planning and management. Accountable for the creation and development of technology solutions appropriate to business needs and objectives Oversees implementation of program, projects, or processes Creates and delivers monthly Program Management Reviews Ensures all business functions are appropriately and consistently defined and that these functions meet the objectives of the client. Drives stream of work reporting to customer. Develops status reports, controls project scope and economics, approves changes, and manages and resolves issues, risks, and conflicts. Serves as a single point of contact and the escalation point between technical teams. Demonstrates abilities as a leader, creating a positive work environment by monitoring workloads of the team while meeting client expectations. Accountable for senior level customer relationships and satisfaction Serve in a variety of roles to include, but not limited to proposal management, proposal writing, editing, and pricing.

Cambia Health Solutions

Care Management Nurse - Idaho

Posted on:

May 23, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Idaho

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Work from home within Idaho Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For: Every day, Cambia’s dedicated team of Care Management RN's are living our mission to make health care easier and lives better. As a member of the Clinical Services team, our Care Management RN's provide clinical care management (such as case management, disease management, and/or care coordination) to best meet the member’s specific healthcare needs and to promote quality and cost-effective outcomes. Oversees a collaborative process with the member and those involved in the member’s care to assess, plan, implement, coordinate, monitor and evaluate care as needed - all in service of creating a person-focused health care experience. Are you a Registered Nurse looking to transition out of bedside care and into a role that still utilizes your clinical expertise, but offers a fresh challenge? Is your goal to promote quality, cost-effective outcomes and improve overall health and wellbeing? Then this role may be the perfect fit.

Associates or Bachelor's Degree in Nursing or related field 3 years experience in case management, utilization management, disease management, or behavioral health case management Equivalent combination of education and experience will be considered Current licensure or certification in a U.S. state or territory in a health/human services discipline that permits independent assessment within the scope of practice (medical or behavioral health) Minimum 3 years (or full-time equivalent) direct clinical care experience Must possess at least ONE of the following: Certification as a case manager from the URAC-approved list Bachelor's degree or higher in health/human services-related field (psychiatric RN or Master's in Behavioral Health preferred for behavioral health positions) Current unrestricted Registered Nurse (RN) license (required for medical care management) Skills and Attributes: Knowledge of health insurance industry trends, technology and contractual arrangements. General computer skills (including use of Microsoft Office, Outlook, internet search). Familiarity with health care documentation systems. Strong oral, written and interpersonal communication and customer service skills. Ability to interpret policies and procedures, make decisions, and communicate complex topics effectively. Strong organization and time management skills with the ability to manage workload independently. Ability to think critically and make decision within individual role and responsibility.

Conducts case management activities, including assessment, planning, implementation, coordination, monitoring, and evaluation to identify and meet member needs. Applies clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care, utilizing evidence-based criteria and practicing within the scope of their license. Collaborates with physician advisors, internal and external customers, and other departments to resolve claims, quality of care, member or provider issues, and identifies problems or needed changes, recommending resolutions and participating in quality improvement efforts. Serves as a resource to internal and external customers, responding to inquiries in a professional manner while protecting confidentiality of sensitive documents and issues. Provides consistent and accurate documentation, ensuring compliance with performance standards, corporate goals, and established timelines. Coordinates resources, organizes, and prioritizes assignments to meet goals and timelines. Monitors and evaluates the effectiveness of case management plans, gathering sufficient information to determine the plan's effectiveness and making adjustments as needed.

Cambia Health Solutions

Supervisor Clinical Appeals

Posted on:

May 23, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Oregon

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through.

Work from home within Oregon, Washington, Idaho or Utah Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For: Every day, Cambia’s dedicated team of clinical leaders are living our mission to make health care easier and lives better. As a member of the initial review team, our Supervisor Clinical Appeals supervises the team and acts as a resource for nursing professionals and support staff. This role oversees and coordinates team activities to achieve business objectives and ensures that clinical appeal decisions are accurate and consistent with medical policies, reimbursement policies, provider contracts, member benefits and supported by the medical record. The position may also assist in planning, coordinating, conducting and reporting on clinical appeals – all in service of making our members’ health journeys easier. As a people leader, you are willing to learn and grow, understanding that leadership is a craft that is continuously honed as you support your team and the lives that depend upon us. Do you thrive on mentoring and supporting nursing professionals? Are you skilled at analyzing medical policies and ensuring consistency in decision-making? Then this role may be the perfect fit.

Bachelor’s degree in nursing or a related field 4 years of leadership experience 7 years of clinical experience or an equivalent combination of education and experience RN License within one of the four operating states (ID, OR, UT, WA) Certified Coder certified with the American Academy of Professional Coders (AAPC) or the American Health Information Management Association (AHIMA) preferred Skills and Attributes: Demonstrated competency in setting priorities for a team and overseeing work outputs and timelines. Ability to communicate effectively, verbally and in writing to a variety of recipients/audiences. Ability to effectively develop and lead a team (including employees who may be in multiple locations or work remotely). Demonstrated experience in recognizing problems and effectively resolving complex issues. Familiarity with health insurance industry trends and technology. Demonstrated competency related to appeal procedures and clinical practices. Ability to apply best practices and designated standards. Knowledge of CPT, ICD-9 and HCPCS coding and MCG (Milliman Care Guidelines). Medicare regulations knowledge is preferred. Familiarity rules applied to appeals by accrediting bodies, state and federal governments, and employer groups.

Manages team operations including work prioritization, goal setting, and performance monitoring while ensuring compliance with medical policies and guidelines Leads staff development through coaching, training, performance reviews, and regular communication via meetings and 1:1s Partners with physician advisors and other departments to resolve complex cases and remove operational barriers Develops and maintains process documentation, implements improvements, and ensures quality standards are met Maintains clinical competency while staying current on medical practices and industry trends Provides educational updates and serves as a technical resource for staff and other departments Manages special projects and provides backup support as needed while seeking continuous improvement opportunities

Cambia Health Solutions

Care Management Nurse - Idaho

Posted on:

May 23, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Idaho

Working at Cambia means being part of a purpose-driven, award-winning culture built on trust and innovation anchored in our 100+ year history. Our caring and supportive colleagues are some of the best and brightest in the industry, innovating together toward sustainable, person-focused health care. Whether we're helping members, lending a hand to a colleague or volunteering in our communities, our compassion, empathy and team spirit always shine through. At Cambia, you can: Work alongside diverse teams building cutting-edge solutions to transform health care. Earn a competitive salary and enjoy generous benefits while doing work that changes lives. Grow your career with a company committed to helping you succeed. Give back to your community by participating in Cambia-supported outreach programs. Connect with colleagues who share similar interests and backgrounds through our employee resource groups.

Care Management Nurse - Idaho Work from home within Idaho Build a career with purpose. Join our Cause to create a person-focused and economically sustainable health care system. Who We Are Looking For: Every day, Cambia’s dedicated team of Care Management RN's are living our mission to make health care easier and lives better. As a member of the Clinical Services team, our Care Management RN's provide clinical care management (such as case management, disease management, and/or care coordination) to best meet the member’s specific healthcare needs and to promote quality and cost-effective outcomes. Oversees a collaborative process with the member and those involved in the member’s care to assess, plan, implement, coordinate, monitor and evaluate care as needed - all in service of creating a person-focused health care experience. Are you a Registered Nurse looking to transition out of bedside care and into a role that still utilizes your clinical expertise, but offers a fresh challenge? Is your goal to promote quality, cost-effective outcomes and improve overall health and wellbeing? Then this role may be the perfect fit.

Associates or Bachelor's Degree in Nursing or related field 3 years experience in case management, utilization management, disease management, or behavioral health case management Equivalent combination of education and experience will be considered Current licensure or certification in a U.S. state or territory in a health/human services discipline that permits independent assessment within the scope of practice (medical or behavioral health) Minimum 3 years (or full-time equivalent) direct clinical care experience Must possess at least ONE of the following: Certification as a case manager from the URAC-approved list Bachelor's degree or higher in health/human services-related field (psychiatric RN or Master's in Behavioral Health preferred for behavioral health positions) Current unrestricted Registered Nurse (RN) license (required for medical care management) Skills and Attributes: Knowledge of health insurance industry trends, technology and contractual arrangements. General computer skills (including use of Microsoft Office, Outlook, internet search). Familiarity with health care documentation systems. Strong oral, written and interpersonal communication and customer service skills. Ability to interpret policies and procedures, make decisions, and communicate complex topics effectively. Strong organization and time management skills with the ability to manage workload independently. Ability to think critically and make decision within individual role and responsibility.

Conducts case management activities, including assessment, planning, implementation, coordination, monitoring, and evaluation to identify and meet member needs. Applies clinical expertise and judgment to ensure compliance with medical policy, medical necessity guidelines, and accepted standards of care, utilizing evidence-based criteria and practicing within the scope of their license. Collaborates with physician advisors, internal and external customers, and other departments to resolve claims, quality of care, member or provider issues, and identifies problems or needed changes, recommending resolutions and participating in quality improvement efforts. Serves as a resource to internal and external customers, responding to inquiries in a professional manner while protecting confidentiality of sensitive documents and issues. Provides consistent and accurate documentation, ensuring compliance with performance standards, corporate goals, and established timelines. Coordinates resources, organizes, and prioritizes assignments to meet goals and timelines. Monitors and evaluates the effectiveness of case management plans, gathering sufficient information to determine the plan's effectiveness and making adjustments as needed. #LI-Remote

Centene Corporation

TeleHealth Registered Nurse - Registry

Posted on:

May 23, 2025

Job Type:

Part-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Compact RN License Required PRN - At Least 29 Hours Per Month - Nights 6 - 4 hr On-Call Shifts Per Month Must be able to pass DFPS Background Check for Texas Position Purpose: Triage inbound calls, gather information, select appropriate triage guidelines, and disposition and care advice based on database protocols and department policies and procedures for a 24 hour per day/7 day a week operation. Provide clinical information and education for inbound and outbound calls providing oversight and support to the non-clinical staff.

Education/Experience: Graduate certificate from an accredited nursing program. 3+ years combined experience in critical care, pediatric, obstetrics, home health, school nursing, or emergency nursing. 5 years experience strongly preferred. Licenses/Certifications: Registered Nurse (RN) State Licensure in the State of residence and Compact State Licensure required Multiple State RN Licensures required

Conduct assessments of callers’ presenting symptoms. Develop, implement, and evaluate a plan of care for each caller presenting symptoms. Answer all calls in a timely manner. Maintain confidentiality of all caller and personnel issues. Document all call inquiries according to department policies and procedures. Participate in the collection of data for department quality projects. Promote recovery concepts and inspire hope. Possess and maintain a thorough grasp of clinical knowledge pertaining to various disease states, medications, treatments, etc. Comply with Federal and respective state’s laws regulating health management organizations and telephone information centers and all department standards and policies and procedures. Apply primary nursing knowledge while performing all aspects of assigned tasks. Performs other duties as assigned Complies with all policies and standards

CVS Health

Telehealth Registered Nurse

Posted on:

May 23, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

At CVS Health, we’re building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation’s leading health solutions company, we reach millions of Americans through our local presence, digital channels and more than 300,000 purpose-driven colleagues – caring for people where, when and how they choose in a way that is uniquely more connected, more convenient and more compassionate. And we do it all with heart, each and every day.

••work from Home- Candidate must reside in Texas•• At CVS Health, we believe we can change the world by improving patient lives, one call at a time. Our Telephonic Registered Nurses (RN) have patient contact in the uniqueness of a telephonic practice setting, where they are impacting lives across the country. You will continue to experience the reasons you became a nurse without having to be in a bedside patient care environment. Our Registered Nurses redefine the way health care is delivered every day. When you join our team, you'll play an integral role in educating patients with medication adherence and disease state training. As a national leader in the healthcare industry and a Fortune 7 company, we seek special RNs who not only possess strong clinical expertise with innovative ideas, but who have the deep compassion and sensitivity it takes to treat our patients. Shift and Hours for our TX Telehealth Registered Nurse role: ****This is a Monday-Friday role with hours starting from 10:30am -7:00 pm (CST) These are set hours, and this is a fulltime hourly position. Learn more about us: https:J/www.youtube.com/watch?v=4Cr04QVn3IQ&list=PLLUzEQYSggzJqVUcnROBLdpspUTuvw7_k&index=2 RN, Registered Nurse, Case Manager, Nurse, Home Health, Autoimmune, Oncology, Telehealth, Telephone, Telephonic, Health Management, Assessment, Education, Training

A Registered Nurse with an unrestricted current compact license Texas and the ability to be licensed in multiple states A Registered Nurse must hold an unrestricted license in their state of residence, with multi- state/compact privileges and have the ability to be licensed in all non-compact states, territories and the District of Columbia based on the needs of the business. Many states’ licensing bodies have their own specific state requirements. Nursing boards may add more requirements from time to time and our nurses are required to meet such requirements. A Registered Nurse with an unrestricted current compact license in Texas and the ability to be licensed in multiple states Candidate must be based in TX for this particular requisition 3+ years of clinical RN experience Experience using Microsoft Office, including Word, Excel and Outlook COVID Vaccine Required: N/A COVID Requirements: N/A Preferred Qualifications: Previous Telephonic Nursing experience EPIC systems experience Bachelor’s degree preferred Licensure in multiple states preferred

Working from home, you will be part of a specialized team on the cutting edge of patient care. Working collaboratively with health care professionals, you will provide a meaningful patient experience, while using your critical thinking skills to develop, implement, and evaluate comprehensive plans of care for multiple disease state patients. As a Telephonic Registered Nurse, you will a profound effect on the lives of the patients and caregivers via each outbound call, providing education and support for their new medication. Along with the Compliance and Persistency team, you are the continuity of care supporting defined patient populations through the use of our state-of-the-art telecommunications nursing outreach programs. To be successful in this Registered Nurse position, you must have excellent written and verbal customer service skills, as well as advanced computer skills in order to interact with patients.

ChenMed

Registered Nurse, CareLine (Telehealth) (Bilingual Spanish) (Remote)

Posted on:

May 22, 2025

Job Type:

Part-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

We’re unique. You should be, too. We’re changing lives every day. For both our patients and our team members. Are you innovative and entrepreneurial minded? Is your work ethic and ambition off the charts? Do you inspire others with your kindness and joy? We’re different than most primary care providers. We’re rapidly expanding and we need great people to join our team.

The Registered Nurse 1, Care Line, is responsible for providing telephonic triage directional patient care advice for general and specific illnesses, health related issues, client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. Providing on-call coverage, the incumbent in this role provides remote clinical advice and assessments within license and as possible given technology and medium. The registered nurse collaborates with primary caregivers and others on the interdisciplinary care plan team to provide a team approach of care. The schedule for this position is as follows each week: Fridays 1630-0800 Saturdays 2000-0800 Sundays 2030-0830

Associate Degree in Nursing required, Bachelor’s Degree in Nursing preferred Nurse Licensure Compact license required Michigan and Illinois Nurse Licensure reguired within 90 days of hire, ability to obtain additional licenses as requested by the organization within 90 days of hire Basic Life Support (BLS) certification from the American Heart Association or American Red Cross required Minimum of 3 years acute clinical nursing work experience preferred Minimum of 1 year virtual care experience preferred Minimum of 2 years experience in Emergency Nursing Services and Emergency Triage with older adult populations required

Connects with patients via phone or video call. Interviews and questions patients to collect health history and uses a computer system to record and store comprehensive and focused data relating to the health needs of patients and families. Provides health assessment and treatment solutions, monitors patient health and at-home care, aids in emergency scenarios and promotes patient wellness. Based on technology available, monitors a patient’s blood oxygen levels, heart rate, respirations, blood pressure and blood glucose as well as other assessment measures. With the help of video chatting, identifies patient’s symptoms and conditions. Analyzes data to determine the appropriate health maintenance and identify appropriate outcomes for patient and family. Collaborate with on-call providers as needed to support expected clinical outcomes for the patient and family. Evaluates and documents progress toward the anticipated outcome. Assist in ensuring achievement of optimal patient outcomes using Telemedicine. Documents interventions in a readable, understandable language. Aids in enhancing the quality and efficacy of the organization’s telehealth practices and professional nursing practice through successful utilization and improvement of outcomes that demonstrate program efficacy. Utilizes appropriate resources to plan and provide services that are safe, effective and fiscally responsible. Performs other duties as assigned and modified at manager’s discretion.

UnitedHealthcare

Clinical Appeals RN - Remote in US

Posted on:

May 22, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

As a Clinical Appeals RN for UHC Clinical Services, you will work on post-service appeals for Medicare-based claims.

Required Qualifications: Undergraduate degree or equivalent experience Unrestricted, active RN license 2+ years of RN experience in acute setting Proven working knowledge of Clinical Criteria and CMS Guidelines Proven proficiency in basic computer skills Demonstrated ability to have high speed internet installed in home for Secure Job use only Proven designated HIPPA compliant home workspace Preferred Qualifications: Undergraduate degree (BSN) Proven utilization management, prior authorization, case management or prior appeals experience Proven claims and coding experience

Review provider post-service appeals for Medicare and Retirement Gather clinical information including medical records and coverage criteria as it pertains to Medicare guidelines Discuss cases with medical directors when applicable Ability to communicate and collaborate with other teams in order to gather medical information to process cases Communicate effectively in both verbal and written documentation Must meet quality and productivity metrics Ability to work independently and prioritize Attend mandatory trainings and scheduled staff meetings Engage in respectful and courteous team dialog via email, IM and in staff meeting

Maximus

Registered Nurse

Posted on:

May 22, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Virginia

Maximus is HIRING 100 % REMOTE Position as a Registered Nurse for Medical Expert Reviewer Peer Review for Quality Management may only be used for improving the quality of health care or utilization of health care resources in VA medical facilities. Its primary focus is whether the clinical decisions and actions of a clinician during a specific clinical encounter met the standard of care. Provider must have access to their own computer to complete online training, complete written reviews using MS word software, be able to access VA EMR system to review medical records and be able to access Maximus’s secure email system to receive encrypted emails. Provider can accept or decline cases; must do so within 24 hrs. Once accepted the review must be submitted within 3-5 business days, expedited cases are within 24 hours. Rate Description of Service per case: $50 to $150 per case. Case normally takes about 30 minutes to an hour + to complete either. Provider can accept or decline cases; must do so within 24 hrs. Once accepted the review must be submitted within 3-5 business days, expedited cases are within 24 hours **There is training provided for the systems used.

Active license in any state 20 hours of direct patient care per month Board Certification within exact specialty requested MUST have National Provider Identifier (NPI) number CANNOT be a VA employee, active-duty military, or provide care in military facilities 3-year experience in appropriate specialty post training (non-MD/DO) 5-year experience in appropriate specialty post training (MD/DO)

AccentCare

Territory Patient Admission Coordinator (Clinical) - Weekends Remote

Posted on:

May 22, 2025

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

California

At AccentCare, our care is most compassionate when we empathize and engage with everyone, and we are at our best when we value diverse perspectives, foster open dialogue, and enact change. And we are stronger when each of us is empowered to grow, be our unique selves, and feel a sense of inclusion and belonging. AccentCare is proud of how we are building a culture and inclusive infrastructure to help elevate the voice of all our employees with a special focus on the underrepresented and marginalized. We offer equal employment opportunities regardless of a person’s race, ethnicity, sex, sexual orientation, gender identity or expression, religion, national origin, color, creed, age, mental disability, physical disability, or any other protected classification.

Find Your Passion and Purpose as a Territory Patient Admissions Coordinator Clinical Reimagine Your Career in Corporate Healthcare As a professional, you know that what you do impacts you as much as our patients and their families, and at AccentCare, we are united in our relentless drive to reimagine care because we want to provide the service we would seek for our own families. We think it’s really special to be a part of our patient’s health journey and create incredible memories while providing world-class patient care. Friday-Monday or Saturday-Tuesday, 8:00a-7:00p PST, must be willing to work Pacific Time Zone This is a fully Remote opportunity

Licensed RN, LVN or PT in practicing state. 3-7 years of experience in facility/physician relationships with a deep understanding of facility discharge processes, preferred. Minimum of one year experience in home care, hospice, or personal care services, preferred Prior use of Electronic Medical Records (EMR), preferred Experience in dealing with a variety of payors in healthcare, e.g., Medicare, Medicaid, and commercial payers, preferred.

The Territory Patient Admission Coordinator is responsible for the timely acceptance or decline of the referral based of the predetermined criteria set by the Agency. This position’s assigned territory, may encompass one or more states in AccentCare’s operation and may change with the needs of the Company. The Territory Patient Admission Coordinator establishes and maintains communication with the clients, family members and referral sources. This role is responsible for partnering with agency staff, referral sources, and sales to achieve optimal patient satisfaction & outcomes. The Territory Patient Admission Coordinator facilitates obtaining all information and documentation necessary to complete a referral through follow up with the Agency, the Referral Source and the Client.

AccentCare

LVN Clinical Scheduler / Part-Time / Remote Weekends

Posted on:

May 22, 2025

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

Georgia

At AccentCare, our care is most compassionate when we empathize and engage with everyone, and we are at our best when we value diverse perspectives, foster open dialogue, and enact change. And we are stronger when each of us is empowered to grow, be our unique selves, and feel a sense of inclusion and belonging. AccentCare is proud of how we are building a culture and inclusive infrastructure to help elevate the voice of all our employees with a special focus on the underrepresented and marginalized. We offer equal employment opportunities regardless of a person’s race, ethnicity, sex, sexual orientation, gender identity or expression, religion, national origin, color, creed, age, mental disability, physical disability, or any other protected classification.

Find Your Passion and Purpose as a LVN Clinical Scheduler, Part-Time Weekends / Remote Reimagine Your Career in Home Health As a medical professional, you know that what you do impacts you as much as your patients and their families, and at AccentCare, we are united in our relentless drive to reimagine care because we want to provide the service we would seek for our own families. We think it’s really special to be a part of our patient’s health journey and create incredible memories while providing world-class patient care. Offer Based on Years of Experience Part-time Schedule Sat & Sun: 2p-10p CST One weeknight: 5p-10p CST (to be discussed during interview) Pay range: $23-$25 per hour, based on years of experience

LVN/LPN license preferred High School Diploma or equivalent Experience with scheduling in the medical field; homecare scheduling experience preferred Required Certifications and Licensures: Minimum of one year data entry, word processing and/or medical records maintenance experience in a medical customer service environment generally required Home Health Scheduling experience preferred

Netsmart

Utilization Review Nurse, Full-Time, Multiple Shifts Available, Remote

Posted on:

May 22, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Kansas

Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart’s sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart’s third party screening provider.

Are you a detail-oriented and experienced RN with a passion for ensuring quality care and appropriate resource utilization? We’re seeking a Utilization Review Nurse to join our fully remote team. In this role, you’ll conduct utilization reviews for emergency admissions and continued stays, applying InterQual criteria to support clinical decision-making and ensure compliance with healthcare standards. As a key member of our Clinical Services team, you’ll collaborate with emergency department physicians, review electronic medical records, and contribute to the efficient delivery of care. This is a full-time, 40-hour-per-week position offering flexibility within a supportive and dynamic work environment. Note: Recent experience with InterQual is required. Experience with MCG is a plus.

Required: Current and unrestricted RN license At least 3 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing At least 2 years utilization management experience in acute admission and concurrent reviews Intermediate level experience with InterQual and/or MCG criteria within the last two years Proficiency in medical record review in an electronic medical record (EMR) Experience in Microsoft Suite including Office and basic Excel Ability to thrive in a fast-paced, dynamic environment and adapt to frequent changing business needs Passing score(s) on job-related pre-employment assessment(s) Preferred: At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing At least 3 years utilization management experience within the hospital setting Bachelor's of Science in Nursing (BSN) Case Management Certifications such as Certified Case Manager (CCM), Accredited Case Manager (ACM), Certified Managed Care Nurse (CMCN), Case Management, Board Certified (CMGT-BC) Work Schedule Requirements: This is a full-time position requiring a total of 40 hours per week, with shifts scheduled within the 9:00 AM – 9:00 PM EST window to best support our clients. Shift Options: (Varies) 8-hour shifts: 9:00 AM – 5:00 PM 1:00 PM – 9:00 PM 12-hour shifts may also be available, depending on business needs. Expectations: Comfortable with remote work arrangements and virtual collaboration tools Physical demands include extended periods of sitting, computer use, and telephone communication

Review and evaluate electronic medical records of emergency department admissions and screen for medical necessity using InterQual or MCG criteria Apply evidence-based clinical guidelines and criteria to assess and ensure proper utilization of healthcare resources Participate in telephonic discussions with emergency department physicians relative to documentation and admission status Enter clinical review information into system for transmission to insurance companies for authorization Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources

Netsmart

Utilization Review Nurse, PRN, Remote

Posted on:

May 22, 2025

Job Type:

Part-Time

Role Type:

Utilization Review

License:

RN

State License:

Kansas

Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart’s sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart’s third party screening provider.

Are you a detail-oriented and experienced RN with a passion for ensuring quality care and appropriate resource utilization? We’re seeking a Utilization Review Nurse to join our fully remote team. In this role, you’ll conduct utilization reviews for emergency admissions and continued stays, applying InterQual criteria to support clinical decision-making and ensure compliance with healthcare standards. As a key member of our Clinical Services team, you’ll collaborate with emergency department physicians, review electronic medical records, and contribute to the efficient delivery of care. This is a full-time, 40-hour-per-week position offering flexibility within a supportive and dynamic work environment. Note: Recent experience with InterQual is required. Experience with MCG is a plus.

Required: Current and unrestricted RN license At least 3 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing At least 2 years utilization management experience in acute admission and concurrent reviews Intermediate level experience with InterQual and/or MCG criteria within the last two years Proficiency in medical record review in an electronic medical record (EMR) Experience in Microsoft Suite including Office and basic Excel Ability to thrive in a fast-paced, dynamic environment and adapt to frequent changing business needs Passing score(s) on job-related pre-employment assessment(s) Preferred: At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing At least 3 years utilization management experience within the hospital setting Bachelor's of Science in Nursing (BSN) Case Management Certifications such as Certified Case Manager (CCM), Accredited Case Manager (ACM), Certified Managed Care Nurse (CMCN), Case Management, Board Certified (CMGT-BC) Work Schedule Requirements: This is a PRN position requiring a total of 48 hours per month. 16 hours must be worked on the weekend per month, weekends are Sat/Sun. Required to work 4 hours on 4 Holidays per year Expectations: Comfortable with remote work arrangements and virtual collaboration tools Physical demands include extended periods of sitting, computer use, and telephone communication

Review and evaluate electronic medical records of emergency department admissions and screen for medical necessity using InterQual or MCG criteria Apply evidence-based clinical guidelines and criteria to assess and ensure proper utilization of healthcare resources Participate in telephonic discussions with emergency department physicians relative to documentation and admission status Enter clinical review information into system for transmission to insurance companies for authorization Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources

Netsmart

Utilization Review Nurse, Part-Time, Remote (Evergreen) (Open)

Posted on:

May 22, 2025

Job Type:

Part-Time

Role Type:

Utilization Review

License:

RN

State License:

Kansas

Netsmart desires to provide a healthy and safe workplace and, as a government contractor, Netsmart is committed to maintaining a drug-free workplace in accordance with applicable federal law. Pursuant to Netsmart policy, all post-offer candidates are required to successfully complete a pre-employment background check, including a drug screen, which is provided at Netsmart’s sole expense. In the event a candidate tests positive for a controlled substance, Netsmart will rescind the offer of employment unless the individual can provide proof of valid prescription to Netsmart’s third party screening provider.

Are you a detail-oriented and experienced RN with a passion for ensuring quality care and appropriate resource utilization? We’re seeking a Utilization Review Nurse to join our fully remote team. In this role, you’ll conduct utilization reviews for emergency admissions and continued stays, applying InterQual criteria to support clinical decision-making and ensure compliance with healthcare standards. As a key member of our Clinical Services team, you’ll collaborate with emergency department physicians, review electronic medical records, and contribute to the efficient delivery of care. This is a full-time, 40-hour-per-week position offering flexibility within a supportive and dynamic work environment. Note: Recent experience with InterQual is required. Experience with MCG is a plus.

Required: Current and unrestricted RN license At least 3 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing At least 2 years utilization management experience in acute admission and concurrent reviews Intermediate level experience with InterQual and/or MCG criteria within the last two years Proficiency in medical record review in an electronic medical record (EMR) Experience in Microsoft Suite including Office and basic Excel Ability to thrive in a fast-paced, dynamic environment and adapt to frequent changing business needs Passing score(s) on job-related pre-employment assessment(s) Preferred: At least 5 years clinical experience in acute care setting in emergency room, critical care and/or medical/surgical nursing At least 3 years utilization management experience within the hospital setting Bachelor's of Science in Nursing (BSN) Case Management Certifications such as Certified Case Manager (CCM), Accredited Case Manager (ACM), Certified Managed Care Nurse (CMCN), Case Management, Board Certified (CMGT-BC) Work Schedule Requirements: This is a Part-time position requiring a total of 64 hours per month, minimum of 16 hours per week. 16 hours must be worked on the weekend per month, weekends are Sat/Sun. Required to work 4 Holidays per year Expectations: Comfortable with remote work arrangements and virtual collaboration tools Physical demands include extended periods of sitting, computer use, and telephone communication

Review and evaluate electronic medical records of emergency department admissions and screen for medical necessity using InterQual or MCG criteria Apply evidence-based clinical guidelines and criteria to assess and ensure proper utilization of healthcare resources Participate in telephonic discussions with emergency department physicians relative to documentation and admission status Enter clinical review information into system for transmission to insurance companies for authorization Review, analyze, and identify utilization patterns and trends, problems, or inappropriate utilization of resources

Elevance Health

Advanced Practice Provider - Nurse Practitioner - 100% Virtual - Bilingual - Carebridge

Posted on:

May 22, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

Carebridge Health is a proud member of the Elevance Health family of companies within our Carelon business. Carebridge Health exists to enable individuals in home and community-based settings to maximize their health, independence, and quality of life through home care and community-based services.

Seeking Bilingual Spanish Nurse Practitioners licensed in either of the following states: MA, VA, TN, FL, IN, OH, TX, KS, AZ, IA, NM, and must have an active RN Compact license. Location: Virtual - This role enables associates to work virtually full-time, with the exception of required in-person training sessions (when indicated), providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Work Shift: 11am – 11pm CST; The NP will work six (6) 12-hour shifts and one (1) 8-hour shift in a two-week period, including Saturday and Sunday every other weekend. The Advanced Practice Provider is responsible for collaborating with company physicians, the patient’s other physicians and providers, and their family members to develop complex plans of care in accordance with the patient’s health status and overall goals and values. Provides clinical and non-clinical support to patients.

Position Requirements: Requires an MS in Nursing. Requires an active national NP certification. Requires valid, current, active and unrestricted Family or Adult Nurse Practitioner (NP) license in applicable states. Experience working with Electronic Medical Records (EMR) required. Requires 2+ years of experience in managing complex care cases. Bilingual or Multi-language skills required. Preferred qualifications, skills and experiences: Emergency Room and/or Urgent Care experience is strongly preferred. Possession of DEA registration or eligibility preferred. Experience in managing complex care cases for developmental disabilities and chronically ill patients is strongly preferred.

Provides primary and urgent health care via telephone and tele video modalities to patients who receive home and community-based services through state Medicaid programs, dual eligible members and other membership as assigned by our MCO partners. Develops and implements clinical plans of care for adult patients facing chronic and complex conditions (e.g., co-morbid medical and mental health diagnoses, limited personal resources, chronic medical conditions.). Gathers history and physical exam and diagnostics as needed and then develops and implements treatment plans given the patient’s goals of care and current conditions. Identifies and closes gaps in care. Meets the patient’s and family’s physical and psychosocial needs with support and input from the company’s inter-disciplinary team. Educates patients and families about medication usage, side effects, illness progression, diet and nutrition, medical adherence and crisis anticipation and prevention. Maintains contact with other clinical team members, patients’ other physicians and patients’ other medical providers to coordinate optimal care and resources for the patient and his or her family in a timely basis and consistent with state regulations and company health standards and policy. Maintains patient medical records and medical documentation consistent with state regulations and company standards and policy. Participates in continuing education as required by state and certifying body. Prescribes medication as permitted by state prescribing authority.

Elevance Health

Transitions of Care RN- 100% Remote, CareBridge

Posted on:

May 22, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

Texas

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

Location: Virtual: This role enables associates to work virtually full-time, with the exception of required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development Work shift: 4/10 works shift with rotating weekends and holidays per business needs. The Transitions of Care RN- 100% Virtual is responsible for participating in delivery of patient education and disease management interventions and for performing health coaching for members, across multiple lines, for health improvement/management programs for chronic diseases.

Minimum Requirements: Requires AS in nursing and minimum of 2 years of condition specific clinical or home health/discharge planning experience; or any combination of education and experience, which would provide an equivalent background. Current unrestricted RN license in applicable state(s) required. Preferred Skills, Capabilities and Experiences: Bilingual strongly preferred. Current, unrestricted, Compact RN license in applicable state(s) is highly preferred. Experience in care of adult, chronically ill patients, chronically ill pediatric patients, and patients with IDD. Home Health, Utilization Management or Case Management experience strongly preferred. Previous Transitions of Care experience a plus. Working knowledge of computers and ability to document effectively and efficiently in an electronic system. Expert communicator over the telephone, providing timely, appropriate advice and/or guidance with health care issues. Experience in care of members with multiple chronic medical conditions such as COPD, CHF, CKD, Catheters, Wounds, Psych, Special Needs Population.

Conducts behavioral or clinical assessments to identify individual member knowledge, skills and behavioral needs. Identifies and/or coordinates specific health coaching plan needs to address objectives and goals identified during assessments. Interfaces with provider and other health professionals to coordinate health coaching plan for the member. Implements and/or coordinates coaching and/or care plans by educating members regarding clinical needs and facilitating referrals to health professionals for behavioral health needs. Uses motivational interviewing to facilitate health behavior change. Monitors and evaluates effectiveness of interventions and/or health coaching plans and modifies as needed. Directs members to facilities, community agencies and appropriate provider/network. Refers member to catastrophic case management.

TriOptus

SMH Level 2 RN 192 Med Surg Psych

Posted on:

May 22, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

New York

Schedule- D/E/N ROTATING SHIFT SCHEDULES, Weekends/Holidays/On-Call/Callback/Charge per Unit Needs URMC will consider 48 hours straight time HCP must have recent med surg experience Great opportunity to become a member of a unique unit, only a handful of similar units in the country. Adult medical/surgical unit for patients with active co-morbid psychiatric and/or behavioral issues. This expanding unit is looking for flexible, enthusiastic and committed nurses to help us grow. Med/surg acute care experience a plus. Willingness to care for a varied patient population in a changing environment a must! Nurses are eligible for dual-certification in both medical/surgical nursing and psychiatric nursing after experience requirement attained.

RN License (NY License ONLY) Psychology Experience Required Telemetry Experience Certifications: BLS (AHA ONLY) Required/Desired Skills: SkillRequired /DesiredAmountof ExperienceTwo (2) years RN ExperienceRequired0RN License (New York ONLY)Required0BLS (American Heart Association ONLY)Required0

AltaMed Health Services

Licensed Vocational Nurse, Out-Patient Case Manager

Posted on:

May 22, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

LPN/LVN

State License:

California

If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn’t just welcomed – it’s nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don’t just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it’s a calling that drives us forward every day.

Graduation from an accredited LVN nursing program. Current valid License as a Licensed Vocational Nurse Experience in and willingness to be part of a multi-disciplinary team. The LVN CM is part of a cohort of LVNs, Social Workers, and Care Coordinators that are supported and guided by an RN Case Manager. Experience with physically or mentally impaired adults and/or the geriatric population. Three years' experience in public health nursing, acute care, case management, and/or in-home health care required; minimum of 2 years of managed care experience in case management with a focus on inpatient and/or outpatient ambulatory care preferred. Bilingual in English and Spanish preferred. A minimum requirement of a valid BLS certification or higher, following the American Heart Association (AHA) or the American Red Cross guidelines.

The LVN Case Manager may provide daily care coordination, case management, coaching, consultation, and intervention to patients with one or more chronic diseases. Is responsible for identifying said population via provider/clinic referral, utilization management referral, disease registry reporting mechanisms, and patient self-referral. This position will also provide case management to patients who are discharged from the hospital and those who may need to be enrolled in ambulatory case management. Works as part of an interdisciplinary care team coordinating social work and mental health counseling, psycho-social support services, in-home support, legal services, skilled nursing, home health, etc. The LVN Case Manager effectively collaborates with the members of the interdisciplinary care team and with the physician in the clinic.

AltaMed Health Services

Registered Nurse, Case Manager

Posted on:

May 22, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

California

If you are as passionate about helping those in need as you are about growing your career, consider AltaMed. At AltaMed, your passion for helping others isn’t just welcomed – it’s nurtured, celebrated, and promoted, allowing you to grow while making a meaningful difference. We don’t just serve our communities; we are an integral part of them. By raising the expectations of what a community clinic can deliver, we demonstrate our belief that quality care is for everyone. Our commitment to providing exceptional care, despite any challenges, goes beyond just a job; it’s a calling that drives us forward every day.

Graduation from an accredited nursing program. Current valid License as a Registered Nurse through the California Board of Registered Nursing; Bachelor’s degree in social work, nursing, or another health or human services field with the appropriate licensure preferred. Experience in and willingness to be part of multi-disciplinary team. Experience with physically or mentally impaired adults and/or geriatric population. Three years experience in public health nursing, acute care, case management and/or in-home health care required; minimum of 2 years of managed care experience in case management with focus in inpatient and/or outpatient ambulatory care preferred. Bilingual in English and Spanish preferred.

The Nurse Case Manager may provide daily care coordination, case management, coaching, consultation and intervention to patients with one or more chronic diseases. May also be responsible for identifying said population via provider/clinic referral, utilization management referral, disease registry reporting mechanisms and patient self-referral. This position may also provide case management to patients who are admitted to the hospital and those patients who may need to be enrolled in ambulatory case management. The case manager will be responsible for identifying (California Children Services) CCS cases, handle transfers, and retro reviews. Works as part of an interdisciplinary care team coordinating social work and mental health counseling, psycho-social support services, in-home support, legal services, skilled nursing, home health, etc. The Nurse Case Manager effectively collaborates with the hospitalist, the hospital nursing personnel, with members of the interdisciplinary care team and with the physician in the clinic.

TRIUNE Health Group

Nurse Case Manager

Posted on:

May 22, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Texas

TRIUNE Health Group is a nationally recognized managed healthcare company with over 35 years of experience. As a mission-driven, second-generation family-owned business, we are dedicated to improving lives by reducing the impact of injuries, enhancing health and wellness, and lowering healthcare and workers' compensation costs. At TRIUNE, we believe that every team member is essential to our success. We foster a supportive and collaborative environment where employees are valued, empowered, and provided with the tools they need to thrive—both professionally and personally. Why Join TRIUNE Health Group as a Nurse Case Manager? Be part of a well-established, family-owned company that prioritizes people over profits. Experience our culture of People Helping People, where every team member is treated with dignity and respect. Enjoy the stability, support, and resources needed to succeed while maintaining a healthy work-life balance.

The Nurse Case Manager coordinates resources and creates flexible, cost-effective options for catastrophically or chronically ill or injured individuals to facilitate quality, individualized, holistic treatment goals, including timely return to work when appropriate.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Skills and Abilities: Proven leadership skills. Excellent verbal and written communication skills, including the ability to interact effectively with patients, customers, and fellow employees via phone, email, in-person, and formal presentations. Methodical in accomplishing job-related goals. Strong analytical and organizational skills, including the ability to multitask with attention to detail. In-depth knowledge of multi-software packages, notably Microsoft Office Suite (Word, Excel, PowerPoint, Outlook) and the Internet. Maintain a friendly, professional attitude at all times. Exercise initiative and be solution-oriented, while keeping management up-to-date on current situations or opportunities. Dependability and adaptability. Education and Experience: Graduate of an accredited school of nursing. Current RN licensure in the state of operation. Fluency in English (speaking, reading, and writing). Three or more years of recent clinical experience, preferably in trauma, psychology, emergency, orthopedics, rehabilitation, occupational health, and neurology. CCM preferred. Certificates, Licenses, Registrations: While not mandatory, individuals with one or a combination of the following certifications are preferred: COHN, COHN-S, and CDMS.

Provide medical case management to individuals through coordination with the patient, physicians, other health care providers, the employer, and the referral source. Utilize the steps of Case Management to provide assessment, planning, implementation, evaluation, and outcome of an individual’s progress. Evaluate individual treatment plans for appropriateness, medical necessity, and cost-effectiveness. Facilitate care, such as negotiating and coordinating the delivery of durable medical equipment and home health services, ensuring clear communication. Assess rehabilitation facilities for appropriateness of care, facilitate transportation, and coordinate architectural assessments of patients’ homes when required. Communicate medical information clearly and compassionately to patients and families. Stay current with medical terminology and the federal and state laws related to health care, Workers’ Compensation, ADA, HIPAA, FMLA, STD, LTD, SSDI, and SSA. Utilize technology (computer, cell phone, fax, and scanning machine) to prepare organized, timely reports while complying with safety rules and regulations in conjunction with HIPAA. Research medical and community resources for individuals with catastrophic or chronic diagnoses, such as but not limited to AIDS, cancer, spinal cord injuries, diabetes, head injuries, back injuries, hand injuries, and burns, ensuring accessibility for individuals. Possess a valid driver’s license with the ability to travel 90% of the time. Perform other duties as assigned.