Western Montana Mental Health Center

Remote Nurse Per Diem

Posted on:

July 19, 2025

Job Type:

Role Type:

Telehealth

License:

RN

State License:

Montana

We are excited to announce that WMMHC and AWARE Inc. are unifying to create a stronger agency that will provide the highest quality of support for the individuals, children, families, and communities we all serve. As we move through this transition, new employees may begin their employment with WMMHC and later transition to AWARE, or they may be hired directly by AWARE, depending on their start date. Together, we are committed to hiring outstanding individuals and offering a comprehensive benefits package that includes generous paid time off, health insurance, a retirement plan with company match, and so much more!

Remote Nurses provide virtual care for up to eighteen (18) hours per shift and are expected to remain available for nursing tasks and calls throughout their scheduled shift. A minimum commitment of four (4) shifts per month is required. The ideal candidate is a licensed RN with strong clinical judgment, excellent communication skills, and the ability to adapt to dynamic care environments. They must be proficient in electronic health records and capable of delivering high-quality care in a fully remote setting.

Graduation from an accredited college with a degree in nursing or a related field. Valid Licensure in MT as a Registered Nurse (RN). Minimum of one (1) year of experience. Ability to work remotely with a suitable workstation to provide telehealth services. Availability for variable scheduling to include weekends and holidays Ability to pass a background check upon offer of employment. Valid current driver’s license with a good driving record. Must reside in the state of Montana

The Remote Per Diem Nurse plays a critical role in delivering compassionate, trauma-informed care to individuals experiencing mental health challenges across various WMMHC programs. This fully remote position provides telehealth nursing services, including crisis intervention, medication administration coordination, health education, and care planning. Working independently and as part of interdisciplinary teams, the nurse supports client stabilization and recovery through timely assessments, medication oversight, and collaborative treatment planning. Responsibilities also include maintaining accurate documentation and ensuring compliance with privacy regulations.

Banyan Medical Solutions

RN, Tele-Health Nurse, Nights-Bilingual

Posted on:

July 19, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

Registered Nurse (RN) – Virtual Nursing (Remote/Work From Home) Banyan Medical Systems – Remote (Work From Home) $31.00 – $32.00 per hour + shift differentials Full-time | 12-hour shifts | Remote/Virtual Escape bedside burnout—without leaving patient care. Banyan Medical Systems is hiring full-time Virtual Registered Nurses (RNs) to work remotely from the comfort of their homes while delivering exceptional virtual patient care. This is a fully remote, work-from-home role. Candidates must have a secure HIPAA-compliant workspace with a door, no background noise or interruptions, and a reliable wired high-speed internet connection. Shift Details: Full-time | 36 hours per week 12-hour shifts | Days or Nights available Rotating weekends & holidays Training Schedule (Week 1): 8 AM – 5 PM CST (Monday–Friday)

Requirements for Remote Setup: Wired high-speed internet connection (no Wi-Fi only setups) HIPAA-compliant private workspace with a door to prevent interruptions and protect patient privacy Quiet, distraction-free environment Professional setting during all working hours (background appearance for video meetings as needed) Active Multi-State RN License in the state you are living in – Required Must be located in the states of AZ, NM or TX Minimum 3 years of recent acute care experience (Med/Surg, ICU, or PCCU) in a hospital setting Strong typing and documentation skills using multiple computer systems Proficient with Epic and/or Cerner platforms Excellent verbal and written communication skills Strong critical thinking skills and keen attention to detail BLS Certification (AHA) – Required Bilingual in Spanish/English – Preferred

Work from the comfort of your own secure, HIPAA-compliant home office Support bedside nurses remotely using our advanced telehealth platform Provide virtual care for admissions, discharges, rounding, and patient education to multiple clients. Interact directly with patients via in-room smart TV technology Help improve patient care while reducing bedside staff workload What You’ll Do: Virtually support bedside nurses by managing non-direct patient care tasks Complete virtual assessments, documentation, and discharge planning Collaborate with physicians and interdisciplinary teams to ensure continuity of care Use multiple EHR platforms (Epic, Cerner) and healthcare applications Maintain accurate and timely electronic documentation and communication

Banyan Medical Solutions

RN, Tele-Health Nurse, Days

Posted on:

July 19, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

Registered Nurse (RN) – Virtual Nursing (Remote/Work From Home) Banyan Medical Systems – Remote (Work From Home) $31.00 – $32.00 per hour + shift differentials Full-time | 12-hour shifts | Remote/Virtual Escape bedside burnout—without leaving patient care. Banyan Medical Systems is hiring full-time Virtual Registered Nurses (RNs) to work remotely from the comfort of their homes while delivering exceptional virtual patient care. If located within 1 hour of Omaha, NE- this person will be required to work on-site in our Omaha office. Candidates must have a secure HIPAA-compliant workspace with a door, no background noise or interruptions, and a reliable wired high-speed internet connection. Why You’ll Love This Role: Work from the comfort of your own secure, HIPAA-compliant home office Support bedside nurses remotely using our advanced telehealth platform Provide virtual care for admissions, discharges, rounding, and patient education to multiple clients. Interact directly with patients via in-room smart TV technology Help improve patient care while reducing bedside staff workload Shift Details: Full-time | 36 hours per week 12-hour shifts | Days or Nights available Rotating weekends & holidays Training Schedule (Week 1): 8 AM – 5 PM CST (Monday–Friday) Pay & Perks: Remote Base Pay: $32.00 per hour On-Site Omaha Base Pay: $34.00 Shift Differentials: +$1.75/hr Nights +$2.25/hr Weekend Days +$4.00/hr Weekend Nights Bilingual (Spanish/English) Pay: +$2.00/hr with Level II Certification Paid training | Team-oriented culture | Innovative healthcare setting

Requirements for Remote Setup: Wired high-speed internet connection (no Wi-Fi only setups) HIPAA-compliant private workspace with a door to prevent interruptions and protect patient privacy Quiet, distraction-free environment Professional setting during all working hours (background appearance for video meetings as needed) Active Multi-State RN License in the state you are living in – Required Must be located in the state of Nebraska. Minimum 3 years of recent acute care experience (Med/Surg, ICU, or PCCU) in a hospital setting Strong typing and documentation skills using multiple computer systems Proficient with Epic and/or Cerner platforms Excellent verbal and written communication skills Strong critical thinking skills and keen attention to detail BLS Certification (AHA) – Required Bilingual in Spanish/English – Preferred

Virtually support bedside nurses by managing non-direct patient care tasks Complete virtual assessments, documentation, and discharge planning Collaborate with physicians and interdisciplinary teams to ensure continuity of care Use multiple EHR platforms (Epic, Cerner) and healthcare applications Maintain accurate and timely electronic documentation and communication

IntellaTriage

Remote Hospice Triage RN- PT 2 shift 6p-12a + rotating Sat & Sun 7:30a-4

Posted on:

July 19, 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 6p-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

BCVS Group

RN Care Management Specialist

Posted on:

July 19, 2025

Job Type:

Contract

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

Position:- RN Care Management Specialist Rate:- $44/hr. Location:- Springfield IL, Fully Remote Job Description: We are seeking a compassionate and organized Registered Nurse (RN) or Licensed Master Social Worker (LMSW) to join our team as a Care Coordinator. This role focuses on discharge planning, episodic case management, and pre/post-discharge counseling for members with acute conditions. This position is responsible for handling duties in an independent manner and may assist other staff. Establish relationship with the member through the immediate post discharge follow-up period or until all short-term care needs are met. Provide education/local resource information and encourage member (self) education.

Active, unrestricted RN or LMSW license (multi-state license support provided) 2+ years clinical experience, 1+ year in health insurance/managed care Strong communication, assessment, and coordination skills Basic computer proficiency

Coordinate discharge and transition of care services Provide education, counseling, and resource referrals Collaborate with physicians and discharge planners to reduce readmissions Assist members with scheduling, follow-ups, and medication adherence Identify case complexity and refer to internal programs as needed Support member self-management and health behavior change

Healthcare Management Administrators Inc

Care Management Coordinator I

Posted on:

July 19, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

None Required

State License:

Washington

HMA is the premier third-party health plan administrator across the PNW and beyond. We relentlessly deliver on our promise to provide medium to large-size employers with customized health plans. We offer various high-quality, affordable healthcare plan options supported with best-in-class customer service. We are proud to say that for three years, HMA has been chosen as a ‘Washington’s Best Workplaces’ by our Staff and PSBJ™. Our vision, ‘Proving What’s Possible in Healthcare™,’ and our values, People First!, Be Extraordinary, Work Courageously, Own It, and Win Together, shape our culture, influence our decisions, and drive our results.

What we are looking for: We are always searching for unique people to add to our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven. What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: https://www.accesshma.com/ How YOU will make a Difference: The Care Management Coordinator demonstrates the ability to independently assess and synthesize work inputs to determine the scope and function of the work to achieve the desired goal; works directly with project team leads to implement new functions; provides input for coordinating member support functions across the Care Team; assesses the needs of the business and forms recommendations in response to business growth. Care Management Coordinator provides ongoing operational support across the organization as needed. HMA provides a generous total rewards package for full-time employees that includes: Seventeen (IC) days paid time off (individual contributors) Eleven paid holidays Two paid personal and one paid volunteer day Company-subsidized medical, dental, vision, and prescription insurance Company-paid disability, life, and AD&D insurances Voluntary insurances HSA and FSA pre-tax programs 401(k)-retirement plan with company match Annual $500 wellness incentive and a $600 wellness reimbursement Remote work and continuing education reimbursements Discount program Parental leave Up to $1,000 annual charitable giving match

High School Diploma required 1-3 years of minimum health plan, clinical or community health experience Ability to communicate complex ideas Ability triage and prioritize work The ability to problem-solve and use critical thinking skills Excellent, internal and external client-facing verbal and written communication skills Proficiency with Microsoft Office applications (Outlook, Word, DOSS) Self-motivated and self-directed Enjoys the pace and rhythm of a deadline-oriented environment with strong prioritization skill sets

Consult and work with healthcare providers throughout the RGA network to coordinate care and review service denials Work independently to create provider and member-facing denial letters by crafting clear and concise sentences using medical director denial information, personal expertise, medical criteria, and nurse input and plan language Use autonomy to triage and analyze requests for Peer to Peer calls, disabled dependent determinations, medical travel benefit work and other member and provider needs to determine next steps and actions Provide direct member contact and coordination for care needs not limited to disabled dependents, medical travel, continuity of care, denials, P2P and appeals Work across departments and with external partners to coordinate care not limited to customer care, Care navigators, intake, utilization review, case management, medical claim review, appeals, COB, enrollment and compliance Assess barriers to a positive member experience and strive to bridge gaps Support and fill-in non-clinical duties as needed to support the function of the Care Team

Healthcare Management Administrators Inc

Utilization Management Nurse III

Posted on:

July 19, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Washington

At HMA, we believe in recognizing and celebrating the achievements of our dedicated staff. We offer flexibility to work schedules that support people in all time zones across the US, ensuring a healthy work-life balance. Employees have the option to work remotely or enjoy the amenities of our renovated office located just outside Seattle with free parking, gym, and a multitude of refreshments. Our performance management program is designed to elevate career growth opportunities, fostering a collaborative work culture where every team member can thrive. We also prioritize having fun together by hosting in person events throughout the year including an annual all hands, summer picnic, trivia night, and a holiday party.

What we are looking for: We are always searching for unique people to diversify our team. We only hire people that care deeply about others, thrive in evolving environments, gain satisfaction from being part of a team, are motivated by tackling complex challenges, are courageous enough to share ideas, action-oriented, resilient, and results-driven. What you can expect: You can expect an inclusive, flexible, and fun culture, comprehensive salary, pay transparency, benefits, and time off package with plenty of personal development and growth opportunities. If you are looking for meaningful work, a clear purpose, high standards, work/life balance, and the ability to contribute to something important, find out more about us at: https://www.accesshma.com/ How YOU will make a Difference: The Utilization Management Nurse collaborates with external entities such as Brokers, Group Contacts, and Stop Loss supports to provide updated information on case specifics within HIPAA regulations. The Utilization Management Nurse is responsible for efficient utilization of health services by providing monitoring of member utilization and claim patterns; and makes referrals to Case Manager nurses for ongoing case management for complex care.

A Bachelor’s degree or equivalent professional experience required Active LPN/RN clinical license required 5-7+ years of clinical nursing experience Knowledge of Utilization Review processes (Preferred) Strong experience in clinical practice with diverse diagnoses Strong problem solving and critical thinking skills Excellent, client-facing verbal and written communication skills Behavioral health experience (Preferred) Ability to be self-motivated and self-directed Enjoys the pace and rhythm of a deadline-oriented environment with strong prioritization skills Proficiency with Electronic Health Records, Microsoft Office applications (Outlook, Word, DOSS)

Performs Utilization Management and applies first the terms of the SPD (Summary Plan Description), considering any benefit limitations/exclusions and PPO status of requesting provider/facility. Reviews are conducted using approved criteria for appropriateness of services, setting/level of care and length of stay. Provides ongoing review management of treatment progress as needed to provide personalized support and care coordination for complex, catastrophic or ongoing chronic medical conditions. Evaluates services requested to meet an individual’s health care needs, with the goal to provide personalized management to promote and ensure continuity of care coordination. Other duties as assigned

Pomelo Care

Perinatal Nurse (RN - Spanish Fluency Required)

Posted on:

July 19, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Pomelo Care is a multi-disciplinary team of clinicians, engineers and problem solvers who are passionate about improving care for moms and babies. We are transforming outcomes for pregnant people and babies with evidence-based pregnancy and newborn care at scale. Our technology-driven care platform enables us to engage patients early, conduct individualized risk assessments for poor pregnancy outcomes, and deliver coordinated, personalized virtual care throughout pregnancy, NICU stays, and the first postpartum year. We measure ourselves by reductions in preterm births, NICU admissions, c-sections and maternal mortality; we improve outcomes and reduce healthcare spend.

Your North Star: Provide and facilitate amazing patient-centered clinical care to our patients. We are currently hiring for FT Daytime hours: M-F 9am-6pm EST.

Registered Nurse, BSN prepared, current unrestricted multi-state (compact) license Have 4+ years RECENT experience in a hospital and/or healthcare practice, serving maternal-child health populations (minimum 3 years in labor and delivery and LDRP or Antepartum) Flexible and agile thinker who embraces change Are internet-connected, able to work remotely via video, phone and text Willing to travel occasionally (infrequent) Willing to work weekends and holidays Understand the prevalence and role that birth inequity and structural racism plays in maternal morbidity and mortality Professionally engaged Bonus points if you have any of the following: Experience working with perinatal patients who have had pregnancy related diseases such as diabetes, hypertension, perinatal loss, etc. Experience providing virtual care Spanish Fluency (without the use of an interpreter)

Ongoing clinical and psychosocial assessment of new patients, providing reassurance and building rapport Establishing individualized care plans to meet specific health needs based on evidence-based standards Developing wellness goals by determining motivating factors and leveraging them for best possible health outcomes Identifying and addressing barriers to care that have been identified by patients and/or the care team. Reducing care gaps (missed appointments, medication management, etc.) by frequent engagements with patient Assessing the need for and educating patients on the equipment they will use to monitor their health remotely Ongoing surveillance and timely response to abnormal diagnostic results (labs, radiology, etc.) Assessment of urgent concerns and proactively triaging patients to support appropriate utilization of emergency services Timely documentation of all care/interactions and escalating to appropriate multidisciplinary teams, as needed Supporting the development of programs and product by providing user feedback

Centene

Lead Care Manager RN

Posted on:

July 19, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Compact / Multi-State

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Location: Remote role, preferred locations Texas or Missouri. Position Purpose: Oversees the care plans / service plans and care management activities of member needs to provide quality, cost-effective healthcare outcomes. Reviews and provides expert knowledge to inform personalized care plans / service plans for complex care members and provides guidance and/or support to the care management team.

Education/Experience: Requires a Degree from an Accredited School of Nursing or a Bachelor's degree in Nursing and 5 – 7 years of related experience. License/Certification: RN - Registered Nurse - State Licensure and/or Compact State Licensure required

Oversees and reviews ongoing care plans / service plans and collaborates with providers to identify providers, specialists, and/or community resources needed to address member's unmet needs Provides insight and guidance on developing care plans / service plans and triaging issues to appropriate healthcare providers for care plans / service plans Provides guidance and expert knowledge as appropriate to care management team members to ensure quality control over work, members are receiving needed care or services, and adherence to contract policies and procedures Monitors the care plans / service plans and/or member status and outcomes or changes in condition, and revises care plan based on member needs and issues identified Provides subject matter expertise insights for care plans / service plans based on prior experience to recommend enhanced member care within the care management plan Works with senior management on escalated and complex care cases, and provides guidance to junior team members to address member concerns May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources Reviews member data to identify health risks and or care gaps, collaborate with providers / specialists as appropriate to address member’s needs / issues Monitors management policies and procedures within the care management team to ensure compliance with corporate, state, and National Committee for Quality Assurance (NCQA) standards Partners and collaborates with healthcare providers as appropriate to facilitate member’s treatments to ensure member service / care needs are met and determine a revised care plan / service plan for member if needed Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators Works as a subject matter expert (SME) and provides training and education to care management team and providers to ensure members are receiving high quality care and information regarding care plan / service plan options, procedures, referrals, and healthcare benefits Partners with leadership team to improve and enhance care and quality delivery for members in a cost-effective manner Performs other duties as assigned Complies with all policies and standards

The Cigna Group

RN Quality Specialist- Telephonic Registered Nurse II - Accredo - Work from Home, Anywhere, USA (Compact License Required)

Posted on:

July 19, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

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.

CLINICAL QUALITY NURSE SPECIALIST- WORK AT HOME- ACCREDO Excited to grow your career? We value our talented employees, and whenever possible strive to help one of our associates grow professionally before recruiting new talent to our open positions. If you think the open position, you see is right for you, we encourage you to apply! Our people make all the difference in our success. Full time work from home – you MUST reside in a compact state. Start Date: 8/25/2025. Shift for this role: 11am – 8pm EST Monday – Friday Please note, the first 6-7 weeks of training will be varied and may start between 8am-11:30am EST depending on the week. The primary responsibility of this role is to provide telephonic education to patients and caregivers following Clinical Protocols and working within the nursing scope of practice and guidelines. Additionally adverse event/product complaint reporting to pharma partners. This opportunity allows you to improve the health and well-being of others, while giving them a sense of security. If you are an RN and looking for a Telephonic role, this opportunity is for you! Read on to learn more. How you will make a difference: Take ownership of patient experience via telephone: Provide telephonic education that includes (but not limited to) disease and drug specific education to both patients and caregivers. Follow clinical protocols and work within the nursing scope of practice and guidelines while assessing and documenting clinical data and intervention. Be a coach to empower your patients to be at their best. Focus on the overall well-being of your patients. Collaborate with the patient’s treating physician to inform them of any new symptoms and health-related matters with an entire network of nurses on which you can learn. At Accredo, you are a part of an eco-system that will support you and advocate you. Grow alongside your peers in a patient-centered environment. Aid our clinical departments with new hire training and mentoring as well as conduct peer-to-peer quality documentation checks to provide feedback to management.

Registered Nurse (RN) compact license required. Must have at least 2 years of relevant clinical experience. MUST reside in a compact state. Require an active unencumbered license in the state that they reside and should have completed the NCLEX or a recognized state board exam. The RN must have the ability, with no restrictions, to apply for additional single state licenses. Must maintain all nursing licenses required for this role is a condition of employment, and the failure or inability to do so will result in termination of employment. Proficient in using micro soft applications. Must have hard wired internet connection. Minimum Internet speed: 5MBPS upload/2 MBPS download - Cable broadband or Fiber Optic Required. Excellent phone etiquette 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.

Adhere to principles stipulated by program-specific contractual agreements and company practices Build relationships with assigned patients throughout duration of program Provide patient-centric education regarding treatment and disease states for assigned products Manage caseload including scheduled maintenance and adherence, scheduled calls/interactions, updating program database per company protocols Deliver customized interactions based on patient’s needs Participate in program-specific customer meetings and training sessions Participate in program-specific orientation meetings and demonstrate clinical and systems competency on tests Complete and submit adverse event and product complaint reports to the pharmaceutical companies or FDA, following contract guidelines and internal practice standards Within the defined time limit, using internal protocols determines if the event meets reporting requirements to the manufacturer or the FDA. Once determined, report the event as outlined within the clinical tools. Responsible for accurate documentation of the event that adhere to contractual /FDA requirements. Respond to manufacturer and/or internal requests when an adverse clarification is required. Responsible for reporting any errors to the leadership team in a timely manner. Complete all applicable trainings on time and remain compliant. Perform special projects and other duties as it pertains to specific contract performance

Care N Care Insurance Company of North Carolina

Utilization Management Nurse

Posted on:

July 19, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

Under the direction of the Director of Care Management, the RN Care Manager is responsible for managing high-risk, chronic illness members to promote effective education, self-management support, and timely healthcare delivery to achieve optimal quality and financial outcomes. The RN Care Manager will formulate and implement a care management plan that addresses the members identified needs by assessing issues, resources, and care goals. The RN Care Manager will advocate for the member and support the member in navigating the health care system. Additionally, the RN Care Manager will work collaboratively with the interdisciplinary team and members PCP / Health Care Team to identify and support the achievement of the members short term and long-term health goals. HTA’s Care Management model is to provide longitudinal care management for identified members. Based on the RN’s work experience in nursing and knowledge of the health care system, the aims are to provide education and resources to members to ultimately reduce preventable emergency room visits and hospitalizations and re-admissions.

Education: Associate Degree in Nursing Required Experience: Five years of nursing-related care experience and/ or home care experience combined. Registered Nurse licensed in North Carolina or a Compact state. Current NC RN licensure in good standing Preferred Experience: BSN or Advanced Degree in Nursing Case Management Certification desirable. Case Management, Care Management, Telephonic Case Management, and/or Disease Management experience Advanced clinical knowledge. Skills related to physical assessment, wound care, blood pressure monitoring, CBG checks, and Foley Cath care. Clinical knowledge and ability to educate clients of all ages about the following core disease management issues: Diabetes, Hypertension, Hyperlipidemia, CAD, Asthma, COPD, and renal disease required. (This is not intended to be an inclusive list of all conditions.) Other Requirements: Annual Flu Vaccine KNOWLEDGE, SKILLS, AND ABILITIES Required Competencies: Knowledge of care management concepts along the continuum Knowledge of Medicare benefits Experience and ability to use Microsoft Office products and word-processing software on a daily basis Excellent written, verbal, and listening communication abilities. Communicates appropriately and clearly to members, coworkers, and providers. Ability to manage conflict, stress, and multiple simultaneous work demands in an effective and professional manner. Ability to successfully articulate the process of attaining goals and outcomes of care management Ability to apply clinical knowledge and experience in a care management role Ability to engage and collaborate with the member and significant others in the care management process Ability to care manage diverse populations without applying one’s own personal values Ability to work with minimal supervision within the nursing scope of practice Ability to think critically and analytically and work with minimal supervision. Ability to evaluate and appropriately respond to verbal and non-verbal communication from patients in diverse stages of development Ability to use good judgment to protect personal safety while performing duties PHYSICAL REQUIREMENTS: Prolonged periods of sitting at a desk and working on a computer. Must be able to lift up to 15 pounds at times.

Collaborates with providers and practice staff in identifying appropriate members for care management, utilizing established Care Management criteria. Performs initial and periodic holistic assessments for identified care managed population. This includes physical and psychological concerns for members as appropriate. The assessment includes a systematic and pertinent collection of data about the health status of the member. Prioritize members according to intensity, need, and required to follow-up. Formulates and implements a care management plan that addresses the member’s identified needs by assessing the member/family needs, issues, resources, and care goals; determining the choices available to individual members; educating the patient/family on the choices available to meet their goals. Establishes a care management plan that is mutually agreed upon by the health care team and the member/family. Plans specific mutual self-management goals and objectives and interventions with the members that are action oriented. Evaluates the effectiveness of the plan in meeting established care goals; revises the plan as needed to reflect changing needs, issues and goals. Monitors and evaluates the progress of the member at prescribed minimal intervals.

Planned Parenthood South Atlantic

Virtual Care Center Licensed Assistant Manager

Posted on:

July 19, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

New Mexico

Planned Parenthood is committed to creating a dynamic work environment that values diversity, equity, inclusion, respect, integrity, customer focus, and innovation. We are committed to creating a welcoming space for all people on our staff, in our health centers, and in our community. We do this by tending to the team, respecting and honoring all people, jumping in, trying and learning, caring for our business, and returning to our mission.

Position Salary Range: $37.35 - $47.31 per hour Starting Pay: Although our full pay range is included above, new hires budgeted hiring range is $ $37.35 - $ 42.33 per hour. Schedule: Full-Time, ~37.5hrs/week; Non-Exempt; Benefits Eligible Monday - Friday: 9am - 5pm with occasional Saturdays Snapshot: Your days will be spent on the computer in a virtual environment providing support to staff individually and as a team, monitoring flow, and implementing and improving processes while maintaining compliance to PPRM Medical Standards & Guidelines and policies. You will also function in flow as a Registered Nurse and be an important part of abortion, family planning, and gender affirming care for patient follow-up, and patient care coordination. Some of your time will be spent assisting the Virtual Care Center Manager in developing and implementing various clinical and operational practices that establish positive employer-employee-patient relationships and promote high levels of employee morale. Some of your time will be spent alone doing things such as reviewing protocols and reports, creating training materials, drafting communications, and managing payroll. This job can be on-site or from home. If you work from home, this position runs software that requires high-speed internet with 25 MB download and 15 MB upload speeds. The ability to consistently run this software is a requirement to be successful in this position. If you work from home, you will need a quiet space that is free of distractions, so that you can focus on your job responsibilities. Background noise should be limited, and you must be able to maintain a space that provides patient confidentiality. You may be required to be in the office occasionally for administrative duties, training, or teambuilding. You may be required to be in the office occasionally for administrative duties, training, or teambuilding.  Key Approaches to the Work: Highly Organized Project Management & Execution Relationship Builder Strong Attention to Detail Strong Communication Flexible Inclusion and Equity Champion

Associate's degree in nursing required Registered Nurse with current state licensure in either Colorado, New Mexico is required and must be willing to obtain a license in each state. Previous experience with Planned Parenthood as an RN or related nursing experience working in reproductive health, abortion care, gender affirming care or family planning preferred. Previous experience with maintaining regulatory compliance is strongly preferred. Ability to be adaptable and function well in an ever-changing environment. Demonstrated leadership and written and verbal communication skills required, previous supervision experience preferred. Ability to effectively manage multiple competing tasks and priorities, meet deadlines, and prioritize work independently with little supervision. Previous experience coordinating follow-up care, critical lab management and patient triage preferred. Experienced in delivering sensitive information and education while reducing stigma required; experienced providing empathetic, patient centered care. Strong computer skills and ability to navigate all Microsoft Suite applications and EHR applications. Bilingual (English/Spanish) preferred. If you work from home, you will need a reliable internet connection and quiet space that is free of distractions so that you can focus on your job responsibilities. Background noise should be limited, and you must be able to maintain a space that provides patient confidentiality COVID-19 Protocol: Vaccination against COVID-19 will no longer be a condition of employment. However, all Health Center/Patient or Community Facing Employees, must have the COVID vaccine or wear a mask at all times beginning November 1st. Proof must be uploaded upon hire. You will upload a picture or pdf of your vaccination card(s) prior to your start date. Flu Protocol: All employees working directly with patients, the community or working in a health center will be required to have the flu shot or wear a mask during patient/community contact or while in the health center from November 1 – April 30 each year (Flu Season). Proof must be uploaded upon hire. You will upload a picture or pdf of your vaccination card(s) prior to your start date. Background Check Required: Planned Parenthood of the Rocky Mountains is an equal employment opportunity employer and is committed to maintaining a non-discriminatory work environment, and does not discriminate against any employee or applicant for employment on the basis of race, color, religion, sex, national origin, age, disability, veteran status, marital status, sexual orientation, gender identity, or any other characteristic protected by applicable law. Required: Associates or better in Nursing.

Direct management of team: You will be involved in all aspects of team management and support, directly managing the VCC RNs, while playing a key role in hiring, onboarding, supporting, training, coaching and evaluating all members of the VCC team. You play a key role in setting the tone and establishing a positive culture for staff. To do this you will: Lead by example and maintain a positive and professional work environment through preparation of weekly staff meetings, team building activities, and exemplifying all PPRM values. Responsible for personnel management, development, and supervision for direct reports including hiring, defining job objectives and skill set requirements, training, performance management, development, and recognition; provide in the moment correction and coaching as appropriate. Create materials, documents, and tools staff utilize while training. Manage staff efficiency and productivity, assist in identifying areas of improvement, and help find ways to address these needs, which can include monitoring patient communication, clinical outcomes, follow-up reports and employee documentation in the Electronic Health Record (EHR). Act as a resource to VCC staff to answer questions, monitor flow, ensure benchmarks are met and resolve issues/concerns for patients and staff to make certain patient care is being delivered effectively and safely. Manage VCC RN payroll needs, including time off requests, schedules and ensure the accuracy of reported hours worked and meeting all payroll deadlines while following all company protocols and guidelines. Participate in interdepartmental communication as needed to provide the best experience to patients and staff by communicating with other PPRM departments as needed to assist in completing tasks, problem solve and improve processes. Participate in the facilitation of staff meetings and facilitate communication among the VCC team. Support Capacity-Building Efforts Internally: You contribute to the culture of the team in explicit and implicit ways, supporting the VCC Manager of Telehealth and Director of the VCC as a key contributor to overall success of team; you collaborate with colleagues in other departments and ensure team priorities and initiatives are carried out. To do this you will: Work to build capacity in others who see patients, serving as a leader with expertise and knowledge that can support the team. Maintain an organized tracking system of all on-going follow-up activity. Work with VCC staff to ensure the team is following all PPRM policies, procedures and the Medical Standards and Guidelines (MS&Gs), maintaining timely and accurate follow-up notification and patient care. In partnership with the Quality and Risk Management Team (QM) and VCC Manager of Telehealth, monitor quality assurance functions and patient safety, reporting deficiencies and develop corrective action plans. Learn and stay current on all relevant protocol requirements. Complete all responsibilities according to established protocols, policies, and standard practices in the areas of customer service, quality assurance and regulatory compliance programs such as HIPAA (Health Information Portability & Accountability Act), OSHA (Occupational Safety & Health Administration) and CLIA (Clinical Laboratory Improvement Act). Implement clinical and regulatory changes and coordinate with QM and VCC Manager of Telehealth on the privileging of staff, as assigned. Demonstrate knowledge of all roles within the VCC, understanding individual responsibilities and how they intersect with Centralized Follow up and act as a leader within the department

Planned Parenthood South Atlantic

Virtual Care Center RN

Posted on:

July 19, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

About Us: Planned Parenthood is committed to creating a dynamic work environment that values diversity, equity, inclusion, respect, integrity, customer focus, and innovation. We are committed to creating a welcoming space for all people on our staff, in our health centers, and in our community. We do this by tending to the team, respecting and honoring all people, jumping in, trying and learning, caring for our business, and returning to our mission. Learn More Abortion Care: At PPRM, we all work in abortion care. This role supports abortion care through direct clinical triage, patient education, and follow-up, ensuring timely and empathetic support to those navigating abortion services.

Your workdays will primarily be remote, spent managing clinical workflows through EHRs, patient portal messages, and telehealth platforms. You’ll respond to patient inquiries, conduct virtual nursing assessments and triage caller needs per policy, support medical follow-up protocols, and collaborate with providers and internal teams. You’ll also serve as a resource for virtual reception staff and support compliance with audits and clinical standards. Occasional travel may be required for training and team meetings. This job can be on-site or from home. If you work from home, this position runs software that requires high-speed internet with 25 MB download and 15 MB upload speeds. The ability to consistently run this software is a requirement to be successful in this position. If you work from home, you will need a quiet space that is free of distractions, so that you can focus on your job responsibilities. Background noise should be limited, and you must be able to maintain a space that provides patient confidentiality. You may be required to be in the office occasionally for administrative duties, training, or teambuilding. In order to be fully considered for this role, please complete this Pre-Hire VCC RN Skills Self-Assessment along with this application.

Minimum of 2 years’ experience in direct/in-person patient care Must have a degree in Nursing Must have state Registered Nurse license or compact in Colorado, New Mexico, or Wyoming Must reside and work from either New Mexico or Colorado Knowledge/Skills Requirements Preference for experience in reproductive healthcare, abortion care, and gender-affirming services Prior experience with virtual care delivery or tele-triage preferred Education Requirements Willingness and ability to obtain licensure/compact licensure in all three states, and must obtain prior to start Skilled in delivering sensitive health education and clinical guidance with empathy and cultural responsiveness Strong clinical judgment and ability to work independently Proficient in Microsoft Office, EHR systems, and virtual communication platforms Bilingual (Spanish/English) strongly preferred Education Required: Associates or better in Nursing. Preferred: Bachelors or better in Nursing.

Provide virtual triage and nursing assessments for medical questions and concerns, including abortion-related care, per PPRM Medical Standards and Guidelines (MS&Gs) Manage follow-up for lab results, STI notifications, HCG tracking, and PUL cases Collaborate with providers on Provider Approval Queue (PAQ) and patient follow-up Respond to patient portal messages and ensure real-time EHR documentation Support Virtual Medical Receptionist (VMR) staff by serving as a clinical resource Participate in clinical audits and quality improvement projects Report as required by state and/or federal law about patient lab results COVID-19 Protocol: Vaccination against COVID-19 will no longer be a condition of employment. However, all Health Center/Patient or Community Facing Employees, must have the COVID vaccine or wear a mask at all times beginning November 1st. Proof must be uploaded upon hire. You will upload a picture or pdf of your vaccination card(s) prior to your start date. Flu Protocol: All employees working directly with patients, the community or working in a health center will be required to have the flu shot or wear a mask during patient/community contact or while in the health center from November 1 – April 30 each year (Flu Season). Proof must be uploaded upon hire. You will upload a picture or pdf of your vaccination card(s) prior to your start date. Background Check Required: Planned Parenthood of the Rocky Mountains is an equal employment opportunity employer and is committed to maintaining a non-discriminatory work environment, and does not discriminate against any employee or applicant for employment on the basis of race, color, religion, sex, national origin, age, disability, veteran status, marital status, sexual orientation, gender identity, or any other characteristic protected by applicable law.

Planned Parenthood South Atlantic

Centralized Follow Up (CFU) Registered Nurse

Posted on:

July 19, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Our doors are open, and we are still providing care. Planned Parenthood South Atlantic is committed to providing high-quality, inclusive, and non-judgmental sexual and reproductive healthcare to all genders, sexual orientations, races, religions, abilities, ethnicities, and cultural backgrounds. We are a team of compassionate and dedicated staff members, and we will continue to open our doors to those who need it. Are you worried about applying because you feel you don’t meet every single requirement? At PPSAT we are dedicated to building a diverse, inclusive, and authentic workplace! If you’re excited about a position but your past experience doesn’t align perfectly with every qualification in the job posting, we encourage you to apply anyways. You may be the candidate PPSAT is looking for! The challenges we face, past and present, only strengthen PPSAT's commitment to our communities and employees. Our work has staying power. Come join us one of the nation's leading providers of sexual and reproductive healthcare. Learn more: ppsatcareers.org

Why Planned Parenthood South Atlantic? We are powerful educators, advocates and innovators for health care. Be part of the diverse Planned Parenthood family. Work hand in hand with like-minded individuals in an environment built on collaboration, open communication, and mutual respect. We’re looking for passionate, dedicated people who are eager to make positive contributions to their community and to our mission. What's interesting about this job? The Centralized Follow Up (CFU) Registered Nurse is responsible for the management and notification of patient lab results contained within follow-up plans. The CFU RN triages contact center phone calls, performing initial patient assessment and answering questions related to PPSAT health care services, including reproductive health care for men and women, sexually transmitted infections, birth control methods, primary care, GAHT and surgical and medication abortion. They support the confidentiality of all patients and make them feel comfortable over the phone. The CFU RN serves as a resource to our Contact Center Staff. Who You Are: Passionate about reproductive health care and justice. Believe sexual health is essential to every person’s overall health, well-being, and happiness. Experience working across a diverse service area. Passionate about organization and time management. Strong communication and computer skills. Experience with working independently with maximum productivity results. Position Details Location: Remote – must be located within the PPSAT service area of NC, SC, VA and WV Schedule: Full-Time working 40 hours per week Monday-Friday Monday: 9:30AM to 6PM Tuesday: 9:30AM to 6PM Wednesday: 9:30AM to 6PM Thursday: 9:30AM to 6PM Friday: 8:30AM to 5PM

RN license in the state where assigned (NC, SC, VA and/or WV) or compact member state. Must be able to prioritize. Good communication and strong organizational skills. Ability to work independently as well as part of a team. Experience in lab/test result management (preferred).

Triage contact center phone calls, performing initial patient assessment and providing patient support and education as appropriate. Support the confidentiality of all patients and make them feel comfortable over the phone. Triage current lab results from provider approval queue (PAQ). Filter/prioritize the urgent notifications. Start the care paths for the given result as indicated by PPSAT Medical Standards and Guidelines (MSGs). Communicate back to Clinicians, Health Care Assistants, Clinical Director of Family Planning (CDFP), Health Center Managers as appropriate for results and next action steps. Create system for communication and management of tasks for results and management of plan with partners. Help to create program data reports and monitor the results for all sites. Notify patients as indicated by the MSGs, including phone calls, letters and reminders. Run necessary reports for all live EHR sites and take the next action steps as indicated. Consult with Clinicians and CDFP as needed regarding patient questions and concerns. Call in or electronically send prescriptions per provider’s verbal or written orders and complete refill request from patients and pharmacies via EHR and fax. Receive daily reports from on call service provider and make necessary contact with patients per After Hours protocol. Complete prior authorizations requests and notify patients as necessary. Assist with any other applicable tasks as needed to the Health Centers.

NaphCare, Inc.

PRN Utilization Management Nurse Practitioner (NP)

Posted on:

July 19, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

NP/APP

State License:

Alabama

At NaphCare, we believe in innovating to improve lives. We partner with local, state and federal government agencies to provide innovative healthcare, technology and administrative solutions for the correctional system. Our success has always been due to our people and our commitment to treating every patient with dignity. Above all, we aim to make a positive impact in the communities we serve. United by this belief, we work as a team to improve each and every life we touch. Join our team of trailblazers who are dedicated to making a difference.

NaphCare is hiring a strong PRN Utilization Management Nurse Practitioner (NP) to join our Utilization Management team in a remote capacity located at our Corporate Headquarters in Birmingham, AL. NaphCare is a family owned, healthcare technology company that has been delivering high quality healthcare to correctional facilities across the nation for over 35 years. Come join our team of over 5000 employees and growing! NaphCare pays well, offers outstanding benefits, and has an incredibly engaged corporate support team to make sure you have what you need to be truly excellent at what you do. NaphCare partners with correctional facilities to provide proactive, patient-focused healthcare. NaphCare has a partnership with NetCE that provides CEU/CME for our staff. NetCE uses a rigorous peer review process to ensure that all activities and content are up-to-date. This service streamlines continuing education for all NaphCare Employees to meet state specific requirements for maintaining licensing. With NaphCare, you'll play a critical role in our continuing mission to be the leading provider of quality healthcare in the correctional industry. If you want a career that will make a difference, choose the company that is different. We support your growth and internal promotion. Once hired, we encourage our employees to continue to seek opportunities for advancement and leadership.

A current and unrestricted NP license A valid CPR card A minimum of 1-year experience in an acute care setting Familiarity with Milliman or Interqual Care Guidelines is preferred Excellent communication and interpersonal skills Attention to detail and decision-making skills are essential BSN or ADN required

Reviews clinical charts to evaluate the medical necessity and appropriateness of off-site specialty visits. This position also performs case management for hospitalized patients.

IntellaTriage

Remote Hospice Triage RN- PT 2 shift 6p-12a + rotating Sat & Sun 7:30a-4

Posted on:

July 19, 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 6p-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

IntellaTriage

Remote Hospice Triage RN- PT 1 shift 4:30p-12a + rotating Sat & Sun 7:30

Posted on:

July 19, 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 4-6 days out of a 14-day pay period Part- time schedule: Work a minimum 1-2 evening shift weekly 4:30p-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

IMCS Group

Clinical Review RN - Utilization Management

Posted on:

July 19, 2025

Job Type:

Contract

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

IMCS Group is an IT, Healthcare, and Professional Staffing Company that helps Enterprises optimize the business value of their Staffing investments and enables them to achieve world-class business performance. IMCS Group supports strategic and operational aspects of IT implementations to help businesses implement growth strategies and leverage technology to achieve competitive advantage. In addition, IMCS provides hospitals and medical facilities with high-quality clinical professionals with the highest standards and compliance to provide the best medical care. At IMCS Group, quality and efficiency are of paramount importance. Our consistent growth, many successful customer engagements, and high customer retention are the hallmarks of our success. In addition, our passion for taking complex business processes and simplifying them by applying the right technology has been the key to our success. At all times, IMCS ensures the highest standards of quality in providing resources, time, and material to design, implement, and support to keep organizations operating efficiently.

Job Title: Clinical Review Nurse – Prior Authorization Duration: 3 months Contract- Potential to extend and/or convert if position opens Location: Remote - Texas Shift Type: Shift 8AM-5PM CST - 1 hour lunch Payrate: 40-42$/hr

ADN, BSN - Requires Graduate from an Accredited School of Nursing or bachelor’s degree in nursing and 2 – 4 years of related experience License: Texas RN License(Must have compact state licensure an/or Texas licensure)

Day to day will include performing clinical reviews for prior authorization requests utilizing policies, Interqual, sending to the MD if needed. Additionally, will assist with out of network requests and redirecting to in network providers as needed. Performance expectations will include completing at least 20 clinical reviews per day and if assisting with out of network requests will perform 2 redirections per hour This role is unique as it supports Marketplace expansion for Texas

Anchor Staffing

Remote MCO RN Nurse Case Manager

Posted on:

July 19, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

Remote MCO RN Nurse Case Manager – RN Compact or licensed in Pennsylvania (must reside in the EST time zone) License must be in good standing LPNs will NOT be considered

Must have experience in Dual Eligible Special Needs Plan (DSNP) (working with those who are enrolled in both Medicare and Medicaid Experience in Case Management Minimum 3-5 years clinical practical experience Minimum 2-3 years CM, discharge planning and/or home health care coordination experience Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications

You will be a frontline advocate for members who cannot advocate for themselves. You are responsible for assessing, planning, implementing, and coordinating all case management activities with members to evaluate the medical needs of the member to facilitate the member’s overall wellness.

Twig Health

Remote Nurse

Posted on:

July 19, 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 via SMS texting and 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 contract position of 100-150 hours per month, that may grow to full-time.

IMPORTANT: You need to have at least 2 years of experience working remotely from home in a telehealth position to be considered. Our nurses and medical assistants reach out to patients by sms text and phone calls to make sure care gets delivered, questions get answered, and issues don’t fall through the cracks. This is not a passive role. We don’t just send text messages and wait for patients to get back to us. We follow up, call, and find any way to connect with patients to help them improve their health. We don’t give up easily. We believe that patient engagement leads to better health outcomes, so we train our team to be both empathetic and persistent, like a smart, supportive care advocate. To succeed at Twig, you’ll need to be: Confident and comfortable with reaching out to patients who may not respond right away (texting and calling) Willing to keep trying when a patient is hard to reach or hesitant Able to educate patients clearly and compassionately about their care plan Not shy! You’re often the voice pushing things forward so the care team doesn’t lose momentum. Independent and internally motivated to succeed Super organized. If you’re the kind of person who shows up, follows through, and isn’t afraid to speak up, we’d love to meet you. Benefits of working for Twig: 100% remote, telehealth position An opportunity to work with advanced technology such as generative AI (ChatGPT) Collaboration with nurses, medical assistants, and technologists Providing concierge-level care to all patients Startup environment with new and exciting career growth opportunities

BSN (preferred) or ADN Licensed in New York or Compact License. Additional states – an advantage At least 2 years of experience working remotely from home High ability to express yourself in written form Excellent grammar, attention to detail, and Efficient at writing medical information at a patient level Moderately fast at typing (check yourself on typingtest.com) Tech savvy and excited about technology in healthcare Fluency in additional languages is a bonus (Spanish, Mandarin, Arabic)

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

ALIS by Medtelligent

Client Onboarding Specialist-Nurse

Posted on:

July 17, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Illinois

ALIS is the industry leading provider of assisted living specific software. We are a purpose driven healthcare technology company passionate about innovation and using technology to help people by solving real world problems. The ALIS team designs, builds, delivers, and supports our flagship product ALIS (pronounced “Alice” and stands for Assisted Living Integrated Solution).

Sponsorship: Sponsorship is not available for this position. Application and Interview Process: No formal cover letter is needed but please include a few sentences describing why you are applying for this position specifically. We truly appreciate people leveraging AI in workflows and projects, that being said we respectfully request your few sentences come from you directly and not an AI helper. Interview Process for selected candidates: Phone screen with Recruiter (10 minutes) In-person or virtual interview with team lead and department VP (1 hour) Potential: Final Round with additional team members (1 hour) For remote applicants, this final round is required to occur in person. Please note that ALIS will cover all expenses related to interview travel. Candidates residing in border states within a four-hour drive or less will be reimbursed for mileage. Minimum Years of Experience Required: 2+ Working Location: For candidates with 2+ years of experience, we offer multiple work arrangements : in-office, hybrid, or remote schedules. Relocation subsidies are available. Ideally, the right candidate for this role would be located in Chicago but this position is open to candidates from all States if they have previous SaaS onboarding experience with a healthcare product specifically. Please note that travel is a key component of this role, requiring at least 3 visits per year to our Chicago headquarters and up to 25% additional client travel. Candidates must be able, willing, and excited to travel. Salary Range: $80,000.00-$100,000.00 The exact salary will vary based on years of experience and the level of proficiency in both hard and soft skills. It is uncommon for someone to be hired at the highest point of the salary range for their position. If you feel like this position is right for you but your desired salary range differs, please still apply.

Current Licensed Practical Nurse, Registered Nurse or Nurse Practitioner 2+ years in EHR implementation, clinical SaaS implementation, direct usage of ALIS or a comparable AL EHR Experience with G-Suite, CRM usage, and ticket writing Strong project management skills Strong interest in helping communities and learning about their business as to help consult on process transformation from electronic to paper. Reliable: You show up at work for your team and the clients and look forward to doing it. Relationship oriented: You have a history of building long term healthy relationships with people and clients. Organized: You can prepare and execute on project plans. Calm demeanor: You aren’t pulled into drama or anxiety but can see clearly in order to help others. Good communicator: You are transparent with information. Patient: You do not get frustrated with people that are less knowledgeable or tech savvy than yourself. Good judgment: You can prioritize needs appropriately. High integrity: You tell the truth even when it is hard to do so. You avoid drama and gossip and prefer to bond over growth, positivity, and optimism. Adaptable and flexible: You don’t freak out if plans change or meetings get moved. Solution oriented: You take ownership to actually solve problems instead of just reporting all of the issues. Strives for excellence / finding ways to delight clients: Not just someone looking to cross a task off their list but spending time to over deliver and leave the relationship better than you found it. The company and this team commits itself to high standards for reliability and performance. Technologically savvy: You like to help others troubleshoot technology and hardware issues and you have an interest in new technologies and data.

Overhaul of and consultation on Resident Assessments for configuration in the ALIS Resident Evaluation Tool. Managing and maintaining EMR Building in current evaluations into ALIS Becoming a subject matter expert on how ALIS implements assessment workflows Training for other clinicians on using the ALIS evaluation tool Assist clients with other ALIS related clinical issues and consult on best practices Learn and establish a solid understanding of the ALIS software Consult with clients to transform their paper process to electronic; create and document new processes and train staff both digitally and (when the time is right) in-person. Create customized project plans to help guide both internal and external operations to get ALIS operating smoothly for our clients. Liaise between departments on clients’ needs, onboarding department needs, product feedback, and bugs reporting.

IMCS Group

Clinical Review Nurse – Prior Authorization

Posted on:

July 17, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

IMCS Group is an IT, Healthcare, and Professional Staffing Company that helps Enterprises optimize the business value of their Staffing investments and enables them to achieve world-class business performance. IMCS Group supports strategic and operational aspects of IT implementations to help businesses implement growth strategies and leverage technology to achieve competitive advantage. In addition, IMCS provides hospitals and medical facilities with high-quality clinical professionals with the highest standards and compliance to provide the best medical care. At IMCS Group, quality and efficiency are of paramount importance. Our consistent growth, many successful customer engagements, and high customer retention are the hallmarks of our success. In addition, our passion for taking complex business processes and simplifying them by applying the right technology has been the key to our success. At all times, IMCS ensures the highest standards of quality in providing resources, time, and material to design, implement, and support to keep organizations operating efficiently.

""Only Accepting Texas Local Candidates"" Job Title: Clinical Review Nurse – Prior Authorization Duration: 3 months Contract- Potential to extend and/or convert if position opens Location: Remote - Texas Shift Type: Shift 8AM-5PM CST - 1 hour lunch Payrate: 40-42$/hr

ADN, BSN - Requires Graduate from an Accredited School of Nursing or bachelor’s degree in nursing and 2 – 4 years of related experience License: Texas RN License(Must have compact state licensure an/or Texas licensure)

Day to day will include performing clinical reviews for prior authorization requests utilizing policies, Interqual, sending to the MD if needed. Additionally, will assist with out of network requests and redirecting to in network providers as needed. Performance expectations will include completing at least 20 clinical reviews per day and if assisting with out of network requests will perform 2 redirections per hour This role is unique as it supports Marketplace expansion for Texas

Chapters Health System, Inc

Rn, Triage Days

Posted on:

July 17, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

It’s inspiring to work with a company where people truly BELIEVE in what they’re doing! When you become part of the Chapters Health Team, you’ll realize it’s more than a job. It’s a mission. We’re committed to providing outstanding patient care and a high level of customer service in our communities every day. Our employees make all the difference in our success!

The RN Day Triage provides telephonic and ad hoc support to patients and families. The RN, Day Triage will establish and maintain positive relationships with team members, patients/families and referral resources.

Current Affiliate state or multi-state license to practice as an RN, and has the ability to apply for/obtain multi-state RN license within 30 days of hire, if not already a holder of a multi-state license. Minimum of one (1) year nursing experience; hospice or hospital experience preferred Previous experience working with an EMR/EHR (Electronic Medical/Health Record) system Ability to effectively communicate in English (verbal and written); bi-lingual in Spanish preferred Excellent critical decision making and problem-solving skills Excellent clinical and assessment skills Ability to use equipment with visual and auditory mechanisms Excellent time management skills with the ability to prioritize demands to meet patient service standards and deadlines Ability to effectively handle stressful situations professionally and calmly with exceptional customer service Strong patient service skills: Information seeking / probing skills Accurate knowledge transfer Listening, understanding, and responding Able to navigate in a fast-paced environment utilizing interpersonal skills to maximize caller reassurance and patient visits Ability to work in a cooperative team environment Able to exhibit a sense of urgency in daily work activities Skilled in computer operations; proficiency in MS Office software applications, on-line research and proven data entry and navigation skills Available to work shifts to accommodate extended hours of operation as scheduled Ability to perform sedentary work with frequent interruptions Ability to manage the emotional stress of working with and caring for terminally ill patients and their families Ability to perform the essential functions and physical requirements lifting patients and/or equipment, bending, pushing/pulling, kneeling) of the job with or without reasonable accommodations Competencies: Satisfactorily complete competency requirements for this position.

Represent the Company professionally at all times through care delivered and/or services provided to all clients. Comply with all state, federal and local government regulations, maintaining a strong position against fraud and abuse. Comply with Company policies, procedures and standard practices. Observe the Company's health, safety and security practices. Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company. Use resources in a fiscally responsible manner. Promote the Company through participation in community and professional organizations. Participate proactively in improving performance at the organizational, departmental and individual levels. Improve own professional knowledge and skill level. Advance electronic media skills. Support Company research and educational activities. Share expertise with coworkers both formally and informally. Participate in Quality Assessment and Performance Improvement activities as appropriate for the position. Job Responsibilities: Triages phone calls and ensures that callers’ needs are met efficiently using excellent customer service skills. Provides and manages direct care to patients and families incorporating psychosocial, spiritual, cultural, physical and biological components, and appropriate nursing intervention and follow-up. Responsible for the timely, courteous, and effective handling of clinical inquiries related to Chapters Health System’s services. Positively promotes and clearly explains benefits of Chapters Health System’s services. Clients include current and prospective patients, friends, or family members, Powers of Attorney, care providers, physicians, nursing staff, nursing homes and Assisted Living Facilities (ALFs), hospital staff, and others, as appropriate. Gathers necessary information and required documentation from appropriate sources to ensure complete, current, and accurate documentation of patient information and data. Accurately enters data into information tracking systems, including entering and tracking patient referral file in electronic medical record (EMR). Provides reassurance to patients and families. Assists in finding solutions to their questions and/or recognizes the need for an in person visit. Coordinates or completes in person visit when needed/or requested. Assists the patient and family to achieve the desired comfort levels. Utilizes appropriate support/expert resources or personnel to resolve complex or difficult situations. Documents patient/family contact information in the EMR and communicates with the Interdisciplinary Group (IDG). Triage RN's who experience technical issues not caused by the company equipment or network (i.e. offsite power outage, personal internet outage) are required to report the situation to leadership immediately, and have 30 minutes to resolve the technical issue. If the issue cannot be resolved in 30 minutes, RN may be required to report to a IPU or Resource Center based on leadership direction. During times of emergencies (i.e. Hurricanes, etc.), the Triage RN may be required to report to work at a location designated by the company, to ensure continuity of services. This may include reporting to work ahead of your scheduled date/time due to planned lock down of unit, and staying overnight(s) based on duration of emergency. Performs other duties as assigned.

Chapters Health System, Inc

RN, Triage Per Diem

Posted on:

July 17, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

It’s inspiring to work with a company where people truly BELIEVE in what they’re doing! When you become part of the Chapters Health Team, you’ll realize it’s more than a job. It’s a mission. We’re committed to providing outstanding patient care and a high level of customer service in our communities every day. Our employees make all the difference in our success!

The RN, Triage provides telephonic support to patients and families. The RN, Triage will establish and maintain positive relationships with team members, patients/families and referral resources.

Current Florida or multi-state license to practice as an RN, and ability to apply for/obtain multi-state RN license within 30 days of hire, if not already a holder of a multi-state license. Florida license as RN, current active single-state out-of-state nurse license, or current active multistate/compact nurse license multi-state license to practice as a registered nurse. Ability to apply for/obtain license to practice as an RN in Washington D.C. within 30 days of hire. Minimum of one (1) year nursing experience; hospice or hospital experience preferred Previous experience working with an EMR/EHR (Electronic Medical/Health Record) system Ability to effectively communicate in English (verbal and written); bi-lingual in Spanish preferred Intermittent Driver - Valid driver’s license and automobile insurance per Company policy Reliable transportation to meet patients’ needs Excellent critical decision making and problem-solving skills Excellent clinical and assessment skills Ability to use equipment with visual and auditory mechanisms Excellent time management skills with the ability to prioritize demands to meet patient service standards and deadlines Ability to effectively handle stressful situations professionally and calmly with exceptional customer service Strong patient service skills Information seeking / probing skills Accurate knowledge transfer Listening, understanding, and responding Able to navigate in a fast-paced environment utilizing interpersonal skills to maximize caller reassurance and patient visits Ability to work in a cooperative team environment Able to exhibit a sense of urgency in daily work activities Skilled in computer operations; proficiency in MS Office software applications, on-line research and proven data entry and navigation skills Available to work shifts to accommodate extended hours of operation as scheduled Ability to perform sedentary work with frequent interruptions Ability to manage the emotional stress of working with and caring for terminally ill patients and their families Ability to perform the essential functions and physical requirements (including, but not limited to: lifting patients and/or equipment, bending, pushing/pulling, kneeling) of the job with or without reasonable accommodations Competencies: Satisfactorily complete competency requirements for this position.

Represent the Company professionally at all times through care delivered and/or services provided to all clients. Comply with all state, federal and local government regulations, maintaining a strong position against fraud and abuse. Comply with Company policies, procedures and standard practices. Observe the Company's health, safety and security practices. Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company. Use resources in a fiscally responsible manner. Promote the Company through participation in community and professional organizations. Participate proactively in improving performance at the organizational, departmental and individual levels. Improve own professional knowledge and skill level. Advance electronic media skills. Support Company research and educational activities. Share expertise with coworkers both formally and informally. Participate in Quality Assessment and Performance Improvement activities as appropriate for the position. Job Responsibilities: Triages after-hours phone calls and ensures that callers’ needs are met efficiently using excellent customer service skills. Provides telephone advice and education for patient needs. Responsible for the timely, courteous, and effective handling of all telephone inquiries related to Chapters Health System’s services. Positively promotes and clearly explains benefits of Chapters Health System’s services. Clients include current and prospective patients, friends, or family members, Powers of Attorney, care providers, physicians, nursing staff, nursing homes and Assisted Living Facilities (ALFs), hospital staff, and others, as appropriate. Gathers necessary information and required documentation from appropriate sources to ensure complete, current, and accurate documentation of patient information and data. Accurately enters data into information tracking systems, including entering and tracking patient referral file in electronic medical record (EMR). Provides reassurance on the phone to patients and families. Assists in finding solutions to their questions and/or recognizes the need for an in person visit. Coordinates in person visit when needed/or requested. Assists the patient and family to achieve the desired comfort levels. Utilizes appropriate support/expert resources or personnel to resolve complex or difficult situations. Documents patient/family contact information in the EMR and communicates with the Interdisciplinary Group (IDG). Triage RN's who experience technical issues not caused by the company equipment or network (i.e. offsite power outage, personal internet outage) are required to report the situation to leadership immediately, and have 30 minutes to resolve the technical issue. If the issue cannot be resolved in 30 minutes, RN may be required to report to a IPU or Resource Center based on leadership direction. During times of emergencies (i.e. Hurricanes, etc.), the Triage RN may be required to report to work at a location designated by the company, to ensure continuity of services. This may include reporting to work ahead of your scheduled date/time due to planned lock down of unit, and staying overnight(s) based on duration of emergency. Performs other duties as assigned.

Chapters Health System, Inc

Nurse Practitioner ( Per Diem) Resource Evening Nights & Weekends

Posted on:

July 17, 2025

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

NP/APP

State License:

Florida

It’s inspiring to work with a company where people truly BELIEVE in what they’re doing! When you become part of the Chapters Health Team, you’ll realize it’s more than a job. It’s a mission. We’re committed to providing outstanding patient care and a high level of customer service in our communities every day. Our employees make all the difference in our success!

The Resource Nights & Weekend (ReNW) Nurse Practitioner (NP) is an active member of Chapters Health System’s Medical Staff and provides fully remote virtual serious illness care management to patients and families throughout our continuum of care. This continuum may include but is not limited to home-based, facility-based, and inpatient adult and pediatric hospice; palliative care; PACE, and additional service lines and programs offered or supported by Chapters Health System.

Experience Requirements: Must have a minimum of 3 years of recent clinical experience, including substantial experience in hospice, palliative care, and/or acute inpatient care. Education Requirements: Must hold a Masters or Doctors degree in Nursing from an accredited Family or Adult Nurse Practitioner Program. Certificates and/or Licenses: The ReNW NP must hold national certification, licensure, and prescriptive authority from the appropriate governing body for advanced nursing practice in their home state and in additional state(s) where care is provided. Licensure and prescriptive authority must be obtained and maintained for all required jurisdictions. Applications for required licenses must be submitted within 60 days of the date of hire and/or receiving notification. Must hold and maintain Basic Life Support certificate from an approved organization by date of hire. Additionally, all eligible NPs must currently hold, or obtain, Advanced Certification in Hospice and Palliative Nursing (ACHPN) within 3 years of the date of hire. NPs who are not eligible to obtain the certification within 3 years of hire will have 6 months from date in which they meet criteria to apply for the exam. Schedule: Shifts may vary and can include nights, evenings, weekends, and/or holidays based on the needs of the business. Overall Skills: The ability to work both independently and as part of a team; demonstrate excellent interpersonal and collaborative skills; demonstrate organizational skills with the ability to delegate and follow up; manage multiple tasks and stressful situations with a positive attitude; demonstrate a strong work ethic and attention to detail. Physical/Mental/Emotional Skills: The ability to see, hear, grasp, lift, speak, sit and walk or otherwise perform essential functions with or without reasonable accommodations; demonstrate the mental and emotional ability to work with death/dying; demonstrate the maturity, customer service skills, and flexibility to work with individuals under stress; work in a fast paced and quickly changing environment; work under pressure and deadlines; effectively recognize and appreciate the diversity in the workplace; develop coping mechanisms in order to care for patients who are terminally ill and to work in a stressful environment; provide care for highly emotional patients/families. Technological Skills: The ability to learn and efficiently use patient health information systems and software required for the provision of care; demonstrate technical competency in the use of computer telephony systems and computer applications used in the organization; demonstrate proficiency with the use of all Microsoft Office programs, specifically Word, Excel, and PowerPoint. Reasoning Ability: The ability to apply common sense understanding to carry out instructions furnished in written or oral form and expert, advanced clinical judgment to problem solve. Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation 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, speak, and hear. The employee is required to use hands to finger, handle, or feel; reach with hands and arms. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability to adjust focus. Work Environment: The work environment characteristics are representative of those an employee would normally encounter while performing in an office environment. Employees are required to maintain a HIPAA compliant, temperature controlled, noise-free work environment at all times. They must maintain reliable HIPPA compliant high-speed (100mb) internet with hardwired backup copiers, fax, scanner, shredder, etc. Patient privacy must be protected at all times, which includes, but is not limited to using headsets for all verbal communication, utilizing company approved devices, websites, and applications, and other HIPAA guidelines. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

Provides fully remote virtual serious illness care management to patients and families throughout our continuum of care; This continuum may include but is not limited to home-based, facility-based, and inpatient adult and pediatric hospice; palliative care; PACE, and additional service lines and programs offered or supported by Chapters Health System. Consults with medical staff, and/or other members of the IDT as indicated to ensure optimal patient care in an effective and efficient manner. Performs virtual assessment of patient/family/caregiver needs. Identifies, manages, orders, and prescribes medication and equipment as appropriate. Adjusts and supports the plan of care in accordance with Chapters policies and procedures and within the guidelines of the corresponding nurse practice act. Assesses the caregiver’s ability to meet the patient’s immediate needs and confidence in the patient’s plan of care. Provides education to increase the caregiver’s confidence as necessary and appropriate. Supports staff by answering clinical questions, entering orders and prescriptions, and supporting the clinical needs of patients and families. Maintains access to all electronic medical records (EMR), electronic prescribing systems, and other required websites and applications. Documents all interactions as appropriate in the corresponding EMR in a timely manner. Communicates and collaborates with the primary team to ensure continuity of care. Supports with discharge planning including prescribing medications, entering discharge orders and instructions, etc. Participates in Quality Assurance/Performance Improvement (QAPI) activities as needed, including regular medical record reviews and medical peer reviews. Seeks to continually improve the care practices of Chapters to assure compliance with regulatory and accreditation standards. Keeps knowledge base and skill levels current to assure quality patient care and professional growth. Organization/Regulatory Compliance: Maintains current knowledge of the latest research and trends in Hospice and Palliative Medicine. Maintains continuing education as required for licensure and to ensure specialty level expertise in end-of-life care. Obtains & maintains hospital/facility credentialing as required. Participates in departmental and medical staff activities as requested. People/Communications: Communicates and collaborates with team members, patients/families/caregivers, partnering providers and staff as required & appropriate within HIPAA guidelines to help provide comfort & deliver upon Chapters core values. Provides patient and family education as needed to maintain quality care, to decrease patient and family anxiety, to facilitate the patient living with the highest quality care, and to assure both the patient and the family have the skills to care for the patient. Participates as a member of the interdisciplinary team to develop by implementing a patient-directed individualized plan of care and assures the availability of information to team members. Provides teaching to staff as required. Functions as a role model in providing exceptional customer service to patients and families through effective and timely communication. Supports organizational changes. Demonstrates flexibility in providing coverage and/or availability, Financial Stewardship: Achieves expected productivity standards as defined by the organization and in alignment with best practices/the Chapters model. If /when Telemedicine billing is accepted, implements time-based billing procedures using the electronic medical record system software and other appropriate methods to capture timely billing (weekly for home and nursing home; daily for inpatient and clinic charges). The above statements are intended to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

Chapters Health System, Inc

Triage RN- Part time. Remote FL Resident Only

Posted on:

July 17, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

It’s inspiring to work with a company where people truly BELIEVE in what they’re doing! When you become part of the Chapters Health Team, you’ll realize it’s more than a job. It’s a mission. We’re committed to providing outstanding patient care and a high level of customer service in our communities every day. Our employees make all the difference in our success!

The RN, Triage provides telephonic support to patients and families. The RN, Triage will establish and maintain positive relationships with team members, patients/families and referral resources.

Current Florida or multi-state license to practice as an RN, and ability to apply for/obtain multi-state RN license within 30 days of hire, if not already a holder of a multi-state license. Ability to apply for/obtain license to practice as an RN in Washington D.C. within 30 days of hire. Minimum of one (1) year nursing experience; hospice or hospital experience preferred Previous experience working with an EMR/EHR (Electronic Medical/Health Record) system Ability to effectively communicate in English (verbal and written); bi-lingual in Spanish preferred Excellent critical decision making and problem-solving skills Excellent clinical and assessment skills Ability to use equipment with visual and auditory mechanisms Excellent time management skills with the ability to prioritize demands to meet patient service standards and deadlines Ability to effectively handle stressful situations professionally and calmly with exceptional customer service Strong patient service skills Information seeking / probing skills Accurate knowledge transfer Listening, understanding, and responding Able to navigate in a fast-paced environment utilizing interpersonal skills to maximize caller reassurance and patient visits Ability to work in a cooperative team environment Able to exhibit a sense of urgency in daily work activities Skilled in computer operations; proficiency in MS Office software applications, on-line research and proven data entry and navigation skills Available to work shifts to accommodate extended hours of operation as scheduled Ability to perform sedentary work with frequent interruptions Ability to manage the emotional stress of working with and caring for terminally ill patients and their families Ability to perform the essential functions and physical requirements (including, but not limited to: lifting patients and/or equipment, bending, pushing/pulling, kneeling) of the job with or without reasonable accommodations Competencies: Satisfactorily complete competency requirements for this position.

Represent the Company professionally at all times through care delivered and/or services provided to all clients. Comply with all state, federal and local government regulations, maintaining a strong position against fraud and abuse. Comply with Company policies, procedures and standard practices. Observe the Company's health, safety and security practices. Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company. Use resources in a fiscally responsible manner. Promote the Company through participation in community and professional organizations. Participate proactively in improving performance at the organizational, departmental and individual levels. Improve own professional knowledge and skill level. Advance electronic media skills. Support Company research and educational activities. Share expertise with coworkers both formally and informally. Participate in Quality Assessment and Performance Improvement activities as appropriate for the position. Job Responsibilities: Triages phone calls and ensures that callers’ needs are met efficiently using excellent customer service skills. Provides telephone advice and education for patient needs. Responsible for the timely, courteous, and effective handling of all telephone inquiries related to Chapters Health System’s services. Positively promotes and clearly explains benefits of Chapters Health System’s services. Clients include current and prospective patients, friends, or family members, Powers of Attorney, care providers, physicians, nursing staff, nursing homes and Assisted Living Facilities (ALFs), hospital staff, and others, as appropriate. Gathers necessary information and required documentation from appropriate sources to ensure complete, current, and accurate documentation of patient information and data. Accurately enters data into information tracking systems, including entering and tracking patient referral file in electronic medical record (EMR). Provides reassurance on the phone to patients and families. Assists in finding solutions to their questions and/or recognizes the need for an in person visit. Coordinates in person visit when needed/or requested. Assists the patient and family to achieve the desired comfort levels. Utilizes appropriate support/expert resources or personnel to resolve complex or difficult situations. Documents patient/family contact information in the EMR and communicates with the Interdisciplinary Group (IDG). Triage RN's who experience technical issues not caused by the company equipment or network (i.e. offsite power outage, personal internet outage) are required to report the situation to leadership immediately, and have 30 minutes to resolve the technical issue. If the issue cannot be resolved in 30 minutes, RN may be required to report to a IPU or Resource Center based on leadership direction. During times of emergencies (i.e. Hurricanes, etc.), the Triage RN may be required to report to work at a location designated by the company, to ensure continuity of services. This may include reporting to work ahead of your scheduled date/time due to planned lock down of unit, and staying overnight(s) based on duration of emergency. Performs other duties as assigned.

Valley Health Partners

Regionalized Call Center Triage Registered Nurse (RN)

Posted on:

July 16, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Pennsylvania

Regionalized Call Center Triage RN- Remote/hybrid work possible Valley Health Partners, Allentown, PA

Education: Required: Graduate of an accredited Nursing program and licensed in the state of Pennsylvania Preferred: Bachelor’s Degree in Nursing, Public Health, or relevant field Experience: One year experience as a Registered Nurse Three-five years’ experience as a Registered Nurse in a pediatric setting, School Based Health Program, or Federally Qualified Health Center, preferred. 1 year of call center triage experience, preferred. Licensure: Active/current Registered Nurse license and Basic Life Support (BLS) required.

Triages incoming calls in an ambulatory setting from patients, makes clinical decisions based on protocols, and communicates with supporting clinical manager, and providers. Provides telephone advice and decision support services. Identifies clinical escalation and provides effective resolutions.

Trinity Health At Home

Contingent/PRN Home Care & Hospice Virtual Care Coordinator RN

Posted on:

July 16, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

At Trinity Health At Home, we bring healing hands and caring hearts to your doorstep. As a member of Trinity Health, one of the nation's largest Catholic health systems, we are leaders in home care, palliative care and hospice services. With a rich legacy of care spanning over a century, we go beyond addressing medical needs to support your overall well-being. We bring compassionate care to you, ensuring you receive the best possible care where you feel most comfortable – in your own home. Learn more about us at Trinity Health At Home

Virtual Care Coordinator RN – Trinity Health At Home Location: Remote / Virtual Care Center (based in Athens, GA; Mishawka, IN; Silver Spring, MD; or Columbus, OH Deliver Care. Virtually. Meaningfully. Join the future of home-based care with Trinity Health At Home’s Virtual Care Center! We’re seeking a compassionate and tech-savvy Virtual Care Coordinator RN to monitor patients remotely, provide timely clinical interventions, and support recovery and wellness—all from a centralized, virtual environment. This role is ideal for a Registered Nurse who thrives in a fast-paced, team-based setting and is passionate about leveraging technology to improve patient outcomes in the home setting. What You Can Expect: Consistent, Reliable Workloads - enjoy steady assignments with guaranteed hours—no surprises.   Supportive Leadership - our management team is here to help you succeed every step of the way.  Career Growth Opportunities - every leader on our team started in a field role—your path to leadership starts here.  Epic EMR System - streamlined documentation and communication for better care and less stress. Fast Hiring Process - quick interviews and job offers—because your time matters. Meaningful Work - deliver one-on-one care that truly impacts lives. Benefits Highlights: 6-8 weeks of comprehensive onboarding and orientation  Pay Range: $32.87-$52.59 per hour Maryland Pay Range Only: $35.80-$57.28 per hour

5+ years of Home Care, Hospice, ER and/or Triage RN Experience Active RN license in a Compact State (eNLC) BSN required by an approved Nursing education program. Proficiency in Epic or Home Care EMR Experience Strong communication and interpersonal skills to build rapport with patients and families virtually Ability to work independently and as a part of collaborative remote team Able to adapt to rapid changes to meet business/department needs Patient/Customer Service Experience

As a Virtual Care Coordinator RN, you will play a pivotal role in delivering telehealth hospice care, ensuring that patients and their families receive personalized support during critical moments. Utilizing virtual platforms, you will monitor patient conditions, coordinate care plans, and provide real-time guidance to field staff and caregivers.

Sprinter Health

Family Nurse Practitioner (Virtual - Illinois Licensed)

Posted on:

July 16, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

NP/APP

State License:

Illinois

Sprinter Health is an on-demand mobile health service that sends medical professionals to patients’ homes to perform blood draws, diagnostic and low acuity services, and wellness visits. We are building the clinical and technological infrastructure to realize a future of healthcare untethered. We have a rapidly growing team of visionary leaders who are passionate about increasing access to care, lowering healthcare costs, and improving outcomes for patients.

Are you ready to join the pioneering healthcare team at Sprinter Health? We're looking for dynamic Nurse Practitioners who are ready to revolutionize healthcare delivery by conducting virtual wellness visits directly to patients in the comfort of their homes. As a Nurse Practitioner with Sprinter Health, you'll leverage your medical expertise to offer a wide range of healthcare services that could include but not limited to virtual adult and/or pediatric wellness visits, health assessments, and more! Successful candidates will have prior experience performing wellness visits, along with key traits such as dependability, professionalism, and problem-solving abilities. A commitment to delivering exceptional customer service is essential, as is the ability to work autonomously while maintaining high-quality standards. Above all, we're seeking individuals who are friendly, compassionate, empathetic, and deeply invested in providing personalized care to every patient they serve. If you're ready to make a difference in patients' lives and shape the future of healthcare, we invite you to join us at Sprinter Health.

Board Certified as a Family Nurse Practitioner in Illinois Active Family Nurse Practitioner License in Illinois Consistently exhibits the highest levels of professionalism, integrity, accountability, confidentiality, care and compassion to provide high quality health services Willingness to work in a revolutionary environment that sometimes necessitates last minute problem solving and out of the box thinking Technologically savvy and comfortable using tools such as laptops or mobile devices for charting and HIPAA secure messaging apps for care coordination Strong written and verbal communication skills Ability to work independently or in a team environment Pass national background check and valid clinical license search

Commencing the day… begin your day by reviewing your case load and preparing your technology, ensuring you have all of the right tools available to service your patients Navigating with ease… using easy and modern technology, you will navigate through your schedule for the day and partner with our clinical in-home team members (Sprinters) that will visit each patient’s home Creating meaningful bonds… you will have the opportunity to make a warm and welcoming connection with a diverse range of patients as you prepare to collect relevant information and perform various services Patient-centric, wellness exam… engage in proactive care by conducting thorough health risk assessments, medication reviews, cognitive screenings and empowering patients’ with educational information regarding their health and well-being Collaborative Patient Care … work directly with Sprinters to evaluate vital signs, arrange blood draws, and carry out necessary tasks to address the specific needs of the patient Comprehensive Care Coordination and Management… provide comprehensive care coordination and management, including preventive care interventions, medication management, referrals to specialists, community resources, and documentation of findings

Sprinter Health

Family Nurse Practitioner (Virtual - Contract through December 2025)

Posted on:

July 16, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

NP/APP

State License:

Compact / Multi-State

Sprinter Health is an on-demand mobile health service that sends medical professionals to patients’ homes to perform blood draws, diagnostic and low acuity services, and wellness visits. We are building the clinical and technological infrastructure to realize a future of healthcare untethered. We have a rapidly growing team of visionary leaders who are passionate about increasing access to care, lowering healthcare costs, and improving outcomes for patients.

Are you ready to join the pioneering healthcare team at Sprinter Health? We're looking for dynamic Nurse Practitioners who are ready to revolutionize healthcare delivery by conducting virtual wellness visits directly to patients in the comfort of their homes. As a Nurse Practitioner with Sprinter Health, you'll leverage your medical expertise to offer a wide range of healthcare services that could include but not limited to virtual adult and/or pediatric wellness visits, health assessments, and more! Successful candidates will have prior experience performing wellness visits, along with key traits such as dependability, professionalism, and problem-solving abilities. A commitment to delivering exceptional customer service is essential, as is the ability to work autonomously while maintaining high-quality standards. Above all, we're seeking individuals who are friendly, compassionate, empathetic, and deeply invested in providing personalized care to every patient they serve. If you're ready to make a difference in patients' lives and shape the future of healthcare, we invite you to join us at Sprinter Health.

Board Certified as a Family Nurse Practitioner Active Family Nurse Practitioner License Consistently exhibits the highest levels of professionalism, integrity, accountability, confidentiality, care and compassion to provide high quality health services Willingness to work in a revolutionary environment that sometimes necessitates last minute problem solving and out of the box thinking Technologically savvy and comfortable using tools such as laptops or mobile devices for charting and HIPAA secure messaging apps for care coordination Strong written and verbal communication skills Ability to work independently or in a team environment Pass national background check and valid clinical license search

Commencing the day… begin your day by reviewing your case load and preparing your technology, ensuring you have all of the right tools available to service your patients Navigating with ease… using easy and modern technology, you will navigate through your schedule for the day and partner with our clinical in-home team members (Sprinters) that will visit each patient’s home Creating meaningful bonds… you will have the opportunity to make a warm and welcoming connection with a diverse range of patients as you prepare to collect relevant information and perform various services Patient-centric, wellness exam… engage in proactive care by conducting thorough health risk assessments, medication reviews, cognitive screenings and empowering patients’ with educational information regarding their health and well-being Collaborative Patient Care … work directly with Sprinters to evaluate vital signs, arrange blood draws, and carry out necessary tasks to address the specific needs of the patient Comprehensive Care Coordination and Management… provide comprehensive care coordination and management, including preventive care interventions, medication management, referrals to specialists, community resources, and documentation of findings

Sprinter Health

Clinical Registered Nurse

Posted on:

July 16, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

We're rapidly growing our clinical team as we cultivate new partnerships with enterprises across the healthcare spectrum. We're looking for an experienced Registered Nurse (RN) to work as a Clinical Nurse to support our existing and growing markets. This role will report to the Clinical Director. The ideal candidate will be an experienced nurse with demonstrated ability to effectively interact with remote teams, identify and create solutions

You will thrive at Sprinter Health if you have: The desire to work collaboratively with a tight-knit but quickly growing team across many different areas of the business Flexibility, humility, and a sense of humor Excitement for working in a fast-paced startup Experience and Skills 2+ years of Registered Nurse experience Comfortable working with modern technology Strong communication skills - verbal and written

Support mobile teams to ensure they have access to clinical support in real time for any questions or concerns. Triage patients that have been escalated by our in-home team to provide education and support for higher level of care needs. Collaborate with the interdisciplinary team to provide goal-directed care. Utilize clinical decision-making to escalate concerns to the care team. Document patient interactions using the EHR system and Mobile App. Provide virtual and telephonic education about a patient’s diagnosis, test results, and needed follow up care. Travel to support market implementations, training, and quality up to 40% of your time as needed. Shadow team members for in patient home visits to provide training, feedback, and quality assurance. 5-10% of role. Perform medical record review to ensure accuracy and that mobile teams are prepared for visits.

TriageNow

Telephonic Triage Nurse - WFH position

Posted on:

July 16, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

As a Telephone Triage Registered Nurse (RN), you will play a critical role in providing high-quality healthcare services remotely. You will assess patients' needs over the phone, provide medical advice, and direct them to appropriate levels of care. Your expertise in clinical assessment, communication skills, and empathy will ensure effective patient care and satisfaction.

Education: Graduate of an accredited nursing program with a current unrestricted/unencumbered Registered Nurse (RN) license (Will need a multistate compact license in the state of permanent residence and an active California license. Upon hire will need to apply for other licenses as directed.) Experience: Previous experience in telephone triage, emergency nursing, or other relevant clinical settings preferred. Minimum 3 years experience working in a hospital setting. Clinical Skills: Proficient in clinical assessment, critical thinking, and decision-making in a remote environment. Communication: Excellent verbal and written communication skills with the ability to convey complex medical information clearly and compassionately to diverse populations. Empathy: Demonstrated ability to show empathy, compassion, and professionalism when interacting with patients experiencing medical concerns or distress. Technology: Comfortable using electronic records systems and other technology tools essential for remote patient care. Teamwork: Strong collaboration skills with the ability to work effectively as part of a telephonic triage team. Adaptability: Flexible and adaptable to changing priorities, workflows, and patient needs in a fast-paced environment. Ethics: Uphold ethical standards of nursing practice, patient confidentiality, and privacy in all interactions. Extended Periods of Sitting and Computer Work/Phone Use: Perform duties requiring sitting at a workstation and using a computer/phone for extended periods (8+ hours) throughout the day to assess patient needs, document interactions, and provide medical advice.

Patient Assessment: Conduct thorough assessments of patients' symptoms, medical history, and current condition over the phone to determine the appropriate course of action. Medical Advice: Provide accurate and timely medical advice to patients based on established protocols, clinical guidelines, and nursing judgment. Triage: Prioritize patient needs and determine the level of urgency for medical care, including recommending immediate emergency care, referring to urgent care, or advising self-care at home. Documentation: Maintain detailed and accurate documentation of patient interactions, including assessment findings, advice given, and recommended follow-up actions. Patient Education: Educate patients about their health conditions and treatment options. Quality Assurance: Adhere to established protocols, standards of care, and regulatory requirements to ensure the delivery of safe and effective telephone triage services. Professional Development: Stay updated on current healthcare practices, guidelines, and technology related to telephone triage nursing through ongoing education and training.

Humana

Senior Compliance Nurse

Posted on:

July 15, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

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 is seeking a Senior Compliance Nurse Professional who ensures utilization management and complex case management processes and procedures meet compliance with Centers for Medicare/Medicaid (CMS), each state Medicaid contractual requirements, and NCQA requirements. The Senior Compliance Nurse Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Active Registered Nurse with a compact license and no disciplinary action. Ability to obtain additional state licensures without restrictions in states that do not participate in the compact licensing agreement. 3+ years of varied clinical nursing experience1+ year experience as a Subject Matter Expert in Medicaid Utilization and/or Complex Case Management. Knowledge/understanding of laws and regulations governed by the Department of Insurance, CMS, NCQA, and multiple Medicaid states. Successful experience leading small to large sized complex projects. Intermediate to advanced proficiency using Microsoft Office Word, Excel, PowerPoint, navigating multiple systems and platforms and ability to troubleshoot and resolve basic technical difficulties in a remote environment. Preferred Qualifications: Bachelor’s degree. Experience auditing and/or performing case management or utilization management chart reviews. Experience with metrics and reporting. Behavioral Health experience. Lean Six Sigma certification. Work at Home Guidance: To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided with a bi-weekly payment for their internet expense Humana will provide Home or Hybrid Home/Office associates 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 Additional Information: Workstyle: Remote, work from home. Location: Must reside in a state that is part of the Enhanced Nursing Licensure Compact (eNLC). Preferred Locations: AL, FL, GA, IN, KY, LA, NC, OH, OK, SC, TN, TX, VA. Travel: 1 to 2 times annually to the local market office as needed for meetings. Core Workdays & Hours: Typically, Monday – Friday 8:00am – 5:00pm Eastern Standard Time (EST). Flexible scheduling upon leader’s approval.

Research compliance issues and recommends changes that assure compliance with CMS, NCQA, and state contract obligations. Develop and implement process improvement initiatives and strategies with Quality and Compliance team to close compliance issues/gaps and mitigate risk, with focus on NCQA accreditation and state specific contractual requirements. Maintains relationships with Medicaid market Regulatory Compliance Professionals to ensure state specific contractual requirements are met regarding utilization management, complex case management, and clinical compliance. Create and maintain National Medicaid Compliance policies and procedures to ensure consistency across the Medicaid organization and decrease compliance risk. Create and maintain National Medicaid Policies for CCM and UM documentation to support NCQA requirements. Influences utilization management, complex case management, and clinical compliance department’s strategies and processes. Coordinates implementation and compliance with corrective action plans, as needed. Create new Medicaid market utilization management letters for state readiness review and submission based on contractual requirements. Makes decisions on moderately complex to complex issues regarding technical approach for project components, and work is performed without direction. Exercises considerable latitude in determining objectives and approaches to assignments.

IntellaTriage

Remote Hospice Triage RN- FT 3:30p-12a +rotating Sat & Sun 3:30p-12a

Posted on:

July 15, 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 3 evening shift weekly 3:30p-12a 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

Actalent

Licensed Vocational Nurse (Remote)

Posted on:

July 15, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

LPN/LVN

State License:

Texas

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

Urgent Hiring for Remote LVN's in San Antonio ,Texas! *Must be located Closer to San Antonio, Texas* Workplace Type: This is a fully remote position. Application Deadline: This position is anticipated to close on Jul 17, 2025.

2+ years of LVN experience working in Prior authorization is must Active LVN License in the state of Texas is Must

Identify special needs members through the completion of health screens and other resources. Work with community outreach/member advocates to coordinate member care. Educate providers and community resources on program components and available support services. Assist with modification and management of care plans under the direction of a Registered Nurse in conjunction with member, medical consenter or caregiver .

Actalent

Clinical Review Nurse (Prior Auth Expr) - Remote

Posted on:

July 15, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Florida

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

3+ Years of experience working with utilization management, concurrent review, prior authorization, utilization review, case management, and discharge planning is Mandatory Active RN License is Mandatory

Review approximately 20 cases a day for medical necessity. Advocate for and protect members from unnecessary hospital admissions. Follow established procedures and processes to complete authorizations. Collaborate with a team of nurses to assist each other and complete cases. Communicate with doctors and case managers to make decisions and obtain additional information about members' conditions. Utilize multiple resources to ensure the successful completion of cases.

IntellaTriage

Hospice Telephone Triage RN- PT 3:30p-12a + rotating Sat & Sun 7:30-4 (REMOTE)

Posted on:

July 15, 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 4-6 days out of a 14-day pay period Part- time schedule: Work a minimum 1-2 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

Thyme Care

Complex Oncology Nurse Navigator (11:30AM - 8PM EST Shift)

Posted on:

July 15, 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 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.

UnitedHealthcare

Clinical Appeals RN - Remote - Work PST hours

Posted on:

July 15, 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.

If you’re interested in bringing your nursing experience to a role that offers regular, Monday through Friday business hours and ample potential for advancement, apply to join us as one of our newest Clinical Admin Nurses! This position will handle the clinical review of Commercial HMO appeals and will be responsible for completing both standard and expedited member appeal requests. Standard appeals must be completed within 25-30 days. Expedited appeals must be completed within 24-72 hours. Requires telephone contact with Members and/or providers initiating an appeal to explain the process, criteria, and outcome. Requires contact with Medical Groups and/or provider offices for records and case effectuation. Requires occasionally telephone contact with Members. Requires completion of written correspondence for Member outcome letters. This is a high-volume, production environment. You’ll need to be efficient, productive and thorough dealing with our members both verbally and in writing. Solid computer and software navigation skills are critical. You should also be patient-focused and adaptable to changes. In addition, you will be accountable for maintaining compliance with policies and procedures. Must be able to work 8:00am – 5:00pm Pacific Standard Time. Overtime may be required in order to meet compliance with federal/state turn-around times. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Required Qualifications: Current, unrestricted RN license in the state of residency Current CA RN License or ability to obtain RN license in State of California 3+ years of clinical experience in a hospital or other acute care setting History of navigating a Windows based environment, encompassing exceptional typing skills Articulatable ability to evaluate and interpret medical records, all specialties Ability to work 8:00am – 5:00pm PST (can live in any state as long as you can work Pacific Time zone hours) Preferred Qualifications: BSN degree or higher Experience in appeals CPT, HCPC, ICD-9 and ICD-10 coding experience Experience in appeals, utilization review and/or case management Experience in a production environment either in telephonic or office-based role Declarable creative problem-solving skills Demonstrated team player History of optimizing resources using excellent clinical judgment Proven expertise in providing outstanding customer service while deescalating stressful situations and conversations Proven ability to work independently with minimal supervision Demonstrated attitude that fosters teamwork and supports organizational goals Demonstrated solid written communication skills

Addressing Standard and Expedited appeals cases Completing a standard number of case volume/day Completing the Standard appeals cases within 25-30 calendar days Completing the Expedited appeals cases within 24-72 hours Researching issues to mitigate risk Working closely with a variety of internal departments (i.e. Regulatory, Claims) Communicating directly with Members, medical groups, and physicians Current, unrestricted RN license for the State of CALIFORNIA Knowledge of and/or experience with HMO and Managed Care Solid computer proficiency Exceptional typing skills (at least 65 WPM) Solid organizational skills, must be detail oriented Solid communication skills – written and verbal Must be able to work with established deadlines and quick turnaround times Make referrals to internal and outside sources

Peoples Community Health Clinic

RN (Adult Clinic)-Triage

Posted on:

July 15, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Iowa

Peoples Community Health Clinic, Inc. is a 501(c)(3) nonprofit, Federally Qualified Health Center guided by its Mission statement. Care is provided no matter what a person’s financial situation is. Both uninsured and insured patients are welcome. Both our Waterloo and Clarksville locations are recognized as Patient-Centered Medical Homes, which places focus on building better relationships between patients and their health care teams. In 2020, the clinic began providing school-based health care at East High School and West High School through Success Street, and most recently at Carver Academy. The concept of "Community" is the heart of our organization. Peoples Clinic is owned and operated by people living in our community. This health center receives HHS funding and has Federal Public Health Service (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals. We are also supported by grant funding from the U.S. Department of Health and Human Services' Health Resources and Services Administration which makes it possible for us to offer financial assistance in the form of sliding fee discounts to low-income individuals. Peoples Community Health Clinic, Inc. is a member of the Iowa Primary Care Association and InConcertCare, as well as an FTCA and IowaHealth+ deemed facility.

Reports to: Clinical Manager This position is primarily responsible for triage patient care with case management, chronic care coordination, and acute assessments. The duties will primarily be performed over the phone with some face-to-face patient interactions. State and federal loan repayment opportunities are available for those that qualify. Job Summary/Objective: Provides primary care nursing, patient education, health care maintenance, patient counseling, and normative care services to patients at Peoples Community Health Clinic. Works with providers and administers nursing care utilizing the nursing process (assessment, planning, implementation, and evaluation). Protected Health Information Requirements/Access: This position will require the use or disclosure of protected health Information. This position will use the Treatment and Health Care Operations classes of protected health information. Restrictions on the protected health information for this position will follow the Privacy Policies of Peoples Community Health Clinic, Inc. Use or disclosure of protected health information not routinely available to this position will follow procedures assessed by or directed by management. Patient Records – Yes Medical Information System – Yes Other Duties: The statements contained in this job description reflect general details as necessary to describe the principal functions of this job, the level of knowledge and skill typically required, and the scope of responsibility. It should not be considered an all-inclusive listing of work requirements as individuals may perform other duties as assigned.

Preferred Education and Experience: Graduate of an accredited nursing program. One year of nursing experience is preferred. Licenses and Certificates: Current Iowa RN licensure Current BLS or CPR/First Aid certification Mandatory reporter training for child and dependent adult abuse certificate

While specialized RN positions in pediatric case management, health coach and Medication Assisted Treatment (MAT) nurse case manager have functions related to their specific position all RN positions will be expected to perform these duties. Provides primary and normative care for patients. Prepares patient for provider visit including explanation of PCMH model and related services. Assesses and evaluates health and development status of the patient, including complete medical and/or social history, vitals, and measurements according to approved protocol. Maintains accurate records and documents appropriate information in patient’s EHR including notifying patients of test results when needed. Reviews patient’s EHR for pertinent information including obtaining documents from other facilities as needed. Evaluates need for referral and makes referrals as needed. Assists providers with procedures, including preparation of equipment and clean-up. Provides medical therapy or monitoring of that therapy as directed by the provider or by protocol, including medication, immunization, and IV fluids administration. Performs EKGs, hearing and vision tests, ear lavage, tympanometry, spirometry, catheterization of the urinary tract and CLIA waved lab testing Administers irrigation, including enemas and removal of impactions. Collects and labels specimens, including cultures. Measures and records physiological and growth indices. Provides patient education. Provides planned educational programs and materials per evidence-based guidelines related to prevention, health maintenance and improvement. Reinforces provider’s instructions and explains patient’s plan of care. Provides patient counseling. Provides emotional support and an atmosphere of confidentiality to facilitate discussion of clinic procedures, prevention or testing for STDs and other communicable diseases. Provides support and guidance to clients and families of clients who are terminally or chronically ill. Serves as a client advocate to provide protection of client rights and for complaints regarding care or service. Coordinates Provider support. Inventories medications, supplies, vaccines, crash carts and exam rooms as needed. Functions as coordinator of patient services to facilitate patient flow. Participates in Team Huddle/Meeting to communicate information among providers and care team members. Aids the Clinical Representatives in areas of practice which are beyond their scope and serves as a resource to other staff members. Provides symptom assessment to determine level of illness and patient care needed. Collaborates with providers to facilitate patient care. Provides advice and follow-up to patients regarding care, including patient education according to protocol. Completes medication refills according to protocol. Schedules patient appointments as needed. Works to improve work processes and clinical outcomes including health disparity and quality improvement collaboratives. Follows policies and procedures. Develops and maintains own competence. Maintains a safe working environment and practices safe working habits. Assists in control of Peoples Community Health Clinic resources. Competencies: Strong analytical, problem-solving, and reasoning skills and ability Communication – listening, speaking, writing, and reading comprehension Attention to detail Working knowledge of MS Office Products (ex. Excel, Word) and Windows Platform. Must be comfortable moving within an EHR computer system regularly Ability to work with diverse groups of people Work with a large degree of independence Calm response in stressful situations

Quest Diagnostics Employer Population Health

RN, LPN, Nurse Health Screener - Fort Wayne, IN

Posted on:

July 15, 2025

Job Type:

Part-Time

Role Type:

License:

RN

State License:

Indiana

Hello! Thank you for your interest in our Health Screener position for Quest Diagnostics. Please keep in mind the following about the position: This is a Per Diem position, not full-time/part time. We do not guarantee hours. Our events take place during regular business hours M-F. Most are scheduled on a Tuesday/Wednesday/Thursday. Two days off during the work week is ideal. (Since this is a supplemental income position – there may not be two days of work available each week.) Recent professional finger stick experience (with in the last 2 years) is required. The next step is to schedule a 30 minute phone interview Please send me your resume along with several days/times you would be available to talk about the position.

Froedtert Health

RN DENIALS MANAGEMENT

Posted on:

July 13, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

The Froedtert & the Medical College of Wisconsin regional health network is a partnership between Froedtert Health and the Medical College of Wisconsin supporting a shared mission of patient care, innovation, medical research and education. Our health network operates eastern Wisconsin's only academic medical center and adult Level I Trauma center engaged in thousands of clinical trials and studies. The Froedtert & MCW health network, which includes ten hospitals, nearly 2,000 physicians and more than 45 health centers and clinics draw patients from throughout the Midwest and the nation.

EXPERIENCE DESCRIPTION: A minimum of 5 years of acute care nursing experience is required. Prior utilization management, insurance background, and denial management experience is preferred. EDUCATION DESCRIPTION: Bachelor's degree is required. Professional knowledge of nursing theory and practice at a level normally acquired through completion of a minimum of four years education at an accredited School of Nursing in order to be eligible for licensure as a Registered Nurse is required. TRAINING DESCRIPTION: Previous experience with clinical validation denial review and appeal processes. Knowledge of ICD-10 Coding Guidelines. SPECIAL SKILLS DESCRIPTION: Interpersonal skills necessary to instruct and maintain effective contacts with a variety of hospital personnel. Analytical skills necessary to prepare statistical reports and develop solutions to problems. Technical writing ability for appeal letters and reports. LICENSURE DESCRIPTION: Requires current state of Wisconsin Registered Nurse License or a Multi-state Nursing License from a participating state in the NLC (Nurse Licensure Compact).

Assumes responsibility for managing inpatient denials for all payers related to medical necessity and clinical validation audits, and coordinates the appeal process with physicians, coding, third party payers, and third party auditors. Assists the case managers with utilization review issues, and provides recommendations for process improvement in the areas of utilization review and denial management. Other duties as assigned.

Humana

Case Manager

Posted on:

July 13, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

None Required

State License:

Wisconsin

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our 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 is seeking a Case Manager/Community Resource Coordinator (CRC), to join the Inclusa team to serve members in the Wisconsin Family Care (FC) program. In this role, you will be responsible for partnering with your fellow colleagues to provide top quality care to our members. They are looking to you in providing assistance when it comes to living their daily lives. The CRC provides comprehensive social service care management for frail elders and adults with intellectual, developmental or physical disabilities who qualify for Wisconsin’s FC program.

Required Qualifications: Four-year bachelor’s degree in the Human Services or related field with one (1) year of experience working with at least one of the Family Care target populations OR a four-year bachelor’s degree in any other field with three (3) years’ related experience working with at least one of the Family Care target populations. ***The Family Care target group population is defined as: frail elders and adults with intellectual, developmental, or physical disabilities*** Preferred Qualifications: Certification in social work Additional Information Workstyle: This is a field position where employees perform their core duties at non-company locations, such as providing services at business partner facilities or prospects' and members' homes. Work Location: Jefferson County WI Travel: up to 40% throughout Jefferson County, WI Typical Work Days/Hours: Monday – Friday, 8:00 am – 4:30 pm CST Limited Geography Remote - This is a remote position but located within a specific geography. 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. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. Driving: This role is part of Humana's driver safety program and therefore requires an individual to have a valid state driver's license and proof of personal vehicle liability insurance with at least 100/300/100 limits. TB: This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB.

Learn what is important to the member and support them in achieving it. Partner with a Health and Wellness Coordinator (RN) and collaborate on an ongoing basis regarding the member and their plan. Perform face-to-face social-related assessments for members upon enrollment and at least every 6 months thereafter in the member's setting. Coordinate, perform, and track quarterly face-to-face visits and monthly phone contacts. Participate in the development and ongoing review and coordination of the member's plan of care. Take the lead in areas related to social, community integration, employment, housing, and non-health related issues. Educate on and promote prevention/wellness and mitigate risk when assessed. Document activity and complete paperwork as required. Traveling will be required and eligible for mileage reimbursement.

Company Nurse LLC

Telephonic Triage Nurse – Remote [TN] - FullTime

Posted on:

July 13, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

We are looking for full-time nurses to triage patients who have experienced a workplace injury, because accidents happen. Our goal is to help people get the care they need without the additional stress of knowing when, where, and how. Our nurses find engagement in delivering patient care in a reimagined and innovative way using technology. What you will experience, being a part of a ‘Remote First’ company: Work / Life Balance – say goodbye to traffic jams and hello to more time to enjoy life. Selfcare – No more physically demanding long hours or exposure to high-risk infectious diseases. Mental care – Workloads focus on ONE patient at a time; deep breath. About the Role: Our medical triage team is hiring for Telephonic Triage Nurses. We are looking for individuals who can adequately triage by asking probing questions, capturing details of the incident, all while using our proprietary algorithms and your clinical expertise to provide guidance. Job Type: Full-Time / 40 Hours per week Location: Remote (Must reside in AZ, FL, TN, or TX) Schedule Days: Monday-Friday with scheduled weekend rotations Shift / Hours: MidShift - 12:00 pm to 8:00 pm MST / 3:00 pm to 11:00 pm EST

What We Look For: 3 years' experience with direct patient care in Ambulatory and/or Inpatient settings. Ability to work remotely by having a private designated workspace to ensure patient confidentiality and secure high-speed internet connectivity. Confidence in navigating various software systems/programs with ease. Nice to Have: Bilingual in English and Spanish – Speaking, reading, writing. Experience in using electronic triage software and computerized medical protocols License(s) / Certification(s): [Required] Must be able to obtain a multi-state compact license and/or any required out-of-state license(s) within 6 months from the date of hire. [Required] Active RN (Registered Nurse) license. [Required] Successful completion of a Background Check and Drug Screen if an offer is extended.

Triage patients virtually by using phone and/or one-way video technology. Creates a positive patient experience by demonstrating highly effective communication skills. Ability to navigate stressful conversations with empathy and professionalism. Accurately documents symptoms/complaints, nursing assessment, advice provided and patient/caller response. Consistently meets productivity, schedule adherence, and quality standards.

Great Lakes Mgmt Co

Triage RN-REMOTE

Posted on:

July 13, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Minnesota

We are hiring for a part-time Triage RN! This is a remote position working 26 hours per week. If you are interested in joining our team, we encourage you to apply today! Must reside in the state of MN, WI or CO. Triage RN Job Details: Hours - 24 hours per week (12 hour shifts) Schedule - Day Shirft 7 am-7pm, every other weekend Pay - $36 - $40 / hour REMOTE

Maintains a current state license as a Registered Nurse per state regulations. A minimum of 5 years’ experience in home health, assisted living or long-term care is preferred. Good organizational skills with the ability to self-start and follow through with initiatives with a minimal amount of supervision. Exhibits a caring heart with a passion to care for the elderly. Possesses good judgment, problem-solving, and decision-making skills. Exceptional verbal and written communication skills. Experience using an HER specifically Eldermark and Point Click Care Must have excellent communication skills, patience and empathy for onsite staff and residents. Must be confident in clinical knowledge and decisive. Have a good understanding of pharmacology, basic first aid and Blood Glucose monitoring. Past supervisory experience a plus.

Take triage calls from the various AL and MC sites during nonbusiness hours and on weekends. Document appropriately in the EHR any direction and necessary information for the site clinical team to follow up and through with Prepare activity and incident reporting for the site Clinical Team(s) to use in order to analyze call volume and potential training necessary for site staff to work safely and efficiently. Must be willing to participate in any investigations and or surveys where after-hours calls are involved. Documents appropriately in the EHR. Promotes a positive, team approach and a healthy work environment for those who rely on their expertise.

WEP Clinical

Lead Mobile Research Nurse (West Region)

Posted on:

July 13, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

What Sets Us Apart: WEP Clinical partners with sponsors to help patients and physicians gain early access to medicines when no other treatment options are available. WEP Clinical has over 15 years of experience distributing products to over 120 countries worldwide to treat unmet patient needs. We're Committed to Our Team: WEP has many initiatives to encourage wellness, growth and development, and team relationships. Check out our LinkedIn Life Page to learn more about our team events, and all that we do to support our employees. We're Committed to DEI: At WEP Clinical, acceptance, recognition, and engagement are the core of our DEI values. We are committed to giving employees opportunities for personal and professional success and growth, embracing everyone's unique identities. Our services include: Access Programs Clinical Trial Services Patient Site Solutions Clinical Trial Supply Market Access and Commercialization

Are you looking for an exciting and fulfilling new position? Join our dynamic team at WEP Clinical, where your contributions will play a key role in driving impactful solutions and improving outcomes for clients and patients. We encourage innovation and collaboration, challenging our team to bring forward ideas that make a real difference. Be part of a mission-driven organization dedicated to advancing clinical research and transforming lives. The Ideal Candidate: Adaptable Problem-solver Collaborative Clinically skilled

Nursing degree from an accredited organization Active RN licensure in home state and eligibility for Compact Licensure or additional state licensure Minimum of 4+ years of clinical experience; 2+ years of research experience preferred Basic Life Support (BLS) Certification Active driver’s license and access to a reliable vehicle Ability to work from a home-based position and travel up to 80% for study participant visits, regional nurse oversight, and project team meetings Physical ability to perform nursing tasks and lift equipment up to 15 lbs Proficient in using technology for assessments and documentation (e.g., care equipment, laptops, communication devices, tablets) Excellent verbal and written communication skills in English Flexibility to work nights and weekends as needed

Provide DCT nursing services to qualified study participants at home within the assigned region Ensure compliance with study protocols through thorough review and documentation at each visit Administer investigational medications/products and assess patients for side effects, reporting findings to the Principal Investigator Perform medical tests, including vital signs, specimen collection, and electrocardiograms; process and ship specimens per protocol Adhere to clinical research policies and ensure ethical conduct and protection of vulnerable populations Maintain compliance with SOPs, GCP principles, and applicable regulations Support the delivery of study-specific nurse training as needed Participate in Site Initiation Visits for assigned studies Apply clinical research and nursing expertise to develop solutions to complex challenges Collaborate with and support per diem DCT research nurses through education and resource support

WEP Clinical

Lead Mobile Research Nurse (South Central Region)

Posted on:

July 12, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

At WEP Clinical, we are With Every Patient, as we believe every patient has the right to treatment! With this as our guiding principle, we have created a market leading, solutions driven, healthcare services company that partners with drug developers (Sponsors) to create broader treatment access solutions for patients worldwide. We take pride in the high-quality output and positive customer experience we create while delivering our services. We specialize in the following: - Expanded Access Programs - Post-Approval Named Patient Programs - Market Access Solutions - Home Nursing Services for Decentralized Clinical Trials - Clinical Trial Sourcing. We would be happy to answer any questions that you may have regarding WEP Clinical and our products and services.

Location: Ideally based in the South Central Region Are you looking for an exciting and fulfilling new position? Join our dynamic team at WEP Clinical, where your contributions will play a key role in driving impactful solutions and improving outcomes for clients and patients. We encourage innovation and collaboration, challenging our team to bring forward ideas that make a real difference. Be part of a mission-driven organization dedicated to advancing clinical research and transforming lives. Role Objectives: The Lead Mobile Research Nurse performs the delivery of care to participants and provides regional support to per-diem Mobile Research Nurses. The Lead Mobile Research Nurse ensures the professional delivery of patient care in compliance with all national/local regulations, Good Clinical Practice, and Standard Operating Procedures. The Ideal Candidate: Adaptable Problem-solver Collaborative Clinically skilled

Nursing degree from an accredited organization Active RN licensure in home state and eligibility for Compact Licensure or additional state licensure Minimum of 4+ years of clinical experience; 2+ years of research experience preferred Basic Life Support (BLS) Certification Active driver’s license and access to a reliable vehicle Ability to work from a home-based position and travel up to 80% for study participant visits, regional nurse oversight, and project team meetings Physical ability to perform nursing tasks and lift equipment up to 15 lbs Proficient in using technology for assessments and documentation (e.g., care equipment, laptops, communication devices, tablets) Excellent verbal and written communication skills in English Flexibility to work nights and weekends as needed

Provide DCT nursing services to qualified study participants at home within the assigned region Ensure compliance with study protocols through thorough review and documentation at each visit Administer investigational medications/products and assess patients for side effects, reporting findings to the Principal Investigator Perform medical tests, including vital signs, specimen collection, and electrocardiograms; process and ship specimens per protocol Adhere to clinical research policies and ensure ethical conduct and protection of vulnerable populations Maintain compliance with SOPs, GCP principles, and applicable regulations Support the delivery of study-specific nurse training as needed Participate in Site Initiation Visits for assigned studies Apply clinical research and nursing expertise to develop solutions to complex challenges Collaborate with and support per diem DCT research nurses through education and resource support

argenx

Nurse Case Manager, Florida (North)

Posted on:

July 12, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Florida

Join us as we transform immunology and deliver medicines that help autoimmune patients get their lives back. argenx is preparing for multi-dimensional expansion to reach more patients through a rich pipeline of differentiated assets, led by VYVGART, our first-in-class neonatal Fc receptor blocker approved for the treatment of gMG, and with the potential to treat patients across dozens of severe autoimmune diseases. We are building a new kind of biotech company, one that maintains its roots as a science-based start-up and pushes our commitment to innovate across all corners of our business. We strive to inspire and grow our company, our partnerships, our science, and our people, because when we do, we deliver more for patients.

The Nurse Case Manager (NCM) is the single point of contact for patients and their caregivers. They are aligned regionally and are responsible for educating patients, caregivers and families affected by generalized Myasthenia Gravis (gMG) about the disease and argenx’s products and support services. The NCM may provide resources to help patients better manage their disease and coordinate their treatment. The NCM is responsible for participating in one-on-one communications with patients and their caregivers. Desired Location: Jacksonville, FL

Skills and Competencies: Demonstrated effective presentation skills; ability to motivate others; excellent interpersonal (written and verbal) skills – with demonstrated effectiveness to work cross-functional and independently Demonstrated ability to develop, follow and execute plans in an independent environment Demonstrated ability to effectively build positive relationships both internally & externally Demonstrated ability to be adaptable to changing work environments and responsibilities Must be able to thrive in team environment and willing to contribute at all levels with flexibility and a positive attitude Fully competent in MS Office (Word, Excel, PowerPoint) Flexibility to work weekends and evenings, as needed Participate in and complete required pharmacovigilance training Comply with all relevant industry laws and argenx’s policies Travel requirements less than 50% of the time Education, Experience and Qualifications: Current RN License in good standing Bachelor’s degree Preferred 5 + yrs.’ clinical experience in healthcare to include hospital, home health, pharmaceutical or biotech 2-5+years of case management 2+ plus years’ experience in pharmaceutical/ biotech industry a plus Reimbursement experience a plus Bilingual or multilingual a plus #LI-REMOTE

Provide direct educational training and support to patients and caregivers about gMG and prescribed argenx products Will manage patient cases across regions as coverage and volume requires. Communicate insurance coverage updates and findings to the patient and/or caregiver Review and educate the patients and/or caregivers on financial assistance programs that they may be eligible for. Coordinate logistical support for patient to receive therapy and manage their disease Collaborate with argenx Patient Access Specialist, Case Coordinator, and Field Reimbursement Manager teams to troubleshoot and resolve reimbursement-related issues Engage with patients and provider case coordinators to ensure appropriate support is being given on an individualized basis Provide patient-focused education to empower patients to advocate on their behalf Develop relationships and manage multiple and complex challenges that patient and caregivers are facing Ensure compliance with relevant industry laws and argenx’s policies Aligned regional travel will be required for patient education to support patient programs Must be an excellent communicator and problem-solver Demonstrated time management skills; planning and prioritization skills; ability to multi-task and maintain prioritization of key projects and deadlines

argenx

Nurse Case Manager, Texas

Posted on:

July 12, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Texas

Join us as we transform immunology and deliver medicines that help autoimmune patients get their lives back. argenx is preparing for multi-dimensional expansion to reach more patients through a rich pipeline of differentiated assets, led by VYVGART, our first-in-class neonatal Fc receptor blocker approved for the treatment of gMG, and with the potential to treat patients across dozens of severe autoimmune diseases. We are building a new kind of biotech company, one that maintains its roots as a science-based start-up and pushes our commitment to innovate across all corners of our business. We strive to inspire and grow our company, our partnerships, our science, and our people, because when we do, we deliver more for patients.

The Nurse Case Manager (NCM) is the single point of contact for patients and their caregivers. They are aligned regionally and are responsible for educating patients, caregivers and families affected by generalized Myasthenia Gravis (gMG) about the disease and argenx’s products and support services. The NCM may provide resources to help patients better manage their disease and coordinate their treatment. The NCM is responsible for participating in one-on-one communications with patients and their caregivers. Desired Location: Houston, TX

Skills and Competencies: Demonstrated effective presentation skills; ability to motivate others; excellent interpersonal (written and verbal) skills – with demonstrated effectiveness to work cross-functional and independently Demonstrated ability to develop, follow and execute plans in an independent environment Demonstrated ability to effectively build positive relationships both internally & externally Demonstrated ability to be adaptable to changing work environments and responsibilities Must be able to thrive in team environment and willing to contribute at all levels with flexibility and a positive attitude Fully competent in MS Office (Word, Excel, PowerPoint) Flexibility to work weekends and evenings, as needed Participate in and complete required pharmacovigilance training Comply with all relevant industry laws and argenx’s policies Travel requirements less than 50% of the time Education, Experience and Qualifications: Current RN License in good standing Bachelor’s degree Preferred 5 + yrs.’ clinical experience in healthcare to include hospital, home health, pharmaceutical or biotech 2-5+years of case management 2+ plus years’ experience in pharmaceutical/ biotech industry a plus Reimbursement experience a plus Bilingual or multilingual a plus #LI-REMOTE

Provide direct educational training and support to patients and caregivers about gMG and prescribed argenx products Will manage patient cases across regions as coverage and volume requires. Communicate insurance coverage updates and findings to the patient and/or caregiver Review and educate the patients and/or caregivers on financial assistance programs that they may be eligible for. Coordinate logistical support for patient to receive therapy and manage their disease Collaborate with argenx Patient Access Specialist, Case Coordinator, and Field Reimbursement Manager teams to troubleshoot and resolve reimbursement-related issues Engage with patients and provider case coordinators to ensure appropriate support is being given on an individualized basis Provide patient-focused education to empower patients to advocate on their behalf Develop relationships and manage multiple and complex challenges that patient and caregivers are facing Ensure compliance with relevant industry laws and argenx’s policies Aligned regional travel will be required for patient education to support patient programs Must be an excellent communicator and problem-solver Demonstrated time management skills; planning and prioritization skills; ability to multi-task and maintain prioritization of key projects and deadlines

argenx

Nurse Case Manager, Oklahoma

Posted on:

July 12, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Oklahoma

Join us as we transform immunology and deliver medicines that help autoimmune patients get their lives back. argenx is preparing for multi-dimensional expansion to reach more patients through a rich pipeline of differentiated assets, led by VYVGART, our first-in-class neonatal Fc receptor blocker approved for the treatment of gMG, and with the potential to treat patients across dozens of severe autoimmune diseases. We are building a new kind of biotech company, one that maintains its roots as a science-based start-up and pushes our commitment to innovate across all corners of our business. We strive to inspire and grow our company, our partnerships, our science, and our people, because when we do, we deliver more for patients.

The Nurse Case Manager (NCM) is the single point of contact for patients and their caregivers. They are aligned regionally and are responsible for educating patients, caregivers and families affected by generalized Myasthenia Gravis (gMG) about the disease and argenx’s products and support services. The NCM may provide resources to help patients better manage their disease and coordinate their treatment. The NCM is responsible for participating in one-on-one communications with patients and their caregivers. Desired Location: Oklahoma City, OK

Skills and Competencies: Demonstrated effective presentation skills; ability to motivate others; excellent interpersonal (written and verbal) skills – with demonstrated effectiveness to work cross-functional and independently Demonstrated ability to develop, follow and execute plans in an independent environment Demonstrated ability to effectively build positive relationships both internally & externally Demonstrated ability to be adaptable to changing work environments and responsibilities Must be able to thrive in team environment and willing to contribute at all levels with flexibility and a positive attitude Fully competent in MS Office (Word, Excel, PowerPoint) Flexibility to work weekends and evenings, as needed Participate in and complete required pharmacovigilance training Comply with all relevant industry laws and argenx’s policies Travel requirements less than 50% of the time Education, Experience and Qualifications: Current RN License in good standing Bachelor’s degree Preferred 5 + yrs.’ clinical experience in healthcare to include hospital, home health, pharmaceutical or biotech 2-5+years of case management 2+ plus years’ experience in pharmaceutical/ biotech industry a plus Reimbursement experience a plus Bilingual or multilingual a plus #LI-REMOTE

Provide direct educational training and support to patients and caregivers about gMG and prescribed argenx products Will manage patient cases across regions as coverage and volume requires. Communicate insurance coverage updates and findings to the patient and/or caregiver Review and educate the patients and/or caregivers on financial assistance programs that they may be eligible for. Coordinate logistical support for patient to receive therapy and manage their disease Collaborate with argenx Patient Access Specialist, Case Coordinator, and Field Reimbursement Manager teams to troubleshoot and resolve reimbursement-related issues Engage with patients and provider case coordinators to ensure appropriate support is being given on an individualized basis Provide patient-focused education to empower patients to advocate on their behalf Develop relationships and manage multiple and complex challenges that patient and caregivers are facing Ensure compliance with relevant industry laws and argenx’s policies Aligned regional travel will be required for patient education to support patient programs Must be an excellent communicator and problem-solver Demonstrated time management skills; planning and prioritization skills; ability to multi-task and maintain prioritization of key projects and deadlines

argenx

Nurse Case Manager, Florida (South)

Posted on:

July 12, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Florida

Join us as we transform immunology and deliver medicines that help autoimmune patients get their lives back. argenx is preparing for multi-dimensional expansion to reach more patients through a rich pipeline of differentiated assets, led by VYVGART, our first-in-class neonatal Fc receptor blocker approved for the treatment of gMG, and with the potential to treat patients across dozens of severe autoimmune diseases. We are building a new kind of biotech company, one that maintains its roots as a science-based start-up and pushes our commitment to innovate across all corners of our business. We strive to inspire and grow our company, our partnerships, our science, and our people, because when we do, we deliver more for patients.

The Nurse Case Manager (NCM) is the single point of contact for patients and their caregivers. They are aligned regionally and are responsible for educating patients, caregivers and families affected by generalized Myasthenia Gravis (gMG) about the disease and argenx’s products and support services. The NCM may provide resources to help patients better manage their disease and coordinate their treatment. The NCM is responsible for participating in one-on-one communications with patients and their caregivers. Desired Location: Miami, FL

Skills and Competencies: Demonstrated effective presentation skills; ability to motivate others; excellent interpersonal (written and verbal) skills – with demonstrated effectiveness to work cross-functional and independently Demonstrated ability to develop, follow and execute plans in an independent environment Demonstrated ability to effectively build positive relationships both internally & externally Demonstrated ability to be adaptable to changing work environments and responsibilities Must be able to thrive in team environment and willing to contribute at all levels with flexibility and a positive attitude Fully competent in MS Office (Word, Excel, PowerPoint) Flexibility to work weekends and evenings, as needed Participate in and complete required pharmacovigilance training Comply with all relevant industry laws and argenx’s policies Travel requirements less than 50% of the time Education, Experience and Qualifications: Current RN License in good standing Bachelor’s degree Preferred 5 + yrs.’ clinical experience in healthcare to include hospital, home health, pharmaceutical or biotech 2-5+years of case management 2+ plus years’ experience in pharmaceutical/ biotech industry a plus Reimbursement experience a plus Bilingual or multilingual a plus #LI-REMOTE

Provide direct educational training and support to patients and caregivers about gMG and prescribed argenx products Will manage patient cases across regions as coverage and volume requires. Communicate insurance coverage updates and findings to the patient and/or caregiver Review and educate the patients and/or caregivers on financial assistance programs that they may be eligible for. Coordinate logistical support for patient to receive therapy and manage their disease Collaborate with argenx Patient Access Specialist, Case Coordinator, and Field Reimbursement Manager teams to troubleshoot and resolve reimbursement-related issues Engage with patients and provider case coordinators to ensure appropriate support is being given on an individualized basis Provide patient-focused education to empower patients to advocate on their behalf Develop relationships and manage multiple and complex challenges that patient and caregivers are facing Ensure compliance with relevant industry laws and argenx’s policies Aligned regional travel will be required for patient education to support patient programs Must be an excellent communicator and problem-solver Demonstrated time management skills; planning and prioritization skills; ability to multi-task and maintain prioritization of key projects and deadlines

Medix™

Case Management Nurse - 243719

Posted on:

July 12, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

Medix provides workforce solutions to clients and creates opportunity for talent in the Healthcare, Life Sciences, Engineering and Technology fields. Through our core purpose of positively impacting lives, we have earned our reputation as an industry leader by providing unsurpassed customer service and top quality professionals to our clients.

Medix is now hiring fully REMOTE Registered Nurse Case Managers for a growing healthcare company! Shift: Mon-Fri (9am-6pm, local timezone) Pay: $40.00 - $42.00, CA Residents: ($47.00-$50.00) Type: Remote

Bachelors of Science, Nursing (BSN) Compact Nursing License and/or CA RN License 2+ years of experience working in care management, case management, and/or disease management, preferably within a health plan, health navigator, or third-party administrator (TPA) environment. CCM is a PLUS!

Conduct high-impact outreach to high-risk and rising-risk members to build trusting relationships, assess needs, and support proactive health management. Make timely outreach calls after hospital discharges to perform intake assessments and offer support for safe and effective care transitions. Collaborate with hospital-based case managers to understand discharge needs and facilitate ongoing engagement with the Care Management program. Perform holistic assessments including physical function, cognition, social determinants of health (SDOH), health behaviors, and life planning goals. Provide patient-centered telephonic and/or video-based Care Management to help members navigate health challenges and access needed services. Partner with members and the care team to create personalized care plans aligned with members’ health goals and values. Connect members to clinical and non-clinical resources—including community-based services—to address barriers and improve health outcomes.

Diana Health

Bilingual Remote Triage Nurse (Full-Time)

Posted on:

July 12, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

LPN/LVN

State License:

Tennessee

Diana Health is a network of modern women’s health practices working in partnership with hospitals to reimagine the maternity and women’s healthcare experience. We are restructuring the traditional approach to care to create an experience that is good for patients and good for providers. We do that by combining a tech-enabled, wellness-focused care program that women love with a clinical system that helps us drive continuous quality improvement and ensure work-life balance for our care team. We work with clients across all life stages to empower and support them to live happier, healthier, more fulfilling lives. With strong collaborative care teams; passionate administrators and a significant investment in operational support, Diana Health providers are well-supported to bring their very best to the work they love. We are an interdisciplinary team joined together by our shared commitment to transform women’s health. Come join us!

We are looking for a full-time LPN passionate about all aspects of women’s health to provide direct patient care as part of an interdisciplinary care team and to serve as the first line of communication with patients in our clinical phone and messaging triage during office hours. The ideal candidate thrives in a busy practice, loves women’s health and building relationships with patients, is an excellent problem-solver and communicator, and is able to multi-task easily. Bilingual skills preferred with a preference for Spanish language, open to other languages.

Current certification as a Tennessee Licensed Practical Nurse 2+ years of experience in an outpatient preferred Excellent communication, interpersonal, and organizational skills Strong computer skills and familiarity with EMRs Lactation certification (IBCLC, CLC, CLE) preferred, but not required Bilingual, Spanish skills preferred

Patient Care: Act as the first line of call in clinical communications for patients, within guidelines/protocols Administer injections and medications Provide direct clinical care as needed for minor check in visits or lab draws Provide supporting paperwork and education for patients Support clinic visits as appropriate and per training when needed Administrative: Support the everyday flow of clinic acting as back up support for MA Maintaining logs Cleaning of rooms as needed and sterilization of instruments Obtaining and transcribing patient medical records Additional workflow items as the need arises

Aveanna Healthcare

Aveanna Healthcare Private Duty Nurse LVN:Full Time/Part Time Days

Posted on:

July 12, 2025

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

Compact / Multi-State

We consider it both a privilege and an honor when we welcome a new patient into our Aveanna family. Our homecare is always delivered from a place of heartfelt compassion and empathy, and every one of our Licensed Practical / Vocational Nurses (LPN/LVN)s works together to make sure we achieve outstanding clinical outcomes. Aveanna isn’t just a provider of compassionate homecare to children and adults. We are a national leader.

The Licensed Practical Nurse (LPN/LVN) is responsible for providing and documenting skilled nursing care, under the supervision of a Registered Nurse, in accordance with the developed care plan and physicians orders for each individual patient while adhering to confidentiality standards and professional boundaries at all times.

Must have and maintain an active, unencumbered license (LPN/LVN) in the state in which the clinician will practice Compact licenses must be transferred to your state of residence within 90 days   Current CPR certification (with hands-on component)- Aveanna can assist in obtaining this requirement after hire, if necessary. TB skin test (current within last 12 months) Six months prior hands-on nursing experience preferred but not required Must have reliable transportation  

Responsible for the delivery and coordination of quality patient care in compliance with physician orders. Continuously observes and assesses patient condition and care needs and reports changes in condition to the supervisor and/or physician as appropriate. Documents all activities, assessments, nursing actions, responses and coordination of care in a timely manner whenever care is delivered. Participate, implement and update the nursing care plan. Takes appropriate nursing action based on assessment and achieves expected outcomes. Recognizes changes in patient needs and responses requiring intervention and implements care to prevent risk or reduce risk. Accepts responsibility for personal and professional accountability by complying with Aveanna policies, state and federal regulations, accrediting bodies and the Nurse Practice Act. Provide care utilizing infection control measures that protect both the staff and the patient according to OSHA standards. Educates the patient and family regarding the disease process, self-care techniques, and prevention strategies, and in meeting the patient’s nursing needs. Maintain knowledge of competencies related to the nursing profession by participating in educational programs, continued education units, internal learning management skills and skill evaluations.

STRIDE Community Health Center

Triage and Advice Registered Nurse; Remote, CO

Posted on:

July 12, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

At STRIDE Community Health Center, we’re dedicated to more than just providing healthcare—we’re committed to making a lasting impact on the lives of our patients and the communities we serve. As one of Colorado’s largest Federally Qualified Health Centers, we offer comprehensive services—including primary care, dental, pharmacy, behavioral health, health education, and outreach—across our 13 clinics in the Denver Metro area. With over 35 years of serving our community, our growing team is at the heart of this mission. We believe healthcare is about more than treating illness; it’s about fostering wellness and addressing the unique needs of every person, ensuring that no one is left behind. If you’re passionate about making a meaningful difference, thrive in a collaborative environment, and are ready for a career that transforms lives—including your own—STRIDE is the place for you.

General Purpose: Under general supervision, the Triage and Advice Registered Nurse (TARN) performs telephone triage and processes medication refill requests in accordance with acceptable nursing standards and organization policies and procedures. This position will primarily work remotely from home; however, training will be held onsite, and continuing education will be held onsite as needed. STRIDE reserves the right to eliminate remote work arrangements and require staff to work at a STRIDE location. Applicants must reside in Colorado.

Education And Experience: Associate or bachelor’s degree in Registered Nursing from an accredited school or training program. Required: 2 years of full-time experience as a Registered Nurse in a hospital or community health setting. Preferred: Previous home health or ambulatory care nursing experience. Preferred: Previous experience in an Emergency Department. Strongly Preferred: Previous experience performing Triage and Advice Nurse duties. Certificates, Licenses, and Registration: An active, unrestricted Registered Nurse license in the State of Colorado or appropriate compact licensing arrangement.

Assesses patient condition/symptoms and gives appropriate clinical direction, education, and recommendation(s) for disposition. Responds to incoming calls in a timely, professional manner and triages (as appropriate) to address and/or support the needs of the caller. Assesses needs using standard evidenced based protocols for triage, offers clinical recommendations, as well as referrals to health care providers, services and community resources using telephone and information system technologies. Utilizes standardized protocols for medication management, prescription refills, and prior authorizations. Schedules appointments. Advises appropriate disposition for guideline selection for patient/caller. Demonstrates the ability to adjust (override) the disposition according to the unique needs/situation of the patient/caller and using appropriate Nursing Judgment. Integrates quality improvement activities into practice. Assists in identifying ways to promote quality care and in collecting data needed to promote process and operational improvements. Maintain patient confidentiality in accordance with Federal and State law and organization policies. Document all patient care delivery in an accurate and timely manner. Meets Key Performance Indicators including quantitative and qualitative expectations for call and medication refills. For example, meeting call and refill volume targets, timely turnaround standards, and successful periodic peer review. Other duties as required.

Momentum Life Sciences

Virtual Nurse Navigator (Remote) 9-6p EST, M-F

Posted on:

July 12, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Indiana

Momentum Life Sciences is the leading provider of patient engagement solutions integrating human connection, advanced technology, and real-world data to deliver holistic support in a personalized environment. Leveraging 25+ years’ experience in patient engagement, our One Voice™ model empowers biopharma teams to optimize the right mix of interventions for each patient. On behalf of our biopharma partners, we deliver 1M+ patient and healthcare provider engagements in person and virtually through our network of 800+ nurse educators nationwide. Our seasoned senior executive team is led by President and CEO Andrea Heslin Smiley, Momentum has been certified as a Great Place to Work® for 7 years running, additionally resulting in being named a Great Place to Work for Women, a Great Place to Work for Giving, and a FORTUNE® 100 Best Medium Workplace. Other distinctions include Best Place to Work in Indiana, Working Mother magazine’s Best Women-owned Companies, Inc. 500 Fastest Growing Companies in America, Growth 100​ company by the Kelley School of Business Johnson Center for Entrepreneurship and Innovation, and a Fortune 500 pharmaceutical client Global Supplier of the Year. Momentum continues to grow at a rapid pace. We are seeking candidates who thrive in an entrepreneurial environment and a culture of innovation. To inquire about our products and services, please email: businessdevelopment@momentumls.com.

The Virtual Nurse Navigator will be responsible for utilizing their professional nursing skills, clinical experience, ability to foster relationships, strong empathy, and to provide personalized high-touch virtual support to patients and healthcare professionals (HCPs) with an emphasis on reimbursement, patient access, and therapy coordination. The role will engage with patients and HCPs to ensure patients have seamless access to treatment. The Navigator will guide HCPs through any access barriers for their patients while also collaborating cross-functionally with the REMS vendor, HUB, specialty pharmacy, and field teams to optimize the patient treatment journey. They will leverage their clinical knowledge while combining technical expertise to deliver best-in-class support, customer service, and ongoing guidance to these patients and providers.

Required Education and/or Experience: Bachelors degree preferred Experience in a telephonic support role centered in patient access, reimbursement, or care coordination roles Experience with high volume inbound/outbound call center Required License and/or credential(s): Current, unrestricted nursing license (RN, NP) Required Skills: High emotional intelligence and ability to exhibit empathy to meet each patient where they are Strong clinical skills and experience with medication compliance, specialty pharmacy knowledge, understanding of the insurance approval process, and motivational interviewing Desire and ability to create an individualized relationship with patients as they progress through their journey Ability to accurately recognize and report AEPQC information Optimistic, upbeat, and enthusiastic in times of challenge and constant change Ability to deliver outstanding patient experience Demonstrate experienced competency and ability to independently navigate technology using multiple platforms, computer screens, and other technical components. (Ex: Telephony Systems, CRM tools, Microsoft Suite) Advanced knowledge of written and verbal communication skills and problem-solving techniques Detail-oriented, highly organized, and able to work through ambiguity Able to work independently, self-motivated, managing workload with minimal supervision Ability to maintain cases and complete calls on time Ability to maintain compliant conversations and documentation in a high-volume role Ability to maintain patient confidentiality by using the headset during all conversations, maintaining a private environment for home office without distraction Ability to maintain great flexibility in an ever-changing environment and willingness to learn other therapies or float to other brands as needed Willingness to assist in shift coverage as needed outside of typical hired shift Special Position Requirements: Travel: As required; less than 10% Working Conditions: Work is generally sedentary in nature but may require standing and walking for up to 10% of the time. The working environment is generally favorable. Lighting and temperature are adequate, and there are no hazardous or unpleasant conditions caused by noise, dust, etc. Work is generally performed within an office environment, with standard office equipment available. Physical Requirements: Must be able to read, write, and communicate fluently in English. Ability to communicate effectively (hear, listen, speak) with or without reasonable accommodations.

Provide virtual omnichannel support through email, chat, text, virtual connections, and inbound or outbound calls Demonstrate strong empathy and high emotional intelligence to engage patients/HCP’s effectively, creating individual relationships built on trust and rapport Provide proactive support to HCP office issues related to REMS, reimbursement, insurance coverage, and product dispense Act as a primary point of contact for patients to provide comprehensive disease/therapy education and access to therapy (including benefit verification, prior authorizations, and navigating insurance reimbursement processes) Collaborate and work cohesively with Momentum Inbound team to identify gaps, barriers, and opportunities to improve process and overall patient/HCP experience Communicate complex information effectively and empathetically to patients/HCP’s Accurately complete patient engagements based on provided criteria Ensure the success of the program through collaborative partnerships with patients, field partners and operational partners Work and communicate cohesively within a team to identify collaborative opportunities, enable process improvement and escalate as needed Provide manager and the account team voice of the customer feedback on the product, support, and insights to enable enhancements Ensure all activities are conducted in a manner that complies with all Momentum, client, and industry-mandated rules and regulations Complete AEPQC reporting and provide all communications in a compliant manner Other duties: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Momentum Life Sciences

Virtual Nurse Navigator (Remote) 11-8p EST, M-F

Posted on:

July 12, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Indiana

Momentum Life Sciences is the leading provider of patient engagement solutions integrating human connection, advanced technology, and real-world data to deliver holistic support in a personalized environment. Leveraging 25+ years’ experience in patient engagement, our One Voice™ model empowers biopharma teams to optimize the right mix of interventions for each patient. On behalf of our biopharma partners, we deliver 1M+ patient and healthcare provider engagements in person and virtually through our network of 800+ nurse educators nationwide. Our seasoned senior executive team is led by President and CEO Andrea Heslin Smiley, Momentum has been certified as a Great Place to Work® for 7 years running, additionally resulting in being named a Great Place to Work for Women, a Great Place to Work for Giving, and a FORTUNE® 100 Best Medium Workplace. Other distinctions include Best Place to Work in Indiana, Working Mother magazine’s Best Women-owned Companies, Inc. 500 Fastest Growing Companies in America, Growth 100​ company by the Kelley School of Business Johnson Center for Entrepreneurship and Innovation, and a Fortune 500 pharmaceutical client Global Supplier of the Year. Momentum continues to grow at a rapid pace. We are seeking candidates who thrive in an entrepreneurial environment and a culture of innovation. To inquire about our products and services, please email: businessdevelopment@momentumls.com.

The Virtual Nurse Navigator will be responsible for utilizing their professional nursing skills, clinical experience, ability to foster relationships, strong empathy, and to provide personalized high-touch virtual support to patients and healthcare professionals (HCPs) with an emphasis on reimbursement, patient access, and therapy coordination. The role will engage with patients and HCPs to ensure patients have seamless access to treatment. The Navigator will guide HCPs through any access barriers for their patients while also collaborating cross-functionally with the REMS vendor, HUB, specialty pharmacy, and field teams to optimize the patient treatment journey. They will leverage their clinical knowledge while combining technical expertise to deliver best-in-class support, customer service, and ongoing guidance to these patients and providers.

Required Education and/or Experience: Bachelors degree preferred Experience in a telephonic support role centered in patient access, reimbursement, or care coordination roles Experience with high volume inbound/outbound call center Required License and/or credential(s): Current, unrestricted nursing license (RN, NP) Required Skills: High emotional intelligence and ability to exhibit empathy to meet each patient where they are Strong clinical skills and experience with medication compliance, specialty pharmacy knowledge, understanding of the insurance approval process, and motivational interviewing Desire and ability to create an individualized relationship with patients as they progress through their journey Ability to accurately recognize and report AEPQC information Optimistic, upbeat, and enthusiastic in times of challenge and constant change Ability to deliver outstanding patient experience Demonstrate experienced competency and ability to independently navigate technology using multiple platforms, computer screens, and other technical components. (Ex: Telephony Systems, CRM tools, Microsoft Suite) Advanced knowledge of written and verbal communication skills and problem-solving techniques Detail-oriented, highly organized, and able to work through ambiguity Able to work independently, self-motivated, managing workload with minimal supervision Ability to maintain cases and complete calls on time Ability to maintain compliant conversations and documentation in a high-volume role Ability to maintain patient confidentiality by using the headset during all conversations, maintaining a private environment for home office without distraction Ability to maintain great flexibility in an ever-changing environment and willingness to learn other therapies or float to other brands as needed Willingness to assist in shift coverage as needed outside of typical hired shift Special Position Requirements: Travel: As required; less than 10% Working Conditions: Work is generally sedentary in nature but may require standing and walking for up to 10% of the time. The working environment is generally favorable. Lighting and temperature are adequate, and there are no hazardous or unpleasant conditions caused by noise, dust, etc. Work is generally performed within an office environment, with standard office equipment available. Physical Requirements: Must be able to read, write, and communicate fluently in English. Ability to communicate effectively (hear, listen, speak) with or without reasonable accommodations.

Provide virtual omnichannel support through email, chat, text, virtual connections, and inbound or outbound calls Demonstrate strong empathy and high emotional intelligence to engage patients/HCP’s effectively, creating individual relationships built on trust and rapport Provide proactive support to HCP office issues related to REMS, reimbursement, insurance coverage, and product dispense Act as a primary point of contact for patients to provide comprehensive disease/therapy education and access to therapy (including benefit verification, prior authorizations, and navigating insurance reimbursement processes) Collaborate and work cohesively with Momentum Inbound team to identify gaps, barriers, and opportunities to improve process and overall patient/HCP experience Communicate complex information effectively and empathetically to patients/HCP’s Accurately complete patient engagements based on provided criteria Ensure the success of the program through collaborative partnerships with patients, field partners and operational partners Work and communicate cohesively within a team to identify collaborative opportunities, enable process improvement and escalate as needed Provide manager and the account team voice of the customer feedback on the product, support, and insights to enable enhancements Ensure all activities are conducted in a manner that complies with all Momentum, client, and industry-mandated rules and regulations. Complete AEPQC reporting and provide all communications in a compliant manner. Other duties: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities, and activities may change at any time with or without notice.

Athletico

Occ Health RN Telephone Triage - PRN - (Remote)

Posted on:

July 11, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Greater Purpose and Core Values: Athletico’s Greater Purpose is to empower people, inspire hope and transform lives. We accomplish this by providing exceptional, progressive, and cost-effective fitness, performance and rehabilitative services through personalized care that emphasizes education and prevention of future injury. This is accomplished through building on our Core Values of one team, understanding our business, recognition, people-focused, accountability, continuous innovation and trust and integrity, which are the foundation for our unique culture.

Pivot Onsite Innovations is now hiring an experienced and passionate PRN Remote Triage Registered Nurse (RN) for our on-site healthcare clinic located at our client's manufacturing plants, supporting telephonically. This is your opportunity to step out of a traditional nurse setting and make your impact on employee health, wellness and safety! Coverage Opportunities: Monday - Friday 6AM-2PM, 2pm-10PM, and 10PM -6AM. Weekend Hours: Saturday -Sunday 6AM-6PM and 6PM-6AM. Pay Range: $45-65/hr Position Summary: The Remote Occupational Health Nurse is responsible for utilizing evidence-based guidelines to employ best practices that require early intervention and setting of realistic expectations for recovery and return to work.

Education: Associate’s Degree in Nursing required, BSN preferred Work Experience: Min 2 years in occupational health preferred Telephonic case management experience preferred Certification/Licensure: Current Compact RN License required State of NY License preferred, not required Maintain Enhanced Nurse Licensure Compact (eNLC) and reside in a compact state Adhere to the requirements and time frames of licensure in all other states Knowledge and Technical Skills: Strong clinical knowledge in Occupational Health Nursing Positive telephone interaction skills including ability to ask open-ended questions to identify problems and focus conversation for goal directed and time limited conversation Ability to effectively interact with HR, safety staff, local medical providers and other designated personnel for proper initiation and follow-up of possible work-related injuries and illnesses Excellent written and oral communication skills and computer skills Competence with Windows operating system environment, Adobe Professional, Microsoft Office Suite (Outlook, Word, Excel and PowerPoint) and learn other software as needed Language Skills: Ability to read, write and speak English proficiently Bi-lingual (Spanish speaking) beneficial Physical Demands: Ability to fulfill office activities including but not limited to remain stationary for extended periods of time (i.e., while working at a desk), stand/stoop/kneel/crough/stretch, bending and stretching, communicate with others (verbal and written), and use fine motor skills including fine hand manipulation and keyboarding. Working under stress and use of computer/phone required Ability to see at close range, distance vision, peripheral vision, depth perception, and the ability to adjust focus. Work Environment: Fully remote position Mainly indoor, office environment conditions Environment must be free from background noise and distraction, noise level is acceptable, temperature is controlled. A home set-up; must meet all Company IT, privacy and safety requirements

Provide initial injury intake, follow up and case closures in accordance with Policy Procedures Provide initial contact with injured worker, employer, provider and other appropriate stakeholders Obtain history of injury (mechanism and setting) and current job functions Assesses functional status and provide recommendations for first aid, self-care, or medical treatment according to treatment protocols Assess and collect data regarding risk factors for delayed recovery, and generate creative solutions to minimize or eliminate obstacles which prevent, or delay return to work Provide appropriate stakeholders with updates regarding the nature and mechanism of injury as well as suggested level of care Serve as an advocate for the injured/ill worker Counsel’s employees on reduction of risks associated with occupational and environmental hazards, and provides appropriate care plans as needed Request medical records as needed Direct care to preferred providers and negotiates as necessary Ensure appropriate use of medical facilities, early and appropriate referrals, and quality of care at controlled or reduced cost Identify excessive, ineffective or inefficient delivery of health care services and redirect care as needed Perform additional duties and assumes additional responsibilities as identified by supervisor

Flagler Health

Lead LPN, Remote

Posted on:

July 11, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

LPN/LVN

State License:

New York

Flagler Health is at the forefront of leveraging technology to revolutionise healthcare delivery. We support physicians by identifying optimal treatment plans, enhancing patient outcomes, and streamlining access to advanced monitoring services, beginning with Remote Therapeutic Monitoring (RTM) and Chronic Care Management (CCM). Our mission is to innovate patient care through technology, improving both the quality and efficiency of healthcare services across the country.

We are seeking a highly organised and proactive LPN Lead to support the onboarding, training, and performance management of new and current MAs. This role is ideal for an experienced MA who thrives in a fast-paced, team-oriented environment and is passionate about elevating the quality and consistency of patient care through operational excellence.

Licensed Practical Nurse (LPN) 3+ years of previous experience training or supervising MAs required Strong organizational, time management, and communication skills Detail-oriented with a passion for process improvement Comfortable using dashboards and documentation tools to track performance Team player who thrives in a dynamic, collaborative environment

Training & Onboarding: Onboard and train new Medical Assistants, ensuring smooth integration into the Flagler workflow. Manage new hires through their initial 4-week training phase, monitoring readiness for team placement. Schedule additional training sessions when issues or knowledge gaps are identified. Performance Oversight: Conduct daily and ad hoc quality checks. Monitor key performance indicators including: Number of patient interactions Fallout and retention rates Protocol adherence Accuracy of documentation and patient statuses Schedule buddy shifts and peer support based on performance data and training needs. Issue Management: Address issues flagged by team leaders, such as time management or training gaps. Identify and report structural issues or repeated errors to leadership (Leon/Dasha). Provide constructive feedback and assign action items to MAs based on performance reviews. MA Engagement & Development: Conduct monthly check-ins with all MAs, including former team leads. Document feedback, complete performance review templates, and set monthly goals and assignments. Team Collaboration: Lead the “housekeeping” section of weekly MA team syncs, sharing examples, screenshots, and reminders. Assist in assigning patients to MAs after upload to the platform. Support schedule management, including coverage coordination and team adjustments.

Flagler Health

LPN / LVN - Remote Nurse

Posted on:

July 11, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

New York

Flagler Health is at the forefront of leveraging technology to revolutionise healthcare delivery. We support physicians by identifying optimal treatment plans, enhancing patient outcomes, and streamlining access to advanced monitoring services, beginning with Remote Therapeutic Monitoring (RTM) and Chronic Care Management (CCM). Our mission is to innovate patient care through technology, improving both the quality and efficiency of healthcare services across the country. Location: Fully Remote Schedule: Full Time (40 hours/week)

We are seeking a dedicated and compassionate LPN/LVN to join our remote team for delivery of RTM & CCM Services. These services provide a personalized mobility for the patients outside the clinic and help to better document their health. You will be conversing with the patients to ensure that they are improving every single day.

Certification as an LPN: 3+ years of experience working in office or remote Proficiency with technology such as Zoom, Slack, and online enrollment platforms. Strong organizational skills and the ability to manage multiple tasks efficiently. Excellent communication skills, both verbal and written, with a focus on empathy and patient support. Ability to work independently in a remote setting, showing initiative and self-motivation. Familiarity with HIPAA regulations and a commitment to maintaining patient privacy. Preferred Medical Specialty: Neurology Orthopedics Physical & Rehabilitation Medicine Sports Medicine What We Offer: A fully remote work environment, allowing for flexibility and work-life balance. Opportunities for professional growth and development within a rapidly growing tech-driven company. A supportive and inclusive culture that values different opinions and fosters innovation. Extensive training before beginning patient outreach.

Facilitate patient enrollment into our RTM (Remote Therapeutic Monitoring) or Chronic Care Management (CCM) programs using Flagler’s portal. Make daily calls and text messages to patients to document patient health status and keep them engaged. Assist in the collection and documentation of patient health information, including histories, health status and new symptoms. Support patients by sending health pointers (stretches, meditation videos, light exercises). Maintain strict confidentiality in handling patient information, adhering to HIPAA regulations and company policies. Participate in ongoing company training and check-ins. Expectations: Punctuality and reliability. Access to laptop with working microphone, camera, and reliable internet connection. Access to a quiet space to work full time.

Sage Hospice, Primary and Palliative Care

Hospice On Call Triage Supervisor- Part Time

Posted on:

July 11, 2025

Job Type:

Part-Time

Role Type:

Leadership / Management

License:

RN

State License:

Arizona

With services available throughout Arizona, we have many opportunities for people who want to develop their careers in care. We champion those devoting their lives to bettering the lives of others. At Sage Hospice, you have the space to develop your talents, to fulfil your aspirations and explore different career paths. We give you the time and freedom to grow with us. That’s how we’re different. If you want your talent for caring to be recognized and nurtured, join us.

*This is a Part-Time schedule, will be every other Weekend (Saturday & Sunday) 8:00am to 8:00pm* *Remote position but must reside in Arizona (Scottsdale)

Registered Nurse with current license to practice professional nursing in the state Associate's or bachelor's degree in Nursing from an accredited program Three (3) years of management or supervisory experience in hospice or related healthcare organization Must have reliable transportation, proof of current automobile insurance, and a valid driver’s license. Must have Hospice Experience SKILLS/ABILITIES/KNOWLEDGE: Demonstrated ability to coach, mentor, develop, supervise, and direct assigned staff. Demonstrated planning and organization skills to effectively manage multiple priorities simultaneously. Ability to proficiently manage workflow within the EMR. Ability to support an interdisciplinary team concept and be able to work as part of a team. Demonstrated skill in managing patient service issues, service recovery, and professionally managing customer relations. Excellent observation, verbal, written, and interpersonal skills. Knowledge of business management, government regulations, and ACHC standards. Proficient in Microsoft Office.

The On-call Triage Supervisor is responsible for the oversight and management of on-call clinical services. The On-call Triage Supervisor ensures on-call hospice services meet and promote the standards of quality care and contributes to the organization's mission, vision, and values.

IntellaTriage

Hospice Telephone Triage RN- FT 6:30a-4p Mon-Fri/no wknds (REMOTE)

Posted on:

July 11, 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 Full- time schedule: Work Monday-Friday 6:30a-4p CST/ no wknds

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

Commonwealth Care Alliance

RN, instED Clinical Resource Center

Posted on:

July 11, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Massachusetts

instED provides on-demand, urgent care in the home for medically complex patients. The RN, instED Clinical Resource Center will receive referrals for services, conduct intake assessments, provide triage to ensure referrals are clinically appropriate, and respond clinical questions related to referrals and services.The InstED RN will engage telephonically with patients, clinicians, and care partners who call with urgent clinical needs for a medically diverse group of patients across the continuum of care. Supervision Exercised: No, this position does not have direct reports.

Working Conditions -Remote work environment: Must be able to work a flexible schedule. RN coverage is Monday thru Sunday 0800-2200. The shifts can be full shifts or half-shift. Weekends and Holidays are required (instED provides services 365 days per year) Required Education (must have): Bachelor’s degree in Nursing Desired Education (nice to have): Required Licensing (must have): Current, active MA RN license Desired Licensing (nice to have): MA Health Enrollment (required if licensed in Massachusetts): No, this is not required for the job. Required Experience (must have): 5+ years of relevant nursing experience Triaging patients with complex medical histories across the lifespan Desired Experience (nice to have): Experience in urgent care,primary care, or emergency department preferred Call center triage experience preferred Quality and process improvement experience preferred Required Knowledge, Skills & Abilities (must have): Willingness to learn best practice in delivering home-based and telehealth care Strong triage skills Comfortable with remote care delivery model and technology (i.e. telemedicine) Strong written and verbal communication skills Experience working collaboratively as a team-player Must be able to exhibit therapeutic communication to a diverse patient population that is patient-focused, empathetic and free from bias Willing to learn and utilize telehealth technologies (video, chat, etc.), when appropriate, for a variety of clinical care and care management services Required Language (must have): English Desired Knowledge, Skills, Abilities & Language (nice to have): Fluency in Spanish a plus

Intake: Receive referrals for an instED visit, both electronically and telephonically, from patients, clinicians, and care partners Ensure complete and accurate information for the visit request Obtain comprehensive data collection electronically and/or via telephone from referring provider or patient directly Triage per instED triage guidelines and protocols, assessing patients and applying solid decision-making to achieve highest patient outcomes Deliver competent, safe, compassionate and individualized telephonic nursing/triage care for patients with complex medical histories Triage: Make clinically-appropriate recommendations for action/interventions Triage and prioritize referrals for acuity and sequencing of visits Identify emergent situations and provide clinical advice appropriately Analyze data to identify and determine expected outcomes Develop a plan with instED team to identify strategies to attain expected outcomes Exercise sound clinical judgment, along with excellent working knowledge of instED, to appropriately disperse accurate level of resources needed for achieving the best patient outcomes Follow-up: Communicate with patients and care partners to provide education and instructions regarding any recommended follow-up care. Follow-up services may include, but are not limited to, follow-up call by Provider, Tele-health re-visit, PCP evaluation, re-deployment of paramedic or other clinical provider, and phone teaching with teach-back to ensure understanding Ensure appropriate teaching has occurred with patient and or family Provide follow-up and encounter summary with referring provider and Primary Care Provider Complete accurate and appropriate documentation in real time Demonstrate strong focus on patient experience, with commitment to service excellence from intake through discharge Secondary responsibilities: Quality Assurance: Work with the instED team to develop metrics and standards for Quality Assurance within the Clinical Resource Center Participate in Quality Assurance activities in other areas within the instED delivery model Ongoing Program Support: Participate in the development and design of the instED Now platform offering feedback and suggestions for improvement

St. Luke's University Health Network

Clinical Triage Specialist, RN or LPN; Rheumatology, Infectious Disease, Pulmonary - Remote Position (Local to NJ/PA)

Posted on:

July 11, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Pennsylvania

The Clinical Triage Specialist (CTS), LPN - Access Center will compassionately deliver an exceptional patient experience providing the first level of clinical triage resources to patients. The CTS-LPN is responsible for using medical training judgment in answering/returning patient calls related to direct care provided by the practices. This includes following a protocol established for the appropriate triage and escalation of medical questions/concerns.

PHYSICAL AND SENSORY REQUIREMENTS: Requires sitting for extended periods of time (up to 8 hours at time). Requires continual use of fingers, writing and computer entry. Requires ability to hear normal conversation and good general near and peripheral vision. EDUCATION: Graduate of an accredited nursing program. Active LPN licensure in the state of Pennsylvania and New Jersey or other nursing compact state and other states as deemed necessary by state law. TRAINING AND EXPERIENCE: Two years of experience in a healthcare setting is required; customer service experience in a contact center is strongly preferred.

Answers telephones, prioritizes clinical triage calls, follows clinical protocols, and coordinates services, as needed. Verifies patient demographic information and accurately enters the updated information into electronic health record. Serves as first level of clinical triage for patient and staff issues, and provides clinical advice based on clinical protocols, procedures, and escalation paths. Escalates patient concerns to CTS (RN) or Clinical Triage Supervisor to better assist patients with complex clinical concerns. Manages and responds to electronic patient messages whenever not answering inbound patient calls, and uses clinical judgment to prioritize, escalate, and accommodate patients. Creates a positive patient experience at every encounter, attempting to independently resolve any issues or concerns of the patient at the time of the phone call, within the scope of the role. Consistently meets productivity, schedule adherence, and quality standards as set by the Access Center. Partners with other Access Center teams/PODs and respective practice clinical team on behalf of the patient to assist with clinical concerns, medication refills, or scheduling appointments. Other related duties as assigned.

Green Key Resources

Utilization Review Nurse

Posted on:

July 10, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

California

Green Key Resources cares deeply about developing personal, lasting relationships with our clients. Our recruitment team consists of seasoned, passionate professionals who leverage intricate industry knowledge and an incredible network to find talented people and align them with the right career. People, not just candidates. Careers, not just jobs. We look at recruitment as a philosophy, and our recruiters are dedicated to a holistic approach in which we first consider the big picture and then go on to match skills, goals, dreams, corporate culture, and more. Our business, and yours, is changing and growing every day. That’s why we’re constantly investing in the newest analytical tools available. New, innovative departments like our in-house Research & Development team is available to provide customized solutions for both career seekers and companies. As the recruiting world begins to rely more and more on technology to find and match talent, we will always remain loyal to the power of the human touch - never underestimating how far it can take both our candidates and clients.

Active and unrestricted Registered Nurse (RN) license in the state of California. Minimum of 2 years of recent Utilization Review experience, with at least 1 year of remote UR experience within the last 12 months. Proficiency with XSOLIS/Dragonfly platforms. Strong knowledge of utilization management principles and payer requirements. Excellent critical thinking, communication, and time management skills. Ability to work independently in a remote environment with minimal supervision.

Conduct timely and accurate reviews of inpatient and outpatient medical records to determine medical necessity and level of care. Apply evidence-based criteria (e.g., InterQual, MCG) and hospital policies to support clinical decision-making. Communicate with physicians and clinical staff to clarify documentation and support utilization decisions. Submit clinical reviews to insurance companies and respond to requests for additional information. Monitor patient status and ensure appropriate documentation for continued stay reviews. Maintain compliance with federal, state, and payer-specific regulations. Accurately document all review activities in the hospital’s electronic medical record (EMR) and UR platforms (e.g., XSOLIS/Dragonfly).

Optum

RN Case Manager PHM Compact Lics CST Time Zone

Posted on:

July 10, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

WellMed, part of the Optum family of businesses, is seeking a RN Case Manager PHM to join our team in Texas. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone. At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

The PHM Nurse Case Manager II (NCM) is responsible for patient case management for longitudinal engagement, coordination for discharge planning, transition of care needs and outpatient patient management through the care continuum. Nurse Case Manager will identify, screen, track, monitor and coordinate the care of patients with multiple co-morbidities and/or psychosocial needs and develop a patients’ action plan and/or discharge plan. They will perform reviews of current inpatient services, and determine medical appropriateness of inpatient and outpatient services following evaluation of medical guidelines and benefit determination. The Nurse Case Manager will provide continuity of care for members to an appropriate lower level of care in collaboration with the hospitals/physician team, acute or skilled facility staff, ambulatory care team, and the member and/or family/caregiver. The Nurse Case Manager will coordinate, or provide appropriate levels of care under the direct supervision of an RN Manager or MD. Function is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating). This includes case management, coordination of care, and medical management consulting. Function may also be responsible for providing health education, coaching and treatment decision support for patients. The Nurse Case Manager will act as an advocate for patients and their families guide them through the health care system for transition planning and longitudinal care. The Nurse Case Manager will work in partnership with an assigned Care Advocate and Social Worker. If you have a Compact License, you will have the flexibility to work remotely* as you take on some tough challenges.

Required Qualifications: Associate’s degree in Nursing Current, unrestricted RN license required, specific to the state of employment Case Management Certification (CCM) or ability to obtain CCM within 12 months after the first year of employment 3+ years of diverse clinical experience; preferred in caring for the acutely ill patients with multiple disease conditions 3+ years of managed care and/or case management experience Knowledge of utilization management, quality improvement, and discharge planning Preferred Qualifications: Experience working with psychiatric and geriatric patient populations Knowledgeable in Microsoft Office applications including Outlook, Word, and Excel Bilingual (English/Spanish) language proficiency Ability to read, analyze and interpret information in medical records, and health plan documents Ability to problem solve and identify community resources Possess planning, organizing, conflict resolution, negotiating and interpersonal skills Independently utilizes critical thinking skills, nursing judgement and decision-making skills. Must be able to prioritize, plan, and handle multiple tasks/demands simultaneously Physical & Mental Requirements: Ability to lift up to 10 pounds Ability to push or pull heavy objects using up to 25 pounds of force Ability to sit for extended periods of time Ability to stand for extended periods of time Ability to use fine motor skills to operate office equipment and/or machinery Ability to receive and comprehend instructions verbally and/or in writing Ability to use logical reasoning for simple and complex problem solving

Engage patient, family, and caregivers telephonically to assure that a well-coordinated action plan is established and continually assess health status Provide member education to assist with self-management goals; disease management or acute condition and provide indicated contingency plan Identify patient needs, close health care gaps, develop action plan and prioritize goals Utilizing evidenced-based practice, develop interventions while considering member barriers independently Provide patients with “welcome home” calls to ensure that discharged patients’ receive the necessary services and resources according to transition plan Conducts a transition discharge assessment onsite and/or telephonically to identify member needs at time of transition to a lower level of care Independently serves as the clinical liaison with hospital, clinical and administrative staff as well as performs a review for clinical authorizations for inpatient care utilizing evidenced-based criteria within our documentation system for discharge planning and/or next site of care needs In partnership with care team triad, make referrals to community sources and programs identified for patients Utilize motivational interviewing techniques to understand cause and effect, gather or review health history for clinical symptoms, and determine health literacy Manages assessments regarding patient treatment plans and establish collaborative relationships with physician advisors, clients, patients, and providers Collaborates effectively with Interdisciplinary Care Team (IDCT) to establish an individualized transition plan and/or action plan for patients Independently confers with UM Medical Directors and/ or Market Medical Directors on a regular basis regarding inpatient cases and participates in departmental huddles Demonstrate knowledge of utilization management processes and current standards of care as a foundation for utilization review and transition planning activities Maintain in-depth knowledge of all company products and services as well as customer issues and needs through ongoing training and self-directed research Manage assigned caseload in an efficient and effective manner utilizing time management skills Enters timely and accurate documentation into designated care management applications to comply with documentation requirements and achieve audit scores of 95% or better on a monthly basis Maintain current licensure to work in state of employment and maintain hospital credentialing as indicated Performs all other related duties as assigned

MAS Medical Staffing

ACTT Nurse

Posted on:

July 10, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

North Carolina

MAS Medical Staffing brings a total staffing solution for our clients, offering per diem, contract and travel staff all under one agency. With over 20 years of experience and a deep national network, our expertise allows us to staff quality caregivers with unmatched service and speed. Our unique hybrid approach pairs our expert client and caregiver service teams with our proprietary technology platform MAESTRA, allowing us to craft a tailored partnership model with each client that solves their staffing challenges, while creating job flexibility and career opportunity for our caregivers.

The SPARC Network, a part of MAS Medical Staffing company, is seeking a compassionate, skilled Registered Nurse to join our Assertive Community Treatment Team(ACTT). The ACTT RN plays a vital role in delivering in-home and community-based nursing services to individuals living with serious mental illness. This position focuses on integrated physical and mental health care, medication management, health education and care coordination to promote client recovery, safety, and independence.

Active RN license (BSN preferred or APRN. One year of experience working with adults with serious mental illness and working knowledge of psychiatric medications. Home Care experience is helpful. Current Licensed RNto practice nursing in the State of NC. Location: This position is remote covering the greater Charlotte, NC area. As such a driver’s license and reliable transportation is required.

Medication Management: Manage the medication system in collaboration with the psychiatrist and psychiatric nurse practitioner Administer and document medications (oral and intramuscular psychotropic and medical medications) Maintain and manage a secure medication room Health Monitoring & Nursing Assessments: Perform regular nursing assessments and monitor for medical conditions and medication side effects Conduct mental status and risk assessments (SI/HI) Monitor and manage chronic conditions such as diabetes and hypertension Health Promotion & Education: Provide psychoeducation on diagnoses, medications, and symptom management Engage in preventive care and health promotion activities, including lifestyle and wellness coaching Support adherence to medication regimens through client-centered strategies (e.g., environmental cues, simplifying regimens) Care Coordination & Collaboration: Coordinate care and communicate with primary care and specialty medical providers Educate ACT team members on psychiatric symptoms, medication effects, and physical health concerns Advocate for clients' medical and psychological needs in both health and social service systems Community-Based Nursing: Deliver nursing care in diverse community settings including client homes, homeless shelters, assisted living facilities, hospitals, and other non-traditional environments Help prevent unnecessary institutionalization (e.g., hospitalization, incarceration) through early intervention and proactive support Work Structure:

CenterWell Home Health

Care Manager, Telephonic Nurse

Posted on:

July 10, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

CenterWell Home Health specializes in personalized, comprehensive home care for patients managing a chronic condition or recovering from injury, illness, surgery or hospitalization. Our care teams include nurses, physical therapists, occupational therapists, speech-language pathologists, home health aides, and medical social workers – all working together to help patients rehabilitate, recover and regain their independence so they can live healthier and happier lives.

This full time 40 hours a week position will not have a set shift. You will be scheduled Monday-Friday for 8 hour shifts between the hours of 7am-7pm EST based on business needs. This position also requires a weekend rotation every third weekend as well as a holiday rotation. When working weekends, it will allow for off-days during the week. The Clinical Care Coordinator/Care Manager, Telephonic Nurse helps to ensure optimal continuity of care for patients transitioning into and out of our services. They are responsible for being highly knowledgeable regarding post-acute levels of care, and an expert regarding CenterWell Home Health services including home health, hospice, and palliative care. The Clinical Care Coordinator is expected to communicate with the CenterWell Home Health clinical team and help facilitate timely patient follow-up for patients in need of (additional) services when appropriate. The Clinical Care Coordinator is under the general supervision of the Manager of Care Coordination and under established performance criteria. This is a work-from-home telephonic nurse position

Associates Degree required. BSN preferred. RN license in a compact state is required. May be required to obtain licensure in additional states as dictated by business needs. At least 3 years post-acute experience. Home Care or hospice experience preferred. Nursing background working across multiple areas of post-acute care. Extensive nursing experience in post-acute care. Current CPR certification. Good working knowledge of home health, hospice, and palliative care services. Good time management skills. Ability to learn and master information related to locations and services of clients. Excellent analytical and problem-solving skills. Excellent verbal and interpersonal skills. Able to communicate effectively with empathy over the phone and while interacting with others. Must read, write and speak fluent English. To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Home or Hybrid Home/Office employees will be provided with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

Act as CenterWell Home Health representative in supporting patients who have been discharged from service or for those who may need post-acute services. Able to navigate healthcare options; care services post-acute offerings, Medicare coverage, billing issues, as well as accessing healthcare resources. Utilize a variety of tools and methods to quickly provide patient options and education including but not limited to sites of service, specialty offerings, post-acute care, and other related questions. Appropriately handle a variety of customer issues including location lookup, directions, and complaints. Makes clinical level of care determination based on discussion, medical records, and any other pertinent clinical data. Matches these needs to a service site location or, if not available, look up and provide alternative services. Act as customer advocate throughout the referral process to ensure timely response and to maximize referral to admission conversion rate. Follow-up and track referral and admission outcomes. Maintains awareness and orientation to department performance objectives, meets standards, and assures patient satisfaction goals are met. Assists in the admissions process by acting as an ambassador for patients who meet the admissions requirements. Focus on placing the right patient to the right care setting at the right time Adheres to and participates in Company’s mandatory training which includes but is not limited to HIPAA privacy program/practices, Business Ethics and Compliance programs/practices, and Company policies and procedures. Reviews and adheres to all Company policies and procedures. Provide education regarding Home Health, Hospice, and Palliative Care Services. Assist with clinical eligibility review for alternate services Participates in special projects and performs other duties as assigned.

Revecore

Health Claims Specialist

Posted on:

July 10, 2025

Job Type:

Full-Time

Role Type:

License:

None Required

State License:

Tennessee

Revecore combines advanced technology, dedicated expertise, and exceptional client service to help health systems maximize reimbursements and minimize the challenges of identifying, recovering, and preventing underpayments and denials from commercial and government payers, and securing accurate reimbursement for Motor Vehicle and Workers’ Compensation accidents and Veterans Affairs Claims. Partnering with Revecore means peace of mind for our clients within these specialized claims. No other company offers the same combination of custom-designed technology, process automation, and teams of clinical and claims subject matter experts, built on over 25 years of experience. As a result, we collect more reimbursements and provide more valuable process improvements than any other firm. Steadfast dedication to our clients’ success has earned us the prestigious title of #1 Best in KLAS Complex Claims for five consecutive years, solidifying our reputation as the industry leader.

Preferred Locations: Remote, United States Job Description Ready to make a difference for hospitals while working from home? Start your next chapter at Revecore! For over 25 years, Revecore has been at the forefront of specialized claims management, helping healthcare providers recover meaningful revenue to enhance quality patient care in their communities. We're powered by people, driven by technology, and dedicated to our clients and employees. If you're looking for a collaborative and diverse culture with a great work/life balance, look no further. Starting Pay: $17.50hr The Role: Health Claims Specialist As a Health Claims Specialist at Revecore, you will bill and investigate health insurance claims to ensure maximum payment from insurance companies on behalf of our clients (hospitals and medical providers). Training: Our comprehensive training begins on your first day and lasts 8-10 business days. It is led by instructors and incorporates interactive discussions and hands-on activities to accommodate diverse learning preferences.

Is this role for you: Has experience researching and resolving claims for commercial health, Medicare, and Medicaid. Knows how to file correct UB04's and 1500 HCFA's with subrogation information to payers for payment. Having a familiarity with billing health insurance as part of auto accidents. Conducts timely follow-up activities to determine claim status and collect and/or provide information to resolve the claim. Wants to grow a career Has experience working in EPIC Has experience with Coordination of Benefits Have a working knowledge of Microsoft Office (Word, Excel, Outlook) Possess technical proficiency to work on multiple computer screens and software applications simultaneously Can maintain strong performance in a fast-paced environment with productivity metrics How we'll set you up for success: Extensive multi-week training with ongoing support from teammates following training. Access to a robust knowledgebase for continued reference in your role. Visibility to your individual performance metrics enables you to set goals. Computers and necessary work equipment are provided  Involved management who leans in to support your productivity metrics. Work at Home Requirements: A quiet, distraction-free environment to work from in your home.  A secure internet connection is required.  Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads.  The workspace area accommodates all workstation equipment and related materials and provides adequate surface area to be productive.  Must reside in the United States within one of the states listed below: Alabama, Arkansas, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maryland, Massachusetts, Maine, Michigan, Minnesota, Missouri, Mississippi, Montana, North Carolina, Nebraska, New Hampshire, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia, Wisconsin, and West Virginia

You will be busy investigating and researching health insurance claims, following up on unresolved claims to facilitate payment of claims for commercial health, Medicare, and Medicaid, ensuring maximized payments to our clients (medical providers). You will also contribute to your team with various denial reports, audits, and overall support.

Revecore

Nurse Consultant

Posted on:

July 10, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Tennessee

Revecore combines advanced technology, dedicated expertise, and exceptional client service to help health systems maximize reimbursements and minimize the challenges of identifying, recovering, and preventing underpayments and denials from commercial and government payers, and securing accurate reimbursement for Motor Vehicle and Workers’ Compensation accidents and Veterans Affairs Claims. Partnering with Revecore means peace of mind for our clients within these specialized claims. No other company offers the same combination of custom-designed technology, process automation, and teams of clinical and claims subject matter experts, built on over 25 years of experience. As a result, we collect more reimbursements and provide more valuable process improvements than any other firm. Steadfast dedication to our clients’ success has earned us the prestigious title of #1 Best in KLAS Complex Claims for five consecutive years, solidifying our reputation as the industry leader.

Preferred Locations: Remote, United States Job Description Ready to make a difference for hospitals while working from home? Start your next chapter at Revecore! For over 25 years, Revecore has been at the forefront of specialized claims management, helping healthcare providers recover meaningful revenue to enhance quality patient care in their communities. We're powered by people, driven by technology, and dedicated to our clients and employees. If you're looking for a collaborative and diverse culture with a great work/life balance, look no further. The Role: Denial Prevention Nurse Consultant Primarily responsible for thorough review of medical records and other medical documentation to determine appropriate billable services for hospital to construct an appeal for payment based on medical necessity or payer specific guidelines or criteria. Responsible for providing clients trending, revenue cycle fail point analysis, and best practice remediation recommendations. Training: Our comprehensive training begins on your first day and lasts 90 business days. It is led by instructors and incorporates interactive discussions and hands-on activities to accommodate diverse learning preferences. Must reside in the United States within one of the states listed below: Alabama, Arkansas, Delaware, Florida, Georgia, Iowa, Illinois, Indiana, Kansas, Kentucky, Louisiana, Massachusetts, Maine, Maryland, Michigan, Minnesota, Missouri, Mississippi, Montana, North Carolina, Nebraska, New Hampshire, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Virginia, Wisconsin, and West Virginia

Revecore encourages our employees to be driven and highly motivated to be successful. We get excited by candidates who: College degree or diploma from school of nursing -- must be RN Clinical nursing experience working in hospital environment, preferably in ER, Critical Care or diagnostic services Minimum 5 years of related experience and/or training in utilization review or patient accounting Are highly proficient with Interqual and MCG guidelines and demonstrate appropriate application to claim appeal argument. Understand patient accounting documents -- UB04, EOB Have a working knowledge of Microsoft Office (Word, Excel, Outlook) Possess technical proficiency to work on multiple computer screens and software applications simultaneously Are able to read and interpret an extensive variety of documents such as medical records, patient care systems, instructions, policies and procedures in written (in English) and diagram form Can maintain strong performance in a fast-paced environment with productivity metrics Have strong analytical skills, attention to detail, and problem-solving skills to identify underpayments and discrepancies Have experience with healthcare billing software and databases (EPIC, Cerner, Meditech) How we'll set you up for success: Extensive multi-week training with ongoing support from teammates following training. Access to a robust knowledgebase for continued reference in your role. Visibility to your individual performance metrics enables you to set goals. Computers and necessary work equipment are provided  Involved management who leans in to support your productivity metrics. Work at Home Requirements: A quiet, distraction-free environment to work from in your home.  A secure internet connection is required.  Home internet with speeds >20 Mbps for downloads and >10 Mbps for uploads.  The workspace area accommodates all workstation equipment and related materials and provides adequate surface area to be productive. 

Build strong, lasting relationships with clients, payors and Revecore personnel Analyze medical records or other medical documentation to validate services, tests, supplies and drugs performed for accuracy related to billing for services rendered Identify and interpret medical, radiological, laboratory or other tests and procedures as well as pharmaceutical drugs Review and understand managed care contracts, hospital billing statements/bills and insurance denials Research commercial and governmental payor policies, clinical abstracts and studies, and other documentation related to claims payment to evaluate and appeal denied claims. Perform research regarding denials and effectively communicate information to associates, colleagues, managers and clients Contact insurance company to obtain missing information, explain and resolve underpayments and/or denials and arrange for payment or adjustment processing on behalf of client Prepare and submit correspondence such as letters, emails, online inquiries, appeals, adjustments, reports and payment posting Perform denial trending for clients, identify fail points within the revenue cycle and on the payer side, and provide best practice recommendations to clients and Revecore managers. Maintain regular contact with necessary parties regarding claims status including payors, clients, managers, and other Revecore personnel Maintain confidentiality of information in compliance with company policy and HIPAA Attend client, department and company meetings Lead client meetings and perform consulting services to client's as it relates to medical necessity of services performed and proper vetting of payers criteria

Sharecare

Care Manager, Registered Nurse- Remote

Posted on:

July 10, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

Sharecare is the leading digital health company that helps people – no matter where they are in their health journey – unify and manage all their health in one place. Our comprehensive and data-driven virtual health platform is designed to help people, providers, employers, health plans, government organizations, and communities optimize individual and population-wide well-being by driving positive behavior change. Driven by our philosophy that we are all together better, at Sharecare, we are committed to supporting each individual through the lens of their personal health and making high-quality care more accessible and affordable for everyone. To learn more, visit www.sharecare.com.

Start Date: Monday September 8th, 2025 Salary: $85,000 annually, plus comprehensive benefits package The Care Manager supports the implementation of the Value Based Care Management program in an appropriate and efficient manner by providing high-quality telephonic Case or Care Management with CareFirst members. The Care Manager partners with members, caregivers, providers, and the interdisciplinary care team to ensure members have an effective plan of care and positive member experience that leads to improved health outcomes. The Care Manager will advocate and guide utilizing motivational interviewing techniques and intervene on behalf of their members to ensure successful completion of member goals, while providing Complex Case Management and/or care management support through the duration of the care plan.

Specific Skills/ Attributes: Strong motivational interviewing and case management skills. Ability to be self-directed, highly organized, multi-task capable, and proficient in problem solving skills. Ability to meet established deadlines. Exceptional oral, written, and presentation skills. Ability to effectively communicate and provide positive customer service to internal and external customers, meeting the expectations for service excellence. Successfully partner with all levels of administrative and professional personnel. Demonstrate resilience and effectively work in a fast-paced environment with frequently changing priorities, deadlines, and workloads. Success with engaging members. Outstanding customer service skills and ability to adapt approach to various personalities. Ability to extrapolate information from a variety of sources including medical records to create concise records that accurately depict the medical “story” of the member. Proficiency with data analysis and ability to organize data in support of reporting needs. Ability to proactively identify and assimilate quality improvement processes into practice. Experience with medically oriented care plan documentation. Experience working effectively within a matrix organizational design. Qualifications: Current multi-state compact Registered Nurse licensure in state of residence is required, with ability to obtain additional licenses without restriction. BSN preferred. Training in motivational interviewing preferred. Minimum 3-5 years varied clinical experience with telephonic Case Management experience strongly preferred. Demonstrates computer competencies to include electronic medical records, word processing, spreadsheet, presentation preparation, and. Demonstrated ability to learn customized computer applications. Maximize all technology inclusive of Microsoft Teams, Microsoft Word, Microsoft Excel, Microsoft Outlook, laptop computers, and all other relevant unified communication technologies. This position will be based from a home office which must satisfy all HIPAA requirements and minimum internet connectivity requirements. Ability to communicate with members, other members of the team, physicians, and plan representatives. Ability to read, analyze, and interpret common scientific and technical journals. Ability to effectively present information to audiences with a variety of knowledge/skill levels

Engage telephonically with members, caregivers, and providers to develop a comprehensive plan of care, identify key strategic interventions, and address the members needs at various stages along the care continuum. Serve as an extension of the care team by collaborating with PCPs, specialists, other clinicians, and member to meet health care goals through development and implementation of Care Plans. Assess the member’s ongoing care needs and progress towards goals throughout the plan duration and make revisions as needed to address changes in the member’s condition, lack of progress toward goals of the care plan, preference changes, and transitions in care settings. Coordinates plan of care with goals of member stabilization, decreased admissions, medication management, behavior change and ability to self-manage. Coordinate patient education in support of standards of care guidelines and related health issues using the most appropriate modality for the member. Identify relevant benefit and community resources, evaluates Social determinants of Health and facilitates referrals based on member need. Assist the member in coordination of any additional tests, images and consults with specialists. Perform medication reconciliation at the onset of care plan, after changes in health status, and every thirty days during the life cycle of the care plan, assessing for efficacy and drug interactions/side effects. Facilitate and monitor the transition of care which involves moving the member from one healthcare practitioner to another as their healthcare needs change. Implements and oversees the agreed upon plan of care as well as coordinates member follow-up post discharge. Utilize established documentation standards to maintain quality of care plan documentation to include member progress toward their established state of being and barriers to achievement of care plan objectives and outcomes. Abide by Value Based Care Management Program Description and Guidelines. Meet productivity and quality metrics as outlined by leadership for each year. Complete mandatory training and annual competency testing. Actively participate in team huddles and contribute to clinical learning. Remain current on clinical knowledge via self-directed learning.

Sharecare

Family Health Advocate - Remote

Posted on:

July 10, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

None Required

State License:

Georgia

Sharecare is the leading digital health company that helps people – no matter where they are in their health journey – unify and manage all their health in one place. Our comprehensive and data-driven virtual health platform is designed to help people, providers, employers, health plans, government organizations, and communities optimize individual and population-wide well-being by driving positive behavior change. Driven by our philosophy that we are all together better, at Sharecare, we are committed to supporting each individual through the lens of their personal health and making high-quality care more accessible and affordable for everyone. To learn more, visit www.sharecare.com.

Start Date: Monday, August 11th, 2025 Training Schedule: Monday- Friday, 8:00am-4:00pm CST *Assigned shift could be at any time between 7:00am-7:00pm CST after training The role of the Family Health Advocate is an exciting and innovative remote role newly created to provide meaningful support to members and their families through personalized resource and referral facilitation, issue resolution and healthcare navigation. Utilizing motivational interviewing and guided approaches, the family health advocate will play a critical role in supporting members to achieve their health goals, reduce costs and optimize quality care.

Specific Skills/ Attributes: Excellent multi-channel communication and problem-solving skills Ability to communicate effectively in both voice and chat channels, including critical thinking skills, effective typing, grammar, and spelling skills. Qualifications: High school / GED diploma 2-yr associates degree in healthcare/health sciences OR equivalent experience in healthcare, preferably helping members navigate benefits and claims, OR held one or more of the following positions: Health Guide/Advocate/Navigator Medical Assistant Pharmacy Technician Phlebotomy Technician Electrocardiograph (EKG) Technician Patient Care Technician (PCT) Physical Therapy Assistant Nursing Assistant Medical Secretary/Clinic Manager Radiology Technician Home Health Aide Occupational Therapist Aide Medical Coder Dental Assistant Experience in customer service in a healthcare contact center, provider office, or healthcare institution Experience in successful resolution of high level/sensitive customer service issues.

Answer inquiries from members (via voice and chat) for the following: Help with eligibility, benefit education, open enrollment / new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, dental, and vision plans Provider search (PCP, specialty, and facility), focused on healthcare cost and quality, and present premier provider options, including but not limited to medical, dental, and vision plans Support for spending accounts, pharmacy, and disability. Assistance with incentives and rewards Aid with ordering durable medical equipment (DME) Community resource search Member preferences management Coordinate issue resolution with providers, payers or 3rd parties for: Claims adjustments Grievances and appeals submissions Utilization management intake or status Complex pharmacy inquiries Complex spending account inquiries Provide proactive care guidance for various value-add opportunities: Guidance on closing care gaps (e.g., No PCP, discussing switching from low quality PCPs to high quality PCPs, reminder for completion of health risk assessment, reminders for exams/tests due) Proactive benefits education for procedures Preparing members for scheduled procedures/admissions Referring members to available 3rd parties for care management and second opinion. Referring members to Clinical Advocates (Nurse) for conditions that require clinical care and case management assistance Primary duties include but are not limited to: Understands and communicates the benefit design packages to members as defined by employer. Interacts with members verbally and in written form to ensure appropriate engagement is achieved. Is fully versed in and can explain plan benefit design, handles benefit and enrollment issues. Drive member's engagement into appropriate programs and offerings. Be an educator on health care related inquiries.

Sharecare

Certified Health Coach - Remote

Posted on:

July 10, 2025

Job Type:

Full-Time

Role Type:

Coaching

License:

None Required

State License:

Georgia

Sharecare is the leading digital health company that helps people – no matter where they are in their health journey – unify and manage all their health in one place. Our comprehensive and data-driven virtual health platform is designed to help people, providers, employers, health plans, government organizations, and communities optimize individual and population-wide well-being by driving positive behavior change. Driven by our philosophy that we are all together better, at Sharecare, we are committed to supporting each individual through the lens of their personal health and making high-quality care more accessible and affordable for everyone. To learn more, visit www.sharecare.com.

Start Date: Monday, June 9th, 2025 Shift: Monday - Friday: Must be open to any shift between the hours of 10:30am – 8pm CST. It is required to work every fourth Saturday from 8:00am-4:30pm CST Training: Training will be a duration of 6 weeks from 8am – 4:30pm CST *Due to the structured training schedule, new hires are unable to miss any days of training. Compensation: Hourly Rate: $21.50 or $25 including certification through NBC-HWC or CHES only The Health Coach is part of a multi-disciplinary team that is responsible for improving both the individual health and wellness of program participants and the overall health status of a client's population. The Health Coach is an integral part of an overall client specific Health and Care Support Team that engages and supports members with improving lifestyles and behaviors that put them "at risk" of developing chronic or disease conditions. The Health Coach looks to be a positive change agent in helping members alter behaviors that lead to better health and reduction / elimination of identified risk factors. A Health Coach is supervised by an Operations Coach Manager.

Specific Skills/ Attributes: Effective interpersonal and communication skills required Understand directions and communicate/respond to inquiries Enthusiastically inspires members to change behaviors and to see possibilities Ability to learn to coach effectively using motivational interviewing Flexibility to work any shift (typically an evening shift) or change shifts based on business needs. This also includes availability to work rotating Saturdays Qualifications: Bachelor's degree in health-related field required (i.e., Psychology, Nutrition, Exercise Science, etc.) 2+ years prior health coaching experience may substitute for a degree 1 -2 years of related experience required; experience in a customer service role preferred Experience with benchmarks and contact center metrics preferred, including adherence to schedule Proficiency in computer data entry and Microsoft Office Ability to coordinate telephonic communication with program participants while simultaneously navigating software platform and entering data, for extended periods of time Knowledge ability to quickly learn information around lifestyle related topics such as: smoking cessation, weight management, nutrition, exercise, stress reduction and sleep desired Ability to work independently and prioritize a moderate workload with minimal supervision Adaptability to schedule changes on an as-need basis Ability to multitask with members and operationally with managers and support staff Hard-wired internet connection is necessary as WIFI is not permitted

Participating in the following types of telephonic calls: Engagement (inbound and outbound)- contacting eligible participants to inform them of the program offering and enroll them in the program Coaching (inbound and outbound)- providing individualized behavior change coaching to reduce or eliminate high risk behaviors and encourage adoption of habits that are conducive to a higher quality of life Chase (outbound)- reaching out to members who are enrolled in coaching, but do not have a scheduled call Coordinate delivery of services and care with other members of a multi-disciplinary care team, including nurses, pharmacists and external vendors. Support operational aspects of the assigned area to meet the organization's customer requirements, which can include multiple customers. Adhere to a schedule and caseload to support success and connectivity of member interaction. Caseloads may be a 1:1 model or team based. This is determined by the business/client need. Participate in daily and monthly meetings for updates and to present findings and insight Note and track the members' progress and efficacy of program

Sharecare

Disease Management Nurse - Remote

Posted on:

July 10, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Sharecare is the leading digital health company that helps people – no matter where they are in their health journey – unify and manage all their health in one place. Our comprehensive and data-driven virtual health platform is designed to help people, providers, employers, health plans, government organizations, and communities optimize individual and population-wide well-being by driving positive behavior change. Driven by our philosophy that we are all together better, at Sharecare, we are committed to supporting each individual through the lens of their personal health and making high-quality care more accessible and affordable for everyone. To learn more, visit www.sharecare.com.

The Disease Management Nurse has the responsibility for supporting the goals and objectives of the Disease Management program by providing high quality telephonic and omni - channel support in an appropriate, efficient and cost-effective manner while ensuring high quality care. The Disease Management Nurse works with participating members to become empowered and active participants in their own healthcare management for their chronic condition. By providing health education and resources, reviewing the provider’s plan of care with the member to ensure understanding and adoption, and utilizing motivation interviewing and behavior change techniques, the nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse is also responsible during their interactions with participants for identification of those who are at risk for increasing acuity, and for educating the participant about that risk and if necessary and with the participants permission contacting their Primary Care Provider according to the disease management program intervention guidelines. A Disease Management Nurse is supervised by an Operations Manager (OM). All Sharecare clinicians are required to participate in the orientation and to take the pre and post tests to review competency during orientation. Yearly competency tests are required for all Sharecare clinicians. Start Date: Monday, August 25th, 2025 Training: 4 weeks from 8am – 4:30pm CT. Due to the structured training schedule, new hires are unable to miss any days of training for the first 60 days of employment. Shift: Monday - Friday: Must be open to any shift between the hours of 10:30am – 9pm CST. It is required to work every fourth Saturday from 8:00am-4:30pm CST ***A compact nursing license is required for this position

Specific Skills/ Attributes: Advanced active listening skills. Prior experience and proficiency with motivational interviewing and behavior change preferred. Ability to thrive in a telephonic and omni-channel environment, while meeting quality and productivity metrics. Ability to be self-directed, highly organized, and proactive. Ability to proactively identify and assimilate quality improvement processes into practice. Effective communication skills and ability to provide positive customer service to internal and external customers. Proven success in influencing patient outcomes. Qualifications: This position requires a responsive, committed individual who recognizes the impact of the health care delivery system on the clinical and financial outcomes of the member population and can identify and take action to facilitate system improvements. 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. Current Registered Nurse multi-state compact license in the state in which they reside and able to obtain additional state licensure; BSN preferred. Minimum of 3 years recent experience in a clinical setting. Basic knowledge of physiology and chronic disease appropriate for an RN. Language Skills: Ability to communicate with members, other members of the team, physicians, and plan representatives. Effective oral and written communication skills. Ability to read, analyze, and interpret common scientific and technical journals. Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exits. Ability to interpret and organize data in an effective and useful manner; ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Computer Skills: To perform this job successfully, an individual should have basic computer skills with the ability to learn and utilize new aspects of software as developed. Typing should be at a rate of 40 WPM minimum. This position will be based in a home office which must satisfy all HIPAA requirements.

Reviews status of participant’s preventive health exams as defined by the disease-specific Standards of Care guidelines to close any existing gaps in care. Contacts participant by telephonic dialer system per Disease Management program design and call cadence for education, assessment, intervention, and behavioral goal setting. Identifies educational needs of participant and facilitate educational opportunities (i.e., education materials; refer to employer or health plan specific vendors or other Sharecare programs as appropriate). Reviews participant’s functional status, formal and informal family support system, determining participant’s desired outcome of care and needs for participant education. Develops in collaboration with participant a care plan addressing their total healthcare needs.. Identifies participant barriers to accessing health care services and advises them of existing benefits and local resources available to help the participant to remove system barriers. Makes referrals to dietician or coach colleagues to ensure continuity of care for participant. Accepts warm transfer calls from non-RN colleagues for assessment and/or additional discussion with participant when necessary.

Sedgwick Government Solutions

Telephonic Triage Nurse Case Manager (Remote)

Posted on:

July 9, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Sedgwick Government Solutions is a fully owned subsidiary of Sedgwick. Sedgwick is a leading global provider of technology-enabled risk, benefits, and integrated business solutions. Taking care of people is at the heart of everything we do. Millions of people and organizations count on Sedgwick each year to take care of their needs when they face a major life event or something unexpected happens. The company provides a broad range of resources tailored to clients' specific needs in casualty, property, marine, benefits, and other lines. At Sedgwick, caring counts; through the dedication and expertise of more than 27,000 colleagues across 65 countries, the company takes care of people and organizations by mitigating and reducing risks and losses, promoting health and productivity, protecting brand reputations, and containing costs that can impact the bottom line.

Telephonic Triage Nurse Case Manager Remote (New York/Florida) Are you looking to make a difference by providing high-quality care with a personal touch that impacts the lives of workers? Would you like to be part of a team focused on empowering and sustaining health by supporting the occupationally injured? Do you have the professional nursing, case management experience, and licenses necessary to help further establish Sedgwick Government Solutions as a leading case management company? We believe in helping those with work-sustained illnesses and injuries to live their best life by providing care, health management, and support through our highly skilled team of home-based Telephonic Triage Nurse Case Managers. As a Telephonic Triage Nurse Case Manager with an active RN license from Puerto Rico residing in the continental US, you will work independently in your home office setting while still being part of a supportive team nationwide. Through the application of a unique mix of experience and certification, you will support federal workers with diagnoses in the fields of occupational-related injuries and illness, emphasize timely facilitation and coordination of diagnosis, and be involved in the acute phases of treatment and support. Your broad responsibilities will include developing a case management plan for each injured worker throughout the various stages of recovery while tracking in a database the patient's improvement goal. You will implement integrated medical disability case management services to prevent, minimize, or overcome a disability, as well as provide medical expertise and serve as the critical communication link between the parties involved in any medical disability case.

Bachelor of Science in Nursing Must have an active RN License from Puerto Rico, and reside in the continental US Compact License Required National certification in case management or a related field is preferred in one of the following areas: Occupational Health (COHN); Case Management (CCM), Insurance Rehabilitation (CIRS/CRRN), Disability Management (CDMS), and/or Nurse Case Manager Board Certified (ANCC/ANA). National certification in a related field or obtained within 12 months of the date of hire. 5 years of related clinical experience, including: Minimum of 2 years in adult medical/surgical nursing Minimum of 2 years in case management within the workers’ compensation arena Minimum of 1 year in adult medical/surgical nursing Minimum of 3 years in case management within the workers’ compensation arena Experience with the Federal Employee Compensation Act (FECA) and FECA-related issues preferred. Demonstrated ability to work independently and with others Attention to detail, timetables, and commitment to completing tasks Experience with Microsoft Windows and computer savvy Must be well organized, efficient, and able to prioritize competing priorities and make sound judgments Ability to define and resolve problems and challenges in a workplace setting Responsible for having reliable High-Speed Cable or Fiber Optic Internet service Ability to utilize telehealth technologies (video, chat, etc.), when appropriate, for a variety of clinical care and care management services Must have Excellent People Skills and Communication Skills via Phone, email, Text, written, and Verbal formats, and provide 24-hour follow-up to all communication Before hiring and training, you must be able to pass a preliminary credit and background check

Accepts assignments based on referrals from DOL with service period limitations Responsible for coordinating timely contact and information sharing with the injured worker, treating provider, and the Agency. Accurate, timely documentation of contact attempts and communications in assigned case management systems, as identified by SGS, as well as DOL Conduct and document an assessment of each injured worker/employee, including (as appropriate) regarding clinical and non-medical obstacles. psychosocial status, consumer knowledge, education needs to health status and treatment plan, past relevant history, and possible non-medical impediments to successful resolution Collaborate and communicate with the injured worker/employee, providers, employer, or the employer's representative in the execution of a plan for return to work or other productive activity. Identify and obtain any required or outstanding medical documentation in support of the individual's plan for a return to work or other productive activity. Understand and implement criteria for the discharge of injured workers from TN services Identify cases that would benefit from additional case management services, such as assignment of a DOL Field Nurse Promote goodwill by assisting all parties involved with issues related to the injured worker/employee, provider relations, and OWCP coordination, as applicable. Understand the organization's quality management program and the case manager's role within that program Is an effective team member; supports the team by pitching in at any level and effectively working across the organization to meet the needs of the business Take ownership of personal actions and outcomes. Embrace change; maintain an open mind, and be flexible and adaptable in the face of ambiguity and change Ability to work independently, multitask, and adjust priorities Proactively seek opportunities to increase knowledge, skills, and abilities May perform other duties, as needed, to meet the needs of the business Ability to utilize a case management system, Electronic Medical Record, or other electronic platform Ability to utilize telehealth technologies (video, chat, etc.), when appropriate, for a variety of clinical care and care management services. Demonstrated ability to use Microsoft applications and demonstrate basic electronic technology understanding Computer literacy, including MS Word, Excel, and Outlook

Sutter Health

RN Intake, Home Health, Work From Home

Posted on:

July 9, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Utah

Position Overview: The Home Health Clinical Referral Nurse serves as the initial point of contact for potential home health patients, working closely with our clerical home health coordinators. This role is pivotal in managing new referrals and ongoing follow-ups, acting as a liaison between patients, families, and referral sources. This position is eligible for mobile/remote work if you meet eligibility requirements. Remote/Mobile Work: Eligible for work from home with reliable power and internet services and if you meet eligibility to work remote (example, dedicated office with door that closes, cannot be a primary care-giver during business hours. On-Site Requirements: Occasional on-site work may be required for training or other purposes if within driving distance to the center. Applications accepted only from the following states: AZ, OR, AR, ID, TN, UT, NV, & TX FULL-TIME DAY SHIFTS: Varied Weekdays / Rotating Weekends

Graduate of an accredited school of nursing CERTIFICATION & LICENSURE: Valid and unrestricted RN license in your state of residence. SCAH After Hours Department: RN-Registered Nurse of California within 90 days TYPICAL EXPERIENCE: 2 years recent relevant experience. SKILLS AND KNOWLEDGE: Must have the clinical knowledge and critical thinking skills to effectively plan and provide coordination of patient care consistent with standards and regulations Must have exceptional interpersonal and customer services skills Must be able to effectively solve unique problems as they arise or identify when to consult the supervisor Must have knowledge of current Hospice/Home Health admission criteria; Medicare, Medi-Cal, Commercial, State and Federal regulations Familiarity with ICD-10 coding preferred but not essential Must be able to demonstrate problem-solving abilities as well as telephone, interpersonal, verbal and written communication skills in English Commitment to teamwork and customer service, both internally and externally, is required Must have proven /proven data entry and general computer skills Must be able to demonstrate proficiency (after training and introductory period) in efficient use of electronic medical record systems Must be able to flex with the increased workflow when census is higher and recognize urgency of each task Must be flexible with schedule including, but not limited to, the ability to participate in department rotation for weekend coverage if needed Must be able to drive to designated SCAH location(s) for meetings, training, and needs as designated by business needs

Referral Management: Receive and process referrals for patient care, ensuring timely and consistent admissions. Communication: Make and take calls for new referrals and follow-ups, maintaining clear communication with patients, families, and referral sources. Collaboration: Work closely with referring hospitals, physicians, board and care facilities, skilled nursing facilities, and other healthcare providers. Data Entry: Enter referral information into the Electronic Medical Records (EMR) system and create initial orders to facilitate the start of care. This is a fast-paced work environment that requires our nurses to be able to work in 2 separate charting systems, manage emails, communicate with multiple teams and leaders, and operate Excel documents. Customer Service: Utilize and promote excellent customer service skills in all interactions. Team Interaction: Collaborate with referral center staff, home health, Advanced Illness Management (AIM), and hospice staff across offices.

WPS—A health solutions company

Medical Review Nurse Analyst

Posted on:

July 9, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Wisconsin

WPS Health Solutions is a leading not-for-profit health insurer and federal government contractor headquartered in Wisconsin. WPS offers health insurance plans for individuals, families, seniors, and group health plans for small to large businesses. We process claims and provide customer support for beneficiaries of the Medicare program and manage benefits for millions of active-duty and retired military personnel across the U.S. and abroad. WPS Health Solutions has been making health care easier for the people we serve for more than 75 years. Proud to be military and veteran ready.

The Medical Review Nurse Analyst is responsible for conducting clinical reviews of medical records to ensure compliance with regulatory and payer guidelines. This role ensures that providers are billing and being paid appropriately for services provided based on Medicare guidelines. The Medical Review Nurse Analyst reviews claims and delivers provider education on current billing and documentation requirements. Salary Range $66,000 - $70,000 The base pay offered for this position may vary within the posted range based on your job-related knowledge, skills, and experience. Work Location We are open to remote work in the following approved states: Arizona, Colorado, Connecticut, Florida, Georgia, Illinois, Indiana, Iowa, Michigan, Minnesota, Missouri, Nebraska, Nevada, New Jersey, North Carolina, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin

Associate’s Degree in Nursing (ASN) or Bachelor’s Degree in Nursing (BSN). Active RN license, applicable to state of practice in good standing. 1 or more years of clinical experience in a healthcare setting. Excellent written and verbal communication skills, with the ability to communicate complex medical information clearly and concisely. Strong attention to detail and organizational skills to manage multiple cases simultaneously. Basic knowledge and understanding of medical/clinical review processes. Solid computer skills with experience working in multiple on-line systems including MS Outlook, Teams, OneNote, Word, and Excel. Preferred Qualifications: Experience working for a Medicare Administrative Contractor (MAC). Basic Medicare knowledge and/or experience. Remote Work Requirements: Wired (ethernet cable) internet connection from your router to your computer High speed cable or fiber internet Minimum of 10 Mbps downstream and at least 1 Mbps upstream internet connection (can be checked at https://speedtest.net) Please review Remote Worker FAQs for additional information

Reviewing submitted claims to ensure that billed services are medically necessary and correctly coded based on Medicare guidelines. Preparing written clinical summaries and determinations with clear rationale for approvals, denials, or modifications. Educating providers in accordance with the Targeted Probe and Educate (TPE) program. Monitoring the progress of assigned providers and educate on current billing and documentation requirements. Ensuring compliance with federal and state regulations, CMS guidelines, and company policies. Staying current on clinical guidelines, medical policy updates, and industry best practices.

HCA Healthcare

NICU Utilization Review Services RN

Posted on:

July 9, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

HCA Healthcare is one of the nation's leading providers of healthcare services with 190 hospitals and 2,400+ sites of care, including surgery centers, freestanding ERs, urgent care centers, home health and hospice agencies, and physician clinics, in 20 states and the United Kingdom. Every day, more than 316,000 colleagues go to work with a collective focus: our patients. Our focus positively impacts the care experience at the bedside and beyond. As a learning health system, HCA Healthcare analyzes data from more than 44 million patient encounters each year. This data helps develop technologies and best practices that improve patient care. We also share our learnings with the larger healthcare community and government agencies to improve care everywhere.

This position will focus on initial and continued to stay utilization review as needed for authorization procurement and mitigation of concurrent denials. This involves assessing the medical record for appropriateness and level of care provided, including assessment of treatment modalities, medications, services, and application of treatment protocols. Remain current with HCA education standards and guidelines, such as annual InterQual education, ongoing Midas education, and Midas worklist rules. Maintain nursing licensure for assigned geographical market and productivity.

RN Associates degree in Nursing or higher required 1+ year(s) of experience in InterQual preferred Strong clinical background with 1-4 years of nursing experience required 1 – 4 years of relevant case management/utilization review experience preferred Registered Nurse - Currently licensed as a registered professional nurse in the state in which he or she resides and practices, in accordance with law and regulation required. Multi-state nursing licensure for compact states required

Conduct medical record review, validate admission status order, conduct a medical necessity review and provide clinical information to the payor Document all efforts to gain authorization and payor communications, confirming all days authorized or denied and document in Midas Utilize critical thinking skills to review and apply medical necessity criteria • Proficient in the application and use of InterQual Analyze documentation of clinical care from the electronic medical record Exhibit determined and assertive verbal and written communication skills when interacting with payors Demonstrate knowledge and effective use of multiple applications, systems, and resources Example, but not limited to: Call Recording, WebEx Teams, Electronic Health Records, Payor portals, Right Fax, SharePoint sites and Onbase Communicate with physicians regarding patient status, clinical documentation, and concurrent denial mitigation strategies Practice adherence to HCA UR guidelines and practice standards Ability to work independently, show initiative, and work with minimal supervision in a work-from home environment

Bethesda

LPN Rehab Nurse

Posted on:

July 9, 2025

Job Type:

Part-Time

Role Type:

License:

LPN/LVN

State License:

Missouri

Bethesda Brings out the Best in Talented, Caring People! At Bethesda, more than 1,200 employees dedicate their careers to improving the lives of others. As a team member at Bethesda, you'll enjoy great benefits such as: 403b, daily pay, bonuses, career advancement opportunities, and holiday pay. Medical, dental, vision, prescription, and life insurance available for regular status full and part time employees.

This position assesses, plans, implements and evaluates nursing care consistent with his/her educational training. Responsible for adhering to all established Standards of Nursing Practices and the organization's policies and procedures.

Education from an accredited school of nursing that results in becoming a Licensed Practical Nurse Long-term care/Rehab/Assisted Living experience preferred Current license in the state you will be working as a Licensed Practical Nurse IV Certification required or willing to obtain within six months of employment Current CPR/AED Certification required or willing to obtain within six months of employment Must be able to assess the basic nursing care needs of the geriatric resident Must possess excellent communication skills to interact with residents, visitors and staff Excellent time management and organizational skills are required Must possess critical thinking skills

LHC Group

Support on Standby Generalist-Part Time (Every Sat/Sun & Holidays)

Posted on:

July 9, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

None Required

State License:

Georgia

LHC Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. At LHC Group we are proud to offer benefits that support your physical and emotional wellbeing. Review LHC Group's comprehensive benefits and perks: https://bit.ly/LHCGBenefits

Provides non clinical support to inbound callers to agencies by accessing LHC system and applicable patient documentation. Works in coordination with clinical triage team, and other home office support teams. Has excellent communication skills written and verbally. First call resolution of patient concern if applicable by protocols and best practices. Ensures customer concerns are documented and addressed for communication with agencies. Primary job functions do require speaking on the phone with with patients, vendors and LHC Staff. This position will work every Saturday/Sunday & holidays. 10 or 12 hour shifts on Saturday & Sunday to total 20-24 hours per week.

Formal Education: High School Diploma or equivalent Experience: 1 year License, Registration, and / or Certification Requirement: No High School Diploma or equivalent Excellent customer service and communication skills Must have strong computer skills and excellent telephone communication skills and be able to type. Strong problem solving skills and analytic skills Must meet remote work policy requirements Willing to work weekings, weekends, holidays, or as needed

Answer, triage and document inbound/outbound calls following protocols and best practices. Escalates appropriate requests to leader when a resolution is not identified by user. Work in conjunction with other Home Office support departments. Complete accurate and through documentation. Proficient knowledge of technical systems. Monitors communication systems throughout shift. Prioritizes incoming task according to patient needs. Meets minimum productivity requirements determined by Director. Will remain current with all required continuing education and compliance training mandated by the company and/or by supervisor Participates in department staff meetings and educational sessions. Other duties as assigned by leadership.

LHC Group

Operations Leadership Support Specialist (Hospice)

Posted on:

July 9, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Compact / Multi-State

LHC Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. At LHC Group we are proud to offer benefits that support your physical and emotional wellbeing. Review LHC Group's comprehensive benefits and perks: https://bit.ly/LHCGBenefits

The Operations Leadership Support Specialist provides support as an ED, DCO, PCM either onsite or remote based on assignment. This role will also be available to educate and support employees of new acquisition sites on all aspects of LHC processes, policies, and applicable clinical software in a professional, clear, and concise way. The integration activity may require both onsite and remote support based on the need. High Volume Travel Schedule (Monday - Friday) -Nationwide RN Compact Licensure Required

Current RN licensure in state of practice with at least 1 year experience as a manager of care in Hospice. Current CPR certification required Clinical Competencies Current Driver's License, vehicle insurance, and access to a dependable vehicle or public transportation CA: One year prior professional nursing experience. LA: At a minimum, one year of clinical experience. RN licensure must have no restrictions.

Responsible for performing duties defined by the Hospice ED /DCO, PCM job descriptions. Provides on site or remote support based on agency needs and in coordination with local and regional leadership. Remote Assignments are occasional and delegated by Supervisor. Responsible for the education and communication of LHC operational processes and policies. Responsible for the education and communication of applicable EMR processes in assigned locations. Responsible for the education and communication of operational metrics/analytics/KPls. Ability to independently plan for an integration to include schedules, education, equipment, materials and all other items applicable within the process. Works in collaboration with the operation teams to identify training needs, develop training plans specifically designed to meet identified needs and ensures understanding and application of relevant training. Any other duties as assigned.

Evolent

Clinical Reviewer, Nurse, Pain MNGT - Night Shift 3-11:30 PM CT

Posted on:

July 9, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Virginia

Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health conditions. Working across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion we would want for our loved ones. Evolent employees enjoy work/life balance, the flexibility to suit their work to their lives, and autonomy they need to get things done. We believe that people do their best work when they're supported to live their best lives, and when they feel welcome to bring their whole selves to work. That's one reason why diversity and inclusion are core to our business. Join Evolent for the mission. Stay for the culture.

As a Pain Management Clinical Reviewer, Nurse, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients’ lives, in a non-clinical environment. You can enjoy better work- life balance on a team that values collaboration and continuous learning while providing better health outcomes. Collaboration Opportunities: As a Clinical Reviewer, Nurse, you will routinely interact with leadership and management staff, other CR’s (Clinical Reviewers), providers, office staff and Field Medical Directors.

Current, unrestricted state licensure as a Registered Nurse Associate or Bachelors in Nursing (Must be a Registered Nurse) Strong interpersonal and communication skills Proficient computer skills; must be able to talk and type simultaneously 5+ years clinical experience is preferred Not under current exclusion or sanction by any state or federal health care program, including Medicare or Medicaid, and is not identified as an “excluded person” by the Office of Inspector General of the Department of Health and Human Services or the General Service Administration (GSA), or reprimanded or sanctioned by Medicare. No history of disciplinary or legal action by a state medical board Must be able to work evening hours Wednesday-Friday 5pm or after CST Technical Requirements: We require that all employees have the following technical capability at their home: High speed internet over 10 Mbps and, specifically for all call center employees, the ability to plug in directly to the home internet router. These at-home technical requirements are subject to change with any scheduled re-opening of our office locations.

Functions in a clinical review capacity to evaluate all cases, which do not pass the authorization approval process at first call while promoting a supportive team approach with call center staff. Clinical Reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. Reviews charts and analyzes clinical record documentation in order to approve services that meet clinical review criteria. Conducts ongoing activities which monitor established quality of care standards in the participating provider network and for other clinical staff. Converses with medical office staff to obtain additional pertinent clinical history/information; notifies of approvals and denials, giving clinical rationale, while providing optimum customer service through professional/accurate communication and maintaining NCQA and health plans required timeframes. Documents all communication with medical office staff and/or treating provider. Practices and maintains the principles of utilization management by adhering to policies and procedures. Participates in on-going training programs to ensure quality performance in compliance with applicable standards and regulations, as well as, being audited to ensure guidelines are applied appropriately.

Interim HealthCare

Registered Nurse (RN)

Posted on:

July 8, 2025

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

RN

State License:

North Dakota

Interim HealthCare is America’s leading provider of home care and healthcare staffing. As a family owned, women owned, and veteran owned business; we are also Medicaid/Medicare Certified. We strive to hire caring and compassionate individuals who wish to make a difference in their community through strong leadership and dedication to the healthcare field.

Flexible Schedules (You provide us with your availability, and we schedule accordingly!) What do we offer? PRN / PART-TIME with opportunities to grow hours; DAYS / EVES / NOC Registered Nurse (RN) Pay Rate: $45-$50 per hour, paid weekly 24/7 on call representative from Interim Healthcare Health Insurance (1 year full-time status and other stipulations apply) Company match 401K Retirement Plan

Six months’ experience in a comparable Registration Nurse job classification, current North Dakota RN license CPR certification 2 professional references required Background check and drug screen completed Driver’s License and current car insurance and 18 years of age

Care for patients with a variety of illnesses, injuries and diseases in facilities such as clinics, medical offices, assisted living facilities, nursing homes, hospitals and schools Examine patients, conduct assessments, document condition and report changes to physician Review, interpret, transcribe and carry out physician orders for patients Administer medication, operate medical equipment and maintain a safe environment

IntellaTriage

Remote Hospice Triage RN- PT 1-2 shift 3:30p-12a rotating Sat & Sun 3:30p-12a

Posted on:

July 8, 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 1-2 evening shift weekly 3:30p-12a 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

RemoteWorker US

Case Management - Nurse, Senior

Posted on:

July 8, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

The Home of Remote Workers in the United States We understand that outstanding performance begins with outstanding hiring, and this approach sits at the head of everything we do. Our focus is on excellent customer service, and on delivering an effective solution that targets the best talent more efficiently. The friendly recruitment experts behind Remote Worker have many years’ experience in matching candidates to their perfect job, we are specialists in bringing recruiters and job seekers together successfully! We have a huge range of jobs on offer right now, join our talent database and receive job alerts today!

The Care Management team will serve to support the mission of the department, which is to provide support to patients in maintaining health and wellness in the outpatient setting. The Case Management – Nurse, Senior will report to the Manager of Care Management. In this role you will play a pivotal role in assessing member needs, providing clinical education, as well as care coordination with providers, medical groups, and community resources. You will be responsible for managing and coordinating patient care, ensuring that our members receive the highest quality of care and services. Care Managers perform care management (CM) activities demonstrating clinical judgement and independent analysis, collaborating with members and those involved with members’ care including clinical nurses and treating physicians.

Requires a current and valid CA RN License or valid RN license(s) from other state(s). Preferred licensure from a compact state. If assigned to another state, must maintain an active, unrestricted RN license in assigned state(s) or the ability to obtain required RN license (in addition to primary state license) within 90 days of hire Bachelor of Science in Nursing or advanced degree preferred Certified Case Manager (CCM) Certification or is in process of completing certification when eligible based on CCM application requirements Requires 5 years experience in nursing, healthcare, or related field A minimum of 3 years managed care experience in inpatient, outpatient, or managed care environment preferred Health insurance/managed care experience preferred Transitions of care experience preferred Strong knowledge of healthcare delivery systems, managed care principles, and care coordination Excellent communication skills

Determine appropriateness of referral for CM services, mental health, and social services Assess members health behaviors, cultural influences and clients belief/value system. Evaluate all information related to current/proposed treatment plan and in accordance with clinical practice guidelines to identify potential barriers Research and design treatment/care plans to promote quality of care, cost effective health care services based on medical necessity complying with contract for each appropriate plan type. Adjust plans or create contingency plans as necessary Identify appropriate programs and services that align with member needs and preferences Initiate timely Individualized Care Plans (ICP) based on Health Risk Assessment (HRA) completion, participation in and documentation of Interdisciplinary meetings (ICT), assisting in transitions of care across all ages Provide Referrals to Quality Management (QM), Disease Management (DM) and Appeals and Grievance department (AGD) Conduct member care review with medical groups or individual providers for continuity of care, out of area/out of network and investigational/experimental cases Research opportunities for improvement in assessment methodology and actively promote continuous improvement. Anticipate potential barriers while establishing realistic goals to ensure success for the member, providers, and BSC Determine realistic goals and objectives and provide appropriate alternatives. Actively soliciting client’s involvement Recognize need for contingency plans throughout the healthcare process Provide education and support to members and their families regarding health conditions, treatment options, and community resources Follow up with members as appropriate to ensure they have successfully connected with recommended programs and services

Berkley Medical Management Solutions (a Berkley Company)

Telephonic Nurse Case Manager

Posted on:

July 8, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

Berkley Medical Management Solutions (BMMS) provides a different kind of managed-care service for W.R. Berkley Corporation. We believe focusing on an injured worker’s successful and speedy return to work is good for people and good for Berkley’s insurance operating units. BMMS was first started in 2014 by reimagining the relationship between medical need and technology to deliver the best outcome for injured workers and Berkley’s operating units. Our goal was clear: combine solid clinical practices, proven return-to-work strategies and robust software into one system for seamless management of workers’ compensation cases. To get it right, we started with a flexible technology platform that allowed for impressive customization without sacrificing the ability for expansion and continued innovation. We deploy integrated systems to give W.R. Berkley Companies recommendations and professional services for managing each individual case in an efficient and appropriate manner. The power of our technology takes medical bill-review services and clinical advisory services to a new level. Our unique marriage of technology, software platforms, data analytics and professional services ensures we provide Berkley’s operating units with reliable results, and reduced time and expenses associated with case management.

Qualifications: Minimum 2 years of experience in workers compensation insurance and medical case management preferred Minimum of 4 years medical/surgical clinical experience required Exhibit strong communication skills, professionalism, flexibility and adaptability Possess working knowledge of medical and vocational resources available to the Workers’ Compensation industry Demonstrate evidence of self-motivation and the ability to perform case management duties independently Demonstrate evidence of computer and technology skills Oral and written fluency in both Spanish and English a plus Education: Graduate of an accredited school of nursing and possess a current RN license RN compact license preferred, CCM preferred, Bachelor of Nursing preferred

Coordinate and implement medical case management to facilitate case closure Timely and comprehensive communication with with employers, adjusters and the injured workers. Assess appropriate utilization of medical treatment and services available through contact with physicians and other specialist to ensure cost effective quality care Review and analyze medical records and assess data to ensure appropriate case management process occurs while providing recommendations to achieve case progress and movement to closure Responsible for assigned caseloads, which may vary in numbers, territory and/or by state jurisdiction Acquire and maintain nursing licensure for all jurisdictions as business needs require Coordinate services to include home services, durable medical equipment, IMEs, admissions, discharges, and vocational services when appropriate and evaluate cost effectiveness and quality of services Document activities and case progress using appropriate methods and tools following best practices for quality improvement Reviewing job analysis/job description with all providers to coordinate and implement disability case management. This includes coordinating job analysis with employer to facilitate return to work. Engage and participate in special projects as assigned by case management leadership team Occasionally attend on site meetings and professional programs Foster a teamwork environment Maintaining and updating evidence based medical guidelines (such as Official Disability Guidelines, MD Guidelines and all required state regulated guidelines) in reference to the injured worker treatment plan and work status. Obtain and maintain applicable state certifications and/or licensures in the state where job duties are performed. Obtain case management professional certification (CCM) within 2 years of hire date Earn Continuing Education Units to maintain certifications and licensures

IntellaTriage

Remote Hospice Triage RN- FT 10:30p-7a + rotating Sat & Sun 11:30p-8a CST

Posted on:

July 8, 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 3 shifts weekly 10:30p-7a CST (shift times are set/ week day flexes) Work every other weekend, both Saturday and Sunday 11:30p-5a 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

Humana

Pre-Authorization Nurse 2

Posted on:

July 8, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

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: Bachelor's degree Less than 5 years of technical experience Active RN license in the state(s) in which the nurse is required to practice Ability to be licensed in multiple states without restrictions A minimum of three years varied nursing experience Proficient with MS Office products including Word, Excel and Outlook Ability to work independently under general instructions and with a team Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications: 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 or Interqual guidelines 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 recommended; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

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.

1ST CALL TRIAGE LLC

Telephone Triage Registered Nurse - Pediatrics

Posted on:

July 8, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

California

We are seeking a highly skilled Registered Nurse with pediatric experience to join our remote telephone triage team. As a remote triage nurse, you will be responsible for providing exceptional patient care over the phone for busy pediatric clinics. In addition, you'll assist with medication refills, prior authorizations, referrals, and other patient needs. Your primary goal will be to ensure that patients receive the appropriate medical attention they need in a timely and efficient manner. You will work closely with physicians and other healthcare professionals to provide the best possible quality care to patients. This is a full-time position. You will be expected to work every Monday - Friday 8-5p PST/11-8p EST with the exception of major holidays. 40 hours per week

Minimum Qualifications: Active Registered Nurse license - California (not a compact state) Minimum of 2 years of experience in a pediatric office Experience caring for pediatric populations Excellent communication and interpersonal skills Ability to work independently and as part of a team Proficiency in electronic medical records (EMR) Preferred Qualifications: Bachelor's degree in Nursing Experience in remote patient care, telephone triage Experience utilizing standard protocols to guide care advice, Schmitt-Thompson protocols Experience working with diverse patient populations across the lifespan Skills: As a remote triage nurse, you will utilize your exceptional communication and interpersonal skills to provide remote patient care and telephone triage. You will also use your proficiency in electronic medical records (EMR) to maintain accurate and up-to-date patient records. Your ability to work independently and as part of a team will be crucial in collaborating with physicians and other healthcare professionals remotely in a busy face-paced environment. Additionally, your experience in remote patient care and telephone triage will be beneficial in providing the best possible care to our patients.

Conduct remote patient assessments and provide telephone triage to patients in need of medical attention Collaborate with physicians and other healthcare professionals Process prescription refills and prior authorizations for medications Maintain accurate and up-to-date patient records Provide patient education and counseling on various health topics Adhere to all relevant healthcare regulations and guidelines

Trinity Health - IHA

RN OBGYN REMOTE OPPORTUNITY

Posted on:

July 8, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Michigan

THIS IS A REMOTE, WORK FROM HOME OPPORTUNITY! Position requires Michigan based training and intermittent office reporting. Applicants must hold active Michigan nursing license and be within commutable distance to primary Ann Arbor region. Outpatient ambulatory triage experience in OBGYN or related subspecialty required. POSITION DESCRIPTION: Provides professional nursing care for patients following established standards and practices, which can include triage (telephone and walk-in visits), and care needs that transpire between office visits. Demonstrates professional clinical leadership and oversight within the scope of the RN role.

MEASURED BY: Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position. ESSENTIAL QUALIFICATIONS EDUCATION: Graduate of an accredited Registered Nurse program. CREDENTIALS/LICENSURE: Valid, unrestricted RN license in the State of Michigan. Valid CPR certification. MINIMUM EXPERIENCE: 1-2 years of clinical experience in a medical or physician office preferred. Previous nursing experience not required. POSITION REQUIREMENTS (ABILITIES & SKILLS): Demonstrated competency in obtaining accurate patient vital statistics (height, weight, blood pressure, temperature, etc.) and patient health history. Must have basic knowledge and understanding as to the relevance of patient vital statistics to the patients’ health history. Proficient/knowledgeable in medical terminology. Proficiency in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, email, e-learning, intranet and computer navigation. Ability to use other software as required while performing the essential functions of the job. Excellent communication skills in both written and verbal forms, including proper phone etiquette. Ability to work collaboratively in a team-oriented environment; courteous and friendly demeanor. Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, providers, patients, vendors, family members, outside customers and community groups. Ability to cross-train in other areas of practice in order to achieve smooth flow of all operations. Good organizational and time management skills to effectively juggle multiple priorities, time constraints and ever-changing medical situations. Ability to exercise sound judgement and problem-solving skills. Ability to perform mathematical calculations needed during the course of performing basic job duties, i.e.: calculating proper dosages for immunizations. Knowledge of the compliance aspects of clinical care and patient privacy and best practices in medical office operations. Ability to handle patient and organizational information in a confidential manner. Ability to travel to other office/practice sites and meeting and training locations. Successful completion of IHA competency-based program within introductory and training period. MINIMUM PHYSICAL EXPECTATIONS: Physical activity that often requires keyboarding, phone work and charting. Physical activity that often requires time working on a computer. Physical activity that often requires lifting over 50 lbs. Physical activity that sometimes requires handling and lifting patients, transferring patients to gurney using slide board, assisting patients with dressing/undressing, transferring patients to wheelchair using gaitbelt, walking, bending, stooping, reaching, climbing, kneeling and/or twisting. Physical activity that sometimes requires lifting, pushing and/or pulling up to 100 lbs. Specific vision abilities required include close vision, depth perception, color vision, peripheral vision and the ability to adjust and focus. Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment. Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English.

The following job functions may not be the responsibility of all RN’s. Some RN’s will be assigned work that has more focused responsibilities (example: prior authorizations or indirect work supporting a provider inbox.): Responsible for efficiently triaging patient needs via telephone and during visits according to IHA's Policies and Protocols. Documents clinical findings in a clear and concise manner according to IHA Policy. Utilizes critical thinking skills within the scope of licensure to appropriately assess patient needs and involves providers as appropriate. Enters orders (medication, laboratory, radiology, referrals) according to provider direction and as per state, local and professional guidelines. Follows clinical and nursing protocols as applicable. Schedules patient appointments as applicable. Encourages patient portal usage and supports where needed. Provides scope-appropriate nursing education during all patient interactions. Consults with providers and other extended care team members (Care Management, Embedded Pharmacy, Behavioral Health and Nutrition) and external case managers as appropriate to effectively ensure quality patient care. Supports physician and advanced practice providers with indirect work according to protocol. This includes and is not limited to test results/orders management. Assesses patients for gaps in care for preventative and disease management needs. Ensures patient medication list is accurate, completes medication reconciliation and processes refill requests per protocol. Works with the entire care team to co-manage indirect patient work according to Standard Work Instructions. Collaborates with insurance, DME, home care and all other care partners to ensure patient needs are met. Reviews patient medical history to identify supporting documentation relevant to ordered services and procedures to assist with or complete prior authorization process. Assists patients with resources for any social influences of health needs. Participates in process improvement projects within the office/department. Serves as a resource to clinical office/department staff within scope of RN role; may direct the work of LPN and Medical Assistant staff as needed and appropriate based on role/scope. May perform clinical support tasks as outlined on the Clinical Support Staff Scope of Practice document. Supports other offices, attends required meetings and training, and participates in committees as requested. Attends weekly patient care meetings and attends daily huddles as applicable. Assumes additional duties as required. ORGANIZATIONAL EXPECTATIONS: Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the IHA CARES mission and core values statement Must be able to work effectively as a member of the clinical care team. Successfully completes IHA’s “The Customer” training and adheres to IHA’s standard of promptly providing a high level of service and respect to internal or external customers. Maintains knowledge of and complies with IHA standards, policies and procedures, including IHA’s Employee Handbook. Maintains complete knowledge of office services and in the use of all relevant office equipment, computer and manual systems. Maintains strict patient and employee confidentiality in compliance with IHA and HIPAA guidelines. Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities. Embraces new ideas and respects cultural differences. Uses resources efficiently. If applicable, responsible for ongoing professional development – maintains appropriate licensure and continuing education credentials, participates in available learning opportunities.

Ohio Living

Triage RN On Call / After Hours - Remote (Toledo, Ohio local only)

Posted on:

July 8, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Ohio

It's fun to work in a company where people truly BELIEVE in what they're doing! Our intention is to have employees who are passionate about making their personal mission statement come to life each day at work! Be it through providing healing, eradicating loneliness, contributing to efficiencies, streamlining processes, being dependable, sparking creativity or something else, the demonstration of HOW you do your job is just as important as WHAT you do in your job. Alongside our valued employees, we are making a difference throughout the state of Ohio in the lives of those that need healthcare or those embracing the next chapter of their lives. Sustained members of our team demonstrate accountable behavior and share our values of customer service, innovation, integrity, inclusion, financial stewardship, leadership and care.

The On Call/After Hours RN is responsible for responding to clinical and non-clinical situations after normal business hours during the evenings, nights, weekends, and holidays by providing skilled nursing assessment, interventions, and supportive care for hospice and home health patients and their families to meet the plan of care for each patient and deliver quality care, ensuring compliance in accordance with company standards and federal, state, and local standards, guidelines, and regulations.

Education: Current unencumbered license for the state of Ohio to practice as a Registered Nurse (RN) required. Bachelor’s of Science in Nursing (BSN) preferred. Experience: Three years experience in acute care, medical-surgical, oncology, or geriatric nursing required. Experience in a Medicare-certified home health agency preferred. Proficiency with Windows, Microsoft Office (Word, Excel, PowerPoint), and the internet required. Proficiency with electronic medical records (EMR) preferred. Other Requirements: Must be able to read, write, speak, and understand the English language. Must possess a valid driver's license and acceptable driving record. Must be insurable under professional liability and crime coverage policies as specified by insurance carrier underwriting standards. Working Conditions and Special Requirements: Sitting - Up to 4 hours/day Standing - Up to 8 hours/day Walking - Up to 6 hours/day Lifting, transferring, pushing or pulling patients or equipment/supplies - Up to 50 pounds Driving - Up to 6 hours/day Work weekends, evenings, and holidays - Required On-call availability - Required - 7 days on, 7 days off Subject to falls, burns from equipment, odors, and cuts - Work day Subject to patients with various disease processes - Occasional May be exposed to infectious waste, disease, conditions, etc. including exposure to the AIDS and Hepatitis B viruses - Work day Risk Category for Exposure to Bloodborne Diseases - I

Care Management and Service Delivery - 85% Triages calls to hospice and home health agency from patients and caregivers. Ensures an accurate evaluation of patient needs and develops and implements a comprehensive care plan that addresses those needs. Follows current hospice and home health nursing professional standards of practice and agency approved protocols. Makes timely home/facility visits to provide, evaluate and/or change plan of care based on effective and timely triage assessment of patient and family needs. Communicates with other health care providers and families about changes in condition and patient needs. Demonstrates knowledge of pain management and symptom control, educates patient/family on physical, emotional and psychosocial aspects of care, disease process, symptom and pain management, and signs and symptoms of death. Provides for accurate administration and evaluation of medication, management of medication orders, and delivery of medication to patient in a timely manner. Completes hospice admission assessments, home health admission assessment (OASIS) and develops patient’s initial plan of care. Communicates response to triage and patient care information in a timely manner to hospice team and attends Hospice Interdisciplinary Group meetings. Communicates response to triage and patient care information to home health team in a timely manner. Commitment to excellent customer service for internal and external customers Informs Clinical Supervisors, Administrator and/or Executive Director of any high risk or critical issues in a timely manner. Quality and Compliance Management - 10% Documents patient and family care and necessary changes made in plan of care to provide current and accurate patient records through use of laptop computers and paper/chart documentation in accordance with company standards and federal, state, and local standards, guidelines, and regulations. Maintains knowledge of and compliance with requirements of regulatory agencies, accrediting bodies, third party payers, and HIPAA standards. Remains current in knowledge and practice of hospice and palliative care standards and regulations. Responsible for chart audits and compiling of quarterly measures. Operations Management and Administration - 3% Collaborates with the hospice team, home health team, and physicians to meet the comprehensive needs of patients and their caregivers and families. People Management and Development - 2% Supervises hospice aides, home health aides, coordinates other disciplines and directs patient caregivers/family members in carrying out necessary changes in patient’s plan of care based on assessment of needs and/or evaluation of effectiveness of plan of care. All other duties as assigned

Trinity Health

RN Utilization Review remote - MediGold Health Plan

Posted on:

July 8, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

MediGold (https://medigold.com/) is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United States. We’re dedicated to providing excellent customer service, cost-effective care, and exceptional healthcare coverage. We rely on talented colleagues in a wide variety of professional roles including information technology, financial analysis, audit, provider relations and more.

RN Utilization Review MCHP is responsible for the coordination of the medical care provided to Plan members with Plan providers, the member's family and other resources as appropriate. Assist in the development of the Plan's UM Program and the review of the Plan's Medical Management Plan.

Education: Associate or Bachelor's Degree in Nursing Licensure / Certification: Current license to practice as a Registered Nurse in their home state or hold a compact nursing license. Experience: Minimum of 5-7 years of clinical nursing experience with at least 2 years’ experience in utilization review or case management. Nursing experience in an HMO insurance setting preferred· Demonstrated ability to analyze, summarize and concisely report medical utilization and medical chart audit results. Ability to compare approved criteria with clinical information to determine appropriateness of service and to document all related information according to department policies and procedures. Conducts claim review as required for appropriate claims processing

Participates in designated committees and task forces according to the UM Program and at the direction of the Sr. Director of Medical Management. Coordinates with the utilization review, case management, discharge planning staff within network facilities. Coordinates with Medical Director/Associate Medical Directors on case-specific issues. Coordinates with Claims, Member Services, Grievance Coordinator and other operational departments regarding case management issues. Documents and communicates to QM staff appropriately all identified quality concerns related to Members. All other duties as assigned.

IntellaTriage

Remote Hospice Triage RN- FT 10:30p-7a + rotating Sat & Sun 11:30p-8a CST

Posted on:

July 8, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

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 3 shifts weekly 10:30p-7a CST (shift times are set/ week day flexes) Work every other weekend, both Saturday and Sunday 11:30p-5a CST

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.

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

IntellaTriage

Remote Hospice Triage RN- PT 1 shift 6p-12a + rotating Sat & Sun 7:30-4p

Posted on:

July 8, 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 1 evening shift weekly 6p-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

Sanford Health

Registered Nurse - RN - Triage - Virtual Care

Posted on:

July 8, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

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 SD (Central Time) Location: Remote, SD Address: Shift: 12 Hours - Varied Shifts Job Schedule: Full time Weekly Hours: 40.00 Salary Range: $32.00 - $48.00 Department Details *ELIGIBLE CANDIDATES WOULD RESIDE IN SD, MN, IA, ND, OR MI* This innovative virtual care role places a Registered Nurse (RN) at the center of a supportive, collaborative model designed to strengthen care in Skilled Nursing Facilities (SNFs) and Assisted Living communities operated by the Good Samaritan Society (GSS). When clinical uncertainty arises-such as a fall or change in condition-the on-site nurse can call the Virtual RN support line. If further evaluation is needed, the RN coordinates with a team of on-call Nurse Practitioners (NPs) to schedule a video visit. This role exemplifies how connected care teams, real-time support, and thoughtful use of technology can elevate frontline nursing, reduce unnecessary transfers, and help seniors age with dignity-right where they live.

Bachelor’s Degree in nursing preferred. Graduate from an accredited nursing program preferred, including, but not limited to, American Association of Colleges of Nursing (AACN), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA). A minimum of two years of clinical nursing experience preferred. Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state. Nurses performing nursing practice over the telephone require licensure in the states where the patients being served reside. Any additional state licensure requirements must be obtained within first 30 days of employment. Obtains and subsequently maintains additional required department specific competencies and certifications.

Responsible for providing virtual care services within nursing scope for appropriate age and population specific standards as assigned. Provides virtual care nursing services and guides the appropriate level of care within nursing scope with a diverse patient population with a wide range of health issues and acuity. Responsibilities may include virtual patient triage; remote patient monitoring; health information documentation; ongoing systematic assessment and data collection; referrals and follow-up care coordination; patient and staff education; and adherence to established protocols for all inquiries and crisis intervention. May perform clinical and operational downtime reporting and assessments as needed or other duties as assigned. Demonstrates competency and practices within the full scope of nursing expertise/knowledge and utilizes appropriate age and population specific standards as designated in their assigned clinical setting. Functions within the scopes and standards of nursing practice as outlined in the Nurse Practice Act and Administrative Rules in state of practice and licensure. The Sanford Professional Nursing Practice recognizes the Scope and Standards of Practice and the Code of Ethics for Nurses with Interpretive Statements as published by the American Nurses Association as the foundation of nursing care delivery and professional conduct.

Aveanna Healthcare

Aveanna Healthcare Private Duty Nurse LVN- Weekend Days

Posted on:

July 7, 2025

Job Type:

Role Type:

License:

LPN/LVN

State License:

Compact / Multi-State

Join a Company That Puts People First! Licensed Practical / Vocational Nurse – LPN/LVN Weekend Day Shifts (10-12 hours shifts) We Currently Have Patients And Openings In We are one of the largest private duty nursing companies in the nation and growing! At Aveanna, we’re proud to foster a workplace culture that celebrates diversity, encourages connection, and supports our team members every step of the way. Here’s what sets us apart: Laredo Surrounding Areas Award-Winning Culture Indeed’s Work Wellbeing Top 100 Company in 2024 Best Company for Work-Life Balance, Happiest Employees and Culture and Best CEO in 2024, as ranked by Comparably

We consider it both a privilege and an honor when we welcome a new patient into our Aveanna family. Our homecare is always delivered from a place of heartfelt compassion and empathy, and every one of our Licensed Practical / Vocational Nurses (LPN/LVN)s works together to make sure we achieve outstanding clinical outcomes. Aveanna isn’t just a provider of compassionate homecare to children and adults. We are a national leader .

Must have and maintain an active, unencumbered license (LPN/LVN) in the state in which the clinician will practice Compact licenses must be transferred to your state of residence within 90 days Current CPR certification (with hands-on component)- Aveanna can assist in obtaining this requirement after hire, if necessary. TB skin test (current within last 12 months) Six months prior hands-on nursing experience preferred but not required Must have reliable transportation

Sanford Health

Registered Nurse - RN - Triage - Virtual Care

Posted on:

July 7, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

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 SD (Central Time) Location: Remote, SD Address: Shift: 12 Hours - Varied Shifts Job Schedule: Full time Weekly Hours: 40.00 Salary Range: $32.00 - $48.00 Department Details *ELIGIBLE CANDIDATES WOULD RESIDE IN SD, MN, IA, ND, OR MI* This innovative virtual care role places a Registered Nurse (RN) at the center of a supportive, collaborative model designed to strengthen care in Skilled Nursing Facilities (SNFs) and Assisted Living communities operated by the Good Samaritan Society (GSS). When clinical uncertainty arises-such as a fall or change in condition-the on-site nurse can call the Virtual RN support line. If further evaluation is needed, the RN coordinates with a team of on-call Nurse Practitioners (NPs) to schedule a video visit. This role exemplifies how connected care teams, real-time support, and thoughtful use of technology can elevate frontline nursing, reduce unnecessary transfers, and help seniors age with dignity-right where they live.

Bachelor’s Degree in nursing preferred. Graduate from an accredited nursing program preferred, including, but not limited to, American Association of Colleges of Nursing (AACN), Accreditation Commission for Education in Nursing (ACEN), and National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA). A minimum of two years of clinical nursing experience preferred. Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state. Nurses performing nursing practice over the telephone require licensure in the states where the patients being served reside. Any additional state licensure requirements must be obtained within first 30 days of employment. Obtains and subsequently maintains additional required department specific competencies and certifications.

Responsible for providing virtual care services within nursing scope for appropriate age and population specific standards as assigned. Provides virtual care nursing services and guides the appropriate level of care within nursing scope with a diverse patient population with a wide range of health issues and acuity. Responsibilities may include virtual patient triage; remote patient monitoring; health information documentation; ongoing systematic assessment and data collection; referrals and follow-up care coordination; patient and staff education; and adherence to established protocols for all inquiries and crisis intervention. May perform clinical and operational downtime reporting and assessments as needed or other duties as assigned. Demonstrates competency and practices within the full scope of nursing expertise/knowledge and utilizes appropriate age and population specific standards as designated in their assigned clinical setting. Functions within the scopes and standards of nursing practice as outlined in the Nurse Practice Act and Administrative Rules in state of practice and licensure. The Sanford Professional Nursing Practice recognizes the Scope and Standards of Practice and the Code of Ethics for Nurses with Interpretive Statements as published by the American Nurses Association as the foundation of nursing care delivery and professional conduct.

Avel eCare

Nurse Practitioner Behavioral Health- Full-Time- Remote

Posted on:

July 7, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

NP/APP

State License:

Florida

Avel eCare is a nationally recognized leader in telemedicine, operating one of the most extensive virtual healthcare networks in the world. Based in Sioux Falls, South Dakota, Avel partners with over 650 healthcare systems, rural hospitals, clinics, and facilities to deliver innovative telehealth solutions. Our services span Behavioral Health, Critical Care, Emergency, Hospitalist, Pharmacy, Specialty Care, Senior Care, and School Health, impacting nearly two million patients annually. For three decades, Avel has been at the forefront of healthcare innovation, developing telehealth solutions that reduce costs, save time, and remove barriers to quality care. Join our mission-driven team and help reshape the future of healthcare.

General Hours of Work: 3–12-hour shifts per week (Varies, including days, nights, weekends and rotating holidays) Exempt/Nonexempt: Exempt (Salaried) Department/Unit: Behavioral Health Hours/FTE: 36 hours per week/.9 FTE Reports To: Director of Behavioral Health Summary: Avel eCare is seeking a dedicated Nurse Practitioner for our Behavioral Health team. This role assumes the responsibility for the provision of medical management of patients in Avel eCare Behavioral Health under the direction and supervision of a physician. Nurse Practitioners practice under the rules and regulations of the Nurse Practice Act of the states in which the practitioner is providing services.

EDUCATION and/or EXPERIENCE: Graduate of an NLN accredited school of nursing or equivalent. Graduate of an accredited Psychiatric-Mental Health Nurse Practitioner (PMHNP) program is required. Master’s or Doctorate degree required. CERTIFICATION, LICENSURE, and/or REGISTRATIONS: An active Nurse Practitioner Florida license required. Must live in the state of Florida. APRN licensure required within the states that Avel eCare acute inpatient services are providing service within 9 months of hire. Federal DEA and/or State DEA licensure required within the states that Avel eCare behavioral health services are being provided within 9 months of hire. An active Federal and State DEA certification is required. Completion of state specific certification/education within the initial and renewal time periods is.

Works with the psychiatrist and other staff (RN, support specialist, MSWs) on shift in the acute assessment, diagnosis, and treatment of patient's presenting to emergency departments, medical inpatient units, and inpatient behavioral health units/crisis stabilization units. Must be comfortable assessing patients for acute suicide and violence risk to recommend an appropriate level of care. This may require collaboration with family when indicated. Is responsible for placing direct admit orders for customers who request support for inpatient behavioral health/crisis stabilization units. Assists with rounding/evaluation when requested for patients in all environments supported by the service. Discusses patient cases with accepting psychiatric facility if requested by customer site. Assists in completing Crisis Response Plans with patients to support nursing staff. Recognizes and reacts appropriately to environmental safety factors related to patient care. Understands, applies, and supports practice policies, procedures, goals, and standards. Effectively provides patient instruction related to environmental care and safety standards. Always follows procedures, policies, and standards as outlines by Avel eCare. Effectively contributes to the development and attainment of nurse practitioner practice goals. Effectively ensures that QA is compiled, reports are prepared for administrative and regulatory agencies. Maximizes opportunities in the clinical setting for education of staff, patients, and families. Participate in the evaluation of Avel eCARE metrics, including performance against clinical aims. Works collaboratively with other health care professionals and agencies to provide, and where appropriate, coordinates services to individuals, families, and groups and to promote quality care for patients. Demonstrates clinical, interpersonal, communication and conflict resolution skills. Works to enhance unit collaboration tighten workflows and assure ongoing commitment to achieving high quality clinical standards. Assists clinical and administrative leaders in crafting remediation strategies when indicated.

Avel eCare

Registered Nurse- Senior Care- Remote

Posted on:

July 6, 2025

Job Type:

Role Type:

Telehealth

License:

RN

State License:

South Dakota

Avel eCare is a nationally recognized leader in telemedicine, operating one of the most extensive virtual healthcare networks in the world. Based in Sioux Falls, South Dakota, Avel partners with over 650 healthcare systems, rural hospitals, clinics, and facilities to deliver innovative telehealth solutions. Our services span Behavioral Health, Critical Care, Emergency, Hospitalist, Pharmacy, Specialty Care, Senior Care, and School Health, impacting nearly two million patients annually. For three decades, Avel has been at the forefront of healthcare innovation, developing telehealth solutions that reduce costs, save time, and remove barriers to quality care. Join our mission-driven team and help reshape the future of healthcare.

The RN is responsible for utilizing the nursing process to provide nursing care through innovative means for assisted living, long term care residents, and other populations through two-way phone & video technology. The RN will play an integral role in the management of the day-to-day functioning of the Advanced Practice Providers and Physicians in the Senior Care Service line. The RN is instrumental in the daily operations of the Senior Care Service Lines and will focus streaming how information is triaged to assure efficient processes are in place and the team is meeting responsiveness expectations. The position will collaborate closely with other clinical members of the Senior Care team to review long-term care residents, post-acute care residents and assisted living residents in sites we serve. The RN will coordinate both the clinical components and operational components of the Senior Care Service line. The RN will answer home care afterhours patient/caregiver calls to improve outcomes by providing knowledge that empowers self-management of their healthcare conditions and reduces unnecessary visits to the emergency department. RN will communicate to the health care team (Hospice, Home Health and Care Transition) as indicated. The RN will complete documentation for various areas of the clinical work being conducted, register and document proper information for new residents in the program, coordinate aspects of the business and service carried out by the Senior Care Medical Director and service line. This position will cross train to the other nursing functions within eCARE Senior Care as needed.

REQUIRED EDUCATION and/or EXPERIENCE: Graduate from a CCNE or NLN accredited school of Nursing is strongly preferred. Graduate from an approved nursing program is acceptable. Bachelor’s degree from four-year college or university school of nursing preferred. Minimum of 2 years nursing experience required. Long Term Care, Assisted Living, or clinic triage experience strongly preferred. Comprehensive knowledge of LTC regulations and quality programs, MDS certification or experience preferred REQUIRED CERTIFICATION, LICENSURE, and/or REGISTRATIONS: Licensed as a Registered Nurse with one unrestricted state license is required. RN Licensure required within the states that Ave eCare Senior Care is providing service within 120 days of hire. Gerontological Certification preferred. Completion of state specific certification/education within the initial and renewal time periods is required. Additional state-specific training and education as required by licensure is required within 120 days of hire.

Assessment/Diagnosis: Collects resident health data, obtains prior medical record from medical facilities, nursing facilities, or assisted living facilities as applicable. Helps assisted living sites by assessing residents via two-way video technologies. Advises and delegates resident care, as appropriate. Analyzes the assessment data in determining nursing diagnosis/problem focus for all pillars of services within Senior Care. Outcome Identification/Planning: Identifies expected outcomes/goals individualized to the resident. Considers factors related to safety, effectiveness and cost in planning and delivering resident care. Implementation/Evaluation: Implements the interventions identified in the plan of care coordinating efforts with the local care team and eCare provider as appropriate. Evaluate residents’ progress toward attainment of the outcomes and obtains orders for new interventions if needed. Quality of Care: Collaborates with eCare and rural providers, nursing staff, universal workers, residents and others to ensure the quality and effectiveness of nursing practice. Efficient in the use of various EMR processes. Collaborates with the management team in developing facility project support. Works closely with internal and external partners on performance improvement project. Participates in advanced care planning discussions. Assists with the development, and implementation of the organizational plans which assures growth and development of the service line that are aligned with strategic initiatives of Avel eCare Senior Care. Assists with the benchmark goals to guide the service line activities and effectively deals with variances. Works with other members of the team to analyze and determine next steps.

Camden Coalition

Telephone Triage Nurse

Posted on:

July 6, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

New Jersey

REMOTE JOB: Heart Transplant Phone Triage 19 week FMLA Coverage - 3 days/week; 24 hrs - 8a-4:30p Phone triage heart transplant experience is highly preferred but in lieu of will consider someone with inpatient and at least 1 year of ambulatory experience Triage Nurse Job Description Overview: We are seeking a dedicated and skilled Triage Nurse to join our healthcare team. The Triage Nurse plays a critical role in assessing patient needs and prioritizing care based on urgency. This position requires a strong foundation in medical knowledge, excellent communication skills, and the ability to work effectively in a fast-paced environment. The ideal candidate will demonstrate compassion and professionalism while providing high-quality patient care.

Valid nursing license with relevant experience in triage or emergency settings. Strong understanding of anatomy, medical terminology, and patient assessment techniques. Certification in Basic Life Support (BLS) is required; Advanced Cardiac Life Support (ACLS) is preferred. Experience in emergency medicine or hospital medicine is highly desirable. Excellent communication skills with the ability to work collaboratively within a team. Proficient in medical documentation practices to ensure accuracy in patient records. Ability to remain calm under pressure while managing multiple patients effectively.

Conduct initial patient assessments to determine the severity of their condition. Utilize medical terminology and anatomy knowledge to accurately evaluate symptoms. Prioritize patient care based on urgency and clinical guidelines. Document medical information and patient interactions thoroughly and accurately. Provide basic life support as needed and assist in emergency medicine situations. Collaborate with healthcare professionals to ensure comprehensive patient care. Maintain up-to-date knowledge of hospital medicine, geriatrics, and pediatric intensive care unit (PICU) protocols. Educate patients and their families about treatment options, follow-up care, and health management.