W.L. Gore & Associates

Cardiac Clinical Specialist Associate - Remote

Posted on:

October 14, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Arizona

W. L. Gore & Associates is a global materials science company dedicated to transforming industries and improving lives. Since 1958, Gore has solved complex technical challenges in demanding environments – from outer space to the world’s highest peaks to the inner workings of the human body. With approximately 13,000 Associates and a strong, team-oriented culture, Gore generates annual revenues of $5 billion.

We are looking for a Cardiac Clinical Specialist to join our Medical Products Division. We have provided creative therapeutic solutions to complex medical problems for 35 years, saving and improving the quality of lives worldwide. As a leading manufacturer of vascular grafts, endovascular and interventional devices, surgical meshes for hernia repair, and sutures. This role will cover the territory of all the United States; the candidate must reside in Atlanta, Georgia or surrounding areas. This is a remote position, and you can work from home in most locations in Atlanta, Georgia or surrounding areas.

Minimum of 3 years related experience with/in the nursing, radiation technology, operating room, cath. lab, radiology/cardiology departments or other medical device support roles Strong communication and interpersonal skills Track record of successfully adapting to changing product and project commitment Availability to support emergent cases in your local market, including remaining “on call”, which could result in the need to work nights and weekends when necessary Current, valid driver's license Demonstrated ability to apply medical, surgical, and interventional skills and terminology Ability to perform the responsibilities of this role at our customer locations, which includes meeting vendor credentialing and hospital access requirements for healthcare professionals, relative to immunizations (which may include a requirement to provide proof that you are fully vaccinated with one of the COVID-19 vaccines) Ability to travel up to 90% per month, with the agility to adapt to frequent changes in travel schedules (e.g., to support emergency clinical cases) and must reside in Atlanta, Georgia or surrounding areas Desired Qualifications: Prior cath lab experience Degree in nursing, life sciences, education or similar experience

Assist doctors in patient screening, case planning, and device selection Troubleshoot problem cases Provide technical support during clinical ASD and PFO CLOSURE cases Conduct in-house and field-based training programs for Gore associates Provide simulation-based training to Interventional Cardiologists, Nurses, and Vascular Surgery and Interventional Radiology Fellows Provide hospital in-services to Interventional Cardiologists, Nurses, and Fellows Help develop materials for doctor- and associate-training programs

Marshfield Clinic Health System

Nurse Auditor - Revenue Integrity (Remote in Wisconsin)

Posted on:

October 14, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Wisconsin

Marshfield Clinic Health System has served rural communities for more than 100 years. Today, the Health System has clinical locations and hospitals spanning more than 45,000 square miles of northern, central and western Wisconsin and the Upper Peninsula of Michigan. As an integrated Health System, we bring together all the pieces of the health care puzzle to provide excellent, comprehensive care to rural communities.

Job Title: Nurse Auditor - Revenue Integrity (Remote in Wisconsin) Cost Center: 101651059 Coding-Audit Appeals Educ Scheduled Weekly Hours: 40 Employee Type: Regular Work Shift: Mon-Fri; 8:00 am - 5:00 pm (United States of America) Job Description: **Wisconsin residents only eligible to apply** JOB SUMMARY The Nurse Auditor - Revenue Integrity is responsible for reviewing medical records to facilitate proper professional and/or facility coding of assigned specialties performed within the Marshfield Clinic Health System (MCHS). This individual acts as a liaison in providing accurate and timely information/guidance to physicians, allied providers, managers, and staff in regard to various coding and/or Medicare/Medicaid policy issues. The Nurse Auditor - Revenue Integrity is responsible for the initial development of payor or Recovery Audit Contractors (RAC) appeals correspondence materials.

EDUCATION: For positions requiring education beyond a high school diploma or equivalent, educational qualifications must be from an institution whose accreditation is recognized by the Council for Higher Education and Accreditation. Minimum Required: Nursing diploma or Associate’s degree in nursing. Preferred/Optional: Bachelor’s degree in nursing. EXPERIENCE Minimum Required: Three years’ experience in medical setting or medical business office. Demonstrated knowledge of surgical and medical procedures. Strong written and verbal communication skills and demonstrated knowledge of Microsoft Office Suite. Preferred/Optional: Demonstrated knowledge of CPT, ICD-9/ICD-10, and HCPCS coding. Demonstrated knowledge of Inter-qual criteria. CERTIFICATIONS/LICENSES: The following licensure(s), certification(s), registration(s), etc., are required for this position. Licenses with restrictions are subject to review to determine if restrictions are substantially related to the position. Minimum Required: Registered Nurse license awarded by the State of Wisconsin. Coding certification awarded by American Academy of Professional Coders (AAPC), American Health Information Management Association (AHIMA), or other approved coding certification must be obtained within three years of hire. Preferred/Optional: Current coding certification awarded by American Academy of Professional Coders (AAPC), American Health Information Management Association (AHIMA), or other approved coding certification at time of hire.

Evergreen Nephrology

Nurse Care Manager - Licensed MI & MN (Central Time Zone)

Posted on:

October 14, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

Evergreen Nephrology partners with nephrologists to transform kidney care through a value-based, person-centered, holistic, and comprehensive approach to kidney care. We believe patients living with kidney disease deserve the best care. We are committed to improving patient outcomes and improving quality of life by delaying disease progression, shifting care to the home, and accelerating kidney transplants. We help nephrologists focus on the right patients at the right time across the full care spectrum. We do this by providing them with the best-in-class interdisciplinary clinical resources, analytical insight and tools, and services to patients. We listen to the needs of our patients, our employees, and our client partners, continually working to push beyond the status quo in which the care system manages patients today.

You are devoted, compassionate, and enjoy being on the front lines of healthcare, changing the lives of patients by supporting them and the team by focusing on customers. You’re excited about being part of a team that is building a healthcare delivery model that ensures the highest possible quality of life and best outcomes for those in our care. You believe people living with kidney disease deserve the best person-centered, holistic, comprehensive care and want to influence the healthcare system to drive towards that. You thrive in innovative and evolving environments with high rates of change. As a Nurse Care Manager with Evergreen Nephrology, you are responsible for managing an assigned patient panel and addressing each patient’s specialized needs based on their individual conditions, healthcare needs, goals, and wishes. You will collaborate with a team of physicians, Advanced Practice Providers (APPs), and Interdisciplinary Team (IDT) members. Nurse Care Managers at Evergreen often focus on patients targeted for specific programs such as Chronic Complex Care Management, Compassionate Care Management, Post Acute Care, Transitions of Care, and CKD Management. While our Nurse Care Manager positions are fully remote, this specific position will support patients in both Michigan and Minnesota. The ideal candidate will hold an active license in both states and be available to support patients in the Central Time Zone.

Required Qualifications: Associate degree in nursing Current RN License is required, Compact License preferred Care management experience required Certified Case Manager preferred Intermediate skills with MS Office Suite of products including Outlook and Teams Able to work effectively in a primarily remote environment: Home internet must support a minimum download speed of 25 Mbps and upload speed of 10 Mbps. Cable, Fiber, or DSL connections hardwired to the internet device are recommended Evergreen will provide remote employees with telephony applications and equipment to meet the business requirements for their role Employees must work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information

Some responsibilities may vary based on specific patient programs, but this role's primary duties include the following: Managing the overall care management of patient panel by leveraging experience, expertise, and knowledge in both the nursing field and value-based care operations. Establishing trusting and empathetic relationships with patients and families to provide clinical and emotional support and foster collaboration throughout their care journey. Serving as an advocate and community liaison for patients to ensure proper and timely resources and support while navigating the health care system and maintaining compliance with the primary care team’s/nephrologist’s treatment plan. Performing assessments and identifying the needs, including social determinants of health, of panel patients and caregivers based on values, care goals, and individual preferences, and translating these into patient-centric actionable care plans through comprehensive evaluations. Coordinating the interdisciplinary approach to achieving continuity of care and reducing fragmentation, focusing on kidney disease progression management, utilization management, and provider coordination through active care plan management. Monitoring and evaluating the effectiveness of care management plans regularly, modifying interventions as necessary. Following evidence-based care management guidelines and established workflow protocols to deliver high quality, efficient, patient-centered care that aligns with Evergreen’s goals, quality metrics, and regulatory and payer requirements. Collaborating with physician partners, community providers, APPs, and other clinical disciplines to create, implement, and manage integrated care plans. Identifying cost-effective measures for patients that support value-based care goals of improving patient outcomes and quality while effectively managing resource utilization. Facilitating patient and caregiver education on treatment options and empowering patients to make informed decisions about their care. Supporting seamless transitions of care as patients move between care settings, proactively addressing potential barriers and collaborating with IDTs. Actively participating in clinical huddles, and patient care conferences for patients under your care management as needed. Engaging in continuous, organizational process improvement to identify opportunities for improvement and execute action plans to optimize care management workflows, patient engagement processes, customer/patient care efforts, and other protocols. Preparing reports and other deliverables to communicate program changes or developments to appropriate stakeholders. Collecting data to prepare and deliver reports alongside program leaders on program success, patient outcomes, and patient/caregiver satisfaction. Other duties consistent with this role, as assigned.

Myelin HealthCare

Remote Nurse Researcher (Arabic Speaking)

Posted on:

October 14, 2025

Job Type:

Part-Time

Role Type:

License:

RN

State License:

Massachusetts

We are a passionate group of medical professionals and engineers, focused on the mission of bringing safety to AI within healthcare.

We are seeking licensed nurses who have seen a diverse set of patients to help make AI safe for patient facing applications. In this task-based role, you will use your unique frontline experience and knowledge to assess AI/Simulated Patient interactions across a variety of dimensions, including medical safety, empathy, and bias. You’ll work at your own schedule, ideally averaging 20 hours per week.

Prefered: Availability of 15-20 hours per week for to complete evaluation tasks; you set your schedule Requirements: Registered Nurse with at least 3 years of bedside experience. Fluent in Arabic (can read and write)

CareFirst BlueCross BlueShield

Clinical Navigator (Remote)

Posted on:

October 14, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information

The Inpatient Management Post Acute Clinical Navigator (RN) manages the timely and smooth transition from inpatient care to home or other levels of care. Utilizing experience and skills in both case management and utilization management including proficiency in MCG to determine medical necessity, appropriate level of care, and case management to engage members, their families and other support systems in discharge planning. The role will function as a liaison with the facility Post-Acute Care team including case managers, social workers, and discharge planners to ensure CareFirst members receive the appropriate level of care and partner to address any potential barriers to discharge. The candidate's primary residence must be within the greater Baltimore metropolitan area as are looking for an experienced professional to work remotely from within the greater Baltimore metropolitan area. The incumbent will be expected to come into a CareFirst location periodically for meetings, training and/or other business-related activities. Bilingual - fluent in Spanish a big plus!

Education Level: Bachelor's Degree in Nursing OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. Licenses/Certifications Upon Hire Required: RN - Registered Nurse - Active State Licensure And/or Compact State Licensure RN- Registered Nurse in MD, VA or Washington, DC. Experience: 5 years clinically related experience working in Care Management, Home Health, Discharge Coordination and/or Utilization Review. Preferred Qualifications: Bilingual - fluent in Spanish. Knowledge and experience with Milliman Care Guidelines. Experience working with both employer group membership and Medicare/Medicaid enrollees and benefits contracts. CCM certification. Knowledge, Skills and Abilities (KSAs): Strong interpersonal skills and the ability to engage in a member facing environment (in-person or telephonically) while at the same time building. relationships and partnerships with hospital care team and alternative care deliver partners to meeting member/enrollee needs. Strong clinical documentation skills along with the ability to type on a computer keyboard with ease and speed. Proficient in the use of web-based technology and Microsoft Office applications such as Word, Excel and Power Point. Strong analytical and problem-solving skills to judge appropriateness of member services and treatments on a case-by-case basis. Knowledge of clinical standards of care and disease process and national, evidence based clinical guidelines and hospital operations. Knowledge of available community resources and programs. Basic understanding of the strategic and financial goals of a health care system, payer organization, health plan and/or health insurance operations (e.g. networks, eligibility, benefits).

Utilize clinical expertise and critical thinking skills to analyze available clinical information, electronic medical records (EMRs), benefit contracts, mandates, medical policy, evidence based published research, national accreditation and regulatory requirements to aid in determination of appropriateness and authorization of inpatient clinical services at post-acute places of service (Skilled Nursing Facility, Acute Rehab, Long Term Acute Care, Inpatient Hospice, and Home Health). Engages onsite and/or telephonically with member, family and providers to identify key strategic interventions, discharge planning and coordination to address members medical, behavioral and/or social determinant of health needs to promote a safe transition to the appropriate level of care and/or home. Collaborates with CareFirst Medical Directors and participates in internal case rounds/discussions to determine appropriate course of action and level of care. Applies sound clinical knowledge and judgment throughout the review process. Follows member benefit contracts to assist with benefit determination. Makes appropriate referrals to other Care Management programs as appropriate for chronic, long term care coordination.

NationsBenefits, LLC

Clinical Quality & DSMES Program Coordinator (RN/CDCES)

Posted on:

October 14, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

NationsBenefits is recognized as one of the fastest-growing companies in America and a Healthcare Fintech provider of supplemental benefits, flex cards, and member engagement solutions. We partner with managed care organizations to provide innovative healthcare solutions that drive growth, improve outcomes, reduce costs, and bring value to their members. Through our comprehensive suite of innovative supplemental benefits, fintech payment platforms, and member engagement solutions, we help health plans deliver high-quality benefits to their members that address the social determinants of health and improve member health outcomes and satisfaction. Our compliance-focused infrastructure, proprietary technology systems, and premier service delivery model allow our health plan partners to deliver high-quality, value-based care to millions of members. We offer a fulfilling work environment that attracts top talent and encourages all associates to contribute to delivering premier service to internal and external customers alike. Our goal is to transform the healthcare industry for the better! We provide career advancement opportunities from within the organization across multiple locations in the US, South America, and India.

The Clinical Quality & DSMES Program Coordinator will lead the strategic and operational execution of our ADA-recognized Diabetes Self-Management Education and Support Program as well as clinical oversight for NationsNutrition programming. This role is responsible for ensuring DSMES program compliance, delivering high-quality diabetes education, quality assurance for clinical coaches, and coordinating interdisciplinary care to support patients in achieving their health goals.

Skills & Competencies: Excellent communication and interpersonal skills Strong organizational abilities and detail oriented Self-starter that is able to manage many priorities simultaneously Thrives in a fast-paced environment that requires critical thinking and creative problem solving Ability to work independently and collaboratively across teams Data-driven mindset with experience in program evaluation Commitment to health equity and patient-centered care Minimum Qualifications: Registered Nurse (RN) with active compact state licensure, 3+ years of experience Must hold and maintain Certified Diabetes Care and Education Specialist (CDCES) certification, staying up to date with the required 75 CEU's in 5 years to maintain certification 2+ years of experience in diabetes education or chronic disease management Experience coordinating ADA-recognized DSME programs, with strong understanding of ADA standards and accreditation processes Must be comfortable utilizing advanced technology 100% Remote: must have consistent access to clean, quiet workspace; solid internet connection; proficient technical experience

Monitor and evaluate the clinical delivery of programs, including ensuring care pathways are up to date, developing appropriate clinical resources, and assessing proper documentation Assess registered dietitian clinical support by monitoring and evaluating quality of care provided through completing monthly quality assurance Collaborate with registered dietitians to support high-quality, integrated care Monitor clinical alerts (blood pressure, blood glucose, heart rate) from members through connected devices and program outcomes, including patient satisfaction, clinical metrics, and utilization data Serve as the DSMES Quality Coordinator in alignment with ADA Education Recognition Program standards Ensure program documentation, reporting, and quality improvement initiatives meet ADA compliance requirements Monitor DSMES coaches to ensure provision of education using evidence-based practices and the AADE7 self-care behaviors Train and mentor staff involved in DSMES delivery and support ongoing professional development Actively participates in ADA audits, process improvements, and support reporting processes Ability to work independently and make decisions based on standard of care Take accountability for your work and the results of your efforts

Ethire LLC

Registered Nurse ($30/Hr)

Posted on:

October 14, 2025

Job Type:

Contract

Role Type:

License:

RN

State License:

Texas

Participates in the audit/overread of the medical record collection and review process for HEDIS quality reporting. Training will be provided prior to the start of the assignment. This position audits and interprets relevant clinical criteria through review of medical records, annotates via Adobe PDF and audits data populated within a data collection tool to support compliance with HEDIS and CMS performance measures. Ensures accurate and complete documentation of required information to meet risk management, regulatory, and accreditation requirements. The candidate must be proficient with databases and with conducting 100% of work activities on the computer.

5 or more seasons of HEDIS experience in reviewing medical records is required Prior experience in performing chart audits is preferred. Candidate must commit to attend all required training and conference calls assigned for the project. Candidate must return all equipment that is supplied to them in good working condition and in a timely manner at the end of the project Medical knowledge/terminology is required. Ability to read and interpret medical records. Professional demeanor and good work ethic. Computer savvy: Microsoft Word, Excel, email, and Adobe reader required. Know how to save a file to a folder. Excellent verbal and written communication skills – clear, concise and appropriate. Conscientious problem solver, willing to learn, and take personal pride in their work performance/accuracy. Exceptional attention to detail and excellent analytical, investigation, and problem-solving skills Proven organizational and time management skills including the ability to meet required deadlines Must keep all information collected in a safe, organized and confidential manner while maintaining confidentiality of PHI, HIPAA Privacy and Security Rules

Participates in the audit/overread of the medical record collection and review process for HEDIS quality reporting. Training will be provided prior to the start of the assignment. This position audits and interprets relevant clinical criteria through review of medical records, annotates via Adobe PDF and audits data populated within a data collection tool to support compliance with HEDIS and CMS performance measures. Ensures accurate and complete documentation of required information to meet risk management, regulatory, and accreditation requirements. The candidate must be proficient with databases and with conducting 100% of work activities on the computer.

St. Luke's University Health Network

Clinical Triage Specialist, RN Oncology/Palliative Access Center, Remote Position (PA/NJ residency)

Posted on:

October 14, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Founded in 1872, St. Luke’s University Health Network (SLUHN) is a fully integrated, regional, non-profit network of more than 18,000 employees providing services at 14 campuses and 300+ outpatient sites. With annual net revenue of $3.2 billion, the Network’s service area includes 11 counties in two states: Lehigh, Northampton, Berks, Bucks, Carbon, Montgomery, Monroe, Schuylkill and Luzerne counties in Pennsylvania and Warren and Hunterdon counties in New Jersey. St. Luke’s hospitals operate the biggest network of trauma centers in Pennsylvania.

St. Luke's is proud of the skills, experience and compassion of its employees. The employees of St. Luke's are our most valuable asset! Individually and together, our employees are dedicated to satisfying the mission of our organization which is an unwavering commitment to excellence as we care for the sick and injured; educate physicians, nurses and other health care providers; and improve access to care in the communities we serve, regardless of a patient's ability to pay for health care. The Clinical Triage Specialist (CTS) (RN) - Access Center will compassionately deliver an exceptional patient experience and provide clinical support to CTS-MA team members by serving as a clinical resource. The CTS-RN is responsible for using nursing judgment in answering/returning patient calls related to direct care provided by the practices. When appropriate, the caller’s symptoms will be assessed and triaged using approved nursing protocols and guidelines to assist in obtaining the appropriate level of care and/or self-care advice.

EDUCATION: Graduate of an accredited nursing program. Active Registered Nurse licensure in the s tate of Pennsylvania and New Jersey or other nursing compact state and other states as deemed necessary by state law. TRAINING AND EXPERIENCE: Minimum 2 years recent clinical experience in a physician office, home health, critical care and/or emergency room is required. Strong communication skills Focused on compliance Demonstrates continuous growth Quality-driven Service-oriented Excels at time management Strong problem-solving skills Ability to work from home in accordance with the Network Work from Home Policy if needed.

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 an escalation point for clinical patient issues and other POD team members requiring clinical support, and provides clinical advice based on clinical protocols and procedures. Manages and responds to escalated electronic patient messages whenever not answering inbound patient calls and uses clinical judgment to prioritize 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. Utilizes all resources and guidelines at his/her disposal to effectively assess, prioritize, advise, schedule appointments, or refer calls when necessary to the appropriate medical facility or personnel. Accurately documents symptoms/complaints, nursing assessment, advice provided and patient/caller response. 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 duties as assigned.

Partners Health Management

Nurse Assessment Specialist (Remote Option-NC)

Posted on:

October 14, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

North Carolina

Location: Remote option in NC; Available for any of Partners' NC locations Projected Hiring Range: Depending on Experience Closing Date: Open Until Filled Primary Purpose of Position: This position is responsible for the comprehensive evaluation of a member’s healthcare needs, goals, and preferences to promote high quality, whole person care for individuals with behavioral health (BH), intellectual/developmental disabilities (IDD), and/or traumatic brain injury (TBI) with physical health complexities who are or may receive skilled nursing services or assistance with activities of daily living. The focus of this position is to ensure that individuals receive appropriate collaborative care assessment and services. This is a mobile position with work done in a variety of locations. Travel is an essential function of this position.

Knowledge, Skills and Abilities: Ability to provide consultative supports for physical health diagnosis and treatment to include education, assessment, and care planning for whole person care.  Understanding of the Diagnostic and Statistical Manual of Mental Disorders (current version) Considerable knowledge of the IDD/TBI/MH/SUD/Physical Health service array provided through the network of the LME/MCO’s Providers Knowledge of NC Medicaid, Managed Care, NC Innovations Waiver, 1915i option, LTSS, Tailored Plan and Standard Plans Ability to analyze data and use data to drive decision-making. Ability to provide effective and clinically sound consultation/education/training to others Ability to establish and maintain positive and effective working relationships with others both within the agency and community Exceptional interpersonal and communication skills Excellent computer skills including proficiency in Microsoft Office products (Word, Excel, Outlook, and PowerPoint) Excellent problem solving, negotiation, arbitration, and conflict resolution skills Detail-oriented, able to organize multiple tasks and priorities and effectively manage projects from start to finish Ability to make prompt independent decisions based upon relevant facts, to establish rapport and maintain effective working relationships Ability to change the focus of his/her activities to meet changing priorities Education/Experience Required: Licensed to practice as a Registered Nurse in North Carolina, and two years of experience in intellectual and developmental disabilities, traumatic brain injury, and/or behavioral health. AND Must reside in North Carolina Must have ability to travel regularly as needed to perform job duties Education/Experience Preferred: Licensed to practice as a Registered Nurse in North Carolina and two years of experience in behavioral health nursing with dually diagnosed MH/IDD; care management/care coordination experience. Experience in collaborative care. Fluency in written and verbal bi-lingual Spanish/English language expertise. Licensure/Certification Requirements: Must be licensed as a Registered Nurse in North Carolina. Employee is responsible for complying with respective licensure board’s continuing education/training requirements in order to maintain an active license.

Provides physical health expertise, assessment analysis, and consultation.  Serves as the point of contact regarding nursing data collection and analysis for service determinations. Gathers available data and medical information to provide accurate and thorough representation of the interventions provided by skilled nursing or supportive services for activities of daily living. Ensures accurate completion of required documentation and forms. Provides direct care management support as needed (informing, educating, linking, phone communication with member or collaterals) Assesses members for skilled nursing needs and personal care assistance needs including levels of assistance member has for activities of daily living through personal care services. Participates in multidisciplinary team meetings with care managers, clinical and medical leadership. Utilizes Healthwise topics for health education and promotion with members. Measures results of intervention and treatment, including reduction in high-risk events and inappropriate service utilization. Analyzes medical, psychiatric, behavioral health diagnosis, intellectual/developmental, and medication data reports to identify potential alternate services available to member. Participates actively in learning collaborative with other Care Management nurses. Will participate and complete other duties as assigned.

HEALTHNET INC

Registered Nurse -OB/GYN Triage

Posted on:

October 14, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Indiana

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

$1,000 SIGN ON BONUS Position is remote - Must reside in Indiana, some in person trainings in Indianapolis. Fair Labor Standards Act Classification: Non-Exempt What you’ll do as a Registered Nurse at HealthNet The Registered Nurse position is a combination of education, experience and environmental awareness that provides high quality, person-centered care to patients. When you’ll work as a Registered Nurse at HealthNet Full-time, 4 day work week Mondays/Thursdays 9:30am-8pm, Tuesdays/Wednesdays 7am-5:30pm

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

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

Cam Bay Health Care

Utilization Review Registered Nurse

Posted on:

October 14, 2025

Job Type:

Contract

Role Type:

Utilization Review

License:

RN

State License:

Texas

We are seeking a dedicated and knowledgeable Utilization Review Nurse to join our healthcare team. This role is crucial in ensuring that patients receive appropriate care while adhering to established guidelines and standards. The ideal candidate will possess a strong clinical background, excellent analytical skills, and a thorough understanding of medical documentation and coding. You will be responsible for reviewing patient records, assessing the necessity of services, and collaborating with healthcare providers to optimize patient outcomes.

Active nursing license with experience in acute care settings; critical care or ICU experience is highly preferred. Strong knowledge of medical terminology, anatomy, physiology, and health information management principles. Familiarity with utilization review processes and medical management strategies. Experience in managed care environments or knowledge of Medicare regulations is advantageous. Proficiency in medical coding (CPT/ICD) and documentation review practices. Previous experience in a hospital setting or nursing home is desirable; Level I or II trauma center experience is a plus. Excellent communication skills for effective collaboration with healthcare teams and patients. Ability to analyze complex clinical data and make informed decisions regarding patient care. Join our team as a Utilization Review Nurse where you can make a significant impact on patient health outcomes while working within a supportive environment that values professional growth and development.

Conduct comprehensive reviews of patient medical records to determine the appropriateness of care provided based on clinical guidelines. Collaborate with healthcare professionals to ensure compliance with utilization management protocols. Utilize knowledge of CPT coding, ICD-9, and ICD-10 for accurate documentation and billing processes. Engage in case management activities, including discharge planning and coordination of care across various settings such as inpatient, outpatient, home care, and hospice. Ensure adherence to HIPAA regulations while handling sensitive patient information. Participate in clinical documentation improvement initiatives to enhance the quality of medical records. Maintain familiarity with EMR and EHR systems such as Epic, Cerner, Athenahealth, and eClinicalWorks for efficient data management. Stay updated on NCQA standards and best practices in utilization review and managed care.

HealthCheck360

Bilingual RN Case Manager

Posted on:

October 14, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Iowa

HealthCheck 360 was created with the employer's needs and the participant's experience in mind. We focus on reducing medical costs, while increasing employee engagement and productivity. This is accomplished by providing onsite biometric screenings, engaging participants through technology and programming, educating the participant with risk-specific targeted communications, and supporting positive behavior change through our Health Coaching and Condition Management programs.

Location: Remote. We are seeking a compassionate and detail-oriented Bilingual RN Case Manager to join our team. This role is responsible for delivering comprehensive case management services across the continuum of care. The RN Case Manager will assess, plan, implement, coordinate, monitor, and evaluate care for assigned consumers, ensuring quality outcomes and cost-effective treatment.

Bilingual: the ability to speak Spanish Education: RN licensure in the State of Iowa required. BSN or higher preferred. Experience: Minimum 2 years of clinical practice. Case management or utilization review experience strongly preferred. Skills: Strong communication, problem-solving, and computer skills. Ability to work independently.

Provide telephonic case management and utilization review for assigned consumers. Develop, implement, and monitor individualized care plans to ensure quality and cost-effective outcomes. Collaborate with healthcare providers, payors, and internal teams to coordinate care. Serve as a liaison between consumers and benefit administrators, ensuring clear communication and support. Track and report case outcomes, including cost savings and quality improvements.

Preferred Healthcare LLC

Wound Care Nurse - PRN

Posted on:

October 14, 2025

Job Type:

Role Type:

Case Management

License:

RN

State License:

Georgia

At Preferred Healthcare, we are more than just a team—we are a purpose-driven organization dedicated to transforming lives through innovative, compassionate care. When you join us, you become part of a mission to provide accessible, expert wound care directly to patients in the comfort of their homes. Our Mission Preferred Healthcare is devoted to simplifying wound care for patients, their caregivers, and healthcare providers. Our mission is to deliver exceptional in-home wound care services that prioritize patient comfort and convenience, reduce the need for unnecessary hospital visits, and achieve optimal healing outcomes. At the heart of everything we do are our guiding principles: Patient-Centered Care: Always putting patient needs and comfort first. Accessibility: Delivering expert wound care directly to the patient's home. Comprehensive Services: Treating a wide variety of wound types with expertise. Convenience: Reducing disruptions to patients' lives by bringing care to them. Optimal Healing Outcomes: Achieving the best possible results for our patients.

Preferred Healthcare seeks a passionate, experienced, and patient-focused PRN WC Nurse to join our team. In this role, you will provide exceptional mobile care, ensure positive patient outcomes, and support our mission of delivering high-quality, home-based healthcare services. Preferred Healthcare is a values-driven organization committed to compassion, collaboration, and operational excellence. If you share our passion for improving patient lives, we want to hear from you! Location: Atlanta, GA Company: Preferred Healthcare Preferred Healthcare seeks a dedicated PRN Nurse Wound Care Nurse to deliver high-quality mobile wound care therapy to patients in their homes. This role involves conducting comprehensive wound assessments, developing and implementing advanced wound care treatment plans, and managing acute and chronic wound conditions. The wound care nurse will collaborate with interdisciplinary teams, ensure compliance with healthcare regulations, and prioritize patient safety, documentation accuracy, and continuous process improvement. The ideal candidate is adaptable, detail-oriented, and passionate about delivering evidence-based wound care solutions that enhance patient healing and quality of life.

Education and Licensure: BSN and/or ADN Certified Wound Specialist (CWS)/Certified Wound Care Associate (CWCA)/Certified Wound Care Technician (CWCT) is preferred. Experience: Minimum of five years of nursing experience in bedside care, case management, social work, or practice management. Demonstrated ability to integrate emotional intelligence in patient care and team interactions. Knowledge of wound care techniques and treatments, including negative pressure wound therapy and biologic dressings. Skills and Knowledge: Exceptional emotional intelligence, including empathy, active listening, conflict resolution, and relationship-building skills. Proven ability to communicate effectively and compassionately with patients, families, and clinical teams. Ability to inspire and mentor staff, fostering a positive and inclusive workplace culture. Proficient in electronic health records (EHR) and other healthcare software. Advanced proficiency in Google Suite and other relevant software. Highly organized with outstanding time management and multitasking abilities. Strong attention to detail and commitment to maintaining high standards of accuracy Must possess a valid driver's license and maintain an acceptable driving record. A reliable personal motor vehicle with proof of insurance is required. Ability to travel within the designated service area with minimal supervision. Must comply with all company policies regarding mileage reimbursement and vehicle maintenance. While offering flexibility, this PRN role requires staff to work a minimum of one day per week to maintain active status and familiarity with our processes and patients.

Clinical Care: Assess, diagnose, and treat patients with various wound care needs, including but not limited to diabetic ulcers, pressure sores, surgical wounds, and vascular ulcers. Develop and implement individualized treatment plans for wound care, including debridement, dressing changes, and advanced wound therapies. Perform procedures such as suturing, incision and drainage, and biopsies as needed. Administer UltraMist therapy treatments according to established protocols, including proper setup of the device, preparation of the treatment area, delivery of the appropriate ultrasonic mist parameters based on wound characteristics, documentation of treatments, and assessment of wound response to therapy. Maintain compliance with clinical protocols, infection control standards, and post-procedure care to promote healing and prevent complications. Patient Management: Educate patients and families on wound care techniques, prevention, and lifestyle modifications. Monitor and evaluate patient progress, making adjustments to treatment plans as necessary. Documentation and Compliance: Maintain accurate and up-to-date medical records in compliance with legal and regulatory standards. Ensure adherence to PHC's policies and procedures and all state and federal regulations. Quality Improvement: Participate in initiatives to improve wound care outcomes and enhance patient satisfaction. Stay current with wound care techniques, treatments, and technology advancements. Traveling to and from patient homes within the assigned service area ensures timely and reliable care. Maintain a valid driver's license and use a personal motor vehicle for patient visits. Adhere to all safety regulations and company policies regarding transportation and patient visits.

Highmark Inc.

Transplant Care Nurse - Remote

Posted on:

October 14, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Pennsylvania

A national blended health organization, Highmark Health and our leading businesses support millions of customers with products, services and solutions closely aligned to our mission of creating remarkable health experiences, freeing people to be their best. Headquartered in Pittsburgh, we're regionally focused in Pennsylvania, Delaware, West Virginia, and eastern and northwestern New York with customers in 50 states and the District of Columbia. We passionately serve individual consumers and fellow businesses alike. And our companies cover a diversified spectrum of essential health-related needs including health insurance, health care delivery, population health management, dental solutions, reinsurance solutions, and innovative, technology solutions. Our financial position reflects strength and stability, with our year-end 2020 consolidated revenues totaling $18 billion. And we’re proud to carry forth an important legacy of compassionate care and philanthropy that began more than 170 years ago. This tradition of giving back, reinvesting and ensuring that our communities remain strong and healthy is deeply embedded in our culture, informing our decisions every day.

This job implements effective complimentary utilization and case management strategies for an assigned member panel. Provides oversight over a specified panel of members that range in health status/severity and clinical needs; and assesses health management needs of the assigned member panel and utilizing data/analytics in conjunction with professional clinical judgement to identify the right clinical intervention for each member. The incumbent conducts outreach to members enrolled in case management including but is not limited to: developing a care plan, encouraging behavior changes, identifying and addressing barriers, helping members to coordinate care, and identifying various resources to assist members in achieving their personal health goals. Will work with providers to insure quality and appropriate care is being delivered in a timely manner.

Required: High School/GED Substitutions None Preferred: Bachelor's Degree in Nursing EXPERIENCE Required: 7 years in any combination of clinical, case/utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience 1 year in a clinical setting Preferred: 5 years in UM/CM/QA/Managed Care 1 year in advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing or dialectical behavior therapy (DBT) 1 year working with the healthcare needs of diverse population and understanding of the importance of cultural competency in addressing targeted populations LICENSES or CERTIFICATIONS Required: RN license in PA or WV or DE or NY is required. Other RN license(s), if applicable, must be obtained within the first 6 months of employment. Preferred: Certification in utilization management or a related field Certification in Case Management SKILLS: Written and verbal presentation skills, negotiation skills, and skills in positively influencing others with respect and compassion Broad knowledge of disease processes Working knowledge of pertinent regulatory and compliance guidelines and medical policies Ability to multi task and perform in a fast paced and often intense environment Understanding of healthcare costs and the broader healthcare service delivery system Ability to analyze data, measure outcomes, and develop action plans Be enthusiastic, innovative, and flexible Be a team player who possesses strong analytical and organizational skills Demonstrated ability to prioritize work demands and meet deadlines Excellent computer and software knowledge and skills

Maintain oversight over specified panel of members by performing ongoing assessment of members’ health management needs, identifying the right clinical interventions to address member needs and/or triaging members to appropriate resources for additional support. Implement care management review processes that are consistent with established industry, corporate, state, and federal law standards and are within the care manager’s professional discipline. For assigned case load, create care plans to address members’ identified needs, remove barriers to care, identify resources, and conduct a number of other activities to help improve the health outcomes of members; care plans include both long and short term goals and plan of regular contacts for re-assessment. Ensure all activities are documented and conducted in compliance with applicable business process requirements, regulatory requirements and accreditation standards. Other duties as assigned.

Atrium Health

RN- Atrium Call Center Weekend Remote PT 9a-9p

Posted on:

October 14, 2025

Job Type:

Part-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

5 yrs of RN experience and BSN preferred Sat/Sun. 9a-9p The Registered Nurse (RN), a member of Advocate Health Nursing Professional Governance community, provides high-quality, patient-centered care through evidence-based practice, clinical expertise, and compassionate care delivery. The RN collaborates with interdisciplinary teams, advocates for patient needs, and upholds professional practice standards to promote optimal health outcomes.

Licensure, Registration, and/or Certification Required: Basic Life Support (BLS). Additional education, training, certifications, or experience may be required based on specialty. Active, unrestricted registered nurse (RN) multi-state compact and/or single-state license with privileges to practice in the state(s) where the RN is providing client nursing services Note: Licensed nurses practicing via telehealth/telenursing/virtual modalities are required to be licensed or hold the privilege to practice in the state(s) where the client(s) is/are located. Licensed nurses are responsible and accountable for knowing, understanding, and practicing in compliance with the laws, rules, regulations, and standards of practice of the state(s) where the client(s) is/are located Education Required: Graduate of a Board of Nursing approved nursing education program. Experience Required: No formal RN experience required. Knowledge, Skills & Abilities Required: Strong clinical judgment and critical thinking. Time management, prioritization and problem-solving skills. Excellent communication and interpersonal skills. Ability to work in a fast-paced, dynamic environment. Proficiency in operating computer functions (e.g., E-mail, electronic records, digital platforms etc.) Physical Requirements and Working Conditions: Must be able to sit, stand, walk, lift, squat, bend, reach above shoulders, and twist frequently throughout the workday. Must be able to lift and support the weight of 35 pounds in handling patients, medical equipment, and supplies. Must be able to: push/pull with 30 lbs. of force and perform a sliding transfer of 150 lbs. with a second person present. Must have functional speech, vision, hearing, and touch with ability to use fine hand manipulation skills for IV insertion and other procedures/functions. Maneuver foot pedals on carts or machines. Perform physical safety interventions such as patient restraint and verbal de-escalation, if needed. May be exposed to chemical and hazardous waste as well as blood and body fluids and communicable disease. Therefore, protective clothing and equipment must be worn as necessary. Must be able to respond quickly to changes in patient and/or unit conditions. Physical Abilities Testing may be required. Additional department specific physical requirements may be identified for unique responsibilities within the department by the nurse leader. Education Preferred: Bachelor of Science degree in Nursing (BSN)

Engages in unit councils, professional governance, and quality initiatives to improve care processes and apply evidence-based practices. Utilizes the nursing process to assess, plan, implement, and evaluate care, engaging patients and families from admission to post-discharge. Monitors patient conditions, adjusts care plans, mobilizes resources, and collaborates with the care team to influence care outcomes. Upholds and promotes a culture of safety. Continuously evaluates patient, team, and unit outcomes, taking action as needed. Administer medications, treatments, and therapies safely and according to clinical protocols and procedures. Demonstrates effective communication, feedback, and conflict resolution, fostering team collaboration and appropriate delegation. Pursues professional development, completes required education, and maintains certifications. Adhere to the ANA Code of Ethics and practices ethical decision-making, respects interdisciplinary roles, and contributes to integrated, unbiased patient care. Appropriate delegation to other registered nurses, licensed practical nurse, nurse assistants, and other unlicensed assistive personnel. Maintains accurate, timely EHR documentation. May be required to float to other units, departments, or facilities within the designated service area to meet patient care needs. Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards.

Northern Arizona Healthcare Corporation

RN Clinical Documentation Informaticist - Remote (see full posting for eligible states)

Posted on:

October 14, 2025

Job Type:

Full-Time

Role Type:

Informatics

License:

RN

State License:

Arizona

Northern Arizona Healthcare, or NAH, is the largest healthcare system in the region. We serve more than 700,000 people over 50,000 square miles with facilities in multiple locations, including Flagstaff, Cottonwood, Camp Verde and Sedona, and are ranked in the top 20 percent of small healthcare systems in the nation by Truven Health Analytics. At NAH, we are more than 3,400 colleagues, 1,000 clinical staff and doctors, 850 volunteers, plus 50 medical specialties, 15 ambulances, seven helicopters, two cancer centers and a Level 1 Trauma Center — and we offer a wide range of exciting opportunities for dedicated healthcare professionals.

NAH reserves the right to make hiring decisions based on applicants' state of residence if outside the state of Arizona. NAH currently hires for remote positions in the following states: Alabama Arizona Florida Georgia Idaho Indiana Kansas Michigan Missouri North Carolina Ohio Oklahoma Pennsylvania South Carolina Tennessee Texas Virginia The Clinical Documentation Information Specialist works to facilitate complete and comprehensive documentation reflective of clinical treatment, diagnosis, accurate severity of illness and risk of mortality. He/she works with a multi-disciplinary team to achieve this goal.

Education: Associates RN, RHIA/RHIT, or Bachelor's Degree with experience/certification in Coding/CDI- Required BSN- Preferred Certification & Licensures: CCDS- Required after 2 years of hire date Current RN License (does not have to be AZ)- Required Experience: 3-5 years clinical documentation specialist, coding, or UR experience- Preferred Supervisory, education, or leadership experience- Preferred Healthcare is a rapidly changing environment and technology is integrated into almost all aspects of patient care. Computers and other electronic devices are utilized across the organization and throughout each department. Colleagues must have an understanding of computers, and competence in using computers and basic software programs.

Clinical: Demonstrates an understanding of complications, co-morbidities, severity of illness, risk of mortality, case mix, secondary diagnoses, impact of procedures on DRG and is able to impart this knowledge to physicians and other health team members. Demonstrates and utilizes the guidelines of care and practice via the nursing process and in accordance with Arizona State Board of Nursing Laws and Regulations being able to perform at a fully competent level. Maintains a review rate of 80% on assigned cases and query rate of 15% on assigned cases, or as determined by clinical performance need. Performs audits of documentation to ensure consistency and that standards are met. Operations: Communicates with physicians face-to-face or through clinical documentation inquiry forms to clarify information, obtain needed documentation, present opportunities and educate for appropriate MS-DRG based on severity of illness. Confers with HIM coders to ensure appropriate MS-DRG assignment and completeness of supporting documentation. Confers with Physician Advisor as needed. Data intergrity Conducts concurrent and retrospective review of each assigned patient in the time frame and frequency as required. Identifies and records the most appropriate principal diagnosis, secondary diagnosis, complications/co-morbidities and procedures to reflect the severity of illness and risk of mortality. Identifies opportunities for improvement in documentation processes. Communicates with physicians face-to-face or through clinical documentation inquiry forms to clarify information, obtain needed documentation, present opportunities and educate for appropriate MS-DRG based on severity of illness. Maintains accurate data in the tracking database to identify trends and issues, developing action plans to achieve team goals. Compliance/Safety Responsible for reporting any safety-related incident in a timely fashion through the Midas/RDE tool; attends all safety-related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner. Stays current and complies with state and federal regulations/statutes and company policies that impact the employee's area of responsibility. If required for the position, ensures all certifications and/or licenses are up-to-date and valid prior to expiration dates. Completes all company mandatory modules and required job-specific training in the specified time frame.

MedViewHealth

HEDIS Reviewer - RN/LPN/LVN (100% Remote)

Posted on:

October 13, 2025

Job Type:

Contract

Role Type:

Utilization Review

License:

RN

State License:

Georgia

MedViewHealth is a medical research company focusing on medical record review/abstraction, retrieval and research database design. Our clients are major health plans and research companies across the US. http://www.medviewhealth.com

Employment Type: Contract—1099 Independent Contractor (Temporary Project Assignment) Project Duration: January 5, 2026 – May 2026 MedViewHealth is seeking experienced RNs and LPNs/LVNs to join our team for the 2026 HEDIS season. This fully remote contract role involves conducting medical record reviews, data abstraction, and quality validation according to NCQA Technical Specifications. Schedule Required availability 40 hours per week (Monday–Friday, standard business hours) Specific start times determined by team leads Evening and weekend work not permitted Hours may vary based on project needs

Active RN or LPN/LVN license in good standing (any state) Minimum 2 years of recent HEDIS review experience (within the past 2 years) Must complete HEDIS Knowledge Assessment and Computer Skills Competency Test Attend all required HEDIS trainings Strong attention to detail with proven accuracy and productivity performance. Performance Expectations Must achieve 100% accuracy on Inter-Rater Reliability (IRR) testing prior to release to full production. Maintain a minimum of 95% accuracy in quality performance throughout the project. Attend weekly meetings with HEDIS Leads and Program Managers Consistently meet or exceed daily and weekly productivity targets as established by client management. Computer Proficiency Using and setting up applications on a company-issued laptop, while navigating and working across multiple systems. Proficient in Microsoft Outlook, Teams and Excel (filtering, copy cells, delete/add rows, navigate between worksheets, rename and save worksheet, merge cells) Ability to learn and navigate client-specific data entry and abstraction systems Resolve minor technical issues independently. Technology & Equipment Client issued laptop provided for project use: Must provide a personal address to receive the company-issued laptop in December before the project begins. Contractor must supply a secure, high-speed internet connection that meets: Approved Providers: Cable (AT&T, Charter, Comcast, Spectrum, Verizon FIOS) Not Approved: Satellite, Wi-Fi, hotspots, cellular-based connections, or line-of-sight internet Minimum Speeds: 5 Mbps upload / 5 Mbps download (20 Mbps recommended)

HEDIS Abstractor: Performs detailed medical record reviews from provider offices, hospitals, and health plan systems to determine compliance with HEDIS Hybrid measures. HEDIS Researcher: Uses claims systems, provider databases (e.g., NPI registry), immunization registries, and EMRs to locate provider- or member-specific data for HEDIS measure completion. HEDIS Over‐Reader: Validates abstraction accuracy and ensures adherence to NCQA Technical Specifications. Extensive abstraction experience required; serves as final quality reviewer prior to submission.

Providence at Home with Compassus

Clinical Quality Specialist- PST

Posted on:

October 13, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Compassus delivers compassionate patient-centered home care services including home health, infusion therapy, palliative care and hospice care. Our brand promise, Care for Who I Am, reflects our unique care delivery model, focusing on the individual needs of every patient we serve. At Compassus, we know that caring for our teammates is the first step in caring for our patients. We are committed to providing care for 'Who You Are' and 'What You Need' to balance work and life including flexible scheduling, a supportive family-focused culture and first-class compensation and benefits. Care for Who I Am is Caring for Who We Are. Together We Are: Welcoming everyone. Empowering belonging. Allying for inclusivity. Removing barriers. Engaging community. WE ARE fostering an inclusive environment where every teammate matters and can be their best selves. WE ARE becoming a reflection of our patients, families, and partners. WE ARE transforming care at home for every community serve.

Providence at Home with Compassus This role will work remotely out of PST Business hours. Position Summary: The Clinical Quality Specialist is responsible for modeling the Compassus values of Compassion, Integrity, Excellence, Teamwork, and Innovation and for promoting the Compassus philosophy, using the 6 Pillars of Success as the foundation. S/he is responsible for upholding the Code of Ethical Conduct and for promoting positive working relationships within the company, among all departments, and all external stakeholders. The Clinical Quality Specialist is primarily responsible for ensuring the accurate entry of all Start of Episode and OASIS forms for patient charts. S/he processes Home Health Director of Clinical Services workflows.

Education and/or Experience: Associate or Bachelor's degree in Nursing required. One (1) year experience in home health care required. QA experience in home health care preferred. Prior experience with Home Care Home Base strongly preferred. Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percentage. Language Skills: Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from leaders, team members, investors, and external parties. Strong written and verbal communications. Other Skills and Abilities: Ability to understand, read, write, and speak English. Articulates and embraces hospice philosophy. Certifications, Licenses, and Registrations Active and unencumbered Multistate Compact Registered Nurse license required. Current COS-C certification required at the time of hire or must be obtained within 90 days of hire.

Completes or reviews all client medical records regarding OASIS. Executes all OASIS reviews on a timely basis. Assures compliance with OASIS time frames as required by law. Completes OASIS activities as appropriate in conjunction with field staff. Reviews and processes the Home Health Director of Clinical Services workflow as assigned, including tasks related to start and resumption of episode, OASIS review and utilization. Performs other duties as assigned.

Pinnacle Home Care

Clinical Review Specialist - LPN

Posted on:

October 13, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

Florida

Pinnacle Home Care Holdings, LLC (“Pinnacle”) is a leading Florida-based provider of home healthcare services. We’re seeking an experienced Clinical Review Specialist to join our growing team and ensure every patient’s care plan starts with clinical excellence, regulatory compliance, and a compassionate touch.

Are you looking to make a difference in patients’ lives with a company that values your expertise? Join us in our mission of delivering compassionate healthcare where it matters most –– at home.

Current RN license (preferred) or LPN with equivalent experience in home health intake/clinical review. 2+ years of clinical experience in home health, intake, or care coordination. Knowledge of Medicare COPs, CMS guidelines, and general home health regulations. Strong critical thinking and clinical decision-making skills. Excellent communication and phone skills; ability to build trust with patients, referral sources, and colleagues. Proficiency with EMR systems (WellSky/KanTime preferred) and Microsoft Office Suite (Outlook, Teams, Excel). Ability to work in a fast-paced, high-volume environment with accuracy and composure.

Review all incoming home health orders for clinical appropriateness. Determine appropriate disciplines, frequencies, and visit types in line with agency protocols and referral source requirements. Confirm compliance with CMS guidelines, Medicare Conditions of Participation (COPs), and internal agency standards. Take and document verbal orders from physicians and referral sources accurately and efficiently. Perform patient welcome calls to ensure a smooth, positive onboarding experience. Triage and troubleshoot patient needs or concerns during intake conversations. Maintain a warm, empathetic, and professional phone presence to reassure patients and referral partners. Accurately document all intake and order-related activities in the EMR (WellSky/KanTime or similar). Ensure physician orders, care plans, and required documentation are completed, accurate, and properly uploaded. Maintain an up-to-date understanding of home health regulatory requirements, including Medicare, CMS, and state guidelines. Proficient in EMR data entry (KanTime experience preferred; WellSky training provided). Comfortable using Microsoft Outlook, Teams, and internal reporting tools. Follow daily reporting and tracking requirements to support transparency. Partner closely with Intake, Care Coordination, and Branch leadership to ensure timely patient starts of care. Escalate clinical concerns or regulatory issues promptly to the Clinical Review Manager. Support branch and central teams with troubleshooting and guidance on referral-related issues.

CorVel Corporation

Professional Review Nurse (Part time to Full time)

Posted on:

October 13, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

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

The Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care. This is a remote role.

KNOWLEDGE & SKILLS: Concise and effective verbal and written communication skills Ability to interface with claims adjusters, attorneys, physicians and their representatives, advisors/clients, and co-workers Ability to effectively promote all Professional Review products with attorneys, claims examiners, customers and management Strong ability to effectively negotiate provider fees Must be proficient with Microsoft Office applications Knowledge of worker's compensation claims preferred EDUCATION & EXPERIENCE: Must maintain current licensure as a Registered Nurse in the state of employment with a minimum of 4 years clinical experience A minimum of an Associate Degree in Nursing as well as have a thorough knowledge of both C.P.T. and I.C.D.9 codes preferred Medical bill auditing experience preferred Experience in the clinical areas of O.R., I.C.U., C.C.U., E.R., and orthopedics preferred Prospective, concurrent and retrospective utilization review experience preferred

Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner/client and/or direct reporting manager Collect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plans Utilize clinical and/or technical expertise to address the provision of medical care and identify inappropriate billing practices and errors, such as: duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time increment discrepancies, inconsistencies with diagnosis, treatment frequency and duration of care, DRG validation, service/treatment vs. scope of discipline, use of appropriate billing protocols, etc. Document work and final conclusions in designated computer program Additional duties as assigned

Monogram Health Inc

Enrollment Team RN

Posted on:

October 13, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

Monogram Health is a leading multispecialty provider of in-home, evidence-based care for the most complex of patients who have multiple chronic conditions. Monogram health takes a comprehensive and personalized approach to a person’s health, treating not only a disease, but all of the chronic conditions that are present - such as diabetes, hypertension, chronic kidney disease, heart failure, depression, COPD, and other metabolic disorders. Monogram Health employs a robust clinical team, leveraging specialists across multiple disciplines including nephrology, cardiology, endocrinology, pulmonology, behavioral health, and palliative care to diagnose and treat health issues; review and prescribe medication; provide guidance, education, and counselling on a patient’s healthcare options; as well as assist with daily needs such as access to food, eating healthy, transportation, financial assistance, and more. Monogram Health is available 24 hours a day, 7 days a week, and on holidays, to support and treat patients in their home. Monogram Health’s personalized and innovative treatment model is proven to dramatically improve patient outcomes and quality of life while reducing medical costs across the health care continuum.

Monogram Health is looking for a skilled Registered Nurse eager for the opportunity to make a difference in patients' lives. The Enrollment RN is a key member of the Monogram Health Team who helps set up our patients with Monogram Health’s services. The patients we serve often struggle with multiple serious diseases. Enrollment RNs help our patients access Monogram Health’s services to improve their quality of life in the home and slow the progression of multiple chronic diseases, enabling positive health outcomes. As a Registered Nurse, you are an integral part of building trusting relationships with patients, so that they can experience a high quality of life at home. You will be instrumental in building our patient panels, where the patients can directly experience the impact of our care. In healthcare systems, the patient has too often become secondary due to processes and incentives that don’t positively impact the patient for the long term. Here at Monogram, we strive to change that narrative by putting our patients and their quality of life at the forefront of what we do.

Current active, unencumbered compact nursing license Fully remote, telephonic position Self-starter with the ability to work independently with minimal supervision Ability to show empathy and quickly build relationships with patients Graduate of an accredited School of Nursing 2+ years previous experience working in care management and/or with CKD/ESRD patients Excellent verbal communication skills on the phone Familiarity with Microsoft Office and mobile phone and web-based applications Preferred: Registered Nurse

Conduct telephonic enrollment visits and develop care plans Perform patient health assessments and surveys as required Collect signed consents from patients to participate in Monogram Health’s program Schedule follow up visits with Monogram Health’s medical providers to provide in-home access to multi-specialty healthcare Inventory and reconcile medications, and encourage medication and treatment adherence Provide education and coaching around medications, medical conditions, diet, exercise, and lifestyle choices

MES Solutions

Client Coordinator

Posted on:

October 13, 2025

Job Type:

Full-Time

Role Type:

License:

None Required

State License:

Massachusetts

MES Solutions (MES) is a premier provider of independent medical examination and peer review services to the insurance, corporate, legal, and government sectors. Members of our credentialed medical panel conduct physical examinations or medical record reviews, delivering reports that assist clients in the resolution of automotive, disability, liability, and workers' compensation claims

The Client Coordinator is responsible for servicing inquiries from clients, physicians, nurses or any representative acting on behalf of a client. This position is responsible for data preparation, data entry, data tracking, documentation and filing. All duties are handled with a high degree of quality customer service and in compliance with all regulatory and company standards.

Education and/or Experience: High school diploma or equivalent required. Minimum one year clerical experience; or equivalent combination of education and experience preferred. Experience in a medical office or insurance industry preferred. Certificates, Licenses, Registrations: No specific requirements. ESSENTIAL COMPETENCIES QUALIFICATIONS Must possess complete knowledge of general computer, fax, copier, scanner, and telephone. Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. Must have ability to be trained on and adhere to HIPAA regulations and compliance standards. Must be a qualified typist with a minimum of 40 W.P.M. Ability to follow instructions and respond to managements’ directions accurately. Must demonstrate accuracy, thoroughness, and responsibility for quality of work, and ability to take initiative to identify improvements. Looks for ways to improve and promote quality and monitors own work to ensure quality is met. Must demonstrate exceptional communication skills. Must be able to work independently, prioritize work activities and use time efficiently. Must be able to maintain confidentiality. Must be able to demonstrate and promote a positive team -oriented environment. Must be able to stay focused and concentrate under normal or heavy distractions. Must be able to work well under pressure and or stressful conditions. Must possess the ability to manage change, delays, or unexpected events appropriately. Ability to follow all company policies and procedures in effect at time of hire and as they may change or be added from time to time. LANGUAGE/COMMUNICATION SKILLS: Ability to read, analyze and interpret common correspondence, medical records, and legal contracts and documents. Ability to write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar. Ability to respond appropriately and professionally to all inquiries or complaints from customers, physicians, regulatory agencies, and/or members of the business community. Ability to effectively present information one-on-one or in small groups. PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This position generally consists of: Ability to work at a desk or similar office-type furnishings up to 8 hours a day or longer as required by business needs. Ability to operate a computer up to 4 hours at a time. Ability to travel to different floors of the office or other locations. Ability to move throughout the office. Occasionally lifting and/or carrying up to 10 lbs. Occasionally pushing/pulling up to 25 lbs. Occasionally subject to bending, squatting or twisting. WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Extended hours are occasionally required beyond the regular eight (8) hour work day. The noise level in the work environment is usually moderate.

Handle and respond promptly to inquiries from clients and/or anyone acting on behalf of the client regarding questions, report status, concerns, or general requests for information. Utilize appropriate systems and databases to enter client or claimant information and or retrieve information. Maintain daily contact with the QA department regarding workflow and pending report status. Contact providers for assignment and update database. File and archive open and closed cases. Verify all client information is current in the database and all client specific guidelines and or rules or information is documented in the system. Work independently and in partnership with other team members to ensure that questions are addressed, documented and cases are returned in a timely fashion. Direct calls to other departments as needed. Perform various clerical duties such as typing, filing, emailing, and proofreading. Assist in resolution of customer complaints and quality assurance issue. Notify management of any report issues or concerns. Ensure all practices are carried out in accordance with state and federal safety and legal regulations. Perform other duties as assigned.

MES Solutions

Clinical Quality Assurance Nurse Auditor

Posted on:

October 13, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Massachusetts

MES Solutions is a premier provider of independent medical examination and peer review services to the insurance, corporate, legal, and government sectors. Members of our credentialed medical panel conduct physical examinations or medical record reviews, delivering reports that assist clients in the resolution of automotive, disability, liability, and workers' compensation claims. MES has been providing services nationally since 1978 in accordance with the industry's highest standards of operating excellence and regulatory compliance.

Are you a detail-oriented RN with a passion for clinical excellence and quality assurance? Join MES as a Clinical Quality Assurance Nurse Auditor, where you'll play a key role in ensuring the accuracy, integrity, and compliance of clinical documentation. In this role, you'll evaluate clinical information submitted by healthcare providers and craft high-quality reports that meet client expectations and regulatory standards. You'll also serve as a resource for quality assurance inquiries and provide vital support to the QA department. This position is 100% remote with a schedule of Monday through Friday: 9:00am-5:30pm EST.

Make a meaningful impact from wherever you are - apply today and help us raise the bar in clinical quality assurance. Bachelor/Associate degree in nursing or related field; or minimum five years related experience; or equivalent combination of education and experience. Experience with medical terminology, medications, medical specialties and treatment protocols required. Experience in the insurance industry preferred. Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values. Must be able to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; Ability to compute rates and percentages. Must be a qualified typist with a minimum of 40 W.P.M Must be able to operate a general computer, fax, copier, scanner, and telephone. Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet. Must possess excellent skills in English usage, grammar, punctuation and style. Ability to follow instructions and respond to upper managements’ directions accurately. Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met. Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed. Must be able to work independently, prioritize work activities and use time efficiently. Must be able to maintain confidentiality.

Evaluate clinical information received, write and/or review various reports including, but not limited to, Medical Record Reviews, Medical Record Chronologies, Provider Bill Reviews, Coding Reviews, Hospital Bill Reviews, List of Missing Records, Medical Bill Apportionments, Mock Billing Invoice and Medical Summary Statements. Perform quality assurance review of peer review reports, correspondences, addendums or supplemental reviews. Ensure clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations. Ensure that all client instructions and specifications have been followed and that all questions have been addressed. Ensure each review is supported by clinical citations and references when applicable and verify that all references cited are current and obtained from reputable medical journals and/or publications. Ensure the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards. Ensure the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report. Verify that the reviewer has attested to only the facts and that no evidence of reviewer conflict of interest exists. Ensure the provider credentials and signature are adhered to the final report. Identify any inconsistencies within the report and contacts the Reviewer to obtain clarification, modification or correction as needed. Contact the appropriate person to recover any missing documentation or verify charges. Assist in resolution of customer complaints and quality assurance issues as needed. Ensure all federal ERISA or state mandates are adhered to at all times. Provide insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications. Promote effective and efficient utilization of company resources. Participate in various continuing education requirements and or training activities. Perform other duties as assigned.

CorVel Corporation

Professional Review Nurse (Part time to Full time)

Posted on:

October 13, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

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

The Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care. This is a remote role.

KNOWLEDGE & SKILLS: Concise and effective verbal and written communication skills Ability to interface with claims adjusters, attorneys, physicians and their representatives, advisors/clients, and co-workers Ability to effectively promote all Professional Review products with attorneys, claims examiners, customers and management Strong ability to effectively negotiate provider fees Must be proficient with Microsoft Office applications Knowledge of worker's compensation claims preferred EDUCATION & EXPERIENCE: Must maintain current licensure as a Registered Nurse in the state of employment with a minimum of 4 years clinical experience A minimum of an Associate Degree in Nursing as well as have a thorough knowledge of both C.P.T. and I.C.D.9 codes preferred Medical bill auditing experience preferred Experience in the clinical areas of O.R., I.C.U., C.C.U., E.R., and orthopedics preferred Prospective, concurrent and retrospective utilization review experience preferred

Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner/client and/or direct reporting manager Collect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plans Utilize clinical and/or technical expertise to address the provision of medical care and identify inappropriate billing practices and errors, such as: duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time increment discrepancies, inconsistencies with diagnosis, treatment frequency and duration of care, DRG validation, service/treatment vs. scope of discipline, use of appropriate billing protocols, etc. Document work and final conclusions in designated computer program Additional duties as assigned

CorVel Corporation

Quality Assurance Nurse

Posted on:

October 13, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Texas

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

The Quality Assurance Nurse is responsible for case management quality assurance and mentorship of operations staff, providing tools and calibrating processes, while ensuring consistent delivery of CorVel’s case management services. This is a remote position.

KNOWLEDGE & SKILLS: Excellent oral and written communication skills PC literate, including Microsoft Office (Word, Excel) Strong knowledge of clinical and case management processes Strong knowledge and experience in quality assurance and training programs Proficient in identifying case management office improvement opportunities and communicating and implementing solutions Ability to remain poised in stressful situations and communicate using diplomacy Ability to manage multiple complex projects and competing priorities while working under pressure to meet deadlines and maintaining strong customer service orientation Effective quantitative and analytical skills Must have strong organizational skills Ability to work independently or in a team environment while functioning as an educator rather than an auditor Knowledge of the entire claims administration, case management and cost containment solution as applicable to third party administrator operations EDUCATION & EXPERIENCE: Graduate of accredited school of nursing with a diploma/Associates degree (Bachelor of Science degree or Bachelor of Science in Nursing preferred) 3 or more years of recent clinical experience, preferably in rehabilitation National certification (CRC, CIRS, CCRN, CVE, CCM, etc.), CCM preferred Four year degree from an accredited college or university preferred Certified Trainer and/or Quality Assurance distinction preferred Four (4) years of case management experience preferred or equivalent experience Prior quality assurance and/or training a plus Current RN licensure

Develop, implement, and provide ongoing quality assurance calibration of processes as well as a case management mentoring, both managed and delivered at the operational level Educate and equip operations with performance measurement and reporting tools that can be used to objectively measure and grow operations Provide national account and regulatory quality oversight As applicable, provide oversight and management of URAC compliance and renewals Work with executive, general and case management department management to ensure the case management department successfully implemented and is adhering to CorVel standards (including quality assurance, reporting, and management processes) Work closely with new hires to ensure consistent and full integration/training of all case management managers to CorVel standards as well as training for system usage pertaining to case management and reporting Identify developmental needs and and participate in training of case management leadership, including the training/re-training of all offices on standards and procedures, and usages of the CorVel case management and reporting system Develop, run and interpret management reports to ensure the case management operations are utilizing the tools available to manage compliance of services delivery within company standards Facilitate peer-to-peer quality reviews to ensure delivery of quality case management Review results and outcomes with general management and case management leadership and develop action plans where warranted Make recommendations in collaboration with field operations to ensure actions toward improvement are identified Develop and oversee case management manager mentor program to facilitate the onboarding of new supervision and management to equip field with the tools for compliance and consistency of CorVel standards and procedures Implementation, oversight and communication of regulatory requirements within case management services to include, state, federal and URAC Identify trends and recommend action plans to management for continuous process improvement Ability to travel up to fifty percent of the time Additional duties as assigned

Elevate Patient Financial Solutions

Clinical Appeals Nurse

Posted on:

October 13, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Texas

Elevate Patient Financial Solutions℠ is a trusted partner who delivers superior RCM solutions to hospitals, health systems, and health providers nationwide. For more than 40 years, we've been developing and continually refining our best-in-class services and innovative, specialized technology to address the most complex challenges of the revenue cycle. We've carefully built teams with unmatched industry experience and service-specific expertise, and our commitment is to deliver on our promises, seek continuous improvement, and the pursuit of excellence to deliver results for our clients. Our services include Eligibility & Disability, Self-Pay, Third Party Liability, Workers' Compensation, Veterans Administration, COB Denials, Out-of-State Eligibility, and A/R Services, including A/R billing and insurance follow up, legacy conversions and project-specific aged A/R work down. With in-depth, state-specific knowledge and a coast-to-coast presence, ElevatePFS℠ delivers exceptional performance and an unmatched client experience.

Elevate Patient Financial Solutions has an exciting career opportunity available as a Clinical Appeals Nurse. This position will be remote based. The Full Time schedule for this role will be 8AM-4:30PM, Monday-Friday. Job Summary: The Clinical Appeals Nurse is the liaison and point of contact for clinical denials and appeals that are received after claim submission. Responsible for the management and communication of denials/appeals received from third party payers, managed care companies, and/or government entities/auditors related to medical necessity and/or level of care.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or abilities. Apply professional standards of practice in the work environment to both internal and external customers Knowledge of regulatory standards, compliance requirements, hospital policies and procedures, and third party requirements Familiar with medical terminology Strong understanding and working knowledge of Medicare and Commercial admission regulations Familiar with third-party admission and continued stay criteria Working knowledge of personal computer and software applications used in job functions (Word processing, graphics, databases, spreadsheets, etc.) A minimum of two years of Utilization Review/Case Management experience in either a managed care or hospital setting is required A minimum of two years’ experience in the denial and appeal process preferred RN license, in good standing and maintained current throughout employment CCM, preferred ​A minimum of two years’ of Utilization Review/Case Management experience in either a managed care or hospital setting is required A minimum of two years’ experience in the denial and appeal process preferred Remote and Hybrid positions require home internet connections that meet the company’s upload and download speed criteria.

Use their clinical knowledge, experience, and advanced critical thinking to ensure accuracy and integrity of the full life cycle of medical necessity denial determinations is properly administered. Evaluate clinical appeal letter correspondence for content, clarity, accuracy, and consistency. Package & send appeal and grievance information to the payors, monitors for the outcome of appeal and takes action accordingly (notify the provider and member as per delegation agreement), track all appeal information. Actively manage, maintain and communicate denial/appeal activity to appropriate stakeholders, and report suspected or emerging trends related to payer denials. Participate in the review of audit findings as needed. Regular and timely attendance. Other duties as assigned.

Broadspire Services, Inc.

Medical Case Manager

Posted on:

October 13, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Indiana

Because a claim is more than a number — it’s a person, a child, a friend. It’s anyone who looks to Crawford on their worst days. And by helping to restore their lives, we are helping to restore our community – one claim at a time. At Crawford, employees are empowered to grow, emboldened to act and inspired to innovate. Our industry-leading team pioneers new solutions for the industries and customers we serve. We’re looking for the next generation of leaders to take this journey with us. We hail from more than 70 countries and speak dozens of languages, reflecting the global fabric of the audience we serve. Though our reach is vast, we proudly operate as One Crawford: united in purpose, vision and values. Learn more at www.crawco.com.

To provide effective case management services in an appropriate, cost effective manner. Provides medical case management service which is consistent with URAC standards and CMSA Standards of Practice and Broadspire Quality Assurance (QA) Guidelines to patients/employees who are receiving benefits under an Insurance Line including but not limited to Workers' Compensation, Group Health, Liability, Disability, and Care Management.

Associate's degree or relevant course work/certification in Nursing is required; BSN Degree is preferred. Minimum of 1-3 years diverse clinical experience and one of the below: Certification as a case manager from the URAC-approved list of certifications (preferred); A registered nurse (RN) license. Must be compliant with state requirements regarding national certifications. General working knowledge of case management practices and ability to quickly learn and apply workers compensation/case management products and services. Excellent oral and written communications skills to effectively facilitate return-to-work solutions within a matrix organization and ensure timely, quality documentation. Excellent analytical and customer service skills to facilitate the resolution of case management problems. Basic computer skills including working knowledge of Microsoft Office products and Lotus Notes. Demonstrated ability to establish collaborative working relationships with claims adjusters, employers, patients, attorneys and all levels of employees. Demonstrated ability to gather and analyze data and establish plans to improve trends, processes, and outcomes. Excellent organizational skills as evidenced by proven ability to handle multiple tasks simultaneously. Demonstrated leadership ability with a basic understanding of supervisory and management principles. Based on federal, state, or local law, this position may require you to be fully vaccinated for COVID-19. Active RN home state licensure in good standing without restrictions with the State Board of Nursing. Must meet specific requirements to provide medical case management services. Minimum of 1 National Certification (CCM, CDMS, CRRN, and COHN) is preferred. If not attained, must plan to take certification exam within proceeding 36 months. National certification must be obtained in order to reach Senior Medical Case Management status. Travel may entail approximately 70% of work time. Must maintain a valid driver's license in state of residence.

Reviews case records and reports, collects and analyzes data, evaluates injured worker/disabled individual's medical status, identifies needs and obstacles to medical case resolution and RTW by providing proactive case management services. Render opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate case management goals to include RTW. Demonstrates ability to meet administrative requirements, including productivity, time management and QA standards, with a minimum of supervisory intervention. May perform job site evaluations/summaries to facilitate case management process. Facilitates timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer and physicians. Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual. May obtain records from the branch claims office. May review files for claims adjusters and supervisors for appropriate referral for case management services. May meet with employers to review active files. Makes referrals for Peer reviews and IME's by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians. Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly. May spend approximately 70% of their work time traveling to homes, health care providers, job sites and various offices as required facilitating RTW and resolution of cases. Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product. Reviews cases with supervisor monthly to evaluate files and obtain directions. Upholds the Crawford and Company Code of Business Conduct at all times. Demonstrates excellent customer service, and respect for customers, co-workers, and management. Independently approaches problem solving by appropriate use of research and resources. May perform other related duties as assigned.

Pinnacle Home Care

Registered Nurse Concierge - Home Health

Posted on:

October 13, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Florida

Pinnacle Home Care, the largest home health provider in Florida, has proudly served our communities for over two decades. We are a team driven by a deep passion for home healthcare and an unwavering commitment to the well-being of our patients and their families. At Pinnacle, we foster a forward-thinking, collaborative workplace culture. This has earned us multiple recognitions including the Top Workplaces USA award – a testament to our focus on supporting and empowering our employees. We offer a comprehensive suite of services, including skilled nursing, physical therapy, occupational therapy, speech therapy, medical social work and home health aide support to more than 10,000 patients across our service areas. We strive to help seniors thrive, not only under our care, but long after our services are complete.

Are you looking to make a difference in patients’ lives with a company that values your expertise? Join us in our mission of delivering compassionate healthcare where it matters most – at home. Hours: Sunday through Wednesday 8:00 AM-6:30 PM Eastern Time Zone Pinnacle Home Care, Florida’s largest Medicare-certified home health provider, has been delivering high-quality, patient-centered care for over two decades, and we’re looking for a Registered Nurse Concierge to join our award-winning team.

Registered Nurse or Licensed Practical Nurse with IV Certification. Health Care experience, preferably Home Health Care experience (minimum 1 year). Medical triage experience. Strong organizational and time management skills with the ability to effectively prioritize and complete tasks with attention to detail while managing multiple responsibilities. Strong written and verbal communication skills with the ability to address concerns in a courteous and timely manner. Commitment to providing compassionate and patient-centered care. Strong knowledge of relevant computer systems and proficient computer literacy skills. Ability to maintain confidentiality and adhere to HIPAA regulations.

Answer incoming and/or make outgoing calls to/from stakeholders, referral sources, and new patients to provide exceptional patient care and customer service in a fast-paced, high-volume call center environment. Demonstrate the ability to prioritize and multitask, operate multiple web-based systems simultaneously, access and comprehend information to determine next steps, and perform data entry with high accuracy. Be able to easily accept and adapt to changes in procedures, programs, and/or role functions based on the needs of the company. Compliance with HIPAA in all interactions. Create, update, and access confidential client data in the company's Electronic Medical Records with a high level of confidentiality and accuracy. Communicate effectively with both internal and external customers. Maintain internal department spreadsheet logs and/or reports. Utilizes appropriate supervisors and leaders to discuss, enhance, and resolve issues.

Stormont Vail Health

Ambulatory Registered Nurse or LPN (Remote) - Diabetes & Endocrinology Center - FT - Day

Posted on:

October 13, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Kansas

Stormont-Vail Health helps to take care of the health of residents in northeastern Kansas. Its facilities include the 590-bed hospital, an emergency and trauma center, an outpatient surgery center, and a network of community clinics located throughout the 12-county region. Its Cotton-O'Neil centers treat heart disease, cancer, skin problems, and digestive system ailments, as well as various clinics and ExpressCare locations. Specialized services include behavioral health, obstetrics, orthopedics, and physical and occupational rehabilitation. Geographic Reach: Stormont-Vail Health serves a 12-county area in northeast Kansas. Strategy: The health system pursues strategic partnerships and organic growth to keep up with demand. The system has partnerships with the Baker School of Nursing, Kansas Rehabilitation Hospital, and Mayo Clinic. In 2011, Stormont-Vail Health added pediatric critical care services to provide care to infants in the neonatal intensive care unit.

Endocrinology nursing is a specialty within the nursing profession that encompasses the care of individuals who suffer from endocrine disorders. Diabetes and Endocrinology department nurses provide episodic and chronic nursing care to patients by telephone or web portal to include assessing patients, refilling medications per standing orders, evaluating the patient's understanding of their medication regime, and providing education and advocacy to patients and their families. The delivery of professional nursing care at Stormont Vail Health is guided by Jean Watson's Theory of Human Caring and the theory of Shared governance, both of which are congruent with the mission, vision, and values of the organization.

Education Qualifications: Bachelor's of Science in Nursing (BSN) Preferred Experience Qualifications: 1 year Nursing experience. Preferred Skills and Abilities: Skill in applying and modifying the principles, methods and techniques of professional nursing to provide on-going patient care. (Required proficiency) Skill in establishing and maintaining effective working relationships with patients, medical staff and the public. (Required proficiency) Ability to maintain quality control standards. (Required proficiency) Ability to react calmly and effectively in emergency situations. (Required proficiency) Licenses and Certifications: Registered Nurse - KSBN Required Required for All Jobs Complies with all policies, standards, mandatory training and requirements of Stormont Vail Health Performs other duties as assigned Patient Facing Options Position is Not Patient Facing Remote Work Guidelines Workspace is a quiet and distraction-free allowing the ability to comply with all security and privacy standards. Stable access to electricity and a minimum of 25mb upload and internet speed. Dedicate full attention to the job duties and communication with others during working hours. Adhere to break and attendance schedules agreed upon with supervisor. Abide by Stormont Vail’s Remote Worker Policy and will review and acknowledge the Remote Work Agreement annually. Remote Work Capability Full-Time Scope No Supervisory Responsibility No Budget Responsibility Physical Demands Balancing: Rarely less than 1 hour Carrying: Rarely less than 1 hour Eye/Hand/Foot Coordination: Occasionally 1-3 Hours Feeling: Rarely less than 1 hour Grasping (Fine Motor): Occasionally 1-3 Hours Grasping (Gross Hand): Rarely less than 1 hour Handling: Rarely less than 1 hour Hearing: Occasionally 1-3 Hours Kneeling: Rarely less than 1 hour Sitting: Frequently 3-5 Hours Standing: Rarely less than 1 hour Stooping: Rarely less than 1 hour Talking: Frequently 3-5 Hours Walking: Rarely less than 1 hour Working Conditions Combative Patients: Rarely less than 1 hour Dusts: Rarely less than 1 hour Electrical: Rarely less than 1 hour Noise/Sounds: Rarely less than 1 hour

Triage of all incoming phone calls by evaluating the physical and psychosocial health status of patients. Follows nursing protocols and guidelines for answering and directing calls. Record and reports patient’s condition and reaction to drugs and treatments to interdisciplinary team. Provide instruction to patients/family regarding treatment. Maintains and reviews patient records, charts, and other pertinent information. Oversee appointment bookings and ensure preferences are given to patients in emergency situations. Arranges for patient testing and admissions. Refill prescribed medications per standing orders. Clarify medication orders and refills to pharmacies as directed by providers. Perform medication prior authorizations as needed by providing needed clinical information to insurance. Maintain timely flow of patient to include scheduling of follow up appointments if needed. Working of in-basket medication refill requests for providers. Provide education to patient and family on medications, treatments and procedures. Record and report patient’s condition and reaction to drugs and treatments to interdisciplinary team, reviewing patient records and other pertinent information. Ensure patients receive appointments that align with triage disposition and that maintain timely flow of patients. Coordinate patient testing, referrals, and admissions Work collaboratively with on-site staff to provider coordinated patient care

BlueCross BlueShield of South Carolina

Registered Nurse Senior Medical Reviewer (Medicare Part B) - CGS

Posted on:

October 12, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

We are currently hiring for a Registered Nurse Senior Medical Reviewer to join CGS, a Celerian Group Company and subsidiary of BlueCross BlueShield of South Carolina. The team the position will work on handles Medicare Part B claims. In this role you will Act as Team Lead for specialty programs, medical review, utilization management, and case management areas by providing assistance and support to manager by giving direction/guidance/training to staff. You will also ensure appropriate levels of healthcare services are provided. The is a computer-based position with no member/patient interaction. CGS Administrators provides a variety of services, under contracts with the Centers for Medicare and Medicaid Services (CMS) for beneficiaries, health care providers, and medical equipment suppliers in 33 states, supporting the needs of more than 20 million Medicare beneficiaries nationwide. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Want to work for a growing company with an innovative eye towards the future? Join us today! Description: Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Logistics CGS (cgsadmin.com) - one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full time (40 hours/week) Monday through Friday . This is a W@H opportunity and can be located anywhere within the U.S. To work from home, you must have high-speed, non-satellite internet and a private home office space.

Required License and Certificate: If RN, active, unrestricted RN licensure from the United States and in the state of hire, OR active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact NLC), OR active, unrestricted licensure/certification from the United States and in the state of hire in specialty area as required by hiring division/area. Required Education: Associate Degree - Nursing, OR or Graduate of Accredited School of Nursing. Required Work Experience: Four years clinical, OR Two years clinical and two years medical review/utilization review, OR , combination of health plan, clinical, and business experience totaling 4 years. Required Skills: Working knowledge of managed care and various forms of healthcare delivery systems. Strong clinical experience to include home health, rehabilitation, and/or broad medical surgical experience. Knowledge of specific criteria/protocol sets and the use of the same. Working knowledge of word processing and spreadsheet software. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service, organizational, and presentation skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Demonstrated oral and written communication skills. Ability to persuade, negotiate, or influence others. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Ability to lead/direct/motivate others. Required Software: Microsoft Office. What We Prefer: Prior experience in Part B Medical Review, Appeals, Utilization Review or Quality Assurance strongly preferred. Five years of varied clinical RN experience in critical care, emergency, inpatient medical/surgical, and/or DME (Durable Medical Equipment). Medicare Part B experience. Proficient in Excel Team player Self-starter

Functions as team leader/senior-level Medical Reviewer. Provides leadership/guidance/direction/training to staff. Maintains working knowledge of unit functions and ability to interpret to new hires, department innerworkings and workflow. Acts as resource for staff/external entities troubleshooting as well as resolving issues. Keeps manager informed of any problems/issues that need resolving. Assists management with monitoring workflow and workloads (including reassignment of work to meet timelines, redirecting work intake source to balance workloads), reporting, and addressing aging issues. Participates in departmental quality reviews. Follows process to ensure quality plan is adhered to and communicated to all parties. Gives/receives feedback regarding medical review decision making and technical claims processing issues. Ensures that quality work instructions/forms/documents are developed/revised as needed. Provides quality service and communicates effectively with external/internal customers in response to inquiries. Obtains information from internal departments, providers, government, and/or private agencies, etc. to resolve discrepancies/problems. Participates in compliance initiatives and other-directed activities. Participates/oversees special projects as requested by management.

J&B Medical Supply Co Inc

Utilization Management Representative - DME - Remote

Posted on:

October 12, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

None Required

State License:

Alabama

Since its inception in 1996, J&B Medical has become a recognized market leader in healthcare. More than a family-owned business, we are a family of businesses that span across all aspects of medical-related care including: insurance covered products, sole source program management and national managed care contracts, medical-surgical products, emergency-medical products, retail home-care products, veterinary products, and technology solutions. J&B Medical is a national certified Women’s Business Enterprise composed of knowledgeable industry professionals. J&B’s passionate teams are motivated to provide exceptional service at every interaction. Our goal is simple: enhance the quality of life, improve clinical outcomes, and reduce healthcare costs. J&B Medical settles for nothing less than the most innovative industry practices and the highest level of integrity.

The Utilization Management Representative is responsible for coordinating cases for prior authorization reviews, ensuring compliance with organizational and regulatory requirements. Need to communicate clearly and professionally with members, providers, and internal departments. This full-time position requires excellent customer service skills, strong attention to detail, and the ability to analyze situations effectively to ensure timely and accurate case processing. The role involves verifying insurance for DME supplies, submitting prior authorizations, requesting documentation, following up on documentation requests, processing orders for shipment and maintaining positive customer relations while adhering to company policies and procedures. HIRING REMOTE EXPERIENCED CSR'S IN THE FOLLOWING STATES: AL FL, GA, IN, KY, LA, MS, NC, SC, TN, TX, VA, & WV

Minimum of 2 year’s DME experience and/or 2 years Utilization Management experience required (any combination) Proven high-quality customer service skills for internal and external customers. Excellent organizational skills and attention to detail. Ability to prioritize tasks and communicate effectively to groups. Proficient with Microsoft Office Suite – satisfactory completion of our skills testing is required. High school diploma or GED required. Equipment is not provided.

Incoming/Outgoing calls Review contract and benefit eligibility. Refer cases requiring clinical review to internal review and/or submit to insurance provider for prior authorization Data entry Respond to telephone and written inquiries from members, providers, Manufacturers, and in-house departments., Conduct clinical screening processes., Request clinical documents from Providers, Follow up on requested documentation Develop and maintain positive customer relations and coordinate with various functions within the company., Participate in developing department goals, objectives, and systems., Attend staff meetings and other meetings and seminars as assigned., Recommend new approaches, policies, and procedures to improve department efficiency., Perform other related duties as assigned.

J&B Medical Supply Co Inc

Registered Nurse - Telehealth Pt Assessment - REMOTE in IN

Posted on:

October 12, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Indiana

Since its inception in 1996, J&B Medical has become a recognized market leader in healthcare. More than a family-owned business, we are a family of businesses that span across all aspects of medical-related care including: insurance covered products, sole source program management and national managed care contracts, medical-surgical products, emergency-medical products, retail home-care products, veterinary products, and technology solutions. J&B Medical is a national certified Women’s Business Enterprise composed of knowledgeable industry professionals. J&B’s passionate teams are motivated to provide exceptional service at every interaction. Our goal is simple: enhance the quality of life, improve clinical outcomes, and reduce healthcare costs. J&B Medical settles for nothing less than the most innovative industry practices and the highest level of integrity.

MUST HAVE VALID INDIANA RN LICENSE Our Nursing Team is growing in Indiana! Great Benefits after 30 days! PTO & Holiday Pay after 90! Summary: Our Staff Nurse's are responsible for conducting patient assessments by phone (ours) to determine individual needs for incontinence supplies. Position Type: This is a full time REMOTE position 40 hours per week. Monday through Friday, hours of work vary between 8:00am to 6:00pm. Occasional early mornings, evening and weekend work may be required as job duties demand.

Requirements: Current Registered Nursing License (RN) with the State of INDIANA (IN ONLY - CNL'S ARE NOT ACCEPTED) 2+ years previous work experience demonstrating patience, compassion and strong communication skills Must be great on the computer, able to use multiple databases simultaneously Preferred Education and Experience: 3 years of nursing experience Knowledge of medical terminology Medicare and Medicaid background Durable Medical Equipment (D

Consults by phone with client, primary caregiver, primary care physician or specialist, case managers and other community resources to determine if client qualifies for a particular program. Expectation is that Nurse will complete 20-25 assessments daily, on average with 98% accuracy. Conducts clinical assessments by phone and documents the client’s medical history. Monitors success rates. All products ordered must be assessed for use and quantity needs per day. Identifies appropriate product and quantity needs based on assessment. If formulary product will not meet needs, then reviews needs and potential solutions with Nurse Manager. Reassesses if there is a change in a client’s medical condition or an increase in quantity request. Obtains prior authorization from the state contract administrator for off-formulary or over-quantity requests. Reviews letters of medical necessity to determine if client qualifies for product or quantity requested. Reviews accounts for accuracy, reporting any errors to the appropriate department manager/leader. Participates in after-hours emergency call rotation. Understanding of insurance guidelines. Utilize intranet tools to complete assessments. Provides education to other J & B employees or external clients regarding products. Other Duties: All other duties as assigned by management. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are request of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Ventricle Health, Inc.

Flex Telehealth Nurse

Posted on:

October 12, 2025

Job Type:

Contract

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

Ventricle Health (www.ventriclehealth.com) is a high-growth virtual healthcare startup launching a national cardiologist network providing specialty telemedicine to members with prevalent cardiovascular diseases including heart failure, coronary artery disease and atrial fibrillation. Our Mission: To deliver a world-class patient experience in which patients have frictionless access to the best healthcare providers, devices, and therapies. Through the implementation of remote patient monitoring via connected medical devices and evidence-based therapy we intend to improve patients’ quality of life across the nation, focusing on heart health. Our Core Values: We strive to deliver exceptional outcomes through virtual care Our focus is our patients and supporting their needs with empathy We work as a team built on a foundation of trust, mutual respect, and open communication We approach problem solving creatively and seek innovative solutions We operate with integrity and accountability

Join our team as a Flex Registered Nurse at our virtual heart failure clinic. This role is a contractor (1099) position with a schedule that flexes based on company needs and your availability, working up to 24 hours per week (minimum hours not guaranteed). Coverage may include weekday business hours (9am-5pm), weekday holidays (9 am-9 pm) as well as full-day shifts on Saturdays and Sundays (9am-9pm EST). Additionally, you may be asked to cover weekday evening triage shifts totaling two (2) hours (Monday to Thursday, 5-7pm EST). To ensure your success, an initial training period will be conducted on weekdays, providing you with the preparation necessary for your new role. Demonstrate initiative, contributing to the ideation, validation, and execution of novel concepts. Make informed and responsible clinical decisions, delivering tangible and meaningful results. Engage in transparent and active communication, offering and seeking constructive feedback. Consistently exceed expectations with teamwork and enhancing the patient experience. Are able to commit to upcoming shifts within 3 business days’ or more notice and/or unplanned shifts within 24 hours notice Our Registered Nurses redefine the way health care is delivered every day. When you join our team, you’ll play an integral role in educating patients with medication adherence and disease state training. As an emerging leader in the healthcare industry, we seek special RNs who not only possess strong clinical expertise with innovative ideas, but who have the deep compassion and sensitivity it takes to treat our patients. Nurses working for Ventricle Health play a pivotal role as the face of the company, overseeing most patient interactions with our products and services. Cultivating professional yet friendly and empathetic patient relationships, you will contribute to providing an exceptional patient experience. This role aligns with Ventricle Health Clinical Policies and Procedures and established Clinical Practice Guidelines, and provides crucial support to Ventricle Health providers.

Registered Nurse (RN) with a valid and current compact licensure RN Diploma, Associate’s or Bachelor's in Nursing or Bachelor of Science in Nursing (BSN) from an accredited institution Minimum 4 years of bedside patient care in a hospital or clinic setting Minimum 2 years of cardiology nursing experience required Responsible for professional development and continuing education to maintain knowledge and skills Nice to have, but not required: CHFN certification Knowledge, Skills, and Abilities: Ability to convey information clearly and empathetically through telephonic and digital communication per company culture and guidelines Willingness to adapt to changing technologies, protocols, and telemedicine practices Flexibility to work outside of established hours when needed Awareness and sensitivity to diverse cultural backgrounds and the ability to provide culturally competent care Able to establish rapid patient rapport via telephonic and written interactions Document consistently and to the standards set by Ventricle Health leveraging the EMR Ability to work simultaneously in multiple platforms to ensure thorough and timely patient care Empowers patients to be able to effectively self-manage their own condition Convey enthusiasm and positive energy during patient interactions Ability to work autonomously in a responsible, efficient manner Possess exceptional time management and organizational skills Willing to learn new procedures and adapt to changes in working environment Must be able to work independently but recognize when escalation is warranted Handle confidential information with discretion Passionate about changing people’s lives and willing to go the extra mile to help patients be successful Demonstrate knowledge of healthcare and medical terminology Comfortable with and interested in technology: Elation or other EMR, Google Workspace and Zoom

General: Meticulous review of patients vital signs, providing real-time responses and offering support to triage patients symptoms and concerns. Provide patient education, symptom management, vitals data collection and review, and escalating patient issues. Initiate positive and enduring behavioral health changes that significantly enhance the patients clinical outcomes and overall health status. Actively engage with patients and fellow clinical staff via tools including email, text, audio/video call and software applications for instant messaging and clinical note-taking. Attend meetings and trainings online and/or in person when required. With time allowing, assist in the evaluation and improvement of health education and intervention strategies. Review and give input on staff/patient communication, policies, protocols, programs and services specific to the health behavior coach team. Maintain confidentiality and adhere to all applicable regulations, including HIPAA.

Guideway Care

Triage Nurse RN (Telehealth) | Weekend |Part-Time

Posted on:

October 12, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

California

Sequence Health is a mission-driven organization committed to improving patient care and providing superior patient activation solutions to healthcare organizations. We pride ourselves on building an inclusive culture and hiring team members who are motivated by purpose, impact, growth, and innovation.

We are seeking an experienced and compassionate Registered Nurse to join our elite team of remote triage professionals. This RN will serve as the front line of clinical support for patients, delivering high-quality assessment, guidance, and care coordination services via telephone and digital communication platforms. This role requires a confident, autonomous nurse with a strong clinical foundation, excellent judgment, and a deep commitment to patient-centered care. You will work remotely in a structured and supportive environment, contributing to improved outcomes and experiences for patients across a variety of primary care and specialty settings. Work Schedule: Saturday/Sunday - 8:00 AM - 8:00 PM CST

Registered Nurse with Unencumbered e-NCL Licensure. RN Licensure in California is required Current demonstration of clinical proficiency Excellent written and oral communication skills Excellent critical thinking and problem-solving skills Ability to work within approved procedure and clinical guidelines Electronic Medical Record Experience, i.e EPIC, Cerner, Greenway Ability to use windows-based computer software including ADOBE, MS Word, MS Excel, Fax and others Minimum of 5 years’ experience in working in a variety of direct patient care settings including Emergency Department, Labor and Delivery, Critical Care. Women's Health or Labor and Delivery experience preferred. Minimum of 3 years’ experience in Adult Nursing

Receive inbound calls from patients and place outbound calls to patients. Provide clinical assessment based on established protocols and triage patients by phone or through patient portal. Respond to patients’ messages in patient portal, create orders and route to appropriate parties. Provide administrative support for patients’ and providers’ needs in terms of FMLA, ADA, and LTD/STD Communicate with Health Care Provider through approved methods as needed. Any other duties necessary to drive our values, fulfill our mission, and abide by our company values Essential Duties and Responsibilities: Able to work remotely at home in a private HIPAA compliant workspace Able to house company equipment needed to perform job Broadband Internet Access Internet download speed must be at least 24 mbps and upload speed at least 4 mbps Immigration or work visa sponsorship will not be provided Physical Demands: Ability to hear in normal range and wear a headset / earpiece Good visual acuity to read computer screens, scripts, forms etc. May sit 100% of the time when taking calls Access to the electronic medical record (EMR) system may require the use of your personal mobile device for authentication purposes.

Northern Kentucky University

Full Time Tenure Track Nursing Position - Graduate Nursing Programs (Remote)

Posted on:

October 12, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Kentucky

The College of Health and Human Services is seeking applications for one full-time, tenure-track, remote faculty position in the School of Nursing for the Doctor of Nursing Practice Program. Northern Kentucky University (NKU) is built on core values that emphasize multidimensional excellence, learner centered education, integrity, civic engagement, community of belonging, innovation, collegiality, and collaboration across disciplines and professional fields. NKU has a strong commitment to interprofessional education and the School of Nursing is located in the Health Innovations building, which offers opportunities for academic innovation and initiatives to influence the health of the region. The position reports to the School of Nursing Program Director.

Doctoral degree required. Current record of active research/scholarship preferred (basic or applied research; publication in peer reviewed journals, etc.). If not, a specific proposed plan for active research/scholarship must be provided (focus of study/scholarship, timeline etc.). Applicants must have a minimum of two (2) years’ experience in nursing within the immediate past five years. Online teaching experience in nursing is preferred. Must possess a valid unencumbered nursing license in state in which you reside. Any candidate who is offered this position will be required to go through a pre-employment criminal background check as mandated by state law. Minimum Education: Doctorate Preferred Education: Doctorate Required Documents: Cover Letter/Letter of Application Curriculum Vitae References Teaching Philosophy Optional Documents: Other

The Department of Nursing invites applications for the tenure track Assistant Professor level position for the Department of Nursing available beginning Fall 2026. Faculty responsibilities will include teaching in the DNP Program, service, scholarship, and academic advising. All DNP courses are offered in an online format using Canvas. Teaching responsibilities include instruction in the 7-week online dyadic courses and full semester practicum courses DNP 881, 882, 883, 884 during the academic year with opportunity to teach in the summer, if desired. All faculty must be prepared to plan and teach courses within their area of expertise. This includes developing (or using provided syllabus) for the classes assigned. Specific responsibilities include. Plan, teach, and evaluate lectures or activities within the course. Assure instructional excellence and innovation in course presentation. Design, redesign, and maintain learning platform (i.e. Canvas) online course shells. Remain current in the discipline through research and attendance at professional continuing education seminars. Serve on committees and other areas of service as assigned and attend faculty, departmental, and other meetings as necessary. Advise students as appropriate throughout the semester. Provide tutoring to students upon request. Maintain virtual office hours to be accessible and available to students and staff. Review textbooks in the discipline and place textbook orders according to the University schedule. Maintain grades and final grades through My NKU by the University deadlines. Participate in curriculum review and revision work as needed. Participate in writing of accreditation reports as needed. Work cooperatively with the faculty team including adjuncts.

Saint Francis Healthcare

System Care Coordinator (RN) - Bootheel Perinatal Network

Posted on:

October 10, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Missouri

Type: Full Time (80 hours per 2 week pay period, with benefits) Typical Hours: Day Shift, Monday - Friday Education: Graduate of an accredited school of nursing- required Bachelors of Science in Nursing degree- preferred Certification/Licensure: Currently licensed to practice as a Registered Nurse in the State of Missouri- required BLS Certification- required Valid driver’s license and ability to travel to various locations throughout the Missouri Bootheel- required Experience: At least two (2) years of nursing experience- required Ability to work independently and exercise sound judgment in interactions with physicians, colleagues’ patient members and their families Excellent interpersonal communication and negotiation skills as well as effective oral and written communication Demonstrated leadership skills Strong analytical, data management and computer skills Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components Experience working in interdisciplinary teams Additional Requirements: Must be at least 21 years of age with a valid driver's license Nursing, perinatal health education and outreach preferred Experience in public health and cultural competency preferred Community resource knowledge preferred Working knowledge of the Missouri Bootheel and its socio-economic issues- preferred Must be able to set up a home office and meet the SFMC telecommuting expectations for remote working Must have access to reliable internet This is a grant funded position.

The System Care Coordinator (SCC) works in collaboration and partnership with colleagues, patients, and their caregivers, as well as clinic, hospital and community partners to achieve project goals and objectives. Using a defined process, the SCC identifies Social Determinates of Health needs of pregnant and postpartum women creating a patient centered, individualized plan for navigation into partner programs, scheduled follow-up contact to reassess need and collect qualitative data (client stories), and routing women through the care system for up to one-year post-pregnancy. The SCC will manage and track referrals by leveraging an electronic closed loop referral system. Additionally, the SCC will compile, analyze and report site specific data which will be used to identify trends, improve workflow and contribute to quality improvement conversations. The SCC works with the team to ensure successful replication of Clinical-Community Integrated Care Coordination model which may include sharing project outcomes and attending educational opportunities.

Broadway Ventures

Medical Claims Reviewer, 6 Month Contract

Posted on:

October 10, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

At Broadway Ventures, we transform challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), we empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth. Built on integrity, collaboration, and excellence, we’re more than a service provider—we’re your trusted partner in innovation.

We are seeking a dedicated RN to conduct medical reviews to perform comparisons between End Stage Renal Disease patient medical records documentation and data submitted to the Centers for Medicare and Medicaid Services (CMS) End Stage Renal Disease Quality Reporting System (EQRS) and the Centers for Disease Control (CDC) National Healthcare Safety Network (NHSN) based on the approved data validation methodology. Determine and classify discrepancies found based on the type and severity of errors. Common error categories might include missing data, incorrect values, and data entered in the wrong fields. Position Details Job Type: Contract (40 hours/week) Duration: November 3rd – May 3rd Schedule: Monday-Friday, 8:00 AM – 4:30 PM Location: Remote U.S. (Work from home) Requirements for Remote Work: High-speed internet (non-satellite) and a private, lockable home office.

Licensure: Active, unrestricted RN licensure in the United States and in the state of hire OR Active compact multistate unrestricted RN license (as defined by the Nurse Licensure Compact). Education: Associate Degree in Nursing OR Graduate of an accredited School of Nursing. Required Experience: Two years of clinical experience plus two years of experience with utilization/medical review, quality assurance or end stage renal disease/dialysis. Skills: Strong clinical background in dialysis, managed care, home health, rehabilitation, and/or medical-surgical settings. Knowledge of specific criteria/protocol sets and the ability to use them effectively. Proficiency with word processing software and Microsoft Office. Ability to work independently, prioritize tasks, and make sound decisions. Excellent customer service, communication, organizational, and critical thinking skills. Ability to handle confidential information with discretion. Proficient with computers, including the ability to use multiple screens and programs simultaneously. Preferred Qualifications: Three years of clinical nursing experience in End Stage Renal Disease/Dialysis (strongly preferred).

Conduct ESRD medical record reviews comparing medical record documentation to EQRS and NHSN to determine accuracy and timely reporting. Determine and classify discrepancies found based on the type and severity of errors. Common error categories might include missing data, incorrect values, and data entered in the wrong fields. Participate in quality control activities to support corporate and team objectives. Assist with special projects or responsibilities as assigned by management.

Cottingham & Butler

RN Case Manager

Posted on:

October 10, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Iowa

At Cottingham & Butler, we sell a promise to help our clients through life’s toughest moments. To deliver on that promise, we aim to hire, train, and grow the best professionals in the industry. We look for people with an insatiable desire to succeed, are committed to growing, and thrive on challenges. Our culture is guided by the theme of “better every day” constantly pushing ourselves to be better than yesterday – that’s who we are and what we believe in. As an organization, we are tremendously optimistic about the future and have incredibly high expectations for our people and our performance. Our ability to grow as a company, fuels investments in new resources to better serve our clients and provide the amazing career opportunities our employees want and deserve. This is why we are a growth company and why we are committed to being better every day.

Location: Remote. We are seeking a compassionate and detail-oriented RN Case Manager to join our team. This role is responsible for delivering comprehensive case management services across the continuum of care. The RN Case Manager will assess, plan, implement, coordinate, monitor, and evaluate care for assigned consumers, ensuring quality outcomes and cost-effective treatment.

Bilingual: the ability to speak Spanish is strongly preferred. Education: RN licensure in the State of Iowa required. BSN or higher preferred. Experience: Minimum 2 years of clinical practice. Case management or utilization review experience strongly preferred. Skills: Strong communication, problem-solving, and computer skills. Ability to work independently.

Provide telephonic case management and utilization review for assigned consumers. Develop, implement, and monitor individualized care plans to ensure quality and cost-effective outcomes. Collaborate with healthcare providers, payors, and internal teams to coordinate care. Serve as a liaison between consumers and benefit administrators, ensuring clear communication and support. Track and report case outcomes, including cost savings and quality improvements.

Healthcare Management Solutions LLC

STS REGISTRY AUDITOR

Posted on:

October 10, 2025

Job Type:

Part-Time

Role Type:

License:

RN

State License:

West Virginia

HMS’s Society for Thoracic Surgeons (STS) Registry Audit team functions to conduct data collection and abstraction of medical records for the STS National Registry Database. HMS is currently looking for part-time or casual Clinical Reviewers/Abstractors to remotely conduct STS National Registry database audits.

Knowledge/Skills/Abilities: The remote registry auditor will abstract or audit clinical data from medical records for comparison to clinical data within STS’s National Cardiac Registries, specifically the Adult Cardiac Surgery Database (ACSD) and the Intermacs/Pedimacs Database. Registry audits are conducted remotely and therefore the ideal candidate will have access to adequate broadband, be familiar with general office productivity software (i.e. MS Office Suite, SharePoint, etc.), and be self-motivated to meet quality and productivity standards. Bachelor's degree in nursing required Active RN license preferred Coding certifications preferred Preferred Experience 2 years coding and medical record abstraction experience with one or more of STS’s National Registries or other related quality registries and databases. Specialty in cardiac nursing with knowledge regarding cardiac procedures. Knowledge of and experience in medical record documentation of coronary artery bypass grafting (CABG), aortic valve repair or valve replacement procedures (AVR), and mitral valve repair or replacement procedures (MVR).

Abstract and audit clinical data from medical record documentation and record results in HMS’ registry audit tool. Participation in meetings and trainings with HMS and participant sites. Accessing electronic abstraction tool(s) and electronic medical records. Meet quality and productivity standards. Ability to conduct job duties within HMS’s core values

Healthmap Solutions, Puerto Rico LLC

Remote Wellness Coach (Puerto Rico)

Posted on:

October 10, 2025

Job Type:

Full-Time

Role Type:

Coaching

License:

None Required

State License:

Puerto Rico

Healthmap Solutions is the future of specialty health management that focuses on progressive diseases, with a particular expertise in kidney health populations. Healthmap Solutions uses clinical big data resources and high-powered analytics to power complex specialty health management programs. Healthmap Solutions is a diverse, growing company committed to our clients and our employees. We are champions for better health, for those who need us most.

Healthmap’s Clinical Services Wellness Coach interacts with members to address care needs, promote wellness, mitigate social determinants of health and improve overall health outcomes. The Wellness Coach will focus on Education, Special Programs and Assessments as part of a Care Team that includes nurses, social workers, and dietitians. This role will manage their caseload through a variety of communications platforms and is responsible for providing exceptional customer service that encourages progress toward healthier habits.

Associate’s degree in relevant field. Equivalent experience with specific certification may be considered in lieu of education 2 years’ experience working in healthcare with individuals preferably with chronic diseases and/or behavioral health needs Experience in managed care, physician office, or account management preferred Experience working with Medicare, Medicaid, preferred Previous experience working in a metrics-driven environment, preferred Bilingual English/Spanish fluency is required Residency in Puerto Rico required Skills: Ability to problem-solve and execute initiatives Excellent verbal and written communication skills Ability to manage multiple priorities Must be proficient in Microsoft Office: Outlook, Word, Excel, PowerPoint Travel: Limited Travel, Scheduled per needs of the business #LI-Remote

Connect with members to develop and support health care. Identifying and addressing barriers and solutions like medication reminders, scheduling appointments, and direction towards community-based support programs, etc. Establish trusting, supportive, and collaborative relationships with members and their caregivers to guides access to resources that allow strengths to be leveraged for positive change Meet with team to review set goals and address targets established by the department and Service Level Agreements Collect and document relevant member demographics and healthcare information and ensure accuracy in the Employee Health Record (EHR) system Answer inbound and outbound calls from members, providers, and other resources to support company objectives Conduct a minimum of outreach calls a day to a targeted list of eligible patients to describe the benefits of Healthmap Kidney Health Management program and enroll Receive inbound self-referral member calls to enroll in Healthmap’s KHM program Engage with members so they understand and are comfortable with the terms of care, following internal scripting and/or talking points to respond to resistance with professional courtesy Report complaints and identify potential corrective and preventative actions to solve issues where possible, some issues may require escalation based on established procedures Perform other duties as assigned

Healthmap Solutions, Puerto Rico LLC

Remote RN Care Manager (Puerto Rico)

Posted on:

October 10, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Puerto Rico

Healthmap Solutions is the future of specialty health management that focuses on progressive diseases, with a particular expertise in kidney health populations. Healthmap Solutions uses clinical big data resources and high-powered analytics to power complex specialty health management programs. Healthmap Solutions is a diverse, growing company committed to our clients and our employees. We are champions for better health, for those who need us most.

The Care Navigator will be responsible for case management specific to kidney health management. The Care Navigator will complete activities for the continuum of care to facilitate and promote high quality, cost-effective outcomes for patients and focus on the whole patient and care delivery coordination. Managing a set caseload of mixed acuity members, reviewing and/or obtaining member data and entry in HealthMap’s Care Management documentation system (Compass), completing member health and social determinants of health screenings, medication reconciliation, creation and maintaining member-centric care plans, updates of identified problems, barriers, interventions, and goals and assistance with ongoing case management. The Care Navigator will collaborate with internal and external (physicians, nurses, and other healthcare personnel) to assure positive patient outcomes and care coordination.

Bachelor’s degree in nursing required Active, unrestricted Puerto Rico RN license required and RN College Membership Prior experience building and managing relationships with health care providers or patients preferred Three (3) years of experience in case management preferred Experience in a dialysis center or transplant center preferred Experience with Medicare and Medicaid preferred Bilingual fluency in English and Spanish Must reside in Puerto Rico Skills: Advocate and energize a culture of collaboration, positivity, and motivation Strategic thinking and planning Deliver effective communication – verbal and written Succeeds in a challenging environment with changing priorities

Handle in and outbound calls delivering world-class service to our members Educate kidney health and related co-morbid conditions as well as optimizing renal replacement therapy by educating members on the types of dialysis and transplant options Engage members into HealthMap’s Kidney Health Program Follow up with members based on complexity and cadence by policy Serve as patient advocate for responding and working to resolve concerns or barriers Utilize community resources and programs in care planning Serve as liaison between the patient, the patient’s support network, treating physician, and other ancillary providers as a member of an interdisciplinary care team to coordinate care, resolve nursing problems and assist patients in meeting individualized goals Notify providers of identified patient needs based on policy Comply with HIPAA privacy laws and all other federal, state, and local regulations Comply with company-defined operational policies and procedures Comply with company security policies Accountable for individual metrics and key performance indicators and identified by the organization Navigate technical applications - Excel, OneNote, Outlook, and Word Support after hours and various time zones based on business need Drive patients and families in their own care and to support self-management Perform other duties as assigned

Centerwell

Care Manager- Telephonic Nurse - FT Evenings & Every Other Weekend

Posted on:

October 10, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Kentucky

CenterWell creates experiences that put patients at the center. As the nation’s largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is focused on whole-person health by addressing the physical, emotional and social wellness of our patients. As part of Humana Inc. (NYSE: HUM), CenterWell offers stability, industry-leading benefits, and opportunities to grow yourself and your career. We proudly employ more than 30,000 clinicians who are committed to putting health first – for our teammates, patients, communities and company. By providing flexible scheduling options, clinical certifications, leadership development programs and career coaching, we allow employees to invest in their personal and professional well-being, all from day one.

Become a part of our caring community and help us put health first Clinical call center. High volume. Fast paced. Shift details: Full time 40 hours a week. The schedule will be 8 hour shifts, Monday-Friday from 3pm-11:30pm EST. Required weekend coverage every other Saturday & Sunday from 3:00pm -11:30pm ET. When working weekends, it will allow for off-days during the week. Required to work every other holiday. The Clinical Care Coordinator 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

Required Qualifications: Licensed Registered Nurse (RN) with compact state licensure in state of residence with no disciplinary action 3 - 5 years of clinical acute care experience Comprehensive knowledge of Microsoft Office applications including Word, Excel, Outlook, Teams and One Note Must be passionate about contributing to an organization focused on continuously improving consumer experiences High speed internet (no hotspot, DSL or satellite) Preferred Qualifications: Experience with case management, discharge planning and patient education for adult acute care Managed care experience Home Health Care experience Telephonic triage experience Bachelor's degree HCHB experience preferred Additional Shift Information: 40 hours per week Weekdays after hours and weekends Holiday coverage Starting pay: $39.42 / hour plus shift differential for evenings and weekends 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.

Pine Park Health

Remote Primary Care Coordinator (Medical Assistant) - TEMP TO PERM

Posted on:

October 10, 2025

Job Type:

Full-Time

Role Type:

Primary Care

License:

None Required

State License:

Idaho

Pine Park Health is a value-based primary care practice that is redesigning how residents of senior living communities get or stay healthy and lead a life they love. We’re on a mission to dramatically improve healthcare for seniors by building a new model of care that’s designed around everyone involved — patients, families, community staff members, providers, and payers. We’ve started by providing regular prevention and screening, care for chronic conditions, lab work, and diagnostic testing to patients in their apartments. We visit each community frequently to see patients and collaborate on patient health needs with staff. We also make it easier for patients to get care urgently with same-day or next-day care, helping them avoid unnecessary trips to the ER or hospital. Over 185 communities across Arizona, California, and Nevada work with Pine Park Health today and we’re growing quickly to expand our reach and impact. Investors include First Round Capital, Google’s AI fund, Canvas Ventures, Foundation Capital, Y Combinator, and Susa. If you’re a determined and mission-oriented person who is looking to build the future of healthcare for seniors, join us!

The Primary Care Coordinator serves as the central point of contact for our primary care geriatric care team, managing 500-600 patients alongside nurses and Primary Care Providers. The role focuses on coordinating patient care, maintaining relationships with senior living facilities, and ensuring excellent healthcare delivery through effective communication and documentation. ***This role is temporary to permanent with a shift of 8:30a-5:00p PST*** Key Evaluation Metrics: Success will be measured in the following focus areas: Inbound Phone Calls: Answer 95% of inbound calls within 60 seconds and expect ~30 inbound calls / day Aim for an average wait time of less than 30 seconds Ensure caller wait times do not exceed 2 minutes Task Completion: Messages and Clinical Emails: Address 95% within 2 hours Complete routine tasks within 7 days; STAT tasks completed within 24 hours Proactively contact all newly enrolled patients within 24 hours to schedule a welcome visit Complete 100% of visit reminder calls each day and expect to make ~20 reminder calls / day Voicemails: Close/resolve all urgent voicemails within 1 hour Return non-urgent voicemails within 1 business day Ensure after-hours voicemails are addressed within first 2 hours of next business day Patient Care Management: Ensure accurate logging of all patient encounters for chronic care management Log 6 hours per day of care coordination using our custom logging software Assist with improvement projects related to quality and efficiency Achieve a patient satisfaction survey score of 8.5/10 or higher

High School Diploma (some college preferred) Basic understanding of Primary Care Operations Medical Assistant Certification preferred Reliable internet and HIPAA-compliant workspace Comfort with healthcare technology platforms Ability to thrive in a fast-paced, changing environment Attendance is critical in this role to ensure quality patient care Must be able to work ~5 on call overnights and/or weekends Ongoing Regulatory Requirement: Must not be on any exclusion or debarment from participation in Federal Health Care Programs at any time and must remain in good standing with government regulators such as the OIG, CMS, etc. Physical Requirements: Ability to remain seated for extended periods High proficiency with computers and mobile devices

Serve as primary contact for patients, families, and providers Schedule and coordinate medical appointments Manage patient documentation and EMR updates Process urgent care calls and STAT tasks Participate in mandatory after-hours shift rotation Handle communications via phone, email, text, and fax Coordinate with community partners and specialty providers Facilitate new patient onboarding

Pine Park Health

Registered Nurse (RN) - Remote

Posted on:

October 10, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

California

Pine Park Health is a value-based primary care practice revolutionizing healthcare for senior living community residents. We empower seniors to get healthy, stay healthy, and lead lives they love through a care model designed with everyone in mind — patients, families, community staff, providers, and payers. Our approach brings healthcare directly to seniors' homes, offering prevention, screening, chronic condition management, lab work, and diagnostic testing in the comfort of their apartments. With weekly community visits, our teams provide consistent care while collaborating closely with facility staff to address comprehensive health needs. We've eliminated unnecessary barriers to urgent care through same/next-day appointments, helping seniors avoid emergency rooms and hospitalizations where they risk exposure to additional health concerns. Today, over 185+ communities across Arizona, California, and Nevada trust Pine Park Health, and we're rapidly expanding our reach and impact. If you're mission-driven and passionate about transforming senior healthcare, this is your opportunity to make a meaningful difference!

The Registered Nurse is responsible for the management and coordination of patient care in collaboration with the primary care provider. The nurse acts as a triage nurse, educator, facilitator and patient advocate.

Skills: Must possess excellent verbal and written communication skills. Tech savvy. Must have superb teamwork abilities, especially with communication and follow up. Demonstrates initiative toward problem solving. Must be able to interface with providers and work closely with IDT members. Knowledge: Prefer knowledge of chronic care and / or geriatric related diseases and treatment options. Good understanding of all state and federal regulations applicable standards. General knowledge of community resources. Experience: Minimum of 2 years clinical experience as a nurse (preferably in case management, home health, community nursing or skilled/long term care.) Licenses: Current unrestricted nursing license in the state of Nevada, California and/or Arizona.

Functions as a member of the Interdisciplinary Team (IDT) to coordinate patient care to promote positive health outcomes. Is responsible to clinically triage all phone calls from providers, patients, caregivers and other outside agencies. Coordinates services with insurance system and the community for benefits to promote the most appropriate disposition of the patient to meet the needs of the patient, family and insurance company when able. Daily review of lab and diagnostic test results, reviews with providers and contacts patient or the responsible party with results and reviews plan of care. Daily tasks: medication and lab orders, admit to SNF, DME, follow up on the status of orders/diagnostics, controlled and non-controlled refills, chart audit and preparation for Providers, patient and family phones calls, specialist referrals, document preparation, prior authorizations Provides daily Chronic Care Management for all eligible PPH patients and documents all CCM time. Develops, implements and monitors Chronic Care Management Patient Centered Care Plans. Provides Transitional Care for all PPH patients discharged from one level of care to another (acute care, skilled care, live discharge from hospice) Coordinates care with the following: acute care case management, ER's, skilled nursing facilities, discharge planners, home health, hospice, EMS Participates in overall program development and adherence to policies, procedures, processes, state and federal regulations. Acts as a resource to internal and external customers. Assists with other duties as assigned.

CircleLink Health

New York Registered Nurse Care Coach

Posted on:

October 10, 2025

Job Type:

Contract

Role Type:

Coaching

License:

RN

State License:

New York

CircleLink Health is a company of passionate clinicians, technologists and businesspeople tackling the $600B problem of preventable chronic and post-acute complications. We’re building a world-class Care Management platform to enable providers while accelerating the shift to preventative care instead of status quo reactive care.

This is a remote role. CircleLink Health is looking for passionate, tech savvy New York registered nurses to work remotely and serve patients enrolled in Medicare’s Chronic Care Management Program. In this part time role (requires about 20 to 25 hours per week, depending on caseload), an RN Care Coach will be assigned a group of patients that they will be following and calling each month. In these monthly calls the Care Coach will provide education, coordinate care, close preventive care gaps, and coach on strategies for self-management to keep patients out of the hospital. This Role Requires Precision, Discipline, and Accountability The Care Manager role is not a step back from bedside nursing — it’s a step into a more complex, structured, and performance-driven environment. To succeed, you must bring more than clinical knowledge: Excellent documentation skills — Your charting must be complete, timely, and accurate. Strong time management — Case tasks must be prioritized and closed on schedule. Ownership of outcomes — Each case is closely tracked for quality, compliance, and effectiveness. Expectations are high, and performance is regularly reviewed. This is not a role where details can be missed or timelines pushed — we need professionals who take initiative, stay organized, and consistently deliver. If you’re ready for a challenging, fast-paced environment where your work is held to high standards and makes a real difference, we encourage you to apply.

Fluent in English Self-directed, able to work independently with little supervision while meeting performance metrics Passion for nursing and improving patient outcomes Good with technology and eager to learn and use new software Excellent organizational and time management skills Strong communication and telephonic skills Strong critical thinking and problem-solving skills Education and Experience: Current, unrestricted New York RN license required. Proficiency with EHRs (electronic health records) and web-based applications 3 or more years' experience as a Registered Nurse Immediate availability Preferred Education and Experience: Case Management or Chronic Disease Management experience highly preferred Certified Diabetes Educator desired but not required Experience with Motivational Interviewing or other behavior change communication techniques is a plus! Scheduling and Other Requirements: Must have a STRONG internet-connected computer. Computer and internet speed tests will be required. A minimum of 20 hours of day time availability per week required. You will commit to your own schedule using our software. This is a 1099 contract position with no end date. Care Coaches are responsible for their own equipment, taxes and insurance.

Utilize our specialized care management software to call Medicare patients with two or more chronic conditions (Diabetes, CHF, Chronic Pain, COPD, etc.) on a monthly basis Build and maintain rapport with patients to help coach them to improved health through SMART goals and education on self-management strategies Implement and improve the Plan of Care by updating medications, appointments due, biometrics, symptoms, and interventions made Connect the patient with community resources as needed, including transportation, personal care needs, prescription/DME assistance, social services, etc. Conduct Transitional Care Management activities to high-risk patients discharged from the hospital and the ER to reduce unnecessary readmissions. Close care gaps by encouraging preventive care measures, i.e. annual well visits, vaccines, cancer screens, follow-up/specialist appointments, etc.

Tenet Call Center Ops

Clinical Scheduler Rep - Remote LPN/RN Required

Posted on:

October 10, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Texas

Tenet Healthcare operates acute-care and short-stay surgical hospitals and other outpatient services in the United States

Responsible for accurately scheduling diagnostic and/or surgical procedures. Demonstrates practice of nursing process, receives verbal orders from physicians and ensures that the documented order is obtained as well as manages all other orders for scheduled patients. Conducts physician office/patient interviews, and explains hospital procedure guidelines and policies. Coordinates with clinical departments on schedule modifications and ensures patients are properly bedded.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skil,l and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Prior RN or LPN clinical experience is mandatory and UR and/or management experience is highly encouraged. Minimum typing skills of 35 wpm Demonstrated working knowledge of software/system/equipment. Knowledge of function and relationships within a hospital environment preferred Advance Customer service skills and experience Ability to work in a Call center environment Ability to receive and express detailed information through oral and written communications Course in Medical Terminology required Advanced understanding in surgery procedure scheduling preferred High achievement in productivity. Builds and maintains collaborative relationships with both internal and external Clients that lead to more effective communication and a higher level of productivity and accuracy. Identifies opportunities to improve patient relations and shorten the time it takes to handle scheduling processes. This position requires high-level problem solving and analytical skills, technical accuracy, excellent communication skills and the highest ethical standards. Include minimum education, technical training, and/or experience required to perform the job. High School Diploma or equivalent Graduate of a professional nursing program with a current LPN or RN licensure is preferred. 2-5 year administrative experience in medical facility, health insurance, or related area. 3+ years in Patient Access/Scheduling preferred. Some college coursework is preferred PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Must be able to sit at computer terminal for extended periods of time Resolves Physician's office and Patient issues. May experience extreme patient volumes and uncooperative Patients. Occasionally lift/carry items weighing up to 25 lbs. Frequent prolonged standing, sitting, and walking WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Responsible for obtaining complete and accurate clinical, demographic and financial information during the scheduling process. Enters data in scheduling system or other applications. Provides the customer with prep and other appointment instructions. Demonstrates practice of nursing process, receives verbal orders from physicians and ensures that the documented order is obtained as well as manages all other orders for scheduled patients. Follows guidelines for special requests/Stat/schedule modification procedures and coordinates communications with clinical areas to accommodate the customers’ requests. Answers telephone calls according to designated scripting for the scheduling process. Maintains positive customer service at all times, referring unresolved issues to appropriate supervisor. Notifies customer of physician order, pre-authorization and other financial clearance requirements. Performs functions of other PASU functions or registration when requested.

CAI (Computer Aid, Inc.)

Case Manager, RN

Posted on:

October 10, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Pennsylvania

CAI is a global technology services firm with over 8,500 associates worldwide and a yearly revenue of $1 billion+. We have over 40 years of excellence in uniting talent and technology to power the possible for our clients, colleagues, and communities. As a privately held company, we have the freedom and focus to do what is right—whatever it takes. Our tailor-made solutions create lasting results across the public and commercial sectors, and we are trailblazers in bringing neurodiversity to the enterprise.

Job Summary: We are looking for a motivated Case Manager, RN ready to take us to the next level! If you have prior experience with coordinating, implementing, and evaluating effective treatment and are looking for your next career move, apply now. Job Description: We are looking for a Case Manager, RN to ensure that members with complex medical and/or psychosocial needs have access to high-quality, cost-effective healthcare. You will play a critical role in holistic assessment, planning, coordination, and monitoring care to optimize member health outcomes while advocating for appropriate and efficient care plans. This position will be a remote, full-time, 6-month contract with the opportunity to renew. Due to the specific legal and contractual requirements associated with this position, only US Citizens will be considered for this role. Candidates must be able to work directly on CAI's W2.

Required: Bachelor’s degree in Nursing (BSN) or valid RN certification Minimum of 3 years of experience in Acute Care, Managed Care, or experience working with Medicaid/Medicare populations Strong knowledge of medical terminology, diagnostic categories, and disease states Proven ability to work independently, assess member needs, and develop tailored care plans Preferred: Case Management Certification (CCM or equivalent) Bilingual proficiency in English and Spanish Physical Demands: Ability to safely and successfully perform the essential job functions consistent with the ADA and other federal, state, and local standards Sedentary work that involves sitting or remaining stationary most of the time with occasional need to move around the office to attend meetings, etc. Ability to conduct repetitive tasks on a computer, utilizing a mouse, keyboard, and monitor

Conduct holistic assessments to identify members' medical, psychosocial, and resource needs Develop individualized care plans that address unmet needs, set realistic goals, and adjust plans as necessary Facilitate member access to healthcare services through collaboration with internal teams and external providers Educate members about their conditions, care plans, and resources to promote adherence and improve health outcomes Communicate effectively with members, healthcare providers, and internal teams (e.g., Case Management Specialists, Management Teams, Physician Advisors) Coordinate with community organizations, ancillary healthcare providers, and other payers to address member needs Participate in interdisciplinary and/or interagency meetings to ensure efficient care coordination Use clinical judgment and consultation with Physician Advisors to determine appropriate interventions Advocate for members by balancing benefit design, cost-benefit analysis, and care needs to create realistic and impactful care plans Use clinical judgment and consultation with Physician Advisors to determine appropriate interventions Advocate for members by balancing benefit design, cost-benefit analysis, and care needs to create realistic and impactful care plans Attend required meetings, rounds, and in-services to enhance professional knowledge and skills Participate in departmental quality initiatives and work teams Maintain licensure and complete continuing education annually Foster effective team relationships through constructive feedback and conflict resolution Perform other duties as assigned to support the overall success of the team

CVS Health

Case Manager, Registered Nurse - Oncology Experience Preferred

Posted on:

October 10, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

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

This is a remote work from home role anywhere in the US with virtual training. Shift schedule is 8:30am–5:00pm within time zone of residence. American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health. Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care for members.

Required Qualifications: 5+ years’ experience as a Registered Nurse with at least 1 year of experience in a hospital setting. A Registered Nurse that holds an active, unrestricted license in their state of residence, and willingness to receive a multi-state/compact privileges and can be licensed in all non-compact states. 1+ years’ experience documenting electronically using a keyboard. 1+ years’ current or previous experience in Pediatrics, Oncology or Specialty Pharmacy. Preferred Qualifications: 1+ years’ Case Management experience or discharge planning, nurse navigator or nurse care coordinator experience as well as experience with transferring patients to lower levels of care. 1+ years' experience in Utilization Review. CCM and/or other URAC recognized accreditation preferred. 1+ years’ experience with MCG, NCCN and/or Lexicomp. Bilingual in Spanish preferred. Education: Diploma or Associates Degree in Nursing required. BSN preferred.

This position consists of working intensely as a telephonic case manager with patients and their care team for fully and/or self-insured clients. Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures and regulatory standards while assessing benefits and/or member’s needs to ensure appropriate administration of benefits. Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning and resolution of member issues. Assessments utilize information from various sources to address all conditions including co-morbid and multiple diagnoses that impact functionality. Consults with supervisor and others in overcoming barriers in meeting goals and objectives, presents cases at case conferences for multidisciplinary focus to benefit overall claim management. Using a holistic approach, consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversations. Identifies and escalates member’s needs appropriately following set guidelines and protocols. Need to actively reach out to members to collaborate/guide their care. Perform medical necessity reviews.

UnitedHealthcare

RN Care Manager, Remote in Southern Wake County, NC

Posted on:

October 10, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

North Carolina

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.

In this Care Manager role, you will be an essential element of an Integrated Care Model by relaying the pertinent information about the member needs and advocating for the best possible care available, and ensuring they have the right services to meet their needs. We offer our established staff the option to work 4 10-hour days (7 am-6pm) in lieu of the traditional 8 hour 5/day week schedule. *After employee has demonstrated competency with the role and are able to meet metrics, etc. Additionally, there is no “on-call” or weekend requirements. If you are located in Southern Wake County, NC or surrounding areas, you will have the flexibility to work remotely* as you take on some tough challenges.

Required Qualifications: Current, unrestricted independent licensure as a Registered Nurse 2+ years of clinical experience 1+ years of experience with MS Office, including Word, Excel, and Outlook Reside in Wake and/or Johnston County, NC, or surrounding areas Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI) Reliable transportation and the ability to travel up to 25% within assigned territory to meet with members and providers Preferred Qualifications: BSN, Master’s Degree or Higher in Clinical Field CCM certification 1+ years of community case management experience coordinating care for individuals with complex needs Experience working in team-based care Background in Managed Care Physical Requirements: Ability to transition from office to field locations multiple times per day Ability to navigate multiple locations/terrains to visit employees, members, and/or providers Ability to transport equipment to and from field locations needed for visits (ex. laptop, etc.) Ability to remain stationary for long periods of time to complete computer or tablet work duties

Assess, plan and implement care management interventions that are individualized for each member and directed toward the most appropriate, least restrictive level of care Identify and initiate referrals for both healthcare and community-based services; including but not limited to financial, psychosocial, community and state supportive services Develop and implement care plan interventions throughout the continuum of care as a single point of contact Communicate with all stakeholders the required health-related information to ensure quality coordinated care and services are provided expeditiously to all members Advocate for members and families as needed to ensure the member’s needs and choices are fully represented and supported by the health care team

The Queen's Health System

REMOTE - Trauma Registrar - Level 1 Trauma Center on Oahu

Posted on:

October 10, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Hawaii

The Queen’s Medical Center has been a leader in trauma care long before it became a national standard. In 1997, under the visionary leadership of Dr. Peter Halford, Ms. Kathy Welsh, and QHS President & CEO Arthur Ushijima, Queen’s became one of the first Level II Trauma Centers in Hawai‘i verified by the American College of Surgeons. Their commitment laid the foundation for the high-quality, life-saving care we deliver today. Trauma affects individuals across all demographics in Hawai‘i—locals and visitors, young and old. It remains a leading cause of death and disability, especially among those aged 18 to 44. Survivors often face long-term physical, emotional, and financial challenges. That’s why our trauma team is available 24/7, ensuring that this vital public health resource is always ready when it’s needed most.

Join the Queen’s ‘Ohana as a Trauma Registrar – Work From Home Opportunity Make a meaningful impact as the next Trauma Registrar at Hawaii’s only Level I Trauma Center. This remote position offers the chance to be part of a dedicated Trauma Program that partners with community organizations to provide comprehensive, collaborative care to the people of Hawai‘i.

High school diploma or equivalent required; associate’s degree in health information management, healthcare, or related field preferred. Completion of: American Trauma Society (ATS) Trauma Registry Course Association for the Advancement of Automotive Medicine (AAAM) Abbreviated Injury Scale (AIS) Course Minimum one (1) year experience as a trauma registrar or in a clinical healthcare role (e.g., EMT, LPN, RN) with trauma registry experience. Preferred certifications: Registered Health Information Technician (RHIT) Certified Professional Coder (CPC) Certified Specialist in Trauma Registry (CSTR) Certified Abbreviated Injury Scale Specialist (CAISS)

Planned Parenthood of Michigan

Clinical Follow Up Manager (RN)

Posted on:

October 10, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Michigan

Planned Parenthood Federation of America, Inc. (PPFA) Works to protect and expand access to sexual and reproductive health care and education, and provides support to its member affiliates. Planned Parenthood affiliates are separatelty incorporated public charities that operate health centers across the U.S. as trusted sources of health care and education for people of all genders in communities across the country. Planned Parenthood (PP) America’s most trusted provider of reproductive health care. Our skilled health care professionals are dedicated to offering all people high-quality, affordable medical care. The heart of Planned Parenthood is in the local community. Our 49 unique, locally governed affiliates operate health centers nationwide, which reflect the diverse needs of their communities. These health centers provide a wide range of safe, reliable health care — and the majority is preventive care, which helps prevent unintended pregnancies through contraception, reduce the spread of sexually transmitted infections through testing and treatment, and screen for cervical and other cancers. Caring physicians, nurse practitioners, and other staff take time to talk with clients, encouraging them to ask questions in an environment that millions have grown to trust. One in five American women has chosen Planned Parenthood for health care at least once in her life.

POSITION TITLE: Clinical Follow Up Manager STATUS: Full Time, Exempt ANNUAL SALARY: Starting at $93,000 per year LOCATION: Remote BENEFITS: Medical, Dental, Vision, STD, LTD. Life & ADD, 403B, Flexible Spending Account, Generous Paid Time off Program and Free healthcare at our clinics for you and your immediate family! Planned Parenthood of Michigan has implemented a mandatory vaccination policy requiring COVID-19 vaccinations for all employees. Position Description In collaboration with the Director of Nursing and Patient Care, the Follow-up Nurse Manager will lead the follow-up team in solution focused work with the objective of maximizing quality and efficiency. They will provide direct supervision to the unlicensed follow-up staff and clinical supervision of the shared RN staff. They will conduct regular observations and audits to ensure compliance with standards of care and develop protocols and procedures to standardize department workflows. They will facilitate regular team meetings to support these efforts, delegating tasks as needed to move projects forward. In addition to their role in managing a team and leading process improvements, they will provide direct follow-up nursing and care coordination services in support of the Planned Parenthood of Michigan (PPMI) mission. The purpose of this position is to provide leadership and direction for the day-to-day operations of Centralized Follow Up in alignment with the mission, values, philosophies, and strategic plan of the organization. This staff person will fully embody a commitment to race equity; evidenced in all interactions with PPMI colleagues and external stakeholders.

Required: Ability and comfort working with people of diverse backgrounds, cultures, and lifestyles, in a manner that engages on-going self-reflection, humility, and continual learning required. Strong recordkeeping/writing/organizational/computer skills as well as experience working in Electronic Medical Records. Licensed to practice as a Registered Nurse in Michigan Demonstrated ability to achieve objectives in collaboration with other functional areas Demonstrated commitment to Planned Parenthood’s mission, vision and values Preferred: Previous experience in leadership and/or quality improvement. Key Requirements: Commitment to advancing race(+) equity in one's work: interest in expanding knowledge about the role that racial inequity plays in our society. Awareness of multiple group identities and their dynamics; bring a high level of self-awareness about personal identity, empathy, and humility to interpersonal interactions. Demonstrated ability to communicate clearly and directly as well as hear and act on feedback related to identity and equity. Strong sense of accountability to diversity, equity and inclusion principles and practices. Understand the impact of identity dynamics on organizational culture. Commitment to Planned Parenthood's In This Together service ethos, workplace values, and service standards.

Demonstrate a strong understanding of and commitment to Planned Parenthood’s mission and core workplace values—respect for all individuals, effective communication, teamwork and collaboration, accountability, and responsibility—while contributing to a culture and environment of belonging for all employees, patients, and partners Show a strong commitment to recognizing the effort required from our employees to ensure that all individuals have access to health care, no matter what. Responsible for leading, coaching, and supervising staff in Centralized Follow-up. Plans and coordinates the day-to-day processes and operations of the Department in a manner that promotes high employee morale, top-quality patient care and a professional and caring atmosphere in accordance with PPMI Medical Standards and Guidelines. Develop, maintain, and communicate schedule to ensure appropriate staffing for CFU and after hours on call. Interviews, selects, and assists with training of both clinical licensed staff and non-licensed staff. Arranges and facilitates monthly staff meetings. Works with the CMO and Director of Nursing The above duties and responsibilities are not an exhaustive list of required responsibilities, duties and skills. Other duties may be added, and this job description can be amended at any time.

Visiting Nurse Service of New York d/b/a VNS Health

Clinical Evaluation Manager, Utilization Management

Posted on:

October 10, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

New York

VNS Health is one of the nation’s largest nonprofit home and community-based health care organizations. Innovating in health care for more than 130 years, our commitment to health and well-being is what drives us — we help people live, age and heal where they feel most comfortable, in their own homes, connected to their family and community. On any given day, more than 10,000 VNS Health team members deliver compassionate care, unparalleled expertise and 24/7 solutions and resources to the more than 43,000 “neighbors” who look to us for care. Powered and informed by data analytics that are unmatched in the home and community-health industry, VNS Health offers a full range of health care services, solutions and health plans designed to simplify the health care experience and meet the diverse and complex needs of the communities and people we serve in New York and beyond.

Assesses member needs and identifies solutions that promote high quality and cost-effective health care services. Manages providers, members, team, or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable state and federal regulations. Delivers timely notification detailing clinical decisions. Coordinates with management, subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is appropriate, timely and cost effective. Works under general supervision.

Licenses and Certifications: Current license to practice as a Registered Professional Nurse in New York State required Certified Case Manager preferred For SelectHealth ETE Only: Nurse Practitioner (NP) certification with background or degree in Public Health preferred Education: Associate's Degree in Nursing or a Master’s degree required Bachelor's Degree or Master’s degree in nursing preferred Work Experience: Minimum two years of experience with strong cost containment /case management background or two years acute inpatient hospital experience in chronic or complex care required Must have experience and qualifications demonstrating knowledge of working with the LTSS eligible population. preferred Knowledge of Medicare and Medicaid regulations required Excellent organizational and time management skills, interpersonal skills, verbal and written communication skills. Working knowledge of Microsoft Excel, Power-Point, and Word and strong typing skills required Knowledge of Medicaid and/or Medicare regulations required Knowledge of Milliman criteria (MCG) preferred For UM Only: Experience must be with a Managed Care Organization or Health Plan. For SelectHealth ETE Only: Experience in Public Health programming, delivery and evaluation preferred Experience working with community-based organizations in underserved communities preferred

Conducts comprehensive review of all components related to requests for services which includes a clinical record review and interviews with members, clinical staff, medical providers, paraprofessional staff, caregivers and other relevant sources as necessary. Examines standards and criteria to ensure medical necessity and appropriateness of admissions, treatment, level of care and lengths of stay. Performs prior authorization and concurrent reviews to ensure extended treatment is medically necessary and being conducted in the right setting. Reviews requests for outpatient and inpatient admission; approves services or consults with medical directors when case does not meet medical necessity criteria. Ensures compliance with state and federal regulatory standards and VNS Health policies and procedures. Participates in case conferences with management. Identifies opportunities for alternative care options and contributes to the development of patient focused plan of care to facilitate a safe discharge and transition back into the community after hospitalization. Reviews covered and coordinated services in accordance with established plan benefits, application of evidenced based medical criteria, and regulatory requirements to ensure appropriate authorization of services and execution of the plan’s fiduciary responsibilities. Identifies and provides recommendations for improvement regarding department processes and procedures. Maintains current knowledge of organizational or state-wide trends that affect member eligibility and the need for issuance of Determination Notices Improves clinical and cost-effective outcomes such as reduction of hospital admissions and emergency department visits through on-going member education, care management and collaboration with IDT members. Provides input and recommendations for design and development of, processes and procedures for effective member case management, efficient department operations, and excellent customer service. Maintains accurate record of all care management. Maintains written progress notes and verbal communications according to program guidelines. Participates in approval for out-of-network services when member receives services outside of VNS Health network services. Provides case direction and assistance ensuring quality and appropriate service delivery. Keeps current with all health plan changes and updates through on-going training, coaching and educational materials. For Utilization Management Only: Issues Determinations, Notices of Action, and other forms of communication to members and providers which communicate VNS Health’s determinations. Ensures all records/logs related to decision requests, Notices of Action, and other communications required by state or federal regulations are saved in the Utilization Management System. Reviews, evaluates and determines the appropriateness of requests, utilize the most appropriate clinical care guidelines based on clinical practice guidelines. Adheres to all federal and regulatory requirements. Evaluates and analyzes care and utilization trends/issues and identifies opportunities for better coordination of members’ care. Weekend Rotation.

CalOptima

Grievance & Appeals Nurse Specialist

Posted on:

October 9, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

We are a mission driven community-based organization that serves member health with excellence and dignity, respecting the value and needs of each person. If you are ready to advance your career while making a difference, we encourage you to review and apply today and help us build healthier communities for all.

We are hoping you will join us as a Grievance & Appeals Nurse Specialist and help shape the future of healthcare where you’ll be an integral part of our Grievance & Appeals team, helping to strive for excellence while we serve our member health with dignity, respecting the value and needs of each of our members through collaboration with our providers, community partners and local stakeholders. You will participate in managing CalOptima Health’s medical appeals and state hearing reviews for all lines of business, including handling expedited and standard requests. You will ensure appeals and state hearing requests are processed in accordance with regulations, compliance standards and policies and procedures. You will investigate and prepare case narratives and statements of position based on clinical information, benefits and applicable regulations related to member or provider disputes of decisions. You will clearly articulate the facts and CalOptima Health’s position regarding disputes to the Administrative Law Judge hearing the case and also be responsible for creating and reviewing resolution letters for appropriateness of clinical criteria and regulatory requirements. Together, we are building a stronger, more equitable health system.

Do You Have What the Role Requires? High school diploma required PLUS 5 years of health care/managed care experience required, preferably in the following related areas of responsibility: grievances and appeals, utilization management and/or quality management; an equivalent combination of education and experience sufficient to successfully perform the essential duties of the position such as those listed above may also be qualifying. You’ll Stand Out More If You Possess the Following: Current unrestricted Registered Nurse (RN) license to practice in the state of California. Bilingual in English and in one of CalOptima Health's defined threshold languages (Arabic, Chinese, Farsi, Korean, Russian, Spanish, Vietnamese). What the Regulatory Agencies Need You to Possess? Current unrestricted Licensed Vocational Nurse (LVN) license to practice in the state of California. Your Knowledge & Abilities to Bring to this Role: Develop rapport and establish and maintain effective working relationships with CalOptima Health's leadership and staff and external contacts at all levels and with diverse backgrounds. Work independently and exercise sound judgment. Communicate clearly and concisely, both orally and in writing. Work a flexible schedule; available to participate in evening and weekend events. Organize, be analytical, problem-solve and possess project management skills. Work in a fast-paced environment and in an efficient manner. Manage multiple projects and identify opportunities for internal and external collaboration. Motivate and lead multi-program teams and external committees/coalitions. Utilize computer and appropriate software (e.g., Microsoft Office: Word, Outlook, Excel, PowerPoint) and job specific applications/systems to produce correspondence, charts, spreadsheets, and/or other information applicable to the position assignment. Your Physical Requirements (With or Without Accommodations): Ability to visually read information from computer screens, forms and other printed materials and information. Ability to speak (enunciate) clearly in conversation and general communication. Hearing ability for verbal communication/conversation/responses via telephone, telephone systems, and face-to-face interactions. Manual dexterity for typing, writing, standing and reaching, flexibility, body movement for bending, crouching, walking, kneeling and prolonged sitting. Lifting and moving objects, patients and/or equipment 10 to 25 pounds Ways We Are Here For You You’ll enjoy competitive compensation for this role. Our current hiring range is: Pay Grade: 313 - $90,820 - $145,312 ($43.66 - $69.8615). The base pay offered will take into account internal equity and also may vary depending on the candidate’s job-related knowledge, skills, and experience among other factors. This position is approved for Full Telework (**If the position is Telework, it is eligible in California only**) A comprehensive benefits package CalPERS pension program and additional retirement packages. Additional benefits and perks including: A generous PTO program A quality work life balance Various wellness programs Tuition Reimbursement Professional development opportunities Career development opportunities Flexible scheduling And the satisfaction of knowing your work directly impacts and improves healthcare access for thousands of individuals and families. Our Work Environment: If located at the 500, 505 Building or a remote work location: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. There are no harmful environmental conditions present for this job. The noise level in this work environment is usually moderate. If located at PACE: Work is typically indoors in a clinical setting serving the frail and elderly. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud. If located in the Community: Work is typically indoors and sedentary and is subject to schedule changes and/or variable work hours, with travel as needed. Employee will occasionally work outdoors in varied temperatures. There may be harmful or hazardous environmental conditions present for this job. The noise level in this work environment is usually moderate to loud.

80% - Program Support Participates in a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Prepares clinical reviews based on clinical guidelines and provides monitoring of cases involving medical decisions and quality of care or service decisions. Ensures all cases are completed in accordance with state and federal regulatory requirements including timelines. Presents recommendations based on clinical review, criteria and organizational policies to CalOptima Health’s physician reviewers for final determination. Resolves complex and sensitive member issues within established timelines. Maintains departmental database and the integrity of records by accurately entering case actions to assigned cases. Analyzes and reports cases through GARS’ subcommittee. Oversees state hearing cases. Assists with the notification process to members or providers on the clinical decision issued. Discusses appeal process, medical decisions and hearing rights with members. Assists members in coordinating their services with providers and communicates the status and outcome to members. Assigns position statements and represents CalOptima Health at state hearings. 15% - Administrative Support Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department. Participates in departmental meetings, trainings and audits as requested. 5% - • Completes other projects and duties as assigned.

Cleveland City Schools

Cleveland Middle School Nurse Paraprofessional

Posted on:

October 9, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Tennessee

REPORTS TO: Special Education Teacher JOB GOAL: To oversee the medical needs for students in self-contained classes, monitor the daily needs of medically fragile students, assist with carrying out goals in students’ Instructionally Appropriate Individual Educational Plans, and keep documentation of medication administered.

Current, valid LPN or RN certification Ability to communicate effectively with students, school personnel and parents Ability to maintain a cooperative, harmonious relationship within the school setting which fosters recognition and respect for every individual PHYSICAL DEMANDS: This job may require lifting of objects that exceed 20 lbs., with frequent lifting and/or carrying of objects weighing up to 25 lbs. Other physical demands that may be required are as follows: Stooping, kneeling, crouching, and/or crawling Pushing and/or pulling Climbing and/or balancing Reaching, handling Talking Hearing Seeing TEMPERAMENT (Personal Traits): Adaptability to perform a variety of duties, often changing from one task to another of a different nature without loss of efficiency or composure Adaptability to accept responsibility of the direction, control or planning of an activity Adaptability to deal with people beyond giving and receiving instruction Adaptability to make generalizations, evaluations, or decisions based on sensory or judgmental criteria CAPACITY AND ABILITY REQUIREMENTS: Specific capacities and abilities may be required of an individual in order to learn or perform adequately a task or job duty. Intelligence: Ability to “catch on” or understand instructions and underlying principles and ability to reason and make judgments Verbal: Ability to understand meanings of works and the ideas associated with them Numerical: Ability to perform arithmetic operations quickly and accurately Data Perceptions: Ability to understand and interpret information which may be presented in the form of graphs, charts, or tables WORK CONDITIONS: Normal working environment GENERAL REQUIREMENTS: The above statements are intended to describe the general nature and level of work being performed by people assigned to this position. They are not intended to be a complete list of responsibilities, duties and skills required of the principal so assigned.

Assesses and provides for the basic and critical needs of ERC and CDC students with life-threatening medical conditions requiring ongoing physical assessment, nursing treatments, and medication administration Provides invasive care within scope of practice (e.g., g-tube feedings, central line, tracheostomy and pulmonary treatments, hygiene and body function needs such as toileting, diapering, and colostomy care, and lice checks) Works with school nurse to document student care administered as part of the student health plan Collects health care and educational data provided for assigned students Administers medications and treatments Assists the special education teacher, consistent with IEP goals, in lesson plan preparation for small group instruction; classroom management; student observation and assessment; communication with staff, in a variety of settings Works in classroom setting, may move from classroom to classroom or school to school, to provide nursing services to students with disabilities Provides assistance and attends to the physical needs of students including moving and positioning students and assisting with personal hygiene needs, including but not limited to: catheterization, changing diapers, toileting Stabilizes the use of equipment to help students to sit, stand, and stoop; attends to student’s needs, and provides instruction Maintains the ability to physically lift students, move and/or lift equipment varying using established procedures Maintains regular attendance during assigned work schedule Maintains observation assessment of medical needs of students in the classroom Adheres to health information updates and records maintenance on all students in the classroom Attends IEP meetings (if needed) as determined by the special education teacher or conferences with parents to assess the medical needs of the children Communicates with physicians and other medical professionals regarding immediate medical needs (with parent’s permission) Works as an educational assistant in the classroom as requested by the teacher such as helping students with instruction Adheres and complies with all state and Federal regulations relating to students’ medical needs Performs other related duties assigned by the Supervisor of Special Populations

Omnicom Health

Bilingual Nurse Health Educator

Posted on:

October 9, 2025

Job Type:

Full-Time

Role Type:

Coaching

License:

RN

State License:

Texas

The Nurse Health Educator (NHE) is responsible for answering incoming calls on the educational support line calls, making outbound calls and will have varied shifts. The Nurse Health Educator may also participate in live or phone-based educational sessions. The key transferrable skills for these positions are problem solving, professionalism, compassion, communication, organization, attention to detail, and resourcefulness. Snow Companies' business is centered around the patient journey, and the Nurse Health Educator, like all positions at Snow, must be open, compassionate, and sensitive to the unique life experiences of these patients and caregivers. The Nurse Health Educator must be able to incorporate the unique patient/caregiver experience into the strategies and solutions we provide to our clients. Nurse Health Educator will report directly to the Team Lead. PATIENT PRIVACY: The core of our business is working with patients. It is most likely that you will come in contact with personally identifiable information (PII) and personal health information (PHI) of patients living with chronic illness. The Nurse Health Educator will be required to successfully complete and adhere to training courses which may include, but are not limited to: Snow Policies and Procedures Health Insurance Portability and Accountability Act (HIPAA) requirements such as the Privacy Rule, the Security Rule, and Sunshine Act reporting Adverse Event (AE) Reporting The promotional requirements for pharmaceuticals under the FDA and FTC and other applicable federal or state regulations Privacy and Data Security

Skills: Verbal and written communication skills Data management and problem-solving skills Organization Collaboration Critical Thinking Adaptability Attention to Detail Time Management Leadership Word-processing (Word) Spreadsheets (Excel) Presentation software (Power Point) Email (Outlook) Internet and World Wide Web EDUCATION, EXPERIENCE AND RELATED QUALIFICATIONS: Current RN/LPN license in good standing required. Basic computer skills, including database data entry and previous experience with patient communication a must. Experience and demonstrated understanding of call center operation and troubleshooting. Working knowledge of MS Office. Fluency in Spanish is highly desired PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is regularly required to stand; walk; sit; use hands (to finger, handle, or feel); reach with hands and arms; and talk or hear. The employee must regularly lift and/or move up to 10 pounds and occasionally lift and/or move more than 25 pounds. Specific vision abilities required by this job include close vision, color vision, and ability to adjust focus. The employee must be able to operate a motor vehicle. WORK ENVIRONMENT/ENVIRONMENTAL CONDITIONS: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. The noise level in the work environment is usually moderate. No or very limited exposure to physical risk. The range below represents the low and high end of the base salary someone in this role may earn as an employee of an Omnicom Health Group company in the United States.   Salaries will vary based on various factors including but not limited to professional and academic experience, training, associated responsibilities, and other business and organizational needs. The range listed is just one component of our total compensation package for employees. Salary decisions are dependent on the circumstances of each hire. $23 - $30/hour This is a remote based job.

As a Nurse Health Educator, in addition to all the essential functions and duties below, individuals should present with relevant experience, bring ideas forth proactively, show the capacity to work independently, prioritize effectively, complete project work openly and proactively, and work collaboratively with team members. 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. The primary job functions and responsibilities include, but are not limited to: Fluent in both English and Spanish Successfully listen to callers on the Nurse Support Line or in person Closely follow written scripts, FAQs, and resource documents Accurately and promptly document outcomes in Salesforce.com Understand patient privacy laws (HIPAA) Maintain disease knowledge and sensitivity Prepare Adverse Event forms in compliance with Snow standards and individual client requirements for any health condition and/or medication/device malfunction which occurs while a patient is taking a medication or using a device of a company that Snow Companies has a relationship with. Conduct research for various initiatives Collaborate to keep other departments informed of call totals and issues that arise Participate in ongoing training and monitoring Demonstrate the ability to effectively and professionally communicate with managers, clients, customers, mentors, and the general public Fluency in a foreign language is a plus but not required. Manage a high volume of inbound/outbound calls and rapidly input information into Salesforce.com Demonstrate organizational skills Able to multitask in a high-pressure environment Anticipate hurdles and overcome them quickly and efficiently Collaborate with people in other departments when appropriate Demonstrate the willingness/ability to step into other roles as needed to drive the success of the company Demonstrate their ability to be a contributing member of a team that has goals that are broader than an individual job description or function Read and comprehend general documents relating to the pharmaceutical/biotechnology industry that include, but are not limited to; medical education, medical periodicals, clinical trial data, package inserts, medical procedures, and industry regulations Occasion travel or presentation of medical information is required This position may include up to 10% in travel to

Pennwood Cyber Charter School

Pennwood Cyber Charter - School Nurse

Posted on:

October 9, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Pennsylvania

Pennwood Cyber Charter School seeks a qualified and dedicated School Nurse to join our team. Reporting to the School Leader, the School Nurse provides essential health and medical services to students while fostering a safe, supportive, and healthy learning environment. In alignment with our charter application, the School Nurse collaborates with local health service providers across Pennsylvania to ensure compliance with Article XIV: School Health Services of the Public School Code. This role combines direct student support with coordination of external resources to comprehensively address student health needs. The School Nurse will be required to travel, as needed, to support marketing, testing, and school events across Pennsylvania. Travel may occasionally require overnight stays.

Education & Licensure: Registered Nurse with a BSN (Bachelor of Science in Nursing). Certification: Pennsylvania Department of Education School Nurse PK–12 certification required. Residency: Must reside within the Commonwealth of Pennsylvania. Skills: Strong written and verbal communication skills. Ability to assess needs, prioritize, and work independently. High attention to detail and organizational skills with a customer-focused approach. Adaptability in a fast-paced, dynamic environment. Proven ability to collaborate within a team and demonstrate leadership when needed. Technology: Proficient with computers, email, and internet; able to learn new systems quickly. Travel: The School Nurse will be required to travel, as needed, to support marketing, testing, and school events across Pennsylvania. Travel may occasionally require overnight stays.

Health Services: Administer first aid, CPR, and routine health services in accordance with established protocols. Health Education: Provide health guidance and counseling to students, staff, and parents following professional standards. Staff Training: Deliver training and professional development on health-related topics as needed. Liaison: Serve as a point of contact among school staff, families, health practitioners, and community agencies to share and interpret health information that supports student wellness and educational planning. Compliance: Maintain and monitor immunization records to ensure adherence to state requirements. Individual Health Plans (IHPs): Develop, implement, and monitor IHPs for students with specific medical needs. Assessments: Conduct required health screenings (vision, hearing, height/weight, tuberculosis, etc.) at prescribed intervals and document results. Recordkeeping: Maintain confidential and accurate student health records in compliance with legal and ethical standards. Other Duties: Perform additional related tasks to support student health and the effective operation of the school health program.

CareDx, Inc.

Clinical Liaison - Dallas, TX

Posted on:

October 9, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Texas

CareDx, Inc. is a leading precision medicine solutions company focused on the discovery, development, and commercialization of clinically differentiated, high-value healthcare solutions for transplant patients and caregivers. CareDx offers products, testing services, and digital healthcare solutions along the pre- and post-transplant patient journey, and is the leading provider of genomics-based information for transplant patients.

As a Clinical Liaison at CareDx, you will interact with medical professionals at leading clinics to provide support and problem resolution, ensuring their long-term success. You will use your knowledge of the healthcare industry and medical diagnostic processes to be a proactive and thorough problem solver, activating customer trust and confidence in CareDx. You will be an integral part of our commercial team and be responsible for the day-to-day support as the lifeline to our transplant centers and patients. Our customers include health care providers (physicians, nurses, clinical laboratory personnel), patients/caregivers, payers, and CareDx counterparts.

RN degree is required 5 plus years Transplant experience preferred Certified Clinical Transplant Coordinator (CCTC) preferred 25 - 30% Field Travel within assigned geography Ability to thrive both independently and in a team environment Proficiency in reporting and data analytic tools like Excel, Salesforce.com Strong verbal and written communication skills Demonstrated ability to influence without direct authority and to develop and maintain strong cross-functional partnerships Proven experience in managing customer expectations and product development updates Remote: US only roles

Responsible for patient management, in support of CareDx’s transplant offerings, with a primary focus on CareDx’s laboratory tests. Work with transplant center staff, as a Clinical Educator, to streamline workflows and integrate CareDx’s transplant services into their process Liaise between customers and cross-functional internal teams, ensuring CareDx solutions are delivered timely and successful Respond to and resolve common external requests in a timely manner, including (but not limited to) customer order entry, results, reporting, reimbursement Work with patients to coordinate blood draw logistics and ensure receipt of compliant orders Lead operational efficiency exercises and identify ordering process improvements for healthcare providers and/or transplant centers. Coordinate timely processing for samples and customer inquiries Maintain compliance with all applicable regulations referenced in CareDx SOPs, including HIPAA, CLIA, FDA, etc. Field travel within assigned geography to key accounts for business reviews and product updates Other duties as assigned

Assisted Home Health & Hospice

Remote RN Educator, Home Health [Part-Time, Temporary] - Los Angeles

Posted on:

October 9, 2025

Job Type:

Part-Time

Role Type:

License:

RN

State License:

California

Assisted is one of the leading providers of home health services with multiple locations in Southern California and Arizona. Throughout the years, the Assisted care team has offered high quality, compassionate hospice services to patients and their loved ones. Financially and strategically, we are positioned to be a key player in the industry for the years to come. Assisted has earned a Home Health & Hospice Elite Status several years in a row -- come and join an elite team of Home Health & Hospice professionals!

We are looking for a Remote Part-Time, Temporary RN Field Educator to assist in Home Health Orientation twice per/month via MS Teams presentations. Must be organized and work well independently. Pay is $60 per/hour. Requires 10- 20 hours per month. This will be a minimum of 4-6 months duration position. JOB SUMMARY: This position requires clinical expertise in home health, effective communication skills, knowledge of adult teaching- learning principles, and patience.

Licensed to practice as a Registered Nurse by the Board of Registered Nursing in the State of California. Bachelor's degree in nursing preferred, with at least 2 years of experience in home health. Staff Development or teaching experience desired. Must provide proof of automobile insurance upon hire and at each renewal and maintain a safe driving record (driving to multiple location is required) Current CPR, health clearance and clinical skills self-assessment. Successful passage (80%) of Agency competency exam and core competency per skills checklist Working knowledge of State and Federal regulations including accreditation standards.

Assist Director of Education or SDC designee in planning and implementation of new employee field orientation. Assist in presenting Agency classroom orientation to support or fill-in for SDC, when requested

Lice Care Solutions

On call RN/ CNA/ MA or LVN - Atlanta

Posted on:

October 9, 2025

Job Type:

Part-Time

Role Type:

License:

RN

State License:

Georgia

Let’s face it, head lice infestations can be annoying, embarrassing and perhaps especially for pre-teens, even devastating. Fortunately, with Lice Care Solutions in your corner, you and your family will have moved past the hardship by the end of the day. What to expect While other lice removal companies require you to wear an olive oil solution in your hair while you sleep (some for as long as three weeks!), Lice Care Solutions provides you with an easy, mess-free follow-up solution that you can perform yourself in the comfort of your own home. That’s right—no follow-up appointments necessary, which means that no hefty follow-up costs are passed down to you. Instead, we’ll provide you with a simple, realistic plan that you and your family can follow to ensure those lice are gone for good. We do this because we love it! At Lice Care Solutions, we realize that there’s more to life than just making a quick buck. That’s why we don’t charge per person, just a simple flat hourly fee. Plus, with our 31-day guarantee—the longest in the business—you can rest assured that when we step into your house, those lice are leaving.

Mobile Lice Technician – Flexible, Part-Time Work ($25–$35+/hr + tips & travel fees) Imagine being in control of your schedule, working when it suits you. That’s what being a lice technician offers. Whether you’re a parent, a student, or simply seeking better work-life balance, this role adapts to your life — while still asking for reliable commitment. As a lice technician, you’ll play a crucial role in helping families through a stressful situation. Your care and expertise can make a real difference. Don’t worry if you’re new — we provide full training so you’ll feel confident in no time!

LVN, MA, RN, or CNA preferred Calm, friendly, professional demeanor Standing for long periods during treatments Strong attention to detail — expected to remove all lice during the visit Willingness to complete on-boarding, training, and learn internal software independently Must pass a thorough criminal background check

Complete on-boarding with team support and tools Participate in our proprietary training (includes a paid sign-on bonus) Monitor jobs in your dispatch area and accept/decline via app For accepted jobs: arrive within 1 hour, check in on the app to notify client you’re en route Arrive punctually, professionally, and with all necessary supplies Perform head checks, nitpicking treatments, and educate families on follow-up care and prevention Collect client signatures to start and finish jobs (tracks your paid time) Submit invoices for jobs (paid twice weekly)

TRIUNE Health Group Inc

Bilingual Telephonic Case Manager

Posted on:

October 9, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

TRIUNE Health Group is a nationally recognized managed healthcare company with over 35 years of experience. As a mission-driven, second-generation family-owned business, we are dedicated to improving lives by reducing the impact of injuries, enhancing health and wellness, and lowering healthcare and workers’ compensation costs. At TRIUNE, every team member is essential to our success. We foster a supportive and collaborative environment where employees are valued, empowered, and provided with the tools they need to thrive—both professionally and personally.

The Bilingual Telephonic Case Manager (RN) coordinates and manages the medical care of injured or ill individuals entirely over the phone to support safe and timely recovery and return to work. The role requires fluency in both Spanish and English to effectively communicate with patients, providers, and employers, ensuring clear understanding and efficient coordination of services — all while reducing unnecessary costs and optimizing quality outcomes.

Registered Nurse (RN) license in Illinois is required; Compact licensure strongly preferred. Fluency in Spanish and English (speaking, reading, and writing). Minimum of 3 years recent clinical experience, ideally in trauma, rehabilitation, orthopedics, occupational health, or related fields. Strong communication skills (verbal and written) in both languages, with ability to build trust and motivate patients over the phone. Highly organized, detail-oriented, and capable of managing multiple cases simultaneously. Proficiency with Microsoft Office Suite and case management software. CCM certification preferred but not required. Compensation & Work Environment: Eligible for incentive compensation. Fully remote, telephonic position with company-provided equipment and support.

Conduct telephonic case management, collaborating with patients, physicians, health care providers, employers, and referral sources in both Spanish and English. Perform assessments, create care plans, monitor progress, and evaluate outcomes via phone and electronic documentation. Review treatment plans for appropriateness, medical necessity, and cost-effectiveness. Coordinate services such as durable medical equipment, therapy, home health, and return-to-work programs, ensuring clear bilingual communication. Educate and support patients and families by explaining medical information and resources in both languages. Maintain up-to-date knowledge of Workers’ Compensation, ADA, HIPAA, FMLA, STD, LTD, SSDI, and other applicable regulations. Prepare accurate, timely reports and documentation while maintaining HIPAA compliance. Utilize medical and community resources for individuals with catastrophic or chronic conditions (e.g., spinal cord injuries, diabetes, cancer, orthopedic injuries).

Home Helpers Home Care of Boca Raton

R.N. - fresh NCLEX passer (Palm Beach & Broward, Florida)

Posted on:

October 9, 2025

Job Type:

Part-Time

Role Type:

License:

RN

State License:

Florida

We are seeking a dedicated and compassionate fresh NCLEX passer, Registered Nurse to join our homecare team. As a Registered Nurse, you will play a critical role in assessing patient needs, developing care plans, and collaborating with other healthcare professionals to ensure the highest standards of care

A valid nursing degree from an accredited institution is required. Excellent communication skills, both verbal and written, are necessary for effective interaction with patients, families, and colleagues. Ability to work collaboratively within a multidisciplinary team while demonstrating strong organizational skills. We invite passionate individuals who are committed to making a difference in the lives of others to apply for this rewarding opportunity as a Registered Nurse.

Conduct comprehensive assessments of patients’ health status and needs (remote or in person). Develop, implement, and evaluate individualised care plans in collaboration with the healthcare team.

Berkeley Research Group, LLC

Healthcare Clinical Documentation Integrity (CDI) Consultant (Part-Time)

Posted on:

October 8, 2025

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

BRG combines world-leading academic credentials with world-tested business expertise purpose-built for agility and connectivity, which sets us apart—and gets you ahead. At BRG, our top-tier professionals include specialist consultants, industry experts, renowned academics, and leading-edge data scientists. Together, they bring a diversity of proven real-world experience to economics, disputes, and investigations; corporate finance; and performance improvement services that address the most complex challenges for organizations across the globe. Our unique structure nurtures the interdisciplinary relationships that give us the edge, laying the groundwork for more informed insights and more original, incisive thinking from diverse perspectives that, when paired with our global reach and resources, make us uniquely capable to address our clients’ challenges. We get results because we know how to apply our thinking to your world. At BRG, we don’t just show you what’s possible. We’re built to help you make it happen.

BRG's Clinical Economics and Healthcare Performance Improvement practices currently have several openings for CDI experts to join our team at the Consultant level. The  Consultant  position is a mid-level consulting staff position. This position requires a highly motivated problem solver with strong analytical ability and a desire to advance within the organization.  An individual with an entrepreneurial spirit and an ability to apply creative solutions is a natural fit for this position. The Consultant is an integral part of the CDI team and works closely with the client’s CDI team, supporting classroom education and mentoring. They are responsible for ensuring the successful transfer of CDI best practices from the consulting team to the client team. The Consultant also facilitates accurate documentation for severity of illness (SOI) and quality in the medical record, which involves extensive record review and interaction with physicians, health information management professionals, coding professionals, and nursing staff. Work Schedule & Location Flexibility: This part-time position offers a flexible schedule, with an expected commitment of 20–30 hours per week. Hours may be scheduled during core business hours or evenings, depending on candidate availability and team needs. For candidates located in the San Francisco or Seattle areas, occasional onsite work may be required to support client needs. Consultant Salary Range: $33/hr - $64/hr Candidate must be able to submit verification of his/her legal right to work in the U.S., without company sponsorship. #LI-REMOTE | #LI-JQ1 | PM22

4-7 years of experience as a Clinical Documentation Improvement (CDI) Specialist within a hospital setting or as a CDI consultant, or a combination thereof. RN, BSN, or Health Information Management degree required. Currently licensed as a Registered Nurse – ICU, OR, ED specialty preferred, with a strong understanding of clinical workflow. Minimum 2 years of inpatient coding experience with ICD-10 CM/PCS preferred. ACDIS or AHIMA certification preferred. Strong knowledge of CDI principles, including the ability to audit medical records, teach CDI principles to clinicians, coders, and other healthcare professionals. Experience in clinical documentation improvement, coding, audit, or Health Information Management. Ability to assist with the development of CDI and HIM training and consulting tools and methodologies. Excellent organizational, analytical, and writing skills, with the ability to demonstrate critical thinking and problem-solving. Strong verbal and written communication skills, with excellent public speaking and presentation abilities. Effective communication with physicians, coding professionals, and other stakeholders. Knowledge of regulatory guidelines and Medicare Part A, MS-DRG, and/or APR-DRG payment methodologies. Ability to pass a written clinical competency assessment. Familiarity with hospital systems such as EPIC, MEDITECH, or similar platforms is desired. Strong proficiency in MS Office applications, including Word, PowerPoint, Excel, and Outlook. Excellent time management skills and the ability to handle multiple priorities effectively.

Review inpatient medical records for identified payer populations on admission and throughout hospitalization. Analyze clinical information to identify areas within the chart for potential gaps in physician documentation. Formulate credible clinical documentation clarifications to improve clinical documentation of principal diagnosis, co-morbidities, present on admission (POA), quality measures, and patient safety indicators (PSI). Facilitate modifications to clinical documentation through extensive interaction with physicians, nurses, and ancillary staff. Work collaboratively with the coding staff to assure documentation of discharge diagnoses and comorbidities are a complete reflection of the patient’s clinical status and care. Develop and implement plans for education of physician, nursing, and ancillary staff on documentation improvement.

cloudteam

Medical-Clinical Support-Nursing

Posted on:

October 8, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Cloudteam's concept was founded by long-time friends Lou Exline and Kris Kocan in July of 2011. Prior to launching cloudteam, Lou was on the business and Kris on the technical side of consulting. Over a long dinner, they discussed how frustrated they were with the IT consulting industry. The discussion varied, from consultants receiving relentless calls from competing consulting company recruiters, all trying to fill the same client positions; to customers interviewing and selecting a person for a position and another showing up. Spending hours writing all the issues down on several napkins, they decided to design a system and process that would eliminate these issues and change the industry. They set up shop in Titusville, FL and started to go to work, employing a small, motivated development team and investing a great deal of time and money. Cloudteam’s goal is to address the issues that exist in the industry today. Consultants and customers are going to enjoy our emphasis on qualifying, transparency, training, privacy and service. Not to mention our ability to reduce margins by eliminating friction. Eliminating friction means consultants make more and customers pay less!

FLSA: Non-Exempt Shift: Monday–Friday, 8am–5pm EST. Some weekend work may be required; flex weekday scheduling permitted (no more than 40 hours/week). Contract: Contract only (no conversion to perm at this time). Equipment: Provided and mailed to employee. Location: Remote (Florida only).

Active Florida RN License (unrestricted) or Nursing Compact License (required). Bachelor’s degree in Nursing (required). 2+ years of related nursing experience, or equivalent combination of transferable education and experience. CMS experience with review of all organization determinations, including pharmacy reviews. Hands-on experience with Jiva, Siebel, and Diamond systems. Ability to work remotely within Florida. Preferred Qualifications: Managed care experience, including use of InterQual, NCD, and LCD review criteria. Familiarity with regulatory agencies and Medicare Advantage plans. Prior Florida Blue (FLBL) experience. Ability to work effectively across multiple screens and systems. Licenses & Certificates: Florida RN License (or Compact State Licensure) – Required. Florida Driver’s License (valid and in-state) – Required.

The Medical-Clinical Support-Nursing – Pre/Post Service Medical Review Nurse (RN) plays a critical role in supporting clinical decision-making through the review of appeals and post-service cases. This position ensures timely, accurate, and compliant determinations by reviewing cases against CMS, Medicare Advantage, InterQual, and other medical review criteria. The nurse is responsible for documenting findings, drafting determination statements, and collaborating with medical directors and regulatory teams to meet strict compliance standards.

IntellaTriage

Remote Hospice Triage RN- PT 1 shift 3:30p-11a + rotating Sat & Sun 3:30p-11p

Posted on:

October 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 4-6 days out of a 14-day pay period Part- time schedule: Work a minimum 3 evening shifts per pay period 3:30p-11p CST (shift times are set/ week day flexes) Work every other weekend, both Saturday and Sunday 3:30p-11p 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

Cognizant

Registered Nurse - Remote

Posted on:

October 8, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Pennsylvania

We help our clients modernize technology, reimagine processes and transform experiences so they can stay ahead in our fast-changing world. Every day, our people engineer impact―with their clients, communities, colleagues and in their own lives. Together we work as one to improve everyday life—everywhere we operate

Schedule: Monday to Friday - Eastern Time Location: Remote About the role: As a Registered Nurse you will make an impact by performing advanced level work related to clinical denial management and managing clinical denials from Providers to the Health Plan/Payer. The comprehensive process includes analyzing, reviewing, and processing medical necessity denials for resolution. You will be a valued member of the Cognizant team and work collaboratively with stakeholders and other teams. We strive to provide flexibility wherever possible. Based on this role’s business requirements, this is a remote position open to qualified applicants in United States. Regardless of your working arrangement, we are here to support a healthy work-life balance though our various wellbeing programs. The working arrangements for this role are accurate as of the date of posting. This may change based on the project you’re engaged in, as well as business and client requirements. Rest assured; we will always be clear about role expectations.

Educational background - Registered Nurse (RN) 2-3 years combined clinical and/or utilization management experience with managed health care plan 3 years’ experience in health care revenue cycle or clinic operations Experience in utilization management to include Clinical Appeals and Grievances, precertification, initial and concurrent reviews Intermediate Microsoft Office knowledge (Excel, Word, Outlook) In-patient and outpatient experience These will help you stand out: Epic experience Experience in drafting appeals disputing inpatient clinical validations audits is a plus.

Maintain ownership and responsibility for assigned accounts. Maintain working knowledge of applicable health insurers’ internal claims, appeals, and retro-authorization as well as timely filing deadlines and processes. Review clinical denials including but not limited to referral, preauthorization, medical necessity, non-covered services, investigational/experimental and billing resulting in denials and/or delays in payment. Draft and submit the medical necessity determinations to the Health Plan/Medical Director based on the review of clinical documentation in accordance with Medicare, Medicaid, and third-party guidelines. Effectively document and log claims/appeals information on relevant tracking systems Utilize critical thinking skills to interpret guidelines of internal policies for clinical determination. Medical Necessity Reviews can be based on InterQual, Milliman Clinical Guidelines (MCG), Medicare guidelines, and health insurer specific guidelines. Review retro-authorizations in accordance with health insurer requirements and follow insurer process guidelines. Identify denial patterns with clients to mitigate risk and minimize regulatory penalties. Escalate potential risks to client, client partners and/or leadership. Demonstrates critical thinking skills to interpret guidelines of internal policies for clinical determination

Professional Services Network, Inc

HEDIS Registered Nurse Reviewer (RN) Remote - Fulltime Temp

Posted on:

October 8, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Maryland

Experienced HEDIS Licensed Registered Nurse (RN) needed for temporary full-time position(s). Mid-late January though mid-late May of 2026. Licensed Registered Nurse with residency in any of the 50 states and DC. Temporary Full-time (40 hours/week) Applicants can reside in any of the 50 states and DC. Must be licensed in state where work is being performed Monday – Friday from 9AM-5PM PT, for all reviewers Paid training Equipment provided

This temporary position is 100% remote. 2 years clinical experience and use of electronic medical records (EMR) required. 2+ years of HEDIS and comprehensive medical record reviews experience required. Knowledge and experience with Prospective/Retrospective Medical Record Reviews (PMRR/RMRR) and Primary Source Validation (PSV). Ensure compliance with HEDIS measure specifications, guidelines, and regulatory requirements. Ensure confidentiality and privacy regulations are utilized to protect patient information. Prepare accurate and timely reports on findings of HEDIS performance and medical record reviews. Seeking HEDIS nurses who has knowledge and experience with HEDIS TRC and COA standards as a plus.

HANKER SYSTEMS PRIVATE LIMITE

Registered Nurse – Remote Utilization Review

Posted on:

October 8, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

California

Registered Nurse – Remote Utilization Review Location: Remote (must work Pacific Standard Time) Duration: 13 weeks Schedule: Monday–Friday, 8:00 AM–4:30 PM PST (5x8-hour day shifts) Weekend Requirement: Every other weekend rotation Overview: We are seeking a dedicated and detail-oriented Utilization Review Nurse to join our healthcare team. This role is essential in ensuring that patients receive appropriate care while adhering to established guidelines and standards. The ideal candidate will possess a strong clinical background, excellent analytical skills, and a thorough understanding of medical documentation and coding.

Active RN License (CA license is required) Minimum 3 years of recent hospital Case Management or Utilization Management experience Proficiency with InterQual criteria (non-negotiable requirement) Epic charting experience (within the past 12 months) Experience with Medicare regulations (CC44s, ABNs, HINNs, MCSNs, etc.) Must have previous travel experience

Perform concurrent and retrospective utilization reviews for hospital admissions and continued stays Apply InterQual criteria to determine medical necessity and appropriate level of care Collaborate with physicians, case managers, and insurance representatives for care coordination Handle appeals, denials, prior authorizations, and benefits eligibility reviews Ensure compliance with CMS, CA Medi-Cal, and Joint Commission regulations Maintain accurate and timely documentation within Epic Participate in weekend rotation (every third weekend) and maintain flexibility across assigned facilities Follow all California labor laws regarding breaks, overtime, and work schedules

IntellaTriage

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

Posted on:

October 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 2 shifts weekly 4:30a-10a CST (shift times are set/ week day flexes) Work every other weekend, both Saturday and Sunday 4:30a-10a CST

MUST have or be willing to obtain a Compact RN license (states with pending or future implementation dates are not considered current compact states until the implementation date) You must remain in good standing and ensure your home state license remains active. IntellaTriage will cover the cost of non-compact state licensure if necessary for client support. Hospice, palliative, end-of-life care is strongly preferred Experience in a fast-paced environment: ED, surgical services, or critical care, etc. Must be comfortable accessing multiple technology applications to document during calls Ability and comfort with typing in a fast-paced environment Fluency in English is required, additional languages are a bonus Must physically reside in the U.S. and be legally eligible to work for any employer Must be able to complete three weeks of remote paid training that is conducted during days and evenings Must be available to work every other Saturday & Sunday Must be available to work some Holidays as required Must be able to handle stress and multitask when receiving calls (minimum of 5 calls per hour on weekdays, and up to 8 per hour on weekends) Must be able to communicate empathically with patients while adhering to protocols Must maintain CEU’s as designated by the states in which you are answering calls Must attend any in-services, and additional training on an as needed basis Must pass background check and nurse licensing check

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

Premier Home Healthcare Florida

Registered Nurse (RN)

Posted on:

October 8, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Florida

We are seeking a dedicated and compassionate Registered Nurse to join our healthcare team. The ideal candidate will possess a strong commitment to providing high-quality patient care and will be responsible for assessing, planning, implementing, and evaluating patient care plans. This role requires a thorough understanding of anatomy and a passion for supporting patients through their healthcare journeys.

Skills: Strong knowledge of human anatomy and physiology to inform patient assessments and care strategies. Excellent patient care skills, demonstrating empathy, compassion, and professionalism at all times. Effective communication skills, both verbal and written, to interact with patients, families, and healthcare professionals. Ability to work collaboratively within a team environment while also being capable of working independently when required. Strong organisational skills with the ability to prioritise tasks effectively in a fast-paced environment. Proficiency in using healthcare technology and electronic medical records systems. We invite qualified candidates who are passionate about making a difference in the lives of others to apply for this rewarding opportunity as a Registered Nurse. Tipo de puesto: Tiempo completo, Medio tiempo, Temporal, Por contrato Licencia/Certificación: RN Llicense (Obligatorio) BSL Certification (Obligatorio) Lugar de trabajo: Empleo remoto

Conduct comprehensive assessments of patients’ health status and needs. Develop and implement individualised care plans in collaboration with multidisciplinary teams. Administer medications and treatments as prescribed, ensuring compliance with safety protocols. Monitor patients’ progress and respond promptly to changes in their condition. Educate patients and their families about health conditions, treatment options, and self-care strategies. Maintain accurate and up-to-date patient records in accordance with legal and organisational standards. Provide emotional support to patients and their families during challenging times. Participate in continuous professional development to enhance nursing skills and knowledge.

Managed Medical Review Organization

RN - Clinical Case Manager - Remote

Posted on:

October 8, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Michigan

We are an interdisciplinary group of professionals who serve our Client's needs with a single shared goal in mind: exceed expectations with clinically accurate outcomes and service excellence! Working collaboratively, we’re able to achieve results that are creative and strategic, with measurable business impact. MMRO provides services in the Disability Management and Healthcare Review space. MMRO is the industry leader and trailblazer in creating and modernizing disability programs across the country, offering clients independence, industry best practices and evidenced-based outcomes. As an URAC Accredited Independent Review Organization (IRO), MMRO provides medical peer review services across the country. Our healthcare reviews are objective and evidence-based.

MMRO's Clinical Case Manager works remotely to perform Case Management for Disability Benefit recipients. There is no face-to-face patient care. MMRO is an Independent Review Organization and manages Disability / Disability Retirement & Healthcare Claims and Appeals. In this position, the Clinical Case Manager is responsible for case management for patients who are on disability programs with a goal of returning to work at some point. This service is called "Rehabilitation Services".

Applicants must have a current RN license with no sanctions. Associates degree required, bachelors degree preferred. Relevant experience is required. CCM certification preferred, required within 6 months of hire.

Identification of appropriate Rehabilitative Services case management track (Catastrophic or Active). Perform telephonic Clinical Assessment of disabling and impacting co-morbid condition(s), which includes, but is not limited to: Activities of Daily Living Assessment; Psycho-Social Assessment; history of recent hospitalizations, review of current clinical status (as of time of outreach), review of current treatment plan and medications, identification of current treating physicians, identification of special needs, and identification of case-specific periodic outreach interval. Development of customized, member-specific clinical Case Management Plan. Perform ongoing periodic telephonic clinical outreach at intervals determined upon completion of Clinical Assessment and Case Management Plan. Perform the periodic telephonic clinical outreaches at the schedule timeframe, consistent with the format and structure as required. Request and determine receipt of necessary information/documentation to help identify ongoing case management needs. Development of a comprehensive case management resource library from which to provide members information relevant to their disabling and impacting co-morbid condition(s). Determine MBR necessity via information gathered from the telephonic outreaches and documentation received for a return to the member’s own occupation. Determine appropriate physician specialty for MBR, when need is identified. Clinical Case Manager will be responsible for providing the appropriate vocational resources and tools to assist members in their efforts to seek employment in the labor market. Provide educational resources, including pamphlets, community resources, workshop information, and other relevant information deemed necessary to maximize employability. Communicate with members, physicians, employers, and clients, as deemed appropriate.

Western Healthcare Alliance

Regional Care Coordinator - Registered Nurse (RN) - Remote in Colorado Only

Posted on:

October 8, 2025

Job Type:

Full-Time

Role Type:

Primary Care

License:

RN

State License:

Colorado

Western Healthcare Alliance (WHA) began in 1989 when a small group of rural Colorado hospitals decided that there was power in numbers. Today, WHA celebrates over 30 years of collaboration with healthcare members in Colorado, Utah, and Michigan. A subset of WHA members own Healthcare Management, a sister company of WHA, which provides revenue cycle solutions to healthcare entities. Developing and managing a menu of member-owned and partner programs, WHA saves members money that helps them remain sustainable and viable in their communities.

Reports To: Manager of Care Coordination Location: Remote - Must Reside in Colorado Position Pay Range: $32.01 - $43.21 Status: Hourly/Non-Exempt Supervisory Role: None Benefits include: Medical, Dental, Vision, 5% 401k Employer Match, FSA, Paid Hours Off, Paid Holidays, Group Discounts, Life & LTD, EAP, and more! Position open until 10/6/2025 or until filled. Position Summary: The Regional Care Coordinator is responsible for growth and maintenance of the care coordination program which includes recruitment and maintenance of patients enrolled in care management services; assurance of the completion of the annual wellness visit and follow up on all elements of the preventative plan of care; and discussing advance care planning with patients. These responsibilities will be completed by providing outreach, disease management/care management, care coordination/health promotion, education/training and motivational support to patients, referral sources and the community. This position will work to improve the quality of life of patients enrolled through supporting quality outcomes, smooth care transitions, coordination of care across the health continuum, encourage healthy lifestyle choices to reduce long term effects of chronic illness. This position is accountable for working with and representing our clinics across multiple constituents, and collaborating with your assigned team.

Competencies: To perform the job successfully, an individual should demonstrate the following competencies: Must be able to work collaboratively with diverse individuals at all levels of the CCA organization and external customers. Requires a general knowledge of business, healthcare and healthcare coverage issues. Notable experience with data analytics and electronic medical record systems Notable experience with value based contracting and networking and healthcare policy. Ability to think creatively and provide office management oversight. Ability to simultaneously manage multiple projects with tight schedules. Ability to work independently and as part of a team. Good verbal and written communication skills, including the ability to do group presentations and work one-on-one. Current driver’s license and ability to travel, including some overnight stays. Qualifications: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Education/Experience: Unencumbered Registered Nurse in the State of Colorado 2-3 years primary care clinical experience including working with the geriatric population preferred Previous work experience with educating patients and patient goal setting preferred Previous work experience in an autonomous position Language Skills: The ability to converse in English and Spanish is preferred. Ability to read, analyze, and interpret common scientific and technical journals, financial reports, and legal documents. Ability to respond to common inquiries or complaints from customers, regulatory agencies, or members of the business community. Ability to write policies and procedures that conform to prescribed style and format. Ability to effectively present information to top management, public groups, and/or boards of directors. Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percent and is knowledgeable in metric, apothecary and household measurements and can convert from one system to another. Reasoning Ability: Ability to solve practical problems and deal with a variety of concrete variables in situations where only limited standardization exists. Ability to interpret a variety of instructions furnished in written, oral, diagram, or schedule form. Ability to modify care based on the developmental / functional age of the patient as well as that of the patient's ethnic background. Age Specific: Must be able to provide care according to the developmental level and or chronological patient served. This includes, but is not limited to, identifying the needs and abilities of each patient, and demonstrating an understanding of how a patient’s chronological and developmental age influences his/her need for adaptations related to his/her abilities. Also, an understanding of how a patient’s age impacts his/her ability to deal with and adapt to the care needed/provided is required. General census of neonatal to geriatric patients. Other Skills and Abilities: Ability to act as a patient advocate. Ability to interact with patients, families, visitors, and co-workers. Ability to interact assertively and tactfully when dealing with conflict and in group solving activities. Ability to demonstrate a professional, open minded approach in identifying problems and resolving problems/conflicts. Ability to develop creative solutions outside of the health care setting. Ability to develop relationships with community resources. Ability to appropriately manage time and work in flexible environments. Ability to work autonomously and meet demanding deadlines. Supervisory Responsibilities: This job has no supervisory responsibilities. Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The noise level in the work environment is usually moderate. The employee is subject to inside and possibly outside weather conditions. The employee is also subject to exposure to blood and body fluids, proximity to moving mechanical parts, electrical shock, exposure to burns and radiant energy, exposure to explosives, exposure to toxic chemicals and biological agents. The employee will have a flexible work environment with a combination of work performed in the primary care and specialty clinics with some interactions in the hospital setting as well. Remote Work Environment: The employee must maintain patient confidentiality at all times and ensure remote locations such as home office or travel locations where patient interactions occur meet privacy standards. The employee will be provided with necessary equipment to work remotely such as computer, mobile phone, and other technologies as needed. Residence Location: The employee must live within the Western Slope region of Colorado and be within day-trip driving distance of many of our member practices and hospitals to allow for in-persons visits.

Work collaboratively with clinic staff to provide education and recruitment techniques. Exhibit competence in the Seven Domains of Care Coordination in the primary care setting: Population Health Management, Comprehensive Assessment and Care Planning, Interpersonal Communication, Education/Coaching, Health Insurance and Benefit knowledge, Community Resource knowledge and Research and Evaluation skills. Provide outreach, disease management, education and other needed clinically based activities to patients managing various chronic health conditions and to referral sources and community. Assess and identify participant’s readiness, willingness, and ability to change. Identify patient coaching, support, and educational needs by focusing on what is important to their quality of life. Determine and connect with relevant community and/or health care resources to support solutions; provide educational tools to promote self-management. Collaborate with the patient to develop interventions and sets goals for behavioral modification within the scope of nursing practice. Conduct health and wellness coaching sessions to assist participants in making lasting changes to their health and wellness. Monitor and document the patient’s progress toward his or her optimal level of wellness. Promote wellness and provides education regarding preventative care measures. Act as a liaison between referral sources, facilities, and outside entities to prevent and/or resolve continuum of care issues Communicate with service delivery partners, providers, and other health professionals to provide care coordination to ensure the plan of care facilitates the efficient use of health care resources. Demonstrate skills in effectively coordinating and monitoring care to promote quality and cost-effective outcomes. Proactively follow up with patients discharged from all hospitals, rehab facilities and emergency rooms to recruit patients into the care management services to ensure patient has an appointment with their provider and reviews any unmet needs prior to the upcoming appointment. Analyzes clinical data generated from EHR/Registry system and identifies patients who have gaps in care and utilizes risk stratification intervention metrics for care coordination recruitment purposes. Assist clinics with billing questions related to services provided by Regional Care Coordinator. Remains current on industry trends, best practice operational models, and changing patient and provider needs.

Slocum Orthopedics

Remote RN Triage - Per Diem

Posted on:

October 8, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Oregon

Handles incoming calls from or on behalf of patients who have questions about their orthopedic care, pain medication concerns, or other medical issues to be addressed. Provides case management for orthopedic patients as needed.

Physical demands: Specific vision abilities required by this job include close vision, distance vision, peripheral vision, depth perception, and ability to adjust focus. Able to sit or stand for long periods of time. Be able to work on a computer and keyboard for up to eight hours a day. Able to walk, and use hands to finger, handle, or feel. Able to reach with hands and arms. Ability to hear and understand in person and over the phone. Able to speak and provide information in person and over the phone. Education and Experience: Current and valid Oregon RN License required. At least one year of experience as a registered nurse, preferably in an orthopedic, surgical, or acute care setting. Knowledge of orthopedic terminology required EMR and computer experience required. Medical office and hospital experience desired.

Answer all phone calls from patients with medical concerns that are directed through switchboard or other internal departments Determines if patient has had recent trauma, closed reduction, or surgery and manages the patient concerns according to protocols Is mindful of the most common medical complications related to surgery and trauma (i.e. DVT/PE, infection, compartment syndrome, and unmanaged pain) and triages per protocols Identifies emergency situations and instructs patients to call 911 Ensures that a valid “Authorization to Communicate” is in effect when speaking about a patient to someone other than the patient him/herself Communicates clearly and promptly with physicians regarding serious changes in patients’ condition related to their orthopedic condition for which they are being treated Documents all patient phone calls in the electronic medical record upon completion of the call Supports a coordinated workflow for patients between triage, medical assistants, and physicians. Proactively works with supervisor when it is noticed that physician standards of practice are not currently reflected in protocols Strictly adheres to all HIPAA rules and regulations Acts as a positive role model in demonstrating excellent patient care and service standards Promotes patient education Able to skillfully navigate through EPM and EHR in Next Gen, and outside health information systems such as Centricity, McKenzie Portal, etc. Has and maintains a current knowledge of orthopedic surgeries, plans of care, conditions, and terminology RN Case Management- if assigned 10-15 hours per week. Responsible for performing case management with the scope of licensure for patients with complex and chronic care needs. Activities include coordination and oversight of care plans and services to promote effective utilization of services and quality patient care. Monitors progress over time and initiates changes as needed. Assess patient populations to identify those resources or other factors needed to achieve the desired outcome for health maintenance or health improvement. Develops professional relationships with community resources Ability to oversee and assist the patient with referral navigation. Assess patient readiness for change and develop self-management goals. Competencies High level of knowledge, experience, and skill in the area of orthopedic nursing Efficient problem solving and decision making skills Excellent communication, interpersonal, and conflict resolution skills Ability to type by touch Able to plan, prioritize, and multi task Prioritize work load daily, weekly and monthly Excellent cultural competency skills with patients Communicate clearly, concisely and courteously via phone, email and in person Supervisory responsibilities: None

TeamHealth

Bilingual Spanish RN Telephone Triage (Work from Home)

Posted on:

October 8, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

AccessNurse is the premier provider of medical call center solutions, including 24/7 telephone nurse triage, and answering services. In business since 1996, AccessNurse serves more than 20,000 clinicians and practices, along with healthcare systems, health plans and Federally Qualified Health Centers (FQHCs) across the country. AccessNurse is a TeamHealth Company.

Now hiring remote Bilingual Spanish Telephone Triage RNs! Evenings, Weekend Only, Full-time & Part-time opportunities available (20hrs +) Hiring for evenings and weekends (*weekends and holidays are required) The Telephone Triage Nurse role is a great alternative to bedside nursing working 12-hour shifts. This is an opportunity to work remote from home! Training and equipment are provided. Training classes are starting soon. Overview The Telephone Triage Nurse will take phone calls and help patients across the lifespan of the call and determine the best way to address their medical issues and concerns.

Qualifications / Experience: Current multi-state RN license with no restrictions; nurses currently holding a single-state RN license must obtain a multi-state license prior to being made a job offer 2+ years of nursing experience Proficiency using computers and type a minimum of 25 wpm Excellent listening and comprehension skills to determine key information by patient Professional, courteous telephone voice Ability to defuse conversations Ability to handle confidential information; HIPAA compliance is mandatory Flexibility with scheduling Remote Workstation / HIPAA Requirements Must have a high-speed internet connection Workstation must be in a room where door can be locked Desk should be large enough to hold 2 monitors, computer, accessories + hands-free headset REMOTE: Training Class Dates 100% ATTENDANCE IS REQUIRED 4-week Remote Training over Zoom Video Week 1: Nov 3 - Nov 7 Monday-Friday 9a-5p ET Week 2: Nov 10 - Nov 14 Monday-Friday 9a-5p ET Week 3: Nov 17 - Nov 21 Monday-Friday 2p-10p ET Week 4: Shift days/times with a preceptor will be discussed with your recruiter

Assesses patient’s symptoms utilizing a physician-written algorithms When appropriate, provide home care instructions using the approved, written guidelines as well as approved reference material provided Utilize all resources and guidelines to effectively assess, prioritize, advise, schedule classes or physician appointments, or refer calls when necessary to the appropriate medical facility, personnel or specialized community service Completes all documentation in the appropriate software Provides guidance recommending a variety of levels of care (e.g. home care, an office visit, emergency room) Responds to patient’s questions Provides and documents health education to help patients manage their symptoms when indicated Consults with physicians as needed

ChenMed

Registered Nurse, Remote Emergency Triage

Posted on:

October 8, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

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

The Registered Nurse, CareLine, PRN is responsible for providing telephonic triage directional patient care advice for general and specific illnesses, health related issues, client counseling, patient advocacy, health education and referral and resource management to ChenMed patients and their families. Providing on-call coverage, the incumbent in this role provides remote clinical advice and assessments within license and as possible given the technology and medium. He/She collaborates with primary caregivers and others on the interdisciplinary care plan team to provide a team approach of care. The schedule for this position is: Wednesdays 1700-2230 Thursdays 1700-2230 Fridays 1700-2200 Saturdays 0830-2030 Sundays 0830-2030

KNOWLEDGE, SKILLS AND ABILITIES: Advanced-level business acuity In-depth knowledge and understanding of general/core Nursing-related functions, practices, processes, procedures, techniques and methods Broad nursing knowledge and understanding Ability and willingness to provide extraordinary customer service and professionalism to all customers Maintains current nursing knowledge and competency to stays abreast of budding nursing trends and best practices Excellent written and verbal communication skills through a variety of formats, tools and technologies Capable of building trust and professional relationships to deliver VIP care across the continuum Ability to demonstrate excellent clinical judgement Ability to problem solve Ability to prioritize and work under pressure Ability to provide constructive feedback Ability to effectively collaborate with physicians, patients, family members, colleagues and other team members in a courteous and professional manner Ability to effectively collaborate with a multidisciplinary team Proficient skill in Microsoft Office Suite products including Excel, Word, PowerPoint and Outlook; competent in other systems required for the position Ability and willingness to travel locally, within South Florida, to attend meetings and trainings up to 10% of the time; requires availability to work evening, weekends and/or holidays Minimum requirement to work 3 holidays in the calendar year. ​ Spoken and written fluency in English; bilingual (Spanish/Creole) a plus This job requires use and exercise of independent judgment EDUCATION AND EXPERIENCE CRITERIA: Associate Degree in Nursing required, Bachelor’s Degree in Nursing preferred Nurse Licensure Compact multistate license required Michigan and Illinois Nurse Licensure required within 90 days of hire, ability to obtain additional licenses as requested by the organization within 90 days of hire Basic Life Support (BLS) certification from the American Heart Association or American Red Cross required Minimum of 3 years acute clinical nursing work experience, in emergency services with triage responsibilities highly preferred Minimum of 1 year virtual care experience preferred

This is a PRN/Per Diem position, requiring a minimum of 160 hours per year, with scheduling flexibility based on the needs of the department. Works on an as-needed basis, including nights, weekends and holidays. Expected to pick up shifts to cover PTO, LOA and other unexpected absences, with some shifts being planned in advance and others requiring minimal notice. Connects with patients via phone or video call. Interviews and questions patients to collect health history and uses a computer system to record and store comprehensive and focused data relating to the health needs of patients and families. Provides health assessment and treatment solutions, monitors patient health and at-home care, aids in emergency scenarios and promotes patient wellness. Based on the technology available, monitors a patient’s oxygen levels, heart rate, respiration, blood glucose and other assessment measures. With the help of video chatting, identifies patient’s symptoms and conditions. Analyzes data to determine the appropriate health maintenance and identify appropriate outcome for the patient and family. Collaborates with on-call PCP as needed to support expected clinical outcomes. Implements the appropriate protocol to attain the expected outcome. Evaluates and documents progress toward the anticipated outcome. Assists in ensuring achievement of optimal patient outcomes through use of Telemedicine. Documents interventions in readable, understandable language. Aids in enhancing the quality and effectiveness of the organization’s telehealth practices and professional nursing practice through successful utilization and improvement of outcomes that demonstrate program effectiveness. Utilizes appropriate resources to plan and provide services that are safe, effective and fiscally responsible. Performs other duties as assigned and modified at manager’s discretion.

Legacy IHP Solutions

Registered Nurse (RN)

Posted on:

October 8, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

South Dakota

Legacy IHP Solutions is seeking a full-time Registered Nurse (RN) to provide overnight remote clinical support in older adult, senior living, behavioral health, and chemical dependency communities. This is a work-from-home position open to those based out of Minnesota, North Dakota, South Dakota, Montana, Wyoming, Idaho, Texas, or Florida.

Current state Registered Nurse Licensure Associate Degree from accredited institution Bachelor’s Degree in related field, preferred Work experience that demonstrates increased level of supervisory responsibility in the healthcare field Geriatrics, dementia and/or assisted living work experience, preferred Behavior health and/or chemical dependency experience, preferred

Anchor Staffing, Inc.

Remote Nurse Case Manager II - PA

Posted on:

October 8, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Pennsylvania

We combine experience and best practices to deliver innovative solutions while keeping the focus on you, the customer. That's workforce Simplified! We offer Contingent to Permanent, Contingent, and Direct Hire Placement.

THIS ROLE IS COMPETELY REMOTE HOWEVER MUST RESIDE WITHIN EASTERN STANARD TIME ZONE TO BE CONSIDERED FOR THIS ROLE Monday through Friday 8:00 AM - 5:00 PM EST Pay Rate $35.00- $38.00 (Commensurate of experience)

Associate's degree in Nurse An active and unrestricted RN license in the state of Pennsylvania 2 years of Case Management, discharge planning and/or home health care coordination experience 3 years of clinical practical experience Bilingual desired Proficiency in Microsoft Office (Word, Outlook, Excel, and Teams)

Nurse Case Managers are frontline advocates for members who cannot advocate for themselves. They 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.

CGC Group Inc.

Team Lead, Care Specialist UM

Posted on:

October 8, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

None Required

State License:

Florida

The Team Lead, Care Specialist UM is responsible for supporting utilization management processes, supervising non-clinical staff, and ensuring compliance with organizational, regulatory, and legal requirements. This role includes staff oversight, caseload management, and serving as a key contributor to projects, initiatives, and operational improvements.

Education, Training, Licenses, Certifications Bachelor’s degree required (additional experience may substitute). Experience, Knowledge, Skills, Abilities 3–5+ years of managed care experience, preferably in utilization management or prior authorization. Experience in non-clinical UM or care management operations. Familiarity with discharge planning, care transitions, and quality measures. Strong knowledge of medical terminology, ICD, and CPT coding. Experience working with community health and social service agencies. Strong communication, problem-solving, and organizational skills. Ability to work independently, set priorities, and manage a flexible schedule. Computer literacy with Windows and automated systems. Bilingual (English/Spanish) preferred. Customer service and data entry expertise; competency in UM functions (acute care, home care, prior authorization, etc.). Must be available to work weekends and holidays as needed.

Support non-clinical functions required for successful utilization management. Ensure work is completed within appropriate timeframes and in compliance with regulatory and organizational standards. Supervise 5–8+ non-clinical staff, including assignment planning, workload balance, and performance oversight. Manage a personal caseload 50% of the time. Represent the team and supervisor in projects, testing sessions, and organizational initiatives. Conduct performance reviews, mentoring, and coaching of staff. Participate in staff hiring and performance improvement processes. Provide direction to the team on schedules, priorities, and issue resolution. Serve as a subject matter expert on processes, systems, and delegated functions. Research and resolve authorization discrepancies and claims issues. Communicate authorization decisions and benefit information to members and providers. Collaborate across departments to resolve issues and ensure process efficiency. Monitor quality, cost, and efficiency trends and recommend improvements. Provide case review, documentation oversight, and preauthorization support as needed. Lead and develop staff, ensuring adherence to organizational and departmental goals. Perform additional related duties as assigned.

CGC Group Inc.

Clinical Training Nurse

Posted on:

October 8, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

New York

We are seeking a Clinical Training Nurse to design, deliver, and evaluate training programs that support clinical and non-clinical staff across Medical Management. This role ensures staff are equipped with the knowledge and tools needed to meet regulatory requirements, improve performance, and support quality patient care.

Education & Licensure: Bachelor’s degree required RN required; BSN preferred Active New York RN license (unrestricted) Experience & Skills: 4–6 years of clinical experience (required) At least 2 years in managed care (required) Training experience and knowledge of adult learning principles (preferred) Regulatory, compliance, and accreditation experience (preferred) Experience with medical management or claims systems (preferred)

Why This Role Matters: Design and deliver effective training for Case Management (CM), Utilization Management (UM), and related functions. Partner with internal teams and external vendors to ensure consistent and compliant training programs. Support onboarding, annual compliance training, and performance-based development. Key Responsibilities: Training Delivery (40%) – Train workflow, process, and clinical content for clinical and non-clinical staff. Training Resource Development (25%) – Create resources and tools to ensure consistent understanding and application of UM and CM principles. Onboarding & Compliance Training (15%) – Develop and maintain new hire and annual required training, including regulatory and accreditation updates. Cross-Departmental Training (10%) – Provide training to other teams (e.g., Quality, Pharmacy, Neighborhood Care) and external vendors. Project-Based Training (5%) – Develop training plans for systems and special projects, including evaluation and testing. Vendor Coordination (5%) – Coordinate external training on healthcare topics such as disparities, diabetes, and asthma.

CGC Group Inc.

Care Manager, Complex Disease Management – Remote

Posted on:

October 7, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

New York

Job Description Care Manager, Complex Disease Management – Remote **New York RN license required** Summary of Position: The Care Manager is responsible for providing care management as part of a multidisciplinary team. This includes coordinating care, conducting telephonic and face-to-face assessments, identifying gaps in care, and implementing interventions to support members’ physical, environmental, and psychosocial needs. The Care Manager works closely with providers, caregivers, and community resources to promote safe, effective, and member-centered care.

Education, Training, Licenses, Certifications: Bachelor’s degree required. Current, active New York RN license required. CCM certification preferred. Certification in utilization or care management preferred. Experience, Knowledge, Skills, Abilities: 4–6 years of clinical experience. Background in case management, care coordination, managed care, or utilization management. Strong organizational and prioritization skills; ability to manage a caseload of highly complex members. Proficiency in motivational interviewing techniques. Experience with electronic medical records and MS Office applications. Strong communication and interpersonal skills. Bilingual abilities strongly preferred. Ability to collaborate across teams and problem-solve effectively. Flexibility to work evenings.

Assess and evaluate the needs of complex members, collaborating with caregivers, providers, and community resources to address medical, financial, and psychosocial concerns. Develop individualized care plans with clear goals and interventions, including referrals, education, and activation of support resources. Coordinate safe and timely transitions of care, ensuring members receive the right care at the right time in the right setting. Engage members, families, and primary care providers in setting and achieving care goals that improve health outcomes and quality of life. Collaborate with interdisciplinary team members such as dietitians, social workers, and community health workers to deliver holistic care. Act as an advocate and liaison for members, connecting them with providers, nonprofit, and governmental resources. Ensure compliance with federal, state, NCQA, and organizational standards in all care management processes. Document all activities in the electronic medical record system accurately and within required timeframes. Participate in case conferences, committee work, and training as assigned. Monitor and evaluate members’ progress, updating care plans as needed. Support population health, transitions of care, and complex case management initiatives.

Amedisys

Hospice Afterhours Triage Registered Nurse part time benefitted

Posted on:

October 7, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Amedisys is one of the largest and most trusted home health and hospice companies in the U.S. Here, each member of our team is considered a caregiver, no matter their job title. From nurses to business office staff, therapists to aides and beyond – we’re always looking for talented, passionate people who can help us make a difference where it matters most, to our patients and their families. Apply now to join the Amedisys family – and be on your way to a rewarding career, where you will make a meaningful impact every single day.

PT Benifitted Position 30-32 Hours per week 2-3 PM Shifts starting at 5pm EST scattered through Mon to Fri (can be 3, 6 or 8 hour shifts) Every weekend Sat and Sun Day shift hours (8,10 or 12 hour shifts) 4/6 Major Holiday required Bilingual Needed, not required Compact required with ability to pick up additional licenses Are you looking for a rewarding career in homecare? If so, we invite you to join our team at Amedisys, one of the largest and most trusted home health and hospice companies in the U.S.

Current, unencumbered license to practice as a registered nurse in the state you are assigned to work. One year of experience as a registered nurse. Current CPR certification. Knowledge of physical, psychosocial, and spiritual needs of terminally ill patients and their caregivers. Must be comfortable with technology. Must be willing and eligible to obtain additional RN licenses in other states (reimbursed). Preferred: Previous hospice experience. Telephone triage experience. Spanish speaking.

Assesses physical, environmental, and emotional factors telephonically to determine hospice needs. Utilizes EHR, including the patient's plan of care to develop recommendations. Provides recommendations, patient/caregiver education/instructions and hospice support telephonically based on the situation and the plan of care. Collaborates with pharmacies, DME vendors and other agencies for effective patient management. Facilitates delivery or maintenance of provided medical equipment to meet patient needs. Assigns all visits, admissions and follow-up calls to on-call field staff (RN, LPN, HA, CH, SW) as needed. Submits accurate and detailed documentation in real-time to promote continuity of care. Utilizes a combination of agency resources and nationally recognized standards of practice to achieve excellent pain and symptom management and high-quality end-of-life care. Participates in agency performance improvement initiatives. Performs other duties as assigned.

Serva Health LLC

Patient Services Specialist - Nurse

Posted on:

October 7, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Florida

We are a dynamic fast-growing company, specializing in Telephonic Patient Services to the pharmaceutical and healthcare industries. Our clients are sponsors, marketers or distributors of medications and/or devices for chronic and/or rare diseases. Our team of registered nurses serve clients by providing impeccable service to patients.

Patient Services Specialist Providing Virtual Patient Support Fast-Growing Company is Seeking a virtual nurse to provide Patient Support Services. Serva Health is currently growing our registered nurses team to provide Telephonic Patient Services for a variety of patient-facing programs. Currently hiring nurses from the following states: Florida, Texas, Georgia, North Carolina, Pennsylvania, Ohio, Illinois, and Tennessee

Full-time opportunities are given preference. Evening hours are in the greatest demand. Full-time availability, 48 weeks of the year is required. Previous non-clinical and/or telephonic patient services experience is strongly preferred Case management experience a plus Must complete a set of competency quizzes in the areas of nursing, computer skills and customer service Possess intermediate to advanced computer skills Have a computer with Broadband Internet Access (*high speed internet access is NOT provided or reimbursed by the company) Have traditional landline phone service (or willing to get) (corded phone and HSIA) (*No VOIP, Satellite, or Magic Jack) Comfortable understanding and pronouncing complex medical terms Have a quiet, professional in-home workplace Able to work independently Possess intermediate to advanced typing skills Have ability to work within a virtual team environment Have a clear speaking voice as well as the ability to clearly enunciate sentences Provide a minimum of two professional references Work-at-Home Registered Nurse Providing Virtual Care Assistance Duties Include: Answer inbound calls from patients, caregivers and/or potential volunteers Make outbound callbacks to patients, caregivers and/or potential volunteers Read a pre-written script and ask scripted medical screening questions Answer questions using approved answers from clients/sponsors/distributors. Identify and process escalations according to standard procedures Identify and process Adverse Events according to standard procedures Complete client and company-required training Navigate and accurately enter data into the computer software

Work-at-Home Registered Nurse Providing Virtual Care Assistance Role: This opportunity is a work-at-home/Telephonic//virtual position. You will work at home as part of a team of registered nurses that provides stellar customer service to patients with chronic and/or rare diseases. These patients are looking for help as they try to find new cures for their diseases. They need assistance to better understand how to navigate the therapeutic options available for their diseases. Work-at-Home Registered Nurse Providing Virtual Care Assistance Requirements: Education: Bachelor's Degree (minimum educational requirement) Experience: Nursing: 3 years License: Registered Nurse (RN) (Required) Active and clear registered nurse license (RN - any state) (or equivalent) US-based credentials preferred – either medical license or education For foreign credentials, must have certified translation of diploma or license Language: Fluent in written and spoken English English/Spanish bilingual is a plus

IntellaTriage

Remote Hospice Triage RN- PT 1 shift 3:30p-11a + rotating Sat & Sun 9:30a-4p

Posted on:

October 7, 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 3 evening shifts per pay period 3:30p-11p CST (shift times are set/ week day flexes) Work every other weekend, both Saturday and Sunday 9:30a-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 4:30a-10a + rotating Sat & Sun 9:30-4p CST

Posted on:

October 7, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Built around a mission to improve the lives of nurses and patients, IntellaTriage has been providing after-hours nurse triage for hospice and home health providers since 2008. Utilizing best-in-class technology, IntellaTriage provides round-the-clock direct access to licensed, registered nurses using client-customized protocols for patient-centered, compassionate care. We are growing rapidly and excited to support our clients’ nursing staff in the field by leveraging our outsourced team of nurses to manage after-hours care delivery. Our triage nurses become an extension of our clients’ care team, and they trust us to support them and their patients during their non-core hours. Learn more at www.intellatriage.com.

We invite you to join our growing team! IntellaTriage Nurses enjoy the benefits of working from home, providing care, without the stress and expense of commuting each day! **MUST have or be willing to obtain a Compact RN license **MUST live in/work from a Compact US state **Experience with end-of-life care is required **Must have high speed internet **Must be tech savvy, enjoy a fast-paced environment, and have keyboard competence Part- time schedule: Work a minimum 2 shifts weekly 4:30a-10a CST (shift times are set/ week day flexes) Work every other weekend, both Saturday and Sunday 9:30a-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

Insight Global

Registered Nurse – Telehealth Wellness Visits (Contract)

Posted on:

October 7, 2025

Job Type:

Contract

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

We aren’t just a staffing company. We’re a company that cares for others. It might sound lofty, but it's the idea that gets us up everyday, determined to make it true. Insight Global is a company that people can anchor to in moments of triumph, struggle, and every time in between. Whoever you are and wherever you come from, you matter to us and we have your back. Together, anything is possible

Contract Position – Telehealth Wellness RN A leading healthcare organization is hiring Registered Nurses for a fully remote, contract role focused on telehealth wellness visits. This position begins in September, offers flexible scheduling, and supports a mission-driven approach to improving access to preventive care. RNs in this program will not serve as the patient’s primary care provider, but will act as a bridge-to-care, helping patients understand their health status and guiding them toward appropriate follow-up care. Each visit is scheduled for one hour and includes a Medical Assistant-led intake followed by a comprehensive RN-led consultation.

Required Qualifications: Active Registered Nurse license in a compact state. Associate or Bachelor’s degree in Nursing. Minimum 2 years of RN experience, preferably in primary care, geriatrics, or Medicare populations. Familiarity with HEDIS measures, preventive screenings, and quality gap closure. Medicare enrollment or willingness to apply upon contracting. Strong communication skills and comfort with technology-driven care delivery. Preferred Qualifications: Multi-state RN licensure across target states. Experience with Athena EMR. Knowledge of risk adjustment coding and documentation in telehealth. Background in preventive care, population health, and quality performance metrics

Conduct 30–40 minute telehealth wellness visits following MA-led intake. Perform clinical assessments, provide patient education, and support care planning. Identify care gaps, encourage preventive screenings, and refer patients to follow-up care. Document visits using Athena EMR, ensuring accurate coding and compliance. Deliver patient-centered education and coordinate referrals as needed.

CareTalk Health

RN Team Lead – Virtual Clinic & Contact Center - 1099 - Remote

Posted on:

October 7, 2025

Job Type:

Contract

Role Type:

Leadership / Management

License:

RN

State License:

Compact / Multi-State

CareTalk Health is a leading national telehealth provider, offering a comprehensive range of services to healthcare organizations. These include staffing, cutting-edge technology, and billing solutions aimed at enhancing the delivery of healthcare. We are committed to providing high-quality, affordable, and accessible healthcare services to all patients. At CareTalk Health, we believe in fostering a supportive and innovative work environment for our employees, offering competitive salaries, flexible hours, and the convenience of working from home.

The RN Team Lead drives the day-to-day execution of virtual clinical workflows and contact-center operations, so Registered Nurses deliver accurate assessments, complete high-quality documentation, and close care gaps efficiently. This role manages RN performance during virtual visits, validates documentation, directs transcription of provider orders in RXNT, and coordinates with the patient contact center (inbound/outbound calls, SMS, portal messages) to reduce no-shows, accelerate rescheduling, and improve patient access. The Team Lead provides hands-on coaching, training, and real-time feedback while ensuring seamless collaboration with providers.

Active RN license; compact license preferred. 5+ years nursing experience in telehealth, ambulatory care, CCM/AWV, population health, or similar. 2+ years leading or coordinating team-based workflows in a contact-center or queue-based environment (healthcare strongly preferred). Demonstrated success coaching clinical staff and improving documentation/coding quality. Strong working knowledge of Medicare documentation standards, HEDIS gap closure, and EMR workflows (RXNT experience preferred). Data-savvy: comfortable with dashboards, Excel/Google Sheets, and QA scorecards Excellent communication, de-escalation, and customer-service skills; strict adherence to HIPAA and privacy practices. Reporting: Reports to the SVP Clinical Services. Direct Reports: Registered Nurses (virtual clinic). Schedule: Full-time, remote; occasional evening/weekend coverage to support intraday needs. This is a remote position. You will work from a home office, requiring reliable internet connectivity and a secure, private workspace. Technical Requirements: Computer: Windows or Apple Computer ONLY Headphones: Wired headphones required for optimal audio quality. Internet Speed: Meet minimum internet speed requirements (50 MBPS download speed and 20 MBPS upload speed), with a wired connection to the router Browser and System: Use Google Chrome with Amazon Workspaces (regardless of computer type). Video Capability: Required for video calls. Recommended Equipment: A second monitor is suggested for laptop users; dual monitors for PC users.

Audit RN Documentation & Patient Assessments Review RN notes daily for accuracy, completeness, and compliance with Medicare and CareTalk standards. Confirm vitals, screenings, and assessments (e.g., HRA, ADL/IADL, ROS) are documented correctly. Flag errors immediately; assign corrections with clear due-by times and verify completion. Monitor RN Hours, Productivity & Throughput Track daily RN hours, visit volumes, and time-to-note-lock; reconcile logged vs. scheduled time. Identify under-utilization and overtime trends; recommend schedule adjustments to the Supervisor. Maintain RN huddle board with daily goals, blockers, and follow-ups. Order Transcription & Gap Closure Direct RN transcription of provider orders into RXNT; verify medication/diagnostic/follow-up accuracy. Ensure HEDIS/Medicare gap-closure actions (e.g., OMW/CBP/SPC) are entered promptly with correct CPT/ICD-10. Track pending orders/results and escalate delays to providers or the Quality team. RN Coaching, Training & Onboarding Run daily/weekly huddles to reinforce workflow expectations and clinical quality. Deliver targeted coaching on documentation, communication, and patient engagement skills. Create and maintain competency checklists; execute onboarding checklists for new RNs. Publish quick-hit job aids when recurring errors are detected. Collaboration with Providers Partner with the Provider Team Lead to ensure providers receive accurate, actionable patient data. Streamline RN-to-provider handoffs; remove bottlenecks and close feedback loops quickly. Surface documentation or coding issues with concrete examples and corrective guidance. Contact Center & Patient Access Responsibilities (Queue-Based Operations) Queue & Intraday Management: Monitor Zoom dashboards, balance workloads, and trigger staffing changes for peaks; coordinate RN availability for urgent clinical callbacks. Appointment Health: Drive confirmation cadence, same-day rescheduling, and waitlist fills to reduce no-shows and increase slot utilization. Scripting & QA: Ensure adherence to call/chat scripts, identity verification, HIPAA standards, and empathy language; calibrate with Quality (e.g., call-review tools) and provide RN-focused coaching. Workforce Coordination: Collaborate with contact-center leads on schedules, breaks, and coverage; escalate telephony/EMR issues to IT quickly and track resolution. Knowledge Management: Maintain up-to-date playbooks, triage decision trees, and escalation paths for clinical staff. Issue Resolution: Serve as first-line escalation for RN operational questions and complex patient access problems; ensure documented closure and learning capture.

CareTalk Health

Licensed Practical/Vocational Nurse (Contractor) – Remote

Posted on:

October 7, 2025

Job Type:

Contract

Role Type:

Care Management

License:

LPN/LVN

State License:

Compact / Multi-State

CareTalk Health is a leading national telehealth provider, offering a comprehensive range of services to healthcare organizations. These include staffing, cutting-edge technology, and billing solutions aimed at enhancing the delivery of healthcare. We are committed to providing high-quality, affordable, and accessible healthcare services to all patients. At CareTalk Health, we believe in fostering a supportive and innovative work environment for our employees, offering competitive salaries, flexible hours, and the convenience of working from home.

We are seeking dedicated and skilled Licensed Practical/Vocational Nurses (Contractors). Shifts are 8 hours daily between 8:00am-8:00pm EST with every other weekend and rotating holidays, compensated at a rate of $25.00 per hour. As a Licensed Practical/Vocational Nurse (LPN/LVN), specializing in virtual care, your responsibilities will encompass the continuation of comprehensive care plans started by the Registered Nurse for Chronic Care Management (CCM), Remote Patient Monitoring (RPM), Remote Therapeutic Monitoring (RTM), and any other relevant services within your professional scope.

Active LPN/LVN multi state license Proficiency in using remote healthcare platforms and virtual communication tools. Strong communication and interpersonal skills, with the ability to establish rapport with patients remotely. Excellent organizational and time-management abilities to manage virtual visits and appointment schedules efficiently. Knowledge of medical terminology, basic health assessments, and health education Familiarity with electronic health record (EHR) systems and documentation procedure Technical Requirements: Computer: Windows or Apple Computer ONLY Headphones: Wired headphones required for optimal audio quality. Internet Speed: Meet minimum internet speed requirements (50 MBPS download speed and 20 MBPS upload speed), with a wired connection to the router Browser and System: Use Google Chrome with Amazon Workspaces (regardless of computer type). Video Capability: Required for video calls. Recommended Equipment: A second monitor is suggested for laptop users; dual monitors for PC users.

Chronic Care Management (working under the supervision of an RN) Assessing patient conditions: Conduct monthly assessments of patients with chronic conditions to identify changes in their condition, needs, and concerns. Developing care plans: Collaborate with the patient, family, and healthcare team to develop and implement individualized care plans that address the patient’s unique needs and goals. Coordinating care: Coordinate care with other healthcare professionals, such as physicians, specialists, and other nurses, to ensure comprehensive and continuum care. Providing patient education: Educate patients and their families on self-management techniques, medication management, and health promotion strategies to improve health outcomes. Remote Patient/Therapeutic Monitoring Monitor Vital Sign of patients that are receiving remote patient monitoring. Document information in the medical record as appropriate. Collect adherence percentage data for the patient’s quarterly visit with provider. Work in collaboration with a registered nurse to update patient care plan. Assist in setting up new patient charts. Makes calls to patients as needed. Documentation and Record-Keeping: Accurately and comprehensively document all findings, assessments, and discussions in the electronic health record (EHR) system. Maintain patient confidentiality and comply with all relevant HIPAA regulations. Communication and Patient Engagement: Maintain clear and professional communication with patients throughout the virtual visit and appointment scheduling process. Act as a liaison between patients and healthcare providers, conveying relevant information to ensure continuity of care. Engage patients in a compassionate and empathetic manner to build trust and rapport. Ability to prioritize tasks effectively in a busy healthcare environment. Efficiently managing patient schedules, follow-ups, and care plans.

CareTalk Health

Nurse Practitioner Contractors (1099) – Select States – Telehealth

Posted on:

October 7, 2025

Job Type:

Contract

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

CareTalk Health is a national virtual care provider that offers organizations a variety of solutions, including staffing, technology, and billing services. As a CareTalk Health team member, you’ll be working to provide virtual visits to our client’s patients. If you’re a Physician or Nurse Practitioner passionate about providing patients with high-quality care, CareTalk Health is a great place to work. We offer a variety of benefits, including competitive salaries, flexible hours, and a work-from-home environment.

We are looking for experienced Nurse Practitioners (1099 contractors) to provide virtual care to patients across all 50 states. You will play a key role in conducting telehealth visits via phone or video, ensuring high-quality patient assessments and care coordination.

Active Nurse Practitioner license in at least one of the listed states (multi-state licensure is a plus!). Experience with electronic health records (EHR) and telehealth platforms. Strong technology proficiency and ability to navigate virtual care systems. Excellent communication and interpersonal skills to enhance patient engagement. Telehealth experience preferred but not required. Availability for both phone and video consultations to accommodate patient needs. Technical Requirements: Computer: Windows or Apple Computer ONLY   Headphones: Wired headphones required for optimal audio quality.  Internet Speed: Meet minimum internet speed requirements (50 MBPS download speed and 20 MBPS upload speed), with a wired connection to the router  Browser and System: Use Google Chrome with Amazon Workspaces (regardless of computer type).   Video Capability: Required for video calls.  Recommended Equipment: A second monitor is suggested for laptop users; dual monitors for PC users. 

Conduct scheduled synchronous virtual evaluations (via phone and/or video) with patients. Assess patient conditions, review medications, and provide care recommendations. Utilize strong communication skills to build rapport and ensure meaningful patient interactions. Accurately document medical records and maintain compliance with telehealth protocols. Participate in remote training sessions to stay updated on best practices and telehealth workflows.

CareTalk Health

RN Chronic Care Manager (Contract) – Telehealth

Posted on:

October 7, 2025

Job Type:

Contract

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

CareTalk Health is a physician-owned medical practice with licensed doctors and registered nurses serving patients across all 50 states and the District of Columbia. We specialize in providing longitudinal care services such as Chronic Care Management, Remote Patient Monitoring, and Remote Therapeutic Monitoring. As a CareTalk Health team member, you’ll be working to provide virtual care to our client’s patients. CareTalk Health is committed to providing high-quality, affordable, and accessible healthcare to all patients. If you’re a healthcare professional passionate about providing patients with high-quality care, CareTalk Health is a great place to work.

We are excited to invite a skilled Registered Nurse with expertise in Chronic Care Management (CCM) to join our innovative Telehealth Services team. This contract role offers the flexibility of being 100% remote, allowing you to work from any state across the nation. In this position, you will work up to 40 hours per week, Monday through Friday, with 8-hour shifts that may vary between 8:00 AM and 10:00 PM EST. Additionally, opportunities may arise for weekend and holiday shifts. As a valued member of our team, you will receive competitive hourly compensation of $35.00 for clinical services. Your responsibilities will encompass the development and oversight of comprehensive care plans for Chronic Care Management (CCM), Remote Patient Monitoring (RPM), Remote Therapeutic Monitoring (RTM), and any other relevant services within your professional scope. Under the guidance of the Clinical Team Leader, you will play a crucial role in the intake and care management of medically complex patients. This patient population may include individuals with significant medical conditions, as well as social, economic, and mental health co-morbidities. Our program’s mission is to empower these patients to achieve optimal health and foster independence in managing their care. In this dynamic role, you will leverage your expertise to apply the principles of Chronic care management and provide compassionate, patient-centered, and culturally sensitive care coordination. Your responsibilities may include: Developing tailored care plans that encompass comprehensive motivational assessments and strategies for encouraging patient engagement and adherence. Conducting thorough nursing assessments and closely monitoring patient and family care plans, including considerations for end-of-life planning where appropriate. Serving as the primary contact for patients, families, and other involved healthcare providers, facilitating effective communication primarily through phone interactions.

Current, unrestricted RN license in a compact state with multi-state licenses Willingness and ability to obtain additional state licenses upon hire (paid for by the company) 3+ years of clinical nursing experience Chronic Care Management (CCM) or Remote Patient Monitoring (RPM) experience through Medicare Proficiency in using telehealth platforms and virtual communication tools. Strong clinical skills and comprehensive understanding of nursing principles and practices Excellent communication and interpersonal skills for effective interaction with patients, families and healthcare team members in a remote setting. Excellent organizational and time-management. Empathy, compassion, and a patient-centered approach to care. Commitment to maintaining patient confidentiality and adherence to HIPAA guidelines. Ability to work across multiple programs. Agility in adapting to various platforms and tools. Dedicated workspace from home Other duties as assigned. Technical Requirements: Computer: Windows or Apple Computer ONLY Headphones: Wired headphones required for optimal audio quality. Internet Speed: Meet minimum internet speed requirements (50 MBPS download speed and 20 MBPS upload speed), with a wired connection to the router Browser and System: Use Google Chrome with Amazon Workspaces (regardless of computer type). Video Capability: Required for video calls. Recommended Equipment: A second monitor is suggested for laptop users; dual monitors for PC users.

Assess the physical, functional, social, psychological, environmental, and learning needs of patients. Identify problems, goals and interventions designed to meet patient’s needs, including prioritized goals that consider the patient/caregivers goals, preferences, and desired level of involvement in the care management plan. Create care plans including objectives, goals and actions designed to meet patient’s needs. Provide appropriate interventions, which demonstrate knowledge of the sensitivity toward cultural diversity and religious, developmental, health literacy, and educational backgrounds of the population served. Utilize interpreter services as needed. Assess the patient’s formal and informal support systems, including caregiver resources and involvement as well as available benefits and/or community resources. Implement and monitor the care plan to ensure the effectiveness and appropriateness of services. Evaluate patient’s progress toward goal achievement, including identification and evaluation of barriers to meeting or complying with care management plan of care, and systematically reassess for changes in goals and/or health status. Communicates with primary care physician and members of the comprehensive care team regarding the status of patient as needed or requested by patient. Utilize motivational interviewing skills to build patient engagement in the development of the plan of care. Provide education, information, direction, and support related to care goals of patients. Act as a patient advocate and assist with problem solving and addressing any barriers to care or compliance with care plan. Provide referrals to appropriate community resources; facilitate access and communication when multiple services are involved; monitor activities to ensure that services are actually being delivered and meet the needs of the patient, coordinate services to avoid duplication. Maintain accurate patient records and patient confidentiality. Measure outcomes and effectiveness of care management including clinical, quality of life and patient/family satisfaction. Engage in professional development activities to keep abreast of care management practices and patients’ engagement strategies. Use of Electronic Record and utilizes technology as appropriate to meet the requirements of the job functions. Must have the ability to make critical independent decisions and prioritize appropriately. must be detail oriented and able to multitask. Displays an exemplary level of patience, courtesy, and flexibility. Performs other duties as assigned.

PharmD Live

Spanish Speaking LPN Nurse (REMOTE), Nevada

Posted on:

October 7, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Nevada

Location: Remote (Nevada-based license required) Hours: Flexible – part-time and full-time availability Requirement: Must hold an active Nevada nursing license (LPN/RN) Role Summary: PharmD Live is seeking a Spanish-speaking Licensed Practical Nurse (LPN) support our Chronic Care and Remote Patient Monitoring services. This role focuses on improving health outcomes for patients with chronic conditions by delivering patient-centered care, education, and support in both English and Spanish.

Active Nevada LPN or RN license in good standing. Fluency in Spanish and English. Minimum 2 years of clinical or telehealth experience, preferably in chronic disease management. Excellent communication, critical thinking, and problem-solving skills. Prior exposure to CCM or RPM programs strongly preferred. Ability to work independently in a secure, HIPAA-compliant remote environment.

Guide patients through their care journey, ensuring they understand their care plans and treatment goals. Conduct telehealth visits in both Spanish and English to educate patients on disease self-management, medication safety, nutrition, and lifestyle modification. Monitor and respond to RPM data trends, escalating concerns to supervising clinicians. Facilitate smooth care transitions, including hospital discharges and specialist referrals. Collaborate with interdisciplinary teams to ensure continuity and quality of care. Maintain accurate, timely documentation in alignment with CMS guidelines. Drive patient engagement by building trust and addressing barriers to adherence.

PharmD Live

Spanish Speaking LPN Nurse (REMOTE), Colorado

Posted on:

October 7, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Colorado

Location: 100% Remote Flexible Hours: Set your own schedule Requirement: Must hold an active Colorado's LPN license Job Summary: We are seeking a bilingual (Spanish-speaking) Licensed Practical Nurse (LPN) to join our team and support Chronic Care Management (CCM) and Remote Patient Monitoring (RPM) programs. This role focuses on improving health outcomes for patients with chronic conditions by delivering patient-centered care, education, and support in both English and Spanish.

Active Colorado Licensed Practical Nurse (LPN) license in good standing. Fluency in Spanish and English (oral and written). At least 2 years of experience in patient care, care coordination, or chronic disease management. Experience with CCM or RPM programs preferred. Proficiency in EHR systems and familiarity with RPM tools. Strong communication, organizational, and patient engagement skills. Ability to maintain a HIPAA-compliant remote workspace.

Conduct comprehensive assessments of patients’ physical, emotional, and social health needs. Collaborate with physicians, pharmacists, and care teams to develop and update individualized care plans. Educate and engage patients in both English and Spanish on chronic disease management, medication adherence, nutrition, lifestyle changes, and self-monitoring. Coordinate care across healthcare providers, ensuring referrals, follow-ups, and test results are managed efficiently. Monitor RPM data for trends or risk signals and escalate concerns as needed. Document patient interactions accurately in the EHR, ensuring compliance with CMS guidelines for CCM and RPM. Assist in enrolling eligible patients into CCM and RPM programs and support continuous program improvement.

PharmD Live

Nurse Practitioner / Physician Assistant – Remote (Hawaii Licensed & Residents Only)

Posted on:

October 7, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Hawaii

Why Join Us: 100% remote work with flexible scheduling. Opportunity to make a meaningful impact on preventive and personalized care for Medicare patients in Hawaii. Supportive and innovative clinical team environment. Competitive compensation structure.

Location: 100% Remote Schedule: Flexible hours – set your own schedule Eligibility: Must be a Hawaii resident with an active Hawaii NP or PA-C license Job Summary We are seeking a dedicated and compassionate Nurse Practitioner (NP) or Physician Assistant (PA-C) to conduct virtual Annual Wellness Visits (AWVs) and Advanced Care Planning (ACP) sessions for Medicare patients. This is a fully remote, flexible role ideal for a self-motivated provider who excels in patient engagement, clinical assessment, and proactive care planning within a telehealth environment.

Active, unrestricted Hawaii NP or PA-C license. Minimum 3 years of clinical experience, including AWVs and ACP. Strong knowledge of Medicare guidelines and preventive care protocols. Proficiency with virtual care technology and EHR systems. Excellent communication and interpersonal skills. Bilingual in Tagalog or Ilocano is a plus (not required). Ability to work independently and manage a flexible virtual schedule. Preferred Skills: Background in geriatrics, primary care, or internal medicine. Familiarity with HCC coding and risk adjustment. Experience in value-based care or accountable care organizations (ACOs).

Conduct comprehensive AWVs for Medicare beneficiaries via secure telehealth platforms. Facilitate structured ACP discussions, documenting patients’ goals and care preferences. Review medical histories, medications, functional and cognitive status, and preventive care needs. Identify and close care gaps by guiding patients on screenings, vaccinations, and chronic disease management. Collaborate with interdisciplinary care teams and primary care providers to ensure coordinated, patient-centered care. Maintain timely, accurate documentation in the EHR. Adhere to CMS guidelines and clinical quality standards.

PharmD Live

Nurse Practitioner / APRN – Remote (California)

Posted on:

October 7, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

California

Why Join Us: 100% remote work – flexible schedule and work-from-home convenience. Opportunity to impact preventive and personalized care for underserved populations. Supportive and innovative clinical team. Competitive compensation structure.

Location: 100% Remote ****FLEXIBLE HOURS (Set your schedule) ***ONLY CALIFORNIA LICENSED We are seeking an experienced and compassionate Nurse Practitioner (NP) licensed in California to conduct virtual Annual Wellness Visits and Advanced Care Planning sessions for Medicare patients. This fully remote position is ideal for a self-motivated NP who excels at patient engagement, clinical assessment, and proactive care planning in a telehealth environment.

Qualifications: Active and unrestricted California Nurse Practitioner license. Minimum of 3 years of experience in clinical practice, including Annual Wellness Visits and Advanced Care Planning. Strong knowledge of Medicare guidelines and preventive care protocols. Comfort and proficiency with virtual care technology and EHR systems. Excellent communication and interpersonal skills. Bilingual in Spanish is a plus, but not required. Ability to work independently and manage a flexible virtual schedule. Preferred Skills: Background in geriatrics, primary care, or internal medicine. Familiarity with HCC coding and risk adjustment models. Experience working in a value-based care or accountable care setting.

Conduct comprehensive Annual Wellness Visits (AWVs) for Medicare beneficiaries via secure telehealth platform. Facilitate structured Advanced Care Planning (ACP) discussions, ensuring patients' goals and preferences are clearly documented. Review and assess patients’ medical histories, medications, functional and cognitive status, and preventive care needs. Identify and address gaps in care, providing guidance on screenings, vaccinations, and chronic disease management. Collaborate with interdisciplinary care teams and primary care providers to support coordinated, patient-centered care. Maintain accurate and timely documentation in the electronic health record (EHR). Ensure compliance with CMS guidelines and clinical quality standards.

PharmD Live

Spanish & English speaking LPN – Tennessee

Posted on:

October 7, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Tennessee

Job Title: Spanish & English speaking LPN – Tennessee Location: Fully Remote Schedule: Flexible – create your own hours Requirement: Must hold an active Tennessee RN or LPN license Position Overview: We are looking for a bilingual Care Coordinator (RN/LPN) fluent in Spanish and English to play a key role in managing patients enrolled in Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) programs. This role emphasizes patient engagement, data review, and coordination of care to reduce preventable complications and hospitalizations.

Active Tennessee RN or LPN license. Fully bilingual in Spanish and English (oral and written). 2+ years of experience in care coordination, telehealth, or chronic disease management. Strong skills in patient education, clinical judgment, and data interpretation. Proficient in EHR systems and comfortable with telehealth technology. Organized, compassionate, and able to thrive in a remote, HIPAA-compliant workspace.

Serve as the primary point of contact for patients enrolled in RPM and CCM programs. Review transmitted patient health data daily, identify red flags, and escalate issues to the clinical team. Provide culturally competent health education in Spanish and English, empowering patients to manage chronic conditions effectively. Partner with physicians, pharmacists, and interdisciplinary teams to optimize patient outcomes. Coordinate follow-ups, specialist referrals, and care transitions. Document interactions thoroughly in the EHR, ensuring accuracy and compliance with CMS regulations. Support program enrollment and assist with patient onboarding for RPM devices.

CGC Group

Care Manager, RN

Posted on:

October 7, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

New York

Care Manager, Complex Disease Management Remote **New York RN license required** Summary of Position: The Care Manager is responsible for providing care management as part of a multidisciplinary team. This includes coordinating care, conducting telephonic and face-to-face assessments, identifying gaps in care, and implementing interventions to support members' physical, environmental, and psychosocial needs. The Care Manager works closely with providers, caregivers, and community resources to promote safe, effective, and member-centered care.

Education, Training, Licenses, Certifications Bachelor's degree required. Current, active New York RN license required. CCM certification preferred. Certification in utilization or care management preferred. Experience, Knowledge, Skills, Abilities 4 6 years of clinical experience. Background in case management, care coordination, managed care, or utilization management. Strong organizational and prioritization skills; ability to manage a caseload of highly complex members. Proficiency in motivational interviewing techniques. Experience with electronic medical records and MS Office applications. Strong communication and interpersonal skills. Bilingual abilities strongly preferred. Ability to collaborate across teams and problem-solve effectively. Flexibility to work evenings.

Assess and evaluate the needs of complex members, collaborating with caregivers, providers, and community resources to address medical, financial, and psychosocial concerns. Develop individualized care plans with clear goals and interventions, including referrals, education, and activation of support resources. Coordinate safe and timely transitions of care, ensuring members receive the right care at the right time in the right setting. Engage members, families, and primary care providers in setting and achieving care goals that improve health outcomes and quality of life. Collaborate with interdisciplinary team members such as dietitians, social workers, and community health workers to deliver holistic care. Act as an advocate and liaison for members, connecting them with providers, nonprofit, and governmental resources. Ensure compliance with federal, state, NCQA, and organizational standards in all care management processes. Document all activities in the electronic medical record system accurately and within required timeframes. Participate in case conferences, committee work, and training as assigned. Monitor and evaluate members' progress, updating care plans as needed. Support population health, transitions of care, and complex case management initiatives.

Renalogic

Clinical Care Manager (Bilingual)

Posted on:

October 7, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

Renalogic is dedicated to helping our clients manage the human and financial costs of chronic kidney disease. To help us in our mission, we hire people who are humble, hungry, and smart. And it sure helps if you have a sense of humor. We're not perfect, but we're trying to build a company that we are all proud of. Our 96% client retention suggests we're on the right path.

This role will be responsible for providing remote health coaching to members at risk for dialysis in both English and Spanish languages. Some evening hours and travel are required.

Must have an RN license in good standing within a compact state. A minimum of five years of RN experience in a related role. Be able to flex your schedule to work evenings and some weekend hours to accommodate our members' schedules, especially in Pacific Standard Time. Bilingual in Spanish is required. CDE or CDCES highly preferred. Ability and willingness to travel multiple times a year, which will include overnight stays for corporate gatherings, conferences, and health fairs. Ability to attend and professionally engage in video meetings. Strong technological skills, meaning you can effectively and efficiently use computers, peripheral equipment, and applications/systems, including Microsoft products. Autonomous self-starter who is comfortable with ambiguity. Creative mindset and ability to appropriately challenge the status quo. Superb written and oral communication skills. Ability to overcome obstacles with a ‘yes if...' approach. Ability to effectively balance competing deadlines without losing focus on the bigger picture. Reliable internet and power with a designated area to conduct work with minimal interruptions.

Establishing and maintaining contact with assigned and active members via phone, text, and email. Obtain and utilize clinical information to develop an individualized member care plan and clinician-centered care plan per NCQA guidelines. Assess members health status and care coordination needs. Collaborate with members' health care providers as needed. Utilizing motivational interviewing techniques, individualized care plans, and the Triple Aim framework to empower active Members to reach their health goals. Understanding and explaining to new or inactive members the benefits of our Program as it relates to those with chronic kidney disease and those at risk. Utilizing motivational interviewing techniques with assigned new or inactive members to encourage enrollment in the employer-sponsored program. Appropriately documenting, requesting, and sending member information in accordance with HIPAA compliance. Meet individually assigned metrics, including call volume and enrollment requirements; proactively assess and revise approach as needed or directed using multiple forms of communication (i.e. phone, text, secure online chat).

Interim HealthCare - Ringling Group

Remote Quality Assurance (QA) Registered Nurse (RN) - Home Health

Posted on:

October 7, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Colorado

Founded in 1966, Interim HealthCare is the nation’s first home care company and a leading employer of Registered Nurses (RNs). Operating through 300+ offices, our commitment to nurses is expressed through our passion to put patients first; a culture that values and appreciates nurses; and our ongoing efforts to advocate for nurses in ways that elevate their profession and reward their sacrificial work. Join a nationwide network of nurses who have rediscovered the passion that led them to nursing.

Status: Full-time, fully remote (with required in-person training at our Pueblo, Colorado location) Salary: $71,000 – $73,000 annually Schedule: Monday through Friday, 8:00 AM – 5:00 PM Quality Assurance (QA) Registered Nurse (RN) - Home Health in Pueblo, Colorado Experience a work culture where nurses are valued, management backs you and you’re empowered to be a patient’s advocate. At Interim HealthCare®, these are just a few of the rewards you’ll enjoy as a Registered Nurse. Interim HealthCare is a local leader in Health Care and we are seeking a dynamic Registered Nurse (RN) to work as the Quality Assurance (QA) in the specialty area of Home Health. At Interim HealthCare, we believe all of our employees, whether on the field or behind the scenes, play a key role in enabling our clients to live happy, healthy and independent lives. We are looking for a Quality Assurance Nurse (RN), who will be responsible for the efficient and effective delivery of all clinical services as well as ensuring employees and contractors meet regulations and standards of care. Our Quality Assurance (QA) Registered Nurse (RN) will enjoy some notable benefits: Salary rates: $71,000 - $73,000 a year Work from the comfort of your home! Competitive, Weekly pay with travel time and mileage reimbursement! Holiday and PTO pay for full-time employees. Supportive, caring management that will have your back! Medical for full-time, dental, vision and supplemental benefits are available for everyone. 1:1 patient ratio; where you make a difference in our patients care with flexible assignments to fit your needs! Continuing education benefits and discounted coursed through Colorado Christian University and Rasmussen University.

Current Registered Nurse (RN) license that is active and in good standing in the state of Colorado. BSN preferred. CPR Certification (demonstration course required) Two (2) years of home care experience as a Registered Nurse (RN) within the last five (5) years. One (1) year of home care experience, managing caregivers within the last five (5) years. Two (2) years of OASIS experience, preferred. Ability to conduct extensive OASIS documentation and chart audits. MUST be computer proficient. Able to work independently and provide effective communication to patient/family, team members, and other health care professionals. Knowledge of state, federal, and licensure regulations.

Ensure that daily patient care and related office activities are conducted in accordance with applicable law and regulation. Responsible for identifying opportunities to improve the quality of patient care of client services, formulating and implementing an action plan and evaluating results. Responsible for the documentation of patient complaints, occurrences, and infection logs. Responsible for understanding current trends and advancement in the delivery of care in the home. Responsible to ensure that appropriate paperwork is being utilized by clinical staff. Responsible for efficient use of the in-office and field resources related to patient care and client services. Responsible to participate in QAPI program as requested. Responsible for educating home health clinicians in documentation standards when necessary or requested by manager.

Momentum Life Sciences

Quality & Compliance Specialist (Remote)

Posted on:

October 7, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

None Required

State License:

Indiana

Momentum is a Fortune® 100 Best Small & Medium Workplace – a distinction earned for the second time. Momentum has been certified as a Great Place to Work® for 7 years running and additionally named a Great Place to Work for Women, and a Great Place to Work for Giving. 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 and a Fortune 500 pharmaceutical client Global Supplier of the Year.

The Quality & Compliance Specialist is responsible for ensuring that the organization adheres to all applicable regulatory standards, internal policies, and industry best practices. This role supports the development, implementation, and continuous improvement of quality and compliance programs to maintain operational excellence and regulatory readiness. Responsible for assisting in data and audit related projects. This position communicates internal teams to improve, enhance and ensure quality data for the Educator Networks.

Required Education and/or Experience: Bachelor's degree required Minimum 2–4 years of experience in a dedicated quality and/or compliance role with audit experience Previous experience in a training role in the healthcare/pharmaceutical industry preferred Experience in developing training materials Required License and/or credential(s): NA Required Skills: Strong understanding of operational workflows, preferably in pharmaceuticals/healthcare Excellent presentation, facilitation, and communication skills Ability to manage multiple programs and adapt to changing business needs Self-motivation: can motivate others and has a strong desire to empower others towards personal and professional growth opportunities Experience in Salesforce, Power BI, and other programs essential to success in this role Entrepreneurial spirit and grit Experience using multiple software applications within a multiple-screen environment including Microsoft products Ability to utilize reporting and data to develop training plans and coach appropriate behaviors Advanced knowledge of Microsoft office required Detail oriented, highly accurate, and strong organizational and customer service skills Ability to proactively identify potential issues and risks Ability to maintain confidential information Highly adaptable, flexible, and ability to prioritize multiple tasks Working knowledge of OIG, HIPAA, HITECH, CIA, PhRMA, AdvaMed and other related regulations Strong written and verbal communication skill; strong presentation skills Strong analytical skills, organizational and time management skills High attention to detail and accuracy in documentation Special Position Requirements: Travel: Less than 10% as needed Working Conditions: Work is generally sedentary in nature but may require standing and walking for up to 10% of the time. The working environment is generally favorable. Lighting and temperature are adequate, and there are no hazardous or unpleasant conditions caused by noise, dust, etc. Work is generally performed within an office environment, with standard office equipment available. Physical Requirements: Must be able to read, write, and communicate fluently in English. Ability to communicate effectively (hear, listen, speak) with or without reasonable accommodations.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Audits/Monitoring: Conduct internal audits to ensure compliance with company policies, regulatory requirements, and industry standards Manage safety reporting across all clients – audits, reconciliation, documentation, process execution and training Responsible for organizational state compliance reporting Conduct required compliance call monitoring across the organization Risk Assessment & Mitigation Ownership: Complete and own the risk assessments, determine audit needs, impact, and report accordingly Develop and deliver compliance and quality training programs for staff. Identify potential compliance risks and proactively recommend mitigation strategies. Audit Escalation: Prepare reports on audit findings and collaborate with relevant departments to implement corrective and preventive actions Investigate compliance incidents and lead root cause analyses when required. System and Documentation Management: Support the development and maintenance of the Quality Management System (QMS). Review and approve controlled documents, including SOPs, work instructions, and training materials in partnership with department subject matter experts Training, Communication and Reporting: Promote a culture of quality, transparency, and ethical conduct across the organization. Maintain accurate and detailed records of risk assessments, findings, and resolutions in QMS Maintain communication with internal stakeholders Prepare client and internal compliance scorecard and related reporting Perform other duties as assigned 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

Full Time Virtual Clinical Educator (9-6p EST) (Remote)

Posted on:

October 7, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Indiana

Momentum is a Fortune® 100 Best Small & Medium Workplace – a distinction earned for the second time. Momentum has been certified as a Great Place to Work® for 7 years running and additionally named a Great Place to Work for Women, and a Great Place to Work for Giving. 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 and a Fortune 500 pharmaceutical client Global Supplier of the Year.

The Virtual Clinical Educator is responsible for utilizing professional clinical skills, including the ability to foster patient relationships through empathy and clinical experience, to provide personalized, high-touch support to patients recently prescribed a complex therapy. The role will engage with patients and providers to provide expert, clinically relevant, individualized counsel in conjunction with product support the new therapy regimen. The VCE will manage a series of touch points as the trusted clinical advocate to a specified patient caseload. The touch points will uncover patient barriers and internal motivators, taking patients from product onboarding to therapy initiation to milestone celebrations, motivation, maintenance, and eventual “graduation” from the program. This role will work collaboratively to enhance the patient start experience and support patient compliance and persistence initiatives by building individual relationships with patients. The educator will provide ongoing education and therapy support to the patient, their caregiver, clinical staff, and/or support network.

Registered Nurse with current, unrestricted license Previous telephonic patient support environment experience, including use of an inbound/outbound call system, with seamless warm transfers HCP and/or Patient education experience, including infusion or injection experience required Compassion, high emotional intelligence, and a passion to be a patient educator Strong communication and written skills to a variety of audiences, and experience working with a treatment team Proven adaptability to changing business demands and problem solving in a fast-paced environment Competent and comfortable utilizing technology Experience working for or contracting with pharmaceutical preferred Experience in motivational interviewing and coaching behavior change Ability to work within established guardrails while maintaining personal rapport with the patient Self-starter with proven adaptability to changing business demands and product relevance in a fast-paced environment Ability to actively listen while multi-tasking High level of comfort with technology, including Microsoft Office products, working on dual monitors, CRM, and strong typing skills are required #LI-Remote

Serves as the single point of contact in the treatment process from start to finish Demonstrates empathy and effectively engages patients, creating a personalized relationship-based connection built on trust and rapport Provide disease education, product overview, device training, and side effect management Proactively reaches out to the patient to provide high-touch support to connect the dots for the patient throughout their program journey Create patient empowerment through a series of “wow” engagements along the patient journey Utilize motivational interviewing tools to quickly and accurately anticipate and address patient barriers; personalize patient messaging concisely, within established time parameters, and in a way that resonates Communicate effectively; understand and influence patient initiation and support processes, encourage patient confidence and accountability to help patients start and stay on therapy Ensure success of program through collaborative partnerships with patients, brand, and operations partners Use intuition and clinical expertise to offer patients appropriate responses to their questions; discern the most beneficial information for the patients; accurately assess patients using provided guidelines outlined in approved messaging Ensure the patient is aware of all the patient services available to them and assisting to connect them to the right resource Connect the patient to local support groups, advocacy groups, and other external resources Provide health coaching throughout the journey to support adherence and compliance to medication Provide assistance and guidance through access and affordability journey Provide HCP feedback to keep them aware of the patient’s participation in the support program Provide education to the care team and proactively reaching out after the clinical decision has been made to start a new patient on regimen Triage and follow-up with Specialty Pharmacy to support patient getting product and knowing where product is in process Provide continuous updates, guidance, and triaging when needed and most importantly ensuring that the patient is driving towards the right health outcomes. Ensure all activities are conducted in a manner that is compliant with all VMS, client, and industry mandated rules and regulations Perform other duties as assigned

Prescott Personal Care Agency

Registered Nurse

Posted on:

October 6, 2025

Job Type:

Contract

Role Type:

License:

RN

State License:

Compact / Multi-State

Looking for experienced RN to conduct initial intakes and follow up visits with new and existing clients. Non-medical agency.

HealthCheck360

RN Case Manager

Posted on:

October 6, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Iowa

HealthCheck 360 was created with the employer's needs and the participant's experience in mind. We focus on reducing medical costs, while increasing employee engagement and productivity. This is accomplished by providing onsite biometric screenings, engaging participants through technology and programming, educating the participant with risk-specific targeted communications, and supporting positive behavior change through our Health Coaching and Condition Management programs.

RN Case Manager Location: Onsite in Dubuque, IA. Also accepting remote applicants. We are seeking a compassionate and detail-oriented RN Case Manager to join our team. This role is responsible for delivering comprehensive case management services across the continuum of care. The RN Case Manager will assess, plan, implement, coordinate, monitor, and evaluate care for assigned consumers, ensuring quality outcomes and cost-effective treatment. This role is based in our Dubuque office and is also available remotely within Iowa.

Qualifications: Bilingual: the ability to speak Spanish is strongly preferred. Education: RN licensure in the State of Iowa required. BSN or higher preferred. Experience: Minimum 2 years of clinical practice. Case management or utilization review experience strongly preferred. Skills: Strong communication, problem-solving, and computer skills. Ability to work independently.

Provide telephonic case management and utilization review for assigned consumers. Develop, implement, and monitor individualized care plans to ensure quality and cost-effective outcomes. Collaborate with healthcare providers, payors, and internal teams to coordinate care. Serve as a liaison between consumers and benefit administrators, ensuring clear communication and support. Track and report case outcomes, including cost savings and quality improvements.