HARTMANN

Clinical Specialist

Posted on:

November 11, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

South Carolina

Hartmann USA is a leader in advanced wound care solutions, dedicated to empowering clinicians, manufacturer representatives, and distributor partners through education that drives real outcomes.

The Clinical Specialist will support the sales team, marketing team and customers with clinical information relating to the company’s products and markets. This is a remote role with travel.

Bachelor’s degree in Nursing. Currently Licensed as an RN or equivalent. Current Wound Care Certification A minimum of 5 years of progressively responsible clinical experience in wound management Program management, education and/or leadership experience preferred A high level of commitment to customer service. Strong verbal, influencing, presentation and written communication skills Able to build strong working relationships and collaboration effectively within teams Proficient computer skills in MS Office; Experience in using CRM is a plus Ability to travel 75% of the time

Coordinate and support clinical education opportunities and programs. Effectively articulate, educate and train sales representatives and customers on the features and benefits of our products and services. Collaborate with the sales training team to develop effective product training for employees. Assist marketing in Key Opinion Leader (KOL) development and provide expertise and support on clinical trials and white papers. Support the National Accounts team by educating clinicians on the appropriate use and training for the company’s products. Develop and deliver a targeted sales message based on accurate clinical information, utilizing approved marketing materials and medical reprints to support the patients, and discuss strategies to inform and influence decision makers. Act as a subject matter expert at customer presentations. Engage in clinical selling activities, including delivering the clinical value proposition, advancing customers across a brand belief continuum. Support account on-boarding, initial clinical educational support and in-service for medical staff. Establish professional working relationships with Health Care Providers, decision makers, support staff, and influencers within assigned customers, to support the use of the company's products - through developing and applying clinical and business expertise, and effective selling skills. Develop and implement medical education opportunities and sponsor programs to expand the knowledge of healthcare professionals. Maintain Wound Care Certifications and credentials. Keep current on the wound care industry and trends by attending continuing education programs, symposiums, and trade shows.

BlueCross BlueShield of South Carolina

RN Case Management Coordinator

Posted on:

November 11, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, disability, or protected veteran status

We are currently hiring for a Case Management Coordinator to join BlueCross BlueShield of South Carolina. In this role as a Case Management Coordinator, care management interventions focus on improving care coordination and reducing the fragmentation of the services the recipients of care often experience, especially when multiple health care providers and different care settings are involved. Taken collectively, care management interventions are intended to enhance client safety, well-being, and quality of life. These interventions carefully consider health care costs through the professional care manager's recommendations of cost-effective and efficient alternatives for care. Thus, effective care management directly and positively impacts the health care delivery system, especially in realizing the goals of the "Triple Aim," which include improving the health outcomes of individuals and populations, enhancing the experience of health care, and reducing the cost of care. The professional care manager performs the primary functions of assessment, planning, facilitation, coordination, monitoring, evaluation, and advocacy. Integral to these functions is collaboration and ongoing communication with the client, client's family or family caregiver, and other health care professionals involved in the client's care. Location: This position is full-time (40 hours/week) Monday-Friday from 8:00am-4:30pm or 8:30am – 5:00pm EST and will be fully remote.

Required Education: Associates in a job-related field. Degree Equivalency: Graduate of Accredited School of Nursing or 2 years job related work experience. Required Experience: 4 years recent clinical in defined specialty area. Specialty areas include: oncology, cardiology, neonatology, maternity, rehabilitation services, mental health/chemical dependency, orthopedics, general medicine/surgery. Or, 4 years utilization review/case management/clinical/or combination; 2 of the 4 years must be clinical. Required Skills and Abilities: Working knowledge of word processing software. Knowledge of quality improvement processes and demonstrated ability with these activities. Knowledge of contract language and application. 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. Required Software and Tools: Microsoft Office. Required License/Certificate: An active, unrestricted RN license 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 as counselor, or psychologist from the United States and in the state of hire (in Div. 75 only). For Div. 75 and Div. 6B, except for CC 426: URAC recognized Case Management Certification must be obtained within 4 years of hire as a Case Manager. We Prefer That You Have the Following: Preferred Work Experience: At least 4 years of renal nursing experience. Prior hemodialysis, peritoneal dialysis, nephrology nursing, and/or access management experience. 7 years-healthcare program management. Preferred Education: Bachelor's degree- Nursing Preferred Skills and Abilities: Working knowledge of spreadsheet, database software. Thorough knowledge/understanding of claims/coding analysis, requirements, and processes. Preferred Licenses and Certificates: Case Manager certification, clinical certification in specialty area.

Provides active care management, assesses service needs, develops and coordinates action plans in cooperation with members, monitors services and implements plans, to include member goals. Evaluates outcomes of plans, eligibility, level of benefits, place of service, length of stay, and medical necessity regarding requested services and benefit exceptions. Ensures accurate documentation of clinical information to support and determine medical necessity criteria and contract benefits. Provides telephonic support for members with chronic conditions, high-risk pregnancy or other at-risk conditions that consist of: intensive assessment/evaluation of condition, at-risk education based on members’ identified needs, provides member-centered coaching utilizing motivational interviewing techniques in combination with reflective listening and readiness to change assessment to elicit behavior change and increase member program engagement. Participates in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks and benefit plans. May identify, initiate, and participate in on-site reviews. Serves as member advocate through continued communication and education. Promotes enrollment in care management programs and/or health and disease management programs. Provides appropriate communications (written, telephone) regarding requested services to both health care providers and members. Performs medical or behavioral review/authorization process. Ensures coverage for appropriate services within benefit and medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.). Participates in data collection/input into system for clinical information flow and proper claims adjudication. Demonstrates compliance with all applicable legislation and guidelines for all regulatory bodies, which may include but is not limited to ERISA, NCQA, URAC, DOI (State), and DOL (Federal). Maintains current knowledge of contracts and network status of all service providers and applies appropriately. Assists with claims information, discussion, and/or resolution and refers to appropriate internal support areas to ensure proper processing of authorized or unauthorized services.

JRNYS Wellness

Telehealth Provider — Multi-State

Posted on:

November 11, 2025

Job Type:

Contract

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

Our vision at JRNYS is to create a world where geographical boundaries and socio-economic status no longer dictate the quality of healthcare one receives. We envision a future where preventative treatments are readily available to everyone, anytime, anywhere. By leveraging cutting-edge technology and compassionate care, we strive to proactively address health concerns, reduce the burden of chronic diseases, and promote a global culture of wellness and prevention. We see a future where everyone has the tools and knowledge to embark on their health journey with confidence and support..

Active NP or MD/DO license in at least ten states; multiple state licenses preferred. Telehealth experience preferred. Nurse Practitioner, Autonomous practice preferred where applicable Strong communication, empathy, and patient-centered care skills. Comfortable with a fast-paced virtual care environment.

Conduct telemedicine visits via video, phone, and portal messaging. Evaluate, diagnose, and develop individualized treatment plans in metabolic health, weight management, and wellness. Document all encounters accurately in EMR. Collaborate with interdisciplinary team to ensure continuity of care.

Truhealth

Nurse Practitioner-Remote Weekend On-Call

Posted on:

November 11, 2025

Job Type:

Part-Time

Role Type:

Primary Care

License:

NP/APP

State License:

Iowa

At TruHealth, we’re transforming care for seniors in long-term care with an innovative, proactive model that promotes dignity, independence, and quality of life. Join a team built on trust, teamwork, and a shared commitment to service. We offer competitive pay, excellent benefits, growth opportunities, and a culture that values work–life balance and celebrates the people who care for our patients. Part of American Health Partners, we include the fastest-growing provider-owned Medicare Advantage plans, plus divisions in psychiatric care and pharmacy services. Join us and change lives — one patient, one day at a time.

TruHealth is seeking an advanced practice provider, either a nurse practitioner (NP) or physician assistant (PA) with experience in primary care or internal medicine, preferably with geriatrics focus. This position gives you the opportunity to improve outcomes for long-term care residents by collaborating with a team of providers and case managers. You’ll enjoy a great benefit/pay package and possibilities for career growth. If you are an advanced practice registered nurse (APRN or NP) or physician assistant (PA) who enjoys working with the aging population, consider joining the TruHealth team. Our providers work primarily within nursing homes or assisted living communities with residents who are enrolled in special Medicare Advantage plans. You will be responsible for providing plan members with personalized, coordinated health care that improves quality of life and prevents unnecessary hospital visits. As one of our advance practice providers, you will exercise your independent judgement to treat patients with acute and chronic conditions, consulting with a supervising physician as appropriate. You will work closely with our facility partners and health plan leadership to Implement our national model of care in compliance with all federal and state regulations.

Required: Masters or better. Experience Preferred: Primary Care in Geriatric Medicine 3 years: Long Term Care Licenses & Certifications Required: APRN Advanced Practice RN

Our NPs and PAs are team players who contribute to TruHealth’s success and help our partners enhance their residents’ quality of life. Duties include: Assessing patients’ medical and mental health needs and providing a plan of care that proactively manages their conditions and addresses barriers to care Ensuring compliance with local, state, and federal agencies related to clinical services you provide Prescribing medications and ordering lab work, diagnostic procedures and consultations Monitoring patients’ compliance and response to their treatment and modifying those plans Working with RN case managers as part of an integrated care team WORK EXPERIENCE, CREDENTIALS AND EDUCATION: FNP, AGNP, AHACNP or PA license required Degree from an accredited APRN or PA program 3 years’ experience in clinical nursing or rehab in geriatric populations Electronic Health Records experience Working knowledge of Microsoft applications, including Word, Outlook and Excel SUPERVISORY RESPONSIBILITIES: May be required to provide training and advice to facility staff

Truhealth

RN Case Manager-Remote Weekend On-Call

Posted on:

November 11, 2025

Job Type:

Part-Time

Role Type:

Case Management

License:

RN

State License:

Georgia

TruHealth’s nurse practitioners and physician assistants provide medical treatment and care coordination in nursing homes with specialized Medicare plans. Our providers work closely with each patient’s caregivers to deliver integrated, holistic and transitional care.

To perform this job, an individual must perform each essential function satisfactorily with or without a reasonable accommodation.

Primary Care in Geriatric Medicine 3 years: Long Term Care

Triage calls to the Nurse Practitioner Conduct comprehensive health assessments through video, audio, or chat interactions with patients. Assess, plan, and provide a comprehensive plan of care that proactively manages healthcare issues and addresses barriers along the care continuum for patients in the nursing home setting. Answer calls immediately. Monitor compliance with medications and evaluate patient response to plan of treatment; modify plan of treatment when necessary

SynaptiCure Inc.

Telehealth Care Navigator

Posted on:

November 11, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

None Required

State License:

Illinois

As a patient and caregiver-founded company, Synapticure provides instant access to expert neurologists, cutting-edge treatments and trials, and wraparound care coordination and behavioral health support in all 50 states through a virtual care platform. Partnering with providers and health plans, including CMS' new GUIDE dementia care model, Synapticure is dedicated to transforming the lives of millions of individuals and their families living with neurodegenerative diseases like Alzheimer’s, Parkinson’s and ALS.

The Care Navigator is a direct support to people affected by neurodegenerative diseases. This person oversees the relationship, enrollment, documentation and care experience of patients through the Synapticure program as well as the development of the Care Coordination team workflows and processes in collaboration with your peers and other leaders. Applicants should be passionate about the power of involving patient voices in their care experiences and outcomes, and should thrive on direct patient support, particularly for vulnerable populations. Our most successful Care Navigators are thoughtful, organized, curious, compassionate, and empathetic. They value the opportunity to positively impact patients’ lives and to improve continually. Most of all, they are eager to help shape a program from inception and are comfortable with growth, change, and evolution in service of the neurodegenerative community.

Bachelor’s degree in a related field 2+ years experience in direct case or care management in the healthcare setting. Comfortable using technology to support members without in-person contact (telephone and text etiquette, virtual visit platforms, etc.) Excellent verbal and written communications, organizational skills, and interpersonal skills to work effectively in a diverse team Understanding of how to use scheduling platforms to ensure accurate appointment scheduling and management Understanding of how to use electronic health record systems and/or care facilitation platforms to ensure accurate documentation Proficient in collecting member clinical and demographic data and documenting appropriately in a timely manner Strong problem solving skills - can make difficult decisions and knows when to collaborate with other team members Able to provide creative solutions to challenges within the healthcare system that are impeding optimization of members’ care and health Growth and learning mentality, ability to think outside the box, go outside the bounds of “traditional” responsibilities Adaptable to change and prepared for frequent, fast-paced changes and shifting priorities Ability to establish cooperative working relationships with patients, teammates, and health care and community service providers

Establishes and manages compassionate relationships with and serves as the primary point of contact for patients with neurodegenerative diseases and their caregivers Adhering to HIPAA guidelines and standards, executes on patient care plans, and provides ongoing patient support in order to coordinate connections to neurology experts, genetic experts, and various referral resources Provides basic health education including information about diagnosis, treatment and care options, and research opportunities. Maintains accountability to ensure high quality standards in client and partner interactions ensuring the highest levels of privacy and confidentiality. Develops and adheres to standardized processes including operating procedures, quality assurance and documentation, in order to create high levels of efficiencies and effectiveness. Maintains positive and effective relationships within the multidisciplinary Care Coordination and broader Synapticure team to ensure a streamlined and supportive experience for patients. Collaborates with internal teams to ensure appropriate representation of Synapticure to external audiences. Nurtures and maintains positive and effective relationships with medical and community partners. Maintains working knowledge of research development and other trends and advances in neurodegenerative diagnoses, treatment and care. Speaks expertly internally and externally about the program and company.

SynaptiCure Inc.

Cognitive Nurse Practitioner (Telehealth)

Posted on:

November 11, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Oregon

As a patient and caregiver-founded company, Synapticure provides instant access to expert neurologists, cutting-edge treatments and trials, and wraparound care coordination and behavioral health support in all 50 states through a virtual care platform. Partnering with providers and health plans, including CMS' new GUIDE dementia care model, Synapticure is dedicated to transforming the lives of millions of individuals and their families living with neurodegenerative diseases like Alzheimer’s, Parkinson’s, and ALS. Synapticure’s Cognitive Care team delivers compassionate, personalized care for individuals living with dementia, Alzheimer’s disease, mild cognitive impairment (MCI), and related disorders. Through our interdisciplinary telehealth model, we combine expert clinical care, behavioral health support, and dedicated care coordination to improve outcomes, empower caregivers, and enhance quality of life for patients nationwide.

Synapticure is seeking an experienced and compassionate Dementia Care Nurse Practitioner (NP) to join our growing Cognitive Care team. In this fully remote role, you will provide comprehensive telehealth care to patients living with Alzheimer’s disease and other dementias—partnering closely with cognitive neurologists, geriatricians, behavioral health clinicians, and care coordinators to deliver coordinated, high-quality virtual care. You will diagnose, treat, and manage dementia and cognitive disorders while supporting patients and caregivers through education, medication management, and care planning. The ideal candidate has a deep understanding of dementia and cognitive medicine, experience supporting patients with complex neurodegenerative diseases, and the ability to thrive in a fast-paced, technology-enabled, team-based environment. This position offers both full-time and part-time opportunities, with flexible scheduling options.

Master of Science in Nursing (MSN), Doctor of Nursing Practice (DNP), or completion of an accredited Nurse Practitioner program Active, unrestricted APRN license and national NP certification (ANCC or AANP) Minimum 2 years of experience as a Nurse Practitioner in geriatrics, neurology, internal medicine, or primary care, with a strong preference for dementia and cognitive care experience Proven ability to assess, diagnose, and manage patients with cognitive impairment, dementia, and related neurodegenerative conditions Working knowledge of geriatric medicine, behavioral and psychological symptoms of dementia (BPSD), and multidisciplinary care coordination Proficiency with telehealth technologies, virtual visit platforms, and EHR documentation Excellent interpersonal and communication skills, with the ability to provide empathetic, patient- and caregiver-centered care Ability to balance clinical responsibilities, patient education, and collaboration with remote teams Strong organizational and time-management skills in a fast-paced clinical environment Commitment to continuous learning, evidence-based practice, and quality improvement Preferred Qualifications Prior experience in a dementia or cognitive neurology program, memory care clinic, or GUIDE-model program Clinical research experience related to Alzheimer’s disease or dementia treatment Familiarity with amyloid targeting therapies and other emerging Alzheimer’s treatments Bilingual fluency in English and Spanish Experience providing caregiver training and community resource navigation Comfort presenting in educational or caregiver support forums

Conduct comprehensive telehealth visits for patients with cognitive and memory disorders, including Alzheimer’s disease, vascular dementia, Lewy body dementia, and frontotemporal dementia Diagnose, treat, and manage cognitive impairment and behavioral symptoms through evidence-based approaches and ongoing monitoring Collaborate with neurologists, geriatricians, behavioral health clinicians, and interdisciplinary team members to create and implement individualized dementia care plans Perform annual care plan reviews, monitor disease progression, and modify treatment plans as needed based on patient and caregiver feedback Provide education, coaching, and behavioral management strategies to caregivers and families to improve care quality and reduce distress Order and interpret appropriate laboratory and diagnostic tests, adjusting treatment plans in alignment with best practices and patient goals Facilitate coordination with specialists and community resources to ensure comprehensive, continuous care Participate in on-call rotation during daytime hours to triage patient concerns and support urgent issues Maintain accurate, timely documentation in the electronic health record (EHR) and ensure compliance with all federal, state, and program guidelines Support Synapticure’s CMS GUIDE dementia care initiatives through adherence to program workflows, data collection, and quality improvement activities Contribute to ongoing education and mentorship for care navigators, caregivers, and clinical colleagues on dementia care best practices Collaborate with leadership to optimize clinical operations, patient satisfaction, and performance outcomes

All Care To You

UM Outpatient Review Nurse

Posted on:

November 11, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

All Care To You is a Management Service Organization providing our clients with healthcare administrative support. We provide services to Independent Physician Associations, TPAs, and Fiscal Intermediary clients. ACTY is a modern growing company which encourages diverse perspectives. We celebrate curiosity, initiative, drive and a passion for making a difference. We support a culture focused on teamwork, support, and inclusion. Our company is fully remote and offers a flexible work environment as well as schedules. ACTY offers 100% employer paid medical, vision, dental, and life coverage for our employees. Additional employee paid coverage options available. We also offer paid holidays, birthday off, and unlimited PTO as well as a 401k plan.

The position of UM Outpatient Review Nurse reports to the Director, Case Management. The position of UM Outpatient Review Nurse is part of the Case Management team and is responsible for clinical, quality, and patient outcomes. This position is expected to implement the effectiveness and best practices of Utilization Review and will provide high quality medical review by appropriately applying the State, Federal, health plan and clinical guidelines used to determine medical necessity.

Valid CA and Texas/Multi State Registered Nurse license, Licensed Vocational Nurse CM and/or UM training and/or certification. Knowledge of CM standards, UM standards, Clinical Standards of Care, NCQA requirements, CMS guidelines, Milliman guidelines, and InterQual guidelines. Medi-Cal, Commercial and Medicare contracts and benefit interpretation is preferred. Five years+ clinical experience. Prefer of two (2) years+ experience in an HMO/IPA/Managed care setting is preferred and recommended. Ability to work independently with minimal supervision, exercising judgment and initiative. Ability to manage multiple tasks with effective prioritization. Proficiency using Outlook, Microsoft Teams, Zoom, Microsoft Office (including Word and Excel) and Adobe Detail oriented and highly organized Strong ability to multi-task, project management, and work in a fast-paced environment Strong ability in problem-solving Ability to manage self-manage, strong time management skills. Ability to work in an extremely confidential environment. Strong written and verbal communication skills Education and Additional Requirements: Holds Current Unrestricted CA and Texas/Multi State RN or LVN license

Review authorization requests for medical necessity, determines which requests need Medical Director review, obtains sufficient medical documentation for an informed consent. Process all requests within established time frames. Documents all steps of process in authorization system in the authorization notes. Utilizes CMS and Health Plan Hierarchy criteria. Clinical documentation, specific criteria, and record attachment for referral prior to sending to the Medical Director for review. Retrospective review of services to determine medical necessity. Refer cases to the Medical Director for review of requests that may not meet medical necessity criteria. Process denials within established timeframes. Writes denial letters to meet CMS and Health Plan requirements. Work closely with other MSO team members as necessity requires. Applies the appropriate clinical criteria/guideline, policy, EOC/benefit policy and clinical judgment to render coverage determination/recommendation for the review process. Review member’s utilization and claim history when processing a referral. Maintain quality reviews while meeting the established TATs for Urgent, Routines and Retro requests. Maintains Interrater Reliability Rate at least 95% or above. Daily production standard is a minimum of 50-90 referrals/day depending on complexity with accuracy & quality. Makes approval determinations when request meets appropriateness, medical necessity and benefit criteria. Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services that meet criteria and can be authorized by a nurse level reviewer. Act as clinical resource to all departments. Communicates with health plans, providers, members and other parties to facilitate member care treatment plans. Participating in team training Comply with UM policies and procedures. Annual review of UM policies. Attend to provider and interdepartmental calls in accordance with exceptional customer service. Ability to keep high level of confidence and discretion when dealing with sensitive matters relating to providers, and members. Always maintains strict confidentiality. Other duties as needed.

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

Remote Patient Monitoring Registered Nurse – Clinical Care Manager (CCM)

Posted on:

November 11, 2025

Job Type:

Full-Time

Role Type:

Telehealth

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. What We Provide: Personal and financial wellness programs  Opportunities for professional growth and career advancement  Internal mobility, generous tuition reimbursement, CEU credits, and advancement opportunities   Referral bonus opportunities

The Remote Patient Monitoring (RPM) RN plays a critical role in supporting the Care Management Program by collecting and analyzing biometric data to monitor patient health status. This role involves telephonic clinical assessments, patient education, and proactive care coordination to ensure timely interventions and optimal health outcomes. The RPM RN collaborates with internal teams and external partners to drive program success and continuous improvement.

Licenses and Certifications: Active and unrestricted Registered Nurse (RN) license in New York State. Education: Associate's Degree in nursing required Bachelor of Science in Nursing (BSN) preferred; graduation from an accredited nursing program required. Work Experience: Minimum of 3 years of experience as a Registered Nurse (RN). At least 2 years of experience in care management; telehealth experience is a plus. Clinical expertise in geriatric care preferred. Skills: Strong analytical and clinical assessment skills. Excellent communication and patient engagement abilities. Proficiency in telehealth platforms and remote monitoring tools. Bilingual skills may be required based on operational needs.

Biometric Data Collection & Monitoring: Collects and reviews patient biometric data to identify changes in health status and activate appropriate care management resources. Clinical Assessment & Education: Conducts skilled telephonic assessments and provides patient education based on data transmissions and clinical findings. Alert Response & Care Coordination: Responds to alert patterns using evidence-based triage strategies to address clinical concerns and promote problem resolution. Program Development & Collaboration: Partners with the Care Management Team, Nurse Practitioners, Care Providers, Certified Home Care Agency, Health Plans, and vendors to develop and implement strategies that support targeted program outcomes. Quality Improvement: Analyzes population-level data to identify trends and opportunities for program enhancement. Professional Development: Engages in ongoing education to stay current with telehealth technologies and clinical best practices.

NORTHEAST MICHIGAN COMMUNITY SERVICE AGENCY INC.

Supports Coordinator - Registered Nurse

Posted on:

November 11, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Michigan

Northeast Michigan Community Service Agency, Inc. (NEMCSA) is a private, nonprofit Community Action Agency, whose Mission is to provide quality programs and services to strengthen and enhance the self-sufficiency of individuals, families and communities through the best use of human and financial resources, focusing on those who are experiencing an economic hardship.

Location will be based on organizational needs and the selected candidate’s proximity within the service area. Multi county travel is required. What you will do: Responsible for assessing participants' care needs to determine eligibility for various programs and services. This role involves developing and implementing person-centered care plans, coordinating services, and advocating for participants to ensure their health, safety, and welfare. The supports coordinator RN will work collaboratively with their partner, participants, allies, and community entities. Additionally, the Supports Coordinator RN will maintain compliance with state, federal, and agency guidelines, documentation standards, and timelines.

Education and Experience: Experience serving frail older adults or disabled persons preferred. Experience in case management, long-term care, or human/social services is preferred. Working knowledge of computers, including proficient typing skills. Experience working within the Microsoft Office Suite. (RN) associate degree is required minimally or bachelor's degree in nursing Certificates, Licenses, Registrations: The ability to obtain a professional license in Michigan is required.

Essential Duties and Responsibilities: Other duties may be assigned. Assessment and Planning: Conduct comprehensive assessments and reassessments within the discipline’s scope of practice to evaluate participants' program eligibility and care needs. Develop and implement person-centered care plans that reflect the individual’s needs, preferences, and goals. Collaborate with participants, their allies, and care teams to establish contingency plans for critical services. Service Coordination and Advocacy: Coordinate, arrange, and authorize services and supports necessary to meet participants' needs. Advocate for participants and their allies to ensure access to required services and support. Assist participants with program applications, including follow-up to ensure timely eligibility determinations.· Maintain ongoing communication with participants, families, and community entities to support effective service delivery. Monitoring and Follow-up: Regularly monitor participants' health status and progress, adjusting care plans to address their condition or changes in need. Conduct follow-up contacts and assessments to ensure effective care plans and service delivery. Monitor participants' medical and financial eligibility for appropriate program enrollment. Compliance and Documentation: Apply and abide by state, federal, and agency standards by maintaining participant files and completing required documentation accurately and promptly. Report any critical incidents and suspected cases of abuse, neglect, or exploitation following mandatory reporting regulations. Collaboration and Community Engagement: Establish and maintain professional relationships with community partners, including local MDHHS offices, mental health agencies, health departments,  senior centers, hospitals, funders, and other service providers. Represent the agency at local, state, and federal meetings as required. Participate in developing and implementing agency policies, procedures, and training initiatives. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed represent the required knowledge, skill, and/or ability. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.

Pomelo Care

Obstetrics Triage RN - Weekend Focus (Sat, Sun & Flex Day)

Posted on:

November 10, 2025

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

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

SHIFT SCHEDULE: This position involves working three 12-hour shifts per week (9:00 AM to 9:00 PM EST). You would work weekend shifts (Saturday & Sunday) and a single weekday shift you can self-schedule based on team needs. Additionally, there is a rotating holiday commitment, alternating between summer and winter holidays. Your North Star: Provide and facilitate amazing patient-centered clinical care to our patients.

Required: Registered Nurse (RN) with a Bachelor of Science in Nursing (BSN). Must hold a current, unrestricted multi-state (compact) license and reside in a nursing compact state Have 4+ years experience in a hospital and/or healthcare practice, serving maternal-child health populations (minimum 3 years in labor and delivery) Flexible and agile thinker who embraces change Are internet-connected, able to work remotely via video, phone and text Willing to travel occasionally (infrequent) Willing to work nights, weekends and holidays Understand the prevalence of birth inequity and role that structural racism plays in maternal morbidity and mortality Professionally engaged Bonus points if you have any of the following Experience working with perinatal patients who have had complicated pregnancy-related conditions such as diabetes, hypertension, perinatal loss, etc. Experience providing virtual care Experience providing care in Spanish

Ongoing clinical and psychosocial assessment of new patients, providing reassurance and building rapport Identifying and addressing barriers to care that have been identified by patients and/or the care team. Reducing care gaps (missed appointments, medication management, etc.) by frequent and personalized engagements with patient Assessing the need for and educating patients on the equipment they will use to monitor their health remotely Timely response to abnormal diagnostic results (labs, radiology, etc.) Assessment of urgent concerns and proactively triaging patients to support appropriate utilization of emergency services Timely documentation of all care/interactions and escalating to appropriate multidisciplinary teams, as needed Supporting the development of programs and product by providing user feedback

Pomelo Care

Evening Peri/Menopause RN

Posted on:

November 10, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

Pomelo Care is a multi-disciplinary team of clinicians, engineers and problem solvers who are passionate about improving care for moms and babies. We are transforming outcomes for pregnant people and babies with evidence-based pregnancy and newborn care at scale. Our technology-driven care platform enables us to engage patients early, conduct individualized risk assessments for poor pregnancy outcomes, and deliver coordinated, personalized virtual care throughout pregnancy, NICU stays, and the first postpartum year. We measure ourselves by reductions in preterm births, NICU admissions, c-sections and maternal mortality; we improve outcomes and reduce healthcare spend. We extend that same personalized model to support women through the midlife transition. We provide expert guidance for symptom management, long-term health planning, and navigating the physical and emotional changes of menopause.

Your North Star: Provide and facilitate amazing patient-centered clinical care to our patients.

Registered Nurse, BSN prepared, current unrestricted multi-state (compact) license 3+ years recent experience in an outpatient healthcare setting, serving full spectrum Women’s Health (OB/GYN, Fertility, Hormonal Health) Passionate about comprehensive women’s health, including perimenopause and menopause, with a strong desire to support patients through all stages of midlife care Flexible and agile thinker who embraces change Are internet-connected, able to work remotely via video, phone and text Willing to travel occasionally (infrequent) Understand the prevalence and role that health inequity and structural racism play across a woman's lifespan, from maternal morbidity and mortality to the diagnosis, treatment, and long-term health consequences of menopause Professionally engaged Bonus points if you have any of the following Direct perimenopause & menopause care experience Health coaching experience Telehealth and/or remote monitoring experience Spanish Fluency (without the use of an interpreter) Schedule Options Evening Shift - Monday - Friday, 1:00 PM - 9:00 PM ET

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

Pomelo Care

Evening Perinatal Nurse - (5p-12a EST)

Posted on:

November 10, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

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

Your North Star: Provide and facilitate amazing patient-centered clinical care to our patients. We are currently hiring for FT evening hours: M-F 5pm-12a EST.

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

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

Honest Health

Nurse Care Manager (Evergreen)

Posted on:

November 10, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Michigan

At Honest Health, we believe in purpose and partnership to lead the transformation in primary care. Our team of healthcare experts and clinicians collaborates with a range of stakeholders—from health systems, physician organizations, and payers to providers, practices, and patients — to deliver innovative solutions that elevate care, control costs, and support long-term health. Guided by our core values, we’re creating a value-driven model that creates lasting benefits for everyone, now and into the future. For us, that's just an Honest day’s work.

You’re a collaborative professional, driven by the potential to make a meaningful impact in healthcare. The challenges of healthcare don’t deter you—instead, you see them as opportunities to find innovative solutions that benefit the partners, people, and communities we serve. Honest Health’s commitment to purpose, innovation, communities, and kindness resonates with you, inspiring you to bring commitment, creativity, and compassion into your work. You’re ready to join a team focused on reimagining primary care for a healthier future that benefits all. Your Role: You will manage patients’ specialized needs based on their individual condition(s) and/or reason for recent utilization in collaboration with physicians, advanced practice providers, and care coordination team members. Your job duties will include taking full ownership of assigned patients with complex chronic conditions, serious illness, advanced frailty, or recent healthcare utilization with the goal of avoiding preventable admissions, reducing unnecessary healthcare use, and optimizing patient outcomes. Through standardized assessments and workflows you will work with the patient to identify needs based on their values, goals and preferences. From this assessment, in partnership with the patient, you will develop an effective, and comprehensive plan of care for each member. Care plans will be used to coordinate patient care delivery with Honest clinicians, network providers, contracted vendors, and community-based services. This work takes place remotely, but you must be licensed in the state or states where the role is based (Michigan and/or New York).

You reviewed the Who You Are section of this job posting and immediately felt the need to read on. This makes you a match for our innovative culture. You accept things change quickly in a startup environment and are willing to pivot quickly on priorities. Must have reliable access to high-speed internet to ensure seamless remote work communication and productivity Current Registered Nurse license is required in the state or states where the role is based (Michigan and/or New York) Willing and able to obtain additional state nursing license(s) if needed, and with the support of Honest leadership. Bachelor’s of Science in Nursing preferred. Certified Case Manager (CCM) credential preferred 3+ years of clinical practice in a hospital, clinic, home care, or nursing home setting highly preferred Case management experience with a senior population preferred Disease management and/or physician office experience highly preferred Prior experience with electronic health records or health registries required Microsoft Office skills, including Excel, Word, PowerPoint, Outlook required. Experience with PowerPoint preferred

Quickly build empathetic relationships with patients and families. Evaluate and identify patients’ needs based on their respective values, goals, and preferences, then translate these needs into clinical needs. Interface with primary care physicians, advanced practice providers (APP), specialists, and various disciplines on the development of case management plans/programs. In conjunction with the physician/APP, implement care/treatment plans by coordinating access to health services across multiple providers/ disciplines. Refer patients to internal Honest team members for care management activities as outlined by defined procedures. Monitor care and identify cost-effective measures, including recommendations for alternative levels of care and utilization of resources. In partnership with Honest team members, effectively coordinate patient admissions and discharges from hospitals or skilled nursing facilities via coordination with respective facility clinicians and case managers. Build relationships across network hospitals, SNFs, home health companies, and DME vendors within the respective community. Monitor and evaluate the effectiveness of the case management plans based on quality and cost drivers and modify as necessary. Coordinate the interdisciplinary approach to providing continuity of care, including transfer coordination, discharge planning and obtaining all authorizations/approvals/transfers as needed for outside services for patients/families. Act as a patient advocate and educator to assure that the patient has the knowledge to care for his/her condition and patient is educated and empowered to be responsible for participating in the plan of care. Develop individualized patient/family education plan focused on self-management and deliver patient/family education specific to a disease state. Engage internal resources to identify and respond to social determinants of health such as lack of transportation, stable housing, or food resources. Participate in data collection and analysis of clinical outcomes of care and customer satisfaction standards. Participate in the formulation and implementation and monitoring of action strategies and outcomes of care or customer service. Ensure that accurate records are maintained of the care associated with each patient. Actively participate in huddles, interdisciplinary team (IDT) sessions, and patient case conferences. Commendably represents Honest to patients, their families, and the community. Perform other related responsibilities as assigned.

Honest Health

Nurse Care Manager

Posted on:

November 10, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

New York

At Honest Health, we believe in purpose and partnership to lead the transformation in primary care. Our team of healthcare experts and clinicians collaborates with a range of stakeholders—from health systems, physician organizations, and payers to providers, practices, and patients — to deliver innovative solutions that elevate care, control costs, and support long-term health. Guided by our core values, we’re creating a value-driven model that creates lasting benefits for everyone, now and into the future. For us, that's just an Honest day’s work.

You’re a collaborative professional, driven by the potential to make a meaningful impact in healthcare. The challenges of healthcare don’t deter you—instead, you see them as opportunities to find innovative solutions that benefit the partners, people, and communities we serve. Honest Health’s commitment to purpose, innovation, communities, and kindness resonates with you, inspiring you to bring commitment, creativity, and compassion into your work. You’re ready to join a team focused on reimagining primary care for a healthier future that benefits all. Your Role You will manage patients’ specialized needs based on their individual condition(s) and/or reason for recent utilization in collaboration with physicians, advanced practice providers, and care coordination team members. Your job duties will include taking full ownership of assigned patients with complex chronic conditions, serious illness, advanced frailty, or recent healthcare utilization with the goal of avoiding preventable admissions, reducing unnecessary healthcare use, and optimizing patient outcomes. Through standardized assessments and workflows you will work with the patient to identify needs based on their values, goals and preferences. From this assessment, in partnership with the patient, you will develop an effective, and comprehensive plan of care for each member. Care plans will be used to coordinate patient care delivery with Honest clinicians, network providers, contracted vendors, and community-based services. This work takes place remotely, but you must be licensed in the state(s) where the role is based in New York.

You reviewed the Who You Are section of this job posting and immediately felt the need to read on. This makes you a match for our innovative culture. You accept things change quickly in a startup environment and are willing to pivot quickly on priorities.  ​​Must have reliable access to high-speed internet to ensure seamless remote work communication and productivity Active Registered Nurse license is required in the state(s) where the role is based: New York Willing and able to obtain additional state nursing license(s) as business needs dictate, with support from Honest leadership and reimbursement for required fees Experience and high level of comfort with engaging patients virtually using different technologies including phone, text, video, etc. is required Bachelor’s of Science in Nursing preferred Certified Case Manager (CCM) credential preferred 3+ years of clinical practice in a hospital, clinic, home care, or nursing home setting highly preferred Case management experience with a senior population preferred Disease management and/or physician office experience highly preferred Prior experience with electronic health records or health registries required Microsoft Office skills, including Excel, Word, PowerPoint, Outlook required. Experience with PowerPoint preferred

Quickly build empathetic relationships with patients and families. Evaluate and identify patients’ needs based on their respective values, goals, and preferences, then translate these needs into clinical needs. Interface with primary care physicians, advanced practice providers (APP), specialists, and various disciplines on the development of case management plans/programs. In conjunction with the physician/APP, implement care/treatment plans by coordinating access to health services across multiple providers/ disciplines. Refer patients to internal Honest team members for care management activities as outlined by defined procedures. Monitor care and identify cost-effective measures, including recommendations for alternative levels of care and utilization of resources. In partnership with Honest team members, effectively coordinate patient admissions and discharges from hospitals or skilled nursing facilities via coordination with respective facility clinicians and case managers. Build relationships across network hospitals, SNFs, home health companies, and DME vendors within the respective community. Monitor and evaluate the effectiveness of the case management plans based on quality and cost drivers and modify as necessary. Coordinate the interdisciplinary approach to providing continuity of care, including transfer coordination, discharge planning and obtaining all authorizations/approvals/transfers as needed for outside services for patients/families. Act as a patient advocate and educator to assure that the patient has the knowledge to care for his/her condition and patient is educated and empowered to be responsible for participating in the plan of care. Develop individualized patient/family education plan focused on self-management and deliver patient/family education specific to a disease state. Engage internal resources to identify and respond to social determinants of health such as lack of transportation, stable housing, or food resources. Participate in data collection and analysis of clinical outcomes of care and customer satisfaction standards. Participate in the formulation and implementation and monitoring of action strategies and outcomes of care or customer service. Ensure that accurate records are maintained of the care associated with each patient. Actively participate in huddles, interdisciplinary team (IDT) sessions, and patient case conferences. Commendably represents Honest to patients, their families, and the community. Perform other related responsibilities as assigned.

All Care Home Health Prov

Registered Nurse

Posted on:

November 10, 2025

Job Type:

Part-Time

Role Type:

Care Management

License:

RN

State License:

California

The Registered Nurse in this role will provide comprehensive home health nursing care to patients in their residences, ensuring their health and well-being are maintained outside of traditional clinical settings. This position focuses on delivering direct patient care tailored to individual needs, including wound management, medication administration, and monitoring of vital signs. The nurse will serve as a patient advocate, educating patients and their families about health conditions, treatment plans, and preventive care to promote optimal health outcomes. Collaboration with interdisciplinary healthcare teams is essential to coordinate care plans and ensure continuity of care. Ultimately, the role aims to enhance patient quality of life by providing compassionate, skilled nursing care in a home environment, supporting recovery, and preventing hospital readmissions.

Current and valid Registered Nurse (RN) license in the state of practice. Completion of an accredited nursing program (Associate's or Bachelor's degree in Nursing). Basic Life Support (BLS) certification. Demonstrated experience in home health nursing or direct patient care. Strong knowledge of wound care management and patient education techniques Preferred Qualifications: Bachelor of Science in Nursing (BSN) degree. Certification in Wound Care (e.g., Wound Care Certified - WCC). Experience with electronic health records (EHR) systems. Advanced certifications such as Certified Home Health Nurse (CHHN) or similar. Experience working with diverse patient populations and chronic disease management. Skills: The required skills such as Home Health Nursing and Direct Patient Care are essential for delivering personalized and effective nursing services in patients' homes, ensuring their safety and comfort. Patient Education skills enable the nurse to empower patients and families with knowledge about health conditions and self-care practices, which is critical for long-term health management. Wound Care expertise is applied daily to assess, treat, and monitor wounds, preventing complications and promoting healing. Patient Advocacy skills ensure that nurses represent and support patient interests, facilitating communication between patients and healthcare providers. Preferred skills like proficiency with electronic health records enhance documentation accuracy and care coordination, while advanced certifications deepen clinical knowledge and improve patient outcomes.

Conduct thorough patient assessments in home settings to evaluate health status and care needs. Administer medications, perform wound care, and manage other nursing procedures according to established protocols. Develop and implement individualized care plans in collaboration with physicians and other healthcare professionals. Educate patients and their families on disease management, medication adherence, and health maintenance strategies. Advocate for patient needs and preferences, ensuring their voices are heard in care decisions. Document all nursing care and patient interactions accurately and timely in compliance with regulatory standards. Monitor patient progress and report any changes in condition to the healthcare team promptly. Coordinate with social workers, therapists, and other home health providers to deliver holistic care.

Momentum Life Sciences

Full Time Virtual Clinical Educator (8-5p EST) (Remote)

Posted on:

November 10, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Indiana

**This role will be covering the the hours of 8-5p EST, Monday through Friday** About the Position: 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

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

Aleknagik Technology

Trauma Registry Nurse Abstractor

Posted on:

November 10, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Texas

Organization: Aleknagik Technology, LLC Support To: Joint Trauma System (JTS), Defense Health Agency (DHA), Department of Defense (DoD) Center of Excellence for Trauma Location: Fully Remote Position Overview: Aleknagik Technology, LLC is seeking a qualified Trauma Registry Nurse Abstractor to provide critical support to the Joint Trauma System (JTS) under the Defense Health Agency (DHA) at the Department of Defense Center of Excellence for Trauma. This position is fully remote and requires a detail-oriented professional capable of accurately collecting, abstracting, coding, and verifying trauma-related clinical data in accordance with established DoD and DHA protocols.

Minimum of five (5) consecutive years of nursing experience, including at least three (3) years as a critical care nurse in a critical care unit, trauma unit, emergency department, or inpatient operating room. Background in Medical or Surgical ICU, Emergency Room, Operating Room, or other Critical Care settings required. Demonstrated experience in medical records abstraction, coding, data entry, and familiarity with medical system design. Working knowledge of ICD-9/10 coding; prior experience as a medical abstractor strongly preferred. Proficient with personal computers and Microsoft Office applications (Word, Excel, Outlook, and Access). Previous trauma nursing experience required; military nursing experience preferred. Minimum Requirements: Bachelor of Science (BS) in Nursing. Active United States Registered Nurse (RN) license. Proof of immunizations: TB Test; Hepatitis B vaccine, titer, or waiver; Tetanus booster within the last five (5) years; and HIV titer. U.S. citizenship (or eligibility to obtain citizenship) and the ability to pass a government background investigation.

Collect comprehensive and accurate data related to trauma patients by abstracting all trajectories of care. Verify, update, and enter data into the Trauma Registry in a timely manner. Perform coding of injuries, procedures, and causes of injuries using standard medical record references, including ICD-9/10 codes. Assign AIS and ICD-9/10-CM diagnoses, and complete ISS and other trauma score calculations for an average of 3-6 patient charts per week, maintaining a minimum 90% accuracy rate. Apply Abstracting Business Rules as described in data abstraction resources to ensure data integrity and compliance. Provide education and consultation as a clinical subject matter expert (SME) for the AHI/TBI/DoDTR Registry to Joint Trauma System personnel and customers. Support training activities related to clinical abstraction, coding, and business rules for new and existing team members. Conduct quality assurance evaluations to ensure clinical accuracy of Registry data across all Roles of Care, maintaining a 90% accuracy rate. Perform Registry Consents and related documentation as required.

Vis-À-Vis Health

Remote Weekend Acute Care Nurse Practitioner (Part-Time)

Posted on:

November 10, 2025

Job Type:

Part-Time

Role Type:

Triage

License:

NP/APP

State License:

Illinois

Vis-À-Vis Health is a comprehensive care solution providing physician services both in the community and in Skilled Nursing Facilities (SNFs). We deliver convenient access to high-quality medical care in a compassionate, complete, and cost-effective manner. Our mission is to create a revolutionary, patient-centric healthcare model that leverages technology to improve outcomes and generate savings through our exceptional clinical teams.

Vis-À-Vis Health is seeking a Part-Time (W2) Remote Weekend Acute Care Nurse Practitioner to provide medical support for patients in skilled nursing facilities (SNFs). This role involves triaging urgent patient concerns, conducting telehealth assessments, and coordinating care with nursing staff to ensure timely and appropriate medical interventions. The ideal candidate is a compassionate and skilled provider with strong clinical judgment and the ability to work independently in a remote care setting. Schedule: Part-Time (W2): 24 hours/weekend only Available weekend shifts: Daylight: 8 AM – 8 PM Overnight: 8 PM – 8 AM Compensation: Part-Time W2 Base Salary: $75,000 Plus RVU Bonus

Must hold a valid and active NP license in Illinois Required Skills and Experience: Minimum 3 years of experience as a Nurse Practitioner (telehealth, SNF, urgent care, or emergency medicine preferred). Minimum 3,500 NP practice hours; NPI# required and eligible to bill Medicare/Medicaid. Strong computer and EMR documentation skills. Excellent communication and problem-solving skills. Ability to work independently and manage multiple priorities remotely. Education & Certification: Master’s or Doctorate in Nursing (MSN/DNP) from an accredited institution. Board Certification (ANCC or AANP). Experience in telehealth or virtual care strongly preferred. Employment Type: Part-Time (W2), Weekend Only Schedule: 24 hours per weekend (day or overnight) Specialty: Geriatrics Work Location: Remote

Triage and respond to inbound calls from SNF nursing staff regarding patient concerns. Conduct real-time telehealth medical assessments and make timely clinical decisions. Evaluate symptoms, order and interpret diagnostic tests, and prescribe medications. Provide guidance to nursing staff on urgent medical management. Coordinate care and update treatment plans as necessary. Maintain accurate documentation in EMR and ensure compliance with HIPAA. Complete daily billing logs, including CPT codes. Participate in quality improvement initiatives and required virtual team meetings.

Coast Medical Service - Internal

Clinical Liaison

Posted on:

November 10, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

Coast Medical Service is a healthcare staffing company focused on per diem and travel nurse placements. We are a family business celebrating our 42nd anniversary. Coast is a tight knit group that values each other and recognizes / rewards good work. We believe in doing the right things the right way and pride ourselves on our unrelenting commitment to customer service, allowing healthcare providers and facilities to focus on what they do best: providing world class healthcare to patients. We are fanatical about improving the quality of healthcare and focus on finding working environments that meet the needs of our healthcare providers, clients and corporate employees. As a result, Coast has grown 100x in the last 10 years and was included on the Inc. 5000 list of fastest growing private companies in America as well as Los Angeles Business Journal Top 100 fastest growing companies in LA 3 years in a row.

We are seeking a highly motivated and compassionate Clinical Liaison to join our dynamic team. As a Clinical Liaison, you will play a pivotal role in supporting the sales, recruitment, and human resources teams by enhancing the traveler experience and ensuring that all clinicians have a positive and rewarding experience with our agency. Your expertise in healthcare and exceptional interpersonal skills will be instrumental in building strong & lasting relationships with our clinicians and maximizing client satisfaction. Benefits and Compensation: A competitive base salary of $75,000-$90,000 Health and dental benefit contribution; additional insurance available (pet, identity, etc) Sick and vacation paid time off 401(k) program Access to “Working Advantage” – discounts on things from movie tickets to ski passes A company that invests in the team. Opportunity to grow personally and professionally with our company Equipment including laptop and extra monitors Opportunity for professional and financial growth as the organization continues to scale Work from home (or anywhere else you want!!)

Skills and Requirements Bachelor's degree in Nursing or a related healthcare field Active and unrestricted RN license in the United States Minimum of 2 years of clinical experience in nursing Experience in travel nursing or healthcare staffing is highly desirable Proven success in a sales or recruiting position Excellent interpersonal and communication skills, with the ability to effectively build relationships and collaborate with a diverse range of individuals Strong problem-solving and conflict resolution abilities, with a focus on delivering excellent customer service Knowledge of healthcare regulations, industry trends, and best practices Proven ability to work independently and as part of a team in a fast-paced, deadline-driven environment Proficient in using technology and various software applications for communication, documentation, and data analysis

Clinician Support: Serve as the primary clinical point of contact for clinicians throughout their onboarding and assignment, offering personalized support and guidance to ensure a smooth and positive experience. Relationship Management: Develop and maintain strong relationships with clinicians, providing ongoing communication, addressing concerns, and fostering a sense of trust and partnership. Clinical Guidance: Offer clinical expertise and guidance to clinicians, addressing questions or concerns related to patient care, professional development, and assignment-related challenges. Incident Resolution: Act as a mediator and problem solver for any issues or conflicts that may arise involving a clinician, ensuring timely resolution and minimizing any negative impact on the clinician and client experience. Quality Assurance: Collaborate with the recruitment and compliance teams to ensure that clinicians meet agency and client expectations, adhering to industry standards and best practices. Feedback Collection: Solicit feedback from clinicians on their experience with the agency, and work closely with the recruitment and human resources teams to implement necessary improvements and address any concerns. Collaboration: Collaborate with the sales and recruitment teams to identify opportunities for clinician retention, expansion, and cross-selling, based on a thorough understanding of each clinician's skills, preferences, and goals. Market Research: Stay updated on industry trends, healthcare regulations, and competitive landscape to provide valuable insights and recommendations for enhancing the clinician experience and the agency's offerings. Training and Education: Support the development and delivery of training programs and educational resources for clinicians, ensuring they have the necessary tools and knowledge to succeed in their assignments. Travel Support: Coordinate with the travel department to assist clinicians with travel arrangements, housing accommodations, licensing requirements, and other logistical aspects to ensure a smooth transition and assignment experience. Leadership: Collaborate w/ senior and executive leadership teams to establish best practices and develop new initiatives related to improving the traveler experience and increasing retention.

Long Tail Health Solutions Inc.

Utilization Management Review Nurse

Posted on:

November 10, 2025

Job Type:

Contract

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

Long Tail Health Solutions is a provider advocate, delivering a suite of technology-enabled services which discover and operationalize payer rules and behaviors to improve the visibility, execution, and outcomes of utilization review, case management, and revenue cycle functions. Our mission is to optimize the financial performance and work-lives of healthcare providers by eliminating administrative waste with modern technology applied to long tail problems.

Contractor position for ad hoc needs (PRN/0.0 hours) based on current demands of operational work. Role is designed to help fill gaps within service department and assignment could be variable day to day. Contracted employees are expected to work with minimal oversight and modified training on assignments matched to their distinct background and experience. Advanced or extended training may be approved based on needs of department. Volume and schedule of hours are pre-arranged with manager in advance and approved based on contractor's availabilities and needs of the department. The operations team works 24/7/365 mainly supporting healthcare systems with hospital sites. Therefore, hours have opportunity for extreme flexibility. We will consider contractors who are interested in working partial shifts, off-normal business hours, intermittent and variable commitment of hours, all the way up to full-time traditional M-F allotment of work dependent on business needs of our client(s). The Utilization Management Review Nurse (UM RN) will play a crucial role in supporting our clients in the healthcare industry by providing expert clinical guidance, facilitating effective utilization management, and ensuring revenue cycle efficiency. UM RN's oversee patient insurance authorization, compliance with governmental regulations related to hospital stays, prevention of and management of denials. Embedded within our utilization review management platform are clinical criteria guidelines, streamlining the review and documentation process. This operational department conducts perspective, concurrent, and retrospective reviews for authorization of all Levels of Care (LOCs) and services, engaging with program managers, reviewing records to prove and support medical necessity, and liaising with individuals within healthcare system and hospital institutions. Long Tail works within a team approach with many specialists having a high-touch approach on each case. UM RNs are primarily responsible for completing clinical criteria reviews related to determining appropriate LOC for hospitalized patients and subsequently aligning necessary orders and patient status. Work Context: A 100% remote work force will require very strong communication and remote relationship building skills. Contract workers are provided Azure Virtual Desktop (AVD) which will include any applications or software required for specific assignment. Contract workers are not provided hardware (i.e. computer) and are expected to utilize virtual desktop through their self-owned hardware. Note: This job description in no way states or implies that these are the only duties to be performed by the employee(s) incumbent in this position. Employees will be required to follow any other job-related instructions and to perform any other job-related duties requested by any person authorized to give instructions or assignments. All duties and responsibilities are essential functions and requirements and are subject to possible modification to reasonably accommodate individuals with disabilities. To perform this job successfully, the incumbents will possess the skills, aptitudes, and abilities to perform each duty proficiently. Some requirements may exclude individuals who pose a direct threat or significant risk to the health or safety of themselves or others. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities. This document does not create an employment contract, implied or otherwise, other than an “at will” relationship. The pay range for this role is: 45 - 45 USD per month(Remote (United States))

Registered Nurse (RN) or Licensed Practical Nurse (LPN) licensure LOC reviews with use of criteria set(s): Proficient or above with either Milliman (MCG) or Interqual (IQ) criteria set reviews Proficient in all hospital LOC: Inpatient (IP) vs Observation (OBS) vs Outpatient in a Bed (OPIB) vs Not Medically Necessary Proficient in Avoidable Day/Delay (AD) determination and documentation. Proficient in processes for hospital medical necessity LOC and LOC status changes: Observation/OPIB reviews, recommendations, and status determinations Upgrade to Inpatient vs discharge vs AD IP downgrades Code 44 process Basic understanding of CMS Hospital-Issued Notices of Noncoverage (HINNs). Collaboration with Utilization Managment Phyician Advisors. Minimum 3 years' experience in hospital level utilization management. Minimum of 3 years of clinical nursing experience. Strong understanding of revenue cycle management and healthcare reimbursement. Excellent communication, interpersonal, and teamwork skills. Ability to work independently and make sound clinical and financial decisions. Strong analytical and problem-solving skills. Proficient in using healthcare information systems and technology. Commitment to maintaining patient confidentiality and ethical standards. Preferred: Bachelor of Science in Nursing (BSN) preferred. CCM or ACM certification Epic EMR experience. Account platform experience (billing and denials) Work queue experience Knowledge: Knowledge of hospital revenue cycle and/or utilization review Proficient with principles of all payer types including managed care, Medicare/Medicaid, and private insurer reimbursement rules Knowledge of medical necessity criteria and payer reimbursement arrangements

Follow Standard Operating Procedure (SOP) for all activities assigned, escalate to designated leader if unsure of steps to take or procedure not readily available within accessible resources. Manage case/account reviews via client's EMR. Complete work within a team approach by finalizing and organizing tasks to the extent of specific assignment clearly and accurately so that next staff member can efficiently and effectively complete their portion of work. Use escalation pathways to resolve identified issues. Document all activities and interactions clearly in the electronic utilization review record. Enhance customer satisfaction among patients, families, physicians, internal and external partners, payors, and vendors. LOC specific functions include: Evaluate patient records to assess severity of illness and intensity of service. Apply medical necessity screening criteria and clinical knowledge to ensure appropriateness of admissions and length of stays. Conduct initial admission, continuing stay, observation and outpatient in a bed (OPIB) reviews for all patients. Collaborate with payor sources to communicate clinical information and secure approvals. Consult with physicians, nursing staff and other clinical care team members Effectively communicate need for change in status recommendations and follow up on order entry to ensure all adjustments are made as timely and accurately as possible. Adhere to policies, procedures, regulations, and standards governing the agency. Maintain strict confidentiality according to Federal and State guidelines. Uphold the Professional Code of Ethics. Other duties as assigned.

CommunityCare

Medical Management - Supervisor Medical Review 145-4005

Posted on:

November 10, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Oklahoma

The Medical Review Supervisor is responsible for overseeing activities and personnel involved in the day to day operations of CommunityCare’s medical claim review program. The Supervisor guides individuals in implementing auditing and monitoring functions aimed at identifying areas of risk and/or potential fraud, waste and abuse, as it relates to provider billing practices.

Excellent analytical and problem-solving skills Able to work independently as well as supervise others to meet stringent deadlines Strong attention to detail. Highly organized and capable of managing multiple projects. Proficient in Microsoft applications. Possess strong oral and written communication. Ability to work as a team in a high paced environment. Successful completion of Health Care Sanctions background check. EDUCATION/EXPERIENCE: Current active, unrestrictive license to practice as a Registered Nurse (RN) in the State of Oklahoma. BSN preferred Minimum of five years combined employment in facility/provider health care settings or managed care organization. Two years supervisory experience preferred. Prefer strong clinical related background and case review experience focused in healthcare fraud, waste and abuse. Require experience or familiarity with state and federal regulations governing healthcare coding, billing and claims processing. Recognized healthcare coding certification (CPC, AHIMA, etc.) preferred.

Provides technical expertise to Medical Review (MRE) staff including analysis, problem solving, and decision making of complex claim reviews. Identifies medical necessity and /or quality issues for further evaluation. Oversees triage of pended and high dollar claims. Collaborates with external vendors on cases meeting reinsurance thresholds and specific requirements for ASO lines of business. Works collaboratively with other departments in providing or seeking claims review and/or clinical guidance. Participates in company committees or work groups as assigned. Proactively conducts routine monitoring and identifies areas of potential fraud, waste and/or abuse (FWA). Formulates recommendations based on findings. Suggests opportunities for focused reviews. Works collaboratively with the Compliance Officer and/or Special Investigations (SIU) as needed. Coordinates and/or oversees daily activities of the MRE staff. This includes planning, implementing and evaluating MRE goals. It also includes monitoring workload, staff supervision, training, coaching, auditing, teambuilding, performance evaluation and hiring/retaining staff. Provides training for new MRE staff including one-to-one sessions as required for successful staff mastery of job tasks related to claim reviews and special projects. Develops and implements operational guidelines for applicable payment policies and/or for other processes pertaining to the medical claim review function. Seeks organizational approval as indicated. Monitors the medical claim review tracking database for quality control. Compiles and analyzes data and prepares routine compliance reports. Performs other duties as required.

Science 37

Field Nursing Operations Manager

Posted on:

November 10, 2025

Job Type:

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Science 37 is a mobile technology and clinical trials organization based in Los Angeles. We are focused on the development of networked patient-centric models for clinical research to rapidly accelerate biomedical discovery. We leverage partnerships with national mobile nursing companies, pharmacy chains, patient advocacy groups, virtual e-consenting, mobile devices, and other technology companies to maximize efficiency. Then, using design-thinking principles and rapid prototyping, S37 puts patients first and brings the best clinical trials right to their homes.

*This is a fully Remote and Work From Home (WFH) opportunity within the US, requiring up to 60% travel. *Role can be located in the following states Southeast States: AR, LA, MS, AL or FL POSITION OVERVIEW Science 37’s mission is to accelerate clinical research by enabling universal trial access for patients. Through our solutions; Direct-to- Patient Site and Patient Recruitment, we accelerate enrollment by expanding the reach of clinical trials to patients beyond the traditional site and rigorously qualifying patients prior to referring them to a traditional site. Our solutions are powered by a proprietary technology stack with in-house medical and operational experts that enhance quality through standardized workflows and best-in-class study orchestration. The Field Nursing Operations Manager is a Registered Nurse who has experience across multiple therapeutic areas with the ability to work independently and integrate well within the Nursing Solutions Group. With interest/expertise in Science 37’s decentralized model of care delivery, the Field Nursing Operations Manager is responsible for the operational oversight, implementation and daily management of all nursing activities for clinical research studies within their region at Science 37. The Field Nursing Operations Manager ensures the professional delivery of patient care in compliance with all federal and state regulations, Good Clinical Practice, and Standard Operating Procedures. In addition, the Field Nursing Operations Manager coordinates with other departments to help carry-out company objectives and ensures compliance with study protocols. This position manages a specific location region, the role will be 60% Administrative and 40% travel.

Supervise all nursing activities related to assigned Region Supervise all nursing activities related to assigned Region. Ensure the safety of study participants and per diem mobile research nurses within the assigned Region. Provide a safe environment for study participants, caregivers, and study personnel at all times through compliance with all federal, state, and professional regulatory standards. Maintain strict patient confidentiality according to HIPAA regulations and applicable law. Collaborate with per diem mobile research nurses on helping to solution issues, education, and as a resource support. Ensure quality of data collection and timely data entry into the Science 37 Platform by nursing staff. Act in a line management capacity for assigned per diem nurses, documenting meetings with assigned direct reports, as required. Identify, develop, and deliver training protocol-specific training, skills, remediation, and any other training as necessary. Develop study-specific nurse-facing resource materials to maximize the nurses’ ability to successfully carry out a protocol in the home Delivers study-specific training to nurses in their assigned Region Ensures appropriate documentation of all training Serve as the Nursing SME for assigned studies, collaborating cross-functionally. Actively participates in the implementation and execution of clinical trial activities from study start-up preparations, planning, execution and closure.Provide mobile research nurse services to qualified study participants, as needed. Apply clinical research and nursing practices to develop solutions to complex problems. Participate in activities that will further the operational development of Science 37’s nursing service delivery. Develop relationships with study team members and serve as the subject matter expert (SME) on all nursing processes. Advise nursing leadership of actual or potential issues. Participate in internal audits of nursing documentation in the Science 37 Platform and work to improve and/or correct deficiencies. Identify opportunities to improve processes and minimize inefficiencies. Assist with any other ad hoc projects, analysis or analytics as needed.

Qualifications: BSN degree preferred Active RN licensure in home state required Eligibility for Compact Licensure preferred Minimum 5+ years clinical/research experience preferred Basic Life Support (BLS) Certification Active driver’s license Ability to work remotely Maintain a positive reflection of the company by representation in participant’s homes or in clinic settings Minimum of one year of supervisory experience required; 3+ years preferred Skills/Competencies: Practices professionalism and integrity in all actions – Demonstrated ability to foster concepts of teamwork, accountability, cooperation, self- control, and flexibility to get the work done. The ability to adapt to a rapidly changing work environment. Able to successfully work as a matrix in a decentralized team environment. Skilled in situational responsive decision-making. Expert nursing practices – An expert nurse with strong clinical experience and the ability to effectively train others. Should be proficient in performing nursing skills including but not limited to venipuncture, IV placement, medication administration, comprehensive and focused nursing assessments, ECGs, vital sign collection, and emergency first-responder care. Identifies deficiencies in documentation and clinical practice. Additionally, medical record review and abstraction for protocol inclusion/exclusion criteria. Flexibility – Able to make quick accommodations to schedule changes as well as process changes and to travel with limited notice. Strong communication and presentation skills - Demonstrates strong written and verbal communication skills. Ability to establish and maintain positive study participant and project team member rapport. Ability to interact with study participants and caregivers in a compassionate and empathetic manner. Excellent customer service skills Computer skills - Working knowledge of MS Office suite and Google applications. Able to generate business correspondence, create forms and generate reports as required. Willingness to gain expertise in the use of propriety software. Problem solving – Ability to quickly and proactively identify problems, formulate solutions, execute solutions, and assess efficacy of solutions. Interpersonal savvy - Understands interpersonal and group dynamics and reacts in an effective and tactful manner and has a range of interpersonal skills and approaches with ability to select a best-fit approach. Understands and demonstrates cultural competency and sensitivity. Ability to educate – Able to communicate with and educate study participants, health care workers and study staff from diverse socioeconomic, geographical and cultural backgrounds. Organizational Skills – Ability to multitask with priorities defined by research protocol and visit. Planning for specific visits with equipment and additional supplies for potential needs and malfunctions in mind. Capabilities: Up to 40% travel, as needed, for study participant visits, project team meetings, client presentations and other professional meetings/conferences, as needed. Ability to support and complete administrative duties. Ability to obtain nursing license in multiple states based on study needs. Physical ability to perform nursing tasks and lift equipment up to 15 kg in weight. Access to a reliable vehicle in order to perform study participant visits and transport equipment. Ability to drive to local and/or remote locations to perform study participant visits. Ability to use technology effectively and appropriately. Ability to communicate in English (both verbal and written). Ability to work nights and/or weekends, as needed. REPORTING: Position requires ability to perform with minimal supervision. Incumbent reports directly to the Director, Nursing Solutions or Senior Manager, Nursing Solutions. DIRECT REPORTS: Mobile Research Nurse (Per Diem)

Brilliant Care

Remote - Nurse Care Coordinator, Full-time (West Coast - AZ)

Posted on:

November 9, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Arizona

Brilliant Care is a very innovative, fast-growing, mission-driven population health management company that assists with value based care initiatives. Our objective is simple: improve health outcomes and reduce total cost of care. We proactively identify at-risk hypertensive, diabetic and CHF patients and provide them with personalized access to a nurse care manager who works as an extension to the provider. Using high-touch care coordination and advanced remote technologies, we improve patient compliance and medication adherence while reducing unnecessary ER and hospital visits. Essentially, we help improve outcomes substantially, without heavy lift or any out-of-pocket costs for healthcare organizations.

This position will assist healthcare providers and practices to successfully manage their care management and remote patient monitoring program and provide remote patient monitoring services to patients who are enrolled in the program. Must have a passion for educating patient on how to manage their chronic conditions, be self-driven to meet required monthly goals, and have ability to maintain flexibility in a constantly changing environment.

Education & Experience: LPN or RN Min 5-year work experience working in practice or healthcare setting. Licensure requirement: Only candidates with an active multistate compact nursing license (NLC) will be considered. Location: Work from home. Must reside in Arizona.

Patient Enrollment: Enroll patients in Remote Patient Monitoring (RPM). Possess the skill to verbally train and educate patients on how to use devices Data Collection: Monitor daily capture of patient physiologic data from devices Conduct coaching call to remind patients to capture daily data Follow-up with non-compliant patients Care Management: Act as primary contact for patients to build rapport and maintain patient satisfaction, improvement in health status, and compliance with program Analyze collected data and triage out of range readings in a timely manner Escalate cases which require provider attention Provide health coaching to high-risk diabetic, hypertensive, and congestive heart failure patients Document assessment data, education provided, and lifestyle interventions planned in patient charts Capture detailed and concise notes of all patient interactions Act as a resource to patients and providers in enabling access to the provider and presenting information to the provider for medical decision-making Provider & practice management: Understand physician and practice challenges or objections which come in their way of enrolling patients in RPM Professionally address provider expressed challenges and workflow related issues to ensure program success Possess ability to change workflow and processes as requested by provider or practice Communicate with provider of patient needs and institute care changes per provider instructions

OncoveryCare

Part-Time Oncology RN/LPN Clinical Reviewer (Eligibility Specialist)

Posted on:

November 9, 2025

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

OncoveryCare is an early-stage virtual healthcare company committed to fundamentally rethinking and transforming the landscape of physical and mental healthcare for cancer survivors. Our team is composed of cancer survivors, clinicians, and experts in cutting-edge healthcare delivery. We believe that world class care after a cancer diagnosis shouldn’t end when treatment is over, and we provide an innovative, evidence-based approach to deliver patient-centered, whole-person support for survivors throughout the cancer journey. Our vision is a world where living beyond cancer isn’t just “surviving”—it’s thriving. A few tidbits about cancer survivorship: There are over 18 million cancer survivors in the United States today—and that number is expected to grow to 26 million by 2040 Cancer survivors experience a range of physical and mental health side effects from treatment Survivorship starts at the moment of diagnosis and continues post-treatment—we are starting in the “transitions of care” phase post-treatment, when there is often not a specialized team to take over caring for the survivor moving forward Our Guiding Principles: By survivors, for survivors: We build the survivor voice and experience into all that we do Clinical integrity and rigor: We prioritize evidence-based approaches and an integrated team to deliver the highest-quality care Trauma-informed care: We “meet survivors where they are” and respect their lived experience Changing the status quo: We are committed to radically reinventing how cancer survivorship care is designed, delivered, and experienced Transparency & inclusivity: Building a new frontier of cancer care is both hard and rewarding—everyone has a role to play, and fostering a positive and open team culture is our priority

The Oncology RN/LPN Clinical Reviewer plays a key role in ensuring the right patients are identified and connected to survivorship services. This role focuses primarily on clinical chart review, helping to ensure patient eligibility, safety, and continuity of care. You’ll collaborate closely with our Nurse Practitioners, behavioral health clinicians, and operations team to review oncology charts, verify patient criteria, and flag cases that need additional clinical input. Active RN/LPN licenses in both New York and Tennessee are preferred. Please note this is a part-time, 1099 position.

What You Will Need: Active Registered Nurse (RN) or Licensed Practical Nurse (LPN) license in New York and Tennessee preferred and willingness to potentially obtain additional state licenses 3–5 years of clinical experience, ideally in oncology or cancer survivorship Bachelor's degree in a healthcare-related field (e.g., nursing) Strong clinical judgment, attention to detail, and documentation skills Proficiency with EHR systems and comfort working in a virtual, technology-enabled environment Excellent communication and teamwork skills, with the ability to collaborate effectively across clinical and operational teams Part-time availability (~20 hours per week, Monday–Friday) Who You Are: Strong clinical focus. You’re committed to delivering excellent evidence based and trauma-informed clinical care to cancer survivors Survivor-centered. Patients are your “why” for the work - you value building and maintaining meaningful relationships with cancer survivors and thinking creatively about how to improve their care High emotional intelligence. You pride yourself on being a strong listener, communicator and are able to empathize with people with diverse life experiences Go-getter: You’re psyched to roll-up your sleeves, get things done, and don’t mind playing a versatile role on a fast-paced team Growth Mindset. You embody a spirit of continuous improvement, actively seek to enhance care programs, and are comfortable sharing insights with clinical leadership Forward thinking. You are interested in fast paced, early stage health innovation and are excited by big ideas and creating impact

Review oncology patient records to confirm eligibility for OncoveryCare’s survivorship services Identify red flags or clinical nuances that warrant additional NP review Summarize relevant medical history, treatment details, and ongoing care considerations in a standardized format Collaborate with operations and clinical leadership to refine chart review workflows and maintain quality standards

Herself Health

Registered Nurse (Per Diem)

Posted on:

November 9, 2025

Job Type:

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

At Herself Health, we're on a mission to help women get more life out of life, together. We are building a new model of primary care for women 65+ to solve long-standing problems: rushed appointments, long wait times, and care that's generalized rather than specialized towards women's needs later in life such as post-menopausal care, bone density, weight management, and mental, social and emotional well-being. Our patient-centric Primary Care clinics are dispersed across Minneapolis/St. Paul, MN. We are thrilled to serve the Twin Cities metro and Eagan. Our team of 100+ colleagues is on a mission to innovate the primary care landscape for women 65+. We're seeking like-minded individuals who share this passion to join us! As we grow our early team, we are seeking strategic thought leaders who have a passion for building and innovating. We foster a culture of collaboration, excellence and the willingness to roll up our sleeves and learn as we grow. We have a customer first mindset, and we are looking for team members who share that. Our ideal candidates have strategic prowess and the ability to use data to build best practices and implement great ideas in collaboration with our team and our community. About the Registered Nurse (Per Diem) Role: Within a value-based and patient-centered model of care reporting to the Company's Lead Registered Nurse, the Registered Nurse (RN) at Herself Health provides exceptional care to women ages 65 and up. Through Transitional Care Management and Triage, the RN educates and empowers women to manage their health conditions and achieve their individual goals of care. The RN role facilitates collaboration and continuity of care among team members, including providers, medical assistants, and health coaches.

Employment Type: Per Diem, non-exempt Level: Associate Location: Remote, MN Compensation: Starting at $35.00/hour, based on experience

An active, unrestricted Minnesota RN license required, or ability to obtain by start date. Multi-state compact license preferred Willingness to obtain additional cross-state licensure as needed Minimum of 2 years' experience as an RN in clinical setting Prior experience working as a triage RN or RN case manager required Exceptional communication skills and patient-centered focus Ability to monitor and evaluate opportunities for cost-effective care with high-quality outcomes Demonstrate effective, independent nursing judgement and skills Demonstrate skill and experience in effectively collaborating with care team members Demonstrate skill in effective use of electronic health records Demonstrate flexibility, organization, and appropriate decision-making in ambiguous situations Nice-to-have Qualifications and Skills: Prior experience working in telephonic case management preferred Knowledge of Medicare and NCQA regulatory transitions of care preferred Experience in value-based care preferred

Transitional Care Management (TCM): Focused on outreach during the 30 days after discharge with the goal of reducing ER visits, hospitalizations, readmissions, and post-acute stays Reviews daily ADT feeds and initiates contact with patients within 2 days of discharge Schedule follow-up for TCM visit with the PCP within 7 days of discharge Complete weekly outreach for 30-day post-discharge Review discharge plan and ensures services (e.g. Physical Therapy, Home Health) are in place; provides community resources for SDOH (Social Determinants of Health) needs Provides patient/ family education regarding health conditions and disease self-management Completes medication reconciliation and monitors adherence Documents all telephone/ video interactions in EHR patient chart Identifies patterns and episodes of care that are predictive of future needs and services Coordinates care with other providers involved in the patient's care as needed Triage: Respond to patient telephone calls, refill requests, and electronic health messages Demonstrates critical thinking skills and expert nursing judgement to provide appropriate recommendations for care utilizing an approved evidence-based telephone nursing triage protocol Works with the RN scope of practice and standing orders to provide prescription refills, medication titration, and home treatments Educates patient regarding test results and medical conditions, and explains medical terms and procedures Maintains a professional demeanor and focus on patient-centered care

Calibrate

Full-time Nurse Practitioner PA or IL + 3 other states IN, IA, MI, MN, MT, NE, ND, OH, SD, WV, WI, WY

Posted on:

November 9, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

Calibrate is on a mission to change the way the world treats weight by redefining obesity care as a matter of biology, not willpower. Designed by world leaders in metabolic health, our program combines clinical research, personalized coaching, and lifestyle intervention to deliver lasting weight loss and improved metabolic outcomes. With obesity as America’s largest chronic condition, impacting 175mm adults in a $600B market, we’re closing the care gap by offering the first value-based model in obesity treatment. Since launching DTC in 2020, we’ve expanded into enterprise channels to improve access, and our app-based experience supports members with coaching, tailored education, daily tracking, and community engagement across the four pillars of metabolic health: food, sleep, exercise, and emotional wellbeing.

At Calibrate, our clinical team of nurse practitioners, nurses and doctors are at the heart of our mission to change the way the world treats weight by offering comprehensive obesity care that results in life-changing, sustainable results. In this role, you’ll play a pivotal part in delivering evidence-based, patient-centered care that integrates coaching and curriculum for lifestyle support. We’re looking for full-time nurse practitioners who are passionate about improving lives through a holistic approach to weight health. You'll collaborate with an interdisciplinary team, contribute to an innovative care model, and help patients achieve meaningful, lasting results. This is an exciting opportunity to join a growing team and help shape the future of obesity medicine through telehealth. This role offers a chance to make a significant impact in the lives of patients while working in a supportive environment as a full-time employee at 40 hours per week.

BACKGROUND AND EXPERIENCE: Board-certified Nurse Practitioner (FNP, AGNP, or other relevant specialties). Active, unrestricted license in PA or IL + 3 other states IN, IA, MI, MN, MT, NE, ND, OH, SD, WV, WI, WY Demonstrated excellent written/verbal communication skills and virtual “bedside” manner. Experience conducting telehealth visits Prior experience with metabolic health strongly preferred Ideal Qualities: A clinical style that will work well with our belief that healthy, long-term, sustainable weight-loss is impossible to achieve without dedicated medical and coaching support Excited to build and deliver a new model for achieving lasting weight health Creative and flexible, but always puts the patient first Excellent at forging successful and respectful relationships with the entire team Participation in the RN Compact is encouraged but not required for this role. Additional Details: Well compensated Malpractice coverage provided by employer

Consistently provide a world-class level of clinical care and patient experience Review patient intake and provide the initial patient interaction, including the discussion of the scientific principles of obesity and the prescription of appropriate weight loss therapy based on Calibrate clinical protocols Review and manage daily tasks, member messages, and lab results during shifts; oversee patient progress; engage with coaches to coordinate care for patients; and review progress in regularly scheduled check-ins Utilize and support a detailed clinical treatment paradigm, developed and updated by the Calibrate team and specialized to support obese patients achieve weight-loss goals Able to commit 40h/wk in a telehealth (remote) setting Monday through Friday Follow state regulations for collaboration agreements with supervising physicians as required by each state you’re licensed to practice.

Calibrate

Full-time Nurse Practitioner NC, MA, or NY + 3 other states CT, DC, DE, ME, MD, NH, NJ, RI, VT, VA

Posted on:

November 9, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

Calibrate is on a mission to change the way the world treats weight by redefining obesity care as a matter of biology, not willpower. Designed by world leaders in metabolic health, our program combines clinical research, personalized coaching, and lifestyle intervention to deliver lasting weight loss and improved metabolic outcomes. With obesity as America’s largest chronic condition, impacting 175mm adults in a $600B market, we’re closing the care gap by offering the first value-based model in obesity treatment. Since launching DTC in 2020, we’ve expanded into enterprise channels to improve access, and our app-based experience supports members with coaching, tailored education, daily tracking, and community engagement across the four pillars of metabolic health: food, sleep, exercise, and emotional wellbeing.

At Calibrate, our clinical team of nurse practitioners, nurses and doctors are at the heart of our mission to change the way the world treats weight by offering comprehensive obesity care that results in life-changing, sustainable results. In this role, you’ll play a pivotal part in delivering evidence-based, patient-centered care that integrates coaching and curriculum for lifestyle support. We’re looking for full-time nurse practitioners who are passionate about improving lives through a holistic approach to weight health. You'll collaborate with an interdisciplinary team, contribute to an innovative care model, and help patients achieve meaningful, lasting results. This is an exciting opportunity to join a growing team and help shape the future of obesity medicine through telehealth. This role offers a chance to make a significant impact in the lives of patients while working in a supportive environment as a full-time employee at 40 hours per week.

BACKGROUND AND EXPERIENCE: Board-certified Nurse Practitioner (FNP, AGNP, or other relevant specialties). Active, unrestricted license in NC, MA, or NY + 3 other states CT, DC, DE, ME, MD, NH, NJ, RI, VT, VA Demonstrated excellent written/verbal communication skills and virtual “bedside” manner. Experience conducting telehealth visits Prior experience with metabolic health strongly preferred Ideal Qualities: A clinical style that will work well with our belief that healthy, long-term, sustainable weight-loss is impossible to achieve without dedicated medical and coaching support Excited to build and deliver a new model for achieving lasting weight health Creative and flexible, but always puts the patient first Excellent at forging successful and respectful relationships with the entire team Participation in the RN Compact is encouraged but not required for this role. Additional Details: Well compensated Malpractice coverage provided by employer

Consistently provide a world-class level of clinical care and patient experience Review patient intake and provide the initial patient interaction, including the discussion of the scientific principles of obesity and the prescription of appropriate weight loss therapy based on Calibrate clinical protocols Review and manage daily tasks, member messages, and lab results during shifts; oversee patient progress; engage with coaches to coordinate care for patients; and review progress in regularly scheduled check-ins Utilize and support a detailed clinical treatment paradigm, developed and updated by the Calibrate team and specialized to support obese patients achieve weight-loss goals Able to commit 40h/wk in a telehealth (remote) setting Monday through Friday Follow state regulations for collaboration agreements with supervising physicians as required by each state you’re licensed to practice.

Calibrate

Part-time Registered Nurse

Posted on:

November 8, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

Calibrate is on a mission to change the way the world treats weight by redefining obesity care as a matter of biology, not willpower. Designed by world leaders in metabolic health, our program combines clinical research, personalized coaching, and lifestyle intervention to deliver lasting weight loss and improved metabolic outcomes. With obesity as America’s largest chronic condition, impacting 175mm adults in a $600B market, we’re closing the care gap by offering the first value-based model in obesity treatment. Since launching DTC in 2020, we’ve expanded into enterprise channels to improve access, and our app-based experience supports members with coaching, tailored education, daily tracking, and community engagement across the four pillars of metabolic health: food, sleep, exercise, and emotional wellbeing.

A modern approach to weight requires modern practices, and that means radically remodeling how intensive lifestyle intervention programs operate and scale. As part of our clinical program team, you’ll deliver several critical components of the Calibrate program: outreach and support for members to enhance their program progress, clinical program coordination, and confirmation of clinical appropriateness for clinical care pathways, introduction to our method, and setting program plans with members. In addition to providing exceptional patient care, your feedback on how we can continue to improve our program to help patients achieve–and maintain–their metabolic health and weight loss goals will help shape and improve the program. Additional Details: Malpractice coverage provided by employer Weekdays plus possible weekend hours required Must be willing to work PST, MST, or CST hours (9am-5pm EST, 10am-6pm EST, 11am-7pm EST) Ability to flex hours up based on business needs during peak time Training will require a full-time weekday schedule for 3 weeks with some training during EST working hours The hourly rate for this role is $50.00 per hour.

Bachelor of Science Degree in Nursing (BSN) graduate of an accredited school of nursing Current state license(s) in the state(s) practicing. Must possess a compact RN license. At least three years of direct clinical experience required At least one year of health tech experience required Primary/preventative care, acute care, or emergency medicine experience required Demonstrated excellent written/verbal communication skills and virtual “bedside” manner Excellent communicator & critical thinker, with a customer service mentality Experience with project management, and strong organizational and time management skills Creative problem-solving skills that can be leveraged to empower others and drive member outcomes Self starter, solutions-oriented mentality Excited to build and deliver a new model for achieving lasting weight health Adaptable and flexible, but always puts the patient first Excellent at forging successful and respectful relationships with the entire team Quick learner, comfortable using a variety of applications and software

Consistently provide a world-class level of patient experience and clinical care Utilize and support a detailed clinical treatment paradigm, developed and updated by the Calibrate team and specialized to support obese patients achieve weight-loss goals Provide care management for patients who need additional clinical support throughout the program Serve as a program ambassador to address clinical and programmatic questions for patients at all stages of their Calibrate journey Engage cross-functionally with physicians, nurse practitioners, and support teams to coordinate care for patients Review and manage daily tasks; patient messaging and callbacks

Trilogy Quality Assurance

Per Diem QA RN

Posted on:

November 8, 2025

Job Type:

Role Type:

Clinical Operations

License:

RN

State License:

Kentucky

Position is Per-diem to start- must be able to work at least 10 hours per week, with the intent of moving into a full-time position. You will be asked a series of OASIS questions in the interview to determine your Oasis knowledge. Please, Do not apply of you do not meet all of the criteria listed, and if you are not interested in moving to a full-time position, or if you cannot dedicate at least 10 hours per week. Conduct quality assurance review of OASIS, Evaluations, and visit notes to ensure compliance with CMS, State, and accrediting oversight.

Must have the ability to review at least 2 Oasis/hour. Must have the ability to learn new EMRs as needed.

Develop the plan of care for OASIS Collaborate with cross-functional teams to identify areas for improvement and implement corrective actions Participate in the development and execution of training programs for staff members to include OASIS training and education, face to face education. Stay up-to-date with industry trends and best practices in quality assurance Experience: Experience working in Home Health as a field clinician, and in a supervisory position (DON, DPCS, Clinical Supervisor) and Quality Assurance Role Familiarity with HIPAA regulations and compliance requirements Knowledge of PDGM guidelines, Face to face Criteria, Home Health, CMS regulations Must have strong technological skills and be able to learn MULTIPLE EMRs, scrubbers, word, excel Ability to work independently and as part of a team If you are a detail-oriented individual with a passion for ensuring high-quality standards in healthcare settings, we encourage you to apply for the position of Quality Assurance Registered Nurse.

Sheakley Group, Inc

RN Case Manager

Posted on:

November 8, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Ohio

The Case Manager serves as the primary clinical contact for injured workers, coordinating care and facilitating safe, timely return-to-work outcomes. This role involves assessing treatment plans, collaborating with medical providers, employers, and insurers, and ensuring quality, compliance, and effective communication across all parties. The Case Manager must exercise strong clinical judgment, organizational skills, and maintain confidentiality.

A current, unrestricted Ohio state licensure or certification in a health or human services discipline that allows the professional to conduct an assessment independently as permitted within the scope of practice of the discipline Eligibility to hold a multi-state licenses as needed to meet the needs of the company Two years full-time equivalent of direct clinical care to the consumer and Prefer a minimum of one (1) year of active case management experience in worker's compensation Maintains continuing education as required to maintain licensure and certification Excellent leadership, verbal/written communication skills, strong organizational skills, and excellent decision making and judgment

Reports directly to The Case Management Team Lead Serve as the first point of post-injury contact after triage, developing and managing return to work opportunities with injured workers, designated network providers, and employer contacts Assess the appropriateness of the level of care, diagnostic tests and clinical procedures for utilization review on a concurrent basis Work closely with Utilization Review team in coordinating C-9 (treatment plan)/vocational rehab plans ongoing until completion Assess quality and clinical risk issues on a concurrent basis; report any recognized issue to the Case Management Team Lead Assess documentation of medical records for completeness on a concurrent basis Ability to obtain and interpret information appropriate to injured workers' needs as required for assessment, treatment, and patient care services Assess, develop, implement and monitor plan of care; Initiate communication and consistently communicate with the injured worker, employer, provider, BWC, and TPA (five-point contact, which could include attorney for IW/employer) Provide education and guidance to all parties to the claim; this includes: claim review at staffings, and/or providing direction to any member of the five-point contact Develop and maintain a positive work atmosphere and support overall team; demonstrate ability to work within a team structure Practice capable and effective problem identification and resolution skills as a method of sound decision making Maintain confidentiality Work independently, efficiently, and deal with priorities Understand and uphold UniComp philosophy and demonstrate commitment to UniComp's core values: have a sense of urgency, be optimistic, promote independence, and respect human dignity Perform other duties as assigned Practice nursing within the Scope of Practice as designated by the State of Ohio Board of Nursing Employee may be asked to travel from time to time to attend employer meetings or other offsite functions.

Caring Hands Palliative and Hospice, Inc.

Visiting Nurse

Posted on:

November 8, 2025

Job Type:

Contract

Role Type:

Case Management

License:

RN

State License:

Arizona

Caring Hands Palliative and Hospice Care Inc is looking for a Hospice Nurse to provide care and support to terminally ill patients. Your presence and services should bring comfort to the person who faces the end of their lives and help them reach acceptance and peace of mind. For this role, you need to be a registered nurse who sees the value of hospice care in alleviating pain and suffering. A compassionate nature and excellent interpersonal skills will make you a good candidate for this position. We expect you to be knowledgeable in caring for the terminally ill, performing tasks such as administering medication and providing emotional support. The goal is to help patients live their final days with dignity and comfort.

Valid nursing license with current registration; experience with RN licensure preferred. Proven experience in diverse clinical environments such as outpatient clinics, or home & community health settings. Extensive knowledge of medical terminology, anatomy & physiology, Ability to perform complex procedures like spinal taps or gastrostomy tube management; experience with ostomy & wound care highly desirable. Strong skills in infection control practices and aseptic technique; experience working with infectious disease patients preferred. Excellent patient assessment skills across age groups including pediatrics (toddler & neonatal care) to geriatrics (memory & dementia care). Critical care experience including ICU or trauma center background is advantageous; familiarity with post-acute & sub-acute care settings is beneficial. Ability to work independently in patients’ homes while maintaining high standards of safety and professionalism. This role offers an opportunity to make a meaningful difference by delivering expert nursing care directly within the community while working within a supportive team environment that values ongoing professional development and excellence in patient-centered healthcare delivery.

Conduct thorough patient assessments including vital signs, physical examinations, and physiological evaluations. Administer medications via injections, IV infusions, and catheter care while adhering to aseptic techniques and HIPAA regulations. Manage complex cases involving critical care, trauma medicine, cardiac catheterization recovery, infectious disease care, hospice & palliative medicine, and geriatrics. Coordinate discharge planning and case management to ensure seamless transition between inpatient and outpatient or home care settings. Educate patients and their families on disease management, medication administration, nutrition, health coaching, and mobility assistance such as Hoyer lifts. Collaborate with multidisciplinary teams including physicians specializing in primary care, internal medicine, pediatrics (including behavioral health, and occupational health. Ensure infection control protocols are strictly followed during all patient interactions to prevent cross-contamination. Provide specialized care for populations with disabilities or developmental delays including dementia & Alzheimer’s care and memory care. Support urgent care needs such as acute pain management and triage assessments for emergent situations requiring immediate intervention. Collaborate with physicians and other professionals to plan care, Make frequent visits to the patient to evaluate their condition, Provide support and comfort according to individual patient’s needs, Work with caregivers to plan and execute excellent patient care, Help in administering medication

Vironix Health

Chronic Care RN / NP / PA (Remote - 1099 Position)

Posted on:

November 8, 2025

Job Type:

Contract

Role Type:

Care Management

License:

RN

State License:

Nevada

Vironix Health is one the fastest growing Ai-health technology companies across the globe with cutting edge virtual care management (VCM) technologies that provide invaluable preventative care to patients with coronary, respiratory, and kidney diseases.

Our comprehensive virtual care solution, includes Remote Patient Monitoring (RPM), Remote Therapeutic Monitoring (RTM), Chronic Care Management (CCM), Preventive Care Management (PCM), and Comprehensive Chronic Care Management (CCCM).

Licensed RN, NP, or PA (REQUIRED) Experience in chronic care management and/or remote patient monitoring Excellent communication and data interpretation skills Proficient with EHRs, Microsoft Office, Google Workspace, and web/mobile apps Comfortable working independently and taking ownership of clinical oversight Interest in startups, innovation, and healthcare technology

Manage chronic care remotely for patients with heart, lung, kidney, and endocrine conditions Develop and maintain personalized care plans Analyze and interpret physiologic monitoring data Onboard and engage patients to ensure compliance and quality care Collaborate with medical assistants and clinicians to deliver whole-person care Provide feedback on product usability, patient outcomes, and user adoption Support product documentation and present findings in internal/customer meetings

Calyxo

Northern VA based Clinical Specialist - Remote, USA

Posted on:

November 8, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

Calyxo, Inc. is a medical device company headquartered in Pleasanton, California, USA. The company was founded in 2016 to address the profound need for improved kidney stone treatment. Kidney stone disease is a common, painful condition that consumes vast amounts of healthcare resources each year. Our team is led by executives and investors with a proven track record of commercializing paradigm-shifting devices to meet unmet needs within urology. Are you ready to change the future of kidney stone treatment? We are seeking high achievers who want to be part of a dynamic team working in a fun, diverse atmosphere.

The Clinical Specialist is a focused individual who has a passion for patient care and physician and staff education. This person will proctor cases to excellence and independently cover CVAC procedures, training the surgical team on the safe and effective uses of the device. The Clinical Specialist works closely with the surgical team members to provide clinical product assistance to the surgeon by being familiar with the surgical procedure, instruments, supplies, and equipment. The Clinical Specialist will train the surgical team on instrument preparation prior to cases and during the surgical procedure. This role will manage inventory needs in the account and any accompanying administrative requirements. This role is not a pathway to a Territory Sales Manager, and this person does not seek to become a TSM. Ideal candidates will live in the targeted geographical area. This position is capable of covering any CVAC case in the territory, region, or at times, the nation, as assigned. The Clinical Specialist will also provide clinical support for physician training and sales training programs. Who You Will Report To: Regional Clinical Development Manager

Clinical Specialist I Requirements: Clinical experience Clinical Specialist II Requirements: In addition to all of the above: Industry experience (1-3 years) Prior Employment as a Clinical Specialist with a medical device company or experience working with Mobile Litho Provider Companies Comfortable with the pace required to be successful in a start-up Ability to provide intraoperative procedural guidance Willingness to travel outside of the designated territory Sr. Clinical Specialist Requirements: In addition to all of the above Clinical experience: Intraoperative Coaching Experience OR experience: Fluent in Staff and Support Training Industry experience: 3+ years of full-time employment by a medical device company as a clinical specialist (or comparable position) focused on case coverage and patient outcomes (not equipment/service provider). Track record of success. Urology experience preferred. Understands the medical device industry Comfortable with the pace required to be successful in a start-up Ability to provide intraoperative procedural guidance Understands sales processes and training Willingness to travel outside of the designated territory General Requirements: Experience in surgical technique and sterile procedures in the operating room Experience utilizing fluoroscopy is a plus Customer relationship and procedural skill development are highly desired Highly desirable candidates will have a degree or certification in a medical-related field (ex: LPN, RN, Surg Tech, Rad Tech, etc). Able to travel up to 80% Compliance with relevant county, state, and federal rules regarding vaccinations.

Provide clinical case coverage as assigned Train the surgical team to assist in good patient outcomes and verbally support cases during training period Acquire and maintain current knowledge of perioperative surgical technology practice and hospital policies and procedures Develop technical acumen to a level to serve as an educational resource Demonstrate appropriate interactions with all hospital service providers Maintain and prepare equipment and kits for surgery, including Quality Control audits of equipment and kits Troubleshoot equipment according to standard procedure Provide intra-operative clinical product support Ensure that 100% of received inventory and returned inventory matches shipping documents Reconcile inventory/usage as well as missing inventory Assist in the delivery of procedural training to physicians and medical staff Be an effective member of the commercial team and play a key role in ensuring positive clinical outcomes Support sales and marketing initiatives Ensure compliance with all company policies, including the quality policy, on label promotion and interactions with health care professionals Other duties as assigned

Hawthorne Health Inc

Pediatric Registered Nurse - Part Time, Contract

Posted on:

November 8, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

New Jersey

Hawthorne Health brings trials directly to investigators and patients in their communities by combining innovative technology with compassionate medical professionals, and we invite experienced healthcare experts to grow their careers by becoming part of the Hawthorne Hero network. Our Heroes are capable, motivated, and diverse - more importantly, they are dedicated to improving patients lives and the future of medicine for humanity.

Must be experienced in pediatric and infant blood draw Experienced Registered Nurse (Adult, Pediatric, Neonatal) with active unencumbered license to practice Experience and knowledge of working in clinical research trials preferred Attention to detail and highly organized Ability to prioritize and manage multiple tasks Excellent verbal and written communication skills in English and the ability to complete detailed data Ability to work independently and as part of a wider team Technology savvy Ability to travel locally or across states lines based on licensure

Complete onboarding and training requirements to perform clinical trial visits Provide availability, confirm visit acceptance, communicate with clinical trial/program participant/patient Prepare for the clinical trial visit by gathering supplies and equipment, testing the equipment, verifying expiration dates and determining visit readiness Travel to location of clinical trial/program participant Perform clinical trial visit activities within RN scope of practice such as (but not limited to): Physical Assessment Venipuncture PK Collection Centrifuging, processing of blood, preparations for shipment Medication or Investigational Medicinal Product administration/reconciliation ECG Specimen collection IV catheter insertion Screenings Questionnaires Vital Signs, Height, Weight Adverse events collection Perform post visit data uploads/submissions as required Communicate with project team for any issues with may arise or concerns during visit Ensure clinical trial visit is conducted according to ICH/GCP and accuracy of data collected during the visit

Specialty Care Management

LPN Coach

Posted on:

November 7, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Texas

Specialty Care Management is the industry leader in dialysis cost containment and chronic kidney disease (CKD) management solutions. With 1 in 7 U.S. adults facing kidney disease (over 35 million Americans) and the average dialysis claim exceeding $500,000 per year, it’s imperative for self-funded health plans to have a reliable risk management partner to address these challenges. Specialty Care Management is that partner. Founded in 2002, we work with self-funded employers of all sizes to mitigate both the human and financial costs associated with renal dialysis and CKD claims. Our primary lines of business include Dialysis Risk Management & Repricing, Chronic Kidney Disease (CKD) Management & Clinical Coaching, and Comprehensive Data Analytics. We bring together top talent in Healthcare Administration, Clinical Case Management, and Provider/Payee Contract Law to deliver innovative and effective solutions. Moreover, our programs can be implemented off-cycle, are TPA agnostic, and SCM proudly boasts ZERO % of savings fees, implementation fees, or other ancillary fees, common across the industry. Further, we offer FREE data analytics services for enrolled plans, allowing SCM to proactively analyze risk levels within the member population and identify pre-dialysis claimants before they escalate into multimillion-dollar claims. This data-driven process in tandem with our industry-leading clinical programs allows SCM to help reverse and mitigate various pre-dialysis conditions, enhancing member health while safeguarding plan assets. To learn more about our solutions, email us at info@specialtycm.com, call (267) 544-0566, or schedule a complimentary discovery call by copying this link into your browser: https://go.specialtycm.com/meetwithus.

Type: Permanent and FLSA Exempt Pay: $55,000 - $65,000 annually, plus bonus potential Location: 100% remote with minimal travel Hours: Full-time with some evening and weekend hours Reports To: Clinical Director About Specialty Care Management Specialty Care Management (SCM) creates clinical and financial solutions that make employer health benefits more predictable, affordable, and sustainable. This is accomplished by providing industry leading claim analytics, chronic kidney disease (CKD) Management, Outpatient Dialysis Cost Containment Services and Oncology Management Services. Role Summary SCM’s clinical LPN has strong communication, planning, organizational and interpersonal skills. The ideal candidate has a passion for helping members to improve their self-care and reports directly to the RN Team Lead. The LPN will be tasked to assist in outreach and related supportive follow up work with member-patients and providers to support the work in reducing the risk of kidney disease and its progression to ESRD and dialysis. The primary responsibility of this role is to support Oncology members by facilitating access to essential resources and cancer-related social services. This role works closely with the RN team to reinforce oncology care plans, assist with coordination needs, and ensure timely follow-up.

LPN with oncology experience preferred Minimum of 3 years LPN/LVN experience Preferred to be fluent/native speaking and writing in Spanish Ability to work some evening and weekend hours Ability to work some evening and weekend hours to meet with members based on their availability 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.

Reporting: Responsible for amalgamation and creation of quarterly reports for each client group: tallying cost-savings testimonials KPI’s Medical Records: Receive and process incoming faxes: MD records including labs, meds, OV notes and input pertinent info into chart; file fax in member record and document in chart Oncology Coordination Support: Assist the oncology nursing team with supportive services, social needs navigation, and care coordination Monitor for changes in claims or labs indicating disease progression or toxicity concerns and escalate to RN Chart Audit and QA: Audit member charts for completeness, accuracy and assist with end of month reconciliation for invoice prep and Quarterly Reporting Manage Follow-up for graduated members for Oncology: labs and check-in call 1-2 x per year as directed by the managing RN. Refer to RN as needed. Other Duties and Functions Outreach assistance as needed with peak enrollment periods: Telephone calls with members to encourage engagement with the RN Coach: Assist in making initial outreach calls to members and scheduling with the assigned RN Explains program/intake & history via telephone/secure video chat and sets appointment with the member and assigned RN Gather pertinent medical records including laboratory data and medications Performs phone number research as needed/requested Able to develop good relationships with providers, family/support persons, and all members of the care team to provide education and support. Perform claims reviews and eligibility verification Assists with mailings for outreach/introductory Build supportive rapport with members, family/support persons, and providers to reinforce engagement Conduct eligibility and benefits checks related to oncology services Assist with mail or electronic distribution of member education resources Adhere and comply with HIPAA regulations in a remote-working environment. Active, unrestricted LPN license

The Fertility Concierge

Registered Nurse- Fertility Nurse Injector

Posted on:

November 7, 2025

Job Type:

Part-Time

Role Type:

License:

RN

State License:

Texas

Since 2017, The Fertility Concierge (TFC) has been honored to support patients through one of life’s most meaningful journeys. Our TFC-Certified™ nurses provide expert at-home fertility injections, delivering not just clinical excellence but also peace of mind, compassion, and confidence. With thousands of visits completed nationwide, we’re redefining what supportive, patient-centered fertility care looks like.

We’re seeking licensed Registered Nurses to join our growing national network. As a TFC nurse, you’ll provide at-home medication administration (subcutaneous and intramuscular injections), brief patient education, and compassionate support — all while working flexible hours that fit your schedule.

Active RN license in good standing (state of service required) Fertility experience a plus (through personal IVF journey or clinic work) Strong communication skills and professional, polished, and positive Reliable, compassionate, and patient-centered Tech-comfortable (mobile apps, basic documentation) Reliable transportation for patient visits

Administer fertility injections in patient homes/hotels/offices Verify medication, dose, and timing (including trigger shots) Document visits in UnifyTime (our secure scheduling and tracking platform) Respond to patient needs with warmth, presence, and professionalism Interface directly with patients and the TFC team Participate in ongoing training and receive support from Alex, our Director of Nurse Experience

Optum

RN Complex Case Manager - Remote on PST

Posted on:

November 7, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Required Qualifications: Associates Degree in Nursing Valid multi-state compact license Case Management Certification or ability to obtain within 2 years of hire 2+ years of job-related experience in a healthcare environment Experience utilizing excellent communication, interpersonal, organization and customer service skills Knowledge of computer functionality and software applications (e.g., navigating systems, troubleshooting, electronic charting, accessing intranet and record management databases) Demonstrated knowledge of relevant state and federal guidelines (e.g., Medicare, Medicaid, commercial) or regulatory bodies (e.g., NCQA) Understanding of relevant health care benefit plans Ability to work in Pacific Standard Time Preferred Qualifications: Bachelor’s degree or higher in healthcare related field 3+ years of experience providing case management and/or utilization review functions within health plan or integrated system Proven self-motivated, attention to detail

Conducts clinical evaluation of members per regulated timelines, determining who may qualify for complex case management based on clinical judgment, changes in member’s health, social determinants, and gaps in care Creates and implements a case management plan in collaboration with the member, caregiver(s), provider(s), and/or other appropriate healthcare professionals to address the patient’s needs and goals Performs ongoing updates of the care plan to evaluate effectiveness, and to document barriers, interventions, and goal achievement Partners with primary providers or multidisciplinary team members to align or integrate goals to plan of care Completes telephonic visits for member engagement and enrollment Uses motivational interviewing to evaluate, educate, support, and motivate change during member contacts Identifies and considers appropriate options to mitigate issues related to quality, safety or affordability when they are identified, and escalates to ensure optimal outcomes, as needed Ensures compliance with quality metrics specific to health plan delegation and accrediting body requirements Conducts self and peer audits on a regular and assigned timeline Maintains caseload per defined medical management department standards Sustains productivity and audit requirements per medical management department standards Demonstrates ability to work independently and implement innovative approaches to complex member situations Determines need for continued member management, creates care plan and facilitates transition to medical management programs Attends departmental meetings and provides constructive recommendations for process improvement Performs other duties as assigned

argenx

Global Indication Lead, Medical Affairs & Evidence Generation

Posted on:

November 7, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Massachusetts

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

The Integrated Medical Affairs and Evidence Generation group delivers ambitious, patient-focused cross-regional and cross-indication medical strategies, driving data generation and dissemination, to maximize patient benefit from argenx products. The Global Indication Lead will provide expert medical leadership to guide development, launch planning, life cycle management and support for approved products, as relevant for the indications stage of development. Working in collaboration with cross-functional colleagues, and as a key member of the Indication Development Team the Global Indication Lead will input to development and delivery of the target product profile, clinical development plans and pre-launch strategy, and brand plans ensuring regional Medical Affairs teams insights and requirements inform all stages of development.

SKILLS AND COMPETENCIES: Able to quickly understand complex disease areas, treatments and development and brand strategies Proven track record of building productive collaborations with external medical experts and networks and to gain actionable insights Understands how to build internal cross-functional and cross-regional collaborations, ensuring broad input to decision making Embraces innovation and shared goals Has excellent communication skills: verbal, written and when giving presentations Has strong influencing skills to be able to engage effectively with internal and external stakeholders Able to thrive as part of a team and when working independently Proven track record of delivering results that meet or exceed targeted objectives Fluency in English, in addition to the local language(s), both oral and written EDUCATION, EXPERIENCE AND QUALIFICATIONS: Scientific, healthcare or medical degree (BSc, MS, PhD, PharmD, RN, MBBS, MB.ChB or equivalent). Substantial medical affairs experience, throughout the product lifecycle A strong understanding of the drug development process and launch planning Relevant drug development, therapeutic area expertise and existing external expert network is an advantage Robust knowledge of regulations and practices related to industry interactions with healthcare professionals Experience partnering with regional/country and global functions and leadership #LI-remote

Provide expert medical input to guide clinical development, comprehensive evidence generation, launch planning and brand plan execution in relevant indications Develop and execute ambitious short-term and long-term medical strategies, as key elements of the integrated data generation plan and brand plan Accountable for the alignment of all global medical affairs activities in partnership with other cross-functional members of the Indication Development Team Develop close partnerships with regional and country medical affairs leads/teams, and the regional indication strategy teams and ensure all activities maximise cross-regional impact whilst enabling regional team empowerment and supporting local delivery Build and maintain close partnership with external experts, in collaboration with regional/country Medical Affairs teams, to bring insight to all activities Initiate and support high impact medical activities, such as advisory boards, congress symposia and medical research projects Drive the identification and development of productive collaborations including with healthcare organisations and experts, other important customers and stakeholders and professional organizations Support strategy development for investigator sponsored studies and assessment of proposals Partner with scientific communications to support development of publication and medical education strategies Develop and continuously maintain the highest scientific and medical expertise with relevant diseases and products and be acknowledged internally and externally as an expert Systematically capture, distil and proactively communicate insights and activities within argenx Ensure all medical affairs activities maintain the highest standards, comply with applicable pharmaceutical regulations, as well as argenx policies and procedures

argenx

Nurse Case Manager, Central Territory (Denver or Michigan)

Posted on:

November 7, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Michigan

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

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

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

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

Medasource

RN Denials Manager

Posted on:

November 7, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Arizona

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

RN Denials Manager Fully Remote Equipment Provided We are seeking an experienced RN Denials Manager to lead a centralized clinical denials review team for a large multi-state health system. This leader will oversee RN Denials/Audit Specialists responsible for reviewing medical necessity denials, coordinating appeals, and evaluating case documentation to support maximum reimbursement and high-quality patient care outcomes. This is a hands-on leadership role with direct oversight of team performance, operational workflow, payer-related escalation support, and staff development. Schedule: Monday–Friday, 8:00 AM–4:30 PM (AZ Time) No weekends, call, or holiday rotation

Active RN license (any state where residing) 5+ years of RN experience 2+ years of leadership experience with direct reports Experience in clinical denials management / appeals / utilization review Familiarity with payer approval criteria and reimbursement processes Bachelor’s degree preferred (BSN strongly encouraged) Preferred Experience: Hospital or health system background Prior experience managing centralized denial review teams Strong clinical documentation review and medical necessity appeal writing Details: Fully remote (must reside in an approved state) Laptop/equipment provided Competitive hourly rate

Lead daily operations of clinical denials review team; manage workflow and queue assignments Review medical necessity denials and support clinical appeal documentation Collaborate closely with Utilization Review, Case Management, and Physician Advisors Act as clinical subject matter expert for denial resolutions and case review standards Coach, develop, and mentor direct reports; support growth, training, and onboarding Monitor trends, identify payer patterns, and recommend process improvements Ensure compliance with internal review policies and payer requirement

Aledade, Inc.

Manager, Care Management

Posted on:

November 7, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Maryland

Aledade, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of health plans, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to help create a health care system that is good for patients, good for practices and good for society - and if you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place.

Lead transformative care management initiatives as our Manager, Care Management who will directly improve patient outcomes across Maryland and Delaware markets. As Aledade's foremost expert on the Maryland Primary Care Program (MDPCP) and AHEAD Model programs, you'll shape care management strategy while guiding an interdisciplinary team toward measurable market performance goals. Reporting directly to the Market President, you'll serve as the strategic bridge between cutting-edge CMS Innovation programs and real-world practice success, ensuring compliance while coaching partner practices to thrive in value-based care environments. Your leadership will span from developing evidence-based training programs and managing vendor partnerships to providing thought leadership on care management metrics and coordinating life-changing interventions for complex patients. This role offers the unique opportunity to stay at the forefront of healthcare innovation, continuously adapting Aledade's services based on the latest intervention evidence while directly impacting both practice success and patient lives. Candidates will need a Registered Nurse Licensure in the state of Maryland to be considered.

Registered Nurse Licensure in the state of Maryland. Bachelor’s degree or equivalent. Minimum 5 years experience in a care manager, case manager, or related role with at least 3 years in a people manager role. At least 2 years experience providing care to complex high risk older and/or disabled adults. Comprehensive knowledge of Social Determinants of Health (SDOH) including screening techniques and appropriate resources and interventions. Technical mastery of electronic health record charting, population health tools, and health information exchanges. Experience designing and utilizing interdisciplinary team communications and protocols. Experience managing projects and vendor relationships. Preferred KSA's: Care management credential(s) or certification(s) preferred Physical Requirements: Ability to travel to visit practices, HQ, or other team or company events as needed up to 4 times per month. Sitting for prolonged periods of time. Extensive use of computers and keyboard. Occasional walking and lifting may be required.

Manage from end-to-end a Care Management program that incorporates Aledade perspective on effective care management interventions. Leverage internal and external experts and literature. Utilize internal staffing as well as vendor contracts to execute the program and be accountable for the quality and impact of the Aledade Care Management program as well as the tools used to coordinate internally. Stay up to date with payer program and regulatory requirements applicable to the Care Management program and implement changes to ensure ongoing program and regulatory compliance. Directly manage, coach and lead a team of interdisciplinary care managers, ensuring patients receive the appropriate care at the appropriate time to help longitudinally and episodically prevent unnecessary medical spend and promote high quality of care. Develop and report metrics for direct reports and market leaders to measure their success & the success of the overall program. Determine and deploy appropriate staffing assignments considering team skillsets and practice partner attributes and preferences as well as the strategic goals of the market. Perform the tasks of the Care Manager temporarily when vacations or other events create temporary staffing shortages. Ensure team members including junior team members are performing “top of license” scope of work. Provide data and insights to physician and administrative leaders in partner practices including performance metrics, coaching, and program guidance related to the services they are receiving from the Aledade team, incorporating asks and preferences of the physicians and administrators into the team’s approach to the work.

Aledade, Inc.

Clinical Risk Educator

Posted on:

November 7, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

South Carolina

Aledade, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of health plans, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to help create a health care system that is good for patients, good for practices and good for society - and if you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place.

The Clinical Risk Educator is responsible for developing and delivering educational content designed to improve accurate and complete clinical documentation practices. This role supports a diverse audience, including external clinicians, billers, coders, and Aledade’s clinical and non-clinical staff. Key responsibilities include interpreting and utilizing trended data related to CDI outcomes to identify learning opportunities primarily for clinical audiences. The Clinical Risk Educator collaborates with colleagues and leadership to design and implement educational materials, ensuring alignment with regulatory compliance requirements, and value-based care principles. This position requires a deep understanding of clinical documentation concepts and a commitment to fostering education that promotes high-quality, compliant documentation practices within a value-based care framework.

Bachelor’s degree in a healthcare related field or equivalent work experience required 5+ years of clinical experience Current medical coding certification such as Certified Professional Coder (CPC), Certified Coding Specialist - Physician-based (CCS-P), Certified Risk Adjustment Coder (CRC), Certified Clinical Documentation Specialist (CCDS), Certified Documentation Expert Outpatient (CDEO), Certified Clinical Documentation Specialist-Outpatient (CCDS-O), etc. through AAPC, ACDIS, or AHIMA 2+ years of clinical documentation improvement experience Extensive knowledge of ICD-10-CM, HCPCS and CPT coding, medical terminology, human anatomy and physiology, clinical indicators associated with disease processes and pharmacology is required Subject matter expertise on the CMS HCC Risk Adjustment program, methodology, and impact to value-based contracts Comfortable presenting to large and small groups in person and in virtual format (Google Meet, Zoom, etc.) Ability to work both independently and collaboratively Flexible and able to multi-task and prioritize work load on a daily basis Availability for market-specific events, including the execution of 1-2 Saturday events per year in select markets Flexibility to work occasional evening hours, with the potential for 1-2 evenings per month on a national scale Preferred Qualifications: Active nursing credential as Registered Nurse (RN), Licensed Practical Nurse (LPN), or international medical graduate (IMG) Background in working directly with providers in an outpatient setting Experience developing and delivering clinical education and training via Google Slides or Powerpoint presentations Ability to use insights from clinical and quality data to address opportunities for improvement Advanced knowledge of Medicare billing and coding regulations, along with a deep understanding of CMS compliance standards and guidelines General understanding of the billing requirements and reimbursement structures for FQHCs/RHCs Willingness to travel as needed to Aledade’s headquarters or markets Physical Requirements: Sitting for prolonged periods of time. Extensive use of computers and keyboard. Occasional walking and lifting may be required.

Conduct educational sessions for Aledade ACO member practices and their key staff on clinical documentation and risk concepts, delivered either in person or virtually. Serve as an individual contributor on the Risk Education team, collaborating with team members to develop and update educational materials related to clinical documentation, coding and billing for both internal and external audiences. Conduct ongoing annual reviews of repository content to ensure alignment with CMS regulatory updates. Analyze clinical process measures and outcome data, informed by CDI chart reviews, market performance, and field team input, to identify knowledge gaps and opportunities. Address and clarify missing, unclear, conflicting, or non-compliant information captured by the CDIS, providing clear explanations and guidance to clinicians. Research, investigate and remain up to date on both clinical and coding guidelines as they relate to clinician documentation improvement. Serve as a resource for appropriate clinical documentation and coding practices for assigned Regional Market.

Aledade, Inc.

Specialist, Clinical Strategy, Remote

Posted on:

November 7, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

None Required

State License:

North Carolina

Aledade, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of health plans, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to help create a health care system that is good for patients, good for practices and good for society - and if you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place.

The Specialist, Clinical Strategy is responsible for developing and implementing robust processes to track and evaluate clinical initiatives. This role will focus on quality performance goals and objectives that improve patient outcomes.

Bachelor's degree in a healthcare related field (i.e. Public health) 5 years experience in healthcare, ideally with experience in quality improvement, value-based care, or population health management. Ability to interpret complex data and identify key trends for strategic decision-making Ability to plan, manage, and execute clinical initiatives Strong communication and collaboration skills to work effectively with diverse teams and present findings to leadership Proficient in Google Sheets and Google Slides and/or Excel and PowerPoint Preferred Qualifications: Masters's degree Physical Requirements: Prolonged periods of sitting at a desk and working on a computer.

Data Analysis & Reporting: Analyze performance data to identify emerging issues and opportunities for strategic improvement within the Clinical Strategy team and across the broader organization. Develop and implement systems to track progress against quality goals and objectives across the organization, aligning with the Company’s OKR process. Partner with Business Intelligence to develop and maintain data-driven dashboards and reports to track key quality performance indicators across non-MSSP lines of business. Create reports for internal and external stakeholders, including senior leadership, practice partners, and payers. Cross-Functional Collaboration: Collaborate with key stakeholders to plan and execute Team and company meetings (i.e. Executive Leadership Meetings, Steering Committee Meetings, Board Meetings, etc). Build and maintain strong working relationships with key stakeholders across the organization, demonstrating effective upward management skills. Create compelling presentations presenting strategy and insights in a clear and concise manner to both technical and non-technical audiences. Innovation: Lead cross-functional project teams on a variety of strategic initiatives related to clinical strategy Conduct research and analysis on emerging trends and best practices in value-based care and quality improvement. Stay abreast of industry best practices and regulatory changes impacting value-based care and quality reporting. Other duties as assigned

IntellaTriage

Remote Hospice Triage RN- PT OVN (10p-5a) 3 week rotation

Posted on:

November 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 **Work a 3 week rotation with, sample rotation schedule below: Week 1- Sunday, Monday & Tuesday 10p-5a CST Week 2- Friday & Saturday 10p-5a CST Week 3- Wednesday & Thursday 10p-5a CST

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

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

NPHire

Work-From-Home Nurse Practitioner / Telehealth / Flexible Schedule / New Grads Welcome

Posted on:

November 7, 2025

Job Type:

Contract

Role Type:

Telehealth

License:

NP/APP

State License:

Georgia

A leading virtual care network is hiring Nurse Practitioners to join its rapidly growing remote team. This is a fully remote, contract-based role offering flexibility, independence, and an opportunity to deliver modern, data-driven healthcare from anywhere in the U.S. 🌎 New graduates are encouraged to apply — training and support are available.

Active Nurse Practitioner license in at least one U.S. state FNP or ANP certification required Strong clinical judgment and decision-making skills Excellent communication and documentation abilities Telehealth experience preferred but not required — training available Ability to practice independently or under a collaborating physician arrangement

Perform virtual visits for acute conditions (UTIs, sinus infections, respiratory, and more) Deliver telehealth consults in synchronous (live) and asynchronous (on-demand) settings Provide care in areas including weight loss, longevity, ED, TRT, and functional medicine Collaborate with an experienced telehealth clinical team Ensure accurate charting and compliance with all state and federal telemedicine standards

Ascension

RN Program Manager - Care Management

Posted on:

November 7, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Missouri

Ascension associates are key to our commitment of transforming healthcare and providing care to all, especially those most in need. Join us and help us drive impact through reimagining how we can deliver a people-centered healthcare experience and creating the solutions to do it. Explore career opportunities across our ministry locations and within our corporate headquarters. Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states. Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.

Department:Care Management Operations Schedule:Full Time/8-Hour Day Shift, Monday-Friday Location:Remote with about 20% travel Salary: $73,590.40 - $103,875.20 per year Eligible for an annual bonus incentive

Licensure / Certification / Registration: Registered Nurse obtained prior to hire date or job transfer date required. Education: Required professional licensure/certification AND 3 years of experience and 1 year of cumulative leadership experience required. Additional Preferences Must be a Registered Nurse 3 years of Care Management experience CCM (Care Management Certification) is preferred #LI-Remote

Design, validate, and evaluate clinical care management programs (chronic disease, transitions of care, wellness/disease management) using evidence-based guidelines and URAC/NCQA standards. Serve as clinical subject matter expert (SME) for NCM workflows, regulatory compliance, and integration of Social Determinants of Health across all programs and patient education materials. Lead clinical education and onboarding, applying adult learning principles to develop and deliver training, monitor competency, and facilitate ongoing professional development and CE opportunities. Oversee clinical workflow design and documentation platform governance, translating clinical protocols into workflows, leading User Acceptance Testing (UAT), and chairing enhancement committees to ensure clinical integrity. Provide field-based coaching and mentorship, including shadowing associates, auditing documentation, and hosting office hours to strengthen clinical decision-making and performance. Partner with analytics and operations teams to ensure accurate registry logic, reporting, and evaluation of program outcomes to drive continuous improvement and meet NCM quality goals. Collaborate across specialty service lines and NCM steering bodies to align care management programs with organizational priorities and national directives.

Ascension

AVP-Nursing Practice

Posted on:

November 7, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Missouri

Ascension associates are key to our commitment of transforming healthcare and providing care to all, especially those most in need. Join us and help us drive impact through reimagining how we can deliver a people-centered healthcare experience and creating the solutions to do it. Explore career opportunities across our ministry locations and within our corporate headquarters. Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states. Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.

Ascension is hiring an AVP of Nursing Practice to lead systemwide nursing quality, governance, and patient safety initiatives. This is a unique opportunity to drive evidence-based practice, advance nurse engagement, and elevate outcomes across the health system. Department: Research and EBP Location: Remote

Licensure / Certification / Registration: Registered Nurse obtained prior to hire date or job transfer date required. Education: Master's of Science in Nursing required AND 7 years of applicable cumulative job specific experience required, with 4 of those years being in leadership/management. Certification in area of nursing practice preferred.

Oversee the development, implementation, and evaluation of policies, protocols, and standards aligned with evidence-based practice. Responsible for advancing professional governance and nursing peer review processes to ensure the highest standards of quality and safety in nursing. Execute nursing priorities aligned with the Ascension Strategic Plan. Promote a healthy work environment through structured recognition, and drive excellence via nurse engagement metrics, ensuring alignment driving outperformance with national benchmarks. Ensure high performance in regulatory compliance and national programs, with scalable infrastructure supporting data-driven improvements at all organizational levels. Advance nurse-sensitive patient experience measures as reflected in nurse executive scorecards, aligned with broader system strategies. Design and scale evidence-based nursing standards and protocols across care settings. Collaborate with informatics and digital teams optimizing technology-enabled nursing practice across all practice settings.

Ascension

Clinical Programs RN Coordinator

Posted on:

November 7, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Texas

Ascension associates are key to our commitment of transforming healthcare and providing care to all, especially those most in need. Join us and help us drive impact through reimagining how we can deliver a people-centered healthcare experience and creating the solutions to do it. Explore career opportunities across our ministry locations and within our corporate headquarters. Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states. Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.

As the Clinical Programs RN Coordinator you'll coordinate nursing program activities and resources within clinical specialty or department.

Licensure / Certification / Registration: BLS Provider obtained within 1 Month (30 days) of hire date or job transfer date required. American Heart Association or American Red Cross accepted. Registered Nurse obtained prior to hire date or job transfer date required. Advanced Life Support preferred. American Heart Association or American Red Cross accepted Education: Diploma from an accredited school/college of nursing OR Required professional licensure at time of hire. Additional Preference: Active, unrestricted RN License in state of Texas (required) 2+ years experience in utilization review or case management, required. 2-3 years of Appeals Health Plan experience preferred Supervisory experience in a healthcare setting a must have. #LI-Remote

Supervises day to day appeal team operations to ensure operational effectiveness and efficiency Assists with orientation and training of new staff Distributes staff case assignments and ensures appeal, external review and fair hearing turnaround times are met. Under minimal direction, prepare reports and documentation for committee presentation and ad hoc reports as needed. Analyze appeals and grievances data and make recommendations based on trends identified. Take initiative to follow through on issues and opportunities for process improvements. Initiate, develop and implement in-service educational presentations. Provide leadership for the appeals department in day to day activities Maintain a working knowledge of all activities in the department and provide assistance to departmental staff and interdepartmental staff as necessary

Medasource

Utilization Review Nurse Auditor

Posted on:

November 7, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Indiana

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

Our client offers a range of services that help navigate the path to compliant revenue. The Payor Peer to Peer team reviews cases for which the authorization has been denied evaluating if the proper documentation was available to support the admission status, procedure, and care setting that was requested. The Nurse Author in Payor Peer to Peer advises our clients regarding the appropriateness of the request based on available documentation. Our goal is to assist our client facilities in ensuring proper billing and authorization level; thereby increasing clean claims submission and reducing accounts receivable days. This team can also serve as a clinical resource to medical and case management staff by providing identification, facilitation, and resolution of documentation and utilization issues.

Skills: Strong clinical knowledge base across multiple clinical areas Computer proficient Strong verbal and written communication skills Professional, organized and possess persuasive writing and speaking skills Possess strong negotiating/reasoning/logic and problem-solving skills Other Qualifications: Proficient computer skills (including, but not limited to, spreadsheets, Internet, and email) are required. Active, current registered nurse license in at least one US state At least 3 years of acute, hospital-based clinical experience in a medical/surgical unit, emergency department, and/or ICU Must have some flexibility with schedule (minimum of 20/hours week) Home office that is HIPAA compliant BSN preferred Desired Qualifications: Basic knowledge/prior experience with InterQual and/or Millman/MCG criteria a plus Prior utilization management experience preferred License and Certification Level: Registered Nurse Required. Mathematical Skills: Ability to add, subtract, multiply, and divide into all units of measure using whole numbers, common fractions, decimals, and percentages.

Writing client-facing clinical reviews evaluating the authorization requested, documentation support or lack of support for that authorization, evidenced based criteria for that support, and complex clinical evaluation of the request as a whole Evaluation and interpretation of multiple types of hospital documentation as it relates to the requested authorization, including but not limited to emergency department documentation, history and physical, progress notes, interpretation of lab and imaging results, vital sign trends, physical and occupational therapy notes, and medication administration records Provide strength evaluation and recommendations to clients using a combination of understanding of commercially available criteria and clinical judgement for establishing medical necessity arguments in the setting of concurrent denials Nurses should be highly capable of working independently with a high level of performance in in a rapidly changing, fast paced environment. Successful nurses will meet or exceed minimum productivity and quality standards. Provide feedback regarding actionable root cause analysis of the specific cases to customer utilization review team and/or case managers regarding submitted case determinations. Provide written analysis of the case and perform case reviews across multiple specialties

Theoria Medical

Clinical Care Specialist - Remote (US)

Posted on:

November 7, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Leading the charge in healthcare innovation, Theoria Medical offers a unique blend of medical excellence and technological advancement, primarily serving the post-acute and primary care sectors. Our extensive network includes multispecialty physician services and RPM, covering skilled nursing facilities across the country. In our national push for expansion, we're scouting for the brightest nurse practitioners and physicians eager to drive change and deliver superior care. Join us for a rewarding career that promises professional growth, flexibility, and the chance to shape the future of healthcare.

Position Type: Full-time, salaried, exemptCompensation: TBD Job Location: Remote (US)Job Highlights Work-Life Balance: Competitive compensation with balanced hours. Patient-Centered Care: Directly impact patient outcomes through chronic care management. Remote Flexibility: Work from the comfort of your home. Flexible Scheduling: Your schedule, tailored to fit your life. No set daily shift times. No Overnight Duties: Sleep peacefully with no overnight call/requirements. Meaningful Connections: Establish lasting relationships with patients and staff. Culture of Appreciation: Your work is valued and rewarded. Licensure Reimbursed: We cover your medical licensure costs. Benefits: 401k match, Medical/Dental/Vision, Disability, Employer-paid Life Insurance. Referral Bonus: Earn more by expanding our team. Career Advancement: Leadership opportunities promoted. Continuous Learning: Opportunities for ongoing education and professional development, including coding and risk adjustment. Shift Structure: Monday-Friday, 8 hour shift (Typically 9am-5pm but can vary)

RN in Applicable State Must have active compact license Fast home internet and strong computer skills required Five years of experience practicing nursing required Excellent communication and time management skills required Strong critical thinking and problem solving required Self-motivated and independent worker Experience serving chronically ill patients preferred Telephonic case management or care coordination experience preferred Compassionate and friendly demeanor Physical Requirements: Must be punctual or on time and adhere to the company's Time and Attendance policy. Must be able to remain sitting for the majority of their shift.

Maintain, monitor, and manage your own patient census across multiple facilities to: Coordinate the implementation of Chronic Care Management (CCM) services amongst chronically ill patients residing in long term care facilities Create individualized Care Plans for patients with chronic conditions. Responsible for updating and tracking monthly Responsible for monitoring labs, vitals, medications, and testing for patient census. Conduct care coordination with patients, their care team, and their families (this is done through email, text, and phone communication) Provide patient education on management of chronic conditions, medications, and testing Constant communication and coordination with members of the care team such as physicians, physician assistants, nurse practitioners, pharmacists, and other health care professionals Assess, identify, and close clinical and non-clinical gaps in patient care Provider and CCS team training and support

IntellaTriage

Remote Hospice Triage RN- PT 2 shifts 3:30p-11p+ rotating Sat & Sun 3:30-11p CST

Posted on:

November 6, 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

Machinify

Medical Review Nurse II - Commercial Home Health

Posted on:

November 6, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

California

At Performant, we’re focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Through this important work we accomplish our mission: To offer innovative payment accuracy solutions that allow our clients to focus on what matter most – quality of care and healthier lives for all.

The Medical Review Nurse II - Commercial Home Health primarily performs medical claims audit reviews. As a MR Nurse, you will join a team of experienced medical auditors and coders performing retrospective and prepayment audits on claims for Government and Commercial Payers. You will work remotely in a fast paced and dynamic environment and be part of a multi-location team.

Knowledge, Skills And Abilities Needed: Experience with utilization management systems or clinical decision-making tools such as Medical Coverage Guidelines (MCG) or InterQual. Experience with and deep knowledge of ICD-9, ICD-10, CPT-4 or HCPCS coding. Knowledge of insurance programs program, particularly the coverage and payment rules. Ability to maintain high quality work while meeting strict deadlines. Excellent written and verbal communication skills. Ability to manage multiple tasks including desk audits and claims review. Must be able to independently use standard office computer technology (e.g. email telephone, copier, etc.) and have experience using a case management system/tools to review and document findings. Must be able to manage multiple assignments effectively, create documentation outlining findings and/or documenting suggestions, organize and prioritize workload Effectively work independently and as a team, in a remote setting. Required And Preferred Qualifications: Active unrestricted RN license in good standing, is required. Must not be currently sanctioned or excluded from the Medicare program by the OIG. Minimum of five (5) years diversified nursing experience providing direct care in an inpatient or outpatient setting. One (1) or more years' experience performing medical records review. One (1) or more years' experience in health care claims that demonstrates expertise in, ICD-9/ICD-10 coding, HCPS/CPT coding, DRG and medical billing experience for an Insurance Company or hospital required. Strong preference for experience performing utilization review for an insurance company, Tricare, MAC, or organizations performing similar functions.

Auditing claims for medically appropriate services provided in both inpatient and outpatient settings while applying appropriate medical review guidelines, policies and rules. Document all findings referencing the appropriate policies and rules. Generate letters articulating audit findings. Supporting your findings during the appeals process if requested. Working collaboratively with the audit team to identify and obtain approval for particular vulnerabilities and/or cases subject to potential abuse. Work in partnership with our clients, CMD colleagues, and other contractors on improving medical policies, provider education, and system edits. Keep abreast of medical practice, changes in technology, and regulatory issues that may affect our clients. Work with the team to minimize the number of appeals; Suggest ideas that may improve audit workflows; Assist with QA functions and training team members. Participate in establishing edit parameters, new issue packets and development of Medical Review Guidelines. Interface with and support the Medical Director and cross train in all clinical departments/areas. Other duties as required to meet business needs.

Molina Healthcare

LVN Delegation Oversight Nurse Remote

Posted on:

November 6, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Arizona

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

The Delegation Oversight Nurse provides support for delegation oversight quality improvement activities. Responsible for overseeing delegated activities to ensure compliance with the National Committee for Quality Assurance (NCQA), Centers for Medicare and Medicaid Services (CMS), state Medicaid entity requirements and all other standards and requirements pertaining to delegation agreements. Contributes to overarching strategy to provide quality and cost-effective member care. This position will support our Corporate Compliance business. The candidate must have an unrestricted LVN licensure. Candidates must be technologically proficient, self-directed, autonomous and experience working from home. Care Management & Waiver Service Auditing experience is highly preferred. Work hours: Monday - Friday 8:00am – 4:00pm Remote position

At least 3 years’ experience in health care, including 2 years’ experience in a managed care environment facilitating utilization reviews, or equivalent combination of relevant education and experience. Licensed Vocational Nurse (LVN) or Licensed Practical Nurse (LPN). The license must be active and unrestricted in state of practice. Knowledge of audit processes and applicable state and federal regulations. Ability to work effectively in a fast-paced, high-volume environment, maintain accuracy and meet established deadlines. Ability to collaborate effectively with team members and internal departments. Strong attention to detail with a focus on maintaining quality in all tasks. Strong verbal and written communication skills. Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications: Certified Clinical Coder (CCC), Certified Medical Audit Specialist (CMAS), Certified Case Manager (CCM), Certified Professional Healthcare Management (CPHM) or Certified Professional in Healthcare Quality (CPHQ).

Coordinates, conducts and documents pre-delegation and annual assessments as necessary to comply with state, federal and National Committee for Quality Assurance (NCQA) guidelines, and other applicable requirements. Distributes audit results letters, follow-up letters, audit tools and annual reporting requirement as needed. Works with delegation oversight analytics representatives on monitoring performance reports from delegated entities. Develops corrective action plans (CAPs) when deficiencies are identified, and documents follow-up to completion. Assists with delegation oversight committee meetings. Works with delegation oversight leadership to develop and maintain delegation assessment tools, policies and reporting templates. Assists with preparation of delegation summary reports submitted to the Eastern US Quality Improvement Collaborative (EQIC) and/or utilization management committees. Participates as needed in joint operation committees (JOCs) for delegated groups. Assists in preparation of documents for Centers for Medicare and Medicaid Services (CMS), state Medicaid, National Committee for Quality Assurance (NCQA) and/or other regulatory audits as needed.

NPHire

Remote Family Nurse Practitioner – Short Virtual Consults | 5–6 hrs/day | NATIONWIDE

Posted on:

November 6, 2025

Job Type:

Contract

Role Type:

Telehealth

License:

NP/APP

State License:

Georgia

A growing telehealth group is seeking licensed MDs and Nurse Practitioners to deliver brief, focused virtual consultations for adult patients nationwide. This fully remote, contract role is ideal for clinicians who want flexible, on-demand hours (typically 5–6 per day) and streamlined workflows with no follow-ups or in-person visits. What’s Offered: $25–$60/hour, paid per consultation with monthly payouts 100% remote, flexible timing—only be online when patients are scheduled No controlled substances on formulary Admin and patient coordination support provided

Active U.S. license: MD or NP (FNP/AGNP/AGPCNP/ANP/DNP) Strong clinical judgment and clear patient communication Comfortable with telemedicine platforms and virtual workflows Experience: 4+ years (per posting)

Conduct short (1–2 minute) video or phone assessments Review patient info in the EHR and approve prescriptions for non-inflammatory medications Complete concise, compliant EMR documentation Coordinate with an admin team that manages scheduling and patient communication

Innovaccer

3521-Clinical Education and Training Lead

Posted on:

November 6, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Compact / Multi-State

Innovaccer activates the flow of healthcare data, empowering providers, payers, and government organizations to deliver intelligent and connected experiences that advance health outcomes. The Healthcare Intelligence Cloud equips every stakeholder in the patient journey to turn fragmented data into proactive, coordinated actions that elevate the quality of care and drive operational performance. Leading healthcare organizations like CommonSpirit Health, Atlantic Health, and Banner Health trust Innovaccer to integrate a system of intelligence into their existing infrastructure— extending the human touch in healthcare. For more information, visit www.innovaccer.com.

Story Health is seeking a Clinical Education and Training Lead to join our team. The Clinical Training Lead develops and delivers high-quality, evidence-based content to ensure clinical competency for members of the clinical team.

Current active Registered Nurse license in a compact state 5+ years clinical experience in a specialty practice or acute care setting 1+ year(s) experience teaching/training clinical staff 1+ year(s) experience developing curriculum to deliver to a remote workforce Bachelor’s or equivalent degree Able to take on multiple tasks in a dynamic, fast-paced, and changing team environment Passion for implementing technology to improve healthcare and able to quickly learn and use new software and tools High-speed home internet access Quiet home office space, free of distractions Nice to Have: Prior start up or digital health experience, particularly in a training or product design role Prior experience with one or more LMS applications

Own the design and delivery of the standard onboarding curriculum for new clinical team hires, to support the rapid scaling of a growing clinical team Lead new hire training sessions Monitor the performance of new hires for the first 30-60 days of employment in conjunction with the employee’s direct supervisor Identify ongoing training needs for all members of the clinical team Facilitate educational sessions to improve professional practice and ensure high-quality patient care. This may include developing and delivering course content or identifying external educational opportunities. Collaborate with Product and Growth teams to design trainings to support expanded service offerings Collaborate with Product team to ensure clinical staff have appropriate training related to product updates and enhancements Support training needs for customer clinical staff related to the Story Health platform and clinical workflows

Innovaccer

3515-RN Health Coach

Posted on:

November 6, 2025

Job Type:

Full-Time

Role Type:

Coaching

License:

RN

State License:

Compact / Multi-State

Innovaccer activates the flow of healthcare data, empowering providers, payers, and government organizations to deliver intelligent and connected experiences that advance health outcomes. The Healthcare Intelligence Cloud equips every stakeholder in the patient journey to turn fragmented data into proactive, coordinated actions that elevate the quality of care and drive operational performance. Leading healthcare organizations like CommonSpirit Health, Atlantic Health, and Banner Health trust Innovaccer to integrate a system of intelligence into their existing infrastructure— extending the human touch in healthcare. For more information, visit www.innovaccer.com.

Innovaccer is seeking a RN Health Coach to join our Story Health Team. You provide remote support to patients to optimize their medical therapy and serve as the liaison with the healthcare provider.

Current active Registered Nurse license in a compact state. 2+ years clinical experience in a specialty practice or acute care setting Bachelor’s or equivalent degree required Highly proficient written/verbal communication and interpersonal skills to interact with patients, caregivers, and healthcare providers Analytical skills required to problem solve patient issues and prepare reports Strong customer service skills, with ability to identify problems and formulate solutions. Able to take on multiple tasks in a dynamic, fast-paced, and changing team environment. Passion for implementing technology to improve healthcare and able to quickly learn and use new software and tools High-speed home internet access Quiet home office space, free of distractions Nice to Have: Cardiology experience Fluent in Spanish Experience working with patients in a virtual environment (via phone or telehealth platforms) Prior coaching or patient education experience

Support LPNs in managing patient panels, including medication management, lab work, and adherence to care plans Provide remote patient care including coaching and education using digital communication tools (including texting, phone calls, and telehealth platforms). Provide telephone triage to patients with acute or worsening symptoms and escalate to providers as appropriate Work with patients and their caretakers to increase engagement and help them overcome barriers in their healthcare journey Guide patients with their changing medical therapies using a clinician-designed protocol. Connect patients back with their clinicians as needed when their condition changes. Serve as the interface between the patients and others in the healthcare system, including providers, clinics, pharmacies, etc Other responsibilities as required, including supporting early-stage initiatives in an innovative health tech startup

Innovaccer

3513- LPN/LVN Health Coach

Posted on:

November 6, 2025

Job Type:

Full-Time

Role Type:

Coaching

License:

LPN/LVN

State License:

Compact / Multi-State

Innovaccer activates the flow of healthcare data, empowering providers, payers, and government organizations to deliver intelligent and connected experiences that advance health outcomes. The Healthcare Intelligence Cloud equips every stakeholder in the patient journey to turn fragmented data into proactive, coordinated actions that elevate the quality of care and drive operational performance. Leading healthcare organizations like CommonSpirit Health, Atlantic Health, and Banner Health trust Innovaccer to integrate a system of intelligence into their existing infrastructure— extending the human touch in healthcare. For more information, visit www.innovaccer.com.

Story Health is seeking a licensed practical nurse or licensed vocational nurse to join our team. You will work with our patients to optimize their medical therapy and serve as the liaison with the healthcare provider.

Associates or equivalent degree required Hold an active multistate license as a practical nurse or vocational nurse in a compact state 2+ years of experience in a patient care role, preferably in a remote setting Highly proficient written/verbal communication and interpersonal skills to interact with patients, caregivers, and healthcare providers Analytical skills required to problem solve patient issues and prepare reports Strong customer service skills, with ability to identify problems and formulate solutions. Able to take on multiple tasks in a dynamic, fast-paced, and changing team environment. Passion for implementing technology to improve healthcare and able to quickly learn and use new software and tools High-speed home internet access Quiet home office space, free of distractions Nice to Have: Cardiology experience Fluent in Spanish Experience working with patients in a virtual environment (via phone or telehealth platforms)

Provide remote patient care to patients with chronic conditions using digital communication tools (including texting, phone calls, and telehealth platforms) Complete onboarding calls with patients to review program expectations, perform medication review, and address initial care needs Educate patients and their families on the use of home monitoring devices (scales, blood pressure cuffs, etc.) Conduct monthly engagement calls with patients to ensure they have the support they need to follow their provider’s treatment plan Coordinate care related to prescribed medications, lab work, and other therapies for your assigned patient panel Provide education to patients and their families regarding disease processes and adherence to their care plan Screen patients who report new symptoms or have questions related to their care Be a key contributor to the early stages of an innovative health tech startup contributing wherever needed

NPHire

Telehealth Family NP – Remote Consults | Work From Home | $60/hr

Posted on:

November 6, 2025

Job Type:

Contract

Role Type:

Telehealth

License:

NP/APP

State License:

Georgia

A growing telehealth organization is seeking experienced Nurse Practitioners licensed in Georgia to join its nationwide virtual care network. This role is ideal for NPs who want flexibility, autonomy, and supplemental income while providing short, focused virtual consultations to adult patients across the U.S. Clinicians from other states are welcome to apply — however, NPs with an active Georgia license will be prioritized due to rising patient demand in the region. What’s Offered: ~$60/hour, paid per consultation (monthly payouts) Flexible hours — 5–6 hrs/day, work only when scheduled Fully remote — work from anywhere No controlled substances on formulary Admin and scheduling support provided

Active U.S. NP license (Georgia preferred) FNP, AGNP, ANP, AGPCNP, or DNP certification Strong clinical assessment and decision-making skills Comfortable using telemedicine technology

Conduct brief (1–2 minute) video or phone consults for non-inflammatory conditions Review patient information and issue prescriptions when appropriate Document efficiently using a streamlined EHR platform Collaborate with an admin team that handles scheduling and patient coordination

Provider Network Management

Now Hiring: Texas Licensed Nurse Practitioners (Remote | 1099 | Part-Time | Flexible Hours)

Posted on:

November 6, 2025

Job Type:

Part-Time

Role Type:

Primary Care

License:

NP/APP

State License:

Texas

Provider Network Management coordinates provider recruiting, scheduling, software training, and revenue cycle management. We take a very hands-on approach to management and have a dedicated staff to answer questions and assist in the process of onboarding. Our proprietary software allows us to track the onboard process and find placement opportunities for remote healthcare providers nationwide.

Provider Network Management is hiring Texas licensed Nurse Practitioners (1099) to provide part-time, low-acuity telemedicine consultations remotely through our proprietary EHR platform. Applicants must hold an active, unrestricted Texas state license. Flexible Weekday Hours: Monday–Friday, 9 AM–6 PM CST Pay: $25 per completed consultation, paid weekly (NET-7) Malpractice coverage with tail included No controlled substances prescribed Minimum commitment: at least 9 hours per week

Applicants must hold an active, unrestricted Texas state license.

Common patient conditions include pain, muscle spasms, migraines, skin issues, acid reflux, constipation, and nausea. Ideal for NPs experienced in primary care, family medicine, internal medicine, urgent care, or pain management who hold a current Texas license and seek flexible, independent telehealth work.

Cadence

Nurse Practitioner - West Coast

Posted on:

November 6, 2025

Job Type:

Full-Time

Role Type:

Primary Care

License:

NP/APP

State License:

Compact / Multi-State

In the U.S., 60% of adults – more than 133 million people – live with at least one chronic condition. These patients need frequent, proactive support to stay healthy, yet our care system isn’t built for that level of attention. With rising clinician shortages, strained infrastructure, and reactive care models, patients too often end up in the ER or the hospital when those outcomes could have been prevented. At Cadence, we’re building a better system. Our mission is to deliver proactive care to one million seniors by 2030. Our technology and clinical care team extend the reach of primary care providers and support patients every day at home. In partnership with leading health systems, Cadence consistently monitors tens of thousands of patients to improve outcomes, reduce costs, and help patients live longer, healthier lives.

The Cadence Health team seeks a remote-based Nurse Practitioner to serve as the point person to help patients navigate their remote care journey. Our Nurse Practitioners are responsible for appropriately triaging patients based on vitals, and managing treatment plans and medications in collaboration with the patient’s physician/provider. Licensure: Active Compact RN license required, plus active NP licenses in CA and WA, and in at least one of: AK, AZ, HI, MT, NM, or OR. The schedule for this position would be Monday–Friday, 8 AM–5 PM in Pacific Time.

5+ years experience treating patients with chronic diseases (T2D, Hypertension, CHF) either in an outpatient or inpatient setting at a high-performing medical center. Active multi-state compact RN license. ANCC or AANP certification required. Master’s Degree as a Nurse Practitioner with the willingness to expand state licensure as Cadence adds new markets and partners. Experience managing CHF with GDMT. To ensure that our clinicians have the necessary tools for a successful remote work environment, home office setups must have consistently stable Wi-Fi with strong upload and download speeds. A Wi-Fi speed test is required before participating in the interview process to verify that these standards are met. Ability to thrive in an environment founded on trust, autonomy, and direct communication & feedback. Love of owning of problems end-to-end. Independent thinker/operator. Passion for the patient/customer experience and systematically improving healthcare with digital innovation. Experience working in a CHF bridge clinic or T2D clinic (preferred). Experience working with remote patient monitoring technology (preferred). Experience working in a startup environment (preferred).

Oversee the monitoring of patient vitals, symptoms, and labs in collaboration with our team of RNs and MDs. Manage the patient's treatment plan and medications – with an emphasis on initiating and titrating guideline-directed medical therapy (GDMT) for Heart Failure and other appropriate guidelines for T2D and Hypertension. Respond to patient escalations identified via RPM – i.e. abnormal vitals, symptoms, and labs. Lead regular virtual check-ins with patients to review labs and GDMT optimization and adherence. Our programs support both primary care offices as well as cardiology offices. Ensuring every healthcare interaction with Cadence is an exceptional experience that prioritizes the well-being of the patient and aligns with the goals of the health system. Support internal growth efforts to help Cadence scale exceptional care delivery to patients with CHF and other chronic conditions including hypertension, and Type 2 diabetes. Be instrumental in shaping the culture of one of the fastest-growing teams at Cadence.

Urrly

Cardiology Nurse Practitioner - Remote

Posted on:

November 6, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Maryland

At Urrly, we are transforming healthcare recruitment by specializing in both clinical talent and the professionals who power the business side of healthcare. Our true partnership approach combines expert recruiters with cutting-edge AI, automating administrative tasks and connecting candidates and companies at scale. This allows us to cut the average time to fill to 21.5 days—about half the industry average—while reducing hiring costs significantly. We excel in recruiting for clinical and telehealth roles, as well as sourcing finance professionals, technology experts, and executives who are critical to supporting healthcare operations. Our focus on value-based care models—including preventive, post-acute, telehealth, home health, and hospice—ensures that we match talent with organizations where they can have the greatest impact. Our proprietary role rubric allows us to assess both passive and active candidates with precision, delivering match scores that ensure the right talent fits the right opportunity. This tailored approach spans from nurse practitioners and allied health professionals to finance, IT, and leadership roles. By partnering with fast-growing healthcare organizations, we’ve reduced hiring costs by up to 85%, helping build the clinical and operational teams that shape the future of healthcare.

Cardiology Nurse Practitioner – Telehealth (Full-Time, Remote After Training) Location: Maryland or D.C. License Required Training Site: Columbia, MD (4–6 weeks onsite) Compensation: $123,528–$146,836 all-in Schedule: Full-time, weekdays only Make an Impact in Cardiology—Without the Burnout You became a clinician to make a difference, not to drown in paperwork or endless follow-ups. This role lets you focus on meaningful patient interactions—while helping cardiologists dedicate more time to high-acuity care. After a short onsite training period in Columbia, MD, you’ll transition to remote telehealth visits with stable hours, strong protocols, and a supportive health system behind you.

Active NP license in Maryland or D.C. 2+ years of cardiology experience (outpatient preferred) Willingness to complete 4–6 weeks of onsite training in Columbia, MD Strong comfort with telehealth workflows and independent patient management Bonus points if you have: Prior telehealth experience Familiarity with large health system operations

Lead telehealth visits for low-acuity cardiology patients Manage ongoing care plans using clear, evidence-based protocols Conduct routine follow-ups that reduce strain on cardiology specialists Document progress and outcomes in the EMR Collaborate with multidisciplinary teams across a large health system

Urrly

Telehealth NP/PA – Musculoskeletal Care

Posted on:

November 6, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Arizona

At Urrly, we are transforming healthcare recruitment by specializing in both clinical talent and the professionals who power the business side of healthcare. Our true partnership approach combines expert recruiters with cutting-edge AI, automating administrative tasks and connecting candidates and companies at scale. This allows us to cut the average time to fill to 21.5 days—about half the industry average—while reducing hiring costs significantly. We excel in recruiting for clinical and telehealth roles, as well as sourcing finance professionals, technology experts, and executives who are critical to supporting healthcare operations. Our focus on value-based care models—including preventive, post-acute, telehealth, home health, and hospice—ensures that we match talent with organizations where they can have the greatest impact. Our proprietary role rubric allows us to assess both passive and active candidates with precision, delivering match scores that ensure the right talent fits the right opportunity. This tailored approach spans from nurse practitioners and allied health professionals to finance, IT, and leadership roles. By partnering with fast-growing healthcare organizations, we’ve reduced hiring costs by up to 85%, helping build the clinical and operational teams that shape the future of healthcare.

Work 100% remotely while shaping modern MSK care with a leading value-based team. Role: Remote Nurse Practitioner or Physician Assistant – Musculoskeletal Care (AZ License Required) Location/Type: Remote • AZ-based (preferred) Pay: $124,000–$133,000 (exempt) Schedule: Full-time • M–F • 7am–4pm PST

Active NP or PA license in AZ 2+ years in a clinical setting U.S. work authorization Strong charting and documentation skills Comfortable collaborating across virtual and in-clinic teams Nice to have: Experience in MSK or spine care Familiarity with care navigation platforms

Evaluate patients via telehealth and clinic rounds Review charts and prep for physician consultations Coordinate care with PT and virtual wellness teams Track patient progress through dashboards and reports Identify high-risk or slow-progress patients and guide next steps Document care events accurately and promptly Support data review and outcomes reporting

CVS Health

Certified Palliative / Hospice Nurse Practitioner - Aetna Compassionate Care Program

Posted on:

November 6, 2025

Job Type:

Full-Time

Role Type:

Care 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.

Our palliative and hospice care certified Nurse Practitioners (NP) are key members of the Aetna Compassionate Care Program (ACCP), supporting members with advancing illness by serving as their primary advocate and point of contact. The NPs work closely with an interdisciplinary care team to deliver compassionate care and guidance during a critical time in the member’s life. This position is fully remote. Eligible candidates may reside anywhere in the United States but must hold an active nursing license in the state of Illinois, with the ability to obtain a compact nursing license.

Active and unrestricted Registered Nursing license in the State of Illinois with an ability to obtain a compact nursing license. 5–8 years of experience as a Nurse Practitioner in palliative and/or hospice care is required. A combination of RN and NP experience in these care settings may also be considered. Experience working in a matrixed environment, including cross-functional collaboration across multiple departments and teams Preferred Qualifications Preferred Board Certification in Hospice or Palliative Care, or enough education / experience to sit for Certification exam within first 6 months of hire. Required Education / Certification: Masters degreed Nurse Practitioner ANCC or ANP Board Certified Nurse Practitioner

Medication management, and adherence Significant and time-intensive investment in patient and caregiver education, incl. symptom detection/management and diet/lifestyle modification Partnership, communication, and integration with community-based Primary Care Physicians Home safety checks Screening for behavioral, social, and psychosocial determinants of health Lead responsibility for care management engagement while working with targeted members, as well as collaborate with ACCP RN care managers Support members with advance care planning. As a part of this process, the option of hospice is addressed when appropriate and support is provided for members electing to transition to hospice. ACCP RN care managers will continue to follow and be available to members electing hospice to ensure a smooth transition, avoid a sense of abandonment and to help members to navigate their continued health plan benefits and services. Provides consultation both formal and informal, education, review of literature and evidence-based care for the support of the member, coordinates needed care or follow up care for patients to provide safe, effective, efficient, and timely patient centered care. Liaises between visiting nurses, clinical staff and specialist consult services, care plan execution will encompass the entire service to tie all disciplines supporting the member together, consults with physicians or surgeons regarding the care of patients for more complex diagnosis. Documents care coordination encounters with interdisciplinary care team and works collaboratively with other health professionals to determine health needs of member and family. Demonstrates and role models an interdisciplinary collaborate approach to support the member and their family. While working with members the certified hospice or palliative care NP will evaluate members for needed service. When needed services are identified, the NP will work with the members’ physicians to facilitate access to benefits and services to address identified needs.

Optum

RN Telephonic Nurse Case Manager – Kidney

Posted on:

November 6, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

For those who want to invent the future of health care, here’s your opportunity. We’re going beyond basic care to health programs integrated across the entire continuum of care. As an RN Telephonic Nurse Case Manager, you will be responsible for clinical operations and medical management activities across the continuum of care from assessing and planning to implementing, coordinating, monitoring, and evaluating. You will also be responsible for providing health education, coaching and treatment decision support for members. You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. Monday-Friday business hours as you take on some tough challenges in a fast paced environment. Hours: Monday through Friday 8AM -5PM within your local time zone with one night a week until 7PM

Active, unrestricted RN license in a compact state Compact License OR Compact Equivalent and ability to obtain additional licenses if needed 3+ years of clinical experience within Nephrology/ Dialysis setting Computer proficiency utilizing MS Office (Word, Excel, PowerPoint, and Outlook), including the ability to type and talk at the same time while navigating a Windows environment Reside in a location that can receive a UnitedHealth Group approved high speed internet connection or can leverage existing high – speed internet service Access to dedicated workspace from home for in home office set up Preferred Qualifications: BSN Certified Case Manager (CCM) Telephonic case management experience Experience with discharge planning Experience in a remote position

Making outbound calls to assess members’ current health status Identifying gaps or barriers in treatment plans Providing patient education to assist with self-management Interacting with Medical Directors on challenging cases Coordinating care for members and services as needed (home health, DME, etc.) Educating members on disease processes Encouraging members to make healthy lifestyle changes Making “welcome home” calls to ensure that discharged member receive the necessary services and resources Documenting and tracking findings

Aspire Health

Seeking nurse practitioner

Posted on:

November 6, 2025

Job Type:

Contract

Role Type:

Primary Care

License:

NP/APP

State License:

Compact / Multi-State

As a telemedicine practice, our mission is to, truly make a difference in patients’ lives. We strive to demonstrate empathy, aspire to give our patients hope and help them live healthier, happier lives. We bridge the gap between functional care and traditional medicine ensuring that every patient receives a superior standard of care.

Now Hiring: Telemedicine Nurse Practitioner Aspire Health is seeking a Nurse Practitioner with experience in weight management to join our growing telemedicine team! 100% Telemedicine Provide expert care from anywhere with a flexible, supportive team. Comprehensive Weight Loss & Hormone Care We’re not your typical national telehealth provider. Our clinicians take time with every patient, offering personalized treatment plans for sustainable weight management, hormone balance, and overall wellness. We truly follow our patients throughout their journey with consistent, compassionate care. 1099 to Start, with Growth Potential Begin as an independent contractor with the opportunity to grow into a full-time position as our team expands. Flexible Schedule

Weight Management Experience (Required) Hormone Replacement Therapy (Required) Peptide Therapy Experience (Preferred) Midwest-Based Candidates Preferred Multi-state license (Required)

Merakey

LumiLink Nursing Assistant Manager - Remote

Posted on:

November 5, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Compact / Multi-State

Merakey is a leading developmental, behavioral health and education non-profit provider offering a breadth of integrated services to individuals and communities across the country. We leverage our size and expertise to develop innovative solutions and new models of care to meet the needs of individuals, their families, public and private healthcare funders and community partner organizations. We recognize that complex needs require a holistic approach. With our experience, expertise and compassion, we empower everyone within our communities to reach their fullest potential.

Position Type: Full-Time Shift: 2nd Shift - with week-ends Work Schedule: Wednesday - Sunday 3pm-11pm with every other week on call responsibilities Are you looking for an opportunity to advance your career while working with an extraordinary team? Our Merakey affiliate (LumiCare) is looking for a Remote Nursing Assistant Manager to join the team.

Schedule requirements - Wednesday - Sunday, 3pm-11pm with every other week on call responsibility (1st, 2nd, 3rd, weekends) Current/active U.S. Pennsylvania State RN licensure. Compact RN license or will obtain PA compact license within 1 month of hire (internal applicants) Minimum of 2 years’ clinical experience in an acute or ambulatory care setting within the U.S. Preferred IDD group home and supervisory experience

The Assistant Nursing Manager is responsible for providing scheduled on-call support to nursing staff, ensuring continuity of care and effective triage for health-related concerns. This role involves being available for staff questions, training, and scheduling needs during assigned on-call periods. The Assistant Nursing Manager will alternate weekend/after-hours on-call responsibilities with the Nursing Supervisor every week, including holidays, and may be required to flex shifts as needed to maintain adequate coverage and support nursing staff. Additional responsibilities include assisting in maintaining 24/7 RN coverage, responding to inquiries, and managing healthcare monitoring dashboards for the Health Monitoring Package and Nurse Connect Program. The role will serve in a leadership capacity with direct reports, overseeing performance, conducting interviews, and participating in hiring and termination decisions. This role will also be responsible for employee relations, providing coaching and support to ensure team accountability, growth, and alignment with organizational values.

Insight Global

Case Management Nurse

Posted on:

November 5, 2025

Job Type:

Contract

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

Insight Global is an international professional services and staffing company specializing in delivering talent and technical solutions to Fortune 1000 companies across the IT, Non-IT, Healthcare, and Engineering industries. Fueled by staffing and talent experts, Evergreen, our professional services brand, brings technical advisors and culture consultants to help customers tackle their biggest challenges. With over 70 locations across North America, Europe, and Asia, and global staffing capabilities in 50+ countries, our teams of tech-enabled recruiters are dedicated to finding the right talent and technical solutions to help our customers thrive. At our core, we are dedicated to empowering people to do great things. That’s why we’re passionate about developing our people personally, professionally, and financially so they can be the light to the world around them. To find out more, visit www.insightglobal.com

Position: RN Care Managers Location: Remote (Must be in a Compact License State!) Duration: 6-month C2H Pay Rate: $35 - $40/hr Schedule: 40 hours per week, 9:00am – 6:00pm (1 hour lunch)

Active, unrestricted RN Compact license (Must reside in the state their license is valid in) 2+ years in case management, care management, or disease management for a health insurance company, a health navigator or a TPA 2+ years of remote care or telephonic case management Bachelor of Science in Nursing (BSN) Plusses: CCM (Certified Case Manager) certification

Insight Global is looking for a Remote Nurse Care Manager to support a virtual care and healthcare navigation company. This individual will act as a clinical partner helping high-risk and rising-risk members through proactive outreach, post-discharge planning, and care coordination. They will collaborate with a multidisciplinary team to develop and execute holistic care plans while ensuring that each member receives the guidance, education, and support they need throughout their healthcare journey. Day-to-day responsibilities include but are not limited to, coordinating communication with hospital care management teams, supporting medication reconciliation efforts, and navigating members to their employee resources. This is an awesome opportunity to join a tech-enabled care integrator and contribute to a growing Care & Case Management team!

Clarest Health

Remote Licensed Practical Nurse

Posted on:

November 5, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Akansas

CSS Health (a division of Clarest Health) is a software company that supports health insurance companies by providing software solutions and outsourced services. We license software to help manage medical programs, particularly the Medication Therapy Management (MTM) Program required by CMS for Medicare Part D. We also offer outsourced MTM services, utilizing our team of pharmacists, clinicians, and support staff to conduct Comprehensive Medication Reviews (CMRs) for our clients' members. These reviews are crucial for maintaining high star ratings in Medicare Part D programs.

Our Licensed Practical Nurse will play a key role in performing telephonic patient outreach, interviewing patients about their medications, and ensuring adherence and patient safety. This position does not involve hands-on care. Dept: Medication Management and Care Coordination Reports To: Nursing Supervisor Location: Remote eligible in AR, CA, FL, GA, IL, ME, MI, MO, NY, NC, OH, OK, OR, PA, TX, WV and WY Salary: Start at $22/hr with ample opportunity to increase base comp throughout the first year Schedule: Monday through Thursday: 11 a.m. to 7:00 p.m. and Friday: 9:00 a.m. to 5:00 p.m

Graduation from an accredited nursing program (LPN) or (LVN) with an active license. (Must be in good standing) At least 1 year of experience in the healthcare industry and/ or call center experience preferred. Intermediate understanding of Microsoft Office Suite (Excel, Word, etc.) and database navigation. Understanding of HIPAA, Privacy, Safety, and Compliance guidelines. Understanding of Medicare and Medicaid programs preferred. Knowledge of MTM and Transition of Care procedures and processes preferred. Skills + Abilities: Strong multitasking abilities to manage patient interactions and documentation efficiently. In-depth knowledge of medications, including common uses, side effects, and interactions. Ability to work as a team member, demonstrate professionalism, and possess strong telephonic communication skills. Attention to detail and exercise professional work ethics. Maintain a student mentality to continuously learn and improve in the role. Ability to navigate database systems efficiently. Excellent record-keeping techniques. Specific vision abilities include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus. Proficient with computers and comfortable learning new programs. Must have high-speed internet.

The ability to adhere to Clarest’s Code of Conduct, follow Clarest Compliance policies and procedures, and report any suspected violations of any federal or state laws to either their direct supervisor, Human Resources or the Compliance Officer Conduct telephonic patient interviews in both Spanish and English about their medications, including prescriptions and over-the-counter items. Discuss adherence, adverse effects, current health status, and provide therapeutic recommendations. Accurately document clinical data in patient charts. Identify potential issues based on patient interviews and information gathered. Maintain current knowledge of medications and adhere to CSS Health policies and procedures, including HIPAA, privacy, and security. Operate office equipment such as voicemail messaging systems, email, and various software applications to support operational processes. Multitask effectively to manage multiple patient interactions and documentation tasks simultaneously. Maintain a student mentality, continuously seeking opportunities to learn and stay updated on the latest in medication management and care coordination. Perform other duties or tasks as assigned or required. Must have high-speed internet.

Clarest Health

Remote Licensed Practical Nurse - Bilingual (Spanish)

Posted on:

November 5, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Virginia

CSS Health (a division of Clarest Health) is a software company that supports health insurance companies by providing software solutions and outsourced services. We license software to help manage medical programs, particularly the Medication Therapy Management (MTM) Program required by CMS for Medicare Part D. We also offer outsourced MTM services, utilizing our team of pharmacists, clinicians, and support staff to conduct Comprehensive Medication Reviews (CMRs) for our clients' members. These reviews are crucial for maintaining high star ratings in Medicare Part D programs.

Our Bilingual LPN Clinical Interviewer will play a key role in performing telephonic patient outreach, interviewing patients about their medications, and ensuring adherence and patient safety. This position does not involve hands-on care. Dept: Medication Management and Care Coordination Reports To: Nursing Supervisor Location: Remote Salary: Start at $23/hr with ample opportunity to increase base comp throughout the first year Schedule: Monday through Thursday: 11 a.m. to 7:00 p.m. and Friday: 9:00 a.m. to 5:00 p.m

Graduation from an accredited nursing program (LPN) or (LVN) with an active license. (Must be in good standing) At least 1 year of experience in the healthcare industry and/ or call center experience preferred. Fluency in both Spanish and English. Intermediate understanding of Microsoft Office Suite (Excel, Word, etc.) and database navigation. Understanding of HIPAA, Privacy, Safety, and Compliance guidelines. Understanding of Medicare and Medicaid programs preferred. Knowledge of MTM and Transition of Care procedures and processes preferred. Skills + Abilities: Strong multitasking abilities to manage patient interactions and documentation efficiently. In-depth knowledge of medications, including common uses, side effects, and interactions. Ability to work as a team member, demonstrate professionalism, and possess strong telephonic communication skills. Attention to detail and exercise professional work ethics. Maintain a student mentality to continuously learn and improve in the role. Ability to navigate database systems efficiently. Excellent record-keeping techniques. Specific vision abilities include close vision, distance vision, peripheral vision, depth perception, and the ability to adjust focus. Proficient with computers and comfortable learning new programs. Must have high-speed internet.

The ability to adhere to Clarest’s Code of Conduct, follow Clarest Compliance policies and procedures, and report any suspected violations of any federal or state laws to either their direct supervisor, Human Resources or the Compliance Officer Conduct telephonic patient interviews in both Spanish and English about their medications, including prescriptions and over-the-counter items. Discuss adherence, adverse effects, current health status, and provide therapeutic recommendations. Accurately document clinical data in patient charts. Identify potential issues based on patient interviews and information gathered. Maintain current knowledge of medications and adhere to CSS Health policies and procedures, including HIPAA, privacy, and security. Operate office equipment such as voicemail messaging systems, email, and various software applications to support operational processes. Multitask effectively to manage multiple patient interactions and documentation tasks simultaneously. Maintain a student mentality, continuously seeking opportunities to learn and stay updated on the latest in medication management and care coordination. Perform other duties or tasks as assigned or required. Must have high-speed internet. This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of this employee for this role.

BridgePoint Healthcare

Appeals Nurse (28670)

Posted on:

November 5, 2025

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Virginia

BridgePoint Healthcare is dedicated to promoting healing and wellness in a safe and welcoming environment, with an individualized path to recovery for each patient. BridgePoint Healthcare provides patient-centered, individualized care for patients requiring longer hospitalizations in post-acute care settings. We are a diversified provider of post-acute care in settings ranging from long-term acute care hospitals to skilled nursing facilities. Our locations include two in Washington, DC (BridgePoint Hospital National Harborside and BridgePoint Hospital Capitol Hill), and one in New Orleans (BridgePoint Continuing Care Hospital - West Jefferson Campus).

At BridgePoint, whether you work with patients every day or support those who do, you are making a difference that matters. We know the path to recovery doesn't happen alone. As a team, we work cohesively to meet each patients unique needs. We are a team-driven environment and we care about our own! Our employees form the foundation of everything we do optimizing patient healing and wellness, and creating a warm and welcoming environment. It is because of the dedication of our employees that we can live out our mission, vision, and company values every day. It is at BridgePoint where care, community, and careers happen.

Education: Associates degree. Bachelor's degree preferred. Licenses/Certification: Current RN - Registered Nurse license. Experience: Minimum 2 years of acute care experience in a hospital or LTACH. Safety Sensitive-Designated Positions

Here at BridgePoint, the Appeals Nurse is responsible for managing payer denials and coordinating the appeal process to ensure accurate reimbursement for medically necessary LTACH services. The Appeals Nurse role involves detailed clinical review of medical records, preparation of evidence-based appeal letters, and collaboration with physicians and clinical teams to support medical necessity, continued care, and regulatory compliance. The Appeals Nurse plays a critical role in protecting hospital revenue, improving documentation quality, and reducing denial rates across LTACH facilities.

Summit Home Care & Hospice

Quality Assurance Registered Nurse (9435)

Posted on:

November 5, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Ohio

Summit Home Care is a skilled home care agency committed to providing comprehensive health care in the comfort and convenience of home. Our mission is to positively impact quality of life by redefining the delivery of care. We are driven to exceed the standard of care that our competitors accept. The vision of Summit Home Care is to revolutionize health care in the home by becoming the unmatched leader across the US.

Summit Home Care and Hospice is searching for an experienced and motivated Quality Assurance Registered Nurse to join our Home Health & Hospice teams. At Summit, we believe healthcare should be personal, compassionate, and delivered where it matters most—at home. QA Registered Nurse Hours: Monday – Friday; Standard Business Hours (40 Hours/Week) Work Setting: Remote Approved Remote Location: Ohio Pay Rate: $28.00 – $31.00 per Hour Job Summary: The Quality Assurance (QA) Nurse is a professional, Registered Nurse (RN) responsible for analyzing data integrity and consistency of OASIS documentation and assessment processes. This position will ensure appropriate ICD-10 coding and sequencing and will work with clinical staff to clarify documentation and data integrity issues.

Associate or bachelor’s degree in nursing from as accredited school of nursing. A valid/active RN license in the state of Ohio. At least one (1) year of OASIS review required. 1-2 years of clinical home health experience preferred. OASIS certification preferred. Working knowledge of OASIS and ICD-10 coding. Knowledge of federal regulations and state licensure requirements. Proficient in Wellsky EMR. Working knowledge of Microsoft 365. Excellent coordination and communication skills. Detail oriented and able to work with minimal supervision. Must successfully pass a background check in accordance with state and federal regulations.

Prospectively review all OASIS assessments to ensure appropriateness, completeness, and compliance with federal and state regulations and organization policy. Utilize OASIS variation or alert reports when reviewing OASIS data. Ensure appropriate ICD-10 coding and sequencing as it relates to the patient's medical condition. Consult with appropriate clinical staff to clarify any data integrity issues and will work with the clinician to make appropriate corrections according to policy. Review visit utilization for appropriateness of care guidelines and patient condition; reports potential financial losses and/or underutilization to the clinical manager/designee. Notify organizational leadership of problematic trends as a result of OASIS review. Work with managers to address trends that affect the agency's outcome and process measures noted during OASIS review. Participate in Quality Improvement and Corporate Compliance activities as assigned. Assist with other chart audit activities as assigned. Maintain professional and technical knowledge by attending educational workshops and reviewing professional publications. May be requested to perform job-related tasks other than those stated in this description.

MPF Federal, LLC

Remote Call Center Nurse (RN-BSN) December Start

Posted on:

November 5, 2025

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

Compact / Multi-State

Ready to Bring Your Acute Care Skills Home? Join Our Remote RN Team Supporting Our Military Communities! Are you a seasoned ER or Med-Surg nurse looking for a meaningful, mission-driven role that lets you care for others without the scrubs and long drives to the hospital? MPF Federal is hiring Remote Telehealth Triage Nurses (RNs) to join our 24/7 Nurse Advice Line—supporting veterans and their families—all from the comfort of your home. This isn't just a job; it's your chance to use your clinical expertise, empathy, and critical thinking skills to guide patients through their toughest moments—all while achieving better work-life balance. Pay & Perks: $35.00/hr base rate Evening, night, and weekend differentials may apply 100% Remote - Work From Home Most schedules include Saturday and Sunday and do not rotate Shifts Available (Share Your Schedule Preference!) Day Shifts Evening Shifts Night Shifts Training Approximately 6 Weeks Paid Training | Monday-Friday, 8:00 AM - 4:30 PM Start Date: December 1, 2025 - You will be required to also work BOTH Christmas and New Years

You're a Great Fit If You Have: 5+ Years of Recent Hands-On Acute Care RN Experience ER or Med-Surg strongly preferred Current Compact RN License in good standing from the state you are physically in BSN Degree from an accredited American university Confidence with phone-based care and multi-screen computer systems Strong clinical judgment, emotional intelligence, and documentation skills A mission-first mindset and passion for serving military-connected communities Bonus Points If You Also Have: Experience with behavioral health, mother-baby, and/or peds Past work in telehealth, triage, or call center nursing Familiarity with military healthcare systems or VA patients Tech & Work Environment: Must have a hard-wired Ethernet internet connection (Wi-Fi only, satellite, or radio internet is not acceptable) Quiet, distraction-free home office space with a door for HIPAA compliance Metrics-driven environment - you'll need to meet quality, handle time, and documentation goals Federal Requirements: Must be a U.S. Citizen Ability to pass a Public Trust Background Check & Drug Screening per federal guidelines Must be willing and able to obtain licenses in all 50 states (we support you here!)

Triage Symptoms: Assess callers using evidence-based protocols Deliver Immediate Care Advice: Recommend next steps, from self-care to urgent care, calmly and confidently Offer Health Education: Counsel patients on medications, test results, and chronic condition management Crisis Triage: Handle behavioral health, emergency, and complex calls with empathy and grace Document Interactions: Accurately chart calls in our EHR and follow compliance protocols Team Collaboration: Work closely with a supportive leadership team and fellow remote RNs If you're an experienced nurse with a calm voice, a critical mind, and a heart for service—this is your moment to make a real difference.

Mercor

Critical Care RN Nurse

Posted on:

November 5, 2025

Job Type:

Part-Time

Role Type:

License:

RN

State License:

California

Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst, Peter Thiel, Adam D'Angelo, Larry Summers, and Jack Dorsey.

Position: Registered Nurse Type: Independent Contractor Compensation: $60–$110/hour Location: Remote Duration: 3–4 weeks Commitment: 30–40 hours/week

Must-Have: 4+ years professional experience in your domain. Excellent written communication with strong grammar and spelling skills. Start Date: Immediately Compensation & Legal: Hourly contractor, Paid weekly via Stripe Connect.

Create deliverables addressing common requests in your professional domain. Review peer-developed deliverables to enhance AI research. Diagnose and solve real issues in AI model training and evaluation. Work independently and asynchronously to meet deadlines. Collaborate with AI research teams to improve model outputs.

Central California Alliance for Health

Temporary Quality Improvement Nurse PQI

Posted on:

November 5, 2025

Job Type:

Contract

Role Type:

Primary Care

License:

RN

State License:

California

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

Location: Mariposa County, California; Merced County, California; Monterey County, California; San Benito County, California; Santa Cruz County, California ABOUT THIS TEMP POSITION: This is a temporary position and the length of assignment is estimated to the end of the year with an opportunity for extension. The length of the assignment is always dependent on business need and dates may change. While the assignment would be at the Alliance, if selected, you would be an employee of a temporary employment agency that we would connect you with. OTHER INFORMATION: We are in a hybrid work environment and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. This is a temporary position and does not provide the benefits that are listed below (it is standard language from our regular job posts and cannot be altered or removed).

Desirable Qualifications: Experience in process improvement, practice coaching, or health care quality improvement Experience performing PQI activities Working knowledge of managed care, the Medi-Cal program, and related policy Working knowledge of the methods of conducting and interpreting quantitative and qualitative analysis Some knowledge of NCQA HEDIS abstracting guidelines Some knowledge of CPT and ICD coding principles To read the full position description, and list of requirements click here. Knowledge of: The principles and practices of clinical nursing Medical practice operations and healthcare delivery systems Ability to: Participate in and support internal and external audits Identify issues, conduct research, gather and analyze information and data, reach logical and sound conclusions, and make recommendations for action Analyze information and data and prepare oral and written reports Education and Experience: Current, unrestricted license as a Registered Nurse issued by the State of California Bachelor’s degree in Nursing and a minimum of three years of experience as a Registered Nurse in acute care or primary care with an emphasis on preventative care (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying

Reporting to the Clinical Safety Supervisor, this position: Develops, manages, and measures a comprehensive healthcare strategy in alignment with Department of Health Care Services (DHCS) standards of care and in collaboration with internal stakeholders and network providers to promote best evidence-based practices and improve member health outcomes Evaluates patient safety and quality issues and communicates findings to internal stakeholders, network providers and community partners

Ivim Health

Nurse Practitioner

Posted on:

November 5, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

At Ivim Health, we are redefining health and wellness through personalized care and innovative solutions. Our mission is to empower patients to achieve their health goals by tailoring care to their unique needs and perspectives. We believe in fostering collaborative partnerships with our patients, ensuring that their voices are at the heart of every decision. By combining compassion, continuous innovation, and a commitment to affordability and accessibility, we aim to create a world where personalized health care is not just a privilege but a standard. Together, we strive to enrich lives by supporting physical, mental, and emotional well-being—one patient at a time.

Job Title: Nurse Practitioner Department: Medical Reports To: Care Team Lead Nurse Practitioner Compensation: The starting base salary for this position is $125,000 annually, with a planned increase to $135,000 annually following a successful 90-day review period. Final compensation will be based on experience, qualifications, and performance during the initial ramp-up period Your Impact Starts Here At Ivim Health, we’re building a new standard for care—one that’s personal, accessible, and rooted in science. As a Nurse Practitioner on our clinical team, you’ll play a key role in delivering care that supports long-term wellness through evidence-based, patient-centered treatment. You’ll be joining the #1 rated telehealth platform, and the only platform with published, peer-reviewed data to support our high quality care model. We’re looking for an experienced NP (minimum 3 years of clinical practice and previous telehealth experience) who is confident in delivering care through telehealth. This fully remote role offers the opportunity to work with a diverse patient base focused on weight optimization, hormone balance, longevity, and overall wellness—including FDA-approved and compounded therapies, lifestyle-based plans, and data-informed strategies. In addition, the position offers a unique opportunity in telehealth to participate as a full-time, salaried, W2 provider with a full benefits package while having the flexibility offered by working through a remote platform. You’ll be part of a supportive, multidisciplinary team, collaborating to provide consistent, high-quality care to patients looking to take control of their health!

Required: Active NP license in one or more U.S. states (multi-state licensure preferred) Minimum of 3 years’ post-licensure clinical experience Prior experience in telehealth or virtual care delivery Strong understanding of obesity treatment, metabolic health, or hormone management Proficiency with digital health platforms and EHR systems Preferred: Experience in functional, integrative, or preventive care Familiarity with GLP-1s and compounded medication protocols Familiarity with HRT and bioidentical hormone replacement therapy Familiarity with anti-aging and longevity strategies to promote healthy aging Skills That Matter: Strong clinical decision-making and diagnostic skills. Excellent communication and interpersonal skills for telehealth patient interactions. Ability to work collaboratively in a fast-paced, remote multidisciplinary team. Commitment to patient-centered care with an empathetic approach to obesity management. Strong research and data analysis skills to stay informed on best practices.

Patient Evaluation & Management Conduct thorough medical evaluations for patients seeking weight management, hormone replacement, sexual health, longevity, and anti-aging programs focused on holistic, preventative care Develop comprehensive treatment plans incorporating nutrition, behavior modification, and pharmacological interventions. Monitor and adjust treatment plans based on patient progress, lab results, and response to medications. Patient Education & Support Educate patients and their families on health conditions, treatment options, and long-term wellness strategies. Guide patients in using remote health monitoring devices and telehealth applications. Multidisciplinary Team Collaboration Work within a multidisciplinary team, including physicians, nurse practitioners, registered nurses, nutritionists, and patient experience specialists. Foster effective communication to ensure a seamless, patient-centered care experience. Administrative & Quality Improvement Maintain accurate, confidential patient records within electronic health systems. Engage in continuous quality improvement initiatives to enhance telehealth services. Technical Skills & Digital Health Proficient in using EHR and telemedicine platforms for virtual consultations. Adapt quickly to new healthcare technologies and digital platforms.

Titan Financial LLC

Nurses/ NPs Healthcare- Remote Work

Posted on:

November 5, 2025

Job Type:

Part-Time

Role Type:

License:

NP/APP

State License:

New Jersey

We are seeking motivated healthcare professionals who want to work remotely in a flexible, part-time role. This position focuses on educating families and professionals about financial wellness while offering an opportunity to build extra income outside of your current career. What We Offer: Comprehensive training provided – no prior finance experience required Flexible schedule – work part-time or alongside your healthcare role Remote work – anywhere with internet access Mentorship and support from experienced leaders Growth opportunities for those who want to expand in sales & marketing

Current or former healthcare professional (RN, NP, PA, allied health, etc.) Passion for helping others improve their financial health Strong communication and relationship-building skills Self-motivated with a positive, coachable attitude Looking for additional income and flexibility

Educate individuals and families on financial literacy concepts Share financial solutions tailored to clients’ needs Network and connect with professionals Participate in ongoing training and development Support the team in sales and marketing initiatives

Banner Health

Associate Manager RN Denials Management

Posted on:

November 4, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Arizona

Headquartered in Arizona, Banner Health is one of the largest nonprofit health care systems in the country. The system owns and operates 33 acute-care hospitals, Banner Health Network, Banner – University Medicine, academic and employed physician groups, long-term care centers, outpatient surgery centers and an array of other services; including Banner Urgent Care, family clinics, home care and hospice services, pharmacies and a nursing registry. Banner Health is in six states: Arizona, California, Colorado, Nebraska, Nevada and Wyoming.

$37.14 - $61.90 / hour, based on location, education, & experience. In accordance with State Pay Transparency Rules. Innovation and highly trained staff. Banner Health recently earned Great Place To Work® Certification™. This recognition reflects our investment in workplace excellence and the happiness, satisfaction, wellbeing and fulfilment of our team members. Find out how we’re constantly improving to make Banner Health the best place to work and receive care. As an Associate Manager of RN Denials Management, you will be an integral part of leadership within the team. During your typical duties, you will have the opportunity to educate and develop team members, roll out process changes and projects, as well as troubleshooting questions from your team and outside stakeholders, and conducting review of findings. In this role you will have 10-12 direct reports who will be working centralized denials management for our 31 Banner facilities. A typical day would include overseeing RN denials mgt specialists and Audit team, posting bill reviews, and managing workflow and queue designation. The team is very independent and work remotely. Location: Remote, Banner supplies equipment Schedule: Exempt, Mon-Fri 8am-4:30pm AZ Time (No Weekends or Call) Position Summary: This position provides leadership, direction and support in response to denials from federal, state and commercial reimbursement programs. Provides leadership in clinical, financial, and personnel management within the department to result in overall reduction in payer clinical denials. Collaborates with Care Coordination, physician, Utilization Review, and other internal/external departments to overturn and/or reduction of payer denials. Reviews internal department practices and standards with staff to ensure maximum reimbursement while ensuring the provision of high quality, safe, and cost effective patient care. Demonstrates account denial and appeal review expertise and oversees the leadership of clinical, financial, and personnel management of the assigned department. This position supervises employees and participates in selection, orientation, counseling, evaluation and staff scheduling. Maintains clinical, leadership and post-acute care services knowledge and competency to evaluate denial and/or appeal outcomes related to delivery of clinical services.

Ideal Candidate: Must have at least 5 years experience as an RN, with current licensure in state of practice; Must have a bachelors degree or equivalent experience; At least 2 years of leadership, including Direct Reports; Ideal candidate will be experienced in Denials Management, Case review, and understanding of insurance. This can be a remote position if you live in the following state(s) only: AL, AK, AR, AZ, CA, CO, FL, GA, IA, ID, IN, KS, KY, LA, MD, MI, MN, MO, MS, NC, ND, NE, NH, NY, NM, NV, OH, OK, OR PA, SC, TN, TX, UT, VA, WA, WI, WV, WY Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care. Requires a level of education as normally demonstrated by a Bachelor’s degree. Requires Registered Nurse (R.N.) licensure in the state of practice. Requires experience in federal, state and commercial reimbursements and in reviewing clinical information typically acquired in three years auditing DRG coding and reimbursements. Requires five or more years of clinical nursing and/or related experience. Experience in hospital operations, reimbursement methods, medical staff relations, and the charging/billing is required. A working knowledge of utilization management and patient services is required. A working knowledge of medical and third party payer requirements and reimbursement methodologies is required. Highly developed human relation and communication skills are required. Must demonstrate critical thinking, problem-solving, effective communication, and time management skills. Must demonstrate ability to work independently as well as effectively with team members. Must have developed leadership skills, interpersonal skills and the ability to work collaboratively in a matrix model as normally demonstrated through increased scope with project work, stretch assignments, progressive scope and complexity. Preferred Qualifications" BSN preferred. Additional Related Education And/or Experience Preferred. Anticipated Closing Window (actual close date may be sooner): 2026-02-27

Oversees the operations of the team to ensure smooth and efficient payer denial and/or appeal review. Assures appropriate team assignments. Completes daily rounding on team members to ensure quality reviews of payer denials and/or appeals. Accurately and thoroughly completes documentation required for claims payment of services approved through concurrent review Supervises the team to ensure internal/external client and employee satisfaction while promoting quality denial and/or appeal reviews and retention. Serves as a real-time resource and assists with clinical expertise for team members and physicians for problem-solving on various denials and/or appeals related patient services, processes, and specific denial issues. Identifies educational needs regarding payor issues, functions as preceptor, and provides appropriate education. Develops leadership skills among staff including communication, decision-making problem-solving/critical thinking and employee engagement. Leads the development of staff and supports career advancement opportunities. Functions as a role model and encourages staff to participate in their own development. Responsible for selection, orientation, on-boarding, and retention. Demonstrates leadership through coaching, performance evaluations, corrective actions, and development opportunities to create a culture of learning. Assists in the daily operational resource management including staff, approve/edit time cards, supplies, and equipment, and ensures optimal productivity for the department. Tracks, monitors and documents denial causes and resolutions with appropriate management staff. Builds and continually updates a knowledge of payer requirements for covered treatment protocols by diagnosis, approval requirements for procedures, and coverage norms.

Banner Health

Trauma Registrar Remote

Posted on:

November 4, 2025

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Arizona

Headquartered in Arizona, Banner Health is one of the largest nonprofit health care systems in the country. The system owns and operates 33 acute-care hospitals, Banner Health Network, Banner – University Medicine, academic and employed physician groups, long-term care centers, outpatient surgery centers and an array of other services; including Banner Urgent Care, family clinics, home care and hospice services, pharmacies and a nursing registry. Banner Health is in six states: Arizona, California, Colorado, Nebraska, Nevada and Wyoming.

You must have working knowledge in anatomy and medical terminology and ICD 10 coding and knowledgeable with computer use. 2 or more years of coding, abstracting and data management work experience is required. Requires the ability to abstract registry data from the patient’s medical/health record. Exceptional data entry and data management skill sets are required. Experience with Trauma One is preferred. Must be able to work effectively with common office computer software, the Trauma Registry software, the electronic medical records system and databases, spreadsheet and graphical programs. RHIT, RHIA and Coder CPC certification preferred and LPN or RN is preferred. The ideal applicant will hold an RHIT Certification, ICD 10 Training and have up to two years of Trauma Registrar experience. Innovation and highly trained staff. Banner Health recently earned Great Place To Work® Certification™. This recognition reflects our investment in workplace excellence and the happiness, satisfaction, wellbeing and fulfilment of our team members. We are proud to foster an environment where our team members feel supported, fulfilled, and motivated to deliver the best care possible. Join us an be part of an innovative, supportive team dedicated to making Banner Health the best place to work and receive care. This remote role is Monday through Friday. Eligible only for applicants who reside in the following states: Arizona (AZ), California (CA), Colorado (CO), Nebraska (NE), Nevada (NV), and Wyoming (WY)." Within Banner Health Corporate, you will have the opportunity to apply your unique experience and expertise in support of a nationally-recognized healthcare leader. We offer stimulating and rewarding careers in a wide array of disciplines. Whether your background is in Human Resources, Finance, Information Technology, Legal, Managed Care Programs or Public Relations, you'll find many options for contributing to our award-winning patient care. POSITION SUMMARY: This position participates in activities associated with the trauma registry, including data gathering, data abstraction, timely and accurate data entry/coding, data validation and reporting that meets trauma center requirements. Acts as a member of the multi-disciplinary trauma team to support patient quality and performance improvement initiatives.

Requires a level of education equivalent to that of a Registered Health Information Technologist (RHIT) or certified coder, including advanced education in medical terminology, anatomy and physiology. Must have or will have required course work, including the ATS trauma registrar course, AIS training course, within one year of hire. Must have a level of experience and ability in coding, abstracting and data management as normally acquired over two or more years of clinical and/or experience in a coding or clinical data management position. Requires the ability to interpret and comprehend information contained within the patient’s medical record and to find all required data elements for the Trauma Registry. Requires the ability to abstract registry data from the patient’s medical/health record using the above standard setters regarding abstracting and coding procedures. Must have excellent organizational, written and verbal communication skills, and the ability to prioritize multiple work projects and tasks. Exceptional data entry and data management skill sets are required with an expected high degree of accuracy. Must be able to work effectively with common office computer software, the Trauma Registry software, the electronic medical records system and databases, spreadsheet and graphical programs. PREFERRED QUALIFICATIONS: Registered Health Information Technologist or Registered Health Information Administrator certification (RHIT or RHIA), Certified Professional Coder (CPC), Certified Specialist Trauma Registry (CSTR) preferred. Past trauma registry experience preferred. Additional related education and/or experience preferred.

Collects required information for all injured trauma victims meeting inclusion criteria by reviewing multiple sources including medical records, EMS records, and various hospital software programs. Abstracts required data elements including basic patient demographics, clinical procedures, clinical and diagnostic results, etc. Enters data accurately related to the trauma patient's history, diagnosis, therapy, and outcome. Uses scaling and scoring tools such as current International Classification of Diseases codes (ICD), the Abbreviated Injury Scale (AIS) developed by the Association for the Advancement of Automotive Medicine (AAAM), and Injury Severity Score (ISS). Codes injuries and procedures for the database as required for clinical care, research, benchmarking and accreditation. Ensures the hospital remains compliant with all applicable standards as they relate the respective State registry, American College of Surgeons, National Trauma Data Bank, Trauma Quality Improvement Program (TQIP) and trauma center accreditation. Maintains the Trauma Registry database in compliance with state regulations and accreditation requirements. Assists team with documentation and management of the registry database as it relates to clinical research, benchmarking and accreditation. Develops and produces timely information/reports as requested and contributes to timely data submission to national and state agencies to ensure accreditation/verification/designation statuses are maintained. Works as an integral part of the trauma quality and performance improvement program by contributing to identification of opportunities for improvement and/or areas of concern commensurate with the level of training/knowledge/experience. Works independently under limited supervision. This position functions at assigned facility and has no budgetary responsibilities. Internal and external customers include physicians, clinical staff, facility employees, trauma team members and state and national agencies. Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.

Central California Alliance for Health

Quality Improvement Nurse PQI (RN)

Posted on:

November 4, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

We are a group of over 500 dedicated employees, committed to our mission of providing accessible, quality health care that is guided by local innovation. We feel that our work is bigger than ourselves. We leave work each day knowing that we made a difference in the community around us.

Location: Remote in California We have an opportunity to join the Alliance as a Quality Improvement Nurse PQI (RN) in the QI and Population Health Department. OTHER INFORMATION: We are in a hybrid work environment, and we anticipate that the interview process will take place remotely via Microsoft Teams. While some staff may work full telecommuting schedules, attendance at quarterly company-wide events or department meetings will be expected. In-office or in-community presence may be required for some positions and is dependent on business need. Details about this can be reviewed during the interview process. The full compensation range for this position is listed by location below. The actual compensation for this role will be determined by our compensation philosophy, analysis of the selected candidate's qualifications (direct or transferable experience related to the position, education or training), as well as other factors (internal equity, market factors, and geographic location). Typical areas in Zone 1: Bay Area, Sacramento, Los Angeles area, San Diego area Typical areas in Zone 2: Fresno area, Bakersfield, Central Valley (with the exception of Sacramento), Eastern California, Eureka area

Desirable Qualifications: Experience in process improvement, practice coaching, or health care quality improvement Experience performing PQI activities Working knowledge of managed care, the Medi-Cal program, and related policy Working knowledge of the methods of conducting and interpreting quantitative and qualitative analysis Some knowledge of NCQA HEDIS abstracting guidelines Some knowledge of CPT and ICD coding principles Knowledge of: The principles and practices of clinical nursing Medical practice operations and healthcare delivery systems Ability to: Participate in and support internal and external audits Identify issues, conduct research, gather and analyze information and data, reach logical and sound conclusions, and make recommendations for action Analyze information and data and prepare oral and written reports Education and Experience: Current, unrestricted license as a Registered Nurse issued by the State of California Bachelor’s degree in Nursing and a minimum of three years of experience as a Registered Nurse in acute care or primary care with an emphasis on preventative care (a Master’s degree may substitute for two years of the required experience); or an equivalent combination of education and experience may be qualifying

Reporting to the Clinical Safety Supervisor, this position: Develops, manages, and measures a comprehensive healthcare strategy in alignment with Department of Health Care Services (DHCS) standards of care and in collaboration with internal stakeholders and network providers to promote best evidence-based practices and improve member health outcomes Evaluates patient safety and quality issues and communicates findings to internal stakeholders, network providers and community partners

Compunnel Inc.

Registered Nurse (Claims & Appeals Review)

Posted on:

November 4, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Florida

Compunnel Inc. is where AI-native solutions meet human ingenuity, helping enterprises reimagine talent, technology, and growth. A world where your people and your platforms don’t just coexist — they co-elevate. At Compunnel, we build bridges between intelligent systems and human potential, forging paths to transformation in real time. For over 30 years, we’ve been the quiet force behind digital revolutions. We speak two languages fluently: empathy and algorithm. Our AI-powered infrastructure weaves into human workflows (not over them), enabling clients to scale with agility, adapt with foresight, and compete with confidence. From coast to coast in the U.S. (30+ delivery centers) and across global innovation hubs in Canada, India, and the UK, we serve 200+ clients — including 23% of the Fortune 500. Whether you’re a global enterprise or a public sector agency, you lean on us for recruitment (IT, non-IT, public sector) and future-forward digital capabilities. Twelve times ranked on the Inc. 5000 list for fastest-growing private companies, our core strengths lie in Software Development, Cloud, Data Analytics, AI/ML, and Cybersecurity. But what defines us is how we activate them — turning insights into outcomes, plans into momentum. We’re also proud to be a certified Minority Business Enterprise (MBE) in the U.S. and Canada. Inclusion isn’t just values-speak — it’s baked into our DNA. Our alliances with AWS, Microsoft, UiPath, Google Cloud, and more reflect a commitment to staying at the bleeding edge of AI innovation and co-creating centers of excellence with our clients. Let’s not just build technology. Let’s build a future that’s intelligent, inclusive, and impossible to ignore.

Job Title: Registered Nurse – Claims & Appeals Review Location: Remote (Anywhere in Florida) Duration: 06 Months/Can be Extended Working hours: Day Shift Job Type: Subcon Pay Rate: Negotiable Position Purpose: The Quality Analyst is responsible for ensuring the accuracy, compliance, and timeliness of appeal reviews through both manual and automated reporting mechanisms. This role supports continuous improvement in clinical operations by identifying quality gaps, performing root cause analysis, and recommending corrective actions.

Education/Experience: Bachelor’s degree in healthcare, life sciences, or related field preferred 2+ years of experience in appeals, grievance, or quality assurance in a healthcare setting Experience with audit tools, EMR systems, and reporting platforms Licensure/Certification: Valid RN, LPN, or LVN license in applicable state (Florida) Skills: Strong analytical, leadership and documentation skills Proficiency in Excel and data visualization tools Familiarity with InterQual criteria and CMS guidelines Ability to work independently and manage multiple priorities

Review appeal cases and supporting documentation to ensure completeness and compliance with InterQual and contractual guidelines. Conduct manual audits and reporting to assess quality of appeal decisions and documentation. Analyze operational data and performance metrics to identify trends, errors, and improvement opportunities. Collaborate with clinicians and MD reviewers to validate decisions and escalate complex cases. Maintain dashboards and SLA tracking for appeals turnaround time, audit coverage, and accuracy. Support calibration sessions and feedback loops with transaction monitors and team leads. Document findings and prepare reports for internal and client-facing reviews. Ensure compliance with NCQA, CMS, and state regulations.

Mercor

Advanced Practice RN

Posted on:

November 4, 2025

Job Type:

Part-Time

Role Type:

License:

RN

State License:

California

Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst, Peter Thiel, Adam D'Angelo, Larry Summers, and Jack Dorsey. Position: Nurse Practitioner Type: Independent Contractor Compensation: $80–$100/hour Location: Remote Duration: 3–4 weeks Commitment: 30–40 hours/week

Must-Have: 4+ years professional experience in the nursing domain. Excellent written communication with strong grammar and spelling skills. Start Date: Immediately Compensation & Legal: Hourly compensation, paid weekly via Stripe Connect. Payments based on services rendered; contractors maintain full control over their work schedule and methods. Application Process (Takes 20–30 mins to complete) Upload resume AI interview based on your resume Submit form Resources & Support: For details about the interview process and platform information, please check: https://talent.docs.mercor.com/welcome/welcome For any help or support, reach out to: support@mercor.com PS: Our team reviews applications daily. Please complete your AI interview and application steps to be considered for this opportunity

Create deliverables addressing common requests in the nursing domain. Review peer-developed deliverables to enhance AI research. Diagnose and solve real issues in machine learning systems. Contribute expertise to cutting-edge AI research. Work independently and asynchronously to meet deadlines.

NPHire

Work From Home Nurse Practitioner | Telehealth | Georgia NP | $200/hr

Posted on:

November 4, 2025

Job Type:

Contract

Role Type:

Telehealth

License:

NP/APP

State License:

Georgia

A respected telehealth group is hiring Nurse Practitioners to provide acute care and wellness-focused virtual consultations. This position is perfect for new graduates and experienced providers who want to practice modern, patient-first telemedicine while maintaining complete control of their schedule. What’s Offered: $120–$200/hr (hourly contract) Flexible scheduling with full autonomy Malpractice insurance provided 100% remote telehealth model Expanding nationwide patient base Supportive clinical and admin teams

Active NP license in any U.S. state (all 50 accepted) FNP certification required GEORGIA licenses in high demand Strong clinical assessment & independent decision-making skills Excellent communication & EMR documentation abilities Telehealth experience preferred (not required) DEA registration a plus (for prescribing controlled medications) Comfortable with GLP-1, TRT, or peptides—or willing to train

Conduct acute care telehealth visits (UTI, sinus, ear infections, etc.) Offer on-demand consultations for weight loss, longevity, peptides, and ED Provide functional medicine care, including TRT and CIRS support Work with both synchronous (live) and asynchronous (messaging) consults Collaborate with a professional virtual care team across multiple states

Joint Commission

Surveyor - Home and Hospice Care Registered Nurse

Posted on:

November 4, 2025

Job Type:

Part-Time

Role Type:

License:

RN

State License:

Illinois

Joint Commission enables and affirms the highest standards of healthcare quality and patient safety for all. Founded in 1951, it is the nation’s oldest and largest standards-setting and accrediting body in healthcare, evaluating more than 23,000 healthcare organizations and programs across the United States. As an independent, nonprofit organization, Joint Commission inspires healthcare organizations across all settings to excel in providing safe and effective care of the highest quality and value.

Nationwide Search for a Home Health and Hospice Care Registered Nurse Surveyor Seeking Registered Nurses located anywhere in the United States for this remote opportunity. Seeking Candidates with Home Health and Hospice Care experience.

Requirements: Qualified candidates must be a graduate of approved school of nursing and hold a Master’s degree in appropriate discipline. Current professional license in discipline required at time at time of hire and must be maintained throughout the duration of employment. Certification requirement: You must hold a CPHQ certification (Certified Professional in Healthcare Quality) through National Association for Healthcare Quality (NAHQ) at time of hire or attain by 12/31/28. Candidates must have five years of recent healthcare experience, including 3 years of direct clinical experience in the appropriate health care settings, and 2 years of accreditation or certification leadership or senior management experience. Qualified candidates must have knowledge of Joint Commission standards with direct involvement in two Joint Commission surveys. Previous experience in Home Healthcare and Hospice care required. Experience working in a Medicare Certified home health agency is required. Ideal candidates will have experience in a culturally diverse work environment; fluency in Spanish is a plus. The team players we select to take on these highly visible, challenging roles will have strong interpersonal, communication and problem-solving skills, expertise in interviewing, and PC proficiency. Physical Abilities: Must be able to observe, in real time and without slowing or otherwise interrupting the progress of, all applicable types of ongoing health care treatment (e.g., including emergency treatment, treatment during weather and other extreme situations, etc.). Standing for long periods of time, walking lengthy distances, lifting, climbing, stooping, pulling, and pushing in order to adequately inspect and observe all medical facilities, equipment and procedures, such as emergency exit procedures, remote storage facilities, any areas where cleanliness may affect the possibility of infection, medical equipment, etc., including the following activities: walking up and down stairways (e.g., to test escape routes, assess safety of emergency exits, regulatory compliance, etc.); removing obstructed covers or impediments to equipment or other mechanical areas; examining small and often dirty printed labels and print on equipment; Must be able to engage in extensive travel as set forth above, including driving a car to remote locations, flying on small airplanes and into small airports, traveling in all types of weather conditions, etc. Candidates interested in part time positions must be available to work two or three weeks per month, and must provide three or four weeks of availability for the purpose of scheduling. All positions require 100% nationwide travel (paid). We offer a full benefits package including medical, dental, vision, 401k, pension and a generous paid time off (PTO) package. Full time - 1.0 FTE requires 4 weeks out of the month with 100% travel.

The RN Field Representative surveys hospice and home care organizations throughout the United States. Applies systems analysis skills and inductive reasoning skills to determine health care organizations' degree of compliance with applicable standards and functionality of care delivery systems. Engages health care organization staff in interactive dialogues on standards based issues in health care in order to assess compliance and to identify opportunities for improving compliance. Prepares management reports that clearly link individual standards deficiencies with potential systems vulnerabilities and related organization risk points. Effectively communicates this information to health care organization leadership in a constructive and collegial style. Participates in other Joint Commission activities as assigned by supervisor.

Performant Healthcare, Inc.

Manager, Itemized Bill Review (Hospital Bill Pay Review) - RN/Medical Coder

Posted on:

November 4, 2025

Job Type:

Full-Time

Role Type:

Leadership / Management

License:

RN

State License:

Florida

At Performant, we’re focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Through this important work we accomplish our mission: To offer innovative payment accuracy solutions that allow our clients to focus on what matter most – quality of care and healthier lives for all. If you are seeking an employer who values People, Innovation, Integrity, Fun, and fostering an Ownership Culture – then Performant is the place for you!

The Itemized Bill Review Manager is a key member of the medical review audit group and supports building a world class healthcare services organization. The leader in this role directs the timely delivery of high-quality Itemized Bill Review (IBR) audits for our business, ensuring organizational goals are met. This position may provide direct oversight of multiple departments and individual contributors, including Nurse Auditors and Coding Auditors. As such, the qualified individual for this role will be a “Nurse Coder”, holding an active RN license and Coding certification(s) in addition to having experience with IBR (also known as hospital bill pay review) audits. Hiring Range: $95,000 - $115,000

Possess a broad and comprehensive understanding of IBR standards and hospital bill pay review, policies and regulations, applies a broad and comprehensive knowledge in areas including medical chart reviews. Thorough working knowledge of CPT/HCPCs/ICD-9/ICD-10/MS-DRG coding and demonstrated capability in developing and implementing effective coding audit strategies. Strong project management and interpersonal skills, makes sound decisions, exhibiting initiative and intuitive thinking. Consulted often by others for advice and opinions and recognized as a leadership role model. Problem solving, strong analytical skills, people skills, teamwork, people management, and managing processes. Strong interpersonal skills for interfacing with all levels of internal and external audit teams and management. Ability to prioritize and multitask. Must be a strong effective communicator, both orally and in writing, with an energetic, charismatic and approachable style. Proven experience in managing high performing, dynamic teams. Ability to work in a diverse and fast paced environment. Strong general technical skills, including, but not limited to Desktop and MS Office applications (Excel Skills required), application reporting tools, and other system/tools to review and document findings Solid technical aptitude with demonstrated ability to quickly learn and adapt to new systems and tools. Acts as a change champion by being flexible and adaptable in a highly dynamic and rapidly changing environment. Able to ideate around how to work more efficiently (when necessary) and views work with a long-term vision. Consistently delivers on promises and deadlines. Skill in analyzing information, identifying trends and presenting solutions. Ability to independently organize, prioritize and plan work activities effectively for self and others; develops realistic action plans with the ability to multi-task effectively. Demonstrated ability to be proactive; identifies and resolves problems in a timely manner; develops alternative solutions. Self-starter with the ability to work independently in remote setting with minimum supervision and direction in the form of objectives. Required and Preferred Qualifications: Registered Nurse with an unrestricted nursing license Certification as a CPC, CPC-H, CPC-P, RHIA, RHIT, CCS, or CCS-P; other relevant coding certification may be considered Must have sufficient depth and breadth of outpatient and/or inpatient coding experience BA/BS degree or 10+ years of business experience in healthcare with increasing levels of responsibility At least 7 years relevant clinical audit experience in the Health Care industry; IBR experience is required At least 3 years relevant experience managing staff in a healthcare related industry Experience in developing, documenting and implementing process and procedures

Performs, Develops and executes on itemized bill review (IBR) plans, in accordance with internal audit standards and relevant statement of work. Prepares reports and manages IBR activities for assigned clients. Applies in depth level of expertise in performing IBR audits and development of policies and procedures and workflows processes to review claims, and identify processing, procedural, systemic and billing errors and practices leading to claims inaccuracies; also applies in-depth expertise in both outpatient and inpatient medical coding to the development of policies, procedures, guidelines, coding issues/refining coding parameters, workflow and tools. Manages team members performing IBR activities to identify trends, determine root cause of payment inaccuracies, and to recommend process and systems improvements. Proactively identifies opportunities for process improvement, efficiency, resolving problems, preparing and completing action plans. Manages and trains team leaders and staff. Supports staff recruitment, develops auditors and builds effective teams. Supports subcontractor communication, oversight and reporting. Establishes accountability for performance monitoring (productivity/quality), communicates job expectations, trends, documentation, and ensures timelines are met. Supports strategy by conducting needs assessments, capacity planning, cost/benefit analyses, preparing staffing models, establishing productivity and quality standards. Maintains professional and technical knowledge by tracking emerging trends in IBR management; this may include attending educational workshops, reviewing professional publications, establishing personal networks, benchmarking state-of-the-art practices and participating in professional societies. Develops effective relationships with leaders in the organization and has a strong understanding of the business. Applies in-depth understanding of the inter-relationships of the business and support units throughout the organization. Accomplishes organizational goals by accepting ownership of requests; exploring opportunities to add value. Participates in business initiatives and pro-actively advises and assists the business on initiatives. Builds value and credibility with internal and external clients and represents the organization in meetings with the client, provider organizations, contractors, subcontractors and vendors. Uses excellent communication skills to influence a wide range of internal and external audiences. Provides timely response to escalated inquiries from the client and providers. Supports other departments in problem resolution as necessary. Completes required reports and ad hoc requests for information. Inspires trust and credibility; delivers on commitments; acts as IBR subject matter expert. Facilitates meetings as necessary. Performs other duties as assigned.

The Judge Group

Precertification RN

Posted on:

November 4, 2025

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Pennsylvania

The Judge Group is an international leader in business technology consulting, talent solutions, and learning and development. With over 30 locations across the U.S., Canada & India, Judge is proud to partner with the best and brightest companies in business today, including over 60 of the Fortune 100. We serve organizations in financial services, healthcare, life sciences, insurance, government, aerospace & defense, manufacturing, and technology & telecommunications. Judge has always been committed to doing what’s right – for our colleagues, our client partners, and our communities. At Judge, we cultivate an inclusive environment that empowers our employees to produce their best work. As a family-owned business, we’re not just a high-performing team, but a high-performing family. Through building relationships and our cultural commitment to caring, we support one another.

Our client is currently seeking a Precertification RN: Precertification RN – PT/OT/ST & Bariatric Reviews Location: Remote (Must reside in PA, NJ, or DE) License Required: Active PA RN or LPN (Compact licenses not accepted) REQUIRED Contract Duration: Ongoing (3+ months) Join our dynamic Precertification team, where your clinical expertise will help ensure members receive medically necessary care in a timely and compliant manner. As a Precertification RN, you will conduct thorough reviews of medical records—including history and treatment plans—to determine the appropriateness of services such as physical therapy (PT), occupational therapy (OT), speech therapy (ST), and bariatric procedures. You’ll apply clinical criteria, collaborate with providers, and advocate for members navigating the healthcare system.

Must reside in Pennsylvania, New Jersey, or Delaware Active PA RN or LPN license (Compact licenses not accepted) Minimum 2 years of acute care experience in a hospital or healthcare setting Clinical background in orthopedic unit, outpatient ambulatory surgery center, or surgical unit Prior experience in medical management, precertification, or prior authorization Proficiency in Microsoft Word, Outlook, Excel, SharePoint, and Adobe InterQual experience highly preferred

Clinical Review & Determination: Evaluate healthcare service requests using advanced clinical knowledge and independent judgment Apply established guidelines (e.g., InterQual, Medical Policy) to assess medical necessity for inpatient admissions, procedures, and ancillary services Collaborate with providers to clarify clinical details and ensure alignment with criteria Refer cases to the Medical Director when services fall outside standard guidelines Care Coordination & Referral: Identify members early for discharge planning and coordinate appropriate transitions Refer cases to Case Management, Disease Management, or Quality Management as needed Compliance & Documentation: Confirm service coverage under member health plans Ensure all decisions meet federal, state, and accreditation standards Meet regulatory turnaround times and productivity goals Maintain accurate documentation and data integrity Utilization Management Monitor and report utilization trends Recommend process improvements to enhance efficiency and care quality

The Judge Group

Precertification RN

Posted on:

November 4, 2025

Job Type:

Contract

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

The Judge Group is an international leader in business technology consulting, talent solutions, and learning and development. With over 30 locations across the U.S., Canada & India, Judge is proud to partner with the best and brightest companies in business today, including over 60 of the Fortune 100. We serve organizations in financial services, healthcare, life sciences, insurance, government, aerospace & defense, manufacturing, and technology & telecommunications. Judge has always been committed to doing what’s right – for our colleagues, our client partners, and our communities. At Judge, we cultivate an inclusive environment that empowers our employees to produce their best work. As a family-owned business, we’re not just a high-performing team, but a high-performing family. Through building relationships and our cultural commitment to caring, we support one another.

Are you a compassionate and experienced RN with a background in NICU care? Do you thrive in a remote work environment and enjoy making a meaningful impact through utilization management? We’re looking for a dedicated Registered Nurse to join our clients team in a part-time remote role supporting hospital admission reviews and discharge planning. If you live in the tri-state area (PA, NJ, DE) and meet the qualifications below, we’d love to hear from you! Part-Time Work Schedule (Post-Training) Week 1: Monday & Tuesday Week 2: Wednesday, Thursday & Friday Repeats every two weeks Approximate weekly hours: 18 hours Position Summary: Under the direction of a designated Manager, the RN will perform telephonic reviews of hospital admissions, recommend alternative levels of care when appropriate, and promote efficient, high-quality healthcare delivery. The role includes early discharge planning, collaboration with hospital staff and physicians, and referral to case management when needed.

Training Requirements: Must be available Monday through Friday during regular business hours Training duration: 2–3 weeks Full-time hours required during training period Active RN license in PA or Compact license including PA Minimum 3 years of acute care hospital experience NICU experience required Prior utilization management and/or discharge planning experience BSN preferred

Conduct telephonic utilization management for inpatient admissions Assess medical necessity using established criteria Collaborate with attending physicians and hospital case managers Facilitate discharge planning and transitions of care Refer cases to Case Management and Disease Management Identify and report quality of care issues Maintain accurate documentation and compliance Provide exceptional customer service and provider education

VITALE NURSING INC

Licensed Vocational Nurse- Private Duty

Posted on:

November 4, 2025

Job Type:

Part-Time

Role Type:

License:

LPN/LVN

State License:

California

VITALE NURSING INC is a company based out of 8549 WILSHIRE BLVD SUITE #813, BEVERLY HILLS, California, United States. Providing compassionate care with a gentle touch. We know it isn’t just bodies that need care, it’s hearts and minds as well. We listen to our clients with a tender ear so they feel completely heard and understood. All services are provided in luxurious comfort and with complete confidentiality. We provide caregiving services for patients in any length of required care. Caregivers are available from 8-24 hours a day, 7 days a week. A wide spectrum of hospitals, doctors, and insurance companies all trust Vitale Nursing, Inc. to provide excellent care, often for patients with special circumstances who require in-home services.

Private Duty Licensed Vocational Nurse (LVN) Vitale Nursing, Inc. – Beverly Hills, Bel-Air, Brentwood, Santa Monica, Pacific Palisades Vitale Nursing, Inc. is seeking compassionate, skilled, and professional Licensed Vocational Nurses (LVNs) to join our concierge-level home health team. Our LVNs provide direct, one-on-one patient care in private homes and recovery settings, ensuring the highest standards of safety, professionalism, and compassion.

Preferred Clinical Experience: IV therapy and blood draws (if certified) Post-operative recovery and wound care G-tube and stroke patient support Tracheostomy and ventilator care (experience strongly preferred) Medication administration and monitoring Hospice and palliative care support Minimum Requirements: Valid California LVN License Current BLS Certification (ACLS preferred) Reliable transportation Strong communication and clinical skills Professional, punctual, and trustworthy demeanor Three professional references Proof of Malpractice Insurance Successful completion of a background check Required Documentation: Valid California LVN license Two forms of identification (Driver’s License/Passport and Social Security card) Signed employee agreement (provided during hiring) Completed application (provided during hiring) Physical exam and TB test (within 1 year) Current CPR/BLS certification Proof of COVID-19 vaccination and booster (or plan to obtain) Proof of Malpractice Insurance

Provide direct nursing care to patients in private residences or hotel recovery suites Assist patients with ADLs (Activities of Daily Living) such as bathing, dressing, grooming, toileting, feeding, and mobility support Administer and oversee medication management, including reminders, administration (within LVN scope), and monitoring for safety and effectiveness Provide post-operative care, wound care, and recovery support under RN or physician guidance Assist with long-term in-home assignments and palliative care patients Monitor vital signs, patient status, and promptly report changes to supervising RN or physician Conduct documentation in compliance with Vitale Nursing, Inc. standards and state requirements Assignments are available in Beverly Hills, Bel-Air, Brentwood, Santa Monica, and Pacific Palisades.

Performant Healthcare, Inc.

Medical Review Clinical QA Auditor (RN) - Home Health & Hospice

Posted on:

November 4, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Florida

At Performant, we’re focused on helping our clients achieve their goals by providing technology-enabled services which identify improper payments and recoup or prevent losses due to errant billing practices. We are the premier independent healthcare payment integrity company in the US and a leader across several markets, including Medicare, Medicaid, and Commercial Healthcare. Through this important work we accomplish our mission: To offer innovative payment accuracy solutions that allow our clients to focus on what matter most – quality of care and healthier lives for all. If you are seeking an employer who values People, Innovation, Integrity, Fun, and fostering an Ownership Culture – then Performant is the place for you!

The Medical Review Clinical Quality Auditor (RN) is responsible for conducting Quality Assurance (“QA”) reviews of medical review audit work completed by the medical review audit team members to ensure the accuracy of claim findings and applicable documentation for our clients both Government and Commercial payors.

Knowledge, Skills and Abilities Needed: Experience in conducting medical audits, investigations, reviewing and researching post service claims for aberrant billing patters, thorough review of the medical record documentation preferred. Demonstrated ability to perform claim payment audits with high quality and production results, as well as successful application of skills to conduct quality assurance review of audit work completed by others. Must be able to manage multiple assignments effectively, create documentation outlining findings, QA review results and/or documenting suggestions, organize and prioritize workload, problem solve, work independently and with team members. Thorough working knowledge of CPT/HCPCs/ICD-9/ICD-10/MS-DRG coding. Proficiency with CMS 1500/UB 04 forms Strong knowledge of medical documentation requirements and an understanding CMS, Medicaid and/or Commercial insurance programs, particularly the coverage and payment rules and regulations. Working knowledge of encoder Proven ability to review, analyze, and research coding issues. Reimbursement policy and/or claims software analyst experience. Familiarity with interpreting electronic medical records (EHR) Basic understanding of accounting principles for accounts payable and receivable as it relates to medical billing. Independent, out-of-the-box thinker; Performs successfully against work given in the form of objectives and projects; leads by example. Understands processes, procedures, and workflow; and demonstrated ability to identify areas of opportunity. Demonstrated ability to consistently apply sound judgment and good effective decision making. Understands Medical Review Audit and Quality Assurance objectives, activities, and key drivers in achieving operational goals. Strong communication skills, both verbal and written; ability to communicate effectively and professionally at all levels within the organization, both internal external. Demonstrated ability to collaborate effectively in a variety of settings and topics. Excellent editing and proofreading skills. Ability to independently organization, prioritize and plan work activities effectively for self and others; develops realistic action plans with the ability to multi-task effectively. Excellent time management and delivers results balancing multiple priorities. Strong analytical skills; synthesizes complex or diverse information; collects and researches data; uses experience to compliment data. Leverages strong critical thinking, questioning, and listening skills to research and effectively resolve complex issues. Demonstrated ability to identify areas of opportunity and create efficiencies in workflows and procedures. Demonstrated ability to be proactive; identifies and resolves problems in a timely manner; develops alternative solutions. Ability to create documentation outlining findings and/or documenting suggestions. Strong general computer skills, including, but not limited to Desktop and MS Office applications (Intermediate Excel Skills), application reporting tools, and case management system/tools to review and document findings. Solid technical aptitude with demonstrated ability to quickly learn and adapt to new systems and tools. Ability to be flexible and thrive in a high pace environment with changing priorities. Adaptable to applying skills to diverse operational activities to support business needs. Self-starter with the ability to work independently in remote setting with minimum supervision and direction in the form of objectives. Serves as a positive role model; and demonstrates characteristics that align and contribute to a collaborative culture of continuous improvement and high performing teams. Capability of working in a fast-paced environment, flexibility with assignments and the ability to adapt in a changing environment. Required and Preferred Qualifications: Current active unrestricted Nursing license in good standing required (RN required for government contract focused positions) Not currently sanctioned or excluded from the Medicare program by OIG 3+ years diversified nursing experience providing direct care in an inpatient or outpatient setting. 2+ years of performing medical record audits in a provider setting, or in a payer setting for a health insurance company. 5+ years in health care claims that demonstrates expertise in ICD-9/ICD-10 coding, HCPS/CPT coding, DRG and medical billing experience for an Insurance Company or hospital required. (less than 5 yrs. may be considered for internal candidates based upon demonstrated skills and results)

Conducts quality assurance reviews on medical review audit work completed by the audit team members, maintaining productivity and quality standards as defined by department policy. Objectively and accurately documents quality review results in accordance with department quality policies and procedures, scoring and reporting all QA results in an approved QA tracking system and routes record appropriately within audit platform based upon how QA review resulted in concurrence with audit finding or identified corrections required. Reviews audit documentation and conducts research, analyzes claims data, applies knowledge of client SOW, applicable concept guidelines, policies, and regulations as necessary to determine if audit result is accurate and includes complete details to support findings. Provides correction to narrative rationale to correspond with audit determination and flags patterns of concern to audit leadership for real-time intervention, preventing an accumulation of improper findings Contributes to the continuous improvement feedback process and suggests or makes any edits, documentation, next steps, and reporting as may be necessary in accordance with department process and audit leadership direction. May support findings during the appeals process, if needed. May perform primary audit activity as assigned by management. Monitors, tracks, and reports on all work conducted in accordance with QA process and management direction. May prepare QA reports for management that includes a variety of data and trends at the individual, department, and client program level, as well as date range or concept based/trended, or other characteristic that will provide valuable business insights. Consults with internal resources as necessary. Become subject matter expert for assigned business segment(s). Maintain current knowledge and changes that affect our industry and clients as it pertains to medical practice, technology, regulations, legislation, and business trends. Participates in and contributes to applicable department meetings. Successfully completes, retains, applies, and adheres to content in required training as assigned that includes but not limited to information security, anti-harassment and other compliance and policy/procedures training applicable for position. Proactively contributes to continuous improvement of activities and sets positive example Contributes collaboratively to identifying opportunities for improvement of audit results and continuous improvement initiatives. May support training material/tools and best practices development. May identify/make recommendations to management for supplemental team/concept type training. May support training activities for new audit staff or provide supplemental training for existing staff as needed. Contributes to positive team environment that fosters open communication, sharing of information, continuous improvement, and optimized business results. Receives feedback and adjusts work priority as necessary. Serves as positive role model and example for other audit staff and conducts work in accordance with company policies, government regulations and law. Performs job duties with high level of professionalism and maintains confidentiality Perform other incidental and related duties as required and assigned to meet business needs.

Wellbox Health

(LPN) Remote Chronic Care Management

Posted on:

November 4, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

Compact / Multi-State

Wellbox is a fast-growing healthcare company on a mission to empower people to lead healthier lives. Through comprehensive, preventative care solutions delivered by an exceptional team of nurses, we help patients manage chronic conditions from the comfort of their homes. If you're a compassionate, tech-savvy LPN who thrives in a remote care setting, we’d love to meet you!

As a Patient Care Coordinator, you’ll play a vital role in our patients’ health journeys by conducting monthly telephonic outreach, assessing their unique needs, and creating individualized care plans Schedule & Compensation: Full-time, 40 hours/week | Monday–Friday between 8 AM – 6 PM in the patient's time zone. Orientation + Training (First 2 Months): $20/hr. Monthly Bonus Potential (up to $525). Referral Bonuses: Up to $1,000.

What We’re Looking For: Active Compact LPN license. At least 2 years of clinical experience (care coordination preferred). Tech confidence: you’re comfortable using EMRs, Microsoft Office, and other digital tools. Strong communication and problem-solving skills.

Manage patient care through scheduled phone conversations. Document visits using technology platforms and electronic health records (EHRs). Develop care plans focused on physical, mental, and preventative health. Coach patients through their treatment plans—including wellness, nutrition, and goal setting. Help patients prepare for medical appointments and connect with resources.

Ascend Learning

Nursing Academic Readiness Educator (Part-Time)

Posted on:

November 4, 2025

Job Type:

Part-Time

Role Type:

Coaching

License:

RN

State License:

Kansas

Ascend Learning is a national leader in data driven, online educational solutions for learners, educators and employers in high-growth, licensure-driven professions spanning healthcare, fitness and wellness, skilled trades, insurance, and financial services. We are passionate about accelerating learning while impacting job readiness, employment success and employee retention with the belief that our work changes lives. Our culture is intentionally results-driven and selfless with a relentless focus on our customers. We believe in trust, transparency, freedom, and responsibility with a commitment to meritocracy, inclusion, and diversity of thought. Continual investment in our over 1500 employees is also a core principle realized through ongoing professional development and providing opportunities to grow, develop and lead. Ascend Learning is headquartered in Burlington, MA with additional office locations and remote workers in cities across the U.S. Ascend Learning’s Nursing Segment is fueled by a commitment to excellence in nursing education. Our nursing brands — ATI, APEA, and NursingCE — offer evidence-based solutions designed to develop practice-ready nurses who are prepared for board certification and clinical practice. We use data analytics and engaging learning tools to help nursing students master core content. And we provide nursing education programs and professionals with best-in-class support and expertise from some of the sharpest minds in nursing education. We aid nurse educators in understanding students’ comprehension based on nearly two decades of data — including more than 12 million proctored assessments — that detail student learning and performance. The result is customers who are confident in the advice and guidance we provide with our quality-focused assessments and positive outcomes.

The Client Success Team is responsible for supporting clients purchasing nursing solutions with product training, implementation, integration, and test preparation delivery to achieve client centric outcomes. The team leads the success planning, onboarding, ongoing proactive and reactive client support, and the delivery of ATI NCLEX products. The Client Success team is accountable for delivering quality services that will lead to key business performance indicators for client success including, client satisfaction, product adoption and usage, NCLEX pass rate, institutional and student retention. Do you have a passion for education and providing students support for success? We are now hiring experienced secondary-level educators with knowledge and expertise in Math, Science, English, and Reading to join our Assessment Technologies Institute (ATI) team. We are seeking an Educator for Nursing Success to work remotely and provide part-time one-on-one online guidance and support to entry-level nursing students.

Education & Experience Master’s or higher degree in education with teaching certification (preferred) Master’s or higher degree in Nursing (considered) Preferred instructional technology experience Knowledge at secondary education level of math, science (including anatomy and physiology), English, and reading Minimum of 2 years recent teaching experience, 5+ years preferred Current secondary-level teaching experience; experience teaching in an online environment, preferred Skills & Abilities Communicate professionally and clearly in the online environment Comfortable navigating in an online environment Demonstrate technological competence with a variety of application Respond to customers twice daily via online interaction Apply best practice guidelines and follow process to service customers Ability to work remotely from a home office Guide students to identify their personal learning needs Create a collaborative atmosphere with faculty and students Analyze student performance to individualize study plans

Provide one-on one-instruction using a distance learning platform to support entry-level nursing students to engage in review of content for math, science (including anatomy and physiology), English, and reading Learn and maintain understanding of ATI products and solutions to assist customers Demonstrate analytical skills with the ability to interpret participant outcomes Implement consistent process to optimally deliver high-quality support in an online, asynchronous environment Collaborate with team members and faculty to promote excellence in delivery, discuss students’ outcomes and be a player in supporting product development Provide scheduled virtual student office hours, weekly Have access to dependable computer with reliable internet access

Conifer Health Solutions

Clinical Appeals Nurse - Remote - $10K Sign On Bonus

Posted on:

November 3, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Texas

For over 35 years, Conifer Health has partnered with health systems, hospitals, physician groups, and employers to deliver tailored, technology-enabled revenue cycle and value-based care solutions that improve financial performance, enhance the care experience, and reduce the cost to collect. Supporting more than 600 clients and managing over $32 billion in NPR annually, we operate with a “by operators, for operators” mindset — combining deep operational expertise with intelligent automation, advanced analytics, and a mature global delivery model. Our commitment is simple: deliver on client goals with full transparency and measurable outcomes at every step.

The Revenue Cycle Clinician for the Appellate Solution is responsible for: a) Recovering revenue associated with disputed/denied clinical claims or those eligible for clinical review b) Preparing and documenting appeal based on industry accepted criteria.

KNOWLEDGE, SKILLS, ABILITIES: 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. Demonstrates proficiency in the application of medical necessity criteria, currently InterQual® Possesses excellent written, verbal and professional letter writing skills Critical thinker, able to make decisions regarding medical necessity independently Ability to interact intelligently and professionally with other clinical and non-clinical partners Demonstrates knowledge of managed care contracts including reimbursement matrixes and terms Ability to multi-task Ability to conduct research regarding State/Federal appellate guidelines and applicable regulatory processes related to the appellate process. Ability to conduct research regarding off-label use of medications. Conifer requires its candidates, as applicable and as permitted by law, to obtain and provide confirmation of all required vaccinations and screenings prior to the start of employment. This may include, but is not limited to, the COVID-19 vaccination, influenza vaccination, and/or any future required vaccines and screenings. EDUCATION / EXPERIENCE: Include minimum education, technical training, and/or experience required to perform the job. Must possess a valid nursing license (Registered) Minimum of 3 years recent acute care experience in a facility environment Medical-surgical/critical care experience preferred Minimum of 2 years UR/Case Management experience preferred Managed care payor experience a plus either in Utilization Review, Case Management or Appeals Previous classroom led instruction on InterQual® products (Acute Adult, Peds, Outpatient and Behavioral Health) preferred CERTIFICATES, LICENSES, REGISTRATIONS: Current, valid RN licensure (Must) Certified Case Manager (CCM) or Certified Professional in Utilization Review/Utilization Management/Healthcare Management (CPUR , CPUM, or CPHM) 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. Ability to lift 15-20lbs Ability to travel approximately 10% of the time; either to facility sites, National Insurance Center (NIC) sites, Headquarters or other designated sites Ability to sit and work at a computer for a prolonged period of time conducting medical necessity reviews 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. Characteristic of typical office environment requiring use of desk, chair, and office equipment such as computer, telephone, printer, etc. OTHER: May require travel – approximately 10% Interaction with facility Case Management, Physician Advisor is a requirement.

Performs retrospective (post –discharge/ post-service) medical necessity reviews to determine appellate potential of clinical disputes/denials or those eligible for clinical review. Demonstrates proficiency in use of medical necessity criteria sets, currently InterQual® or other key factors or systems as evidenced by Inter-rater reliability studies and other QA audits. Constructs and documents a succinct and fact based clinical case to support appeal utilizing appropriate module of InterQual® criteria (Acute, Procedures, etc). If clinical review does not meet IQ criteria, other pertinent clinical facts are utilized to support the appeal. Pertinent clinical facts include, but are not limited to, documentation preventing a safe transfer/discharge or documentation of medical necessary services denied for no authorization. Demonstrates ability to critically think and follow documented processes for supporting the clinical appellate process. Adheres to the department standards for productivity and quality goals. Ensuring accounts assigned are worked in a timely manner based on the payor guidelines. Demonstrates proficiency in utilization of electronic tools including but not limited to ACE, nThrive, eCARE, Authorization log, InterQual®, VI, HPF, as well as competency in Microsoft Office. Demonstrates basic patient accounting knowledge i.e. UB92/UB04 and EOB components, adjustments, credits, debits, balance due, patient liability, denials management, etc. Additional responsibilities: Serves as a resource to non-clinical personnel. Provides CRC leadership with sound solutions related to process improvement Assist in development of policy and procedures as business needs dictate. Assists Law Department with any medical necessity reviews as capacity allows up to and including attending mediation hearings, other litigation forums, etc.

UnitedHealth Group

RN Concurrent Review - Kelsey Seybold Clinic - Remote

Posted on:

November 3, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Texas

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation’s leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.

Required Qualifications: Associate Degree in Nursing or higher Texas RN License 5+ years of nursing experience in concurrent review Managed Care knowledge Preferred Qualifications: Certification in area of specialization, BSN ACP certification Case Management Certification 2+ years in area of specialization, 2+ years of Case Management/Utilization Review experience Proven program development skills Proven communication and problem-solving skills; Computer literate

The Concurrent Review Case Manager is responsible for telephonic monitoring and the documentation of medical treatment and comparing it to established criteria to determine if treatment meets established guidelines. In addition, the Concurrent Review Case Manager monitors patients progress toward recovery for early identification of continuing care needs in an attempt to facilitate discharge for specified populations. This position works closely with Medical Management Physician leadership and various internal departments You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Sutherland

Contract Clinical Appeals RN

Posted on:

November 3, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Texas

We are One Sutherland — a global team where everyone is working together to create great breakthrough solutions. Our workforce has thrived in an environment of diversity of thought, experience and background. We celebrate our diversity and embrace it whole-heartedly. Sutherland is an equal opportunity employer. We promote a positive work environment by conducting ourselves professionally and helping each other achieve our goal of One Sutherland Team, Playing to Win.

This role is contract and does not offer an hourly rate. Payment is a 1099 paid bi-weekly upon Reviews. We will pay $50 per Appeal, and $25 per Review if cannot be appealed. You will also be paid $25/hour for any IT/ Compliance trainings that require completion of your time. The Appeals Nurse will review medical records to construct compelling clinical appeals in order to overturn managed care denials based upon clinical nursing judgment and the medical necessity of services delivered.

Licensed RN. 5 years experience working in acute hospital setting. Knowledge of managed care and utilization review process. Knowledge of Interqual criteria and/or Milliman Guidelines. Knowledge of DRGs. Excellent written skills. Proficient computer skills including Microsoft Office, with access to high-speed internet. Experience as a Case Manager or UR nurse who has written appeals is required.

Review of medical records to evaluate the validity of 3rd party denials. Assess strength of completed appeal to predict favorable outcomes. Ability to detect issues resulting in denials and constructively report on issue to assist in resolution. Construct 1st and 2nd level appeals by applying clinical rationale. Manage assigned workload of accounts so appeals are submitted timely in accordance with payer timeframes.

Ensemble Health Partners

RN Clinical Appeals

Posted on:

November 3, 2025

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Virginia

Ensemble Health Partners is a leading provider of technology-enabled revenue cycle management solutions for health systems, including hospitals and affiliated physician groups. They offer end-to-end revenue cycle solutions as well as a comprehensive suite of point solutions to clients across the country. Ensemble keeps communities healthy by keeping hospitals healthy. We recognize that healthcare requires a human touch, and we believe that every touch should be meaningful. This is why our people are the most important part of who we are. By empowering them to challenge the status quo, we know they will be the difference! O.N.E Purpose: Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results.

CAREER OPPORTUNITY OFFERING: Bonus Incentives Paid Certifications Tuition Reimbursement Comprehensive Benefits Career Advancement This position pays between $56,800.00 – $108,900.00 based on experience This individual will be responsible for reviewing denials and performing root cause analysis while partnering with the Denial Prevention Nurse Manager to improve process and reduce denials. The RN Clinical Appeals performs all appeals for clinically related claim denials across Ensemble Health Partners, or in a role that primarily assists with analyzing and reviewing records to prevent future denials, provide clinical records to payers, and prepare for provider-to-provider (P2P) reviews. Job duties include, but are not limited to, contacting insurance plans to determine reasons claims were denied, analyzing the claims and determining if appeal is necessary, preparing the appeal materials which may include correcting and resubmitting claims, gathering additional information, including reviews of medical records, acting as a liaison between healthcare providers for any additional medical documentation or clarification, and submitting appeals in a timely manner. In addition, the Specialist will work closely with other departments, such as Case Management, HIM, Physician Advisory, Clinical Denials, Denial Prevention, Accounts Receivable, Bedded Inpatient Authorization and Virtual Utilization review, to ensure denial trends and outcomes are communicated in a timely manner. The Specialist will perform these duties while meeting the mission of Ensemble Health Partners, as well as meeting the regulatory compliance requirements.

Employment Qualifications: Current unrestricted license to practice nursing (LPN, RN) CRCR or other approved professional certification required with 9 months of date of hire Job Experience: 1 to 3 Years Desired Education Level: Associates Degree or Equivalent Experience Preferred Area of Study: Nursing Other Preferred Knowledge, Skills and Abilities: 4 year/ Bachelors Degree Preferred Minimum Education - Specialty/Major: Registered Nurse (RN) or relevant discipline Minimum Years and Type of Experience: 2 years of denials, utilization review, or case management experience strongly preferred Other Knowledge, Skills and Abilities Required: Proficient computer skills, including Microsoft Suite Experience in hospital operations, chart audit/review, and provider relations.

Customer Obsession: Consistently provide exceptional experiences for our clients, patients, and colleagues by understanding their needs and exceeding their expectations. ​Embracing New Ideas: Continuously innovate by embracing emerging technology and fostering a culture of creativity and experimentation. Striving for Excellence: Execute at a high level by demonstrating our “Best in KLAS” Ensemble Difference Principles and consistently delivering outstanding results. ​Contacting insurance plans to determine reasons claims were denied, analyzing the claims and determining if appeal is necessary, preparing the appeal materials which may include correcting and resubmitting claims, gathering additional information, including reviews of medical records, acting as a liaison between healthcare providers for any additional medical documentation or clarification, and submitting appeals in a timely manner. In addition, work closely with the Case Management Department and HIM Department to ensure denial trends and outcomes are communicated in a timely manner. This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Associates may be required to perform other job related duties as required by their supervisor, subject to reasonable accommodation.

EK Health Services Inc.

Bill Review Nurse Specialist - REMOTE - LVN/LPN/RN

Posted on:

November 3, 2025

Job Type:

Full-Time

Role Type:

License:

LPN/LVN

State License:

Arizona

EK Health Services Inc. is a leading national workers’ compensation managed care organization. EK Health partners with companies, insurers, healthcare professionals, and patients to successfully resolve and simplify the complex issues surrounding work comp healthcare. With a complete line of managed care solutions, EK Health sets the gold standard for early intervention, medical case management, utilization and peer review, medical bill review, network management, clinical specialty programs, preventative ergonomics, interpretation and translation, vocational rehabilitation, and medicare set-aside. Striving to transform the managed care industry, EK Health is focused on restoring quality of life for injured workers through innovative, cost-effective solutions. Clients trust us to provide services with high-touch experiences, customizable and nimble solutions, lower costs, and proven results. Our holistic approach integrates the best people, processes, and technology to facilitate the best medical treatment available for return-to-work possibilities.

Under the direction of the Bill Review Manager, the Bill Review Nurse Specialist is responsible for utilizing clinical acumen and medical review expertise related to reviewing workers’ compensation medical bills, including but not limited to: reviewing medical records, detailed/itemized statements and other documentation and applying medical necessity or payer guidelines to identify billed items and services that do not meet appropriate regulatory and compliance guidelines Position Specifics: Exempt-Full Time, Remote, Business Hours Monday through Friday

US state licensed Nurse (RN, LPN, LVN) Experience in performing Bill audit reviews 3+ years of experience in complex Workers' Compensation Bill Review with customer service exposure (preferred) Knowledge of medical terminology and coding Ability to read, analyze, and interpret technical procedures, medical reports, state laws and fee schedules CPC (Certified Professional Coding) coursework or certification a big plus Excellent Written and Oral Communication Skills Excellent Interpersonal & Organization Skills Experience with computers and computer programs (MS Word, MS Excel, Email) Ability to work independently with minimal supervision Ability to meet deadlines in a high pressure, time sensitive environment Physical Requirements: The candidate must be able to sit the majority of the day. The candidate must be able to keyboard the majority of the day. Candidate must have manual dexterity. Candidate must be able to speak on the telephone intermittently throughout the day. Candidate must be able to read and write English fluently. Candidate must be able to provide and confirm safe home office environment. Home office must be HIPAA compliant. *Requires DSL, fiber, or cable internet connection from home, 100 Mbps preferred or better. *

Accurately and appropriately analyze complex medical bills and make payment recommendations based on claim history, medical notes, usual and customary rates (UCR), statutory regulations including state laws and fee schedules, available MPN/PPO contracts, coding guidelines, client instructions, and company policies and procedures Research and apply applicable guidelines, and document clear and concise notes related to the recommendations along with related rationales Perform coding analysis. e.g. Medically Unlikely Edits (MUEs), Healthcare Common Procedure Coding System (HCPCS)/ Current Procedural Terminology (CPT), Diagnosis Codes, etc. Engage with medical providers to negotiate medical services on behalf of our clients while creating long lasting relationships Communicate with medical providers to obtain needed information and resolve bill-specific issues Affidavits/Testify – Bill Review expert witness to provide expert testimony in legal cases involving medical billing disputes, or reasonableness of charges, particularly with insurance claims, workers’ compensation, personal injury, and medical malpractice. Review bills with missing Codes. Review corresponding medical documentation and provide appropriate billing. Medical Records – Able to review medical records Explanation of Review (EOR) – Provide EORs that include detailed sources to complete an analysis. Matching Diagnostic Codes with Bills – Able to match diagnostic codes to codes on a bill Respond to issues and drive problem resolution in a quick turn- around time Participate in ongoing training to enhance job skills and knowledge Maintain emphasis on privacy and confidentiality in all review interactions and completions Complete assigned cases accurately, meeting all regulatory and compliance timelines Continuous working knowledge of Ahshay and the BR system Support and assist all levels of the organization Other duties as assigned

Planned Parenthood of Northern New England

Registered Nurse (RN) - Remote Care Team

Posted on:

November 3, 2025

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

Planned Parenthood of Northern New England (PPNNE) is the largest sexual & reproductive health care provider, educator, and advocate in northern New England, with 20 health centers across Maine, New Hampshire, and Vermont. We provide, promote, and protect access to reproductive health care and sexuality education so that all people can make voluntary choices about their reproductive and sexual health

POSITION TITLE: Registered Nurse (RN) – Remote Care Team LOCATION: ME, NH or VT HOURS: Full time, 37.5hrs/week, hourly (Non-Exempt) position UNION MEMBERSHIP: This position is represented by AFT union in NH/VT & MSEA union in ME POSITION PURPOSE PPNNE’s Remote Care Team (RCT) provides both Telehealth clinical care to patients, as well as Centralized Clinical Support to both patients and health center staff at our 16 health centers regarding lab work follow up, patient communications, referral care coordination, and health information management Affiliate-wide. The Registered Nurse for Remote Care Team Nurse may serve as the first point of contact for patients via remote support services, ensuring outstanding customer service and patient satisfaction by collaborating with the team to provide high-quality patient centered care, while also attending to daily administrative centralized support duties Affiliate-wide. JOB PERKS: Work with a group of dedicated professionals Collaborative Work Environment – PPNNE upholds high workplace values and patient service standards, fostering respect, engagement, and teamwork to create the best experience for employees and patients alike. Cost Coverage for State RN licensure renewal Gain experience with a trusted leader in affordable, high quality, health care Gain experience using the Electronic Medical Records program EPIC Make a Difference! - Make a direct impact in your community by providing patients with access to high quality & essential health care services

KNOWLEDGE, SKILLS AND ABILITIES: RN, with associate degree in nursing (bachelor's degree preferred), plus 1-3 years of relevant clinical experience, or an equivalent combination of education and experience from which comparable knowledge and skills are acquired Compact RN license in Vermont, New Hampshire and Maine Ability to work completely remotely and collaborate effectively with remote team members across 3 states Excellent customer service skills and ability to discuss sensitive topics using trauma informed approach to care Experience with telephone and EHR portal triage Ability to navigate multiple digital applications at once including EHR, Microsoft 365 (Excel, Word, Teams, SharePoint), Outlook, RingCentral phones/faxing, and other technologies as needed, or willingness to learn Ability to sit or stand for up to 6-7.5 hours per day

Schedule patients for appointments based on medication, symptom or follow up needs Provide excellent, patient-centered care in collaboration with PPNNE colleagues including licensed and non-licensed staff Counsel/educate patients regarding all services offered by PPNNE including general reproductive health care; all FDA-approved methods of birth control, including emergency contraception; pregnancy options; and other services related to physical and emotional health and wellbeing Assist the Remote Care Team managers with assigned responsibilities, primarily related to follow up of lab results, incoming patient medical questions, and care coordination in collaboration with members of the Remote Care Team Notify patients of results, follow up care plans, and send reminders for care, while completing communications within appropriate timeframes per Medical Standards and Guidelines (MS&G) Triage and respond to incoming patient communications, via telephone and electronic communications Fulfilling prescription treatments based on lab result findings Assist with regular Clinical Quality Assurance initiatives and associated required audits Provide health care that is culturally and linguistically appropriate to PPNNE patient populations Demonstrate approach to sexual and reproductive health care consistent with Planned Parenthood’s philosophy, service standards and fundamental concepts of reproductive justice.

Molina Healthcare

Care Review Clinician LVN

Posted on:

November 3, 2025

Job Type:

Full-Time

Role Type:

Utilization Review

License:

LPN/LVN

State License:

California

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

California residents preferred. Candidates who do not live in California must work Pacific business hours permanently Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary and align with established clinical guidelines, insurance policies, and regulations - ensuring members reach desired outcomes through integrated delivery of care across the continuum. Contributes to overarching strategy to provide quality and cost-effective member care.

At least 2 years health care experience, including experience in hospital acute care, inpatient review, prior authorization, managed care, or equivalent combination of relevant education and experience. Clinical licensure and/or certification required ONLY if required by state contract, regulation or state board licensing mandates. If licensed, license must be active and unrestricted in state of practice. Ability to prioritize and manage multiple deadlines. Excellent organizational, problem-solving and critical-thinking skills. Strong written and verbal communication skills. •Microsoft Office suite/applicable software program(s) proficiency. Preferred Qualifications: Certified Professional in Healthcare Management (CPHM). Recent hospital experience in a medical unit or emergency room. Previous experience in Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. CALIFORNIA State Specific Requirements: Must be licensed currently for the state of California. California is not a compact state. WORK SCHEDULE: Tues - Sat with some holidays. Training will be held Mon - Fri

Assesses services for members to ensure optimum outcomes, cost-effectiveness and compliance with all state/federal regulations and guidelines. Analyzes clinical service requests from members or providers against evidence based clinical guidelines. Identifies appropriate benefits, eligibility and expected length of stay for requested treatments and/or procedures. Conducts reviews to determine prior authorization/financial responsibility for Molina and its members. Processes requests within required timelines. Refers appropriate cases to medical directors (MDs) and presents cases in a consistent and efficient manner. Requests additional information from members or providers as needed. Makes appropriate referrals to other clinical programs. Collaborates with multidisciplinary teams to promote the Molina care model. Adheres to utilization management (UM) policies and procedures.

NPHire

Remote Nurse Practitioner – Telehealth Consults | ~$60/hr

Posted on:

November 3, 2025

Job Type:

Contract

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

A growing telehealth group is seeking licensed MDs and Nurse Practitioners to provide brief virtual consultations for adult patients nationwide. This contract role is 100% remote with flexible scheduling—you’re only online when patients are booked, typically 5–6 hours per day. Compensation & Highlights $25–$60 per hour (paid per consultation / monthly payouts) Remote, flexible—set availability around patient demand No controlled substances on formulary; admin & patient coordination provided

Active U.S. license: NP (FNP/AGNP/AGPCNP/ANP/DNP) or MD (multi-state welcomed) Strong clinical judgment, clear communication, and comfort with telemedicine workflows Ability to use modern EHR/video platforms; reliable remote setup Preferred state licenses: New York, California, Texas, Georgia

Conduct short (1–2 minute) phone or video assessments for focused complaints Review patient info on a proprietary EHR and determine appropriate non-controlled prescriptions Complete concise, compliant EMR documentation and coordinate with support staff as needed

Personify Health

Case Manager Nurse

Posted on:

November 3, 2025

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

California

Ready to create a healthier world? We are ready for you! Personify Health is on a mission to simplify and personalize the health experience to improve health and reduce costs for companies and their people. At Personify Health, we believe in offering total rewards, flexible opportunities, and a diverse inclusive community, where every voice matters. Together, we’re shaping a healthier, more engaged future.

We are seeking a Case Manager Nurse, RN to join our team on a part-time basis, working up to 29 hours per week. In this role, you will provide telephonic case management between providers, patients and caregivers to help ensure cost-effective, high-quality healthcare for health insurance plan participants. This position offers flexibility and is ideal for candidates looking for reduced hours while making an impact within the team. Evening and weekend availability may be required.

Graduation from an accredited RN program and possession of a current California RN license. Minimum of five (5) years medical/surgical or acute care experience, including two years’ experience in case management, or an equivalent combination of education and experience. Prefer case management experience, emergency room, critical care background or some other area of clinical care that is pertinent to case management. Knowledge of medical claims and ICD-10, CPT, HCPCS coding. Ability to critically evaluate claims data and determine treatment plan; discharge planning experience.

Contact patient and complete a thorough assessment, including physical, psychosocial, emotional, spiritual, environmental, and financial needs. Use claims processing tools to review and research paid claim data to develop a clinical picture of a member’s health and identify for participation in appropriate programs. Develop treatment plan for standard and catastrophic cases in collaboration with the patient, caregivers or family, community resources and multi-disciplinary healthcare providers that include obtainable short- and long-term goals. Monitor interventions and evaluate the effectiveness of the treatment plan in a timely manner; report measurable outcomes that record effectiveness of interventions. Initiate and maintain contact with the patient/family, provider, employer, and multidisciplinary team as needed throughout the continuum of care. Advocate for the patient by facilitating the delivery of quality patient care, and by assisting in reducing overall costs; provide patient/family with emotional support and guidance. Be able to meet productivity, quality and turnaround time requirements on a daily, weekly and monthly basis. Negotiate and implement cost management strategies to affect quality outcomes and reflect this data in monthly case management reviews and cost avoidance reports. Establish and maintain working relationships with healthcare providers, client/group, and patients to provide emotional support, guidance and information. Evaluate and make referrals for wellness programs. Maintain complete and detailed documentation of case managed patients in Eldorado and UM Web; maintain site specific files ensuring confidentiality; prepare reports and updates at 30-day intervals for high-risk cases and 90 days interval for low risk cases ensuring confidentiality according to Company policy and HIPAA Perform Utilization Review for assigned members. Serve as mentors to LVNs and provide guidance on complicated cases as it relates to clinical issues.