PharmD Live

Chronic Care Management Nurse – Virtual Care (Nevada)

Posted on:

January 27, 2026

Job Type:

Contract

Role Type:

Care Management

License:

RN

State License:

Nevada

PharmD Live is a virtual care management solutions company powered by a multidisciplinary clinical team, with clinical pharmacists at the center of all care delivery. We focus on reducing medication-related risk, preventing adverse drug events, and lowering total cost of care through integrated medication therapy management, disease management, and patient-centered education. Our comprehensive solutions support the full spectrum of value-based care and include Chronic Care Management (CCM and Complex CCM), Advanced Primary Care Management, Advanced Care Management, Annual Wellness Visits (AWV), Transitions of Care Management (TCM), Medication Therapy Management (MTM), post-discharge medication reconciliation, polypharmacy and high-risk medication reviews, Remote Patient Monitoring (RPM), Remote Therapeutic Monitoring (RTM), Behavioral Health Integration (BHI), adherence optimization, deprescribing initiatives, chronic disease and medication education, and longitudinal care coordination. We partner with medical clinics, specialists, health systems, ACOs, FQHCs, and payers to close care gaps, improve outcomes, and deliver measurable, sustainable clinical and financial impact.

Location: Remote | Nevada Licensure Required Employment Type: Flexible (PT/FT Options Available) Role Description: PharmD Live is seeking a Chronic Care Management Nurse to deliver longitudinal support to patients with multiple chronic conditions. This role is central to improving care continuity, reducing avoidable utilization, and supporting value-based care initiatives through structured remote engagement.

Active LPN or RN license issued by the State of Nevada Minimum of 2 years nursing experience in ambulatory, chronic, or virtual care Experience with CCM, population health, or care coordination preferred Strong organizational and patient communication skills Comfortable working independently in a remote clinical setting

Conduct routine CCM check-ins and patient assessments via telehealth Reinforce individualized care plans and chronic disease self-management strategies Identify clinical risks and coordinate escalation pathways when needed Track and respond to remote monitoring data in collaboration with clinicians Support transitions of care following hospital or emergency encounters Coordinate with interdisciplinary care teams to ensure consistent follow-up Complete accurate clinical documentation in accordance with CMS requirements Address social, behavioral, and educational barriers impacting adherence

Myers and Stauffer LC

RN Clinical Reviewer

Posted on:

January 27, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Indiana

Myers and Stauffer LC is a certified public accounting and health and human services consulting firm, specializing in audit, accounting, data management and consulting services to government-sponsored health care programs (primarily state Medicaid agencies, and the federal Center for Medicare & Medicaid Services). We have 45+ years of experience assisting our government clients with complex health care reimbursement and provider compliance issues, operate 21 offices and have over 900 associates nationwide. At Myers and Stauffer, you will have a career that is rewarding while also supporting our state and federal government health and human service clients that focus on those in need. We are committed to providing our employees with professional growth and development opportunities, a diverse, dynamic, challenging work environment, and a strong and visionary leadership team. Our firm takes pride in the welcoming and collaborative culture we have throughout our offices. We are always willing to discuss potential flexibility that an employee may need to better suit their work-life wellbeing.

The RN Clinical Reviewer will independently review/audit nursing facility medical records relating to the Minimum Data Set (MDS).

Bachelor’s degree in Nursing or other related health care field required (Associate’s Degree from accredited nursing school with related experience may be substituted in lieu of a bachelor’s degree) Licensed Registered Nurse (RN) 3 years of long-term care experience; 5 years preferred MDS experience preferred Experience and knowledge of State and Federal healthcare regulations in long term care Knowledge of Medicaid reimbursement and coverage policies desired Proficient use of applicable software programs, including Microsoft Windows, Word, Excel Strong verbal and written communication skills Ability to manage multiple deadlines and prioritize assignments Ability to work in a team environment Well organized with a high degree of accuracy and attention to detail Must be able to travel based on client and business needs (up to 20% Travel) Minimum Qualifications: High school diploma or GED

Review resident medical records for accuracy, completeness and consistency with professional standards Participate in remote and on-site field examinations of Medicaid providers to review clinical documentation Successfully interact with providers in a professional manner, developing rapport and enhancing business relationships Maintain security of and confidentiality of all Protected Health Information (PHI) Additional responsibilities as assigned

Sentara Health

106444 - Integrated Case Manager - Registered Nurse

Posted on:

January 27, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Virginia

Sentara Health, an integrated, not-for-profit health care delivery system, celebrates more than 135 years in pursuit of its mission - "we improve health every day." Sentara is one of the largest health systems in the U.S. Mid-Atlantic and Southeast, and among the top 20 largest not-for-profit integrated health systems in the country, with 34,000 employees, 12 hospitals in Virginia and Northeastern North Carolina, including 10 hospitals with the prestigious Magnet®️ recognition, and the Sentara Health Plans division which serves more than 1 million members in Virginia and Florida. Sentara is recognized nationally for clinical quality and safety and is strategically focused on innovation and creating an extraordinary health care experience for our patients and members. Sentara was named a Health Quality Innovator of the Year (2024), was recognized by Forbes as "America’s Best-In-State Employer” (2024), "Best Employer for Veterans" (2022, 2023), and "Best Employer for Women" (2020), and named to IBM Watson Health's "Top 15 Health Systems" (2021, 2018).

Sentara Health in Lawrenceville, VA is looking to hire an Integrated Case Manager, RN. This is a remote position; however, candidates must reside in Lawrenceville, and surrounding areas as travel is required. The Integrated Case Manager is responsible for case management services within the scope of licensure; develops, monitors, evaluates, and revises the member's care plan to meet the member's needs, with the goal of optimizing member health care across the care continuum. Performs telephonic or face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical and behavioral health, social services and long-term services.

Education: Associates Bachelors preferred Certification: Registered Nurse required Experience: 3 years of nursing experience required Managed care preferred Discharge planning experience preferred

Identifies members for high-risk complications and coordinates care in conjunction with the member and health care team. Manages chronic illnesses, co-morbidities, and/or disabilities ensuring cost effective and efficient utilization of health benefits; conducts gap in care management for quality programs. Assists with the implementation of member care plans by facilitating authorizations/referrals within benefits structure or extra-contractual arrangements, as permissible. Interfaces with Medical Directors, Physician Advisors and/or Inter-Disciplinary Teams on care management treatment plans. Presents cases at case conferences for multidisciplinary focus. Ensure compliance with regulatory, accrediting and company policies and procedures. May assist in problem solving with provider, claims or service issues. Demonstrates the minimum knowledge, skills and abilities to care for the individualized needs of the patient to include physical, psychological, socio-cultural, spiritual and cognitive needs as well as functional abilities including the need for diversified use of such practices. Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills

Sailor Health

RN Healthcare Advocate (Remote)

Posted on:

January 27, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

New York

Sailor Health is revolutionizing mental health care for older adults, addressing one of the fastest-growing and most underserved healthcare segments in America. With over 60 million seniors projected to represent nearly 25% of the population by 2030, we're facing a seismic shift in healthcare demand. Yet, today, millions of older adults remain isolated, underserved, and struggling with mental health challenges such as anxiety, depression, loneliness, and life transitions without adequate support. Join us on our mission to redefine the golden years, enabling older adults across the nation to live happier and healthier lives. This isn't just a job—it's an opportunity to pioneer a movement in geriatric mental health and reshape the future of aging.

Join a mission-driven team transforming senior mental health care with compassion, flexibility, and support. Work remotely from your home and on your own hours. Sailor will take care of finding patients to you so that you can focus on providing exceptional care! About the Role: Sailor Health is seeking experienced and action-oriented RN Healthcare Advocates to support older adults on Medicare throughout their health journeys. As a Healthcare Advocate at Sailor Health, you’ll be a trusted partner for patients and families — offering empathetic guidance, tackling complex care challenges, and ensuring our patients feel supported and empowered. You’ll help connect the dots between mental health, physical health, and daily life — especially around Social Determinants of Health. This is a remote, 1099 position with flexible hours — starting at 15 hours per week. Compensation: $40 / hour

Registered Nurse license, active and in good standing Experience working in healthcare advocacy or care navigation with Medicare populations Familiarity with SDOH and how they affect patient outcomes Clinical judgment balanced with empathy and problem-solving Organized, communicative, and able to manage multiple patients and needs Tech-savvy—you’re comfortable learning new systems and working remotely Action-oriented and energized by building something new Based in the U.S.

Build trusted relationships with older adults and their families, grounded in listening and empathy. Serve as a go-to resource for navigating medical systems, social services, and emotional wellness needs. Create individualized care plans that address both clinical needs and SDOH, such as: Access to food and housing programs Transportation coordination Medication management and reminders Appointment scheduling and follow-ups Caregiver support and education Collaborate with Sailor’s therapists, care coordinators, and tech platform to deliver seamless, person-centered care. Provide feedback to help shape Sailor’s patient advocacy model as we scale.

Artemis

Bilingual LVN/LPN Care Navigator (Remote)

Posted on:

January 27, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

LPN/LVN

State License:

California

At Artemis, we offer a talent delivery methodology, that actually delivers. We go above and beyond the checkboxes, references and resumes. By harnessing our unique delivery methodology, we can produce higher quality talent at a much quicker and more efficient speed, offering your organization better results in a timely manner for the following talent verticals: Executive Search Technologies Accounting & Finance Healthcare Experience a better way to find your talent.

Artemis Healthcare Partners is seeking a dedicated and passionate professional to join our client's team! Position Name: Bilingual LVN/LPN Care Navigator Location: Remote (must live in Pacific, Central, or Mountain Time Zone) Employment Type: Direct-Hire & Permanent Setting: Telehealth / Virtual Care (Cardiac Specialty) Pay: $27-$30 per hour Shift: Full-Time | Mon-Fri, 9am-5pm In this LVN/LPN Care Navigator Remote role, you’ll play a key role in transforming cardiac care. You’ll work alongside a supportive virtual care team of nurses, practitioners, and pharmacists, using innovative tools to make a real difference in patients’ lives. If you’re looking for a role where your skills, compassion, and adaptability are valued, this is the place.

Required: LVN/LPN License Cardiology Experience (please ensure this is reflected on your Resume) Bilingual in Spanish Must live in Pacific or Central Time Zone Prior EMR/EHR experience (i.e. Epic, Athena, or NextGen) Preferred: Telehealth experience Strong organizational skills and attention to detail Excellent communication and interpersonal skills Ability to work efficiently in a fast-paced environment while maintaining confidentiality

Conduct routine and as-needed calls with patients regarding onboarding, treatment plans, and administrative needs. Transcribe and update patient information across EHR systems. Coordinate with the clinical care team to support patient care priorities. Communicate offerings to patients, addressing inbound calls and questions promptly. Follow escalation protocols to ensure patient safety and care. Build trust and encourage ongoing engagement with patients and caregivers. Proactively manage responsibilities and adapt to evolving team and patient needs.

Haven Headache & Migraine Center

Advanced Practice Provider (Nurse Practitioner/Physician Assistant) – Headache Medicine (California, Remote)

Posted on:

January 27, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

California

Haven Headache and Migraine Center is a virtual-first specialty clinic dedicated exclusively to the care of patients with headache and migraine disorders. Building headache care for the future. Founded by board-certified headache specialists, our mission is to radically improve access to expert care for the millions suffering from migraine and related conditions.

Are you passionate about transforming lives through innovative, patient-centered care? Do you want to be at the forefront of redefining how headache medicine is delivered? We are seeking a passionate, skilled, and autonomous Nurse Practitioner (NP) or Physician Assistant (PA) with experience in headache medicine to join our growing California-based team. If you're ready to make a profound difference and shape the future of telehealth in headache medicine, this is the opportunity for you.

A licensed NP or PA in California or Texas (required) Clinically experienced in headache medicine (2 years+ preferred) Skilled in key headache procedures: Botox for chronic migraine, nerve blocks, trigger point injections Comfortable with — or excited to grow in — telemedicine care delivery Compassionate, autonomous, and energized by a startup-style environment

Deliver exceptional telehealth care to patients with migraine and other headache disorders Interpret detailed headache histories and diagnose using ICHD-3 criteria Create and manage personalized, integrative care plans using both pharmacologic and non-pharmacologic strategies Guide patients in lifestyle approaches like sleep, nutrition, hydration, and exercise Perform or coordinate in-person procedures like Botox, nerve blocks, and trigger point injections Review text-based headache diaries and support patients between visits with real-time insights Partner with a dynamic, physician-led team on care innovation and clinical excellence

Haven Headache & Migraine Center

Triage RN - Headache Medicine (California )

Posted on:

January 27, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

California

Haven is building the future of migraine care for the 40 million Americans who suffer from this debilitating neurological condition. Backed by Precursor Ventures and 1843 Capital, we're transforming how migraine is treated through an innovative combination of telemedicine, AI-enabled monitoring, and personalized care plans. Our early results are exceptional—our initial patient cohort is seeing a 70% improvement rate with days impacted by headache reduced by half.

As an early member of our Triage Nurse team, you will have a direct, meaningful impact on patients’ lives. Migraine is one of the most misunderstood and under-treated neurological conditions — only 8% of patients receive adequate care. You will help change that. You'll work closely with our founding team, including our Stanford-trained Chief Medical Officer, to deliver truly personalized headache care. This is a unique chance to bring high-quality, guideline-driven migraine management to patients nationwide and help build the clinical foundation of a fast-growing, mission-driven startup. If you’re energized by patient connection, evidence-based care, and building something that doesn’t widely exist today, you’ll thrive here. Location information: We are based in downtown San Francisco and value in-person collaboration. This is a remote-first role for candidates based in the Bay Area, with very occasional onsite collaboration at our San Francisco headquarters. We are looking for candidates located anywhere in California. Working Hours & Schedule: This role is shift-based and aligned with Haven’s clinical operating hours. Core coverage is typically Monday–Friday, 9:00 AM–5:00 PM (Pacific Time). Team members work remotely, with multiple shift options available based on patient needs and team coverage. As our patient population and clinical team expand, shift availability and coverage requirements may evolve over time. Flexibility across time zones may be required, particularly as we continue to grow and support patients across California and beyond.

A registered nurse (California license preferred) with 2–4 years of triage experience in neurology, emergency/urgent care, primary care, or related fields Experience in Telehealth, virtual care, or remote patient communication A strong clinical communicator who can balance efficiency with empathy Comfort navigating early-stage startup ambiguity and evolving processes A genuine passion for helping patients feel seen, supported, and understood You’re likely a strong fit if you’re a clear communicator, highly organized, and excited to help build a modern migraine-care model that blends clinical excellence with technology.

Your primary focus will be guiding patients throughout their care journey — ensuring they have timely access to medications, clinical support, and care plan coordination. You’ll be an essential voice for patients, clinicians, and our broader care team. Key responsibilities include: Meeting response-time SLAs for patient questions and clinical concerns Conducting triage and escalation per established protocols Processing medication refills and prior authorizations Ensuring seamless coordination across the patient’s care plan Providing clear, concise clinical documentation Delivering empathetic, patient-centered communication at every step Remote Therapeutic Monitoring (RTM): Oversee patient RTM dashboards, review data, escalate clinical concerns to APPs/MDs, and conduct monthly RN check-ins to evaluate progress.

TAMMIRA

Remote Work- Telehealth Registered Nurse –Virtual iOS App for Adolescents

Posted on:

January 27, 2026

Job Type:

Contract

Role Type:

Telehealth

License:

RN

State License:

California

A telemental health platform for youth aged 10-22 a space to navigate the challenges of online beauty and wellness (mis) information. Wellness Program: Using evidence-based practices, our Nurse Personalizers provide a fun, safe, welcoming environment for education, entertainment, questions, and support without judgment. This builds self-advocacy, communication, social media literacy, and decision-making skills among our youth Learners. Our methods are designed to increase quality of life, self-esteem, and resilience, thereby improving the mental health of our youth Learners. Nurse Personalizers educate and connect with youth Learners about beauty, mental health, and wellness, helping them feel heard and seen while providing support and positivity. By partnering with medical professionals and engaging in monitored collective wisdom circles with peers, TAMMIRA offers a platform for asking questions about changing bodies and minds. Accurate, evidence-based, age-appropriate information is readily available to youth through TAMMIRA.

Remote Part-Time Work- Telehealth Registered Nurse –Virtual livestream mobile app for Adolescents- California licensed - and be comfortable educating on livestreamed events about our wellness modules for students (10-22 years old). There will always be 1-2 nurses and/or health care professional hosting/moderating during each livestreamed event. You can work a few hours on the weekends as needed based on students schedules and for training purposes. Due to the negative influences of social media, adolescents can feel insecure about their appearance with risks for eating disorders and poor mental and physical health. We’re a wellness and beauty livestream platform focused on providing our youth a safe space to feel comfortable with personalized digital spaces co-habited by responsible yet relatable nurses who can offer real-time accurate information about wellness, health and beauty-related topics. This is remote, virtual role is to provide wellness support to our pediatric users in their mental health and wellness journeys through education (e.g., self-awareness, self-esteem) in a supportive environment. Role Summary: Our Virtual Wellness RNs provides virtual, professional nursing care to the platform’s adolescents as referred by the school districts; school nurse, school counselors, social workers and/or requested by the adolescent/family, and in compliance with the state’s Nurse Practice Act, any applicable licensure/certification requirements, and the organization’s policies and procedures. The RN is fully responsible for the virtual assessment, care planning, telephonic intervention, and overall virtual care remote monitoring and follow up. Provides triage/on-call support with referrals to behavioral health medication support as needed. Makes appropriate referrals for evaluation/care to other disciplines and services if need identified, and coordinates care with office care manager to ensure effective and efficient care is provided. Utilizes interview, evaluation in assessing clients and applies nursing judgment, consistent with practice standards, in formulating interventions & making recommendations to the physician, agency, and client.

You must have an iOS iPhone (we're only in the Apple App Store) You must be a U.S. Citizen to apply for this job Experience working in a virtual or telehealth setting is a plus Care and compassion, and a desire to build rapport with patients Pediatric experience preferred Behavioral health experience preferred Reliable high-speed internet service Provide 2-3 professional references that you report to upon request Education Requirements: Associates Degree in Nursing required; Nursing Diploma or by endorsement Bachelors Degree in Nursing preferred Graduate of a school of practical or vocational nursing approved by the appropriate State, agency, and/or accredited School of Nursing or by the National League for Nursing Accrediting Commission (NLNAC) at the time the program was completed by the applicant. Experience Requirements: 3 years of nursing or case management experience required. Working knowledge of regulatory requirements and accreditation standards strongly preferred. Licenses/Certification Requirements: RN License required; Current state nursing licenses or valid RN license from a participating state in the National Licensure Compact This is freelance, remote-work only For licensed nurses in California, USA candidates only apply Please no agencies Please (1) submit your resume via LinkedIn to this job post *Must be ACTIVELY LICENSED IN CALIFORNIA*

Conduct TAMMIRA Wellness Program via our virtual livestreamed secured platform Provide mental health early prevention screenings, psychoeducation, counseling, mentorship and emotional support Accurately assessing needs, delivering or directing the appropriate level of care Identify potential health problems and influence adolescents to make better, healthier decisions Utilize evidence-based practice to provide best in class virtual care Serves as liaison between adolescents, parents, and TAMMIRA nurse staff Observe, recognize, report and respond appropriately to physical, emotional and behavioral changes by our adolescent users Actively participate in interdisciplinary team meetings to discuss about the care, address challenges and develop future collaborative Wellness Program plans Provide education on preventative care, lifestyle modifications and self-management strategies Provide feedback about opportunities to improve the quality of care and operational processes Contributes to the development, implementation, and evaluation of the Wellness Program Demonstrates the knowledge, skills and ability to recognize emergency situations and seeks assistance and initiates appropriate intervention Properly triage for depression, crisis, and suicide issues Demonstrated strong nursing, nutrition, exercise, chronic disease and health promotion, and customer service skills. Well-developed communication and interpersonal skills to provide effective interface with wellness team, parents and adolescents, and other related customers. Demonstrated ability to effectively use health coaching and motivational interviewing techniques to assist patients in achieving health goals. Health Coach Certification a plus. Preferred by not required: Analyze clinical data and prepare reports to identify trends, measure outcomes, and support continuous quality improvement efforts.

Sentara Health

Commercial Utilization Review Nurse/RN- Remote in VA

Posted on:

January 27, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

Sentara Health, an integrated, not-for-profit health care delivery system, celebrates more than 135 years in pursuit of its mission - "we improve health every day." Sentara is one of the largest health systems in the U.S. Mid-Atlantic and Southeast, and among the top 20 largest not-for-profit integrated health systems in the country, with 34,000 employees, 12 hospitals in Virginia and Northeastern North Carolina, including 10 hospitals with the prestigious Magnet®️ recognition, and the Sentara Health Plans division which serves more than 1 million members in Virginia and Florida. Sentara is recognized nationally for clinical quality and safety and is strategically focused on innovation and creating an extraordinary health care experience for our patients and members. Sentara was named a Health Quality Innovator of the Year (2024), was recognized by Forbes as "America’s Best-In-State Employer” (2024), "Best Employer for Veterans" (2022, 2023), and "Best Employer for Women" (2020), and named to IBM Watson Health's "Top 15 Health Systems" (2021, 2018).

Sentara Health is currently hiring for a Utilization Review Nurse- Remote in VA! Status: Full-time, permanent position (40 hours) Standard working hours: 8am to 5pm EST, M-F. Location: Remote in Virginia.

Education: BLD – Bachelor's Level Degree in Nursing preferred Certification/License: Registered Nurse License (RN) – Nursing License – Compact/Multi-State License Experience: Minimum 3 years of acute care clinical experience. Previous Utilization Review and Case Management experience a plus. Commercial Health Insurance experience preferred InterQual or Milliman experience preferred. Knowledge of NCQA preferred. Requires strong oral, written and interpersonal communication skills, problem-solving skills, facilitation skills, and analytical skills.

RN Clinician responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, inpatient review, concurrent review, retrospective review, medical director referrals and execution of member/provider approval and/or denial letter. Reviews provider requests for services requiring authorization. Conducts pre-certification, continued stay review, care coordination, or discharge planning for appropriateness of treatment setting reviews to ensure compliance with applicable criteria, medical policy, and member eligibility, benefits, and contracts. May manage appeals for services denied. Responsible for written and/or verbal notification to members and providers. Demonstrates proactive anticipatory discharge planning; serves as joint transition of care coordinator with case management and facilitates member care transition. Ensures medical director written decision is consistent with criteria (CMS, state, medical policy, clinical criteria). Facilitates accreditation by knowing, understanding, correctly interpreting, and accurately applying accrediting and regulatory requirements and standards.

MDCanHelp

NP/PA/APP Coach - Remote - Part Time

Posted on:

January 27, 2026

Job Type:

Contract

Role Type:

Primary Care

License:

NP/APP

State License:

Massachusetts

MD Can Help is a premier clinician coaching group that has helped over 1000 physicians and Advanced Practice Providers (APPs) overcome burnout and rediscover fulfillment in their careers. We are growing rapidly and seeking an experienced NP/APP coach who is passionate about helping nurse practitioners, physician associates/assistants, and other APPs navigate the challenges of clinical practice and build sustainable, rewarding careers. Our CEO, Dr. Gail Gazelle, is an ICF Master Certified Coach (MCC), Assistant Professor at Harvard Medical School, and author of Mindful MD. She is one of the most respected leaders in clinician coaching, and this role provides a unique opportunity to be mentored directly by her while making a tangible impact on the lives of APPs.

This is a client-facing coaching role, where you will work directly with APP clients using proven coaching methodologies. If you are a former practicing NP, PA, or other APP with experience coaching clinicians, love helping others overcome burnout, and want to continue developing as a coach under the mentorship of Dr. Gazelle, this could be a great fit for you.

A former practicing NP, PA, or other Advanced Practice Provider who understands firsthand the pressures of clinical practice. Experienced in coaching APPs—you have worked directly with APPs in a coaching capacity. Deeply passionate about helping other clinicians overcome burnout and find fulfillment. An exceptional listener who can create a safe space for clients to reflect, grow, and take action. Motivated to be mentored by Dr. Gail Gazelle and grow into the best coach you can be. Skilled in motivational interviewing, coaching techniques, or related methodologies. Comfortable with virtual coaching sessions and working remotely. Highly professional, reliable, and compassionate in working with clinician clients.

Work one-on-one with APP clients, helping them overcome burnout and build careers they love. Guide clients through proven coaching frameworks developed by MD Can Help. Provide structured, goal-oriented coaching that leads to tangible results. Receive direct mentorship and training from Dr. Gail Gazelle to refine your coaching skills. Collaborate with our team to enhance coaching programs and contribute to clinician well-being. Maintain confidentiality, professionalism, and high ethical standards in all coaching interactions. What We’re Looking For (Must-Haves) Former practicing NP, PA, or other APP with relevant clinical background. Experience coaching clinicians 1:1. Full coach training in an ICF-accredited program. Passion for coaching and APP well-being. Excellent communication and listening skills. Eager to receive mentorship from Dr. Gail Gazelle and continuously improve as a coach. Ability to work remotely and provide high-quality virtual coaching. You reside in the United States. An audio of a coaching session (Do not apply if you cannot share an audio.) Preferred (But Not Required) ICF certification (or in the process of obtaining it). Background in executive coaching, positive psychology, or leadership development.

GlobalHealth, Inc.

Care Specialist LPN (49539)

Posted on:

January 27, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

LPN/LVN

State License:

Compact / Multi-State

GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.

This position, under the direction of the Supervisor, Care Management, performs and manages all aspects of care management to improve the long-term wellness of members, becoming an advocate for our members through coordination of care.

Education And Experience: Active Licensed Practical Nurse in the state of Oklahoma required Active multi-state license is preferred Previous experience in managed care/utilization management preferred Knowledge, Skills And Abilities: Knowledge of current nursing processes, techniques, and established standards, including disease management, medications, and community resources. Strong attention to detail and good organization and time management skills, including ability to multi-task, learn new skills and reach set goals. Must be able to communicate, both orally and in writing, clearly and effectively Knowledge of Microsoft software programs including Word, Excel, and PowerPoint. Proven ability to work independently or as a member of a team. Work Environment: Current work environment is remote, however, some state exclusions apply. Must have access to a reliable and secured internet connection source. Work environment must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. This position will also be required to use reasonable and necessary safeguards to protect GlobalHealth records from unauthorized access, disclosure or damage and will adhere to all GlobalHealth privacy and security policies.

Conducts telephonic case management for complex, high-risk members to include identification and assessment of needs, planning and coordination of care, and monitoring outcomes in accordance with GlobalHealth and the departments policies and procedures. Coordinates with providers when applicable to ensure holistic, healthy, beneficial outcomes. Communicates with respect to family culture, ethnic origin, race, language, gender, age, religion, socioeconomic status, sexual orientation, mental and/or physical challenges. Through interdepartmental communication, network communication, and member outreach the Case Manager remains aware of patient needs and changes in condition, providing patient advocacy, support, assessing and ensuring quality care, and providing crisis intervention. Coordination of services for members, including community resources and collaboration with other members of the care team. Educate members and their caregivers on conditions and self-management techniques. Participate in elements of the SNP MOC, including completing HRA and working with the member to reach desired goals, under the direction of the assigned Case Manager Complete TOC activities to include post-discharge assessment, medication reconciliation/review, and ensuring member has access to follow up care. Other Duties: This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

Inspire Hospice and Palliative Care

Remote Triage Nurse

Posted on:

January 27, 2026

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Georgia

Our mission is to provide compassionate, expert hospice care for patients, families and the communities we serve throughout metro Atlanta and North Georgia.

Are you a compassionate RN looking to make a meaningful impact—without leaving home? Inspire Hospice and Palliative Care is seeking a dedicated, part-time Remote Triage Nurse to join our care team. This position is ideal for experienced hospice nurses who want to deliver exceptional end-of-life support while enjoying the flexibility of remote work. Position: Remote Triage Nurse Schedule: Part-time | Saturdays and Sundays, 8:00 AM – 8:00 PM Compensation: $25 per hour

Current Georgia RN license Must reside in Georgia Prior experience in hospice, palliative, or end-of-life care Reliable high-speed internet and access to a private, HIPAA-compliant workspace Strong technical skills with the ability to navigate multiple EMR and communication platforms Ability to thrive in a fast-paced, high-touch environment The Ideal Candidate Will Demonstrate outstanding communication and triage skills Bring a calm, empathetic presence to patients and families during sensitive moments Be highly organized and efficient in managing multiple tasks and priorities Have a background in critical care, triage, or hospice nursing

Provide phone-based triage, assess patient needs, and offer appropriate clinical guidance Review patient records using our electronic medical record (EMR) system and document interactions accurately Collaborate closely with the interdisciplinary care team to support patients and families Respond to patient calls with empathy, urgency, and clinical precision

LumiCare

Registered Nurse - Remote

Posted on:

January 27, 2026

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Whether it is used to manage daily tasks, participate in the community, be successful at one’s employment, or simply to allow someone to experience new things, technology solutions and planning can be the needed step toward elevating a person to the next level of independence.

The vast array of technologies available for those with neuro and physical diversities and other identified needs can be overwhelming. At LumiCare, we have nearly a decade of first-hand experience with technology implementation with one of the largest providers of human services in the country as well as engaging in data driven research as to what is successful. Not only do we have expertise with assessments and recommendations, procuring and customizing technology, but also the most important piece which is sustainability. We are unique in our services, and we pride ourselves on a wide knowledge base in the area of mainstream and specialized solutions. Remote services make our expertise available despite anyone’s geographical location. We will share our knowledge and continue to always research and vet the most useful technologies for optimal outcomes for our customers.

Remote weekend position EVERY Saturday and Sunday 7am-7pm - $30/hr plus Shift Differential for weekend hours.

Current RN Compact License Preferred IDD group home experience Call Center experience Candidate MUST reside in Ohio, Delaware, Virginia, Louisiana, Tennessee, Pennsylvania, or Texas Minimum of 1-2 years clinical experience in an acute or ambulatory care setting Additional RN licenses as determined by LumiCare

Triaging needs Clinical decision making Monitoring remote patient support system when applicable and advising the customer or their support team on actions to take for vital sign or compliance alerts Symptom-based problems, injuries, or general health questions by utilizing clinical software and guideline information.

Louisiana Healthcare Connections

Clinical Review Nurse - Prior Authorization

Posted on:

January 27, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

Louisiana

As the largest Medicaid health plan in the state, Louisiana Healthcare Connections proudly serves more than 400,000 Louisianans. We provide children and families in need with quality healthcare coverage that improves health outcomes. With offices in Baton Rouge, Lafayette, and Covington, our 600-plus Louisiana employees work with physicians and community organizations to help all of our members achieve health and wellness.

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Analyzes all prior authorization requests to determine medical necessity of service and appropriate level of care in accordance with national standards, contractual requirements, and a member's benefit coverage. Provides recommendations to the appropriate medical team to promote quality and cost effectiveness of medical care.

Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. Clinical knowledge and ability to analyze authorization requests and determine medical necessity of service preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: LPN - Licensed Practical Nurse - State Licensure required

Performs medical necessity and clinical reviews of authorization requests to determine medical appropriateness of care in accordance with regulatory guidelines and criteria Works with healthcare providers and authorization team to ensure timely review of services and/or requests to ensure members receive authorized care Coordinates as appropriate with healthcare providers and interdepartmental teams, to assess medical necessity of care of member Escalates prior authorization requests to Medical Directors as appropriate to determine appropriateness of care Assists with service authorization requests for a member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities Collects, documents, and maintains all member’s clinical information in health management systems to ensure compliance with regulatory guidelines Assists with providing education to providers and/or interdepartmental teams on utilization processes to promote high quality and cost-effective medical care to members Provides feedback on opportunities to improve the authorization review process for members Performs other duties as assigned Complies with all policies and standards

CareHarmony

Remote Intake Coordinator - Licensed Practical Nurse (LPN) - $21/hr - Day Shift

Posted on:

January 27, 2026

Job Type:

Full-Time

Role Type:

License:

LPN/LVN

State License:

Compact / Multi-State

At CareHarmony, we are singular in focus—we seek to improve the patient experience and clinical outcomes by providing compassionate, whole-person care coordination services. Our high-tech, high-touch offering includes a turnkey Chronic Care Management solution designed to offer healthcare providers an easy, limited-risk first step into value-based care. CareHarmony serves a variety of organizations across the country, including physician practices, ACO and IPAs.

CareHarmony’s Intake Coordinators (LPN) (NLC) (LVN) work comprehensively with providers to deliver value-based care management initiatives for their patients. CareHarmony is seeking an experienced Licensed Practical Nurse – LPN Nurse (LPN) (NLC) (LVN) with at least 3 years of direct patient-facing work experience; that thrives in a fast-paced environment, is self-motivated, has impeccable attention to detail, and values the impact they can have on a patient’s healthcare journey. You will have experience identifying resources and coordinating needs for chronic care management patients. This role is great for anyone who loves meeting and assisting new patients daily. What's in it for you? Fully remote position - Work from the comfort of your own home in cozy clothes without a commute. Score! Consistent schedule - Full-Time Monday – Friday, no weekends, rotational on-call-once per year on average. Career growth - Many of our team members move up in the company at a faster-than-average rate. We love to see our people succeed!

Additional Requirements: Active Compact/Multi-State license (LPN) (LVN) Technical aptitude – Microsoft Office Suite Excellent written and verbal communication skills Remote Requirements: Must have active high-speed Wi-Fi Must have a home office or HIPAA-compliant workspace Plusses: Epic Experience Bilingual Additional Single State licensures Physical Requirements: This position is sedentary and will require sitting for long periods of time This position will require the ability to speak clearly and listen attentively, often by telephone, for an extended period of time The position will require the ability to understand, process, and take thorough notes in real-time on telephone conversations

Accepting transfers from the Patient Enrollment team to conduct preliminary health assessments for newly enrolled patients in our network. Resolve patients' questions and create an open dialogue to understand needs. Identify and coordinate community resources with patients that would benefit their care. Provide patient education and health literacy on the management of chronic conditions. Assist with medication management, including identifying potential medication concerns, adherence, and coordinating refills. Assist in ensuring timely delivery of services to your patients; Home Health, DME, Home Infusion, and other critical needs. This individual must be able to quickly adapt to a fast-paced work environment. This role requires most of your shift on the phone.

Empassion Health

LPN/LVN Care Coordinator - Fully Remote

Posted on:

January 27, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

New York

Empassion is one of the most impactful and exciting start ups in health care. We are focused on improving the experience and lowering costs for seniors at end of life. Specifically, we provide palliative and hospice care for seniors with serious illness and high risk of an over-medicalized death. This population is highly neglected in the current market. Empassion clients are payers and risk-bearing entities and we work with community palliative and hospice partners to deliver superior outcomes. We are live today across 44 states and growing rapidly. Empassion is a hybrid remote/in-person company, with headquarters in NYC. We prioritize asynchronous work and communication but are quick to get on a call or Zoom

We are hiring a Care Coordinator/LPN to work within our contact center, including directly interfacing with patients, providers, and families in our palliative care program managing day to day functions such as educating patients by phone and scheduling them for palliative appointments. Working with clinical files to close out palliative visits and enter notes into the systems. The Care Coordinator/LPN will spend part of the day on the phones and part of the day doing administrative work. Looking for someone with an empathetic ear and strong multitasking skills to ensure our patients are getting the care they need and deliver on our mission of getting them more good days. The Care Coordinator/LPN will join our Central Operations team, looking for a candidate with deep healthcare, clinical and contact center experience. Empassion will provide in-depth training and resources to ensure that you will be successful in this role. This position is fully remote, but our team communicates regularly on Zoom and Slack.

Minimum 3+ years as an LPN Minimum 3+ years of reading and updating clinical notes Minimum of 1+ years of relevant work experience in a customer service call center Able to receive calls from patients, caregivers, and providers Bring with you strategic thinking to get the job done Enthusiastic about providing an outstanding experience for Empassion Health’s patients and their caregivers Passionate about making a change in the healthcare experience: you love to serve and make a difference, and you go the extra mile for patients, by insisting on the highest standards from the Care Coordinators Strong communication and written skills Detailed oriented Comfortable working with technology and in a dynamic, startup environment Secure Wi-Fi connectivity Spanish-speaking a plus but not required

Help the patient understand the value of palliative care Ensure you spend time connecting to the patients in need of the program to the palliative care providers Answer questions that patients have about palliative care or the program more broadly Confirm patient encounters are documented and triage of patient needs has taken place Review follow up with patients to ensure they are receiving high-quality care from Empassion’s network of providers Review and close cases that are completed daily Assist your supervisor by balancing your time between clinical triage and patient calls

Virta Health

Nurse Coach - LPN/ LVN

Posted on:

January 26, 2026

Job Type:

Full-Time

Role Type:

Coaching

License:

LPN/LVN

State License:

Colorado

Virta is an online specialty medical clinic that reverses type 2 diabetes safely and sustainably without the risks, costs, or side effects of medications or surgery. We also treat patients with pre-diabetes and obesity. Our innovations in the application of nutritional biochemistry, data science, and digital tools--combined with our clinical expertise--are shifting the diabetes treatment paradigm from management to reversal. Virta has developed a novel, team-based care model that delivers the Virta treatment exclusively through a telemedicine platform, with no brick-and-mortar clinics. Our clinical trial, which has already produced ten peer-reviewed publications, shows that the Virta treatment has lowered hemoglobin A1c values under the diabetes threshold while discontinuing diabetes medications. The American Diabetes Association has endorsed the core component of the Virta treatment, personalized carbohydrate restriction, as a first-line nutritional therapy for people with type 2 diabetes. We’ve been reversing diabetes for the last seven years, we see patients in all 50 states, and we are expanding our reach to patients with pre-diabetes and obesity. Our mission: Reverse type 2 diabetes and obesity in 1 Billion people. To achieve that mission, Virta is hiring RN’s to join our team.

We are hiring for fully virtual, full time roles with 8 hr shifts, although some shifts between the hours of 7am to 7pm, with one rotation weekend shift per quarter. The Role: Virta is launching a service for a select group of patients to assist them with their weight loss goals leveraging Virta’s well established approach to obesity reversal as well as GLP-1 agonist medications. We are looking for a small number of RNs who live in a nursing compact state to help our physicians and nurse practitioners launch this service. The role requires experience with diabetes and obesity care and an innovator’s spirit, as this program is new, and we need problem solvers who are willing to help Virta build this program from the ground up. Some experience working in a non-traditional healthcare setting such as a health tech company or other innovative environment is essential to success in this role.

Graduate of an accredited Practical/Vocational Nursing (LPN/LVN) program. Required Licensure: Current, active, and unencumbered LPN or RN license LPNs are encouraged to apply and will be considered for the position based on experience and scope of practice. Active nursing license in a Nursing Licensure Compact state with residency. Eligible for nursing licensure in every U.S. state. Minimum of two years experience working with diabetes patients in a clinical setting Interest and knowledge of diabetes care, education and prevention. Must be proficient in computers and pass a technology assessment. Knowledge of low carbohydrate nutrition and meal planning. CDCES preferred but not required. Interest and aptitude for working with a growth stage, tech-enabled healthcare organization. Occasional (2-3x/yr) travel to team and company events. An outstanding bedside manner: patients trust you and feel supported and empowered by your presence on the phone/video and your communication. Excellent communication, time management, and critical thinking ability necessary in this remote role. Team player: You work well with others, put your team first, and contribute toward the betterment of the Virta clinical team. On Our Values-Driven Culture: Virta’s company values drive our culture, so you’ll excel if: You put people first and take care of yourself, your peers, and our patients equally. You take initiative and complete tasks conscientiously while empowering others to do the same. You value positive impact over busy work. You can check your ego and recognize that everyone has something to bring to the table. You take risks and iterate rapidly. You promote transparency, trust, and empowerment through open access of information. You prioritize data and science over seniority and dogma.

Manage the prescriptions of a panel of patients seeking to reverse their obesity in collaboration with the patient’s Virta medical provider. Educate patients about Virta and Virta’s treatment and help them prepare for their nutritional and behavioral journey with Virta, setting them up for clinical success. Use motivational interviewing techniques to help patients progress in their weight management journey. Supporting patients on their obesity reversal journey, whether it involves nutritional change, medication or both, but with a firm understanding and commitment to Virta’s nutrition-first approach to weight loss. Collaborate closely with our clinical and technology teams to help us build out this new service line. We are committed to providing our patients with an evidence-based, highly-effective clinical program. Embrace a MVP (minimal viable product) approach to clinical program development. As time allows, provide clinical support for our team of providers (MDs and NPs). Responsibilities include panel management, triage calls with patients, medication entry, and diabetes education regarding medication administration, sliding scale insulin, carb counting, etc Commitment to providing care of the highest quality that delivers an exceptional experience for the patient. As time allows, conduct 20-minute clinical intake visits with prospective patients via video and/or phone. Intakes include verifying and documenting a clinical history, verifying medications, answering basic questions about Virta treatment, and identifying and flagging concerning history or labs for provider review.

argenx

Nurse Case Manager (Must have California License)

Posted on:

January 26, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

California

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: Must live in the specified time zone. 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 must Reimbursement experience a plus Must live in geographically assigned territory Bilingual or multilingual a plus

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

CVS Health

Case Manager Registered Nurse - Field (Passaic County, New Jersey)

Posted on:

January 26, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

New Jersey

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.

Location: This role will be work at home with 25-50% travel within Passaic County, NJ. (50-mile radius from applicants’ home) Schedule: Standard business hours Monday-Friday 8:00am-5:00pm EST. Position Summary The ICM Case Manager develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness. This is a remote role with 25-50% travel required, candidates must have a dedicated workspace free of interruptions. Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.

Required Qualifications: Minimum 3+ years of clinical practice experience. Must have active and unrestricted RN licensure in the state of NJ. Must reside close to or within Passaic County, New Jersey. Willing and able to travel 25-50% of their time using your own vehicle to meet members face to face in their assigned area. Reliable transportation required. Mileage is reimbursed per our company expense reimbursement policy. The protection and security of our colleagues is paramount. CVS Health encourages it’s nurses to meet with members in a public place if they feel that is more appropriate. If needed, security escort is also available. Preferred Qualifications: Certified Case Manager is preferred. Minimum 2+ years Care Management, Discharge Planning and/or Home Health Care Coordination experience preferred. Confidence working at home/independent thinker, using tools to collaborate and connect with teams virtually. Excellent analytical and problem-solving skills. Effective communications, organizational, and interpersonal skills. Ability to work independently. Effective computer skills including navigating multiple systems and keyboarding. Demonstrates proficiency with standard corporate software applications, including MS Word, Excel, Outlook, and PowerPoint, as well as some special proprietary applications. Bilingual Preferred. Educational: Associate's Degree required. Bachelor's degree preferred.

Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits. Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning. Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality. Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members. Collaborates with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences. Utilizes case management processes in compliance with regulatory and company policies and procedures. Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation.

ComForCare

Part-Time RN

Posted on:

January 26, 2026

Job Type:

Part-Time

Role Type:

License:

RN

State License:

Michigan

Live your best life possible by helping others live theirs. At ComForCare, we like to celebrate successes and have fun while building meaningful relationships. Join our team and be a part of a certified Great Place To Work®! Why join our team: Work a flexible schedule Paid Travel Time To and From Appointments Mileage Reimbursement 401(k) Matching Employer provided benefits that include: Medical Dental Vision Referral bonus Same Day Pay Available with Tapcheck Paid Training

Geriatric experience preferred. Graduate of an accredited school of professional nursing. Current license as a Registered Nurse (RN). Potiential for transitioning into the Director of Nursing role. Current CPR certification. Access to reliable transportation. Maintains confidentiality in all aspects of the job. Knowledge of safety and infection control practices.

Performing comprehensive client assessments. Developing an individualized plan of care for each client. Providing interventions with a focus on achieving realistic client outcomes. Reporting changes to update the plan of care to reflect progress towards goals and outcomes. Maintaining client records showing systematic assessments, planning interventions, and evaluations Being cross trained to perform orientations, new hire skill assessments, drug testing and on-going caregiver training. Performing other clinical tasks as needed.

Midi Health

REMOTE Nurse Practitioner - Maryland (MD) License

Posted on:

January 26, 2026

Job Type:

Full-Time

Role Type:

Primary Care

License:

NP/APP

State License:

Maryland

At Midi Health, we're on a mission to revolutionize healthcare for women at midlife—to relieve their symptoms, support their wellbeing, and ensure they feel seen, heard, and cared for. Our care is personalized, evidence-based, and covered by insurance, making it more accessible to women across the country. Wherever they live. Whatever their health story. We’re rapidly growing and looking for passionate full-time Nurse Practitioners to join our dedicated clinical team. You’ll help close the gender health gap by guiding women through perimenopause, menopause, and other midlife transitions with compassionate, evidence-based care.

Mission-Driven Impact: Join us in transforming healthcare for women in midlife—making a meaningful difference every day. Remote (U.S.–Based) Role with Structured Hours: Work fully remote from within the United States with patient-facing hours scheduled between 7:00 AM and 7:00 PM, adjusted by patient location and licensure. This is not a digital nomad role; work may not be performed while you are outside the United States. Continuous Learning: Access weekly clinical education to stay sharp and advance your expertise in women’s midlife health. Purposeful Visits: Our appointments provide you with time to listen, educate, and deliver personalized care that truly supports your patients. Technology + Clinical Support: Benefit from structured onboarding, user-friendly tech, and operational assistance—including elements of logistics, scheduling, and clinical operations—so you can focus on care without being on your own. Community of Care: Be part of a collaborative, respectful team passionate about women’s health and dedicated to your professional growth.

Active, unrestricted, and unencumbered Nurse Practitioner license in at least one U.S. state.*Multiple state licenses are highly preferred. Prescriptive authority as a Nurse Practitioner. Active national board certification (FNP, WHNP, AGNP, or similar). Minimum 3 years of recent experience (within the last 5 years) practicing as a Nurse Practitioner in Primary Care, Women’s Health, or Gynecology. Ability to work independently and make sound clinical decisions. High proficiency and efficiency with technology (telehealth platforms, EMRs, communication tools). A strong passion for caring for women navigating menopause and midlife health transitions.

At Midi, you’ll practice with purpose in a virtual-first care model that puts women’s needs front and center: Quality visits, better conversations: Appointments designed to allow time to listen, educate, and personalize care. Evidence-based protocols: Trained in expert-developed clinical pathways combining hormonal therapy, lifestyle coaching, and medication when appropriate. Care beyond the screen: Patients receive labs, prescriptions, supplements, and referrals as needed—our platform makes it seamless. You’re never alone: Supported by a collaborative team of clinicians, care coordinators, and clinical leaders, with opportunities to grow and specialize over time. Meaningful specialty focus: Practice in women’s midlife health, a critically underserved area where you help close one of the most persistent gaps in care. Mission-aligned, patient-centered culture: Join a team dedicated to empathy, equity, and clinical excellence.

Optum

Per Diem Nurse Practitioner - Telephonic Assessment - Remote from anywhere (VA Licensure Required)

Posted on:

January 26, 2026

Job Type:

Part-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Virginia

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.

Provide nursing telephonic assessment, individualized care, and care coordination for patients receiving telephonic services for Optum OB Homecare postpartum hypertension services according to Optum policies and procedures, scope of practice, and certification. You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges.

Required Qualifications: Current unrestricted advanced practice nursing license for state of residence and the state of Virginia 3+ years of full-time clinical experience as an APC and willingness to apply to licensing board for approval for autonomous practice 1+ years of obstetrical nursing experience Proven exceptional communication skills (written and verbal) Proven exceptional clinical assessment skills Ability to manage patient/family conflict resolution and grievances Demonstrated ability to work with individuals with disabilities Willing to become licensed in other states as business needs arise Demonstrated technology knowledge to include desktop/laptop computer proficiency; use of analytical software, Microsoft Office, Outlook (internet and email). Attend in-services on applicable technology enhancements Preferred Qualifications: 3+ years of obstetrical nursing experience Telephonic nursing experience Independent case load management experience

Individualize patient assessments based on care/services being provided and patient need Ensure interventions respect and encourage the patient’s ability to make choices Respect each patient’s rights and conduct business in an ethical manner Educate patients and families with a systematic approach, promoting patient understanding of treatment and services, health status, coping ability and patient/family involvement in the continuum of care or service Initiate the plan of treatment/care pathway based upon the analysis of information obtained and within scope of practice and certification Coordinate care with the patient services centers, social worker and other healthcare professionals to promote the continuum of care or service Accurately communicate (written/verbal) patient status information to prescribing physician and case manager in timely manner and provide necessary clinical information to Optum pharmacists and other healthcare professionals as applicable Provide care and services to assigned caseload in an efficient, organized manner. Maintain flexibility in assignments and scheduling Modify the plan of care, as appropriate, based on re-assessment, change in prescriber orders, the patient’s need for further care or services, and the achievement of identified goals within scope of practice and certification Complete clinical record documentation per Optum policy in a timely, complete, and accurate manner Provide service-related clinical support to key physicians/hospitals through personal contacts and in- services, as directed Positively represent the Company to both internal and external customers; always maintain a professional and courteous manner Uphold the Optum core values in the conduct of work Adhere to Company privacy guidelines; ensure compliance with local, state, and federal regulations May be asked to participate in training or act as preceptor Additional duties as assigned

Conifer Health Solutions

Clinical Appeals Nurse - Remote

Posted on:

January 25, 2026

Job Type:

Full-Time

Role Type:

Case Management

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: Recovering revenue associated with disputed/denied clinical claims or those eligible for clinical review 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 yearsacute care experience in a facility environment Medical-surgical/critical care experience preferred Appeals writing experience preffered 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® or MCG products (Acute Adult, Peds, Outpatient and Behavioral Health) preferred CERTIFICATES, LICENSES, REGISTRATIONS: Current, valid RN/ licensure 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. Adhers 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.

IntellaTriage

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

Posted on:

January 25, 2026

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 remote team of nurses to manage after-hours care delivery. Our triage nurses become an extension of our clients’ care team, and they trust us to support them and their patients during their non-core hours.

We are seeking a compassionate registered nurse (RN) to join our growing team! In this role, you will provide critical after-hours support, triaging hospice patients and family needs over the phone wit professionalism and empathy. You will help ensure timely interventions and coordination of care for patients receiving hospice services.

Active multistate Registered Nurse (RN) license Hospice, palliative, or end-of-life care is strongly preferred Must be comfortable with technology and electronic medical records (EMR) utilized for documentation of calls Ability and comfort with typing documentation and notes in a fast-paced environment Must be able to handle stress and multitask when receiving calls (minimum of 5 calls per hour on weekdays, and up to 8 per hour on weekends) Strong communication and critical thinking skills Ability to work independently in a remote environment This is a remote position that requires consistent attendance, active communication, and reliable internet connectivity during all scheduled shifts to support timely patient care coordination

Provide telephone triage for hospice patients and families Assess patient conditions and determine appropriate next steps Collaborate with on-call teams to coordinate care and resources Accurately document all communications and interventions Maintain a calm and professional demeanor while handling urgent calls.

US Tech Solutions

Utilization Review Nurse

Posted on:

January 25, 2026

Job Type:

Contract

Role Type:

Utilization Review

License:

RN

State License:

Massachusetts

US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com .

Location: Remote (must hold an unrestricted Massachusetts RN license) Employment Type: 5-month contract Overview: We are seeking an experienced Inpatient RN Utilization Reviewer to independently manage a clinically complex inpatient caseload across multiple care settings, including acute, subacute, rehabilitation, and LTAC. This role is responsible for determining medical necessity and benefit coverage across multiple lines of business, including government-sponsored health plans. The ideal candidate is a self-directed clinical professional with strong utilization management experience, sound judgment, and the ability to balance clinical decision-making with health plan business objectives.

Education & Licensure: Registered Nurse with a current, unrestricted state license BSN preferred Experience: Minimum 3 years of clinical nursing experience Minimum 3 years of utilization management experience (inpatient or managed care preferred) Skills & Competencies: Strong clinical judgment and decision-making skills Excellent communication, negotiation, and interpersonal skills Ability to work independently in a fast-paced environment Strong time management and organizational skills Proficiency with or ability to learn UM systems and web-based communication tools Working knowledge of Microsoft Word, Excel, and related applications Flexibility to manage shifting priorities and caseloads Additional Notes: Holiday and weekend rotation may be required Role requires frequent interaction with providers and internal stakeholders

Perform inpatient utilization management and discharge planning activities. Apply nationally recognized clinical criteria (e.g., InterQual, MCG) to determine medical necessity, level of care, and readiness for transition. Make timely, clinically appropriate, and cost-effective coverage determinations. Manage a complex caseload independently while collaborating with internal clinical teams. Communicate effectively with providers to facilitate care transitions across the continuum. Apply product-specific payment and reimbursement models such as DRG, case rate, or per diem structures. Identify issues requiring escalation and collaborate with leadership and cross-functional teams. Maintain accurate documentation in accordance with departmental standards. Participate in quality activities, audits, mentoring, and special projects as assigned.

Insight Global

Pre-Access Utilization Review Registered Nurse

Posted on:

January 25, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Georgia

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: Remote Pre-Access Utilization Review Registered Nurse Location: Remote Duration: 5-month contract to hire Working Hours: 4x10's or 5x8's (no weekends during training - first 12 weeks, however 1 weekend day must be included in their schedule post training) PR: $35/hr-$40/hr Insight Global is looking for a Pre-Access Utilization Management Registered Nurse to sit remotely with one of their large health insurance clients.

1-2 years of experience in UM on the payer side 5+ years of clinical experience Reside in either TX, GA, FL, or AZ Registered Nurse Proficiency using a MacBook Proficiency in Google Suite Applications (google sheets, calendar, etc.) Associate Degree or Bachelors Degree - Nursing or Graduate of Accredited School of Nursing

This person will be responsible for evaluating 3.5 patient care cases per hour and collaborating with doctors, and other healthcare professionals. Day to day this individual will be assessing patient care requests for medical services (such as surgeries, procedures, hospital admissions, etc.) and collaborating with providers to ensure the requested services align with medical necessity. It is critical that this person adheres to company policies regarding confidentiality and privacy. This person needs to pay very close attention to detail, be a team player, have flexibility in their day to day, etc. Being an expert within the plan and benefit template is crucial, and having great written and verbal communication is important!

Oscar Health

NP/PA - Virtual Urgent Care

Posted on:

January 25, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

Hi, we're Oscar Medical Group. We're hiring a Physician Assistant or Nurse Practitioner to join our Virtual Urgent Care team. At Oscar Medical Group, we are refactoring healthcare. We want to help each of our members achieve their healthcare goals in a personalized way. To help us achieve that goal we are looking for innovative leaders who think big and push boundaries to refactor healthcare and the healthcare delivery system.

We are looking for virtual care providers who can provide telemedicine services and are always looking to explore new ways we can provide virtual care. You will deliver patient care on Oscar's platform(s) both via messaging and phone. As an Oscar Medical Group provider, you'll have the opportunity to re-imagine how we diagnose, treat and follow up with members virtually. You will work remotely, and work hand in hand with our team to provide exceptional patient care. This is a full time employed role with Oscar Medical Group. You will report into the Medical Director, Virtual Urgent Care Shift: 1pm-11pm EST 2 weekend requirements per month (Sat & Sun) Work Location: Oscar Medical Group is a blended work culture where everyone, regardless of work type or location, feels connected to their teammates, our culture and our mission. This is a remote / work-from-home role. You must reside in one of the following states: Arizona, California, Colorado, Florida, Georgia, Illinois, Massachusetts, Michigan, Nevada, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Texas, or Virginia. Note, this list of states is subject to change. #LI-Remote Pay Transparency: The base pay for this role is: $104,000 - $136,000 per year. You are also eligible for employee benefits, and annual vacation grant of up to 18 days per year, and annual performance bonuses.

DNP, FNP, ENP, or PA from accredited program Board Certification (NCCPA or AANP or ANCC) Licensed in at least 3 out of the 5 following states: FL, TX, OH, NJ, GA Willingness to be licensed in additional states with our assistance, working with our licensing vendor 3+ years experience in urgent care, ER or outpatient family medicine practice 2+ years of Telemedicine experience Bonus points: Licensed in other OMG states: AZ, CO, CT, IA, IL, KS, MI, NC, NJ, NY, OH, OK, PA, VA Bilingual (Spanish - read, write, and speak)

Provide medical care virtually (both by phone and message) Provide patient care in alignment with Oscar Medical Group guidelines, practices and policies Focus on efficiency and quality of care delivery Ensure patient access to VUC services Collaborate with MAs, RNs, and other providers across service lines (e.g. primary care and health assessments)

ConcertoCare

RN Case Manager - Florida

Posted on:

January 25, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Florida

ConcertoCare is a tech-enabled, value-based provider of at-home, comprehensive care for seniors and other adults with unmet health and social needs. ConcertoCare deploys physician-led interdisciplinary teams— supported by its proprietary population health platform, Patient3D®, and clinical decision support tools — to manage the country's most medically and socially complex and costly patients in ways that keep them in their homes and out of the hospital. The results are better health outcomes, reduced costs, and a more personalized and integrated experience for patients and their families. ConcertoCare works with a wide variety of payers and can partner with a patient’s current primary care physician or serve as the provider of record. Led by a world-class team of home-based care physicians, population health technology experts, former policymakers, and senior health plan executives, ConcertoCare serves seniors across the country. For more information, visit www.concertocare.com.

The ConcertoCare Case Manager coordinates all aspects of a patient’s care (medical, behavioral, functional, and social) and serves as a patient advocate across the continuum of care in partnership with the patient’s providers and extended care team. This is a unique Case Management role that is intimately integrated with a larger care team. This role requires a high level of interaction to successfully engage patients and foster positive, trusting relationships to help them achieve their goals. The ideal Case Manager has excellent communication skills, takes initiative, works well with other members of the care team, and creatively solves problems to address a patient’s needs holistically. This position is part of the Population Health Team, reports to the Vice President of Case Management, and works closely with other Population Health team members as well as market-based care teams. This is an ideal position for a registered nurse who seeks an opportunity to contribute to the health and well-being being of highly complex patients, enjoys a collaborative multidisciplinary team-based approach to care, and is excited to engage in developing and nurturing our innovative, value-based clinical model focused on caring for patients with complex and social support needs that the current health system does not serve well.

Current RN License in good standing in the state of practice required. Bachelor's degree in nursing required, or associates in nursing with other clinical or business bachelor’s degree Minimum of 4 years experience working in a clinical setting, with at least 2 years of case management experience in home health care, ambulatory care, community public health, and/or the insurance setting Certified Case Manager (CCM) certification or commitment to complete when eligible Geriatric care experience is highly desired 2 years of discharge planning, utilization management, case management, performance improvement, and/or managed care preferred. Knowledge of Medicare and Medicaid regulations and insurance benefits preferred Strong knowledge of clinical best practices as they relate to case management, discharge planning, utilization management, performance improvement, and/or managed care Strong clinical skills and ability to implement evidenced-based care. Ability to manage patient complexity and multiple clients with diverse needs Demonstrated ability to triage patient-reported symptoms and issues that require escalation to our field-based team and to apply critical thinking skills in unexpected circumstances. Ability to communicate effectively in writing and verbally. Demonstrated ability to perform multiple concurrent tasks with minimal supervision and meet deadlines. Ability to work in a fast-paced, dynamic environment and work well with others on a team. Proficient computer skills including Microsoft Office Suite (Outlook, Excel, PowerPoint, Word) as well as clinical systems/ EMR competency Knowledge and ability to navigate internet-based tools and applications, and proficiency in computer documentation Demonstrates a high level of professionalism.

Conduct initial intake calls as well as scheduled and urgent patient outreach based on individual patient’s needs and risk levels to review and update the care plan, monitor progress, ensure needs are met, and identify new areas of concern. Provide ongoing care coordination for an assigned panel of complex patients. Conduct needs assessments and develop plans of care in partnership with the rest of the patient’s care team. Ensure care is coordinated, patient-centered, and aligned with the needs and wishes of the patient. Support patients during care transitions, including outreach and assessment during and post hospitalization to ensure discharge needs are addressed, to facilitate provider follow-up, and to perform medication reconciliation. Identify and implement interventions and collaborate closely with ConcertoCare’s multidisciplinary team (providers, Director of Clinical Care, social work, behavioral health, and clinical pharmacy), external providers, and social service organizations to: (1) address gaps in care, (2) mitigate the risk of inpatient admissions, readmissions, emergency room visits and movement to an institutional setting, (3) and keep patients safely living in their desired and appropriate home environment. Identify and verify appropriate utilization of resources across the continuum of care. Actively participate in interdisciplinary care team huddles, and other clinical meetings. Participate in quality improvement and evaluation processes. Adhere to compliance policies, procedures, and standards of conduct including all applicable laws and regulations. Serve as a mentor for new hires and existing case management team members Other duties as assigned.

Molina Healthcare

Care Manager (RN)

Posted on:

January 25, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Arizona

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

Provides support for care management/care coordination activities and collaborates with multidisciplinary team coordinating integrated delivery of member care across the continuum. Strives to ensure member progress toward desired outcomes and contributes to overarching strategy to provide quality and cost-effective member care.

Required Qualifications: At least 2 years experience in health care, preferably in care management, or experience in a medical and/or behavioral health setting, or equivalent combination of relevant education and experience. Registered Nurse (RN). License must be active and unrestricted in state of practice. Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law. Understanding of the electronic medical record (EMR) and Health Insurance Portability and Accountability Act (HIPAA). Demonstrated knowledge of community resources. Ability to operate proactively and demonstrate detail-oriented work. Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations. Ability to work independently, with minimal supervision and self-motivation. Responsiveness in all forms of communication, and ability to remain calm in high-pressure situations. Ability to develop and maintain professional relationships. Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change. Excellent problem-solving, and critical-thinking skills. Strong verbal and written communication skills. Microsoft Office suite/applicable software program proficiency, and ability to navigate online portals and databases. Preferred Qualifications: Certified Case Manager (CCM). The ideal candidate will have experience with maternity, post partum, and pediatrics.

Completes comprehensive assessments of members per regulated timelines and determines who may qualify for care management based on clinical judgment, changes in member health or psychosocial wellness and triggers identified in assessments. Develops and implements care coordination plan in collaboration with member, caregiver, physician and/or other appropriate health care professionals and member support network to address member needs and goals. Conducts telephonic, face-to-face or home visits as required. Performs ongoing monitoring of care plan to evaluate effectiveness, document interventions and goal achievement, and suggest changes accordingly. Maintains ongoing member caseload for regular outreach and management. Promotes integration of services for members including behavioral health, long-term services and supports (LTSS), and home and community resources to enhance continuity of care. Facilitates interdisciplinary care team (ICT) meetings and informal ICT collaboration. Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts. Assesses for barriers to care, provides care coordination and assistance to member to address concerns. May provide consultation, resources and recommendations to peers as needed. Care manager RNs may be assigned complex member cases and medication regimens. Care manager RNs may conduct medication reconciliation as needed. 25-40% estimated local travel may be required (based upon state/contractual requirements).

Tech Observer

Lead Clinical Documentation Improvement (CDI) RN

Posted on:

January 25, 2026

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

ech Observer has been providing Staffing(Clinical/Scientific/IT/Professional) and Clinical Research Services since 2005. We have offices in New Jersey: US (Headquarters), India ,UK, Denmark and Singapore. Being ISO 9001:2008, ISO 14155:2011 and ISO 27001 certified company, we believe in quality & responsible work ethic. We are proud in providing strategic & real-time insights to the client to achieve their goals. Our services range offer flexible solutions to our clients ranging from ‘standalone service’ to ‘end to end support’ for their needs. With a team of 500 employees globally, we are serving more than 50 companies in over 30 countries. Our Key Services are: • Clinical Operations • Clinical Data Management • Biostatistics & SAS Programming • Medical Writing & Scientific Communications • Post-Marketing Clinical Studies • Staffing (US only)

Responsible for improving the overall quality and completeness of clinical documentation. Facilitates modifications to clinical documentation through extensive interaction with physicians, nursing staff, other patient caregivers, and medical records coding staff to ensure that compliant documentation is achieved, with resultant appropriate level of severity reflected and reimbursement received for service rendered to all patients with a DRG based payor.

Required Skills & Experience: A minimum of five (5) years in an acute care setting as an RN. Working knowledge of computers. Preferred Skills & Experience: Coding experience, i.e. CCS, RHIT background. Education: Required Education: Associate degree in Nursing. Preferred Education: Bachelor's degree in Nursing. Required Certifications & Licensure: Requires current state of Wisconsin Registered Nurse License or a Multi-state Nursing License from a participating state in the NLC (Nurse Licensure Compact). Advanced certification related to CDI (CCDS, CDIP) is required within 6 months of hire.

Ensures the accuracy and completeness of clinical information used for measuring and reporting physician and hospital outcomes. Assists the Case Management Manager in the day to day responsibilities of overseeing the Documentation Specialists. Includes, but is not limited to, participation in the Documentation Specialist performance appraisal process, supervision of workload assignments, and practice supervision. Plans and implements compliant documentation goals and objectives across the Community Hospital Division (CHD), which support hospital goals and objectives. Assists in development of agendas and in material preparations for meetings to support hospital improvements in identified hospital initiatives, including CDE System Steering Committee. Coordinates and manages program reporting and outcome measurements. Assists the Case Management Manager in the development and updating of policies, procedures and workflow. Facilitates modifications to clinical documentation to ensure compliant documentation with appropriate reimbursement received for the level of service rendered to all patients with a DRG based payor. Improves the overall quality and completeness of clinical documentation, ensuring documentation integrity, by performing initial reviews, continued stays reviews and reconciliation process using the 3M 360 Program. Coordinates professional growth for the Community Hospital Division - RN Clinical Documentation Specialists through appropriate educational opportunities. Coordinates staff development activities related to education, quality assurance and outcome measurements. Coordinates staff development activities related to education, quality assurance and outcome measurements. Facilitates communication and confers with providers face to face or via Clinical Documentation Excellence (CDE) Shared Note to clarify diagnoses information, obtain needed documentation, present opportunities and educate for appropriate DRG based on severity of illness (SOI) and risk of mortality (ROM). Reviews patient record to ensure points of clarification have been recorded. Educates all internal customers on compliant documentation opportunities, coding and reimbursement issues, as well as performance improvement methodologies. Assists with staff recruitment and interviewing RN Clinical Documentation Specialists ( CDS) candidates. Serves as Primary lead for orientation and training for new RN CDS. Assists with management of 3M 360 program and serves as subject matter expert with IT on resolution. when operations impacted. Other duties as assigned.

Saltu Healthcare

Remote Registered Nurse - Make $1850-$2000/Week

Posted on:

January 24, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Texas

Saltu Healthcare is rooted in the community. We partner directly with local hospitals and clinicians to make every travel assignment supportive, transparent, and built around your success from start to finish.

A leading hospital is looking for a CVOR Registered Nurse to support high-acuity cardiovascular surgical services. The ideal candidate has strong clinical judgment, procedural expertise, and seamless collaboration within multidisciplinary care teams. The role includes structured scheduling, on-call coverage, and exposure to advanced cardiovascular procedures.

Requirements: Active Registered Nurse (RN) license BLS certification required Minimum 3 years of CVCT/CVOR experience (required) General RN experience (required) Epic EMR experience (required) Top Skills: Cardiovascular operating room procedures High-acuity patient monitoring Evidence-based nursing practice Clinical assessment and care planning

Perform comprehensive patient assessments and develop individualized plans of care Deliver perioperative and procedural nursing care in CVOR settings Assist in cardiovascular and cardiothoracic surgical procedures Coordinate care with physicians, surgical teams, and interdisciplinary staff Maintain aseptic technique and patient safety standards Monitor patient responses and adjust care plans accordingly Support patient education, advocacy, and informed decision-making Utilize Epic for clinical documentation and care coordination Contribute to quality improvement and patient safety initiatives

Guidehealth

RN Case Manager - Remote

Posted on:

January 24, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

Guidehealth is a data-powered, performance-driven healthcare company dedicated to operational excellence. Our goal is to make great healthcare affordable, improve the health of patients, and restore the fulfillment of practicing medicine for providers. Driven by empathy and powered by AI and predictive analytics, Guidehealth leverages remotely-embedded Healthguides™ and a centralized Managed Service Organization to build stronger connections with patients and providers. Physician-led, Guidehealth empowers our partners to deliver high-quality healthcare focused on outcomes and value inside and outside the exam room for all patients. 

Helping patients feel supported, heard, and guided—right from your home. At Guidehealth, we’re transforming how patients experience healthcare by combining clinical expertise with compassionate, person-centered support. As a Remote RN Case Manager, you’ll build trusted relationships with patients by phone, helping them navigate complex health needs, understand their care plans, and improve their overall well-being. If you’re a nurse who loves making a direct impact—without the physical demands of bedside care—this role offers the meaningful patient connection you’re looking for. This is a primarily remote role with 10–15% local travel to clinical sites in your hiring area.

Active Compact Registered Nurse license in good standing is required. 3+ years of RN Case Management experience, preferably in outpatient or ambulatory care. Strong critical-thinking and problem-solving skills to anticipate barriers and drive care forward. Ability to work independently, manage multiple priorities, and make sound clinical decisions remotely. Outstanding communication—warm, clear, confident, and patient-focused. Excellent telephonic interviewing skills and the ability to document accurately in real time. High comfort level with technology: EMRs, care-management systems, multi-screen workflow, Microsoft Office, and telecommunication tools. Understanding of accreditation and quality standards (NCQA, HEDIS). A quiet, private home office suitable for patient calls and handling PHI. Alignment with Guidehealth policies, clinical protocols, and compliance standards. What we'd love for you to have: BSN and Case Management certification preferred.

Conducting in-depth telephonic assessments to understand each patient’s medical, psychosocial, and social needs. Reviewing and updating medical histories—including medications, chronic conditions, and preventive care. Developing individualized care plans and guiding patients through their treatment goals and care options. Providing empathetic, evidence-based education on chronic disease management and preventive health. Monitoring progress by phone, adjusting care plans, and ensuring patients stay connected to their providers. Completing Medicare Annual Wellness Visits (AWVs) via telehealth under physician supervision. Partnering with Healthguides who support non-clinical needs like scheduling, transportation, food assistance, and SDOH resources. Performing proactive outreach and timely follow-ups to maintain continuity of care and patient engagement. Advocating for patients, helping them access the right resources at the right time. Documenting clearly and accurately in the EHR and care-management systems during and after calls. Supporting quality outcomes (HEDIS, NCQA) by coordinating preventive services and managing chronic conditions. Participating in virtual meetings, ongoing education, and clinical training to stay current with care standards. Using multiple communication methods (phone, text, patient portals, email, AI-supported tools) to reach high-risk patients. Collaborating in AI-driven outreach programs that help connect with vulnerable populations. Protecting patient privacy in a secure, private home workspace. Performing additional responsibilities as needed to support patients and the care team.

Trillium Community Health Plan

Care Navigator Child Welfare LPN

Posted on:

January 24, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

LPN/LVN

State License:

Oregon

At Trillium Community Health Plan (Trillium), we know all healthcare is local. Our Trillium staff are proud members of the communities we serve and we’re dedicated to transforming the lives of our members through programs and services that focus on prevention, health equity, and access to high-quality care. Trillium serves Oregon Health Plan members through the Coordinated Care Organization (CCO) model, connecting members to a network of healthcare providers for medical, dental, behavioral and mental health services. We also offer Trillium Advantage, a Medicare Advantage plan with prescription drug coverage. Trillium Advantage is available to those who qualify for Medicaid through the state of Oregon and are eligible for Medicare. Our 56,000 members live in Lane, Western Douglas and Western Linn counties, and in Clackamas, Washington and Multnomah counties. At Trillium, our focus is on whole health and active local engagement to help all people live a healthier life. Trillium is a wholly-owned subsidiary of Centene Corporation. To learn more about our offerings, please contact us at 1-877-600-5472 (TTY: 711) or visit our website at www.TrilliumOHP.com. Follow us on Facebook at facebook.com/TrilliumCHP or Twitter @trilliumchp.

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. ** Qualified applicants are preferred be licensed in the state of Oregon as an Licensed Practical Nurse (LPN) but are able to live in any state. Prefer candidates with child welfare, foster care, or peds experience.** Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. Position Purpose: Develops, assesses, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a personalized care plan/service plan for members and educates members and their families/caregivers on services and benefit options available to improve health care access and receive appropriate high-quality care through advocacy and care coordination.

Education/Experience: Requires a Bachelor’s degree and 2 – 4 years of related experience. Requirement is Graduate from an Accredited School of Nursing if holding clinical licensure or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. License/Certification: State of Oregon LPN clinical license preferred. ** Qualified applicants are preferred to be licensed in the state of Oregon as an Licensed Practical Nurse (LPN) but are able to live in any state. **

Role will consist of working with our child welfare population and require qualified candidates to hold a LPN license in the state of Oregon. Evaluates the needs of the member, barriers to care, the resources available, and recommends and facilitates the plan for the best outcome Develops or contributes to the development of a personalized care plan/service ongoing care plans/service plans and works to identify providers, specialists, and/or community resources needed for care Provides psychosocial and resource support to members/caregivers, and care managers to access local resources or services such as: employment, education, housing, food, participant direction, independent living, justice, foster care) based on service assessment and plans Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified care or services are accessible to members in a timely manner May monitor progress towards care plans/service plans goals and/or member status or change in condition, and collaborates with healthcare providers for care plan/service plan revision or address identified member needs, refer to care management for further evaluation as appropriate Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators May perform on-site visits to assess member’s needs and collaborate with providers or resources, as appropriate May provide education to care manager and/or members and their families/caregivers on procedures, healthcare provider instructions, care options, referrals, and healthcare benefits Other duties or responsibilities as assigned by people leader to meet the member and/or business needs Performs other duties as assigned Complies with all policies and standards

Dane Street

Registered Nurses (RNs) for Disability Case Reviews - Remote Opportunity

Posted on:

January 24, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Dane Street is the industry's fastest growing national IME and Peer Review provider with a panel of board-certified, active-practice physicians in all 50 states. Services are provided to the Workers Compensation, Pharmacy, Disability, Group Health and Auto/Liability lines of business. Dane Street's Review and Evaluation services provide improved report quality, faster turnaround time and higher adjuster/nurse satisfaction and productivity.

Dane Street is seeking experienced Registered Nurses (RNs) to support our disability case review process. In this role, you will perform clinical reviews of disability claims, providing essential support to our decision-making team. These reviews will follow a structure similar to those performed by MDs, but are specifically designated for RN-level review. Previous experience in disability claims or clinical case review required

Active, unrestricted RN license (multi-state preferred) Previous experience in disability claims or clinical case review required Strong attention to detail and critical thinking skills Excellent written and verbal communication Comfortable working independently in a remote setting Experience with insurance or occupational health is a plus

Conduct thorough clinical reviews of disability claims Analyze medical records for accuracy and completeness Apply clinical expertise to evaluate claim validity Follow established review protocols and documentation standards

LanceSoft, Inc.

RN Clinical Documentation Specialist

Posted on:

January 24, 2026

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Virginia

Established in 2000, LanceSoft is a pioneer in delivering top-notch Global Workforce Solutions and IT Services to a diverse clientele. We pride ourselves on fostering global cross-cultural connections that advance both the careers of our employees and the success of our clients' businesses. At LanceSoft, our mission is clear: to leverage our global network to seamlessly connect businesses with the right talent and individuals with the right opportunities, all without bias. We believe in providing Global Workforce Solutions with a personalized, human touch. Our comprehensive range of services spans various domains, encompassing temporary and permanent staffing, Statement of Work (SOW) arrangements, payrolling, Recruitment Process Outsourcing (RPO), application design and development, program/project management, and engineering solutions. Currently, our team of over 5,000 professionals caters to 110+ enterprise clients worldwide, including Fortune companies. Our client base represents a diverse spectrum of industries, including Banking & Financial Services, Semiconductor/VLSI, Technology, Healthcare & Life Sciences, Government, Telecom & Media, Retail & Distribution, Oil & Gas, and Energy & Utilities. Headquartered in Herndon, VA, LanceSoft operates 32+ regional offices across the North America, Europe, Asia, and Australia. We also have nine delivery centers strategically located in India in Bangalore, Indore, Noida, Baroda, Hyderabad, Bhubaneshwar, Dehradun, Goa, and Aligarh to further enhance our client service capabilities.

The Clinical Documentation Specialist is an experienced Clinical Documentation Nurse who has obtained knowledge and expertise in all patient populations across the enterprise to provide comprehensive Clinical Documentation Integrity (CDI) chart reviews. Facilitates modifications to clinical documentation to ensure appropriate reimbursement is received for the level of service rendered. Ensures the accuracy and completeness of clinical information used for measuring and reporting clinical and quality outcomes.

Required Skills & Experience: Minimum of five (5) years of acute care nursing experience is required. Minimum of one (1) year of CDI experience in a hospital setting is required. Efficient use of MS Office products (Excel, Outlook, Word), WebEx and Epic (or similar EMR). Excellent communication, negotiation, troubleshooting, and presentation skills. Ability to read and correlate an extensive variety of medical / surgical medical treatments and monitoring to clinical conditions. Ability to interact with all levels of organization. Ability to document and maintain process documentation. Excellent follow-through from initiation to conclusion. Working knowledge related to MSDRG and APRDRG payer trends and rules. Working knowledge related DRG and CMI impacts. Working knowledge of coding guidelines and coding clinics.

Collects and assesses data within CDI software systems. Independently applies experience and critical thinking skills to identify opportunities for documentation improvement that support the program and organizational goals. Facilitates modifications to clinical documentation to ensure appropriate reimbursement is received for the level of service rendered. Improves quality and completeness of clinical documentation by performing initial, follow-up, reconciliation reviews while adhering to organizational workflows and ACDIS / AHIMA guidelines. Provides training and guidance to Associate CDS nurses. Identifies and reviews complex clinical issues / service line trends upon reconciliation process via level process with coding. Facilitates and enhances procedural coding practices. Collaborates with physicians, midlevel providers, nursing staff, other patient providers, and coding staff to ensure appropriate reimbursement is received for the level of service rendered and to capture Quality specific codes related to patient encounter specific DRG’s. Ensure points of clarification have been recorded in the patient’s chart. Maintains records that support appropriate financial reimbursement (DRG and CMI) and organization quality benefit rankings. Other duties as assigned.

Elevance Health

Transitions of Care RN- Carebridge

Posted on:

January 24, 2026

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

Compact / Multi-State

Fueled by our bold purpose to improve the health of humanity, we are transforming from a traditional health benefits organization into a lifetime trusted health partner.   Our nearly 100,000 associates serve more than 118 million people, at every stage of health. We address a full range of needs with an integrated whole health approach, powered by industry-leading capabilities and a digital platform for health.  We believe that improving health for everyone is possible. It begins by redefining health, reimagining the health system, and strengthening our communities.

Virtual: This role enables associates to work virtually full-time, except for required in-person training sessions, providing maximum flexibility and autonomy. This approach promotes productivity, supports work-life integration, and ensures essential face-to-face onboarding and skill development. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law. A proud member of the Elevance Health family of brands, Carelon Health (formerly CareMore Health) offers clinical programs and primary care options for seniors. We are a team of committed clinicians and business leaders passionate about transforming American healthcare delivery. Location(s): Costa Mesa, CA, Grand Prairie, TX, Tampa, FL, Miami, FL, Overland Park, KS, St. Louis, MO, Chicago, IL, Mendota Heights, MN, Cincinnati, OH, Iselin, NJ, Nashville, TN and Wilmington, DE Work Hours: Monday – Friday plus 2 weekends a month Eastern Time: 8:00AM – 7:00PM All other time zones: 7:00AM – 6:00PM, 8:00AM -7:00PM or 9:00AM -8:00PM The Transitions of Care RN- Carebridge is responsible for participating in delivery of patient education and disease management interventions and for performing health coaching for members, across multiple lines, for health improvement/management programs for chronic diseases.

Minimum Qualifications: Requires AS in nursing and minimum of 2 years of condition specific clinical or home health/discharge planning experience; or any combination of education and experience, which would provide an equivalent background. Current unrestricted RN license in applicable state(s) required.’ Preferred Skills, Capabilities and Experiences: RN compact license is highly preferred BS in nursing preferred Prior case management experience preferred Bilingual in Spanish or Mandarin is highly preferred Experience working with members that have chronic diseases is highly preferred Experience working in home health is preferred

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

CareHarmony

Remote Triage Nurse - Weekend Shift - Licensed Practical Nurse - LPN - LVN

Posted on:

January 24, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

LPN/LVN

State License:

Compact / Multi-State

CareHarmony works comprehensively with providers to deliver value-based care management initiatives for their patients. Our clinicians are driven by their passion for the level of care delivered; experts in assisting patients and caregivers navigate a sometimes-fractured healthcare system and consistently prioritize a high-quality standard so patients may better manage chronic illnesses and improve their Quality of Life.

Under the direction of the Lead Triage RN, the triage nurse will be responsible for providing exceptional patient care for all calls after business hours. This includes telephonic triage of complex patients, assisting with psychosocial needs and business initiatives.

Required Skills/Abilities: Compact/Multistate Licensure required (additional licensures are a plus) Innovative mindset, driven to change how patients manage their health Robust clinical knowledge Extensive experience in telephonic triage Ability to quickly determine appropriate level of care based off clinical assessment Ability to navigate multiple technological platforms Excellent attention to detail Excellent customer service skills Excellent organizational skills Excellent verbal and communication skills Excellent professional presence when dealing with colleagues, clients and patients Ability to function cohesively within a team Education and Experience: Graduate of accredited School of Nursing Nursing license must be active and in good standing A minimum of five (5) years of professional experience in nursing Experience in Triage required Remote Requirements: Must have active high-speed Wi-Fi Must have a home office or HIPAA-compliant workspace Physical Requirements: This position is sedentary and will require sitting for long periods of time This position will require the ability to speak clearly and listen attentively, often by telephone, for an extended period of time The position will require the ability to understand, process, and take thorough notes in real-time on telephone conversations Schedule: 6am - 7pm CST (Saturday and Sunday every OTHER weekend)

Conduct thorough telephonic assessments with proprietary tools Identify and address patient concerns Address acute clinical concerns with close collaboration with the patient’s providers. Provide telephonic education to patients Participate in Innovation team projects Ensure excellent quality of care provided during on-call and triage interactions Foster relationships within the team to ensure the CareHarmony culture is positive and supportive

IntellaTriage

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

Posted on:

January 24, 2026

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 remote team of nurses to manage after-hours care delivery. Our triage nurses become an extension of our clients’ care team, and they trust us to support them and their patients during their non-core hours.

We are seeking a compassionate registered nurse (RN) to join our growing team! In this role, you will provide critical after-hours support, triaging hospice patients and family needs over the phone wit professionalism and empathy. You will help ensure timely interventions and coordination of care for patients receiving hospice services.

Active multistate Registered Nurse (RN) license Hospice, palliative, or end-of-life care is strongly preferred Must be comfortable with technology and electronic medical records (EMR) utilized for documentation of calls Ability and comfort with typing documentation and notes in a fast-paced environment Must be able to handle stress and multitask when receiving calls (minimum of 5 calls per hour on weekdays, and up to 8 per hour on weekends) Strong communication and critical thinking skills Ability to work independently in a remote environment This is a remote position that requires consistent attendance, active communication, and reliable internet connectivity during all scheduled shifts to support timely patient care coordination

Provide telephone triage for hospice patients and families Assess patient conditions and determine appropriate next steps Collaborate with on-call teams to coordinate care and resources Accurately document all communications and interventions Maintain a calm and professional demeanor while handling urgent calls.

Sun River Health

Registered Nurse - Patient Care Contact Center (Remote)

Posted on:

January 24, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

New York

Sun River Health has a rich history of providing quality, affordable health care to communities in need. Founded in the early 1970s by four African American women in Peekskill, New York, the organization was established to address the lack of accessible health services in their community. With the help of a small federal grant, the first Sun River Health site opened its doors in 1975. Over the years, Sun River Health has grown into a comprehensive Federally Qualified Health Center (FQHC) system with over 45 locations, serving more than 250,000 patients across the Hudson Valley, New York City and Long Island. Our exceptional primary care practitioners, specialists and support staff are dedicated to delivering high-quality care to all individuals, regardless of their ability to pay. In December 2018, Sun River Health expanded its reach by merging with Brightpoint Health, an FQHC network offering integrated medical, behavioral and social support services in New York City. This merger allowed us to enhance our services and continue our mission under the unified name of Sun River Health

Sun River Health provides the highest quality comprehensive primary, preventative and behavioral health services to all who see it, regardless of insurance status and ability to pay, especially for the underserved and vulnerable. Sun River Health is a Federally Qualified, Non-Profit Health Center serving communities in Suffolk, Rockland, Orange, Dutchess, Ulster, Sullivan, Columbia and Westchester County. Sun River Health is currently seeking a full-time Patient Care Center Registered Nurse to join our team. The PCC Registered Nurse is a licensed nurse responsible for delivery of nursing care remotely to individual clients. The Registered Nurse maintains the quality of client care through the ongoing processes of assessment, planning and implementation of nursing activities through the Patient Care Center.

Bachelors Degree in Nursing Required New York State Registered Nurse license CPR/BLS -HCP Required Bilingual Preferred

Meets good customer service to ensure quality call handling Follows call center nursing and scheduling workflows Assist staff with Urgent and Red Flags patient's health concerns. Support site level Prescription Refill and Medical Call Buckets during scheduled outbound call times Develops, implements and evaluates the nursing care regimens for clients. Plans, coordinates and assesses client care. Identifies client needs and provides remote nursing care based on the client’s care plan. Collaborates with interdisciplinary team members to develop, implement and evaluate client care. Meets call handling performance Functions as preceptor to students, new hire candidates and other clinical team members/ staff when needed Assists with Quality Assurance audits as assigned. Identifies quality issues and opportunities for improving quality of care. Documents client care with accurate and accessible records. Communicates with Pharmacy, Laboratories and other vendors as needed. Assists with medication refills per Sun River Health protocols Maintains professional competence through participation in staff development and educational program. Provides clinical education and counseling to patients for health promotion and disease prevention to improve health outcomes Have an appropriate and quiet remote work environment, as well as supplying and maintaining good Internet Connectivity required for Call Center Platforms

HydraMed Mobile IV + Longevity RX

Mobile I.V. Therapy Registered Nurses

Posted on:

January 24, 2026

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

HydraMed, a collective of leading medical professionals, offers Mobile IV Therapy for preventive and robust immune support and Longevity RX Treatments for smarter aging and enhanced longevity. Through a revolutionary approach that challenges conventional healthcare models, we bring personalized, cutting-edge treatments directly to you. Committed to accessibility and customization, our values are driven by the mission to empower you to live more and age smarter. Bear Harper, the original founder and principal owner of HydraMed, provides strategic direction and leadership to the company. Mark Baldwin, a full-time firefighter, also lends his expertise as a part-time owner and managing partner at HydraMed. Despite his full-time commitment to firefighting, Mark dedicates his time to HydraMed, aiding the company's success. With Bear and Mark's dedication and expertise, HydraMed delivers science-backed IV therapy and Longevity RX treatments tailored to smarter aging and enhanced longevity. Experience optimal well-being in the comfort of your own home or at any location of your choosing with HydraMed's convenient and expert services and treatments. HydraMed, committed to a healthier future, upholds safety, excellence, and innovation. Medical direction is led by Dr. Thomas Paluska and Nurse Practitioner Courtney Williams, we ensure our Longevity RX home-kits and treatments meet the highest standards, using premium compounds from FDA-registered US pharmacies. Our mission transcends typical healthcare, aiming to transform lives with custom treatments that promote longevity and vitality. HydraMed isn't just about providing care; it's about pioneering a future where living more and aging smarter becomes the norm for our community.

HydraMed is seeking experienced Registered Nurses to join our team as Mobile IV Therapists. You will deliver safe, medical-grade IV treatments in various settings, including homes, hotels, and offices. To ensure safety and consistency, all therapists must adhere to the following: Availability: Maintain activity by working at least once per month and submit weekly availability to Dispatch. Commitment: Once a booking is assigned, completion of the appointment is required unless an emergency occurs. Work Location: Clinical services are performed on-site at patient locations within a designated service area.

License: Active and valid Registered Nurse (R.N.) License in the state of practice (Compact license preferred). Certification: Current BLS Certification. Experience: 2+ years of clinical experience in specialized units (ICU, OB, NICU, ER, Med Surg, or Surgery). Skills: Proficiency in starting IVs, including difficult sticks, and administering IM injections.

Administer IV drips and IM injections according to established protocols Conduct patient assessments and obtain informed consent. Monitor patients during IV infusion and provide post-care guidance Complete medical documentation in the Intake form while maintaining HIPAA compliance Deliver professional, concierge-level care.

Accredo Specialty Pharmacy

Telephonic Critical Support Nurse, PM Shift - Accredo - Remote

Posted on:

January 24, 2026

Job Type:

Full-Time

Role Type:

Triage

License:

RN

State License:

Compact / Multi-State

Accredo® Specialty Pharmacy goes beyond the prescription, it provides deeply personalized care for individuals living with chronic, complex, and rare conditions that require specialty medications. Our expert teams—organized into condition-specific Therapeutic Resource Centers® (TRCs)—offer 24/7 clinical support, copay coordination and proactive patient outreach. We collaborate with prescribers, employers, health plans and pharmaceutical manufacturers to ensure access to vital therapies and improve patient outcomes. As part of Evernorth Health Services and The Cigna Group, Accredo Specialty Pharmacy combines compassionate care with data-driven insights to help patients live healthier, fuller lives.

Telephonic Critical Support Nurse (RN) Remote, Work from Home, United States Schedule Information: Evening shifts available: Four 10-hour days (12:30pm to 11:00pm Central Time) Three 12-hour days (10:30am to 11:00pm Central Time) plus an additional 4-hour shift on a fourth day Days off will vary week-to-week Must be available to work occasional overnight shifts (1–2 weekdays per month, 2–4 weekends per year) Evening and overnight shifts include a shift differential All shifts include every third weekend and some holidays Position Overview: This role supports a busy 24/7 clinical call center, responding to a wide variety of incoming calls from patients, clinicians, referral sources, and hospitals. The team provides support for chronic therapies, including Home Infusion Therapy, and handles after-hour calls for all divisions of Accredo Health Group Specialty Pharmacies.

Registered Nurse (RN) with multistate license in good standing, with ability to obtain licensure in all 50 states. Valid RN license in state of primary residence. Bachelor of Nursing degree (BSN) preferred. Minimum of 5 years of relevant RN experience in critical care or home infusion. Ability to work the shifts listed above. Proficiency with Microsoft Office software (Word, Excel, PowerPoint). Understanding of legal and regulatory issues. Ability to compile data and statistics. Strong customer service focus and ability to counsel patients. Ability to develop and maintain a cross-section of networks. Strong oral and written communication and organizational skills.

Triage incoming calls from patients, clinicians, hospitals, and other sources. Intervene to address life-threatening medication interruptions. Guide patients, caregivers, and clinicians through assessment of potential disruptions in medication administration, including pump malfunction, central line problems, and patient error. Troubleshoot issues with infusion devices, answer infusion access questions, and provide therapy support. Coordinate communication between patients, caregivers, pharmacists, nurses, hospital staff, and physicians. Ensure timely provision of products and supplies. Contact appropriate personnel as needed and document transactions in patients’ electronic charts. Maintain up-to-date knowledge of all services, products, and resources provided by Accredo, incorporating new product and service information. Identify trends and needs within the scope of customer/client contact.

VetJobs

RN CNA or CMA Healthcare Customer Service Representative - Remote

Posted on:

January 23, 2026

Job Type:

Full-Time

Role Type:

Telehealth

License:

RN

State License:

Missouri

VetJobs brings military and veteran job seekers together with employers who are looking to hire. Our career coaching services are unrivaled as VetJobs leads the nation in military and veteran job placement assistance services - all at no cost to the service member or veteran. With an average salary greater than $90,000 our team has provided job placement services to more than 300,000 military affiliated jobseekers and have surpassed our 100,000 job hires! These industry leading achievements are possible by providing consistent, effective, individualized career coaching services to those looking for their next career opportunity. Connect. Get started today. We look forward to serving you.

ATTENTION MILITARY AFFILIATED JOB SEEKERS - Our organization works with partner companies to source qualified talent for their open roles. The following position is available to Veterans, Transitioning Military, National Guard and Reserve Members, Military Spouses, Wounded Warriors, and their Caregivers. If you have the required skill set, education requirements, and experience, please click the submit button and follow the next steps. At this time, TP can only offer employment to individuals located in the following states: AL, AR, AZ, CT, DE, FL, GA, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, NY, OH, OK, PA, RI, SC, SD, TN, TX, UT, VA, VT, WI, WV, WY. Job_Category: Work From Home

Minimum Education Required: Certifications/Security Clearances/Other Qualifications: High School Diploma or equivalent (CNA/CMA). College degree (RN) Minimum of 6 months of healthcare/customer service experience. Must be 18 years of age or older. Ability to type at least 25 words per minute. Comfortable with desktop computer systems and have general knowledge of Windows-based systems. Must hold an Active License for the RN role Must have proof of school/experience for CNA/CMA role, Active license is preferred Must be comfortable working in a call center environment as this is not patient facing. Key Competencies: Process Excellence: Demonstrate commitment to following established procedures and be customer service driven. Collaboration: Proven ability to collaborate effectively with team members, supervisors, and support departments to resolve customer issues and achieve performance goals. Communication: Outstanding communication, listening, and analytical skills. Organizational Skills: Strong organizational and problem-solving skills. Emotional Intelligence: Ability to prioritize tasks and work well under pressure while remaining focused. Open-Mindedness: Open-minded approach to feedback, evolving policies, and working within a structured schedule that includes a variety of shifts. Critical Thinking: Sharp critical thinking skills, enabling quick analysis of customer issues and thoughtful, informed decision-making. Solution-Oriented: Proactive approach to problem-solving with a focus on creating a positive customer experience. Work from Home Requirements: Internet Requirements: Minimum subscribed download rate equal or exceeds 30.0 Mbps Minimum subscribed upload rate equal or exceeds 15.0 Mbps ISP must have no packet loss and ping under 50ms Internet connections cannot be Satellite, Mobile Data (5G, 4G, 3G hotspots), P2P or VPN Proof of internet speed required Clean and quiet workspace

Healthcare Customer Service Representatives field customer inquiries by finding innovative ways to respond to varying questions, issues, and concerns. Connect with customers via phone/email/chat/and or social media to resolve their questions or concerns Calmly attempt to resolve and de-escalate any issues Escalate interactions when necessary and appropriate Respond to requests for assistance and/or possible processing payments Track all call related information for auditing and reporting purposes Provide feedback on call issues Upsell if required

Career Management Group

Telehealth Diabetes RN (Remote, NY)

Posted on:

January 23, 2026

Job Type:

Contract

Role Type:

Telehealth

License:

RN

State License:

New York

Hiring doesn’t fail because of a lack of candidates — it fails because of misalignment. We partner with growth-minded companies nationwide to bring clarity, strategy, and execution to their hiring process. At Career Management Group, we take a boutique, hands-on approach to recruiting — learning the business, pressure points, and goals behind every role so we can deliver hires that actually move the needle. Our work spans high-growth and impact-driven industries including healthcare, telehealth, life sciences, medical devices, technology, sales, and corporate functions. Whether the need is contract talent, direct hire, or a more embedded recruiting partnership, we tailor solutions that scale with the business — without résumé flooding or wasted time. We believe recruiting should feel less transactional and more like a true extension of your team. When hiring is done right, growth follows.

Registered Nurse (RN) – CDCES Remote | RPM / CCM Telehealth | NYS RN License (Required) The Role We're hiring a Registered Nurse (RN) with CDCES credentials to support patients enrolled in Remote Patient Monitoring (RPM) and Chronic Care Management (CCM) programs. This is a telehealth-focused role centered on education, engagement, and ongoing support — not bedside care, not call-center chaos. You'll work with patients managing diabetes and related chronic conditions, using real-time data, structured touchpoints, and evidence-based education to drive better outcomes. If you love coaching patients, interpreting trends, and actually seeing progress over time, you'll thrive here. Why This Role: 100% remote — work where you work best Focus on education, engagement, and outcomes No bedside burnout. No shift work. Structured programs with real impact on patient health Competitive compensation + benefits (role dependent)

Active NYS RN license CDCES certification ( preferred ) Experience or strong interest in RPM, CCM, or telehealth care models Solid understanding of diabetes management and chronic disease workflows Comfortable reviewing patient-generated health data and identifying trends Strong communication skills — clear, empathetic, and efficient Tech-savvy and comfortable working across EHRs and digital platforms Nice to Have: Prior experience in RPM, CCM, care coordination, or population health Familiarity with CGMs, insulin pumps, and connected monitoring devices Experience working with Medicare patients and CCM documentation standards Bilingual skills

Deliver diabetes education and coaching within RPM and CCM programs Monitor and interpret RPM data (blood glucose, BP, weight, etc.) and escalate concerns appropriately Conduct scheduled CCM outreach (monthly touchpoints, care plan reviews, follow-ups) Educate patients on: Diabetes self-management and lifestyle strategies Medication adherence (insulin and non-insulin therapies) CGMs, connected devices, and remote monitoring tools Identify barriers to adherence and engagement (behavioral, social, technical) Collaborate with providers and care teams to support treatment plans Document care plans, patient interactions, and outcomes to meet CCM/RPM requirements Support quality measures, patient retention, and program engagement metrics

Aptino, Inc.

Remote - Nurse / Telehealth Nurse / Telemedicine Nurse / Registered Telehealth Nurse / Telephonic Nurse / Call Center Nurse / Clinical Nurse / Tele Nurse

Posted on:

January 23, 2026

Job Type:

Contract

Role Type:

Telehealth

License:

RN

State License:

Kentucky

Welcome to Aptino where we combine APTITUDE of talent, skills, and expertise with INNOVATION of continuous change and transformation to deliver the highest quality of total talent strategies and results. Aptino is a specialized IT consulting firm that leverages cutting-edge AI technology and innovative methodologies to create a comprehensive strategy tailored to the unique needs of each client. Our efficient, focused determination leads us to the highest quality results focusing on a true partnership with our clients and workforce. Our Vision To innovate your approach to sourcing superior talent. Our Mission We leverage cutting-edge AI technology and innovative methodologies to create a comprehensive strategy tailored to the unique needs of each client. Our efficient, focused determination leads us to the highest quality results focusing on a true partnership with our clients and workforce.

Role: Telehealth Nurse Location: Louisville, KY 40219 / Remote Job Job Description: Work timings: Monday - Friday Shifts we can start with below however may have some flexibility in shifts: 8:30 - 5pm EST, 10:30-7pm EST or 11:30-8pm EST Telehealth experience preferred Work from home policy – high level overview this is a call center environment- a dedicated workspace to be HIPAA compliant and childcare is required. To provide service to patients, caregivers, healthcare providers and their staff in support of prescription and specialty drugs through inbound and outbound telephonic interactions relative to program and regulatory requirements inclusive of the coordination of services such as: testing, monitoring and counseling follow up. The Tele-Health Nurse provides service and support to defined stakeholder populations through the use of telecommunications in accordance with the Nurse Practice Act and licensure guidelines.

Education/Training: Vocational or technical training is required. Registered or Licensed Practical Nurse licensure is required. Licensure must be current and maintained upon hire and throughout duration of employment in this role. Business Experience: Two or more years of experience working for a healthcare company, a physician’s office or in a laboratory environment. Knowledge Skills: Reading, writing, arithmetic, medical terminology, good communication skills, read and interpret documents such as safety rules and procedure manuals, PC and word-processing skills, and working knowledge of the company products. Specialized Knowledge/Skills: Ability to express ideas clearly in both written and oral communications, read and interpret documents such as safety rules, procedure manuals, and work instructions, resolve problems independently, and speak effectively and professionally to patients, caregivers, and internal/external stakeholders of the organization. Pro-active self-starter with experience in researching available services and agencies to assist clients with any issues. Strong computer skills required, data entry, proficiency with Microsoft Suite software, basic keyboarding skills. Strong attention to detail to work, accuracy in data collection/note documentation, ability to navigate multiple online platforms and programs synchronously, and comply with competing regulatory requirements. Experience in developing and preparing action plans in addition to consulting with patients and caregivers to resolve complex issues. Adaptable and excited about change which positively impacts the patient experience, adherence to therapy, and goals. Ability to accommodate a fast-paced environment, changing needs within health care. Knowledge to identify Adverse Events and Product Complaints. Working Conditions: Remote - WFH Must have secure and professional working environment space, HIPAA compliant workspace. Must have reliable high-speed internet capable of supporting multiple online platform resource access including VOIP calls and video conferencing Physical Requirements: May sit or stand seven (7) to ten (10) hours per day. May be necessary to work extended hours as needed. Finger dexterity to operate office equipment required. Headset may be required for prolonged hours.

Provide telephonic and electronic service and support of stakeholders, utilizing experience in Behavior Modification and Motivational Interviewing to help achieve and sustain medication adherence through telephonic outreach. Coordinate the collection of patient specific clinical data required to support adherence to regulatory program requirements and therapy protocols Demonstrate understanding of and compliance with regulatory and specific service line and program requirements Utilize clinical knowledge and defined processes to identify stakeholder needs, risks and safety concerns, ensuring timely escalation and reporting Follow up with physicians and patients for purpose of compliance and persistency in reference to program protocols Maintenance of professional licensure

HarmonyCares

Advance Practice Provider - Primary Care

Posted on:

January 23, 2026

Job Type:

Full-Time

Role Type:

Primary Care

License:

NP/APP

State License:

Michigan

HarmonyCares is a leading national value-based provider of in-home primary care services for people with complex healthcare needs. Headquartered out of Troy, Michigan, HarmonyCares operates home-based primary care practices in 14 states. HarmonyCares employs more than 200+ primary care providers to deliver patient-centered care under an integrated, team-based, physician-driven model. Our Mission – To bring personalized, quality-based healthcare to the home of patients who have difficult accessing care. Our Shared Vision – Every patient deserves access to quality healthcare. Our Values – The way we care is our legacy. Every interaction counts. Go the extra mile. Empower and support each other. Why You Should Want to Work with Us Competitive Base Salary Accountable Care Organization Comprehensive benefit package including 401K with match Annual stipend for CME and license/association dues Paid Subscription UpToDate for your tablet and company phone A+ rated malpractice coverage with tail coverage Additional Benefits No holidays, no hospital rounds Minimal call responsibilities Provide primary care to high acuity patients in their home Monday - Friday Assistant to support your appointments in select markets Company Car w/ Driver in select markets

Advance Practice Provider (NP or PA) managing chronic conditions of own patient panel. See 6-8 patients per day, Monday - Friday. This role comes with a full-time exempt salary + quality-based bonus + full benefits.

Licensed as a NP in the State where HarmonyCares Medical Group office located Federal DEA License/eligibility Geriatric training/experience preferred Active CPR/BLS Certification Board Certification

The Nurse Practitioners we seek are those who have directly related experience in home health, geriatrics, hospice and primary care. The Nurse Practitioner who wants to practice medicine with a focus on patient care, not volume. We want our clinicians to take the time needed to truly address the patient’s needs.

HarmonyCares

Health Risk Assessment Nurse, Licensed Practical Nurse (LPN) OHIO

Posted on:

January 23, 2026

Job Type:

Full-Time

Role Type:

Primary Care

License:

LPN/LVN

State License:

Ohio

HarmonyCares is a leading national value-based provider of in-home primary care services for people with complex healthcare needs. Headquartered out of Troy, Michigan, HarmonyCares operates home-based primary care practices in 14 states. HarmonyCares employs more than 200+ primary care providers to deliver patient-centered care under an integrated, team-based, physician-driven model. Our Mission – To bring personalized, quality-based healthcare to the home of patients who have difficult accessing care. Our Shared Vision – Every patient deserves access to quality healthcare. Our Values – The way we care is our legacy. Every interaction counts. Go the extra mile. Empower and support each other. Why You Should Want to Work with Us 401K Retirement Plan (with company match) Paid Orientation and Training Established in 11 states More details about the benefits we offer can be found at https://careers.harmonycares.com/benefits.

A current unencumbered State professional nurse license Proficient in basic clinical skills Proficient in Microsoft Office

HRA, LPN/LVN collects Health Risk Assessment data both telephonically and face to face to initiate the formulation of a plan of care. As a HRA, LPN/LVN you will: Schedule and perform home visits to collect Health Risk Assessment (HRA) data, unless request to obtain telephonically Communicate any patient needs timely with Nurse Manager in effort to expedite process of getting the patient needs fulfilled Maintain accurate records providing detail of calls attempted and telephonic HRA

DataAnnotation

Registered Nurse

Posted on:

January 23, 2026

Job Type:

Contract

Role Type:

License:

RN

State License:

Idaho

Welcome to DataAnnotation! We pay smart folks to train AI. We offer a remote, flexible work model- you choose your own hours and get to work when you want, whenever you want. Apply now through our open Job Listings.

We are looking for a Registered Nurse to join our team to train AI models. You will measure the progress of these AI chatbots, evaluate their logic, and solve problems to improve the quality of each model. Physicians & Advanced Practice Clinicians In this role you will need to be an expert in healthcare. We are interested in a wide range of expertise, so relevant backgrounds include: Physicians of all specialties (e.g., Internists, Cardiologists, Oncologists), Physician Assistants, Nurse Practitioners, Certified Nurse-Midwives, Certified Registered Nurse Anesthetists, Clinical Nurse Specialists, Registered Nurses. Therapists Physical Therapists, Occupational Therapists, Speech-Language Pathologists, Respiratory Therapists, Athletic Trainers, Massage/Recreational Therapists. Diagnostic & Laboratory Professionals Radiologic Technologists, Sonographers, MRI & Nuclear Medicine Technologists, Medical Laboratory Scientists, Phlebotomists, Histology & Genetics Technicians. Public Health & Specialized Roles Dietitians/Nutritionists, Genetic Counselors, Epidemiologists, Public Health Nurses. Benefits: This is a full-time or part-time REMOTE position You’ll be able to choose which projects you want to work on You can work on your own schedule Projects are paid hourly starting at $50-$60 USD per hour, with bonuses on high-quality and high-volume work

Fluency in English (native or bilingual level) A current or in progress medical degree

Give AI chatbots diverse and complex healthcare related problems and evaluate their outputs Evaluate the quality produced by AI models for correctness and performance Ensure the medical accuracy of model performance

Cherokee Federal

Licensed Practical Nurse, LPN/LVN

Posted on:

January 23, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

Oklahoma

Cherokee Federal, a division of Cherokee Nation Businesses, is a trusted team of government contracting professionals who can rapidly build innovative solutions. We work around the globe to help solve issues in national security and intelligence, information technology, health solutions, DoD logistics and humanitarian relief. Our businesses serve the Cherokee Nation tribe, where 100% of our profits support building a brighter future for tribal citizens.

Accurately advises patients of their referral eligibility, beneficiary status, and health treatment options as outlined by their TRICARE enrollment and/or DEERS status. Coordinates with the military treatment facility, (MTF), Staff for all active, reserve, and guard referrals not covered under the TRICARE benefit for approval. Directs patient to the patient travel coordinator and provides information on travel-related benefits. Assists MTF, as necessary, on advising patients regarding Line-of-Duty, Personal Reliability Program (PRP), and Medical Evaluation Board issues as outlined in AFI 41-210, Tricare Operations and Patient Administration Functions, and AFI 36-3212, Physical Evaluation for Retention, Retirement, Separation (in conjunction with MTF Physical Evaluation Board Liaison Officer and MTF monitors). Verifies appropriate paperwork is on file before authorization. Initiate, receive, and coordinate, (telephone/computer/written), communication between beneficiaries, team members, internal staff and providers, network/outside providers, and ancillary health care workers regarding specialty clinic appointments and referrals.

Professional license for LPN required. Knowledge of MHS Genesis is preferred. Knowledge of military patient referrals is preferred. Must pass the pre-employment qualifications of Cherokee Federal.

Shall read, understand, speak, and write English fluently. Shall have knowledge, skills, and computer literacy to interpret and apply medical care criteria, such as, but not limited to, InterQual or Milliman Ambulatory Care Guidelines. Shall have a minimum of two (2) years broad-based clinical nursing experience in either an inpatient or outpatient care setting within the last three (3) years. The license must be valid and unrestricted. Contract personnel shall be in good standing, and under no clinical restrictions, with the licensure boards in all jurisdictions in which a license is held or has been held within the last ten (10) years. Operational computer skills with general working knowledge of word processing, and Microsoft applications (including Windows, Word, Excel, and Outlook). General medical ethics, telephone etiquette, written/verbal/electronic communication, and customer service skills. Performs other job-related duties as assigned.

Oscar Health

Case Management Nurse

Posted on:

January 23, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

Hi, we're Oscar. We're hiring a Case Management Nurse to join our Case Mangement team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

You will educate members on improving health outcomes, assist with transitions from care settings, participate in process improvement and other pilot programs as they arise, and work with support teams to ensure exceptional care for our members. You will report into the Associate Director, Clinical. Work Location: This is a remote position, open to candidates who reside in: Arizona; Florida; Georgia; or Texas. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role is: $39.28 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license Ability to obtain additional state licenses to meet business needs 2+ years of clinical experience to include payer, hospital, outpatient or community based care management 1+ years of experience in Care Coordination and Navigation Bonus points: CCM Certification Bilingual in Spanish and/or creole reading, writing, speaking BSN Working knowledge of Milliman Guidelines

Assist in the coordination of care across a variety of settings (inpatient, outpatient, post acute, ER, home care) Actively reach out to members undergoing difficult health challenges and develop care plans Proactively reach out to hospital case managers to assist with discharge planning Communicate with members via phone or secure messaging to provide education on health conditions, new medications, and procedures. Compliance with all applicable laws and regulations Other duties as assigned

Oscar Health

Utilization Review Nurse

Posted on:

January 23, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

Hi, we're Oscar. We're hiring a Utilization Review Nurse to join our Utilization Review team. Oscar is the first health insurance company built around a full stack technology platform and a relentless focus on serving our members. We started Oscar in 2012 to create the kind of health insurance company we would want for ourselves—one that behaves like a doctor in the family.

You will perform frequent case reviews, check medical records and speak with care providers regarding treatment as needed. You will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions. You will report into the Supervisor, Utilization Review. Work Location: This is a remote position, open to candidates who reside in: Texas, Georgia, Arizona, and Florida. While your daily work will be completed from your home office, occasional travel may be required for team meetings and company events. #LI-Remote Pay Transparency: The base pay for this role is: $35.00 - $45.94 per hour. You are also eligible for employee benefits and monthly vacation accrual at a rate of 15 days per year.

Active, unrestricted RN licensure from the United States in [state], OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC) Associate Degree or Bachelors Degree - Nursing or Graduate of Accredited School of Nursing MCG or InterQual tooling experience Ability to obtain additional state licenses to meet business needs 1+ year of utilization review experience in a managed care setting 1+ years of clinical experience (including at least 1+ year clinical practice in an acute care setting, i.e., ER or hospital) Bonus points: BSN Previous experience conducting concurrent or inpatient reviews for a managed care plan

Complete medical necessity reviews and level of care reviews for requested services using clinical judgment and Oscar Clinical Guidelines, Milliman Care Guidelines Obtain the information necessary (via telephone and fax) to assess a member's clinical condition, and apply the appropriate evidence-based guidelines Meet required decision-making SLAs Refer members for further care engagement when needed Compliance with all applicable laws and regulations Other duties as assigned

Sedgwick

PRN Crisis Care Triage (RN)

Posted on:

January 23, 2026

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

Tennessee

Sedgwick is the world’s leading risk and claims administration partner, helping clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.

Sedgwick is currently seeking Triage Nurses to join our Crisis Care team. This is a remote PRN position offering up to 20 hours per week. The team operates 24/7, with the greatest staffing needs during afternoon and evening hours. PRIMARY PURPOSE: Triages incoming catastrophic injury referral calls from clients; gathers vital case details, obtains and provides medical status updates to the customer, and assigns a Field Case Manager (FCM) for onsite visits as appropriate. Ensures that client service guidelines are followed and communicated to the appropriate parties and promotes quality cost-effective outcomes through communication and available resources.

Education & Licensing: Bachelor's degree in nursing (BSN) from an accredited college or university preferred. Licenses as required. Active unrestricted RN license issued in a state or territory of the United States required. Experience: Six (6) years of related experience or equivalent combination of education and experience required to include three (3) years of recent clinical practice or Telephonic/ Field Case Management experience in Worker’s Compensation. Skills & Knowledge: Strong knowledge of nursing practice and theory Demonstrate a high level of clinical skills and triage ability Ability to apply critical thinking under pressure Knowledge of the insurance industry and claims processing Knowledge of field case management Excellent oral and written communication skills, including presentation skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills Excellent interpersonal skills Excellent negotiating skills Ability to work in a team environment Ability to meet or exceed Performance Competencies WORK ENVIRONMENT: When applicable and appropriate, consideration will be given to reasonable accommodations.

Provides professional and timely responses to incoming catastrophic referral calls from clients, applying all phases of the nursing process, i.e. assessment, planning, implementation, and evaluation when triaging calls. Triages the catastrophic referral utilizing critical reasoning, the department triage log, and associated workflow; utilizes customer specific guidelines to obtain pertinent data. Identifies life-threatening emergencies and recommends appropriate interventions. Assigns appropriate Field Case Manager assignment and facilitates initial onsite hospital visit for the claim. Maintains communication with the customer, Client Service Director, and Claims Examiner providing timely updates on changes in injured worker status and FCM estimated time of arrival. Communicates phone advice in a calm manner, ensuring it is properly received and understood. Ensures triage benchmarks are met, activity is professionally documented and enters incident data into computer system. Educates the assigned FCM on Sedgwick benchmarks and customer specific guidelines. Maintains ongoing communication with the client, Client Service Director, and Claims Examiner until the assigned Field Case Manager arrives onsite. Adheres to quality assurance standards. ADDITIONAL FUNCTIONS and RESPONSIBILITIES: Performs other duties as assigned.

Tenavi Staffing

Quality Outreach RN - Care Coordinator

Posted on:

January 23, 2026

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Tenavi Staffing delivers execution-ready talent with speed, flexibility, and strategic precision — helping businesses thrive through change. Tenavi Staffing is a women-owned, modern staffing firm built on Tenacity, Navigation, and Vision. We deliver high-quality, cost-effective talent solutions for organizations that need to move fast and build smart.

We are seeking an experienced and motivated Quality Outreach RN to join our team and play a key role in improving member outcomes and quality performance. The Quality Outreach RN will leverage clinical expertise and quality knowledge to conduct member outreach, close care gaps, and enhance overall member experience. This role is ideal for a nurse with a background in quality improvement, HEDIS, and managed care programs such as Medicare and CHIP.

Active, unrestricted RN (state-specific or compact license acceptable). HEDIS experience required, strong understanding of measure specifications, disease management, and gap closure strategies. Experience with Medicare and/or CHIP populations is strongly preferred. Minimum of 3-5 years of clinical experience in managed care, quality improvement, or population health. Strong communication, organization, and analytical skills. Proficiency with electronic health records, data entry, and reporting tools.

Coordinate care across multiple providers and service settings to assist members in receiving timely, appropriate and continuous care. Monitor member progress and address barriers as needed to promote engagement and care coordination. Review and interpret medical records, claims data, and HEDIS measure criteria to identify actionable opportunities for intervention. Support the execution of quality improvement initiatives aimed at improving HEDIS and member experience performance. Document outreach efforts, barriers to care, and member engagement outcomes accurately and efficiently. Serve as a clinical resource for care teams and participate in cross-functional efforts to enhance quality reporting and compliance. Maintain confidentiality and adhere to all organizational, state, and federal regulatory requirements.

Mercor

Clinical Nurse Specialist

Posted on:

January 23, 2026

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

Mercor is at the intersection of labor markets and AI research. We connect human expertise with leading AI labs and enterprises to train frontier models.

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: Medical Expert Type: Contract Compensation: $60–$162/hour Commitment: 20+ hours/week

Relevant higher education degree and professional certificates (e.g., Nursing license, MD, PhD). 3+ years of relevant experience. Demonstrated clinical experience in patient care settings. Strong understanding of medical terminology, procedures, and standards of care. Experience with clinical documentation, case review, or similar evaluative tasks. Excellent communication skills with attention to detail.

Review and validate clinical content, scenarios, and annotations for medical AI workflows. Provide domain-expert feedback on model outputs related to nursing and patient care practices. Advise on clinical guidelines, best practices, and potential safety concerns. Assist in crafting realistic clinical use cases and medical question sets. Communicate insights and recommendations clearly to technical and non-clinical teams.

Conexus MedStaff

Clinical Development Specialist

Posted on:

January 23, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Texas

At Conexus MedStaff, we don’t just recruit healthcare professionals, we empower them to thrive. We're a dedicated healthcare recruitment and staffing agency, that supports international registered nurses, U.S. nursing graduates, and international medical technologists to turn their dreams of a healthcare career in the U.S. into reality. Our work changes lives, and strengthens communities. Whether it's providing the support our candidates need to build successful, fulfilling careers or helping our clients deliver exceptional patient care, we’re all in. We lead with purpose, guided by a commitment to ethical practices, excellence in care, and a deep belief in the power of diversity to drive innovation. To improve community wellbeing by investing in and supporting healthcare professionals, ensuring stability, quality, and long-term impact for the patients and clients we serve. Why We Do It At Conexus, we believe that when healthcare professionals feel supported, valued, and inspired, they deliver their best. Our vision is clear: we are one team, driven by purpose, building better futures, one healthcare professional at a time.

United States, Eastern or Central Time zone preferred Permanent, full-time, remote Competitive Salary + bonus and benefits The Clinical Development Specialist designs, delivers, and continuously improves education programs that support internationally trained clinicians transitioning to practice in the United States.

What we’re looking for: Active U.S. RN license BSN required, MSN preferred Minimum 3–5 years of recent U.S. nursing practice, specifically in acute care settings (e.g., med-surg, ICU, ER). Core Requirements: Experience in U.S. clinical practice Experience in education, staff development, or clinical training Strong knowledge of adult learning principles Cultural competence and experience with internationally trained professionals Comfort with virtual learning platforms and LMS tools Soft Skills: A natural collaborator who enjoys working closely with others to achieve common goals Strong attention to detail, ensuring high-quality outputs without losing sight of the bigger picture Flexible and adaptable, able to adjust quickly to change and new challenges Confident in managing stakeholders and building positive, productive working relationships Motivated by continuous improvement, with a proactive approach to refining processes and practices

This role contributes to a One Foundation curriculum that establishes shared expectations for all clinicians, including U.S. healthcare systems, professional communication, cultural adaptation, safety, documentation standards, and workplace norms. In addition to shared foundational education, the Clinical Development Specialist delivers license-specific clinical education aligned with the individual’s professional scope of practice (e.g., Nursing, Medical Laboratory Science). The role partners cross-functionally to ensure clinicians are prepared, supported, and successful throughout pre-deployment, arrival, and post-deployment phases. This position requires a strong understanding of global nursing education, cultural competency, and the ability to innovate within virtual and remote learning environments.

Functional Health of Lancaster

Nurse Practitioner

Posted on:

January 23, 2026

Job Type:

Part-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Pennsylvania

Functional Health of Lancaster is an interdisciplinary private practice committed to providing comprehensive functional medicine, adult primary care, and wellness services. We emphasize the importance of the patient-provider relationship and actively involve patients as vital partners in improving their health. Our holistic approach includes services such as functional and nutritional medicine, certified health coaching, thermography, IV supplement therapy, mind-body therapy, and adult primary care. Telehealth options are available to residents in Pennsylvania, Delaware, and Maryland.

This is a part-time, telehealth role. As a Nurse Practitioner at Functional Health of Lancaster, you will provide patient-centered care through comprehensive health assessments, diagnosis, treatment, and education.

Strong clinical expertise in primary care, functional medicine, and holistic approaches Proficiency in patient assessments, care planning, diagnosis, and treatment Excellent interpersonal and communication skills for effective patient interactions and collaboration with team members Knowledge of nutritional medicine, mind-body therapy, or other holistic practices is a plus Experience with telehealth platforms and virtual patient care is desirable Currently licensed as a Nurse Practitioner with the ability to practice in Pennsylvania Certification in Functional Medicine Commitment to patient-centered care and ongoing professional development Minimum 2 years working as a nurse practitioner and at least 1 year working in functional medicine

Your responsibilities will include developing personalized care plans, collaborating with our interdisciplinary team to deliver integrated care, and utilizing functional medicine approaches to optimize patient outcomes. Additional tasks may involve managing patient records, monitoring progress, and implementing preventative healthcare strategies.

Independence Blue Cross

Care Management Coordinator RN (Acute UM) - Remote (PA/NJ/DE)

Posted on:

January 22, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Pennsylvania

Independence Blue Cross is the leading health insurance organization in southeastern Pennsylvania. For 85 years, we have been enhancing the health and well-being of the people and communities we serve. We deliver innovative and competitively priced health care products and services; pioneer new ways to reward doctors, hospitals, and other health care professionals for coordinated, quality care; and support programs and events that promote wellness.

Our organization is looking for dynamic individuals who love to learn, thrive on innovation, and are open to exploring new ways to achieve our goals. If this describes you, we want to speak with you. You can help us achieve our vision to lead nationally in innovating equitable whole-person health. Position Summary: This position is responsible for overseeing and coordinating medical care provided to members, ensuring that appropriate and cost-effective care is rendered. The Care Management Coordinator (CMC) maintains quality care standards and limits the member’s and client’s exposure to medically unnecessary and inappropriate treatment. The Care Management Coordinator acts as a patient advocate and a resource for members, when accessing the health care system. Fully Remote: This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence’s physical office locations to perform the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania.

Experience: Licensed registered nurse within state of PA, BSN Preferred Minimum three years clinical experience or equivalent (Intensive Care, Trauma, Home Health a plus) required Medical management/precertification experience preferred Oriented in current trends of medical practice Active PA Licensed Registered Nurse required Skills: Strong problem solving and critical thinking abilities Proficiency utilizing Microsoft Word, Outlook, Excel, Access, SharePoint, and Adobe programs. Excellent organizational planning and prioritizing skills Ability to work independently and provide positive resolution of complex medical and interpersonal challenges Highly professional interpersonal skills for internal and external contacts, particularly in situations where medical evaluations are in conflict with treating providers proposed treatment plans Participates in the process of educating providers on managed care Comfortable with new ideas and methods; creates and acts on new opportunities; is flexible and adaptable. Builds team spirit and interdepartmental rapport, using effective problem solving and motivational strategy Performs additional job-related duties as assigned

Evaluate proposed plans of treatment, as defined in the precertification requirements of the group plan Using the medical criteria of InterQual and/or Medical Policy, establish the need for inpatient, continued stay and length of stay, procedures and ancillary services Directs the delivery of care to the most appropriate setting, while maintaining quality Contacts attending physicians regarding treatment plans/plan of care and clarifies medical need for inpatient stay or continued inpatient care Identifies admissions no longer meeting criteria and refers care to plan Medical Directors for evaluation. Presents cases to Medical Directors that do not meet established criteria and provides pertinent information regarding member’s medical condition and the potential home care needs. Performs early identification of members to evaluate discharge planning needs. Collaborates with facility case management staff, physician and family to determine alternative setting at times and provide support to facilitate discharge to the most appropriate setting Identifies and refers cases for case management and disease management. Identifies quality of care issues including delays in care Appropriately refers cases to the Quality Management Department and/or Clinical Services Supervisor when indicated. Maintains the integrity of the system information by timely, accurate data entry. Utilization decisions are compliant with state, federal and accreditation regulations. Ensures that all key functions are documented via Care Management and Coordination Policy Works to build relations with all providers and provides exceptional customer service. Reports potential utilization issues or trends to designated manager or clinical supervisor and recommendations for improvement Participates in the process of educating providers on managed care Open to new ideas and methods; creates and acts on new opportunities; is flexible and adaptable. Builds team spirit and interdepartmental rapport, using effective problem solving and motivational strategy Performs additional job-related duties as assigned

Prime Therapeutics

Infusion Referral Nurse Sr- REMOTE

Posted on:

January 22, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

Prime Therapeutics LLC (Prime) is a diversified pharmacy solutions organization. We offer innovative pharmacy benefit management, specialty and medical drug management, and state government solutions to millions of people across the country. At Prime, we’re reimagining pharmacy solutions to provide the care we’d want for our loved ones. We challenge the way it’s always been done to develop intelligently designed solutions that deliver savings, simplicity and support to help people achieve better health.

Under supervision, is responsible for performing referral services to support independent physician offices with maintaining member drug infusions in office or to help offices locate a lower cost alternative treatment site (e.g., home infusion) for drug infusion services versus the hospital outpatient facility.Discusses financial and clinical considerations with members who are considering care at a higher cost treatment site, researches available financial programs to decrease members' out-of-pocket expense for drug services in office, and coordinates lower cost site of service for drug administration if provider is referring due to convenience factors (e.g., distance, non-typical infusing provider, etc.). Performs functions under supervision.

Minimum Qualifications: Bachelors - Nursing RN - Registered Nurse, State and/or Compact State Licensure - Care Mgmt 5+ years Clinical Must be eligible to work in the United States without the need for work visa or residency sponsorship Additional Qualifications: Registered Nurse (RN). 5 years of post-degree clinical experience. Experience in managed care, specialty drugs, care management and utilization review. Meets Credentialing criteria. At minimum must have current and active nursing license. Ability to apply knowledge in relation to clinical findings from evidence based guidelines. Ability to function independently and as a team member. Good organizational, time management and communication skills. Possesses the ability to achieve organizational goals through development of effective teams. Comprehensive clinical knowledge of medical specialty drugs and the management of those drugs. Understanding of the clinical aspect of the infusion of those drugs within various sites of service. Preferred Qualifications: Every employee must understand, comply with and attest to the security responsibilities and security controls unique to their job, and comply with all applicable legal, regulatory, and contractual requirements and internal policies and procedures Every employee must be able to perform the essential functions of the job and, if requested, reasonable accommodations will be made to enable employees with disabilities to perform the essential functions, absent undue hardship. In addition, Prime retains the right to change or assign other duties to this job.

Provides site of service solutions to patients seeking care at non-preferred treatment sites (e.g., Hospital inpatient or outpatient facilities, non-par cancer treatment centers, etc.). Discusses the financial aspect of the specialty drugs to both the member and the ordering physician (or office staff) and to agree to find a lower cost versus higher cost sites of service, coordinating drug infusion at an alternate lower cost treatment site and coordinating concomitant services to support infusion administration in lower cost sites. Provides member with resources to optimize their treatment outcomes, by utilizing critical thinking skills and providing specific resources related to their complex illness. Actions include supporting member copay-assistance programs, research and coordination to decrease member out of pocket financial responsibility in an office or home setting for drug services. Will actively maintain a required case load and the activities to reach overall goals of switching site of service treatment to a lower cost setting while maintaining members' satisfaction during the process. Documents and enters data of these cases in web-based application and spreadsheets. Supports clinical services such as the appeals program. Participates in meetings and consults with management on regular basis to discuss member interaction and program outcomes. Maintains appropriate par levels of literature. Familiarizes self with community resources available, benefit information or any other information that is valued with the program. Maintains an active case load and accurate case records, adhering to all company policies and laws governing patient records including documentation of all daily activities. Performs related duties as requested. Clinical and Quality oversight for this program is provided by the Manager, Patient Programs.

Thyme Care

Oncology Transitions of Care Nurse

Posted on:

January 22, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Compact / Multi-State

Thyme Care is the leading value-based care enabler, collaborating with payers and providers to transform the experience and outcomes for individuals living with cancer. The company partners with health plans, employers, and risk-bearing providers to assume accountability for enhanced care quality, improved health outcomes, and reduced total cost of care. Thyme Care's approach combines a technology-enabled Care Team and seamless integration with more than 800 oncologists in Thyme Care Oncology Partners, creating a hybrid collaborative care model that guides and supports the entire patient journey. Thyme Care empowers oncologists nationwide through purpose-built tech, advanced data analytics, and virtual patient engagement, driving better care and outcomes in value-based arrangements. Thyme Care is a founding member of CancerX, and is backed by leading investors. To learn more about how Thyme Care is enabling the shift to value-based care in oncology, visit www.thymecare.com.

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

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

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

Vivo Care Inc

Care Navigator- Licensed Nurse - Remote - EST Time Zone - Michigan AND Compact License Required

Posted on:

January 22, 2026

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

Compact / Multi-State

At Vivo Care, we believe the best care doesn’t end at the clinic, it lives in the moments between visits. That’s why we’re building something bigger than software. We’re creating a future where care is continuous, personal, and truly connected. If you’re driven to make a difference, we want you on our team. We’re not here to make care a little better, we’re here to rethink it entirely. From our platform to our partnerships, we challenge the status quo and design for what patients and providers really need. Every team, every role, every idea is part of building something new. While healthcare is complex, we don’t shy away from tough problems. We stay focused, move fast, and push through barriers with creativity, grit, and a commitment to doing what’s right, even when it’s not easy. We care deeply about our work, our mission, and each other. Our team brings heart to everything we do, showing up every day to improve lives, strengthen relationships, and make care feel like care again.

As a care navigator, you love building relationships with patients based on trust, utilizing motivational communication techniques , to help drive positive health behavior change and improved patient outcomes. This program is based around triaging vital signs and using this data to promote positive lifestyle and health behavior changes. This is accomplished through collaboration with the patients care team to provide wellness calls with patients to outline patient-centric goals and the development of associated action plans to improve their health and well-being. Our ideal candidate has clinical background working with the adult and geriatric patient population ideally with experience in phone triage. Has a strong working knowledge of remote-patient monitoring (RPM) preferred and/or Chronic Care Management (CCM), Behavioral Health, Care Coordination or Utilization Management principles. Experienced in remote working technologies, being a strong team player and a desire to clinically and emotionally support our patients while keeping a keen eye on reimbursement requirements are valued in this role. Being a Care Team Member at Vivo Care provides the chance to serve patients by proactively monitoring vital signs, educating, and coaching patients on a plan for better health. Early intervention through RPM, reduces risk for emergent care and/or hospital admission/re-admissions. Encounters with patients will be performed via phone through a Remote Care Platform that receives electronically transmitted physiological markers like blood pressure/weight/blood glucose . The care team member will perform monitoring as well as synchronous and asynchronous communication with the patient within Vivo Care’s industry-leading platform.

Unrestricted RN/LPN/LVN license in a compact state and Michigan Ability to work EST zone between 8:00a - 5:00pm Spanish speaking a plus 1-3 years of clinical experience, patient management, or disease management desired Experience working with different provider practices and workflows Fast learners Ability to work independently with minimal direction Experience with Medicare patients Experience performing virtual visits with patients and telephonic care management Interest in professional leadership growth and development opportunities with a growing organization Interest in operating in a new, exciting clinical program and become an integral player in the development of processes and best practices in caring for RPM patients Motivational Interviewing/Health Behavior Change experience a plus Health Coach certification a plus.

Manage physiological markers like blood pressure/weight/blood glucose with clinical appropriateness Meet team goals and standards outlined metrics Significantly impact longitudinal patient engagement in RPM program(s) Provide preventive health and disease management education and coaching Perform monthly wellness calls with assigned patients Lead collaborative wellness calls with the patients to define health goals outlined by their Care Team Manage patient messaging and alerts Direct patients to treating physician for routine questions Meet patient engagement program goals Follow appropriate escalation pathways for any urgent care needs

Sedgwick

RN Utilization Review

Posted on:

January 22, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Ohio

Sedgwick is the world’s leading risk and claims administration partner, helping clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.

PRIMARY PURPOSE: To utilize evidence based tools to evaluate the prescribed medications to ensure patient safety and quality standards are in alignment with best practice standards.

Education & Licensing: Active unrestricted RN license in a state or territory of the United States required. Bachelor's degree in nursing (BSN) from an accredited college or university or equivalent work experience preferred. Certification in case management, pharmacy, rehabilitation nursing or a related specialty is highly preferred. Experience: Four (4) years of related experience or equivalent combination of education and experience required to include two (2) years of direct clinical care OR two (2) years of case management/utilization management. Skills & Knowledge: Knowledge of pharmaceuticals used to treat pain Knowledge of behavioral health Knowledge of pain management process Knowledge of drug rehabilitation process Knowledge of workers' compensation laws and regulations Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Leadership/management/motivational skills Analytic and interpretive skills Strong organizational skills Excellent interpersonal skills Excellent negotiation skills Ability to work in a team environment Ability to meet or exceed Performance Competencies WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations.

Performs clinical assessment via information in pharmacy reports and case files; assesses client's situation to include psychosocial needs, cultural implications and support systems in place. Evaluates patient drug usage and physician prescribing patterns. Evaluates overuse, underuse and misuse of prescribed medications and may recommend testing to determine if drug diversion is present. Evaluates need for and recommends alternative treatment. Sends letters as needed to prescribing physician(s) and refers to physician advisor as necessary. Negotiates appropriate level and intensity of care through use of medical and disability duration guidelines, adhering to quality assurance standards. Negotiates changes in pharmacy plan with providers. Acts as a resource in consulting with the client, nursing staff and claims examiners regarding pharmacy issues. Performs drug utilization reviews through the pharmacy benefit manager or vendor. Communicates effectively with claims examiner, client, vendor, supervisor and other parties as needed. Maintains client's privacy and confidentiality; promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s).

Providence Health & Services

Clinical Program Manager RN - REMOTE - Days

Posted on:

January 22, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Compact / Multi-State

At Providence, our strength lies in Our Promise of “Know me, care for me, ease my way.” Working at our family of organizations means that regardless of your role, we’ll walk alongside you in your career, supporting you so you can support others. We provide best-in-class benefits and we foster an inclusive workplace where diversity is valued, and everyone is essential, heard and respected. Together, our 120,000 caregivers (all employees) serve in over 50 hospitals, over 1,000 clinics and a full range of health and social services across Alaska, California, Montana, New Mexico, Oregon, Texas and Washington. As a comprehensive health care organization, we are serving more people, advancing best practices and continuing our more than 100-year tradition of serving the poor and vulnerable.

Providence caregivers are not simply valued – they’re invaluable. Join our team at St. Jude Medical Center and thrive in our culture of patient-focused, whole-person care built on understanding, commitment, and mutual respect. Your voice matters here, because we know that to inspire and retain the best people, we must empower them.

Required Qualifications: Associate's Degree - Nursing. Bachelor's Degree - Nursing. California Registered Nurse License upon hire. Preferred Qualifications: 5 years - Experience as a utilization/case manager in an acute care setting. Experience in a multi-hospital and/or integrated healthcare system.

Leads the alignment, standardization and ongoing improvement of ministry length of stay for designated patient populations. Serves as designated ministry liaison with providers and ministry Care Coordination teams, to move patients towards safe and effective discharge plans or transitions to the most appropriate next level of care. Plans and develops reporting tools for sharing of information between division and ministry teams.

Optum

Inpatient Utilization Management Nurse, RN - Remote in PST or MST

Posted on:

January 22, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

California

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

The Utilization Review Nurse, RN is responsible for providing clinically efficient and effective Inpatient utilization management. Reviews inpatient criteria for acute hospital admissions and concurrent review and or prior authorization requests for appropriate care and setting by following evidence based clinical guidelines, medical necessity criteria and health plan guidelines. Reviews and applies hierarchy of criteria to all inpatient admission and preauthorization requests from providers that require a medical necessity determination. Is involved in assuring that the patient receives high-quality cost-effective care. Uses sound clinical judgement and managed care principles in the coordination of care. Prepares any case that does not meet medical necessity guidelines for medical appropriateness of procedure, service or treatment for review with the Medical Director for a decision. The shift is Monday through Friday 8am-5pm in Pacific or Mountain Time Zone. Occasional participation in weekend rotation is required. If you are located in PST or MST, you will have the flexibility to work remotely* as you take on some tough challenges.

Required Qualifications: Current unrestricted Registered Nurse (RN) license in state of residence Ability to obtain Registered Nurse license in the state of California within 90 days of hire 3+ years clinical nursing experience in acute care hospital or LTAC setting 1+ years Utilization Management experience in hospital or insurance setting Experience applying Medicare and/or Medicaid guidelines Experience with Milliman (MCG) or InterQual guidelines Experience researching and preparing clinical information for case review with Physician Leadership for patient treatment and care planning Experience providing accurate and timely documentation of clinical review and supporting rational of decision in care management systems Experience employing analytical skills necessary for quality case management, utilization review, and quality improvement to meet organizational objectives Experience using various computer software applications with an intermediate level of competence, including Microsoft Word and Excel Primary residence in Pacific or Mountain time zone and ability to work required hours in PST or MST Preferred Qualifications: Inpatient Utilization Management experience Utilization Management experience for insurance or managed care organization Prior Authorization experience

Maintains clinical expertise and knowledge of scientific progress in nursing and medical arena and incorporates this information into the clinical review and care coordination processes Performs clinical review for appropriate utilization of medical services by applying appropriate medical necessity criteria guidelines Authorizes healthcare services in compliance with contractual agreements, Health Plan guidelines and appropriate medical necessity criteria Documents clinical reviews in care management system. Provide accurate and timely documentation and supporting rational of decision in care management system Utilizes care management system and resources to track and analyze utilization, variances and trends, patient outcomes and quality indicators Research and prepares clinical information for case review with Physician Leadership for patient treatment and care planning Utilizes knowledge of resources available in the health care system to assist the physician and patient effectively Identifies members who are appropriate for care coordination programs and collaborates with the Medical Management team for care coordination of the member’s needs along the continuum of care Successfully completes the Interrater Reliability Testing to ensure consistency of review and application of criteria Meets timeliness standards for decision, notification, and prior authorization activities Serves as an advocate for all providers and their patients Demonstrates a positive attitude and respect for self and others and responds in a courteous manner to all customers, internal and external Maintains the confidentiality of all company procedures, results, and information about patients, contracts, and all other proprietary information regarding Optum business Performs other duties as required or requested in a positive and helpful manner to enable the department to achieve its goals

Healthmap Solutions

Remote RN Case Manager (Michigan Licensure Required)

Posted on:

January 22, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Michigan

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

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

Active, unrestricted RN license required Bachelor's degree required CCM preferred Three (3) years of experience in case management preferred Experience in a dialysis center or transplant center preferred Experience with Medicare and Medicaid preferred Skills: Advocate and energize a culture of collaboration, positivity, and motivation Strategic thinking and planning Deliver effective communication – verbal and written Succeed in a challenging environment with changing priorities

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

Healthmap Solutions

RN Care Navigator - PA (100% Remote)

Posted on:

January 22, 2026

Job Type:

Full-Time

Role Type:

Case Management

License:

RN

State License:

Pennsylvania

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

The Registered Nurse, Care Navigator will be responsible for case management specific to kidney health management. The Care Navigator will complete activities for the continuum of care to facilitate and promote high quality, cost-effective outcomes for patients and focus on the whole patient and care delivery coordination. Managing a set caseload of mixed acuity members, reviewing and/or obtaining member data and entry in HealthMap’s Care Management documentation system (Compass), completing member health and social determinants of health screenings, medication reconciliation, creation and maintaining member-centric care plans, updates of identified problems, barriers, interventions, and goals and assistance with ongoing case management. The Care Navigator will collaborate with internal and external (physicians, nurses, and other healthcare personnel) to assure positive patient outcomes and care coordination. Location We are hiring candidates located in Pennsylvania. This position is 100% remote for Pennsylvania residents.

Active, unrestricted RN license required Bachelor's degree required CCM preferred Three (3) years of experience in case management preferred Experience in a dialysis center or transplant center preferred Experience with Medicare and Medicaid preferred Skills: Advocate and energize a culture of collaboration, positivity, and motivation Strategic thinking and planning Deliver effective communication – verbal and written Succeed in a challenging environment with changing priorities

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

Healthmap Solutions

RN Quality Assurance Reviewer - Bilingual (100% Remote)

Posted on:

January 22, 2026

Job Type:

Full-Time

Role Type:

Care Management

License:

RN

State License:

Florida

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

The Registered Nurse, Quality Assurance Reviewer will work in conjunction with the Quality Manager and will be responsible for completing quality reviews for the Clinical Services and Provider Relations teams and reporting results. The role supports Quality Improvement Programs related to delegation, accreditation, and regulatory standards. The role will collaborate with Clinical Services, Provider Relations, and Clinical Training teams to improve the quality of the Kidney Health Management program and other clinical programs.

Must be bilingual English/Spanish RN or LPN licensure and a Bachelor’s degree required (8+ years of clinical quality improvement experience will be considered in lieu of degree and/or RN/LPN licensure) Three (3) years of healthcare experience in a care management or quality management setting required Experience working in electronic medical records, generating reports and analyzing data required Knowledge of regulatory, CMS and accreditation agencies (NCQA and/or URAC) strongly preferred Knowledge of Care Management and Managed Care setting strongly preferred Experience monitoring calls of a clinical staff preferred Skills: Effective verbal and written communication Advocate and energize a culture of collaboration, positivity, and motivation Performance metrics driven Ability to manage multiple concurrent deadlines Strong organizational skills and attention to detail Must be proficient in Microsoft Office: Outlook, Word, Excel, PowerPoint

Audit clinical documentation and audit calls to provide feedback ensuring that delegation requirements related to NCQA, URAC, and client are met Ensure files comply with federal, state, local CMS accreditation standards Support clinical operations in pre-delegation, delegation, and accreditation reviews Provide support to clinical operations in auditing clinical documentation and member facing calls as part of clinical excellence review initiatives Maintain all required quality, organization, and project documentation Prepare and audit files based on regulatory, accreditation, and client requirements in a timely manner to provide key stakeholders an opportunity to correct deficiencies before external audits Prepare and deliver weekly reporting statistics of audit activities and outcomes Assist with health plan interface and participate in prep for external audits of clinical program Be a subject matter expert who is able to provide innovative solutions to problems and assist quality improvement initiatives Navigate technical applications – Excel, Outlook, PowerPoint, and Word Participate in the quality testing of platform and products enhancements of our electronic medical records system Other duties as assigned

CVS Health

Utilization Management Nurse Consultant - Medical Review (Remote)

Posted on:

January 22, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

American Health Holding, Inc. (AHH), a division of Aetna/CVS Health, is a URAC-accredited medical management organization founded in 1993. We provide flexible, cost-effective care management solutions that promote high-quality healthcare for members.

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time. Position Information Schedule: Monday–Friday 8:00am-5:00pm EST Location: 100% Remote (U.S. only) Join a team that’s making a difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, you’ll play a vital role in ensuring members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote position offers the opportunity to apply your clinical expertise in a fast-paced, desk-based environment where precision, communication, and compassion intersect.

Required Qualifications: Active, unrestricted RN license in your state of residence with multistate/compact licensure privileges. Ability to obtain licensure in non-compact states as needed. Minimum 3 years of clinical experience. 5 years demonstrated to make thorough independent decisions using clinical judgement. 5 Years proficient use of equipment experience including phone, computer, etc. and clinical documentation systems. 1+ Year of Utilization Review Management and/or Medical Management experience. Commitment to attend a mandatory 3-week training (Monday–Friday, 8:30am–5:00pm EST) with 100% participation. Preferred Qualifications: Experience with interpreting Plan Language, Policies, and Benefits to determine medical necessity. MCG Milliman, CPB or other criteria guideline application experience is preferred. Education Associate's degree in nursing (RN) required, BSN preferred.

Utilizes clinical experience and skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. Applies the appropriate clinical criteria/guideline and plan language or policy specifics to render a medical determination to the client. Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines. Med Review nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. Assists management with training new nurse reviewers/business partners or vendors to include initial and ongoing mentoring and feedback. Actively cross-trains to perform reviews of multiple case types to provide a flexible workforce to meet client needs. Recommends, tests, and implements process improvements, new audit concepts, technology improvements, etc. that enhance production, quality, and client satisfaction. Must be able to work independently without personal distractions to meet quality and metric expectations. Remote Work Expectations This is a 100% remote role; candidates must have a dedicated workspace free of interruptions. Dependents must have separate care arrangements during work hours, as continuous care responsibilities during shift times are not permitted.

PsynergyHealth

Virtual Registered Nurse

Posted on:

January 22, 2026

Job Type:

Part-Time

Role Type:

Telehealth

License:

RN

State License:

Missouri

At PsynergyHealth, we are transforming the future of healthcare staffing through technology-driven solutions. Our innovative approaches span nearly every aspect of the healthcare continuum, ensuring seamless staffing support where it’s needed most. By leveraging burst-capacity services and tailored staffing solutions, PsynergyHealth is redefining how healthcare organizations manage and optimize their workforce. Our goal is to "Right-Size" workforces, enhance clinical outcomes, and drive operational efficiencies.

This is a part-time, fully remote role for a Registered Nurse. The Registered Nurse will provide comprehensive and compassionate patient care, and manage the admissions and discharges at our partner health systems. Daily tasks will include ONLY admitting and discharging patients in an acute setting.

Proficient in Patient Care, Medication Administration/Management, and Health Assessments Strong skills in Patient Monitoring, Care Planning, and Collaboration with Healthcare Teams Effective communication skills and ability to educate patients and their families Ability to work independently and as part of a team Current Registered Nurse (RN) license in the state of Missouri Experience in an inpatient hospital setting is required Experience in a virtual setting is preferred A degree in Nursing (BSN) or equivalent qualification to provide clinical services within a hospital Authorized to work in the United States Yes

Healthcare Quality Strategies, Inc. (HQSI)

Nurse Reviewer - Reading, PA

Posted on:

January 22, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Pennsylvania

Healthcare Quality Strategies, Inc. (HQSI) offers independent medical review services for private and government insurers, hospitals, third-party administrators, and employers. As a URAC-certified organization and a member of NAIRO, HQSI performs reviews across all major medical specialties while upholding the highest ethical and professional standards. HQSI efficiently and accurately conducts reviews in the following areas: • Medical necessity • Appropriateness of setting • Level of care • Quality of care • Experimental treatments/procedures • Coding • DRG assignment With over 25 years of experience in health quality improvement, HQSI collaborates with providers, communities, and government agencies, including the Centers for Medicare & Medicaid Services, to enhance the safety, efficiency, and effectiveness of healthcare.

PT (20-30 hours week) – Remote Work Environment Non-Exempt: $40.00 hour Supports Medical Review Services. The Nurse Reviewer plays a critical role in supporting the Medical Review Services department by performing comprehensive medical necessity reviews and policy reviews for Medicaid claims. This involves meticulous examination of claims and medical records to ensure compliance with established guidelines and regulations. The RN will work closely with the Team Lead, Physician Peer Reviewer and contract team. Reviews must be completed timely.

Knowledge, Experience, Skills and Education: Medical terminology, ICD-10, CPT and HCPCS Clinical criteria (InterQual and MCG) Utilization/Medical record review and chart abstraction Current standards of medical practice Comply with HIPAA/HITECH laws and regulations Experience in: At least three- five years performing medical record review and/or abstraction (Utilization Review experience preferred) Experience performing medical record review, audit for federal or state contracts Knowledge and experience of Medicare and Medicaid policy Proficiency with Microsoft Office (Word, Excel, and Outlook) Proficiency with Adobe PDF files and features Generating accurate, timely, and understandable correspondence Current experience (within the last 3 years) in the application of clinical screening criteria (InterQual and MCG) Skills Requirements include: Professional interpersonal skills; ability to interact with providers, physicians and peers Solid analytical, assessment and documentation skills Effective written and verbal communication, both internally and externally Strong attention to detail Strong attention to deadlines Organizational skills including effective time management, priority setting and process improvement Ability to work independently and as a member of a team Adapt to changing work situations and readily adjusts schedules, tasks and priorities when necessary to meet business fluctuations Educational Background: BSN with active RN licensure in good standing Physical Demands: Remote Work, Prolonged Sitting, Screen Exposure

Conduct comprehensive medical record reviews to assess medical necessity and compliance with established standards of care and applicable policies Manage end-to-end case screening processes, ensuring all activities are completed within established deadlines Document evidence-based criteria applicable to specific contract requirements Record and report screening results, including relevant referral questions, into a centralized database Evaluate medical claims against industry standards, utilizing research of relevant ICD-10, CPT, and HCPCS codes to determine medical necessity Maintain expert knowledge of evolving multi-state Medicaid policies and vendor expectations Participate in ongoing training and consistently meet or exceed productivity and quality assurance standards

Heartbeat Health

Virtual Cardiology Nurse Practitioner- Overnight On-Call Shifts

Posted on:

January 22, 2026

Job Type:

Contract

Role Type:

Telehealth

License:

RN

State License:

Compact / Multi-State

Heartbeat Health is a venture-backed health tech startup revolutionizing the delivery of cardiovascular care. Our vision is a world where cardiac conditions are detected early, care coordination is friction-free, and at-risk individuals are empowered to live long, heart-healthy lives. Powered by a connected ecosystem of heart health providers, Heartbeat delivers a range of clinical services, including same-day diagnostic reads, televisits, and virtual care programs for patients with atrial fibrillation, vascular disease, and heart failure. We have been featured on TechCrunch, CNBC, Fast Company, and Forbes – and listed on CB Insights Top 150 Digital Health Startups, New York Digital Health Top 100 Startups, and BuiltIn’s 2023 Best Places to Work.

We are seeking an experienced Cardiology Nurse Practitioner for overnight, on-call shifts contract to provide specialized telehealth support for patients with cardiovascular conditions. This role focuses on patient assessment, disease management, care coordination, and documentation within a remote clinical environment. The contract clinician will collaborate closely with cardiologists, primary care providers, and the broader healthcare team to ensure high-quality patient care and continuity during the assignment period. We are looking for applicants with availability to work at least 2 night shifts per week, Sunday through Thursday with the hours of 7 pm to 7 am ET. Each shift will be compensated at a rate of $500 per shift. Applicants must have an active NP license in both Georgia and Florida.

Master of Science in Nursing (MSN) with a specialization in cardiology or a related field. Current, unrestricted RN license (multi-state/compact preferred). NP certification in cardiology or relevant specialty (e.g., Adult-Gerontology Acute Care NP or Family NP with cardiology focus) from ANCC or AANPCB. An active NP license in both Florida and Georgia Minimum 3 years of experience as a nurse practitioner in an outpatient cardiology or telehealth setting. ACLS certification highly recommended. Strong communication and collaboration skills for effective patient education and multidisciplinary teamwork. Ability to make informed clinical decisions and adjust treatment plans during the short-term assignment. Attention to detail in patient assessments, documentation, and treatment planning. Familiarity with electronic health record (EHR) systems and telehealth technologies. Commitment to maintaining relevant certifications and licensure during the contract.

Overnight Clinical Coverage: Answer 100% of incoming calls from patients seeking overnight support Patient Assessment (Telehealth): Conduct virtual assessments, including medical history reviews, symptom assessment, and visual examinations to evaluate cardiovascular health. Diagnosis & Treatment Planning: Formulate differential diagnoses and develop focused treatment plans to reduce uneccesary ED visits and hospitalizations. Patient Education: Educate patients on treatment plans and folow up actions required, including follow up with primary cardiology careCare Collaboration: Coordinate with cardiologists, primary care providers, and other healthcare professionals to ensure continuity of care. Documentation: Maintain accurate, timely patient records and treatment notes in compliance with legal, ethical, and organizational standards. Knowledge Transfer: Ensure smooth handoff of patient care information and documentation to permanent staff prior to the conclusion of the contract.

Humana

SNF Utilization Management RN - Compact Rqd

Posted on:

January 21, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers, and our company. Through our Humana insurance services, and our CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action.

Required Qualifications: ​Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action. MUST have Compact License Greater than one year of clinical experience in a RN role in acute care setting with preference for specialty areas such as critical care, emergency room, trauma units, etc. Comprehensive knowledge of Microsoft Word, Outlook and Excel Ability to work independently under general instructions and with a team Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications: Education: BSN or Bachelor's degree in a related field Three or more years of clinical experience in an acute care setting with preference for specialty areas such as critical care, emergency room, trauma units, etc. Experience as an MDS Coordinator or discharge planner in an acute care setting Previous experience in utilization management/utilization review for a health plan or acute care setting Compact license PLUS a single state RN Licensure in any of the following non-compact states: California, Hawaii, Nevada, Oregon Health Plan experience Previous Medicare/Medicaid Experience a plus Call center or triage experience Bilingual is a plus Additional Information Scheduled Weekly Hours: 40 Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Work-At-Home Requirements Must have the ability to provide a high-speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance is 25mbs download x 10mbs upload is required. Check your internet speed at www.speedtest.net A dedicated office space lacking ongoing interruptions so you can meet productivity requirements, and to protect member PHI / HIPAA information. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent critical thinking skills towards interpreting criteria, policies, and procedures to provide the best and most appropriate treatment, care or services for members. Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to related areas. Makes decisions regarding own work methods, occasionally in ambiguous situations, and requires minimal direction and receives guidance where needed. Follows established guidelines/procedures.

Crossing Hurdles

Clinical Nurse Specialist | Remote

Posted on:

January 21, 2026

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Position: Registered Nurse Type: Hourly contract Compensation: $60–$100/hour Location: Remote Commitment: 10–40 hours/week

Registered Nurse with strong full-time clinical work experience. Strong understanding of real-world nursing workflows and responsibilities. Excellent written communication skills with strong attention to detail. Ability to translate clinical expertise into clear, structured documentation. Access to a desktop or laptop computer (Chromebooks not supported). Comfortable working independently in a fully remote, project-based environment.

Design high-quality, occupation-specific questions based on real-world registered nursing workflows. Apply professional clinical experience to support AI research and evaluation initiatives. Create structured nursing scenarios and prompts that reflect practical healthcare decision-making. Review and refine content to improve accuracy, clarity, and domain relevance. Work independently and asynchronously while meeting project deliverables.

Medix™

Clinical Review RN - 249062

Posted on:

January 21, 2026

Job Type:

Contract

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

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

Job Title: Clinical Review RN (Independent Dispute Resolution/Appeals) Experience: Open to various clinical backgrounds/experience. Appeals experience not required. Must have 2+ years of clinical experience post clinicals. Must has strong computer skills, critical thinking and problem solving skills. ***Must have BSN and New York State RN license*** Location: Remote for the first 3-4 months and then will be asked to work full time onsite in Jericho or Albany, NY once there is enough office space ***free shuttle from the Jericho LIRR station to the office + parking onsite Hours of Operation: M-F between operating hours of 7a-5:30p *flexible start between 7am-9am (40hrs/wk) Start date: ASAP Pay: $50-53/hr DOE Volume: Will do appeals work under the IDR team handling on average 10 cases a day. These will be a mix between simple and complex cases. They will be reviewing documentation, codes, and more for out of Network bills and cost and making determinations on how to move forward based on the evidence. This individual will complete the full spectrum of activities related to State and Federal Independent Dispute Resolution (IDR) case determinations. They will conduct clinical level review, Prior Authorization, and disputed benefits review, supporting Medical Review Analysts, and Physician Consultants to ensure an appropriate and accurate process.

Knowledge and experience with electronic medical records. Ability to oversee, problem solve, and work collaboratively with peers, medical, analytical, and administrative support staff. Excellent written and verbal skills. Ability to work independently with little supervision. Ability and desire to be flexible, innovative, and creative. EDUCATION AND EXPERIENCE: Licensed, Registered Nurse, required in New York Baccalaureate degree in Nursing Minimum of two years’ experience in a clinical setting, required.

Conduct reviews up to and including the appeal level. This includes chart screen, compiling regulatory guidance, researching insurer requirements, complete electronic worksheets and preparing final determinations. Act as a resource for the administrative and clinical staff in training, problem solving, and clarifying determinations. Will provide technical assistance and conduct/participate in staff huddles. Training and mentoring new RNs as the project expands. Claims assessment and adjudication. Participate in collaborative training. Other activities as may be deemed necessary.

Medix™

Utilization Review Nurse - 249106

Posted on:

January 21, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

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

Our client is seeking a Utilization Review Nurse to perform frequent case reviews, check medical records, and communicate with care providers regarding treatment as needed. The nurse will make recommendations regarding the appropriateness of care for identified diagnoses based on the research results for those conditions.

Active, unrestricted RN licensure from the United States in the respective state or active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC). Associate Degree or Bachelors Degree in Nursing or a graduate of an accredited school of nursing. Experience with MCG or InterQual tools. Ability to obtain additional state licenses to meet business needs. Experience 1+ year of utilization review experience in a managed care setting. 1+ years of clinical experience including at least 1 year of clinical practice in an acute care setting such as ER or hospital. Skills Proficiency with MCG or InterQual tools. Strong communication skills. Ability to work both independently and as part of a team. Additional Requirements Ability to work a flexible schedule, including 4 x 10s as an option, 8-5 this timezone for 5 days a week, including 1 weekend day (either Saturday or Sunday). Training schedule: M-F 8:30-5pm, usually lasting 6-8 weeks.

Perform frequent case reviews. Check medical records. Communicate with care providers regarding treatment as needed. Make informed recommendations on care appropriateness based on research results.

You Health Medical Groups

Nurse Practitioner - Women's Health/Menopause - Telehealth/1099/Remote

Posted on:

January 21, 2026

Job Type:

Contract

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

You Health Medical Groups employs telehealth practitioners serving patients on the Hims & Hers platform. The Hims & Hers Telemedicine Team handles the business operations, allowing practitioners to concentrate on delivering top-notch patient care.

[While we're not actively hiring at the moment, we encourage candidates to apply as we maintain a talent pool for future consideration.] We’re looking for a talented, high-performing, and passionate Board-Certified Nurse Practitioner to join the growing network of telehealth providers through You Health Medical Groups. In this 1099 Independent Contractor role, you will provide care to patients seeking treatment for a range of women’s health concerns, with a specific focus on perimenopause and menopause care. This role centers on supporting female patients navigating hormone-related changes, so providers should have experience and a strong interest in women’s health. Hims & Hers Health, Inc. (better known as Hims & Hers) is the leading health and wellness platform on a mission to help the world feel great through the power of better health. We are revolutionizing telehealth for providers and their patients alike. Making personalized solutions accessible is of paramount importance to Hims & Hers, and we are focused on continued innovation in this space. Hims & Hers offers nonprescription products and access to highly personalized prescription solutions for a variety of conditions related to weight loss, mental health, sexual health, hair care, and more. To learn more about the Hims and Hers platform, you can visit forhims.com and forhers.com. Telehealth providers serving patients on the Hims & Hers platform are employed by You Health Medical Groups. Hims & Hers provides administrative support to You Health providers, allowing providers to concentrate on delivering top-notch patient care. Providers must reside in the continental US to access the Hims & Hers platform.

Board-Certified Nurse Practitioner (FNP, A-GNP, AG-ACNP, WHNP, etc.) Board Certification in one or more of the following specialties: Family, Women’s Health Passion and experience in Women’s Health 2+ years of applicable experience in clinical practice, exclusive of orientation/training 1+ years of previous telehealth experience Must be able to commit a minimum of 10 hours per month Strong diagnostic skills, excellent communication abilities, and proficiency in electronic medical records (EMR) systems No current or pending malpractice lawsuits, active state license in good standing Skilled at using online tools and technology to deliver care and communicate with patients Caring, detail-oriented, and dedicated to providing high-quality patient care Excellent written and verbal communication with an emphasis on clarity and compassion 5+ full practice authority state medical licenses

Deliver high-quality asynchronous care by assessing, screening, diagnosing, prescribing, and titrating medication for patients as necessary Uphold unparalleled clinical patient care through the delivery of prompt and empathetic care on the platform. Adhere to Hims and Hers platform guidelines and policies and complete all required training. Provide clinical care for a variety of conditions

You Health Medical Groups

Nurse Practitioner - Weight Loss - Telemedicine/1099/Remote

Posted on:

January 21, 2026

Job Type:

Contract

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

You Health Medical Groups employs telehealth practitioners serving patients on the Hims & Hers platform. The Hims & Hers Telemedicine Team handles the business operations, allowing practitioners to concentrate on delivering top-notch patient care.

Telehealth providers serving patients on the Hims & Hers platform are employed by You Health Medical Groups. The Hims & Hers Telemedicine team handles the business operations, allowing you to concentrate on delivering top-notch patient care. Providers must reside in the continental US to access the Hims & Hers platform.

Masters of Science in Nursing (You Health is not currently hiring Physician Assistants) Board certification: Family (preferred), Adult-Gerontology 1+ years of applicable experience in clinical practice, exclusive of orientation/training 5+ active medical state licenses in good standing is a strong plus Have Independent Prescriptive Authority (in states where available)​​ Willingness to work more than 10+ hours per week is a strong plus Strong diagnostic skills, excellent communication abilities, and proficiency in electronic medical records (EMR) systems Comfortable providing care asynchronously. Skilled at using online tools and technology to deliver care and communicate with patients Caring, detail-oriented, and dedicated to providing high-quality patient care. Excellent written and verbal communication with an emphasis on clarity and compassion

Deliver high quality, asynchronous care by assessing, screening, diagnosing, prescribing, and titrating medication for patients as necessary Uphold unparalleled clinical customer service through the delivery of prompt and empathetic care on the platform Provide clinical care for weight loss Adhere to Hims and Hers platform guidelines and policies and complete all required training

You Health Medical Groups

Nurse Practitioner - Sexual Health/Hair Health/Weight Loss - Telemedicine/1099/Remote

Posted on:

January 21, 2026

Job Type:

Contract

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

You Health Medical Groups employs telehealth practitioners serving patients on the Hims & Hers platform. The Hims & Hers Telemedicine Team handles the business operations, allowing practitioners to concentrate on delivering top-notch patient care.

Telehealth providers serving patients on the Hims & Hers platform are employed by You Health Medical Groups. The Hims & Hers Telemedicine team handles the business operations, allowing you to concentrate on delivering top-notch patient care. Providers must reside in the continental US to access the Hims & Hers platform.

Masters of Science in Nursing (You Health is not currently hiring Physician Assistants) Board certification: Family (preferred), Adult-Gerontology 1+ years of applicable experience in clinical practice, exclusive of orientation/training 2+ active medical state licenses in good standing is a strong plus Have Independent Prescriptive Authority (in states where available)​​ Willingness to work more than 10+ hours per week is a strong plus Strong diagnostic skills, excellent communication abilities, and proficiency in electronic medical records (EMR) systems Comfortable providing care asynchronously. Skilled at using online tools and technology to deliver care and communicate with patients Caring, detail-oriented, and dedicated to providing high-quality patient care. Excellent written and verbal communication with an emphasis on clarity and compassion

Deliver high quality, asynchronous care by assessing, screening, diagnosing, prescribing, and titrating medication for patients as necessary Uphold unparalleled clinical customer service through the delivery of prompt and empathetic care on the platform Provide clinical care for a variety of conditions, including sexual health, hair loss, and weight loss (depending on your specialty and experience) Adhere to Hims and Hers platform guidelines and policies and complete all required training

You Health Medical Groups

Clinical Escalations Provider - NP (Part Time)

Posted on:

January 21, 2026

Job Type:

Part-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

You Health Medical Groups employs telehealth practitioners serving patients on the Hims & Hers platform. The Hims & Hers Telemedicine Team handles the business operations, allowing practitioners to concentrate on delivering top-notch patient care.

You Health Medical Groups is seeking a Clinical Escalations Provider to provide health care services to patients via the Hims and Hers telehealth platform. The Clinical Escalations Provider is responsible for managing high-acuity and escalated patient cases, particularly those involving business disruptions or complex clinical needs. This role provides counseling and clinical support to patients utilizing diagnostic or other healthcare services that require follow-up care. The Clinical Escalations Provider will be primarily responsible for managing patient escalations, providing counseling to patients utilizing our diagnostic or other services that require follow-up. Through proactive communication and compassionate care, the Clinical Escalations Provider ensures that every patient receives exceptional support and continuity of care, even in challenging or urgent circumstances. This role reports to the You Health Associate Director of Clinical Safety and participates as an active team member focused on clinical quality, patient experience, and performance improvement. Current You Health 1099 Independent Contractors cannot work concurrently as a W2 provider and would need to terminate 1099 IC contracts.

Board Certified Nurse Practitioner (Family, Adult Gerontology, Acute Care, Women's Health) 1+ years of previous telehealth experience 3+ years of experience in clinical practice, exclusive of orientation/training Extremely strong clinical judgment and the ability to respond rapidly in escalated scenarios, and provide empathetic patient care along the way. Excellent written and verbal communication with an emphasis on clarity and compassion. Skilled at using online tools and technology to deliver care and communicate with patients. Resilient and flexible with the ability to thrive and adapt in a fast-paced, high-growth, and rapidly changing environment. Multiple state licenses (Minimum of 20 licenses, 40+ a strong plus).

Deliver high-quality clinical care for a range of patient-reported concerns and side effects Manage patient escalations and ensure appropriate responses and follow-up, including results from diagnostics that require timely and sensitive follow-up. These interactions will be mostly synchronous. Comply with safety legislation and healthcare industry practices Provide after-hours and weekend support for urgent patient escalations on a rotating on-call basis Serve as a specialist/subject matter expert for treatment services offered on the platform, providing clinical expertise, guidance, and support to both patients and internal teams Conduct ongoing patient care duties, special projects as needed, and additional duties as assigned by their manager and/or clinical leadership. Adhere to the Hims and Hers platform guidelines and policies, and complete all required training Maintain competence through Continuing Medical Education/Continuing Education Maintain applicable Board Certification

Vivo Care Inc

Care Navigator- Licensed Nurse - Remote - EST Time Zone - New York AND Compact License Required

Posted on:

January 21, 2026

Job Type:

Full-Time

Role Type:

Behavioral Health

License:

RN

State License:

Compact / Multi-State

At Vivo Care, we believe the best care doesn’t end at the clinic, it lives in the moments between visits. That’s why we’re building something bigger than software. We’re creating a future where care is continuous, personal, and truly connected. If you’re driven to make a difference, we want you on our team. We’re not here to make care a little better, we’re here to rethink it entirely. From our platform to our partnerships, we challenge the status quo and design for what patients and providers really need. Every team, every role, every idea is part of building something new. While healthcare is complex, we don’t shy away from tough problems. We stay focused, move fast, and push through barriers with creativity, grit, and a commitment to doing what’s right, even when it’s not easy. We care deeply about our work, our mission, and each other. Our team brings heart to everything we do, showing up every day to improve lives, strengthen relationships, and make care feel like care again.

As a care navigator, you love building relationships with patients based on trust, utilizing motivational communication techniques , to help drive positive health behavior change and improved patient outcomes. This program is based around triaging vital signs and using this data to promote positive lifestyle and health behavior changes. This is accomplished through collaboration with the patients care team to provide wellness calls with patients to outline patient-centric goals and the development of associated action plans to improve their health and well-being. Our ideal candidate has clinical background working with the adult and geriatric patient population ideally with experience in phone triage. Has a strong working knowledge of remote-patient monitoring (RPM) preferred and/or Chronic Care Management (CCM), Behavioral Health, Care Coordination or Utilization Management principles. Experienced in remote working technologies, being a strong team player and a desire to clinically and emotionally support our patients while keeping a keen eye on reimbursement requirements are valued in this role. Being a Care Team Member at Vivo Care provides the chance to serve patients by proactively monitoring vital signs, educating, and coaching patients on a plan for better health. Early intervention through RPM, reduces risk for emergent care and/or hospital admission/re-admissions. Encounters with patients will be performed via phone through a Remote Care Platform that receives electronically transmitted physiological markers like blood pressure/weight/blood glucose . The care team member will perform monitoring as well as synchronous and asynchronous communication with the patient within Vivo Care’s industry-leading platform.

Unrestricted RN/LPN/LVN license in a compact state and New York Ability to work EST zone between 8:00a - 5:00pm Spanish speaking a plus 1-3 years of clinical experience, patient management, or disease management desired Experience working with different provider practices and workflows Fast learners Ability to work independently with minimal direction Experience with Medicare patients Experience performing virtual visits with patients and telephonic care management Interest in professional leadership growth and development opportunities with a growing organization Interest in operating in a new, exciting clinical program and become an integral player in the development of processes and best practices in caring for RPM patients Motivational Interviewing/Health Behavior Change experience a plus Health Coach certification a plus. Our benefits: Weekends, Holidays and evenings/nights off We’re a fast-growing startup where everyone has a voice, and every team member is encouraged to help share our organization’s future We are passionate about our mission to modernize and improve the future of healthcare. We foster a culture of inclusion, collaboration and innovation We foster team alignment with meetings of all shapes and sizes—a monthly all-hands meeting, weekly team meetings, happy hours etc We cover 100% of the employee premium for health, dental and vision We contribute up to $3,000 towards an HSA account for each employee Generous PTO, Company Holidays and Paid Sick Time. Hourly Rate: $22 - $25, commensurate with experience and qualifications

Manage physiological markers like blood pressure/weight/blood glucose with clinical appropriateness Meet team goals and standards outlined metrics Significantly impact longitudinal patient engagement in RPM program(s) Provide preventive health and disease management education and coaching Perform monthly wellness calls with assigned patients Lead collaborative wellness calls with the patients to define health goals outlined by their Care Team Manage patient messaging and alerts Direct patients to treating physician for routine questions Meet patient engagement program goals Follow appropriate escalation pathways for any urgent care needs

UASI

Clinical Denials Specialist

Posted on:

January 21, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Ohio

Since 1984, UASI has been one of the largest independent healthcare revenue cycle consulting firms in the United States. We are a nationally recognized leader in Health Information Management, delivering solutions that support optimization and strategic alignment across the mid-revenue cycle. UASI partners with healthcare organizations to strengthen financial, clinical, and operational performance through flexible problem solving and proven expertise. Our services are designed to help clients achieve accuracy, compliance, and efficiency while aligning documentation, coding, and revenue integrity efforts with organizational goals. UASI is a trusted partner to more than 1,100 hospital facilities and physician groups nationwide, supported by 540 nationally credentialed experts, including CCS, CCDS, CDIP, RHIA, and RN professionals. Our teams consistently deliver results, achieving 96%+ coding accuracy based on third-party audits, and earning recognition as Best in KLAS. We offer comprehensive services and employment opportunities across Remote Coding, Coding Compliance Review, Education and Training, Clinical Documentation Improvement, HIM and Coding Interim Management, and Revenue Integrity. Our work supports mid-revenue cycle optimization by identifying opportunities, reducing risk, and delivering actionable insight that drives sustainable performance. Our client base includes top-ranked hospitals recognized for academic excellence, research, quality, and patient care. Through this diverse client portfolio, remote employment opportunities, and multiple service lines, we engineer individualized career paths and promote balance for every employee. As regulatory complexity and coding demands continue to increase, UASI remains grounded in the core values on which the company was founded, providing strategic, practical solutions that help healthcare organizations produce low-cost, high-quality records with confidence.

United Audit Systems, Inc. (UASI), a rapidly growing healthcare consulting firm seeks to expand its professional team of employees by adding experienced Clinical Appeals Review Nurse to our team. The Clinical Appeals Review Nurse is responsible for completing clinical denial reviews to determine appropriate appeal of patient accounts. The ideal candidate will have a combination of clinical experience in a hospital acute care setting and experience providing reviews of the hospital billing and charging policies.

RN Certification CCDS or CDIS Certification preferred Experience with DRG Denials Epic experience preferred InterQual and Medical Necessity experience Ability to read and comprehend itemized billing statement, patient medical record and other laboratory reports Ability to analyze medical information and determine appropriate billing procedures Ability to effectively communicate with others Analytical thinking process

Completes clinical review of pre- and post-claim denials DRG Denials Perform a variety of audit services including charge audit, compliance audit, medical necessity, denials and other requests as needed. Audits may be performed on a concurrent or retrospective basis Review and analyze the client inpatient and/or outpatient itemized billing statement and the patient medical record and related documentation to identify items that were not billed correctly. Document findings on appropriate form and submit findings to client management staff daily so new billing forms can be generated in hospitals billing systems. Adhere to the National Health Care Billing Audit Guidelines, UASI Code of Conduct and Compliance Program, and the client third party audit policy while performing all duties. Attend meetings with members of client-hospital finance, medical records, and ancillary departments. Educate Client-Hospital personnel on validation and documentation of charges if requested by client contract relationship. Navigate hospitals medical record system and understand where to locate the financial information in relation to the patient payor billing information

Imagine360

Medication Benefit Review Nurse – Gene & Cell Therapy

Posted on:

January 21, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

Imagine360 is an integrated health plan addressing one of the greatest challenges on behalf of self-funded employers: healthcare costs are harming the bottom line, they're increasingly unaffordable for employees, and the experience remains poor. We help businesses and their employees navigate through clutter and chaos and bring deep cost savings that protect everyone’s well-being and budgets. It’s way more than a health plan. It’s a promise. We’ve helped hundreds of self-funded clients. Our solutions are ready to be implemented. The results are proven and impactful. Imagine360’s innovative payment model includes preferential contracting with providers and health systems, and additional price protection through reference-based pricing, saving employers 15-30% on average compared to the national carriers. With more than 17 years’ experience, and 25-million-months of member data, Imagine360 offers care coordination and medical management to proactively guide members through the complexities of healthcare. We bring employers a reimagined health plan solution, created to provide the flexibility, service and support employers need to take good care of employees, their families and business. We do this through: Assistance with plan design and expert administration with integrated third-party administration Built-in price protection from the #1 reference-based pricing solution in healthcare Provider contracts with Imagine Health’s top-rated providers and health systems Comprehensive member support throughout their healthcare journey It’s more than a health plan. It’s our promise to deliver a better health plan experience.

Imagine360 is seeking a Medication Benefit Review Nurse – Gene & Cell Therapy to join the team!  The Medication Benefit Review Nurse – Gene & Cell Therapy (CGT) is responsible for conducting comprehensive utilization reviews, clinical benefit determinations in alignment with plan language, and clinical assessments for medications and treatments, specifically high-cost, gene and cell therapies (CGT). This role requires advanced critical thinking, mastery of clinical evidence evaluation, and application of P&T committee guidelines, vendor-supplied criteria, or client-preferred clinical guidelines to ensure consistent, accurate, and compliant determinations. In addition to gene and cell therapy reviews, the nurse also performs standard medication benefit reviews, including coordination of specialty medications and traditional benefit determinations. The nurse collaborates across UM, Claims, Care Navigation, and external partners and practices within the licensed scope to support safe, high-quality review processes. Position Location: 100% remote

Required Education, Licensures/Certifications, and Experience: Education - Nursing degree from an accredited college, university, institution, or nursing school. Licensure - Active, unrestricted registered nursing in an eNLC compact state. Experience - Minimum 1 year Utilization Review/Benefit Review or transferable clinical experience. Preferred Education and Experience: Education - Bachelor's degree in nursing preferred but not required Experience: Preferred experience managing patients with conditions/treatments in oncology, hematology, transplant medicine, infusion therapy, or rare genetic disorders – all age groups Familiarity with: NCCN, MCG, or other specialty framework guidelines FDA-authorized REMS programs P&T committees Experience with specialty medication reviews or high-cost therapy adjudication, such as chemotherapy and specialty medications. Experience working in a URAC-accredited program Experience working within an insurance agency or TPA experience specializing in employee benefits and self-funded medical plans. Skills and Abilities: Ability to work independently in a home office environment. Computer skills which include proficiency in Microsoft Outlook, Word, Excel, and PowerPoint, as well as navigation utilizing the internet. Ability to resolve problems independently and demonstrate ability to multi-task. Strong written, oral, and telephonic communication skills. Strong presentation skills. Strong competency in reviewing complex medical records for advanced therapies and standard medications. Ability to interpret and apply CGT related and standard clinical guidelines. High proficiency in critical analysis, clinical reasoning, and risk identification. Excellent written, verbal, and telephonic communication skills. Ability to work independently in an intensive, fast paced environment with minimal supervision. Strong proficiency using Microsoft Office Suite and UM platforms. Ability to manage sensitive, high complexity cases requiring efficient turnaround times. Strong organizational, prioritization, and multitasking skills. Ability to stay organized and interact well with others in any situation. Ability to collaborate effectively across multidisciplinary teams. Attend and participate in team meetings, trainings, and other job specific events as required. Communicate professionally and effectively with brokers, vendors, Relationship Managers, HR representatives, and stop‑loss partners (in compliance with HIPAA). Adhere to internal regulations regarding Department of Labor, HIPAA, ERISA, and all department/company policies and procedures. Complete HIPAA and URAC training annually. Perform all tasks in accordance with HIPAA/PHI guidelines. Appropriately escalate difficult issues. Complete duties in accordance with scope of licensure and certifications held or requested. Perform other duties and projects as assigned License and Certifications: An active, current, unrestricted Licensed Nurse in eNLC compact state. Must maintain CEUs as required by applicable State Board(s) of Nursing and required certifications. Must be willing to obtain and maintain additional licenses as required to perform the job functions of the organization. CGT-specific training highly encouraged

Medication and Treatment Review Functions (CGT and Standard): Identify, collect, process, and manage data to complete reviews for medical necessity per Medical Management approved clinical guidelines. Perform medical necessity reviews for gene and cell therapies using evidence based guidelines, FDA labeling, clinical trial data, and national standards (e.g., NCCN) Conduct standard medication benefit reviews of medical necessity, including: Traditional clinical benefit determinations including but not limited to medical necessity and experimental/investigational evaluations in alignment with plan language. Specialty medication coordination Application of standard, evidence-based clinical guidelines for non-CGT treatments and therapies Review of precertification/retrospective requests for medical necessity. Evaluate clinical records for all medication types (CGT and non‑CGT): prior therapies, comorbidities, treatment plans, dosing, and safety considerations. Identify discrepancies, contraindications, or missing documentation and request supplemental information. Provide clinical assessments for all high cost or complex medication cases. Program Coordination (CGT and Standard): Complete eligibility assessments, medical necessity reviews, and coordination steps for all medication review types. Collaborate with Care Navigation and internal teams to support scheduling needs, documentation requirements, and clarification of treatment plans. Serve as a clinical resource for medication review questions across internal and external stakeholders. Regulatory and Quality Compliance: Ensure compliance with URAC, ERISA, state specific regulations, and organizational guidelines across all review categories. Participate in quality review activities to ensure consistency and accuracy in clinical decision-making. Accurately document all reviews in UM systems, including required time slips, and maintain strict HIPAA/PHI adherence. Collaboration and Escalation: Consult with Team Leads, Supervisors, Physician Advisors, and Independent Review Organizations (IROs) for complex cases. Participate in peer-to-peer/provider discussions when required. Support appeals process with detailed clinical review and documentation. Operational Excellence: Contribute to process improvement initiatives for both CGT and standard medication review workflows. Participate in pilot programs, training, and cross functional initiatives. Maintain awareness of emerging therapies, evolving guidelines, and changes to clinical review standards. Scope of Practice – Specialized CGT Components: The Licensed Nurse participates in elevated CGT specific clinical assessment, including: Applying therapy specific eligibility criteria (e.g., prior therapies, clinical severity indicators, transplant candidacy). Ensuring patient safety considerations are addressed (e.g., bridging therapy, apheresis,, readiness, preconditioning requirements). Interpreting high complexity laboratory and clinical findings relevant to CGT. Overview Areas of Responsibility - Scope of Practice: In addition to performing standard duties, the Licensed Nurse is involved in clinical decision-making. The scope of practice includes, but is not limited to: Evaluating clinical data Assessment and evaluation of the acquired clinical data to assess appropriateness of treatment based on Imagine360 clinical guidelines. Respect the client's right to privacy by protecting confidential information. Promote and participate in education and counseling to a participant based on health needs. Clarify any treatment that is believed to be inaccurate, non-efficacious, or contraindicated by consulting with an appropriate practitioner.

Machinify

Medical Review Nurse II - Home Health

Posted on:

January 21, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

California

In October 2025, Machinify acquired Performant and we are now part of the Machinify organization. Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plans. Deployed by over 75 health plans, including many of the top 20, and representing more than 170 million lives, Machinify’s AI operating system, combined with proven expertise, untangles healthcare data to deliver industry-leading speed, quality, and accuracy. We’re reshaping healthcare payment through seamless intelligence.

Hiring Range:$75,000 - $80,000 The Medical Review Nurse II - 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.

Humana

Utilization Management Appeals Nurse

Posted on:

January 21, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Kentucky

Humana will never ask, nor require a candidate to provide money for work equipment and network access during the application process. If you become aware of any instances where you as a candidate are asked to provide information and do not believe it is a legitimate request from Humana or affiliate, please contact yourcareer@humana.com to validate the request At Humana, our cultural foundation is aligned to helping members achieve their best health by delivering personalized, simplified, whole-person healthcare experiences. Recognizing healthcare needs continue to evolve for each person, for each family and for each community, Humana continuously creates innovative solutions and resources that help people live their healthiest lives on their terms –when and where they need it. Our employees are at the heart of making this happen and that’s why we are dedicated to building an organization of dynamic talent whose experience and passion center on putting the customer first.

The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Humana is seeking a Part C Grievance & Appeals (G&A) Nurse who will assist in preparation of cases prior to review by the Humana G&A Medicare Medical Directors. The Nurse reviews the medical documentation, researching claims, benefits, as well as prior determinations pertinent to the appeal and provides a written summary of findings using a template for each case. The associate will be working and collaborating with Humana CIT teams, Vendors, G&A specialists, and Humana Medical Directors on submitted G&A cases.   The G&A Nurse will participate in initiatives which result in improved member outcomes, operational efficiencies, and process improvement opportunities.

Required Qualifications: Licensed Registered Nurse (RN) in the (appropriate state) with no disciplinary action 3 or more years of clinical experience preferably in an acute care, skilled or rehabilitation clinical setting or broad clinical nursing experience Comprehensive knowledge of Microsoft Word, Outlook and Excel Strong organizational and effective time management skills Ability to work independently under general instructions and with a team Preferred Qualifications: Bachelor’s degree (BSN) Appeal Review Experience Knowledge of MHK Previous Medicare/Medicaid Experience Previous experience in utilization management Previous claims experience Work-At-Home Requirements: To ensure Home or Hybrid Home/Office associates’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: ​ At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested Satellite, cellular and microwave connection can be used only if approved by leadership Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Additional Information: Hours are Monday-Friday 9am-6pm EST with a weekend rotation (Your 8-hour shift will fall within this timeframe) Candidate’s must also commit to working on the holidays as needed This is a remote position, but all candidates must work in the Eastern Standard Time Zone (EST) Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

Case preparation of Medicare and/or Duals line of business involving expedited, pre-service and post service appeals Apply and implement Medicare, Medicaid, MCG, claims policy and evidence of coverage guidelines for reviews Perform outreach to providers and/or members Utilize multiple systems such as MHK, CGX, MRM, SRO

Pinnacle Home Care

Concierge - Registered Nurse RN

Posted on:

January 20, 2026

Job Type:

Full-Time

Role Type:

License:

RN

State License:

Florida

Pinnacle Home Care, the largest independent home health provider in Florida, has proudly served our communities for over two decades. We are a team driven by a passion for home healthcare with an unwavering commitment to the well-being of our patients and their families. At Pinnacle, we foster a forward-thinking, collaborative workplace culture. This has earned us multiple recognitions including the Top Workplaces USA award – a testament to our focus on supporting and empowering our employees. We offer a comprehensive range of services, including skilled nursing, physical therapy, occupational therapy, speech therapy, medical social work, and home health aide support to more than 10,000 patients every day. We strive to help our patients confidently manage their health at home and maintain their dignity, not only now, but long after our services are complete. At Pinnacle, we are proud to make a meaningful difference in the lives of patients and their families every day. Join us in our mission to deliver compassionate healthcare where it matters most – at home.

Are you looking to make a difference in patients’ lives with a company that values your expertise? Join us in our mission of delivering compassionate healthcare where it matters most – at home. Pinnacle Home Care, Florida’s largest Medicare-certified home health provider, has been delivering high-quality, patient-centered care for over two decades, and we’re looking for a Clinician Concierge to join our award-winning team. *Hours: Mon - Fri 12:00 PM - 8:30 PM Eastern

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

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

Trillium Community Health Plan

Care Navigator Pregnancy Postpartum LPN

Posted on:

January 20, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

Oregon

At Trillium Community Health Plan (Trillium), we know all healthcare is local. Our Trillium staff are proud members of the communities we serve and we’re dedicated to transforming the lives of our members through programs and services that focus on prevention, health equity, and access to high-quality care. Trillium serves Oregon Health Plan members through the Coordinated Care Organization (CCO) model, connecting members to a network of healthcare providers for medical, dental, behavioral and mental health services. We also offer Trillium Advantage, a Medicare Advantage plan with prescription drug coverage. Trillium Advantage is available to those who qualify for Medicaid through the state of Oregon and are eligible for Medicare. Our 56,000 members live in Lane, Western Douglas and Western Linn counties, and in Clackamas, Washington and Multnomah counties.

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility. Must be authorized to work in the U.S. without the need for employment-based visa sponsorship now or in the future. Sponsorship and future sponsorship are not available for this opportunity, including employment-based visa types H-1B, L-1, O-1, H-1B1, F-1, J-1, OPT, or CPT. ** Prefer candidates who are currently licensed in the state of Oregon for LPN. Any labor and delivery, pregnancy, postpartum care experience is preferred. Role is fully remote can work from any state as long as they hold preferred Oregon license** Position Purpose: Develops, assesses, and coordinates care management activities based on member needs to provide quality, cost-effective healthcare outcomes. Develops or contributes to the development of a personalized care plan/service plan for members and educates members and their families/caregivers on services and benefit options available to improve health care access and receive appropriate high-quality care through advocacy and care coordination.

Education/Experience: Requires a Bachelor’s degree and 2 – 4 years of related experience. Requirement is Graduate from an Accredited School of Nursing if holding clinical licensure. Or equivalent experience acquired through accomplishments of applicable knowledge, duties, scope and skill reflective of the level of this position. License/Certification: Oregon state’s clinical license (LPN) preferred.

Evaluates the needs of the member, barriers to care, the resources available, and recommends and facilitates the plan for the best outcome Develops or contributes to the development of a personalized care plan/service ongoing care plans/service plans and works to identify providers, specialists, and/or community resources needed for care Provides psychosocial and resource support to members/caregivers, and care managers to access local resources or services such as: employment, education, housing, food, participant direction, independent living, justice, foster care) based on service assessment and plans Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure identified care or services are accessible to members in a timely manner May monitor progress towards care plans/service plans goals and/or member status or change in condition, and collaborates with healthcare providers for care plan/service plan revision or address identified member needs, refer to care management for further evaluation as appropriate Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators May perform on-site visits to assess member’s needs and collaborate with providers or resources, as appropriate May provide education to care manager and/or members and their families/caregivers on procedures, healthcare provider instructions, care options, referrals, and healthcare benefits Other duties or responsibilities as assigned by people leader to meet the member and/or business needs Performs other duties as assigned Complies with all policies and standards

Curology

Nurse Practitioner (NP): Part-time, Weekends Only

Posted on:

January 20, 2026

Job Type:

Part-Time

Role Type:

Telehealth

License:

NP/APP

State License:

Compact / Multi-State

Curology’s mission is to make effective, personalized skincare accessible. We were founded by dermatologists who believe everyone should have access to skincare products that actually work. Today, our licensed dermatology providers have helped millions of patients across all 50 states + DC make that mission a reality. We combine expert medical care with personalized prescription formulas and dermatologist-developed skincare essentials to deliver science-backed solutions that meet people where they are. Join us in our mission to transform skin health and enhance lives—one patient at a time.

The mission of the Nurse Practitioner is to bring together clinical excellence, sound judgment, and a genuine commitment to patient-centered care. This role is designed for clinicians who thrive in a fast-paced telemedicine environment and value thoughtful, evidence-based decision-making—without cutting corners. Reporting to the Medical Team Manager, the Nurse Practitioner will provide asynchronous dermatologic care to patients across multiple states. You’ll deliver high-quality consultations, treatment plans, and follow-up care while upholding Curology’s rigorous clinical standards and commitment to patient trust.

Required Qualifications: Board certification as a Family Nurse Practitioner (FNP), or Adult Nurse Practitioner (ANP) Minimum of 1 year post-training clinical experience Active, unrestricted licensure in at least 25 U.S. states Excellent written and verbal communication skills Strong clinical judgment and a patient-first approach Comfort with technology and digital health platforms Must reside in the continental United States Ability to work weekends Nice-to-Haves: Experience practicing in high-volume telehealth settings Experience delivering care in asynchronous or store-and-forward models Experience in Dermatology Location: Fully Remote

Complete initial consultations and respond to patient messages within established response-time guidelines Assess and diagnose patients via asynchronous messaging, telephone, and/or video consultation Develop individualized treatment plans in accordance with clinical protocols Prescribe appropriate pharmacologic and non-pharmacologic treatments within the approved formulary Monitor patient progress and adjust treatment plans as clinically indicated Transmit prescription orders to pharmacies when appropriate Collaborate with supervising physicians and clinical leadership as needed Deliver care aligned with Curology’s high standards for quality, safety, and patient experience

CareSource

REMOTE - Clinical Care Reviewer - RN - Must have a MSL License - R11357

Posted on:

January 20, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Ohio

Health Care with Heart. It is more than a tagline; it’s how we do business. CareSource has been providing life-changing health care to people and communities for 30+ years and we continue to be a transformative force in the industry by placing people over profits. CareSource is and will always be member-first. Even as we grow, we remember the reason we are here – to make a difference in our members’ lives by improving their health and well-being. Today, CareSource offers a lifetime of health coverage to more than 2 million members through plan offerings including Marketplace, Medicare products and Medicaid. With our team of 4,500+ employees located across the country, we continue to clear a path to better life for our members. Visit the "Life"​ section to see how we are living our mission in the states we serve.

Clinical Care Reviewer II is responsible for processing medical necessity reviews for appropriateness of authorization for health care services, assisting with discharge planning activities (i.e. DME, home health services) and care coordination for members, as well as monitoring the delivery of healthcare services.

Education and Experience: Associates of Science (A.S) Completion of an accredited registered nursing (RN) degree program required Three (3) years clinical experience required Med/surgical, emergency acute clinical care or home health experience preferred Utilization Management/Utilization Review experience preferred Medicaid/Medicare/Commercial experience preferred Competencies, Knowledge and Skills: Proficient data entry skills and ability to navigate clinical platforms successfully Working knowledge of Microsoft Outlook, Word, and Excel Effective oral and written communication skills Ability to work independently and within a team environment Attention to detail Proper grammar usage and phone etiquette Time management and prioritization skills Customer service oriented Decision making/problem solving skills Strong organizational skills Change resiliency Licensure and Certification: Current, unrestricted Registered Nurse (RN) Licensure in state(s) of practice required MCG Certification or must be obtained within six (6) months of hire required Working Conditions: General office environment; may be required to sit or stand for extended periods of time Travel is not typically required

Complete prospective, concurrent and retrospective review such as acute inpatient admissions, post-acute admissions, elective inpatient admissions, outpatient procedures, homecare services and durable medical equipment Identify, document, communicate, and coordinate care, engaging collaborative care partners to facilitate transitions to an appropriate level of care Engage with medical director when additional clinical expertise if needed Maintain knowledge of state and federal regulations governing CareSource, State Contracts and Provider Agreements, benefits, and accreditation standards Identify and refer quality issues to Quality Improvement Identify and refer appropriate members for Care Management Provide guidance to non-clinical staff Provide guidance and support to LPN clinical staff as appropriate Attend medical advisement and State Hearing meetings, as requested Assist Team Leader with special projects or research, as requested Perform any other job related duties as requested.

Cadence

Licensed Practical Nurse

Posted on:

January 20, 2026

Job Type:

Full-Time

Role Type:

Coaching

License:

LPN/LVN

State License:

Compact / Multi-State

Cadence Health was built around a simple promise: patients always come first. Our technology-enabled remote care model pairs continuous health insights with a highly skilled clinical Care Team, empowering seniors to stay healthier, avoid complications, and live more independent, fulfilling lives, all without the limits of a traditional office visit.

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 Health Coach, Licensed Practical Nurse to help provide patient care remotely alongside our Registered Nurses and Nurse Practitioners. This role will be required to work Mon-Fri 8am-5pm or 9am-6pm within a candidate's local time zone.

Active multi-state compact Practical Nurse License. Active CA state LPN/LVN license is preferred 5+ years of clinical experience as a Licensed Practical Nurse. To ensure that our clinicians have the necessary tools for a successful remote work environment, home office setups must have consistently stable wifi with strong upload and download speeds. A wifi speed test is required before participating in the interview process to verify that these standards are met. Highly skilled in behavioral-based coaching. Possesses excellent clinical acumen and competency in patient assessment. Excels in patient support and delivers a high level of service. Demonstrates a consistent track record of attendance and adherence to work schedules. Exceptional written, verbal, and interpersonal communication skills. Demonstrates reliability in meeting deadlines and fulfilling job duties. Works effectively with minimal supervision and is consistently punctual. Prior experience working in a high-growth, fast-paced startup environment while maintaining high clinical standards. Experience in patient education for individuals managing chronic conditions. Experience in supporting patients remotely is a plus.

Support delivery of health care to patients by performing a variety of activities and procedures which are prescribed by and performed under the direction of the Cadence Nurse Practitioner and Cadence clinical policies and procedures. Provide one-on-one coaching and support to patients managing chronic conditions, including but not limited to type 2 diabetes, hypertension, and cardiovascular disease. Conduct comprehensive assessments of patients' health status, lifestyle behaviors, nutritional habits, and readiness to change. Help patients execute on their personalized care plans and goals, focusing on behavior modification, nutrition, physical activity, and self-management strategies. Monitor patients' progress, adherence to treatment plans, and health outcomes through regular check-ins and remote monitoring tools. Educate patients on disease management, medication adherence, symptom recognition, and prevention strategies.

Evry Health

Care Coordination (RN) - REMOTE (EST or CST)

Posted on:

January 20, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

We are on a mission to bring humanity to health insurance. Our high-technology health plans expand benefits, increase access and transparency, and feature a personalized, human approach. We strive to ensure members live happier, healthier lives. Evry Health is the major medical division of Globe Life (NYSE:GL). Globe Life has 16.8 million policies in force, and more than 3,000 corporate employees and 15,000 agents. For more than 45 consecutive years, Globe Life has earned an A (Excellent) rating or higher from A.M. Best Company.

Evry Health is seeking a tech-savvy Nurse to join our team for Care Coordination. As a Care Coordinator you work with members to improve their wellness and engage with our health plan's benefits. You build good relationships with both our health plan members and our medical providers through phone calls, emails, and texts. This is an exciting role allowing the ability to work with members across the continuum with ~25% utilization review and ~75% care coordination. Our teams are 100% virtual. While this is a remote role, you must reside in the United States and in the Eastern or Central time zone.

Experience and Skills Desired: You have 1-2 years of experience working at a health plan, preferably with a commercial population. You have 3-5 years of nursing experience in a clinical setting assisting with direct patient care, such as a hospital or ambulatory setting. Must have a current, unrestricted Texas nursing license or Compact License. Please include your license number(s) and the corresponding state(s) in your resume. Diploma from an accredited school/college of nursing required. You have working knowledge of medical and insurance industry terminology including basic understanding of health plan benefits, CPT/ICD10, authorizations, and digital health programs. You have an area of interest or experience within cardiology/pulmonology, women’s health, orthopedic surgery/physical medicine, primary care/pediatrics, and oncology. You have experience outreaching and educating members telephonically. You have an innovative and entrepreneurial spirit with a passion to contribute to a much-needed change in our health care system. Bonus: Familiarity with Salesforce/Healthcloud/CareIQ. Bonus: Experience working in a call center. Bonus: Spanish fluency (conversational). Telecommuting Requirements This is a remote position. Our whole company works remotely. Company headquarters are in Dallas, Texas. Company business hours are weekdays 9-5 CST. We will only consider candidates in the United States who reside in the CST or EST time zones. Required to have a dedicated work area established that is separate from other living areas and provides information privacy. Ability to keep all company sensitive documents secure. Must live in a location that receives an existing high-speed internet connection/service.

Communicate and provide education to members and providers on insurance plan benefits and digital health solutions. Use negotiation and motivational interviewing techniques to increase engagement. Pro-active and reactive support for members, including outbound phone/email/text outreach. Employ active listening & motivational interviewing skills, and can handle difficult calls tactfully, courteously, professionally and document accordingly that can build patient trust and engagement. Ability to effectively excel in a virtual work environment through active participation in team huddles, Supervisor 1:1s, Instant Messaging, or check-ins, efficiently answering and documenting member/provider calls. Accurately track and document work on a variety of internal software tools and platforms. Consult with supervisors, utilization management team, medical directors, as needed to overcome barriers. Effectively manages escalations within the department by ensuring appropriate accountability, sense of urgency, communication and follow through to closure. Assist departmental staff with coding, medical records/documentation, pre-certification, reimbursement, and claim denials/appeals. Ability to interact with external facility or providers as needed to gather clinical information to support the medical necessity review process and plan of care.

Blood Cancer United

Clinical Trial Nurse Navigator - Grant Funded through June 2027

Posted on:

January 20, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

District of Columbia

We are Blood Cancer United, and we believe everyone with blood cancer deserves a longer, better life. That’s why we are on a mission to find a cure and improve the quality of life for everyone with blood cancer. How? We fund life-saving blood cancer research around the world, provide free information and support services for patients and their families, and are the voice for those seeking access to quality, affordable, coordinated care. With your help, we have invested more than $1.8 billion in groundbreaking research supporting many of today’s most innovative approaches to treatment—helping those with blood cancer not only survive but also thrive.

Works with patients, family members and/or health-care providers to assist patients in their efforts to identify appropriate clinical trials and help overcome obstacles to enrollment. Utilizes nursing assessment skiBlood Cancer United, online databases, and information from clinical sites to determine qualification for clinical trials. Educates patients and family members about the patient’s blood cancer diagnosis, helps them to understand both standard of care and clinical trial treatment options, and provides support around decisions to end treatment. Collaborates with The Blood Cancer United’ Information Resource Center (IRC) staff to provide education, services and support to patients and family members. This is a Blood Cancer United staff role, however is Grant funded and has an end date of June 30, 2027**

Education, Experience, And Qualifications: Bachelor’s degree in Nursing required; Masters preferred. Master’s degree in non-nursing area considered. Current RN licensure required Oncology experience preferred; specialty training in Oncology/Hematology preferred; OCN certification preferred; clinical research experience preferred Ability and desire to excel in independent work and in a team environment Spanish speaking preferred Position Requirements: Outstanding critical thinking, problem-solving, and collaboration skills Excellent ability to communicate verbally and in writing Ability and desire to excel in independent work and in a team environment Demonstrated commitment to independent learning and skill enhancement Expertise in Microsoft Office including Excel, Word, and OneNote Physical Demands & Work Environment: Physical demands are minimal and typical of similar jobs in comparable organizations Work environment is representative and typical of similar jobs in comparable organizations Occasional travel to national oncology/hematology meetings and team meetings Must have reliable internet; minimum download speed 50mbps minimum upload speed 50mbps. Recommended download speed 100mbps recommended upload speed 100mbps.

Independently maintain own caseload of patients seeking enrollment into clinical trials; this includes assessing, educating, and objectively presenting information to patients about available treatment options, including clinical trials Use problem solving skills to help patients overcome obstacles to enrollment Collaborates with Blood Cancer United’s Information Resource Center (IRC) staff to educate and support patients and family members in their efforts to understand their diagnosis, treatment options and available services Serve in consulting role to the Information Resource Center about clinical trials Serves as a resource to The Blood Cancer United Patient and Professional Education staff as they develop clinical trial related materials and programs. Maintain/increase knowledge and understanding of hematologic cancers, blood and bone marrow transplant and psychosocial aspects of living with cancer Contribute to continual process improvement of Clinical Trial Support Center procedures Develop effective working relationships within Blood Cancer United and with trial site staff, investigators, sponsors, patient and professional organization Exhibit comprehensive understanding of ethical standards and federal regulations in human subjects research

Humana

Pre-Authorization Nurse 2

Posted on:

January 20, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

RN

State License:

Compact / Multi-State

Humana Inc. (NYSE: HUM) is committed to putting health first – for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health – delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large.

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

Required Qualifications: 2+ years Utilization Management experience Active RN license in the state(s) in which the nurse is required to practice Ability to be licensed in multiple states without restrictions A minimum of three years varied nursing experience Previous experience in utilization management, case management, discharge planning and/or home health or rehab Proficient with MS Office products including Word, Excel and Outlook Ability to work independently under general instructions and with a team Must be passionate about contributing to an organization focused on continuously improving consumer experiences Preferred Qualifications: Bachelor's degree Health Plan experience working with large carriers Previous Medicare/Medicaid experience a plus Outpatient or home health experience in Utilization Management Experience working with MCG or Interqual guidelines Additional Information Schedule: Monday through Friday, 8:00 AM – 5:00 PM with flexibility to work overtime/weekend as needed. Work Location: US Nationwide Work Style: Remote Travel Requirements: Less than 1% Work-at-Home (WAH) Internet Statement To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.

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

CenterWell Pharmacy

LPN- RX Clinical Program Professional

Posted on:

January 20, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

LPN/LVN

State License:

Compact / Multi-State

CenterWell Pharmacy provides convenient, safe, reliable pharmacy services and is committed to excellence and quality. Through our home delivery and over-the-counter fulfillment services, specialty, and retail pharmacy locations, we provide customers simple, integrated solutions every time. We care for patients with chronic and complex illnesses, as well as offer personalized clinical and educational services to improve health outcomes and drive superior medication adherence.

The RX Clinical Program Professional 1 integrates programs developed to improve overall health outcomes with a focus on prescription drugs. The RX Clinical Program Professional 1 work assignments are often straightforward and of moderate complexity. Shift can be M-F anywhere between 8AM ET and 8PM ET. There is also one rotating shift from 11:30AM-8PM ET every other week on a specific day.

Active LPN license Minimum of 1 year LPN experience Strong data entry skills Ability to solve problems and encourage others in collaborative problem solving Self-directed, but also able to work well in a group A positive, proactive attitude, energetic, highly motivated and a self-starter Work ethic that is focused, accurate and highly productive Preferred Qualifications: Mail Order Pharmacy experience. 1 year or more of experience as an LPN in a specialty pharmacy setting. LPN Compact license WAH requirements: Must have the ability to provide a high speed DSL or cable modem for a home office. Associates or contractors who live and work from home in the state of California will be provided payment for their internet expense. A minimum standard speed for optimal performance of 25x10 (25mpbs download x 10mpbs upload) is required. Satellite and Wireless Internet service is NOT allowed for this role. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.

The RX Clinical Program Professional 1 (LPN) oversees medication therapy, strategy on comprehensive medication reviews, and prescription drug optimization in cases where patients are taking multiple medications. Drives health awareness with patients through Rx Education and targeted quarterly campaigns. Places outbound calls to confirm patients are taking drugs and provides counseling. Understands own work area professional concepts/standards, regulations, strategies and operating standards. Makes decisions regarding own work approach/priorities and follows direction. Work is managed and often guided by precedent and/or documented procedures/regulations/professional standards with some interpretation.

Centene Corporation

Clinical Review Nurse - Concurrent Review

Posted on:

January 20, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Oregon

Centene Corporation is a leading healthcare enterprise committed to helping people live healthier lives. Centene offers affordable and high-quality products to more than 1 in 15 individuals across the nation, including Medicaid and Medicare members (including Medicare Prescription Drug Plans) as well as individuals and families served by the Health Insurance Marketplace. Centene believes healthcare is best delivered locally. Our local health plans provide fully integrated, high-quality, and cost-effective services to government-sponsored and commercial healthcare programs, focusing on under-insured and uninsured individuals. Centene’s hiring practices reflect the composition of the members and communities we serve, allowing us to deliver quality, culturally sensitive healthcare to millions of members. Centene employees help change the world of healthcare and transform our communities. To learn more about career opportunities with Centene, visit: https://jobs.centene.com/

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Performs concurrent reviews, including determining member's overall health, reviewing the type of care being delivered, evaluating medical necessity, and contributing to discharge planning according to care policies and guidelines. Assists evaluating inpatient services to validate the necessity and setting of care being delivered to the member. This is a 100% remote role. Must have a Oregon LPN or RN license. One of the following shifts will be needed: Sunday - Thursday 8-5pm OR 9-6pm Tuesday - Saturday 8-5pm OR 9-6pm Friday - Monday 10 hour shifts

Education/Experience: Requires Graduate from an Accredited School of Nursing or Bachelor’s degree in Nursing and 2 – 4 years of related experience. 2+ years of acute care experience required. Clinical knowledge and ability to determine overall health of member including treatment needs and appropriate level of care preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. License/Certification: LPN - Licensed Practical Nurse - State Licensure required - Must have an Oregon license Registered Nurse - Must have an Oregon license

Performs concurrent reviews of member for appropriate care and setting to determine overall health and appropriate level of care Reviews quality and continuity of care by reviewing acuity level, resource consumption, length of stay, and discharge planning of member Works with Medical Affairs and/or Medical Directors as needed to discuss member care being delivered Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines Works with healthcare providers to approve medical determinations or provide recommendations based on requested services and concurrent review findings Assists with providing education to providers on utilization processes to ensure high quality appropriate care to members Provides feedback to leadership on opportunities to improve appropriate level of care and medically necessity based on clinical policies and guidelines Reviews member’s transfer or discharge plans to ensure a timely discharge between levels of care and facilities Collaborates with care management on referral of members as appropriate Performs other duties as assigned Complies with all policies and standards

Hippocratic AI

Supervising Nurse (Arabic/Hebrew)

Posted on:

January 20, 2026

Job Type:

Part-Time

Role Type:

Leadership / Management

License:

RN

State License:

California

Hippocratic AI is the leading generative AI company in healthcare. We have the only system that can have safe, autonomous, clinical conversations with patients. We have trained our own LLMs as part of our Polaris constellation, resulting in a system with over 99.9% accuracy.

We are seeking licensed nurses with diverse patient care experience to help make AI safe for patient-facing applications. In this task-based role, you will leverage your unique frontline experience and knowledge to supervise Arabic and/or Hebrew patients' interactions across various dimensions, including medical safety, empathy, and bias.

Registered Nurse Arabic-speaking - Reading, conversation, writing, and medical terminology or Hebrew-speaking - Reading, conversation, writing, and medical terminology Minimum 3 years of care management experience Intermediate skill level in G Suite products Excellent time management skills Strong attention to detail Ability to work 20-30 hours per week Overnight weekday and weekend hours What We Offer Flexible work schedule Remote work opportunities Chance to contribute to cutting-edge AI safety in healthcare Collaborative environment with medical and tech professionals

Supervise Arabic and/or Hebrew patient calls and interactions with AI systems Perform Arabic error and/or Hebrew quality reviews of AI-patient communications Access AI performance in terms of medical safety, empathy, and potential bias Provide feedback and insights to improve AI systems based on your nursing expertise Collaborate with our team of medical professionals and engineers to enhance AI safety in healthcare

Hippocratic AI

Registered Nurse Researcher (Bilingual - Arabic/English) - Remote

Posted on:

January 20, 2026

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

North Carolina

Hippocratic AI is the leading generative AI company in healthcare. We have the only system that can have safe, autonomous, clinical conversations with patients. We have trained our own LLMs as part of our Polaris constellation, resulting in a system with over 99.9% accuracy.

We are seeking a fluent Nurse to assist in evaluating and refining our medical Large Language Model. We are looking for nurses fluent in both English and Arabic. This role involves providing expertise on the language, offering cultural insights, and reviewing error reports from simulated patient interactions. The ideal candidate will have experience working with patients that speak the language and a keen understanding of the nuances in medical communication within this demographic.

Must‑Have Nursing License: Valid nursing license in your practicing country. Fluency in language: Proficiency in both general and medical Experience with Patients speaking with the specific language: Demonstrated experience, preferably in a clinical setting. Communication Skills: Strong ability to communicate complex medical information clearly and effectively. Attention to Detail: Keen eye for detail, especially in identifying and addressing language and cultural nuances in medical communication. Nice‑to‑Have Cultural Competence: Understanding of cultural variations and their impact on healthcare delivery Technical Proficiency: Familiarity with virtual communication tools and model evaluation processes.

Evaluate Medical Model: Assess the effectiveness and accuracy of our multilingual speaking model, ensuring it aligns with clinical standards and cultural expectations. Provide Insights: Advise on linguistic and cultural nuances to improve patient communication and model effectiveness. Review Error Reports: Analyze and provide feedback on error reports from simulated patient calls, identifying areas for improvement. Ongoing Support: Offer continued evaluation and advice as the model evolves

Hippocratic AI

Registered Nurse (Bilingual - Japanese/English) - Remote

Posted on:

January 20, 2026

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

North Carolina

Hippocratic AI is the leading generative AI company in healthcare. We have the only system that can have safe, autonomous, clinical conversations with patients. We have trained our own LLMs as part of our Polaris constellation, resulting in a system with over 99.9% accuracy.

We are seeking a fluent Japanese-speaking Registered Nurse to assist in evaluating and refining our Japanese-speaking medical Large Language Model. This role involves providing expertise on medical Japanese, offering cultural insights, and reviewing error reports from simulated patient interactions. The ideal candidate will have experience working with Japanese-speaking patients and a keen understanding of the nuances in medical communication within this demographic.

Must-Have Nursing License: Valid nursing license in your practicing country. Fluency in Japanese: Proficiency in both general and medical Japanese. Experience with Japanese-speaking Patients: Demonstrated experience working with Japanese-speaking patients, preferably in a clinical setting. Communication Skills: Strong ability to communicate complex medical information clearly and effectively. Attention to Detail: Keen eye for detail, especially in identifying and addressing language and cultural nuances in medical communication. Nice-to-Have Cultural Competence: Understanding of cultural variations and their impact on healthcare delivery among Japanese-speaking communities. Technical Proficiency: Familiarity with virtual communication tools and model evaluation processes.

Evaluate Japanese-speaking Medical Model: Assess the effectiveness and accuracy of our Japanese-speaking model, ensuring it aligns with clinical standards and cultural expectations. Provide Insights: Advise on linguistic and cultural nuances to improve patient communication and model effectiveness. Review Error Reports: Analyze and provide feedback on error reports from simulated patient calls, identifying areas for improvement. Ongoing Support: Offer continued evaluation and advice as the model evolves.

Hippocratic AI

Nurse Triage and Safety Specialist

Posted on:

January 20, 2026

Job Type:

Part-Time

Role Type:

Triage

License:

RN

State License:

California

Hippocratic AI is the leading generative AI company in healthcare. We have the only system that can have safe, autonomous, clinical conversations with patients. We have trained our own LLMs as part of our Polaris constellation, resulting in a system with over 99.9% accuracy.

We are seeking an experienced Nurse with triage experience to support clinical product development and evaluation for AI-driven healthcare applications. This contract, remote role focuses on applying triage expertise to guide model development, training data strategy, and clinical evaluation, ensuring outputs are safe, appropriate, and aligned with real-world nursing judgment and standards of care.

Active, unrestricted nursing license (RN or equivalent) in your practicing state. Minimum of 3 years of clinical experience with a primary focus on triage (e.g., ED, urgent care, telehealth, nurse advice lines). Strong clinical judgment and ability to clearly articulate triage reasoning. Excellent written communication skills and attention to clinical detail. Experience working collaboratively with multidisciplinary teams in a remote or asynchronous setting.

Guide model development by applying clinical triage expertise to inform reasoning, prioritization, escalation, and safety boundaries. Review and supervise the generation of clinical training data, including scenarios, reference answers, and edge cases. Design and guide clinical evaluation frameworks, including test cases, rubrics, and acceptance criteria. Evaluate model outputs for accuracy, appropriateness, and alignment with triage best practices. Interpret evaluation results and provide clear, actionable feedback to product and technical teams. Participate in ongoing expert review as models and use cases evolve.

InfuSystem

Clinical Support Nurse, Part Time

Posted on:

January 20, 2026

Job Type:

Part-Time

Role Type:

Clinical Operations

License:

RN

State License:

Michigan

InfuSystem is a leading national health care service provider, facilitating outpatient care for durable medical equipment manufacturers and health care providers by delivering ambulatory pumps and supplies, along with related clinical, biomedical and billing services, to practices and patients nationwide. With a comprehensive suite of services, InfuSystem improves clinician access to quality medical equipment and promotes patient wellness and safety while reducing the overall cost of infusion care. InfuSystem offers Oncology, Pain Management and Wound Care therapies, including Negative Pressure Wound Therapy. The company’s Durable Medical Equipment (DME) Services are composed of direct payer rentals, pump and consumable sales, and biomedical services and repair, including on-site and depot services. InfuSystem provides the sale, rental, lease and associated supplies, including infusion pumps, nerve blocks for acute pain, nerve block catheters, postoperative pain pumps, central venous catheters, IV pumps, pole-mounted pumps, syringe pumps, enteral pumps, Huber needles, clean room supplies, IV extension tubing, pump tubing, ambulatory pumps, replacement pumps, disposable products, central venous access devices, closed system transfer devices, negative pressure wound therapy vacs, wound vac, and chemotherapy and oncology infusion pumps. Biomedical services include both on-site and depot preventive maintenance, repair and warranty services, ranging from equipment inspections to extensive repairs, including compression device systems, defibrillators, EKG machines, electrosurgical units, external pacemakers, humidifiers, infusion pumps, LCDs, light sources, modules, patient monitors, printers, pulse oximeters, telemetry transmitters and tourniquets – all completed to factory specifications. Headquartered in Rochester Hills, Michigan, InfuSystem delivers local, field-based customer support and operates Centers of Excellence in Michigan, Kansas, California, Massachusetts, Texas and Ontario, Canada.

The required working schedule for this role is part-time, every other weekend, and every other holiday. The candidate must have a dedicated workspace, reliable internet, and cellular phone service. The candidates must be available to work evenings, midnights, weekends, and holidays.

Ambulatory infusion pump experience Negative Pressure Wound Vac experience Experience within home health care, specialty pharmacy administration, home infusion, oncology, pain management, and/or hospice Ability to quickly assess situations and make accurate decisions Listening skills are essential Ability to respond to common inquiries or complaints from patients and facilities in a calm manner SUPERVISORY RESPONSIBILITIES: No supervisory or management responsibilities THE IDEAL CANDIDATE WILL HAVE THE FOLLOWING QUALIFICATIONS: Minimum completion of ADN or BSN Minimum 3 years of clinical nursing experience, IV specialty training, infusion therapy, home health care required Current Licensure as a Registered Nurse in your state of residence required Bachelor’s Degree in nursing preferred, but not required PICC certification, OCN/INCC certification preferred, but not required PERSONAL AND PROFESSIONAL ATTRIBUTES: The ideal candidate must be a rigorous analytical thinker and problem solver with the following professional attributes: Strong work ethic Sound judgment Proven written and verbal communication skills Natural curiosity to pursue issues and increase expertise Pursue and design innovative analytical performance metrics The courage to promote and defend ideas and analyses Passionate about InfuSystem and serving customers and patients Strives to make an impact on improving our business processes and results Exemplary honesty and integrity Ability to collaborate effectively and work selflessly as part of a team 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. 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. Qualifications Skills Required Critical ThinkingNovice Behaviors Required Dedicated: Devoted to a task or purpose with loyalty or integrity Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well Education Preferred Bachelors or better in Nursing or related field. Experience Required 3 years: Minimum clinical nursing experience Licenses & Certifications Required Cert Reg Nurse (RN, RNC)

The primary responsibility of the support nurse is taking patient, facility, and physician phone calls for ambulatory pumps and other related products. The ideal candidate will have excellent communication skills, critical thinking skills, ability to handle stressful situations, capacity to function independently, possess varied clinical experience, and the ability to document meticulously.

Acentra Health

Clinical Reviewer - SCA (Remote - RN)

Posted on:

January 20, 2026

Job Type:

Full-Time

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

Acentra Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra Health. Think of it as an open invitation to embrace the mission of the company; to actively engage in problem-solving; and to take ownership of your work every day. Acentra Health offers you unparalleled opportunities. In fact, you have all you need to take charge of your career and accelerate better outcomes – making this a great time to join our team of passionate individuals dedicated to being a vital partner for health solutions in the public sector.

The Clinical Reviewer utilizes clinical expertise during beneficiary interaction in conjunction with contract requirements, critical thinking and utilize decision-making skills to assist with communicating medical appropriateness, while maintaining production goals and QA standards. Ensures day-to-day processes are conducted in accordance with NCQA and other regulatory standards. *Shift Information: This position requires availability to work between 8:00 a.m. and 8:00 p.m. ET, Monday through Friday, and 11:00 a.m. to 6:00 p.m. ET on weekends and holidays.*

Required Qualifications: Active, unrestricted LPN or RN license in the applicable state and/or a Compact State license. Knowledge of the organization of medical records, medical terminology, and disease process required Strong clinical assessment and critical thinking skills required Medical record abstracting skills required 2+ years of clinical experience in a hospital or post-acute environment required. Preferred Qualifications: Minimum of one year UR and/or Prior Authorization or related experience. Requires excellent written and verbal communication skills Must be proficient in Microsoft Office and internet/web navigation Bachelor’s Degree from an accredited college or university in a related field Some knowledge of Case Management, UR and/or Prior Authorization or related experience is preferred Experience in call center environment a plus Experience in a behavioral health setting a plus Bilingual (English/Spanish) a plus

Assures accuracy and timeliness of all applicable review type cases within contract requirements Assesses, evaluates, and addresses daily workload and call queues; adjusts work schedules daily to meet the workload demands of the department In collaboration with Supervisor, responsible for the quality monitoring activities including identifying areas of improvement and plan implementation of improvement areas Maintains current knowledge base related to review processes and clinical practices related to the review processes, functions as the initial resource to nurse reviewers regarding all review process questions and/or concerns Functions as providers’ liaison and contact/resource person for provider customer service issues and problem resolution Performs all applicable review types as workload indicates Fosters positive and professional relationships and act as liaison with internal and external customers to ensure effective working relationships and team building to facilitate the review process Attends training and scheduled meetings and for maintenance and use of current/updated information for review Cross trains and perform duties of other contracts to provide a flexible workforce to meet client/customer needs Read, understand, and adhere to all corporate policies including policies related to HIPAA and its Privacy and Security Rules

Crossing Hurdles

Clinical Nurse | Remote

Posted on:

January 20, 2026

Job Type:

Contract

Role Type:

Clinical Operations

License:

RN

State License:

Compact / Multi-State

At Crossing Hurdles, we specialise in customised recruitment and staffing solutions designed to drive success for businesses and professionals. Our focus is on connecting organisations with top-tier talent by sourcing, screening, and presenting only the top 1% of candidates across a wide range of industries. We work closely with clients to understand their unique needs, ensuring that we find candidates who not only fit the role but also align with their organizational culture. Over the past few quarters, we've successfully partnered with leading companies such as Angel One, Ixigo, Turing, Cars24, Veera, ABP Network, Battery Smart, Zavya, and Twin Engineers. Our expertise spans various sectors, including Tech, Product, Sales, Customer Support, Growth, Finance, and Marketing. At Crossing Hurdles, our mission is to help organizations thrive by matching them with exceptional talent while simultaneously enabling candidates to find opportunities that foster long-term career growth and development.

Position: Registered Nurse Type: Hourly contract Compensation: $60–$110/hour Location: Remote Commitment: 10–40 hours/week

Registered Nurse with strong professional experience in clinical practice. Strong professional experience in nursing or a related clinical domain. Excellent written communication skills with strong grammar and attention to detail. Ability to translate clinical knowledge into clear, structured documentation. Comfortable working independently in a fully remote, project-based environment.

Create structured deliverables based on common nursing workflows and real-world clinical scenarios. Apply professional nursing expertise to support AI research and system evaluation. Review peer-created deliverables to improve accuracy, clarity, and domain relevance. Provide feedback to help refine AI-generated healthcare workflows and outputs. Work independently and asynchronously while meeting project deliverables.

Sedgwick

Utilization Review Coordinator

Posted on:

January 20, 2026

Job Type:

Full-Time

Role Type:

Utilization Review

License:

None Required

State License:

Tennessee

Sedgwick is the world’s leading risk and claims administration partner, helping clients thrive by navigating the unexpected. The company’s expertise, combined with the most advanced AI-enabled technology available, sets the standard for solutions in claims administration, loss adjusting, benefits administration and product recall. With over 33,000 colleagues and 10,000 clients across 80 countries, Sedgwick provides unmatched perspective, caring that counts, and solutions for the rapidly changing and complex risk landscape.

To assign utilization review requests; to verify and enter data in appropriate system(s); and to provide general support to clinical staff in a team environment.

Education & Licensing: High School diploma or GED required. Experience: Two (2) years of administrative experience or equivalent combination of experience and education required. Customer service in medical field preferred. Workers compensation, disability and/or liability claims processing experience preferred. Skills & Knowledge: Knowledge of medical and insurance terminology Knowledge of ICD9 and CPT coding Excellent oral and written communication, including presentation skills PC literate, including Microsoft Office products Analytical and interpretive skills Strong organizational skills Detail Oriented Good interpersonal skills Ability to work in a team environment Ability to meet or exceed Performance Competencies WORK ENVIRONMENT When applicable and appropriate, consideration will be given to reasonable accommodations.

Accesses, triages and assigns cases for utilization review (UR). Responds to telephone inquiries proving accurate information and triage as necessary. Enters demographics and UR information into claims or clinical management system; maintains data integrity. Obtains all necessary information required for UR processing from internal and external sources per policies and procedures. Distributes incoming and outgoing correspondence, faxes and mail; uploads review documents into paperless system as necessary. Supports other units as needed. ADDITIONAL FUNCTIONS and RESPONSIBILITIES Performs other duties as assigned. Supports the organization's quality program(s).